Healt h Talk ISSUE: 5 | APRIL, 2017

We frequently use MAST for our adequately managed with a 2.5 cm various patients. skin incision, and with the use of MAJOR BACK SURGERIES Fractures of spine microscopes and MAST these have become day care surgeries with Fractures of spine due to fall, patient being discharged free of accidents etc can be adequately pain the same or next day. managed with percutaneous MINUS MAJOR SCARS Lumbar Canal Stenosis pedicle screws with stab incisions and patients are relieved of pain and Lumbar canal stenosis is a disease of can be allowed to sit and walk elderly in which due to age related Minimal Access Spinal Technologies (MAST) immediately after surgery without degeneration old people develop the fear of further worsening of radiating pain in lower limbs which patients to return to regular, active imaging systems, tiny cameras and ability to walk due to possible typically increases with walking and lives with less interruption and pain. small skin incisions. damage to nerves and spinal cord gets better with rest. It leads to Spine problems can develop due to This offers patients physical, following fracture. deterioration of both quality and birth defects, age related wear and psychological, emotional and Old age leads to weakening of quantity of life as the patient tear, fracture or injury, infection, aesthetic advantages that make bones either due to age related gradually loses his ability to walk. cancer etc. Most of these problems surgery less daunting. osteoporosis or some underlying This is a rampant problem present in can be dealt with medications, Benefits of MAST Procedures disease of bone which can lead to our elderly and if non operative physiotherapy, regular exercises, treatment fails, it can be managed The direct benefits to the patients fractures of spine, these can be bracing but for some surgery may with minimally invasive unilateral of MAST procedures are quicker adequately managed with the be the best option for restoring laminectomy and bilateral return to normal activities, less technique of balloon kyphoplasty patient's quality and quantity of life. decompression in which with a 2.5 pain after the surgery, less damage under xray machines to provide cm skin incision nerves of spine M i n i m a l A c c e s s S p i n a l to muscle and skin, less blood patients strength and stability and going in both the limbs are Technologies loss, easier rehabilitation after r e l i e v e s p a i n o f f r a c t u r e decompressed from one side. Minimally invasive procedures surger y and smaller scars. immediately. Spine surgery for years have been daunting and exhaustive. made possible by Minimal Access Outpatient surgery is also possible Prolapsed Intervertebral Disc done with traditional open Spinal Technologies (MAST) for some patients. A basic tenet of surgery is to Prolapsed intervertebral disc or approaches but has been associated potentially help to successfully treat effectively treat pathology with We at Sarvodaya Centre for Spine commonly known as the problem of with long incisions, cutting and spine problems with the least minimal disturbance of normal can proudly say that we have disc which causes excruciating pain removal of muscle from the spine, amount of interruption with the anatomy: leaving “the smallest both the infrastructure and skill to in legs of patients and severe and considerable post-surgical pain. patient's body tissues, while f o o t p r i n t ” a n d d e v e l o p i n g provide our patients the benefit functional and psychological All these factors sometimes made achieving the same surgical procedures through minimally of minimal access spine surgery impact on patients, can be the patients’ experience of surgery objectives as open surgeries with using the latest techniques. Dr. Ashish Tomar invasive methods may allow Consultant - Orthopedics & Spine Surgery SARVODAYA ACCOMPLISHES A MAJOR MILESTONE BY PERFORMING FIVE SUCCESSFUL COCHLEAR IMPLANT SURGERIES Sarvodaya Centre for ENT & Empowerment and Sh. Krishan Pal gives an opportunity for the child to Cochlear Implant announced the Gurjar, Honourable Minister of lead a normal life like anyone else accomplishment of a major milestone State for Social Justice & post cochlear implantation. in aid of hearing impaired by Empowerment with initiative of Who should get a cochlear performing five successful Cochlear whom the deaf children will be able implant ? Implant surgeries. The department to benefit from Sarvodaya's headed by Dr. Ravi Bhatia, Senior cochlear implant program in • People having severe to Consultant, ENT is backed by Faridabad. profound sensorineural hearing & deafness in both ears. dedicated team of ENT surgeons, Sh. Krishan Pal Gurjar addressed the audiologist and speech therapists to press conference at Sarvodaya • Those having a functional provide a comprehensive cochlear Hospital & Research Centre where hearing nerve implant program. The team is well media was able to interact with • Patients willing to work toward equipped to serve children and adults children operated at Sarvodaya. speech and language skills with of all ages with varying levels of therapy hearing impairment. What is Cochlear Implant? Cochlear implant (bionic ear) is a • People not benefitting from Parents from low-income group can other kinds of hearing aids now get cochlear implant - a costly device that restores useful hearing • Having no medical reason to medical device - free of cost for their in severe to profoundly hearing avoid surgery children, who are either born deaf or impaired people, when the organ of have hearing loss. Thanks to hearing situated in the inner ear has • Living in or desiring to live in the Ministry of Social Justice & not developed or is destroyed. It “hearing world”

No one will guess you had a spine surgery. Minimally Invasive Spine Surgery. Big spine surgeries no longer leave behind big ugly scars. At Sarvodaya, we now perform many complex spine surgeries through minimally invasive (keyhole) technique. Which results in minimal scarring, lesser pain and faster recovery. So if you have a problem in your spine, don't suffer unnecessarily. Many spine correction surgeries can now be performed even with little, or no hospital stay.

Sarvodaya offers the following spine surgeries: • Minimally invasive transforaminal lumbar interbody fusion • Microscopic discectomy • Percutaneous pedicle screws fixation • Scoliosis and kyphosis correction

To know more, or to book an appointment SMS ‘SHRC SPINE’ to 52424 or call 9643408039

SARVODAYA HOSPITAL & RESEARCH CENTRE: Y.M.C.A. Road, Sector - 8, Faridabad, Haryana | Ph: 0129-4184444 EMERGENCY 105959 02 ISSUE: 5 | APRIL , 2017

1.5 CM STONE IN 9 YEAR OLD GIRL REMOVED BY NO-CUT NO SCAR TECHNIQUE (RIRS)

Neelam, a nine year old girl, came to is avoided in these developing off from school. Stone fragments Sarvodaya with on and off right Kidneys which was done in the can be obtained for biochemical flank pain for last 2 years. On earlier popular technique of PCNL analysis and it is usually a single investigating she was found to have (Key Hole surgery). stage procedure unlike ESWL 1.5 cm x 1 cm stone in right Kidney. commonly known as Lithotripsy. RIRS is the future of stone surgery. Dr. Tanuj Paul Bhatia, Sr. Urologist, With availability of LASER at both Metabolic workup for stone Sarvodaya Centre for Urology & our centres of Sarvodaya (sector 8 forming children at SHRC Laser Surgeries explained parents and sector 19), we are providing this of Neelam about the new scarless It is important to know the reason of facility at both the centres. More technique of Retrograde Intrarenal formation of stones in children. For than 1000 LASER procedures have Surgery (RIRS) using Holmium same reason, Department of been performed by Department of LASER. The child underwent single Pathology at SHRC now provides Urology over last 2 years. stage right RIRS. After complete facility of metabolic workup of clearance of stone was achieved, Advantage of RIRS in children with stone formation to elucidate the Neelam was discharged next day Kidney Stones exact cause of Kidney stone formation in these children and thus and she recovered very well. The benefits of RIRS are that it treat accordingly. At Sarvodaya, we have performed involves no cut, no scar technique, RIRS for 6 such children with no hole in children's developing excellent results. RIRS is very good kidneys, it is safe and effective. It surgery option for children as a hole has Excellent results and Cost effectiveness with minimum days Dr. Tanuj Paul Bhatia (left) and Dr. Ghanendra (right) with patient in centre

HoLEP: NEARLY BLOODLESS EXTENSIVE DISEASE OF TECHNIQUE OF LASER PROSTATE SURGERY PERIPHERAL VESSELS Dr. Tanuj Paul Bhatia, Consultant - Urology TREATED Prostate is a gland which surrounds Only a certain number of Prostate Resection of Prostate). This popular the surgery, and patient can go the urethra (Urinary outlet tube) patient’s require surgery.The technique involved resection using home. With increasing prevalence of bilateral superficial femoral artery. near the neck of Urinary bladder. indications for surgery of Prostate e l e c tr i ca l cu r re n t (cau te r y ) . Another benefit of HoLEP is better diabetes, hypertension & smoking, Pankaj was a young active male with This gland is present only in males. are no or poor response to Problems that some patients clearance of adenoma and probably peripheral vascular disease (PVD) long life expectancy, he was treated As men age, this gland grows in size medication, recurrent urinary encountered with TURP were has become increasingly prevalent. with “Aorta – bifemoral– by long recurrence free period. HoLEP thus producing obstruction to retention(blockage of urine), intraoperative fluid overload and However, because of lack of popliteal bypass surgery”. He got is costlier compared to TURP but urinary flow. Gradually bladder impairment of Kidney function tests hyponatremia(TUR syndrome), awareness among people & also discharged on fifth day of the quite cost effective as it involves muscle adapts itself and gradually due to Prostate, formation of occasional torrential bleeding, among community physician the surgery. Within few weeks his foot lesser amount of bleeding, lesser disease is under diagnosed & where wound got healed & he is now fails to produce enough pressure to bladder stones due to enlarged formation of urethral stricture in late risk of fluid overload and a shorter diagnosed, diagnosis is very late leading an active healthy life. void if the symptoms are ignored for Prostate, recurrent bleeding in postoperative period, bladder injury hospital stay. Few risks associated after setting of complications like a very long time. urine(Hematuria) or recurrent and risk or recurrence of Prostate Similarly Ram Prakash (name include risk of stricture formation, gangrene & large non healing changed), a 72 Year old diabetic urinary infection due to Prostate. enlargement in 5 to 10 years. TURP bladder injury during morcellation wounds, which causes patient smoker with coronary artery was considered 'gold standard' It is also important to ascertain and stress incontinence. morbidity & loss of productivity disease (post angioplasty) had treatment for Prostate surgery till before surgery whether the growth besides causing financial loss. severe chronic obstructive airway some time ago. Sarvodaya Hospital and Research of prostate is benign (adenoma) or Patients with complex PVD are disease (COPD). He presented with treated with different modalities rest pain, bilateral lower limbs with malignant (cancerous). Prostate The next revolution in Prostate Bladder Enlarged prostate tissue removed d e p e n d i n g o n p a t i e n t ' s bluish discoloration of tips of toes of specific antigen (PSA) and Digital surgery came with development of Enlarged on this side Prostate characteristics. left foot. CT angiography showed rectal examination (DRE) by a LASER for urological surgery. This bilateral aorta – illiac complete urologist are two important tests in evolution resulted in development Pankaj (name changed), a 47 year occlusion with good distal vessels. this regard. of a new gold standard – HoLEP. old active, diabetic, hypertensive, smoker male had no other major co C o n s i d e r i n g m u l t i p l e c o HoLEP stands for Holmium Laser When it is more likely that the morbidity. He had pain in both his morbidities, age of patient & good Enucleation of Prostate. HoLEP Prostatic growth is benign in nature, lower limbs and had non-healing vascular anatomy of patient, the involves no scar technique of patient is explained options of Laser wound, after amputation of great doctors at Sarvodaya Centre for removal of Prostatic adenoma using laser resectoscope urethra surgery. Many years ago, open toe of right foot 3 months back due CTVS planned for endovascular High power Holmium LASER. It has to gangrene. On CT angiography intervention & aorta bi-illiac surgery for prostate was the only Centre is equipped with high power been found that this technique patient had extensive disease of stenting using kissing stent option available. This involved long laser & have performed more than involves less amount of bleeding peripheral arteries-bilateral iliac technique with good end results. cuts on lower abdomen with 100 HoLEP surgeries last year. Many when compared to previous artery, bilateral common femoral Ram Prakash is now symptom free & opening of bladder and blind of these have been patients from Thus treatment of bothersome techniques like TURP. For same artery & completely blocked is leading a normal life. enucleation of Prostate using finger. countries like Iraq, Afghanistan, urinary symptoms due to Prostate is reason, it is specially preferred for The technique frequently led to Tanzania and Nigeria. My personal of utmost importance. These patients who have Prostate glands massive bleeding requiring blood experience of HoLEP is of more than symptoms can be poor flow of urine, more that 70 cc in size and those on transfusion and 7 to 10 days of 200 cases and I feel HoLEP is the intermittent stream, increased blood thinners(antiplatelets). It is hospital stay. A urinary tube had to future of Prostate surgery with frequency of voiding, having to also the preferred technique in high be kept for more than 1 week. immense benefit to our patients. wake up at night to void, urgency to risk patients (heart patients, HoLEP is technically a difficult void, recurrent urinary infection and As the surgical techniques became patients with kidney failure, surgery, because of this very few appearance of blood in urine. less and less invasive, a scarless asthmatics) as it involves lesser risk Urologists have been able to Majority of men with bothersome technique for surgery of prostate of fluid absorption and TUR master the technique and only a symptoms can be managed with or through urinary passage evolved syndrome. Many a times we remove few centres in our country are without medication for Prostate. c a l l e d T U R P ( Tr a n s u r e t h r a l the urinary tube next day itself after providing this facility. Dr. Sumit Narang Senior Consultant- CTVS

Think of it as a kidney transplant, or the gift of a new life.

Sarvodaya Institute of Transplants.

Leave the problems associated with a kidney disorder operative care add to its ability to maintain an excellent behind and start life anew. Get a kidney transplant at the track record of success. Sarvodaya Institute of Transplants. This advanced Hardly surprising then, that its attracting patients from near institute has both, the state-of-the-art infrastructure, as and far. well as the medical expertise to match the finest in the The Sarvodaya Institute of Transplants offers: country. • Kidney Transplant An integrated team approach and exceptional post- • Bone Marrow Transplant (for blood related disorders)

Cure+Care ISSUE: 5 | APRIL , 2017 03

CERVICAL CANCER: SCREENING AND PREVENTION

What is Cervical Cancer ? Causative Agent for Cervical intercourse, early age at first sexual activity, omiting smoking. Cervical cancer is the cancer of Cancer pregnancy, too many births, low Two types of vaccines are available lowermost part of the uterus which The major cause of cervical cancer socioeconomic status, multiple to prevent cervical cancer- Cervarix opens into the vagina. It is the is genital infection due to Human s e x u a l p a r t n e r s , s e x u a l l y and Gardasil. Cervarix protects second most common cause of the Papilloma virus or HPV. Genital HPV transmitted diseases, infection of against two high risk HPV types and cancer in females in INDIA next only is a virus that is spread by sex. There HPV, HSV, Immunosuppressed Gardasil protects against four to breast cancer. The current are many different types of HPV. individuals (HIV positive) or strains. These can be given to girls estimates indicate approx. 1,32,000 Certain high risk HPV types can smoking. aged 9-15 years as two doses at new cases diagnosed and 74,000 cause cell changes and cervical Symptoms of Cervical Cancer interval of 6 months. Above 15 years cancer. deaths annually in INDIA, equal to Irregular or continuous vaginal of age, 3 doses are recommended at nearly 1/3rd of the global cervical Risk Factors for Cervical Cancer bleeding is the most common 0,1,6 months. Females upto 26 years cancer deaths. There are various risk factors for symptom. Patient can also have of age should be vaccinated. Ideally cervical cancer like early sexual offensive vaginal discharge, pelvic vaccination should be done before pain, urinary problems (painful female become sexually active and micturition, blood in urine), abnormality. If abnormal cells are How to Prevent Cervical Cancer? exposed to HPV. The vaccine is not recommended for pregnant women. diarrhea, rectal pain and blood in found, they can be treated before Cervical cancer can often be It is important that women continue stool. they turn into cancer. prevented by having regular to be screened for cervical cancer, Screening for Cervical Cancer Screening Recommendations: screening to find out any pre- even after getting all recommended METHODS OF SCREENING Latest recommendations are to cancers so they can be treated. shots of the HPV vaccine. screen asymptomatic women aged Preventing pre-cancers means Pap Smear: Pap smear is the test for 21 to 65 years, every 3 years with controlling possible risk factors cervical cancer screening. It is a Pap test irrespective of age of onset such as delaying first sexual minor OPD procedure, which can be of sexual activity or other risk intercourse, limiting the number of done like normal gynecological factors. For women age 30 to 65 sex partners, avoiding sexual examination in OPD without years who want to lengthen the intercourse with people who have anesthesia. In pap smear test cells screening interval, screening with a had many partners or who are are collected from the surface of combination of pap test and HPV obviously infected with genital cervix. These cells are checked testing every 5 years can be done. warts, using condoms for every Dr. Deepti Goyal under the microscope for any Consultant Gynecology

How can people with diabetes • Focal/grid macular laser surgery. Facts about diabetic disease protect their vision? • Corticosteroids. Corticosteroids, • All forms of diabetic eye diseases Vision lost to diabetic retinopathy is either injected or implanted into the have the potential to cause severe sometimes irreversible. However, eye, may be used alone or in vision loss and blindness early detection and treatment can combination with other drugs or • Controlling diabetes—by taking reduce the risk of blindness by 95 laser surgery to treat DME. medications as prescribed, staying p e r c e n t . B e c a u s e d i a b e t i c physically active, and maintaining a How is proliferative diabetic retinopathy often lacks early healthy diet—can prevent or delay retinopathy (PDR) treated? vision loss. E symptoms, people with diabetes should get a comprehensive dilated For decades, PDR has been treated • Because diabetic retinopathy ften goes unnoticed until vision loss eye examination at least once a year. with scatter laser surger y, occurs, people with diabetes should People with diabetic retinopathy sometimes called panretinal laser s u r g e r y o r p a n r e t i n a l get a comprehensive dilated eye Y E may need eye examination more exam at least once a year. frequently. Women with diabetes photocoagulation. • Early detection, timely treatment, Scatter laser surgery works best who become pregnant should have and appropriate follow-up care of D I S a comprehensive dilated eye exam before new, fragile blood vessels diabetic eye disease can protect as soon as possible. have started to bleed. Recent against vision loss. How is DME treated? studies have shown that anti-VEGF • Diabetic retinopathy can be E A S E treatment not only is effective for DME can be treated with several treated with several therapies, used treating DME, but is also effective therapies that may be used alone or alone or in combination. for slowing progression of diabetic I N D I A B E T E S in combination. retinopathy, including PDR, so anti • Anti-VEGF Injection Therapy. - -VEGF is increasingly used as a first- Available anti-VEGF drugs include line treatment for PDR. Avastin (bevacizumab), Lucentis Diabetic eye disease comprises a in a region of the retina called the ( r a n i b i z u m a b ) , a n d E y l e a What if treatment doesn't improve group of eye conditions that affect macula. The macula is important for (aflibercept). Lucentis and Eylea are vision ? people with diabetes. These the sharp, straight-ahead vision that approved by the U.S. Food and Drug Low vision aids and rehabilitation conditions include diabetic is used for reading, recognizing Administration (FDA) for treating services may help make the most of retinopathy, diabetic macular faces, and driving. DME is the most Dr. Jaidrath Kumar DME. remaining vision. Consultant- Ophthalmology edema (DME), cataract, and common cause of vision loss among glaucoma. All forms of diabetic eye people with diabetic retinopathy. diseases have the potential to cause About half of all people with severe vision loss and blindness. diabetic retinopathy will develop Normal Vision Diabetic retinopathy is the most DME. DME can happen at any stage common cause of vision loss among of the disease. Diabetic eye disease people with diabetes and a leading also includes cataract and RESTORE YOUR SKIN'S GLOW. cause of blindness among working- glaucoma: age adults. • Cataract is a clouding of the REVIVE ITS HEALTH. DME is a consequence of diabetic eye's lens. Adults with diabetes retinopathy that causes swelling in the are 2-5 times more likely than those without diabetes to develop area of retina called the macula. After Advanced Diabetic Retinopathy TREATMENTS AVAILABLE FOR PSORIASIS, cataract. Cataract also tends to Diabetic Retinopathy ECZEMA, ALLERGIES, WHITE SPOTS, HAIR FALL, develop at an earlier age in people The early stages of diabetic What causes diabetic retinopathy? with diabetes. retinopathy usually have no ACNE (PIMPLES), FACIAL PIGMENTAION Chronically high blood sugar from • Glaucoma is a group of diseases symptoms. The disease often diabetes is associated with damage that damage the eye's optic progresses unnoticed until it affects to the tiny blood vessels in the vision. Bleeding from abnormal nerve—the bundle of nerve COSMETOLOGY FACILITIES retina, leading to diabetic fibers that connects the eye to retinal blood vessels can cause the retinopathy. The retina detects light the brain. In adults, diabetes appearance of “floating” spots. and converts it to signals sent nearly doubles the risk of These spots sometimes clear on • Chemical Peeling through the optic nerve to the brain. glaucoma. their own. But without prompt Diabetic retinopathy can cause treatment, bleeding often recurs, • Laser Treatment Who is at risk for diabetic blood vessels in the retina to leak increasing the risk of permanent retinopathy? fluid or hemorrhage (bleed), vision loss. • Laser Hair Removal distorting vision. In its most People with all types of diabetes How are diabetic retinopathy and advanced stage, new abnormal (type 1, type 2, and gestational) are DME detected? • Hair Regrowth Therapy blood vessels proliferate on the at risk for diabetic retinopathy. The Diabetic retinopathy and DME are surface of the retina, which can lead longer a person has diabetes, higher • MICRO Dermabrasion ( Skin Polishing) detected during a comprehensive to scarring and cell loss in the retina. is the risk of diabetes retinopathy. Women who develop or have dilated eye exam that includes Diabetic retinopathy may progress • Antiaging Therapies diabetes during pregnancy may Visual Acuity Testing (eye chart test through four stages: have rapid onset or worsening of to measure a person's ability to see Mild nonproliferative retinopathy, diabetic retinopathy. at various distances), Tonometry(to M o d e r a t e nonproliferative measure pressure inside the eye), What are the symptoms of diabetic r e t i n o p a t h y , S e v e r e Pupil dilation (to examine the retina retinopathy and DME? nonproliferative retinopathy and optic nerve), Optical coherence The same scene as viewed by a person To know more, or to book an appointment SMS ‘SHRC FAC’ a n d Pr o l i fe r a t i ve d i a b e t i c tomography (which captures normal vision (Top) and with (Center) to 52424 or call 9643408039 retinopathy (PDR). images of tissues inside the eye). If advanced diabetic retinopathy. The SARVODAYA HOSPITAL & RESEARCH CENTRE: Y.M.C.A. Road, Sector - 8, What is diabetic macular edema DME or severe diabetic retinopathy floating spots are hemorrhages that Faridabad, Haryana | Ph: 0129-4184444 EMERGENCY 105959 (DME)? is suspected, a fluorescein require prompt treatment. DME DME is the build-up of fluid (edema) angiogram may be used to look for causes blurred vision. Cure+Care damaged or leaky blood vessels. 04 ISSUE: 5 | APRIL , 2017

MORE ACCURATE AND CUSTOMIZED KNEE REPLACEMENT SURGERIES ARE CHANGING LIVES KNEE REPLACEMENT GOES HITECH WITH IMPROVED TECHNIQUES

Total knee replacement (TKR) is intact by taking it to one side. It is looks better cosmetically. Sarvodaya Hospital & Research worldwide cost effective and technically demanding but result of • MINIMAL PAIN FOLLOWING Centre is the only hospital in accepted mode of treatment in TKR are encouraging. Patient TKR:- To minimise pain following Faridabad which caters to all the advanced osteoarthritis of knee. equirement for physiotherapy is s u r g e r y, w e u s e p a t i e n t needs for Orthopedic patients. Satisfaction rate following TKR is minimized and muscle functions controlled analgesia(PCA) using Specialists having rich experience in almost 80%, however to have more are restored early. Baxter Epidural Pump, Buvalor skin joint replacement including revision acceptability among patients and • HIGH FLEX KNEE:- patches and physiotherapy to surgery, minimal invasive spine surgery, arthroscopic surgery of increase client satisfaction, Majority of patients undergoing minimise the requirement of knee, shoulder, hip and ankle are Orthopedic Surgeons at Sarvodaya TKR at Sarvodaya are implanted narcotics.. doing exclusive pediatric surgery Centre for Orthopedics & Joint high flex knee which can help the Patient is made to walk next day and cancer surgery. Replacement are performing the patient in sitting crossed-legged following surgery and fully knee replacement surgery with and squatting. Elderly canworshipin functional after one month of special techniques to offer greater Mandir, Gurudwara in normal way. surgery. benefits to patients. There are: • LIGAMENT SPARING TKR Only Super specialty Orthopedics • COMPUTER NAVIGATION:- (CR):- We use ligament sparing Centre in Faridabad Sarvodaya is equipped with painless techniques to have optimal function latest navigation machine to have of knee after TKR. Cruciate retaining accuracy in implant alignment. (CR) knee gives better function of • KINEMATIC ALIGNMENT:- knee. Both cruciate lig sparing (XR) W i t h n e w t e c h n i q u e s o f Knee are future knee which when kinematic alignment, bone cuts are imported in India will be giving minimized and ligaments are almost normal knee function. preserved. • NO SUTURE REMOVAL:- After • MUSCLE SPARING: knee replacement self dissolving In this technique muscles in front of sutures are applied and p a t i e n t knee are not cut & knee is need not come for suture & staple r e m o v a l . A l s o k n e e exposed keeping muscle fully Dr. (Col) IP Arora (Centre), Dr. (Maj) Mukesh Garg (Right), Dr. Ashish Tomar (Left) with Rehab & Para medic team

using same toilet, etc. hepatitis B with efficacy of around How hepatitis B infection manifest ? 95% in preventing infection. HOW YOU Hepatitis B vaccination is available If HBV infection occurs at birth from in national immunization schedule infected mother or in childhood also. First dose of hepatitis B (<5yr age) from infected person, it vaccine should be given to all usually persists for many years in COULD AVOID newborn at birth. form of chronic hepatitis B. These patients usually remain symptom World health organization (WHO) free till patients develop advanced recommends vaccination of all non- HEPATITIS B disease like cirrhosis or cancer. vaccinated children, adolescents or adults. WHO celebrates 28th July Infection in adult age usually lasts every year as World Hepatitis Day to Hepatitis B is present in roughly 3% cirrhosis (scarring) of liver and liver for short duration (acute hepatitis B) increase awareness of viral hepatitis of general population, 95% of the cancer. but can last for many years (chronic (hepatitis B and C). infected persons are not aware that How is Hepatitis B infection hepatitis B in 5%). testing by HBV markers to detect any body fluid of infected person, they are infected. It can cause All blood donations are routinely acquired ? Acute hepatitis B can present with whether you have acute or chronic contact doctor immediately. chronic (long term, usually life long) screened for hepatitis B along with Hepatitis B infection occurs by symptoms like fever, bodyache, infection and active or inactive What is treatment for hepatitis B ? infection and can put the person to other infections prior to transfusion contact with body fluids of infected tiredness, weakness, abdominal infection. You also need certain test risk of death from liver cirrhosis Medications are available like oral to ensure safety and avoid person e.g. blood, semen, vagina (tummy) pain, nausea, vomiting, to know extent of liver damage like (scarring) or cancer. It is usually antivirals (Entecavir, Tenofovir, etc) accidental transmission. fluid, menstrual fluid, etc. This is decrease appetite, dark color urine liver function test, prothrombin detected incidentally during routine or injectable (Pegylated-interferon) usually acquired from infected or yellow color eyes (jaundice). If time, ultrasound, endoscopy, health check up or investigation for which suppress the replication of mother to child during delivery, by person has advanced disease then fibroscan or liver biopsy (small cause of abnormal blood test (liver virus and improves the long term having sex without condom with h e /s h e ca n h a ve j au n d i ce, sample of liver tissue). function test), cirrhosis (scarring) of survival. infected person, sharing infected abdominal distension, blood What to do if you get infected liver and liver cancer. How to prevent Hepatitis B needle/syringe used for drug vomiting, black or red color stool, incidentally ? What is hepatitis B ? infection ? injection, getting tattoo or piercing abnormal behaviour, decrease All HBsAg positive persons are Hepatitis B vaccine is fairly safe Hepatitis B is infection of liver from infected needle and sharing appetite, weight loss, etc. potential source of transmission. method to get protection against caused by hepatitis B virus (HBV) razor, nail clipper or toothbrushes. How is Hepatitis B diagnosed? Most of infected persons (95%) are which causes liver cell injury and hepatitis B. Usually three doses of Hepatitis B infection does not occur Hepatitis B is usually diagnosed if not aware of their infection so best can lead to acute infection (short hepatitis B vaccine (0, 1, 6 months) from touching, handshaking, HBsAg blood test is positive. If it is way to prevent infection is hepatitis term), chronic infection (long term), gives long lasting immunity against Dr. Vishal Khurana hugging, sharing food or utensils, positive, then you need further B vaccination. If you get exposed to Consultant- Gastroenterology

ACT FAST AT THE FIRST SIGN OF STROKE

lasting for short duration and is T h e p a t i e n t s w h o r e c e i v e has to be continued life time despite termed as “transient ischemic thrombolysis have significantly complete improvement as the attack” or “mini stroke”. Its better neurological recovery at 1 underlying risk factors needs to be importance lies in the fact that mini month and 3 months as compared to controlled, else patient is highly stroke serves as a warning signal for those who did not. Unfortunately susceptible to repeat stroke. major stroke and should never be not all the patients are eligible for The stroke prevention is partially i g n o r e d . R a t h e r a n u r g e n t lysis and only 15% of ischemic stroke possible by controlling it s consultation in emergency and patients are eligible to receive the modifiable risk factors like treatment can prevent future drug. hypertension, diabetes, any FACE ARM SPEECH TIME serious stroke. underlying cardiac condition, Check their FACE. Can they lift both Is their SPEECH slurred? TIME is critical. If you see any In case of hemorrhagic stroke or Has their mouth drooped ? ARMS ? Do they understand you ? of these signs act fast. keeping lipid levels within Treatment of stroke bleeding in the brain, therapeutic permissible range, adopting healthy options could be conservative or The treatment can be broadly lifestyle and regular exercise. surgical, depending upon the site of classified into acute and post stroke Stroke is one of the major health deficit. Despite being such a Symptoms of stroke bleeding, extent of bleeding and At Sarvodaya Hospital we not only rehabilitation. burdens of the society with long devastating illness majority of other risk factors associated with treat but also educate the patients The symptoms of a stroke include term social, financial, physical and population seeks alternative means The acute treatment of ischemic the patient. The control of blood for post stroke care at home. We are sudden numbness or weakness, following the International emotional consequences. Stroke for its treatment. stroke earlier comprised only of pressure, blood sugars and especially on one side of the body; protocols for the procedure and commonly known as “paralysis” is medicines (antiplatelets, statins) hemodynamics are common in the Analysis of community surveys from sudden confusion or trouble monitor the patient carefully during also one of the most sub-optimally but now the treatment is available to t r e a t m e n t o f i s c h e m i c o r different regions of India shows a speaking or understanding speech; the procedure to maximize the treated debilitating illness. Stroke dissolve the clot so that permanent hemorrhagic stroke. crude stroke prevalence rate of sudden trouble seeing in one or both benefit to patient and to minimize occurs when blood supply to brain is damage to brain can be minimized. about 203 per 100,000 population eyes; sudden trouble with walking, The post stroke rehabilitation starts t h e r i s k a s s o c i a t e d w i t h interrupted either because of However this treatment can be above 20 years of age, amounting to dizziness, or loss of balance or in the acute stage and has to be thrombolysis. blockage of its blood supply given maximum 4.5 hours within a total of about 1 million cases. The coordination; or sudden severe continued in the post stroke period. (ischemic stroke) or rupture of onset of stroke, else the risk of ignorance of the population, poor headache with no known cause. It involves physiotherapy of the blood vessels causing leakage of bleeding increases. Its important to health infrastructure, financial Majority of the population suffers weak limbs, applying compression blood into the brain substance realize that thrombolysis is effective issues and myths propagated by from ischemic stroke or attack stockings to lower limb so that (hemorrhagic stroke). The worst if given within 4.5 hours of stroke, faith healers are major obstacles in caused by interruption of blood blood does not clot in lower limbs part of stroke is that it leaves the the sooner the better. Every minute and other factors which needs to be the treatment of stroke. supply. The symptoms of stroke at person with lifelong neurological delay can cause the brain to lose 1.9 individualized . The most important times occurs transiently, that means million neurons. aspect of stroke treatment is that it Dr. Ritu Jha Consultant - Neurology