MEDICAL BULLETIN

Citing to the rising cases of cancer cases among the paediatric population and with the availability of advanced treatment modules, there is a dire need to raise awareness among parents to get timely access for better quality outcomes.

In view of the same Fortis Hospital Gurugram, on the occasion of International Childhood Cancer Day, launched first of its kind Paediatric Solid Tumor Clinic, in their hospital today. While cancer in children is not treated like adult cases and the types in children are different from that seen in the adults, they are vulnerable to a unique clinical challenge.

With the advent of the specialized Paediatric Solid tumor clinic at Fortis Hospital Gurugram, the main motive is that ‘No Child should die in the dawn of life’. The clinic will be operational on every Wednesdays from 2 PM to 4 PM, under the able leadership of Dr. Vikas Dua and Dr. Mansi Sachdev (Paediatric Oncologist)

This clinic which is functional from today will be efficiently treating children with a variety of solid tumors/malignancies, from brain and spinal cord tumors to tumors affecting bones and muscles and those arising from the liver and kidney. A team of doctors including Paediatric medical Oncologists, Surgical Oncologists, Radiation Oncologist, Neurosurgeons, Interventional Radiologists and Nuclear Medicine doctors will apply a multidisciplinary approach to treat children with such malignancies.

Present at the launch were the multidisciplinary team of oncologists and surgeons along with various cancer survivor children with their parents who shared their victorious journey battling through cancer.

“While most of the parents are unaware of the condition and tend to ignore the early symptoms, it is imperative to raise awareness among them that such conditions are completely curable with advanced technology and experienced medical team. Paediatric Oncology is a medical speciality focusing on effective treatment of children with cancer and is associated with excellent outcomes. Thus parents must be aware of the early and common symptoms, for seeking the timely intervention for a better quality of life. Our team has a vast experience of treating children with cancer not only from India but also abroad” Said Dr Vikas Dua, Additional Director & HOD, Paediatric Haematology Oncology & Bone Marrow Transplant, Fortis Hospital, Gurugram

As per the recent data provided by World Health Organisation (WHO) around 4 lakh children in the age bracket of 0 to 19 years are diagnosed with some form of cancer. And according to Indian Cancer Society India attributes to over 50000 such cases every year. Unlike in adults, paediatric cancer in children grows and proliferates rapidly, but at the same time cancer cells are highly sensitive to chemotherapy treatment which makes it a very practical and realistically achievable goal.

“While most of the childhood cancers are curable with generic medications and other treatment modules including chemotherapy, radiation therapy or surgeries, early diagnosis, prompt and right treatment is the key. Although cases of paediatric cancers are rare attributing to 3% of all the cancer cases in India, but is yet one of the leading causes of death by disease after infancy among children. With recent advancements in the field of oncology treatment, the cure rate is high and the productive life in cured children are also found to be significantly high provided appropriate treatment is availed.” Said Dr Mansi Sachdev, Senior Consultant, Paediatric Haematology Oncology & Bone Marrow Transplant, Fortis Hospital, Gurugram.

“It is very troublesome to hear the news that your kid is suffering from cancer. Our 10-year-old kid was in recurring pain, a vision that no parent can accept. But we as parents never lost hope and believed that with timely diagnosis and appropriate treatment. Doctors at Fortis Hospital, Gurugram counselled us about the treatment modules and the outcomes. We are very thankful to see our son back to normal since past one year and enjoys mingling with other kids.” Said one of the parent present.

Dr Biplab Das, Consultant Neurology and Interventional Neuroradiology under the guidance of Dr. Praveen Gupta, Director and HOD, Neurology. Fortis Memorial Research Institute (FMRI), Gurugram, and Dr Vijay Kant Dixit, Director, Interventional Neuroradiology, FMRI organised the National Stroke CME cum Stroke Preceptorship and Training Programme in Guwahati, Assam. The programme was endorsed by the Indian Stroke Association (ISA) and Indian Academy of Neurology (IAN). The academic event was attended by more than 250 delegates comprising of Neurologist, Neurointerventionist, Physicians and Paramedic stroke teams. Many national and international doyens of Stroke Neurology, including Prof M. V. Padma (AIIMS, Delhi), Prof Dheeraj Khurana (PGIMER, Chandigarh)and Dr Monica Saini (CGH, Singapore) graced the event.

Haryana Pulmocon 2019 was organized under the aegis of Haryana Chapter of Indian Chest Society in collaboration with the Association of Physicians of India, Haryana by Fortis Memorial Research Institute, Gurugram on 6th and 7th of April 2019 at Gurugram. Dr. Manoj K Goel, Director, Pulmonology, FMRI was the organizing chairman. Dr Ajay Kumar and Dr Gargi Maitra were the Organizing and Joint Organizing Secretary respectively. The conference was held at a seven-star facility, The Hotel Leela Ambiance; however, the registration was complimentary.     There were also three workshops with Hands-on training and Simulation on EBUS Bronchoscopy, Medical Thoracoscopy, Mechanical Ventilation, and Sleep Medicine.    A galaxy of renowned speakers from all over India shared their valuable knowledge and experiences during lectures, debates and panel discussions.    Some of the Luminaries of Haryana were honoured with Prestigious Awards for their immense contribution to the field of Pulmonology.    The theme of the conference was ‘Bringing Reality to Practice’.   The conference was highly successful with over 500 registrations.  This two-day event matched international standards in the arrangements, scientific content, and training of delegates during the workshops.

Baby Maryam from Tajikistan was born with a condition that caused her skull to swell

Doctors at Fortis Memorial Research Institute recently came across a highly complex case. It was the unique case of Baby Maryam from Tajikistan, who was suffering from Congenital Hydrocephalus with magalencephaly. She was two years old and was born with ‘hydrocephalus’, a condition in which the fluid is collected in the brain causing the head size to increase. For Maryam, mobility was next to impossible, and she had been struggling with this condition since she had been one month old. A team of doctors, led by Dr. Sandeep Vaishya, Executive Director – Neurosurgery, Fortis Memorial Research Institute, successfully diagnosed and operated the patient’s condition by carrying out an extremely risky and rare surgery.

The usual treatment for such a condition is to perform a VP shunt surgery. This involves installing a small tube in the brain to drain the excess fluid. This surgery was performed (in Tajakistan) when Marayam was just eleven months old. It reduced the circumference of her head from 72 cms to 64 cms. However, brain damage had already occurred and the bones had fused together because of which her brain size could not be reduced further. She was also unable to sit up or hold her head up.

Dr. Sandeep Vaishya said, “We were reluctant to perform the surgery as chances of improvement in such cases are extremely low and the risk factors are extremely high. However, the family was ready to give consent despite the risks. We performed eight surgeries on the patient over a period of five months. We managed to reduce the size of the head, but the surgery proved to be extremely challenging. At one point, we almost lost her, but she fought back. Though it is still early, we have noticed some positive changes. Her last CT scan showed good brain development and she has started to lift her head. While there are chances of brain damage, it is her best chance to live a nearly normal life.”

Dr. Ritu Garg, Zonal Director, Fortis Memorial Research Institute, Gurugram said, “It was a rare case, fraught with risk of complications and each course of action seemed dangerous. However, I was confident about the team handling the case. Dr. Sandeep Vaishya is a pioneer in his field and has previously handled numerous such cases. He is experienced and adept at intricately handling the elaborate nexus of the brain. Maryam’s post operation phase was smooth and we have been monitoring her closely.”

The family of the patient said, “Dr Sandeep Vaishya had in 2013 operated successfully a similar child – Baby Roona Begum (from Tripura, India) who had the largest recorded head (94 cms) in the word at 09 month age. That case was covered internationally by CNN and Discovery channel also made a documentary on the child. This was seen by us and we came here for the surgery. We were scared and had lost all hope. Maryam had previously undergone a shunt installation at Tojikistan but we knew she would eventually have to go through surgery again. I am hopeful that Maryam will be able to lead a better quality of life post the surgery.”

Gurgaon Obstetrics and Gynae society organised the annual conference of Indian menopausal society and showed keen interest in robotic surgery live workshop. They wanted to observe how the robot works, docking of the robot and the surgery of hysterectomy and sentinel node mapping when possible. They also wished to understand how robotic surgery is different from laparoscopic. Dr Rama Joshi, Director, Gyanea-Oncology & Robotic Surgery conducted this workshop at Lemon Tree hotel in Gurgaon. Around 350 delegates attended the conference from all over the country.. International faculty from Sri Lanka, Pakistan, Bangladesh and United States participated as well.

Robotic Head-Neck Surgery Masterclass-2018: Department of Head-Neck and Thoracic Surgical Oncology, FMRI Gurgaon conducted the Robotic Head-Neck Surgery Masterclass – 2018 on 26th February, 2018 at FMRI Gurgaon. Under the mentorship of Dr. Surender Dabas, Director, Department of Head-Neck and Thoracic Surgical Oncology. 22 dedicated Head-Neck surgeons from North India attended and benefited from the programme. The program included live robotic surgery (Trans-oral Robotic Surgery); Interaction with the expert on the finer nuances of robotic surgery and live hands on training on the Si Da Vinci Surgical system. The programme was highly appreciated by all the delegates.

Dr Aniruddha Dayama’s poster on Autologous Stem Cell Transplant in Adult Multiple Sclerosis Patients: A Pilot Study from North India that was submitted for the 2018 BMT Tandem Meetings, was selected for Poster Presentation at salt lake city Utah on Feb 21, 2018.

Neelam Babbar a 56 year female was suffering from a rare disease in which there was a large collection of abnormal proteinaceous material in her lungs, a condition called Pulmonary Alveolar Proteinosis. This abnormal protein collection had led to severe lung dysfunction and she was in severe respiratory distress with very low oxygen concentration in her blood. She had to be ventilated and had very little chance of survival. She was managed by the Pulmonlogy and Critical Care Teams at Fortis Memorial Research Institute. Dr Manoj K Goel, Director, Deptt. of Pulmonology, Sleep and Pulmonary Critical Care did washing of her both the lungs with more than 20 litre of saline, a procedure called whole lung lavage. This procedure resulted in removal of this abnormal protein from her lungs and her life could be saved. She is now breathing normally with good oxygen saturation in her blood.

An underlining heart condition that emerged for 66-year-old Arif Abd Allateef (a resident of Baghdad) in 2015 came as a shock for the cancer survivor who was living with just his left lung post an onco-surgery done in on account of removal of his entire right lung for cancer surgery in 2005 in Iraq. Since surgery under the current circumstances was not possible factoring his age cardiologists back home put him on medical management.

However, since June this year, Allateef developed severe chest pain and his health progressed downhill from then. Cardiologists back in his country suggested a surgery but with his single lung, they were not very sure whether the patient would be able to survive.

"The alternative for me, looking at cost effectiveness along with a good surgical outcome was to travel to India," said Allateef.

The patient was thoroughly examined for his condition and evaluated for surgery by Dr Udgeath Dhir, additional director, CTVS at FMRI and his team.

"There were several challenges in this case starting from his age to the history of his illness and his overall health. The patient had a blockage in one of the main arteries supplying blood to the muscles of the heart but stenting was not viable because of the anatomy of the blockage. They decided to conduct a bypass surgery (CABG - Coronary artery bypass grafting). According to available literature, there have been only 29 such cases of CABG conducted on a patient with a single lung reported world over with mortality of 16%.

The bypass surgery was carried out on a beating heart by carrying out a sternotomy (surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided) to reach the chest cavity.

"We also had to ensure that the patient did not face difficulty in breathing post-surgery so we stopped his antiplatelet and put him on high thoracic epidural catheter to ease normal breathing for which special medications and techniques had to be used. The patient was discharged on day 7 of his surgery.

Cystic Fibrosis is a chronic, life limiting, pulmonary disease in which children are destined to die early, remains largely undiagnosed in our country. In its commitment to serve these children, the Division of Pulmonology, Fortis Memorial Research Institute, Gurgaon, hosted its Fifth Annual Cystic Fibrosis (CF) Meet. Patients were also given free consultations/ annual reviews and free relevant investigations were done for diagnosed patients and those with chronic respiratory infections.

A young patient married for last 7 years, was looking forward to having a baby. Her first pregnancy in 2011 ended in a spontaneous miscarriage. She conceived again in 2012 and unfortunately miscarried at 7 weeks. She was advised certain tests and it came to light that the patient was infected with HIV.

The couple came to Fortis Hospital (Gurgaon) to meet Dr. (Prof.) Suneeta Mittal and was evaluated completely and offered assisted conception. Couples who are discordant for some transmissible infection can still have a baby with this technique. Having a child through natural conception was not an option as this would risk the husband of acquiring the same infection. So an intrauterine Insemination was planned. The husband’s semen was collected, processed and washed and injected directly into Mrs. A’s uterine cavity at the right time of cycle, synchronising the process with egg rupture. The destiny favoured this time and she got pregnant in very first cycle. The pregnancy was followed up for 9 months in liaison with ART (Anti-Retro Viral Therapy) specialist. She continued to have the anti-retro viral drugs throughout pregnancy and was delivered by elective lower segment caesarean at 38 weeks, giving birth to a healthy baby boy weighting 2.85kgs.

With the advent of assisted conception, having a pregnancy and child birth is now a reality for such couples. Without any Intervention the risk of transmission of HIV from infected pregnant women to her child is around 25-40%. The risk however is reduced to less than 1% by treating the mother with highly active anti-retroviral therapy (HAART) during pregnancy, delivering by elective LSCS at 38 weeks and totally avoiding breast feeding. The baby is also given prophylactic anti retro viral therapy and baby’s blood is tested after birth on D1, 6 weeks, 12week and at 18months of age to ensure the child has not contracted the infection.

FMRI conducted their 50th free surgery at the Cleft Lip and Palate Centre for Children by carrying out a successful cleft repair surgery on a six-month old infant, Akansh, from Mewat. The Centre was launched at FMRI in collaboration with Fortis Foundation and Mission Smile India in February 2015 to initiate a comprehensive Clinic for Cleft Lip, Palate and other facial deformities exclusively for children from the economically weaker sections of society. Baby Akansh had a congenital deformity called cleft lip due to which there was opening in the upper lip that extended till his nose. At that time the child was too small to be operated. A regular follow up was planned and when the baby turned six months old the cleft repair surgery was conducted on Monday, May 16th by Dr Amitabh Singh, Consultant Cosmetic and Plastic Surgeon.