The Chhattisgarh chapter of SEMI was launched with the aim is to create awareness in the development of Emergency Medicine in Chhattisgarh with major thrust being on training more personnel. Emergence Medicine is perhaps newest of the specialties accepted in India and by MCI. It is a vast specialty catering practically to each and every specialty in the field of medicine. The vastness of the specialty can be accessed from the range of cases which includes MI, stroke, Trauma and Sepsis to a foreign body in the ear. Needless to say, with the enormous amount of cases, there has to be structured department with trained personnel with procedures and protocols. Above all, Emergency department is where most of the medico legal cases are dealt with. Also, an Emergency medicine department has to function quickly, precisely, proficiently while coordinating with other hospital departments. SEMI being the oldest, largest and undoubtedly the best Emergency medicine organization consented to launch a chapter in Chhattisgarh. The team would be focussing on forming a structured and protocol oriented emergency department for hospitals, initiate training of Doctors and Nurses. The coordination between hospitals, government and private sectors would need constant and sustained support from various hospitals, Government, Community leaders, the media and the community itself.  

Considered to be the most complex and challenging surgeries in the medicine, the liver transplant performed by the team of medical experts at Apollo Hospitals saved the lives of two patients from Bijapur. Basavaraj Maralabhavi, 46 years old and Dhanraj Pattanshetty, 42yrs had lost all hopes when they were detected with advanced stages of liver diseases. Both men faced a similar dilemma when they could not find donor-match or liver tissue within their family. Upon discussion, Dr. Mahesh S Gopasetty, Consultant and Multiorgan Transplant Surgeon at Apollo Hospitals advised them to enlist in the cadaver transplant program. Soon both the patients found appropriate tissue-match and underwent the surgery. “Apollo Hospitals is one of the very few institutions that can perform organ transplants seamlessly. Liver transplants of this nature are highly complex surgeries but a patient suffering from liver disease needs to know that these diseases are curable and treatable. Correct information and counselling can bring hope back to people”, said Dr. Mahesh S Gopasetty, Consultant, Multiorgan Transplant Surgery, Apollo Hospitals. Elaborating on their experience, Dhanraj Pattanshetty, Office Superintendent at Agricultural Produce Market Committee said, “I was suffering from the worst case of jaundice with increased bilirubin level for the past six years. We had almost lost all hopes of my survival but then we came to know about Apollo Hospitals and Dr Mahesh told us that we can actually find cadaveric donor liver. Thanks to the team that a major operation of this nature was conducted and I was given complete care during the process” Majority of the people on the waiting-list for organ transplant face a long wait due to shortage and unavailability of appropriate donor-match. Herein, Apollo Hospitals, through their vast network, ensures that donated organs reach the needy in time. “Just like the heart, the liver is also prone to infection and when such organs are transplanted through cadaver-donation, it requires proper guidance, precautions and proper medication to ensure a seamless healing process. Although the risk of infection is high in such cases the team ensured that all safety measures were in place.” added Dr. Mahesh S Gopasetty.  

Doctors at Apollo Hospitals, Jubilee Hills, performed a rare case of nose implantation on a Tanzanian man, recently. Dr Sudhakar Prasad, Senior Consultant Plastic & Cosmetic Surgeon, who performed this surgery, briefed media on implanting a fabricated nose, repaired to function, by painstakingly constructing it using skin, cartilage & blood vessels, from different parts of the body. The Patient, a Tanzanian man, lost his nose in a grievous assault and came to India after exhausting options elsewhere in the last two years since the incident. The serious assault with knives on the 46-year-old, Mr Sillah Kwahu, in September 2014 in Tanzania, led to defacement with multiple facial injuries and chopping off of the nose completely. He was initially treated at Tanzania. But his continuing ordeal led to him being referred to Dr Sudhakar Prasad at Apollo Hospitals, for further treatment. Dr Sudhakar Prasad, on evaluating the patient realized the enormous complexity in restoring a proper and functional nose. Normally in such patients the obvious choice of treatment is the famous Indian rhinoplasty technique described by Sushruta. Unfortunately, due to multiple knife injuries on his face, this treatment option was found to be inappropriate and the other regular options were ruled out too one by one. Dr Sudhakar Prasad falling back on his vast experience of over three decades in plastic and micro surgery, conceived a pioneering and complex procedure to provide lasting relief to the patient. This unique method combined the techniques of plastic surgery and micro vascular surgery. In the initial stage with a combination of patient’s forearm skin, cartilage grafts from ears and skin graft, a nose was moulded and cultured on the left forearm. After a suitable healing period, the newly created nose and blood vessels supplying it, were separated from the fore arm and transferred to the face. The blood supply was restored in the face by micro surgically joining the blood vessels of forearm to the blood vessels of the face, using sutures thinner than human hair. The new nose healed in a few weeks’ time. As a final refinement, the nose was sculpted into a much thinner size and some more cartilage from the rib was added to create a good nasal bridge. Now he has a normal nose, in place of the one he lost two years agso.

Sixty-six-year-old, Mr Ashok Katkade would have never expected that his ordeal for next 2 months at Apollo hospitals, Nashik would become an example of team approach for management of critically ill cardiac patient. His visit to the emergency department was in a very unstable condition. Cardiologist Dr Sudhir Shetkar said,” The patient had presented to us with extremely low blood pressure with excess fluid in his lungs, impairing oxygenation, a condition known as cardiogenic shock with acute pulmonary edema”. His cardiac function had reduced to mere 30% due to a recent heart attack and he also had severe kidney dysfunction with highly uncontrolled diabetes. He required mechanical ventilation for next 21 days, during which his kidney function, heart function, Lung infection and diabetes were managed by a team of critical care physicians, chest physician and nephrologists, led by Cardiologist Dr Shetkar. After stabilization over 21 days he underwent a coronary angiography which showed critical multiple blockages, for which bypass surgery was the only option. Senior cardiac surgeon Dr. Abhaysingh Walia, Cardiologist Dr Sudhir Shetkar and Cardiac anaesthetist Dr. Bhupesh Parate discussed the scenario with patient and relatives. Normally in bypass surgeries, a patient is completely made unconscious and put on ventilator, but this patient having very poor lung, kidney and heart condition was at very high risk of death during surgery with such anaesthesia. Hence it was collectively decided to perform an awake bypass surgery in which patient is not made unconscious and is not put on ventilator machine. The cardiac anaesthetist gave the patient a special type of anaesthesia called as epidural anaesthesia, in which the patient doesn’t feel pain but is still conscious. He was then successfully operated upon by cardiac surgeon. This case is peculiar in its criticality of disease and good team approach, in managing a seriously ill patient, who because of his multiple ailments would have been lost. It also reinstates the fact that outcome of such patients is really much better when a complete heart team consisting of cardiologist, cardiac surgeon and cardiac anaesthetist take collective decision rather than any one dictating the calls. This Heart team approach is routinely recommended by most international heart societies for management of critical cardiac patients with extensive coronary artery disease, however is rarely followed in our country.  

Mr. Mahmud, 50-year-old male from Somalia had a bullet injury 9 months before he had come to Apollo Hospitals. Since then, he was having continuous pain in the abdomen which prevented him from doing his work. He visited lot of hospitals both in his country and in India and was advised surgical removal of the bullet. In all the hospitals, he was advised conventional open surgery – wherein the abdomen is cut open and bullet along with some part of the liver are removed. He was also told that it is a high-risk surgery. He then visited Apollo hospital and after evaluating him thoroughly Dr.P.Siva Charan Reddy and team planned a laparoscopic surgery – wherein two small holes of 0.5 cm are placed in the abdomen and with the help of specialized instruments the exact location of the bullet was identified and the bullet was removed preserving the liver and the surrounding important structures. This surgery was done with very minimal blood loss and the patient was discharged within 24hrs. Post operatively patient was totally pain free and was back to his routine work. Laparoscopic removal of such a bullet injury is probably a first in the country and we at Apollo are proud to have done. With the increased expertise of laparoscopic surgeons, we are able to perform many such complicated and challenging surgeries safely and effectively in many such patients. The conventional or open surgery would have left a large scar about 15 – 20 cms in length and post-operative recovery would have taken about a week to ten days, but with laparoscopic surgery the patient does not have any scar and was discharged in less than a day.

Blood Transfusion Service (BTS) is a vital part of the modern healthcare system, without which efficient medical care is impossible. The aim of BTS is to provide effective blood and blood products, which are as safe as possible, and adequate to meet the patients’ need. Apollo’s Department of Transfusion Medicine is self-sufficient at meeting the blood requirements for all in-house patients, and also provides blood and blood components to other hospitals in Delhi/NCR as and when required. Department of Transfusion Medicine accepts and receives only voluntary/voluntary replacement donors for blood donation. With a warm welcome, Apollo’s well-trained staff performs donor screening, and maintains donor privacy and confidentiality at all times. Trained phlebotomists take the donation in specialised blood collection bags with integral filters; first sample pouch, which diverts the first 15-20 ml of blood, and needle guard to ensure 3-4 log leukoreduced blood, reduced bacterial contamination and prevent needle stick injuries to the phlebotomist respectively. Leucoreduction prevents Febrile Non Haemolytic Transfusion Reactions (FNHTR), HLA alloimmunisation, transmission of lymphotropic viruses such as EBV, CMV and HTLV-I & II. The Immunohaematology Laboratory of the Department is a reference centre providing advanced Immunohaematology work-ups for patients across Delhi. Provision of extended phenotyping for all blood donors is in place, and helps the department to provide phenotypically-matched blood for patients with common type of Rh and Kell alloantibodies. The Department is capable of resolving grouping discrepancies, autoimmune haemolytic anaemia workups, and multiple alloantibody workups. The Department is the first centre to introduce Hepatitis C antibodies and Hepatitis B core antibodies in blood donors in the year 1996, besides the other mandatory tests, i.e., HbsAg for Hepatitis B, HIV I &II, malaria, and syphilis. Hepatitis C antibody testing later became mandatory in the year 2000. The Department is a pioneer in starting Individual Donor (ID)-NAT (Nucleic Acid Test) on all the donated blood units in the country, since 2006. This has reduced the window period of HIV, HBV, and HCV considerably, and is a step forward in our quest for zero-risk blood. The Department caters to the transfusion needs of approximately 75 thalassemic patients. We provide ID-NAT tested, 3 to 4 log leukoreduced blood to these patients. We perform regular screening for any irregular red cell antibodies and extended blood group phenotyping for thalassemic patients, thus providing the safest possible blood to them. These patients are also typed by advanced molecular methods for red cell antigenic profile and receive a phenotype matched blood, thereby reducing the risk of alloimmunisation. The Department has a wellestablished Donor Apheresis Programme that functions round the clock, and has extended its services to the bedside of the patient by performing therapeutic apheresis procedures like plasma exchange and red cell exchange. A well advanced peripheral blood stem cell harvesting programme for autologous and allogenic donors with cryopreservation is in place for treatment of several haematological and non-haematological approved conditions.

The Patient was a thirty-five-year-old man who was struggling to live due to his chronic kidney disease and his Mother came forward and donated the kidney. Dr Mohan Patel said that kidney donation from living family member is preferable and is as safe as blood donation. He also added that soon they will be starting SWAP kidney transplant (Paired Kidney Exchange), Paediatric transplant and laparoscopic surgeries for the donor. The transplant was done by the team of consultants involving Nephrologist (Dr Mohan Patel and Dr Prakash Ugale), Transplant surgeons (Dr Kishor Wani, Dr Nandan Vilekar and Dr Pravin Govardhane) and Anaesthesiologists (Dr Chetan and Dr Ketan) along with transplant coordinator Ms Charusheela Jadhav. Apollo Hospitals, being India’s leader in organ transplant, now has fully functional Kidney transplant unit in Nashik hospital with world class standards at affordable rates. It has all facilities required for the kidney patients like pre-transplant evaluation, 24 x 7 dialysis, post-transplant isolation care, 24 x 7 trained intensivists and nursing staff. It has reduced the financial burden on patients travelling to Mumbai and Pune.  

It gives us immense pleasure to inform you that Indraprastha Apollo Hospitals, New Delhi received awards for ‘Best Indian Hospital for Medical Travel’ and ‘Best Organ Transplant Centre’ at ASSOCHAM – Meditravel 2017, held at New Delhi on 21st February 2017. The awards were given by Gen. (Dr) V.K. Singh (Retd), Minister of State for External Affairs Government of India.

The workshop comprised of patients who are very sick to undergo CABG or have been refused angioplasty because of complexity of the lesions or arterial blockages. Dr. Jan Kovak, will be the main Surgeon and will be supported by team of experts from Apollo Hospital, Indore, comprising of Dr. K. Roshan Rao, Dr. Sarita Rao, Dr. Kshitij Dubey, Dr. Vikas Gupta and Dr. Sushil Jain. After the workshop, a scientific meeting was held in the evening where Dr. Kovak addressed the doctors of the city and neighbouring areas and there was a one to one interaction amongst the doctors. This workshop will benefit the patients carefully selected and they will be treated by a world famous and eminent cardiologist from Europe at no additional charges. Dr. Ashok Bajpai, medical director of Apollo Hospital reiterated that it is again an example of high standards and expertise of world class that Apollo Hospital brings to the people of the city at affordable price.  

An 80-year-old lady was having a huge dilation of the arch of the aorta, which was leaking and could have ruptured at any instance, causing instantaneous death. Her detailed work up in the form of aortic angiogram and CT aortic angiogram confirmed the diagnosis as well as the exact extent of the disease. Open surgery would have involved a long incision and splitting of her breast bone, long general anaesthesia, stopping her heart, putting the patient on cardio-pulmonary bypass and then replacing the dilated aorta. She was too fragile to withstand the surgery. Endovascular treatment was the treatment of choice for her but the stent would have caused blockage of the arteries supplying her brains and upper limbs. This led doctors to go for a hybrid procedure – the first part was surgical and the second one – interventional endovascular stenting. In the first part a team of surgeons involving Dr. Kshitij Dubey, Dr. Sushil Jain and Dr. Alok Biyani implanted a graft from her right artery of the brain to the left common carotid artery (supplying to the left side of the brain) and left subclavian artery (supplying to the left upper limb). This ensured that even if the mouths of the arteries are blocked by the stent, the blood supply will be maintained by the innominate artery through the graft. This was done under local anaesthesia thereby minimizing the risk of general anaesthesia. Once the circulation to the brain and the upper limb was secured, interventional cardiologists Dr. Sarita Rao, Roshan Rao and Dr. Vikas Gupta under local anaesthesia, through a puncture in the right lower limb artery, implanted the bulky stent graft in the dilated part of the thoracic aortic aneurysm covering brain and upper limb artery which were already grafted so that there was no risk of any compromise to the brain and the upper limb. Team effort by the surgical and the interventional team led to complete cure of the patient with minimal risk. The patient recovered well without any complications and was discharged from the hospital on the third post-operative day.

The patient, a five-year-old girl had multiple health problems including advanced liver cirrhosis, congenital heart defects, severe growth retardation and rickets. Briefing media about this amazing accomplishment, Dr Manish C. Varma, Head of the Liver Transplant Department, Apollo Hospitals, Jubilee Hills; Dr Girish Warrier, Consultant Pediatric Cardiac Surgeon, Apollo Hospitals, Jubilee Hills and Ms Sangita Reddy, Joint Managing Director, Apollo Hospitals; said the baby was suffering from a rare genetic disorder. Though the ailment was diagnosed two years ago elsewhere, the complexity of performing a liver transplant and heart defect correction in one go and not having a precedence to this, prevented them from providing succour to the baby. Five-year-old baby girl, Parvati Rohra, hailing from Hyderabad, was suffering from a rare genetic disorder called Alagille Syndrome. It occurs with a frequency of 1:1,00,000 children and can impact the liver, heart, lungs, kidneys, bones among others. However, the severity of the problem varies from patient to patient. Because of Alagille Syndrome, Parvati had advanced liver cirrhosis, severe cardiac defects including Pulmonary Artery hypoplasia, Pulmonary valve dysplastic, Atrial and Ventricular septal defect, resulting in severe Pulmonary Artery Hypertension, severe growth retardation and rickets. Compounding the problem was her weight of just about ten kilograms. She was leading an extremely traumatic life, deprived of the normal childhood which kids of her age longed for. Although she was mentally developed, she was not going to school or out to play, as any attempt to walk would lead to fractures of the leg bones due to rickets. She was leading a very restricted life and was not able to achieve motor milestones. Her medical history indicated that she presented initially with jaundice in the first few months after birth. Her parents consulted a hospital in Mumbai, which diagnosed this as biliary atresia and were counselled for a liver transplant. However due to the baby being underweight – 10 kgs, the transplant team was not confident of operating on such a small child. Though the problem was later diagnosed elsewhere in Hyderabad, two years ago, looking at the complexity of the patient with heart defects and advanced cirrhosis of liver occurring together and there being no precedence in treating such cases earlier, the hospitals she approached expressed its inability to treat. The family was desperately exploring all avenues known to them in the last 2 years, before they came to Apollo Hospitals. Commenting on the high-risk nature of the case, Dr. Manish C. Varma said “Trying to deal with the problem one at a time would have been definitely fatal. If we attempted to perform liver transplant with a bad heart, she was at risk of dying in the operation theatre. On the other hand, if we tried to correct the heart alone, she was at a very high risk of dying after the heart surgery.” A multidisciplinary team of doctors led by Dr. Manish Varma, consisting of specialists, Liver Transplant Surgeons, Pediatric Hepatologists, Liver Transplant Anesthetists, Pediatric Cardiac Surgeon, Pediatric Cardiologist, Pediatric Anesthetists and Pediatric critical care specialists, took up this case as a challenge. The task ahead was daunting for the team, especially since there is no precedence of treatment for such a complex case being attempted in medical history. “We had no roadmap for us. We could find only one case in medical literature from a different country. However, that was a less complex case and the doctors in that case were able to correct the cardiac defect by endovascular balloon dilatation. We attempted that in our patient’s case but, unfortunately, that failed to correct the heart defect” explained Dr. Girish Warrier. Left with no other option, the doctors at Apollo decided to do something that was never attempted before in medical history. They decided to perform an open-heart surgery for the cardiac defects and then a liver transplant in quick succession. During an eight hour cardiac surgery performed on 23rd January 2017, by Dr. Girish Warrier and his team, the holes in the heart were closed, Pulmonary Artery was widened, Pulmonary valve was excised and an artificial flap valve was created. This was followed by an observation in the ICU for about 12 hours during which the baby was monitored closely for the improvement in heart function and for any deterioration in liver functions. Thereafter, a live donor liver transplant was performed by Dr. Manish Varma and his team, using a part of her mother’s liver, in the earliest available window of opportunity on 24th January 2017. The baby has since recovered and was discharged on February 7th, 2017. Elaborating on the complexity of the case and the importance of clinical decision making, Dr. Manish Varma said, “All our investigations suggested that an open heart surgery would be able to achieve a cardiac function that would enable us to do the liver transplant. However, the most important thing was to identify the correct window of opportunity to do the liver transplant. Attempting a transplant too early would have meant that we would be stressing the heart which had still not recovered fully, and attempting it late meant that the failing liver would have made Baby Parvati so sick that a liver transplant would be impossible. We could attempt this only because we had a living donor transplantation option in her 32-year-old mother Prerna Rohra, as the mother’s liver was a perfect match for the baby.” After this surgery, the baby will have a better growth curve and is likely to catch up on her growth over the next 2 years. The rickets will get treated with vitamin D supplements which will now work due to a functioning liver. The jaundice and itching will go away. She will need to be on some medicines for her heart and will need to be monitored for her heart status. After a few months, she will be able to walk, go to school, and do other age appropriate activities. The multidisciplinary team which was part of this historical surgery consisted of Dr. Manish Varma, Dr. Girish Warrier, Dr. Anand Khakhar, Dr. Anand Ramamurthy, Dr. Mahesh Gopashetty, Dr. L. Sasidhar Reddy, Dr. Manjunath Balasubramaniam, Dr. Meena Trehan, Dr. Kavitha Chintala, Dr. Dinesh Babu, Dr. Vishnu Vardhan Reddy, Dr. Sunita Nareddy, Dr. Shweta Priyadarshini, Dr. Ramesh Srinivasan, Dr. Senthil, Dr. Kirubakaran, Nutritionists, Physiotherapists and pediatric nurses, among others.

Over 250 school children and teachers along with gym instructors received training in “Basic Life Support and First Aid” at Apollo Institute of Medical Sciences & Research (AIMSR) recently The training in Cardio-Pulmonary Resuscitation (CPR) was done by a team of Life-Support Instructors from the Department of Emergency Medicine as a part of the National Assembly on Pediatric Emergency Medicine (NAPEM) conference. NAPEM 2017 is being conducted by the Society for Trauma and emergency Pediatrics (STEP) in collaboration with the Society for emergency Medicine India (SEMI), the India Academy of Pediatrics (IAP) and Apollo Hospitals. The conference is hosted with the intent of raising awareness and standard of care for pediatric emergencies in all hospitals. Dr. Imron Subhan, Head of the Apollo Hyderabad Emergency Department, said, “In an emergency, bystanders who witness an accident should provide first-aid and quickly get the victim to the hospital. If they hesitate or delay the transportation, then even Emergency Doctors cannot do much for the Patient”. “Every family should have at one person trained in Basic Life Support and First-Aid skills” said Dr. Dinakar who was the lead Instructor. Dr. Imron, who is also the organizing secretary for the conference said, “We have to make all emergency departments safer for children and better take care of sick and injured pediatric patients. Children with emergency conditions are bound to land up both in pediatric as well as adult emergency departments. All emergency doctors have to be ready to resuscitate and stabilize infants and children, and this can happen only with good training by using simulated scenarios on manikins”.