Care Institute of Medical Sciences Outcomes 2018

International Certificate No. MC-3049 Centers Of Excellence Green Hospital

A premier multi-super specialty GREEN hospital What's Inside n Vision, Mission and Values n Trauma Center n Board of Directors n Gastro-Intestinal and General Surgery n Awards n Endoscopy n Abbreviations n Oncology n About CIMS n Nephrology n Departmental Overview n Urosurgery n In Vitro Fertilization Center n Bariatric and Metabolic Surgery n Heart Transplant n Plastic Surgery n Bone Marrow Transplantation Unit n Obstetrics and Gynecology n Renal Transplant Center n Neonatal Center n Blood Bank n ENT n Genetic Center n Pain Management n Fever Clinic n Dentistry n National Cardiovascular Data Registry (NCDR): n Ophthalmology Knowledge Processing n Pathology n Cardiology n Radiology n Cardiac Investigations n Physiotherapy, Rehabilitation and Nutrition n Cardiac Rhythm Disorders n Code Blue n Cardiac Surgeries n Quality Measures n Heart Failure n Ambulance and Transport Services n Cardiac Valve Disorders n Care At Homes n Minimal Invasive Cardiac Surgery n Patient's Say n Pediatric Cardiac Sciences n Ethics n Vascular and Endovascular Surgery n Research Projects n Thoracic n CIMS Foundation n Orthopedic n CIMS Learning Center n Critical Care n CIMS Education n Infectious Disease n Publication List n Pulmonary Medicine n Neurosurgery n Spine Surgery 1 Vision, Mission and Values

2 Vision, Mission and Values

2 Vision, Mission and Values

VISION

To be one of the most trusted hospital in India by providing personalized care for best patient experience.

MISSION

Care To provide superior quality Innovation Health Care using Innovation Manage Lives } to Manage and Save lives. Save Lives

VALUES Patient’s well-being: It will be our top most priority To Serve with a Smile Adopt and encourage ethical practices Provide a safe and comfortable working environment to employees and associates Embrace technology and innovation in the delivery of healthcare Provide socially responsible and safe healthcare Comply with all applicable laws and regulations

3 Board of Directors

Dr. Keyur Parikh Dr. Milan Chag Dr. Anish Chandarana Dr. Hemang Baxi Chairman Managing Director Executive Director Director

Dr. Urmil Shah Dr. Ajay Naik Dr. Satya Gupta Dr. Dhiren Shah Director Director Director Director

Dr. Ashit Jain Mr. Kirti Patel Dr. Kamlesh Pandya Dr.(Prof.) Dilip Mavlankar Director, USA Director, UK Director, USA Director, India

4 Awards

International Healthcare Global Healthcare Excellence 3rd Digital Health Innovation Awards, 2018 Awards, 2018 Summit 2019

Gujarat Best Brand International Healthcare Awards, 2018 Awards, 2019

5 Abbreviations

2D 2 Dimensional BMT Bone Marrow Transplant

3D 3 Dimensional BSI Blood Stream Infection

4D 4 Dimensional CABG Coronary Artery Bypass Grafting

ACCF American College of Cardiology Foundation CAD Coronary Artery Disease

ACE Angiotensin -Converting -Enzyme Inhibitor CAE Carotid Artery Endarterectomy

ACLS Advanced Cardiac Life Support CAS Carotid Artery Stenting CBC Complete Blood Count ACR American College of Radiology CCU Critical Care Unit ACS Acute Coronary Syndrome CHD Coronary Heart Disease AHA American Heart Association CIED Cardiovascular Implantable Electronic Devices AIDS Acquired Immune Deficiency Syndrome CLC CIMS Learning Center AMA American Medical Association COPD Chronic Obstractive Pulmonary disease ARB Angiotensin II Receptor Blocker CPR Cardiac Pulmonary Resuscitation ASD Atrial Septal defect CRRT Continuous Renal Replacement Therapy AV Aortic Valve CRT Conformal Radiotherapy AVM Arteriovenous malformation CRT-D Conformal Radiotherapy- Dimensional AVR Aortic valve replacement CT Computed Tomography

BA/BE Bio Availability/ Bio Equivalent CT-SCAN Computed Tomography

BAS Ballon Artrial Septostomy CV Cardiovascular

BAV Balloon Aortic Valvuloplasty CVD Cardiovascular Disease

BLS Basic Life Support D TO B Door To Ballon

BMI Body Mass Index DAP Dose Area Product

6 Abbreviations

DBP Diastolic Blood Pressure H2F Hospital To Family

DHS Dynamic Hip Screw H2H Hospital To Home

DLCO Diffusing Capacity of the Lungs for Carbon HAI Hospital Acquired Infection

Monoxide HDL High Density lipoprotein

DVR Double Valve Replacement HDU High Dependency Unit

ECG Echocardiograms HEPA High Frequency Particulate Air

ECHO Echocardiogram HFOV High Frequency Oscillatory Ventilation

ECMO Extracorporeal membrane oxygenation HIV Human Immunodeficiency Virus

ENT Ear, Nose, Throat HLA Human Leukocytic Antigen

EP Electrophysiology HPV Human Papilloma Virus

EPS Electrophysiology Study ICCU Intensive Coronary Care Unit

ERCP Endoscopic Retrograde Cholangio ICD Implantable Cardioverter Defibrillator

Pancreatography ICH-GCP International Council of Harmonisation -

FDA Food and Drug Administration Good Clinical Practice

FESS Functional endoscopic sinus surgery ICMR Indian Council of Medical Research

FISH Fluorescence In Situ Hybridization ICSI Intra Cytoplasmic Sperm Injection

FT Flurotime ICU Intensive Care Unit

GERD Gastroesophageal Reflux Disease IITV Image Intensifier Television

GI Gastrointestinal IMRT Intensity Modulated Radiotherapy

GICU General Intensive Care Unit IUI Intrauterine Insemination

GIST Gastrointestinal Stromal Tumor IV Intravenous

7 Abbreviations

IVF In vitro Fertilization NCDR National Cardiovascular Drug Registry

IVU Intravenous Pyelogram NIBP Non-Invasive -Blood Pressure

JIC Joint International Conference NICU Neonatal Intensive Care Unit

LDL Low Density Lipoprotein NIEPS Non invasive EP Study

LOS Length of Stay NO Nitric Oxide

LV Left Ventricular OPD Out Patients Deparments

LVEF Left Ventricular Ejection Fraction OT Operation Theatre

LVRS Lung Volume Reduction Surgery PAD Peripheral Arterial Disease

MDR Multi-Drug-Resistant PAMI Primary Angioplasty in Acute Myocardial

MICAS Minimally Invasive Cardiac Surgery Infraction

MLC Multileaf Collimator PCI Percutaneous Coronary Intervention

MRA Magnetic Resonance Angiography PCNL Percutaneous Nephrolithotomy Surgery

MRI Magnetic Resonance Imaging PDA Patent Ductus Arteriousus

MUFA Monounsaturated Fatty Acids PERM Programme Electronic Review Management

MV Repair Mitral Valve Repair PFO Patent Foramen Ovale

MVR Mitral Valve Replacement PFT Pulmonary Function Test

NABH National Accreditation Board for Hospital & PGD Preimplantation Genetic Diagnosis

Healthcare Providers PM10 Particulate Matter 10

NABL National Accreditation Board for Testing and PM2.5 Particulate Matter 2.5

Calibration Laboratories PPPPP Prior Planning Prevents Poor Performance

NBP Noninvasive Blood Pressure PRP Platelet-rich Plasma

8 Abbreviations

PT Prothrombin Time TIFFA Targeted Imaging for Fetal Anomalies

PT CA Percutaneous Transluminal Coronary TMT Treadmeal Test

Angioplasty TOF Tetralogy of Fallot

PTSMA Percutaneous Transluminal Septal Myocardial TOT Transobturator Tape

Ablation TPN Total Parental Nutrition

PUFA Polyunsaturated Fatty Acids TRA Tranradial Approach

PVL Periventricular Leukomalacia TTI Transfusion Transmitted Infection TURBT Transurethral Resection of Bladder Tumor QCI Quality Council of India TURP Transurethral Resection of The Prostate RCT Root Canal Treatment TV Tidal Volume RFA Radiofrequency ablation TVT Tension Frees Vaginal Tape RVG Radionuclide Ventriculogram URS Ureteroscopic SBP Systolic Blood Pressure US United States SICU Surgical Intensiv Care Unit USG Ultra Sonography SLE Systemic Lupus Erythematosus UTI Urinary Track Infection SO2 Sulfur Dioxide VAD Ventricular Assist Device SPO2 Peripheral Capillary Oxygen Saturation VAP Ventilator-Associated Pneumonia SSI Surgical Site Infection VATS Video Assisted Thoracic Surgery STEMI ST-Elevation Myocardial Infarction VIU Visual Internal Urethrotomy SVR System Vascular Resistance VMAT Volumetric Modulated Are Therapy TAVI Transcatheter aortic valve Implantation VSD Ventricular Septal Defect TB Tuberculosis VSG Vertical Sleeve Gastrectomy

TEVAR Thoracic Endovascular Airtic Repair WBC White Blood Cell

TFA Transfemoral approach XDR Extensively Drug-Resistant 9 About CIMS

A 350-bedded, multi-super specialty, Care Institute of Medical Science

(CIMS) Hospital is one of the best hospitals of Ahmedabad (Gujarat) providing

a range of diagnostic and treatment services.

Delivering the highest standards of global healthcare, CIMS Hospital is

accredited by JCI – Joint Commission International (USA), NABH (National

Accreditation Board for Hospitals & Healthcare Providers) and NABL

(National Accreditation Board for Testing and Calibration Laboratories) for

providing quality healthcare and patient safety across India.

Spread across two spacious and state-of-the-art buildings CIMS East and

West, CIMS Hospital offers a combination of the most experienced doctors,

latest technology and excellent infrastructure, ensuring world -class patient

care and treatment.

The Hospital has evolved a culture to deliver human and compassionate care

to its patients.

Our motto of ‘‘Patient First Always” is the backbone of firm commitment to

deliver the best and safest care to our patients.

CIMS has a vast pool of talented and experienced team of doctors, who are

further supported by a team of highly qualified, experienced & dedicated

support staff & cutting edge technology. More than 110 consultants and 940

employees work together to manage over 16393 inpatients per year. The

hospital has an infrastructure comprising of around 350 beds including about

128 ICU beds, 12 Operation Theatres, state-of-the-art digital flat panel Cath

lab, an ultra-modern dialysis unit besides a host of other world-class facilities. 10 About CIMS

CIMS Hospital Scores High on Technology: ŸGujarat’s first digitized operation theatres and ICUs. ŸGujarat’s First ECMO facility ŸLatest Cancer Radiation machines ŸLatest Radiology- MRI and CT scan Machine ŸGujarat’s first certified GREEN Operation Theaters: certified for safe practices and environment friendly features such as low emission of carbon dioxide, infra-red rays and radiation within permissible limits. ŸOne of the most advanced ultra-modular and fully monitored emergency & trauma facility ŸAdding to its clinical triumphs, CIMS Hospital following first heart transplant has further performed a total of 8 heart transplants - the only center in Gujarat to perform heart transplant. Besides, CIMS has also recently established Paediatric Bone Marrow Transplant programme and Blood Bank within the premises of the hospital to facilitate smoother services for all patients.

11 About CIMS

CIMS Flagship ŸJCI (Joint Commission International), NABH(National Accreditation Board for Hospitals and Healthcare Providers) and NABL(National Accreditation Board for Testing and Calibration Laboratories) accreditation ŸNABH Emergency ŸNABH Ethics committee (First in India) ŸGreen OT International Certificate No. MC-3049 Centers Of Excellence ŸFirst Heart Transplant Surgery of Gujarat ŸPediatric Bone Marrow Transplant Unit - First in Gujarat ŸRadial Lounge (One of the first in the country) ŸTAVI (Transcatheter Aortic Valve Implantation ) - First in Gujarat ŸDigitized OTs and ICUs for better patient care - First in Gujarat ŸCertified Heart and Renal Transplant Center ŸFirst ever ECMO (Extracorporeal Membrane Oxygenation) machine for patients with cardio respiratory failure ŸThe High level Isolation Unit (HLIU) ŸFirst in Asia Pacific to set up Elekta Versa HD for cancer radiation treatment ŸOne of the only private Hospital in Western India with 3 Cath labs ŸOne of the only Indian Hospital Certified as International Center of Excellence(ICOE) by American college of Cardiology (ACC) ŸCare at Home : A branch of homecare for medical and nursing care at home ŸHospital to Home visits to improve drug (medicine) adherence and patient compliance ŸA fleet of well-equipped ambulances with ECMO facility; pediatric ambulance ŸExclusive Trauma Center following ATLS (Advanced Trauma Life Support) protocols Center ŸRound-the-clock dialysis facility ŸEthics Committee that provides assistance with ethical issues related to patient’s safety and well-being. 12 About CIMS

TECHNOLOGICAL EXCELLENCE ŸState-of-the-Art Equipment ŸHigh-end Cath Labs with DSA and stent boost facility ŸCT Scan Revolution EVO 128 slice-First in India ŸMRI Sigma Explorer Electrophysiology with 3D system ŸEchocardiography machines with 3D-TEE, 3D adult and pediatric Echo Ÿ24 x 7 x 365 'stroke' unit with latest CT scan with CT angiography and perfusion scan facilities First in India ŸPACS system to view various imaging in ICU and doctor's lounge ŸCarto-3 system, state-of-the-art imaging system offers enhanced visualization for treating arrhythmia patients ŸState-of-the-art 12 operation theaters 4 modular OT's with class 100 laminar air flow traction device with IITV to support all types of trauma fully digitized ICUs and OTs ŸExtracorporeal membrane oxygenation (ECMO) ŸDedicated Neutropenic Care ŸGujarat’s First Carl Zeiss Pentero 900 Microscope (High - end path breaking innovation for enhanced visualization during surgery)

13 Department Overview :

14 Department Overview :

15 In Vitro Fertilization Center

CIMS Hospitals is a state-of-the-art specialty hospital in India for all infertility treatment and IVF. CIMS hospital provides best quality, comprehensive and holistic care to women in India at a reasonable cost. An interdisciplinary team of expert and caring professionals is committed to meeting the physical as well as emotional and spiritual needs for each woman and her family. The Hospital has been designed and furnished to provide a high level of Fertility care with comfort and privacy. Every room is spacious and private. The architecture is soothing and dignified, with a clean, modern design. Hospital is having India’s first 0.3 micron clean air IVF treatment lab. CIMS IVF provides a wide range of infertility services including: ŸOvulation Induction ŸIUI-Intrauterine Insemination ŸReproductive Surgery: Laparohysteroscopy for evaluation of infertility ŸIVF – In Vitro Fertilization ŸAssisted Hatching ŸGenetic Counselling ŸFrozen embryo Transfer ŸCryopreservation ŸICSI – Intra Cytoplasmic Sperm Injection ŸAndrology Services ŸSurgical Sperm Retrieval ŸFamily-friendly labour and delivery suites ŸExpert in high risk deliveries with continuous monitoring ŸEpidural and pain management through in-house anesthesiologists ŸNeonatal Intensive Care Unit (NICU) IVF is Useful to Treat Patients With ŸBlocked or damaged fallopian tubes ŸMale factor infertility including decreased sperm count or motility ŸWomen with ovulation disorders, premature ovarian failure, uterine fibroids ŸWomen who have had their fallopian tubes removed ŸIndividuals with a genetic disorder ŸUnexplained infertility

16 Heart Transplant

Because of awareness to organ donation in India, treatments for heart failure and heart transplants are increasing across the country. CIMS's heart transplant doctors and surgeons use proven innovations to successfully treat people with congestive heart failure and other serious heart diseases. Their experience in using advanced technology, specialized procedures and an integrated approach focused on the patient makes CIMS Hospital a leader in transplant outcomes Heart Transplantation CIMS Hospital Ahmedabad achieved one of the rare feats by doing the 1st heart transplant surgery in Gujarat. CIMS Heart Transplant Team has successfully completed 8 Heart Transplant so far. Heart transplants are performed when other treatments for heart problems haven't worked, leading to heart failure. In adults, heart failure can be caused by several conditions, including: ŸA weakening of the heart muscle (cardiomyopathy). ŸCoronary artery disease ŸHeart valve disease. ŸA heart problem you're born with (congenital heart defect). ŸDangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other treatments. ŸAmyloidosis. ŸFailure of a previous heart transplant. ŸIn children, heart failure is most often caused by either a congenital heart defect or a cardiomyopathy.

17 Heart Transplant

18 Bone Marrow Transplant

CIMS Centre for Bone Marrow Transplant is one of the best in India and Gujarat. Centre for Bone Marrow Transplant is a stand alone dedicated facility, equipped with ultra-modern infrastructure and internationally trained and widely experienced faculty. The Centre is supported by state-of-the-art laboratory services and transfusion services, along with a fully equipped radiation oncology unit with facility for total body irradiation. The Centre offers both allogenic and autologous stem cell transplant using bone marrow, peripheral blood stem cells and cord blood stem cells for various benign and malignant disorders like Thalassemia, Aplastic Anaemia, Leukemia, Lymphomas, Multiple Myelomas and Advanced Paediatric Solid Tumors.

CIMS Bone Marrow Transplant Unit has Performed 73 BMT with 96% Disease free Survival Success Ratio.

Key Department Highlights ŸEach room is supported by separate HEPA filter with triple level air filtration ŸTransplants are routinely performed for children as well as adults ŸLeading bone marrow transplant and high end Hematology reference center ŸBoth Allogenic and Autologus stem cell bone marrow transplantations are done for various Hematological disorders, Auto immune disorders and Genetic disorders ŸRehab and Counselling – This supportive service is very essential for the Haematology Department and is taken care of by a team of expert Physiotherapists, Yoga specialists and Clinical psychologists ŸVery active Hemet OPD – 15000/year and IPD 5000/year ŸOne of the Tertiary Haematology referral unit in India ŸVery busy Leukemia, Hemophilia/Lymphoma, Myeloma programme

19 Bone Marrow Transplant

Support services from Haematology Lab ŸRoutine investigations ŸCoagulation studies ŸHemolytic work up ŸThrombophilic work up ŸMolecular Genetics ŸCytogenetics and FISH Lab Ÿ24 hours Blood Bank

20 21 Renal Transplant Center

With the blue print in place, CIMS poises for a comprehensive RENAL TRANSPLANT program with stringent processes in place following international guidelines and practices, maintaining its registry. CIMS Renal Transplant Team has successfully completed 10 Renal Transplant so far. State-of-the-art procedures for kidney transplantation include: ŸLiving donor kidney transplants ŸCadaveric renal transplantation Renal Transplant Team ŸRenal transplant programme co-ordinator for counseling sessions for patient and relatives ŸRenal Transplant Committee constituted by subject matter experts and key opinion leaders for transparent, non-objectionable ethical review ŸBest infection control practices while harvesting kidney to be transplanted and also throughout the procedure. RENAL TRANSPLANT SALIENT FEATURES: The center is functional under the able hands of experienced and efficient urologists and transplant surgeons so as to perform minimally invasive surgery, with minimum post-operative recovery time and hospitalization. The already existing state-of–the art-operation theaters offer a sterile, post-operative environment, controlling infections and continuous patient monitoring. In house diagnostic services-pathology and radiology will make the procedure ABO and Human Leukocytic Antigen (HLA) compatible and compliant. The kidneys are well transplanted such that cold and warm ischemia times are as short as possible. The ethical/legal committee reviews and permissions are finally implemented. The operating protocol are certified ethically and legally.

22 Blood Bank

Only a life lived for others is a life worth while. In India, Heath System currently operates within an environment of rapid social, economical and technical changes. Such changes raises the concern for the quality of health care. Blood banks/ blood centers are an integral part of health care system. Accreditation would be the single most important approach for improving the quality of blood banks. Blood transfusions are a critical part of everyday life and assist in saving countless lives each year. The blood bank has a vast array of state of the art equipment for its smooth functioning, which include: Deep Freezers which maintain temperatures of -30 C and -80 C, heavy duty refrigerated centrifuge for the separation of components at different speeds, Platelet agitators, Cryobath, Tube Sealers and Blood Collection Monitors. All the above equipment have automatic temperature monitors and digital readout systems as well as automatic alarms, with continuous temperature surveillance, which ensure the safety of the blood and components issued from the Blood Bank. At CIMS, the Blood Bank, equipped with modern medical apparatus, is functional all through the year and has 24/7 Blood bank services; like ŸBlood grouping and typing ŸBlood cross matching ŸCoombs test (updated method using gel technology now routinely done for all blood cross matches) ŸCoombs cross match ŸTests for uncommon blood cell antigens and antibodies ŸAntibody titre ŸScreening for TTI (Transfusion Transmitted Infections) and essential testing

23 Genetic Center

CIMS clinical Genetics team works into the causes and inheritance of genetic

disorders.

We treat birth defects and dysmorphology, mental retardation, autism, and

mitochondrial disorders, skeletal dysplasia, connective tissue disorders,

cancer genetics, teratogens, and prenatal diagnosis.

We treat or advice regarding neurologic, endocrine, cardiovascular,

pulmonary, ophthalmologic, renal, psychiatric, and dermatologic conditions.

The geneticist's advice is helpful in cases of

ŸAdvanced maternal age (age 35 or older)

ŸFirst trimester/nuchal screening pre-test education/ counseling

ŸAbnormal maternal serum screening

ŸConcerns about genetic disease because of ethnicity – Thalassemia, Sickle

Cell Disease

ŸAbnormal ultrasound findings

ŸPrevious child with a genetic condition, birth defect(s) and/or mental

retardation

ŸRecurrent miscarriages

ŸFamily/personal history of genetic condition

ŸFamily/personal history of birth defect(s)

ŸFamily/personal history of mental retardation

ŸMedication exposures during pregnancy

ŸConsidering Preimplantation Genetic Diagnosis (PGD)

24 National Cardiovascular Data Registry (NCDR)

Knowledge Processing: The National Cardiovascular Data Registry (NCDR) of the American College of Cardiology Foundation (ACCF), CathPCI Registry collects detailed clinical, process-of-care 100% and outcomes data for patients undergoing coronary 80% angiography and percutaneous coronary intervention (PCI) 60% in the USA. The registry contributes to quality of care by 40% providing data feedback on a wide range of performance 20% metrics to participating centers and by facilitating local and 0% national quality improvement efforts.

In Comparison to US hospital CIMS hospital performed CIMS the only INDIAN center voluntarily submits complete, 55 percent higher radial procedure. consistent, and accurate data of both diagnostic catheterization (angiography) and angioplasty procedures to NCDR CATH PCI registry so as to identify and close gaps in the quality of care; reduce wasteful and inefficient care variations; and implement effective, continuous quality improvement of clinical practice improving patient outcomes and lowering health care costs. The earlier CathPCI version 4.4 has 252 data fields which is replaced with current Version 5 which is effective from April 1, 2018 (Timeframes 2018Q2 and subsequent) changes include 218 new elements and 131 retired elements including selections. Elements encompassing patient In Indian population prevalence of cardiac disease is demographics, medical history and risk factors, hospital higher between age 55 to 65 years. presentation, initial cardiac status, procedural details, Data at CIMS reveals high burden of cardiac disease medications, laboratory values, and in-hospital as well as 30 between ages 55 to 65 years. days outcomes to create and implement protocols that improve care for patients nationwide. 25 National Cardiovascular Data Registry (NCDR)

CIMS follows ACC/AHA guidelines drivenpractices

performed by a group of expert cardi ologists including

interventional cardiologist, electrophysiologists, cardiac

surgeons, cardiac anesthetists, experienced Cath lab

technicians and nurses.

Following diagnostic catheterization, based on ACC

guidelines CIMS has developed its own quality metrics for

treatment. Depending on severity of disease,

associated risk factors, patient characteristics the

treatment matrix is individualized for best outcomes.

ŸDoor to balloon time averages about 60 minutes shorter

than the protocol of 90 minutes

ŸData comparison of door-to-ballon time (interval starts

with the patient's arrival in the emergency department,

and ends when a catheter guide wire crosses the culprit

lesion in the cardiac cath lab) presents CIMS

Hospital comparable to ACC and AHA guidelines.

ŸIn comparison to ACC guidelines D2B at CIMS is shorter

depicting following of quality protocols and procedures.

26 National Cardiovascular Data Registry (NCDR)

As per ACC guidelines on hospital discharge, nearly all patients without a contraindication were receiving aspirin and a statin medication. CIMS care continues at home through its Care at Homes department.

PCI associated bleeding rate is nearly half in comparison to US data establishing reduce bleeding complications following radial intervention.

RIGHT MEDICATION FOR BETTER OUTCOME Doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of blood to clot, which may help prevent obstruction of coronary arteries. At CIMS, medications are discharged appropriately according to ACC guidelines affecting long term patient care and Quality of life.

27 Cardiology

CIMS has an ultra-modern 24×7 heart care facilities. The

department is handled by renowned Cardiologists,

Cardiothoracic Surgeons, Electro-physiologists,

Intensivists and Anesthesiologists who offer heart care

services across the spectrum of adult and pediatric heart

care.

CIMS Cardiology Unit

The group cardiology practice caters to

ŸCoronary Artery Disease, Non-Coronary & Peripheral

Vascular Diseases, Electro-physiology & Device

Therapies.

ŸOur Intensive Coronary Care Units (ICCUs) are managed

and monitored round-the-clock by critical care specialists

and intensivists, supported by highly trained paramedical

and nursing teams.

Department of Interventional Cardiology provides advanced

diagnostic tests and treatment for problems as common as a

bout of chest pain (Angina), as serious as heart attack

(Myocardial Infarction) and as rare as Tricuspid Atresia. The

Invasive Cardiology offers treatment for Coronary Artery

Disorders, using Angioplasty, Stents, Laser, Ultrasound

techniques etc.

28 Cardiology

CIMS Cath-Lab

Our sophisticated Cathlab and advance technology offers

unmatched outcome in various cardiac ailments. Team of

dedicated and highly skilled interventional cardiologists

perform coronary and peripheral angiographies, balloon

angioplasties, stenting, EP studies and ablation, pulmonary

and mitral valvuloplasties and other interventions.

Cardiology Department focuses on holistic approach to

Cardiac Care through invasive & non-invasive therapeutic &

diagnostic services, managed by dedicated team of doctors

and is one of the finest in the country. The department

consists of Interventional Cardiology and Cardio-Thoracic

Surgery.

Radial Lounge

29 Cardiology

CIMS holds the ability to perform interventional procedures in octogenarian (> 80 years) patients as well as pre mature CAD patients (< 45 years).

Proportion of males undergoing catheterization was higher as compared to females.

Prevalence of hypertension and diabetes was high among patients undergoing cardiac catheterization. These statistics show that when patients have both hypertension and diabetes, Majority of patients who underwent cardiac catheterization which is a common combination, their risk for cardiovascular were within age group 51-70 years. disease doubles. 30 Cardiology

The best outcomes for patients with PAMI are achieved at

hospital like CIMS with 24*7 accesses to primary PCI.

Low Door to Balloon time reduces treatment delays and

establishes the adage that “time is muscle”. Data

comparison of door-to-ballon time (interval starts with the

patient's arrival in the emergency department, and ends

when a catheter guide wire crosses the culprit lesion in

the cardiac cath lab) presents CIMS Hospital

comparable to ACC and AHA guidelines

At CIMS, our well experienced interventional cardiologists with technical expertise perform majority of procedures through radial approach as compared to femoral approach.

50% of people suffering from a heart attack do not survive

because they don’t get treated on time. At CIMS, our doctors

are trained and equipped to open blocked arteries in a

record time to save heart from further damage.

31 Cardiology

Single Vessel Disease

Double Vessel Disease

Triple Vessel Disease

32 Cardiology

In general, drug-eluting stents are preferred over bare- metal stents for most patients. The reduced risk of re- blocked arteries from drug-eluting stents reduces the need for repeat angioplasty procedures, which carry the risk of complications such as heart attack and stroke. The choices of intracoronary device were similar at CIMS and US facilities relating similar patient treatment.

33 Cardiology

In the radial approach: ŸEase of catheter passage even in overweight or obese patients. ŸThe patient does not require post-procedural immobility up to 4 to 5 hours. ŸEarly ambulation and PCI can be performed as a day care procedure. ŸAccording to AHA guidelines (2011) of PCI, compared to femoral access, radial access decreases the rate of access-related bleeding and local vascular complications.

Cardiology Average Length of Hospital Stay

ŸThe (H2H) and Hospital to family (H2F) program of CIMS

takes care of patients after discharge and counsels family

members to take care against CAD risk factors.

ŸAverage Length of hospital stay after Cardiac Producers is

gradually reduced.

34 Cardiac Investigations

CIMS is well- equipped with latest technologies to help

make right treatment decisions. The well experienced

cardiology team and validated diagnostics offer best

treatment to its patients.

The Cardiac Investigations Unit undertakes several

procedures including:

ŸECGs

ŸTransthoracic Echocardiograms

ŸDobutamine Stress Echocardiograms

ŸExercise Stress Echocardiograms

ŸTransoesphagel Echocardiograms

ŸExercise stress tests

ŸTilt table testing

Ÿ24 and 48-hour Holter monitoring

ŸCardiac Event Monitoring (seven days)

Ÿ24-hour Ambulatory Blood-Pressure Monitoring

ŸNon-invasive EP study (NIEPS)

35 Cardiac Investigations

36 Cardiac Rhythm Disorders

CIMS has established a unique Cardiac Arrhythmia Management Centre which provides customized catheter - based treatment that incorporates comprehensive state-of-the-art technology to effectively cure arrthymias. CIMS offers various treatments for cardiac rhythm disorders ŸElectrophysiology studies (EPS) for diagnosis of cardiac arrhythmia (conventional and 3 Dimensional Mapping System) ŸRadiofrequency Ablations (RFA) of complex cardiac arrhythmias pacemaker Implantation ŸBiventricular Pacing (Cardiac Resynchronization Therapy) for heart failure ŸAutomatic Implantable Cardioverter Defibrillator (AICD) implantation ŸComprehensive Device Follow up Clinic (Pacemaker, CRT, AICD) Carto-3 Systems

With improved facilities and increased expertise for CIED Carto-3 system, state-of-the-art imaging system offers procedures, the average length of stay at CIMS has enhanced visualization for treating arrhythmia patients. reduced with progressing time. At CIMS, patients with EF <35% were also evaluated for risk CIMS electrophysiologists work closely with our of sudden cardiac death and a need for ICD. All patients cardiothoracic surgeons and heart failure specialists implanted with defibrillators were followed up. These to treat patients who may require heart surgery or whose heart rhythm disorder is related to heart patients have successfully survived sudden cardiac failure. arrest episodes due to VT/VF

37 Cardiac Rhythm Disorders

38 Cardiac Surgeries

Today, our centre treats patients with the latest technologies in Minimally Invasive Cardiac Surgery, Minimally Invasive Hybrid Cardiac Surgery, Interventional Cardiology, Non- Invasive Cardiology, Pediatric Cardiology and pediatric Cardiac Surgery for Coronary Artery Bypass Graft Surgery, Valve Replacement and Repair, Aneurysm and Aortic Dissection Surgery. Our Intensive Coronary Care Units (ICCUs) are managed and monitored round-the-clock by critical care specialists and intensivists, supported by highly trained paramedical and nursing teams. Our hospital also offers an excellent cardiac rehabilitation program that focuses on the post- operative care of cardiac patients. Services at CIMS: ŸCongenital heart surgery ŸMitral valve repair ŸSingle and double valve replacement ŸAortic root replacement ŸOf f pump coronary artery bypass grafting (CABG) on beating heart ŸMinimally Invasive Cardiac Surgery (MICAS) CABG for LV dysfunction ŸPatent ductus arteriosus (PDA), Atrial septal defect(ASD), Ventricular septal defect(VSD), Tetralogy of Fallot (TOF ) ŸCombined carotid and bypass procedure Facility: Ÿ2 Class 100 laminas air flow modular operation theatres only devoted to cardiac surgery ŸPositive and Negative isolation chambers in the SICU Ÿ20 bed surgical intensive care unit 39 Cardiac Surgeries

Our hospital also offers an excellent cardiac rehabilitation program that focuses on the post-operative care of cardiac patients. Today, our centre provide patients with the latest technologies in Minimally Invasive Cardiac Surgery, Minimally Invasive Hybrid Cardiac Surgery, Interventional Cardiology, Non-Invasive Cardiology, Paediatric Cardiology and Paediatric Cardiac Surgery for Coronary Artery Bypass Graft Surgery, Valve Replacement and Repair, Aneurysm and Aortic Dissection Surgery.

40 Cardiac Surgeries

ASD Closures can be performed by use of devices as well through surgery depending upon the case, suitable treatment option is selected. We also offer comprehensive treatment for congestive heart failure and end-stage lung disease, including: ŸSurgical ventricular remodeling procedures ŸHeart and lung transplantation ŸVentricular assist devices Surgeons at CIMS Hospital are committed to continually studying and evaluating new methods of surgical treatment and improving surgical outcomes through clinical and laboratory research in such areas as protection of the brain and neurological systems during bypass operations and the future use of stem cells for concomitant procedures in patients with congestive heart failure.

CIMS Cardiologist Team CIMS Cardio Vascular and Thorasic Surgeon Team

41 Heart Failure

In an effort to keep heart failure complications under check,

CIMS has been tirelessly striving to bring better heart care to

the country.

Along with performing path-breaking surgeries, our team of

experts at CIMS has also been constantly introducing world-

class heart management methods to India.

Today, we offer comprehensive solutions to advanced heart

failure conditions all under one roof. In addition to cutting-

edge Ventricular Assist Device (VAD) therapy, the CIMS

heart failure clinic for Heart Failure and Transplant has

changed the way heart patients are treated today.

The centre offers outpatient ambulatory therapy for

administration of inotropic medications which helps in

rapidly improving symptoms and restoring vital organs to

their normal conditions. CIMS is one of the first hospital to offer LVAD Left Ventricular Assist Device (LVAD) Bridging to Transplantation. The device serves as a temporary bridge so that a patient can recover some life- sustaining degree of heart function prior to transplantation. Heart Translplant Heart Transplant is a surgical procedure performed to remove the diseased heart from the brain dead patient and replace it with a healthy one from the organ donor.

42 Cardiac Valve Disorders

CIMS Valvular Clinic is state-of-the-art center for the

diagnosis and treatment of heart valve disease.

Cardiovascular imaging specialists use best procedures to

determine the type and severity of heart valve disease and

plan treatment. The decision to prescribe medical treatment

or proceed with surgical repair or replacement is based on

the type of heart valve disease, the severity of damage the

age and medical history.

Surgeons in the Department of Thoracic and

Cardiovascular Surgery have perform over 250 heart valve

surgeries each year, including valve repair and replacement

of the mitral valve, aortic valve, pulmonic valve and tricuspid

valve.

In addition, via a process that begins with evaluation at The

CIMS Valvular Center, these heart valve specialists also

perform:

ŸVentricular Septal Defect (VSD) Closure (post-surgical or

post-infarction)

ŸAtrial Septal Defect (ASD) Closure

43 Cardiac Valve Disorders

ŸPatent Formen Ovale (PFO) Closure

ŸValvuloplasty (Aortic, Mitral, Pulmonic and Tricuspid)

ŸParavalvular Leak (PVL) Closure

ŸLeft Ventricular Pseudoaneurysm Closure

ŸValve-in-valve procedures for degenerated bioprosthetic

valves in inoperable/high-risk surgical patients

ŸTranscatheter Left Atrial Appendage Exclusion

ŸClinical Research Study Opportunities

MVR cases are always predominant as mitral valve is commonly affected in rheumatic disease and degenerative disease. Double valve replacement carries higher morbidity and mortality risks.

Heart Valve Disease

44 Minimal Invasive Cardiac Surgery

CIMS is the first official center to launch a fully equipped MICS program in Ahmedabad and Gujarat As world has changed from 'big' to 'small', so has cardiac surgery. It has evolved and changed from routine midline sternotomy to Minimally Invasive Cardiac Surgery (MICS). We have come across problems related to big incisions like wound infection, keloid scars, pain, delayed recovery and more over cosmetic problem in young patients. MICS resolves the challenges faced. MICS has undergone numerous changes in technique and philosophy. With innovations in perfusion techniques, refinement of transthoracic echocardiography and the development of specialized surgical instruments, necessary tools to progress to less invasive approaches are available today at CIMS.

MICS Surgeries at CIMS (1) ASD (2) Mitral valve repair / replacement (3) Aortic valve replacement (5) Selected cases of CABG (6) Hybrid CAB CIMS also offers an excellent cardiac rehabilitation program that focuses on the post-operative care of cardiac patients.

With time, average length of hospital stay following cardiac surgery is reduced, relating the established protocols followed and experienced expertise. 45 Pediatric Cardiac Sciences

The Pediatric Cardiac Sciences department at CIMS is one of the most advanced in Western India with latest equipment including inhaled Nitric Oxide, ECMO (Extra Corporeal Membrane Oxygenation) and intra operative Transesophageal Echocardiography. Our team has produced tremendous impact on outcome of several hundred small infants and children born with heart disease since birth. This includes all varieties of catheter interventions, device closure, closed and open cardiac surgeries, neonatal and infant cardiac surgeries, cardiac surgeries in adults (Grown up Congenital Heart Disease), redo operations and hybrid cases. The pediatric cardiac team at CIMS is one of the most comprehensive team catering to all varieties of congenital heart disease(CHD). Patients from one day / premature neonate to adult with CHD are treated at CIMS

46 Vascular and Endovascular Surgery

Carotid artery surgery is a procedure to restore proper blood

flow to the brain. There are two procedures to treat a carotid

artery that has plaque buildup in it. This can be treated by

endarterectomy (CAE) or by stent placement (CAS)

At CIMS, Duplex ultrasound or magnetic resonance

angiography (MRA) as well as other imaging and

pathological tests are used to suggest the diagnosis but the

gold standard is conventional renal angiography.

At CIMS, Vascular Surgery Includes:

ŸCarotid Endarterectomy for Stroke prevention

ŸOpen Repair of Aortic and Peripheral aneurysms

ŸAorto – Femoral – Popliteal Bypasses

ŸA – V Access (Fistula) surgery

ŸDiabetic Foot Care Clinic

Highly skilled Cardiothoracic surgeons of CIMS operate

various procedures such as Lobectomy, Pneumonectomy,

Thorectomy, Embolectomy, Pleuroscopy including Video-

assisted Thoracic Surgery (VATS). Expert thoracic

surgeons mainly focus on early diagnosis and prediction of

recurrent diseases in lung and esophageal cancer.

ŸEndovascular Interventions

ŸAngioplasties and stenting for Peripheral Vessels

Occlusive Diseases

47 Vascular and Endovascular Surgery

ŸThoracic Endovascular Aortic Repair (TEVAR)

ŸAt CIMS the cardiologists, vascular and endovascular

surgeons treat thoracic and thoracoabdominal

aneurysms with a minimally invasive procedure called an

endovascular stent graft.

The skills necessary to perform TEVAR cannot be attained

Endovascular Sugery through short “courses”. A dedicated team of vascular surgeons, interventional radiologist/cardiologist,

cardiothoracic surgeons is necessary in order to obtain the

“wire skills” and to perform these endovascular procedures.

At CIMS the PPPPP (Prior Planning Prevents Poor

Performance) rule is followed. Preoperative imaging and its

accurate interpretation, vessel access, calcification or

tortuosity in the arteries are considered. Patient is closely

watched in the postoperative period and timely evaluated for

endoleak, migration, device structural deterioration, etc.

Our surgeons are uniquely trained and experienced to weigh the various treatment options available, including medical therapy, as well as surgical and endovascular approaches.By offering the entire spectrum of therapeutic options, our physicians can assure patients that they are receiving the most appropriate therapy for their conditions.

48 Vascular and Endovascular Surgery

Carotid Endarterectomy

49 Thoracic Surgery

Highly skilled Cardiothoracic surgeons of CIMS operate various procedures such as Lobectomy, Pneumonectomy, Lung Decortication, Thorectomy, Embolectomy, Pleuroscopy including Video-assisted Thoracic Surgery (VATS). We provide care for all diseases of the chest, including: ŸEsophageal Cancer ŸLung Cancer ŸChronic Pleural Effusion ŸOther Chest Tumors ŸThe Range of such operations, routinely done include: ŸLobectomy ŸPneumonectomy ŸThoracotomy

50 Orthopedic Surgery

At CIMS, the Department of Orthopedic Surgery is committed to deliver the highest quality of diagnostic and therapeutic patient care to both adults and children for a diverse spectrum of orthopedic disorders. At CIMS, complex orthopedic injuries are taken care by a team of eminent experts that includes orthopedic surgeons, anesthesiologist, physical and occupational therapist and nurses, who are in constant touch with the patient's right from pre-surgery assessment to post-operative hospital stay. Orthopedic surgeries and treatments carried out at CIMS are: ŸJoint Replacement, Knee, Hip, Shoulder and Elbow Replacement ŸRevision Knee and Hip Replacement Surgery ŸComplicated Intraarticular and periarticular factures ŸComplicated poly trauma and high risk orthopedic surgery ŸArthroscopic surgery ŸArthroscopic reconstruction ŸSports surgery CIMS Orthopedic surgery team includes experienced Joint Replacement Surgeons, Plastic Surgeons, Intensivist, Anaesthetologist which conduct complicated procedures with excellent outcomes. CIMS joint replacement team is backed by an ultramodern high tech laminal airflow operation theatre with all sophisticated and latest anesthesia equipment, power

51 Orthopedic Surgery

instruments, latest electro coagulation system, dual shadow less imported lights and many more gadgets. CIMS joint replacement department is supported for complicated and high risk patient by ultramodern well equipped incentive care units, round the clock critical care support of efficient critical care department and renowned experienced cardiology team. Outcomes Measures of Total Knee Replacement: ŸDecreased morbidity and mortality ŸImproved functional status

Knee Replacement Hip Replacement

Shoulder Replacement Elbow Replacement

52 Critical Care

CIMS CRITICAL CARE is supported by advanced in-house

radiology and pathology services, state-of-the-art

rehabilitation including physiotherapist, clinical nutritionist,

and occupational therapist. CIMS CRITICAL CARE

performs regular in-house teaching / training program for

supportive medical and nursing staff, medical students,

public seminars/awareness programs, etc.

Critical Care Unit Critical care Services include:

ŸManagement of all types of shock state

ŸManagement of cardiorespiratory arrest by dedicated

CPR team

ŸThrombolytic therapy for acute pulmonary thrombo-

embolism and acute ischemic stroke

ŸRenal and hepatic failure care

ŸAll kinds of sepsis including oncology, post-transplant,

immuno-compromised patients

ŸNeurological emergencies

ŸAll kinds of surgical and obstetrics emergencies

ŸPoly trauma & burns care

ŸCare for pre-operative high-risk patient, intra and post-

operative complicated patient (including care of

complicated GI, orthopaedic, neuro, onco, bariatric

surgeries, acute pancreatitis) ECMO Machine 53 Critical Care

ŸTPN (total parental nutrition) Core Principles of Safety Science at CIMS

ŸCare of poisoning patient ŸCreate a culture where mistakes are identified.

ŸPalliative care (pain relief) for terminally ill ŸFocus on systems rather then people.

ŸIntermediate care at high dependency unit (HDU) ŸLeader controls the potential to change system.

At CIMS, CCU Process Measures Include: At CIMS, core principles are achieved through: Ÿ Avoid excessive use of antibiotics ŸCommit no harm ŸJudicious monitoring of fluid and inotrope therapy ŸEncourage open communication Ÿ Avoid excess sedation ŸCelebrate safety Ÿ Avoid too liberal blood transfusion CIMS ICU/GICU Design: Responsibilities of CIMS Critical Care Physician The ICU complex at CIMS is designed in such a way that ŸCreating guidance for granting of specific privilege in the each ICU cubicle has adequate sunlight day long with ICU exposure to common green atrium area, making the ICU ŸDeveloping ICU programs, policies, rules and regulations really a green ICU with added advantage of making it least ŸDeveloping recommendations about the need for prone for ICU related delirium or psychosis. continuous educational programs that are consistent with

the type of service offered by critical care and developing At CIMS Merging ICU/GICU and Emergency Room:

performance improvement activities This is a major and novel concept to place ICU, next to

ŸManaging physician staff members adherence to medical emergency room (ER) to complement ER to manage all

laws and other hospital policies, sound principles of critical patients from the ER itself. This ensures treatment

clinical practice regulation that promote patient safety from ER itself relating with golden hour management.

Ÿ

54 Trauma Center

We, at CIMS, are extremely committed to provide the best and the right care to all trauma patients. At CIMS, trauma personnel are trained and re-trained using nationally available education tools such as the Advanced Trauma Life Support and Advanced Burn Life Support courses. The goal of our expert trauma center in Ahmedabad is to provide treatment to a child within 30 minutes (Platinum Hour) and Treatment to an adult within 60 minutes (Golden Hour)".

Goals achieved at CIMS Trauma Centre ŸTo assist in improving the care of the injured patient by providing emergency consultation and comprehensive trauma care under one roof according to Resources for Optimal Care of the Injured Patient. ŸTo assist in the ongoing assessment of trauma patients for Optimal Care of the Injured Patient for appropriateness, timeliness, and efficient management. Emergency and Trauma care services and features include ŸSTEMI Cardiac Care Designation – state of the art care for patients suffering heart attacks ŸStabilization of life-threatening conditions ŸLife-saving procedures ŸImmediate treatment of medical and surgical emergencies ŸEmergency treatment for minor injury or illness ŸEmergency care for minor or major trauma victims Facilities at CIMS ŸBLS and ACLS trained doctors, nurses and technicians Ÿ24 X 7 services round the year ŸTriage area equipped with facilities of a world class emergency room ŸFacilities of directly shifting patients with MI for PAMI to 55 Trauma Center

cathlab. ŸICU-ON-WHEELS and other Ambulance services run forth to collect trauma and emergency patients from the site ŸMobile unit with a defibrillator, multipara monitor and ventilator ŸExcellent communication facilities backup. ŸEmergency team gets activated according to CODE BLUE, when called for ŸEntire staff is trained in patient resuscitation so that they are helpful to save patients ŸHighly experienced team of orthopedic surgeons, general surgeons and anesthetists CIMS Trauma Centre Principles: ŸLife-threatening injuries are appropriately treated promptly and in accordance with appropriate priorities, so as to maximize the likelihood of survival. ŸPotentially disabling injuries are treated appropriately, so as to minimize functional impairment and to maximize the return to independence and to participation in community life. Ÿ Pain and psychological suffering are minimized. Cognizance Initiative A unique program is undertaken by CIMS hospital to provide early awareness to the general public regarding the prevention and safety of traumatic incidents either roadside, workplace or home by conducting seminars and conferences and distributing pamphlets emphasizing safe driving and sudden medical attention required to prevent negative long term psychological reactions.

56 Infectious Disease

CIMS infectious disease unit with help of a full-time dedicated Infectious Diseases consultant, provides in- patient and out-patient care for: HIV and AIDS (Acquired Immunodeficiency Syndrome) Pulmonary and extra pulmonary tuberculosis, including MDR (Multi-drug resistant) and XDR (Extensively drug- resistant) TB Community acquired infections like upper respiratory infections, pneumonia, urinary tract infections, brain infections, etc. Tropical infections like malaria, dengue, typhoid fever, chikungunya Opportunistic fungal infections like candidiasis, aspergillosis, and mucormycosis in immuno-compromised patients Hospital acquired infections, post-surgical infections Infections in cancer patients Infections in organ transplant recipients Adult Vaccination: Vaccination for prevention of infectious diseases is of utmost importance in this era of globalization, increasing life expectancy, and growing population of immuno- compromised patients, migration and increasing international travel.

57 Pulmonary Medicine

CIMS Pulmonary Medicine Department is managed by senior and eminent pulmonologists. They are well versed with all modern techniques in their field including Fiber Optic Bronchoscopy, Pulmonary Function Testing including DLCO Sleep study, fiber optic pleuroscopy and allergy testing. Various procedural and surgical treatments offered at CIMS include: ŸAtypical mycobacterial infections ŸPulmonary fibrosis ŸBalloon dilation and stent placement to open windpipes ŸLaser treatment for palliation ŸBronchoscopy including interventional treatments with lasers and stents ŸMesothelioma ŸLung volume reduction surgery (LVRS) ŸNicotine dependence ŸEmphysema ŸChronic chough and bronchitis ŸPulmonary embolism ŸPulmonary vasculitis ŸSleep apnea ŸFlolan infusion Pulmonary function tests: Pulmonary function tests are a group of procedures that measure the function of the lungs, revealing problems in the way a patient breathes.

58 Pulmonary Medicine

The tests can determine the cause of shortness of breath

and help in differential diagnosis of lung diseases, such as

asthma, COPD or interstitial lung disease.

The tests are also performed before any major lung surgery

to make sure the person is not disabled by having a reduced

lung capacity.

CIMS PFT lab has facility to conduct DLCO, which is an

integral tool to measure extent of problem in interstitial lung

disease.

Sleep lab:

ŸCIMS hospital houses senior and renowned

pulmonologists. Besides, it is equipped with world class

instruments like Video bronchoscope and Advanced PFT

with DLCO apart from sleep laboratory at par to

international standards.

ŸCIMS Sleep Lab is like a private bedroom equipped with

cable television, queen bed, recliner and private

bathroom.

ŸThe sleep lab is equipped with additional sensors,

hardware and software to carryout cardiovascular studies

and other uncommon sleep disorders.

ŸHome sleep study with portable devices

59 Neuro and Spine Surgery

CIMS Neurosurgery department utilizes multi-disciplinary

approach to diagnose and treat neurological disorders in

patients.

Complex medical and surgical conditions including

malignant and benign brain tumors, skull based tumors,

epilepsy, movement disorders and vascular malformations

are treated.

CIMS neurosurgical team is focused on treating the most

complex medical and surgical conditions including

malignant and benign brain tumors, skull based tumors,

epilepsy, movement disorders and vascular malformations.

Skull Base Surgery Services:

ŸSkull base tumor excision: acoustic neuromas,

chordomas

ŸCerebro spinal fluid leaks

ŸCraniofacial deformities

ŸCranial base osteomyelitis

ŸMicro vascular decompression for trigeminal neuralgia,

hemifacial spasm.

60 Neuro and Spine Surgery

Pediatric Neurosurgery

ŸHydrocephalus: Endoscopic ventriculostomy, shunt

surgery

ŸPediatric brain and spine tumor surgery

ŸSpinal dysraphism and tethered cord surgery

ŸCraniosynostosis correction

ŸOccipito cervical decompression for chiari malformation.

Brain Surgery services

ŸBrain tumor surgery

ŸMicroscopic/ endoscopic transnasal pituitary tumor

excision

ŸNeuro Vascular lesions: Aneurysm, AVM

ŸStroke surgery: brain hemorrhage, carotid endartrectomy

ŸStereotactic surgery

ŸCranioplasty

ŸEpilepsy surgery

ŸCranial trauma

Stroke Surgery

ŸBrain hemorrhage, carotid endartrectomy

ŸStereotactic surgery

ŸCranioplasty

ŸEpilepsy surgery

61 GI Surgery and General Surgery

GI Surgery and General Surgery: Surgeries Performed and Diseases Treated CIMS division of GI surgery is dedicated to provide Basic Laparoscopic Surgeries comprehensive surgical care for patients with basic and Appendectomy complex gastrointestinal diseases. Patients are referred to Cholecystectomy CIMS surgeons from across the state and country for Advanced Laparoscopic Surgeries ŸInguinal and ventral hernia repair management of a variety of benign and malignant GI ŸPeptic and enteric perforation repair disorders. The surgeons provide complete evaluation, ŸFundoplication diagnosis, best mortality treatment available as well as ŸHeller's cardiomyotomy surgery required for patient's alignment and surgical treatment ŸCystogastrostomy /cystojejunostomy for a wide variety of GI disorders. We have pioneered some ŸMinimally invasive surgery for acute necrotising of the most advanced, minimally invasive procedures while pancreatitis achieving the fewest complications, highest survival rates ŸRectopexy Ÿ and best outcomes in the state. Colectomy ŸThoracolaparoscopic esophagectomy

Esophagus and Stomach ŸCorrosive oesophageal and gastric stricture ŸEsophagus and stomach malignancy ŸGastric GIST ŸEsophageal motility disorders ŸAcid peptic diseases ŸGERD CIMS is certified and accredited for Liver Transplant Biliary and Liver Diseases ŸBiliary and hepatic malignancy ŸBile duct injuries and post cholecystectomy billiary structure ŸHydatid liver disease ŸLiver tumour ŸShunt surgeries for portal hypertension

Pancreas ŸPancreatic malignancy ŸChronic pancreatitis ŸPancreatic neuroendocrine tumour ŸAcute necrotising pancreatitis

Small and Large bowel ŸCarcinoma of colon and rectum ŸUlcerative colitis ŸFecal fistula ŸRectal prolapse 62 Endoscopy

Designed for the privacy and comfort of our patients, The happy .A commitment to ethical medical practice plays a key Endoscopy Unit at CIMS Hospital is a dedicated, state-of- role and to ensure that the the patient receives the best the-art unit for therapeutic and diagnostic procedures. available treatment at an affordable cost CIMS has an expertise of nation's leading and good Staffed by experienced Gastroenterologists, Gastro specialists in gastrointestinal diseases. Our gastro- Surgeons, Pulmonologist and Endoscopy nurses, CIMS is enterologists are the best and nationally recognized for committed to deliver expert endoscopic procedures in a providing breakthrough care of complex digestive diseases. timely, safe, and patient friendly manner. We provide acute At CIMS, all efforts are made earnestly to make the patient care 24 x 7 days, to manage life threatening illnesses as well as screening procedures for diagnostic, preventive and therapeutic purposes.

Endoscopy services at CIMS: ŸOlympus Colonoscope is used to examine Large Bowel i.e. Colon, Rectum (large intestine). ŸUltramodern endoscopy from Olympus–Gastro scope for Upper GI tract i.e. Oesophagoscopy - Gastroscopy and Upper Gastrointestinal Endoscopy Duodenoscopy ŸColonoscopy ŸERCP to evaluate bile duct and pancreatic ducts ŸCapsule Endoscopy for small intestinal diseases ŸRemoval of tumors like polyps from stomach, duodenum, large intestine ŸRemoval of stones from bile duct ŸStent placement in food pipe, bile duct and pancreatic duct ŸManagement of acute upper and lower GI hemorrhage 63 Bariatric Surgery

“LOOSE WEIGHT, GAIN HEALTH”. Any type of Obesity, CIMS has performed more then 200 Surgeries till date. however mild, is a risk factor that can aggravate into life off, now there are convincing data that many patients are threatening conditions. The CIMS is equipped with state-of- cured of obesity-related diseases, notably type 2 diabetes. the-art technology to perform laparoscopic and bariatric In fact, the procedure may pay for itself within a few years by surgeries of varied complexities. reducing medical costs due to obesity-related illness. Best Bariatric surgery is the most advanced and scientific of all, the long term mortality rate seems to be lower for method of losing weight and correcting all the morbidly obese patients who undergo this surgery than for comorbidities associated with obesity. those who do not. CIMS is equipped with state-of-the-art technology to GASTRIC BYPASS: Under this procedure, a small stomach perform laparoscopic and bariatric Surgeries of varied pouch is created and section of the small intestine is complexities: directly attached to the pouch. By creating a smaller At CIMS, outcomes of bariatric surgery are getting better all stomach pouch, a Gastric Bypass limits the amount of the time, as surgeons gain experience in performing these food that can be eaten at one time, so you feel full technically demanding procedures laparoscopically. The sooner and stay full longer. It also causes your body to risks are not trivial, but they are acceptably low. The absorb fewer calories. benefits: not only do patients lose weight and keep it

64 Oncology

Expert surgical oncology team offers optimum multimodality tailored treatment to the need of every patient. Cancer is one of the most feared diseases of recent times. A lot of medical progress has been undertaken in this field and new findings have been brought to the forefront. This includes improved understanding for the biology of cancer, precision in diagnosis and staging of cancer and optimizing the treatment of cancer. Services ŸEarly detection and prevention programs and cancer- related health check-up ŸAll types of surgery according to latest protocols ŸOrgan preserving surgery for different cancers (Mandible i.e. jaw, voice-box in throat cancers, breast cancers, sphincter preserving rectal surgeries, pouch surgeries, limb preservation in bone cancers) ŸChemotherapy for all solid cancers ŸProtocol based chemotherapy for hemato-oncology disorders ŸReconstructive surgery and prosthesis for jaw, breast, limbs and other defects and rehabilitation ŸSpecially trained doctors and intensivists for medical management of patients ŸNutrition plan guided by dietician before and after surgery ŸPhysiotherapy and functional rehabilitation Follow up is stratified according to disease risk. Patients are given information regarding their personal follow up programme (clinical and imaging). High risk patients are followed up more closely with joint care by surgeons and oncologists according to agreed local protocols. 65 Oncology

Techniques of Radiotherapy:

Ÿ2D Radiotherapy: It is based on simple X-ray based

planning, treats larger area of body.

Ÿ3D CRT (3 Dimensional Conformal Radiotherapy):

Itisbased on CT Scan based planning and uses multiple

beam & MLC (Multileaf Collimator) to form the shape of

radiation beam according to tumor contour.

Cancer Surgery ŸIMRT (Intensity Modulated Radiotherapy): It is conformal radiotherapy which allows higher radiation dose to be

focused to region within the tumor and minimizing the

dose to surrounding normal critical structures.

ŸVMAT (Volumetric Modulated Are Therapy):It is advanced

form of IMRT.

CIMS Cancer Center has one of the largest surgical oncologist team affiliations in India

66 Oncology

67 Nephrology

ŸManagement of difficult vascular access ( AV Fistula) ŸSalvation of failing AV Fistula, fustulography and fistuloplasty ŸRenal biopsy ŸPlasmapheresis At CIMS, 7 renal transplants have been successfully performed till date ŸThe department consists of highly skilled committed nephrologists, transplant surgeons and a large team of registrars. ŸState-of-the-art department to provide all kidney related ŸIt is an academically well established, teaching /training care under one roof institute for the super specialty of Nephrology and has to Ÿ6 Hemodialysis HD machine and 1 CRRT machine for the its credit to have trained more than ten nephrologists patients serving in various prestigious institutes of India. ŸFacility for CRRT (Continuous Renal Replacement ŸThe paramedical staff including dialysis technicians, Therapy) for critically ill patients nurses and housekeeping staff are well versed with their ŸAdherence to international standards for infection control technical skills. It provides a full range of renal services and quality in dialysis including hospital hemodialysis, peritoneal dialysis and ŸTo reduce incidence of hepatitis B and C, rigorous care for transplant recipients. precautions are taken and such patients are dialyzed on We are well-equipped with all necessary resources for a separate machines. successful renal transplantation which include, but not Services limited to: ŸManagement of acute renal failure, chronic renal failure, ŸHighly experienced and qualified team of doctors acute and chronic nephritis, nephrotic syndrome, reno- ŸAppropriate counseling sessions for patient and relatives vascular hypertension, and collagen vascular disorders ŸTransparent, non-objectionable ethical review by Renal involving kidneys etc. Transplant Committee constituted by subject matter Ÿ24 x 7 Dialysis experts and key opinion leaders ŸCRRT for dialysis in critically ill patients. ŸRegulatory compliance as per State Govt. guidelines for ŸTunneled cuffed catheter insertion (PERM CATH) for organ transplantation patients having difficulty in constructing-working-AV ŸBest infection control practices while harvesting kidney to Fistula be transplanted and also throughout the procedure.

68 Urosurgery

Within the urology specialty at CIMS there is a dedicated Urosurgery treatment program for prostate cancer treatment and

facilities to carry out laparoscopic (keyhole) surgery

wherever possible.

At CIMS full range of services, available from the urology

team include the following Services:

(I) Surgical Procedures for Enlarged Prostate Age distribution of urosurgery patients ŸTrans-Urethral Resection of the Prostate (TURP) with

Holmium laser

ŸProstatic Biopsy

(II) Prostate Cancer Diagnosis and Treatment

ŸRadical Prostatectomy

ŸLaparoscopic Prostatectomy

Gender distribution of urosurgery patients (III) Bladder CanceruFlexible Cystoscopy

ŸTransurethral Resection of Bladder Tumor (TURBT)

ŸOpen Radical Cystectomy

ŸLaparoscopic Radical Cystectomy

ŸRadical Cystectomy and Neobladder Formation

69 Urosurgery

(IV) Kidney Cancer

ŸPartial Nephrectomy

ŸLaparoscopic Radical Nephrectomy

ŸOpen Radical Nephrectomy

ŸPercutaneious Nephrolithotomy Surgery (PCNL)

/Ureteroscopic Lithotripsy (URS) / Flexible URS /

Cystolitholepexy for Urinary Stones.

ŸVisual Internal Urethrotomy (VIU) – for Stricture

Urethnal.

ŸPediatric Endoscopic Surgeries.

ŸTension-free Vaginal Tape (TVT) / Transobturator

Tape (TOT) for Stress Urinary Incontinence.

ŸPlastic Surgery for Hypospadias, Hernia,

Hydrocele Operations and Mesh Repairs.

Orchiopexy, Varicocelectomy, Vasectomy

CIMS Renal Transplant Team has successfully completed 10 Renal Transplant so far.

70 Plastic Surgery

The Plastic surgery procedures at CIMS Hospital include both Total Volume of Plastic Surgery cosmetic enhancements as well as functionally reconstructive operations using surgical and non-surgical techniques to change the appearance and function of a person's body. Plastic surgery at CIMS repairs and restores appearance and function through wide range of reconstructive cosmetic surgery services. CIMS plastic surgeons team with surgeons in dermatology, otolaryngology (ENT) and oral/maxillofacial surgery and physicians to offer a comprehensive restoration. Services available at CIMS include ŸReconstructive surgery ŸReconstructive microsurgery including ŸBrachial plexus injuries Ÿ Age Distribution of Plastic Surgeries Craniofacial surgery ŸAesthetic plastic surgery ŸLaser surgery ŸPediatric plastic surgery ŸHand surgery ŸSkin grafting to treat wounds, trauma, burns and infection. ŸPlastic surgery at CIMS for cancer patients include ŸMastectomy for breast cancer ŸHead and neck cancer ŸSurgery for skin cancer ŸSurgery for colorectal cancer, ŸGynecological or peritoneal cancers.

Gender Distribution of Plastic Surgeries

71 Obstetrics and Gynaecology

The Gynecology division at CIMS offers a wide range of gynecological care for women from adolescence through post-menopause. Our care extends from preventive care to diagnostic, operative and educational care. Department at CIMS is fully committed to deliver world class health care services to women looking for gynecological solutions. At CIMS we have a dedicated team of obstetricians and gynecologists offering a wide range of services. From pre-pregnancy care to childbearing and post-menopausal care, there is a solution for all health Age Distribution of Gynaecology Surgeries concerns a woman experiences during these stages. Gynecological and pregnancy related services provided at CIMS include ŸPregnancy care and birth ŸHigh risk pregnancy ŸInfertility ŸMenorrhagia Clinic (Heavy Periods) ŸWhite discharge / Leucorrhoea ŸMenopausal symptoms

Types of Gynaecology and Obstetrics Surgeries ŸUrinary leakage ŸCancer screening and treatment ŸContraception and family planning ŸAdolescent clinic and guidance ŸOperative laparoscopy and hysteroscopy surgery ŸAll types of gynec surgery ŸFoetal USG and doppler and anomaly scan ŸHPV vaccine (for prevention of cervical cancer)

72 Obstetrics and Gynaecology

Obstetrics and Gynaecology ŸHigh Risk Pregnancy Unit with round-the-clockexpert team of obstetrician ŸState-of-the-art NICU & Green ICU ŸRound-the-clock intensivists ŸIn-house availability of Neonatologist, Cardiologist, HematoIogis t, Gastroenterologist and Nephrologist ŸFacilities of CT, MRI, Blood Bank & Dialysis ŸExpert in management of medical disorders in pregnancy, pre-pregnancy consultation Foetal Medicine ŸFacility for 3D/4D TIFFA/anomaly scan ŸColour doppler, foetal well-being scan, foetal echo ŸPrenatal diagnostic and therapeutic procedures like ŸAmniocentesis ŸFoetal reduction ŸCordocentesis ŸIntra-uterine blood transfusion ŸAneuploidy screening ŸFirst trimester combined screening (NT Scan + S.BHCG + S.PAPP-a) ŸQuadruple marker ŸNIPT(Non-invasive prenatal diagnostic technique) Our team of experienced gynecologists along with round- the-clock medical and paramedical staff provide tender care to pregnant females and gynec patients. At CIMS besides, pregnant and gynec patients Comprehensive Woman Health checkup program are arranged and conducted successfully.

73 Neonatal Center

Neonatal Department of CIMS Hospitals specializes in treating babies with a wide range of congenital and acquired conditions through state of the art technology and care. Goal of CIMS Neonatal care unit. ŸTo reduce the neonatal morbidity & mortality. ŸTo provide continuing in- service training of medical & nursing personnel in the care of newborn. ŸTo improve clinical care of the critically ill. ŸKey features of Neonatal and Pediatric Critical Care Unit. ŸHighly qualified intensive care team to treat critical neonates and children. State-of-the-art 12 bedded advanced neonatology setup, well equipped with conventional as well as high frequency oscillatory ventilation (HFOV-SLE 5000) with facility of Nitric Oxide(NO) delivery. Multi-disciplinary intervention program with facilities like in- house pediatric surgery, pediatric cardiology and pediatric cardiac surgery, fibreoptic bronchoscopy, post trauma care. 24x7 emergency support and pediatric transport team equipped with pediatric ventilators. Goal of CIMS Neonatal care unit ŸTo improve clinical care of the critically ill neonate. ŸTo reduce the neonatal morbidity &mortality ŸTo provide continuing in- service training of medical & nursing personnel in the care of newborn.

74 ENT

As medical advances in otolaryngology occur, CIMS are at the forefront at offering new techniques and treatments. CIMS ENT is dedicated to providing the highest quality, most advanced non surgical and surgical ear, and nose and throat care for patients of all ages. We provide patient with complete ENT diagnosis, treatment and surgical services. CIMS Goals: To discover new insights into the pathophysiology of otalaryngological diseases. To invent new technological application designed to optimize therapy of challenging clinical problems as well as to overcome disabilities brought on by illness. ŸTo patients with complicated ear, nose, and throat disorders ŸTo discover new insights into the pathophysiology of otolaryngological disease ŸTo invent new technological applications designed to optimize therapy of challenging clinical problems as well as to overcome disabilities brought on by illness

At CIMS, Head and Neck Surgeries include: ŸTympanoplasty (reconstruction of the ear drum) ŸNasal endoscopy ŸStapedectomy (removal of all or part of a bone in the middle ear) ŸCochlear implants (implantation of a device to stimulate nerve ends within the ear to enable hearing) ŸMyringotomy (insertion of ear tubes to drain fluid in persons with chronic ear infections) ŸCorrection of a deviated septum and various forms of endoscopies ŸTonsillectomy and Adenoidectomy of various grades were successfully performed. 75 ENT

Advantages of Balloon Sinuplasty Technique:

ŸLess invasive: No need of cutting and removing the normal

tissue of nose

ŸLess trauma : The pressure needed to inflate the

balloon can be monitored from out side

ŸLess pain : Minimum intra operative and post-

operative pain

ŸLess recovery time: Procedure is recommended as office

procedure / day care procedure

ŸLess scarring: No need of putting any incision over face or

nose Less follow up : No post-operative endoscopic nasal

cleaning is required

CIMS ENT department is dedicated to making sure our

patients have the most positive, comprehensive and

highest quality of care. The ENT experts at CIMS,

diagnose and treat conditions of the ear, nose, sinuses,

Balloon Sinuplasty larynx (voice box), mouth, throat, head, and neck. ŸBalloon Sinuplasty – A Novel Treatment for Chronic Physicians at CIMS, treat patients through both medical Rhinosinusitis and surgical means providing facial plastic and ŸBalloon Sinuplasty is safe and minimally invasive procedure that opens blocked sinus passages. reconstructive surgery, pediatric ENT, cochlear implants, ŸSurgeon thread a soft tipped guide wire equipped with and hearing aids as well as treatment for balance a tiny balloon into the nostrils and up to the area of disorders, inhalant allergies, sinus and snoring blockage. They then inflate the balloon just enough to disorders, voice and swallowing problems, and cancer of open the passageway. Finally they spray fluid into the the head and neck. infected sinus to flush out the pus and mucous.

76 Pain Management

Conditions treated at CIMS Pain Center ŸBack pain ŸKnee pain ŸJoint pain ŸNeck and shoulder pain ŸHeadache and migraine ŸCancer pain ŸFibromyalgia ŸTrigeminal neuralgia ŸSports injuries At CIMS, we do very high end procedures like: ŸNerve root blocks ŸFacet joint blocks ŸMedian branch blocks / Radio frequency ablation ŸOzone nucleolysis ŸVertebroplasty / Kyphoplasty ŸSacroiliac joint injection ŸPiriformis injection ŸCaudal, lumbar, thoracic, cervical epidural injection ŸMyofascial trigger injection ŸHypodermic needling ŸSympathetic blocks like Sphenopalatine block, stellate Pain management is a challenging issue arising from block, T2, T3 Block, Splanchnic block /RF ablation, Celiac either complicated medical, surgical or neurological block, Superior hypo gastric plexus block, Ganglion impar issues. CIMS Pain Management center is a one-stop block etc. ŸGasserion ganglion Radiofrequency ablation / V2,V3 Block destination for patients with chronic pain disorder. At CIMS a ŸOccipital, intercostal, suprascpular, Genicular nerve blocks specialized team of doctors, anesthetist, neurologist, etc. Ÿ medical psychologist, and physiotherapist diagnose, Spinal cord stimulator implantation and monitoring ŸIntrathecal morphine pump implantation evaluate and treat acute or chronic pain. ŸPRP therapy We use latest and advanced IMAGE GUIDANCE techniques ŸJoint injections ŸLive fluoroscopy to control pain. This improves precision and results with ŸLive USG minimally invasive technique. ŸLive CT Scan guidance 77 Dentistry

Other Services ŸRoot Canal treatment ŸFillings ŸProsthodontics ŸPreventive Dentistry ŸPedodontics ŸOrthodontics ŸPeriodontics ŸMaxillofacial Surgery

At CIMS, we improve the quality of life with DENTAL IMPLANTS ŸImproved aesthetic ŸPreserved facial structure ŸImproved chewing function and confidence ŸImproved dental hygiene ŸReplacement of a whole missing tooth (root) ŸAvoiding the need to prepare adjacent teeth, since a conventional bridge is not used. CIMS State-of-the Art Dental area: CIMS Hospital provides the best dental care in Ahmedabad ŸMinimum Dental Sittings and Western India for families in a comfortable, modern and ŸLess Operational time relaxed environment using the best and latest techniques Ÿ and modern dental instruments. Painless Treatment Our Area of Expertise ŸNo Cross Infection ŸCardiac Dentistry ŸDay care/indoorfacilities for medically compromised and ŸDentistry for Cancer Patients seriously ill patients ŸImplants ŸFacility of generalanaesthesia on dental chair only Ÿ Full mouth rehabilitation ŸTotal care for NRI and overseas patients by special Ÿ Cosmetic & Esthetic Dentistry international patient's department. 78 Dentistry

Ÿ3 Dental chair set up: separate area specially designed for ŸWe are an NABH accreditated institute. We have best the extra comfort, care with high end facilities and privacy. implant kits, physio dispenser and total instrumentation for ŸWe follow strict sterilization protocols. sinus lift procedures. ŸWe ensure our patient’s safety first. We have central ŸFor endodontic procedure (Root canal treatments) we sterile supply department which guarantees perfect have very sophisticated rotary motors with Apex locator sterility. which makes treatment painless more accurate and in minimal sittings. ŸWe have two x-ray machines and 2 RVG. ŸFor teeth whitening procedures, we have a bleaching light ŸIntra oral cameras are used to show pictures of each and to enhance your whitening experience. every tooth which help our patient understand the ŸUltrasonic scalers. treatment plan with more clarity. ŸBest software for patient data maintenance.

79 Pathology

CIMS is a NABL accredited State-of-the-Art Quality Customer friendly ambience aids to their experience to a Laboratory which offers 24x7 operational support to the great extent. medical teams in the hospital. The Pathology Department at CIMS is well-equipped to CIMS Pathology strongly supports clinicians in diagnosing carry out the latest test on patients and assist clinicians in and treating their patients. Services are also available for evaluation and diagnosis of diseases. outdoor, walk in patients.

80 Pathology

81 Pathology

82 Radiology

Department of Radiology and Imaging at CIMS offers : ŸDigital X-ray ŸIITV ŸVarious X-ray procedures ŸUltrasonography ŸColour Doppler ŸMammography ŸComputerized Tomography Scan (CT Scan) ŸInterventional procedures like tapping, biopsy, aspirations.

Various CT scan services available at CIMS hospital are ŸCT Brain ŸCT Thorax, abdomen, pelvis, neck, etc. ŸCT IVU (IntraVenous Urography) ŸCT coronary calcium scoring ŸCT carotid angiography ŸCT cerebral angiography ŸCT aortography ŸCT subclavian angiography ŸCT lower limb angiography ŸCT renal angiography ŸCT mesenteric angiography ŸCT brain perfusion, etc.

Mammography is a specific type of imaging that uses low dose X-ray for examination of breast. It plays central role of early detection of breast cancer. Current guide lines of American cancer society (ACS), American medical association (AMA) and American college of radiology (ACR) 83 Radiology

recommend screening mammography every year for Various diagnostic and therapeutic radiological women above 40 years of age. procedures are conducted, including:• Benefits ŸAbdominal imaging For cardiac patients in particular, the benefits are significant: ŸBiopsy, using CT, ultrasound and fluoroscopic procedures Acute chest pain can be evaluated quickly with a single ŸBreast imaging scan. ŸCardiac radiology The test can take as little as 10 minutes from scan to ŸComputed tomography :Coronary artery calcification diagnosis instead of hours, and can potentially avoid other scoring tests such as stress testing, ECG studies, and blood testing. Ÿ Lung cancer screening The scanner's speed shortens the length of time patients ŸDiagnostic imaging in oncology must hold their breath - from 17 seconds to just 9. ŸGastrointestinal radiology Images of the beating heart in real time permit the evaluation ŸGeneral radiology, chest and skeletal of heart valves and related structures. ŸGenitourinary radiology Since cardiac catheterization is no longer required, there are ŸMammography fewer risks and complications. ŸMusculoskeletal imaging Since there is no recovery time involved, patients can leave ŸUltrasound, including duplex and color-flow imaging when their exam is completed. ŸUroradiology The procedure is less expensive than traditional ŸThoracic radiology angiography helping to control cost. ŸVascular radiology. 84 Physiotherapy, Rehabilitation and Nutrition

Physiotherapy team handles patients of CABG, Valve Replacement, PTCA, Congenital heart diseases etc. at pre and post procedure. At CIMS Physiotherapy Treatment Includes: ŸManual Therapy (manipulations / mobilizations) ŸElectrotherapy Modalities ŸShort Wave Diathermy ŸUltrasound ŸTractionuInterferential Therapy ŸTENS (Transcutaneous Electrical Nerve Stimulation) ŸMuscle Stimulator ŸWax Bath ŸHydrocollater (Hot pack) ŸSuspension Frame ŸBiomechanical Assessment ŸOrthotic and Prosthetic Exercises ŸMuscle Imbalance Correction Geriatric Rehabilitation provides rehabilitation and treatment for older adults who are experiencing multiple, complex medical and psycho-social problems, or a recent unexplained breakdown in health and function. Cardiac Rehabilitationis specially designed and programmed to provide specific information and planned exercise that helps a cardiac patient to get back to everyday life as efficiently as possible after a heart attack, heart surgery or procedure. Orthopedic Rehabilitation and Physiotherapy-Individuals who undergo joint replacement, musculoskeletal injury, Hip replacement, trauma, amputation or degenerative joint diseases are treated to rebuild strength, restore physical function and enhance the skills needed to perform daily activities. 85 Physiotherapy, Rehabilitation and Nutrition

CIMS Women Wellness Program CIMS provides total women fitness program that includes obesity management, pre-natal and post natal (before and after pregnancy) exercises and post-menopausal rehabilitation.

Nutrition Dietary intake of fats, cholesterol, fruits, vegetables, fish and sodium are linked to cardiovascular risk. A cardio protective diet should consist of a variety of foods and aim to achieve four major goals. –a healthy overall diet –a healthy body weight –a desirable lipid profile, blood sugar level –a desirable blood pressure There is strong evidence that reducing the intake of total, saturated fat and salt and increasing fruits and vegetables are beneficial. There are 5 dietician at CIMS to take care of the patients by preparing diet plans for the rehabilitation patients, counseling patients and their relatives for their dietary intake and advising them about the food-drug interactions. Saturated Fat: SAFA Sources include : Palm Oil, Coconut Oil, Butter, Dark Chocolate, Fish Oil, Cheese. Polyunsaturated Fats: PUFASources include: Soyabean Oil, Corn Oil, Walnut Seed, Sunflower seed Oil. 1. Protective against cardiac arrhythmias 2. Protective against insulin resistance 3. Decrease cholesterol and increase HDL levels Monoun- saturated fats: MUFA Sources include: Mustard oil, Macadamia nut oil, Olive oil, Canola oil, Peanut oil.

86 Code Blue

Code Blue is the term for a medical emergency, meaning a person is possibly in danger of immediate dying. Calling criteria for our MET service are based on acute changes in 1. Heart rate (<40 or >130 beats/min), 2. Systolic blood pressure (<90 mmHg), 3. Respiratory rate (<8 or >30 breaths/min), 4. Conscious state, urine output (<50 ml over 4 hours), and 5. Oxygen saturation derived from pulse oximetry (<90%, despite oxygen administration).

CIMS, as a part of its disaster plans, has set a policy to determine which units provide personnel for code coverage. This team is staffed by physician, anesthetist, respiratory therapist, pharmacist and nurses. A rapid response team leader or a physician is responsible for directing the resuscitation effort and is said to “run the code”.

In-hospital cardiac arrests are common and delayed treatment is associated with a lower survival rate and poor push hard and push fast neurological outcomes. However, early recognition of “at- risk” situation is important for the safety of the patients. But 100 compressions blue code alarms in response to the misused cases may per minute demoralize the team, and the team could not respond to the alarm. Hence it is possible to set up an intermediate step 4.5 cm called “confirmation step” between an initial blue code call and an activation of hospital-wide alert.

87 Quality Measure

health care costs. Similar results have been achieved in lowering the rate of VAP and in reducing blood transfusions. Medication Error: ŸA medication error is any preventable event that may cause or lead to inappropriate medication use or harm to a patient (US-FDA). Examples include, but are not limited to: ŸErrors in the prescribing, transcribing, dispensing, administering, and monitoring of medications; Wrong drug, wrong strength, or wrong dose errors; ŸWrong patient errors ŸWrong route of administration errors ŸCalculation or preparation errors. Adverse Anesthesia Event: Is any untoward medical occurrence that may present during treatment with an anesthetic product but which does not necessarily have a causal relationship with this treatment. Re- Scheduling: Re-scheduling of patients includes cancellation and postponement (beyond 4 hours) of the surgery. Based on above principles Appropriateness of Care can be measured using below indicators which directly and/or indirectly relate to patient wellbeing. These indicators include- The purpose of Quality Measures is to Ensure Proper Process I) Patient care indicators for Selection, Collection, Analysis of Measures and Validation II) Guideline driven indicators of Data. III) Clinical outcome indicators Hospital-acquired infection rates at CIMS are very low. IV) System specific indicators Typically, the two leading causes of hospital-acquired V) Cost-effective indicators infections in the ICU are central line infections and ventilator- VI) Structural indicators. associated pneumonia (VAP). A mindset of zero infection At CIMS Appropriateness of Care is the followed ideology. tolerance at CIMS and the consistent following of protocols Length of stay (LOS) is a term used to measure the duration of have resulted in reduction in central line infections over past a single episode of hospitalization. Inpatient days are years. This reduction in catheter-related bloodstream calculated by subtracting day of admission from day of infections has saved many lives and significantly reduced discharge. 88 Ambulance and Transport Service

Ambulance Number of Services Patient Drop 502 Patient Pick up 501 MRI & Check up 83 Other 14 Ambulance services are available in the hospital for 7x24x365 days. CIMS Ambulance Services include ŸDoctor Ambulances are equipped with international quality ŸTrained Nurse instruments for international standards of service & care. ŸECG The doctors on board are trained adequately experienced to ŸEmergency Medicines handle all kinds of emergencies. ŸStretcher 24 x 7 services are provided for all patient transport needs ŸLaryngoscope with all size blades Transfers from home to hospital and from hospital to ŸSilicon Ambu Bag hospital ŸAnatomical face mask (all sizes) Highly trained medical personnel ŸVenti mask and nasal cannula and 2nasal catheter Our ambulances carry oxygen therapy equipment with ŸGuedel's Air way (all sizes) defibrillator to provide aid in the event of any ŸStylet Magill's forceps deterioration of patients whilst in our care. ŸPortex Endotracheal tubes CIMS Hospital has a well organized strategically placed fleet ŸLaryngeal mask Air way of ambulances in order to serve the increasing emergency Ÿ medical needs. Combitube ACLS/BLS trained emergency technicians and nurses with ŸWorking suction Machine advanced life saving equipment like defibrillator, ventilator, ŸCylinder with Regulator2 oxygen cylinder and other medicaments for an integral part ŸIV Cannula of our ambulance service. ŸI.V. Set and Microdrip Set Round the clock ambulance service is available which is ŸDisposable Syringes and Needles equipped with a mobile ICU- set-up to transport critical ŸDefibrillator patients. The department is geared to face challenges of the ŸMultipara monitor Pediatrics age groups with in-house Pediatrics / ŸXylocaine Jelly 2%, spray. Neonatology Care,

89 Care At Homes

CIMS care at home unit provides complete state-of-the art medical care at home which includes: 24 x 7 Specialized Nursing Service ŸEscort nurse for patients shifting ŸWound care and dressing ŸIntravenous (IV) infusion therapy, Intra Muscular (IM) and Sub Cutaneous (SC) injections ŸFocus on continuous training and development ŸCatheter (urinary) insertion and care ŸVaccination at home

90 Care At Homes

Skilled nursing in chronic illnesses like: ŸNebulizer ŸDiabetic care ŸAir bed / Water bed ŸNephro care ŸNimbus air bed ŸNeuro care ŸSuction machine ŸPost transplant care, ŸOxygen (O2) cylinder B-type ŸParkinson’s disease ŸOxygen (O2) concentrator(05 LTR.) Ÿ ŸMental illnesses Multi-parameter monitor Ÿ ŸPost discharge care Fully and Semi motorized bed ŸSemi Fowler (1 function) bed ŸCancer care ŸWheel chair ŸGeriatric care ŸPaediatric care ŸMedical Equipment For Sale ŸMaternity care ŸBlood pressure (BP) instrument ŸPulse oxymeter Caregiver Services ŸGlucometer ŸBathing, grooming and toiletry services ŸNebulizer machine ŸEscorting patients for appointment ŸThermometer Ÿ Mobilization and ambulation with walker and wheel chair ŸSuction machine Ÿ Nutrition assistance with eating ŸAir bed / Water bed ŸPicking up prescription and medication reminder ŸWalker Rehabilitation Services ŸWalking stick ŸPhysiotherapy (Occupational Therapy & Rehabilitation ŸWeighing scale Centre) ŸWheel chair ŸNutritional assessment (with qualified Dietician) ŸPatient bed side table Ÿ Medical Equipment For Rental ŸIV stand ŸVentilator machine ŸBi-pap machine ŸInfusion pump ŸBlood pressure (BP) instrument 91 Patient’s Say

S. L. Great care from all. The staff is very attentive and caring to provide the best service. Very calming atmosphere and the hospital itself is so clean and shiny! It has been the best hospital I have been to in my life."

S. S. There is all facilities needed in this hospital. Give 5 stars all the way. There are so much reassuring staff and experienced doctors here. The convenience of cleaning and canteen is alsonice. Thank you everyone.

S. M. Best Hospital in India . The Hospital with best team of doctors. And Dr Keyur Parikh is one of the best personality i have ever met in my life. I stayed more than a week but didn't feel that i am in hospital, it felt like home to me. The Doctors and nurses are so friendly that u dont feel like u are taking to doctors. The services provided here are better than service provided in a 5star Hotel. And not only services but the patients care taken by Hospital is unimaginable. They treat patients as a family member.

N. D. All over Security experience is wow.I appreciate overall the way hospital is operating. Every staff right from gaurd medical officer nursing staff billing and insurance staff even canteen staff all are wonderful..attandant and housekping also done their wonderful job. Patients guests team is best part of cims. Inshort each and every staff very caring. THANK YOU CIMS R. D. Dr. Manish Gandhi, A top most gastroenterologist surgeon attended my father surgery last month in Feb at CIMS. The operation lasts 6-8 hours long. Dr. Gandhi and his team done the job carefully and now my father is much better. He was suffering from a critical disease of Hilar cholangiocarcinoma. After resection Dr. Gandhi shown me snaps taken during resection. I am grateful to have the best response and familiar behaviour of Dr. Gandhi and his team. Entire staff and attenders at CIMS were very helpful. A REAL CARE INSTITUTE OF MEDICAL SCIENCE.

N. M. Dr. Shri Shaunak Shah sir is the best pediatrician and cardiologist surgeon. A lot of achievements he has done and I pray to God for always success as well as achievements for him towards every patient in future. Thanks a lot

92 Patient’s Say

N. R. CIMS Ahmedabad is very professionally operated hospital. Recently I have undergone prostrate operation in CIMS by Dr. Rupesh Shah. He has a great expertise and is a very caring doctor. It appears that they all have great mission.

A. L. Cims hospital all staff are down to earth .specially patients care is very good. really appreciate all. Thank you CIMS. All instuments are very latest. PGET concept is very good. I appreciate them also.

N. M. Last week my mother was treated for TKR (Total knee replacement) surgery at CIMS. Nice experience with staff behavior and their services. And specially thanks to dr. Keyur Buch and his team.

P. P. Very good hospital with clean rooms. We have a very high regard for Dr. Dhiren Shah (cardiologist). He is calm and takes time to discuss the case which justifies his busy schedule. Canteen facility is good too in case family members need lunch or dinner. Don’t have much experience with other departments but Over all good hospital for heart treatment.

I.H Dr. Pranav Shah has a fantastic attitude, both humorous and caring. His straight forward honesty was a breath of fresh air. He told me what l needed what to expect and did it all with humor a great skill. I m delighted with my experience. Every single person on your staff was terrific. A big thank you to Dr. Pranav Shah n his team for prompt and efficient service.

A.D The hospital provides diagnostic medical, surgical, palliative care facilities and is Ahmedabad's first Green Hospital. The hospital is accredited to Joint Commission International (JCI), National Accreditation Board for Hospitals & Healthcare Providers and National Accreditation Board for Testing and Calibration Laboratories. CIMS Foundation provides financial aid and affordable healthcare to needy patients.

93 Ethics

Review and approve clinical drug and device trials/studies from Phase I to Phase IV as well as all Bioavailability / Bio- equivalence (BA/BE) studies.

Review and approve observational and experimental: A) Investigator initiated B) Sponsored research C) Academic Projects D) Clinical Registry E) Others (e.g. Bio-Banks, tissue research, nutraceuticals and food products etc.)

Ethics Committee of Care Institute of Medical Sciences is registered by Central Drugs Standard Control Organization, Government of India with Registration number ECR/206/Inst/GJ/2013 and re-registered with ECR/206/Inst/GJ/2013/RR-16 as per the provision of Rule 122DD of the Drugs and Cosmetics Rules, 1945 and registration is sought for Institutional Ethics Committee. Ethics Committee of Care Institute of Medical Sciences is also accredited by National Accreditation Board for Hospitals & Health care Providers (NABH), Constituent Board of Quality Council of India (QCI) under clinical trial Code of ethics program with certificate number EC-CT-2017-0001 The management is fully aware of ethical management and accreditation till August 05, 2020 also EC NABH ethical practices. Hospital has established the Ethical surveillance assessment was done on 21st & 22nd committee. Committee follows code of ethics established by December 2018. Medical Council of India, Indian Council of Medical Research (ICMR) and ICH-GCP guide lines. The underlying goals of CIMS ethics committee are: To promote the rights of patients; Scope of committee To promote decision making between patients and their Issue policy on medical ethics clinicians; Review, evaluate and approve cases for, ethical dilemmas, To promote fair policies and procedures that maximize the terminal care. likelihood of achieving good, patient-centered outcomes; Any other potential conflict of ethical issues and medical and To enhance the ethical environment for health care policy and practice professionals in health care institutions. 94 Research Projects

1) Health Outcome of Metabolic Parameters in Conclusion: The occurrence of hyperuricemia was Hyperuricemic Population observed in 662 subjects including both male &female aged over 21. Study showed prevalence of hyperuricemia in A Objective: Despite the modest antioxidant activity exerted Specific locality. Finding of study clearly indicates a positive relationship of age, gender, BMI, Triglycerides, LDL, HDL, & by uric acid (7.0 mg/dL), is a potentially harmful condition Cholesterol with UA Levels. Hyperuricemia can be leading to complications such as gout, nephrolithiasis and considered to be the common life-style disorder, chronic nephropathy. The present study evaluates the accompanied with risk factors that can be affected by health outcome of metabolic parameters in hyperuricemia locality. Hyperuricemia can be considered as better Subjects. predictor of metabolic syndrome.

Methodology: This was an observational Study. Various variables of 2784 subjects were collected (2017-2018) from CIMS hospital. The subjects were divided into two groups based on uric Acid Level (UA): Group A I- 2122 Subjects with normal UA level; Group A II- 662 Subjects with hyperuricemia. Group AII was further sub-grouped in two groups based on Locality.Group B I- General population; Group B II – A specific locality. After analysis correlation was performed between Group A vs Group B & Group 1B vs Group 2B. 2) To Evaluate Outdoor Air Pollution and Wellness Parameters in Ahmedabad Result: 2169 subjects were males & 615 were females aged over 21 years. Males have higher prevalence of Objectives: The aim of this study was further understand hyperuricemia. These variables were significantly higher in the correlation between air pollution and assess the effects Group 2B than Group 1B. Diet & habits also influence UA of air pollution on Hospital visit due to symptoms of Cardiovascular, Respiratory disease. levels; high intake of non-veg diet and alcohol were associated with prevalence of hyperuricemia. Group B have Background: Ahmedabad is 7th largest metropolitan city of higher prevalence of obesity, hypertension, dyslipidemia, India, situated on bank of Sabarmati river in state of Gujarat diabetes and metabolic syndrome as compared to Group A. India at Ahmedabad. AAP and PM have been closely These risk factors were significantly higher in Group 2B than associated with adverse health effects such as respiratory Group 1B. disease and cardiovascular diseases. 95 Research Projects

Study Method: This was an observational study wherein group in patients undergoing CABG. Data was collected Ahmedabad was divided in to 5 zones East, West, south, from medical record files of patients undergoing CABG in North, Central. We further divide each zone in to different between 2017-2018 from CIMS Hospital. A total of 80 wards for easiness of recording. We gathered air pollution patients were included which were divided in to two equal records from Gujarat pollution control board. Air pollution groups: Group I : Subjects treated with Levosimendan; parameters studied included SO2, NO2, PM2.5, PM10 Group II : Subjects with no treatment of levosimendan. concentration at different times of the year and correlated Hemodynamic, cardiac function and cardiac biomarkers cardiovascular and Respiratory disease patients at CIMS. parameters were collected and reviewed.

Result and Discussion: During winter period air pollution Results: Among patients with low ejection fraction who parameters were-PM10 (Mean=176.9), PM2.5 underwent CABG, levosimendan compared with control (Mean=54.2), NO2(Mean=31.7) while visit to CIMS due to group did not result in a significant difference in the cardiovascular and respiratory disease were [159(26.4%)] and [104(21.5%)] respectively. Prevalence of composite end points: Conversion of off-pump into on- cardiovascular disease patients was predominant.PM10, pump, requirement of Inotropes and Vasopressors infusion, PM2.5, NO pollutants were associated with increase in use of Pre/Post-operative IABP (Intra-Aortic Ballon Hospital visit for HTN, Coronary artery disease. Pacemaker), Post-operative renal replacement therapy/dialysis, total hrs on ventilator, post-operative Conclusion: Air pollution is an important risk factor for adverse events and patient baseline demographic detail.. cardiovascular disease in Ahmedabad region with the Conclusion:These finding do not either support or rule out highest heart disease incidence supported the evidence of beneficial effect of use of levosimendan in patients with low effects on CVD due mainly to outdoor particulate pollutants LVEF in perioperative period for CABG surgery. during winter period. Fig 1:Comparison of requirement of Inotropes and Vasopressors 3) To Evaluate Safety and Efficacy of Levosimendan in Patients with Coronary Artery Bypass Grafting(CABG). Aim & Objective: To compare the hemodynamic effects and immediate postoperative outcomes with levosimendan and control group in patients undergoing coronary artery bypass grafting (CABG).

Methodology: This was an Observational Study to compare the hemodynamic effects and immediate postoperative outcomes with levosimendan and control 96 Research Projects

4) Impact of Blood Transfusion on Outcomes in Patient Conclusion: Blood transfusion works as an independent Undergoing Coronary Artery Bypass Grafting factor for complication. Also, interaction with other co- morbidities, patient’s characteristics, demographic details, Objective: To determine blood transfusion rate, factor types of procedure, duration of surgery and patient’s pre- affecting blood transfusion and outcomes in patient operative condition are other significant factors affecting undergoing CABG. blood transfusion. Based on this study, it was found that hospital mortality rate was unaffected by blood transfusion Study Method: This was a retrospective study. A total of 200 although it serves as a predictor for clinical outcomes. patient’s data from medical record file was collected. Factors affecting blood transfusion, major post-operative clinical outcomes were analyzed .Also Subgroup analysis of anemic and non-anemic groups were performed.

Result & Discussion: of the 200 CABG patients: 175(87.5%) were males while 25(12.5%) were female patients. Of these 145 (72.5%) patients received blood transfusion. Ventilator support time, LOS in ICU, LOS in hospital were longer in blood transfusion patients. Graph 4.1 Post-Operative Outcomes Table 4.1: Subgroup analysis of anemic and non-anemic groups 5) Transradial vs. Transfemoral Approach for Diagnostic Percutaneous Coronary Intervention and Coronary Angiography in Patients with Coronary Artery Disease

Objective: To compare radiation exposure in invasive cardiac procedures performed by transradial and transfemoral approaches

Background: Several benefits have been described over years for transradial (TRA) versus transfemoral approach (TFA) in cardiac interventions. Both are main approaches used as a diagnostic and therapeutic purpose in cardiac catheterization. 97 Research Projects

Methodology: This was an observational study to Methodology: This is an observational study to find out the determine TRA Vs. TFA radiation exposure in outcomes of pulmonary arterial hypertension patients. A catheterization for Coronary Artery Disease. Data was total 547 patients were included in this study. The data was collected from July 2014 to March 2018 of CIMS Hospital collected from CIMS hospital from 2008 to 2018.The patients. A total of 484 subjects aged over 18 years were treatment included use of Ambrisentan, Sildenafil, included in study. 330 subjects underwent Coronary Bosentan, Tadanafil, Treprostinil, Riociguat, Macitentan, Angiography (CAG), 20 Subjects underwent Percutaneous Coronary Intervention (PCI) and 134 subjects underwent digitalis etc. CAG and PCI. Fluoro dose (FD), Fluoroscope Time (FT) and Contrast Volume (CV) & Dose Area Product (DAP) of TRA Result: Prevalence of PAH was observed in all age groups, and TFA were compared. Following Statistical analysis highest (49%) was observed between ages 19-55 years correlation was done to compare TRA Vs. TFA. (Age group :0-18(7.31%), 19-55(48.08%), >56 (8.04%).Of the total 547 patients 293 (53.56%) were males while 254 Results: The results depict that in CAG FT (Min) and FD (46.43%) were females. Average weight of the subjects was (ml) for TRA was higher than TFA. In PCI DAP (GY.cm2) and 63.44Kg (SD=57.70). The mean -body mass index was FT (Min) were higher for TRA than TFA whereas FD (ml) and CV (ml) were higher in TFA.In CAG + PCI DAP (GY.cm2), FD 24.12 Kg/m2 (SD=22.41), pulse rate was 58.54bpm (ml) and FT (Min) for TRA were higher than TFA. Marked (SD=66.56), systolic blood pressure was 90.40mm difference was observed in Prior CABG (0.006). hg(SD=91.65),diastolic blood pressure was 56.53mm hg (SD=58.23), pulse pressure was 33.69mm hg Conclusion: Radiation dose and exposure was higher to (SD=33.41).Treatments varied amongst subjects the interventional cardiologist in TRA compare to TFA. depending upon contributing risk factors and confounding However patient compliance and duration of hospital stay variables. Treatment options included teprostinil, was shorter in TRA as compared to TFA. Ambrisentan, Sildenafil, Bosentan, Tadanafil, Treprostinil,

6) An Observational Study to determine Management Riociguat, Macitentan, digitalis. Mortality at 10years was and Treatment Outcomes in Pulmonary Arterial high in these subjects . Hypertension Patients Objective: To determine outcomes in terms of mortality and Conclusion: At 10 years mortality rate of PAH patients was morbidity in pulmonary arterial hypertension(PAH) disease as high. patients when managed with different therapeutic options.

98 Research Projects

7) A Prospective, Randomized Study to Assess the respectively with maximum number of male subjects in both Effects of Magnesium Sulfate Pre-treatment on the groups. 6 (20%) male subjects in magnesium group and Analgesia and Prevention of Arrhythmias After Off- 17 (85%) subjects in control group whereas 4 (80%) Pump Coronary Artery Bypass Graft Surgery in First 24 female subjects in magnesium group and 3 (15%) subjects Hours in control group. No marked differences were observed in subjects of both the groups with respect to post-operative Objective: The purpose of this study was to determine the vitals (P < 0.05). Perception of pain was lower in group beneficial effect of magnesium sulfate as a supplement for treated with MgSO4 as compared to control group reducing pain and treating arrhythmias associated with significantly at 20 and 24 hours. postoperative off-pump coronary artery bypass graft surgery.

Methodology: This was a single centric, prospective and randomized study. Written informed consent was obtained from patients before performing any assessments. The study was performed in the operation theatre hold and SICU of CIMS Hospital. Patients were randomly allocated into two groups: Group-A and Group-B, Group A – subjects received Fig 1: Visual Analogue Score between groups at 50 mg/kg of magnesium sulfate intravenously over 15 various timelines after CABG minutes and 30 minutes before the anesthesia induction. Conclusion: Using VAS it was observed that post-operative Group B subjects did not receive magnesium sulfate pain intensity was higher in subjects of control group as infusion.Visual analog scale was used to determine pain compared to subjects of magnesium groups at different perception following CABG at 0,1,2,3,4,6,8,12,16,20 and 24 interval of times. The study shows significant decrease in hours. intensity of pain in subjects treated with MgSO4.none of the subjects in either groups developed arrthymias following Results: A total of 40 subjects were included in this study. CABG. 20 Subjects in magnesium group and 20 subjects in control group with mean age of 57.05±8.08, 58.95±9.58 99 CIMS Foundation

CIMS Foundation is established to provide support in delivering remedial healthcare to the vulnerable sections of the society. In India, 21 % percent of people die each year because they are unable to afford proper medical care. CIMS FOUNDATION welcomes all contributions in the form of cash/cheque/draft/NEFT/wire transfer in favour of “CIMS FOUNDATION”, IDBI Bank A/c No: 0067102000026798, IFSC Code IBKL0000067. All the Contributions to CIMS FOUNDATION are exempted u/s 80G (5) of the Income- Tax Act, Subject to the limits prescribed therein. CIMS Foundation Focus Areas More than 700 patients are supported by CIMS Foundation / To support patients and the family members who are CIMS CSR Programme / Trust every year which covers Heart socially , emotionally and financially weak. Patients, Paediatric, Cancer Patients, Trauma Patients, To assist people who cannot complete their medical Renal/Kidney Patients, Obstetrics & Gynecology Patients, treatment / care due to financial constraints. Geriatrics Patients, Neuro Patients and other needy patients, To establish regular camps for providing medical from all over the world who are getting their treatment at assistance at doorsteps in the rural areas. CIMS Hospital. To promote the welfare of children in need, including children with physical disabilities and/or life threatening diseases. To provide care, hope and dignity to all patients to fight against the disease and maintain good quality of life. Grant of subscriptions and donations to deserving private and public institutions for administering medical relief to the needy people. “ To interact with patients and relatives on daily basis to collect and maintain patient data required for philanthropy. To collect donations from donors for contribution and -Mahatma Gandhi ” disburse the donation to under privileged patient. 100 CIMS Learning Center

Care Institute of Medical Sciences (CIMS) is pleased to present the CIMS Learning Center (CLC) Program for the year 2018.Growth is driven by curiosity; curiosity is assuaged by knowledge. And knowledge is gained by continuing education. At CIMS CLC, we recognize that teaching and practice go hand in hand. CLC is founded on that premise. To share what we learn and pursue bigger ideas.

101 CIMS Education

CIMS Health care Number of CIMS Health care Number of Awareness Participants Awareness Participants Programme Venue Programme Venue Ahmedabad 4435 Navsari 335 Mundra 1650 Bilimora 280 Neemuch 1540 Dwarka 280 Amreli 1050 Adipur 220 Deesa 1020 Surat 140 Palanpur 1015 Jamnagar 133 Dehgam 780 Udaipur 132 Ratlam 494 Bidada 110 Bhuj 402 Mehsana 90 Idar 387 Gandhidham 78 Balotra 363 Other 319 CIMS organizes various national and international conferences like JIC, NATACON, AFPACON, NGPCON, APGCON etc. at various places throughout Gujarat and adjoining states of India. As a continuos process of education and social awareness, CIMS has organized more than 22 CMEs in various places of Gujarat, Rajasthan and MP. CIMS hospital also conducts in-house learning courses like Echo f e l l ows hi p, ECG Learning (Basic and Advance) and, CPR training for medical fraternity as well as common man. C P R training sessions were conducted. Medical camps are also organized by CIMS doctors wherein super specialist doctors impart free consultation to general public in both rural and urban areas.

102 Publication List (2014 Onwards)

1. Keyur H. Parikh, Clinical efficacy and safety of Sirolimus coated balloon in a real world single center registry of Indian population TCT-264 Journal of the American College of Cardology, Vol. 72, No. 13, Supply B, 2018.

2. Parth Parikh, Parloop Bhatt, Deepa Shah, Piyush Thakar, Ajay Naik, Hemang Baxi, Shmuel Banai, Keyur Parikh First-in- Human Use of Coronary Sinus Reducer in Patients With Refractory Angina Journal of the American College of Cardiology December 18, 2018, 72 (24) 3227-3228; DOI:10.1016/j.jacc.2018.09.061

3. Parth Parikh, Parloop Bhatt, Deepa Shah, Piyush Thakar, Ajay Naik, Hemang Baxi, Shmuel Banai, Keyur Parikh, "First- in-Human Use of Coronary Sinus Reducer in Refractory Angina: 12 Years Anatomical and Clinical Outcomes" (Manuscript Accepted at JACC 2018)

4. Parloop Bhatt, Urmil Shah, Milan Chag, Dhiren Shah, Ajay Naik, Hemang Baxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Piyush Thakar, Aditi Nanavati, Keyur Parikh NCDR® as a Resource Improvement in Hospital Quality Parameters Abstract Accepted at NCDR 2018

5. Parloop Bhatt, Urmil Shah, Milan Chag, Dhiren Shah, Ajay Naik, Hemang Baxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Piyush Thakar, Aditi Nanavati, and Keyur Parikh Achieving Highest Benchmarks in Interventional Cardiology: NCDR® Cath PCI a Critical Contributing Factor Abstract Accepted at NCDR 2018. 6. Parloop Bhatt, Urmil Shah, Milan Chag, Dhiren Shah, Ajay Naik, Hemang Baxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Piyush Thakar, Aditi Nanavati, Keyur Parikh Reduced Median Fluoro Time: An Outcome of NCDR® Participation Abstract Accepted at NCDR 2018

7. Parloop Bhatt, Urmil Shah, Milan Chag, Dhiren Shah, Ajay Naik, Hemang Baxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Tejas Patel, Vipul Kapoor, Piyush Thakar, Aditi Nanavati, Keyur Parikh Reduced Percutaneous Coronary Intervention In-hospital Risk Adjusted Rate of Mortality And Bleeding Events via Radial Access: NCDR® Findings Abstract Accepted at NCDR 2018

8. Keyur H. Parikh, Sameer Dani, Ranjan Shetty, Prathap Kumar, J.S.Hiremath, Dinesh Shah : Sirolimus Coated Balloon For the Treatment of Coronary Artery Stenosis: Long Term Outcome From a Real World Experience (Abstract Accepted in American College of Cardiology ACC March -2018)

103 Publication List (2014 Onwards)

9. Keyur H. Parikh, Sameer Dani, Ranjan Shetty, Prathap Kumar, J.S.Hiremath, Dinesh Shah : Treatment of Coronary In- Stent Restenosis With Sirolimus Coated Balloon Catheter: Sub-Analysis Results From Nanolute Study (Abstract Accepted in American College of Cardiology ACC March -2018)

10. Keyur H. Parikh, Clinical efficacy and safety of Sirolimus coated balloon in a real world single Center registry of Indian population

11. Parloop Bhatt, Parth Parikh, Anish Chandarana, Milan Chag, Vipul Kapoor, Aditi Nanavati, Tejas Patel, Satya Gupta, Hemang Baxi, Urmil Shah, Vineet Sankhla, Neil Jain, Keyur Parikh, CIMS Hospital, Ahmedabad, India, L. M. College of Pharmacy, Ahmedabad, India: Impact of Drug Eluting Stent Price Reduction in India: Selection for Stent Type Placement and Associated Outcomes.

12.Keyur H. Parikh, Parth Parikh, Parloop Bhatt, Aenasha Chag, Hemang Baxi, Milan Chag, Urmil Shah, Satya Gupta, Anish Chandarana, Manish Doshi, CIMS Hospital, Ahmedabad, India, Cleveland Clinic Foundation, Cleveland, OH, USA: Real World Clinical Outcomes of Sirolimus Coated Balloon in Coronary Artery Lesions: Results from Single Center Study.

13.Keyur H. Parikh, Parth Parikh, Deepa Shah, Parloop Bhatt, Piyush Thakar, Ajay Naik, Hemang Baxi, Shmuel Banai, CIMS Hospital, Ahmedabad, India, Cleveland Clinic Foundation, Cleveland, OH, USA: Coronary Sinus ReducerTM Retains Patency and Efficacy at Twelve Years: A Prospective Cardiac CT Angiography Outcomes.

14.Patel B Krunal, Chag C Milan, Gupta B Satya, Bhatt A Parloop, Parikh K Parth, Patel Aditi, Patel K Apurva, Jain N Neil, Parikh H Keyur, CIMS Hospital, Ahmedabad, India, Cleveland Clinic Foundation, Cleveland, OH, USA: First In Man Vascular Use Of Axiostat®: A Novel Whole Chitosan Haemostatic Dressing For Transradial Coronary Intervention Accepted: At WEC, Rajasthan, India, October, 2017

15.Dhiren Shah, Milan Chag, Deepa Shah, Dhaval Naik, Amit Chandan, Chintan Sheth, Niren Bhavsar, Hiren Dholakiya, Parloop Bhatt Late Coronary Stent Infection: A Difficult to Diagnose Rare Complication after Percutaneous Coronary Intervention Manuscript Accepted at Indian Journal of Thoracic and Cardiovascular Surgery (IJTC-D-18-00066R1) 2018

104 Publication List (2014 Onwards)

16.Parikh K Parth, Patel B Krunal, Chag C Milan, Gupta B Satya, Bhatt A Parloop, Parikh K Parth, Patel Aditi , Patel K Apurva, Jain N Neil, Parikh H Keyur, CIMS Hospital, Ahmedabad, India, Cleveland Clinic Foundation, Cleveland, OH, USA: Superiority Of Newer Oral P2y12 Inhibitors In Treatment In Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention At A High Volume Non-Us Center Abstract Accepted: at WEC, Rajasthan, India, October, 2017

17. Keyur H. Parikh, Parth Parikh, Parloop Bhatt, Satya Gupta, Hemang Baxi, Urmil Shah, Tejas Patel, Milan Chag, Sameer Dani, Ranjan Shetty, Prathap Kumar, Jagdish Hiremath, Dinesh Shah, Manish Doshi, CIMS Hospital, Ahmedabad, India, Cleveland Clinic Foundation, Cleveland Clinic, India: Prospective Real World Registry for the Use of Sirolimus Coated Balloon in Small Vessel De Novo Lesions (Accepted in American College of Cardiology ACC March -2018)

18.Parth Parikh, Parloop Bhatt, Vipul Kapoor, Hemang Baxi , Satya Gupta, Tejas Patel, Anish Chandarana, Roosha Parikh, Apurva Patel, Keyur Parikh. Optimal P2Y12 Inhibitors for Primary Percutaneous Coronary Intervention Patients in ST Segment Elevation Myocardial Infarction: Actual Care Trends and Outcomes. Accepted and presented in SCAI 2017, Orlando.

19.Parth Parikh, Apurva Patel, Parloop Bhatt, Milan Chag, Roosha Parikh, Anish Chandarana, HemangBaxi, Satya Gupta, Vipul Kapoor, Vineet Sankhla, Keyur Parikh, Care Institute Medical Sciences, Ahmedabad, India, Cleveland Clinic Foundation, Cleveland, OH, USA: Evaluation of a New Radiation Protection Technology (Cardio-TRAP®) in Transradial Percutaneous Coronary Intervention Procedures. Abstract Accepted and presented at ACC 2017,Washington, DC. Published in Journal of the American College of Cardiology 69(11):1365 • March 2017. DOI: 10.1016/S0735- 1097(17)34754-X.

20.Poonam Chodvadiya, Keyur Parikh, Ranjan Shetty, Sameer Dani, N. Prathapkumar: Sirolimus Coated Balloon in the Treatment of Acute Coronary Syndrome: Result from the Nanolute Registry Keyur H. Parikh Page 31 of 38 Abstract Accepted: TCT 388 Journal of The American College of cardiology Vol 68. No 18 Suppl 8, 2016 21.Milan Chag, Parloop Bhatt, Urmil Shah, HemangBaxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Aditi Nanavati, Piyush Thakar, Keyur Parikh. Hospital to Home Visit, an Effective Health Care Initiative to Reduce Complications and Improve Drug Compliance and Adherence: NCDR® Participation Advantage. Accepted in NCDR 2016.

105 Publication List (2014 Onwards)

22.Urmil Shah, Milan Chag, Dhiren Shah, Ajay Naik, Hemang Baxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Keyur Parikh, Parloop Bhatt. NCDR® as a Resource to Develop Cardiac Disease Specific Clinical Care Clinics. Accepted in NCDR 2016.

23.Urmil Shah, Milan Chag, HemangBaxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Keyur Parikh, Parloop Bhatt. An Asian Indian Single Center Radial Access Percutaneous Coronary Intervention Experience: NCDR® Findings. Accepted in NCDR 2016.

24.Satya Gupta, Parloop Bhatt, Milan Chag, Parth Parikh, ,Roosha Parikh, Apurva Patel, Aditi Nanavati, Piyush Thakar, Jawahar Mehta, Keyur Parikh. Depression Adversely Affects Long Term Outcomes in Acute Coronary Syndrome Patients: A Real World Scenario. Accepted in SCAI 2016. 25.Satya Gupta, Parloop Bhatt, Milan Chag, Parth Parikh, Aditi Patel, Vatsal Chhaya, Anish Chandarana, HemangBaxi, Urmil Shah, Dhiren Shah, Ajay Naik, Keyur Parikh. Temporal Trends in Young Indian Heart Failure Patients: A Ray of Hope. Accepted in SCAI 2016.

26.Satya Gupta, Parloop Bhatt, Milan Chag, Parth Parikh, Aditi Patel, Roosha Parikh, Apurva Patel, Apurva Patel, Aditi Nanavati, Anish Chandarana, HemangBaxi, Effect of Mono-therapy versus Combinational Therapy on Exercise Capacity of Pulmonary Arterial Hypertension Patients: Actual Care Data. Accepted in SCAI 2016.

27.Satya Gupta, Parloop Bhatt, Milan Chag, Nairuti Trivedi, Keyur Parikh, Apurva Patel, Roosha Parikh, Parth Parikh, Aditi Patel, Jawahar Mehta, Dhiren Shah. Chest Pain in Acute Coronary Syndrome Patients with Depression after 179 Bypass Surgeries. Accepted in SCAI 2016.

28.Keyur Parikh, Ranjan Shetty, Sameer Dani, Parloop Bhatt, Manish Doshi, Prakash Sojitra. Real-world Safety and Outcome Measures of Novel Sirolimus Coated Balloon Catheter. Accepted in ACC 2016.

29.Keyur H. Parikh, Satya Gupta, Parth Parikh, Aditi Patel, Aporva Patel, Roosha Parikh, Anish Chandarana, Milan Chag, HemangBaxi, Urmil Shah, Sustained Long Term Safety Out comes of “NEOVASC” Coronary Sinus Reducer in No Option Patients of Refractory Angina: 10 Year Follow up. Accepted in SCAI 2016.

106 Publication List (2014 Onwards)

30.Parloop Bhatt, Parth Parikh, Aditi Patel, Roosha Parikh, Apurva Patel, Jawahar L. Mehta, Keyur Parikh: Unique Aspects of Coronary Artery Disease in Indian Women Abstract Accepted; Cardiovascular Drug & Therapy, 26th May 2015, by Springer.

31.Parloop Bhatt, Parth Parikh, Apurva Patel, Milan Chag, Anish Chandarana, Roosha Parikh, Keyur Parikh: Long- term Safety and Performance of the Orbital Atherectomy System for Treating Calcified Coronary Artery Lesions: 5- Year Follow-Up in the ORBIT I Trial Cardiovascular Revascularization Medicine. (Accepted as a publication Cardiovascular Revascularization Medicine 2016, S1553-8389 (15) 00091-3

32.Parth Parikh, Aditi Patel, Apurva Patel, Roosha Parikh, Keyur Parikh. Novel First in man use of first ever Sirolimus Drug Coated Balloon in carotid in stent restenosis. (Accepted as a Poster Presentation in American College of Cardiology ACC March -2015)

33.Parloop Bhatt, Aditi Patel, Parth Parikh, Jawahar Mehta, Piyush Thakar, Aditi Nanavati, Roosha Parikh, Apurva Patel, Keyur Parikh. Depression and Outcome of Patients with Acute Coronary Syndrome: A 3 Year Follow-up Study. (Accepted as a Poster Presentation in American College of Cardiology ACC March -2015)

34.Apurva Patel, Roosha Parikh, Parth Parikh, Milan Chag, Urmil Shah, HemangBaxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Chintan Mehta, Neil Mehta, Jawahar Mehta, Parloop Bhatt, Keyur Parikh: A Hospital to Home Visit Model to Ensure Medical Compliance and Reduce Complications Following Percutaneous Coronary Intervention: A Novel Global Concept. Accepted as a presented at the Society for cardiovascular Angiography and Intervention(SCAI) May 28-31,2014 Las Vegas, USA.

35.Niren Bhavsar, Roosha Parikh, Apurva Patel, Parth Parikh, Satya Gupta, Dhaval Naik, Chintan Mehta, Parloop Bhatt, Keyur Parikh, Dhiren Shah: Comparative Safety and Efficacy Evaluation of Ivabradine, Metoprolol and its Combination in Management of Inappropriate Sinus Tachycardia in Coronary Artery Bypass Graft patients. (Submitted in American College of Cardiology ACC March -2014) Volume 63, Issue 12, A1569 doi: 10.1016/S0735-1097(14)61572-2 Jam Col lCardiol . 2014; 63(12_S):.doi:10.1016/S0735-1097(14)61572-2

107 Publication List (2014 Onwards)

36.Roosha Parikh, Apurva Patel, Shmuel Banai, Parth Parikh, Milan Chag, Urmil Shah, HemangBaxi, Anish Chandarana, Ajay Naik, Satya Gupta, Vineet Sankhla, Parloop Bhatt, Keyur Parikh: A Possible Alternative Percutaneous Treatment for Patients with Disabling No-Option Angina: “Neovasc” Coronary Sinus Reducer Assessment - 8 Year Follow Up. Presented at SCAI, May 28-31,2014 Las Vegas, USA.

37.Apurva Patel, Roosha Parikh, Parth Parikh, Milan Chag, Urmil Shah, HemangBaxi, Anish Chandarana, Satya Gupta, Vineet Sankhla, Parloop Bhatt, Keyur Parikh: Orbital Atherectomy System in Treating Calcified Coronary Lesions: First in Man Assessment- 5 Year Follow Up. Presented at SCAI, May 28-31, 2014 Las Vegas, USA.

38.Apurva Patel, Roosha Parikh, Anish Chandarana, Parloop Bhatt, Milan Chag, Satya Gupta, HemangBaxi, Vineet Sankhla, Mehul Dudhasia, Urmil Shah, Keyur Parikh: Short-term Outcomes In Coronary Artery Disease Patients With Multi-Lesion Disease Implanted With Multiple Bio absorbable Vascular Scaffolds. Submitted in American College of Cardiology ACC, March 29-31,2014 Washington DC, USA.

39.Roosha Parikh, Apurva Patel, Parth Parikh, Keyur Parikh, Dhaval Naik, Niren Bhavsar, Hiren Dholakia, Chintan Mehta, Neil Mehta, Parloop Bhatt, Jawahar Mehta, Dhiren Shah: A Hospital to Home Health Care Initiative for Early Follow-up, Post Discharge Management, Patient Self Care and Activation Following Coronary Artery Bypass Graft Surgery - A First Indian Pilot Study Submitted in American College of Cardiology ACC, March 29- 31,2014 Washington DC, USA.

40.Roosha Parikh, Apurva Patel, Parth Parikh, Milan Chag, Urmil Shah, HemangBaxi, Anish Chandarana, Satya Gupta, Piyush Thakar, Jawahar Mehta, Parloop Bhatt, Vineet Sankhla, Keyur Parikh: Increasing Penetration of Drug Eluting Stents in Developing Countries - A Single Center 10 year Study Submitted in American College of Cardiology ACC, March 29-31,2014 Washington DC, USA.

41.Parloop Bhatt, Apurva Patel, Roosha Parikh, Parth Parikh, Aditi Patel, Satya Gupta, Jawahar Mehta, WafiaEteiba, Sharon Mulvagh, Giuseppe Ambrosio, Naranjan Dhalla, James Willerson, Keyur Parikh: International Task Force for Prevention of Cardiovascular Disease: Determining Factors to Assess Primary Prevention Outcomes in Western India Submitted in American College of Cardiology ACC, March 29-31,2014 Washington DC, USA.

108 Publication List (2014 Onwards)

42.Parloop Bhatt, Parth Parikh, Apurva Patel, Milan Chag, Anish Chandarana, Roosha Parikh, Keyur Parikh: Orbital Atherectomy System in Treating Calcified Coronary Lesions: 3-Year Follow-Up in First Human Use Study (ORBIT I Trial). Accepted as a publication Cardiovascular revascularization medicine: including molecular interventions 06/2014; 15(4). DOI: 10.1016/j.carrev.2014.03.004

43.William Wijns, Ph. Gabriel Steg, Laura Mauri, Volkhard Kurowski, Keyur Parikh, Runlin Gao, Christoph Bode, John P. Greenwood, Erik Lipsic, FarqadAlamgir, Tessa Rademaker-Havinga, Eric Boersma, Peter Radke, Frank van Leeuwen, and EdoardoCamenzind for the PROTECT Steering Committee and Investigators- Endeavour zotarolimus-eluting stent reduces stent thrombosis and improves clinical outcomes compared with cypher sirolimus-eluting stent: 4 year results of the PROTECT randomized trial. Accepted and Published in European Heart Journal Advance Access published 08/2014; 35(40). DOI:10.1093/eurheartj/ehu318 14.72 Impact Factor

44.Parloop A. Bhatt ,Advances in heart health-The need for developing Indian guidelines for cardiovascular disease in women, CV Network-The official bulletin of the international academy of cardiovascular sciences, Vol. 13 No. 4 - November 2014. International 22 CV Network – Vol. 13 No. 4 – November 2014

45.Bhatt PA, Parikh PK and Parikh KH. Prevalence, Assessment and Clinical Outcome in Cardiovascular Disease: Impact of Gender Disparities. Austin J PharmacolTher. 2014; 2 (8).4. Peer Reviewed. International. Austin J PharmacolTher - Volume 2 Issue 8 - 2014

46.Parloop A. Bhatt, Akhita B. Bhatt, Coenzyme Q10 supplement in breast cancer: The nutrient on horizon, Kadakia International Journal of Research in Multidiscipline, ISSN: 2349 – 4875, Volume 1, Issue 1, June 2014, 150-158. Peer Reviewed. National. Volume 1, Issue 1, June 2014

47.Kama Raval, Reena Desai, and Parloop Bhatt, Comparative Evaluation of Safety Outcomes of Different Prosthetic Valves in Indian Subjects, Research and Reviews: Journal of Pharmacology and Toxicological studies, Volume 2,Issue 3,July - September, 2014, e-ISSN:2322-0139 , p-ISSN:2322-0120 ,RRJPTS | 19-24. Peer Reviewed. International. RRJPTS | Volume 2 | Issue 3 | July - September, 2014 Page:19-24

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