Meitra Hospital Launches Apheresis Unit Across Kerala State

Blood Centre and Department of Transfusion Medicine at Meitra Hospital has started the Apheresis procedure at their Blood Centre. The hospital now joins the elite group of medical facilities which routinely offers this procedure. An invasive procedure, it entails removing whole blood of a donor or a patient and subsequently separating its individual components by centrifugation. The required individual component is isolated for use while the remaining components are re-introduced into the blood stream of the donor or the patient.

There are several uses of the procedure and at present it is commonly used for collection of platelets from a single donor and is known as Platelet Apheresis. The extracted component is equivalent to6 units of platelets prepared from whole blood donation, resulting in not just a higher quantity of product with good quality; but also preventing multiple donor exposure to patients as well. By this procedure, the donor can donate platelets 2 times a week. The traditional form of whole blood donation requires a gap of one month before a second donation from the same donor to collect platelets. 

Apheresis not only aids in the collection of cellular or plasma constituents from a donor, it can also harvest peripheral blood stem cells from the donors and patients, thereby circumventing extraction from the bone marrow. These stem cells are then used for bone marrow transplant for several blood disorders like in certain types of blood cancers. The procedure prevents wastage and increases the ability to facilitate production of optimal components as required by the patient. 

“Modern medicine has witnessed giant strides in transfusion medicine resulting in a growing demand for blood components. In addition, there is an increasing concern about safety issues. Apheresis is not only a viable, but also a preferred procedure in current medical practices. In fact, the technique has recently found a great application in isolating the plasma of a person who has been cured of COVID-19 to treat those who are in a life-threatening situation following COVID-19 infections. This procedure is known as convalescent plasma therapy.” informed Dr. P Mohanakrishnan, Chief Executive Officer, Meitra Hospital.

Some of the other conditions apart from COVID-19, where the procedure proves beneficial can be in Systemic Lupus, Severe Vasculitis, Chronic Autoimmune Polyneuropathy, Dengue, Severe Rheumatoid Arthritis, Myasthenia Gravis, Waldenstrom’s Macroglobulinemia, Goodpasture’s Syndrome, Familial Hypercholesterolemia, Hyperviscosity Syndrome (such as mixed Cryoglobulinemia, Thrombotic Thrombocytopenic Purpura), The HELLP Syndrome of Pregnancy, Clogging of blood vessels (Leukostasis) caused by severely elevated white blood count in Leukemia, andseverely elevated platelet counts in Leukemia or Myeloproliferative disorders as well as in cases of solid organ transplantation with a high risk of antibody-mediated rejection of the transplant.

Meitra Hospital aims to be at the fore front of the global best practices in healthcare as well as latest advancements. This is yet another step in the direction. Through this addition the facility aims to strengthen the medical care being currently offered not just in Kozhikode but also in the state of Kerala.

Meitra Hospital Sets a New Benchmark for India in Stroke Treatment

Kozhikode based tertiary care Meitra Hospital crosses yet another milestone when its team of highly skilled Neurointerventionists performed a successful brain procedure using Endovascular Revascularization techniques. The three-hour long procedure also known as Endovascular Intracranial Angioplasty and Stenting for Chronic Total Occlusion (CTO) was conducted under the skilful guidance of Dr Rafeeque. It entailed the reopening of the cranial blood vessels of the Omani sexagenarian, Shamsa Mohammad Hilal Al Balushi who is a native of Al Batinah. These were completely blocked following an episode of Stroke a month ago which had her right side fully paralyzed, as well as had resulted in total loss of comprehension and speech. The patient also suffered from Idiopathic Thrombocytopenic Purpura (ITP), a condition where the platelet count becomes drastically low and this could have caused serious complications in the already challenging procedure.

“Usually this procedure promises success when done within 24 hours of the Stroke. A month had elapsed since the patient was fully paralyzed and totally bed ridden. Moreover, a major blood vessel inside her brain was blocked completely in addition to poor and slow blood circulation, as revealed in the perfusion scan. This posed tremendous challenge to the treating team,” recounts Dr Mohammed Rafeeque PK. “We could successfully perform the extremely complicated intervention inside the brain in which there was a great risk of haemorrhage that could have been fatal, using fine devices through delicate blood vessels without any surgery,” he further explained.

“The patient was brought to us in a very critical condition. Chances of success were very dismal, yet our team at our Centre for Neurosciences took on the challenge. This is the 1st successful Neurointervention of its kind in India. It will open more doors to further research and studies. It is an exciting development indeed not only for the Indian medical landscape, but globally as well,” said Dr P. Mohanakrishnan, CEO of Meitra Hospital.

“Since the brain cells start to deteriorate within minutes of a Stroke, getting emergency help is decisive. It is imperative that the patient be brought for treatment as early as possible. There is still a lack of awareness around the condition and new developments in treatment. For instance, in Kerala, only less than 10% of the population is aware of the latest developments. I do not suppose the national figures would be greatly different. Today there is excellent treatment for stroke via endovascular route / thrombolysis. The blood flow in blocked arteries can be restored and brain tissue saved from permanent damage, provided the patient can reach a comprehensive stroke centre at the earliest. There is an urgent need to bring to people’s attention on how these latest advancements can aid in changing their quality of life as well as educate them about the benefits of timely action,” he further added.

Following the intervention, the sixty-four-year-old Shamsa Mohammad showed noticeable changes after the first week of the intervention. Within a span of 2 weeks, she was able to normally comprehend, respond to commands and started to walk with help. Now after a few months, she can speak meaningful words and is back to an independent life from a totally bed ridden state. Today she lives a much fuller life with her family.

Dr Mohammed Rafeeque PK is a pioneer in Intracranial CTO Angioplasty and Stenting in India. He is also the 1st person in India to conduct Intracranial Intervention with exclusive 4D Robotic Navigation. His specialist team consisted of Chairman of Neurosciences - Dr K A Salam, Senior Consultant Neurologist Dr Ashraf VV, Neuro-Anesthesiologists Dr A V Kannan, Dr Gopal, Dr Nitin, Dr Smera and a Hematologist.

The Kozhikode based hospital has been at the fore front of bringing latest in healthcare technologies and practices to elevate the standards of care delivery. It has strived to provide warm and calming healing environment so required to ensure a speedy and comprehensive recovery of all its patients.

About Meitra

Meitra Hospital, Calicut, is one of the most advanced tertiary care centre in South India, committed to provide world class patient care by blending the concepts of a care path based on ‘Evidence Based Guidelines’ along with the benefits of modern technology. Meitra effectively integrates clinical expertise and world class infrastructure to enhance the quality of life of patients. Meitra offers unparalleled clinical care, backed by expertise in almost all medical disciplines. This newly established hospital provides patients with Primary, Secondary, Tertiary Healthcare as well as a network of facilities that is conducive for good health. Meitra will strive to provide outstanding tertiary care for patients to India and beyond. Translating breakthroughs in Science and Technology into patient care, the Meitra team comprises of skilled, innovative, and passionate doctors with centres of excellence in Cardiology (heart & vascular care), Orthopaedics (bone & joint care) & Neurosciences. 

Caregivers Caught Between COVID and Cancer Patients in India

By Dr. V. Satya Suresh Attili, Head Medical affairs, EON

It’s a double jolt for the cancer patients. While they are coming in terms with the fact that “they have cancer” and accepting- Covid pandemic started gripping them to suffocate.  

The scientific dilemma and Oncology body recommendations 

The initial approach of deprioritised, delayed, and discontinued oncology management is slowly getting better. Thanks to various global bodies, which worked relentlessly to come up with guidelines in short possible time (with more logic and moderate evidence- whatever they can gather), the oncologists today are in much better informed to take therapeutic decisions. The majority consensus is “Official advice is that urgent cancer care can continue, but other treatments should be rationed and adapted”

Social/logistic factors

The “lockdown” too have impacted the logistics of cancer medications and mobility of the patient’s to seek timely treatment. The redeployment of personnel, beds, and equipment to COVID-19 wards in few regions also contributed to the scarcity of the “quality Oncology care” on occasions.

The Oncologist Dilemma

As most of the recommendations as quoted in “The lancet Oncology” are “inconsistent, and not evidence-based—multidisciplinary teams are being put in the unenviable position of making best guesses for each patient.” In my practice at least few dozens of “operable cases have become “inoperable” with inferior disease outcome- It pains. With resource constraints “risk of delayed cancer treatment with disease progression” vs “Contracting COVID due to immunosuppression” is extremely challenging. There is no “best course of action” for any oncologist and these decisions are not easy to make

TESTING FOR COVID-19: What information is available on testing for COVID-19?

The corporates insist on ”test everyone” – and its more of a paranoid reaction- I believe which can potentially waste the limited testing resources and the ones in real need may suffer. While few of the governments say “test only if symptomatic” – which is more into “dismissive behaviour” that leads to undertesting and faster viral spread. Having said that “it is difficult to draw a line” and balance. The only hope is to enhance the “testing capabilities” 

Where does cancer screening stand

Well - I feel its bit easier to answer. If low risk of disease/ conventional screening- its best to wait. If its high risk screening – well you may still wait based on the ”level of risk”. But for sure “there should not be any community camps” that can potentially spread the COVID like wildfire- and the  lives you save by early detection are mathematically lesser compared to the risk of viral spread. 

Are the rules Same 

What are the recommendations for general care of patients with cancer?

ASCO encourages anyone caring for patients with cancer to follow the existing CDC guidance where possible:

General health care facility and health care professional guidance

Clinical care guidance

Home care guidance

High-risk subpopulation guidance- details can be found https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19

IS the same rule true for surgery/chemotherapy/radiation/BMT etc

 Definitely not. There are matured and logical guidelines available from various reputed bodies and the detailed discussion on this is beyond the scope of this article- which can be browsed trhough various links ex- https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic 

Where does technology help 

Things like wearables for remote health monitoring, telemedicine, POC testing, AI driven screening tools and what not – have surely helped the oncologists in this pandemic and paved the “way to future” 

What about palliative care and home care

Probably these are worst affected. Stress is more disturbing than cancer itself- They are already counting the days and trying to put their best to sustain the quality of life. But the logistics of medications, and nursing care had impacted them as I see in my practice. The impact is worse in rural regions from where two thirds of my patients come from. 

Cancer vs Covid deaths- extract from “The lancer Oncology”

A 5–10% decrease in survival in high-income countries has been predicted, which will account for hundreds of thousands of excess deaths, dwarfing those caused by COVID-19—but we are missing precise data on mortality that can be used to anticipate future cancer care needs.

Steve Jobs on leave till June

I am sure all of you saw my letter last week sharing something very personal with the Apple community. Unfortunately, the curiosity over my personal health continues to be a distraction not only for me and my family, but everyone else at Apple as well. In addition, during the past week I have learned that my health-related issues are more complex than I originally thought.

In order to take myself out of the limelight and focus on my health, and to allow everyone at Apple to focus on delivering extraordinary products, I have decided to take a medical leave of absence until the end of June.

I have asked Tim Cook to be responsible for Apple's day to day operations, and I know he and the rest of the executive management team will do a great job. As CEO, I plan to remain involved in major strategic decisions while I am out. Our board of directors fully supports this plan.