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It is a surgical procedure to remove the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. Usually performed by a  gynecologists’ , a hysterectomy  may be total or partial.


  1. Total hysterectomy- Surgeon removes your uterus and tour cervix but not your ovaries
  2. Hysterectomy with oophorectomy – The surgeon removes your uterus one or both the ovaries and sometimes your fallopian tubes
  3. Radical hysterectomy – Surgeon removes your uterus , cervix , the top portion of your vagina , most of the tissue that surrounds the cervix and sometimes the pelvic lymph nodes
  4. Supra cervical hysterectomy – Surgeon removes the body of you uterus, but leaves your cervix intact


  1. Abdominal Hysterectomy:

Surgeon removes your uterus through a 6-8 inch long incision in the abdomen. The  doctor might recommend this technique for

  • Removal of ovaries and fallopian tubes
  • An enlarged uterus
  • Large fibroid
  • Endometriosis , cancer

2.Vaginal Hysterectomy:

Surgeon removes your uterus through vagina . This technique is most often used to treat uterine prolapse or when vaginal repairs are necessary for related conditions. It involves the least surgery pain as external scar is not present

     3.Minimally Invasive Robotic Hysterectomy:

Surgeon removes your uterus through small incision on the lower abdomen . He or she inserts a laparoscope – a thin , flexible tube containing a video camera through a cut in your belly bottom . Uterus is removed in sections through the laparoscope tube or through the vagina

     4. Minimally invasive Robotic Hysterectomy:

Surgeon uses a combination of high definition 3D magnification , robotic technology and miniature instruments to view manipulate and remove your uterus. 4-5 small incisions in your abdomen is made to allow small robotic arms and surgical tools to reach your uterus



  • Hot flushes
  • Night sweats
  • Vaginal dryness
  • Difficulty sleeping
  • Mood swings and irritability
  • Weight gain
  • Hair loss
  • Dry skin
  • Incontinence
  • Loss of bone density
  • Rapid heart beat

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It is a small pouch that sits just under the liver. It stores bile produced by the liver


Gall stones are hardened deposits of digestive fluid that can form in your gall bladder. It range in size from as small as a grain of sand to as large as a golf ball


  • Abdominal pain so intense that you cant sit still or find a comfortable position
  • Yellowing of your skin and the whites of your eyes
  • High fever with chills


  • If there is too much cholesterol in your bile
  • If bilirubin content is high in bile
  • If gall bladder doesn’t empty  correctly


  • Common type- Cholesterol gall stones
  • Pigment gall stones –  dark brown or black stones form when your bile contains too much bilirubin


  • Females
  • Age 40 or older
  • Over weight or obese
  • Pregnant
  • Sedentary
  • High fat diet
  • Family history
  • Diabetes
  • Sickle cell anemia or leukemia


  • Inflammation of the gall bladder
  • Blockage of common bile duct
  • Gall bladder cancer


  • Abdominal ultrasound
  • CT
  • Blood test


Most people with gall stones that doesn’t  cause symptoms will never need treatment . Treatment is decided depending upon the symptoms and diagnostic testing

Treatment options include:

  • Medications to dissolve gall stones
  • Surgery to remove the gall bladder -Cholecystectomy – It is recommended if gall stones frequently reoccur.  Once your gall bladder is removed bile flows directly from liver into small intestine , rather than being stored in your gall bladder


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alzheimers 11


Its a progressive neurological disorder that causes the brain to shrink and brain cells to die . The early signs of the disease include forgetting recent events or conversations .As the disease progresses , a person with this disease will develop severe memory impairment and loss the ability to carryout every day task


It is thought to be caused by the abnormal build up of proteins in and around brain cells. Proteins such as amyloid , deposits of which form plaques around brain cells


  • Memory loss
  • poor judgement leading to bad decision
  • loss of spontaneity and sense of initiative
  • Taking longer to complete normal daily tasks
  • Repeating questions
  • Trouble handling money and paying bills
  • Wandering and getting lost
  • Losing things or misplacing them in odd places


  • Pre clinic alzheimers disease
  • Mild cognitive impairment
  • Mild dementia
  • Moderate dementia
  • Severe dementia


  • Cognitive and memory tests to assess the persons ability to think and remember
  • Neurological function tests to test their balance , senses and reflexes
  • Blood and urine tests
  • A CT scan or MRI scan of the brain
  • Genetic testing


There is no known cure for Alzheimers disease. Treatments can however relieve its symptoms and improve quality of life for the person and their family and care givers

  • Effective management of any condition occurring alongside  alzheimers
  • activities and day care programs
  • involvement of support groups and services

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appendicitis 111


It is an inflammation of the appendix, a finger shaped  pouch that projects from your colon on the lower right side of your abdomen . It causes pain in your lower right abdomen . However in most people , pain begins around the navel  and then moves. As inflammation worsens pain typically increases and eventually becomes worse


Signs and symptoms of appendicitis may include :

  • Sudden pain that begins on the right side of the lower abdomen
  • Sudden pain that begins around your navel and often shifts to your lower right abdomen
  • Pain that worsens if you cough , walk or make other jarring movements
  • Nausea and vomiting
  • Loss of appetite
  • Low grade fever that worsen as the illness progresses
  • Constipation or diarrhea
  • Abdominal bloating
  • Flatulence

Acute appendicitis:

Acute appendicitis is a severe and sudden case of appendicitis. The symptoms tend to develop quickly over the course of one to two days. It requites immediate medical treatment , if left untreated , it may cause your appendix to rupture .This can be a serious and even fatal complication . Acute  appendicitis is more common than chronic appendicitis.

Chronic appendicitis:

Chronic appendicitis is less common than acute. In chronic cases appendicitis , the symptoms may be relatively mild. They may disappear before reappearing again over a period of weeks , months or even years. This type of appendicitis can be challenging to diagnose. Sometimes its not diagnosed until it develops into acute appendicitis


Many things can potentially block your appendix, including

  • a buildup of hardened stool
  • enlarged lymphoid follicles
  • Intestinal worms
  • traumatic injury
  • tumors


Depending on the condition doctor may recommend

  • surgery to remove your appendix
  • needle draining or surgery to drain an abscess
  • antibiotics
  • pain relievers
  • IV fluids
  • liquid diet


The type of surgery used generally is called appendectomy. During this procedure they will remove your appendix . If your appendix has burst , they will  also  clean out your abdominal cavity


Risk factors include

  • Age: most often affects people between the ages of 15-30
  • Sex : common in males than females
  • Family history: People who have family history of appendicitis are at high risk


  • A ruptured appendix
  • A pocket of pus that forms in the abdomen

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Prepared by: Dr Sajna Hamza


cataract `111


A cataract is a dense , cloudy area that forms in the lens of the eye. A cataract begins when proteins in the eye form clumps that prevent the lens from sending clear images to the retina. The retina works by converting the light that comes through the lens into signals. It sends the signals to the optic neve which carries them into the brain

Cataract develops slowly and eventually interferes with your vision. Cataracts are common in older people


  • blurry vision
  • trouble seeing at night
  • seeing colors as faded
  • increased sensitivity to glare
  • halos surrounding lights
  • double vision in the affected eye
  • a need for frequent changes in prescription glasses


  • an over production of oxidants which are oxygen molecules that been chemically altered due to normal daily life
  • smoking
  • ultra violet  radiation
  • the long term usage of steroids and other medications
  • certain diseases such ass diabetes
  • trauma
  • radiation therapy


SURGERY: It is recommended when cataracts prevent you from going about your daily activities such as reading  or driving . Its also performed when cataract interfere with the treatments of other eye problems’

One surgical method known as phaco-emulsification involves the use of ultra sound waves to break the lens apart and remove the pieces

Extra capsular surgery involves removing the cloudy part of the lens through a long incision in the cornea .After  surgery  an artificial intra ocular lens is placed where the natural lens was. Cataract surgery   usually an out patient procedure  takes an hour or less to perform. First your doctor will place eye drops in your eye to dilate your pupil . You will receive local anesthesia to numb the area and you may be given a sedative to help you relax

Surgical methods used to remove cataracts include , using ultra sound probe to break up the lens for removal or making an incision in the eye and removing the lens in one piece

After the removal of the cataract the artificial lens is implanted into the empty lens capsule

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sinusitis 2

A condition in which cavities around the nasal passages become inflamed .Sinuses are hollow spaces within the bones between your eyes, behind your cheekbones and in your forehead. They make mucus which keeps the inside of your nose moist. That in turn helps to protect against dust , allergens and pollutants. Healthy sinuses are filled with air , But when they become blocked and filled with fluid , germs can grow and cause an infection


  • Acute sinusitis – usually start with cold like symptoms such as runny , stuffy nose and facial pain . It may start suddenly and last 2-4 weeks
  • Sub acute sinusitis – usually last 4-12 weeks
  • Chronic sinusitis- usually symptoms last 12 weeks or longer
  • Recurrent sinusitis – happens  several times a year


  • Swelling inside the nose like from common cold
  • Blood drainage ducts
  • Structural differences that narrow those ducts
  • Nasal ducts
  • Immune system deficiencies or meditation that suppress the immune system
  • Allergies
  • Pacifiers
  • Drinking water while lying on back


  • Sinus headache
  • Facial tenderness
  • Pressure or pain in sinuses
  • Fever
  • Cloudy discolored nasal or postnasal drainage
  • Feeling of nasal stiffness
  • Sore throat Cough
  • Facial swelling
  • Pus like nasal discharge
  • Reduced sense of smell and taste
  • Tooth ache


  • Nasal irrigation – Rinse and clear the nasal passages with  salt water or a saline solution
  • Rest
  • Steal inhalation


Treatment options depend on how long the condition last. Your doctor may prescribes antibodies if they think you have acute bacterial  sinusitis . In some cases surgery may be necessary to treat the underlying cause of acute sinusitis .Your doctor may perform surgery to

  • remove nasal polyp
  • correct a deviated nasal septum
  • clean and drain your sinuses


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tennis elbow

An irritation of the tissue connecting the forearm muscle to the elbow .Tennis elbow can be caused by respective wrist and arm motions


Tennis elbow usually develops over time. Repetitive motions like gripping a racket during a swing can strain the muscles and put too much stress on the tendons .That constant tugging can eventually cause microscopic tears in the tissue. Tennis elbow might result from

  • Tennis
  • Racquet ball
  • Squash
  • Fencing
  • Weight lifting

It can also affect people with jobs or hobbies that require repetitive arm movements or gripping such as

  • Carpentry
  • Typing
  • Carpentry
  • Raking
  • Knitting


Symptoms include pain and tiredness in the bony knob on the outside of your elbow .This knob is where the injured tendons connect to the bone. The pain may also radiate into the upper or lower arm. Although the damage is in the elbow you are likely to hurt when doing things with  your hands

Tennis elbow may cause the most pain when you

  • Lift something
  • Make a fist or grip an object such as a tennis racket
  • Open a door or shake hands
  • Raise your hand or straighten your wrist
  • Tennis elbow is similar to another condition called golfers elbow which affects  the tendons on the inside of elbow


The good news about treatment is that usually tennis elbow will heal on its own. Types of treatment that help are

  • Icing the elbow to reduce pain and swelling.
  • Using an elbow strap to protect the injured tendon from further strain
  • Taking internal medicines
  • Performing range of motion exercises to reduce stiffness and increase flexibility
  • Getting physical therapy to strengthen and stretch the muscles

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laproscopic surgery 11


Laparoscopic surgery is a surgical technique in which short, narrow tubes ( trocars)  are inserted into the abdomen through small ( less than one centimeter ) incisions . Through these trochars long narrow instruments to manipulate, cut and see tissue


In patients terms, laparoscopic surgery has the advantages of avoiding large open wounds or incisions and thus of decreasing blood loss , pain and discomfort . Patients have fewer  unwanted effects from analgesia because less analgesia is required .The fine instruments are less apt to cause tissue trauma and blood loss. Also it has better quality of life outcomes than open surgery for cholecystectomy, splenectomy and esophageal surgery. However open hernioplasty has at least as good if not better , health status outcomes than laparoscopic repair


It can take longer to perform than open surgery ( if not performed with right technique) . The  longer time under anesthesia may increase the risk of complication. Sometimes complications do not appear right away but occurs few days to few weeks after surgery


  • Fever or chills
  • Abdominal pain that becomes more intense over time
  • Redness , swelling , bleeding or drainage at the incision sites
  • continuous nausea or vomiting
  • Persistent cough
  • Shortness of breath
  • Inability to urinate
  • Lightheadness


It is usually done as an outpatient procedure. General anesthesia is given as intravenous line in one of your veins. In some cases  local anesthesia is also used. During laparoscopy, the surgeon makes an incision below your belly button and then inserts a small tube called a cannula. The cannula is used to inflate your abdomen with carbon dioxide gas. This gas allows your doctor to see your   abdominal organs more clearly. Once abdomen is inflated , the surgeon inserts the laparoscope through the incision. The camera attached to the laparoscope displays the images on a screen, allowing your organs to be viewed in real time. Generally you get from one to four  incisions  that are each between 1 and 2 centimeters in length. These incisions allow other instruments to be inserted . After the procedure is done , the instruments are removed. Your incisions are  then closed with stitches or surgical staples


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knee 1

Knee replacement surgery also known as knee arthroplasty can help relive pain and restore function  in  severely diseased knee joints. The procedure involves cutting away damaged bone and cartilage from your thigh bone , shin bone and knee cap and replacing it with an artificial joint( prosthesis) made of metal alloys high grade plastics and polymers


Knee replacement surgery is usually   necessary when the knee joint is worn out or damaged so that your mobility is reduced and you are  in pain even while resting . The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include rheumatoid arthritis


  • Infection
  • Blood clots in the leg
  • Heart attack
  • Stroke
  • Nerve damage


Before the procedure-

  1. Your doctor will explain the procedure to you
  2. Consent form is asked to sign
  3. Physical examination is done
  4. Complete medical history is asked
  5. Notify your doctor if you have a history of bleeding disorder
  6. You will be asked to fast for eight hours before procedure
  7. You may receive a sedative prior to the surgery to help you relax

During the surgery-

Generally knee replacement surgery follows this process

  1. You will be asked to remove clothing and will be given a gown to wear
  2. An intravenous (IV) line may be started in your arm or hand
  3. You will be positioned on the operating table
  4. Urinary catheter may be inserted
  5. Excessive hair at the surgical site may be clipped off
  6. Skin over the  surgical site will be cleaned with an antiseptic solution
  7. The doctor will make an incision in the knee area
  8. The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with  the prosthesis . The prosthesis is made up of metal and plastic, A cemented prosthesis  attaches  to the bone with a porous surface onto which the bone grows to attach to the prosthesis. The prosthesis is generally comprised of 3 components-the tibial component, the femoral component and the patellar component
  9. The incision will be closed with stitches or surgical staples
  10. A sterile bandage or dressing will be applied

After the procedure-

In the hospital -after the surgery you will be taken to the recovery room for observation . Once your blood pressure , pulse and breathing are stable and you are alert you will be taken to your hospital room. Knee replacement  surgery usually requires as in hospital stay of several days

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Hip-fracture 33

A hip fracture is a break in  the upper portion of the femur ( thigh bone) . Most hip fractures occur in elderly patients whose bones have become weakened by osteoporosis . When a hip fracture occurs in a younger patient it is typically the result of a high energy event such as a fall from a ladder or vehicle collision


  • Inability to get up from a fall or to walk
  • Severe pain in your hip or groin
  • Inability to put weight on your leg on the side of your injured hip
  • Bruising and swelling in and around your hip area
  • Outward turning of your leg on the side of your injured hip


  • Age
  • Osteoporosis
  • Other chronic medical conditions
  • Nutritional problems
  • Physical inactivity


  • Blood clots in your legs or lungs
  • Bedsore
  • Urinary tract infection
  • Pneumonia
  • Further loss of muscle mass, increasing your risk of falls and injuries
  • Death


Most hip fractures occurs in one of the two locations on the long bone that extends from your pelvis to your knee

  • The Femoral neck- This area is situated in the upper portion of your femur, just below the ball part( femoral head ) of the ball and socket joint
  • The intertrochanteric region- This region is a little farther down from the hip joint , in the portion of your upper femur that juts outside

Treatment of hip fracture usually involves a combination of surgery , rehabilitation and medication

Surgery- The type of surgery you have generally depends on the the where and how  severe the fracture is , whether the broken bones aren’t properly aligned and your age and underlying health conditions. The options include :

  • Internal repair using screws
  • Total Hip replacement
  • Partial hip  replacement
  • Your doctor might suggest total or partial hip replacement if the blood supply to the ball part of the hip joint was damaged during the fracture

Rehabilitation- Physical therapy will initially focus on  range of motion and strengthening exercises.

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