Apollo News (1108)
Clinical Excellence
Apollo Hospitals, Bangalore performed a challenging and lifesaving small bowel transplant – a first of i...
Considered as one of the challenging surgeries of all time, team of expert transplant surgeons at Apollo Hospital Bannerghatta road Bangalore performed lifesaving small bowel transplant on a 45-year-old male Mr. Venkatesh Naik. It is said, to be a first of its kind surgery performed in the state of Karnataka.
It is believed that the bleak chances of receiving organs at the right time for the donation and shortage of expert surgeons in the country to perform this surgery, adds to the criticality of the case. It is a very challenging surgery and only a handful of centres in the world are performing such surgeries. In India till date only three such surgeries were performed in the past.
The patient, Mr. Venkatesh Naik, in June 2016, developed severe abdominal pain and went for medical advice. It was found that he had developed a clot in the superior mesenteric artery which supplies blood to intestine, and as a result his intestine had become gangrenous. Then, in order to save his life, doctors removed his entire small intestine.
Talking about his recent and rare surgery, Dr. Mahesh S Gopasetty, Consultant, Multiorgan Transplant surgeon (liver, kidney, pancreas, small bowel), Apollo Hospitals Bannerghatta, said, “It is considered to be very critical surgery as the exposure to infection is much higher. The patient was referred to Apollo Hospital, Bangalore for small bowel transplant and was supported and maintained by the Apollo Hospital gut rehabilitation team with total parenteral nutrition (TPN, nutrition given through vein) and enteral feeds. The expert team of surgeons, his loving family, The Love your Liver foundation and other NGOs helped him in overcoming these complications both mentally and physically during his four months in hospital under intense observation. Finally, after eight months, on 1st of March 2017, our team of experts at Apollo Hospitals, operated on him by transplanting small bowel and gave him a new lease of life.” The patient is recovering well and is stable.
Events
Apollo Life hosted an awareness session and Panel Discussion on Pelvic Pain – Myths and Reality
The panellists for the event comprised of acclaimed experts in the field of health and fitness, Dr Rooma Sinha(Gynaecologist), Dr K J Reddy (Orthopaedic), Dr Ravi Andrews (Nephrologist) and Ms Dinaz Vervatwala (Fitness Expert). They elaborated on pelvic pain from their respective disciplines perspective, dispelled some myths and also addressed the queries of the audience present and few from the 10000 viewers over webcast.
Ms Upasana Kamineni, Managing Director, Apollo Life, in her opening remarks said, this panel discussion was being hosted to dispel myths about pelvic pain, which most women suffer during their lifetime. The expert panel from various specialities will demolish these common myths and give a sense of assurance to women.
Speaking on the occasion Dr. Rooma Sinha said, “Chronic pelvic pain is a common problem in women, felt either in lower abdomen or in the back which could be associated with cyclical periods or can be present all through the month. There are a wide variety of conditions that could lead to pelvic pain. If the pain is mild it could be treated with medication, but if it is persistent, lasts for six months or more, or fails to respond to treatment, often difficult to treat, it can be considered as chronic and may need further treatment including surgery through minimally invasive Laparoscopic or Robotic techniques and in rare complicated cases through Hysterectomy.
According to Dr. K J Reddy, almost every women in her lifetime is afflicted of low back pain at some point or the other, it is also the second most common cause for pain. However, on the brighter side, one can completely recover from back pain with just some simple measures. He said the common causes of low back pain is poor posture, obesity, spondylosis, disc prolapse, osteoporosis and rarely cancer. Simple measures like sitting properly on a chair, regular exercises like walking, swimming, cycling, taking simple precautions while lifting weights and carrying heavy things will prevent this problem. Also, during pregnancy if one exercises regularly, most back pains will be prevented. Hence, the best medicine to prevent and treat low back pain is regular exercises, he added.
Dr. Ravi Andrews said, “Pelvic pain is very common in women and nearly 75% of women get pelvic pain at some time or the other in their lives. Renal causes of pelvic pain include urinary tract infection (UTI), stones, cancers, prolapse of the bladder and past surgical scars. Of these, UTI is the commonest. One in three women get at least one UTI by age 24 and as they grow older, the rate increases and 50% of women get at least one UTI in their lifetime. Untreated UTI leads to fertility issues. The common myths for the cause of UTI are Pants or tight clothing; Tampons or pads; Bicycle; Showers, baths, bubble baths; Coffee, tea or alcohol etc, but the actual reality is UTI is caused by frequent sexual intercourse; Previous UTI; usage of Condoms, Diaphragm or Antibiotic abuse.
According to Ms Dinaz Vervatwala, “The musculoskeletal causes of pelvic pain could be very weak core muscle or tight hamstring muscles. Weak and tight back muscles could also give rise to pelvic pain. A good analysis by a physical therapist will help in diagnosing the problem and giving an accurate exercise prescription. Posture plays a major role in preventing pelvic pain. A regular exercise program under the guidance of physical therapists will help in the prevention of pelvic pain. Excess body weight could also be a reason for pelvic pain so therefore, a balanced diet will help in keeping weight under control.”
The President of Apollo Life, Ariz Rizvi, moderating the session said, “Women are the primary caregivers and it is unfair to load them with the responsibility of taking care of everyone and themselves too.” Thus, he advocated that men should take personal interest in the well-being of their partners.
New Initiatives
On the occasion of International Women’s Day, Apollo Cradle, Chennai launched 4 Speciality clinics
International Women’s day is marked to celebrate the spirit of Womanhood world-wide. This day recognizes women as an embodiment of strength and power and an individual who gives birth to new life. A baby’s birth is one of the most special and unique times in a family’s life; an occasion met with a combination of unbridled joy, and jittery nerves, which surrounds the woman and her baby.
On this occasion, Apollo Cradle, Chennai highlighted an unusual yet successful surgery performed by a team of experts. The patient, a 32-year-old woman, who was carrying 34 weeks foetus had complaints of excruciating pain in the back and decreased movement of left leg. Earlier antenatal check- ups at a private hospital, suggested degenerative disc disease and precautions by the patient was not taken. Pregnancy becomes more critical in a woman with spinal disc prolapse. The growing foetus enhances the physical limitations of women with spinal disability. This pregnant mother with spinal injury was successfully managed in Apollo Cradle by a multi-disciplinary team comprising of obstetrician, orthpedician, anaesthetist, paediatrician and on the third day she was able to walk with the help of physiotherapist,” said Dr. Charumathi, Gynecologist.
Led by India’s best Obstetricians and specially trained nurses, Apollo Cradle houses experienced clinical support and personal attention which are hallmarks of the obstetric care. “We have an immense pleasure in celebrating the second anniversary of this speciality. We will continue to provide care and service with soothing, tastefully adorned environments paired with the state-of-the-art equipment and delivery suites,” Dr Sumana Manohar, Gynaecologist, Apollo Cradle.
Apollo Cradle is well known for dealing with high risk obstetrics such as patients with pre-eclampsia, liver dysfunction, neurological problems, cardiac diseases, placental problems and sfetal anomalies since the time of its inception,” said Dr. Jaishree Gajaraj, Gynecologist.
The event concluded with the launch of 4 specialty clinics, a clinic for High Risk pregnancy, Urinary Continence Clinic, Sexual Health Clinic and a clinic for Polycystic Ovary Syndrome.
Technology
Apollo Hospitals announces partnership with TechEmerge to increase screening capacity for cervical cancer at a...
The Apollo Hospitals Enterprise Limited proudly announced its partnership with MobileODT that will apply its Enhanced Visual Assessment (EVA) System to reduce loss of follow up for women who screen positive on cervical cancer screening tests, and increase internal capacity to screen for cervical cancer at a lower cost.
Cervical cancer kills 1 Indian every 7 minutes and more women die from cervical cancer in India, than in any other country and it is preventable. However, to be effective in reducing cervical cancer incidence and mortality, screening programs must be of high quality. MobileODT’s Enhanced Visual Assessment (EVA) System, is a comprehensive point of care tool, built on a smartphone, for cervical cancer screening. The device augments a smartphone’s optics to enable enhanced imaging while the app allows for image and patient data capture for remote consultation.
Apollo Research and Innovations (ARI), a division of Apollo Hospitals has a comprehensive ecosystem to undertake evaluation and validation of Innovations in Healthcare. With the burden of cervical cancer, it is important to have clarity on cervical cancer screening to get information and actual data from the rural, semi-urban and urban areas to get realistic community data and perspective.
Seemant Jauhari, CEO – Research & Innovations, Apollo Hospitals said, “The Indian healthcare landscape presents significant challenges related to patient volumes access and affordability. Traditional healthcare delivery models necessarily need to be disrupted by converging Technology with healthcare. Mobile ODT is one such disruptive technology which shall facilitate taking cervical screening to the people of India, enable early screening and hence early treatment thus slowing down incidences of cervical cancer. It maximises the chances of making cervical cancer screening programme successful.”
“India is home to 1/3 of all cervical cancer deaths worldwide. We are honoured to be working with Apollo Hospitals given its focus on quality, innovative, and patient centred care to tackle this large, but preventable challenge women face across all of India. We hope this partnership continues to expand, to ensure all Apollo patients have quality cervical cancer screening from the smallest rural clinic and telemedicine efforts to the large urban centres.” said Ariel Beery, CEO, MobileODT.
Mobile ODT EVA system has been piloted around the world (namely in Haiti, Guatemala, Botswana, Kenya, Nepal, Mexico, Kenya, United States) before the collaboration with Apollo Hospitals. It is important to pilot the device over 5 sites to understand the efficacy, utility and usability of the technology. The sites chosen cover rural area (Aragonda), semi-urban (Apollo Vanagaram, Apollo Madurai), urban (Apollo First Med, Apollo Tondiarpet) and high income group (Bangalore). With the presence of Apollo Hospital centres in all the areas, Apollo Research and Innovations (ARI) is in a position to give the public data, rather than restricting to only a regional data.
Apollo Hospitals Enterprise Limited with MobileODT was selected from 330 companies to apply the life-saving technology in India through TechEmerge, which matches technology companies around the world with partners in emerging markets to deliver tools that improve quality of life. As a result of the rigorous process, with advisors from IFC and Health 2.0 part of the design, MobileODT is launching new pilots with Apollo Hospitals and International Oncology.
Clinical Excellence
Apollo Hospitals, Muscat successfully performed an OATS surgery arthroscopically – a rare feat in Oman
Dr Ranjith Nair, head of Department, Orthopaedics, Apollo Hospital Muscat, led his orthopaedic team to perform an entire Osteochondral Autograft Transfer System (OATS) surgery arthroscopically (keyhole surgery technique). A surgical procedure of this kind is a rare feat in Oman, as majority of centres skilled in this discipline perform this technique as open surgeries involving a longer recovery period.
“OATS is not recommended for everyone but is typically used for younger patients under 50 years with minimal cartilage damage and available healthy cartilage for transfer. A successful OATS surgery will enable the bone and cartilage to grow into the damaged area of the knee, successfully resolving the patient’s knee pain. OATS is considered to be the gold standard in orthopaedic surgery for successful cartilage repair,” said Dr Nair.
The patient was a 22-year-old male who approached Dr Nair with continuing pain in his left knee, the aftermath of a fall while playing football three months ago. Dr Nair added, “The patient is recovering smoothly and post operatively has already started physiotherapy and non-weight bearing crutch walking.”
Dr Dilip Singhvi, Medical Director, Apollo Hospitals, said, “Dr Nair and his team have always been focused on using better surgical techniques for excellent results.”
New Initiatives
Apollo Hospitals, Bilaspur extended its support to the launch of the Chandigarh Chapter of SEMI
The Chhattisgarh chapter of SEMI was launched with the aim is to create awareness in the development of Emergency Medicine in Chhattisgarh with major thrust being on training more personnel. Emergence Medicine is perhaps newest of the specialties accepted in India and by MCI. It is a vast specialty catering practically to each and every specialty in the field of medicine.
The vastness of the specialty can be accessed from the range of cases which includes MI, stroke, Trauma and Sepsis to a foreign body in the ear. Needless to say, with the enormous amount of cases, there has to be structured department with trained personnel with procedures and protocols. Above all, Emergency department is where most of the medico legal cases are dealt with. Also, an Emergency medicine department has to function quickly, precisely, proficiently while coordinating with other hospital departments.
SEMI being the oldest, largest and undoubtedly the best Emergency medicine organization consented to launch a chapter in Chhattisgarh. The team would be focussing on forming a structured and protocol oriented emergency department for hospitals, initiate training of Doctors and Nurses. The coordination between hospitals, government and private sectors would need constant and sustained support from various hospitals, Government, Community leaders, the media and the community itself.
Clinical Excellence
Apollo Hospitals, Bangalore successfully performed complex liver transplant surgeries, saving the lives of two...
Considered to be the most complex and challenging surgeries in the medicine, the liver transplant performed by the team of medical experts at Apollo Hospitals saved the lives of two patients from Bijapur.
Basavaraj Maralabhavi, 46 years old and Dhanraj Pattanshetty, 42yrs had lost all hopes when they were detected with advanced stages of liver diseases. Both men faced a similar dilemma when they could not find donor-match or liver tissue within their family. Upon discussion, Dr. Mahesh S Gopasetty, Consultant and Multiorgan Transplant Surgeon at Apollo Hospitals advised them to enlist in the cadaver transplant program. Soon both the patients found appropriate tissue-match and underwent the surgery.
“Apollo Hospitals is one of the very few institutions that can perform organ transplants seamlessly. Liver transplants of this nature are highly complex surgeries but a patient suffering from liver disease needs to know that these diseases are curable and treatable. Correct information and counselling can bring hope back to people”, said Dr. Mahesh S Gopasetty, Consultant, Multiorgan Transplant Surgery, Apollo Hospitals.
Elaborating on their experience, Dhanraj Pattanshetty, Office Superintendent at Agricultural Produce Market Committee said, “I was suffering from the worst case of jaundice with increased bilirubin level for the past six years. We had almost lost all hopes of my survival but then we came to know about Apollo Hospitals and Dr Mahesh told us that we can actually find cadaveric donor liver. Thanks to the team that a major operation of this nature was conducted and I was given complete care during the process”
Majority of the people on the waiting-list for organ transplant face a long wait due to shortage and unavailability of appropriate donor-match. Herein, Apollo Hospitals, through their vast network, ensures that donated organs reach the needy in time. “Just like the heart, the liver is also prone to infection and when such organs are transplanted through cadaver-donation, it requires proper guidance, precautions and proper medication to ensure a seamless healing process. Although the risk of infection is high in such cases the team ensured that all safety measures were in place.” added Dr. Mahesh S Gopasetty.
Clinical Excellence
Apollo Hospitals, Hyderabad performed a pioneering and complex case of nose implantation through a complex pla...
Doctors at Apollo Hospitals, Jubilee Hills, performed a rare case of nose implantation on a Tanzanian man, recently. Dr Sudhakar Prasad, Senior Consultant Plastic & Cosmetic Surgeon, who performed this surgery, briefed media on implanting a fabricated nose, repaired to function, by painstakingly constructing it using skin, cartilage & blood vessels, from different parts of the body. The Patient, a Tanzanian man, lost his nose in a grievous assault and came to India after exhausting options elsewhere in the last two years since the incident.
The serious assault with knives on the 46-year-old, Mr Sillah Kwahu, in September 2014 in Tanzania, led to defacement with multiple facial injuries and chopping off of the nose completely. He was initially treated at Tanzania. But his continuing ordeal led to him being referred to Dr Sudhakar Prasad at Apollo Hospitals, for further treatment.
Dr Sudhakar Prasad, on evaluating the patient realized the enormous complexity in restoring a proper and functional nose. Normally in such patients the obvious choice of treatment is the famous Indian rhinoplasty technique described by Sushruta. Unfortunately, due to multiple knife injuries on his face, this treatment option was found to be inappropriate and the other regular options were ruled out too one by one.
Dr Sudhakar Prasad falling back on his vast experience of over three decades in plastic and micro surgery, conceived a pioneering and complex procedure to provide lasting relief to the patient. This unique method combined the techniques of plastic surgery and micro vascular surgery. In the initial stage with a combination of patient’s forearm skin, cartilage grafts from ears and skin graft, a nose was moulded and cultured on the left forearm. After a suitable healing period, the newly created nose and blood vessels supplying it, were separated from the fore arm and transferred to the face. The blood supply was restored in the face by micro surgically joining the blood vessels of forearm to the blood vessels of the face, using sutures thinner than human hair. The new nose healed in a few weeks’ time.
As a final refinement, the nose was sculpted into a much thinner size and some more cartilage from the rib was added to create a good nasal bridge. Now he has a normal nose, in place of the one he lost two years agso.
Clinical Excellence
Apollo Hospitals, Nashik performed an awake bypass surgery on a critically ill patient suffering from a cardia...
Sixty-six-year-old, Mr Ashok Katkade would have never expected that his ordeal for next 2 months at Apollo hospitals, Nashik would become an example of team approach for management of critically ill cardiac patient. His visit to the emergency department was in a very unstable condition. Cardiologist Dr Sudhir Shetkar said,” The patient had presented to us with extremely low blood pressure with excess fluid in his lungs, impairing oxygenation, a condition known as cardiogenic shock with acute pulmonary edema”. His cardiac function had reduced to mere 30% due to a recent heart attack and he also had severe kidney dysfunction with highly uncontrolled diabetes. He required mechanical ventilation for next 21 days, during which his kidney function, heart function, Lung infection and diabetes were managed by a team of critical care physicians, chest physician and nephrologists, led by Cardiologist Dr Shetkar.
After stabilization over 21 days he underwent a coronary angiography which showed critical multiple blockages, for which bypass surgery was the only option. Senior cardiac surgeon Dr. Abhaysingh Walia, Cardiologist Dr Sudhir Shetkar and Cardiac anaesthetist Dr. Bhupesh Parate discussed the scenario with patient and relatives.
Normally in bypass surgeries, a patient is completely made unconscious and put on ventilator, but this patient having very poor lung, kidney and heart condition was at very high risk of death during surgery with such anaesthesia. Hence it was collectively decided to perform an awake bypass surgery in which patient is not made unconscious and is not put on ventilator machine. The cardiac anaesthetist gave the patient a special type of anaesthesia called as epidural anaesthesia, in which the patient doesn’t feel pain but is still conscious. He was then successfully operated upon by cardiac surgeon.
This case is peculiar in its criticality of disease and good team approach, in managing a seriously ill patient, who because of his multiple ailments would have been lost. It also reinstates the fact that outcome of such patients is really much better when a complete heart team consisting of cardiologist, cardiac surgeon and cardiac anaesthetist take collective decision rather than any one dictating the calls. This Heart team approach is routinely recommended by most international heart societies for management of critical cardiac patients with extensive coronary artery disease, however is rarely followed in our country.
Clinical Excellence
Apollo Hospitals, Hyderabad performed a first of its kind surgery to remove a bullet from the Patient’s ...
Mr. Mahmud, 50-year-old male from Somalia had a bullet injury 9 months before he had come to Apollo Hospitals. Since then, he was having continuous pain in the abdomen which prevented him from doing his work. He visited lot of hospitals both in his country and in India and was advised surgical removal of the bullet. In all the hospitals, he was advised conventional open surgery – wherein the abdomen is cut open and bullet along with some part of the liver are removed. He was also told that it is a high-risk surgery.
He then visited Apollo hospital and after evaluating him thoroughly Dr.P.Siva Charan Reddy and team planned a laparoscopic surgery – wherein two small holes of 0.5 cm are placed in the abdomen and with the help of specialized instruments the exact location of the bullet was identified and the bullet was removed preserving the liver and the surrounding important structures. This surgery was done with very minimal blood loss and the patient was discharged within 24hrs. Post operatively patient was totally pain free and was back to his routine work.
Laparoscopic removal of such a bullet injury is probably a first in the country and we at Apollo are proud to have done.
With the increased expertise of laparoscopic surgeons, we are able to perform many such complicated and challenging surgeries safely and effectively in many such patients. The conventional or open surgery would have left a large scar about 15 – 20 cms in length and post-operative recovery would have taken about a week to ten days, but with laparoscopic surgery the patient does not have any scar and was discharged in less than a day.
Milestones
Apollo Blood Transfusion Service – Setting New Milestones
Blood Transfusion Service (BTS) is a vital part of the modern healthcare system, without which efficient medical care is impossible. The aim of BTS is to provide effective blood and blood products, which are as safe as possible, and adequate to meet the patients’ need. Apollo’s Department of Transfusion Medicine is self-sufficient at meeting the blood requirements for all in-house patients, and also provides blood and blood components to other hospitals in Delhi/NCR as and when required.
Department of Transfusion Medicine accepts and receives only voluntary/voluntary replacement donors for blood donation. With a warm welcome, Apollo’s well-trained staff performs donor screening, and maintains donor privacy and confidentiality at all times. Trained phlebotomists take the donation in specialised blood collection bags with integral filters; first sample pouch, which diverts the first 15-20 ml of blood, and needle guard to ensure 3-4 log leukoreduced blood, reduced bacterial contamination and prevent needle stick injuries to the phlebotomist respectively. Leucoreduction prevents Febrile Non Haemolytic Transfusion Reactions (FNHTR), HLA alloimmunisation, transmission of lymphotropic viruses such as EBV, CMV and HTLV-I & II.
The Immunohaematology Laboratory of the Department is a reference centre providing advanced Immunohaematology work-ups for patients across Delhi.
Provision of extended phenotyping for all blood donors is in place, and helps the department to provide phenotypically-matched blood for patients with common type of Rh and Kell alloantibodies. The Department is capable of resolving grouping discrepancies, autoimmune haemolytic anaemia workups, and multiple alloantibody workups.
The Department is the first centre to introduce Hepatitis C antibodies and Hepatitis B core antibodies in blood donors in the year 1996, besides the other mandatory tests, i.e., HbsAg for Hepatitis B, HIV I &II, malaria, and syphilis. Hepatitis C antibody testing later became mandatory in the year 2000.
The Department is a pioneer in starting Individual Donor (ID)-NAT (Nucleic Acid Test) on all the donated blood units in the country, since 2006. This has reduced the window period of HIV, HBV, and HCV considerably, and is a step forward in our quest for zero-risk blood.
The Department caters to the transfusion needs of approximately 75 thalassemic patients. We provide ID-NAT tested, 3 to 4 log leukoreduced blood to these patients.
We perform regular screening for any irregular red cell antibodies and extended blood group phenotyping for thalassemic patients, thus providing the safest possible blood to them. These patients are also typed by advanced molecular methods for red cell antigenic profile and receive a phenotype matched blood, thereby reducing the risk of alloimmunisation.
The Department has a wellestablished Donor Apheresis Programme that functions round the clock, and has extended its services to the bedside of the patient by performing therapeutic apheresis procedures like plasma exchange and red cell exchange. A well advanced peripheral blood stem cell harvesting programme for autologous and allogenic donors with cryopreservation is in place for treatment of several haematological and non-haematological approved conditions.
Milestones
Apollo Hospitals, Nashik performs its First Live Related Kidney transplant on a 35-year-old patient
The Patient was a thirty-five-year-old man who was struggling to live due to his chronic kidney disease and his Mother came forward and donated the kidney.
Dr Mohan Patel said that kidney donation from living family member is preferable and is as safe as blood donation. He also added that soon they will be starting SWAP kidney transplant (Paired Kidney Exchange), Paediatric transplant and laparoscopic surgeries for the donor.
The transplant was done by the team of consultants involving Nephrologist (Dr Mohan Patel and Dr Prakash Ugale), Transplant surgeons (Dr Kishor Wani, Dr Nandan Vilekar and Dr Pravin Govardhane) and Anaesthesiologists (Dr Chetan and Dr Ketan) along with transplant coordinator Ms Charusheela Jadhav.
Apollo Hospitals, being India’s leader in organ transplant, now has fully functional Kidney transplant unit in Nashik hospital with world class standards at affordable rates. It has all facilities required for the kidney patients like pre-transplant evaluation, 24 x 7 dialysis, post-transplant isolation care, 24 x 7 trained intensivists and nursing staff. It has reduced the financial burden on patients travelling to Mumbai and Pune.
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