Tag: Saket

Dr Vikas Singla, Director & Head, Gastroenterology Max Super Speciality Hospital, Saket, New Delhi
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Advanced endoscopic Ultrasound procedures paving way for treatment of GI disorders

Aug 19, 2021 by Rekha Nair 0 Comments #Director & Head, #Dr. Vikas Singla, #Gastroenterology Max Super Speciality Hospital, #New Delhi, #Saket

by Dr Vikas Singla, Director & Head, Gastroenterology Max Super Speciality Hospital, Saket, New Delhi

Endoscopic procedures have undergone tremendous advances in recent years paving way for an advanced and minimally invasive approach towards the treatment of a multitude of disorders pertaining to the Gastro-intestinal Tract (GI Tract). Being such a remarkable tool, Endoscopic Ultrasound (EUS) has made a paradigm shift in the management of patients suffering from various GI tract disorders.

As the purpose of innovation is to change the treatment of various diseases towards a better and lesser invasive direction with a lesser criterion, various diagnostic and therapeutic procedures can be performed without a scar on the skin using EUS. Performing the ultrasound from within the GI Tract, EUS makes use of a miniature ultrasound probe attached to the tip of the endoscope that helps in obtaining high-quality and informative pictures.

After the fasting of at least 8 hours, Endoscopic ultrasonography is performed under sedation, making it a painless procedure. During EUS, structuring surrounding the esophagus, stomach, upper intestine and lower part of the large intestine are studied. Patients suffering from disorders of the gall bladder, bile duct, pancreas, and lymph node enlargement may benefit from the procedure. If tissue sampling is planned, blood thinners medications need to be stopped after discussion with the doctor. Tissue samples are also obtained if required, and now with the newer needles, even the biopsies can be done during the procedure.

EUS – Treating a multitude of disorders

1. Evaluation of the cause of Jaundice – While normal ultrasound may show the presence of obstructed ducts but often fails to detect the cause. Endoscopic ultrasonography is extremely useful to test to detect the cause of jaundice especially if the stones are the cause of obstruction of the bile duct, many such stones migrating from the gall bladder. Once the stones are detected, removal can be done in the same setting, by another endoscopic procedure known as Endoscopic retrograde cholangio-pancreatography or ERCP. Cancer of the bile duct, gall bladder and pancreas are the other common cause of bile duct obstruction leading to jaundice and is more common in the elderly. EUS can easily detect these tumors, and sampling can be done in the same setting without any risk of the spread of the tumor.

2. Evaluation of pancreatic pathologies – Alcohol, smoking and gall bladder stones are the common risk factors for pancreatic pathologies such as acute pancreatitis, chronic pancreatitis and pancreatic cancer.

a) Acute Pancreatitis – Patients with acute pancreatitis can have severe pain in the upper abdomen and vomiting. After treatment of acute pancreatitis, further episodes should be prevented by treating the underlying cause. One of the common causes of acute pancreatitis is gall bladder stone, which may migrate in the bile duct and transiently block the pancreatic duct at the ampulla, leading to acute pancreatitis. Stones causing acute pancreatitis may be very small and maybe missed by ultrasonography. EUS can essentially detect very small stones in the gall bladder, treating which will prevent further episodes of acute pancreatitis.

b) Chronic pancreatitis – Individuals consuming alcohol or having predisposing genetic factors, can suffer from persistent pain in the upper abdomen, which can be due to chronic pancreatitis, a condition that can lead to stone formation and dilatation of the duct pancreas. In the early stage, conditions may be missed by the conventional techniques. EUS provides the highest level of information in this stage and can change the management of the disease altogether.

In patients with both acute and chronic pancreatitis, fluid may accumulate around the pancreas, forming a cyst known as a pseudocyst. The best treatment of pseudocyst nowadays, is drainage in the stomach and upper part of small intestine, under the EUS guidance. EUS guided drainage avoids the need of surgery and placement of external tubes.

c) Pancreatic Cancer – Patients with diabetes and a history of smoking are at increased risk of cancer, the common symptoms are pain upper abdomen and jaundice. EUS can detect the smallest of cancer in the pancreas, define the extent and enable tissue sampling without compromising resectability. The cystic lesions in the pancreas are common and can be due to pancreatitis or may be due to tumor formation. EUS is the best tool to define the nature of the lesion and is a useful guide for further treatment.

3. Cancer Pain Management – Many patients with cancer of upper digestive tract can have severe pain abdomen, which is not controllable by oral medications. EUS guided injection around the nerve fibers carrying the pain sensation is a useful modality for pain relief. Small stones in the gall bladder known as microliths and early chronic pancreatitis are common causes of upper abdomen pain, which are often missed by conventional techniques. EUS is the best performing test in such conditions enabling the early diagnosis and treatment.

4. Treatment of jaundice and vomiting in patients with pancreatic cancer – Patients with pancreatic lesions may suffer from vomiting and jaundice due to obstruction of the stomach and bile duct respectively. In both conditions, stent placement may be necessary depending upon the circumstances and tumor spread. EUS guided stenting is emerging as a new technique for the treatment of jaundice and vomiting. Moreover, once the conventional techniques fail, EUS is a useful rescue technique.

5. Control of bleed in patients with liver cirrhosis – In patients with cirrhosis of the liver, veins of the esophagus and stomach may dilate and are known as varices. Varices in the stomach require an injection of a special fluid known as glue. Placement of coils in varix under the EUS guidance prior to glue injection makes the procedure very safe.

6. Evaluation of fever – Prolonged fever may be due to enlargement of the lymph nodes, which can be due to various diseases such as tuberculosis, sarcoidosis and tumor of lymph nodes such as lymphoma. A sampling of the nodes is necessary to define the cause and for further treatment. EUS is very safe in such conditions and enables the direct visualization and sampling of the lymph nodes.

Dr. Ripen Gupta, Director & Unit Head – Cardiology, Max Super Speciality Hospital, Saket
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Patients with heart ailments must take adequate precautions amid the pandemic

Jun 25, 2021 by Rekha Nair 0 Comments #Director & Unit Head – Cardiology, #Dr. Ripen Gupta, #Max Super Speciality Hospital, #Saket

Prayagraj: While the World’s largest vaccination drive is on its peak to defeat the COVID pandemic, yet it becomes very important to prevent from acquiring theinfection by taking adequate precautions and also to identify patients who are at high risk for developing complications from COVID -19.

Patients who are older, smokers, obese, diabetic or already have heart, lung, or kidney problems are at a higher risk. Heart patients are especially at a higher risk as most of them are elderly and have other co-morbid conditions. In addition, COVID-19 infection itself can also lead to heart attacks, heart failure, and cardiac arrhythmias. In fact, some of the medications given to treat COVID-19 infection can also precipitate fatal cardiac arrhythmias.

It is the duty of every citizen to follow the safety norms, wear mask, sanitize themselves and avoid outdoor activities unless necessary. While the healthcare structure and the frontline workers are striving hard to save lives and stop the spread of this deadly disease, we as responsible citizens should do our part. Following a healthy lifestyle is not only good amid the pandemic crisis but also ensures healthy well-being in the long run as well.” Said Dr. Ripen Gupta, Director & Unit Head – Cardiology, Max Super Speciality Hospital, Saket

Several new studies also reveal that the patients with pre-existing heart conditions are highly vulnerable to catch the infection and vice versa that the virus is also responsible for damaging the heart muscles. Though the researches are still underway whether the consequences are short-termed or long-termed, but the COVID 19 infection leads to the inflammation of the heart muscles, a condition known as myocarditis.

As the virus do not affect the heart muscles directly, but triggers the formation of anti-inflammatory bodies known as cytokines, which attacks the heart muscles and reduces its pumping efficiency. This is long-term or as a consequence of the COVID response, can lead to heart failure due to continuous damage to the heart muscles.

Dr Amod Manocha, Senior Consultant & Head, Pain Management Services, Max Hospital, Saket
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Treat Pain like a disease, not like a symptom

Apr 8, 2021 by Neel Achary 0 Comments #Dr Amod Manocha, #Max Hospital, #Pain Management Services, #Saket, #Senior Consultant & Head

By Dr Amod Manocha, Senior Consultant & Head, Pain Management Services, Max Hospital, Saket

Amid the COVID era, people have been conscious about their overall health and wellness. Yet there is a dire need to raise awareness about preventing lifestyle ailments that contributes a major burden on the healthcare sector in the country.

It is believed that persistent pain beyond 3-6 months period can lead to changes in the nervous system which can be responsible for continuing pain even when the original cause of pain is removed. This is the rationale behind the recommendation for early treatment. Chronic pain conditions are amongst the leading causes of disability as even mild joint pain can have a debilitating impact on mobility and quality of life. Poor pain control is not only associated with suffering but also affects one’s functional ability, mood and quality of life.

The complexities of pain and the fact that surgery or pills cannot resolve all pain issues has been long recognised. After all it is the pain which brings a patient to the hospital whether it’s a slipped disc or a cancer hiding deep inside the tummy, so why should the treatment of pain be a second priority. It is time chronic pain is managed as a disease and not as a symptom. In certain situations where the root cause cannot be removed the emphasis shifts to management of pain and prevention of flare up episodes. Like diabetes and high blood pressure, pain therapy needs to be adjusted from time to time. The concept of pain management is not well appreciated by many and in quest for a cure the suffering is often prolonged.

Increasing emphasis on the quality of life is challenging the medical fraternity to improvise and keep pace with community expectations. A number of new drugs and interventional options for pain treatment have been developed in the last few years.

Besides medications, new interventions such as radiofrequency treatment for knee, hip and shoulder pain offer advantages in terms of being minimally invasive day care procedures without any prolonged rehabilitation requirements and with the potential of offering long lasting pain.

Raredisorder in the food pipe can mimic heart attacks, right diagnosis is the key to treatment
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Raredisorder in the food pipe can mimic heart attacks, right diagnosis is the key to treatment

Feb 27, 2021 by Rekha Nair 0 Comments #Director & Head, #Dr. Vikas Singla, #Gastroenterology, #Hepatology & Endoscopy, #Max Super Specialty Hospital, #New Delhi, #Saket

New Delhi: Esophageal Manometery is a test to diagnose one of the rarest motility disorders in the esophagus when its functioning is impaired. The rare condition known as Achalasia, involves complaints of difficulty in swallowing, sensation of food or water getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack), regurgitation of food and weight loss.

Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms. Endoscopy, which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.

“A ring of muscle called the lower esophageal sphincter encircles the lower esophagus just above the stomach. This sphincter muscle when contracts, closes the esophagus. When the sphincter is closed, the contents of the stomach cannot flow back into the esophagus. Backward flow of stomach contents (reflux) can irritate and inflame the esophagus, causing symptoms such as heartburn. The act of swallowing causes a wave of esophageal contraction called peristalsis, which pushes the food along the esophagus down into the stomach. Normally, during peristalsis, esophageal sphincter relaxes to allow the food into the stomach. In achalasia, which means failure to relax, is a rare esophageal motility disorder in which the normal esophageal peristalsis and the lower esophageal sphincter relaxation are impaired.” Said Dr. Vikas Singla, Director & Head, Gastroenterology, Hepatology & Endoscopy, Max Super Specialty Hospital, Saket, New Delhi.

Such ailments need to be diagnosed correctly, for which a test known as Esophageal manometry is used. The procedure involves passing a thin tube through the esophagus to assess the contraction and relaxation timing during swallowing. Max Superspeciality hospital is one of the very few centres in India to perform manometry along with an incisionless endoscopic procedure to treat Achalasia.

“The non-invasive endoscopic procedure known as Per oral endoscopic myotomy (POEM) is one of the latest treatment modules for patients with the complaints of Achalasia. Being a scarless procedure it is highly safe and provides excellent long-term results with a minimal hospital stay. The procedure is followed by an X-ray after 24 hours and the patient can be put on liquid diet initially.” He added

Dr Bipin Walia
Health

Osteoporosis increases the risk of spinal fracture by upto five times

Feb 20, 2021 by Neel Achary 0 Comments #Dr Bipin Walia, #Max Super Specialty Hospital, #New Delhi, #Osteoporosis, #Saket, #Senior Director & Head- Neurosurgery

Srinagar : Osteoporosis remains the most prominent factors for onset of bone weakness and thereby causing spinal fractures and deformities with aging, it is important to ensure a healthy lifestyle at least from the age of 20 years. Even though with the availability of a plethora of treatment modules, fractured vertebrae result in severe back pain, loss of height or spinal deformities such as kyphosis (stooped posture), depleting the quality of life among the geriatric population.

While spinal fractures are the most common fractures caused due to osteoporosis, the long-term consequences can be devastating with acute and chronic debilitating pain, and changes in the spinal alignment post the fracture has healed. Other comorbidities include significant performance impairment in physical, functional and psychological domains in older women, decreased pulmonary function and increased risk of lung disorder. Further there is an estimated fivefold risk of development of future spinal fracture after the first one. Thus, a bone density test is preferred especially for post-menopausal women which can predict the risk of future osteoporosis and hip fracture, which not only determined the rate of bone loss but also helpful in monitoring the effect of treatment thereby preventing a fracture before occurring.

“Balloon Kyphoplasty is a minimally invasive treatment that stabilizes the fracture, thereby reducing pain and providing correction of the deformity. A small balloon is guided through the instrument into the vertebra. The incision size is approximately 1 cm in length. The balloon is carefully inflated in an attempt to raise the collapsed vertebra and return it to its normal position inflation of the balloon creates a void (cavity) in the vertebral body. Once the vertebra is in the correct position the balloon is deflated and removed. The cavity is filled with bone cement forming an internal cast to support the surrounding bone and prevent further collapse. Generally, the procedure is done on both sides of the vertebral body.” Said Prof. (Col). Dr Bipin Walia, Senior Director & Head- Neurosurgery, Max Super Specialty Hospital, Saket, New Delhi

Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue leading to bone fragility and an increased susceptibility to fracture of hip, spine and wrist. The exact data for India is not available but it is estimated the over 20 crore Indians have abnormally low bone mass placing them at an increased risk of Osteoporosis. And approximately one in four patients dies within one year following an Osteoporotic hip fracture.

“Patient with painful spinal fractures have traditionally received palliative (Pain reducing) care, including bed rest, narcotic analgesics and external bracing. Severe pain caused by spinal fracture may require bed rest for up to six months. The balloon kyphoplasty procedure typically takes about one hour per fracture and may require an overnight hospital stay. Post operatively there is a significant improvement in mobility including the ability to perform daily activities such as walking hobbies and work, and as many as 90% of the patients report a complete pain relief within 24 hours of the procedure” he added.

Building strong bones during childhood and adolescence may be the best defense against developing Osteoporosis. By about age of 20, the average woman acquired 98% of her skeletal mass. There are four steps to prevent Osteoporosis. No one step alone is enough to prevent the disease, but a combination of the following is recommended. A balanced diet rich in calcium (1200mg daily for men and women over 50) and vitamin D (between 400 and 600 IU daily). Besides these weight bearing exercises (any exercise in which your bones and muscles work against gravity), a healthy lifestyle with no smoking or excessive alcohol intake and bone density testing and medication are also recommended. There are medications which will be advised by the physician depending on the disease severity to treat the Osteoporosis.

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Hi-tech intervention cures young bank officer suffering from brain tumor

Jan 28, 2021 by Rekha Nair 0 Comments #Dr VK Jain, #Max Hospital, #Neurosurgery, #Saket, #Senior Director

New Delhi: Mr Sharma, a young bank employee was successfully cured, after being diagnosed with a benign (non-cancerous) tumor in his brain with the assistance of advanced microsurgical procedure at Max Hospital Saket. The patient who used to have intense and frequent headaches suddenly lost the ability to speak and got bed ridden due to weakness in his right side of the body.

Assuming this to be a general weakness and would go away with some medications had delayed the diagnosis for almost 15 days. Upon consultation at Max Hospital, Saket, where the MRI of the brain revealed a benign tumor, he and his family were left in utter shock and horrified about the condition.

While a common myth persists in the minds that any surgical procedure of the brain mostly leaves people with permanent paralysis or in a vegetative state. He and his family were counselled about the latest minimally invasive intervention procedures and hi-tech equipment, which has zero risk and are highly safe procedures.

“Our team decided to perform a microsurgical intervention making use of the navigation technique for precisely targeting the tumor. With latest advancements made in the field of neurosurgery and interventions in the recent decades, surgeries have become completely safer and risk-free. The patient successfully underwent the procedure and made a swift recovery. He was completely cured and did not have any complications as noted before the surgery. Since the procedure was done in a minimally invasive manner, the functional and aesthetic outcomes were preserved.” Said Dr VK Jain, Senior Director, Neurosurgery, Max Hospital, Saket.

Within a span of one month, Mr Sharma had joined back to his bank job and feels better as earlier. Latest generation MRI scans have the potential to accurately position the site of tumor in the brain. Further with the assistance of Functional MRI(f-MRI) even the functional areas of the brain can be traced with accuracy without affecting the adjoining healthy cells.

“I would suggest to the public to not hesitate in getting the surgery done for a brain tumor from a well-established neurosurgical centre. Since delay in each and every second damages the brain cells and can potentially lead to paralysis or even mortality in the worst case.” Added Dr Jain

Brain tumour is the tenth leading cause of morbidity in India. The incidence of this deadly disease is rising and different kinds of tumours manifest at different age groups. As per the GLOBOCAN 2018 report, issued by the International Association of Cancer Registries (IARC) associated with the World Health Organization (WHO), in India over 28,000 cases of new brain tumour cases were reported annually.  Around 24,000 patients lost their lives battling this neurological ailment.

Although the prognosis of highly malignant tumors (cancerous) are not good, but with advancements in surgery, radiotherapy and chemotherapy, many patients make exceptionally good recovery.

Health

Precision Stenting – An advanced procedure launched for the first time in India by Max Hospital Saket

Dec 22, 2020 by Neel Achary 0 Comments #Cardiac Sciences, #Chairman, #Dr. Balbir Singh, #Max Hospital, #Saket

While the number of cardiac ailments in India is on an exponential rise attributing to a plethora of factors, so are the advancements made in this field. Poor eating habits, sedentary lifestyle and physical inactivity, lack of awareness about the symptoms and available treatment modules are some of the most common factors influencing the rising mortality and morbidity rate in the country due to heart ailments.

Interventional cardiology that refers to the procedures done with minimally invasive percutaneous processes, is a latent field which has developed leaps and bounds in the last decade. Such interventions not only allow the patients a quicker recovery time but also reduces the hospital stay along with preserving the aesthetic and functional outcomes with efficacy. In the recent years, many patients with different facets of Cardiovascular diseases (CVD) have been highly benefited through the treatment done via interventional cardiology, and avoided a possible casualty says Dr. Balbir Singh, Chairman, Cardiac Sciences, Max Hospital, Saket.

The inception of Intervention cardiology

Since the inception of this subspecialty, technological innovations have played the most critical role in shaping and labelled it as the most cutting edge and transformative field known till today.

As a resultant of collaborations between the medical fraternity, community and technology, these developments have brought about substantial advancements in the treatment of patients with CVD, providing less-invasive alternatives and in some cases hope in the fight against disease that would have otherwise been unavailable.

The latest advancements are also helpful in determining the functional significance in some tricky situations which otherwise would be seemingly borderline, such advanced procedures not only help in treating the patients effectively, but also improves their quality of life. The initial phases saw development of coronary angioplasty and stenting which has now become a procedure which the community is confident about.

Precision Coronary Angioplasty – In collaboration with Columbia University, New York, Max Hospital, Saket, New Delhi is the first to introduce and implement the protocols of precision Coronary Angioplasty. With the available technical expertise for performing even the most complex cases, the Hospital has showcased a success rate of over 95%. Recently the Hospital treated the First Indian case using the procedure of precision angioplasty with advanced Optical Coherence Tomography (OCT) imaging technique. The patient suffered a severe heart attack due to a complex arterial blockage, which otherwise would have cost her life. but in synchronisation with the OCT technique, the precision of stenting had also improved the outcomes with a better quality of life.

With detailed information of the arteries and with a lot of in-depth understanding this advanced procedure could lead to much better outcomes in patients undergoing coronary stenting.

Structural Heart Interventions – This is one of the most attracted dimensions to have been attracted. The procedure that involves valve replacements under local anesthesia with no cut or incision marks on the body has received a lot of importance in the hospital and is an area that will add new dimensions while entering into the New year 2021.

Heart Rhythm Management (Electrophysiology) – Being the leaders in the management of Heart rhythm disorders, with several cutting-edge technological procedures and many Internationally recognised areas of work, the Cardiac Centre has cured the disease to many patients. The word cure is rare in medicine and to give cure to a difficult problem indeed does make us feel proud.

Collaboration and a combined approach to patient care are evolving on many fronts. The historic approach of providing a service independent or irrespective of what else is going on in the patient care continuum is a thing of the past. As such, the traditional relationship between patient, primary physician and subspecialist coming together and providing compassionate and comprehensive care should be the goal. Greater alignment and working more closely together will result in better patient care, greater efficiencies and ultimately take cost out of the system.