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Seal the Deal P6 Radiant PULSEISSUE 37 SEAL THE DEAL P6 BLK Super Speciality Hospital Accredited by JCI Dr. B.L. Kapur Memorial Hospital Dr. Balabhai Nanavati Hospital Pusa Road, New Delhi-110005 (India) Swami Vivekanand Road, Vile Parle West 24-Hour Helpline: 011- 3040 3040 Mumbai, Maharashtra-400056 (India) Email: [email protected] 24-Hour Helpline: +91-22-26267500 www.blkhospital.com Email: [email protected] www.nanavatihospital.org PATIENT SPEAKS P8 A STROKE OF LUCK P9 FROM THE CONTENTS DIRECTOR’S DESK 4 DUAL LOBE LIVER TRANSPLANTATION by Dr. Abhideep Chaudhary 5 SWIFT ADEPT AID by Dr. Mihir Raut Dr. Mradul Kaushik Director - Operations & Planning 6 - 7 BLK Super Speciality Hospital New Delhi (India) SEAL THE DEAL Exclusive Interview of Mr. Abhay Soi 8 Dear Reader, PATIENT SPEAKS by Dr. Bhushan Nariani This year, so far, has been an extraordinarily transplantation with livers harvested from his 9 successful one for our Group and the hospitals, two brothers. Another interesting read is the story A STROKE OF LUCK marked by many significant and triumphant of a patient from the US as she shares her life- by Dr. Rohit Shahapurkar moments, foremost of which is beginning of the transforming Knee Replacement journey in India. process of merger with Max Healthcare and 10 Radiant Life Care. The merger which is almost We have other intriguing stories from our group A THRILLING hospital in Mumbai, including the case where EPISODE underway now will put us amongst the top three prompt action by the doctors at Nanavati helped by Dr. Neeraj Bhalla hospital networks in India by revenue and the 11 Dr. Amit Goel fourth largest in India in terms of operating beds. save the injured foot of a 30-year-old male diabetic PROTECTING patient. You will also come across the story of an THE FRAGILE Quite naturally, the cover story for this month’s 11-year-old child from Nanded Village with a rare by Dr. Kumar Ankur issue of Pulse features an exclusive interview of heart disease who is now living a much healthier Mr. Abhay Soi, Chairman, Radiant Life Care and and improved life. 12 - 13 EVENTS AND Max Healthcare wherein he talks about his future ACTIVITIES plans for the group and his vision to redefine I, on behalf of the entire editorial team, would healthcare delivery model through a patient – like to thank you all for your support during 14 - 15 centric approach. all the issues we have had so far. Your words of BLK & NANAVATI encouragement have induced a positive effect on IN NEWS Apart from the cover story, we have multiple the team. I am sure you will continue to support interesting cases from both our group hospitals. us with your contributed articles, valuable inputs One significant story covered in the newsletter is and suggestions. the case of a newborn with neonatal hypoglycemia. Fortunately, experts at BLK were able to ensure Our editorial team will be more than happy Nanavati to receive your feedback on this issue at: CREATIVE CONCEPT Super Speciality Hospital the baby a healthy normal life. A similarly CONTENT EDITOR-IN-CHIEF PARUL CHHABRA DESIGN & VISUALISATION Mumbai, Editorial Team [email protected] SHIKHA GIRGLA remarkable story is the case of a patient with PARUL CHHABRA SHIKHA GIRGLA SUNIL KUMAR MAMTA SINGH PRAJAKTI SHIRSEKAR end-stage liver cirrhosis. The patient got a new SUNIL KUMAR SHYAM SHIRSEKAR chance to life after undergoing a living donor liver Stay Healthy, Stay Happy! 02 Radiant Life Care | Newsletter | Issue 37 BLK, New Delhi | Nanavati, Mumbai 03 DUAL LOBE LIVER SWIFT TRANSPLANTATION ADEPT AID Two livers harvested from two donors Prompt expert action helped a 30-year-old saved the life of one male diabetic patient with a foot injury It is a known fact that 50% of the MELD of 28. He was evaluated for Liver A 30-year-old male, a resident of a small history was also unknown. He had the standard liver volume of the recipient Transplant and was found fit to undergo village in Kerala, working as a craftsman typical history of abdominal pain since is the minimum liver graft volume a transplant. His two brothers were in a workshop in Mumbai, was admitted early childhood, which was treated by required to provide adequate functional selected as potential donors. Volumetric to Nanavati Super Speciality Hospital 's painkillers, and fatty stools after heavy hepatocytes. To fulfill the metabolic computed tomography analysis of Donor general ward after sustaining a foot injury meals. No traits of smoking or alcohol demands of an adult recipient right liver 1 liver showed a right lobe GRWR of only at the workshop. The patient was diagnosed consumption were recorded. lobe grafts with 60-70% of total liver 0.57 with a prospective remnant liver with Diabetes Mellitus (DM) 5 years back mass are used for partial Orthotopic volume of 44% of his total liver volume. when his blood glucose levels were found to The patient's vitals and other parameters Liver Transplantation. The remnant His left lobe GRWR was 0.46, with 55% Dr. Abhideep be high during a routine check-up. After the after changing to OHA’s were recorded Dr. Mihir Raut liver volume should not be less than 30% remnant. The Donor 2 liver showed a Chaudhary diagnosis, the patient was started on Oral as follows: Body Mass Index - 19, Blood Consultant of the total liver volume of the donor right lobe GRWR of only 0.57 prospective Director & HOD Hypoglycemic Agents (OHA’s). Pressure - 110/70 mmHg, Fasting Blood Physician & Diabetologist to maintain the donor's safety. Even remnant liver volume of 32% of his total HPB Surgery & Liver Sugar - 250, Post Prandial Blood Sugar Nanavati Super though a donor’s right lobe is suitable liver volume. His left lobe GRWR was Transplantation Given his foot injury, urgent surgery was - 335 and no urinary ketones as before. Speciality Hospital in size as a graft for an adult recipient, 0.27, with 67% remnant. So, neither of BLK Centre for Digestive needed. He was rushed to the hospital, In view of his history and investigative Mumbai the remaining left lobe may be too the two probable donors was suitable as a & Liver Diseases and at the time of admission, his blood findings, the patient was advised for small when considering the safety of single donor, and the decision was made BLK Super Speciality sugars were recorded to be >400 mg/ X-ray abdomen erect, USG / CT Abdomen the donor. Under these circumstances, to perform LDLT using dual grafts. For Hospital, New Delhi dl, but urine and serum ketones were C-peptide, GAD Antibodies, Serum the donor cannot be allowed to either this case, the doctors planned to harvest absent. As surgical intervention was Glucagon levels, Amylase / Lipase. The donate the right or left liver lobe for an the right liver lobe of Donor 1 with urgently needed, insulin by intravenous X-ray result showed calcification in the adult recipient. In these rare scenarios, respect to the prospective remnant liver (IV) drip was started before the operation pancreas; his C-peptide was low which a second donor is required to perform volume of 44 % of his total liver volume, to stabilise the blood glucose. Post- explained the lack of insulin in the Dual Graft Liver Transplantation in together with the left lobe of Donor 2 to operation, he was put body and low glucagon which one graft from each of two donors receive an adequate total graft GRWR. on insulin subcutaneous levels, which is why the Fibro Calculous is implanted into one recipient. This (S/C). patient never went into Pancreatic alternative offers a sufficient graft size The operative procedure was uneventful. ketoacidosis despite high Diabetes (FCPD) for the adult recipient as well as a higher After five days in the intensive care unit The patient was blood sugar levels and degree of safety for the donors. (ICU), the patient was moved to the discharged after the low insulin in the body. is diagnosed regular ward and was discharged on the surgery and was told to mainly in young 18th post-operative day with excellent get the dressing done Fibro Calculous and malnourished graft function. The post-operative course daily and to take insulin Pancreatic Diabetes individuals of the donors was uneventful as well. regularly to stabilise (FCPD) is a unique form belonging to Both the donors were kept in the ICU The major his blood glucose levels. of diabetes secondary to tropical and for a day and were discharged on post- limitation The patient came for follow up in the Chronic Pancreatitis seen in developing operative day 7. So far, the patient and Diabetic OPD, and his blood glucose countries of the world associated with developing in adult-to- grafts are in satisfactory conditions. levels were found to be well-controlled either over protein-calorie malnutrition countries None of the donors, in either case, adult Living thanks to his insulin intake. He was or more likely, with deficiency of certain suffered from any complication related to Donor Liver advised to continue with his insulin and micronutrients. Its occurrence is reported the operative procedure. Transplantation regular follow-ups. However, the patient to be more in South India, with most cases diagnosed among the young and (LDLT) is an discontinued taking insulin after the This article reports the case of an adult- Whereas, considering the normal wound healed and switched to old oral adolescent age groups. Some of its to-adult Living Donor Liver Transplant course, there was a high likelihood that adequate graft medications on his own accord. symptoms include low BMI, abdominal (LDLT) performed on a patient using both donors could have been rejected.
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