April 2019

Why all Snoring shouldn’t be ignored

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  • Apr 04, 2019
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By Dr Shweta Bansal

Snoring can be a symptom of the potentially-dangerous obstructive sleep apnoea, which may need medical help to overcome.

At some point in our lives, everyone has snored. Although a common condition that can affect anybody, males and overweight persons are more prone to snoring, which increases with age.

Though it disturbs family members’ sleep, snoring occasionally isn’t a serious issue. Habitual snorers, however, interrupt their own sleep and end up disrupting others’ sleep too. Regularly-disturbed sleep patterns then hold grave health implications arising from an inadequate night’s rest.

Ultimately, habitual snorers can suffer serious health problems, including OSA (obstructive sleep apnoea), caused by daily sleep disruptions. Medical help is then required to ensure the situation doesn’t worsen.

The problems from OSA include:

  • Long interruptions in breathing (lasting more than 10 seconds) when asleep, triggered by partial or complete airway obstruction.
  • Light, interrupted sleep since the body tries to keep the throat muscles tense for ensuring enough air flow.
  • Pressure on the heart because prolonged OSA can cause high blood pressure and even heart enlargement; in turn, raising the risk of heart attack and stroke.
  • Daytime fatigue and sleepiness that lowers the quality of life.
  • Low oxygen supply in the blood, causing constricted blood vessels in our lungs, eventually leading to pulmonary hypertension.
  • Chronic headaches.
  • Obesity.

Sleep apnoea can be potentially dangerous due to breathing repeatedly stopping and starting, which may trigger a heart attack. Whereas death due to OSA is rare, the demise of Star Wars actress Carrie Fisher is attributed to apparently-untreated sleep apnoea.

Clearly, all forms of snoring cannot be ignored, especially when chronic. Therefore, it’s important to first understand snoring. When breathing during sleep, the soft tissues in our neck relax, narrowing the airway passage. The neck tissue then vibrates each time we breathe, creating a noisy sound – snoring. Anything narrowing our breathing passage can trigger snoring – tonsils, an enlarged uvula, nasal blockade, excess weight creating large soft tissue around our neck, etc.

Snoring can be controlled and treated by simple lifestyle changes to limit its severity, including:

  • Promptly treating sinusitis and nasal congestion
  • Shunning sedatives, muscle relaxants and antihistamines
  • Sleeping on your side (to prevent a relaxed tongue from blocking the airway)
  • Avoiding alcohol and cigarettes
  • Suitable dietary changes
  • Exercising regularly
  • Losing weight

While every snorer won’t have OSA, snoring is a key symptom. OSA impacts the quality of life of sufferers and remains a common disorder in those suffering from obesity, diabetes or hypothyroidism. In the US, around 18 million suffer from OSA. Although nationwide studies are not available in India, cross-sectional surveys across numerous groups indicate a 13.7% prevalence among adults, with 7.5% urban middle-aged males affected, as per a report in the Asian Journal of Pharmaceutical and Clinical Research. Another report states the prevalence is thrice as higher in males than females.

The following could indicate the possibility of OSA:

  • Loud snoring daily
  • Sleep interrupted by gasping/choking sounds
  • Irregular pauses in breathing and breathlessness
  • Increased night-time urination
  • Morning headaches
  • Daytime fatigue and sleepiness
  • Irritability and lower concentration

If you suffer some of the above symptoms (a few of which you’d be unaware of, so ask your spouse or family), it’s important to consult a pulmonologist. Since the risks posed by OSA include disturbed sleep rhythms, imbalanced body and brain functions, stroke and other cardiovascular ailments as well as road traffic accidents, it’s best to play safe…

February 2019

The Inside Story about Stomach Cancers

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  • Feb 28, 2019
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Since symptoms rarely occur in the early stages, stomach cancers are tough to detect.

Cancers arising in the stomach are called stomach or gastric cancers. Generally, stomach cancers develop gradually over the years. Before this, however, precancerous changes often arise in the stomach mucosa (inner lining). Since such early changes rarely show symptoms, they often go undetected.

Types of stomach cancers:

  • Adenocarcinoma (about 90–95% of stomach cancers, developing from cells in the mucosa).
  • Lymphoma (immune system tissue cancers sometimes found in the stomach wall).
  • Carcinoid tumour (arises in the stomach’s hormone-making cells; typically, won’t spread to other organs).
  • Gastrointestinal stromal tumour (rare, some benign or non-cancerous; others cancerous).
  • Other types include squamous cell carcinoma, small cell carcinoma and leiomyosarcoma (rare).


Several risk factors predispose people to develop stomach cancers, such as:

  • Gender: More common in men.
  • Age: Sharp rise of cases in 50-plus people; usually in their 60s and thereafter.
  • Helicobacter pylori infection: Though a major cause, many carrying this bacteria in their stomach never develop cancer.
  • Diet: Processed, smoked, salted fish and meat; pickled vegetables.
  • Tobacco: Cigarettes and tobacco-related products double the risk.
  • Alcohol abuse: Consumption can cause carcinogens such as acetaldehyde and nitrosamines.
  • Obesity: Being obese or overweight is another possible cause.

Signs and Symptoms

Stomach cancer rarely shows early signs and symptoms, which can include:

  • Loss of appetite, sometimes along with sudden weight loss.
  • Abdominal pain, worsening after meals.
  • Constant bloating; abdominal swelling or fluid build-up.
  • Fullness/early satiety even after small meals.
  • Heartburn or indigestion.
  • Nausea and vomiting (with/without blood).
  • Bloody stools.
  • Frequent heartburn.
  • Excessive fatigue.
  • Low red blood cell count (anaemia).

Note that other stomach ailments or ulcers can cause the same problems and may not be cancerous. Once confirmed, stomach cancer can be treated via multiple modalities (depending on the stage), including surgery, chemotherapy, immunotherapy (vaccines/medications), radiation and targeted therapy (specific drugs). Often, two or more treatments are used to suppress stomach cancer.

Preventive Measures

  • Exercising regularly.
  • Maintaining a healthy body weight.
  • Avoiding cigarettes, drugs and
  • Consuming fresh fruits (especially citrus) and vegetables daily.
  • Eating fresh white meat and fish rather than processed foods and red meat.
  • Early screening in case of suspected symptoms or family history of cancer.

As in all cancers, early diagnosis and timely treatment can save lives.

January 2019

Common Lung Infections during Winters in Children

  • nayati_admin
  • Jan 18, 2019
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As children’s susceptibility to infections soars during
the cold months, precautions are better than cures.

The common cold lives up to its name by infecting almost every person at some time or the other. Termed an upper respiratory infection (URI) in medical parlance, it is the world’s most common lung infection. Children are prone to lung infections, especially during winters. Those under five years are particularly susceptible to winter infections, being afflicted more than half-a-dozen times annually. After the age of six, however, common colds occur less frequently.

Frequency and Impact

Due to the frequency and potency of attacks, the common cold can lead to multiple doctor’s visits and absence from school every year compared to other illnesses. The culprit is a virus inflaming membranes in the nose and throat lining. More than 200-plus viruses can cause the common cold. But rhinoviruses cause most colds in the young and old.

Higher incidents occur in winter because many viruses thrive in low humidity conditions, which also make nasal passages drier, increasing infection vulnerability. Once the virus is in the child’s body, the immune system reacts. This reaction causes increased mucus production (and a runny nose); swelling in the nose lining (causing congestion and difficulty in breathing); bouts of sneezing (due to nasal irritation) and cough (triggered by higher amounts of mucus sliding down the throat).

The other concern in winters regarding children is lower respiratory infections (LRI). The major ailments are bronchitis, pneumonia, influenza and respiratory syncytial virus. If not treated in time, some variants such as pneumococcal pneumonia can be fatal. Also, respiratory symptoms last longer in children than in adults. The common cold could last up to 15 days, acute cough for 25 days and non-specific respiratory symptoms for a fortnight. If any chronic cough occurs daily for more than four weeks, it merits additional check-ups for lung disease.

Worldwide, LRI remains a major morbidity and mortality cause. The Global Burden of Diseases Study 2016 analyses LRI burden in 195 nations. The study reveals LRI led to 652,572 deaths of children below five years, globally, with pneumococcal pneumonia being the prime cause.

Precautions Work Best

While the above statistics sound alarming, simple precautions can help prevent lung infections. Consider pneumonia. Although a bacterial or viral infection can cause pneumonia, getting wet cannot, despite the popular misconception. Consequently, a child’s untreated cold or flu or one that worsens can lead to pneumonia. This happens because the lungs are irritated by a cold or flu, thereby creating an enabling environment and making it easier for an invasion and infection by pneumonia germs. Therefore, any cold or flu should be treated promptly via a doctor’s visit rather than home medications.

Furthermore, the child should stay at home, avoiding school or playing outside since this can spread the infection to others. During winters, children must be well covered in warm garments to avoid exposure. When the temperature dips, the child should wear a cap or hat, while using gloves and socks to protect exposed hands and feet.

Children with cough and colds should be taken to a specialist within 48 hours. Besides, all severe symptoms such as breathlessness, laboured breathing, inability to sleep at night, high fever, chest pain, vomiting after cough and failure to thrive must be referred to a specialist immediately. Symptoms such as drawing of intercostal muscles (pasli chalana) in children need the immediate attention of a doctor.

Respiratory infections can also be prevented by washing hands periodically, using soap and running or warm water. This should be done particularly before touching and eating food and after blowing the nose. Instead of a handkerchief, the child can cough or sneeze into a tissue and then throw this into the dustbin. The mouth should always be covered when coughing or sneezing. The hands should also be kept away from the face. The teeth should be brushed twice daily after meals.

When eating and drinking, cups, glasses or cutlery should not be shared. The child should drink plenty of water and eat fruits as well as vegetables daily since these contain essential nutrients boosting immunity. Moreover, household surfaces should be clean. Over-the-counter medications dispensed by chemists and repeated use of cough syrups should be avoided.

Finally, an annual flu vaccine could also help prevent the disease during winters or monsoons. Following these simple precautions can help reduce lung infections in children – and adults too.

Rising risk of Skin Cancer in winters

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  • Jan 03, 2019
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The seemingly-benign winter sun can be unsafe for the skin since harmful ultraviolet
rays are present at all times. So year-round skin protection is best to prevent skin cancers.

A popular misconception prevails that ‘the risk of skin cancer is lower in winters’. This is a dangerous myth. Throughout the year, direct exposure to sunrays can cause cancer because ultraviolet (UV) radiation is always present in sunlight. Even on cloudy days, protection is required as UV rays can penetrate cloud cover and still damage the skin. Moreover, sun damage has a cumulative impact. Therefore, whether a person is exposed to direct sunlight in summer or winter, it can still affect the skin.

That does not mean sunlight must be avoided throughout the day. The body needs adequate quantities of vitamin D, which is synthesized in our body on exposure to sunlight. But it is best to soak in sunlight before 10:00 am and after 4:00 pm, when it is comparatively benign and less likely to trigger skin damage. During the six hours when sunlight is harsh, it is safer to stay indoors or seek protection via a hat, cap, umbrella or sunscreen.

Categorisation and Early Detection

The cumulative damage from direct exposure to sunlight causes various skin cancers. The three skin cancer types are:

  • Basal cell carcinoma: Caused by sun exposure, this often emerges as a pink bleeding spot.
  • Squamous cell carcinoma: Showing up as a scaly sunspot, it is easy to cure – if detected early.
  • Melanoma: An aggressive form, this represents about 5–10% of skin cancers. It can infect tissue cells early and then spread speedily within weeks. A person’s life expectancy depends on the stage of its detection.

From the above, it will be clear that timely or early detection is essential to stop the spread of aggressive skin cancers as well as for ensuring normal life expectancy. To achieve this goal, one can follow the ABCDE rule in detecting melanoma early: Asymmetry; Borders (uneven outer edges); Colour (dark black or with multiple colours); Diameter (more than 6mm); Evolving (change in size, shape or colour).

Therefore, if an old mole changes in shape, size or colour, or begins bleeding and/or itching, it is advisable to visit a doctor or skin specialist and have this checked up. Any suspected sign of skin cancer should not be ignored because early detection is crucial to stop its spread. As per the World Health Organization, up to three million non-melanoma skin cancers and 132,000 cases of melanoma skin cancers emerge annually, worldwide. Consequently, any preventive measures are not misplaced or alarmist.

Sunburn or prematurely ageing/wrinkling skin could be a sign of damage via excess UV radiation. If true, it is time to take immediate precautions. It is better to take preventive measures earlier, however, rather than doing so after the skin is severely damaged. Even the malignant forms of melanoma are easy to prevent while less-malignant forms can be treated when discovered early.

These skin changes can be appreciated by self-examination. It is always wise to consult a cancer specialist or skin specialist, if any suspicion of malignancy is there, so that it can be cured by early detection and treatment.

Preventive Approach

Skin protection and cancer prevention tips include:

  • Always using a broad-spectrum sunscreen showing an SPF (Sun Protection Factor) of 30 or higher, whenever outdoors. A broad-spectrum cream protects against all forms of UV radiation.
  • Applying sunscreen evenly and liberally on all exposed parts of the body.
  • Reapplying sunscreen every couple of hours to counter wipe-off by humidity and sweat.
  • Using an SPF 15 (or higher) lip balm, since lips can be extra-sensitive and require equal protection.
  • Covering the head to protect one’s scalp and staying warm in winters by wearing gloves, jacket and a hat.
  • Wearing sunglasses with large frames for protecting the eyes and eyelids as well as the skin around the eyes, which are sensitive and more vulnerable to sun-induced ageing and skin cancer.

Application of sunscreen reduces the risk of skin cancers dramatically. The protection is all the more important when visiting snow-bound regions or beaches. In the high altitudes of mountains, UV rays can be intense even in winters. Worse, the thinner atmospheric air offers less protection from UV rays and sunlight reflecting off the snow can increase ‘silent’ sunburn. In fact, almost 80% of sunrays can be reflected from the snow. Similarly, winter sunrays reflecting off the sand can still give sunburns.

In all such scenarios, sunscreen is mandatory to safeguard the skin. Always follow the mantra: ‘Better safe than sorry!’

Managing Kidney Stones during Pregnancy

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  • Jan 03, 2019
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Preventing kidney stones is essential to avoid
complications during delivery or damage to the foetus.

In any condition, kidney stones can be a pain in more ways than one. But having a kidney stone during pregnancy can be a double whammy since the regular problems of child-bearing are compounded. It is important to clarify, however, that pregnant women are not more prone to developing kidney stones. The issue is simply that diagnosing and treating a woman with a kidney stone is more difficult due to the chances of the foetus being harmed. By itself, though, kidney stones are not harmful for the developing baby.

Kidney stones are hard deposits or crystals of minerals and salt that form in the kidneys. These can then move to other parts of the urinary tract. Such stones can vary in size. A small one can pass through the bladder without any problem or pain. But a medium-sized or large stone could lodge along the ureter, leading to severe pain or even bleeding, requiring medical attention.

Causes and Symptoms

Generally, dehydration is a prime cause in kidney stone formation. In a dehydrated body, fluids pass slowly via the kidneys, raising the risks of salts and minerals colliding and binding to each other. Kidney stones are also formed if the urine contains high amounts of calcium, oxalate, phosphate, uric acid and other trace elements. Foods rich in oxalate (beetroot, spinach, chocolate, most nuts and tea) and phosphate (colas) also contribute to stones and should be avoided or consumed minimally.

People with a family history of stones, recurring urinary tract infections, urinary tract blockage (which may occur during pregnancy due to the pressure of the baby on the kidneys), digestive issues, those consuming more colas than water and even women with type 2 diabetes can be more prone to kidney stones.

The symptoms of stones can include pain while urinating, blood in the urine, cloudy or smelly urine, intense pain in the back, lower abdomen or side and accompanying nausea and vomiting. Other tell-tale signs comprise the urge to urinate frequently, passing only small amounts each time as well as fever and chills (indicating infection). Complications from kidney stones during pregnancy may include preterm delivery, gestational diabetes, preeclampsia and other hypertensive issues.

An analysis of blood and urine can determine the presence of kidney stones during pregnancy. Urine tests can detect the presence of blood, calcium crystals or uric acid. CT scans and X-rays are, however, not advisable during pregnancy due to the risk of foetal damage from radiation.

Treatment and Prevention

Typically, treatment depends on their size. While small stones may pass out on their own, daily hydration and medications can also be used to expel stones. In the case of large stones, these can be extracted through surgery. Whereas sound wave lithotripsy is used in the case of normal women to break up stones, it cannot be done during pregnancy as this may harm the baby.

Medications can be administered to control the pain while surgery is done under anaesthesia, ensuring the mother and unborn baby are unhurt during the procedure.

While preparing for pregnancy, all preventive measures must be taken against kidney stones:

Drinking water: Drink 8-10 glasses of water and other liquids daily. Remember, the body requires more water during pregnancy.

Decreasing salt intake: Limit salt intake. Avoid processed, packaged and junk foods high in sodium.

Reducing animal protein: Amino acids and trace elements in protein can promote stone formation.

Limiting calcium consumption: Although calcium supplements are recommended in pregnancy, women with kidney stones need to be watchful, minimising intake.

Despite precautions, if a woman displays the following symptoms, call a doctor immediately:

  • Pain in the back, abdomen or side not controlled by painkillers.
  • Bright-red blood in the urine.
  • Nausea and vomiting that is unresponsive to medication.
  • Watery discharge or vaginal bleeding.
  • Cramps or painful contractions lasting more than four hours.
  • Decreased or minimal foetal movement.
  • Temperature exceeding 100-degree Fahrenheit.

Although kidney stones are not fatal per se, they can lead to kidney infection. In turn, this can cause sepsis. Septic shock or sepsis can arise from any infection in the body, including influenza, pneumonia or urinary tract infections. Globally, sepsis results in almost 33% fatalities.

Moreover, in the third trimester of pregnancy, kidney stones could induce labour pain. Therefore, it is best to take all precautions in avoiding unwanted complications from kidney stones during pregnancy.

December 2018

सावधान! गैस गीज़र ले सकता है आपकी जान

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  • Dec 28, 2018
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सर्दी का मौसम है और इस मौसम में सबसे ज्यादा कष्ट दायक काम है ठंडे पानी से स्नान करना। पानी गर्म करने के लिए हम विभिन्न तरीके अपनाते हैं जिसमें एक है गैस गीज़र का इस्तेमाल करके पानी गर्म करना। गैस गीज़र एक ऐसी व्यवस्था है जिसमें हम एलपीजी गैस को जलाकर पानी को गर्म करते हैं और गैस के चलने से विभिन्न प्रकार की जहरीली गैसे जैसे कार्बन मोनो ऑक्साइड, प्रोपेन, ब्यूटेन व अन्य हाइड्रोकार्बन उत्सर्जित होते हैं, जो कि गैस गीज़र सिंड्रोम के कारण बनते हैं।

जब आप गैस गीज़र चलाकर स्नान करते हैं तो बाथरूम में ऑक्सीजन की कमी हो जाती है और समय के साथ जहरीली गैस सांस के द्वारा आपके शरीर में प्रवेश कर जाती है।

शुरुआत में सिर का भारी होना, चक्कर आना, उल्टी होना, इसके प्रमुख कारण हैं और अधिक समय तक जहरीली गैस के संपर्क में रहने पर मिर्गी आ सकती है, मूर्छित हो सकते हैं, मनुष्य कौमा में जा सकता है और उसकी जान भी जा सकती है।

गैस गीज़र सिंड्रोम की समस्या की उन घरों में ज्यादा संभावना होती है जिनमें बाथरूम छोटे हो, वेंटिलेशन की उचित व्यवस्था ना हो। गैस गीज़र सिंड्रोम से बचने के लिए गैस गीज़र का इस्तेमाल ना करें, और अगर करें तो बाथरूम का इस्तेमाल करने से पहले पानी गर्म कर ले। बाथरूम का वेंटिलेशन अच्छा रखें। किसी भी प्रकार के लक्षण दिखाई देने पर तुरंत दरवाजा खोलकर, खुली हवा में गहरी गहरी सांस लें ।

लगातार बेहोशी की स्थिति में, बार बार उल्टियां होने पर, मिर्गी आने पर अविलंब चिकित्सक का परामर्श लें। ये छोटी सी जानकारी आपके और आपके अपनों को एक खतरनाक बीमारी से बचा सकती है जो जानकारी के अभाव में किसी की जान भी ले सकती है।

Parkinson’s Disease: A common Neurological Disorder in India

  • nayati_admin
  • Dec 20, 2018
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Though generally not fatal, the debilitating disease can affect the quality of life, unless lifestyle changes and the doctor’s recommendations are followed.

A degenerative, progressive brain disorder, Parkinson’s disease (PD) primarily affects the dopamine-producing areas in the brain called basal ganglia and substantia nigra. Nerve cells in the latter create a neurotransmitter, dopamine, which relays messages for controlling body movements.

Beginning gradually but worsening over time, the symptoms may include stiffness, tremors, limb rigidity and difficulty in walking, including poor balance and coordination. Although symptom progression varies across individuals, it may later result in difficulty in walking and talking. Those affected could also experience sleep disruptions, memory issues, fatigue, depression as well as mental and behavioural changes.

Varied Symptoms

Besides motor or movement-related symptoms, PD could have non-motor symptoms too. Therefore, those with PD can sometimes be more affected by non-motor symptoms such as apathy, difficulty in chewing/swallowing, urinary issues, constipation, cognitive impairment, skin problems and the loss of their sense of smell.

While its cause remains relatively unknown, men and women could both develop PD, though around 50% more men fall victim. Age is, however, one risk factor. Generally, persons with Parkinson’s have their first brush with the disease around the age of 60. But up to 10% experience an early onset, which happens before they turn 50. Some forms of early-onset PD are occasionally inherited, while others are linked to certain gene mutations.

Initial symptoms can occur gradually and subtly, such as experiencing mild tremors or difficulty in getting out of chairs. Their handwriting may slow down and they may begin speaking softly. Family and friends may be the first in noticing these changes, which can include an expressionless face and the arms and legs not moving normally. A tendency in leaning forward while walking, taking small but quick steps and lesser arm swinging while walking are other noticeable symptoms. These symptoms may occur on one side only. With disease progression, both sides may be affected, but with symptoms still being more severe on one side.

Such early symptoms are sometimes dismissed as normal signs of ageing. Since no medical tests exist for conclusively detecting Parkinson’s, accurate disease diagnosis is difficult. Presently, though no specific cure exists, treatment avenues can include medications and surgery. By itself, PD is not fatal. But complications from the disease could be serious, occasionally proving fatal. Consequently, it is essential to first understand the ailment and its progression.

Cause and Control

Parkinson’s occurs when the neurons/nerve cells in the region of the brain controlling movement are damaged and/or die. Typically, these neurons produce an essential chemical called dopamine. If the neurons are damaged or dead, less dopamine is produced, thereby triggering the movement complications identified with PD. What causes the dopamine-producing cells to die is unknown.

Persons with PD can also suffer the loss of nerve endings producing norepinephrine – which acts as the prime chemical messenger of the sympathetic nervous system. The latter controls many of the body’s automatic functions, including the heart rate and blood pressure. Besides dopamine deficiency in the nigrostriatal pathway, an imbalance occurs in the dopaminergic and cholinergic neurotransmitters responsible for motor symptoms. In-striatum imbalance of neurotransmitters such as serotonin, GABA, glutamate and neuropeptides like dynorphin and neurotensin are responsible for non-motor symptoms related to PD such as mood and behaviour, which includes psychiatric symptoms, cognitive decline and autonomic disturbances.

The loss of dopaminergic neurons leads to major motor symptoms such as bradykinesia (slowness of voluntary or ongoing movement), rigidity and rest tremors. Conversely, multiple neurotransmitter deficiencies occurring in the central and peripheral nervous system can trigger non-motor signs, including psychiatric (apathy, depression, delusions and hallucinations) and autonomic (orthostatic hypotension, constipation and urinary/genital disturbances) features, cognitive impairment, olfactory dysfunction, sleep disorders and pain, altogether contributing in worsening the person’s quality of life and disability.

Though some PD cases could be hereditary, others may arise from certain genetic mutations. Usually, however, PD occurs randomly and may not run in families. Today, researchers think PD arises from both genetic and environmental factors, including exposure to toxins.

Nonetheless, a good quality of life is possible by following the doctor’s advice and the recommended treatment regimens that manage the symptoms through dopaminergic medications. At present, PD therapies only alleviate symptoms without slowing or stopping its progress. The therapies comprise physical, occupational and speech therapies, addressing tremors and rigidity, gait and voice problems as well as deteriorating mental functions. The other supportive regimens include having a healthy diet and exercises that help in boosting muscle strength and improving balance.

If the above regimen is followed strictly, people with Parkinson’s can lead a normal life with minimal disruptions.

Winter has arrived! Please protect your Heart

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  • Dec 19, 2018
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Millions of people worldwide die due to heart and blood vessel diseases. Heart attack incidents rise with the onset of winter. Consequently, it is necessary to understand how the cold weather affects one’s heart and how to protect it from such weather.

Several changes occur within our body during the winter months, making the heart more vulnerable. The heart rate and blood pressure rise, putting extra burden on the heart. The tendency of the blood to form clots increases and stress hormone levels rise. Due to these changes, heart attack and brain stroke cases increase in winters.

Some risk factors and tips to manage them are highlighted below:

Exposure to cold, high winds and snow: Indians are fond of morning walks. Under normal conditions there is no problem. But in winters, this may affect people adversely because of exposure to cold. Accordingly, it’s advisable to avoid venturing out before sunrise, besides being well protected from cold by warm clothing. Wearing several layers is better than wearing a single layer of thick clothing. Special attention should paid to cover the head, neck and ears because maximum loss of body heat occurs from these areas. Gloves and thick socks provide additional protection. If early morning walks are a must, it is better done indoors in a warm atmosphere on a treadmill or a stationary exercise bicycle.

Over-exertion: Although it is necessary to continue regular accustomed exercises, unaccustomed heavy exertion beyond an individual’s capacity is strictly inadvisable. Over-exertion – especially if accompanied by mental stress such as running to catch a train – must be avoided. When any heavy outdoor activity is unavoidable, doing the job at a slow pace and taking frequent breaks before exhaustion occurs and going indoors into a warm atmosphere can be helpful.

Overheating: The body can end up overheating, particularly after heavy exertion, if one exercises heavily while fully covered in a warm indoor environment. One indication about overheating is when a person feels uncomfortable and begins perspiring beneath warm clothing. If this happens, allow the body to cool gradually by removing some of the warm clothing, stop exercising and relax.

Air pollution: People residing in Delhi NCR are familiar with air pollution and how it worsens during winters via fog and smog. Increased incidents of heart attacks and strokes in winters are attributed to some pollutants such as small particulate matter being at high levels during winters. Reducing air pollution is not an easy task and requires multilevel interventions. But individuals can reduce their risk by spending more time indoors or using air purifiers and protective masks when venturing out.

Infection: The number of infectious ailments – of the respiratory tract specifically – increase dramatically during winters, becoming the cause for increased hospitalizations and death, especially of the elderly. Infections trigger an inflammatory response in the body, including the blood vessels, leading to higher incidents of heart attack and strokes. Besides protection from cold, the preventive steps include avoiding overcrowded closed spaces, using protective masks, frequent hand washing, and preventing contact of the eyes and nose with unwashed hands. One of the mainstays of preventing flu and pneumonia is by immunization via their respective vaccines, which is mandatory for cardiac patients and elderly persons.

Lifestyle changes: Major changes in the lifestyle occur during winter months. The exercise routine takes a back seat, frequent parties add to the consumption of excessive unhealthy diets, reduced sleep times as well as increased smoking and alcohol intake. These factors heighten the risk of heart attacks and stroke. Therefore, people should be careful to avoid falling into this trap if they wish to stay fit during winters. Skipping medicines is also one of the reasons patients face problems.

Although winters are enjoyable, don’t go overboard by breaking discipline. Look after your heart well if you wish to enjoy life heartily. Merry Christmas and Happy New Year in advance!

November 2018

A balanced diet is the key for management of Diabetes

  • nayati_admin
  • Nov 14, 2018
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Comprehensive diabetic management include maintaining healthy weight with balanced diet and regular exercise  along with  keeping  blood sugars in well-defined targets  with  help of medication and monitoring as per the  healthcare professional’s advice.

Healthy food choices, understanding individual’s needs and tailoring dietary prescription accordingly is the need of the hour.  Extreme and strict dietary options can be counterproductive and makes the person vulnerable to lose hope, enthusiasm and optimism during management.  Medical nutrition therapy is the term used for nutritional prescription offered to Diabetic patients; it incorporates dietary advice which is customized according to the medical, personal and lifestyle factors of an individual. It is both the art and science of medicine.

The meal for type 2 Diabetic should have the right combination of carbohydrate, protein and fats along with all essential vitamins and minerals. Carbohydrates are the important source of energy. There are three different types of carbohydrates i.e. starch, sugar and fiber. Starches are complex carbohydrates and found in whole grains, processed grains, starchy vegetables, legumes, fruits, dairy products and sweets. Fiber is very good for gut health and has very low glycemic index and does not increase the blood sugar levels, so it should always be a part of regular meals. Refined sugars and processed carbohydrate has got very high glycemic index and should be avoided.

Can a Diabetic eat rice?

Rice is a staple food in many parts of India and cannot be completely abandoned. Limiting portion size and following the principle of moderation is the key. Along with that; type of rice, method of preparation, timing of eating, mixing rice with other low calorie foods and some rice sparing therapies aid in controlling sugar levels.

Practical tips for rice eating diabetics:

  1. Amount and portion size:  1/3 cup rice contains 15 gm of carbohydrate and is sufficient for one meal.  Rest of the caloric needs can be met up by combining it with low caloric food like beans, non-starchy vegetable, legumes, and soluble fiber which decreases the rate of digestion and minimizes the spike in blood sugar levels.
  2. Regular fiber intake: 20-30 gm of daily soluble fiber intake is recommended.  Vegetable, fruits, legumes, nuts and whole grains are natural fiber containing foods.   There are many soluble fiber supplements are available in market to supplement the dietary deficiencies.
  3. Type of rice: long grain basmati rice and brown rice are having low glycemic index and high fiber content in comparison to white rice and should be preferred.
  4. Cooking method: cook in an open pan and remove extra water after cooking to get rid of extra starch.
  5. Day to day carbohydrate consistency for timing and content should be maintained.
  6. Food rich in vitamin C, calcium and magnesium will give an extra edge in controlling the blood sugar levels when combined in diet.
  7. Know Glycemic index of your food: It is the scale which measures how quickly food gets digested in to sugar and absorbed in blood.  GI score >70 is considered high, 56-69 is moderate and <56 is low. Avoid foods having high glycemic index.
  8. Look for rice substituting recipes which are readily available online.
  9. Patient’s compliance of dietary advice should be monitored regularly by reviewing their food diaries and give positive feedback and motivation for their achievements frequently.

June 2017

QUAD fever: beware of non-infectious fever in high spinal cord injuries

  • rachna
  • Jun 23, 2017
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by – Jyoti Goyal, Rakesh Jha, Paramjeet Bhatia, Raj Kumar Mani


A case of cervical spinal cord injury and quadriparesis with prolonged fever is being described. Initially, the patient received treatment for well-documented catheter-related bloodstream infection. High spiking fever returned and persisted with no obvious evidence of infection. Read More