September-October 2009 Newsletter I

An overview of

Case StudiesHamstring ACL ReconstructionHaemophilic Knee Replacement

Elbow Prosthesis Surgery

Nutrition Guide

Sahara Hospital

Orthopaedic and Joint Replacement Centre

64 Slice CT Scan

5th September, 2009 Academic Sessions on Transfusion Medicine and Haematology at Sahara Hospital, Lucknow, U.P.

5th September, 2009 - Free Kidney Disease Screening Test at Sahara Hospital, Lucknow, U.P.6th September, 2009 - C.M.E. at Faizabad, U.P.

19th September, 2009 - C.M.E. at Barabanki, U.P.

30th September, 2009 - C.M.E. at Hardoi, U.P.

10th October, 2009 - C.M.E. at Basti, U.P.

Note : Dates are subject to change, if required.

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UPCOMING ACTIVITIES AT SAHARA HOSPITAL

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Sahara Hospital,

Gomti Nagar, Lucknow-226010

U.P., India

Dear Friends,

It is a matter of immense pleasure that Sahara Hospital is coming out with its

inaugural Newsletter. It is also a privilege to be able to communicate our thoughts

and feelings to the medical fraternity as well as the common man.

Sahara Hospital ranks high among our most ambitious projects. It is a deeply

emotional endeavour of Sahara India Pariwar, in line with its commitment to

socio-economic development and to contribute productively to the nation's

well-being. The vision behind this endeavour is to bridge the gap in quality

healthcare, especially tertiary healthcare in U.P. and the adjoining states and

various other countries.

Since being opened to the public in February, 2009, the Hospital has repeatedly

shown its pre-eminence in the domains of medical science and healthcare. Its

dedicated team of doctors and paramedical staff and the newest generation

medical and diagnostic facilities have helped the patients avail the best of medical

and tertiary care and happily go back to leading healthy lives.

Sahara Hospital is thus surging ahead to establish its credentials in advanced,

hi-tech and multi-disciplinary healthcare services in the whole of Asia, having

reliability and commitment as its hallmark.

I hope this Newsletter will be an informative and educative experience for all

readers. On its maiden publication, I congratulate everyone who has been a part of

the emotional mission named Sahara Hospital.

Sahara Pranam

Subrata Roy SaharaManaging Worker & Chairman

Sahara India Pariwar

Sahara Hospital - A Multi Disciplinary, Super Speciality, Tertiary Care Hospital

On 12th February, 2009, Reverend Smt. Chhabi Roy, range of services in a phased manner. The inauguration mother of Mr. Subrata Roy Sahara, Managing Worker marked the completion of the first phase. It now provides and Chairman, Sahara India Pariwar, inaugurated Sahara 41 major specialities like emergency & polytrauma care, Hospital at Gomti Nagar in Lucknow, Uttar Pradesh. In neurology, neurosurgery, plastic surgery/microvascular this short span of six months, commencing from its surgery, cosmetology, paediatric & neonatology, inauguration till August 2009, Sahara Hospital has orthopaedics, sports medicine, clinical immunology, achieved many milestones in the field of healthcare. ENT, obstetrics & gynaecology, internal medicine,

general surgery, paediatric surgery, minimal access There was a time not too long ago, when Lucknow surgery, nephrology, urology, clinical cardiology, lagged way behind on the national medical care scenario. interventional cardiology, cardiothoracic & vascular Hi tech surgeries and advanced treatments were not surgery, bariatric surgery, gastro medicine including available in the city and patients had to go to Delhi or paediatric gastro medicine, gastro surgery, clinical Mumbai, even abroad, to get the latest treatments. While haematology, rheumatology, anaesthesiology, the city did boast of a couple of premier medical pulmonology, ophthalmology, paediatric ophthalmology, institutions, these ranked low on availability of new age dermatology, pathology, radiology, microbiology, critical treatments, lacked the latest diagnostic machines and had care medicine, psychiatry, surgical oncology, hemato-almost non-existent facilities for patients' and attendants' oncology, preventive medicine, nutrition & dietetics, comfort. physiotherapy and ayurveda & panchkarma. In its second

phase, Sahara Hospital also proposes to offer kidney and Now Sahara Hospital, a 554-bedded super specialty, bone-marrow transplant unit, paediatric cardiology, multi-disciplinary, tertiary care hospital, spread on an radiation oncology, advance dentistry, homeopathy, unani area of 27 acres, is here. It proposes to progressively offer and geriatric medicine among others.services in more than 52 specialties, super specialties and diagnostic modalities, all under one roof. With its To provide high quality treatments, Sahara Hospital has advanced and multi-disciplinary medical services, built a team of expert doctors and experienced para-it is ready to provide qualitative medical care on a medical staff. All our departments are manned by highly pan-Asia level. qualified doctors with comprehensive experience in their

fields of specialization.Sahara Hospital shall unfold its wide and comprehensive

Announcement of the inauguration of the multi-speciality, tertiary care Sahara Hospital at Lucknow: Mr. Sushanto Roy, Head-Infrastructure & Housing, Sahara Prime City Limited (center), Mr. Abhijit Sarkar, Head-Corporate

Communications, Sahara India Pariwar (right) and Dr. H.P. Kumar, Director, Sahara Hospital, Lucknow (left)

Inauguration of Sahara Hospital: (third from left) Reverend

Smt. Chhabi Roy, Mother ofMr. Subrata Roy Sahara,

Managing Worker & Chairman, Sahara India Pariwar, inaugurates the hospital by cutting the ribbon.

Also present, Mr. Subrata Roy Sahara (third from right),

Mrs. Swapna Roy, Deputy Managing Worker (P&W), Sahara

India Pariwar (extreme left),Mr. O.P. Srivastava, Deputy

Managing Worker (C&A) (extreme right), and

Mr. Sushanto Roy,Head-Infrastructure & Housing,

Sahara Prime City Limited(fourth from right)

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As an integral component of quality medical care, Sahara forwarding a request for the authorization of this unique Hospital provides a wide spectrum of basic as well as service. Thus a patient's relative can view and speak to high end investigative services, round-the-clock, under him/her in the counselling room at the hospital through one roof including biochemistry, clinical chemistry, high resolution IP cameras without compromising the haematology, hormone study, tumour markers, drug hygiene and sterility of critical care areas. The entire levels, microbiology, pathology, endoscopy, security and surveillance unit of the hospital is designed bronchoscopy, PFT, Urodynamic Study Lab, radiology and based on IT patterns whereby warnings and alerts including latest generation cardiac CT, functional MRI, pertaining to fire break-outs etc. can be sent to each cardiac cath lab, 2D Echo and holter. corner of the hospital by means of a single mobile phone.

For ensuring the highest level of security in the mother The hospital offers highly dependable critical care and child ward, 'event based recording cameras' have services backed by a full fledged trauma care centre, a been installed to track movement of persons in the ward.network of critical care ambulances and 100 critical care beds including dedicated Neuro/Stroke ICU, Intensive As a social responsibility measure towards reducing Cardiac Care Unit, Medical & Surgical ICU, Transplant global warming, the hospital is being developed as a 'soft ICU, Neonatal and Paediatric ICU & High Dependency document / paperless working place'. Here machines and Units as per the international norms. These are further equipments are being installed to minimize paperwork.augmented by 15 'Ultra Clean' operation theatres,

Sahara Hospital has been designed to achieve an (6 OTs are operational in the first phase while 9 OTs will optimum functional flow. Its holistic design includes be added in the second phase), dedicated to different specially designed OPD for the convenience of patients specialities. The hospital puts special focus on infection making available essential investigations in OPD area. control via Central Sterilization and Supply Department The hospital has dedicated waiting lounges and separate (CSSD) and patient safety including radiation safety utilities areas in respective departments. A five star hotel norms. These facets of medical services make it a high-has also been built within the hospital campus which end and first-of-its kind hospital in the region.shall be available very soon for patients' relatives as well

Sahara Hospital is equipped with new age IT and as those patients who wish to stay nearby for easy Automation systems, which offer the facility to remotely consultation during convalescence.monitor patients in the critical care area from anywhere in the hospital, home or anywhere in the world by simply Welcome to Sahara Hospital.

Continuous Renal Replacement Therapy

Neo Natal Transport Ventilator

Intensive Care Unit

Latest Generation EquipmentsMobile Intensive Card Unit Sahara Hospital-Curing through CareCardiac Catheterization Laboratory

Operation TheatreEntrance Lobby

Neo Natal Intensive Care Unit

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Giving Life to Your BonesThe Orthopaedic and Joint Replacement Center at Sahara Hospital

MAINTAINING YOUR JOY OF FREE MOVEMENTAt the Orthopaedic and Joint Replacement Center of Our bodies have shapes because they have skeletons to Sahara Hospital, modern treatments are available for give them support. Our bodies are mobile because we wide ranging trauma problems. The Center offer latest have bones (the skeleton), muscles, cartilage, tendons, treatments for hip fractures (acetabulum surgery, pelvis ligaments, joints and other connective tissues (the tissue stabilization), MIPPO technique (treating fractures by that supports and binds tissues and organs together), in small incisions), knee injuries (locked plating, ligament short the musculoskeletal system to bring motion to body reconstructions), calcaneal plating, shoulder fractures parts. The musculoskeletal system's primary functions (three part fixation, HRA), elbow fractures (radial head include supporting the body, allowing motion and fixation and replacement, coronoid fixation, TRAP protecting vital organs.approach in intercondylar fractures), wrist fractures (scaphoid fixation, carpal dislocations, S-L ligament Yet the human body is fragile and damage prone. Injury, repairs, arthroscopic assisted distal radius fixation, TFCC disease, congenital conditions, inflammation, age related repairs) and hand injuries (ligament, tendon, nerve wear and tear or any damage, big or small, to any of these repairs, volar plate arthroplasty, EHDS). The Center is parts of musculoskeletal system, can cause it to become also a destination for treatment of neglected trauma such stiff, painful or even immobile. These problems, if and as stiff wrist, elbow and knee, malunited fractures when they occur, require expert medical care to putresulting in deformed limbs (do check out real patient them right. This is where the Orthopaedics stream of story titled 'A Dream Comes True', a case study on page medicine steps in. 14) and non-union of fractured bones.

For on-the-spot timely care, the Center has a fleet of ambulances equipped with advanced monitoring

Sahara Hospital's Orthopaedic and Joint replacement equipment and communication systems. To facilitate

Center is a fully equipped department.speedy handling of emergencies, our specialists for

It has all the six components that are required for any set multiple streams are on duty at all hours of day and night.

of medical services to be termed as outstanding. These For rapid yet superior treatments, modern ICUs, OTs and

are a complete team of super-specialist and experienced CT scanning facilities too are available 24 hours a day,

doctors and surgeons covering all aspects under the 7 days a week.

department, ultra-clean operation theatres, new generation diagnostic and clinical equipment and For effective rehabilitation of trauma patients, the Center facilities, well equipped rehabilitation facilities, world is equipped with a trained and experienced team of class transplant ICU, expert para-medical staff and last physiotherapists and a well equipped Physiotherapy but not the least, a firm conviction towards offering Center. compassionate care and healing. As Dr. Sandeep K. Garg, Senior Consultant, Orthopaedics and Joint Replacement, comments, "In conjunction with the vision of the The Center offers comprehensive management of joint hospital, the center is providing specialised solutions for problems. Available here for this purpose is an able team orthopaedics, joint replacement and trauma cases. of orthopaedicians, rheumatologists and physiotherapists. Though the practices, facilities and services at the Center This team receives full support from a modern pathology are benchmarked with the world's best yet the charges for lab, latest MRI facilities and arthroscopy instruments to these ultra modern facilities are kept at the lowest range." carry out their jobs effectively.

Sahara Hospital's Orthopaedic and Joint Replacement The specialist surgeons at the Center are adept in the Center offers a full range of world class orthopaedic latest hip, knee, ankle, shoulder, elbow and finger joint services. These encompass the following sub-fields : replacement facilities. In fact, the Center is one of the

few in the country to offer total shoulder, elbow, ankle • Trauma care managementand finger replacements. These advanced surgeries are

• Joint replacement surgeriesdone with minimal incisions, and most of the patients are

• Bone replacement, resurfacing, revision and discharged just five days after their surgery!reconstruction surgeries

Assures Dr. Sandeep Kapoor, Senior Consultant, • Bone tumorsOrthopaedics and Joint Replacement, "We are bringing in

• Sports medicine and arthroscopy some of the latest practices and technologies available in

• Pediatric orthopaedics the field of orthopaedics from across the globe. With the wide experience of our team and modern facilities

TRAUMA CARE

SAHARA HOSPITAL'S

MANAGEMENT OF JOINTS PROBLEMS

JOINT REPLACEMENT SURGERIES

ORTHOPAEDIC AND

JOINT REPLACEMENT CENTER

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available at the Center, we are performing complex and reconstructions. Their expertise encompasses challenging surgeries and foresee ourselves as becoming management of neglected shoulder, elbow, wrist and hand the destination for tertiary healthcare." disorders. Thus we are able to offer management of

ailments such as stiff elbow, tennis elbow and arthritic elbow. Our expertise also covers treatment of difficult wrist problems like scaphoid non-unions, carpal As with joint replacement surgeries, the Center is one of dislocations and TFCC disorders.the very few destinations in India which are equipped to

offer help to patients suffering from loose artificial joints. Our strong rehabilitation team further helps such patients, post speedy recoveries. Bone tumours can have drastic consequences for the

patients. Often patients have to lose affected limbs in order to save their lives. Sahara Hospital's Orthopaedic and Joint Replacement Center offers a ray of hope to Sports injuries require not just super-specialized those afflicted with bone tumours. It offer limb salvage treatments but also a 360 degree approach to healing.surgeries (using megaprosthesis) and pelvic resection The Orthopaedic and Joint Replacement Center at Sahara treatments that can save affected limbs.Hospital, offers holistic

treatments that are tendered by a super-specialist team staffed It is another key super-specialty on offer at the Center. with orthopaedicians, Young patients who come here can gain from corrective physiotherapists and and curative treatments that are available with us.nutritionists. The Center

Children suffering from cerebral palsy and neurological also offers advanced disorders often suffer additionally from limb deformities. arthroscopic treatments for knee, shoulder, ankle and The Center has surgical treatments to help them.wrist joints. Thus soft tissue injuries, especially those of

ligaments and cartilages, can be treated in a minimum of The Center also provide treatments for children related time and fuss and the patient can be discharged on the orthopaedic disorders such as foot and hand deformities, same day as surgery. Besides common knee and shoulder congenital dislocation of hip and Erb's palsy.arthroscopic procedures, the Center also offer advanced

expertise required for complicated wrist and small joint arthroscopies. Other super-specialist treatments offered include the endoscopic carpal tunnel release (pinhole release) and percutaneous fixation of scaphoid fractures.

The specialists are also experienced in ligament

REVISION OF LOOSE JOINTS

BONE TUMOURS

SPORTS MEDICINE AND ARTHROSCOPY

PAEDIATRIC ORTHOPAEDICS

Polio is a limb deforming disease that's yet to be eradicated fully. For those struck by this crippling menace, Sahara Hospital's Orthopaedic and Joint Replacement Center has made special provisions for polio corrective surgeries for growing children.

SPORTS MEDICINE: HAMSTRING ACL RECONSTRUCTION

SURGERY AT SAHARA HOSPITAL

procedure that's ideal for healing sporting injuries sustained in the joint region.

Nineteen year old Mohammed Zameel is an athletic Zameel underwent this surgery on 17th July, 2009.

Dr. Shamshery conducted the operation with assistance of teenager who loves to play basketball. A student of Guru Gobind Singh Sports College, Barabanki, Zameel one day Dr. Gaurav Kumar and Dr. Amit Sharma (both hurt his knee cap badly. orthopaedic surgeons) and Dr. Arti Agarwal, the

anaesthesiologist. Zameel's injury has healed rapidly post His injury at this sensitive joint put this advanced surgical procedure. a break on his playing, running and Right now, he is undergoing jumping. It was a huge shock for physiotherapy sessions at the this sports loving youngster. Hospital. There's no pain in the Thankfully for him, his grandfather

knee region, it is moving smoothly. took the matters in his hand and

As Zameel tells it with a beaming brought him to Sahara Hospital's

smile on his face, “I am glad that I Orthopaedic and Joint Replacement

came to Sahara Hospital. The care Center.

and facilities given to me have

been tremendous. It's so much Thus Zameel came to Sahara more than I or my family could Hospital. After initial investigation have hoped for. I know for sure of Zameel's injury, Dr. Prasoon Kant

now that I will soon be at my favourite place, the Shamshery, Asst. Consultant, Orthopaedics and Joint basketball court. And that I will be shooting baskets as Replacement, Sahara Hospital suggested a diagnostic well as I ever did before hurting my knee.”arthroscopy for precise measurement of damage to the

joint. During this hi-tech procedure, it was found that Talking of Zameel's case, Dr. Shamshery says, “It is so

Zameel had torn his ACL. The medical and lateral important that sporting injuries receive proper medical

meniscus too were probed but luckily those were found to care as soon as possible. Many a times, if left untreated,

be undamaged.these injuries can aggravate and cause lifelong damages

to the joints. We are glad that we could help an injured Zameel was advised an arthroscopic double bundle youngster gain full mobility and flexibility.”hamstring ACL reconstruction surgery – an advanced

Arthroscopy yieldsthe facility of directvisualization inside

a joint via a keyhole.

ORTHOPAEDIC AND JOINT REPLACEMENT CENTER, SAHARA HOSPITAL

(seated, from left): Dr. Sandeep Kapoor & Dr. Sandeep K. Garg, both Senior Consultants, Orthopaedics and Joint Replacement; Dr. Prasoon Kant Shamshery, Asstt. Consultant, Orthopaedics and Joint Replacement

(standing, from left - Orthopaedic Surgeons):Dr. Amit Sharma, Dr. A.S. Pandey, and Dr. Gaurav Kumar.

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“We discovered the precise extent and location of the patient's injury with the hi-tech diagnostic tools available with us at the hospital and knew that his knee could be put right with this advanced arthroscopic procedure.”

- Dr. Prasoon Kant Shamshery

Knee Replacement in Haemophilic ArthropathyMr. Muzammil Hasnain, 52, suffers from a medical Replacement Center carried out knee replacements on disorder called haemophilia. The root cause of several both knee joints, the department of Clinical Haematology severe problems - it leads to a complication that causes and Transfusion Medicine ensured effective management bleeding inside his joints, destruction of joint cartilage of haemophilia. and tremendous pain in knees. This complication is called

On 3rd August, 2009, the procedure was performed by a haemophilic arthropathy.team of skilled orthopaedic surgeons of Sahara Hospital - Dr. Sandeep Kapoor and Dr. Sandeep Garg (both Senior Consultants) with assistance of the OrthopaedicSurgeons - Dr. Gaurav Kumar, Dr. A. S. Pandey andDr. Amit Sharma

The haemophilia management procedure was conducted by Dr. Sunil Dabadghao, Clinical Haematologist, Sahara Hospital (recipient of Fellowship from Australia and special training from CMC, Vellore) and Dr. Ashish Tewari, Consultant, Transfusion Medicine (with MD in

In advanced stages of any type of arthritis, the advocated Transfusion Medicine from SGPGI, Lucknow).treatment is joint replacement surgery. But in The anesthetists on the case were Dr. Meena Murti andhaemophiliac patients, any sort of surgical procedure is Dr. Adesh Srivastava. deemed risky as the control of bleeding is very difficult.

Dr. Sunil Dabadghao says, "Mr. Hasnain approached many hospitals, all in vain, as none of these places had the expertise and infrastructure needed for it. In the meanwhile his arthritis went from bad to worse, making it difficult for him to manage even his daily routine's activities.

Mr. Hasnain came to Sahara Hospital which incidentally is the only hospital in this part of the country that has the capability of administering this advanced treatment. The bilateral surgery was planned jointly by the department of

Though a bilateral simultaneous total knee replacement is Clinical Haematology and Transfusion Medicine along a routine procedure for Dr. Sandeep Garg and Dr. with the Orthopaedic and Joint Replacement Center of Sandeep Kapoor, due to severe destruction of joint Sahara Hospital. While Orthopaedic and Joint

Haemophilia is a group of genetic disorders that impair the body's ability to control blood clotting or coagulation. Normally in events of bleeding, the blood coagulates, bleeding stops and wounds heal. But if the body has limited ability for congealing its blood, healing of even small cuts and incisions can become a huge task. Haemophilic patients often suffer from frequent bleeding inside the joints, a condition called haemarthosis which has been the bane of Mr. Hasnain's life as well.

The case was quite critical. In Haemophilic patients, even a small cut can become quite fatal and management of a replacement procedure of this magnitude, at our end too requires meticulous planning and a range of preparations for handling all possible complications, both during surgery and post surgery. The Haemetology Department and the bloodbank of the hospital are equipped to extend support tothese types of critical procedures."

Dr. Sandeep Kapoor is a trauma and joint replacement surgeon with MBBS and MS from KGMU, Lucknow and AO Fellowship from the Johannes Gutenberg University, Mainz, Germany. A member of AOAA, Davos, Switzerland, he has been trained under leading global orthopaedic surgeons at the Royal Australian College of Surgeons, Melbourne, Australia and John Flynn Hospital, Gold Coast, Australia. Formerly, the Head of Department for Orthopaedics and Joint Replacement Surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Dr. Kapoor has over 20 years' professional experience that spans hospitals in Lucknow, Delhi, Dubai and Australia.

Dr. Sandeep KapoorSenior Consultant, Orthopaedics and Joint Replacement, 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.

Pre-surgery X-rays of haemophilic arthritis showing severely damaged knees - gross destruction of lower and upper tissues.

Post-surgery X-raysof haemophilic arthritis showing special artificial joints in place. The implant is designed for severely damaged knees

Dr. Sunil DabadghaoSenior Consultant, Department of Pathology, Sahara Hospital

Dr. Sunil Dabadghao is a leading haematologist who did his doctoral programme- Licentiate in Haematology- from the renowned Karolinska Hospital, Sweden. A DM in clinical immunology from SGPGI, Lucknow, he served as a Senior Resident in the Department of Immunology there. Dr. Dabadghao has also served as a Registrar at CMC, Vellore where he acquired expertise in bone marrow transplantation. He has also received advanced training at the Queen Elizabeth Hospital, Australia, where he was a Registrar in the Department of Haematology-Oncology between 2002-2005. Dr. Dabaghao's areas of specialist expertise include management of haematological malignancies, bone marrow transplants, non-malignant haematological disorders, systemic autoimmune and rheumatological disorders and immunodeficiencies among others. Before joining Sahara Hospital, Dr. Dabadghao was attached with the Bhopal Memorial Hospital and Research Centre as an Associate Professor.

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cartilage, the normal anatomy of his joints was grossly such surgeries conducted in India till date. We at Sahara distorted. The complexity called for implanting Hospital are glad to be able to provide cure to such specialized 'S-ROM NOILES' prosthesis. complex ailments".

Commenting on the surgery, Dr, Sandeep Garg said, Today Mr. Muzammil Hasnain is recuperating nicely. He "Besides being the first haemophilic knee replacement in is progressing towards a full recovery and looks forward the state of Uttar Pradesh, it is also one of the very few to leading a pain-free life.

A DREAM THAT BECAME A REALITY

Vinod (name changed on request) came to Sahara Hospital with a debilitating left elbow. He left the hospital with a fully working arm and a wide smile on his face.

Vinod had always thought that it was destiny's cruel diktat that his left arm had become badly deformed. He says, "I was born with two good arms but the destiny willed otherwise. While an infant, I received an injury that hurt my left elbow badly. As a result of which, with time, the bones of my elbow joint fused together, became bent and deformed, restricting the movement of the arm."

His disability brought long term repercussions. Seemingly trivial day-to-day jobs such as eating and dressing himself too became tall orders. Vinod, a qualified computer engineer, due to his restrictive left arm, even found it difficult to work on his computer. The worse was yet to come. His deformity was increasing gradually with age.

In spite of all this, Vinod cherished a seemingly impossible dream. He dreamed of being a happily married man and a proud father. He cherished the thought of someday holding and carrying his child in his own arms. A far fetched dream, many would have said. Yet Vinod did not lose hope. He recalls, "I consulted numerous doctors, visited many hospitals, all in vain." Then he heard of Sahara Hospital and the successful treatments of many chronic and critical ailments that were being done there.

"Just when my hopes were dimming, Sahara Hospital came as a ray of hope in my life. I also heard of its Orthopaedic and Joint Replacement Centre where world class surgeries were being performed." adds Vinod. He came to the hospital and consulted Dr. Prasoon Kant Shamshery, Asst. Consultant, Orthopaedics and Joint Replacement, Sahara Hospital and an ex-AIIMS Consultant.

Dr. Shamshery and his team evaluated Vinod's case in detail. As Dr. Shamshery says, "Vinod's case illustrates the importance of giving proper treatment to childhood injuries which otherwise could become severe as the child grows to adulthood. These then might require corrective surgery. Had Vinod's injury been given proper attention and right treatment during his childhood only, it would have not aggravated to such debilitating proportions. As he grew up, his bones progressively

deformed and the joint got fused leading to complete restriction of movement of the elbow. His deformity was actually increasing progressively with age". Considering the magnitude of deformity and its impending effects, Vinod was advised an elbow prosthesis surgery - total elbow replacement. "Elbow prosthesis surgery restores full hand movement back to normal. The joint replacement surgery is an ideal remedy for patients suffering from restricted joint movement due to childhood injuries or trauma. It is also a boon for rheumatoid arthritis patients who are crippled with degenerated joints. This surgery makes them move towards a normal life." For Vinod these words were a glimmer of hope.

Using this method, initially, the patient's fused bones were carefully separated while protecting the nerves and arteries around the elbow. The medullary cavity of bones was reamed and washed with pulsatile lavage. Thereafter, the specially designed elbow prosthesis was fixed in place of the joint. The patient was given a PCA pump to eliminate pain because it allows him to get pain relief all by himself. This also allowed immediate movement of the operated elbow. The surgery was successfully performed by Dr. Shamshery with assistance of Dr. A. S. Pandey, Dr. Gaurav Kumar (both Orthopaedic Surgeons) and Dr. Sandeep Pawar, Anaesthetist.

The surgery came as nothing less than a miracle for Vinod. He says, "Within a few hours of the surgery, I was in a position to move my elbow without any difficulty". Vinod's rehabilitation process involved strengthening up of his muscles which had been weakened by his prolonged deformity. Hence, after the surgery, his muscles were electrically stimulated and thereafter, he was put on physiotherapy.

He went for the surgery on 16th June, 2009. This intricate surgery was conducted using 'Conrad - Morrey's semi constrained elbow prosthesis' method. Dr. Shamshery adds, "The Conrad - Morrey's semi-constrained elbow prosthesis' was invented by Mayo Clinic of U.S.A. and is today known to be 'Gold Standards' worldwide."

Today Vinod leads a fully normal life with two optimally working arms. And the dream of carrying his child in his own arms now does not appear to be far fetched. And we, at Sahara Hospital are feeling blessed to be able to help hitherto disabled patients lead normal lives.

ElbowProsthesis Surgery Dr. P.K. Shamshery is a distinguished orthopaedic surgeon who specializes in advanced treatments and surgeries such as primary

and revision joint replacements, upper extremity surgeries, microsurgeries, musculoskeletal tumours and handling of complex trauma cases. An ex-Asst. Professor with AIIMS before joining Sahara Hospital, Dr. Shamshery acquired MBBS, MS and Fellowship in Arthroplasty from there. He also served his senior residency at AIIMS and was actively involved with the Hand Clinic, the Rheumatology Clinic, the Bone Bank and the Replantation Team there. Also an MRCS from Glasgow,UK, Dr. Shamshery has published and presented more than 34 papers and 27 abstracts till date.

Dr. Prasoon Kant ShamsheryAsst. Consultant, Orthopaedics and Joint Replacement, Sahara Hospital

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HEART WARMING ADDITION AT SAHARA HOSPITAL

The 64 slice cardiac scan checks the heart thoroughly via non-invasive screening and for which no hospitalization is required. The 64 slice CT scan usually takes just 5 seconds of scanning time for a CT coronary angiogram. The entire procedure takes close to 20 minutes after which the patient can go back to his regular life and work.

cardiac ailments should take extra precautions. Patients who receive early diagnosis and take treatment

A recently published study predicts that by 2020, more accordingly, substantially reduce their risk of long-term

than 10 crore Indians will suffer from heart ailments. In side effects and a potentially life threatening heart attack.

two years' time, 60% of world's heart patients will be in India and these potentially fatal maladies will strike more and more younger people!

Physical symptoms of cardiac ailments appear only after The instances of coronary artery disease are indeed on a the problem has taken root in the heart. So it is always sharp rise in India. And therefore the number of cardiac preferable to get checked regularly to rule it out.patients seeking superior medical care too is rising

There are two methods of detection of coronary blockage rapidly. As prevention is always better than cure, the first and other structural abnormalities. One is the invasive requirement for staying safe from cardiac ailments is to coronary angiography which is a catheter (a tubular, ensure at regular intervals that your heart is healthy. After flexible surgical instrument) based diagnostic method in all, it's best to nip trouble at its budding stage. And if all which a thin catheter is inserted into an artery or vein is not what it should be, the next best step is to seek through a puncture with a needle or a tiny incision. The effective medical treatments as soon as possible in order catheter is then threaded through the major blood vessels to reduce the possibility of a heart attack occurring which and into the heart chambers. The catheter injects a dye might cause irreparable damage to heart muscles leading that can be seen on x-rays. The procedure takes 40 to 60 to weakening of heart.minutes and requires hospitalization.

The other method is detection through new generation "Most of the heart ailments originate from the diseases Computed Tomography (CT). This method is non-related to the arteries which supply blood to the heart and invasive and very convenient for people. nourish the heart muscles." says Dr. Shekhar Tandon, Cardio-thoracic & Vascular Surgeon, Sahara Hospital. In regular CT scans, numerous X-ray beams and a set of When coronary arteries (i.e. heart's arteries) become X-ray detectors rotate around the patient. At the same narrowed due to build up of fatty substances, cholesterol time, the examination table too moves around the and other substances in their inner lining, the supply of scanner, so the X-ray beam follows a spiral path. A sufficient oxygen and nutrients to the heart and flushing special computer program processes this series of out of carbon dioxide and waste products gets reduced. pictures to create cross-sectional images that doctors can When this narrowing is significant, it is referred to as use for making diagnosis. coronary artery disease. If blood flow is decreased, it leads to what is commonly called as angina. Further if the cardiac arteries get blocked completely, it causes a heart

The 64 slice CT scan goes many steps ahead, and uses as attack. An heart attack, even if not fatal, causes

many as 64 detectors to create extremely detailed, high permanent damage to the heart muscles which further

resolution 3-D images that cardiologists and radiologists increases the vulnerability of the heart.

can use to spot even the smallest of blockages in the coronary arteries at a very early stage. As the images are "Prevention is better than cure. This is true for heart three-dimensional, the doctors can look at the arteries and diseases as well" suggests Dr. Tandon, "This requires organs from any essential direction. An extremely regular check ups, diet management and a fitness valuable tool while diagnosing something as serious as regime." While this is essential to every human being, it cardiac complications!is very important for people who come under the major

risk categories making them prime candidate for coronary heart disease. The major risk categories are as follows:

• Males aged more than 45 and females of morethan 55

• Persons with abnormally high cholesterol levels

• People who have family history of heart disease

• People with diabetes

• Those suffering from hypertensionThe 64 slice CT scan can evaluate coronary artery disease • Cigarette smokers and other cardiac abnormalities such as congestive heart

• Obese peoplefailure and congenital heart disease with an

• People with less physical activity unprecedented accuracy. The scan is also used to detect narrowing of the arteries supplying organs, aneurysms

People belonging to any of these high risk categories for and tears in major arteries, and pulmonary emboli (clots

DETECTION OF CARDIAC BLOCKAGE

THE ROOT CAUSES OF CARDIAC PROBLEMS

64 SLICE CT SCAN - SUPERIOR TECHNOLOGY AT WORK

Superior Technology at Work64 Slice CT Scan at Sahara Hospital

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that have broken off within an artery) which has travelled through the bloodstream and got lodged in the small arteries of the lungs.

"Our Radiology Department provides these CT scans that are not just technically superior but are also time saving. The patient requires no hospitalization, it delivers 70% less radiation than other CT scanners, there's no invasion of the body unlike what's required in conventional catheter angiography, the entire procedure takes just 20 minutes and the patient can resume his or her normal routine immediately afterwards." explains Dr. Devendra Sonkar, the Associate Consultant of Department of Radiology and Imaging at Sahara Hospital.

Adds Dr. Shekhar Tandon, “Many patients came to us saying that they feel mild pain on exertion that goes away in a short while with or without medication. They had been advised coronary angiography by their treating physicians but these patients were reluctant to undergo an invasive procedure. These patients were then advised a CT Coronary Angiogram (64 slice) which they readily underwent and it clearly showed their coronary anatomy and pathology. Most of these are now being managed with drugs and lifestyle changes.”

After patient's arrival for the test, his/her medical history is reviewed. He/she is given a hospital gown to wear during the scan. An intravenous line is started and a beta blocker drug may be administered at this stage. The radiology technician guides the patient in positioning himself/herself better on the screening table. The usual position is lying flat on the back, or possibly on one's side or stomach. Straps and pillows may be given here for better maintenance of required body position. Patients are also asked to raise their arms over their heads during the scan. A contrast medium is administered in a peripheral arm vein with a painless prick. During the actual

64 SLICE CT SCAN: NOW AVAILABLE AT SAHARA

HOSPITAL

THE PROCEDURE OF SCANNING

The Radiology Department at Sahara Hospital offers new generation 64 slice computed tomography (CT) for heart patients. This advanced diagnostic machine offers sharp, crystal clear and detailed 3-D images of the heart, and that too without any invasive procedure.

scanning, the patient is required to lie still and hold his/her breath.

After the scan is complete, which usually takes 5 seconds to the satisfaction of the attending medical team, the patient can resume normal activities. The patient is advised to drink lots of fluids to help eliminate the contrast medium from the body via natural routes.

Patients coming for the CT scan have to take few precautions before the scan which are as follows:

• No caffeine and smoking for four hours beforethe scan

• Inform the doctor in advance if pregnant or on diabetic medication

• If required, the doctor will advise 6-hrs. fasting before the test

• If required, the doctor will prescribe a medicine (a beta blocker) to be taken a day before the scan to slow down the heart rate in order to obtain accurate CT images

A process called calcium scoring is also usually performed on 64 slice CT scans to ascertain the amount of calcium build-up in arteries of heart. It is an important step as higher the level of calcium, higher are the odds of developing heart disease.

If coronary artery disease is detected in a heart scan, the patient can consult a cardiologist well in time for prevention by medical treatment or he/she may be advised an interventional procedure or surgery before a heart attack occurs.

Cardiologists advise these scans for the following:

• High-risk individuals e.g. those with high BP, diabetes, high cholesterol, smoking habit or a family history of early coronary disease

• Those getting chest pains

• Equivocal nuclear/ stress test

• Evaluation for by-pass graft patency in patients with prior coronary by-pass surgery

• Evaluation of coronary arteries prior to major non-cardiac surgery

• Evaluation of congenital abnormalities of the coronary arteries

• Characterization of plaque

THE SUITABILTY FACTORS FOR CT SCANNING

Poonam Tiwari has studied dietetics and nutrition at Lucknow University and S.N.D.T. Women's University, Mumbai.Post M.Sc., Ms. Tiwari did her PG internship at P.D. Hinduja Medical Research Centre and Christian Medical College, Vellore. She has worked as a dietician at Rama Hospital and Research Centre, Kanpur and at Vivekanand Polyclinic, Lucknow. She has also taught clinical nutrition and dietetics at I. T. college , Lucknow to B. Sc./ M.Sc. students.

Poonam TiwariDietician, Sahara Hospital

Dr. Shekhar Tandon is a leading Cardio-thoracic & Vascular Surgeon who ranks among those who pioneered 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.

Dr. Shekhar TandonCardio-thoracic & Vascular Surgeon, Sahara Hospital

Today it has become a general opinion to say a big NO to 2. Deep fat frying : It is used in preparing pooris, fatty foods, as they are held responsible for obesity, kachauris, vadas, and pakodas. In deep frying, there is cardiac disorders, etc. One cannot deny this fact that fats direct transfer of heat from hot food to cold foodare one of the essential nutrients required for body

From the point of view of health conscious people, it is growth. If people become obese or suffer from any of the desirable to hold fat absorption by fried foods to cardiac disorder such as chilestremia, lipidemia, etc. the minimum. The factors that affect the amount of fat reason is that they consume too much of fat or they absorbed are:choose wrong types of fats. Different types of fats have

following advantages.Foods having higher amount of sugar and fat absorb

They are the concentrated sources of energy more fatThey reduce bulk in the diet Addition of egg in batter increases fat absorption

significantlyThey are excellent sources of fat-soluble vitaminsA, D, E and K Porous foods like bread and fermented foods absorb

more fatThey provide essential fatty acids, which are components of membranes of living cells Addition of soda bi-carb increases rate of fat

absorptionThey are also used by the body to make prostaglandins involved in large variety of physiological functions Greater the surface area, greater the fat absorption.

Foods cooked at lower temperature absorb more fat.Food cooked in fats and oils is basically of two types

If same oil is used again, fat absorption increases1. Pan frying : It is used to cook dosas, paranthas,

omlette, cutlets and tikkis. In pan frying, the amount of If above stated facts are kept in mind, one can surely fat used can be limited enjoy even fried foods occasionally

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