August 2019


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  • Aug 26, 2019
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By- Dr Anupama Singh, Senior Consultant – Internal Medicine, Vimhans Nayati Super Specialty Hospital, New Delhi

  1. What causes Dengue?

Dengue is a viral illness prevalent in tropical and subtropical countries. It is caused by the Dengue virus which is transmitted by the bite of the Aedes mosquito.

  1. How many serotypes of Dengue virus exist?

There are five serotypes of Dengue virus and infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different serotype increases the risk of severe complications.

  1. What are the symptoms of Dengue?

While the symptoms of Dengue are not specific, they can be found in other viral illnesses, there we some clues that should make you suspect Dengue.

  • High grade fever which typically lasts 4-5 days. The fever is associated with.
  • Severe headache and a peculiar pain behind the eyes
  • Generalized severe body aches including muscle and joint
  • A diffuse appearance of the skin which blanches on pressure
  • A distaste for, or bitter taste on eating solid foods
  • Pain in the stomach, nausea and/or vomiting
  • Children often have symptoms of gastroenteritis (vomiting and diarrhea) and are at risk for more serious complications


  1. What is the course of Dengue fever?

The course of the illness includes three phases febrile, critical and recovery phase.

  1. What to expect during the febrile phase of Dengue fever?

Febrile phase involves high fever upto 104°F (40°C), which lasts 3-5 days It is associated with severe headache and nausea and vomiting, a flushed appearance of the skin described as ‘islands of white in a sea of red”. The fever is classically biphasic or saddleback in nature breaking and returning for day or two.

  1. When and how does the critical phase evolve?

Critical phase:  As the fever resolves the platelet counts begin to drop starting from day of illness and day 7 of the illness. The counts usually begin to increase from day 7 of illness and normalise by day 10.

In some people the disease proceeds to a critical phase tic than 5 % as fever resolves.  During this period there is leakage of plasma from the blood vessels, typically lasting one to two days. This may result in formulation in the chest and abdominal cavity as well as depletion of fluid from the circulation and raised blood supply to vital organs.

Those who have previously been infected with other serotypes of dengue virus(“secondary infection”) are at an increased risk. This critical phase, while rare, occurs relatively more common in children and young adults

  1. What lab investigations can be done in early disease?
  • The earliest change detectable on laboratory investigations is a low white blood cell count, which may then be followed by low platelets and metabolic acidosis
  • A moderately elevated level of aminotransferase(AST and ALT) from the liver is commonly associated with low platelets and white blood cells
  • The NS1 antigen test is used to detect early infection by the dengue virus. It is detectable from day I to day 3 of the illness
  • In severe disease, plasma leakage results in hemoconcentration (as indicated by a rising hematocrit) and hypoalbuminemia.


  1. Classification of Dengue fever?

The World Health Organization’s 2009 classification divides dengue fever into two groups: uncomplicated and severe dengue is defined as that associated with severe bleeding, severe organ dysfunction, or severe plasma leakage while all other cases are uncomplicated

  1. What is the warning sign predating severe Dengue?
  • Worsening abdominal pain
  • persistent vomiting
  • Liver enlargement
  • Mucosal bleeding
  • High hematocrit and low platelet count
  • Lethargy or restlessness
  • Serosal effusions
  1. How to differentiate Dengue from other viral illnesses?

A probable diagnosis is based on the findings of fever plus two of the following: nausea and vomiting, rash, generalized pains, low white blood cell count positive tourniquet test, or any warning sign (no. 10) in someone who lives in an endemic area.

  1. Management of Dengue fever
  • There are no specific antiviral drugs for dengue; however, maintaining proper fluid balance is important. Treatment depends on the symptoms.
  • Those who are able to drink, are passing urine, have no “warning signs” and are otherwise healthy can be managed at home with daily follow-up and oral rehydration therapy
  • Those who have other health problems, have “warning signs”, or cannot manage regular follow-up should be cared for in hospital
  • In those with severe dengue care should be provided in an area where there is access to an intensive care unit
  • Paracetamol (acetaminophen) is used for fever and discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding.


  1. How serious is Dengue?

Most people with dengue recover without any ongoing problems. The fatality rate is 1-5%, and less than 1% with adequate treatment; however those who develop significantly low blood pressure may have a fatality rate of up to 26 % I believe I have tackled most of the frequently asked questions, however should you have any questions, feel free to put them up in the comments section and I will attempt to answer them.

June 2019

Educate yourself: Here are the most frequent questions about Hernia

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  • Jun 28, 2019
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Hernia is one of the most common, yet dangerous medical conditions. It refers to the formation of a bulge in the abdomen or groin. Due to the location of affected area, people are often hesitant to visit the doctor or talk to someone and tend to ignore it. However, a hernia doesn’t heal by itself and not ensuring timely treatment is only going to make it worse. With an aim to increase awareness and remove the taboo about the condition, doctors at Nayati Healthcare answer the most frequently asked questions about hernia:

What causes a hernia?

A tear in the abdominal muscle wall is the primary cause of hernia. Due to this opening, the inner lining sticks out similar to a torn vehicle tire. As the inner lining sticks out, it forms a pouch. In addition, the bulge felt by the person is a result of a loop of intestine entering the pouch via the wall tear.

Common causes of hernia include:

  • Straining
  • Cystic fibrosis
  • Persistent cough
  • Smoking
  • Heavy lifting
  • Obesity

What are the symptoms of a hernia?

Experts at Nayati Healthcare state that in most of the cases, hernia looks like a small, painless swelling which disappears on lying down. However, if the bulge like swelling doesn’t go in after applying minor pressure and feels firm, it could be a complicated hernia. Other symptoms that a person is likely to experience include:

  • Pain
  • Vomiting


A step towards Brain Tumor awareness: Here’s everything you need to know

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  • Jun 07, 2019
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Brain tumor is the abnormal growth of cells similar to a swelling or mass in any part of the brain. According to the Globocan Report 2018 by the International Association of Cancer Registries (IACR), over 28,142 cases of brain tumor are reported annually in India.

Considering the severity of this life-threatening medical condition, it becomes imperative to spread awareness for breaking the myths and educating people. On June 8, World Brain Tumor Day, here are some of the facts, symptoms, treatment procedures, and preventive measures about Brain Tumor.

Facts about Brain Tumor

  • Children, adults, or elderly people – there is no age exempt in brain tumor
  • Approximately 1/3rd of brain tumors are cancerous in nature
  • The root cause of brain tumor is usually unknown
  • The symptoms are determined by the location, type, and size of the brain tumor


Listed below are the most common signs and symptoms that can be observed in an individual who might be suffering from brain tumor:

  • Headache
  • Impaired vision
  • Weakness in any part of the body like arm, legs
  • Seizures
  • Speech imbalance

Treatment for Brain Tumor

Brain tumors can be cancerous or non-cancerous, and on the basis of this, there are two major types of treatment courses: medicines or and surgery. While former includes a long, dedicated course of tablets and regular tests, latter usually involves non-extensive surgeries. With the help of new-age technologies at Nayati Healthcare such as Neuro Navigation, Gamma Knife, Stereotaxy, endoscopic brain tumor surgeries, and Microscopic procedures, the outcomes of surgeries have a good success ratio.

In cases of cancerous tumors, the life-expectancy has been considerably increased post-surgery. In addition, some patients may need sessions of radiotherapy or chemotherapy to avoid further repercussions. However, in benign or non-cancerous tumors, surgery is generally sufficient.

Furthermore, it is important to understand that the outcome of a surgery majorly depends upon the type, location, and grade of the tumor.

Can you prevent Brain Tumor?

There are no definitive preventive measures in the case of brain tumors. However, if a person experiences any of the aforementioned symptoms or has a family history of the condition, he/she should visit their nearest physician and get an MRI or CT scan done, as recommended by the doctor.


This World Brain Tumor Day, lets pledge to spread awareness about the disease and be proactive in ensuring timely treatment.


Authored by:

Dr Dhruv Chaturvedi

Senior Consultant (NeuroSurgeon), Vimhans Nayati Hospital, Delhi

MBBS (Gold Medalist) | MS (Gen. Surgery) | MCh (Neurosurgery)

May 2019

World No Tobacco Day 2019:

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  • May 30, 2019
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Why Human Health and the War on Tobacco are Non-negotiable

Remember the iconic Marlboro Man campaign that created an irresistible aura for smokers? While the cowboy smoking on horseback captivated generations – catapulting Marlboro as the world’s No.1 tobacco brand – there’s little doubt the campaign played a dubious role in making millions of smokers victims of debilitating diseases and death.

As we commemorate World No Tobacco Day on 31 May, it’s important to recognise the role of tobacco and cigarettes in the healthcare mayhem arising from cancer-causing habits such as smoking and tobacco chewing. The tobacco scourge is so widespread even a senior Maharashtra politician fell victim to oral cancer. While the well-heeled have the resources to recover from cancer, common persons cannot always afford expensive cancer treatments. The devastating impact on middle-class families can well be imagined when their breadwinner is afflicted.

It’s not just smoking that’s harmful; even indirect or passive smoke can kill or maim. Besides oral cancer, tobacco causes or aggravates various serious ailments, including lung cancer, chronic respiratory diseases, cardiovascular ailments, asthma, TB, etc. Moreover, since tobacco smoke contains more than 7,000 chemicals (69 rated carcinogenic), it is one of the deadliest indoor air pollutants. Whereas the smoke is sometimes odourless and invisible, it may linger in the air for almost five hours. Therefore, even non-smokers are at potential risk for reduced lung function, chronic respiratory ailments as well as oral and lung cancer.

The WHO reveals more than 50% of adults in India have no idea smoking can trigger stroke. Sadly, even in-utero infants exposed to tobacco toxins (via maternal smoking or the mother’s exposure to ambient smoke) can experience lower lung function and impaired growth. Kids exposed to passive smoke risk the onset and exacerbation of pneumonia, asthma and frequent infections of the lower respiratory tract. Consequently, about 165,000 kids die globally before turning five. Those surviving into adulthood then continue suffering the consequences arising from second-hand smoke exposure, including the increased risk of contracting COPD (chronic obstructive pulmonary disease) as adults.

Incredibly, tobacco is the only major legally-available killer product! Which is why tobacco is the chief cause of easily-preventable deaths and diseases universally. In India, nearly 232 million adults consume tobacco daily, while 266 million persons (those above 15 years) use tobacco in some form or the other. These statistics are as per the Global Adult Tobacco Survey, released in June 2018 by the Ministry of Health and Family Welfare. Worldwide, the WHO says more than seven million persons die annually due to active or passive smoking.

Across the world, the WHO reveals some 10.6 million acres of land is used for growing tobacco. Given the harmful effects of tobacco use, its growth and usage need to be controlled. Yet, nationally and internationally, the tobacco industry spins a false narrative about how any ban on tobacco use will hurt the government’s tax and revenue generation efforts. This argument is meaningless when we consider that multiple times the amount is spent on healthcare costs for people afflicted with life-threatening or debilitating tobacco-linked ailments. Clearly, human health and well-being must always remain a non-negotiable instrument in such scenarios.

A Brief Overview on Technological Journey and Transformation of Cath-lab and Equipments

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  • May 14, 2019
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Dr H.S. Somanath, Chairman – Cardiology at Nayati Healthcare

  • Cath lab imaging technology has now evolved from the Analogue-based Image Intensifiers to fully Digital Flat-Panel technology with high resolution that leads a long way in serving healthcare to its fullest extremity. There are enormous advancement in combining various features like inclusion of Hybrid Systems, Intravascular Ultrasound (IVUS), Rotablation Atherectomy Device, 3D Rotational Angiogram, Fractional Flow Reserve (FFR), Stent Boost and many more.
  • Although there has been an evolution of care in the cath lab, the core technology of Angiographic Imaging, Wires, Catheters, and Balloon Interventions has not changed dramatically over the years. Some of the incremental advancements that have changed the way cardiac care is delivered.
  • Nowadays, we can automatically, without radiation exposure, collimate an image by using the previous images to collimate on, which reduces direct and scatter radiation exposures to our patients and to clinical team as well. In addition, we have lowered up frame rates from 60 frames/second to 7.5 to 30 frames/second.
  • In the beginning phase Cath-Lab, X-ray images were of very high-dose, images from low-quality image intensifiers, were recorded on 16-mm or 35-mm film with Aero techno film magazines and video reel-to-reel tapes for playback. The Jamison or Combulator processor in the darkroom could engage a person’s entire day’s work. The transformation has been through C-arms to Aerotechnic cameras, mounted overhead as image intensifiers, form intensifiers to flat-panel technology, pulsed fluoroscopy, digital enhancing of images, subtracted images and bolus-chasing, 3D visualization tools that are enabling cath labs to perform as a highly specialized research center and multipurpose facilities. The 3D rotational angiogram allows for a single dye injection and rotational images, the ability to view all coronaries/cerebral arteries with one shot, lets the clinicians use less dye which reduces the risk of any future side-effects.
  • We have also witnessed the advancement in PACS archival technology that transmits images via the web viewing the patient’s films which have gone from a noisy Tagarno film-snagging projector to a completely digital based PACS system that constantly needed our diligent attention and up-gradation.
  • The introduction of stents significantly altered the care landscape. The evolution of stent technology from the bare-metal stent to the approval and adoption of drug-eluting stents (DES), had a major impact on improving clinical outcomes. Stent Boost subtraction feature shows the enhanced stent image in relation to the vessel wall to support precise pre and post stent deployment.
  • Access techniques have migrated over the years from Judkins percutaneous approach through the femoral artery to more recently Radial Artery Approach, which can significantly decrease the risk of post-procedure bleeding (Hematomas) and reduce the post-procedure length of stay (LOS), thus influencing the care delivery model to a significant level.
  • Valvuloplasty, the widening of stenotic aortic valve was introduced into the cath lab procedure armamentarium. The endovascular approach for the valvular disease has developed significantly over the years, with the advent of Transcatheter Aortic Valve Replacement (TAVR) procedures.
  • Vascular Closure Device has been widely accepted over manual compression that includes patient comfort, early mobilization, and discharge, avoidance of local compression and its sequel and less time constraint on staff.
  • The cardiac cath lab of the future projects the functionality as a hybrid suite, supporting cardiac and vascular catheter-based interventions and associated complex staged/combined interventional and open surgical procedures under the same roof.
  • In order to conclude, we may say cath labs have come a long way, but we also need to think upon, what is next on the horizon? Will cath labs as they exist today, become obsolete with CT and MRI technological advances? Or, will robot-assisted procedures in the cath lab become common practice in all hospital set up? These are few of the contemporary issues concerning the future of the technology.

Exercise Protocol for Heart Patients

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  • May 02, 2019
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While exercise is important in maintaining good heart health, doing it safely and scaling up gradually remain extremely important.

Dr Mitendra S Yadav

There’s a misconception among some people that exercise of any kind should be avoided if they are heart patients. On the contrary, regular exercise is critical if you have heart disease since physical activity strengthens heart muscles, helping one in managing cholesterol levels and blood pressure.

Indeed, a regular, carefully-controlled exercise regimen can make you more active without causing chest pain or other symptoms of a heart ailment. What’s more, if you are diabetic, exercise will help you control blood sugar levels too – however, avoid walking in a fasting state. Moreover, do not walk immediately after a meal; keep a gap of at least an hour after meals. Over the months, regular exercise will ensure you lose weight, making you feel much better, physically and mentally.

For instance, daily walks will help you control knee problems while also making your bones strong. And other forms of aerobic exercises will strengthen your heart and lungs while boosting your body’s ability in using oxygen. In fact, your heart can benefit the most from aerobic exercise, which includes walking. Those suffering from blood pressure, however, should take their BP medication one hour before walking. Done over a prolonged period, aerobic workouts could decrease blood pressure and heart rate while improving your breathing too.

Some safety guidelines

Bear in mind, though, it’s important to consult your physician before beginning any exercise regimen, ensuring every exercise you do is absolutely safe in your condition. This is crucial if you:

  • Recently suffered a heart attack.
  • Have been experiencing shortness of breath and chest pain or pressure.
  • Underwent a heart surgery or procedure recently.
  • Happen to be diabetic.

Your cardiac care provider will be best placed to recommend safe exercises, including the level of intensity that’s permissible. A 30-minute morning or evening walk five or six times a week should be safe initially. Over the weeks, depending upon how your body feels, you may increase the pace and time as required.

As mentioned earlier, aerobic activities (walking, light jogging, swimming, cycling or dancing) are good for your heart. But you need to begin slowly. Although the goal is to make one’s heart work somewhat harder each time, it’s best not to overdo the tempo.

Besides, always remember to warm up sufficiently by stretching or moving around at a slower pace for five minutes before gradually increasing the tempo. Towards the end of your aerobic activity, cool down by slowly decreasing the pace rather than ending the activity abruptly. Adequate warm-up and cool down will ascertain you do not sprain, overstrain or injure any muscles.

Additional safety tips while exercising:

  • Take a break if you feel tired.
  • If you feel fatigued or experience heart symptoms – STOP!
  • Always wear comfortable, compatible clothing.
  • In summers, exercise in the mornings or evenings only, wearing light clothing.
  • In winters, always cover your nose and mouth when outdoors.

Workout within limits

If any activity overstrains your heart, you will experience symptoms such as:

  • Chest pain
  • Light-headedness
  • Irregular pulse or heartbeat
  • Shortness of breath
  • Nausea

If you feel any or all of the above, stop immediately. Rest. Then consult your doctor, if necessary. Make notes of your resting and exercising pulse rate. During the latter, if it remains high, simply slow down. Then recheck it 10 minutes later to see whether it has returned to normal after exercising. Drink adequate amounts of water after exercising.

At any time if you feel pain, pressure, heaviness or tightness in your chest, neck, jaw or arm; shortness of breath; numbness in the arms; are sweaty or lightheaded, it may be advisable to call the doctor. But if you follow the exercise guidelines mentioned above, you will remain safe and healthy while exercising.


The writer is Senior Consultant – Interventional Cardiology, Vimhans Nayati Super Speciality Hospital

Tips for taking good care of your Back

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  • May 02, 2019
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Twelve top tips to prevent back pain:

  1. Pillow under the knees: Sleeping on your back pressurises the spine. A pillow under your knees reduces 50% of the pressure by elevating the legs. Or sleep on either side.
  2. Back exercises: Do back and abdomen-strengthening exercises, five or six times a week, during your workout routine for a more flexible, stronger back.
  3. Increase Vitamin D and calcium intake: Deficiency of key substances is a common cause of back pain in adult years.
  4. High heels hurt: High-heel shoes are another cause of back pain. Wear heels of less than an inch.
  5. Maintain proper posture: Bad posture stresses your back, even changing the spine’s architecture. Standing or sitting, don’t slouch, but keep shoulders straight.
  6. Support your back: In an office chair or the car, sit erect with a cushion under your lower back for support, if required.
  7. Move around: While sitting or standing, don’t stay motionless for long; move around periodically. Standing continuously pressurises your spine.
  8. Stop smoking: Nicotine curbs blood flow to the spinal discs, cracking, drying or rupturing them. Smoking also lowers the blood’s oxygen supply, reducing nourishment to back muscles and tendons, making them vulnerable.
  9. Reduce the load: Heavy bags are bad for the back. Reduce their weight or keep shifting from one shoulder to the other. Use a trolley/bag with wheels, if possible.
  10. Avoid tight clothes: Tight trousers/belts hamper sitting, bending or walking, worsening back pain.
  11. Don’t keep wallets in back pockets: Overstuffed wallets in back pockets cause silent discomfort and cumulative back pain, particularly when driving. Avoid, or lighten their load.
  12. Lift properly: Never bend your waist when lifting heavy objects. Instead, bend the knees and then lift. If an extremely-heavy object needs to be moved, push instead of pulling it.

Are you suffering from Hypertension?

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  • May 01, 2019
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A silent killer globally, BP is best treated – not ignored.

High blood pressure (or hypertension) is a common condition wherein the long-term pressure of blood against artery walls is high enough to eventually trigger health problems, including heart disease. The volume of blood pumped by the heart and the degree of resistance to the blood flow in the arteries determines blood pressure. Therefore, the more blood the heart pumps and the narrower the arteries, the higher is the blood pressure.

Signs and Symptoms
You could suffer hypertension for years devoid of symptoms. Without symptoms too, damage to your heart and blood vessels can continue undetected. Uncontrolled BP raises the risks of severe health problems such as heart attack and stroke, even resulting in death.

Affecting almost every person, high BP can develop gradually over the years. Nonetheless, it can be easily detected. Once aware of your status, you can control it with the doctor’s help. Many afflicted with high BP show no obvious signs or symptoms – even when it reaches dangerously high levels. Some people, however, may suffer headaches, shortness of breath and nosebleeds. Yet, such symptoms may not be specific and generally not occur until the BP reaches alarming or life-threatening levels.

So it’s safer to have your BP checked once in two years after age 18. If BP runs in your family, or if you are 40-plus, take BP readings annually. Also, BP should be checked in both the arms to discover any difference. If already diagnosed with high BP – or suffering risk factors such as cardiovascular disease – your doctor will recommend frequent check-ups. BP machines are also available, allowing one to check readings at home. If BP readings remain high consistently, your doctor will recommend suitable drugs to control it.

Causes and Control
Stress, excess salt consumption and underlying conditions such as kidney disease can cause high BP. Though blood pressure can be controlled through diet, after it reaches the hypertension stage, medications are advisable.

To control high BP, moderate-intensity exercise of minimum 30 minutes, 5-6 times a week is essential. Avoiding stress and abstaining from alcohol, drugs, tobacco as well as junk food can all help control BP. Remember, globally, BP is one of the major silent killers that’s best not ignored but treated immediately.

April 2019

The importance of Vaccination/Immunization in Adults

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  • Apr 30, 2019
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A general misconception prevails that vaccination is only required in our formative years. Yet, thousands of adults fall ill annually and are hospitalised due to ailments that vaccines can prevent. Besides, the effect of some childhood vaccines wears off over the years, making adult re-immunisation safe and efficacious.

Indeed, some diseases need immunisation even in adulthood. For example, the:

  • Hepatitis B vaccine lowers liver cancer risk.
  • HPV vaccine lowers the risk of cervical cancer.
  • Flu vaccine lowers the risk of flu-related heart attacks or other complications from existing health conditions such as diabetes and chronic lung disease.

Additionally, all vaccines:

  • Are tested and monitored for years before being cleared for public use.
  • Have mild side effects (soreness, swelling, redness, etc.) that vanish within hours or days. Major side effects are extremely rare.
  • Remain one of the safest ways to preventive healthcare.

Given the threat from HPV (causing certain cancers), hepatitis, meningococcal disease, measles, mumps, rubella and chickenpox, among others, vaccines are the safest means to reduce disease and death rates.

Adding Activities to Subtract Sedentary Lifestyles

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  • Apr 26, 2019
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The global onslaught of technology, competitive living and incorrect lifestyles has inevitably turned people into sedentary beings. Be it food habits or the quality of food products, everything across the globe has experienced deterioration due to numerous factors.

Given below are some simple and easy ways to overcome sedentary lifestyle habits:

  1. Walking the Talk! Treat the mobile phone like your friend. So each time you talk, take a walk! Take a stroll in the balcony, go around the office aisle, walk across corridors and go to the terrace – there are innumerable ways in which mobiles can make people walk often.
  2. Standing Often: Identify routine tasks that can be done standing. Watching 10 minutes’ news headlines, cleaning the workstation, drinking tea in the office, folding clothes at the wardrobe, etc. These tasks will help one stretch and strengthen the back and legs.
  3. Doing Chores: Identify some tasks to do on your own. Wash the dishes, clean the mug, keep the wardrobe intact, streamline the shoe rack, etc. This requires effort as well as thought, thereby helping a person become active and systematic.
  4. Be a Sport: Take up some moving sport. Join a cycling club, play gully cricket, go to a volleyball club, play badminton after finding a suitable partner, etc.
  5. Go Green: Treat at least five plants at home as your responsibility. Water and trim them, trowel the soil, etc. This will make you active and sensitive towards nature.
  6. Conveyance Cues: Adopt public transport or a mix of modes to commute. This will require some effort each time one is moving. If still using one’s own vehicle, park it some way off or take the stairs in reaching the destination.
  7. Dance with Abandon: Even if dancing seems unfamiliar, still try shaking a leg, adding music to the routine. When getting ready every morning, play some favourite music that will help in grooving a little. If possible, join a dance class or form a dance club.