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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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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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Spine Treatment In India

Spine Treatment In India

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.
Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Types of spinal stenosis

The types of spinal stenosis are classified according to where on the spine the condition occurs. It's possible to have more than one type. The two main types of spinal stenosis are:
  • Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
  • Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It's the most common form of spinal stenosis.

Spinal stenosis care at CMCS Health care

Symptoms

Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.

In the neck (cervical spine)

  • Numbness or tingling in a hand, arm, foot or leg
  • Weakness in a hand, arm, foot or leg
  • Problems with walking and balance
  • Neck pain
  • In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)

In the lower back (lumbar spine)

  • Numbness or tingling in a foot or leg
  • Weakness in a foot or leg
  • Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
  • Back pain

When to see a doctor

See your doctor if you have any of the symptoms listed.

Causes

The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves). Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:
  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget's disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk's exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
  • Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
  • Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
  • Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.

Risk factors

Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes.

Complications

Rarely, untreated severe spinal stenosis may progress and cause permanent:
  • Numbness
  • Weakness
  • Balance problems
  • Incontinence
  • Paralysis
Treatment From Mayo Clinics
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Cardio-Thoracic Surgeries In India

Cardio-Thoracic Surgeries In India

Cardiothoracic Surgery involves surgical procedures involving organs in the thoracic cavity,i.e. heart ,lungs,esophagus and other organs in chest. At CMCS Health ,we offer the best and most cost-effective Cardio - thoracic surgery in India with most experienced Indian cardiac surgeons at best equipped and well managed Hospitals. The Cardio - Thoracic surgeries we offer for our Global guests includes :

CABG ( By pass Heart Surgery ) :

Valve Replacement Surgery :

Heart failure Surgery:

Minimally Invasive Surgery:

Thoracic Surgery:

 

Dr Rajneesh Malhotra is the chief of cardiac surgery at Max Super speciality hospital ,Saket,New Delhi. Dr Rajneesh has specialized in minimally invasive cardiac surgery ,CABG (Bypass Heart surgery),Mitral valve replacement and repairs,Aortic valve replacement and repair and Atrial septal defects .

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Multiple Myeloma – Treatment in India.

Multiple Myeloma Treatment In India

Multiple Myeloma is a diseased medical condition involving plasma cells. Normal plasma cells are found in the bone marrow and form an integral God gifted immune system for a healthy Individual. At CMCS Health we are associated with Best Hematologist and BMT specialist from India for cost effective treatment of hematological malignancies in India. We Offer cost effective Multiple Myeloma -  Treatment in India for our Global guests seeking specialized medical treatment in India.

What is Multiple Myeloma:

Multiple Myeloma is a diseased medical condition involving plasma cells. Normal plasma cells are found in the bone marrow and form an integral God gifted immune system for a healthy Individual. In Multiple Myeloma patients the normal plasma cells are converted into Malignant plasma cells. These Myeloma plasma cells produce large quantities of abnormal immunoglobulins called M Protien. The large quantities of this abnormal immunoglobulin hampers the production of normal blood cells in Multiple myeloma patients.

Symptoms of Multiple Myeloma:

Although many of the patients suffering from multiple myeloma may not exhibit or feel any symptoms and it is diagnosed because of some lab. tests recommended by a clinician for other health complaints of the patients. The common symptoms of Multiple myeloma experienced by patients are:
  • Pain in bones ,which could be in all skeleton system but more prominent in skull,back or hips. Patients of multiple myeloma can easily fracture their bones even with a slight stress or injury because of weakening of bone (osteoporosis ) either in the entire skeletal system or at a place of plasmacytoma.
  • A routine CBC recommended by a physician to rule out a health complaint reveals low RBC , WBC and platelets.Low RBCs cause fatigue , a general feeling of malice and not being well, difficulty in breathing and dizziness. Low WBCs will make patient prone to frequent infections and some patient may have pneumonia. Low blood platelet count may culminate  in delayed blood clotting time and excessive bleeding even with a minor cut or bruise .
  • Hypercalcemia or excess calcium in blood may cause extreme thirst and drinking of plenty of fluids and frequent urinating, dehydration,kidney problems,severe constipation, loss of appetite ,a feeling of drowsiness and confusion.
  • Spinal cord compression in multiple myeloma patient because of weakening of bones and collapsing of spinal vertebrae may cause muscle weakness and numbness in legs or sudden severe back pain.
  • Other more severe symptoms may include congestive heart failure, enlarged liver and spleen ,enlarged tongue ,skin changes, persistent diarrhoea and numbness and weakness in hands called carpal tunnel syndrome.

Diagnosis Of Multiple Myeloma:

Once a clinician suspects that a patient is having multiple myeloma ,he recommends certain blood ,urine , a bone marrow biopsy , Xrays ,CT scans and MRIs to confirm the diagnosis.

 Multiple Myeloma - Treatment in India:

The treatment of multiple myeloma depends on staging done by a hematologist. Usually treatment of multiple myeloma consists of chemotherapy and supportive care , radiation therapy ,surgery in certain cases and Bone Marrow or Stem cell Transplant.

BMT or Stem Cell Transplant for Multiple Myeloma:

 

Follow up Post Multiple Myeloma Treatment:

   
Dr. Pawan Kumar Singh - Blood Cancer | BMT specialists is well qualified and well trained in field of Hemato Oncology and Bone Marrow Transplant among Indian clinical hematologists.

Dr Pawan Kumar Singh currently heads the Hematology and Bone Marrow Transplantation department at Artemis Hospital in Gurgaon, India

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Fibroscan Treatment in India -CMCS Health

Diagnosing Liver Health |Liver transplant Treatment In India

Fibroscan is  a pain free,risk free and convenient way for diagnosing Liver fibrosis. A fibroscan can monitor the progression of an individual's liver disease and gives an accurate quantitative measure of success of treatment. It can also suggest life style modifications required for maintaining a healthy liver and ensure stopping further damage to already damaged liver.

Diagnosing Liver Health - Fibroscan :

Fibroscan is the latest technology for assessment of liver stiffness. Liver tissues are spongy naturally but in a diseased liver the spongy tissues undergoes fibrosis. A fibroscan is an instant ,non-invasive and painless diagnostic test for knowing liver health. The newer and latest versions of A Fibroscan machine can also measure Liver fat.

Advantages of Fibroscan Over normal ultrasound scan:

A normal ultrasound of liver can detect only tumors of liver ,Cysts, abscesses , structural lesions of liver and gallstones. Whereas a fibroscan can detect significant liver fibrosis even in early stage. It can also estimate liver fat accurately ,even in early stage.

Who can benefit from Fibroscan :

A fibroscan can diagnose liver health accurately for everyone but those who stand a high risk of liver tissue degeneration can benefit tremendously from a fibroscan.
  • People known to have chronic liver disease.
  • Frequent Alcohol consumers.
  • Obese or overweight people ( When body mass index is more than 23.5)
  • Abnormal liver function test.
  • Enlarged liver.
  • Diagnosed with fatty liver.
  • Diagnosed with hepatitis-B or Hepatitis-C infection.
  • Diabetics.
  • Family history of liver disease.
  • A possible Liver Donor.

Duration of Fibroscan:

No Hospitalization is required for fibroscan. It takes approx. 10 minutes and reports are printed immediately. A person can go to home immediately after a fibroscan as it is pain free and done without sedation.

How Fibroscan is done:

A person undergoing fibroscan lie on his/her back with right arm raised behind the head. The Technician operating Fibroscan applies a waterbased gel to skin of the person undergoing fibroscan. A fibroscan probe is placed with a little pressure at the abdomen of the person. The fibroscan probe sends a sheer wave into liver and the on board computer registers the data and values. Ten such readings are noted by placing the probe at different places and the average gives the result.

Who should be advised to not undergo a Fibroscan:

A Fibroscan is a generally safe diagnostic tool for diagnosing liver health but
  • Anyone who has implantable device such as a pacemaker or defibrillator.
  • Pregnant Females.
  • People with abdominal ascities.
Dr Pawan Rawal MBBS , MD, DM Gastroenterology  is Unit Head -Department of Gastroenterology , digestive and liver diseases at Artemis Hospital ,Gurgaon.  

 
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The Inaugural CHS Program at AHH,Kabul.

Afghan Youth service Organization ,an NGO of Afghanistan, Registered with Islamic Republic of Afghanistan , started conducting A CHS ( Continuous health Support) Program with an Indian,Government of India and ministry of commerce registered medical and healthcare consultancy firm CMCS Health, to create awareness for medical and healthcare among the Afghan Nationals. The Inaugural CHS Program was conducted at The Capital city of Afghanistan,Kabul, Under the banner of AYSO, AHH ( Afghan Health Hospital ) and CMCS Health on 17th November 2016. The program was well attended by doctors from Various Government and private hospitals of Afghanistan. Presentations were made from attending Afghan Doctors ,Chairman of Taroon Group Dr Wahid Taroon and CMCS Health MD Mr. Arshad J. Ahmad about the current state of Medical and healthcare segment in Afghanistan and the corrective measures required for short term and long term improvement. Afghan Health Hospital ( AHH) proposed start of a state of art ,video conference facility for Tele consultation of Afghan patients coming to India for specialized medical treatment with Indian medical specialists. Training and exchange of ideas program through video conference of Afghan Doctors with their Global counterparts. OPDs of Indian Medical specialists doctors at Afghan Medical Hospital for Afghan patients on regular basis. Conducting workshops and training programs for Afghan Medical doctors , paramedical and nursing staff  At Afghan Medical Hospital for improvement in services for Afghan patients. Regular CMEs with international faculties at Afghan Health Hospital.  

   
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Robotic assisted Pyeloplasty | dr.anant-kumar

da vinci Robotic Prostatectomy In India.

da vinci robotic prostatectomy has considerable advantages over conventional laproscopic prostatectomy as it not only empowers the surgeon  to overcome shortcomings associated with both open prostatectomy and laproscopic prostatectomy but also offers better patient compliance.
Dr ( Prof.) Anant Kumar has good experience of performing da vinci robotic prostatectomy in India.
da vinci robotic prostatectomy offers higher resolution images and enhanced field of vision that empowers the surgeon with very precise movements inside the incision and thus less chances of residual malignant tissues and damage to surrounding healthy tissues. It not only reduces the recovery period for patient post surgery but also decreases chances of relapse of the disease because of the possibility of residual malignant tissues. As the incisions made during the da vinci robotic prostatectomy are much smaller in size,they reduces chances of any post surgery infections and lesser hospital stay for patients.  

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Arthroplasty

Knee Replacement surgery in India.

Knee replacement surgery

Knee joint replacement surgery is recommended for those who suffer from severe arthritis pain. Doctors recommend a knee joint replacement surgery usually for patients above 60 years but younger patients may also require a knee replacement surgery if all other treatments options are unable to bring in desired results. In younger patients who undergo a knee replacement surgery the chances of an early wear out are high because of hectic life styles that put additional stress on the artificial knee.

Know your Knee:

Human knee joint is the largest joint in human skeletal system. Knee joint is also referred as "Hinge Joint" because it is able to flex , bend and straighten like a door hinge.Like all bone ends  in the human skeletal system,the knee joint bones are also covered with a layer of cartilage. This cartilage acts as shock absorbing cushion to prevent wear and tear to bone ends because of continuous friction created by movements. In addition meniscus is a unique cartilage  between the joint surface of leg and thigh. Meniscus does not have a nerve ending or blood supply. Meniscus receives it's nutrient from a lubricant fluid called synovial fluid contained within the knee joint. Knee joint bones are surrounded by synovial lining that produces this moisturizing lubricant. In the absence of synovial fluid ( reasons may be due to a damage because of natural ageing or degenerative disease like arthritis or rheumatism ),meniscus is not able to repair itself from the wear and tear of continuous friction of knee movement. Ligaments,which are strong fibrous tissues link the bones of knee joint ,hold them in place,thus adding stability and elasticity for the knee movement.Muscles and tendons also support knee joint movements and keeping them stable.

 What Makes a person need Knee Joint replacement surgery ?

The major reasons for a knee joint replacement are severe arthritis,knee damage due to trauma or injury and knee pain.

Knee Joint Replacement Surgery:

Depending about severity of knee joint condition ,age,requirement of patient various surgical interventions are available to give the best treatment option to patients.
  • Arthroscopic debridement is removal of tissues of wear and tear by inserting a telescope in affected knee.
  • High Tibial Osteotomy is cutting of Tibia ( shin bone ) at the upper end and re aligning it to distribute the weight on knee joint. This is done for arthritic knees.
  • Unicondylar Knee replacement also called partial knee placement is a surgery performed by qualified and well experienced knee joint replacement surgeons ,where only the partially damaged portion of the knee is replaced or resurfaced and knee ligaments and unaffected cartilage is preserved.
  • Total knee joint replacement Surgery  is done for usually for patients with rheumatoid arthritis and when the entire knee joint is affected.
 

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Robotic assisted Pyeloplasty | dr.anant-kumar

Pyeloplasty – UPJ obstruction treatment.

Dr ( Prof.) Anant Kumar - Urologist | Kidney Transplant Surgeon is regarded as the best and most experienced Kidney Transplant Surgeon of India and Director-Urology,Kidney Transplantation and Robotics at Max Hospital,Saket,New Delhi,India.

What is Uretero-pelvic junction Obstruction?

Uretero-pelvic junction obstruction occurs when the flow of urine from the renal pelvis to proximal ureter have an obstruction. The condition may lead to Hydronephrosis. Hydronephrosis is a medical condition ,where the kidneys are swollen with urine because of narrowing or blocking of ureters. Ureters empty the urine from kidneys into urinary bladder. The resultant back pressure within the renal pelvis may cause progressive kidney damage or deterioration of kidney function. Uretero-pelvic junction obstruction may appear in children due to a congenital abnormality or even in adults following any previous surgery or any other medical condition that causes inflammation of upper urinary tract.

What causes pediatrics UPJ Obstruction ?

The exact cause of pediatrics uretro pelvic junction obstruction is still not known. Many times the defect is present in an unborn baby and is termed as congenital defect. It is diagnosed during routine prenatal ultrasound. There may be many reasons for UPJ obstruction during the gestation period. some of them are:
  • During the developing phase the child's ureter is not fully formed resulting in a narrowed section of ureter which may be blocked later on.
  • A faulty muscle in ureter wall which may not squeeze normally.
  • Formation of a "Crossing Vessel" ,i.e., an additional artery feeding the kidney of developing fetus. This may result in kinking or blocking of the ureter.
It can have a genetic component,i.e., it runs in families .Although the responsible gene is not identified yet.

What are symptoms for pediatrics UPJ Obstruction?

Sometimes a UPJ Obstruction in a child does not have any symptoms. A UPJ Obstruction in a developing fetus is usually observed during a routine prenatal ultrasound. It is detected because of hydronephrosis. In majority of cases it is corrected on its own after the child birth. But in moderate to severe condition the following symptoms may occur and they do need a medical attention as if left untreated,it may cause a permanent damage to kidney or urinary system of child.
  • The renal pelvis or kidneys or both are dilated (hydronephrosis).
  • Abdominal,back or flank ( sides) pain.
  • Frequent UTIs ( Urinary tract infections).
  • Edema
  • Swelling around eyes.
  • Lump in abdomen ( Abdominal mass).
  • Poor or retarded growth in infants.
  • Fever.
  • Rashes.
  • vomitting.
  • Bloody urine or diarrhea.
  • Abnormal urine output.

How UPJ Obstruction is diagnosed?

If Hydronephrosis is observed in a developing fetus during a routine prenatal ultrasound , doctor in charge for delivery of child will do more periodic ultrasound to keep a close vigil on any complications arising of the present medical condition. Many times this medical condition is resolved on it's own ,once the child is born. But the doctor may do following tests after a few week of birth of child.
  • Creatinine clearance.
  • BUN ( Blood urea Nitrogen).
  • CT Scan.
  • Electrolytes.
  • CT- Urogram.
  • Nuclear scan of Kidneys.
  • Voiding cystourethrogram.
  • Ultrasound.

What causes UPJ Obstruction in adults?

The reasons for UPJ obstruction in adults may be due to scar tissues,infection,any previous surgery or renal calculi (Kidney Stones). The other reasons may be:
  • A previous renal pelvic trauma.
  • Obstructing calculus immediately distal to PUJ.
  • Previous pyelitis with scarring.
  • Intrinsic malignancy,e.g. upper tract urothelial carcinoma.
  • Extrinsic ureter compression due to
  1. Fibrosis. 2. Crossing vessel at PUJ. 3.An underlying malignancy.

Symptoms of UPJ Obstruction in adults:

Adults may experience following symptoms because of UPJ Obstruction:
  • Renal colic.
  • Chronic back pain.
  • Other non specific signs may be hematuria,Urinary tract infections and pyelonephritis.

Treatment Options:

Treatment line depends on presence of underlying cause.In Majority of congenital cases,no intervention is required and the condition subsides after some time however in case of a definite structural obstruction ,surgical intervention in the form of pyeloplasty or stenting may be needed. Surgery is also inevitable in case of deterioration of renal function or when associated symptoms are severe and progressive.Aim of treatment is to normalize renal drainage and if possible,improve if  reversing the damage to kidneys is not possible.    

         
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Uterine Fibroids – Cause of female Infertility | Infertility treatments in India.

Uterine Fibroids - Cause of Female Infertility | Infertility Treatments in India.

We offer cost-effective Uterine Fibroids - Infertility Treatments in India. Uterine Fibroid is one of the factors associated with female factor infertility. Uterine fibroids are benign (non-cancerous growth) in the muscular walls of the uterus. They are common in women of childbearing age. Fibroids can be very small or big, sometimes they are huge too. There may be multiple fibroids in the uterus. Generally,  fibroids do not cause any problem or symptoms but in some women, because of the location and size, they may cause pain and heavy bleeding during menses. Fibroids are also associated with infertility in women of childbearing age. The formation and growth of uterine fibroids are estrogen and progesterone-dependent. Women in the age group of 25 years onwards and up to pre-menopause are more susceptible to fibroids, which may cause infertility. As more and more women are delaying pregnancy because of career goals, the chances of uterine fibroid being the cause of Infertility are increasing.

What are the factors responsible for Uterine fibroids:

The factors responsible for Uterine fibroids cannot be pinpointed. But the factors commonly associated with Uterine fibroids are the non-malignant mutation in a single cell, causing it to produce the abnormally larger amount of collagen and other proteins. Female hormones estrogen and progesterone play a role in the growth of uterine fibroids. Proteins common in bloodstream known as growth factors are also associated with formation of uterine fibroids.

Who are at risk of developing Uterine Fibroids:

postpubertal women are at risk of developing uterine fibroids, the risk is higher in the age group of 25 to 35 years.
  • A hereditary medical condition, if someone's mother or sisters have developed uterine fibroids, they are at increased risk of developing them too.
  • Women of African-American origin are at 2 to 5 times higher risk of developing uterine fibroids.
  • Obesity is associated with the formation of uterine fibroids.
  • deficiency in Vitamin-D may be one of the associated factors for uterine fibroids.

Diagnosis of Uterine Fibroid:

The treating Doctor may diagnose the uterine fibroid by taking the detailed history of the patient and by physical examination called bimanual physical examination. The treating doctor evaluates the shape and size of the uterus by inserting two fingers properly sterilized and gloved, into the cervix and surrounding pelvic regions while palpating the patient's abdomen above the pelvic bone with the other hand. Ultrasounds, hysteroscopy, hysterosalpingogram, CT Scans and MRI are confirmatory tests for Uterine fibroids and polyps.

Not all Uterine Fibroids or Polyps cause Female Infertility:

Not all uterine fibroids cause infertility. It is the location and size of uterine fibroid that makes the Infertility specialist suggest medical treatment for infertility. A uterine fibroid that may be blocking the passage of sperm to the fallopian tube to fertilize the ova needs to be treated. Uterine fibroids may also obstruct implantation of fertilized ova in the uterus to grow as an embryo. Large Uterine fibroids may cause miscarriage or natural termination of pregnancy and need to be treated. Uterine fibroids can affect fertility in many ways. They may change the shape of the cervix and obstruct the flow of sperms in the uterus. Change in the shape and structure of the uterus hampers the movement of sperms and embryo. Even fallopian tubes may be blocked by the fibroids. They may have an impact on the size of the lining of the uterine cavity and reduced blood flow, thereby reducing the chances of a fertilized embryo to be implanted in the uterus. The uterine fibroids which are supposed to have a big impact on fertility ( unless they are large and many in numbers) are the submucous type. Because submucous fibroids infiltrate the uterine cavity, they may cause an abnormality in the uterine cavity and cause infertility and miscarriage. Submucous fibroids are surgically removed to increase the chances of conception.

How Uterine Fibroids are treated:

The treatment of uterine fibroids depends on their location and symptoms. The treatment of uterine fibroid can be broadly classified into three categories.

Medical Intervention:

The medical management of Uterine fibroid involves using GnRH Analogue (Leuprolide acetate) and levonorgestrel-containing intrauterine device( Mirena). But they are not advised for a woman trying to conceive. Leuprolide and Mirena delay the ability to pursue attempts at conception.

Alternative treatments for fibroid:

Uterine artery embolization is a radiological alternative to surgery that involves placing a catheter into an artery in the leg and guiding the catheter via x-ray pictures to the arteries of the uterus. Once there, the catheter is used to deliver agents that block off these major blood vessels. The safety of this procedure in women desiring pregnancy has not been demonstrated yet and is discouraged by treating infertility specialists.

Surgical Interventions:

Surgical interventions are most advocated by infertility specialists for treatment of Uterine fibroid as they increase the chances of conception. Surgical removal of uterine fibroids are the most appropriate treatment for fibroids if the infertility specialists feel that they are the cause of infertility and recurring miscarriages, Hysteroscopic myomectomy is most appropriate for infertility causing submucous fibroids of size as large as 4 to 5 centimeters. Laparotomy, minimally invasive laparoscopy, and latest robot-assisted laparoscopy are also used as a minimally invasive surgical procedure for fibroid removal.

When should a woman start trying for conceiving after Fibroid treatment:

Different infertility specialist suggests a different time frame after myomectomy, most of the doctors suggest a time gap of six months for recovery of the uterus before woman start trying for conceiving. However, it is safe to start trying after three months.

     
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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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