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Signs of Diabetes- What to Look for?

Posted by on Apr 7, 2016 in Apollo Health Blog, Doctor's Articles, Endocrinology | Comments Off

Signs of Diabetes- What to Look for?

‘Diabetes’, this word is heard more often these days than ever before. Friends, family members, colleagues at work place, or someone we know seems to develop this condition regularly. Men and women, young and the aged, no one seems to be immune. Then the question arises, am I prone and how to identify the signs of Diabetes.

Before we go on to discuss about the signs and symptoms of Diabetes, it makes sense to first understand what Diabetes is. Diabetes is a disease in which the ‘blood Glucose’ commonly known as ‘blood Sugar’ is higher than normal. No wonder most of the signs and symptoms of Diabetes tend to revolve around this high blood Sugar levels and the consequences of such high blood Sugar.

Insulin production is insufficient for the bodily needs in people who develop Diabetes. Lack of adequate Insulin results in high blood Sugar levels as Glucose cannot enter the cells from blood without Insulin. The high blood Sugar results in various symptoms and signs.

Polyurea is passing large quantities of urine. If one is passing large volumes of urine, for instance more than about three litres in a day, one has to suspect Diabetes amongst other health ailments. As the blood rich in Glucose passes through Kidneys, the high Glucose content in the blood draws excess water along with it and results in excess urine production. For the same reasons, waking up several times at night time to pass urine, called Nocturia is well described as a presenting symptom in Diabetes. ‘Increased Thirst’ is a common symptom with which many Diabetics present to the physician and this is due to loss of water from the body in the form of excess urine.

Weight loss not explained by other reasons may sometimes point towards underlying Diabetes. Unexplained tiredness could be due to Diabetes as well. Fungal infections such as Candida, commonly known as Thrush is not an uncommon presenting feature in some Diabetics, more so in women. The good old adage that a slow healing wound warrants a screening for ‘Sugar problem’ still holds true!

While this is so, some Diabetic patients do present with the complications of Diabetes, such as Heart problems, for instance Heart attacks, loss of sensation in the feet due to damage to the nerves, blurred vision, Cataracts at a younger age, and impaired kidney function. In fact, several cases of Diabetes are detected serendipitously when a person has a routine health check-up, or blood tests as part of an insurance screen. It is also not uncommon for a new diagnosis of Diabetes to be made when admitted to a hospital for other reasons like a medical or surgical emergency.

It is pertinent to state that some hither-to undiagnosed Diabetics with a type of Diabetes called Type1 Diabetes may present to doctors extremely unwell, or even in a comatose state with very high blood glucose readings as there is little or no Insulin left in their bodies. This type of Diabetes is much common in children and youngsters although adults are not completely spared. The symptoms in this variety of Diabetes are rather more severe and develop within a short span of time, over days to weeks and it is of paramount importance to identify this early so as to treat the condition.

After a thoughtful read of the above, one might wonder what makes him or her prone to Diabetes in general. There are some risk factors that increase the risk of Diabetes. Having a first-degree relative, parent or sibling with Diabetes makes a person prone to Diabetes, emphasizing the role of genes in the development of the disease. South-East Asians are at higher risk of developing Diabetes than their Caucasian counterparts due to their genetic makeup.

Being overweight, a larger waist circumference- 80 cm in men and 85 cm in women predispose a person to risk of Diabetes. Sedentary life style with desktop jobs, little exercise and unhealthy diets, all these increase the risk of Diabetes. If one were to have a slightly elevated Glucose level that is not yet in the ‘Diabetes range’ but not in the ‘normal range’ either, it is called Impaired Glucose Tolerance or Pre-Diabetes and such people are at higher risk of developing Diabetes. Those women with higher than normal blood Sugar detected first time during pregnancy, known as Gestational Diabetes are at higher risk of developing Diabetes during their life time. Similarly, those women with a health condition called Polycystic Ovarian Syndrome are at higher risk for Diabetes as well.

To summarise, it is pertinent that everyone is aware of the risk factors that predispose one to developing Diabetes and address such risk factors early on in life by trying to lead a healthy lifestyle. It is equally important to know the various signs and symptoms of Diabetes so as to detect it early on and treat Diabetes effectively to prevent the various complications.




Dr. Ravi Sankar Erukulapati, MBBS, MRCP(UK), CCT- GIM,

Diabetes & Endocrinology (UK),

Consultant- Apollo Hospital, Jubilee Hills,



World Autism Awareness Day

Posted by on Apr 2, 2016 in Apollo Health Blog, Doctor's Articles, Pediatrics | Comments Off

World Autism Awareness Day

What is Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is a disorder of brain development. Children with this disorder have persistent trouble communicating with others. In addition they have repetitive behaviours and a restricted interests and activities. These symptoms can occur in combinations and the degrees of intensity vary in each individual.

ASD can be associated with intellectual disability, difficulties in motor co-ordination, attention and health issues such as sleep. Some persons with ASD excel in Visual skills, music, math and art.

How common is Autism Spectrum Disorder?

ASD has a prevalence of about 1 %.  However the prevalence is rising and recent US figures from CDC identified around 1:68 children have been identified with ASD. This increase is only partly explained by improved diagnosis and awareness. Environmental influences also seem to have a role. Studies also show that Autism is 4 to 5 times more common among boys than girls.

What causes Autism Spectrum disorder?

There is no one particular cause of autism as there is no one type of autism. A number of rare mutations or gene changes are identified by scientists to be associated with ASD. However most of the cases of autism appear to be caused by combination of genes and environmental factors influencing early brain development.

What are the signs of Autism Spectrum Disorder?

Children affected by ASD often exhibit early signs by 12-24 months of age.
A child may demonstrate only a few of these signs
•       Poor eye contact
•       Does not point and look
•       Doesn’t smile
•       Trouble making meaningful gestures by 1 year
•       Does not respond to their name
•       Begins to develop language and then loses it or doesn’t acquire language at all
•       Cannot speak 1 word by 16 months or combine 2 words by 2 years
•       Does not exhibit bonding (example does not initiate cuddles)
•       Not interested in interacting or playing with other children
•       Does not engage in adequate imaginative play
•       Has problems with, or is not interested in playing with toys
•       Strongly resists change in routines
•       Has difficulty sleeping/ wakes at night
•       Self-restricted/ selected diet

If you see any signs of ASD in a family member, talk to your health care professional.

How is ASD diagnosed?

A team of professionals will use various standardised tests to make a diagnosis.

Timely screening and diagnosis is very important. Early intervention with proven behavioural therapies can improve outcome in a child’s development and daily functioning. Most of the times receiving a diagnosis can be very helpful, as it enables parents, as well as others to understand and support the child better. Diagnostic assessment also helps to clarify if the child needs any extra support and appropriate help can then be sought.

What does it mean to be on the “Autism spectrum”?

Each individual with Autism is unique.
Many have exceptional abilities in visual skills, music, math , academics and art. About 40 % have average or above average intellectual abilities. Others have significant disability and are unable to live independently.
About 25 % are nonverbal but can learn to communicate with other means.

Is there a treatment?

There is no known “cure” for this condition. However there are many useful programmes and interventions to develop the child with specific difficulties,  which, may impact them and their families quality of life.

It is also important to note that ASD affects every child in a different way. An intervention that helps one child might not be suitable for another.
Parents are strongly adviced to seek professional guidance.

It is important to help children in their areas of difficulties, but it is equally important to support them in their areas of strengths. It is often their strengths that increase their quality of life, help them to achieve their potential and contribute to society.

It is important to be aware that children with ASD are at increased risk of developing other difficulties like sleep difficulties, anxiety, depression, or behavioural problems. These are often treatable and it is important to seek medical help if concerns arise.
The medications have significant side effects and should be prescribed by a doctor who specialises in the condition being treated. If medication is offered, your child will have regular check-ups to assess if the medication is working.

Is there any role for Dietary Restriction?

Dietary restrictions (example Gluten free and casein Free diet) are widely practiced. However there is not enough scientific evidence to recommend this routinely.
Some children with ASD already have a self-restricted diet. In addition if a dietary restriction is imposed, it can be detrimental, as some of the essential nutrient needs of the growing child might not be met.

If the parents are concerned, please discuss the diet needs with the medical doctor. The child might need an evaluation by a qualified medical professional for any underlying medical conditions, which might benefit from the diet restriction.

Parents should be cautious about any treatment that claims to be a ’cure’ for autism.



Dr. Pranathi Gutta MBBS ; MRCPCH(UK)

Paediatric Neurologist,

Apollo Health City, Jubilee Hills, Hyderabad


What Are the Benefits of Stress Balls?

Posted by on Mar 29, 2016 in Apollo Health Blog | Comments Off

What Are the Benefits of Stress Balls?

A stress ball relieves stress simply because it keeps your hands busy doing a simple, repetitive movement which eventually becomes almost subconscious. Your anxiety or stress is redirected to the stress ball.

Stress balls are small balls or objects filled with a malleable gel or clay that are held in the palm of your hand. The act of repeatedly squeezing the ball releases tension and helps to relieve stress. The benefits of stress balls also include boosting blood circulation and helping with the treatment of carpal-tunnel syndrome — and they’re used as a tool for meditation. The balls can also be used as a physical therapy tool to help strengthen the muscles of the hand and wrist. Consult with a physician before treating stress or injuries on your own.

Relieve Stress

Decreasing stress and tension can help to improve the quality of your life by promoting better sleep, warding off illness and enhancing a general feeling of well-being. Squeezing the ball activates the muscles of your hand and wrist; releasing the grip allows the muscles to relax. The repeated pattern of grip and release helps to alleviate tension and stress.

Long Sitting Cancer Risks

Posted by on Mar 12, 2016 in Apollo Health Blog, Cancer | Comments Off

Long Sitting Cancer Risks

The exact medical connections are still being studied, but doctors presume that approximately 80,000 cancer cases each year can be attributed to inactivity from long hours spent at a desk.

Who’s at risk?

Basically everyone with a desk job! Even those who work out regularly are not excluded from the risks of cancer.


  • A person spends approximately 16 waking hours in a day of which 30 minutes of physical activity constitutes of only 3 per cent of the day’s workout. The other 15½ hours pack in enough inactivity to up your cancer risk significantly.
  • Cancer risk increases even further when long periods of sitting idle lead to weight gain and overweight and obese people are more susceptible to cancer.
  • A desk bound lifestyle causes increased inflammation, which contributes to cancer risk.

Preventive Measures

  • In order to lower your risk of cancer you need to be active throughout the day.
  • Even a minute long walk every hour can cut back your chances of having cancer by 40 per cent. It is particularly effective in protecting against breast or colon cancer.
  • For people with desk jobs, it is strongly recommended that they get up several times a day to lower the bio-markers of cancer.
  • Being active not only lowers your chances of getting cancer, it also leads to a slimmer waistline thus cutting back several other health risks too, such as insulin resistance or joint pains.

Get active

  • Get up and walk around for a couple of minutes after every hour. If necessary, set a timer on your computer to remind you to get up.
  • If possible keep a few lightweights in your office, use them while you are talking on the phone or reading up on something.
  • Conduct meetings and phone calls while standing. Move around the room if you can, it contributes to your daily physical activity level.
  • Cut back on emails to colleagues. Go over to their desks and convey the message instead.
  • Replace your water bottle with a tumbler and refill it periodically from the water cooler.

World Kidney Day 2016

Posted by on Mar 10, 2016 in Apollo Health Blog, Doctor's Articles, Kidneys | Comments Off

World Kidney Day 2016

World Kidney Day (WKD) is an annual global awareness and education event, held on the second Thursday in March. Every year, countless local, national and international events are organised by kidney charities, healthcare professionals, patient groups and individuals who want to make a difference. The 2016 campaign has a specific focus on Kidney Disease & Children.

Pediatric Nephrology relates to kidney diseases in newborn and children up to 18 years age. Kidney diseases in children can occur due to structural or developmental defects (that happen during birth process), genetic factors (that run in families) or disturbances in environment / immune factors or medications. A number of these problems, if detected early, can prevent kidney damage.

Kidney problems can occur in children both due to genetic / structural problems or acquired after birth. Early detection and management of these problems can definitely improve both the short as well as long term outcome.

Some preventive aspects of kidney problems in children include:

  1. Check urine test in young children below 2 years of age with unexplained high fever to rule out urine infection
  2. Encourage children more than 3 years age to pass urine in a relaxed manner every 2-3 hours during the day (avoid “holding of urine”)
  3. Daily intake of fruits and vegetables
  4. Moderate decrease in salt and meat product intake in family’s diet
  5. Decrease in TV / computer time and more of outdoor activities to minimize excess weight gain
  6. Avoid pain killer medicine intake such as Nimesulide, Ibuprofen etc, and Ayurvedic / Unani medicines
  7. Use Crocin / Calpol / Paracetamol as much as possible for control of fever
  8. Check blood pressure once a year in every child beyond 3 years age
  9. Evaluate for kidney disease if the child is not growing well, has anemia, high blood pressure, blood in urine, body swelling or recurrent urine infections.


Dr Mehul A. Shah

MD (Ped), DCH (Bom), MD (USA), DABPN (USA)

Consultant Pediatric Nephrologist

Apollo Health City


Kidney Transplantation across blood groups

Posted by on Mar 9, 2016 in Apollo Health Blog, Kidneys | Comments Off

Kidney Transplantation across blood groups

‘Transplantation across Blood –Groups’ – In this method the preformed antibodies are removed by plasmapheresis and special medicines are given to the recipient to prevent antibody formation. Some centres also remove the spleen. The levels of antibodies are monitored in the post transplant period and necessary steps taken to keep them down, to prevent rejection. This form of transplant involves a lot of cost and generally the rates of rejection are high, but with technological improvement, the results are improving.

Post transplant follow –up:It is of utmost importance to know that the recipient has to be on lifelong immunosuppressive medicines (medicines which prevent the rejection of the kidneys). He also has to be under the regular follow up of a nephrologist so that any problem of the transplant kidney can be picked up quickly.

During each visit, the nephrologist monitors the functioning of the transplanted kidney and tries to adjust the dose of immunosuppressive medicines to keep the side-effects of these medicines to a minimum.

He will look for any new-onset infection or a malignancy, which are quite common in these patients. Metabolic complications post transplant, like Diabetes, hypertension, hyperlipidemia , obesity and Coronary artery disease have to be actively searched for, to prevent deaths and morbidity in these patients.

The current recommendations suggest that the patient should visit the nephrologist or the transplant team 2-3 times per week after discharge in the immediate post transplant period. The visit dates are extended gradually if the patient is stable and is expected to come for follow up every month till the first three months. Later they come every 2-3 months or as directed by their doctor.


Neuropsychological Rehabilitation

Posted by on Mar 4, 2016 in Apollo Health Blog | Comments Off

Neuropsychological Rehabilitation

Neuropsychological Rehabilitation –
It is a treatment option used by a neuropsychologist to help patients who have sustained cognitive, emotional and behavioural problems as a result of the brain injury. Many patients referred for neuropsychological rehabilitation are likely to have suffered brain injury due to one of the following:
– Traumatic brain injury following a road traffic accident, fall, industrial
or sporting accident or assault.
– Cerebro vascular accident (stroke).
– Viral infection of the brain, particularly encephalitis.
– Hypoxic brain damage following, for example, cardiac arrest,
respiratory arrest, status epilecticus, carbon monoxide poisoning or
anesthetic accident.
– Neurosurgery for head trauma, AVMs, brain tumour removal,
clipping or coiling of aneurysm.
– Degenerative disease such as dementias (dementia of the
Alzheimers type, vascular dementia, fronto-temporal dementia so
on), Parkinson’s Disease or dementia associated with AIDS.

What Are the Types of Neurological Disorders?

Posted by on Mar 1, 2016 in Apollo Health Blog, Neuro | Comments Off

What Are the Types of Neurological Disorders?

There are many types of neurological disorders, including:

  • Alzheimer’s disease (AD)
  • Epilepsy
  • Multiple sclerosis
  • Parkinson’s disease
  • Migraines

The World Health Organization reports that various types of neurological disorders affect millions of people around the world, including 24 million that suffer from Alzheimer’s disease and 326 million who experience migraines.

What Causes a Neurological Disorder?

If you suspect that you or a loved one may be suffering from one of these issues, you may also be wondering about what causes a neurological disorder. The causes of such dysfunction can be quite diverse. Both the spinal cord and brain are insulated by numerous membranes that can be vulnerable to force and pressure. The peripheral nerves located deep under the skin can also be vulnerable to damage. Neurological disorders can affect an entire neurological pathway or a single neuron. Even a small disturbance to a neuron’s structural pathway can result in dysfunction. As a result, neurological disorders can result from a number of causes, including:

  • Lifestyle-related causes
  • Infections
  • Genetics
  • Nutrition-related causes
  • Environmental influences
  • Physical injuries

What Are the Signs of Neurological Disorders?

The signs of neurological disorders can vary significantly, depending upon the type of disorder as well as the specific area of the body that is affected. In some instances, you might experience emotional symptoms while in other cases physical symptoms may be the result.

Do you crave for salted foods ?

Posted by on Feb 17, 2016 in Apollo Health Blog, Apollo Health City News | Comments Off

Do you crave for salted foods ?

Does less salt in your food make you angry and reject the plate of food? If so, think twice and change the habit as salt is one of the reasons for increasing incidences of stomach cancer in India. Stomach cancer risk is 68 per cent higher among people with high salt intake compared to those with low salt intake, according to a meta-analysis.

Salt and salty foods are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a probable cause of stomach cancer. This is one of the reasons why the World Health Organisation has recommended 6gm of salt per day for a normal person and reduced it to 3.75 gm per day in case of people suffering from cardiovascular diseases and uncontrolled hypertension.

Majority diagnosed too late:

Food high in salts like meats, fish, pickled foods and typical Indian dishes have increased the risk of nasopharyngeal cancer in the upper throat behind the nose. This incidence has been recorded at two to six per cent, according to the clinical evaluations from 12 major cancer registries in the country. The incidence of gastric cancer has been recorded at 6.8 to eight per cent, which is an alarming number.

Nasopharyngeal cancer is found among those aged between 15-25 and 50-60, while gastric cancers are seen in those 60 years and above.

Dr P. Vijay Anand Reddy, Director, Apollo Cancer Hospital explains, “Majority of the patients are diagnosed too late because of the non-specific symptoms of both these cancers. Hence regular screening is recommended to detect at the earliest.”

Salt and salty foods are classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) as a probable cause of stomach cancer.

The most prone to stomach cancer Helicobacter pylori (H. Pylori)
Working in rubber production
Tobacco smoking
X-radiation, gamma-radiation

Limited/Probable risk factors
Epstein-Barr virus
Inorganic lead compounds
Nitrate or nitrite[a]
Pickled vegetables (traditional Asian)
Salted fish, Chinese-style
Salted/salty foods

Symptoms to watch out for
Vague discomfort in the abdomen, usually above the navel
A sense of fullness in the upper abdomen after eating a small meal
Heartburn or indigestion
Poor appetite
Weight loss (without trying)
Vomiting, with or without blood
Low red blood cell count (anaemia)


Reported in Deccan Chronicle


ZIKA – An Alarming Caution

Posted by on Feb 1, 2016 in Apollo Health Blog, General Health | Comments Off

ZIKA – An Alarming Caution

Mosquitoes spread many types of viruses and parasites that can cause diseases like Chikungunya, Dengue, Zika, and Malaria. The #Zikavirus is “spreading explosively” in the Americas and can infect upto four million people, the WHO warned yesterday(30-01-2016) as it issued a warning to all countries, including INDIA.

Zika is a disease caused by Zika virus. Zika is transmitted through female Aedes mosquitoes. There is no treatment or vaccine available for Zika. People with Zika virus typically have symptoms like – mild fever, skin rashes, conjunctivitis, muscle fatigue, joint pains, and headache. These symptoms normally last for two to seven days.

Transmission of this infection happens with mosquito bite in the morning hours. In pregnant women around the time of birth if the mother is infected there are chances of Zika virus passing to new born babies too, but chances are rare. Zika virus can spread through Blood Transfusion & sexual transmission too.

Zika virus causes brain damage in babies. This mosquito also carries the viruses that cause Dengue and Chikungunya which are of great public health concern in tropical countries like India.

It may be dangerous to India as the same type of mosquito spreads dengue, chikungunya and yellow fever too. The symptoms of Zika are similar to those of dengue and chikungunya, as these diseases re spread through the same mosquito ‘Aedes Mosquito’.

Zika Virus Symptoms


As there is no vaccine for Zika, Prevention is the only option

  1. Use mosquito repellent creams, liquids, machines, nets to avoid mosquito bites.
  2. Mosquitoes that spread Zika bite mostly during day times.
  3. Stop mosquitoes from breeding by keeping surroundings clean, removing standing water, by covering water storage containers, tanks, units, cover open vents or plumbing pipes etc.
  4. Use screens for doors & windows, repair if any holes in them.

If you are traveling to countries where Zika Virus or other viruses spreading because of, please take the following necessary steps as preventive measures:

  1. Wear long-sleeved dresses, shirts and long pants.
  2. Use mosquito repellents without fail & sleep under mosquito net.
  3. Do not use repellents on babies younger than 2 months of age.
  4. Do not apply insect repellents on eyes, near mouth, on cuts or irritated skin.
  5. Choose your hotel or lodging with air conditioning or screens on windows and doors.


No vaccine or medications are available to prevent Zika.