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Hemophilia – A bleeding disorder

Posted by on Apr 17, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

Hemophilia – A bleeding disorder

         Hemophilia is a bleeding disorder where the blood does not clot normally due to deficiency of clotting factors; i.e. it takes a much longer time to clot compared to the normal 8-9 mins . In lay terms, normally, if blood is dropped on the ground or on the table, it clots in 8-9 mins. In hemophiliacs this does not happen and blood continues to be in fluid shape and keeps flowing. Therefore in hemophiliacs, an injury would lead to prolonged bleeding resulting in blood loss which can be life threatening. If the injury is a small cut, the bleeding can often be stopped with application of pressure locally. Bleeding in case of surgeries or internal bleeding as in the case of joints/brain or organs can be problematic and can endanger life.

         Hemophilia is an inherited disorder and therefore is usually identified in childhood itself, between 9 months and 2 years of age. Like most genetic disorders, it is not curable. Hence an understanding of the disorder by the patient and his family can help maintain an active and productive lifestyle.

         The intensity of hemophilia in an individual depends on the level of clotting factors present in his body. This clotting factor level estimation is called ‘Factor Assay’.  This level too is genetically determined and is constant throughout life. Depending on the level, the Clotting factor deficiency can be mild, moderate or severe. It is the severely deficient hemophiliacs that are at maximum risk.

The child or patient presents with one or more of the following symptoms:        (i) prolonged or excessive bleeding from injuries, or surgery, or dental procedures

(ii) bruises

(iii) Pain and swelling in joints, commonly knees and ankles and sometimes elbows, hips and shoulders

(iv) Nosebleeds or gumbleeds

(v) Any other bleeding such as in urine, stools, etc.

         The bleeding can sometimes be sudden and excessive and can be an emergency situation forcing the individual to report to emergency for immediate attention. Any prolonged bleeding or easy bruising in a small boy should be reported to a doctor for further evaluation and management.

         Though hemophilia is an inherited condition in the majority, in 30% of the cases it is caused by a  change in the genes called spontaneous mutation. There would therefore be no family history in such cases. In other words, a patient with excessive bleeding needs to be evaluated for hemophilia and clotting factor deficiency, even though there is no family  history. An female with a family history of hemophilia and who is pregnant or intending to conceive  should consult a doctor for genetic testing and exclusion of occurrence of hemophilia in the fetus. In such a case where fetus is effected or likely to be affected,  medical termination of the pregnancy can be considered.

         There are two main types of hemophilia – Hemophilia A and Hemophilia B, both occurring only in males. Hemophilia A is caused by Clotting Factor VIII deficiency and is the most common type. Hemophilia B is caused by Clotting Factor IX deficiency and is the second most common type.

Hemophilia C is rare and can occur in both sexes and is caused by Clotting Factor XI deficiency.

         The gene that causes Hemophilia is located on the sex chromosome X. A female has two X chromosomes, one from  her  mother and the other from her father. The chromosome that is normal is dominant and hence a female will not manifest hemophilia (i.e. there are no signs or symptoms of bleeding), but only remains a carrier of the gene. A male has XY sex chromosomes, X coming from his mother and Y  from his father. As Y is different from X and cannot dominate it, the male manifests hemophilia if he gets the hemophilia carrying X chromosome from his mother.Therefore hemophilia is typically is seen in males.

         When a patient presents to the hospital the diagnosis is made after a series of tests viz., coagulation profile, mixing experiments wherein the factor that is deficient is identified. This is then quantified with the relevant Factor Assay, and characterized as mild, moderate or severe. Depending on the degree of the deficiency, the factor deficiency is corrected  after arriving at the necessary dose through a  standard calculation. The factor is then supplemented at this dose every eight hourly till the bleeding stops completely. The factor is available in fresh frozen plasma or cryoprecipitatepreparations in blood bank or as factor VIII or IX concentrate injections prepared through recombinant technology or as a derivative of donated human blood.

         The complications of Hemophilia include swelling due to internal bleeding in the muscles, pain and numbness due to pressure of the  bleed on nerves. The joints can get damaged and develop arthritis called hemarthroses. This may need joint replacement if the arthritis becomes severe and leads to frozen joints. Infection is another complication that the hemophiliacs have to contend with, due to the blood component transfusions  that they undergo, especially Hepatitis and HIV. This can be avoided if only genetically engineered recombinant factor  concentrates are used. Availability of these concentrates at all places and exhorbitant cost are the problems faced by the majority of the populace in India.Desmopressin hormone (DDAVP) injection or nasal spray is a cheaper alternative useful in ‘mild’ hemophiliacs .

         Some of the preventive measures that hemophiliacs should follow are (i)Vaccination against Hepatitis A and B; (ii) avoiding drugs like aspirin and ibuprofen and using paracetamol as a safer alternative; (iii) avoid blood thinners like heparin and warfarin; (iv) practice good dental hygiene (v) avoid injuries; (vi) avoid intramuscular injections (vii) wear a medical bracelet indicating that the individual is a hemophiliac and (viii) let the individual’s friends, teachers and coaches know about his condition.


Basics of Cancer

Posted by on Apr 16, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

Basics of Cancer

What you should know about ‪‎Cancer‬ basics.

1) Cancer is not just one ‪‎disease‬.

There are many types of Cancer. It’s not just one disease. Cancer can start in different places in the body. It can start in the lungs, the breast, the colon, or even in the blood. Cancers are alike in some ways, but they are different in the ways they grow and spread.

2) How are Cancers alike?

The cells in our bodies all have certain jobs to do. Normal cells divide in an orderly way. They die when they are worn out or damaged, and new cells take this place. Cancer is a disease in which cells take their place. The Cancer cells keep on growing and making new cells. They crowd out normal cells . This causes problems in the part of the body where the Cancer started.

Cancer cells can also spread to other parts of the body.

3) How are Cancers different?

Some Cancers grow and spread very quickly. Others grow more slowly. They also respond to treatment in different ways. Some types of Cancer are best treated with ‪‎surgery‬, others respond better to drugs called‪‎ Chemotherapy‬. Often 2 or more treatments are given to get the best results.

4) What are tumors‬?

Most Cancers form a lump that doctors call a tumor or a growth. But not all lumps are Cancer. Doctors take out a piece of the lump and look at it to find out it it’s Cancer. Lumps that are not Cancer are called benign‬. Lumps that are Cancer are called ‪‎malignant‬.

There are some Cancers, like Leukemia‬ ( Cancer of the blood ) that do not form tumors. They grow in the blood or other cells of the body.



Dr Vijay Anand Reddy,

Director, Apollo Cancer Hospitals,



Focus on Improving Working Posture and Equipment Design

Posted by on Apr 15, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

Focus on Improving Working Posture and Equipment Design

Ergonomic recommendations to curtail risk of back injuries; focus on improving working posture and equipment design. These include: 

  1. Alter Posture – Alternate between sitting and standing to reduce postural fatigue and make the most of postural diversity, which helps to reduce static muscle fatigue.
  2. Use Support – When sitting or standing, don’t lean forwards or stoop in an unsupported posture for extended periods. If you are sitting, sit up straight or recline slightly in a chair with good back support, and use a good footrest if necessary. If you are standing for prolonged periods try to find something to help you lean against.
  3. Safe reaching – Avoid having to reach inelegantly to equipment and work close to the patient. Keep the objects used most frequently within a distance of about 20 inches (50 cm). Use assistants to help move equipment into this zone.
  4. Use Comfortable Equipment – Use equipment that isn’t too heavy, that can be used without awkward upper body posture and that feels comfortable to use. Ergonomically designed equipment helps to minimize stresses on the upper extremities and the back.
  5. Manage Time – Avoid long schedules where possible, or intersperse these with frequent breaks in which you alter posture and relax the back.
  6. Think about taking a walk on your lunch break. Be certain you have a good sitting position at work or in your car. Your knees should not be higher than your hips and make a habit of keeping your hips toward the back of the chair. This prevents slouching. Consider the use of a lumbar roll to keep a good sitting posture.
  7. If you are performing any activity that requires prolonged or repeated bending at the waist, straighten your back often and walk around. Intermittently perform a standing backward bending activity (place hands in the small of your back and bend backwards 5-10 times). This offsets the constant pressure in the back caused by bending forward and takes less than a minute to do every twenty to thirty minutes.
  8. After activity, avoid slouched postures immediately following the activity as your body cools down. Often, this is the time low back pain develops, not during the physical activity itself.



Dr Ajay Kumar,

Department of Orthopedics,

Apollo Hospitals Hyderguda,

Cartilage Damage

Posted by on Apr 15, 2015 in Apollo Health Blog, General Health | Comments Off

Cartilage Damage

Cartilage is a tough but flexible tissue that is the main type of connective tissue in the body. Cartilage covers the surface of joints, enabling bones to slide over one another while reducing friction and preventing damage. It helps to support your weight when you move, bend, stretch and run. Unlike other types of tissue, cartilage does not have its own blood supply. Blood cells help repair damaged tissue, so damaged cartilage does not heal as quickly as damaged skin or muscles.

Cartilage Damage generally occurs in the knee joints, resulting in swelling, joint pains and stiffnes. It becomes difficult to walk, stand for long, to sit down, etc activities which involves major role of joints.

Types of Cartilage:

  1. Elastic cartilage – also known as yellow cartilage is the most springy and supple type of cartilage. This type of cartilage makes up the outside of the ears, some of the nose, the larynx, and also the epiglottis.
  2. Fibrocartilage – is the toughest type of cartilage, found between the discs (vertebrae) of the spine and between the bones of the hips and pelvis
  3. Articular (hyaline) cartilage –it is both springy and tough type of cartilage found between the ribs, around the windpipe (trachea) and between the joints. Catilage between the joints is called ad Articular Cartilage.

 Causes of Cartilage Damage:

1. Accidents

2. Fall/Sprain

3. Oestoarthritis

4. On High Heels for longer hours regualrly

5. Continous standing or sitting in samew position.

6. Carrying lots of weight

7. Lack of calcium intake



Vegetable Soup

Posted by on Apr 14, 2015 in Apollo Health Blog, General Health | Comments Off

Vegetable Soup

A combination of vegetables makes our food rich in vitamins & minerals. It is easy to combine all of them into  a soup.


  • 5 g butter
  • 25 g green onion, chopped
  • 1 clove garlic, crushed
  • 1 small tomato, diced
  • 25 g peeled, chopped carrots
  • 25 g beans, chopped
  • 25 g peas
  • 50 g pumpkin/bottle gourd
  • 250 ml water
  • Salt to taste
  • Freshly ground black pepper, to taste

Heat butter in a large pot. Stir in onions; cook until the onion has softened. Add the other vegetables. Cover and cook until vegetables have softened slightly. Add water.

Bring to a simmer and reduce heat to low. Cover and let simmer until vegetables are tender. Add salt, pepper, to taste. Remove from heat, cool and blend slightly. Reheat before serving

Calories:        100 K cal per serving



Recipe by Ms. Sunita Pant Bansal

What is Breast Reconstruction?

Posted by on Apr 9, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

What is Breast Reconstruction?

Breast Reconstruction is a surgery to make a new breast shape after removal of the breast (mastectomy) or removal of some breast tissue (lumpectomy or partial mastectomy)

The main ways of making a new breast shape include

  1. Removing the whole breast and the skin and then putting in an implant to gradually stretch the remaining skin and muscle
  2. Removing just the breast tissue, but leaving the skin ,and putting in an implant(a skin sparing mastectomy)
  3. Reconstruction with your own living tissue taken from another part of your body
  4. A combination of your own tissue and an implant.

Prior to surgery, the type of procedure planned will be discussed in detail with the patient.

The surgeon aims to create a breast similar in size and shape to your own breast.

What is an Implant?

It is a semi solid substance made of -Saline or silicane gel covered in a strong synthetic coating which is easily acceptable by the body and

is called therapeutic Mammoplasty. The surgeon removes the tumor and an area of surrounding tissue matches the normal remaining breast in size and shape.

When to have breast reconstruction

  1. Immediate reconstruction -You can have reconstruction at the same time as your breast cancer surgery
  2. Delayed reconstruction -after completion of cancer treatment



  1. Quadrantectomy and Miniflap Reconstruction-A Quadrantectomy means the surgeon removes about a quarter of the breast tissue. This type of surgery leaves a dent in the breast and means the treated breast ends up smaller than the other breast. But is sometimes possible to get back the shape of the breast by filling the dent with a small area of living tissue. The surgeon usually uses tissue from your back to do this- called a Latissimus Dorsi Flap. You will need radiotherapy to the remaining beast tissue to reduce the risk of the cancer coming back.
  2. Reshaping the breast -Reshaping may be an option if you need part of your breast removed and you have quite large breasts. It. They then reshape the remaining breast tissue to create a smaller breast. You will need radiotherapy to this remaining breast tissue to reduce the risk of cancer coming back. At the same time as your reconstructive surgery you can also have surgery to make your breast smaller (breast reduction)so that they match in size.


Dr T P S Bhandari,

Surgical Oncologist,

Apollo Cancer Hospital ,

Jubilee Hills, Hyderabad

Bone Cancer‬

Posted by on Apr 8, 2015 in Apollo Health Blog | Comments Off

Bone Cancer‬

This type of cancer‬ is a #cancer of the cells that make up the bones‬ of your body. When this cancer is found in bones, it has usually started in other another location in the body and has spread to the bones. This process will originate a phenomenon that is known as metastatic cancer of the bones.

The 3 most Common types of ‪‎primary bone cancer‬ are the following:

• Osteosarcoma- This type of cancer arises from osteoid tissue in the bone. Most of the times this tumor occurs in the knee and upper arm;

• Chondrosarcoma- This type of cancer normally begins in cartilaginous tissue. Cartilage pads the ends of bones and lines the joints. Chondrosarcoma occurs most often in the pelvis (located between the hip bones), upper leg, and shoulder. Sometimes a chondrosarcoma contains cancerous bone cells. In that case, doctors classify the tumor as an osteosarcoma.

• Ewing’s Sarcoma – This type of cancer most commonly occurs between 5 and 20 years of age. The most common locations are the upper and lower leg, pelvis, upper arm, and ribs

How is bone cancer diagnosed? Take a look!

• X-rays – This method can show the location, size, and shape of a bone tumor. If this exam suggests that something is wrong, the doctor will recommend special imaging tests.

• A bone scan – During this test a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.

• A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.

• A magnetic resonance imaging (MRI)- During this procedure its used a powerful magnet linked to a computer to create detailed pictures of areas inside the body.

• Biopsy – During this test will be removed a tissue sample from the bone tumor to determine whether cancer is present.

Some symptoms of bone cancer

• Bone pain
• Swelling and tenderness near the affected area
• Broken bone
• Fatigue
• Unintended weight loss



Dr. Vijay Anand Reddy

Director Of Apollo Cancer Hospital

Apollo Health City

Jubile Hills


Food Safety

Posted by on Apr 7, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

Food Safety
  1. Food safety begins from farm till the food reaches our plate (i.e) from production, preparation, storing and serving of the food.
  2. Two most important concerns in food safety are food handling and food adulteration
  3. Safe food handling helps in preventing entry of pathogenic organisms into the food which could lead to typhoid, paratyphoid, bacillary and amoebic dysentery.
  4. Food adulteration is where the quality or the given nature of the food substance is reduced either through addition of a foreign substance or removal of a vital element
  5. Food adulteration could lead to health hazards like gastro intestinal disturbances, muscular paralysis, convulsions etc depending upon the adulterants like metallic or physical substances like sand or animal filth.
  6. Toxic colors like lead chromate, metanil yellow, rhodamine B etc in excess could lead to abnormalities of eyes, bone, skin, lungs, ovaries, testis etc,
  7. Public awareness and education could help in preventing unhygienic practices of food handling either at home or food service industries.
  8. Resistance to use of adulterated food products by the consumers will help in improvising the quality of the food by food service industries.
  9. Food safety measures helps in providing safe and healthy food for healthier nation


Ms. Sowmya K
M. Sc (nutn), R.D., C.D.E,
Regional Manager- Dietetics,
Apollo Sugar Clinics

Head and Neck cancer causes

Posted by on Apr 6, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

Head and Neck cancer causes

       Smokeless tobacco use like chewing or snuff and alcohol are the two most important risk factors for head and neck cancers. People who use both tobacco and alcohol are at greater risk of developing these cancers. Paan (betel quid) has been strongly associated oral cancer. In cases who do not have above mentioned habits, poor oral hygiene and jagged teeth may cause cancers of the oral cavity. Cancer may develop in presence of white patch or oral submucosal fibrosisHuman papillomavirus (HPV) infection, especially HPV- 11 and 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue. Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer. Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity.


Dr. Arsheed .H.Hakeem

Consultant Head and Neck Oncologist/Surgeon

Apollo Cancer Hospitals, Jubilee Hills, Hyderabad.


How to diagnose Autism?

Posted by on Apr 2, 2015 in Apollo Health Blog, Doctor's Articles | Comments Off

How to diagnose Autism?

How common is Autism?

Autistic Spectrum disorder was first described in 1943 by Kanner. It is not a rare condition.  It is more prevalent than cancer or diabetes in children, with current incidence of 1:500 children.


Why should Autism be diagnosed early?

Autism is a treatable disorder. Early screening and identification are crucial for improving the outcomes of children with autism. Accurate diagnosis leads to improved functioning and reduces the severity of symptoms.


When do the symptoms present?

The improved understanding of this medical disorder has emerged over the past 2 decades only though symptoms are present in 1st year the children usually diagnosed between 2-3 years.


Can Autism be diagnosed by a blood test?

There is no biological marker or laboratory test for the diagnosis of autism. History remains the most important tool used to screen.


Who can Diagnose?

The diagnosis of autism requires a comprehensive multidisciplinary approach. Diagnosis and evaluation should be performed by professionals who specialise in the treatment of children with autism like child psychiatrists, psychologists, neurologist etc.  The doctor should co-ordinate the work of the other service providers to avoid duplication of the work.

A thorough medical and neurological evaluation should be performed to look for any medical explanation of the symptoms

Then the diagnosis is confirmed by formal evaluation by at least 2 trained professionals independently.


What are co-morbidities with Autism?

Co morbidities are prevalent and difficult to diagnose in children with autisms because of communication problems. They are usually under diagnosed.

All children with Autism should be screened regularly for Sleep difficulties, eating problems, pica, ADHD, Seizures, aggression, anxiety, depression, learning difficulties etc.


What investigations are needed?

Investigations vary and need to be individualised.

EEG should not be done routinely. Performed only  if clinical seizures or history of regression.

MRI brain or Neuro Imaging is not to be done routinely. It is performed if any neurological features are there which are not explained by autism. Functional imaging modalities (MRI, SPECT and PET) are considered for research purposes only

Metabolic screening should be done if only clinically indicated.

Genetic testing if clinically indicated, for Fragile X, Karyotype, Rett Syndrome etc.


Should they be evaluated for Allergies?

Allergy testing, hair analysis for trace elements, micronutrients such as vitamin levels are not recommended.


What are the available treatment modalities?

Behavioural modification and applied behavioural analysis (ABA) are the main stay of treatment.

Dietary modification does not have scientific evidence. The dietary restrictions if at all are to be prescribed, have to be done under supervision of trained medical doctor. Adequate supplementations should be prescribed as children are grown and lack of essential nutrients can be detrimental.

Management of Co- morbidities is important as they are chronic and not transient. They tend to persist and impair the quality of life of the child.


Can this condition occur again in the next pregnancy?

Almost 50-fold increased risk of having a second child on the autistic spectrum (1 in 20 to 1 in 10, as compared with 1 in 1,000 to 1 in 500 for the general population)

Autism is a treatable condition with a wide range of outcomes. Information about the benefits of early intervention for children with autism needs to be widely disseminated to health care professionals and others working with young children and families.  Health care providers and others need to increase their comfort level in talking with families about autism, which is a treatable disorder.

Paediatricians can and should play an important role in raising a suspicion of autism, paving the way to appropriate referral to professionals knowledgeable about autism.



Dr. Pranathi Gutta, MBBS ; MRCPCH(UK)

Consultant Paediatric Neurologist,

Apollo Health City, Jubliee Hills, Hyderabad