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THE EXCHANGE | Newsletter May 2018

THE EXCHANGE | Newsletter May 2018

In this edition, Dr. Sunit Singhi shares his recent clinical experiences.


An integrated team which offers exceptional expertise in a caring and compassionate environment, the Paediatric Division at Medanta extends unparalleled width and depth of clinical experience. It follows a cohort driven, multi-disciplinary approach to treatment, in which doctors of various paediatric sub-specialties, work in cohesion to deliver best paediatric care. The team uses latest technology, diagnostics and research to deliver the most effective, personalized treatment for children.


Medanta’s Paediatric Division offers an extensive range of in-patient facilities and specialised critical care.

  • Paediatric Surgery
  • General Paediatrics
  • Paediatric Neurology
  • Paediatric Nephrology
  • Paediatric Endocrinology
  • Paediatric ICU & Emergency
  • Paediatric Gastroenterology
  • Paediatric Hemato-oncology
  • Paediatric Urology Surgery
  • Paediatric Cardiology & Cardiac ICU


  1. Please share your view on the changing pattern of diseases.We are observing a recent trend of occurrence of 'early

infancy diseases' late in childhood. For instance Measles mostly affects children below five years of age. These days, however, 8-12 year olds also show measles like rash and fever, and eventually have a confirmed diagnosis of measles.

              Similarly, this year we are noticing Whooping Cough in older children in the 14 – 15 year age group.


  1. When should practitioners suspect mixed infection?

In case of persistent fever, do not confine yourself to one diagnosis. One should think broad and test for common and uncommon infections such as typhoid, scrub typhus, brucellosis, infectious mononucleosis etc, which may co-exist.


  1. When should a patient with fever be referred to a tertiary care centre?

              If a patient develops any of the following conditions, they should be referred to a tertiary care centre:

  • Fever that lasts beyond five days and does not respond to treatment
  • Alteration in level of consciousness
  • Underlying weight loss or malnutrition
  • Patient goes into shock
  • Breathing difficulty
  • High grade fever beyond 39 °C



Don't handover your neck to the barber!


Experiencing breathlessness and chest heaviness for three months, 54-year-old AKS* was admitted to Medanta. A CT scan of the PSU employee from Varanasi suggested that he had pneumonia for which he was treated promptly. Despite the complete treatment, the symptoms did not subside. AKS was still experiencing severe shortness of breath as he walked small distance and it worsened as he lied down. Since all his vitals seemed normal, the doctors explored further, looking for a cue to his condition.


While he was being examined for other possible causes of breathlessness, the doctors at Medanta noticed a paradoxical breathing pattern in AKS. “Paradoxical breathing is a condition in which during inhalation, the chest instead of expanding, moves inward. This abnormal chest movement affects the breathing pattern and leads to a drop in the blood oxygen levels,” explains Dr. Anand Jaiswal, Director, Respiratory and Sleep Medicine, Medanta - The Medicity. “As we investigated the possible reasons for paradoxical breathing, a neurological examination revealed that AKS was suffering from a damaged phrenic nerve - a nerve that originates in the neck and passes down between the lung and heart to reach the diaphragm, the principal muscle of respiration. The damaged nerve was impacting his breathing, which was manifesting in symptoms such as breathlessness and chest heaviness” adds Dr. Anand Jaiswal


As the doctors investigated reasons for the phrenic nerve damage, AKS revealed that he used to often visit the neighbourhood barber for a ritual 'neck-crack'.


In a typical Indian barber shop, it is not uncommon to find customers such as AKS who like to end their hair cut in a special way. They often pay extra for a head and shoulder massage followed by a customary neck massage and 'neck-crack'. While some people do it because they enjoy the loose-ness of the neck area, others do it because they believe that it is a good practice to keep the neck loose. “Because of repeated neck-cracks over the years, he had damaged his phrenic nerve, developing a condition called bilateral diaphragmatic paralysis, the root cause of his uncontrolled breathlessness,” explains

Dr. Anand Jaiswal. Upon the complex diagnosis, AKS was suitably treated for the condition.


The neck massage and neck-crack that barbers in India ritually perform after haircut can cause long-term damage to neck joints and surrounding tissues, muscles, and nerves or even bilateral diaphragmatic paralysis. It is a very risky practice and should be completely avoided.



Dr. Anand Jaiswal

Director - Respiratory & Sleep Medicine

Medanta - The Medicity


The da Vinci Surgical System


The da Vinci Robotic Surgical System is the most advanced platform for minimally invasive surgery available today. This state-of-the-art technology enables surgeons to perform delicate and complex procedures through a few small incisions. The benefits:

  • Magnified vision system allows surgeons a 3D HD view inside

              the patient's body

  • Ergonomically designed console where the surgeon sits while operating
  • Patient-side cart where the patient is positioned during surgery
  • Wristed instruments that bend and rotate far more flexibly with greater reach than the human hand


The da Vinci System is powered by robotic technology which allows the surgeon's hand movements to be translated into smaller, precise movements of tiny instruments inside the patient's body. One of the instruments is a laparoscope – a thin tube with a tiny camera and light at the end. The camera sends images to a video monitor in the operating room to guide doctors during surgery. The surgeon is 100% in control of the da Vinci System at all times.


At Medanta, our surgeons use the latest dual console da Vinci System to perform complex urological, gynaecological, cardiothoracic and general surgical procedures as well as training. To register for our next training session, email at aditya.ganguli@medanta.org  or  mathias.pinto@medanta.org


Mobile Apps to power your practice


According to a survey, more than 80% doctors and medical students use mobile devices to seek information and enhance skills. Here's a lowdown on the five most popular mobile apps in the medical community.


Medscape: One of the Apple App Store's most downloaded medical apps, Medscape can retrieve news articles from 34 different health fields. It also includes a very useful clinical reference section that contains safety guidelines on drugs, videos tutorials on various procedures and education activities for students.


MedPage Today: This is an online medical news service for doctors. Recently, MedPage partnered with Thomson Reuters Healthcare to provide prescription drug monographs and disease pathology information to their users.


Prognosis: One of the most useful resources for doctors as well as medical students, this app has over 1500 interactive clinical cases across 30 specialties which allow doctors to assess their diagnostic skills with stimulated clinical cases.


3D4Medical: This app uses innovative 3D technology to navigate through the body effortlessly. Users can rotate, cut, zoom and acquire superior/inferior perspectives. 3D4Medical also offers anatomic animations, which provide great resources for patient education.


MedCalX: A unique mobile app, MedCalX helps doctors use complicated formulas, classifications, and scores. The app comprises more than 300 formulas, scores, and classifications with the ability to create customized series.

It allows data sharing via email and print, transferring it to the patient's database.


First in India - 2,000 Femto Laser Cataract Surgeries


In a very short duration of four years since we installed the Cataract Refractive Suite, the Division of Ophthalmology has achieved the milestone of benefitting over 2,000 people with Femto Laser Cataract Surgeries on the LenSx.

Dr. Sudipto Pakrasi, Chairman, Medanta Division of Ophthalmology is the fastest in India to achieve this.

Femto Laser Cataract Surgery is the most advanced option in the customized management of cataract, and Medanta is one of the very few institutions offering this in New Delhi / NCR region. 


Dr. Sudipto Pakrasi

Chairman, Division of Ophthalmology


Medanta Medical Team
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