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Max Super Speciality Hospital, Saket
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Bio Medical Waste Report For Shalimar Bagh

Month Red Autoclave(Infected Plastic Waste) Yellow- Incineration(AnatomicalWaste & Soiled Waste) Blue Autoclave (Glass- Bottles) Black Cytotoxic- Incineration( Cytotoxic Contaminated Items) White- Sharp Total Bags Total Weight(In KG's)
  No. of Bags Weight (in KG's) No. of Bags Weight (in KG's) No. of Bags Weight (in KG's) No. of Bags Weight (in KG's) No. of Bags Weight (in KG's)    
Apr-17 924 2963.50 954 2994.10 239 1017.30 103 279.20 1645 606.40 3865 7861.00
May-17 1175 4624.12 1028 3498.40 276 1524.34 87 195.01 1803 823.85 4369 10665.71
Jun-17 1060 4511.45 902 2886.66 293 1324.05 76 194.00 2057 1100.69 4388 10016.85
Jul-17                     0 0.00
Aug-17                     0 0.00
Sep-17                     0 0.00
Oct-17                     0 0.00
Nov-17                     0 0.00
Dec-17                     0 0.00
Jan-18                     0 0.00
Feb-18                     0 0.00
Mar-18                     0 0.00
YTD 3159 12099.065 2884 9379.155 808 3865.69 266 668.705 5505 2530.94 12622 28543.555

Interventional Neurology

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Clinical Directorate

For more info please call 8744 888 888 (Delhi – NCR) & 9988 422 333 (Chandigarh Tri-city), or mail at homecare@maxhealthcare.com

Dr. Himanshu Agarwal

Dr. Himanshu Agarwal
Consultant – Interventional Neurology
Dr. Himanshu Agarwal - Max Hospital
Memberships: 
  • Society of Therapeutic Neurointervention (STNI)
  • Indian Society of Neuroradiology (ISNR)
  • Indian Radiological and Imaging Association (IRIA)
     
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PROFESSIONAL JOURNEY

Work Experience: 
  • Consultant, Interventional Neurology, Max Saket
  • Ex. Associate Consultant, INR, Max Saket
  • Ex. Assistant Professor, INR, AIIMS, New Delhi
  • Ex. Senior Resident, INR, AIIMS, New Delhi
     
Education & Training: 
  • DM, AIIMS, New Delhi
  • MD, GSVM Medical College
  • MBBS, SN Medical College
     
Awards Information: 
  • Gold Medal from President of India for best student in post graduation
  • PGME topper in entire state
  • First prize in health awareness video competition
  • Honors in various subjects in MBBS
  • Published multiple papers in International and National journals, including largest series of Vein of Galen Aneurysmal Malformation from India
     
Speciality Interest: 
  • Diagnostic cerebral and spinal angiography
  • Acute stroke  Mechanical Thrombectomy
  • Intracranial Aneurysms
  • Cranial and Spinal AVM;s
  • Cranial and Spinal DAVF
  • Carotico-cavernous fistulas
  • Parent vessel occlusion
  • Carotid Stenting
  • Head and Neck Tumor embolisation
  • Balloon test occlusion
  • Petrosal sinus sampling
  • Venous sinus thrombectomy
  • Intra-arterial chemotherapy for Retinoblastomas
  • Brain and Spine Imaging 
  • CT guided Spinal Interventions
     
Duration Of OPD: 

   Max Super Speciality Hospital, Saket

  • Mon to Fri : 11 am – 4 pm

What to Do When You Have Tremor?

May 18, 2018 0 93 3 minutes, 6 seconds read

Tremor is an involuntary, rhythmic muscle movement of one or more parts of the body. It is unintentional and can affect any part of the body such as arms, head, hands, trunk and legs. However, most tremors occur in the hands.

What Causes Tremor?

The primary cause of tremor can be either an underlying neurological disorder or a side effect of a certain class of drugs. Typically, it is caused due to problems in the part of the brain that controls the muscles. Tremor is also one of the major symptoms of brain stroke, multiple sclerosis and other neurodegenerative diseases that affect the cerebellum. When tremor occurs on its own, it can be a symptom associated with various neurological disorders, such as:

  • Stroke
  • Parkinson’s disease
  • Multiple sclerosis
  • Traumatic brain injury

Other causes of tremor include:

  • Use of certain medications like corticosteroids and amphetamines
  • Drug and alcohol abuse or withdrawal
  • Mercury poisoning
  • Liver failure
  • Overactive thyroid

Furthermore, some forms of tremor are linked with genetic disorders and run in families without any known cause.

Tremor Resulting from Stroke

Cerebellar tremor is caused due to lesions or damage in the cerebellum; typically resulting from a stroke, a condition like multiple sclerosis, or even a tumour. These abnormal involuntary movements are common after an event of an ischemic or hemorrhagic stroke. Strokes in the pons or midbrain are linked to acute head tremors.

Holmes’ Tremor

A type of resting tremor, Holmes’ tremor involves the cerebellum, brainstem or the thalamus. It is a low-frequency tremor that typically affects the upper limbs. The tremors are slow and involve uncontrollable shaking that occurs when the muscles are at rest. This type of tremor worsens during voluntary muscle contractions.

Palatal Tremor

Palatal tremor occurs after a stroke and is characterised by rhythmic movements of the pharynx and soft palate, which typically persist during sleep.

When to See a Doctor?

Tremor can be one of the symptoms of brain stroke or can occur after one has had a stroke. Furthermore, several types of tremor can have different causes. However, the important thing is to consult our Institute of Brain and Spine in case of an occurrence of tremors. Immediately opting for brain stroke treatment in case of tremor can help in managing it better.

Here are things to keep in mind if you have a tremor:

       1. Beat the Stress

Anyone who is suffering from tremor should try and reduce stress from their daily life. It is one of the first things doctors’ advice to patients who have had a stroke or show the signs or symptoms. Furthermore, controlling anger is also necessary.

       2. Save Tough Tasks When You Are Most Active

Most people who get tremors because they had a stroke are advised to keep heavy tasks for the time of the day when they are most active. For instance, if you have tremor during the daytime, it is advisable to do essential things involving your hands in the later part of the day.

       3. Use Heavy Utensils

According to research, using heavy utensils to eat can help some people in ‘damping out’ their tremors. Moreover, utensils with larger handles are easier to control.

       4. Wear Comfortable Clothes and Shoes

Loose clothes with buttons are much more easy to wear. Shoes such as slip-on are advised to patients affected by tremors.

A neurologist from our Institute of Brain and Spine will suggest medications after thoroughly diagnosing the symptoms of brain stroke and tremors associated with it. However, there are treatment options like a deep brain stimulator that delivers electrical stimulation to the part of the brain responsible for tremors. In severe conditions, a neurosurgeon will perform a brain surgery only if the incision does not affect critical functions of the brain.

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FAQs on Hemorrhagic Stroke or Blood Clot in the Brain

February 23, 2018 0 110 1 minute, 25 seconds read

What is it?

This is a type of stroke where a damaged blood vessel leaks blood into the brain.There are two kinds of hemorrhagic strokes: Intracerebral haemorrhage and Subarachnoid haemorrhage

  • Intracerebral haemorrhage happens when blood leaks into the brain tissue.
  • Subarachnoid haemorrhage happens when blood leaks around the brain tissue eg: aneurysm rupture.

Is hemorrhagic stroke an emergency?

Yes, it carries a high risk of death.

How do you recognize a hemorrhagic stroke?

Dr. Chandril Chugh, Senior Consultant & Head – Interventional Neurology, Max Super Speciality Hospital, Saket says you need to REMEMBER THE 7 S METHOD TO DIAGNOSE STROKE

  • SUDDEN (symptoms usually start suddenly)
  • SLURRED SPEECH ( speech is not clear as if drunk)
  • SIDE WEAK ( face, arm or leg or all three can get weak)
  • SPINNING ( VERTIGO, accompanied by vomiting and imbalance)
  • A SEVERE HEADACHE
  • Sight ( loss of vision)
  • SECONDS ( note the time when the symptoms start and rush to the hospital)

What is the treatment?

Treatment depends upon the kind cause of haemorrhage and the clinical condition of the patient. However, the first step in the treatment of hemorrhagic stroke is stabilising the patient, controlling the blood pressure and brain swelling. Time is of the essence in the management of hemorrhagic stroke. Delaying treatment for a few hours may result in the death of the patient.

What are the risk factors for hemorrhagic stroke?

Hypertension is the most common risk factor for hemorrhagic stroke.

IS recovery possible?

Yes, recovery is possible but, it depends upon the haemorrhage and the quality of care the patient has received.

Can we give aspirin to the patient, like in heart attack?

No, aspirin is a blood thinner and can cause complications in a patient with hemorrhagic stroke.

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FAQs on Carotid Artery Disease/ Carotid Stenosis

February 1, 2018 0 214 1 minute, 13 seconds read

1. What are carotid arteries?

These are two large tubes which take blood from the heart to the brain through the neck. You can feel them pulsating in the neck if you press lightly (only one side) just away from the midline.

 

2. What is carotid stenosis?

Over time cholesterol may get deposited in the arteries and form a plaque which tends to block the flow of blood. As this plaque keeps getting bigger the artery may get completely blocked or occluded.

3. What are the risk factors for carotid stenosis?

High blood pressure, Cholesterol, Diabetes, Obesity and smoking are some of the risk factors.

4. Do I need to get my carotids fixed?

Dr. Chandril Chugh, Senior Consultant & Head – Interventional Neurology, Max Super Speciality Hospital, Saket, says not all carotid stenosis need procedural treatment, in fact, most don’t.  Treatment depends on a lot of factors like age, sex, risk factors and symptoms.

5. Does carotid stenosis increase my risk of stroke?

Yes, it does.

6. Can it be controlled by medicines only?

Yes, of course.

7. If I need a procedure for carotid stenosis what options do I have?

Carotid Stenting and Carotid endarterectomy (open surgery) are two options available.

8. I am scared of open surgery, what do I do?

Endovascular minimally invasive surgical options can be used to do carotid stenting.

9. How long do I have to stay in the hospital?

Stay usually lasts for about 2 days. It may change depending on the clinical condition of the patient.

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STROKE: It’s a CHOICE! Don’t Call it a Disease

December 8, 2017 0 72 2 minutes, 18 seconds read

For ages we have known that prevention is better than cure, it holds true even for a Stroke. Stroke or brain attack is a lifestyle associated disease and it is entirely your choice on how you choose to prevent it.

Dr. Chandril Chugh, Head, Interventional Neurologist, Max Super Speciality Hospital, Saket,  says the majority cases of stroke are due to a sedentary lifestyle and an unhealthy diet. Also, some of us are prone to having a stroke due to genetic causes, which is a different topic altogether. Preventing a stroke is not a rocket science and it can be prevented easily.  

Know about the Stroke Prevention Strategy:

High blood pressure: The single most important thing that anyone can do to prevent stroke is to control their blood pressure. The easiest way to control blood pressure is through exercise and diet and if needed medications. Normal blood pressure is less than 120/80 mm hg and anything higher should not be ignored.

High Cholesterol:  Second amongst the usual suspects is cholesterol.  One easy way to manage cholesterol is to increase fruits and vegetables in the diet and avoid fried foods. Consuming healthy fats from nuts (almonds or walnuts), fish oils and oils like olive oils and flax seed oil is also beneficial. If the diet doesn’t work then medications can come to rescue.

High Sugar: Sugar beyond the normal values is not good for the body. It is important to realize that and eliminate or at least limit the intake of sugary foods like cold drinks, juices, cookies, biscuits, chocolates, sweets etc. One 500 ml bottle of cold drink contains about 55 gm of sugar which is equivalent to 11 teaspoons of sugar….you can aptly call it the Devil’s drink,  it’s not going to do any good to you.

Smoking: The smoke that travels through the lungs into the blood and then gets circulated throughout the body gets mixed with blood, causing the blood to become sticky and causing a stroke. Stay away from smoking. There are two kinds of people who don’t smoke: The healthy ones and the ones who are paralyzed due to stroke.

Diet: My advice for diet is simple, you can eat anything that comes out of the ground (fruits, vegetables) is white (low-fat milk) or sometimes pink (fresh fish or lean chicken).  Stay away from anything in a plastic packet or a bottle.

Exercise: A good diet with regular physical exercise is the secret to good health. If you follow this routine you will not have to worry about the first three points of the discussion.

Doctor: The last piece of stroke prevention puzzle is the doctor.

“Your brain is the Ferrari of your body, and you don’t take your Ferrari to a roadside mechanic”. Choose wisely.

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Who is the Real “Hero” of Stroke Care?

November 17, 2017 0 79 3 minutes, 32 seconds read

We know more about our clothes and cars than we know about our health and body. It is astonishing that we spend more time to research about which laptop to buy, but when it comes to our own health most of us take a passive approach. This deficiency of knowledge is even more evident when it comes to dealing with emergencies.  “Ït is too late now, I am sorry!”  Unfortunately, we have heard this line more often in the real life than in films. 

The question arises, what can we do to change this? How do we tackle this deficiency? Dr. Chandril Chugh, Senior Consultant, and Head, Interventional Neurology, explains this with an example.

We had a 70-year-old female brought to the emergency room by her granddaughter for confusion and difficulty walking due to weakness on the right side. The granddaughter was sure that the symptoms had started right after the breakfast. It took them 45 minutes to drive, so they were in the hospital within the first hour of the symptoms. The patient was evaluated and head imaging was done which showed occlusion of the left middle cerebral artery (largest blood supply to the brain).

An Interventional Neurologist intervention was necessary, who recommended Mechanical Thrombectomy. The patient underwent the procedure successfully and was discharged without any deficits. The entire family was happy and satisfied with the treatment. Now my question is: who deserves the credit for this good outcome- The Interventional Neurologist, Neurologist or the emergency physician?  I personally believe that the “Hero” of this scenario is neither of the above but, the granddaughter. If she had not recognized the symptoms and brought her grandmother to the hospital in time, then we would not have been able to achieve what we did. She was aware of the stroke symptoms and took the right decision of coming to the hospital. When it comes to dealing with emergencies like Stroke or Brain attack, information and knowledge are life-saving.

Below mentioned are the important aspects of stroke diagnosis and care.

How do you recognize a stroke?

STROKE: REMEMBER THE 6 S METHOD TO DIAGNOSE STROKE

  • SUDDEN (symptoms usually start suddenly)
  • SLURRED SPEECH ( speech is not clear, as if drunk)
  • SIDE WEAK ( face, arm or leg or all three can get weak)
  • SPINNING ( VERTIGO)
  • SEVERE HEADACHE
  • SECONDS ( note the time when the symptoms start and rush to the hospital)

Can stroke be really serious?

If I were to say stroke is really bad, you will probably not believe me. Luckily, some studies have made my job easier. According to a study done by researchers in 2006 in the USA, a patient with ischemic stroke loses 190,00,00 brain cells every minute, about 14000,000,000 nerve connections are destroyed every minute and 12 km (7.5 miles) of nerve fibers are lost every minute. The end result is the patient gets paralyzed for life and becomes dependent. That's pretty scary!!!

Is there a treatment available for stroke?

Yes. The Stroke treatment depends on which kind of stroke the patient has. Up to 85 % of all strokes are ischemic (blocked blood vessel). For ischemic brain attack, there is an option of intravenous medication called tPA (recombinant tissue plasminogen activator) available which can be given to the patient within first 3 to 4.5 hours of the symptom onset. The patients who have a blockage in a large blood vessel can be offered a procedure called mechanical thrombectomy, which involves removing the blockage in the blood vessel and restoring the blood supply.  This procedure is done through a small nick in the groin and there is no open surgery involved. Recent trials have shown that patients do exceedingly well post mechanical thrombectomy and have a greater chance to live life independently.

Till what time can you do mechanical thrombectomy?

Mechanical Thrombectomy can now be offered up to 24 hours from the symptoms onset but, sooner its done better the patient does.

What is the single most important factor in stroke care?

The most important part of stroke care is not the doctor or the hospital, it’s the patient! As most of the strokes are painless, patients tend to ignore their symptoms and hence delay the treatment. If the patient and the family are aware of stroke symptoms they can reach the hospital in time and can get treated.

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Yes, it is a medical emergency. A brain attack occurs due to a blocked vessel (medically known as ischemic stroke) or due to a ruptured blood vessel (medically known as hemorrhagic stroke or a subarachnoid haemorrhage).

Time is of the essence when it comes to neurological ailments. Be it a stroke, aneurysm or head trauma, fast, safe and timely intervention is essential for a good outcome of the patient. Keeping this in mind, the best hospitals in India are investing in Biplane Cath Labs for Neuro-intervention.

This technology aids in the Diagnosis as well as treatment of disorders related to brain spinal cord, neck and face. 

Diagnostic:

What is an aneurysm?

An aneurysm is a weak spot in the blood vessel that expands into a balloon shaped structure over time. As the heart keeps pumping blood in the blood vessels of the brain this balloon (a saccular aneurysm) keeps getting bigger and may rupture. Some aneurysms may not look like balloons but, rather look like elongated tubes (fusiform).

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