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November - December, 2009 Newsletter I

FEATURE STORY

SAVING LIVES:

EMERGENCY &

POLYTRAUMA

CARE CENTER

Sahara Hospital's Newsletter, "Cure & Care" is meant for internal circulation only.

This Newsletter has been conceptualized, edited and published by Corporate Communications, Sahara India Pariwar

Sahara Hospital starts its 'Sunset Clinics'Now you don't have to take a leave to visit your doctor!

Sahara Hospital, the multi-disciplinary super-speciality pathology and imaging cover blood tests, E.C.G., echo,

tertiary care hospital, inaugurated its Sunset Clinics on X-Ray, C.T. Scan and M.R.I.

19th September 2009, under which it will provide Out Talking of 'Sunset Clinics', Dr. H.P. Kumar, Director – Patients Department (O.P.D.) services in the evening Medical Health, Sahara Hospital, says, “The Sunset hours as well. Intended to benefit people who find it Clinics are particularly beneficial for the people who find difficult to visit doctors during regular daytime working it difficult to take out time to visit doctor during the day hours, Sahara Hospital's 'Sunset Clinics' will operate from time, owing to their busy schedules. These could include 5:00 p.m. to 7:00 p.m. on all the six working days. These businessmen, housewives, executives working in services will be supported by 24x7 diagnostic services of corporate houses, school going children, and even small the hospital and will be in addition to the regular O.P.D. kids waiting for their parents to return home after work services being offered between 9:00 a.m.and take them for consultation, investigation, counselling and 4:00 p.m. and tips on healthy lifestyle.” Dr. Kumar added, “It is our

The Sunset Clinics will provide outpatient services in endeavour to add more services to fulfill total health

General Medicine, Orthopaedics, Cardiology, Psychiatry, needs under one roof.”

Paediatrics and Gynaecology departments. In addition to Sahara Hospital has a dedicated team of expert doctors these services, under sunset clinics, the hospital will also and paramedical staff as well as the modern generation provide specialized clinics for Rheumatology on every medical and diagnostic facilities. These evening clinics Monday, Arthritis on every Tuesday, Hypertension on will surely and substantially help people in availing every Wednesday and Psychiatry on Monday, Wednesday, outpatient services in evening hours as well.Thursday and Friday. The 24x7 (round the clock)

diagnostic services provided by Sahara Hospital, under

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Welcome to Sunset Clinics

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TRAUMA KNOWS NO ANATOMICAL BARRIER hospital phase of care where primary care is provided at the site of the accident only. At the second echelon stage,

Speed is taking a severe toll on our lives, especially when minimal life saving treatment is provided at a smaller

it causes road accidents. Today, grievous physical injuries hospital and if required, the patient is evacuated to a third

caused due to road accidents have become one of the echelon. At the third echelon level, management of

major causes of human mortality across the world, trauma is provided at the tertiary care hospital (like

including India. It is stating the obvious when we say that Sahara Hospital) that has all the specialties, modern

these injuries and the physical trauma sustained due to diagnostic care and support systems along with modern

them, is often considerably severe and damaging to O.T. available 24x7.

several organs and parts of the body. This complex condition of having several organs and systems in a state This echelon system though helps in reducing mortality, of injury is known as the condition of polytrauma. still posts death figures a little higher as compared to the

other popular system, the Emergency Medical Service The term 'polytrauma' finds its origin in wars. When

System (EMSS). "In a fast developing country like ours, soldiers hit by shells and bomb splinters got critically

more people are getting injured and/or killed on the roads injured, specialized, high level multiple organ surgical

than by sickness, and under these circumstances the procedures and intensive care were required. "The high

Emergency Medical Service System (EMSS) offers better impact of the velocity, of the moving vehicle on road or of

outcome of trauma care" asserts Dr. Col. Sabhlok. explosives in war, causes damage to the body that may involve head injuries, crushing of bones, organ ruptures, The object of an Emergency Medical Services System excessive bleeding etc. Trauma knows no anatomical (EMSS) is to deliver medical aid to the accident victim as barrier and its treatment is a multi-disciplinary approach quickly as possible and then rapidly transport the injured where coordination between various specialities is to a definitive care facility so as to increase the patient's essential" says Dr. Colonel S. Sabhlok, Senior Consultant chances of survival. If the condition of the patient is of General Surgery at Sahara Hospital and the Ex-Senior critical and there are multiple injuries, this definitive care Advisor of Surgery (Indian Army). facility should primarily be a tertiary care Hospital with a

24X7 functional Polytrauma Care Center.

This complex medical condition calls for many things. It requires a scientifically established protocol for handling one or more of such cases- 24 hours a day, 7 days a week. It also requires a complete bandwidth of functional departments or specializations and technological support for prompt diagnoses and effective life saving support systems. As you can gauge from the real life stories carried elsewhere in this issue, polytrauma cases invariably need coordinated efforts and treatments from different expert doctors who can work as a single cohesive unit to treat multi-organ and multi-system

Sahara Hospital has set up both these systems, the injuries.Echelon and the EMSS. Knowing the requirements of

Sahara Hospital is not just a tertiary care medical facility polytrauma cases, Sahara Hospital has established a

with extremely speedy trauma treatment services. Its team complete Critical Care Medicine set-up for their speedy

of specialist doctors is also adept at working in tandem and effective treatment. The hospital, thus has a dedicated

with each other to carry out simultaneous management. 1Echelon III / Level I Trauma Center amply supported by

Dr. Col. Sabhlok says, "Handling medical emergencies equipped Mobile ICUs (critical care ambulances) and well

during accidents whether vehicular, train, air or natural trained and experienced Quick Reaction Team (QRT) for

disasters like earthquakes, floods, even avalanches etc., prompt evacuation and proper treatment en route to

asks for an already-in-place management system at the Sahara Hospital.

city level. The absence of an effective management system further adds to the responsibility of the major "The Emergency & Polytrauma Care Center of Sahara hospital of the area having a Polytrauma Center Unit to Hospital has been developed to act optimally under both bridge the gap. There are primarily two systems which are these management systems. These protocols are set to followed worldwide. One of them is the 'Echelon offer polytrauma services to people of Lucknow and Concept' which professes echelon or hierarchical system surrounding areas, along with the patients of polytrauma of trauma handling." from farther places as well who come to our hospital at

the third echelon." says Dr. H. P. Kumar, Director- Under the Echelon Concept, the first echelon is the pre-

POLYTRAUMA MANAGEMENT SYSTEMSThe components of EMSS are as follows:

1. Pre-hospital Care - Assessment and transportation to the nearest trauma center

2. Communications - It involve: (i) Activations (ii) Dispatch; and (iii) Uplink - The next level communication

3. Pre-hospital Triage - Development of protocol to evaluate and determine the level of care required

4. EMS Personnel - The Trauma Team

Saving Lives Emergency and Polytrauma Care Centre of Sahara Hospital

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Medical Health, Sahara Hospital. He further adds, "As Trauma Care Center of Sahara Hospital is equipped with trauma knows no anatomical barrier, its treatment is a a network of hi-tech critical care ambulances that has multi-disciplinary approach and coordination between been established with the motto of '24 Hours - No Matter various specialties is essential. Sahara Hospital has all What'. This ensures the availability of the best possible diagnostic and support facilities as well as tertiary care medical care without any wastage of time by providing disciplines under one roof, which are the prerequisites medical attention right through the transportation of the for the care of polytrauma. The hospital has state-of-the- victims of polytrauma, stroke, cardiac emergencies and art pre- and post-operative support systems, and other similarly alarming situations.excellent rehabilitation facilities as well."

The Quick Reacting Team (QRT) in the critical care Prompt and proper treatment by trained experts at a well ambulance (Mobile ICU) initiates the resuscitative equipped place can cure most patients completely, measures on way to the hospital. The QRT remains in whereas a delay of even a few hours could mean the loss touch with the hospital team which help in guiding the of valuable life. Considering this, the Emergency & treatment while the patient is on his way and also

enables the hospital team to be prepared even before the exacting, a rigid duty schedule and training is patient is received at the Emergency & Polytrauma Care mandatory." Says Dr. (Col.) Sabhlok. Center of Sahara Hospital. This two-way communication

Sahara Hospital's Trauma Center follows international facilitates the entire arrangement to be ready in terms of protocols in terms of the constituents of its trauma team logistics like the operation theatre, staff etc., promptly also. The Trauma Center has a 24x7 trauma team of and in time.experts to handle the emergency cases arriving at the

Moreover, the critical care ambulances (Mobile ICU) at hospital at any given moment of time. The team, under Sahara Hospital, minimizes the event - intervention time the charge of a Senior General Surgery Consultant, has by taking the patient right to the resuscitation area with on duty an Anesthesiologist and a Senior Resident on-site availability of highly trained specialists, General Surgeon. Alongside, a team of neurosurgeons, diagnostic facilities and a dedicated Trauma operation plastic surgeons, maxillo-facial surgeons, orthopaedic theatre, located in Casualty Department itself. Thus, surgeons, ENT surgeons, eye surgeons, gynecologists proper planning, quick action and the entry of the and pediatric surgeon is also available on emergency ambulance directly into the trauma center where call.immediate measures to resuscitate the patient are

The standard principles of triage, damage, control available, is factually possible at Sahara Hospital due to surgery and tertiary survey systems have also been the design of the trauma Center (which includes a adopted here. Finally, definitive operative management separate Trauma operation theater and a Casualty wing is performed promptly at any hour of night or day. The within the center). The Casualty staff, Trauma boys Trauma Center has its own dedicated ultra clean (technicians and attendants) and the Trauma O.T., all

2 operation theater (O.T.) with state-of-the-art Laminar follow the A, B, C protocol of Resuscitation and the 3 flow system with Hepa filter and the supporting Triage Drill and are kept ready round-the-clock to

technical staff of surgery and anesthesia technicians, receive patients, brought by the QRT. "In a corporate nurses and male and female attendants on duty, on 24x7 hospital, where demands from the clientele are fairly

An interior view of Sahara Hospital's Mobile Critical Care Unit

An Ultra Clean Operation Theater at Sahara Hospital

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basis. The Trauma O.T. is situated right next to the Emergency Room. Thus, the possibilities of any wastage of time in moving the patient to O.T. are also eliminated.

A 100 bedded critical care system with ample number of ventilators and all the intensive care monitoring systems, all staffed by qualified intensive care personnel, trauma trained nursing staff and technicians, are also Trauma that's promptly and meticulously tackled in a available 24x7. world class trauma set up, results in less than 10%

mortality. Sahara Hospital, with its consultants and ancillary staff is indeed proving that the hospital's motto of 'Curing through Care' stands true in action and spirit.

available round-the-clock for prompt services and a definitive management along with Sahara Hospital's world class Blood Bank, which can supply components, FFP and PRBC, etc. 24 hours a day, and technicians on duty at all hours and the 24 hours open in-house Pharmacy.

The hospital has emergency laboratory facilities, diagnostic facilities of X-ray, ultrasound, High Resolution latest generation Ultrafast CT and MRI, all

Reference:1 of Trauma Centers

Level I - Tertiary Care Center (like Sahara Hospital that has all the specialists, modern gadgets,supportive gadgets, modern O.T. available 24x7)

Level II - 200 to 250 bedded tertiary care hospital with some specialtiesLevel III - 25 to 50 bedded hospitalLevel IV - Least facility - only transfer to higher centre possible

2 ABC, originally stands for Airway, Breathing and Circulation, is one of the oldest protocols for the care of an unconscious and unresponsive patient. Airway, breathing, and circulation are vital for life, and each is required, in that order, for the next one to be effective. It is now used as a reminder of the priorities for assessment and treatment of patients in many acute medical and trauma situations, from first-aid to hospital.

3 The Triage process of prioritizing patients acts as a critical link in the mobilization and allocation of resources and is based on the severity of a patient's condition.

Level

Dr. Adesh Kumar Srivastava is a leading Anaesthesiologist who brings to Sahara Hospital invaluable superspeciality skills and professional experience in his field that he gained while working at New Delhi's G. B. Pant Institute and the I.P. Apollo Hospital, both premier medical institutions of India. Dr. Srivastava's comprehensive spectrum of expertise includes anaesthesia for Cardiac, Neurosurgical, Paediatric Cardiac, Gastroenterological, PA Catheterization, Awake Crantoiy, Fibreoptic Intubation, Thorhck Epidural and Celiac Plerxus Block 4 dc surgeries among others. He also has years of experience in managing complicated surgeries independently.

Dr. Adesh Kumar SrivastavaAnaesthesiologist & Critical Care Specialist, Sahara Hospital

Dr. (Col.) S. SabhlokSr. Consultant – General Surgery, Sahara Hospital

Dr. (Col.) Sabhlok has served in the war zone of the Bangladesh War, in Sri Lanka as a member of the IPKF and at the Rajasthan Indo-Pak border. A distinguished medal-winning ex-army officer, he has conducted scores of successful emergency operations of war-hit civilians and soldiers, often suffering from polytrauma. His fields of surgery include general ortho, plastic and neuro surgeries, emergency gynaecological & obstetric operations, paediatric surgeries and laparoscopic surgeries among others. Prior to joining Sahara Hospital, Dr. Sabhlok was serving as the Sr. Advisor (Surgery) & HOD of the Surgical Division at Command Hospital, Lucknow. Dr. (Col.) Sabhlok has been trained in laparoscopic surgeries at Ethicon Institutes of Mumbai and Delhi, and in advanced herniology at the Hernia Institute, Miami, Florida. A former teacher at AFMC, Pune and Command Hospitals of Lucknow and Kolkata, he has also published several publications and delivered numerous lectures at prestigious podiums.

Looking at the smiling face of Ata-Urrehman now, it is his condition of polytrauma further was the leakage of his difficult to believe that only a few months ago, a brain fluid (known medically as the cerebrospinal fluid). dangerous road accident had left his entire face badly In view of the complications involved in the case, Dr. crumbled and his skull fractured critically at many places. Khanna decided to operate upon him without any further It is quite unbelievable that not too long ago, he got delay. The patient then underwent a complex two-staged reconstructive surgeries done on his jaws, nose, forehead, surgery that was performed by a team of doctors including cheek bones and more! Dr. Vaibhav Khanna and Dr. Romesh Kohli along with Dr.

Sandeep Pawar, the Anaesthetist. In stage-1, debridement Ata-Urrehamn (25) lives in Barabanki, a small town or meticulous removal of all foreign materials along with around 30 kms. from Lucknow. A cook by profession, he dead and infected tissues and fixation of the lower jaw drives a motorcycle for commuting. It was while riding (mandible) were conducted. This stage of surgery went on his bike that he met a major accident. This mishap left his for four long hours.face and skull badly damaged. He was rushed to a private hospital in Barabanki for treatment. As Barabanki is a In stage-2 of the surgery, doctors reshaped the patient's small town with limited advanced medical facilities and forehead, nose, cheek-bones (maxilla and zygoma). 'The as Ata-Urrehman's condition was worsening rapidly, the reconstruction surgery was done by using the advanced doctors there wasted no time in referring him to a reputed Bicoronal approach, starting from the scalp area moving Hospital in Lucknow. And his family wasted no time in downwards so as to prevent the patient's face from post-taking him to that hospital. Unfortunately for the patient, operative marks of surgery' said Dr. Vaibhav Khanna. The the doctors in that hospital, after acknowledging the second stage surgery took over six hours to complete. The severity of his injuries and observing the progressive entire surgical procedure was successful. After the ghastly deterioration in his condition, referred the patient to yet nightmare of the past few days, the patient was now another higher medical centre of the city. firmly on the mend.

As a last ray of hope, Ata-Urrehman's kin decided to rush Ata-Urrehman recuperated well and progressed soon to him to Sahara Hospital. As soon as he was wheeled into first taking liquids such as milk and juice, and then on to a the Trauma Care Unit of Sahara Hospital, the doctors on soft diet. He also started speaking and breathing with duty assessed his case, and in view of his injuries, considerable ease. After a period of 14 days of post-assigned the case to Dr. Vaibhav Khanna and Dr. Romesh operative care, he was finally discharged, almost as good Kohli, a team of seasoned Plastic Surgeons. A CT scan of as new. No surprise that Ata-Urrehman and his family the entire skull was conducted which revealed that Ata- expressed considerable satisfaction for the life saving Ur-Rehman has sustained fractures on his lower jaw, nose, treatment and care he received at Sahara Hospital.forehead, cheek-bones and orbital bones. Complicating

DE-TRAUMATIZING A BADLY DAMAGED FACE

Dr. H.P. KumarDirector-Medical Health, Sahara Hospital

Dr. H. P. Kumar ranks high among the path breaking pioneers in the field of health care and administration. He has been deeply involved with the planning, setting up and management of the Super Speciality Tertiary Care Sahara Hospital. Prior to building the blueprint of Sahara Hospital, Dr. Kumar visited several leading hospitals of Europe, US and SE Asia to be able to establish one of the very best medical destinations on the Indian map. An MBBS and MD from the erstwhile KGMC, Lucknow, Dr. Kumar has also held various key governmental administrative positions such as the CMO, Lucknow and the DG (Medical & Health), UP. In a long and distinguished career spanning over four decades, he has been responsible for implementing major state health care policies and management protocols. He is renowned for transforming the Dr. SPM Hospital, Lucknow into a model multi speciality hospital and developing the Mahila Hospital of the city into a modern unit.

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Recovering from near Critical PolytraumaManish Mohan (41), when brought to Sahara Hospital, charge of him. Well informed in advance that Manish was was severely injured, in deep coma and sinking fast. in the state of coma and had a grievous head injury; the A speeding wayward truck had smashed into his sedan a case was first attended to by the Neurosurgeon on duty, short while ago. The resultant accident had left both, Dr. Deepak Singh, Sr. Registrar - Neurosurgery, followed Manish and his car, badly mangled. Manish, who had by the Cardio-thoracic and Vascular Surgeon Dr. Shekhar been in the driver's seat at that time, had received major Tandon, and the Senior General Surgeon Dr. S. Sabhlok. injuries in head, chest, arms and stomach regions. As As per their collective guidance, a CT scan, chest X-ray soon as Manish's relatives saw his extremely serious and abdomen ultrasound were conducted immediately. condition, they rang up Sahara Hospital's Emergency and Recalling the case, Dr. Shekhar Tandon states, “Manish's Trauma Care Centre. Within seconds, the Critical Care list of injuries included brain stem contusion (a deep Ambulance (Mobile ICU) of Sahara Hospital, manned by brain injury), chest injury that was causing paradoxical its Quick Response Team (QRT) was dispatched to bring breathing, abdominal injury with a severely damaged Manish to the hospital and to initiate treatment while still liver, several broken ribs and a fractured right arm. He en route to the hospital. was in coma. His pulse and blood pressure were low.

Actually he received medical care just in the nick of time. The initial diagnostics and care procedures were initiated Any later, and it could have been fatal for him."by the QRT on the way only. The Critical Care Ambulance (Mobile ICU) Unit provided all the support Manish was admitted to the neurosurgery ward, put on required for these procedures and was providing details ventilator and life support systems and prompt treatments of the condition and the injuries of Manish to a team of for his vast and comprehensive injuries were begun. The experts that was advising the QRT and waiting for treatment was done under the guidance of a polytrauma Manish at the Trauma Center of the Hospital. team that was assigned for Manish's case, which

consisted of specialists from all relevant specialties. The As Manish's ambulance drove straight into the Trauma team had the well known neuro surgeon Dr. Mazhar Room at 2.30 a.m., a team of doctors stood ready to take Hussain along with Dr. Manu Rastogi and Dr. Deepak,

Dr. Mazhar HusainSenior Consultant, Deptt. of Neurosurgery, Sahara Hospital

Dr. Mazhar Husain is a renowned neurosurgeon who till recently headed the Neurosurgery Department at the CSM Medical University (formerly KGMC), Lucknow. Also an alumnus from this very renowned institution, Dr. Mazhar Husain's distinguished career spans over three and a half decades. An ex-Visiting Professor of Neurosurgery at NYU School of Medicine, New York and University of Southern California, Los Angeles (both in USA), Dr. Husain has also trained in his chosen super specialization at various leading medical schools in Japan and USA. A pioneer in the field of Endoscopic Neurosurgery in India, he carries out nearly 500 neurological operations every year. Dr. Husain also has 87 publications to his name.

Dr. Vaibhav Khanna is a distinguished plastic surgeon who specializes in advanced emergency and elective cranio-facial, aesthetic and microsurgery procedures. An MBBS, MS and MCh. from CSM Medical University (formerly KGMC), Dr. Khanna also holds Fellowships from leading hospitals located in Taiwan, Thailand, New York and Mumbai. Before joining Sahara Hospital, he was associated with the Vivekananda Polyclinic, Lucknow, where he was the Head of Deptt. of Plastic, Craniofacial and Microsurgery. Dr. Khanna has also served as the Project Director of The Smile Train, A USA based charitable organization that offers free treatment to patients with cleft lip and palates, in developing nations.

Dr. Vaibhav KhannaSenior Consultant, Deptt. of Plastic & Aesthetic Surgery, Sahara Hospital

Dr. Sandeep K. GargSenior Consultant, Orthopaedics and Joint Replacement, Sahara Hospital

Dr. Sandeep K. Garg ranks among the pioneers of joint replacement surgeries in the state. An MBBS and MS (Ortho.) from KGMU, Lucknow, he received his AO Fellowship from the Johannes Gutenberg University, Germany. Dr. Garg undertook specialized training in trauma and joint replacement surgeries at Sir Ganga Ram Hospital, New Delhi; Prince Elizabeth Orthopaedic Centre, UK; Nuffield Hospital, UK; Knappschafts-Krakenhaus. Germany; Mannheim University, Germany; John Flynn Hospital, Australia and the Royal Australian College of Surgeons, Australia. Formerly a Senior Consultant Orthopedic Surgeon with Vivekanand Polyclinic and Institute of Medical Sciences, Lucknow, Dr. Garg has performed nearly 300 hip replacement and close to 150 knee replacement surgeries till date.

Cardio-thoracic Surgeon Dr. Shekhar Tandon, General Under the watchful eyes of the doctors and the staff of Surgeon Dr. S. Sabhlok, Orthopaedic Surgeons Sahara hospital, Manish's condition went from being Dr. Sandeep Garg and Dr. Gaurav Khanna, Plastic 'critical' to 'stable' to 'improving'.Surgeon Dr. Vaibhav Khanna and Anaesthetist Dr. Adesh

After a long stay of about 50 days, Manish was finally Srivastava.ready to go home to recuperate. His treatment continues,

Under the watchful eyes of the doctors, Manish's along with physiotherapy sessions. Today, he is condition showed significant improvement over the next improving rapidly. His arms and joints move well and he few weeks and he finally came out of the state of coma is back on his feet and back behind the driving wheel as after 20 days of being in the hospital. Thereafter the well. Thanking his stars, Manish says, 'It is a new lease of doctors decided to conduct multiple stage-wise surgical life for me. Had Sahara Hospital not dispatched their procedures for setting right his other injuries. In stage ambulance so speedily and had I not been brought there, one, an Open Reduction Internal Fixation (ORIF) surgery I might not have been able to receive such tremendous was conducted by the orthopaedic surgeons to fix the medical care, and that too so promptly. In fact I might not monteggia fracture and the shaft fracture on the left arm have lived to see this day.'of Manish along with temporarily covering the rotation

Road accidents can and do cause anatomical damage flap. Explaining this procedure, Dr. Sandeep Garg tells, across organs and organ systems. As one can understand, "ORIF is a regular method of surgically repairing a in such cases of polytrauma, speed of treatment, quality fractured bone. Generally, this involves either the use of of medical care and teamwork between various specialist plates and screws or an intramedullary (IM) rod to doctors are of essential importance. Effective treatments stabilize the bone. As the patient's right ulna had a also require a complete bandwidth of functional monteggia fracture, we opted for the ORIF."departments or specializations and technological support

After recovery from this stage one surgery, the second for prompt diagnosis and effective life saving support stage procedure was done by the team of plastic surgeons systems. Fortunately for Manish, Sahara Hospital had a which involved debridement and covering of the exposed super-efficient 24x7 Trauma Care Unit well in place. elbow joint by abdominal flap. Mr. Manish Mohan, now fully recovered

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Blood is indeed the life force of the body. Every second we are alive, blood is rushing to do its work. It travels

Sahara Hospital, as a high end tertiary care hospital, has constantly through approximately 10,000 miles of blood

taken the lead in setting up an advanced Blood Centre vessels spread throughout our body, providing each and

that offers modern transfusion medicine services and every corner of it with vital oxygen, heat, nutrients,

strictly follows international norms and guidelines for hormones and antibodies, carrying away with it the

collection, processing, storage and transfusion of blood. harmful waste matter and carbon dioxide that needs to be

The doctors and technicians here are experts with years of disposed of. A complex blend of 22% solids and 78%

experience in leading hospitals of national and water, it contains red blood cells, white blood cells,

international repute. The equipment employed here not platelets, fat globules, chemical substances and gases.

only provide a high degree of safety and comfort to both All these components play critical roles in keeping us

the donors as well as the patients, but also ensure full healthy, alive and kicking.

safety at all stages. As Dr. Ashish Tewari, says, “We are Modern medicine is well aware of the criticality of blood thoroughly aware of what quality is and what is at stake. in maintaining human health. And that's why transfusion We have a Quality Programme in place which ensures the medicine has emerged as a key component of high end best quality for patients”medical care. Dr. Ashish Tewari, Consultant, Sahara Hospital, sums it up in these words, “In today's era of modern medicine, Blood Banking has been completely transformed into Transfusion Medicine with the concept of vein to vein transfusions. Not only does it deal with the

As one of the leading wing of this region's foremost scientific basis of Banking but transfusions, with a hospital, our Blood Centre meets not only the needs of scientific temperament is also in practice”.Sahara Hospital's patients, it also aims to cater to the

THE BLOOD CENTRE AT SAHARA HOSPITAL

A trained and experienced team of professionals, new age equipment, standardized operating procedures in accordance with international norms and 24x7 available services, distinguish our Blood Centre from the rest.

Transfusion Medicine at Sahara Hospital

Chemiluminescence based testing machine

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requirements of safe blood components of other hospitals 3-D Bio Mixer: This is the first-of-its-kind, as the and nursing homes in and around Lucknow. usual ones available are 2-D mixers. This helps in

mixing the blood from every fold and corner of the blood bag at the time of collecting the blood from the donor. Thus, it prevents clotting which may be due to

Sahara Hospital’s Blood Centre has all the machines and improper mixing of blood.

equipment that are required to make it an advanced entity Automatic Component Processor: At the time of in its field. Some of these are:separating whole blood into its components, it is very

Contact Shock Freezer: Coagulation factors that are essential to see that each of the components do not get

present in the plasma are used to stop or prevent mixed with each other, as all these components are

bleeding anywhere in the body. This plasma is partitioned through very fine layers between them.

separated from the whole blood immediately after Thus, all components are processed in this automatic

collection. To preserve all the coagulation factors processor so that each and every component, when

including the labile (factors which are very sensitive to separated, is of the same quality and there is no cross

thermal changes), we use the Contact Shock Freezer. It contamination of the components.

is far more advanced than usual deep freezers, it Sterile Connecting Device: This is specially used for converts normal plasma to Fresh Frozen Plasma in just making paediatric units of components. This half an hour and the core temperature reaches -50 equipment helps in getting the exact quantity that is degree Celsius, thus preserving all the coagulation required for a paediatric patient and the units also factors and most importantly the labile coagulation remain in a closed system. Thus, no bacterial factors. Comparatively, in usual deep freezers, the contamination occurs in any unit. This ensures that time taken for freezing is a couple of hours and if it is there is no change in the shelf life of the unit and no not properly done then the coagulation factors are not threat to a patient since there is no bacterial preserved properly. Thus, Fresh Frozen Plasma (FFP) contamination. All this is not possible if Sterile prepared by contact shock freezer is far better in Connecting Device is not used.quality.

ADVANCED EQUIPMENT AT WORK

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Plasma Thawing Bath: This is used to thaw or melt Cryo Precipitate (Factor VIII)the frozen plasma before transfusing it to any patient. Cryo Poor PlasmaThe thawing is done under a very specific temperature Washed Red Cellsand manner. This helps to preserve all the coagulation Leuco Reduced Red Blood Cellsfactors at the time of thawing. If thawing is done using Leuco Reduced Platelet Concentrateany other mechanism then the quality of plasma is not Single Donor Platelet (SDP) or Aphresis platelets assured. (Leuco Reduced)

Column Agglutination for Cross Match: This We also stock fully sterile and contamination free technology is used for cross matching blood before paediatric units in required quantities.transfusion. The sensitivity of this method is more than that of the conventional methods. The time taken for doing a cross match is also reduced to half which

The quality is assured for every component during every is approximately 30 minutes as compared to the

stage of collection, preparation storage and transfusion at conventional methods, which take more than an hour.

our center. This is done by:Chemiluminescence based Testing: This is used for

Strict adherence to the Standard Operating Protocolstesting each unit of blood for Human

Collecting whole blood and apheresis products from Immunodeficiency Virus (HIV) I &II, Hepatitis C

non-renumerated, voluntary and healthy donorsVirus (HVC) and Hepatitis B Surface Antigen

Imparting regular training to the staff so that they (HBsAg). This technology is used for screening blood

carry out the assigned task with efficiencyunits for better credibility as it is more sensitive thus

An Active Quality Control Programme which is in assuring better accuracy and faster results.

placeApheresis Machine (Cell Separator): The products Regular calibration and maintenance of all equipmentsobtained from this Cell Separator are very beneficial for the patient as the products are all leucoreduced (without white blood cells), including platelets. The

Many patients need blood transfusion as an important exposure of the patient is only towards one donor and part of their treatments. These include those who are not multiple donors, thus decreasing the risk of disease going for critical surgeries, the seriously injured with transmission. blood loss and those suffering from anaemia or bleeding disorders. Often blood transfusion plays a key role in keeping the patient alive.

As there is no substitute for human blood, it needs to be Recently our Orthopaedics, Transfusion Medicine and

collected from healthy donors, processed and stored Clinical Haematology departments collaborated to

properly before it can be given to those patients who need transplant artificial knee joints in a Haemophilic patient

it. Further, as components of blood can be separated to (full story available in the Cure & Care issue dated

treat more than one patient from a single unit of blood, September - October, 2009). As you are aware, a

trained professionals, high standard processes and haemophilic patient’s blood does not clot effectively and

equipment are needed to effectively process, package and therefore any surgical procedure, big or small, is a

store them for appropriate usage at the time of need.difficult proposition. This was the first successful surgery

At our Blood Centre, a range of blood components are of this kind in Uttar Pradesh, a testimony to the expertise available 24x7: of our doctors, paramedics and of course, the Blood

Centre.Packed Red Blood Cells (PRBC)Fresh frozen Plasma (FFP) We are glad that our patients can depend upon our Blood Platelet Concentrate( Plt. Conc.) or Random Donor Centre for safe and the best of quality products for Platelet (RDP) transfusions.

GUARANTEED QUALITY ASSURANCE

BLOOD, IT’S SYNONYMOUS WITH LIFE

BLOOD COMPONENTS AVAILABLE WITH US

Dr. Ashish Tewari is a well known transfusion medicine expert who super specializes in immunohematology and blood transfusion. An MBBS from CSS Medical University ( formerly KGMC),Lucknow, Dr. Tewari acquired his MD in transfusion medicine from SGPGI, Lucknow, the first in the country to offer MD in this particular stream . He has also received advanced training at the Institute of Immunohematology, KEM Hospital, Mumbai. He has served as the Consultant and In-charge at Deptt. of Transfusion Medicine, PSRI, New Delhi. Before joining Sahara Hospital, Dr. Tewari was serving as the Head, Deptt. of Transfusion Medicine, GBH American Hospital, Udaipur, where he established a state-of-the-art Transfusion Medicine Centre

Dr. Ashish TewariConsultant, Deptt. of Transfusion Medicine, Sahara Hospital

Contact Shock Freezer

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technique, the heart continues to pump blood to the rest blockage present in the aorta to migrate through of the body, and surgeons operate on a beating heart. The circulation to the blood vessel of another part of the body. heart lung-pump machine is kept in stand by mode, ready This embolization to other organs was a known but not used except when the heart does not tolerate the complication. Now, with CABG being done on a beating turning and lifting required for bypass grafting. heart (off-pump surgery), this complication is being

prevented.

Moreover, the deleterious effects on all body organs due to the use of cardiopulmonary bypass - heart-lung machine (CPB) too are avoided.

The off pump surgery is also less costly as the cost of disposables used in cardio pulmonary bypass is absent.

During 'on-pump' CABG, the surgery was performed by taking the patient on heart lung machine. During that process, the aorta was cannulated and this process of cannulation into the aorta causes the aortic plaques present in the aorta to embolize. In other words, the canula or tube inserted into the aorta artery to carry the blood to the heart lung machine, causes the plaque or

The 'off-pump' technique has various advantages over the conventional 'on-pump' one, like the 'off-pump' surgery effectively reduces the perioperative mortality, morbidity and resource utilization in high risk and complicated cases. Off-pump surgery remains a useful technique for patients who have damaged kidneys, and for those whose ejection fraction is low.

Sahara Hospital has performed many successful beating heart bypass surgeries and has emerged as a centre for all cardiac surgeries, with the credibility and support from High End Intensive Care Unit, Intensive Cardiothoracic Care Unit, Cardiothoracic Step Down and a world class Operation Theater.

The Role of Stabilizer in the Beating Heart (Off-Pump) Coronary Artery Bypass Surgery

Dr. Devender SinghConsultant, Deptt. of Cardio-thoracic & Vascular Surgery, Sahara Hospital

Dr. Devender Singh, a leading cardiothoracic and vascular surgeon with an M Ch in cardiothoracic and vascular surgery, has trained for 6 years under the globally renowned cardiac surgeon Dr. Naresh Trehan at the prestigious Escorts Heart Institute & Research Centre, New Delhi. Under such distinguished and expert tutelage, Dr. Singh acquired considerable expertise in performing off-pump and minimally invasive cardiac surgeries. He has also acquired additional expertise in reparative aortic aneurysm and mitral valve surgeries at the Wakefield Hospital, New Zealand. Before joining Sahara Hospital, Dr. Singh was associated with the well known Wockhardt Heart Hospital, Surat as a Chief Consultant in the CTVS Deptt. Dr. Devendra Singh also has several publications and presentations to his credit.

In the off-pump surgery, the experienced surgeon does the by pass heart surgery on a beating heart. Because the heart normally moves around while beating, specialized instruments for beating heart bypass surgery are needed. A heart stabilizer as the instrument is called, allows the heart to beat while reducing movement only in the area where your surgeon is working. With a particular area of the heart stabilized, the surgeon can go ahead and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

Dr. Shekhar TandonSenior Consultant, Deptt. of Cardio-thoracic & Vascular Surgery, Sahara Hospital

Dr. Shekhar Tandon is a leading Cardio-thoracic & Vascular Surgeon who ranks among those who pioneered the low cost 'Beating Heart CABG Surgery Programme' at King George Medical University (KGMC), Lucknow. Dr. Tandon acquired his MBBS and MS from Aligarh Muslim University (AMU) and his M Ch in Cardio-thoracic Surgery from Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh. Till recently, Dr. Tandon was the HoD of the Department of Cardio-thoracic Surgery at KGMC. Also an ex- Professor at that prestigious institution, he has been a thesis guide for MS and M Ch studentsas well. In a distinguished career spanning over 33 years, Dr. Tandon has conducted scores of successful lung, vascular andcardiac surgeries.

Saving the Heart without Stopping itBeating Heart (Off-Pump) Coronary Artery Bypass Surgery

Diseases related to the coronary arteries are the most Coronary Artery Bypass Grafting (CABG) involves common causes of heart ailments. Coronary or heart bypassing major blocks in the blood vessels of the heart, arteries supply blood to the heart and nourish the Cardiac by connecting a new channel of blood beyond the Muscle (Myocardium). When these blood vessels obstruction, to improve the blood supply to the Cardiac develop accumulation of atheromatous plaques within Muscle. The conduits used for bypass grafting are veins their walls, the disease called atherosclerosis arises, taken from the legs of the patient or arterial conduits which leads to Angina Pectoris, commonly known as which might include mammary arteries from the chest Angina, a severe chest pain due to ischemia (lack of wall, the radial artery from the forearm or an artery from blood and hence oxygen supply). Then occurs myocardial near the stomach of the patient. infarction, commonly called as a heart attack, which

This surgery is conventionally and usually performed implies death of some heart cells due to interruption of with the heart stopped and a cardiopulmonary bypass blood supply to a part of the heart. commonly called the heart-lung pump machine taking

The extent of Coronary Artery Disease (CAD) can be over the functions of the heart and lungs for the period diagnosed by a procedure known as Coronary when grafting of the conduit is done on a still non-Angiography (CAG). It is the nature of CAD which beating heart. Thus the procedure is called 'on-pump governs further management such as Angioplasty or surgery.' Coronary Artery Bypass Grafting (CABG), pronounced

The other technique to perform CABG is while the heart as 'cabbage'. Usually CABG is the preferred option in is beating, the so-called 'off-pump coronary artery bypass cases of Triple Vessel Disease, Diabetics and Left grafting' (OPCAB) or simply 'off-pump' surgery. In this Ventricular Dysfunction.

Dr. Manoj Kumar Misra is a well known Ayurvedic doctor who did his BAMS and MD( kaya chikitsa) from the State Ayurvedic College and Hospital, Lucknow. Also a holder of the CCYP in Yoga from Lucknow University, Dr. Misra has previously served as a Resident Medical Officer and a House Officer at his alma mater, and has also been a Medical Officer at the CSSMU (KGMC), Lucknow.. He has been associated with various projects conducted by the prestigious NISCAIR, Pusa Instt., New Delhi. A published author of many articles on Ayurveda in leading newspapers, Dr. Misra has researched and presented a paper on treatment of jaundice using ayurvedic drugs. Prior to joining Sahara Hospital as a Consultant, Dr. Misra was serving as an Ayurveda Consultant with NBRI, Lucknow.

Dr. Manoj Kumar MisraConsultant - Panchakarma, Sahara Hospital

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PanchakarmaIn Ayurveda, our ancient system of healing, being in a In this article, we keep our focus on the five procedures natural state of ease implies attainment of health, entailed in the pradhan karma.happiness and an inner sense of well-being. Thus 'health'

Here's a brief look at all the five procedures of the is defined as the body in a state of ease whereas any pradhan karma in panchkarma.disturbance in this ease due to the presence of increasing

waste matters in the body is termed as 'disease'. No wonder that in this fast paced modern world full of

This therapy is mainly used in cases of chronic disorders poisonous residues, a large number of people find arising due to the 'kapha dosha'. It involves induced and themselves 'dis-eased' sooner or later.controlled vomiting with the help of medicines. It is used

In this busy, stressful and polluted world, we go on to treat chronic asthma, chronic hyperacidity, etc.accumulating toxins inside our bodies that cause disturbances in physical functions. Thus, body systems get weakened and chronic and degenerative diseases take This therapy is mainly used in cases of chronic disorders root - a process that ultimately has grossly negative arising due to the 'pitta dosha'. It involves induced and effects on our overall wellness. For a body to be restored controlled purgation with the help of medicines. It is used to its state of health and well being, waste matters i.e. to treat jaundice, chronic helminthes cases, etc.toxins need to be removed from inside it.

Panchakarma is an ancient and effective therapeutic This therapy involves administering medicines as enema.

process for removing these toxins. Dr. Manoj Kumar The medicines used can be decoctions, pure / formulated

Misra, Consultant, Sahara Hospital puts panchkarma in oils and milk etc. It is used to cure arthritis and

perspective with these words, "Simple in their backaches, etc.

application, panchkarma procedures clear our body of toxins, bring balance back into our systems and improve bodily functions which then cleanse the body's deep

This therapy is administered through the nose. Medicated tissues of accumulated toxins, open the subtle channels, powders, decoctions or oil drops are introduced into the and bring life-enhancing energy thereby increasing inner nasal passages. These then remove the residual doshas peace, confidence and well-being. Thus panchkarma is and toxins from the head and neck region. Nasya is used not merely curative in nature; it is also a preventive in cases of migraine, chronic rhinitis and epilepsy, etc. treatment that promotes vitality." Factually speaking,

panchkarma as a treatment has actually been in existence for thousands of years. And that fact alone is sufficient to

Rakta mokshana is performed either with the help of lend it credence as an effective way of bringing back venesections, or by using leeches. It is mainly used to good health and vitality.cure gout, skin and blood disorders (pigmentation), elephantiasis and alopecia.Panchakarma, as a treatment is further divided into three

consecutive phases. These are poorva karma, pradhan Vamana, Virechan and Rakta-Mokshana should not be karma and pashchat karma. Poorva karma includes given to the very young or the very old or during pachana, samsarjana karma, snehana, rasayanadi kriya pregnancy and should always be administered under a and sweda. The pradhan karma includes vamana (induced physician's supervision.vomiting/emesis), virechana (purgation), kashaya basti

and sneha basti (two kinds of medicated enemas with A special diet regime has to be followed after

decoction and unctuous material), nasya (nasal Panchakarma therapy, including food which is easily

medication) and rakta mokshana (blood letting). The digestible and gradually, the regular diet of the person

pashchat karma includes the procedure of sama.is restored.

Vamana - Use of emetics

Virechan - Use of laxatives

Basti - Medicated enema

Nasya - Nasal administration of medications

Rakta Mokshana - Blood letting

“Many diseases can be cured and kept at bay via panchkarma. Sahara Hospital has a full fledged Department of Ayurveda where

ayurvedic treatments including panchkarma are offered under the specialist supervision of experienced ayurvedic doctors.”