ROCKLAND News letter
Market share vs. Pain share
The issues
May - August 2007 Editor’s in Chief: Dr. P.K. Dave, Dr. K.K. Pandey Volume 3 Issue 4
In focus
Technological advancement has rapidly revolutionized medical
Healthcare, worldwide. We as medical specialists, are at a cross
Road of ethical patient care on one hand and advanced extensive
Investigations and protocols on the other. But technology and
modern machines are mere tools for diagnosis and treatment
By the doctor. Howsoever advanced the technology might be
- It is useless unless the human mind makes use of it. The most
important element in this process, thus is, application of human
mind on findings of machines. It is here that a doctor dwells into
His conscience to deliver the best treatment to the patient.
We are in an era of metamorphosis, and our reliance should be
On sincerity, dedication and perseverance. We should not fall
Into a “mirage race” of statistics or patient numbers. God gifts
A blessed few to achieve the pinnacle in medical science and
No better responsibility can fall on human shoulders than to be
A doctor.
Editorial
Dr. K. K. Pandey
Chairman, Oncology Services
Our Visitors
Continuing with the visit of Nobel Laureate Sir V S Naipaul,
Many other dignitaries and business delegations visited the
Hospital including the Ambassadors of Tanzania & Ethiopia. It
Included a Team of doctors from Methodist Hospital, USA, a
team from Otuska Corporation, US and Japan and Dr. Van der
Hoff – Prof. & HOD (Pediatrics), University of Nebraska, USA to
Deliver a key note address in Rockland Hospital on Probiotics.
Path Breaking Surgery
First successful operation for Autologous Cartilage Transplant
Was successfully performed at Rockland Hospital by a team of
Surgeons led by Prof. (Dr.) P. K Dave. A team of Korean Doctors
Were also present during the surgery.This surgery uses tissue
Regeneration using autologous cells. It has become one of
The promising
T e c h n o l o g I e s
In the medical
Field.
CHONDRON,
While hugely
Successful in
South Korea,
Was for the first
Time performed
In another part
Of the world.
The surgery
Makes life more
Comfortable for
The patient5s of
Osteoarthritis.
Did You Know?
The Surya Siddhanta
A textbook on astronomy of ancient India,
Last compiled in 1000 BC, believed to be handed down from
3000 BC by aid of complex mnemonic recital methods still
known today.
Showed the Earth’s diameter to be 7,840 miles,
Compared to modern measurements of 7,926.7 miles.
Showed the distance between the Earth and the Moon as
253,000 miles,
Compared to modern measurements of 252,710 miles.
Bhaskaracharya calculated the time taken by the earth
To orbit the sun hundreds of years before the astronomer
Smart. Time taken by earth to orbit the sun: (5th century)
365.258756484 days
With the Healthcare and Pharma sector
outgrowing the rate of GDP, there is a race to
Aquire a greater share of the market amongst
The major players of the Healthcare Industry.
It is a good thing as it is bringing more
Investment resulting in better Healthcare
Infrastructure. You go to any city in India,
Be it - Delhi, Mumbai, Chandigarh, Chennai,
Pune, Hyderabad or Banglore you will see better hospitals, better
technology and better management.
The question here is while looking for a greater market share, are
these Companies also looking at sharing the pain? Healthcare
ultimately has a single goal - to mitigate the pain of fellow human
beings. All the technological innovations, super specializations
Mean nothing if we fail to address the basic issue i.e. how to make
The patients suffer less.
Economists get excited when they talk about 9% GDP growth,
But has it got any meaning if there is no consequential reduction
Of people below the poverty line? The same holds true for the
Healthcare sector. While the market is growing is it leading to?
More Indians getting health cover? Or are we concentrating on
Providing better facilities to only the select few? Therefore what
Needs to be addressed is - are we here only to share the bounty
With the increase in the disposable incomes of the growing upper
Class or do we also share the pains of our fellow citizens? All the
Players in the Healthcare market private or government hospitals,
Pharma companies GP’s or super specialists will have to come
Up with a structure where the best in Healthcare is available to the
Masses to share the pain with the gain in the market share.
CME’s get highest priority at Rockland
Hospital. A wide range of specialties
Are covered by Sr. Consultants of the
Hospital and many leading Specialists
From overseas in the regular teaching
Interaction. The aim of these CME’s is to disseminate
Knowledge to a wide range of invited doctors and the undergraduate
DNB students.
Apart from the weekly CME every Thursday, the Hospital
Invites leading doctors of Delhi for knowledge enhancement.
Over 200 Top Doctors participated in the CME organized by
The Oncology and Pediatrics dept. The key speakers were
Dr K.K. Pandey, Dr Reena Adhikari, Dr Harsh Mahajan, Dr
Sanjeev Bagai. Dr. Veena Kalra, Dr. Ashok Khurana and Dr.
Rajiv Seth. Attendees also included the regional medical
Officers of the Embassies of the United States of America,
British High Commission and Canadian High Commission.
GPCON Conference held on 14th-15th April 2007 was attended
By over 400 Sr. consultants. Key speakers included Dr. O. P.
Yadav, Dr. Manjeet Kochar. Dr. Sanjeev Bagai and Dr. D.S.
Rana amongst others.
Academic Orientation
OPD
Anesthesia, Cardiology, Cosmetic Surgery, Dental & Facio
Maxillary Surgery, Dermatology, Dietetics & Nutrition, ENT,
Endocrinology, Gastroenterology & Hepatology, General
Surgery, Internal Medicine, Laparoscopic & GI Surgery,
Nephrology, Neuro Sciences - Neurology & Neuro Surgery,
Obstetrics & Gynaecology including Infertility, Oncology
& Onco Surgery, Ophthalmology, Orthopaedics & Joint
Replacement Surgery, Paediatrics & Neonatology, Pain
Management, Physiotherapy, Psychiatry, Pulmonology &
Critical Care and Urology.
Day Care Surgery
The Day Care Unit (DCU)
Laboratory
A fully automated 24 hr. Laboratory with home sample
Collection facility.
Radio Diagnosis & Imaging
Ultrasound, Color Doppler, CT scan, & Mammography and is
Functional round the clock.
Ultra-modern O.T’s
24 hr. Blood Bank
Support Services
Physiotherapy, Ambulance, 24 hr. Chemist Shop, 24 hr. Multicuisine
Cafeteria,
Travel Desk etc.
ICU
Sophisticated, state-of-the-art ICU, is manned by highly
Experienced, senior and well trained doctors. The Hospital
Also has a NICU & a PICU for specialized care.
Other facilities
Endoscopy Suite, Rehabilitation Centre, Telemedicine, TMT,
Dialysis, Lithotripsy and Laser prostrate removal.
Specialties, Services & Facilities
B-33, 34, Qutab Institutional Area, New Delhi -16
Ph. : 91-11-41688752-64
E mail : info@rocklandhospital.com
Website : www.rocklandhospital.com
Editorial Board
Dr K. S. Bhimwal
Rishi Srivastava
Umesh Upadhyay
Dr. Sanjeev Bagai
Congratulations
Dr. P. K. Dave
The Rockland Hospital Chairman Mr. Rajesh
Srivastava joins the entire Rockland family
In congratulating Prof. (Dr.) P. K. Dave on
completing more then 100 TKRs (total knee
replacements) at the Hospital.
Dr. Dave remains the pioneer in the field and
He has almost a total success rate in these operations.
Honoured
Prof. (Dr.) K. K. Pandey – Head of Oncology was awarded
“Priyadarshani Indira Gandhi Award” (2006 – 2007). For his
contribution towards research and treatment of cancer patients.
Padmashree Dr. Sanjeev Bagai was conferred “Best Citizen of
India Award” in 2007 and “Vijay Shree Award” & “DMA Award of
Excellency in Pediatrics” in 2006.
New At Rockland
Rockland Hospital has installed a new state of art Lithotripsy
machine. This will help in giving comprehensive care with the
latest cutting edge technology to Kidney stones patients.
CGHS Empanelment
Rockland Hospital has been empanelled with CGHS, to give
multidisciplinary care to CGHS beneficiaries. This is one more
initiative in the wide array of philanthropic activities
Backache Urinary Tract Infection (UTI)
DISEASE management
Urinary Stone Disease
DISEASE management
Dr. Sanjeev Bagai
Padma Shri, MBBS, MD, DNBE, MNAMS, DCH, FSCH (Aust.), SIMSA Medical Advisor, Director - HOD
(Paed.)
Documented UTI
Introduction
UTI - Presence of micro organisms in urinary tract. Urine C/S
mandatory.
150 million/year become infected, 20% of women (20 - 65
Yrs) - one attack / year
Approx. 50% of women develop UTI during their lives 5% of
General practitioner visits are for UTIs.
Pediatric UTIs often signal an underlying genitourinary tract
Abnormality
Can lead to renal scarring with resultant hypertension and
End stage renal failure
Difficult to diagnose because symptoms are non-specific.
Pediatric Utis: Epidemiology
Prevalence - girls <1 yr. is 6.5%, boys is 3.3%, girls >1 yr.
Is 8.1%, boys is 1.9%
<1 yr., uncircumcised boys have a 10 fold increase in risk.
7% of children <2 years who present with fever without a
Source
Early renal scarring is nearly twice as common in this age
Group
Bacteriology
Urinary tract is normally sterile, UTIs contain gram negative
Aerobic organisms.
Risk Factors
Age<1yr/F>M,Uncircumcisedmales,Constipation, Voiding
Dysfunction, genitourinary abnormalities (PUV, VUR
catheterization
Lower Urinary Tract Infection
Urethritis - Frequency, painful urination and burning,
cloudiness in urine, Blood in urine, irritability, sepsis,
Vomiting, Cystitis - Frequency, dysuria, urgency, suprapubic
Pain.
•Upper Urinary Tract Infection
Pyelonephritis – Acute - Fever with Chills, Nausea, Vomiting,
Tachycardia, Deep abdominal tenderness, Complications:
Sepsis, papillary necrosis, ureteral obstruction,
Abscess, decreased renal function if scarring from chronic
Infection, Ppt of preterm labour, Chronic: inflammation
Of renal and tubular tissue with scarring due to interstitial
Fibrosis.
Imaging
Essential in all children < 5 years old with initial UTI, Clinical
Suspicion is insufficient.
Imaging Modalities
Ultrasound, IVP, MCU / DRCUG, DTPA Scan / DMSA
Scan, Direct cystoscopy
Birth Defect Leading To UTI
VUR, PUJ Obstruction, Mega ureter, PUV, Ureterocele,
Duplex system, Stones / Nephrocalcinosis, Phimosis
•Introduction & Incidence
Urinary stone disease is very ancient dating back to Egyptian
Mummies.
Common in North and Central India and in the North-Eastern
States.
3 times as common in men. Occurring between the ages
Of 20-50 years.
Renal stone disease can cause End Stage Renal Disease
(ESRD), Acute Renal Failure, obstruction and infection,
Coronary disease, hypertension etc.
50–75% of renal damage occurs without any significant rise
In serum creatinine.
50% of men with a renal stone will have atleast one
Recurrence and 15% patients are at risk of recurrent stone
Disease and requiring complete work up.
Metabolic Work Up
Stone crystals form when urine is concentrated, sticking
Together to form stones.
Risk factors for Stone disease – Genetics-Cystinuria, Primary
Hyperoxaluria, Renal Tubular Acidosis (Type I, 2), Uric
Acid, gout, Infection, Hyperparathyroidism, Crohn’s, Family
History, dietary, and occupational factors.
Types of Stone
Many types of urinary stones exist. The common stones are
Composed of calcium oxalate crystals, infection induced
(Triple phosphate stones), uric acid etc.
Natural History
Small stones of <5 mm pass-out in urine, not requiring
Intervention.
Large stones grow and obstruct the urinary tract, causing
Back pressure changes, infection and chronic kidney disease
(CKD), often requiring
Symptoms
Severe back pain, radiating to the front (renal colic), vomiting,
Bloody urine, fever, chills.
Some stones are asymptomatic, growing silently to a large
Size, causing kidney damage.
Treatment
Very small stones pass spontaneously. Only pain relief is
Required.
ESWL (popularly called lithotripsy) is suitable for selected
Kidney stones upto 1 cm in size. No anaesthesia or
Hospitalization is required.
Lithotripsy is not effective for all Kidneys
Stones
PCNL (key-hole surgery) is effective for almost all stones in
The kidney, even if very large, and is done under anaesthesia,
By a skilled Urologists.
URS - method of removing ureteric stones. Special
Endoscopes are inserted for stone removal. Open surgery is
Rarely required.
Patients with kidney failure require dialysis or kidney
Transplantation.
Patients who form stones repeatedly require sophisticated
laboratory tests to determine the cause. It is possible to
Reduce the chance of recurrence with medication.
Anti Stone-forming Measures
Balanced diet, Neutral beverages, diet rich in vegetables,
Lifestyle modification, Stress limitation, adequate physical
Activity, balancing of excessive fluid loss etc.
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