Dr Ananthakrishnan Sivaraman, Consultant Urologist has been conferred a Special Achievement Award in Robotic Surgery by the Bengal Urological Society at Bengal Urology Society Conference( BUSCON) as part of their 50th Anniversary celebrations held in Kolkata. The award was given by Ms Chandrima Bhattacharya, Health Minister of Bengal on November 24th 2013. The award has been given as recognition to his efforts in initiating, facilitating and mentoring robotic surgeons in Kolkata over the past one year. A live work shop on robotic urological procedures was conducted where Dr Ananthakrishnan was the Faculty. Four robotic surgeries were performed as part of the work shop.                       

To mark the International Nurses Day on 12 May 2012, Apollo Group of Hospitals organized the 3rd National Nursing Conclave 2012 at Apollo Hospitals Bangalore, in association with innovative products maker and research and development leader 3M, to help nurses, their leaders and educators build confidence in the complex medical environment and meet patient expectations in a holistic manner. This will be followed by two days of leadership summit. Dr E. V. Ramana Reddy, Secretary – Health and Family Welfare, Government of Karnataka was the chief guest for the conclave. The keynote address was delivered by Dr (Ms) Preetha Reddy, Managing Director, Apollo Hospitals Group. Dr E. V. Ramana Reddy said: “”This is a novel idea to recognize the key role played by nurses in providing healthcare to the people. There has to be a commitment towards achieving good health for all, which must be a country-wide goal. Quality healthcare provisions and their easy accessibility are paramount in a country like India with a population of over a billion. Care is most needed for patients with progressive and life-threatening diseases such as cancer. Nurses must understand their crucial role in bringing health to the ill.”” In her keynote address, Dr (Ms) Preetha Reddy said: “”Care-giving standards and procedures need to be improved across the country. Today’s healthcare settings are quite complex compared to earlier times. In such a scenario, it becomes imperative for nurses to understand the care environment and its requirements so that they can work and serve with confidence despite numerous expectations. Apollo has always tried to develop leadership expertise in nurses besides the necessary care-giving skills. By giving confidence, strength and varied opportunities to the nursing staff, we appreciate their efforts in serving the patients.”” Roadblocks in quality healthcare, medical errors, nursing education, need for nurses to take care of themselves and importance of communication to provide care to others were mooted by way of debates, panel discussions and paper presentations. Capt. Usha Banerjee, Group Director – Nursing, Apollo Hospitals Group, Ms Mary Jose, Director – Nursing, Apollo Hospitals Bangalore and Mr Gautam Khanna, Executive Director, Healthcare Business, 3M India were also present. Capt. Usha Banerjee said: “”With the theme – ‘Caring with Confidence – Building People — this conclave provides a platform for exchange of views among nursing professionals to overcome various challenges they face while taking care of patients. Sharing research outputs and sustainable solutions is important for improving healthcare in the long run. Upcoming nurses must enter their profession with a clear understanding and know-how of its demands. Quality nursing education with emphasis on developing the required skill set will go a long way in the much-needed advancement of nursing standards in the country.”” Mr Gautam Khanna said: “”Superior standards of healthcare practices can only be ensured through adequate training of healthcare providers like the nursing community. 3M’s collaborations with associations like Infusion Nurses Society, Critical Care and Operating Room Nursing Clubs bears testimony to our support for the nursing fraternity. Forums such as these are an excellent platform to engage care-givers and share best practices in healthcare delivery.”” International Nurses Day is celebrated on 12 May every year, which is the birth anniversary of legendary nurse Florence Nightingale – the founder of modern nursing.  

Advancement in technology plays an important role in the healthcare system, and it offers new and better ways to solve the key health problems of the new century. The latest is the Robotic surgery which has gained rapid acceptance over the past four years as the preferred mode of surgery by doctors and the patients. The Apollo Institute of Robotic Surgery, Chennai launched in November 2011, offers world class treatment extensively in Gynaecology, Urology, Oncology, General and Bariatric Surgery. With the use of the state of the art “”da Vinci Robotic System””, Apollo Hospitals has successfully completed 56 complicated surgeries. With more number of patients opting for the robotically assisted surgery, the institute is planning to expand its reach in Cardiac, Head and Neck Surgeries. This minimally invasive field of surgery has integrated advanced technology with computer enhanced platforms and surgical skills to improve efficiency, precision and safety. Less blood loss, faster recovery with invariably less pain and scar, lesser tissue trauma are some of the aspects that make Robotic surgery preferable to the conventional surgical procedure. Highly complicated surgical tasks beyond the limitations of human hand are successfully treated using EndoWrist instruments attached to robotic arms that are controlled by a Robotic surgeon. Though the robot has no intelligence to conduct any single movement on its own, it is primed to carry out several safety checks per second. Robotic Surgery is the best treatment for patients with obesity and diabetes in addition to those who require complex surgical procedures and for patients who have undergone multiple surgeries. Dr Prathap C. Reddy, Chairman, Apollo Hospitals appreciated the overwhelming response to Robotic Surgery. He said, “”Robotic surgery is developing at a fast pace in India. With the inception of the Robotic era, there is a need to spread awareness on this modality of surgery and its technological benefits. Adopting Robotic Surgeries in various specialties will help patients across all regions to access the benefits of minimal invasive surgery.””  

Aneurysms of thoracic aorta and abdominal aorta are rare and their treatment traditionally involved complex surgical repair with attendant morbidity and mortality. Nowadays, interventional non-surgical management with Endovascular grafting using covered stent grafts (EVAR : Endovascular Aneurysm Repair) has become the treatment of choice in the majority of cases. This is the tale of a 67 year old hypertensive gentleman with Coronary artery Disease presenting with very large saccular Aneurysm in the Descending thoracic Aorta with another large saccular aneurysm in infra-renal abdominal aorta, again with impending rupture and layered clot in the aneurysm sac. He was refused treatment citing high risk as the reason in several placed and came to us as a last resort. A double TEVAR and EVAR procedure was performed by Dr Y Vijayachandra Reddy, Consultant Cardiologist, Apollo Hospitals Chennai. The final result was excellent with no complications and no endo-leaks. Patient withstood the procedure well and was shifted to ICU. He has been extubated and doing well now. The points of interest in this case are 1. Rarity of the procedure – stenting of both thoracic and abdominal aortic aneurysms in the same sitting 2. Aneurysm starting just after the left subclavian artery was considered inoperable because of high surgical risk involved and non interventionable due to lack of good landing zone for stenting. A carotid subclavian bypass was done enabling the case to be made suitable for TEVAR : the perfect example of a hybrid procedure. 3. The anatomy of abdominal aorta Aneurysm was interesting with gross disparity in size and tapering distal end precluding the use of the usual aneurysm stents . A balloon expanding Covered stent was deployed across the abdominal aorta aneurysm with post-dilation to mould the stent to the tapered aorta  

The first ABO-incompatible kidney transplant at the Apollo hospitals Chennai was done by using the Immune adsorption columns to reduce the specific blood group antibody titer before the ABO-incompatible transplant. This is the first case in the country using column adsorption of blood group antibodies . What is Column Adsorption Technology? Traditionally ABO compatible donor organs are essential to achieve a successful organ transplant. Transplantation of solid organs like kidney between donors and recipients of incompatible blood group is usually contraindicated because of the risk of “”hyper acute”” rejection. This rejection occurs due to the presence of pre existing Anti-A or Anti B antibodies in the recipient that can destroy the incompatible donor organ. Limitations in donor availability for organ transplantation makes “”living donor”” solid organ transplantation across the blood group barrier to become an alternative to ABO compatible transplantation for those with end stage renal disease facing long waiting times. This problem has been overcome by using a highly selective procedure to remove the potentially damaging blood group antibodies and slow their production during the critical post operative period. This is achieved by removing the anti-A or Anti B from the recipient using antigen-specific immune adsorption by performing several sessions of plasmapheresis. No other beneficial substances present in the plasma are removed and no plasma substitution is made either. This procedure is supported by a protocol of pharmacological drug based immune suppression and the ABO incompatible kidney transplant is performed. The Glycosorb ABO immunoadsorption column contains ABO blood group antigens covalently bound to sepharose particles. The column is used to deplete anti-A or Anti-B from plasma. Plasma is separated from whole blood in the Apheresis system, processed through the column before it is reinfused. The reinfused plasma is depleted only of the anti-A/B but not the other proteins like the coagulation factors or other antibodies in blood. More than 2000 ABO incompatible kidney transplants have been performed worldwide without any serious side effects using the Column Adsorption technology. Our first case A 52-year old male, a case of Diabetic Nephropathy and advanced chronic Kidney Disease was on regular dialysis. Live related renal transplant was performed but had graft loss due to Renal Artery thrombosis and underwent graft nephrectomy. ABO-incompatible re-transplant (donor-Brother) was planned due to non availability of ABO compatible kidney. Recipient was O Positive and donor A Positive. Patient underwent column adsorption plasmapheresis pre-operatively to reduce the Anti-A titer from 1:256 to 1:4 .This is the first time immunoadsorption therapy was instituted in our country using plasmapheresis. He received the kidney from his brother and had a fairly smooth post operative period in the hospital and was discharged on the 11th post operative day. He had normal kidney function and good urine output. One month after the surgery his kidney functions normally and urine output is good. Patient is back at work 3 months after his surgery.  

The Apollo Foot Care [Electronic Baropaedometer & Insole Maker] Service launched at Apollo Hospitals Chennai has been commenced to help in diagnosis of foot and ankle pains & production of thermoformed plantar insoles to treat them by introducing biomechanical corrections. It would deal with patients not only with foot problems [that may include lower kinetic chain problem, neuropathy, orthopaedic problems] but also fitness, sports, athletes and everyday walker. In short it would cater to both the ends of clientele illness as well as wellness. The service would assess, treat, prescribe, and prepare customized insoles for every patient coming to foot care based on the individual profile and need. Everyone is unique! The focus of the rehabilitation process would be very individual, and is dependent on the nature of the problem. Services Apollo Foot Care would offer services that range from the proactive to the reactive. Offered services include: Foot Assessment Foot Scan – Posturographic Analysis (Static & Dynamic ) & 3D imaging, Foot Pressure Analysis Observational gait Analysis Printed & Descriptive reports Comprehensive Physiotherapy Assessment (as appropriate) Mould Design Insole Design Customised Insole Preparation Foot Care education/advices Foot Wear Advices Rehabilitation/Exercises (as appropriate)   Who we can help? Anyone with Foot, Low back and Lower Kinetic Chain issues Diabetes [Diabetic Foot with certain limitations] Orthopaedic/Musculoskeletal [Plantar Fasciitis, Morton’s Neuroma, Achilles Tendonitis, Heel Spur, etc] Neurological {Tropical Neuropathy] Sports – any sport, athletes especially runners Every day Walker Fitness/Wellness   For further details, contact : Dr. Akilesh Anand Prakash, Consultant – Sports Medicine / Mr. Raj Prasanna, Cheif – Physiotherapy & Rehab The Physiotherapy Department Apollo Main Hospital No.21, Greams Lane, Off Greams Road Chennai – 600 006. Tel. : Board : +91-44-2829 3333 / 2829 0200 Direct : +91-44-2829 6572  

Baby Samreen Fatima, suffering from an inherited condition – progressive familial intrahepatic cholestasis (PFIC) underwent a Liver Transplant at Apollo Hospitals, Delhi. Samreen’s father Malik Sarsa Khan, a Pakistani driver, donated 20% of his liver to his daughter. Malik Khan had lost five children before. So when his daughter (3), who was born seven years after the death of his last child, was diagnosed with liver cancer, he decided to “”beg, borrow or steal”” to fund her liver transplant surgery in India. Though the government of Punjab in Pakistan stepped in to help him financially, he was robbed off at gunpoint in Lahore while on his way to India. A determined Khan, somehow, managed to reach Apollo Hospital in Delhi. When finding a liver donor became difficult, he decided to donate 20% of his organ to his daughter. A 10-hour surgery has cured Samreen. “”Liver transplant surgery for children is not conducted in Pakistan. I was told to go to either China or India. I had more faith in Indian doctors and decided to do whatever it takes to get my daughter under their care. I cannot believe that my daughter, who barely spoke a word, used to be down with high fever almost every alternate day and could not stop itching her body and vomited blood, is talking non-stop these days. She is behaving like any other normal child,”” a beaming Khan said. He added “”I had lost my last child also to liver disease. However, this time I was not going to give up. Doctors said Samreen was suffering from an inherited disease and it could be because I am married to my cousin sister – a practice being followed in my family for over three generations.”” Samreen’s case transcended “”against all odds””, said Dr Anupam Sibal, Group Medical Director, Apollo Hospitals & Pediatric Liver Consultant. “”It was heart-warming to see the commitment of the father to save her daughter. Samreen was very ill when she came to our hospital and we were worried whether she would be fit to withstand the liver transplant. Now, she is cured, and back home,”” said Dr.Sibal. Transplant surgeon Dr Subhash Gupta said Samreen was suffering from an inherited condition – progressive familial intrahepatic cholestasis (PFIC). The liver, one of the largest organs in the body, cleans the blood and helps fight infections. It also stores vitamins, sugars, fats and nutrients that travel to the rest of the body. It also removes billirubin whose presence causes jaundice. The liver is responsible for making bile. The build-up of bile in PFIC causes the liver to be damaged. “”This eventually leads to scarring in the liver that leads to cirrhosis or cancer. If Samreen hadn’t undergone the transplant, she would have died soon,”” Dr Gupta said. He added, “”She was malnourished, unable to walk, eat and be mentally alert. The surgery took about 10 hours. In the 70 transplants I have done on children, I can recall only three instances when a father donated for a daughter. Though she is cured, she will have to be on anti-rejection medicines for the rest of her life.””  

Apollo Hospitals launches robot-assisted procedures as a better alternative to laparoscopy for Bariatric Surgery. Addressing a press conference on Tuesday, Dr. Rajkumar Palaniappan, consultant, Apollo Hospital, said that robotic surgery provided good or even better results than laparoscopy. The downside was it would cost at least Rs.1.75 lakh more than a laparoscopic procedure. Advantages The advantages included high precision, increased ergonomic flexibility of the robotic arm inside a patient’s body, lesser blood loss, a pain score of 4/10 as compared to 6/10 for laparoscopy and quicker turnaround time for the patient. Robotic-assisted surgery has applications for all three standard bariatric surgery protocols – gastric band, sleeve gastrectomy and gastric bypass. The hospital is also looking to tap into the other advantage of robotic surgery – remote location procedure – by having a surgeon sitting at the computer console in Chennai operate upon a patient in Kolkata. Apollo Hospitals, which has already introduced robotic-assisted procedure for urology and gynaecology, is also aiming to set up robotic equipment at more of its centres. “”Training in this speciality is easier with a surgeon able to pick robotic-assisted surgery skills in a year or so while it takes five to six years for an open procedure surgeon to master laparoscopy””, Dr. Palaniappan said. A training programme in robotic bariatric surgery has also been proposed to be started. Michael Cameron, a patient from Scotland, said that he decided to undergo robotic bariatric surgery at Apollo as his efforts at dietary control failed to provide a lasting solution to his obesity.  

Pyaare Lal, a 54-year-old man who was suffering from kidney failure, is a health man now! His elder brother offered to donate one of his kidneys. However, a blood group mismatch rendered their kidneys incompatible. But for doctors at Indraprastha Apollo Hospital, Delhi, that was not a restraint at all ! They conducted the transplant using the incompatible kidney, successfully and gave the patient a new lease of life ! “”We used a special technique to prime the recipient’s defence system to accept an organ with a mismatched blood type. The process involved blood cleansing through plasma exchange that rids the system of cells that would have rejected the previously incompatible kidney. We administered the patient with a drug called Rituximab to reduce antibodies in his blood. Pyaare’s blood type is O while his brother’s is type B,”” said Dr Sanjiv Jasuja, Senior Consultant Nephrologist at Apollo. Numerous patients with kidney failure are not able to undergo transplant due to the non-availability of donors with a matching blood group, he said. Dr Gaurav Sagar, another senior doctor, said transplants involving incompatible kidneys have been carried out successfully in Mumbai and Ahmedabad and foreign countries like Japan. “”The five-year survival rate of patients in such cases is almost as good as in regular transplants with matching donors,”” Sagar claimed. Meanwhile, Lal, who was on dialysis for a year, couldn’t be happier. “”My wife and sister-in-law have the same blood group as me. However, they couldn’t donate their kidneys because of health problems like high blood pressure. I had lost all hope and thought that I was going to die. Even my brother, though willing, could not donate the organ. The doctors have given me a new lease of life,”” said the patient, a farmer based in Ghazipur, Uttar Pradesh. The surgery cost Rs 10 lakh approximately. In India, approximately 1,75,000 kidneys, 50,000 hearts and 50,000 livers are needed for transplantation every year, said Dr Anupam Sibal, Group Medical Director, Apollo Hospitals. “”There is a need to promote organ donation,”” he said. At present, only 0.1% of all donations are from cadavers.  

On the occasion of International Women’s Day, Delhi Chief Minister Smt. Sheila Dikshit today inaugurated a Women’s Health Camp, organized by Apollo Hospitals aimed to raise awareness about breast cancer as well as other cancers, including issues related to prevention and early diagnosis. To commemorate the occasion, she also released the special edition of Apollo Life Oncology at the Delhi Secretariat. The Apollo Life special issue highlights the dangers of various cancers, including breast cancer, and emphasizes preventive steps Speaking about the event, the Hon’ble Chief Minister Smt. Sheila Dikshit said: “”Every year, tens of thousands of new cancer cases occur in India. The rise of various cancers is all the more worrying because of the high death toll exacted, as well as due to the disruption of people’s lives caused by stress and the heavy burden of medical expenses. Preventing a dangerous ailment like cancer is therefore is critical. I applaud the sustained efforts of Apollo Hospitals in raising awareness about cancer and its preventive measures among patients and the public.”” With 800,000 new cancer cases every year in India, its impact painfully devastates the lives of cancer patients and their families. With many patients belonging to the productive age group – a significant number being breadwinners in the family – the impact transcends what mere statistics convey. Commenting on rising cancer morbidity and mortalities, in a personal message Apollo Hospitals’ Chairman, Dr. Prathap C. Reddy said: “With improving lifestyles and rising disposable incomes, the traditional diets of most Indian families has undergone a drastic change. Given the high proportion of processed food in the diet, cancer cases are increasing across the spectrum. Modern conveniences have also been promoting sedentary lifestyles, exacerbating health issues and driving up cancer rates. I appeal to all people, particularly women, to embrace the necessary lifestyles changes, including consuming healthy foods and exercising regularly. Prevention is the best means to overcome the ominous threat of cancers.”  

In a perfect combination of healthcare and technology, a unique health camp has caught the attention of people of Rajasthan. This unique effort saw renowned doctors travelling to Ajmer and treating people with the help of latest Information and Communications Technology (ICT) tools. “”Though the basic idea behind the entire project, which took us weeks to prepare, was to ensure presence of leading doctors at Ajmer so that poor and rural people could get basic treatment and consultancy from them, and only patients who require advanced healthcare are taken to Delhi or other places, we wanted to prove that India is ready with its ICT tools to be utilised for medical care,”” said Mr. Sachin Pilot. “”In two days we showcased the prowess of telemedicine and how it can change the way people gets treated in India without travelling to cities…we roped in telemedicine units of various hospitals like Apollo and also technology companies like the Department of Information Technology’s Centre for Development of Advanced Computing, Cisco and Tulip Telecom. We combined their capabilities to set up a unique health camp and help leading doctors provide latest medical care with all possible diagnostic paraphernalia required,”” Mr. Pilot pointed out. In the camp, the telemedicine division of the Apollo Hospitals facilitated virtual consultations using a well-equipped hospital on wheels (HoW) sourced from its Hyderabad unit. Each of the five cubicles in the HoW were connected to Apollo Hospitals in Chennai, Hyderabad, Delhi, Bhubaneshwar and Ahmedabad simultaneously. Some of the cubicles had telemedicine enabled peripheral medical devices for transmitting ECGs, heart sounds, blood pressure and pulse rate oxygen saturation, thus helping doctors to treat a patient on real-time basis. For the record, in just two days over 70,000 people from Ajmer and surrounding areas were given medical consultancy and treatment, while 5,000 reading glasses and spectacles and 800 hearing aids were; distributed to the needy. Over 300 tricycles and wheel-chairs and 200 crutches were also given free of cost, while almost 30,000 various medical tests were conducted. Another 20,000 medical kits comprising antiseptic cream, oral rehydration solution, de-worming tablets, vitamins, over-the-counter medicines were distributed a t the camp.

In a first of its kind initiative in India, the Apollo Hospitals Group provided 535 tele-consults from 65 different specialists in 2 days in 13 different specialities from 5 Apollo Hospitals simultaneously at a general mega-health camp at Ajmer ranging from neurology, cardiology, paediatrics, orthopaedics, dermatology, oncology to sexual medicine. Various subspecialities were covered including Asthma, Spine, pediatric neurology etc using a well equipped Hospital on Wheels, patients were connected to Chennai, Hyderabad, Delhi, Ahmedabad and Bhubaneshwar. Consultants interacted and virtually examined the patients at the camp and give the necessary e- advice thro an e -prescription. Details of the examination were stored in special electronic records. With prior consent the entire consultation was recorded in some of the tertiary centres.The telemedicine division of the Apollo Hospitals ( Apollo Telemedicine Networking Foundation and Apollo Telehealth Services Ltd. ) facilitated these virtual consultations using high speed broad band connectivity. Each cubicle had dedicated 1MBPS connectivity. 1MBPS connectivity was also made available at the registration/ prescription dissemination counter. Chennai based neurosurgeon Prof K. GANAPATHY, President of Apollo Telemedicine Networking Foundation and immediate Past President of the Telemedicine Society of India led the 30 member Apollo Telehealth team ably assisted by Vikram Thaploo CEO Apollo Telehealth Services Ltd.