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Article in Financial Express on Bladder Health Awareness Month by Dr.Kabilan Saminathan- Consultant and Head Department Urology, Dr. Mehta’s Hospitals, Chennai.

Article in Financial Express on Bladder Health Awareness Month by Dr.Kabilan Saminathan- Consultant and Head Department Urology, Dr. Mehta’s Hospitals, Chennai.

Article in DT Next on How is diabetes related to infertility by Dr. Rose Raichel – Head of Internal Medicine, Dr. Mehta’s Hospitals, Velappanchavadi, Chennai.

Article in DT Next on How is diabetes related to infertility by Dr. Rose Raichel – Head of Internal Medicine, Dr. Mehta’s Hospitals, Velappanchavadi, Chennai.

World Spine Day 2021

World Spine Day 2021- Back2Back

On this world spine day, we are slowly limping back to normal from the consequences of the COVID pandemic. As people are slowly returning to work and children are returning to school, health care is moving towards elective issues that had been ignored in the lockdowns. The turmoil caused by the fear of the dreaded virus has led to some unique problems. Some of these are related to lifestyle changes and some of these are related to healthcare delivery.

The new normal has relegated people to working from home with no standardized work hours, higher than normal workloads, and very few avenues for leisure and social life. This combined with the constant fear of contracting the virus as well as the relentless alarmist news distributed through social media has led to high degrees of stress and anxiety in all populations. Homemakers are under the constant stress of children being at home and online classes. These factors have led to patients presenting with multiple pains predominantly related to the low back and neck and sometimes headaches. Once you can get it cleared with your spine surgeon then the answer for these pains is in searching for a balanced lifestyle with not just physical health but also emotional and mental peace. Yoga, meditation, exercise, and adequate social interaction with good sleep is the remedy.

However, what if your pain is actually due to a pathological issue? Pains due to degeneration of the spine, disc prolapse, and other issues due to wear and tear of the spine are usually self-limiting and very few of them require surgery or intervention. Most of them settle with rest and painkillers. What has changed is the fear of patients seeking medical advice and treatment during the active waves of Covid 19. There was also significant fear of getting operated on under these circumstances. At the current point in time, there is adequate scientific evidence and experience to make well-informed decisions and plan treatment for these non-emergent conditions. Clearly, hospitals have taken to very robust protocols to prevent the spread of the disease inside the hospital, including testing of patients and attenders and CT screening of high-risk patients. Your doctor will actively dissuade you from nonemergent surgery if they feel that you are at risk of Covid.

In patients who require surgery for conditions where nonoperative treatment has failed usually undergo a pre-operative COVID swab test as well as if required, a CT chest. Patients who turn out to be positive may require the surgery to be postponed. Patients who have recently recovered from COVID may require certain additional investigations prior to being posted for surgery.

In the unfortunate case, that a patient has active COVID infection but still requires emergency surgery for either infection or fractures of the spine. The patient is informed about the possibilities of worsening of the covid status as well an increased risk of complications including bleeding and infection. Most hospitals that do these surgeries have separate operation theatres for the same with isolated wards and extra protective equipment. Your surgeon and anesthetist are best equipped to advise you regarding the risks and benefits of the situation.

Be safe, mask up, and always get the best possible advice from your surgeon rather than following ill-informed social media opinions.
Safe spine surgery is a reality but it comes with experience and expertise.

Article by
Dr. Parthasarathy Srinivasan
Orthopedic Surgeon and Spine Specialist
Dr. Mehta’s Hospitals.

Our Hygiene is in our Hands

October 15 is Global Handwashing Day, a globally adopted day dedicated to increasing awareness and understanding about the importance of hand-washing with soap as an effective and affordable way to prevent diseases and save lives.

When hand-washing with soap is practiced at key moments, such as after using the toilet or before eating, it can dramatically reduce the risk of many infections like Pneumonia and diarrhea which can cause serious illness and death. Handwashing with soap also helps prevent the spread of other infections and viruses including influenza and COVID-19.

Hand washing is a traditional method followed across generations before eating and upon entering the home from outside. With scientific evidence on the effectiveness of handwashing taking the centre stage during the pandemic the hand hygiene as a single factor in preventing the spread of the deadly COVID, the infection has become a key regulation today. Handwashing has been and will continue to be one of the most effective ways to stay safe during the COVID-19 pandemic and is by far one of the most important behaviors to adopt for a healthy life.

Access to WASH services and information alone is not enough to shift human behavior; individuals must be convinced that they have a vital role to play, and they require frequent reminders to stay motivated and keep up the behaviors that protect themselves and others from disease.

The health care facility is by far the most regulated area in terms of delivering 100 percent compliance towards hand washing and hand hygiene. There are regulatory, auditory, and quality standards for handwashing across the health care system that makes hand washing a defacto practice among health care workers.

Being an anesthetist I advocate and witness a high level of perfection in handwashing in Operation Theatres to prevent infections during surgeries. When we extrapolate this proven technique to the community we get prevention of disease transmission at the best.

The handwashing technique should be taught from the toddler age so that it becomes a standard and custom in itself. We at our hospital take the social responsibility of teaching the technique during our school visits.

The 2021 Global Handwashing Day theme is “Our Future is at Hand – Let’s Move Forward Together.” 

Article by
Dr. Dhenesh R
Deputy Medical Administrator
Dr. Mehta’s Hospitals.

Arthritis Means Joint Inflammation

Since  1996, World Arthritis Day on October 12th has unified people of all ages, races, and genders to raise awareness of rheumatic and musculoskeletal diseases.  This year’s theme, “Don’t Delay, Connect Today,” aims to highlight the importance of early diagnosis of Rheumatic and musculoskeletal diseases.

Arthritis means joint inflammation, but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. The most common form of arthritis is osteoarthritis. Arthritis is more common among adults aged 65 years or older, but it can affect people of all ages, including children. Treatment for arthritis aims to control pain, minimize joint damage, and improve or maintain function and quality of life.A range of medications and lifestyle strategies can help achieve this and protect joints from further damage.

Medication

Non-inflammatory types of arthritis, such as osteoarthritis, are often treated with pain-reducing medications, physical activity, weight loss if the person is overweight, and self-management education.

These treatments are also applied to inflammatory types of arthritis, such as RA, along with anti-inflammatory medications such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and a relatively new class of drugs known as biologics.

Natural remedies

A healthful, balanced diet with appropriate exercise, avoiding smoking, and not drinking excess alcohol can help people with arthritis maintain their overall health.

Diet

There is no specific diet that treats arthritis, but some types of food may help reduce inflammation which includes,

  • Fish
  • Nuts and Seeds
  • Fruits and vegetables
  • Beans
  • Olive oil
  • Whole grains

Foods to avoid

There are some foods that people with arthritis may want to avoid. Nightshade vegetables, such as tomatoes, contain a chemical called solanine that some studies have linked with arthritis pain. Research findings are mixed when it comes to these vegetables, but some people have reported a reduction in arthritis symptoms when avoiding nightshade vegetables.

Management

  • Staying physically active.
  • Achieving and maintaining a healthy weight.
  • Getting regular check-ups with the doctor.
  • Protecting joints from unnecessary stress.

Seven habits that can help a person with arthritis to manage their condition are:

  1. Being organized: Keep track of symptoms, pain levels, medications, and possible side effects for consultations with your doctor.
  2. Managing pain and fatigue: A medication regimen can be combined with non-medical pain management. Learning to manage fatigue is key to living comfortably with arthritis.
  3. Staying active: Exercise is beneficial for managing arthritis and overall health.
  4. Balancing activity with rest: In addition to remaining active, rest is equally important when your disease is active.
  5. Eating a healthful diet: A balanced diet can help you achieve a healthy weight and control inflammation. Avoid refined, processed foods and pro-inflammatory animal-derived foods and choose whole plant foods that are high in antioxidants and that have anti-inflammatory properties.
  6. Improving sleep: Poor sleep can aggravate arthritis pain and fatigue. Take steps to improve sleep hygiene so you find it easier to fall asleep and stay asleep. Avoid caffeine and strenuous exercise in the evenings and restrict screen-time just before sleeping.
  7. Caring for joints: Tips for protecting joints include using the stronger, larger joints as levers when opening doors, using several joints to spread the weight of an object such as using a backpack and gripping as loosely as possible by using padded handles.

Do not sit in the same position for long periods. Take regular breaks to keep mobile.

Physical therapies

  • Warm water therapy: Exercises in a warm-water pool. The water supports weight and puts less pressure on the muscles and joints.
  • Physical therapy: Specific exercises tailored to the condition and individual needs, sometimes combined with pain-relieving treatments such as ice or hot packs and massage.
  • Occupational therapy: Practical advice on managing everyday tasks, choosing specialized aids and equipment, protecting the joints from further damage and managing fatigue.

Physical activity

Joint-friendly physical activities that are appropriate for adults with arthritis and heart disease include:

  • Walking
  • Swimming
  • Cycling

Causes

There is no single cause of all types of arthritis. The cause or causes vary according to the type or form of arthritis. Possible causes may include:

  • Injury, leading to degenerative arthritis.
  • Abnormal metabolism, leading to gout and pseudogout.
  • Inheritance, such as in osteoarthritis.
  • Infections, such as in the arthritis of Lyme disease.
  • Immune system dysfunction, such as in RA and SLE.

Most types of arthritis are linked to a combination of factors, but some have no obvious cause and appear to be unpredictable in their emergence.

Some people may be genetically more likely to develop certain arthritic conditions. Additional factors, such as previous injury, infection, smoking and physically demanding occupations, can interact with genes to further increase the risk of arthritis.

Diet and nutrition can play a role in managing arthritis and the risk of arthritis, although specific foods, food sensitivities or intolerances are not known to cause arthritis.

Foods that increase inflammation, particularly animal-derived foods and diets high in refined sugar, can make symptoms worse, as can eating foods that provoke an immune system response.

Gout is one type of arthritis that is closely linked to diet, as it is caused by elevated levels of uric acid which can be a result of a diet high in purines.

Diets that contain high-purine foods, such as seafood, red wine, and meats, can trigger a gout flare-up. Vegetables and other plant foods that contain high levels of purines do not appear to exacerbate gout symptoms, however.

Risk factors for arthritis

Certain risk factors have been associated with arthritis. Some of these are modifiable while others are not.

Non-modifiable arthritis risk factors:
  • Age: the risk of developing most types of arthritis increases with age.
  • Sex: most types of arthritis are more common in females, and 60 percent of all people with arthritis are female. Gout is more common in males than females.
  • Genetic factors: specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis.
Modifiable arthritis risk factors:
  • Overweight and obesity: excess weight can contribute to both the onset and progression of knee osteoarthritis.
  • Joint injuries: damage to a joint can contribute to the development of osteoarthritis in that joint.
  • Infection: many microbial agents can infect joints and trigger the development of various forms of arthritis.
  • Occupation: certain occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.

Article by
Dr. Vignesh Mathialagan
Consultant Orthopaedic
Dr. Mehta’s Hospitals.

Breast Cancer Awareness in Times of Covid-19

Breast cancer is the most common cancer among the Indian Population, yes ‘population’ not just Indian women. It accounts for 1.62 lakh out of 11.5 lakh new cancer patients every year in our country or in other words, 14% of all cancers in the country irrespective of sex. This should give us pause for thought. Nowadays every one of us knows someone in our family or friends who have been diagnosed with breast cancer. So how can we be alert and aware about? Read on.

What causes this rampaging disease?

There is a wide variety of reasons such as early menarche, late menopause, late childbirth, not having any children, obesity, alcohol, family history of breast cancer which may be a sign of hereditary genetic mutations. Breast cancer predominantly occurs in women and old age, but it can also occur in men. This could be because of genetic mutations and hereditary traits.

How do I know if I have breast cancer?

Breast cancer like all cancers usually sneaks up stealthily on unsuspecting individuals. It may be first noticed as a painless mass felt accidentally while bathing which keeps increasing in size to the point where it can become quite large, multiple in number, ulcerate the skin of the breast or make it look like an orange peel. Sometimes, but not always there may be a discharge from the nipple. If you have any of the above-mentioned signs, it would be advisable to consult your family Physician or an Oncologist.

How can I reduce my risk of getting breast cancer?

There are some risk factors that are beyond your control, like age of menarche or menopause, female sex, old age, genetic mutations. Then there are risk factors very much under your control like adequate breastfeeding, avoiding hormonal replacement treatment, being physically fit, avoiding alcohol and tobacco, avoiding junk food, and eating healthy. If there is a strong family history of breast cancer, consult an Oncologist and get checked for any genetic mutations. In case any mutations are detected specific steps can be taken as advised by an Oncologist to reduce the incidence of breast cancer. Besides these steps, scientific evidence suggests that all women above the age of 40 should undergo a screening mammogram once in two years. This helps in identifying early-stage breast cancer which is amenable to cure, thereby reducing death by breast cancer by up to 30%. Examine yourself, at least once a month. Examine both breasts for any skin changes, palpable lumps, bumps, and nipple discharge. Every day saved in diagnosing breast cancer enables the patient to live longer and have a better quality of life.

How has Covid impacted Breast Cancer?

Covid per se does not cause breast cancer, but it has impacted the stage of presentation and caused treatment delays. Patients who felt a small lump in their breast avoided coming to a hospital fearing coronavirus infection and over time the disease increased in size and spread to nearby organs. This means a patient who in the natural course of events would have presented with curable Stage I/II breast cancer ultimately presented with an incurable Stage IV disease. Secondly, patients with cancer are more susceptible to Covid infection due to the disease itself and side effects of breast cancer treatment like lesser immunity. Death due to covid infection has also been higher in breast cancer patients. Hence it is very important that breast cancer patients be more careful of their surroundings and minimize their interactions with people to avoid getting infected by the virus. Thirdly covid infection during treatment makes further treatment impossible as cancer treatment can aggravate Covid infection and any such break in the treatment adversely affects end result of treatment in terms of cure and long-term survival.

I am diagnosed with breast cancer, can I take the Covid vaccine?

It depends on what stage of treatment you are in. A patient who has completed all treatment and is in good health can very well get vaccinated. For patients who are inactive treatment, consult your Oncologist. During chemotherapy, there is some suppression of the immune system, so vaccines may not elicit the same immune response as in a normal person giving a false sense of security.

How can I safely get treated for breast cancer during the pandemic?

It is very important that you seek help if you think you have a symptom suspicious of breast cancer. If you have a fear of coming to hospitals, numerous platforms for teleconsultation are available nowadays, the first consultation can be done remotely, but a clinical breast examination if needed can only be done in person. If any tests are advised like Mammogram or needle biopsy, they can be scheduled in such a manner that your stay in a hospital is kept to a minimum.

Has Covid changed breast cancer treatment protocols?

Not much really. The core treatment remains the same. During peak covid times, what changed was that breast reconstructive surgeries were discouraged. Surgery for breast cancer involves either removing the breast entirely or removing only the tumor and preserving the rest of the breast, also known as breast conservation surgery. For women who are motivated to retain the shape of their breasts, reconstruction options are available, either in the form of implants or tissue from other parts of the body. As this procedure was deemed nonessential to treatment, it was generally deferred to ensure that patient spent minimal time in hospital and went home early.

Is breast cancer curable?

Yes, very much so if the patient presents at an early stage, especially Stage I and II. For such patients chances of cure are high with the proper treatment and good compliance to treatment. For stage III patients, the prognosis is mixed. The aim of treatment in such patients is curative, but the chance of a recurrence can be around 30- 40% especially if they are young and carry aggressive disease profiles, so they have to be on close follow up. For patients with Stage IV disease, the aim of treatment is to control not cure, but I am happy to say that with the advent of new and advanced drugs, what was a matter of months to live has become years. Motivated compliant patients continue to survive longer with the right treatment.

So, though I started with the gloomy picture of the alarmingly high number of new breast cancer patients every year, I will conclude on a happy note by saying that treatment is rapidly advancing. Today we are able to cure more breast cancer patients than before and for those who cannot be cured, we are able to give a much longer lifetime with a good quality of life. The take-home message is one of hope and determination to beat cancer at all odds.

As an unknown author said, “At the end of the day all you need is hope and strength. Hope that it will get better and strength to hold on until it does.”. Help is at hand, we at Dr. Mehta’s hospitals are at your disposal to answer your queries and treat you and your loved one in the best way possible. Thank You.

Article by
Dr. L Manikandan
Consultant, Surgical Oncologist
Dr. Mehta’s Hospitals.

Live the new normal lifestyle a healthy way.

Live the new normal lifestyle a healthy way. 
(The importance of taking care of your most precious and vital organ, your heart. Even more in COVID-19 times. Live a heart-healthy lifestyle. Live young.)

Penny wise and pound foolish is a famous saying used to refer to people who are extremely careful about small things but wasteful about larger things. After the gloom this pandemic had brought upon us, everyone is desperate to find a light at the end of the tunnel. In the process, the mask and sanitizer alone have become the standing torchbearer and are considered by many as part of the attire as well as a kind of shield. In the long run, we have witnessed a humongous change in work and lifestyle patterns. Many things which very prioritized previously seemed minuscule; be it a vacation tour or friends’ wedding or even a hospital visit for chronic ailments. The focus has shifted on being alive; leave alone the thoughts on a healthy routine. This brings us to the verge of the cliff, pondering where we are heading by this uncharted new normal lifestyle. Has this new normal brought about a real change for good or is it making us blind to a larger picture?

The link between COVID-19 and cardiovascular diseases

Cardiovascular diseases are one of the leading causes of human death irrespective of age and region. A high rate of morbidity, mortality, and disability is associated with cardiovascular diseases. Preventive strategies which include a healthy diet and lifestyle can help combat cardiovascular diseases in a big way. The COVID-19 pandemic has posed an unprecedented challenge to the healthcare sector. COVID-19 is primarily a respiratory illness. But it can cause inflammation of the blood vessels and the heart muscle. Thus, people with comorbid conditions and underlying heart ailments are at a much higher risk for infection and ultimately a negative impact on their cardiovascular health.

The need for a healthy lifestyle in the new normal situation

As the pandemic continues to grow and evolve, a key aspect is that one needs to know how they can keep themselves and their family members safe, particularly for high-risk individuals. Having comorbid conditions like diabetes, smoking can increase this risk. So, keeping your heart strong by following a lifestyle during the pandemic is imperative. So, it becomes a prime requirement to follow a lifestyle that makes our “Heart strong”. Due to the new normal of social distancing and remote working, people are confined to their homes for longer periods of time, the fear of getting infected has made us postpone or cancel regular health check-ups too. Lack of exercise and self-isolation further adds to the problem and a decrease in immunity worsens the chronic illnesses. In these challenging times, maintaining your heart health, monitoring your blood pressure, and staying fit matter a lot.

Consider a few steps given below that can help you maintain your heart health and prevent cardiovascular ailments,

1. Follow a routine. Giving a structure to your day with appropriate timing is a great help. Even if you’re spending more time at home, it’s important that you follow your daily routine. Get an adequate amount of sleep, eat balanced and healthy meals at the right time, do your daily routine tasks and take your medications in time as prescribed by your doctor.
2. Stay connected. Maintaining your emotional health and a happy mental status is even more necessary in these tough times. Stay connected with family and friends over the phone. It helps in elevating your mood and also makes a big difference to your emotional well-being.
3. Consume heart-healthy foods. Make sure to select heart-healthy foods (High fiber/low carb/low fat). Avoid foods with high sodium or saturated fats. Consult your doctor for a heart-healthy diet.
4. Keep yourself physically active. It is important to keep your body moving. Take frequent breaks from sitting to improve circulation, stretch your legs by walking outdoors. Follow a normal fitness routine.
Understand your body. Every person has a unique body. Only you know your body the best. So keep monitoring your body and if you notice any changes in your health, consult your doctor.
5. Schedule a telephonic or online consultation with your doctor. To keep patients safe during the ongoing pandemic, telemedicine may suit to take care of their needs for most of the reviews
6. Also follow the special precautions needed to avoid exposure to COVID-19.
Wear a mask./Avoid touching your face.
Wash your hands with soap often. Wash for at least 20 seconds, and pay special attention to the back of your hands, finger creases, and thumbs.
Follow the guidelines of social distancing. This includes staying home and maintaining a 6foot distance from you and others while in public.
7. Practice healthy habits. (Avoid smoking/tobacco use/drug abuse/alcoholism)

Take care of your heart. Don’t let it run behind time. Eat healthily and stay healthy, even in these challenging times of the pandemic. A healthy heart and healthy cardiovascular health is the key to good living. Prevention is always better than cure.

Article by
Dr.Vivek Muthukumarasamy
Consultant Interventional Cardiologist
Dr. Mehta’s Hospitals

People with a history of covid-19 have pain in the right upper abdomen suspect Gall bladder inflammation.

Gall bladder stone disease is a common problem in India. Gall stones are hardened deposits of the digestive fluid in the gall bladder. The gallbladder is a pear-shaped organ on the right side of the abdomen, just beneath the liver. It is a pouch that stores bile, a green-yellow liquid that helps with digestion. Inflammation of the gall bladder is called cholecystitis. Gall stones are responsible for 90% of cholecystitis which is called calculous cholecystitis.

Gall bladder gangrene is defined as necrosis of the gall bladder wall as a result of ischemia (inadequate blood supply to an organ) followed by progressive vascular insufficiency. Untreated cholecystitis can cause tissue in the gallbladder to die. Factors such as male sex, advanced age, delayed surgery, cardiovascular diseases, and diabetes mellitus increase the likelihood of developing gangrenous cholecystitis. Compared with uncomplicated acute cholecystitis, gangrene carries a significantly higher mortality rate, which has been reported to be between 15% and 50%.

In India, a few cases reports described that patients developed gallbladder gangrene after recovering from coronavirus disease (covid 19). During the peak of the second wave, there were incidences of gangrene of the gall bladder discovered in patients who had recovered from covid. The covid – 19 infection primarily affects the lungs as it has the highest number of ace 2 receptors that the virus uses to bind the human cells. After lungs, bile duct, and gallbladder have the highest number of ace 2 receptors. A high concentration of ace 2 receptors is conducive to the entry of the virus. When the virus enters cells, it causes a dysregulated immune response. These dysregulated abnormal immune responses due to covid antigen produce severe inflammation and increasing intraluminal pressure. If the pressure is not relieved, the gall bladder wall will become progressively ischemic eventually resulting in gangrenous changes. This will lead to sepsis and shock. The other reason may be the immunocompromised state of the covid patient against the virus results in severe inflammation of the gall bladder.

The median duration between covid 19 symptoms and diagnosis of acalculous cholecystitis is 2 months. These patients complain of high fever with chills, pain in the right upper quadrant of the abdomen, nausea, vomiting, loss of appetite, and low blood pressure which could be a sign of septic shock (a life-threatening condition). Patients may start abdominal pain from time to time when eating foods that are high in fat, such as fried foods. The pain does not usually last more than a few hours, some patients may have jaundice (yellowing of skin and eyes). All the patients who had recovered from covid-19 do not have the common and conventional predisposing factors mentioned above.

This condition is diagnosed through ultrasound and CT scan of the abdomen. Acalculous cholecystitis with the gangrenous gallbladder is a serious condition associated with high morbidity and much high mortality than calculous cholecystitis.

In this pandemic, a high index of suspicion of this entity in a patient with fever and right upper quadrant pain especially with a history of recent recovery from covid-19 infection besides timely diagnosis and early intervention with broad-spectrum antibiotics may prevent the development of complication and perforation of the gall bladder.

Acute gangrenous cholecystitis due to covid-19 must be addressed urgently because rapid progression and deterioration may result if untreated. The best definitive therapy is cholecystectomy, either laparoscopic or open. People with a history of covid-19 have pain in the right upper abdomen suspect gall bladder inflammation, they should start the treatment soon.

Acalculous cholecystitis is an inflammatory disease without evidence of gallstones.it accounts for the remaining 10 % of cholecystitis.it is most observed in patients on mechanical ventilation, with severe sepsis, after severe trauma and burn injuries. Long periods of fasting, total parenteral nutrition (TPN), and drastic weight loss can increase the incidence of acalculous cholecystitis. In addition, acalculous cholecystitis is associated with a higher incidence of gangrene and perforation than calculous cholecystitis.

Article by
Dr. Balamurali
Consultant- General & Laparoscopic Surgeon
Dr.Mehta’s Hospitals

People Suffering from Cerebral Palsy have a higher risk of developing a coronavirus Pneumonia.

Cerebral palsy is one of these conditions. Cerebral palsy is a neurological disorder that starts in young children and results in tightness of the muscles in the body and difficulty in walking. In addition, many of these patients have problems in feeding, vision, speaking, and intelligence, along with seizures (fits) in some of these patients. This disorder is generally due to problems during birth (for example, not crying at birth leading to a condition called birth asphyxia).

Children and adults with this disorder have the same risk as other normal children/adults for getting infected with the virus, however, they are at a higher risk of complications due to the infection. The Centers for Disease Control and Prevention (CDC) reports that those with cerebral palsy might have a higher risk of developing severe coronavirus pneumonia.

1. What is the reason for this higher risk?

Now that we have understood that cerebral palsy is a disease affecting the control of muscles, it is easy to understand why these patients have a higher risk of severe disease due to this infection. The muscles of the chest helps in breathing by expanding the chest and helping to get air from the atmosphere into the lungs. When these muscles do not work in a normal way (which occurs in patients with severe cerebral palsy, especially those who cannot walk), there is difficulty in the process of breathing (respiration) leading to weak movements of the chest. This decreases the volume of the air that can be drawn into the lungs (which is called- ‘vital capacity). When these patients get affected by the coronavirus and develop pneumonia, they have a poor lung reserve (because of the low lung volume) to protect themselves from the damage. A simple example will explain this better: an army of 100 soldiers will be weaker against the enemy than an army of 1000 soldiers. This is exactly what happens in these patients. This results in severe pneumonia in these patients.

One additional reason for the higher risk is that, since most of these patients with cerebral palsy are in the less than 18 years age bracket, they are not immunized against the Coronavirus. This increases the risk of getting a severe coronavirus disease. Another specific problem is that since some of these patients with cerebral palsy have seizures (fits), fever caused by this illness can trigger seizures in them.

Finally, one should not forget that many patients with cerebral palsy have difficulty in communication (speech problems) and low intelligence. This can result in their symptoms being missed by parents and caregivers, especially when they are mild.

2. What are the other specific problems seen in this group of patients?

Since patients with cerebral palsy is a chronic (life-long) disease and since they have continued healthcare needs (including physiotherapy, speech therapy, occupational therapy, neurologist visits), one of the most important problems these patients face is that, due to the pandemic, many of these services have been suspended, because of safety issues. This has affected the routine healthcare requirements of these patients and has affected their quality of life. Another issue in these patients who are taking regular medicines (for example, for seizures) is that the availability of these medicines can be affected due to the pandemic. We know that even in high-risk patients (like those with cerebral palsy), Coronavirus is a mild disease in the majority. So, the most important problem faced by this group of patients during the pandemic is the break-in of their other health needs as listed above and not the virus!

3. How to prevent coronavirus infection in these patients and its complications?

The CDC has issued guidelines for those with cerebral palsy and their parents or caregivers to stay safe during the coronavirus crisis.

These guidelines include:

  1. Avoiding public spaces and staying home as much as possible
  2. Calling doctors at the first sign of symptom
  3. Practicing social distancing
  4. Using tissues for coughs and sneezes
  5. Washing hands with soap and water regularly
  6. Wearing facemasks

In addition, caregivers who get sick should self-isolate if someone else can provide care for those with cerebral palsy. It is advisable that when the government approves vaccination for the 12–18-year age group, children with cerebral palsy falling in this age range should get vaccinated. AND as mentioned above, since these patients have difficulties in communicating their symptoms, parents and caregivers should be vigilant to pick up early symptoms and seek appropriate medical care at the right time.

Now that the pandemic is coming down gradually, routine health services for these patients including physiotherapy and regular neurologist visits should be resumed with full precautions. Routine medicines taken by these patients should not be discontinued at any cost and parents and caregivers can make use of the Teleconsultation services to keep in touch with your neurologist.

Following these guidelines will help keep you and your loved ones safe — and reduce the possibility that anyone in your family with cerebral palsy will contract the coronavirus.

Article by
Dr. Shivan Kesavan
Consultant Paediatric
Dr. Mehta’s Hospitals

Stroke – Important Information

Stroke is  “BRAIN ATTACK “ similar to a heart attack.
Every 6 seconds someone in the world suffers a stroke
Stroke is a common neurological disorder in clinical practice.
A second leading cause of death, after a heart attack

Some questions in Stroke are  – Who /  When/ Where/  Why do people develop stroke?
The answer is ANYONE, ANYTIME, ANYWHERE  CAN DEVELOP STROKE

Stroke in numbers

  • One stroke occurs every 6 seconds
  • One in six can develop stroke
  • India -40-140 /lakh population ,lesser in rural- 13/0ne lakh  population ,  more in  Urban -163/one lakh  population
  • Stroke in persons less than 40 yrs is about 12%

What is a stroke?

Focal neurological deficit caused by disruption of blood circulation to the brain, which can be due to obstruction of the blood vessel called thrombosis, clot-forming elsewhere like heart and being sent to the brain called as embolism or breakage of a blood vessel with blood in the brain called as brain hemorrhage.

What are the common symptoms to identify a stroke?

  • If you have any of the following symptoms please see a doctor immediately as it may be a stroke
  • Sudden numbness or weakness of the face, arm, leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Loss of sensation in ½ of body
  • Speech difficulty
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

What produces stroke?

  1.  Obstruction to  arteries ie blood vessel which supplies blood to the brain or narrowing of bloodvessel called stenosis
  2.  Clot arising in heart pushed to brain  eg Cardiac embolism
  3.  Narrowing of a blood vessel (similar to rusting of iron pipes ) called  Atherosclerosis
  4.  Small vessel in brain-damaged due to high BP /sugar etc
  5.  Drop-in blood pressure

 What makes you likely to have a stroke?

  • Age >65yrs, being male increases the risk of stroke
  • DM/HT/Cardiac disease/high lipids
  • Previous strokes
  • Family history of  strokes
  • Smoking
  • Alcohol

Treatment in Stroke –

Stroke can progress for about a week since onset in spite of appropriate and adequate treatment If you are having a Stroke or feel one coming go to the hospital right away. You will be getting the following tests depending upon your condition: CT or MRI of the brain, EKG, Carotid Ultrasound, Echocardiogram, Blood work – sugar, Lipid Profile (checking your cholesterol level), etc is done.

If you are diagnosed within the first 3-4 1/2 hr with stroke and if there is no hemorrhage you may be given a clot-busting drug to dissolve the clot  This decision is to be individualized. Occasionally the clot can be removed using certain devices also.

Blood thinners called antiplatelet drugs such as aspirin, clopidogrel, dipyridamole may be given if no hemorrhage. Statins that reduce cholesterol may be added Control of Diabetes and High blood pressure will be optimized.

If weakness, swallowing, or speech problems are present physiotherapy, speech, and swallowing therapy may be initiated.

Strokes being a BRAIN ATTACK is an EMERGENCY, but not recognized as it has different symptoms occur in different persons depending on the region of the brain affected. It can affect not only the person with stroke, but the whole family as stroke can produce a lot of disability which can be long-lasting.

TIME IS BRAIN SO BE FAST, GO TO HOSPITAL  AT THE EARLIEST TO REDUCE FUTURE DISABILITY.

Article by
Dr . K.Bhanu
Director of Neurology and Neurosurgery
Dr. Mehta’s Hospitals