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Asian Heart Hospital

Multi-speciality Hospital (ENT Specialist, Endocrinologist & more)

G/N Block, Opposite ICICI Tower, BKC, Bandra East. Landmark: Near UTI Building. Mumbai
20 Doctors · ₹0 - 1210
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Asian Heart Hospital Multi-speciality Hospital (ENT Specialist, Endocrinologist & more) G/N Block, Opposite ICICI Tower, BKC, Bandra East. Landmark: Near UTI Building. Mumbai
20 Doctors · ₹0 - 1210
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Call Clinic
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About

Our goal is to provide a compassionate professional environment to make your experience comfortable. Our staff is friendly, knowledgable and very helpful in addressing your health and fin......more
Our goal is to provide a compassionate professional environment to make your experience comfortable. Our staff is friendly, knowledgable and very helpful in addressing your health and financial concerns.
More about Asian Heart Hospital
Asian Heart Hospital is known for housing experienced Endocrinologists. Dr. Anil S Bhoraskar, a well-reputed Endocrinologist, practices in Mumbai. Visit this medical health centre for Endocrinologists recommended by 79 patients.

Timings

MON-SAT
09:00 AM - 11:00 PM
SUN
09:00 AM - 09:00 PM

Location

G/N Block, Opposite ICICI Tower, BKC, Bandra East. Landmark: Near UTI Building.
Bandra East Mumbai, Maharashtra - 400051
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Doctors

Dr. Anil S Bhoraskar

MBBS & DM
Endocrinologist
40 Years experience
1210 at clinic
Unavailable today

Dr. Parul Tank

MBBS
Psychiatrist
12 Years experience
Unavailable today
1000 at clinic
Unavailable today

Dr. Akshay

MBBS
Cardiologist
1100 at clinic
Unavailable today

Dr. Prafulla Kerkar

MBBS
Cardiologist
1100 at clinic
Unavailable today

Dr. Santosh

Cardiologist
1100 at clinic
Unavailable today
1100 at clinic
Unavailable today

Dr. Amith Garg

MBBS
Cardiologist
1000 at clinic
Available today
09:00 AM - 09:00 PM
1000 at clinic
Unavailable today

Dr. Shekar Shriram

MBBS
Cardiologist
1100 at clinic
Unavailable today
Unavailable today
Unavailable today

Dr. Aashish

Cardiologist
Unavailable today

Dr. Bhupendra Gandhi

MBBS, MD - Nephrology
Nephrologist
51 Years experience
Unavailable today
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Bacterial sinus problems of viridians strep with s.epidermidis .which homeo medicines should I take for a long time (immunity enhancement at the same time. Please give me advice.

Diploma in Otorhinolaryngology (DLO), DNB (ENT)
ENT Specialist, Nagpur
Hi when you know about the organism in sinusitis I think you should take organism specific antibiotics and decongestant to add to it .it will help decrease the bacterial load. Yes about homeopathy not sure if you get antibiotics in it. Regards.
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Azee and augmentin antibiotic taken together for throat infection bimistake. Any sideffect.

MBBS, MS - ENT
ENT Specialist, Gurgaon
Azee and augmentin antibiotic taken together for throat infection bimistake. Any sideffect.
You can have loose stools so take a pro biotic More than that taken these 2 antibiotics together is useless stop. 1 of them.
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I am 24 year old girl. Whenever I check my BP in the morning before food it will be 120/80. But after taking breakfast at 11 or 11: 30 if I check it will be 130/70. Always it will be like this. What is the reason? Is 130 too high? What should I do to reduce only systolic pressure? I exercise daily but I don't eat much salt. Per day may be one spoon I will eat. I have a little anxiety issues and acidity problem also.

Diploma in Diet and Nutrition
Dietitian/Nutritionist, Hyderabad
I am 24 year old girl. Whenever I check my BP in the morning before food it will be 120/80. But after taking breakfas...
BP is never constant. It can go up and down depending on physical or mental state. Hence BP is usually measured in the mornings. 120/80 is perfectly normal. You are fine. No need to worry. Just eat healthy and take less salt. Do daily exercise. Stay happy and relaxed, you are fine.
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Sir meri mom ki age 53 hai unka fasting sugar report 103 hai or khana khane ke baad 191 hai toh sir pls aap batayenge ki sugar blood mein aa chuka hai or ye control ki ja sakta hai or kitni tension ki baat hai sir.

Diploma in Diet and Nutrition
Dietitian/Nutritionist, Hyderabad
Sir meri mom ki age 53 hai unka fasting sugar report 103 hai or khana khane ke baad 191 hai toh sir pls aap batayenge...
No tension. No worry. She is Okay. Blood Sugar is little extra and that can be controlled by restricting carbohydrates and sugars. Eat less maida /biscuits/juices/ Sweets. Take whole grain like wheat /Dalia _Raagi / salads / beans /oats etc. Do daily exercise. This way she will be fine.
1 person found this helpful
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I am having this itchy, runny nose with lot of sneezing accompanied by red watery eyes? Am I having a allergy or what is it? What to do?

MD - Internal Medicine
General Physician,
I am having this itchy, runny nose with lot of sneezing accompanied by red watery eyes? Am I having a allergy or what...
Yes it is allergy to some substance. Maybe dust or cold air or pollens if happens only in a particular season. Best is to avoid allergen and when acute episode arises get medicines prescribed by your physician. U can get your allergen test also.
1 person found this helpful
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I am able to hear tap sound in ear which occurs tapping doing from past 3 days I don't know what to do so please suggest me I'm really getting fear please Help me.

Diploma in Otorhinolaryngology (DLO), DNB (ENT)
ENT Specialist, Nagpur
I am able to hear tap sound in ear which occurs tapping doing from past 3 days I don't know what to do so please sugg...
Hi this can be tinnitus. As it is since 3 days it can be secondary to some accumulated fluid behind your ear drum or some amount of wax in your ear or something less serious. I would suggest you to visit an ent specialist and get your ears examined. Regards.
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My 8 years old son gets cough and cold often what is the correct medicine for him he has breathing problem to he has mild heart valve problem with. Doctor said not to worry he his not taking any medicine for it.

Diploma in Otorhinolaryngology (DLO), DNB (ENT)
ENT Specialist, Nagpur
My 8 years old son gets cough and cold often what is the correct medicine for him he has breathing problem to he has ...
Hi this cough and cold can be attributed to the heart valve problem or it can be some allergic condition. Just visit an ent specialist and get your son properly examined and reach a proper diagnosis. Regards.
1 person found this helpful
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DUE TO ALCOHOL WITHDRAWAL I SUFFERED DELIRIUM TREMENS WITH RUMFITS i am TAKING 2 MG lorazepam FOR MY ANXIETY DISORDER. initially i am ON CLONAZEPAM DUE TO BEING DRINKING I SUFFERED FROM DT AND RUMFITS. Now I left alcohol since from six months. Now I would like to have moderate drinking once in months. Pls explain me what I can do briefly.

MBBS, MD - Psychiatry
Psychiatrist, Mumbai
DUE TO ALCOHOL WITHDRAWAL I SUFFERED DELIRIUM TREMENS WITH RUMFITS i am TAKING 2 MG lorazepam FOR MY ANXIETY DISORDER...
Alcohol dependence is associated with significant physical, mental and social problems. Physically, there can be liver failure, jaundice, vomiting of blood, passing blood in stools, stomach ulcers, damage to nerves of the body, swelling of legs, fluid collection in abdomen, and many more. Mentally, there is irreversible brain damage, worsening of anxiety or depression, triggering of psychosis and mood disorders, dementia, etc. From a social point of view, there may be isolation from neighbors or family, increased abusive behavior to children or spouses, legal problems, accidents, etc. Anti craving medications are available which will help to reduce the craving. Consult a psychiatrist with experience in deaddiction.
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My father is suffering from cerebral sinus thrombosis. They have blood clots in superior superior sagittal sinus & right transverse sinus. 15 days ago, they came across stroke, after stroke we had hospitalized them. Doctor gave him treatment of LMWH & now he is on xarelto for min. 2 years. Doctor said he have deficiency of protein C & S. And told us to check clotting status after 3 months. Now he is able to walk ,speak, and do all other activity as earlier. But still I need second opinion. Is possible to get reed of this clotting through operation or current treatment of Anti coagulation is right for them. Please suggest some specialist.

Homeopath, Anand
According to. Me,anti coagulation therapy is going ok. You should start homepathic anti coagulants along with main treatment. It would support the treatment as well as increase immunity and would bring fast recovery. Also homeopathic nerve tonics are quite effective in such type of chronic cases. Include omega 3 rich food good for brain like walnuts, dates, avocados also give protein rich food like nuts, legumes,lentils (dals) etc.
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I am 27 years old female. I am getting blood in my urine n my stools. I dun knw whats happening. Could you please help me with it.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Ayurveda
Ayurveda, Sri Ganganagar
I am 27 years old female. I am getting blood in my urine n my stools. I dun knw whats happening. Could you please hel...
You should consult to your physician. You should avoid spicy, fast food, junk food, heavy food. Intake plenty of water, coconut water, papaya.
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Sir please tell me that ,what is the reason behind for checking bp and sugar before surgery.

BHMS
Homeopath,
Sir please tell me that ,what is the reason behind for checking bp and sugar before surgery.
The basic reason is Raised BP will leads to increased blood loos during surgery, and raised sugar level leads to delayed wound healing after surgery and more chance for infection.
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Mental Health

MBBS, MD - Psychiatry
Psychiatrist, Chennai
Mental Health

When your body is broken, you have no problem in seeking doctors help but when your mind is broken, why are you hesitant? Your mind is no holier than your body. 
Always seek doctor's help but never destroy your precious life.

4 people found this helpful

What is the supplementary medicine, which can stop the urge for Alcohol. I get the urge for alcohol in the evening and when take one peg then it goes ON.

MD - Alternate Medicine, Doctor of Homeopathic Medicine (H.M.D.)
Homeopath, Delhi
Take stapsagaria 30. 1-2 drops in 1/4 cup lukewarm water 4 times a day. For a month. If you wish for further advice you may contact me on my personal messenger.
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Parkinson s Disease

MBBS, DNB, Fellowship in Neurosurgery
Neurosurgeon, Kolkata
Parkinson s Disease

Deep brain stimulation in Parkinson’s disease

Abstract: Deep brain stimulation (DBS) is a widely accepted therapy for medically refractory Parkinson’s disease (PD). Both globus pallidus internus (GPi) and subthalamic nucleus (STN) stimulation are safe and effective in improving the symptoms of PD and reducing dyskinesias. STN DBS is the most commonly performed surgery for PD as compared to GPi DBS. Ventral intermediate nucleus (Vim) DBS is infrequently used as an alternative for tremor predominant PD patients.

Patient selection is critical in achieving good outcomes. Differential diagnosis should be emphasized as well as neurological and nonneurological comorbidities. Good response to a levodopa challenge is an important predictor of favorable long-term outcomes. The DBS surgery is typically performed in an awake patient and involves stereotactic frame application, CT/MRI imaging, anatomical targeting, physiological confirmation, and implantation of the DBS lead and pulse generator. Anatomical targeting consists of direct visualization of the target in MR images, formula-derived coordinates based on the anterior and posterior commissures, and reformatted anatomical stereotactic atlases. Physiological verification is achieved most commonly via microelectrode recording followed by implantation of the DBS lead and intraoperative test stimulation to assess benefits and side effects. The various aspects of DBS surgery will be discussed.

Key words: deep brain stimulation (DBS); Parkinson’s disease(PD),  stereotaxis

Introduction

Parkinson's disease is a slowly progressive, neurodegenerative disease characterized by tremor, rigidity, bradykinesia and postural instability. It is the most common movement disorder in middle or late life with a prevalence of about 0.3% of the general population, rising to 1% in people over 60 years of age. Approximately 130 000 people suffer from it in the UK and it presents an increasing burden in our ageing population. Pathological findings in Parkinson's disease demonstrate greatly diminished neuromelanin pigmented neurons in the substantia nigra of the basal ganglia with associated gliosis, and Lewy bodies present in many remaining neurons.

James Parkinson, in his original 1817 Essay on The Shaking Palsy, gave an account of six patients in which he noted signs of tremor, festinating gait and flexed posture.  Nearly two centuries from Parkinson's observations, and almost four decades after Cotzias' dramatic demonstration of levodopa's efficacy, the limitations and complications of levodopa treatment for Parkinson's disease have become well documented Five years after initiation of therapy, a majority of patients develop medication related motor complications, namely levodopa induced dyskinesias (LID) and motor fluctuations. Deep brain stimulation (DBS) has been developed primarily to address these treatment related motor complications and therapeutic failures.

Pathophysiology of PD

The loss of dopaminergic neurons in the substantia nigra, the main functional characteristic of PD, affects the circuit described above and leads to the cardinal motor symptoms of PD. While the exact mechanism of this process is unknown, animal research as well as human recordings have provided functional and biochemical evidence that bradykinesia in PD results from excessive activity in the STN and the GPi. This leads to an exaggerated beta (10-30 Hz) synchronization within and between structures in the basal ganglia circuitry  that could also contribute to rigidity and akinesia.

The pathophysiology of rest tremor in PD is less clear and probably more complicated. This symptom most likely results from a dysfunction of both the striato-pallidal-thalamocortical and the cerebellodentato-thalamocortical circuits, with hyperactivity and hypersynchronization between central oscillators.

Possible mechanism of action of DBS

DBS acts through delivering an electrical current in a specific target area of the brain. This current can be modulated through modification of voltage, frequency and duration of each electrical pulse delivered. The delivered energy creates an electrical field of variable size and shape according to the parameters used for stimulation. Although initially believed to stimulate the target, thus the name of the whole process, it seems that

DBS actually excites the neuronal fibers, but inhibits the neural cells. In fact, GPi DBS decreases the GPi mean firing rate back to a normal range in animal models as well as PD patients, and high frequency DBS has a similar effect as dopamine replacement therapies, and promotes faster (about 70 Hz) nonhypersynchronous activity in the basal ganglia, correlated with clinical improvement. This might be achieved through stimulation of bypassing inhibitory pathways, synaptic inhibition, depolarizing blockade, synaptic depression, and simulation-induced disruption of pathological network activity. Overall, this leads to modifications of the firing rate and pattern of neurons in the basal ganglia, as well as local release of neurotransmitters such as glutamate and adenosine. In addition, it seems that DBS also increases blood flow and stimulates neurogenesis. Over the last few years, functional imaging, specifically functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT), has been used in an attempt to clarify the mechanism of action of DBS. In fMRI, blood-oxygen-level-dependent (BOLD) signals are acquired, and oxygenated blood marks areas of neural stimulation or inhibition. On the other hand, PET and SPECT allow for imaging of multiple activity markers, such as blood flow, glucose and oxygen metabolism. While fMRI is less powerful than nuclear medicine techniques, it provides a much better spatial and temporal resolution. Because of the suspected inhibitory DBS effects in electrophysiological studies, reduced STN blood flow or glucose metabolism would have been expected on functional imaging. However, the opposite has been found to be true in an overwhelming majority of imaging studies to date. In addition, BOLD activation in the area surrounding the electrode has been reported, despite the electrode imaging artifact preventing direct observation of the STN around the electrode. This discrepancy between apparent STN inhibition in single-cell studies and activation in imaging studies might be explained by a few hypotheses. First, electrophysiological recordings identify short neuronal modulation (in the order of milliseconds) while neuroimaging methods may reflect the summed activity changes over seconds to minutes. Second, non-neuronal contributions to the change in blood flow and/or glucose metabolism cannot be excluded, and could confound the results of neuroimaging.

Finally, it is possible that PET and fMRI actually detect the increased activity in the axons, rather than in the cell bodies. Complicating matters further, some imaging studies after STN DBS have showed increased

activity in the GPi while others reported decreased activity in that nucleus. In summary, it is still unclear how exactly DBS affects the firing rate and pattern of neurons and how these changes actually modify the symptoms of Parkinson’s disease. DBS is presently more of an empirically proven treatment in search of physiological explanation.

The effect of DBS on the cardinal symptoms of PD have been established in three randomized controlled clinical trials --- 

TABLE 1

Author, year

 

No of patients

Follow up

Target

Results

Deuschl et al., 2006

156

6 months

BL STN

QOL better with DBS, motor symptom better with DBS

 

Weaver et al., 2009

255

6 months

BL STN or GPi

Dyskinesia free ON time better with DBS

 

Williams et al., 2010

366

12 months

BL STN  or GPi

QOL better with DBS

 

 

PATIENT SELECTION for DBS in PD

Patient selection is a critical first step as poorly chosen candidates may not have optimal benefits and have increased morbidity. Several factors must be considered before determining if a patient is an appropriate candidate for DBS surgery. A multidisciplinary approach involving the neurosurgeon, neurologist, and neuropsychologist is important to determine the appropriate surgical candidate. It is also important that the diagnosis of idiopathic PD be confirmed prior to proceeding with DBS surgery. Key to this assessment is evaluating the surgical candidate in both the on and off medication states with a corroborating levodopa challenge. Perhaps the best prognostic indicator of a patient’s suitability for DBS surgery is their response to levodopa.In general, a levodopa challenge following a 12-hour medication withdrawal should provide at least a 33% improvement in the motor section of the Unified Parkinson’s Disease Rating Scale (UPDRS).

                     In our institute, we follow a simple chart(below) for screening of patients for DBS in PD.

 

 

  1.  

Age<75 years

 

  •  

No

  1.  

Idiopathic PD ( No PSP/MSA/NSD etc)

 

  •  

No

  1.  

Levodopa responsive  

                      

  •  

No

  1.  

Poor/adverse response to drug          

 

  1.  Increased off period                                                              

 

  1. Disabling dyskinesia                                                              

 

 

  1. Disabling motor fluctuations                 

 

 

Yes

 

Yes

 

 

Yes

 

 

No

 

No

 

 

No

  1.  

Degree of disability(UPDRS part III score)>25

 

  •  

No

  1.  

Neuropsychology, MMSE>24

 

  •  

No

  1.  

LEVODOPA CHALLENGE RESPONSE POSITIVE                                                   

 

(30% improvement in UPDRS after 12-hours off medication)

 

  •  

No

  1.  

Advanced  co-morbidity

 

Yes

  •  
  1.  

long term anticoagulation

 

Yes

  •  
  1.  

Willing for surgery and programming

 

  •  

No

 

 

PREOPERATIVE MANAGEMENT

A full medical assessment is a necessary part of the preoperative evaluation, as advanced PD patients tend to be elderly with significant comorbidities. Major issues are---

 

Anticoagulation/antiplatelets--- The risk of discontinuing medications that affect anticoagulation and

platelet aggregation should be weighed against the potential benefits in the quality of life offered by DBS surgery. However, timely discontinuation of these latter medications is mandatory for stereotactic surgery since intracerebral hematomas are the most serious of all potential complications from DBS. Any anticlotting medications, including aspirin, ticlopidine, clopidogrel, and all nonsteroidal anti-inflammatory drugs should be discontinued at least 7 to 10 days preoperatively to ensure the return of normal blood clotting function.

Arterial hypertension can also increase the risk of intracranial bleeding during stereotactic procedures and must be controlled in the weeks prior to surgery.

A prolonged discussion on the short- and long-term effects of DBS on Parkinson’s disease should be carried out with the patient, family, and caregivers.

The night prior to DBS surgery, the antiparkinsonian medications are typically held to pronounce the Parkinson’s symptoms at the time of surgery to see the clinical effects on symptoms during surgery and the families must be counselled regarding their role in facilitating the patient.

Target selection

The two main targets considered for DBS in PD are the STN and the GPi. current tendency is to prefer targeting the STN because of a greater improvement in the OFF phase motor symptoms as well as a higher chance to decrease the medication dosage and a lower battery consumption linked to the use of lower voltage in the STN compared to the GPi DBS. GPi can be the preferred target if LID is the main complaint. GPi DBS might be preferred for patients with mild cognitive impairment and psychiatric symptoms. Because STN DBS might have a higher rate of cognitive decline and/or depression and worsening of verbal fluency in some studies.

Surgical technique

The basic components of DBS implantation surgery involve frame placement, anatomical targeting, physiological mapping, evaluation of macrostimulation thresholds for improvement in motor symptoms or induction of side effects, implantation of the DBS electrode and implantable pulse generator (IPG).

Head-frame placement

The CRW frame is the most commonly used followed by the Leksell frame. Placement of the frame is done under local anesthesia unless anxiety or uncontrollable movements necessitate the use of sedation or general anesthesia.

Leksell stereotactic frame  placed over the head of a patient showing the correct method for placement of the Leksell head-frame. The frame should be placed parallel to orbito-meatal line in order to approximate the AC-PC plane. It is attached to the patient’s head using four pins under local anesthesia.

Imaging and anatomic targeting

Computerized Tomography (CT) scans and MRI are the two main imaging modalities used for targeting when performing DBS implantations. A thin cut stereotactic CT (_2 mm slices with no gap and no gantry tilt) is obtained after frame placement and is then fused with the stereotactic MRI on a planning station (Stealth station). The advantage of fusing the CT with MRI is the ability to avoid image-distortions inherent to MR imaging adding to the stereotactic accuracy. To better define the STN, T2-weighted images (TR 2800, TE 90, flip angle 90˚, slice thickness 2.0 mm) were obtained.

The AC and the PC were marked and the centre of the AC–PC line determined. The next step is planning the entry point and trajectory. The strategy here is to avoid surface and sub-cortical vessels. After trajectory planning, the patient is placed supine on the operating table and the frame attached to the table using an adaptor. Prophylactic antibiotics are given at least 30 min prior to incision. The head is prepped and draped in a sterile fashion. Under local anesthesia, a burr-hole is placed on the calculated entry point marked on the skull. The entry point is determined by the calculated arc and ring angles. Hemostasis is achieved with bone wax and bipolar cautery.

A Medronic Stim-Loc anchoring device (Medtronic, Minneapolis, MN) burr-hole base ring is then placed on the burr-hole and secured with two screws which are used at the end of the procedure to anchor the DBS electrode.

The dura is then cauterized and opened exposing the underlying surface of the brain. The microdrive is then assembled and cannulae inserted 10 mm above the target to avoid lenticulostriate vessels found deeper. Gel- foam and fibrin glue is applied on dural hole to minimize cerebrospinal fluid (CSF) loss and air entry into the skull. Subsequently, microelectrode recording and stimulation is undertaken.

Microelectrode recording/ Mapping

Microelectrode mapping is used to precisely define the target STN and its boundaries as well as nearby critical structures. We believe microelectrode mapping is crucial in order to give one the best chance for optimal placement of the DBS lead given anatomical inaccuracies due to image distortion and intraoperative brain shifts secondary to CSF loss, and pneumocephalus that can lead to inaccuracies in defining the initial target coordinates and shifts in the target itself once the skull is opened. Microelectrode mapping is performed using platinum-iridium glass coated microelectrodes dipped in platinum black with an impedance of around 0.3–0.5 Mo. These platinum-iridium microelectrodes are capable of recording single unit activity and can also be used for micro-stimulation up to 100 mAwithout significant breakdown in their recording qualities.

As the recording electrode was advanced, entry into the STN was identified by a sudden increase in the density of cellular discharge, with the characteristic irregular pattern of discharge—spikes of different sizes, occurring at random intervals. On coming out of the STN a quiet period (background noise) was seen followed by recording from the substantia nigra if the recording was continued far enough, described as high frequency (50–60 spikes/s) discharge pattern.11 Characteristic STN recordings (visual and audio) were identified and the depth of the STN activity was noted. Identification of STN activity was only based on the visual identification. The centre of the point of best electrical activity was selected as the final target. The microelectrode was replaced with a permanent quadripolar macroelectrode (Medtronic electrode no. 3389) to target the centre of the STN electrical activity. The proximal part of this electrode consists of four nickel conductor wires insulated with a polytetrafluoroethylene jacket tubing. The distal part has four metallic noninsulated contacts of 1.5 mm spaced at 0.5 mm intervals. The diameter of the distal electrode is 1.27 mm. Based on the clinical response any of the four contacts can be used for stimulation. Macrostimulation using the DBS electrode itself is then used to determine benefits and side effects. In most cases lateral skull x rays were obtained at this point with image intensifier carefully positioned to locate the target point in the centre of the Leksell-G frame rings.

Initial programming is always refined by using intra-operative macrostimulation data and a mono-polar review to identify the thresholds of stimulation for improvement in parkinsonian motor signs as well as the thresholds for inducing side effects at the level of each contact. The four variables that are used in programming are choice of contacts (0, 1, 2 or 3 used either as the cathode or anode), frequency of stimulation (hertz), pulse-width (ms) and amplitude (voltage).

POSTOPERATIVE MANAGEMENT

In the immediate hours after surgery, it is important to keep arterial blood pressure in the normal range. In addition, the patient’s preoperative drug regimen should be restarted immediately after surgery to avoid problems with dopaminergic withdrawal. Patients should undergo postoperative CT scans and/or MRI scans to assess the electrode location and intracranial status. In addition, plain X-rays are obtained to assess the location and geometry of the leads and hardware. Parkinson’s medications may need to be adjusted depending on the patient’s status. Cognitive and behavioral changes may occur in the postoperative period, particularly in older patients. Patients can be discharged as early as 24 hours after surgery, depending on their neurological and cognitive status.

Conclusion

For the last 50 years, levodopa has been the cornerstone of PD management. However, a majority of patients develop motor fluctuations and/or LID about 5 years after the initiation of therapy. DBS of the STN or the GPI grant to patients with PD improved quality of life and decreased motor complications, and has been approved as such by the Food and Drug Administration in the US in 2002. We reviewed the experience and available literature on DBS for Parkinson’s disease over the last decade and arrive at the following understandings.

The success of DBS surgery depends on the accurate placement of the leads and meticulous programming of the stimulation. Therefore, it is best accomplished by an experienced team of neurosurgeon, neurologist, and support staff dedicated to the treatment.

Reports of surgical complication rates and long-term side-effects of DBS are very variable, so benefits and potential adverse results should not be under- or over-emphasized.

While essentially equal in improving the motor symptoms of PD, STN and GPi might have their own benefits and risks, and the choice of the target should be individualized and adapted to the patient’s situation.

Knowledge to further improve DBS treatment for Parkinson’s disease, such as a more scientific and reliable protocol on programming, strategies to minimize cognitive and psychiatric complications, and the better

long-term maintenance of the implanted device, are still lacking.

Data on the impact of DBS on non-motor symptoms affecting the quality of life of PD patients, such as pain, speech or gastro-intestinal complaints, are still scarce. Further research in these areas will help make this useful treatment even more beneficial.

Does A Healthy Diet Reduce The Risk Of Depression?

M.Sc. in Dietetics and Food Service Management , Post Graduate Diploma In Computer Application, P.G.Diploma in Clinical Nutrition & Dietetics , B.Sc.Clinical Nutrition & Dietetics
Dietitian/Nutritionist, Mumbai
Does A Healthy Diet Reduce The Risk Of Depression?

Depression is a mental illness marked by feelings of profound sadness and low interest in positive activities. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. There could be various causes of depression, but poor diet is one of the reasons revealed by researchers.

A certain study reinforces the hypothesis that a “healthy diet has the potential to not only ward off depression, but also prevent it."

Depressed individuals often have a poor diet quality and a decreased intake of nutrient rich food. But this is not yet clear in the case of healthy individuals suffering from depression.

A healthy diet characterized by vegetables, fruits, cereals, milk and low fat dairy products, pulses, fish, meat and poultry is associated with a lower risk of depression.

Increased intake of folate was also associated with a decreased risk of depression because low folic acid levels leads to low same (s-adenosylmethionine), which increases symptoms of depression. By improving folic acid status, same increases, and depressive symptoms drop. Vegetables, fruits, berries, whole-grains, meat and liver are the most important dietary sources of folate.

In addition, coffee and tea also act as anti-depressants to an extent because caffeine promotes the production of dopamine (a neurotransmitter released by the brain) which is responsible for the feeling of well being and happiness. But the amount of caffeine consumed should not be more than 300mg per day as caffeine is an addictive substance.

Omega 3-fatty acids, which are found in vegetable oil, nuts and fish oil, increase the level of serotonin (known as the happy hormone), which reduces the level of depression. Not only this, essential amino acids like tryptophan play a role in the formation of serotonin. Meat, fish, beans and eggs are good sources of essential amino acids.

Having refined carbohydrate and processed foods increases your blood sugar levels and does not provide any kind of nutrient to the body and brain. It even utilizes the mood enhancing vitamin b. Sugar also diverts the supply of another nutrient involved in mood enhancing, chromium. The best way to lower your sugar level is to have food low on the glycemic index.

Lastly, vitamin d deficiency may cause depression because vitamin d is responsible for brain development. So consume vitamin d rich foods such as egg, mushrooms, fish etc.

Depression is one of the leading health challenges in the world and its effect on public health, economics and quality of life are enormous. Not only the treatment of depression, but even the prevention of depression needs new approaches. Change in dietary and lifestyle factors are one of the possible approaches.

3 people found this helpful

How to get rid of fear and anxiety without medication. I'm doing yoga and breathing exercises but still not use. I'm getting head pain from overthinkig not able to do any work. From 4 months I'm suffering from this please help me to out of this.

M. S. in Psychotherapy and Counselling
Psychologist, Jaipur
How to get rid of fear and anxiety without medication. I'm doing yoga and breathing exercises but still not use. I'm ...
Hi, if you don't want to take help of medication then try meditation. Go to some places like orphanage or old age home and offer your help. When you will see their inward's pain you will get to know that your worries, fear and anxiety does not stand anywhere in front of them. And thus you may come out of your anxiety. And for fear know the root cause of it and confront it. The best solution of removing fear is to confront it. You may visit a psychological counsellor in person.
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Hello doctor, I have tonsil problem in my neck my voice is also down what can I do ,today is 7 day to face this problem.

BHMS
Homeopath, Secunderabad
If it does not get better then get it examined by a doctor. Keep gargling with salt water daily 3-4 times. Avoid chilled water or oily food. Have more fruits and soups. Revert back after the that. You can take Homeopathy if it does not get better.
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For e.g.l lost somebody close last year and since then feel very depressed and prefer keeping to myself all the time. Please help me.

BHMS
Homeopath, Secunderabad
For e.g.l lost somebody close last year and since then feel very depressed and prefer keeping to myself all the time....
May be you need to take a sincere reality check and correct yourself so that you can move on in life and achieve your goals. Talk to your friends and family members about your feelings and exchange the thoughts. Initially give yourself some time to start mingling with people who are close to you and then you can become more social. If you are not able to handle it then you can take the help of a psychiatrist or a counselor. You can also add Homeopathy as it is safe and gentle and can help you overcome the agony of separation naturally. A detailed case history is necessary to begin Homeopathy. You can contact me later if required. Do revert back to seek further guidance.
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Tuberculosis - Watch Out For These Warning Signs!

MD, MBBS
General Physician, Bangalore
Tuberculosis - Watch Out For These Warning Signs!

Although your body is already in possession of the bacteria leading to tuberculosis, your immune system is able to prevent you from becoming sick. Doctors have made a distinction between latent and active tuberculosis (TB). In case of latent TB, the bacteria in the body in a passive state and it causes no symptoms, and therefore it is not contagious. But, in the case of active TB, you would become sick and may even spread the disease to others. It can take place in the first few weeks or even after several months of being infected with TB bacteria.

What are the symptoms of active TB?

  1. If you are coughing for over three weeks and sometimes even coughing up blood, it can be a sign of TB.
  2. Chest pain and pain while coughing and breathing along with fatigue, fever, chills and night sweat are the common symptoms of TB along with loss of appetite and unintentional weight loss. TB may even affect other organs of your body, including your brain, spine and kidneys.
  3. When TB takes place outside the lungs, then the signs of TB can vary as per the organs that are involved. For instance, TB in the spine can cause back pain and that in kidneys may cause blood in the urine.

What are the causes of TB?
TB is caused by a bacteria which spreads from individual to individual via the microscopic droplets that are released into the air. This may happen when an affected person is left untreated and he speaks or sneezes or coughs or laughs.

Though the disease is contagious, it is not easy to be affected by it. As a result, you are much more likely to get affected with active tuberculosis from a person you live with or come in regular contact with, rather than a stranger. It is important to note here that people who are affected with TB and going through proper medications for over two weeks are no more contagious.

Right from the 1980s, the number of individuals affected with TB has increased dramatically, owing to the spread of HIV, which is the virus known for causing AIDS. A person infected with HIV has a weak immunity system as a result of which it becomes difficult for the body to deal with TB bacteria. So those who have AIDS are more likely to be affected with active TB and sometimes the latent form also progresses to an active one very quickly. Therefore, it is important to seek medical assistance and detect if you have any such health complications concerning TB.

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