Category Archives: Blogs

Swine flu

Swine flu

Swine flu is a respiratory infection caused by a type of Influenza virus (H1N1). This infection can range from asymptomatic infection to mild viral flu to severe, complicated diseases requiring hospitalization. Children, pregnant females and elderly patients have been found to develop complications at a higher rate.

Transmission– It is mainly spread from one person to another through respiratory droplets. Also, it can be transmitted from the patient to a healthy person by direct contact, touch or touching the infected surroundings of the patient.

Clinical signs and symptoms– Fever, cough, sore throat, headache, bodyache, joint pains, severe weakness, vomiting and diarrhea are the major symptoms. Some patients may develop complications like respiratory distress, decrease in oxygen saturation, drowsiness and altered sensorium, kidney and liver dysfunction etc. These patients need hospitalization and may need Oxygen or ventilatory support.

Diagnosis– H1N1 virus infection can be diagnosed by a test called RT-PCR, which is processed from the  nasopharygeal swab of the patient.

Treatment- A medicine called Oseltamivir is available for treatment, which works best if started early, especially within 48 hours of onset of illness. Rest of the treatment is supportive.

Prevention– Swine flu can be prevented by taking vaccine, though the efficacy is not 100%. It is a safe vaccine, it should be taken every year.

Dr Surabhi Madan
MD Medicine
FID (Fellowship Infectious Diseases, PD Hinduja Hospital, Mumbai)
Certified in Tropical Medicine & Antimicrobial Stewardship
Infectious Diseases Consultant, CIMS Hospital, Ahmedabad.

Diabetes and Exercise

Diabetes and Exercise

Physical activity plays an important role in diabetes management. Regular exercise along with dietary management and medications improves quality of life of diabetic patient and delays complications related to high blood sugar.

What is physical activity?

Physical activity is any activity that involves major muscle groups, including routine daily activities such as shopping or climbing stairs. Exercise includes any activity done with a goal of improving or maintaining physical fitness. Physical fitness can be described as the ability to carry out daily tasks with vigour and alertness, without excessive fatigue, and with ample energy to enjoy leisure time pursuits and meet unforeseen emergencies.

What are the  benefits of regular exercise to diabetic patient?

  1. Improves blood sugar control
  2. Reduces blood pressure and cholesterol
  3. Weight reduction
  4. Improves heart function and blood circulation
  5. Reduces stress and elevate mood
  6. Improves overall quality of life

What types of exercise are suitable for diabetic patients?

There are three main types of exercise: (i) Aerobic exercise, (ii) Resistance training and (iii) Stretching exercise.

  1. Aerobic exercise — Aerobic exercise involves exertion such as walking, running, or swimming, which increases the flow of blood through the heart. Aerobic means “with oxygen” and refers to working at a level where the large muscles get adequate oxygen from the blood to sustain prolonged activity.
  2. Resistance training — Resistance training is exercise designed to increase muscle strength and includes lifting weights. This kind of exercise is sometimes called anaerobic, meaning “without oxygen.” In contrast to aerobic exercise, the muscles do not get enough oxygen to sustain anaerobic exercise for prolonged periods of time. As an example, anaerobic exercise involve lifting a heavy weight a number of times.
  3. Stretching exercise — Stretching exercises are movements designed to improve flexibility and prevent injury. Improving flexibility allows joints to move over a wider range of motion. Good range of motion in all joints helps to maintain musculoskeletal function, balance, and agility.

The American Diabetes Association recommends at least 150 minutes of moderate activity a week—that’s 30 minutes five days a week. You can get that through activities such as walking, cycling or swimming.

Tips for safe exercising in diabetic patient:

  1. Deicide time and duration of exercise
  2. Don’t miss meal/snack or medicines
  3. Avoid dehydration: drink plenty of water
  4. Prepare for any episode of low blood sugar during exercise
  5. Chose proper shoe wear
  6.  Avoid exercise during illness
  7. Don’t do over exertion
  8. Ask your doctor for optimal exercise regimen for you before starting or changing exercise pattern

Dr. Vivek Patel

MBBS, MD, DM(Endocrinology)

Tips for healthy brain

Tips for healthy brain

“That’s your best friend and your worst enemy – your own brain.” -Fred Durst

When we usually talk about fitness, we talk about walking, cycling, gym, even marathons, but have we ever discussed our brain fitness? We should!

Our brain is very critical “instrument” in every area of our life, be it work, play, enjoyment, fear, learning, memory and all. Ask yourself: What have we done so far to improve our “brain” performance? You don’t have to “work” hard, it is simple.

There are some simpler ways to achieve more. Recent research suggests that relatively simple lifestyle choices can maintain and improve our brain health.

Few simple tips for healthy & “healthier” brain:

1. Stay physically active.

Not only our body, but brain also needs regular physical activity. It is a valuable part of overall body wellness plan. On a long run, regular exercise and activity is associated with a lower risk of cognitive decline. Try to exercise 30 minutes, at least 5 days a week.

2. Adopt a healthy diet.

Food is not only the gate to heart, but also to “brain”. Diet low in fat and rich in vegetables and fruit helps to keep brain better.

3. Stay mentally active.

“Use it or lose it” is the slogan. Learn new language. Play Sudoku. Solve crosswords. Puzzles are rewarding.

4. Stay socially engaged.

Friends and family are key factors to happiness. So it may be true for the brain health as well. Experimental research in social studies proved that regular social activity promotes creation of new brain cells and supports brain repair.

5. Proper sleep.

Sleep helps for memory consolidation, excretion of toxins and repair of neurons. So get yourself 7-8 hours of sleep every day.

6. Avoid tobacco/alcohol.

Toxins accumulated over years can accelerate the degenerative process. No one needs to be told about risks associated with tobacco or alcohol, but start practicing the right thing today.

7. Keep working as long as you as can and want to.

Keeping yourself busy in work; physical & mental; is good for your brain.

8. Regular Meditation.

 It’s “ME” time! Be with yourself. It may help to reduce stress; and stress is a “known” enemy of your brain.

Healthier brain = Healthier Life…

Stay positive.

Minimally Invasive Cardiac Surgery Current Status and Trends

Minimally Invasive Cardiac Surgery

Current Status and Trends

There are several new directions being pursued in minimally invasive cardiac surgery, including using

Smaller or more directed “limited incisions” to access and repair only the area of interest on the heart.

Coronary grafting is also now being done off-pump without the hemodynamic support of CPB or the “still heart” achieved by using cardioplegia. Conduits for bypass grafting are being harvested in a less invasive fashion, and valvular & certain congenital cardiac surgery to be done solely through intercostal space.

PRIMARY CORONARY ARTERY BYPASS GRAFTING

Primary coronary artery revascularization is the most common cardiac surgical procedure in the world

today. The typical patient presenting for this procedure requires multiple coronary grafts to various regions of the heart. Conventional coronary artery bypass grafting employs CPB for circulatory support and cardioplegia to temporarily stop the heart during the grafting. The heart is accessed through a full median sternotomy incision, and additional longitudinal incisions are required to harvest the coronary bypass conduits. This results in a moderate amount of surgical trauma, a systemic inflammatory response, hemodilution from the CPB circuit, and the potential risk of achieving a suboptimal cardioplegic arrest.

Coronary bypass grafting can be done safely and effectively without the use of cardioplegia or CPB circulatory support. The beating heart is repositioned within the mediastinum to expose the coronary targets using pericardial retraction sutures, and the area of interest is stabilized using various custom made mechanical cardiac stabilization devices. The region involved in the bypass grafting is mechanically stabilized while the rest of the heart continues to beat. Coronary blood flow to that region is temporarily interrupted with snares while the artery is opened and the graft is sewn into place.

Additional developments include minimally invasive saphenous vein harvesting from the leg and, most

recently, minimally invasive radial artery harvesting from the forearm. These conduits can now be

harvested through one-inch access incisions using scopes to visualize and remove the conduit from a

Subcutaneous tunnel. This has dramatically reduced surgical wound complications,

particularly in obese and diabetic patients, and markedly improved early postoperative patient mobilization in the hospital. Minimally invasive direct coronary artery bypass (MIDCAB) grafting of a single coronary artery is an additional strategy reserved for situations where a sternotomy or catheter-based intervention are contraindicated, or a catheter-based intervention has previously failed.

VALVULAR REPAIR AND REPLACEMENT

Cardiac valvular disease, either congenital or acquired, presents a different set of issues for the

minimally invasive cardiac surgeon. Currently cardiac valvular operations require opening the cardiac

chambers, and therefore by definition need to be done with the support of CPB, usually with cardioplegic arrest. Operating off-pump is not possible, and access has to be sufficient to allow cannulation of the circulation to establish the CPB circuit. The benefits of minimal access cardiac valvular surgery will understandably be more modest, but are still important in this select population of patients.

Aortic valve disease is generally treated with prosthetic valve replacement. There are several choices

available for a new prosthetic valve, but the surgical approach to replace the valve is similar in all cases. Minimally invasive aortic valve replacement involves reducing the size or location of the incision by using either an upper partial sternotomy or some version of an upper right para-sternal intercostal approach.

Mitral valve disease can be treated with either valvular repair or replacement. The minimally invasive

approach to accomplish this is through a limited right fifth interspace thoracotomy that will access the left atrium and mitral valve in a more direct fashion than access through a median sternotomy.

Cardiopulmonary bypass support is required, and cannulation can be done either directly though the

thoracotomy incision or percutaneously through the groin. There are more advantages to limited access mitral valve surgery than using this approach for aortic valve replacement. The incision can be much smaller than a sternotomy and more cosmetic within the right infra-mammary fold, particularly in the female patient, but it may also be more painful in the early postoperative period. When the left atrium is small, this more direct right thoracotomy approach gives much better visibility of both the valve leaflets and the subvalvular apparatus which greatly facilitates mitral valve repair.

OTHER MINIMALLY INVASIVE INITIATIVES

Congenital cardiac surgery has also developed minimally invasive approaches for a number of commonly seen problems in newborns and children. The largest experience has been the closure of patent ductus arteriosus using thoracoscopic techniques. This can usually be accomplished with only two thoracoscopic ports and a surgical stapling device for closure of the ductus.ASD closures are mostly operated through small incisions in Rt. Chest wall. The surgical treatment of refractory atrial arrhythmias has traditionally involved a substantial operation called the Maze procedure. This involves the surgical division of re-entrant conduction pathways under direct vision while the patient is supported with CPB and the heart is arrested with cardioplegia.

A minimally invasive Maze procedure through a sternal incision is now being developed to accomplish the same surgical result using a linear cryo probe on the epicardial surface of the heart alone, obviating the need for cardioplegia and CPB support. The field of minimally invasive cardiac surgery continues to be very dynamic with several dramatically different technologies and approaches being developed These efforts will be further advanced by a number of initiatives to develop stent-like devices that will facilitate the fashioning of the coronary and proximal aortic anastomoses eliminating the need for suture management or knot tying by instruments within small closed spaces.

What is Heart Failure?

Heart failure, also called Congestive Heart Failure (CHF), means your heart does not pump blood as well as it should. This does not mean your heart has stopped working, but it is not as strong as it used to be and fluid builds up in the lungs and other parts of your body. This can cause shortness of breath, swelling in the legs, feet, and stomach.

Heart failure starts slowly and can get worse over time.

If you feel you may be at the risk of heart failure contact CIMS Hospital and it’s leading and best cardiac surgery team in Ahmedabad and Gujarat. CIMS Hospital is rated the best heart hospital in Ahmedabad Gujarat for a reason!

What is CABG ?

CABG is a surgical procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.

The goals of the procedure are to relieve symptoms of coronary artery disease (including angina), enable the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems.

At CIMS Hospital, bypass surgery may be performed in combination with other heart surgeries, when necessary, such as valve surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation (an irregular heart beat).

Not sure if you need CABG? Contact CIMS Hospital the best heart hospital in Ahmedabad

What Is Celiac Disease?

What Is Celiac Disease?

Celiac disease is referred to a digestive disorder which is triggered by eating the food containing gluten and causes damage to the small intestine. Gluten is a form of protein that is naturally present in wheat, barley, and rye. Food items such as bread, pasta, cookies, and cakes contain gluten and certain pre-packaged foods, certain lip balms/lipsticks, hair and skin products, toothpastes, nutrient supplements, and rarely certain medicines contain gluten.

Celiac disease is considered to be a serious disease which can cause long-lasting digestive problems while preventing the nutrient absorption. It can also affect the other organs besides the intestines.  It is different from the gluten sensitivity, wheat intolerance or wheat allergy. If you have gluten sensitivity, you may have symptoms similar to those of celiac diseases, such as abdominal pain and tiredness. Unlike celiac disease, gluten sensitivity does not damage the small intestine.

Urogynaecology And Pelvic Reconstructive Surgery

Urogynaecology And Pelvic Reconstructive Surgery

The problems with the laxity of pelvic muscles can be very distressing to a woman.  Childbirth, constipation, obesity, respiratory problems and other conditions can weaken the pelvic muscles. In advanced cases, the upper section of the vagina or portions of the pelvic area drops into the vaginal canal. Too often, women don’t seek medical care because they are embarrassed, or don’t realize treatments can help.

The Urogynaecology Department at CIMS offers cutting-edge diagnostic and treatment options for women with complex pelvic floor disorders. Depending on your condition, a variety of effective options are available, ranging from healthy lifestyle changes and medications to nonsurgical techniques. The center offers a wide range of state-of-the-art diagnostic and therapeutic procedures as well as consultation services for the following –

  • Urinary frequency & urgency
  • Recurrent urinary tract infections
  • Overactive bladder syndromes
  • Pelvic organ prolapse (dropped bladder, vagina, uterus or rectum),
  • Vaginal Fistulas, diverticula, and vaginal agenesis

How does VSD (Ventricular Septal Defect) occur?

How does VSD (Ventricular Septal Defect) occur?

A VSD is the most common heart defect present at birth. It often occurs as a single defect with no known cause but is also found in children with multiple problems.

About one in three children with a heart abnormality discovered at birth has a VSD. VSDs account for one in five heart abnormalities found during childhood and for one in 10 found in adults.

A VSD may occur when a heart attack weakens the muscle of the septum. Blood pressure in the left ventricle breaks opens the weakened septum, pushing blood into the right ventricle through the new opening. Rarely, trauma to the heart may cause a VSD.

What is morbid obesity?

What is Morbid Obesity?

Morbid obesity is a disease of excess weight which is chronic and lifelong. Excessive fat storage results into morbid obesity which increases the BMI (Body Mass Index) beyond 35.

What is Body Mass Index (BMI)?

BMI or Body Mass Index is a measure of calculating a person’s excess weight. It is calculated by the following formula:

BMI = Weight (in Kilograms)/ Height (in Meters)2

Western Asian
Average built 21-25 18-22.5
Overweight 25-30 22.5-27.5
Obese 30-40 27.5-37.5
Morbidly obese <40 <37.5

How does morbid obesity differ from being overweight/obese?

  • Being overweight and obese are reversible conditions that can be treated by medical management whereas morbid obesity requires surgical intervention.
  • The body mechanisms that control a person’s weight are set in such a manner in the morbidly obese patient that they gain weight easily.
  • These patients find it difficult to lose weight and even more difficult to sustain.