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Hematologist

Sickle Cell Anemia – complications – treatments.

Sickle Cell Anemia - complications - treatments.

In this blog we highlight Sickle Cell Anemia - complications - treatments. Sickle cell anemia is a severe form of anemia caused by genetic mutation in the Red blood cells. It is a genetic disorder which is inherited by the patient from the two faulty hemoglobin genes from both the parents. Because of the genetic mutation,the shape of RBC ,which is flexible circular disc shaped changes to rigid sickle or crescent shaped rods. Hemoglobin a protein in RBCs,works as a transporter of nutrients and oxygen to cells all across the body.Normal RBCs are disc shaped,with the centers partially scooped out. They are flexible and soft and therefore have the capacity to squeeze through even the tiniest of blood vessels to reach every cell in the body.Due to genetic mutation the RBCs acquire the shape of a crescent moon or Sickle and become rigid and brittle.These Abnormal shaped RBCs which are not flexible get struck in small blood vessels causing slow or blockage of blood flow to other tissues of body and disrupt supply of Oxygen to those parts. Moreover the lifespan of abnormal sickle shaped RBCs is only 10-20 days as compared to 120 days of normal RBCs.Human body keeps on forming new RBCs to replace the old ones,but in a person with sickle cell disease the balance in formation of new RBCs and Destruction of existing RBCs is disturbed. This results in lower RBC count or anemia  in a person suffering with Sickle cell disease.

Complications Of Sickle cell anemia:

Sickle cell anemia may have different complications in different people at different stages of disease,but the major and severe complications for a person suffering from sickle cell anemia are:

Acute Complication:

Sickle cell crisis:
Sickle cell crisis or VAS ( Vaso occlusive crisis ) manifests as acute severe pain.Sickle cells disrupts blood supply through smaller capillaries resulting in ischemia. Sudden pain across body that may persist from a few hours to a few days.The pain usually occurs in limbs,chest and back.
Fever and infections:
Patients with sickle cell disease are prone to severe bacterial infections because of reduction or absence of splenic function. This may expose the patient to extremely high risk of septicemia and meningitis.Pneumonia is the most common infection ,meningitis,influenza and hepatitis are other infections occurring in sickle cell disease patients.
A Stroke:
Sickle cell disease may cause a a stroke in an affected person because of oxygen deprivation due to blockage in supply of blood to tissue of brain. Some of the sickle cell anemia patients may experience a Transient ischemic attack.
Acute Chest Syndrome:
Pneumonia like complications in a child or adult suffering from sickle cell disease. The reason could be an infection or sickle cells trapped in micro capillaries of lungs.
Hepatobiliary complications:
Hepatobiliary tract abnormalities are common in sickle cell disease patients.They may include cholelithiasis, acute cholecystitis, biliary sludge, and acute choledocholithiasis,acute Hepatic Sequestration and acute intrahepatic cholestasis.
Acute renal failure:
A decrease in kidney functions due to dehydration or obstruction or even because of intrinsic renal disease.
Acute Anemia:
May be because of Splenic sequestration.
Multisystem Organ failure:
A systemic failure of lungs,liver and kidney is a life threatening medical condition for sickle cell anemia patients.

Chronic Complications:

Vision Problems:
A sickle cell disease patient may develop vision problems over a period of time.It may include proliferative sickle retinopathy and vitreous hemorrhage. Complete vision loss is also possible.
Avascular Necrosis:
Avascular or aseptic necrosis can occur when capillaries are occluded by sickled erythrocytes at distal portions of a bone, near a joint, where hypoxia is maximal and collateral circulation is inadequate .The most common site for sickle cell anemia induced avascular necrosis is femoral neck.
Leg Ulcers:
Leg ulcers appear in patients of sickle cell anemia.
Pulmonary Hypertension:
Pulmonary hypertension occur in sickle cell disease patients.

Sickle cell anemia-Treatments:

Sickle cell anemia patients are  usually referred to a Hematologist ( A doctor who has specialized in blood disease management). Treatment of sickle cell anemia may involve determining many factors by the treating hematologist.Treatment of sickle cell anemia includes regular monitoring and follow up with a hematologist,Medications for management of symptoms and complications,pain management,blood transfusions, oxygen supplementation and allogeneic Bone Marrow transplant.

Allogeneic Bone marrow Transplant for treating Sickle cell Anemia:

Stem cell or Bone marrow transplant is a viable treatment option for those young sickle cell anemia patients where the diseases condition is severe and can not be managed with conventional methods. A sickle cell anemia child who is having a matching sibling donor is referred for a bone marrow transplant by the hematologist considering all the pros and cons. Risk involved is big but a stem cell or bone marrow transplant is the only cure for sickle cell anemia child or young adult.

Before the transplant, bone marrow cells are taken from a close matching healthy brother or sister. The patient with  sickle cell disease is then treated with chemotherapy and radiation that destroy his or her bone marrow cells. After that, the donated bone marrow stem cells are transplanted in the patient.

Dr Rahul Bhargava is Head of Department-Bone Marrow Transplant and Blood Cancer Treatment at Forts memorial Research Institute,Gurgaon,India.

 

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Hepatitis-C – Symptoms ,Diagnosis and Treatments.

Hepatitis-C - Treatment -Symptoms -Diagnosis.

Dr Pawan Rawal- Liver Disease Specialist | Gastroenterologist is one of the leading and most experienced Gastro. Physician of North India and is HOD - Hepatobiliary sciences and Gastroenterology at Artemis Hospital ,Gurgaon,India. A New generation Hospital with best Medical equipment and Best Liver transplant ICUs and Paramedical ICU staff in the country.

What is Hepatitis-C ?

Hepatitis C is a viral infection that infects liver and causes inflammation and scarring of normal liver tissues. If left untreated it may cause serious, life threatening damage to liver over a period of time. The prolonged and persisting inflammation in liver tissues may cause scarring of healthy liver tissues. An extensive scarring of Liver tissues leads to cirrhosis. It is this stage of chronic liver disease that starts affecting the life of the Infected. Chronic cirrhosis may also cause Cancer of Liver. Hepatitis-C can be cured in many cases with combination of drugs.Sometimes the treatment for cirrhotic liver is Liver transplant.

How one acquires Hepatitis-C Infection?

Hepatitis-C spreads through mingling of blood from a infected person to a healthy person.Usually it is percutaneous transmission of HCV from an infected person to a healthy person.Hepatitis-C is seven times more infectious than HIV. The most common cause of Hepatitis-C infection is Intravenous drug usage and infected needles (Injections). Unhygienic tattooing and body piercing centers which may use unsterile needles for the purpose,It may be transmitted from an infected mother to an unborn child,Very few and rare chances of transmitting through sexual intercourse,Using common household items like a shaving razor,Scissors,Manicuring equipments,tooth brushes etc., People who may have taken a blood transfusion before 1990,Hemodialysis,a medical procedure , an accidental injection needle prick from an infected person in a healthcare worker etc.

Who are at Risk of Hepatitis-C infection?

Healthcare workers,people who uses common shaving and hair cutting saloons,may be because of an infected razor or scissor,People who had a blood transfusion before 1992,people who had received hemodialysis on a machine which has dialysed an HCV infected person,elderly people who may have had a surgery before 1990. An unborn child whose mother may be HCV positive.

Symptoms Of Hepatitis-C:

Majority of people in early stages of Hepatitis-C Infection does not have noticeable symptoms.But once the disease progress the symptoms start appearing, are: The early symptoms appear in a very small infected population and may be because of other medical conditions too. Yellowing of Skin (jaundice) and whites of eye,Uncommon fatigue or general malice, Dark coloured urine,loss of appetite,fever,muscles and joint pains, Stomach ache etc. But in an advanced stage of disease the symptoms may include Itching and rashes on skin,Weight loss,Enlargement of breast in men(Gynecomastia),Easy bleeding and bruising of skin,Prolonged blood coagulation time ( time taken in stopping of bleeding from a wound is prolonged),swelling of feet,rashes on palms,fluid accumulation in stomach (ascites),appearance of spider web like blood vessels ( Spider angiomas),Kidney functions being derailed ( Cryoglobulinemia),persistent yellowing of skin and eye whites. More severe symptoms of chronic hepatitis-C include portal hypertension ,esophageal varices ( engorged veins in the swallowing tube) that may bleed suddenly,enlarged spleen that may result in anemia,fall in platelets count (thrombocytopenia) that makes the infected person prone to bleeding easily and prolonged time of stopping of bleeding and confusion,disorientation and even coma because of hepatic encephalopathy.

How Hepatitis-C is diagnosed?

HCV Antibody testing ,HCV viral load testing, HCV genotype testing for determining the treatment course and duration,and the possibility of curing the disease.Other tests may be done for a Hepatitis-C patient like LFT (liver function test) to determine the damage to liver,a liver biopsy to determine cirrhosis,imaging tests like ultrasound,CT scan and MRI to determine fatty liver and liver cancer.

Treatment of Hepatitis-C :

Treatment,duration and medication for Hepatitis-C depends on several factors. A gastro. Physician will consider all the aspects in every individual patient before prescribing a medicine or combinations of medicines. Some of the factors determining the course of treatment and management of Hepatitis-C are listed below:
  • Genotype of HCV.
  • Viral load ( The quantity of virus present in blood stream)
  • treatment history ( Previously treated or untreated patient)
  • degree of damage to liver (Cirrhosis).
  • status of patient,i.e., if patient is a liver transplanted patient or a candidate for a planned liver transplant in future.
  • Patient's general health and tolerability of treatment.
The invention and approval of sofosbuvir a new drug for treating Hepatitis-C infection have brought in a dramatic change in the outcome of treatment of HCV. Sofosbuvir can be used in combination with ribavirin or as a three drug combination of Sofosbuvir,pegylated Interferon Alfa and ribavirin. There are contraindications for Sofosbuvir and it should not be used as an empirical therapy for every Hepatitis-C patient.

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Medical Treatment of Afghans in India

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Medical Treatment of Afghans in India

CMCS Health an NCR-India based registered medical and healthcare consultancy firm has signed an agreement with Ghazali Memorial Hospital, Kabul, Afghanistan for Specialized Medical Treatment of Afghans in India. A very high number of Afghan people come to India for various medical treatments. As there is no governing or regulating body, many of these guests fall in hands of touts, who do not have a medical background and these guests lands up at wrong hospitals and wrong specialist doctors and spend a big amount of money on their medical treatments.

Medical Treatment of Afghans in India

Many times the guest are not even aware of the medical treatment required before starting from their country, the course of treatment and approx. cost of medical treatment and India and hospital stay required.

CMCS health and Ghazali Memorial Hospital in Kabul Have decided to bring in more transparency and organize the medical treatment of Afghans in India in a patient benefiting manner.

According to Dr. Walidullah Adil Sahibzada from Ghazali Memorial Hospital, Charleston Qalai, Ghaibi, Kabul, Afghanistan many provinces in Afghanistan does not have proper diagnostic facilities and medical treatment facilities for complicated medical procedures. Awareness among the population is also low. These people are targets for the touts who are eyeing these people for making some fast money. Ghazali Memorial hospital has entered an agreement with CMCS Health to provide video conferencing facility for these guests with treating Indian doctors. An initial screening and basic investigations will be performed at Ghazali Memorial Hospital, the reports will be sent to CMCS Health, who on their part, discuss the case with concerned leading specialist doctors from India and enquire about treatment course, cost and outcome of the treatment. Ghazali Memorial Hospital with CMCS Health's collaborations, help the patient in choosing to treat hospitals and doctors as per their needs and budget. A treatment offer letter is given to the patient with all relevant details in Kabul, Afghanistan, empowering them with all the information about treating doctor, treating hospital, the course of treatment, cost of treatment and logistics even before they start from their country.

Medical Treatment of Afghans in India

On the patient's coming to India, their medical treatment, stay arrangement is well coordinated by CMCS Health, to ensure the patient's best interest and benefits. As per MOU between CMCS Health and Ghazali Memorial Hospital, campaigns for awareness and screening of cancer, kidney and liver diseases, blood cancer and thalassemia will be conducted in all the provinces and then consultation and possible medical treatment will be given to Afghan patients by expert Indian specialist doctors, who will keep on visiting Ghazali Memorial Hospital. These visiting Indian specialist will also train Afghan doctors and paramedical staff for effective management of these life-threatening conditions.

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Scoliosis,Spinal fusion and decompression surgery | Best Spine surgeon in India

Idiopathic-degenerative Scoliosis | Treatment in India|Spine Surgery in India.

Idiopathic-degenerative Scoliosis|Treatment in India|Spine Surgery in India.

Scoliosis is an abnormal sideways (Lateral) Curvature in spine.At CMCS Health,we are associated with best Spine Surgeons of india for cost effective treatment of Idiopathic-degenerative scoliosis| treatment in India|Spine Surgery in India for our Global Guests. Scoliosis treatment depends on age,Abnormal curvature in spine and how this curvature is affecting the quality of life of the person.

Idiopathic scoliosis treatment in India:

When the abnormal curvature in spine is unexplained ,it is called idiopathic scoliosis. Young adults and children are more affected with idiopathic scoliosis. Idiopathic scoliosis treatment in children involves Periodic Observation with Imaging diagnostics to monitor the increase in abnormal curvature of spine,Casting,bracing and spinal fusion surgery as the final step if the condition is severe and affecting quality of life. The surgery may require repetition to keep the pace with child's growth.Young Girls are more prone to idiopathic scoliosis as compared to boys.

Degenerative Scoliosis treatment in India:

Degenerative scoliosis affects the elderly adults. The possible factors responsible for Degenerative scoliosis are arthritis,osteoporosis,a trauma to spine may be because of some injury or illness.usual wear and tear to spine due to ageing, osteoporosis,muscular dystrophy,Vertebral compression fracture and degeneration of disc.Another scoliosis cause may be a benign ,non cancerous tumor in spine,which puts undue pressure on nerves and spinal cord and patient may start bending in the opposite direction to avoid putting pressure on tumor ,which causes a postural bending. Degenerative scoliosis causes pain in mid to lower back,a pain that shoots from lower back and radiates to legs,numbness and weakness in legs and feet.

Signs and Symptoms of Scoliosis:

The signs of idiopathic scoliosis are very sublime and are felt only when the curvature of spine is big and it start affecting the normal functioning.The most common symptoms of scoliosis is a change in posture,a sideways or lateral bending on one side,The affected person may feel that there clothes do not fit them as they used to previously or the pant legs are longer on one side.Scoliosis may cause head to appear off center and one shoulder or hip appear to be higher than the other side.The severe cases may cause difficulty for lungs or heart to function properly.,culminating in shortness of breath or chest pain.

Who are at risk of developing Scoliosis?

Age is one of the risk factors,as symptoms for idiopathic or child scoliosis start appearing between the age of 9 to 15 years.Girls are more prone to be affected than the boys. A genetic history is also considered to be one of the causes.
Earlier it was thought that scoliosis was only a childhood condition but now there are increasing evidences of elderly people getting affected. Arthritis and osteoporosis also increases the risk of Scoliosis in elderly patients.

How Scoliosis is diagnosed?

Scoliosis is diagnosed with physical examination by the treating doctor and is confirmed with diagnostic imaging techniques like,X-ray,CT-Scan and MRI.

Idiopathic-degenerative Scoliosis |Treatment in India|Spine Surgery in India.

Treatment for Idiopathic Scoliosis:

The treatment for idiopathic scoliosis which is common in children involves periodic Observation with diagnostic imaging techniques to keep on monitoring the increase in abnormal curvature of spine,casting,bracing and Spinal fusion surgery as a last resort if the curvature is more than 40%. The child may need subsequent surgeries to keep up pace with growth of child.

Treatment of Degenerative Scoliosis:

Treatment of degenerative scoliosis may involve either one or two procedures. Namely Spinal Fusion surgery or spinal decompression surgery.The aim is to reduces the pressure on spinal chord and give room to nerves.

Post Spine surgery care and Management:

Surgeon advises physiotherapy post the spine surgery for gaining strength in muscles.Antibiotics are prescribed to reduce chances of infection and pain relieving medicines are given to reduce any pain or discomfort. Patient is advised to avoid forward or backward bending as it carries the risk of dislocation of the implants till bone fusion takes place.

Dr Hitesh Garg is Consultant spine and scoliosis surgeon at Artemis Hospital Gurgaon,India.

 
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Liver Transplant in India

Liver Transplant in India | Best liver Transplant In India

Liver Transplant in India

Liver Transplant in India-At CMCS Health we are associated with best Indian Liver transplant Hospitals and best indian Liver transplant surgeons for Best and Cost Effective Liver Transplant in New Delhi-NCR,for our Global Guests. Dr. Anupam Saha did his Post Graduation in General Surgery from Armed Forces Medical College Pune and 2 yr Fellowship in Castro Intestinal Surgery from AIIMS New Delhi. He completed 1 yr Fellowship in Liver Transplantation from Kings College Hospital London.

Best and Cost-effective Liver Transplant in New Delhi-NCR, India.

Liver Transplant in India-He was entrusted to establish the only Liver Transplant Centre of the Indian Armed Forces at the premier Army Hospital Research & Referral, New Delhi in 2007. He was the lead Liver Transplant surgeon of the Indian Armed Forces and has the experience of more than 250 Liver Transplantations involving adult as well as paediatric patients. Performed India's First In Situ Split Liver Transplant in 2008 Performed Liver Transplant in the youngest recipient in India in 2010. Liver Transplant in India-Liver is necessary for survival of a human because of its complex functions in human body. Although liver dialysis techniques can be used for a short term survival but CURE definitely is a liver or hepatic transplant. Liver is the only human organ capable of regeneration. Even 25% of healthy and disease free liver can regenerate in to a full liver.

Best Liver transplant Surgeon In India

Orthotopic transplantation is the most common and widely used liver transplant procedure. in which the diseased liver in a patient is removed and replaced by a portion of liver donated by a healthy Live relative donor. The transplanted liver grows into the recipient to full functionality, and donor’s liver also regenerate to a full liver within few weeks. With the advent of newer class of immunosuppressant medicines, like tacrolimus ,the successs rates have increased many folds.

Best and Cost effective Liver Transplant in New Delhi - NCR,India.

What Liver Patients, require a liver transplant?

Anyone with an irreversible liver damage.Most transplants are done for chronic liver diseases leading to cirrhosis, such as chronic hepatitis C, alcoholism, autoimmune hepatitis, and many others.

Who is a Suitable Liver donor ?

Any member of the family, parent, sibling, child, spouse can donate their liver. The criteria for a liver donation include:
  • Being in good health and preferably of the same or bigger physical size as recipient.
  •  Having a blood type that matches or is compatible with the recipient's.
  • Being between 18 and 60 years old.
  • With the recent advances of noninvasive imaging, living liver donors usually have to undergo imaging examinations for liver anatomy to decide if the anatomy is feasible for donation. The evaluation is usually performed by doing current MDCT and MRI. This will allow to rule out un suitable donor and unnecessary surgery for donor.
Dr Anupam Saha is one of the most experienced liver transplant surgeons of India and director of Liver transplant surgery at Fortis Memorial Research Institute,Gurgaon,India.

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Infertility Treatment in India

Infertility Treatment in India |IUI |IVF| ICSI | IMSI specialists.

Increasing Infertility is one of the major causes of stress in married couples. Infertility can be both primary and secondary.With the advancement in diagnostic procedures and surrogacy,more and more infertile couple are realizing the dream of holding the own bundle of joy in their hands. We offer cost effective Infertility treatment in India| IUI | IVF | ICSI | IMSI | specialist, with globally at par success rates. Dr Nalini Gupta,Founder Director of “Harmony” the super specialty assisted conception program center at Park Hospital,Gurgaon has done her MBBS,MD and M Sc. in clinical Embroyology from Leeds.(United Kingdom).

Infertility Treatment in India

Dr Nalini Gupta is pioneer in field of reproductive medicines and assisted conception programs for infertile couples. Her vast experience and qualification combined with empathetic attitude and religious zeal in the field of managing the infertility among the couples have paved way for A center for reproductive medicine and fertility as a center par excellence with success rates at par with the leading Assisted reproductive treatment centers in the world.

Infertility Treatment in India

The biggest dilemma faced by the married couple these days is to not be able to produce their own bundle of joy.It is still a big social stigma in a conservative society like ours. The Sedentary and ever demanding life styles and environment is creating a big havoc even among the otherwise healthy couples in realizing the biggest joy of their life.

Infertility Treatment in India

Many of these infertile couple can be helped by counseling and recent advent of newer technologies. An Initiative to overcome this ever growing menace has been taken by Dr Nalini Gupta Fertility specialist At Park Hospital,Q-Block,South city-II,Sohna road,Sector 47 ,Gurgaon Haryana. The Biggest joy for a married couple is to have an offspring of their own. The little bundle of joy completes the cycle of life.

Infertility Treatment in India

The biggest dilemma faced by the married couple these days is to not be able to produce their own bundle of joy It is still a big social stigma in a conservative society like ours. The Sedentary and ever demanding life styles and environment is creating a big havoc even among the otherwise healthy couples in realizing the biggest joy of their life. Many of these infertile couple can be helped by counseling and recent advent of newer technologies.

Who require Medical Treatment ?

A healthy couple living together for more than one year and having frequent copulation without any contraceptives and still not conceiving,may be require assisted conception techniques. The chance of getting pregnant in each menstrual cycle (each month) is calculated to be one in four for an average fertile couple. However, it may take a long time to conceive, even if everything is normal. Eight out of every ten women trying for a baby will fall pregnant within the first year. Women who do become pregnant without any medical assistance generally do so within two years of trying. It is common for couples to seek help and advice if there is difficulty conceiving. Overall, around 15 per cent (one in six) of all couples will seek help. The point at which they may want to seek help will depend on various factors. For example, if they are over 35 years of age or if they have any worrying symptoms, such as infrequent periods, the couple should seek help after about six months of trying.

Which partner need Treatment ?

Both the male and female partner may require a thorough evaluation for knowing the exact cause. After knowing the cause a suitable treatment option is chosen.

Management of infertility may be both medical and surgical:

Medical Management:

For correction of hormonal imbalance, Ovulation induction using gonadotrophins in female partner and increasing sperm count and sperm mortality in male partner.

Surgical Management:

Surgeries may be required for uterine fibroid, or blocked fallopian tube in female partner, and for Varicoceles etc. in male partner.

Infertility Treatment in India | IUI |IVF | ICSI | IMSI Specialist.

The Common Treatment course for management of Infertility are :

In vitro fertilization (IVF) Intra-cytoplasmic sperm injection (ICSI) Donor insemination for male factor infertility. • Egg donation for female factor infertility.

Dr Nalini Gupta is an Experienced infertility specialist in India with many successful infertility treatments in her patients. The patient benefiting and ethical approach has made Dr Nalini Gupta a well known name among infertility specialist doctors.

Dr Nalini Gupta is Senior visiting consultant at Miracle IVF center,Director at Harmony, a center for reproductive medicine and fertility and Owner of Dyanamic Fertility and IVF Center in South-Ex New Delhi.

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Spine Surgery in India- CMCS Health

Spine Surgery in India- CMCS Health

Spine Surgery in India-Many of the patients of lower back pain can be helped with proper investigation and subsequent diagnosis. Decompression is done to relieve the pressure over nerves by removing,the diseased discs, ligament flavum and bone which is pressing over the nerves.

Spine Surgery in India

Lumbar fusion surgery is designed to create solid bone between the adjoining vertebras, eliminating any movement between the involved bones. The goal of the surgery is to reduce pain and nerve irritation.We at CMCS Health are associated with Best Neuro. Surgeons of India and well equipped and well manged treatment centers to offer Best Spine surgery in India for our Global guests.

Decompression and Spinal Fusion Surgery:

In this surgery, diseased discs would be excised and  replaced with spacer device, Pedicle screws and rods are attached to the back of the vertebra and an interbody fusion spacer is inserted into the disc space from one side of the spine. The surgery is known as spinal fusion surgery.

Spine Surgery in India

Dr. Hitesh Garg is senior consultant in Neuro-Surgery Department at Artemis Hospital ,Gurgaon,India.

Dr Hitesh has extensive experience in spine surgery having trained from the best spine centers of the world and India.

Spine Surgery in India

Dr. Garg specializes in the comprehensive treatment of numerous conditions affecting the cervical, thoracic, and lumbosacral spine including degenerative disc disease, scoliosis, trauma, infections, and tumors.

Spine Surgery in India

He has performed more than 2000 spine surgeries including more than 1500 spinal fusions, 250 deformity correction procedures (Scoliosis and kyphosis), 150 lumbar and cervical artificial disc replacements.

if you want to visit india for the treatment of spine surgery you can contact to the best spine surgery in india dr hitesh garg For The treatment OF india .he has the leading india best soine surgery in india for the treatment,

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Bone Marrow Transplant for AML in India

Thalassemia Treatment in India | Gurgaon | Delhi -CMCS Health.

Thalassemia Treatment in India | CMCS Health.

Thalassemia is a genetic disorder which affects the hemoglobin in a patient. The conservative treatment consists of recurrent blood transfusions. These recurrent blood transfusion may cause iron overload in the patient and subsequently bone deformity,

Thalassemia Treatment in India

liver damage and other health complications follow. Bone marrow transplant is considered a viable treatment option for pediatrics thalassemic patients. At CMCS Health, we offer Child Thalassemia treatment in India at Best BMT Hospitals in Delhi.,with the best specialist indian medical doctors at well equipped and well managed treatment centers and hospitals at an affordable and reasonable cost with very good success rates.

What is Thalassemia?

Thalassemia is a medical condition in which the affected person's body produces abnormal hemoglobin. This abnormal hemoglobin gets the excessive and premature destruction of RBCs subsequently causing anemia in the affected person. A person with thalassemia may require frequent blood transfusions depending upon type and severity.

What are the causes of Thalassemia?

Thalassemia is a mutation in genes responsible for hemoglobin production. It is a genetic or hereditary disorder, which means the disease is passed on to the patient by the parents who are the carrier of the disorder.

What are the Types of Thalassemia?

Thalassemia can be broadly classified as Alpha and Beta Thalassemia. There are many subtypes of Thalassemia.

Understanding Thalassemia:

Hemoglobin molecules are made up of Alpha and Beta parts. Both Alpha and Beta parts are prone to genetic mutations.

Alpha Thalassemia :

Alpha Thalassemia is more common among the south east Asians , south china,India, Africa and middle eastern countries. Four Genes are involved in formation of Alpha Hemoglobin chain. A child will acquire two each from both father and mother. One mutated gene either from father or mother out of the four genes,causes either no symptoms or mild symptoms in child,the child will grow as healthy human being but will be called a silent carrier of Alpha Thalassemia.

Thalassemia Treatment in India

Two mutated genes either from father or mother,the symptoms will be mild in child, such a thalassemia is called Alpha thalassemia minor. Three mutated genes will cause moderate to severe anemia in child. The child will have chronic anemia and will require regular blood transfusions throughout his/her life.This medical condition is also referred as Hemoglobin H disease. Mutation in all four genes is called Alpha Thalassemia major or Bart hydrops fetalis.Fetuses with mutations in all four genes do not survive or die shortly after birth. Blood transfusion given to fetus with four gene mutations rarely works and have very low success rates.

 Beta Thalassemia:

Beta Thalassemia is more common among the people of mediterranean region. The prevalence is high in North Africa and west asia. Substantial population in Maldives and certain islands in Indian ocean are the careers. Two genes one each from the father and mother constitutes Beta hemoglobin chain. One gene mutation causes mild symptoms and are referred as Beta Thalassemia minor. If both the genes have mutation, the signs and symptoms may vary from moderate to severe.The affected condition is called Cooley's Anemia or Beta Thalassemia Major. Babies born with mutations in both genes are usually born as healthy child but develops complications of thalassemia within two years of birth.Another form of Beta Thalassemia with both genes mutation but with milder symptoms is called Beta Thalassemia Intermedia.

What are signs and symptoms of Thalassemia?

The signs and symptoms of thalassemia depends on it's type.

Signs and Symptoms of Alpha-Thalassemia:

Majority of children with Alpha-Thalassemia or Hemoglobin-H disease are healthy in general.Symptoms may vary from mild to moderate anemia,Fatigue,drowsiness,pale skin or jaundice,abnormally cold hand and feet ,chest pain,frequent headaches,shortness of breath, dizziness and feeling of impending being faint.enlarged spleen and possibly soft to touch and enlarged liver,they may also have deformity of bones,forehead,cheeks ans jaw may overgrow.

Signs and Symptoms of Beta Thalassemia:

Signs and symptoms of Beta Thalassemia ( thalassemia major or Cooley's anemia ) is generally severe and patient may require regular blood transfusions, the symptoms may include jaundice, frequent infections,cold hand and feet,shortness of breath,a general feeling of malice and being tired,poor appetite,skeletal deformity,delayed growth and delayed puberty,iron overload in body that can harm spleen,heart and liver.

How Thalassemia is diagnosed|

Different diagnostics tests are recommended by treating doctor,if he/she suspects the patient to have Thalassemia.
  • Complete Blood Count ( CBC) is recommended for hemoglobin levels,as thalassemia patients usually have lower hemoglobin.
  • Microscopic examination: is conducted to ascertain any abnormality in RBCs,Thalassemia patients RBCs are smaller in size as compared to an unaffected person.RBCs with uneven hemoglobin distribution,that gives Bull's eye appearance under the microscope.
  • A reticulocyte Count is done to ascertain how fast RBCs are formed by the bone marrow and released in blood.
  • Hemoglobin electrophoresis separates different molecules in RBCs,allowing identification of abnormal RBCs.
  • DNA Analysis  is done to diagnose thalassemia or to ascertain if the person is carrier of mutated hemoglobin gene cells.
  • Iron tests in blood  are done to ascertain if the patient's anemia is because of thalassemia or iron deficiency,as thalassemic patient's do not have Iron deficiency.
  • Physical examination is conducted to ascertain enlarged spleen.

    Thalassemia Treatment in India | CMCS Health.

Treatment for moderate to severe thalassemia may involve frequent blood transfusions.Frequent blood transfusions may cause iron overload in patient's body which in longer run may damage spleen,heart and liver. Iron Chelation is removal of excess iron from the blood. Patients may be prescribed subcutaneous injections of deferoxamine or oral deferasirox. Bone Marrow or Stem Cell transplant is a better treatment option for Thalassemia. Chemotherapy cycles given to the patient prior to BMT for destroying abnormal cells and once the patient is in remission phase,bone marrow from a compatible donor preferably a sibling is transplanted in thalassemia patients. Surgery is also done for some patient with bone deformity and sometimes surgery  removal of spleen and gall bladder is also done.

Thalassemia Treatment in India

Dr Vikas Dua is consultant Pediatrics bone marrow transplant specialist at Fortis Memorial Research Institute Gurgaon,India.

Dr Vikas Dua did his advanced Fellowship in Pediatrics Bone Marrow Transplant from National University Hospital Singapore and also did his training in child BMT from world's No.1 institute in pead.BMT ,St. Jude's Children research Hospital Memphis,USA.

Thalassemia Treatment in India

Dr Vikas dua has done several successful child thalassemia treatments by bone marrow transplant procedures for children suffering from Thalassemia not only from India but from Afghanistan,Iraq and Africa too.

 

   
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Robotic assisted Pyeloplasty | dr.anant-kumar

Best Kidney Transplant Doctors in India – CMCS Health

Kidney Transplant Doctors In India -CMCS Health

Best Kidney Transplant Doctors in India-Get the opinion of Best kidney transplant doctors in India -CMCS Health.Kidney diseases are on rise. Life styles,dietary habits and excessive alcohol and tobacco consumptions are the major factors responsible for kidney diseases. In India there are many Kidney transplant specialist surgeons at many better equipped hospitals to provide successfull kidney transplants in India.

Kidney Transplant Doctors In India

Best Kidney Transplant Doctors in India-As the awareness and availability of organ donation post death are still in a very nascent stage, Kidney from deceased donors are not readily available and the patients suffering from end stage renal disease requiring a kidney transplant depend on donation from alive family members for live donor kidney transplants.

Who can be a live donor for a Kidney transplant patient in India?

Best Kidney Transplant Doctors in India-A healthy blood related family member usually a son or daughter/parents,grandparents and grandchildren and brothers and sisters are considered blood relations. The donor needs to be a major in the age group of 18-55 years preferably and healthy enough to donate one of his kidneys,without any risk to his quality of life post donation.

Best Kidney Transplant surgeon in India

Best Kidney Transplant Doctors in India-Prelim tests for fitness and compatibility of donor are done for screening and choosing the correct donor for a successful kidney transplant. Any other relative is considered unrelated donor and certain documents are needed to prove to Government of India appointed organ transplant committee that donor is related to patient requiring kidney transplant. And donor is willing to donate one of his kidneys to patient out of love and family bonding and not under any pressure or monetary obligations.

What happens to a Liver Donor post kidney donation?

Best Kidney Transplant Doctors in India-A healthy and fit donor lives a perfectly normal life post the donation of one of his kidneys. The doctors do advise him certain do's and do nots post donation. Anything which is not good for health of a person with both kidney functioning normally is also considered bad for the live donor.Regular and periodic check ups are suggested for a live donor. As high blood pressure and diabetes are considered two major causes of kidney function going bad,the donor is advised to follow a healthy life style for remaining disease free.

Does a live donor have a health risk or compromised life post kidney donation?

A healthy donor lives a perfectly normal life,post donation. Donation of a kidney does not have an adverse effect on overall life or quality of life for the donor.

Best Kidney Transplant Surgeon in India

Selecting the right donor is important as it cut down the cost of dialysis and the need of frequent admission of patient till the time we get approval from the government of India appointed transplant committee for kidney transplant. Once the approval is given by the Committee, patient is given a date and time for surgery. The following test for donor are required to lessen the chances of flying in a wrong donor and saving time and money for guests till we fly in the right donor.

Best Kidney Transplant Surgeon  in India

1. Urine ( SPOT) ,Protein creatinine ratio,LFT (Liver function test),Urea,Creatinine,Sodium(Na),Potassium (K),Blood sugar( Fasting and Post prandial),HBA1C, Calcium (Ca),Phosphate (Po4),Uric Acid,PTH,Lipid profile,Vitamin D level,T3.T4,TSH and LDH. 2.Complete Haemogram,BT,CT,PT,PTTK and urine routine. 3.Urine culture,CMV-IGG,EBV(CAPSId)_IGG, for MALE patient PSA (if above 50 years of age). for Female patient CA-125 and pap smear. 4.Blood group,HBSAG,Anti HCV antibody,HIV1 & 2, HCV RNA qualitative,Anti HBS antibody. 5. ECG,Echo/stress echo,Cardiac clearence. 6.Chest X-ray,Ultrasound-whole abdomen,CT (Angio) for renal vessels,DTPA scan etc.

Best Kidney Transplant Doctors in India -CMCS Health.

Doctor Prof. Anant Kumar is Director-Urology,robotics and Kidney transplantation at Max Hospital,saket, New Delhi, India.

 

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Bone Marrow Transplant for AML in India

Bone Marrow Transplant for AML in India

Bone Marrow Transplant for AML in India

Bone Marrow Transplant for AML in India-BMT (Bone Marrow Transplant) or Hematopoietic stem cell  transplant is newer medical Intervention for treating hematological malignancies (Blood Cancers) and non malignant medical conditions in children.In this blog,we are discussing the the disease AML,how AML is diagnosed,what are the classific ation method for AML, treatment choices for AML and Bone Marrow Transplant for AML in India.

What are Indications for BMT in Children?

Bone Marrow or Hematopoietic Stem cell transplant is indicated in certain hematological malignancies as well as non malignant medical conditions in Children. The major indications for BMT in children because of blood cancers are: Acute Myeloid Leukemia (AML) Acute Lymphoblastic Leukemia (ALL) The non malignant medical conditions requiring BMT are: Sickle cell disease and Thalassemia. Aplastic Anemia or other Bone marrow Failure Syndrome. Immune deficiency diseases,inherited metabolic disorder and others.

Bone Marrow Transplant for AML in India

  In this Blog we will highlight the need of Bone Marrow Transplant for AML ( Acute Myeloid Leukemias) Acute Myeloid Leukemia (AML) is a kind of blood cancer.It may consists of multiple disorders involving replacement of healthy bone marrow with abnormal primitive hematopoietic cells. It may affect both adults and children.AML can affect children of any age and sex. A subdivision of AML helps the treating doctor chose the best treatment option and ensure better treatment outcome. AML can be subdivided in a cluster of diseased medical conditions.The most common and widely used classification for sub division of AML is French-American-British system also known as FAB. Another newer subdivision recommended by World Health Organization known as WHO system is also prevalent.

As per FAB ,AML subdivision is as follows:

M0 - AML with minimal evidence of myeloid differentiation. M1 - AML without maturation. M2 - AML with maturation. M3 - Acute promyelocytic leukaemia (APL) M4 - Acute myelomonocytic leukaemia M5 - Acute monocytic/monoblastic leukaemia M6 - Acute erythroleukemia M7 - Acute megakaryoblastic leukaemia

Subdivisions of AML as per WHO System:

(Rarely used in pediatrics patients) AML with characteristic cytogenetic translocations. AML with multilineage dysplasia. AML and myelodysplasia syndromes secondary to therapy. AML not otherwise categorized.

Signs and Symptoms of AML in children: Bone Marrow Transplant for AML in India

As we have discussed in earlier slides that AML is not one disease but a cluster of associated medical conditions. The signs and symptoms can also be classified according to diseased medical condition. Symptoms due to deficiency of normal functioning cells: Cytopenia,Anemia.Hemorrhage and fever. Symptoms due to infiltration of abnormal leukemic cell: Extramedullary infiltration,Mediastinal mass which may cause superior Vena Cava Syndrome or respiratory insufficiency. Abdominal masses causing pain or obstruction in GI or urogenital tracts. Gingival hyperplasia. CNS infiltration.

Causes and factors responsible for pediatric AML:

Causes and factors for AML in children are still being studied.Nothing concrete can be said but the things which may be linked to AML in children are: Children with genetic disorders such as downs syndrome or Li Fraumeni Syndrome are considered to be at a higher risk of developing Pediatric Leukemia. Although very small,but children with siblings having AML stand a risk of having AML. Children suffering from Non malignant medical conditions like Aplastic anemia and MDS (myelodysplastic syndrome) also stand the danger of getting AML. Link between exposure to radiation,living nearby high voltage power lines and certain chemicals and pesticides are being studied.

Treatments for AML| Bone Marrow Transplant for AML in India

The treatment for AML is guided with intention of destructio  of the leukemic cells and enabling the bone marrow to produce normal cells and function in a normal way. Chemotherapy is the back bone of AML treatment. A combination of chemotherapeutic or Anti cancer medicines are used for the optimum results and lower side effects.

The treatment of AML is multiphasic.

The first phase is usually called as induction phase. The aim of induction phase is to destroy abnormal leukemic cells. Induction phase involves chemotherapy with combination chemotherapeutic agents for at least for two chemotherapy cycles. A bone marrow test is conducted at the end of this phase to ensure that the child is free of leukemia.If there is no evidence of leukemia ,the child's condition is referred as being in remission. Two more cycles of chemotherapy are given to child post the induction phase,to ensure destruction of any left over leukemic cell in blood or bone marrow and prevent any relapse.

Bone Marrow Transplant For AML in India:

Bone Marrow Transplant or BMT is recommended for treatment of AML when the disease has relapsed or the treating doctor feels that the child is at a higher risk for relapse. Sometimes AML may develop in CNS ,that is spinal chord and brain and in such cases intrathecal chemotherapy is administered to child directly in spinal fluid.Sometimes radiotherapy to brain is also used in conjunction.  

Dr Vikas Dua is Senior Consultant at DEPT. of Hematology and BMT at FMRI,Gurgaon,India.Artemis Hospital is well equipped and well manged for a complicated medical procedure like BMT.

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