Reproductive Medicine

Having a baby is one of the wonders of creation. But some couples have difficulty in fulfilling this dream; this is where the scientific knowledge and application of the medical fraternity brings joy to millions of couples by assisting them to conceive through IVF.

What is IVF?

IVF (In Vitro Fertilization) is the advanced scientific technology for assisted conception for which Prof. Robert G Edwards was aptly conferred the prestigious Noble Prize. With the birth of the first IVF baby Lousie Brown in 1978 and millions born subsequently IVF has established itself as time tested method for achieving pregnancy. Commonly termed as test-tube baby, IVF involves fertilization of the egg and sperm outside the body (in vitro).

IVF comprises of

Stimulation and monitoring of the development of follicles (eggs) in the female
Retrieval of these eggs under ultrasound guidance
Procurement of sperms from the male
Fertilization of the egg with sperm in the lab
Culturing the embryo for a few days
Transfer of the embryo back into the uterus of the female partner
Intra Cytoplasmic Sperm Injection (ICSI) – A variation of the procedure involves injecting the sperm into the egg

Why is the procedure required?

IVF is done to help a woman become pregnant. It is used to treat many causes of infertility, including

Damaged or blocked fallopian tubes (can be caused by pelvic inflammatory disease or prior reproductive surgery)
Endometriosis
Male factor infertility, including decreased sperm count and blockage
Unexplained infertility
Advanced age of the woman

The Department of Rheumatology provides diagnosis, treatment and rehabilitation for adults and children with rheumatic and related disorders. Chronic diseases like rheumatoid arthritis, osteoarthritis, gout, pseudo gout and fibromyalgia are some of the diseases commonly treated. Other diseases managed are collagen vascular diseases like Systemic Lupus Erythematosus (SLE), Poly Arteritis Nodosa (PAN) and Sjögren’s syndrome

Rheumatic diseases affect many parts of the body, hence multi-disciplinary care is required and treatment is customized for each patient. The consultants also use different modes of therapy like pain medications, anti-inflammatory medications, chemotherapeutic agents and intra-articular steroids.

The focus is on alleviating pain, improving quality of life and prolonging the life expectancy of patients with chronic rheumatic diseases. The department is supported by physiotherapists and occupational therapists.
Treatments and Procedures

1. Treatment and management of rheumatoid arthritis, osteoarthritis and spondylo-arthropathies
2. Treatment for psoriatic arthritis, vasculitis, systemic lupus erythematosus and scleroderma
3. Management of gout and pseudogout
4. Treatment of polymyositis and polymyalgia rheumatica
5. Treatment for fibromyalgia

Article By:
Columbiaasia Hospitals.

Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) in India

The Department of Neurosurgery have a team of highly qualified and experienced neurosurgeons and neurologists specializing in all types of neurosurgery for comprehensive management of diseases and disorders of the brain, spinal cord and peripheral nerves. The department aims at excellence in neurosurgical care through the practice of evidence based medicine and treatment according to international protocols.

Columbia Asia Hospital is one among the few centers in India to have DBS expertise in treating neurological diseases like Parkinson’s disease. The hospital has a team of high profile consultants who help patients manage all aspects of the complex condition through an integrated approach including counseling of the patients and their relatives.

Deep brain stimulation is considered to be one of the latest and advanced technologies in the treatment of Parkinson’s diseases. DBS uses high frequency electrical signals to block the abnormal nerve signals that cause the symptoms of Parkinson’s disease (tremor, rigidity, walking problems, stiffness, and others) without harming the brain.
Salient features of DBS In India at Columbia Asia Hospitals

Experienced team of professionals, including a specialist neurologist (movement disorder specialist), specialist neurosurgeon, neuroradiologist, physiotherapist and dietary specialists who provide high-quality care
Over 90% success rate achieved on patients suffering from Parkinson’s diseases
State-of-the-art operation theatre with modern equipment like
Operating microscope- zeiss pentero & opmi vario
Mizuho ot table
Sugita head frame
Midas rex legend drill system
Cusa/ dsac arm
Aesculap & codman micro instruments
Storz spinal endoscope
Leksell steriotaxic apparatus
Minimum blood loss and a short hospital stay of just 3 days
In this surgery the brain is not injured, hence it is relatively risk free.
Surgery is completely reversible and programmable
Parkinson medications are reduced which results in improvement of drug related side effects.
Vast improvement in quality of life

Treatment / Procedures

DBS for Essential Tremours and Dystonia
DBS for management of Parkinsons’s

Psychiatry

Mental illness is a sickness just like diabetes or heart problem or any other disease that requires treatment. The department of Psychiatry at BBH consists of well qualified psychiatrists and a clinical psychologist. The psychiatrists are trained to manage all mental health problems occurring in children, adolescents, adults and the elderly. The clinical psychologist has vast experience in counseling and offers various forms of psychotherapies.

The out-patient department functions on all 6 working days of the week including an evening clinic on Wednesdays. The in-patient facility allows admission of patients who are in need of more supervised care.

We abide by the hospital’s motto and strive to provide quality health care to all our patients at a cost affordable to them.

The following facilities are provided by our department:

Assessment and management of:

All mental health issues

Childhood onset problems like developmental delay, autism, attention deficit hyperactive disorder, behavior problems, communication problems & academic difficulties

Alcohol and other substance-related addiction
Mood changes like depression & bipolar disorder
Anxiety disorders including Obsessive Compulsive Disorder
Psychotic disorders like schizophrenia
Sleep, eating and sexual related problems
Suicidal behaviors

Our psychological/ counseling services include:

IQ tests
Specific Learning Disability Tests
Academic or career guidance
Cognitive behavior therapy
Relaxation therapy
Family therapy
Marital or couple therapy
Personality assessment
Supportive psychotherapy
Care giver assessment and education

Specialty Clinics:

Comprehensive memory and behavior assessment clinic every Wednesday
Developmental Disorders clinic every Friday

Bariatric Surgery

Unwanted weight gain has become a life threatening aspect in the recent past. Losing weight and making drastic changes in lifestyle has now become a necessity for those who tend to gain extra kilos by the pass of every day. Bariatric surgery is a common treatment procedure used to solve health related issues that are associated with excessive weight gain. Critical conditions of such disorders are treated by surgical procedures that involve altering the whole digestive system. Our weight loss surgical procedures are tailored to satisfy the requirements of individual patients. A dedicated team of bariatric nutrition specialists, trained physiotherapist, psychologist, anesthetist, bariatric surgeons, cardiologist and physician who offer the best services and comprehensive care right from the evaluation process to the follow up stage. Being highly equipped with the advanced state of art devices for bariatric surgery, it provides prime concern to patient privacy and comfort when undergoing weight loss treatment in the hospital.

How does bariatric surgery become successful for weight loss?

The bariatric bypass techniques enhance the early sensation of fullness thereby reducing excessive food intake
Decreased absorption of food after critical gastric bypass surgeries
Conversion of extra fat to glucose for body requirement enhancing weight loss
Reduction in size of the abdomen by surgery reduces food intake

Bariatric Surgical procedures are:

Gastric Banding
Laparoscopic sleeve gastrectomy
Gastric bypass surgery
Duodenal switch surgery
Biliopancreatic diversions

Apart from the above mentioned surgical procedures, Manipal Hospital provides special medical management techniques and excellent patient support groups to render unconditional support and help to families and relatives of the patient. Type II diabetes, increased cholesterol, stress, hypertension and sleep disorders are caused due to morbid obesity. A combination of the right exercise regime and proper diet after bariatric surgery is what we recommend to achieve the desired level of weight loss.

We not only concentrate on losing weight when treating such patients. Gaining that extra will power and skill to keep away the aspects causing weight gain is an added task that we consider important. With quality treatment by our experienced professionals in the Bariatric space and excellence in patient care, Manipal Hospital is a place where you can approach and gain treatment for weight related issues and diseases. Approach us, get treated and walk home with confidence.

A hysterectomy is a surgical procedure to remove the uterus.

A hysterectomy is an operation for a woman that will only be recommended if other treatment options have been unsuccessful.
Causes for Hysterectomy

The most common reasons for having a hysterectomy include:

Heavy periods (menorrhagia), due to fibroids for example
Pelvic pain, due to endometriosis, unsuccessfully treated pelvic inflammatory disease (PID) or fibroids for example
Prolapse of the uterus
Cancer of the uterus, ovaries or cervix

Procedure

Vaginal hysterectomy illustration key

Removing uterus through vagina
Pelvic bone
Bladder
Fallopian tubes and ovaries

Performing a hysterectomy

The most common reasons for having a hysterectomy include:

There are three ways that a hysterectomy can be performed. They are:

Open Hysterectomy:
vaginal hysterectomy
abdominal hysterectomy
laparascopic hysterectomy

Open hysterectomy

During an open hysterectomy, the uterus and cervix are removed through an incision that is made.After the uterus and cervix have been removed, the incision will be sewn up. The operation usually takes about an hour to complete.After your uterus has been removed, the incision is stitched up.

The operation will take about an hour to perform and a general anaesthetic is used.An abdominal hysterectomy may be recommended if your uterus is enlarged by fibroids or pelvic tumours and it is not possible to remove it through your vagina.

Laparoscopic hysterectomy

Laparoscopic surgery is also known as keyhole surgery. Nowadays, a laparoscopic hysterectomy is the preferred treatment method for removing the organs and surrounding tissues of the reproductive system. A laparoscopic hysterectomy is less invasive than a vaginal or abdominal hysterectomy because the incisions that are made are much smaller. This means that the wounds will be smaller and the recovery time will be quicker.

During the procedure, a small tube containing a telescope (laparoscope) and a tiny video camera will be inserted through a small incision in your abdomen.Laparoscopic hysterectomies are usually carried out under general anaesthetic.
Preoperative care

If you need to have a hysterectomy, it’s important to be as fit and healthy as possible.Good health before your operation will help reduce your risk of developing complications and speed up your recovery.

As soon as you know that you are going to have a hysterectomy, take the following steps:

Stop smoking (if you smoke).
Eat a healthy, balanced diet.
Exercise regularly.
Lose weight (if you are overweight).

Some blood tests and a general health check is done a few days before the operation to ensure that you are fit for surgery
Postoperative care

You will be given painkillers to help reduce any pain and discomfort.

The day after your operation, you will be encouraged to take a short walk. After the catheter has been removed, you should be able to pass urine normally. Any stitches that need to be removed will be taken out five-to-seven days after your operation.As a laparoscopic hysterectomy is a less invasive operation, you will usually be in hospital for a shorter period of time, providing there are no complications.

It takes about six-to-eight weeks to fully recover after having a hysterectomy. During this time, you should rest as much as possible and not lift anything heavy, such as bags of shopping. Your abdominal muscles and the surrounding tissues need time to heal.
Complications of a hysterectomy
General anaesthetic

It is very rare for serious complications to occur after having a general anaesthetic (1 in 10,000 anaesthetics given).

Bleeding
Bladder or bowel damage
Infection
Thrombosis
Vaginal problems
Ovary failure
Early menopause

Side effects

After having a hysterectomy, you may experience some temporary side effects as outlined below.

Bowel and bladder disturbances
Vaginal discharge

Getting back to normal
Returning to work

How long it will take for you to return to work will depend on how you feel and what sort of work you do.
Driving

Don’t drive until you’re comfortable wearing a seatbelt and can safely perform an emergency stop.
Exercise and lifting

After having a hysterectomy, the hospital will give you information and advice about suitable forms of exercise while you recover.Don’t lift any heavy objects during your recovery period. If you have to lift light objects, make sure that your knees are bent and your back is straight.
Sex

After a hysterectomy, it’s generally recommended that you don’t have sex until any vaginal discharge has stopped and you feel comfortable and relaxed, or after a minimum of six weeks.
Contraception

You no longer need to use contraception to prevent pregnancy after having a hysterectomy. However, you will still need to use condoms to protect yourself against sexually transmitted infections (STIs).

Patient feed back Mr. Philip – Uganda

Hip Replacement Surgery

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.

Who should undergo hip replacement?

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis, rheumatoid arthritis, osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

Why Do People Have Hip Replacement Surgery?

For the majority of people who have hip replacement surgery, the procedure results in:

A decrease in pain
Increased mobility
Improvements in activities of daily living
Improved quality of life.

Diagnosis

X-ray, MRI, CT and Ultrasound
Procedure/ Treatment plan

The hip joint is located where the upper end of the femur, or thigh bone, meets the pelvis, or hip bone. A ball at the end of the femur, called the femoral head, fits in a socket (the acetabulum) in the pelvis to allow a wide range of motion.
Process of hip replacement

During a traditional hip replacement, which lasts from 1 to 2 hours, the surgeon at Manipal makes a 6- to 8-inch incision over the side of the hip through the muscles and removes the diseased bone tissue and cartilage from the hip joint, while leaving the healthy parts of the joint intact. Then the surgeon replaces the head of the femur and acetabulum with new, artificial parts. The new hip is made of materials that allow a natural gliding motion of the joint.

In recent years, smaller incisions and a shorter recovery time than traditional hip replacement is being followed. Candidates for this type of surgery are usually age 50 or younger, of normal weight based on body mass index and healthier than candidates for traditional surgery. Joint resurfacing is also being used.

There are two types of hip replacement:

Unilateral Hip replacement- procedure where only one of the hip joints are replaced
Bilateral hip replacement- procedure where both the hip joints are replaced

Preparing for Surgery
Medical Evaluation

If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure
Tests

Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.
Preparing Your Skin

Your skin should not have any infections or irritations before surgery.
Blood Donations

You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.
Medications

Tell your orthopaedic surgeon about the medications you are taking.
Weight Loss

If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.
Dental Evaluation

Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery.
Urinary Evaluation

Individuals with a history of recent or frequent urinary infections should have a urological evaluation before surgery.
Social Planning

Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.
Home Planning

Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

A raised toilet seat
A stable shower bench or chair for bathing
A long-handled sponge and shower hose
Securely fastened safety bars or handrails in your shower or bath
Secure handrails along all stairways
A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
A reacher that will allow you to grab objects without excessive bending of your hips
Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
Removal of all loose carpets and electrical cords from the areas where you walk in your home.

Post-operative care

Patients are closely monitored by the staff.
Looking after your new hip

With care, your new hip should last well. The following tips will help you care for your new hip:

avoid bending your hip more than 90° (a right angle) during any activity
avoid twisting your hip
do not swivel on the ball of your foot
when you turn around, take small steps
do not apply pressure to the wound in the early stages (so try to avoid lying on your side)
do not cross your legs over each other
do not force the hip or do anything that makes your hip feel uncomfortable
avoid low chairs and toilet seats (raised toilet seats are available)

Possible Complications of Surgery

The complication rate following hip replacement surgery is low.

The most common complication of hip replacement is that something goes wrong with the joint, which occurs in around 1 in 10 cases. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.
Infection

Infection may occur superficially in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later.
Blood Clots

Blood clots may form in the leg veins or pelvis.
Leg-length Inequality

Sometimes after a hip replacement, one leg may feel longer or shorter than the other.
Loosening and Implant Wear

Over years, the hip prosthesis may wear out or loosen. Loosening of the joint can occur at any time, but it normally occurs 10-15 years after the original surgery was performed.
Other Complications

Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. In a small number of patients, some pain can continue or new pain can occur after surgery.
Dislocation

This occurs when the ball comes out of the socket.
Wear and tear

Another common complication of hip replacement surgery is wear and tear of the artificial sockets.
Joint stiffening

The soft tissues can harden around the implant, causing reduced mobility.

The knee joint can be thought of as a hinge joint with the primary motion of straightening and bending. In reality, it is more complex than a simple hinge, as the surfaces actually glide and roll upon one another. It is composed of the end of the thigh bone (femur), the top of the leg bone (tibia), and the kneecap (patella). The ends of the bone are covered with a smooth, glistening layer called articular cartilage. The articular cartilage is what allows the bones to glide smoothly with less resistance than ice sliding on ice. The articular cartilage can be seen on x-ray as the space in between the bones. Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. Knee replacement surgery can be performed as a partial or a total knee replacement.[2] In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.
Who should undergo knee replacement?
Today, a knee replacement surgery is considered a routine operation. Below are the three most common reasons for the procedure:

Osteoarthritis : This type of arthritis is age related – caused by the normal long wear and tear of the knee joint. The majority of patients are over 50; however, younger people may be affected.
Rheumatoid Arthritis : also called inflammatory arthritis, occurs when the membrane surrounding the knee joint is inflamated and thick. This inflammation becomes chronic and will damage the cartilage causing soreness and stiffness.
Post-traumatic Arthritis : This type of arthritis is due to a severe knee injury. When the bones around the knee break or the ligaments tear, this will affect the knee cartilage. Sometimes, surgery is the best option.

When is knee replacement surgery recommended?
When considering the option of knee replacement surgery, doctors take into account a number of symptoms:

Severe knee pain or stiffness : Do symptoms seriously undermine the patient’s ability to carry out everyday tasks and activities, such as walking, going upstairs, getting in and out of cars, getting up from a chair, etc?
Moderate but continuous knee pain : Is pain present while sleeping or resting?
Chronic knee inflammation and swelling : Does the swelling not improve after taking medications or resting? Do drugs cause unpleasant side effects?
Knee deformity : Is there is a noticeable arch in the inside or outside of the knee?
Nothing else worked : The doctor has prescribed medications and physical therapy without any substantial improvement.
Depression : Depression can be a serious, debilitating and devastating illness. Chronic pain and problems with mobility can eventually lead to depression, especially if the patient cannot do normal daily or social activities properly. Replacement knee surgery may prevent depression from occurring, or help get rid of it.

Polycystic Kidney Disease Treatment

The kidney in the human body is too vital an organ to be ignored. Their principal role is to cleanse the blood off the impurities that accumulate as a result of other organ activities. When kidneys fail to carry out their role as was intended by nature, the first casualty is the quality of blood circulating through the body. This will cause other body organs to malfunction as well and generally bring down the quality of life. What causes kidney cysts is not clear. Kidney cysts usually show as an individual grows older, but they are known to occur in young people also.

The kidneys in your body are susceptible to infections and abnormalities like any other body organs and kidney cysts are one of it. Kidney cysts are globular pouches that contain fluid and grow inside the kidneys. There are 2 common varieties of cysts – polycystic and simple cysts. Simple cysts are non-cancerous and rarely cause complications, and generally don’t require treatment. Polycystic kidney disease symptoms seriously affect the normal functioning of kidneys and therefore require to be treated at the earliest.

Symptoms pointing to need for Polycystic Kidney Disease Treatment
Simple kidney cysts generally don’t show any signs or symptoms. However when they grow larger you will know about it from the following symptoms.

Mild pain in the back and on the sides
Fever and abdominal pain

Here are some complications that occur as a result of having polycystic kidney disease symptoms.

Cysts can contract an infection resulting in the kidneys malfunctioning
Cysts can burst and cause severe pain on the back and sides
Cysts can block the normal flow of urine and result in the kidney swelling

The 2 tests that doctors order to establish polycystic kidney disease symptoms are:

Imaging tests – Imaging tests include the use of ultrasound, CT scan (computerized tomography) and MRI (magnetic resonance imaging). These tests will establish whether the growth is a cyst or a tumor.
Kidney function tests – Kidney function tests are done by drawing a sample of blood and checking whether it is due to a cyst.

Overview – Polycystic Kidney Disease Treatment
If your kidney condition is polycystic, you will be treated for:

High Blood Pressure – Controlling high blood pressure can help to slow down cyst growth. You will be also advised to go on a diet consisting of low sodium salt, low fat, low protein and low calorie. You will also have to quit smoking, do exercise regularly and keep stress under control.
Pain – If you have pain on your back and sides you will be required to take medication. In rare cases where polycystic growth is the cause for extreme pain, you will have to undergo surgery for removing it.
Cysts complication – Though rare, if the cysts affect other body organs and blood vessels from functioning normally you will have to undergo surgery for draining off the fluids that have accumulated in the cysts.
Bladder infection – If diagnosis reveals bladder infection due to cysts you will be treated with antibiotics. Likewise signs of blood in the urine will also be treated. You will be required to drink large quantities of water to prevent clotting in the urinary tract.
Other treatments include – non-surgical management of liver cysts, intracranial aneurysms and control of cholesterol.

Facilities for Treating Polycystic Kidney Disease
The Manipal Group of Hospitals has extensive facilities for treating polycystic kidney disease symptoms. Manipal Hospitals is a multi-specialty group of hospitals and uniquely every hospital in the group is self contained. The benefits that accrue to the patient are that they don’t have to hop between different healthcare facilities to get tests done and diagnosed. With more than 1,000 kidney transplants to its credit, patients are assured of utmost safety and first-class care. There is a separate department with expert doctors and paramedics for taking care of patients with kidney conditions. Another advantage of seeking treatment at Manipal Hospitals is the highly developed clinical laboratory attached to each of its hospitals.

Some facilities that make it unique are:

GE Signa 1.5 Telsa super conductive MRI unit
Advanced CT Scan
Color Doppler
Digital Subtraction Angiography
Mammography, X Rays and many other advanced equipment