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Jupiter Hospital, Thane

Jupiter Hospital

Multi-speciality Hospital (Dentist, Dermatologist & more)

Cadbury Junction, Eastern Express Highway, Service Road Landmark : Next To Viviana Mall Thane
150 Doctors · ₹0 - 1300
Book Appointment
Call Clinic
Jupiter Hospital Multi-speciality Hospital (Dentist, Dermatologist & more) Cadbury Junction, Eastern Express Highway, Service Road Landmark : Next To Viviana Mall Thane
150 Doctors · ₹0 - 1300
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Call Clinic
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About

We like to think that we are an extraordinary practice that is all about you - your potential, your comfort, your health, and your individuality. You are important to us and we strive to ......more
We like to think that we are an extraordinary practice that is all about you - your potential, your comfort, your health, and your individuality. You are important to us and we strive to help you in every and any way that we can.
More about Jupiter Hospital
Jupiter Hospital is known for housing experienced Pain Management Specialists. Dr. Kritika Doshi, a well-reputed Pain Management Specialist, practices in Thane. Visit this medical health centre for Pain Management Specialists recommended by 80 patients.

Timings

MON-SAT
08:00 AM - 09:00 PM
SUN
09:00 AM - 09:00 PM

Location

Cadbury Junction, Eastern Express Highway, Service Road Landmark : Next To Viviana Mall
Thane, Maharashtra - 400604
Get Directions

Doctors

Dr. Kritika Doshi

Pain Management Specialist
1000 at clinic
Available today
05:30 PM - 06:30 PM

Dr. Sandeep Vaidya

MBBS
Orthopedist
900 at clinic
Unavailable today

Dr. Sangita Gandhi

DGO, Diploma in Obstetrics & Gynaecology, MBBS
Gynaecologist
28 Years experience
700 at clinic
Available today
11:00 AM - 05:00 PM

Dr. Manasi Gore

MBBS, Diploma in Obstetrics & Gynecology, DGO
Gynaecologist
18 Years experience
650 at clinic
Available today
08:00 PM - 09:00 PM

Dr. Uma Bansal

MS - Obstetrics and Gynaecology, MBBS
Gynaecologist
35 Years experience
700 at clinic
Unavailable today

Dr. Rajashree Mane

Diploma in Obstetrics & Gynaecology, MBBS
Gynaecologist
26 Years experience
1000 at clinic
Available today
04:00 PM - 06:00 PM

Dr. Sandeep Vaidya

Membership of the Royal College of Surgeons (MRCS) , Diploma in Orthopaedics, DNB (Orthopedics) , MS - Orthopaedics, MBBS
Orthopedist
17 Years experience
900 at clinic
Unavailable today

Dr. Sandhya Saharan

MD - Obstetrics & Gynaecology , MBBS
Gynaecologist
27 Years experience
1000 at clinic
Unavailable today

Dr. Prachi Rana

DGO, Diploma of the Faculty of Family Planning (DFFP), DNB (Obstetrics and Gynecology)
Gynaecologist
17 Years experience
700 at clinic
Unavailable today

Dr. Vedhas Nimkar

MBBS, MD - Internal Medicine, AFIH
General Physician
15 Years experience
500 at clinic
Available today
10:00 AM - 07:00 PM

Dr. Alpa Dalal

MBBS, MD - Pulmonary Medicine
Pulmonologist
26 Years experience
1000 at clinic
Unavailable today

Dr. Prajakta P. Gupte

DNB - psychiatry
Psychiatrist
11 Years experience
800 at clinic
Unavailable today
15 Years experience
650 at clinic
Unavailable today

Dr. Rajesh Jadhav

MBBS, MD - Dermatology
Dermatologist
30 Years experience
650 at clinic
Unavailable today
1100 at clinic
Available today
10:00 AM - 05:00 PM
650 at clinic
Available today
04:30 PM - 05:30 PM

Dr. Anand Bhave

General Physician
650 at clinic
Available today
09:00 AM - 09:00 PM
1100 at clinic
Unavailable today
1000 at clinic
Unavailable today
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Nothing posted by this doctor yet. Here are some posts by similar doctors.

Headache: Sinusitis

Diploma in Otorhinolaryngology (DLO), DNB (ENT)
ENT Specialist, Nagpur
Headache: Sinusitis

Patients having chronic nasal problems along with sinusitis often complains of headache.
They most of the time describe the headache as throbbing pain in the cheek bones, over nasal bridge and over the forehead. Which sometimes exacerbates after sudden change in position or straining.
These headaches can be confused with the migraine and hence complete examination and determining the cause of headache is very necessary.
Now what exactly leads to sinus headache. It is the sinus infection or the nasal infection or the allergy leading to congestion in the nose and the draining pathways of the sinuses causing accumulation of the fluid. This fluid in turn causes pressure and inflammation of sinuses, leading to headache.
Sometimes this fluid can get secondarily infected and then patient may experience fever, body pain etc.
Treatment for this headache is just relieve the congestion of nose and form a patent channel for the sinus fluid to drain.
This will include medications like antibiotics, antihistamines, decongestant, nasal local decongestants. Steroid sprays etc. The treatment is tailor made according to the symptoms.
Home remedies include inhaling the steam.
The bottom line is to differentiate the headache cause complete examination and sometimes investigations like ctscan or x-rays are also required and hence we should get ourselves completely evaluated and then start the medication.

Diagnostic Tests Females

DNB (Obstetrics and Gynecology), MBBS
Gynaecologist, Delhi
Diagnostic Tests Females

Diagnostic Tests Females

We provide testing for fertility by all modalities ranging from reproductive hormones to diagnostic ultrasound to ascertain the cause. It is advisable that we make you undergo these tests before your final treatment/ plan of management is started.

  • Blood tests: These include a whole array of blood investigation ranging from CBC , Urine routine microscopy, RBS, TSH, PROLACTIN, VDRL, HIV, HBSAG, HCV, AMH. And any other test depending on the history of the couple.
  • Transvaginal ultrasound: A complete ultrasound of the uterus and adnexa is done to diagnose any anatomical disorder.
  • Specific tests: In cases of recurrent implantation failure and recurrent pregnancy loss or if required other tests are also advised.
  • Diagnostic Laparoscopy and Hysteroscopy: For many, this test is an important part of a fertility evaluation. Laparoscopy takes place under general anaesthesia with small incisions made at or just below the navel and the pubic hairline. A laparoscope (a small-diameter telescope) is passed through the incision, which enables one to view the ovaries, fallopian tubes, uterus and pelvic cavity for abnormalities. We can check that the tubes are open (tubal patency) by injecting dye through the uterus and observing it spill or not through the ends of the fallopian tubes.
  • Hysteroscopy: uses another small-diameter telescope called a hysteroscope. This enables to assess the uterine cavity for abnormalities such as polyps, adhesions or fibroids.
1 person found this helpful

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.

1 person found this helpful

A Peaceful State Of Mind Is The Key To A Healthier Life

MD - Internal Medicine
General Physician,
A Peaceful State Of Mind Is The Key To A Healthier Life

Find the root of all your suffering in some negativity you are nurturing in your life. Rise above all negativity, drop down all things you are holding onto become free at this moment life is very beautiful nd we are all beautiful children of god.

3 people found this helpful

Skin Health

PG Diploma in Emergency Medicine Services (PGDEMS), Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Alternate Medicine
Ayurveda, Ghaziabad
Skin Health

Eat 1 or 2 medium sized balls made of neem leaves everyday, it helps in curing skin itching and pimple problems.

3 people found this helpful

Gall Bladder Stone

Fellowship in Minimal Access Surgery, FACRSI (Colo-Rectal Surgery), Ph. D - Gastrointestinal Surgery, FAIS, DNB (General Surgery), MNAMS (Membership of the National Academy) (General Surgery) , MBBS
Gastroenterologist, Bangalore
Gall Bladder Stone

Gall Bladder Stone

Courtesy -Dr.Kumar Parth (MBBS; MNAMS; FMAS; FAIS; FACRSI (Colo-Rectal Surgery) DNB; FSGE (Surgical Gastroenterology)

(Consultant Surgical Gastroenterologist), drkparth9@gmail.com, www.drparthgastro.com

Definition:   Presence of stones in the gallbladder is referred to as cholelithiasis.               

PredisposingFactors:

  • Genetics , Gender (more in women)
  • Body weight (Obesity), or rapid loss in weight , Fasting
  • Decreased motility (movement) of the gallbladder
  • Diet
  • Drugs : Cholesterol / Lipid lowering drugs , Estrogen
  • Diseases: Diabetes, blood disorder (Hemolytic anemia etc.)

Composition of Gall Bladder Stone:

Cholesterol Stone: Found in western world, causes accounted to diet rich in cholesterol.

Pigmented stone: generally found in diseases related to blood disorder

Mixed stone: Contains Calcium, magnesium, sodium phosphate ( most common type found in Asian population (India).

Symptoms :

  • (70–85%) are asymptomatic or "Silent Gall Stone"
  • Pain in right upper and central part of abdomen (may radiate to inter-scapular region) mostly after half an hour of food (seen more symptomatic after a fatty diet.)
  • post meal fullness, belching, upper abdominal discomfort
  • Jaundice (yellowing of the skin or eyes)
  • Clay colored stools or dark urine

Investigations required:

  • Blood - Liver Function test , Complete Blood Count,
  • Imaging -Ultrasound Of abdomen and if required MRI (MRCP) abdomen.
  • Complications of Gall Stone
  • Infection of gall bladder {Empyema(pus) / Mucocele of Gall bladder}
  • Perforation of gall bladder
  • Stone slipped in Common Bile Duct resulting in obstruction in the passage of bile leading to Jaundice
  • Stone from gall bladder slipped to common bile duct and entering into pancreatic duct through common channel of opening in Duodenum (small bowel) leading to Pancreatitis.

Indications for Surgery:

  • Symptomatic Gall stone with typical history of pain as mentioned above and proven with Imaging (ultrasound)
  • Asymptomatic or Silent gall stone (Found Incidentally during Ultrasound abdomen) - "DOES NOT REQUIRE SURGERY".

Asymptomatic or Silent gall stone requiring surgery in special circumstances are:

  • Pregnant lady diagnosed with gall stone during first trimester (incidental finding)
  • Any blood disorder and patient is going for any abdominal surgery for any reason.
  • Diabetes mellitus - as chances of infection are high on by ground of diabetes
  • Gall bladder polyp (a soft tissue growth in lumen of gall bladder) size > 1 cm or single stone measuring > 3 cms, as risk of Gall Bladder cancer increase by 10 fold in these cases.

Treatment: Surgery - Laparoscopic Cholecystectomy (Key Hole Surgery) is Gold standard worldwide.

  • Safe surgery, there are no side effects of removing of gall bladder as one has to weigh the complication arising from a "symptomatic" gall stone disease.
  • Can be done as a day care surgery
  • Post surgery patients are advised to refrain from fatty meal for a week so as to acclimatize the body to a diluted bile. Normal activity is allowed from day 1 of post surgery.

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.

2 people found this helpful

Is doing physical exercise can solve the my problem of premature ejaculation which happened due to the habit of daily masturbation?

MD - Psychiatry
Psychiatrist, Chennai
Is doing physical exercise can solve the my problem of premature ejaculation which happened due to the habit of daily...
MAsturbation is not cause for PE. Physical exercise will not solve PE too. Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration or foreplay. It happens with minimal sexual stimulation and before the person wishes. It may result in unsatisfactory sex for both partners. This can increase the anxiety that may add to the problem. It is one of the most common forms of male sexual dysfunction. It has probably affected every man at some point in his life. Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Psychological factors such as anxiety, guilt, or depression can also cause it. In some cases, it may be related to a medical cause such as hormonal problems, injury, or a side effect of certain medicines. Consult a psychiatrist Your doctor will discuss your medical and sexual history with you. He or she will do a thorough physical exam. Your doctor may want to talk to your partner also. Premature ejaculation can have many causes. So your doctor may order lab tests to rule out any other medical problem. In many cases premature ejaculation gets better on its own over time. Treatment may not be needed. Practicing relaxation techniques or using distraction methods may help you delay ejaculation. Your doctor may recommend that you and your partner practice certain techniques to help delay ejaculation, as well as medications are there to help. All the best.
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My problem is hair fall. I'll try many shampoo madice but didn't change this problem. Please help.

BHMS, MD - Alternate Medicine
Homeopath, Nagpur
My problem is hair fall. I'll try many shampoo madice but didn't change this problem. Please help.
Hair fall may happen due to many reason like anaemia, nutritional deficiency, skin disorder, mental and physical trauma. In homoeopathy, a huge no. Of wonderful medicines are present that are used to tackle hair fall. You have to maintain your diet, avoid strong chemical effects, styling tools and remove the cause first and also follow the step. If needed we can provide you the hair care regimen, totally natural, free from artificial fragrances and colors which can stop the hair fall naturally.
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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, Mumbai
Please take homoeopathic treatment for tonsillitis. We have amazing medicines which can help you. Consult a homoeopath so that your symptoms can be noted in detail & the appropriate remedy thus can be chosen to relieve you of your problem. Till then take warm salt water gargles, drink ginger-honey water & give rest to your throat by talking less.
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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.

MD - Psychiatry
Psychiatrist, Chennai
For e.g.l lost somebody close last year and since then feel very depressed and prefer keeping to myself all the time....
You are going through extended grief reaction, which is normal after loss of a loved one. Time is the healer for the emotional and behavioral changes, however if your depression is severe enough to affect you in a significant manner, kindly consult a psychiatrist for short term antidepressant medication, depending on the complaints.
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I have a headache. I took medicine then it down but after 30 mnts again it starts. What is its reason?

DM - Neurology
Neurologist,
I have a headache. I took medicine then it down but after 30 mnts again it starts. What is its reason?
Headaches can recur based on certain reasons. Migraine headaches can respond very well initially, but over time, some changes take place in the nerves, which is called Central pain sensitization of the Trigeminovascular network. That may be a big term, but what it means is that headache beget more headaches. In the process of headache attacks, blood vessels play an important role, and some drugs act by modifying the changes in the blood vessels. Specifically, these drugs are called Triptans, and they cause vasoconstriction - and they are the MOST effective treatment for an acute attack of migraine. Unfortunately, they have a duration of action - some of them act for 4 - 6 hours and some for 12 - 24 hours. The drugs available in India have shorter duration of action. So if you are taking one of the triptans - for example sumatriptan or rizatriptan, you may find that the effect wears of in a few hours - the actual relief can be even shorter than that - and the remedy is firstly to take a drug with a longer duration of action - for example Naratriptan - which is currently not available in India. Another reason is that another analgesic may have a similar limitation. Third could be that the medicine is not effective at all, and that your migraine is just waxing and waning in its attack. One remedy would be to take prophylactic treatment - where you take medicines everyday irrespective whether you have an attack or not with the intent of preventing an attack.
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I have been masturbating regularly daily once from last many years. Will it effect my health or is it normal. Will it decrease my sperm. Thank-you very much.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
I have been masturbating regularly daily once from last many years. Will it effect my health or is it normal. Will it...
If you overdo the masturbation, the sperm count will reduce temporarily. Masturbation is not really bad; it is the addiction to it that is bad. Not even the number of years is a problem but the frequency and compulsiveness to do it is to be considered for its ill-effects. At your age you may feel it difficult and it can become addictive if you have alone time, if you obsess about it, and if you are not into relationships. The problem with addiction to this is that you may go on to prefer masturbation to heterosexual contact, even when you are married. That obviously would be an insult to your wife and will lead to a lot of conflict. Heterosexual contact is very wholesome and the physiology is made exactly for penile and vaginal contact. You will instead enjoy a poor replica of this and not know or care for the difference. The second thing that can happen with addiction is that it will become compulsive and will have no boundaries or limits, since it can be done all by yourself, whenever, wherever, and however too. The big problem a lot of children get into is the guilt around this. A useful way to discharge the energy is to get into contact games, or exercises, or even hobbies to channelize it. Also you should not spend too much time alone, and you need to keep your mind occupied with other interesting things and a lot of socializing. Even if you are not interested in marriage, for whatever reasons, it will help you to get into a friendship with a girl and enjoy the relationship where there will be a lot of excitement when you fall in love. Right now your hormones may be very active and your physiological apparatus is primed and ready for sexual stimulation. But because of your age and even otherwise it is important to develop good control and not feed into your impulses. Keeping yourself occupied and living a healthy social life are the keys to manage your sexual drives.
5 people found this helpful
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Is taking a periods delay medicine safe for delaying just for 2-3 days? After the periods she has to go for hymenoplasty. whether there will be any complications or not by taking period delay medicine?

MSc Applied Biology, Diploma in Naturopathy
Ayurveda, Delhi
Is taking a periods delay medicine safe for delaying just for 2-3 days? After the periods she has to go for hymenopla...
extra hormone /steroids from outside if not needed be never advised ...........why take from outside when u can incite from inside body endocrine glands ....but life style you can compel any one whether correction of hymen or some drink /smoke or .................
1 person found this helpful
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7 Fat Rich Foods That Are Actually Good For You!

MSc. Foods & Nutrition, BSc. Dietitics
Dietitian/Nutritionist, Mumbai
7 Fat Rich Foods That Are Actually Good For You!

It is a very common notion that fat is not good for your body. Most people have started opting for sugar instead of fat, which, in turn, has led to the rise in cases of diabetes. Recent studies have shown that fat is actually healthy for your body. Fat plays an important role in the body such as forming the membranes of the cell and reducing inflammation.

Here are some foods that are rich in fat and are actually good for you:

  1. Avocado: Avocadoes are different from other fruits in the way that they are rich in fats unlike other fruits, which mostly contain carbohydrates. It mostly contains oleic acid, a type of monounsaturated fat that is beneficial for the immune system. They are also rich in fiber that lowers the bad cholesterol levels in the body.
  2. Dark chocolate: As mouthwatering as it can get, dark chocolates never fall out of a foodie’s list of things he can’t do without. Studies have always attributed chocolates with all the ill effects they can possibly bring on you. However, recent researches have come up with quite contrary results, which can make all the prejudiced ones eat the humble pie. Dark chocolates, apart from their exotic varieties, come with incredible health benefits as well. It is rich in fats and antioxidants, known to improve your cardiovascular health. Chocolate is also known to lower blood pressure and improve brain function.
  3. Fish: Fish such as sardines, mackerel and salmon are rich in Omega-3 fatty acids which are very beneficial for your heart. It lowers the risk of heart disease and other cardio vascular diseases.
  4. Nuts: Nuts are rich in healthy mono-saturated fats which reduce the risk of diabetes, obesity and heart diseases. Nuts also contain magnesium and Vitamin E which are good for the body.
  5. Extra virgin olive oil: Extra virgin olive oil is rich in Vitamin K and E along with various antioxidants. These antioxidants help in preventing inflammation and free radical damage to the body.
  6. Chia seeds: Chia seeds are types of seeds which are rich in fats and fiber, thus promoting satiety. They have anti-inflammatory properties and help in lowering blood pressure.
5 people found this helpful

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.

Does masturbation causes Hair fall if yes then how should I get my hair follicles back I HV reduced hairline.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
Does masturbation causes Hair fall if yes then how should I get my hair follicles back I HV reduced hairline.
Your hair fall is not at all connected to masturbation. Masturbation is not really bad; it is the addiction to it that is bad. Not even the number of years is a problem but the frequency and compulsiveness to do it is to be considered for its ill-effects. At your age you may feel it difficult and it can become addictive if you have alone time, if you obsess about it, and if you are not into relationships. The problem with addiction to this is that you may go on to prefer masturbation to heterosexual contact, even when you are married. That obviously would be an insult to your wife and will lead to a lot of conflict. Heterosexual contact is very wholesome and the physiology is made exactly for penile and vaginal contact. You will instead enjoy a poor replica of this and not know or care for the difference. The second thing that can happen with addiction is that it will become compulsive and will have no boundaries or limits, since it can be done all by yourself, whenever, wherever, and however too. The big problem a lot of children get into is the guilt around this. A useful way to discharge the energy is to get into contact games, or exercises, or even hobbies to channelize it. Also you should not spend too much time alone, and you need to keep your mind occupied with other interesting things and a lot of socializing. Even if you are not interested in marriage, for whatever reasons, it will help you to get into a friendship with a girl and enjoy the relationship where there will be a lot of excitement when you fall in love. Right now your hormones may be very active and your physiological apparatus is primed and ready for sexual stimulation. But because of your age and even otherwise it is important to develop good control and not feed into your impulses. Keeping yourself occupied and living a healthy social life are the keys to manage your sexual drives.
1 person found this helpful
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I have a very heavily hair fall from last 1 month. Actually I have changed my residence place now I am living in South Delhi. I am not aware of the water purity here but I am worried about my hair fall please suggest me any oil or any method to recover the lost hairs or to stop it as soon as possible.

BHMS, MD - Alternate Medicine
Homeopath, Nagpur
I have a very heavily hair fall from last 1 month. Actually I have changed my residence place now I am living in Sout...
Hair fall may happen due to many reason like anaemia, nutritional deficiency, skin disorder, mental and physical trauma. In homoeopathy, a huge no. Of wonderful medicines are present that are used to tackle hair fall. You have to maintain your diet, avoid strong chemical effects, styling tools and remove the cause first and also follow the step. If needed we can provide you the hair care regimen, totally natural, free from artificial fragrances and colors which can stop the hair fall naturally
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