PUSHPAWATI SINGHANIA RESEARCH INSTITUTE DELHI

http://www.expresshealthcare.in/200712/coverstory18.shtml

Pushpawati Singhania Research Institute

Pushpawati Singhania Research Institute (PSRI) was established in July 1996 as a 37-bed hospital and expanded in two phases to reach a total capacity of 106. The average annual growth rate (revenue) had been approximately 26 per cent.

This super-speciality Hospital is promoted by JK Group—one of the largest industrial houses in India. Says Deputy Medical Superintendent Dr Prashant Kulshrestha, "Our Institute offers services in the fields of gastroenterology, hepatology, gastro-intestinal surgeries, highly specialised hepatic surgeries, nephrology and urology. We have a dedicated renal transplant unit and have carried out many successful transplants. The USP for our Hospital are our endoscopy (diagnostic and therapeutic) services and state-of-the-art dialysis centre. The dialysis unit has isolation dialysis facilities for Hepatitis B, Hepatitis C and HIV patients. We also have CRRT facility for multi-organ failure patients. Research and academics are strong areas of our Institute and we have designated Director (Research) to promote and monitor the quality standards of these activities." The OPD footfall averages about 150 per day. The Institute has a total of 250 staff, excluding outsourced service staff.


Dr Dipak Shukla Director Administration
Says Dr Dipak Shukla, Director-Administration, "We are the first Institute of our kind in India to offer focused super-speciality care in the fields of gastroenterology, hepatology and nephrology under one roof. Our consultants are recognised nationally and internationally."

The Hospital also has a research wing which focuses on liver, renal and digestive diseases and related sub-specialities of medicine to attain the highest standards of preventive, curative and promotive care, and to conduct related field and clinical research through close interaction with reputed institutions and medical scientists of the world.

Information Network

The Hospital uses a Hospital Management System from Akhil Systems. It has in-house capability to develop user interfaces, and has developed modules for dietetics and catering services, and auto SMS generation software. It also has an Intranet site which enables 'click away' connectivity between all users (clinical and administrative) and carries all information about the Hospital, services, facilities and recent development. "We plan to go paperless by April 2008," says Dr Kulshrestha.

Worldwide Plans

For the purpose of medical tourism, the Hospital plans to get accredited for quality healthcare services. "We are exploring opportunities for tie-ups with international tourism companies and speciality hospitals in our neighbouring countries from South East Asia," Dr Kulshrestha says.

Ensuring Welfare

As part of CSR, the Hospital has various employee welfare schemes, which help them grow in their professional field by promoting on-the-job education, training and research. "We have patient forums for patients with chronic diseases to improve their quality of life. We also offer free treatment to patients below the poverty line as per existing norms," he adds.

Focused Future

In future, the management wants to stick to their focus specialities. "We have started a 'one-stop solution' state-of-the-art diabetic centre. We also plan to open a liver transplant unit, shortly. The funds for these expansion projects are being arranged from the Institute's surplus and donations," informs Dr Shukla.

Besides its collaborations in NCR Delhi, namely Sunflag-PSRI Gastroenterology Centre (Faridabad) and Shanti Mukund-PSRI Centre for Gastroenterology, Nephrology and Urology (East Delhi), in the pipeline are plans for collaboration with three more units. "That will happen in the next three years to widen our base," says Dr Shukla

http://www.expresshealthcare.in/200712/coverstory18.shtml

CASPULE ENDOSCOPY

M2A Capsule Endoscopy Given Diagnostic System
M2A Capsule Endoscopy is a non-invasive diagnostic imaging device for use in the gastrointestinal tract. Natural peristalsis moves the M2A Capsule smoothly and painlessly throughout the gastrointestinal tract, transmitting color video images as it passes. The procedure us ambulatory, allowing patients to continue daily activities throughout the endoscopic examination, thereby freeing physicians for other activities.
For the first time ever, images of the entire small intestine are obtainable to assist the physician in the diagnosis and treatment of gastrointestinal diseases.

Superior Diagnostic Yield

Clinical studies in over 65 sites around the world demonstrated the effectiveness of the M2A Capsule Endoscopy, leading the accurate diagnoses in complex cases.

The result studies released and experiences in clinical practice indicate that M2A Capsule endscopy is a reliable and indispensable diagnostic method for the evaluation of the small intestine. Capsule Endoscopy has the added advantage of allowing areas to be visualised where conventional radiological and endoscopic procedure give inadequate results. According to available clinical data, the detection rate of M2A Capsule Endoscopy is substantially superior to both push enteroscopy and to the radiological methods for the small intestine.

The M2A Capsule Endoscopy Procedure

1. Ingesting the M2A Capsule

Simply requiring a 10 - hour fast prior to the procedure, Capsule Endoscopy begins when the patient ingests the capsule with a small amount of water.

2. Undergoing the procedure

Images and data are acquired as the Capsule passes through the digestive system. This information is then transmitted via an array of sensors to the abdomen, to the DataRecorder affixed to a belt worn around the patient's waist.

The duration of the examination is about 8 hours.

3. Viewing the results

The patient returns the DataRecoder for processing on the RAPID workstation. The RAPID application enables the physician to view and analyze the Patient Rapid Report, save individual images or short clips and add comments for consultation and reports


http://www.endotherapy.org/capsule.html

DELHI GASTROENTEROLOGIST DR AJAY KUMAR HONOURED

Dr Ajay Kumar, a city resident who is a senior consultant in Gastroenterology and Hepatology at Indraprastha Apollo Hospital in New Delhi, India has been selected for prestigious Dr B.C. Roy award.
Dr Kumar is a medical graduate from GGS Medical College, Faridkot. After doing his post-graduation in Medicine from PGI, Chandigarh, and post-doctoral training in Gastroenterology at G.B. Pant Hospital, New Delhi, he is currently in Delhi.

After establishing the Department of Gastroenterology and Hepatology at Mool Chand K.R. hospital, New Delhi, in 1996, he moved on to Indraprastha Apollo Hospital, New Delhi, the premier tertiary-care hospital in India.

This now has developed into the key referral center for therapeutic endoscopy and hepatology services in India and South Asia.

He has more than thirty five publications in the national and international journals. He has made significant contributions to the research in the area of corrosive esophageal strictures and nomenclature of gastric varices.

Dr Ajay Kumar is known for his administrative skills. In addition to many responsibilities, he has been President of Society of GI endoscopy of India and has been its Hony. Secretary for three years

LIVER TRANSPLANT SPECIALISTS

DR SANJIV SAIGAL::

Dr. Sanjiv Saigal is presently working as a consultant Hepatologist and Gastroenterologist at Sir Ganga Ram Hospital, New Delhi, India. He did his MBBS from Calcutta, and then did his MD (Medicine) from the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh in 1993. He had been the Gold Medallist in Medicine during his MBBS, and had also been the National Pfizer award winner for his academic excellence during MBBS. He became interested in Liver Diseases during his MD training days. During this period, he carried out research in the form of thesis on haemodynamics in Portal Hypertension which was later published in a leading indexed journal. He then acquired his specialist training in Gastroenterology (DM) from the G.B.Pant Hospital in New Delhi. He was awarded the prestigious INLAKS Fellowship for his training in UK. In order to pursue his interest in Liver Diseases further, he then joined the Liver Unit of King's College Hospital, London to acquire training in advanced Hepatology and Liver Transplantation. During this period he passed the MRCP (UK) examination. At King's College Hospital, he was actively involved in clinical work including management of patients in the state-of-art Liver Failure Unit. He acquired intensive training in management of patients before and after liver transplantation. He also did several clinical research works and his research papers from King's College have been published in International journals of repute. After acquiring his specialised training in Hepatology, he then returned back to India to join and develop the Liver Unit at Sir Ganga Ram Hospital in New Delhi. He is also actively involved with the multi-organ transplant team at Sir Ganga Ram Hospital as a Transplant Hepatologist. His areas of interest include viral hepatitis, portal hypertension and its complications, alcoholic liver disease, hepatocellular carcinoma and liver transplantation


http://doctor.ndtv.com/profile/profile.asp?alias=ssaigal

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Dr. A. S. SOIN ::

MBBS (AIIMS), MS (AIIMS), FRCS (Edin), FRCS (Glas), FRCS (Transplant Surgery)-Cambridge, UK

Dr. Soin is presently a Senior Consultant Multi Organ Transplant and Gastrointestinal Surgeon, and Head of Liver Transplantation and Surgical Gastroenterology (Unit 3) at the Sir Ganga Ram Hospital (SGRH), New Delhi, India. At SGRH, he has established the country's busiest and most successful liver transplant and complex liver surgery Department which handles referred cases from all over India, rest of South Asia, The Middle East and Africa. In his extensive experience of 17 years as a Liver Transplant and Hepatobiliary surgeon, he has performed hundreds of liver transplants and more than 5000 other complex liver, gall bladder and bile duct surgeries.

http://www.livertransplantindia.com/about-author.asp


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Dr Vinay Kumaran, MBBS, MS, M Ch (Gastrointestinal Surgery) is a Gastrointestinal and Liver Transplant surgeon at Sir Ganga Ram Hospital, New Delhi. We presently have the largest living donor liver transplant center in India. We perform advanced Gastrointestinal Surgery including surgery for diseases of the Oesophagus, Stomach, Liver and Gall Bladder, Pancreas, Small and Large Intestine and surgery for Portal Hypertension.

http://vkumaran.net

GUJRAT LIVER FOUNDATION

Gujarat Liver Foundation
A Center Of eccellence for liver, Biliary, and Pancreatic diseases


Redefining Liver Care in Gujarat


Pancreatic surgery
Acute Pancreatitis

Necrosectomy

Neuroendocrine tumours
Pseudocyst
Pancreatico-jejunostomy for chronic pancreatitis

Pancreatic resection for pancreatitis Tumour
Thoracic splancnicectomy
for chronic pancreatic pain



Liver Surgery
Liver Metastasis
Carcinoma Gall Bladder
Hepatocellular Carcinoma
Cyst
Abscess
Hydatid cyst of the liver

Haemangioma
Trauma
Portal Hypertension



Bile duct surgery
CBD injury repair
Choledochal cyst
Cholangiocarcinoma
(Resection/ bypass)
CBD stone
All GI cancers & Advanced Laparoscopy




http://www.gujaratliverfoundation.com

10 YEARS OF LIVER TRANSPLANT AT APOLLO HOSPITAL DELHI

Indraprastha Apollo Hospitals celebrated 'A Decade of Liver Transplantation' at its facility, recently. Apollo Hospitals had created history when it performed the first successful liver transplant in the country on 15 November, 1998 on one-and-a-half-yearold Sanjay Kanthasamy. Sanjay suffered with biliary atresia, the most common condition that necessitates a liver transplant in children. He received 30 per cent of his father's liver. Sanjay is now 11-year-old and his parents joined in along with more than 60 recipients and donors to commemorate 'A Decade of Liver Transplantation' at Indraprastha Apollo Hospital, New Delhi.

Said Dr Prathap Reddy, Chairman, Apollo group of hospitals said, "We gave a commitment to the nation 25 years ago of bringing world class healthcare to the reach of common man. The success of our liver transplant programme exhibits that we are second to none and India is well on its way to become a global healthcare destination. Our programme has encouraged all sections of the society to come together to promote organ donation so that many more lives can be saved."

In 1997, at Indraprastha Apollo Hospital, the first dedicated liver transplant unit was set up. Around this time, advances in liver surgery made it possible for transplant to be conducted in adults from living related donors. "Since 1998, more than 200 liver transplants have been done. In the last two years 128 liver transplants have been done with 90 per cent success rate and 100 per cent success in pediatric cases. Our transplant unit has received patients not only from India but also from fifteen other countries including USA and Canada", said Dr Anupam Sibal, Group Medical Director, Apollo Hospitals.

http://www.expresshealthcare.in/200901/market22.shtml

A DECADE OF LIVER TRANSPLANT IN INDIA

Sanjay Kanthasamy is now 10 years, 5 months old. He was exactly 17-months of age when he underwent liver transplant surgery at Delhi’s Apollo hospital making him the first case in India to have undergone the procedure.

Today he is an active part of the school basketball team and plays other sports like cricket once in a while. “I owe it all to my father who donated 30 per cent of his liver to save my life,” he said.

While it has been an achievement for the boy, it has been a bigger feat for the family to see their only son alive and healthy.

“There can’t be greater joy than seeing him alive. He leads an absolutely normal life like all other boys his age,” said his mother in half English-half Tamil.

“When doctors advised us liver transplantation 10 years ago, we took as chance as there was no option as Sanjay had biliary atresia, where the bile duct between liver and small intestive was blocked and needed transplant to survive. Dr A S Soin and M R Rajashekhar assured us that we were in safe hands and my son would be fine,” she said.

Nihal Upadhyay, who is just 17 months old, underwent the transplant five months ago. “He has recovered well. The surgery was a big decision but it was all worth it,” said his father Vikas, who is also the donor.

Over 60 patients were present in Apollo on Thursday to be a part of a decade of successful liver transplants.

Dr Prathap C Reddy, chairman Apollo hospitals said, “The greatest joy is to see so many parents happy and satisfied. Bringing surgeries to India at an afforable price was a dream and in all these content faces I see fulfillment.”

Since 1998 Apollo has done more than 200 liver transplants.

"In the last two years, Dr Subhash Gupta’s team has carried out 128 liver transplants with 90 percent success rate. A bigger success is that we have had 100 percent success in paediatric cases,” said Anupam Sibal, group medical director of Apollo hospitals


http://www.hindustantimes.com/StoryPage/StoryPage.aspx?sectionName=RSSFeed-India&id=1d999c51-53d3-4d4f-994c-a3edae619832&&Headline=Decade+of+liver+transplant

YOUNGEST EVER TO UNDER GO LIVER TRANSPLANT IN INDIA

Durga Puja couldn’t have been merrier for the Paul couple whose six month old son Sivojit became India’s youngest baby to get a successful liver transplant.

Suffering from a fatal liver ailment - biliary atresia - a condition in which the bile ducts of the liver (responsible for draining the bile produced in the liver into the intestinal tract for digestion) are under-developed, this toddler has finally defeated an imminent death.

“His father donated a portion of his liver to his son. It was a very complicated and long surgery because his organs are too small in size and we had to be very careful, with all the other organs, especially the veins and the nerves,” said Subhash Gupta, consultant, liver transplant, Apollo Hospital, who conducted this 12 hour long surgery.

“Moreover, he had undergone a surgery just one or two months ago which added to complications,” Gupta added.

Admitted to the Apollo hospital in Delhi in August, Sivojit is now ready to return to his hometown Kolkata after undergoing a liver transplant.

“On the second day of his birth, he was detected with jaundice. As it was common with every other child, we followed the usual treatment procedure and within a few days he was back home,” said Mun Mun Paul, Sivojit’s mother, who is an advocate at Kolkata High Court.

“After a few days I saw that his eyes had turned yellow.

We took him to the doctor and they told us that his bilirubin had gone up considerably and Sivojit needed to be operated upon,” recalls Mun Mun.

A Kasai operation (an operation to join liver to the intestines) was performed on Sivojit in Kolkata. However, post surgery his condition kept deteriorating with rising bilirubin and convulsions.

“There was a leakage in the operated area. Blood was coming out. His bilirubin was 42 when we brought him here to Apollo hospital in Delhi,” Indrajit, Sivojit’s father, who is also an advocate at the Kolkata High Court said.

The Pauls had heard of the successful liver transplant of a one-year-old Pakistani boy Sheheryar at the Sir Ganga Ram Hospital so they brought Sivojit to Delhi.

“He was in very bad shape when we decided to operate upon him,” said Gupta.

He was discharged from the hospital two weeks ago and tomorrow he will go back home to Kolkata.

“We have already spent over Rs 15 lakhs and many nights to see this day. Never should any mother undergo what I went...

for more visit.....

http://www.financialexpress.com/news/7month-old-goes-through-liver-transplant-in-kolkata/370929/

LIVING WITH IBS

Changes in diet, prescribing fibre like isabgol, anti-spasmodic drugs, counselling, are the usual ways that gastroenterologists tackle the garden variety of IBS. But, with emerging biopyschosocial model of IBS, new methods of treatment are coming up.

The first step is to eliminate possibility of any other medical condition that could be triggering bowel disorders – say, allergies like celiac disease, lactose intolerance and so on. Then comes the task of counseling the patient that there is no physical or chemical cause behind the syndrome – a fairly Herculean task sometimes. "Most IBS sufferers refuse to accept that there is nothing physically wrong with them and keep thinking they are harbouring a form of cancer," says Dr Deepak Lahoti, consultant gastroenterologist Max Balaji. That worry, in turn, aggravates fresh bouts of bowel disorders.

"It's essentially an open management question," says Dr Vivek Raj of Max Healthcare. The treatment approach varies from case to case. And doctor to doctor.

Also, as Artemis Healthcare's consultant gastroenterologist Dr Paramvir Singh points out, you really have to get into the patient's diet, lifestyle and medical history. In some cases, there are certain trigger foods that set off IBS in a patient. So, consumption of artificial sweeteners, carbonated beverages could be causing the problem. In others, IBS could be psychosomatic – here supportive psychotherapy works as it trains the patient to alter their response to the symptoms.

Another critical factor for patients is to understand diets, avoid the trigger foods, and learning to differentiate between soluble and insoluble fibre. For IBS patients, soluble fibre is what works. As does frequent small meals. Prebiotics (soluble fibre – examples are oats, whole grain, etc.) and probiotics (good bacteria) are also emerging as supportive therapy in many cases.

Talking to doctors, what emerges is that IBS is eminently manageable if treatment is customised on a case by case basis – although it takes time, patience, faith and cooperation to overcome it and make peace with it.

Even as these developments are happening, Indian gastroenterologists are doing their own surveys to find out whether western definitions of IBS fit the bill for India or we need one of our own. Three years ago a task force headed by Lucknow-based senior gastroenterologist, Uday Ghoshal set out to research the Indian gut with the purpose of developing an epidemiological and clinical profile of IBS sufferers in the country.

It was a massive inquiry involving close to 3,000 IBS patients and 4,500 community subjects from the length and breadth of India. The report of the task force was published earlier this year in the Indian Journal of Gastroenterology and, as Dr Gopalan points out, it is pretty significant because it shows that the Rome criteria – a set of guidelines used to diagnose IBS– cannot be applied wholesale in India.

To start with unlike the West, where most IBS sufferers are women, this survey turned up more men and that too predominantly middle-aged men. Parallel studies from Singapore and China also suggest that in the East, the syndrome afflicts more men than women.

Then again, more than half the patients in the Indian study complained of upper abdominal pain, whereas in the West, only a quarter report pain. Bowel disturbances in Indian patients were not as marked as those seen in the West. There were plenty of other technical details showing differences in the Indian situation – for instance, Dr Gopalan points out that in the western criteria IBS among children is accompanied by normal weight gain. But in Indian patients, coming from all strata of society, there were chronically malnourished cases too.

Revieiwing the findings of the study, Kok Gwan Gee, Consultant Gastroenterologist, Gleneagles Hospital, Singapore puts the whole significance of the study in perspective, when he points out, "Much of what we read about IBS is based on Western profiles. The Rome criteria focus on the relation to stool frequency and consistency, but ignore the relation to meals." As he says, what the task force has done is to strike out a brave new world for IBS in India. By challenging some of the assumptions of the Rome criteria, it opens new doors to understanding the syndrome in India and hopefully, pointing the way ahead

http://www.businessworld.in/index.php/Pharma/Gut-Instinct/Page-2.html

IBS

Irritable Bowel Syndrome (IBS) afflicts at least 15 per cent of the population (a conservative estimate) and is pretty common among the corporate workforce. It is essentially a group of bowel disorders without any detectable physical or chemical cause.
The symptoms range from constipation to diarrhea, sometimes accompanied by pain, feeling of bloating, flatulence and a few other abdominal complaints continued over a prolonged period of time.

If it is a gut wrenching problem for the chronic sufferer, it's an equally frustrating condition for the medical community to tackle because there is no single unifying symptom or a single solution. "Each case is unique," says Dr Vivek Raj, consultant gastroenterologist, Max Healthcare. "IBS is not one entity. There is no single blanket therapy," says Dr Paramvir Singh, consultant gastroenterologist, Artemis Healthcare.

Yet, of late, a significant amount of research is emerging on IBS and its causes that is helping doctors tackle the condition better. Indeed, what causes IBS is a most vexing issue for researchers and several explanations have been put forth.

There's the recent brain gut axis theory, for one, which focuses on how factors that affect the functioning of the central nervous system can have a bearing on the function of the intestines. The new hypothesis is that symptoms of IBS result from not just a disordered gut but could happen due to disturbances in any of the pathways along the brain gut axis. So, stress, anxiety, trauma can all trigger off symptoms of IBS – a fact that as Dr Anil Arora, consultant gastroenterologist, Sir Gangaram Hospital, says, has been known for long by gastroenterologists, but now scientifically proved by studying neurotransmitters and the brain-gut route.

This is pointing the way towards psychotherapy and gut-focused hypnotherapy as well as the use of anti-depressants, all of which are now being tried out by Indian doctors. As Dr Samir Parikh, head of department of psychiatry, Max Healthcare says often simple relaxation techniques and counseling along with anti-depressants like SSRIs (selective serotinin reuptake inhibitors) works well - but as some doctors caution, they only refer a patient for psychotherapy, after gauging whether the trigger was stress or anxiety, or some other cause. Then, again, as Dr Raj points out specifically trained psychotherapists in the area of gut behaviour are not easily available in India. Sometimes counselling by the gastroenterologist himself works as well.

On the other hand, another body of research on probiotics (friendly or good bacteria) and IBS is also picking up steam. Although manufacturers of probiotic foods and drugs have been projecting a lot of health claims, doctors are still wary of prescribing them because as yet evidence based data on effect of probiotics on IBS is insufficient.

This August, a paper presented in the World Journal of Gastroenterology reported the effects of probiotic strain Lactobacillus casei Shirota in the fermentation pattern in the intestine among IBS suffers. Essentially, the hypothesis in this paper was that small intestinal bacterial overgrowth (SIBO) occurs in 78 per cent patients with IBS (One theory in gastro circles is that SIBO is a causative factor in certain cases of IBS – though that is not conclusive, still).

Usually, antibiotics (nowadays a targeted antibiotic like Rifaximin which acts only in the gut and nowhere else) and diet change are recommended to weed out the bad bacteria from the gut.

In this pilot study, researchers used probiotic strain Lactobacillus casei Shirota and the findings suggest that this had a beneficial effect. The golden method to test SIBO is to put a small tube into the small intestine through mouth and place through endoscope and aspirate the fluid and culture. However, this is cumbersome so in this pilot study overgrowth was monitored indirectly through the use of lactulose hydrogen breath test or C-xylose breath test.

Other studies are also pouring in from all parts of the world on probiotics, but as many doctors here point out, the data is still limited to act on it. Also, an additional problem is that there are many strains of probiotics – and research is still going on to identify which strain has an effect on which symptom. For instance, probiotic strain Bifidobacterium infantis has been shown to have a beneficial effect in tackling flatutence and abdominal pain. Similarly, another strain will act on another symptom. There's no strain as yet that has demonstrated an overall beneficial effect in tackling all the symptoms of IBS, although research is still on in this area.

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kumarkumar