Lybrate.com has a number of highly qualified Gynaecologists in India. You will find Gynaecologists with more than 36 years of experience on Lybrate.com. You can find Gynaecologists online in Indore and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.
Book Clinic Appointment
Management of Surrogacy
Caesarean Section Procedure
Treatment of Gynae Problems
Gynecology Laparoscopy Procedures
Treatment Of Female Sexual Problems
Treatment Of Menopause Related Issues
Treatment Of Menstrual Problems
Treatment of Mirena (Hormonal Iud)
Pap Smear Procedure
Polycystic Ovary Syndrome Treatment
Treatment of Uterine Bleeding
Antenatal And Postnatal Exercise
Management of Postnatal Care
Adiana System Treatment
Submit a review for Dr. Nutan SharmaYour feedback matters!
Doctor, . I'm 38years of age. I'm hair growth in my side logs, chin and on my throat area. i have my testosterone hormone test done. My thoroughly is slightly towards the higher side, my sugar fasting is 71. My insulin fasting is normal. My follicle stimulating hormone is higher. My testosterone is within range. I still wondering as to y I'm getting hair growth on my face and throat area. Pls help doctor I'm worried.
Hi doc I am married and trying to conceive from 1.5 years this time my doc suggested follicular scan along with siphene tablet for hcg injection but since my et was only 5.4 on 12 the day of my cycle and egg got ruptured she only gave duphaston tablets from 15 the day but today I have too much of abdomen pain whether it is normal please help.
Hi, Mera period date August 12 hy my September 9 Ku pregnancy test kari second line lite aye kya meri pregnancy conform hai na ya phir 12 k bad test karu. Please suggest me. Thanks.
My Wife is 32 yr old and i am suffering from PCOS and because of which she is not able to conceive. Please advise of what are the natural diet and exercise that she can follow.
Hi. Been seven months getting married. Me n my husband trying to conceive for the past three months but got no positive result. Is there something that we are lacking we are so depressed . Wat do we do personally consult a doctor or please help.
Hi, yesterday night during foreplay with my wife, when I was kissing her vagina the liquid from her vagina has gone in my mouth, is there any problem and I have one more doubt in generally I saw women sucks penis of men, if liquid from mens penis goes in women mouth is there any danger. Please advice.
Helo sir my name is rahul I have mpb male pattern baldness iam using finasteride and logi hair since 5months and no effect is seen only 10 percent results are ther and can I have sex with my wife and can conceive baby plzz reply me.
Can I sex without condom? When sperm comes out then if I eject my penis from vagina. There any chance to get pregnant? Say yes or no? If yes. How? I exudation my sperm outside vagina. Explain.
Hello Doc, I have not got my periods for last 4 months. I went through an ultrasound, thyroid and serum prolactin test. All test remains normal except serum prolactin which is 25.5 , Is this normal range? If normal, what could be the reason for irregular period, please advise.
I also test my blood sugar but every test like chromosome analysis,karyotype and genetic test but every test normal. I have two cesarean. I want chance to take pregnancy but I want normal delivery it is possible or not. I have one girl baby that is OK. Please give me solution.
Vomiting heavily as she is pregnant when they will get reduced. She is in third month at present. Please advise.
We are married since 3 years and while we have sec intercourse has not done yet. She is always dry and I have never seen her getting excited in 3 years.
I am 38 years female, with 70 kgs weight. I am bearing a burning sensation with pins and needles feelings on my feet since four months. Kindly suggest.
Cucumber has given away to be grand for sexual stamina. I was reading an article about erectile dysfunction and what things can make it better and cucumber was on top of the list. Cucumber helps to make you last longer and it is dubbed by some as the organic “Viagra”
It has other benefits as well:
Apart from the above said benefits cucumber is also great for your health in general. It is a great digestive aid and helps your digestive track to become smoother. It is also good for removing toxins from the body. Removing these toxins from the body is also good for your sexual health so by using cucumber you get a double whammy.
How to use cucumber:
You can add cucumber to your lunch with your sandwich or just eat a bowl of green salads at night. It will do wonders to your health and you will start feeling the difference in a month or so.
The miracle juice:
Take a cucumber and blend it with some water and garlic cloves. The juice is not the most delicious you have ever had but it sure is very effective. Have this twice a day for fifteen days and you will start feeling as if you have put a new engine down there.
I have periods problem. And my weight is 65 kg. Mujhe thyroid bhi nhi h. Me diet bhi follow kar rhi hu. But my hemoglobin is about 8.
In 5 Years, Threat Of Drug-Resistant Superbugs Doubles
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
( Above Article , with My Inputs was published in a leading Health Magazine)