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NEWSLETTER OF BLK SUPER SPECIALITY HOSPITAL

BLK Super Speciality Hospital

Pusa Road, New Delhi-110005 (India)

24-Hour Helpline: 011- 3040 3040 | Email- [email protected] | www.blkhospital.com

OCTOBER 2016 | ISSUE 7

MOSQUITO MENACE

STRIKES BACK

Chikungunya - Everything

you need to know about it

SURGERY WITH PRECISION

The story of a successful computer-navigated

Total Knee Replacement surgery

BLK PULSE | Newsletter October 2016

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BLK team of doctors liberated woman from

pain and hypertension

GETTING FREEDOMFROM MULTIPLE BLOCKS

Dear Readers,

It is that time of the year again when mosquito borne diseases such as

Chikungunya, Dengue and Malaria take the centre stage. Many cases

have been reported from various parts of the country, especially Delhi &

NCR region. This month's cover story highlights the symptoms and

management of Chikungunya which took a higher toll on patients this

season, as compared to last year. Taking adequate precautions is the

best way to fight the problem. Basic precautions should be taken by

people travelling to risk areas and these include use of repellents,

wearing full sleeves clothes and ensuring rooms are fitted with screens

to prevent mosquitoes from entering.

The issue also encapsulates other stories like the Low Rectal Cancer

Surgery, an unusual case of a 50 year old patient with 4 critical

blockages and computer-navigated Total Knee Replacement surgery.

Last month our team of surgeons visited Gambia to strengthen bilateral

cooperation, a step which was highly appreciated. You can read more of

it in our international section. In September, the hospital also won the

Asian Hospital Management 'Excellence Awards' in Marketing,

PR or Online Presence as well as in the Human Resource categories at a

glittering ceremony held in Ho Chi Minh City, Vietnam.

I would like to thank all those readers who took time out to share their

thoughts on BLK Pulse. Please continue to share your feedback at

[email protected].

Here’s wishing everyone great health!

FROM THE ED’s DESK

MULTI-DISCIPLINARY TREATMENTOF LOW RECTAL CANCER

Neoadjuvant Chemoradiation followed by surgery saved patient's sphincter

MOSQUITO MENACE

STRIKES BACKChikungunya - Everything you need

to know about it

SURGERY WITH PRECISION



AVOIDING A DISASTERHow medical intervention miraculously

contained a boy's suffering

BLK EXPANDS ITSHORIZON

BLK in NEWS

11

EDITOR-IN-CHARGE PARUL CHHABRA

CREATIVE CONCEPT PARUL CHHABRA / SHIKHA GIRGLA / SUNIL KUMAR DESIGN & VISUALISATION SUNIL KUMAR

CONTENT SHIKHA GIRGLA / MAMTA SINGH

INTERNATIONALRECOGNITION



THE CASE

A 68-year-old gentleman had a history of bleeding rectum and was also

experiencing change in bowel habits for the past one year. Close

examination revealed a fungating mass 3-4 cm from anal verge with

good sphincter tone, Colonoscopy of the patient revealed eccentric

passable fungating mass 3 cm from anal canal and MRI revealed a T3

tumour with mesorectal stranding and nodes.

THE PROCEDURE

He received pre-op RTCT (50.4Gy+ oral capecitabine tablet). Response

assessment 6 weeks later revealed reduction in size, bulk of tumour and

complete resolution of mesorectal nodes with residual eccentric mural

thickening in lower rectum. The patient was counselled for APR with

permanent stoma / low anterior resection with temporary Ileostomy. He

successfully underwent Laparoscopic assisted low anterior resection

with covering Ileostomy. Histopathology revealed moderately

differentiated adenocarcinoma with 1 cm distal margins and negative

nodes.

THE RESULT

With multidisciplinary approach - Neoadjuvant Chemoradiation,

followed by surgery, patient's sphincter was preserved which otherwise

would have ended with APR and permanent Colostomy. He is now

receiving Adjuvant Chemotherapy to complete the protocolised

treatment followed by Ileostomy closure.

Multi-disciplinaryTreatment of Cancer

Dr. Pankaj Kumar Pande

Sr. Consultant

Surgical Oncology

BLK Cancer Centre


Getting FreedomFrom Multiple Blocks

THE CASE

A 50-year-old woman was admitted with pain and discomfort in both her

legs. She has been experiencing pain while walking for last 2-3 months.

The pain was accompanied by chest discomfort and hypertension. Her

CT Angiography showed 4 critical blockages in different vascular

regions, all of which were at the ostium or origin of the vessels.

THE PROCEDURE

The patient's multiple problems were completely managed

endovascularly, and treated in 2 sessions with 4 stents. Bilateral access

via both femoral arteries was obtained and 7F sheaths were placed.

Herculink Elite 7X15mm stent was deployed in the left renal artery at

the ostium first. Then, continuing the same procedure, 2 extra stiff wires

were passed across the blockages in the iliac vessels and after dilating

the lesions with 5X40mm balloons, 2 stents, Luminexx (Bard) 10 X

40mm, in right, and Luminexx (Bard) 14 X 40mm in left, were

simultaneously deployed across the blocks in the iliac arteries, extending

into the aorta to reconstruct the aortic bifurcation and keep both vessels

open and flowing normally.

THE RESULT

A day later, the critical lesion in the ostial RCA was stented using Xience

Prime (Abbott) 3.5X15mm drug eluting stent successfully. The patient

was able to travel back to her hometown, Kanpur the very next day after

discharge.

The aim of treating Rectal Cancer is to have a good regional control with

improvement in overall disease-free survival. Distal third Rectal

Cancers were traditionally treated with Abdominoperineal Resection.

The sphincter-saving procedures have been increasing owing to

advances in better surgical techniques and instruments, introduction of

multidisciplinary approach (pre-op Chemoradiation - CT / RT),

specialised high volume centres and improved understanding of

sphincter mechanism and the tumour biology.

BLK team of doctors liberated woman from pain

and hypertension

Dr. Neeraj Bhalla

Director & Senior Consultant

Cardiology

BLK Heart Centre


Neoadjuvant Chemoradiation followed by surgery

saved elderly gentleman's sphincter

“The blockages were all critical

and were causing discomfort

which could have led to

significant complications.

Hence, the patient’s multiple

problems had to be treated

immediately.”

“There is evidence that

pre-operative Chemoradiation

by downstaging and

downsizing the tumour

benefits sphincter

preservation.”



Chikungunya is an infection caused by the Chikungunya virus. The risk

of death is a little less than 1 in 1,000. The elderly or those with

underlying chronic medical problems are most likely to have severe

complications.

The virus is passed to humans by two species of mosquito that belong to

genus Aedes: A. albopictus and A. aegypti. The virus circulates within a

number of animals including monkeys, birds, cattle and rodents,

compared to Dengue, which affects primates only.

SIGNS AND SYMPTOMS

The incubation period of the Chikungunya virus ranges from one to

twelve days. Characteristic symptoms include sudden onset of high

fever, joint pain and rashes. Other symptoms may include headache,

fatigue, digestive complaints and conjunctivitis.

Typically, the disease begins with a sudden onset of high fever that lasts

from a few days to a week, and sometimes up to ten days. The fever is

usually above 102 °F, sometimes reaching 104 °F and may be biphasic -

lasting several days, breaking and then returning. Fever occurs with the

onset of viremia, and the level of virus in the blood correlates with the

intensity of symptoms in the acute phase. When IgM, an antibody that is

a response to the initial exposure to an antigen, appears in the blood,

viremia begins to diminish. However, headache, insomnia and an

extreme degree of exhaustion remains for usually about five to seven

days.

Following the fever, strong joint pain or stiffness occurs; it usually lasts

for weeks or months, but may also last for years. The joint pain can be

debilitating, often resulting in near immobility of the affected joints.

Joint pain is reported in 87–98% of cases, and nearly always occurs in

more than one joint including peripheral joints such as the wrists,

ankles and joints of the hands and feet as well as shoulders, elbows and

knees. Joints are more likely to be affected if they have previously been

damaged by disorders such as Arthritis. Pain may also occur in the

muscles or ligaments.

Chikungunya may also cause long-term symptoms following acute

infection. This condition has been termed as chronic Chikungunya

virus-induced arthralgia. Common predictors of prolonged symptoms

are increased age and prior rheumatological disease.

DIAGNOSIS

Serological tests, such as enzyme-linked immunosorbent assays

(ELISA), may confirm the presence of IgM and IgG anti-Chikungunya

antibodies. IgM antibody levels are highest 3 to 5 weeks after the onset

of illness and persists for about 2 months. Samples collected during the

first week after the onset of symptoms should be tested by both

serological and virological methods (RT-PCR). The virus may be

isolated from the blood during the first few days of infection.

TREATMENT

There is no specific antiviral drug treatment for Chikungunya.

Treatment is directed primarily at relieving the symptoms, including

joint pains using antipyretics such as Paracetamol / Acetaminophen

and fluids. There is no commercial Chikungunya vaccine available as

yet.

PREVENTION AND CONTROL

Best means of prevention is overall mosquito control and avoidance of

mosquito bites in areas where the disease is common. This may be

partly achieved with the use of mosquito nets, mosquito coils and

vapourisers. Appropriate clothing for minimising skin exposure to the

day-biting vectors is also advised. Repellents can be applied to exposed

skin or to clothing in strict accordance with product label instructions.

For those who sleep during the daytime, particularly young children,

sick or older people, insecticide-treated mosquito nets offer good

protection.

“The safest way to prevent

Chikungunya is to prevent

mosquito bites and its spread.

Preventing bites can be difficult,

but it is important, as you can

get sick after just one bite.

Precautionary measures such as

use of good quality mosquito

repellents, mosquito nets and

wearing full sleeves clothes to

keep the body covered is highly

recommended. Avoid travelling

to places where the incidence is

high unless extremely necessary.

Treatment usually is for the

symptoms and include taking

sufficient rest, taking more

fluids, easily digestible food and

medicines to relieve pain.”

Mosquito Menace Strikes BackChikungunya - Everything you need to know about it

Dr. Atul Bhasin

Sr. Consultant

Medical & Allied Services

Internal Medicine


Dr. R. K. Singal

Principal Consultant &

Director and Coordinator of

Medical & Allied Services

Internal Medicine


Chikungunya is a viral

disease transmitted to

humans by infected

mosquitoes. It causes fever

and severe joint pains.

Other symptoms include

muscle pain, headache,

nausea, fatigue and rash.

Joint pain is often

debilitating and can vary in

duration

The disease shares some

clinical signs with dengue,

and can be misdiagnosed in

areas where dengue is

common

There is no cure for the

disease. Treatment is

focussed on relieving the

symptoms

The proximity of mosquito

breeding sites to human

habitation is a significant

factor contributing to the

rise of Chikungunya



Avoiding A Disaster Surgery With Precision

Dr. Mrinal Sharma

Consultant - Joint Replacement

and Arthroscopy

BLK Centre for Orthopaedics,

Joint Reconstruction

& Spine Surgery


THE CASE

Preetha, a 55 year old female from Bangalore had terrible pain in her

knee for past 4 years. All this started after she had an injury 5 years

ago. She started taking local treatment but her pain didn't subside, in

fact it worsened. She was debilitated and could hardly perform her

daily activities.

THE PROCEDURE

Dr. Sharma planned for a computer-navigated Total Knee

Replacement surgery on the patient. Computer navigation helped in

deciding the amount of bone cuts to nearest mm so that minimal bone

was removed during Knee Replacement thereby facilitating bone

preservation. Intramedullary canal was not violated, minimising the

chances of fat embolism. The amount of soft tissue dissection needed

using navigation was minimal, so blood loss was very less leading to

faster rehabilitation.

Navigation helped in accurate alignment and sizing of the components

on the table as well as perfect placement of the implants.

THE RESULT

Post-operative period was uneventful and the patient was able to move,

the very next day without any pain. She could walk on the third day and

was discharged on the fourth. She started walking without support, 15

days after the surgery and is now leading a normal life.

Total Knee Joint Replacement surgery has been evolving over the

years. Knee Joint Replacement fails only in those patients where the

alignment or balance is inadequate. Traditional Total Knee

Replacement is done using alignment jigs and cutting blocks.

Previously, surgeons used eyeballing to make bony cuts to balance the

ligament. Computer navigation uses a software that helps the surgeon

to outline the deformity, plan accordingly and perform bone cuts and

ligament balancing with absolute precision.

How medical intervention miraculously

contained a boy's suffering



“The main challenge was to

stabilise the child and

manage his 'Short Gut

Syndrome' which could have

led to extreme nutritional

deprivation.”

Computer-navigated Total Knee

Replacement offers absolute

precision in taking the bone cuts:

the surgeon can cross check on OT

table and make desirable

changes.

THE CASE

Ankur, a 6 year-old boy was brought to BLK Emergency in a very critical

condition and under tremendous shock. He was suffering with acute

abdominal pain for the past 24 hours and had multiple episodes of

vomiting.

THE PROCEDURE

Ankur was immediately resuscitated with ion tropic and ventilator

support. Paediatric surgery team was called immediately to rule out

any surgical cause of his rapidly deteriorating condition. The surgical

team suspected of intestinal gangrene and advised for urgent surgery to

remove the gangrenous portion. Surgical exploration was done and it

was found that except for about 100 cm of proximal small intestine

(jejunum) and colon, rest of the small intestine was completely black

(gangrenous). CT scan of the abdomen showed a very rare finding of a

major blockage of one of the veins supplying to the intestine which led to

the gangrene. With the help of the Haematology team, complete work-up

was done to ascertain the cause of the thrombus formation.

On post-op day 8, the child again developed severe abdominal pain with

blood in the vomit and stools. Repeat CT scan of the abdomen was done

which showed suspected new gangrenous changes in the remaining

small intestine. A second surgery was conducted by the surgical team

which involved removal of 5 cm long gut. Paediatric Gastroenterologist

and Nutritionist were then involved to gradually establish his enteral

feeds and digested formula feeds were given. This was one of the rarest

case which involved close coordination of multiple departments –

Paediatric Critical Care, Paediatric Surgery, Haematology, Paediatric

Gastroenterology, Dietetics & Nutrition.

THE RESULT

Presently, after 6 months of his illness, Ankur is growing well and is

gradually gaining weight. He is under follow-up care of Paediatric

Gastroenterologist and Nutritionist for his nutritional assessment.

Dr. Prashant Jain

Sr. Consultant

Paediatric Surgery

BLK Centre of Neonatal,

Paediatric and Adolescent

Medicine




BLK Expands Its Horizon

A team of medical specialists from BLK Super Speciality Hospital visited Gambia to strengthen bilateral

cooperation between the two countries by helping Gambia in its healthcare delivery.

Mr. Ram Mohan, Honorary Consul of India to Gambia, described the move as a landmark achievement

for the country by having a private sector teaming up with the Gambian government in providing quality

healthcare delivery to its citizens. He thanked the Gambian government and BLK Super Speciality

Hospital for this mutually beneficial strategic alliance.

Saidou Beyai, CEO of the Serrekunda General Hospital said, “The reason why Gambia and other African

countries are sending their patients to BLK Super Speciality Hospital is because of their highly

specialised team of medical experts, professionalism, reasonable treatment cost and high operation

success rate.”

BLK in NEWSIndian Expert Surgeons in Gambia Visit

It is a matter of great honour for BLK to be bestowed

with Asian Hospital Management ‘Excellence

Awards’ in the categories- Marketing, PR or Online

Presence and Human Resource Development for

the entries titled “Project 360 and Driving Passion for

Healing through Service Excellence”, respectively.

The award was conferred at a glittering ceremony held in

Ho Chi Minh City in Vietnam. There were a total of 322

entries from 92 hospitals in 15 countries, vying for the

awards. Winning the Excellence Awards was a

recognition of the effort and hard work put in by the

Marketing and Human Resource team of the hospital

during the past year.

International Recognition

Team Marketing

Team HR

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