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SCI International Hospital

  4.6  (501 ratings)

Internal Medicine Specialist Clinic

M-4, Greater Kailash, Part -1,Near M Block Market New Delhi
1 Doctor · ₹300
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SCI International Hospital   4.6  (501 ratings) Internal Medicine Specialist Clinic M-4, Greater Kailash, Part -1,Near M Block Market New Delhi
1 Doctor · ₹300
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Patients First and Always....more
Patients First and Always.
More about SCI International Hospital
SCI International Hospital is known for housing experienced Internal Medicine Specialists. Dr. Himanshu Shekhar, a well-reputed Internal Medicine Specialist, practices in New Delhi. Visit this medical health centre for Internal Medicine Specialists recommended by 54 patients.

Location

M-4, Greater Kailash, Part -1,Near M Block Market
Greater Kailash New Delhi, Delhi - 110048
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Doctor

Dr. Himanshu Shekhar

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist
92%  (501 ratings)
10 Years experience
300 at clinic
₹200 online
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Why Drastic Deficiency of Vitamin D is Becoming Increasingly Common Among Urban Indian Youth?

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Why Drastic Deficiency of Vitamin D is Becoming Increasingly Common Among Urban Indian Youth?

Why drastic deficiency of vitamin d is becoming increasingly common among urban Indian youth?

On this women's day, let's understand why young Indians esp. Are women facing this unforeseen deficiency and resultant problems?

Vitamin d is unique because it can be made in the skin from exposure to sunlight. We get a really good amount of sunny days as opposed to many western and northern countries where vitamin d deficiency is ought to be common.

It is surprising that vitamin d deficiency is such a common problem in India nowadays that it finds prevalence among 70-100 percent of the general population in the country. More than 80.63 percent of 73 lakh Indian youth suffer from the deficiency of vitamin d. What's more shocking is that it can lead to a variety of health issues ranging from osteoporosis to diabetes. Without vitamin d, only 10-15% of dietary calcium and about 60% of phosphorus are absorbed - which would certainly lead to weaker bones. Vitamin d sufficiency enhances calcium and phosphorus absorption by 30-40% and 80%, respectively.

Vitamin d exists in two forms - vitamin d2 and d3. Uv rays from the sun hit the skin, and vitamin d3 is naturally synthesized, so it is the most 'natural' form. However, our bodies do not make vitamin d2, and most oil-rich fish such as salmon, mackerel, and herring and eggs contain vitamin d3.

Here are a few reasons why deficiency of vitamin d is becoming increasingly common among urban Indian youth.

1. Being always indoors

Our youth is never out in the sun because they are too occupied with their laptops or video games. Their lifestyle is such that it does not allow them to spend some good time out in the sun, which is a major source of vitamin d for the body. Technological advancement and cut-throat competition have made the youth forget the sun as a source of a healthy dose of vitamin d.

2. No milk, no fish

A lot of Indian youth follow a strictly vegetarian dietary regimen and they avoid milk very commonly. Vitamin d is found in foods like fish, egg yolks, fish liver oils etc. And not consuming them is a major reason why youth face vitamin d deficiency.

In fact certain, distinct symptoms can help you know if you're suffering from vitamin d deficiency or not.

You need to keep an eye out for these:

- excessive sweating without indulging in physical activities or being exposed to high temperatures

- sudden bouts of weakness for no apparent reason

- brittle bones that break easily

- chronic pain in your brains

- feeling of depression

'consult'.

Related Tip: Do You Need Vitamin Supplements?

5525 people found this helpful

I am suffering from premature greyness of hair. And from sometimes some hair of beard also changing color. So please provide me the vest medicine to stop changing color of beard hair.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
I am suffering from premature greyness of hair. And from sometimes some hair of beard also changing color. So please ...
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
2 people found this helpful
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5 Signs Your Body is Lacking in Water

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
5 Signs Your Body is Lacking in Water

5 Signs Your Body is Lacking in Water

Water is indispensable for the human body as 90% of the brain and almost 60 per cent of an adult body is chiefly made up of water. Water is just as important as any of your meals. Each cell and organ depends on water for its proper functioning and for flushing out toxins and fats from the body. An average man must consume roughly 3 litres (10-12 glasses) of water per day; and a woman requires about 2.5 litres (8-10 glasses). If you’re not meeting this requirement, you might be fall prey to dehydration.

The state of water deficiency or dehydration can be determined through various symptoms. Read on to know the 5 most common signs…

1. The colour of your urine is dark

The colour of your urine indicates your health. The lesser the water you drink, the darker is the colour of your pee. If your urine is pale yellow, you drink a sufficient amount of water. If it’s dark yellow and concentrated, it’s a sign for you to refill on water. Also, if you haven’t urinated for more than two hours, you should immediately gulp 2 glasses of water.

2. You experience frequent headaches

Headaches are often caused by dehydration when the pressure from your blood vessels falls. Dehydration makes it tough for your heart to pump enough oxygen to the brain. Drinking sufficient amounts of water ensures the flow of oxygen in your body.

3. You feel dizzy and fatigued

Lack of water can often lead to laziness and restlessness. It may also cause a rapid change in your blood pressure. Low or high blood pressures are stimulants of fatigue. Water gives you instant energy that wakes up your whole system, thus making you feel revitalised.

4. You have constipated bowel movements

Water is one of the top natural remedies for constipation or troubled bowel movements. If your fluid intake is low, you’re likely to have stomach, gastric and bowel problems. The digestive system depends on water to help food move through both the intestines. It checks the functions of the digestive tract, while also keeping it flexible and clean.

5. You experience brain fogs and blackouts

Your brain cells and nerves react severely to water loss. You may start feeling a lack of concentration along with temporary memory loss. Blackouts and fogs are common when you have a deficit of water. You might even experience difficulty in carrying out cognitive tasks.

If you’re experiencing similar issues, you must enhance your daily water intake. You can try carrying a sipper around, which allows you to keep a tab on your water consumption. To relish water as a refreshing beverage, you can infuse freshly chopped fruits and herbs in a pitcher of chilled water. This flavoured water also cleanses your body of all toxins and chemicals, thus keeping you fresh.

'Consult'.

You found this helpful

5 Signs Your Body is Lacking in Water

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
5 Signs Your Body is Lacking in Water

5 signs your body is lacking in water

Water is indispensable for the human body as 90% of the brain and almost 60 per cent of an adult body is chiefly made up of water. Water is just as important as any of your meals. Each cell and organ depends on water for its proper functioning and for flushing out toxins and fats from the body. An average man must consume roughly 3 litres (10-12 glasses) of water per day; and a woman requires about 2.5 litres (8-10 glasses). If you're not meeting this requirement, you might be fall prey to dehydration.

The state of water deficiency or dehydration can be determined through various symptoms. Read on to know the 5 most common signs:

1. The colour of your urine is dark

The colour of your urine indicates your health. The lesser the water you drink, the darker is the colour of your pee. If your urine is pale yellow, you drink a sufficient amount of water. If it's dark yellow and concentrated, it's a sign for you to refill on water. Also, if you haven't urinated for more than two hours, you should immediately gulp 2 glasses of water.

2. You experience frequent headaches

Headaches are often caused by dehydration when the pressure from your blood vessels falls. Dehydration makes it tough for your heart to pump enough oxygen to the brain. Drinking sufficient amounts of water ensures the flow of oxygen in your body.

3. You feel dizzy and fatigued

Lack of water can often lead to laziness and restlessness. It may also cause a rapid change in your blood pressure. Low or high blood pressures are stimulants of fatigue. Water gives you instant energy that wakes up your whole system, thus making you feel revitalised.

4. You have constipated bowel movements

Water is one of the top natural remedies for constipation or troubled bowel movements. If your fluid intake is low, you're likely to have stomach, gastric and bowel problems. The digestive system depends on water to help food move through both the intestines. It checks the functions of the digestive tract, while also keeping it flexible and clean.

5. You experience brain fogs and blackouts

Your brain cells and nerves react severely to water loss. You may start feeling a lack of concentration along with temporary memory loss. Blackouts and fogs are common when you have a deficit of water. You might even experience difficulty in carrying out cognitive tasks.

If you're experiencing similar issues, you must enhance your daily water intake. You can try carrying a sipper around, which allows you to keep a tab on your water consumption. To relish water as a refreshing beverage, you can infuse freshly chopped fruits and herbs in a pitcher of chilled water. This flavoured water also cleanses your body of all toxins and chemicals, thus keeping you fresh.

consult.

5248 people found this helpful

Computer/Tablet/Mobile Phone Related Common Health Problems And There Remedies

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Computer/Tablet/Mobile Phone Related Common Health Problems And There Remedies

In today’s world using Computers, Tablets and Mobile phones  are necessity for the majority of people but not many people actually consider the medical consequences that working with Computers/Mobile Phones can cause, such as damaged eyesight, Ear Problems, bad posture, arthritis in fingers and computer stress injuries that can be caused by sitting in one position for a prolonged period of time.

Excess of consecutive working hours mean that the above problems can feature in both young and old computer/Mobile .

The most common hazards are visual problems, soft tissue injuries, Hearing Problems and stress.

Visual problems

Eye symptoms related to computer/Tablet/Mobile use include:

·         stinging, itching or gravelly sensation;

·         irritation;

·         feeling tired;

·         light sensitivity;

·         redness;

·         blurred or double vision; and

·         temporary myopia (cannot see distant objects clearly right after computer use).

Eye muscles get tired if you stare on a computer screen for a while. If your monitor is near a window, your eyes will get tired trying to adjust to the difference between brighter outside light levels and the monitor's glow.

Computer/Mobile/Tablet  work slows down the blinking rate, so eyes can dry out. Glare, light levels and screen colours and contrast also are important. Bifocal and progressive lenses may not let you see the screen without straining eyes or neck and shoulder muscles, which can lead also to soft tissue injuries.

Soft tissue injuries

Some of the most common injuries linked to computer work show up in the wrist ( Carpal Tunnel Syndrome), arm, shoulders, neck, back and/or legs. Also known as repetitive strain injuries (RSIs) or musculoskeletal disorders (MSDs), they are the result of badly designed and/or organized work, such as:

·         uncomfortable chairs without proper support;

·         poorly-placed monitors, keyboards and/or mouse;

·         lighting problems;

·         low or high work surfaces;

·         lack of breaks and variety; and

·         work pressure and pace.

Too often, computers are put on a regular desk, with no planning. Laptops cause more problems since they can be put anywhere and their keyboards cannot be detached from the screen.

These factors combine to force women into cramped working spaces using awkward or static (staying still) postures, doing repetitive work, without proper breaks, in stressful conditions.

Stress

It's stressful to be tied to a computer all day. Lack of control, high workload demands (mental and physical) and little support are key workplace stressors. Women may also face stresses related to hours of work, juggling family, work and other responsibilities, harassment/violence, pay levels and even being monitored (watched) electronically by the employer.

Stressors cause mental, physical and behavioural symptoms that may become long-term problems.

 

Ear Problems

Consistent talking on mobile phones leads to poor hearing and effects the hearing . Loss of Concentartion.

 

Legally, employers must provide healthy and safe work spaces for all employees. Employers are in the best position to make necessary changes to prevent injuries. But sometimes individual workers and/or their unions must argue for changes.

For the rising number of women who are self-employed, the responsibility rests on the women themselves to ensure their workspace is set up to avoid work-related injuries.

To prevent computer-related problems, consider both your computer workstation and its surroundings.

For your workstation, you need:

·         All of your body in a neutral, relaxed position;

·         Your feet flat on the floor;

·         An adjustable chair that moves easily;

·         Your back supported in the curved lumbar area (not below it), in a reclined                    posture of 100-110 degrees (not the upright 90 degree posture that is often               shown);

·         Your monitor about arms' length away (the larger the size, the further away);

·         To look straight ahead, eyes focussed about 2 - 3 inches/5.5 - 8.5 cm below                the top of the monitor;

·         Glasses that don't force you into awkward postures;

·         A keyboard on a flat (not tilted) tray within easy reach, that can be adjusted for           height;

·         Your keyboard height and design so that your wrists are straight - up/down and            sideways;

·         Your mouse nearby, about the same level as the keyboard;

·         arms close to your body, with shoulders, neck and head in a relaxed position;          

·         Space for the equipment, papers and tools you use, within easy reach.

          In your workplace in general, you need:

·         Adequate background light and brighter task light close to you;

·         To avoid glare from overhead lights or windows (e.g. don't sit looking at a                     window or within 1.5 m of one);

·         Space in which to move around;

·         regular breaks (10 minutes every hour is often recommended and in union                   contracts);

·         opportunities to be creative, do different things, talk to others, and go to the                 washroom as needed

·         Reasonable hours of work; and

·         To avoid other stressors.

          If you already have a computer, ask yourself:

·         How much space do you have to work with?

·         What needs to fit in it, at what distance?

·         What surface cannot be adjusted (e.g. the desk top) -- start from this point to               make adjustments -- and how can I change others (e.g. lower the monitor, use             a foot rest)?

·         If you sit in your usual way and try to relax, what do you want to do (e.g. drop               your shoulders, put your feet on the floor, bring your arm closer to your body)?

          It's also good to:

·         Find out what's happening to other people. There are tools you can use, such             as surveys and body maps.

·         Report problems to your employer, union, health practitioner and compensation           board  and

·         Take care of yourself when your job affects your health.

 

Thanks

Dr.Himanshu Shekhar

You found this helpful

Can diabetes be permanently cured or one have to live with it for rest of his life by taking medicines and strict diet?

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Can diabetes be permanently cured or one have to live with it for rest of his life by taking medicines and strict diet?
Greetings, Diabetic changes occurs at the cellular level. Once diagnosed,Diabetes can only be managed and controlled but cannot be cured. With a healthy lifestyle/Food/exercise we can always prevent Diabetes. Thanks
1 person found this helpful
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Hair fall solutions please sir. I am very upset for this. I do not known. What can I do. Sir please help.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Hair fall solutions please sir. I am very upset for this. I do not known. What can I do. Sir please help.
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
2 people found this helpful
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Hi. I am 26 year old and facing problem of hair loss. What should be my diet and daily life style so I can avoid hair loss in future.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Hi. I am 26 year old and facing problem of hair loss. What should be my diet and daily life style so I can avoid hair...
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
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My hair is getting dusty n worst during industrial visit. That's too irritation to me.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
My hair is getting dusty n worst during industrial visit. That's too irritation to me.
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
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I am diagnosed with jaundice so what diet I should take? Which all fruits I Cn eat?

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Greetings, soft and bland diet. Without oil and without spice food. If you are not diabetic then you need to lot of glucose and sweets. Lots of fluids, properly washed fruits and vegetables. Always drink boiled of filtered water and take home made food. Thanks
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I have extreme pain in passing out stool. Please suggest me some measures to deal with it.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Greetings, constipation is root cause of many medical problems and another rectal problems. Irregular digestive habits, unbalanced untimely diet, lethargic life style, smoking are some of the common cause for constipation. Sime of the common measures to avoid constipaton are 1. Balanced diet with lot of green vegetables and salad. 2. Fibre rich diet 3. Lot of water untie, minimum 8 glasses of water in a day 4. Avoid smoking 5. Daily brisk walk or minimum exercise 6. Small and frequent food just in case you can use laxatives in the night to clear bowel. Follow these advise and you will see the difference. Keep me updated. Thanks
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How to reduce hairfall and regrow hair and suggest good oil and shampoo for daily use.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
How to reduce hairfall and regrow hair and suggest good oil and shampoo for daily use.
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
5 people found this helpful
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Suffering from hairfall and dandruff. please suggest nettr medicine to stop hairfall and to grow hair faster.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Suffering from hairfall and dandruff. please suggest nettr medicine to stop hairfall and to grow hair faster.
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
36 people found this helpful
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What is ZIKA VIRUS? Is it Deadlier than Dengue? Is India Ready To Face the ZIKA

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
What is ZIKA VIRUS? Is it Deadlier than Dengue? Is India Ready To Face the ZIKA
What You Must Know About ZIKA VIRUS

Introduction to the ZIKA VIRUS:

After the deadly Yellow Fever and Ebola pandemics, Zika Virus is yet another disease borne out of the African soil and spreading across the world right now. Named after the Zika forest in Uganda, where it originated, this virus spreads through a mosquito bite - that of ‘aedes aegypti’ mosquito. It can also be passed on from mother to child, blood transfusion and sex.

What’s so deadly about ‘Aedes Aegypti’ Mosquito?

Zika Virus spreads via ‘aedes aegypti’ mosquito, same mosquito that also spreads Dengue and Chikungunya.These mosquitoes typically lay eggs in and near still water found in buckets, bowls, animal dishes, flower pots and vases. They are aggressive daytime biters, prefer to bite people, and live indoors and outdoors near people.
These mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.

Symptoms of Zika Virus Attack
A person bit by an infected mosquito takes about 2-7 days to show symptoms like:
- Mild fever
- Skin Rash
- Conjunctivitis
- Muscle and joint pain
- Weakness and Fatigue

However, it lasts no more than a week and is usually milder than its cousins Dengue or Chikungunya. Although it is not a fatal disease, the real reason behind the panic is for the women who are pregnant. Zika is found to be a major cause of microcephaly – a birth defect due to which children are born with visibly smaller heads, severely limiting their mental and physical abilities.

Should India Worry?

While it originated in the African continent, Zika has already taken South American countries like Brazil, and most others. Although the virus hasn’t reached Indian shores yet, we are very prone to mosquito borne diseases. The Dengue menace since last few years says it all. Since it is from the same family, we need to be all the more cautious.

Preventions and Precautions:

Since no vaccine exists to prevent Zika virus attack, it’s best to act with caution to prevent the spread.

1. Mosquitoes that spread Zika virus bite mostly during the daytime. Stay in places with air conditioning or that use window and door screens to keep mosquitoes outside.
2. Use Mosquito Repellents during the day when exposed to areas prone to mosquitoes and cover yourself very well.
3. Never allow water to stagnate in or around your habitation. Avoid letting the water stand for long eg: puddles, or water in buckets or potted plants, sewage etc.

7897 people found this helpful

Hello sir my name is vivek chand. I have hair fall problem. Can you tell me what can I do. Please tell me.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Hello sir my name is vivek chand. I have hair fall problem. Can you tell me what can I do. Please tell me.
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
13 people found this helpful
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A lot of grey hair on my head doctor, it's kind of humiliating could you tell me the reason for this and solutions for my issues sir please. Ty Doctor.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
A lot of grey hair on my head doctor, it's kind of humiliating could you tell me the reason for this and solutions fo...
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
22 people found this helpful
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I have hairloss problem. When I take bath'most of the hair comes in my hand. This is from 1month. Whst should I do for this help me.

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
I have hairloss problem. When I take bath'most of the hair comes in my hand. This is from 1month. Whst should I do fo...
Greetings, you require good protein supplements and balanced diet. Also you need to take at least 8 glasses of water in a day. Apply good oil to avoid dryness of the hair. Take a good multivitamin supplement also. You also need to see a hair specialist, to rule out any hair or scalp disease. Thanks.
13 people found this helpful
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Doctor Sir/Madam, Sub: Prostate Gland Enlargement and Stone removing from urine bladder, is it any treatment without operation? I am asking about my father health. My father age is 90, he is suffering with Enlargement of Prostate Gland (EPG). please advice

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
Doctor Sir/Madam, Sub: Prostate Gland Enlargement and Stone removing from urine bladder, is it any treatment without ...
Greetings, surgery is the only and best remedy. Of course considering his age, it will be checked whether he is fit for surgery or not. There are state of art equipment's available now days for all these problems. With maximum 1-2 days of stay in the hospital.
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Antibiotics misuse and Developing resistance to Infection

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
A 72-year-old woman in Bengaluru consulted a hospital physician about a severe skin infection and fever. She had previously consulted a couple of general practitioners, who prescribed a course of penicillin for three days and fluoroquinolones—both antibiotics—for two days.

There was no relief.

So, the consultant ordered a culture sensitivity test of pus from the skin lesions to identify what was causing her ailment and figure out what antibiotics it would respond to.

Here’s what the report said:
Pathogen: Klebsiella pneumoniae
Susceptible to: No antibiotic
Resistant to: All antibiotics, including advanced drugs like fluoroquinolones, carbapenems and even the last resort combination usually reserved for severe cases of ICU infection, colistin-tigecycline.

With nothing to offer the patient, save a prescription for paracetamol to keep her fever in check, the doctor sent the patient home, and asked her to return after a week.

In such cases, sometimes, the body’s immunity kicks in and throws off the infection, the physician, Sheela Chakravarthy, consultant (internal medicine) at Fortis Hospital, Bengaluru, told IndiaSpend.

Sometimes, resistance to one or more drugs abates, allowing treatment to be resumed. Chances of that happening are greater at home, not in the hospital, which is a more infectious space where sepsis—a disproportionate and potentially life-threatening immune response by your body to an infection—could set in, she explained.

Most patients, however, succumb to the infection.

Chakravarthy faces situations where she has nothing to offer patients, not because they are suffering from terminal illnesses, such as some forms of cancer, but even when they present with what should be curable infections, “almost every day”, she said.

What Chakravarthy described is the consequence of rampant, inappropriate consumption of antibiotics, spurring the development of superbugs, as the recently released State of the World’s Antibiotics Report 2015 affirms.


India is fast becoming home to superbugs

Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus are three of the deadliest pathogens facing humanity, according to the World Health Organisation (WHO). And India is gradually but increasingly becoming home to multi-drug resistant strains of these pathogens, according to the State of the World’s Antibiotics Report 2015.

Escherichia coli is notorious for causing food poisoning and urinary tract infections.

In 2010, 5% of Escherichia coli samples in India were resistant to carbapenems, last-resort antibiotics for bacteria that are resistant to first-, second- and third-line drugs. By 2014, 12% of E. coli samples were similarly resistant.


Klebsiella pneumoniae causes pneumonia, septicaemia and infections in the urinary tract, lower biliary tract and at surgical wound sites, to name a few.

While 29% of Klebsiella pneumonia isolates were resistant to carbapenems in 2008, this increased to 57% in 2014.

For comparison, fewer than 10% of Klebsiella pneumoniae infections in Europe are carbapenem-resistant.

Staphylococcus aureus can cause skin and soft tissue infections, bloodstream infections, pneumonia and surgical site infections. A particularly nasty strain of, methicillin-resistant Staphylococcus aureus (MRSA), is common in India and increasingly hard to treat.

MRSA was responsible for 40% of post-surgical site infections, according to a 2013 study by the Jawaharlal Nehru Medical College and Hospital, Aligarh.

Between 2009 and 2014, the incidence of MRSA in India has risen from 29% to 47%.

People with MRSA are 64% more likely to die than people with a non-resistant form of the infection, according to the WHO.

How ignorance is spurring the development of superbugs

“My understanding of antibiotic is that it stops bacteria growing in body…I think amoxicillin is for throat infection.”

–An urban participant of a study of perceptions about antibiotic use and resistance among urban and rural doctors, pharmacists and public in Vellore.

Mox, short for amoxicillin, has become a household word across India.

A little knowledge, however, is a dangerous thing. It encourages self-medication, even when medicine is unnecessary, such as when people suffer viral infections—against which drugs are ineffective. Most viral fevers dissipate on their own after a few days with rest, hot fluids and a check on the fever.

Consuming too many antibiotics contributes to pathogen drug resistance.

“Resistance is an outcome of accumulated use,” said Ramanan Laxminarayan, vice president, Research and Policy, Public Health Foundation of India, and director and senior fellow, Centre for Disease Dynamics, Economics & Policy, US, and co-author of the State of the World’s Antibiotic Report 2015.

Indians often rely on corner pharmacists, whose knowledge of dosages may be limited.

Here’s what a rural pharmacist participant of the aforementioned Vellore study said: “Amoxicillin, 6 tablets is to be taken [for full course].”

Amoxicillin’s full course depends on the kind and severity of bacterial infection.

When an antibiotic of lower strength or fewer pills than needed is prescribed, the body cannot fully eradicate the pathogen. Sensing it has come under attack, the bacterium responds by evolving into more resilient, antibiotic-resistant strains.

But with a course of antibiotics, say generic Amoxicillin, costing about Rs 160, close to a day’s wage in many states, and a doctor’s consultation costing anywhere between Rs 100 and Rs 1,000, more than a day’s wage in most places, patients are bound to cut corners.

Another Vellore study participant summed up the situation thus: “If I have money I go to hospital. If not, I get medicine from pharmacy shop. If I get better, I stop and keep for future use.”

Stopping a course of drugs mid-way also contributes to antibiotic microbial resistance.

In a 2015 study in Chennai, 70% respondents confessed to stopping the medication when they felt better. Only 57% completed the antibiotic course.

“Less is more”: the key to preserving antibiotic efficiency

Educate health professionals, policy makers and the public on sustainable antibiotic use, says the State of the World’s Antibiotics Report 2015.

That is sensible advice.

Denmark and Sweden boast of low rates of antibiotic use and near-zero rates of antibiotic resistance because the risks of antibiotic overuse are widely known.

Instituting regulations on antibiotic use has reduced the proportion of MRSA in Europe and the US by about a fifth over the last eight years.

India requires more stringent regulations for antibiotic use.

It isn’t enough to tell physicians that they should prescribe antibiotics only when essential to cure bacterial infections. The right way is to order a culture sensitivity test, which costs money, and the patience to wait for the result.

“Patients want instant and cheap relief, and are willing to shop around for a doctor who obliges,” said Dr Himanshu Shekhar, medical director, SCI International Hospital, New Delhi.

“Some judge doctors on how fast the prescribed medicine cures. Practice pressures lead many doctors to prescribe advanced drugs, without getting a culture-sensitivity test done.”

So, it’s also not enough to have 24 advanced antibiotics, including third- and fourth-generation cephalosporins, carbapenems, and newer fluoroquinolones, under the ambit of Schedule H1 of the Drugs & Cosmetic Rules, 1945, with effect from March 1, 2014.

That means these drugs cannot be sold over-the-counter, but they are still freely prescribed.

Chakravarthy’s suggestion: “Make Schedule H antibiotics available only through hospitals and health centres.”

“Changing antibiotic usage behaviours is critical to preserve the efficacy of existing and new drugs,” proposed Laxminarayan.

India also sorely needs regulations to check antibiotic use in animals raised for human consumption, to meet the State of the World’s Antibiotic Report 2015 recommendation to reduce and eventually phase out sub-therapeutic antibiotic use in agriculture.

Sub-therapeutic use implies mixing antibiotics in animal feed to make them grow faster and to prevent infections from devastating the herd or flock.

India is among the world’s five biggest consumers of antibiotics for livestock. IndiaSpend has earlier reported increasing evidence of antibiotic-resistant bacteria in animals in India, and how this impacts humans.

“Using antibiotics to make animals fatter faster is a waste of a precious resource,” said Laxminarayan.

How surgeons contribute to antibiotic resistance

Surgical antibiotic prophylaxis refers to the prescribing of antibiotics before, during and after operations to prevent infection.

Between 19% and 86% of patients in hospitals in India receive “inappropriate antibiotic prophylaxis”, according to the State of the World’s Antibiotics Report 2015. A prophylactic is preventive treatment for a disease.

Ideally, antibiotic prophylaxis should be administered as a single dose within 60 minutes of the skin incision. However, a 2013 Mangalore-based study found timing adhered to in 22% of cases in a government hospital, 64.9% cases in a medical-college teaching hospital and 80.7% of patients in a tertiary care corporate hospital.

“Smart antibiotic prophylaxis also includes choosing narrow-spectrum antibiotics to target the organism most likely to present concerns based on the kind of surgery being performed, this avoids needless exposure to antibiotics for the other microbes and helps prevent resistance,” said Vimesh Mistry, assistant professor, Pharmacology, Baroda Medical College.

Staphylococcus aureus, which lives on the skin, is most likely to cause infection during surgery. But surgeons frequently make poor antibiotic choices.

“We found appropriateness of choice of antibiotic in 68% cases and 52% compliance with the in-house prophylaxis guidelines,” said Tanu Singhal, infectious diseases specialist, Mumbai, and co-author of another study on antibiotic prophylaxis conducted in PD Hinduja Hospital, Mumbai.

Other prophylaxis inaccuracies include the unnecessary prescribing of antibiotics, inaccurate dose and inaccurate duration of prescription.

“We logged 63% accuracy in prescription duration. Surgeons tend to prescribe antibiotics for too long fearing post-surgery infection,” said Singhal.

In the trade off between protecting the patient better and increasing the risk to society of a pathogen developing resistance, surgeons are choosing the former.

Needed: A back-to-the-basics approach to health

Reducing the need for antibiotics through improved water, sanitation and immunisation is another strategy recommended in the State of the World’s Antibiotics Report 2015.

“Vaccination against pathogens such as the diarrhoea-causing rotavirus and pneumonia-causing Klebsiella pneumoniae helps curtail antibiotic demand, thereby reducing the chances of resistant strains developing,” said Laxminarayan.

In Canada, the widespread use of pneumococcal conjugate vaccines for pneumonia in children has reduced the incidence of pneumonia caused by strains the vaccine covers.

However, just as antibiotic usage spurs the development of superbugs, vaccination is a double-edged sword.

Canada is seeing a rapid increase in the incidence of other strains of pneumonia not protected against by the vaccine.

So, it is better to focus on the basic constituents of health.

Making available clean drinking water and improving sanitation would prevent people from getting sick in the first place. India still has a lot to do on both these fronts.

Improving individual immunity is the best bet to ward off infections, and that is also achievable by healthier eating, exercising, healthier living and the better management of chronic conditions like diabetes and asthma that increase vulnerability to infections when they are not kept in check.


Dr Himanshu Shekhar
MD,Medicine
New Delhi
+919818433208
( Above Article , with My Inputs was published in a leading Health Magazine)
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