Bengaluru, 3^rd March 2022:  Advances in the field of oncology have led to an improvement in outcomes especially in paediatric malignancies. In fact, the 5-year survival rate has reached close to 80%. While the outcome has improved, the quality of life is still far from desirable. With this increase in survival of childhood cancers, research has also shown that children are at a higher risk of suffering from psychological distress, neuro cognitive dysfunction and poor health. In an effort to help childhood cancer warriors lead a normal and healthy life, Narayana Health City in association with the Indian Cancer Society has set up a dedicated ACT (After Completion of Therapy) Clinic.

Dr. Devi Prasad Shetty, Founder and Chairman of Narayana Health along with Dr. Emmanuel Rupert (Managing director and Group CEO, Narayana Health), and Mrs. Kanchan Banerjee, Hon. Secretary of Indian Cancer Society today inaugurated the department. Dr. Purna Kurkure (Chairman – Oncology collegium, Narayana Health), Dr. Sunil Bhat (Clinical Director and Lead of Paediatric Haematology, Oncology and Bone Marrow Transplants) and Dr. Sharath Damodar (Clinical Director and Lead of Adult Haematology and Bone Marrow Transplants) and Children who have fought cancer successfully were also present at the event.

Elaborating about the department, Dr Sunil Bhat, Head of the department of Paediatric haematology, oncology and BMT, Narayana Health City said, “The vision of the ACT clinic is to provide continuous care and support to those the children who have completed treatment for various oncology and haematology conditions and help them to lead normal lives. The clinic will help in addressing the problems of survivorship by ensuring regular follow ups, both clinical as well as emotional. The department will offer psychological consultation, screening and even interventions. The clinic will also assist eligible pediatric cancer survivors with financial support for their late effects treatment. “The purpose of the clinic is to handhold survivors as they return back to society and add quality to the life that lies ahead of them.”

ACT clinic at Narayana Health City will be equipped with a team of dedicated doctors from various specialties and paramedical staff such as psycho-oncologists, physiotherapists etc. The department will also act as a platform that will provide the survivor with access to support groups. The clinic will leverage the collaborations that Indian Cancer Society has with vocational training centres and offer cancer survivors with access to vocational training at subsidized prices.

Also read : Cancer survivorship takes a huge toll on patients.  

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Narayana Health City becomes the first hospital in Karnataka to perform bloodless paediatric Bone Marrow Transplant. 

Narayana Health City becomes the first hospital in Karnataka to perform bloodless paediatric Bone Marrow Transplant. Bone marrow transplant on an average requires  the patient to undergo at least  5 to 6  blood transfusions and platelet transfusions each, but the procedure  was performed without  any transfusion.

Suffering from Stage IV cancer itself minimizes ones chance of recovery. Further, if  beliefs do not approve of certain medical practices then  chances of recovery becomes even more difficult. That was the case with Master Ittai James Moshi from Tanzania, who has been successfully treated for Stage IV neuroblastoma by the paediatric haematology and oncology department of Narayan Health City. The child was saved through bloodless bone marrow transplant. The case gives Narayana Health City the unique distinction of being the first hospital in the state to perform bloodless paediatric bone marrow transplant.

Hailing from Tanzania, Master Ittai James Moshi was suffering from neuroblastoma, a cancer that starts from one of the adrenal glands in the abdomen areas. He was suffering from Stage IV cancers wherein his cancer had spread to the bones and bone marrow. As chemotherapy alone cannot cure him, he was advised to undergo bone marrow transplant. As the child and family were followers of Jehovah’s Witnesses they were not open for blood transfusion which is crucial aspect in bone marrow transplant.

Owing to the complexity of the case, the hospital the child was being treated at referred him to Narayana Health City. The haematology  and oncology team under Dr. Sunil Bhat did a detailed workup and advised for autologous bone marrow transplant. In autologous bone marrow transplant the healthy blood stem cells from one’s own body is taken out and given back after very high doses of chemotherapy. After evaluation, a detailed plan to treat the child was chalked out. Generally in a bone marrow transplant, the procedure requires the patient to undergo blood transfusion. In fact, the patient will need to undergo blood transfusion for around 5 to 6 times during the procedure and equal number of platelet transfusions. Respecting the child and the family’s religious believes, the doctors decided to work on the child three weeks in advance and put him on medications that helps in increasing his blood levels. Once the body started responding positively and his blood levels were optimal they performed the procedure. Firstly they removed the cancerous tumour surgically. The surgery was followed by the bone marrow transplant.

Dr. Sunil Bhat, Director & Clinical Lead – Paediatric Oncology, Haematology and Bone Marrow Transplant at Mazumdar Shaw Cancer Centre, Narayana Health City said, “Bone marrow transplant is a complex procedure in general. In the case of Master Ittai James Moshi it was a high risk case as we could not use any banked blood products on him. We had to depend on his body to produce the necessary blood. In fact, despite medications, many a times the blood production may not be optimal. Further, owing to the low production of platelets there is a high chance of developing bleeding which can affect the survival of the child. The success rate of bone marrow transplant without the support of blood transfusion is very low and many would not even attempt it. However, with the help of our expert team we managed to successfully perform the bone marrow transplant.”

Within 4 to 6 weeks the child body recovered and was discharged. Currently the child is on follow up.Expressing his joy of regaining his child, Mr. James Moshi, “We had lost all hope. In fact, we were contemplating to go back. However, Dr. Sunil Bhat and his team’s confidence instilled some optimism in us. We really appreciate their honesty as they elaborated to us right in the beginning itself about the complexity of the procedure. Further, they even patiently stood with us even emotionally through our tough times. “

The Bone Marrow Transplant Unit at the Mazumdar Shaw Cancer Centre, Narayana Health City is recognized world-over as a leading referral centre for both autologous and allogenic stem transplant. The unit has completed more than 1200 stem cell transplants, including the complex transplants like Haplo-identical (half matched transplants) and unrelated transplants.

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The ECMO Unit of Narayana Health City added another feather to its cap by saving a newborn baby with multiple life-threatening conditions. The baby was suffering from Meconium aspiration syndrome (MAS) and neonatal sepsis and was treated using ECMO (Extracorporeal Membrane Oxygenation).

Meconium Aspiration Syndrome (MAS) is a medical condition that affects newborn babies. It occurs when the baby passes meconium (the baby’s first stool) in the womb  and inhales it into his/ her lungs. Inhalation of meconium can result in severe breathing difficulty. According to medical literature, despite conventional management 10% of babies born with MAS, tend to have fatal outcomes. Neonatal sepsis is a type of infection in the blood which occurs due to bacteria. While the general incidence of sepsis is 14% the mortality owing to it is around 25%.

In this case the meconium aspiration syndrome was compounded by neonatal sepsis making his condition very critical. Due to this, the baby started developing respiratory failure.   At Narayana Health City the baby was immediately admitted to the NICU and was put on ventilator support. However, as the baby’s condition did not improve, the doctors advised ECMO (Extracorporeal Membrane Oxygenation). ECMO is a life-sustaining intervention for patients with heart or lung failure.  It works by artificially removing the carbon dioxide and oxygenating the blood.

Dr. Riyan Shetty, Head of Extracorporeal Life Support, Narayana Health City,  says, “While we have had 100% survival using ECMO for meconium aspiration syndrome, this case was unique and challenging because the newborn also had an infection. The worldwide results of ECMO to save the lives of newborns with infections have been dismal. According to international data the success rate is only 48%. However, with our expert team we were able to successfully treat and save the child.”

“Though life threatening, through timely intervention the mortality rate due to MAS and neonatal sepsis can be brought down drastically. Further, the right infrastructure equipped with capabilities to provide artificial ventilation, nitric oxide and a well-trained multidisciplinary medical team are also key to save children born with such complex conditions.” added Dr.Rajiv Aggarwal, Consultant & HOD Pediatrics, Narayana Health City. Doctors  instituted ECMO on the baby through cannula in the neck. The extracorporeal circuit maintained the functioning of the baby’s heart, lungs and other organs allowing the lungs and heart to recover. In 96 hours, the newborn’s lungs had recovered and he was weaned off ECMO. The baby was discharged in 16 days.

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Infections, twins/multiple pregnancy, excessive amniotic fluid, bleeding in the first and second trimester, low BMI and poor maternal weight gain during pregnancy also can lead to preterm delivery. Factors like anxiety/ depression, domestic violence, cervical insufficiency and genetics also affects pregnancy.

Some of the health conditions that preterm babies are known to suffer from are acute respiratory distress, gastrointestinal, immunologic, central nervous system, hearing, vision, behavioural disturbances along with chances of delayed milestones. They also can suffer from issues such as internal bleeding in the brain.

Preventing preterm delivery will  include antenatal care, cervical encirclage (if required), nutritional intervention, bed rest, hydration, home uterine activity monitoring and usage of antibiotics if required. Regular antenatal care is also important to avoid the risk of preterm delivery.

Dr. Lavanya Kiran,
Senior Consultant, Obstetrics & Gynaecology
Bengaluru

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Stroke is one of the leading causes of mortality in our country and it is increasing every year. According to World stroke organization 1 in 4 will have stroke in their lifetime. In fact, the median age of people getting affected by stroke in India has witnessed a steady decrease.

owing to sedentary and unhealthy lifestyle the cases of stroke are rapidly increasing in people in their late 30s and early 40s. Increase in consumption of processed food, lifestyle habits like consumption of alcohol and smoking are also contributing extensively to the rise in the cases of stroke. People with high blood pressure, diabetes, high cholesterol or a family history of stroke are more prone to stroke.

The common symptoms of stroke can be remembered by Pneumonic FAST – Facial Drooping, Arm Weakness, Speech Difficulties and Time to reach the stroke ready hospital. We can do Intravenous thrombolysis or mechanical thrombectomy for stroke patient if they reach early. Now a days we can remove the clot of few patients upto 24 hours.  Adapting healthy lifestyle can reduce the chances of occurrence of stroke.

Dr. Vikram Huded

Sr. Consultant, Interventional Neurology

Narayana Health City, Bangalore

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How to avoid head injury? Following certain preventive measures like wearing a helmet, avoiding rash driving and adhering to traffic rules.

A majority of the head injuries cases are preventable. Around 85% of the head injury cases are owing to road traffic accident which is avoidable. The other common causes are fall from height, accident at workplace and assault. Head injuries can range from mild to fatal.

Even in case of fatal injuries most of the patients can be saved if the treatment is started within 1 hour of the incident calling for alertness and timely action even by bystanders.

Some of the ways one could help a person who has had a head injury is by moving him/ her away from dangerous location (like fire, middle of the road etc), calling for help and shifting them to a hospital as early as possible. Though timely action may be able to save many, avoiding or prevention is always a better option.

Following certain preventive measures like wearing a helmet while riding, avoiding rash driving or ensuring adherence to traffic rules and driving safely as well as calling for help whenever an accident is spotted can go a long way in preventing casualties owing to head injury.

About Narayana Health:

Narayana Health is headquartered in Bengaluru, India, and operates a network of hospitals across the country, with a particularly strong presence in the southern state of Karnataka and eastern India, as well as an emerging presence in northern, western and central India. Their first facility was established in Bengaluru with approximately 225 operational beds and they have since grown to 22 hospitals, 6 heart centres, 19 primary care facilities across India and an international hospital in the Cayman Islands. They believe that the “Narayana Health” brand is strongly associated with their mission to deliver high-quality, affordable healthcare services to the broader population by leveraging economies of scale, skilled doctors, and an efficient business model.

Dr Vishwas H V
Consultant – Department of Neurosurgery
Narayana Health City
Bangalore

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After being diagnosed with epilepsy, she was no longer allowed to have the freedom a 21-year-old is accustomed of having. She could no longer go to college and places without a constant support. She had started to feel distant and isolated from her friends dealing with her illness. As a parent, I was also emotionally shattered as we did not have monetary support to give her a quality treatment that she deserved. Today, my daughter is leading a normal life she deserves” says patient’s mother expressing her gratitude and happiness.

Epilepsy is a common neurological disorder. In India, there are about 12 million people who are suffering from this condition. But sadly, many cases remain undiagnosed due to lack of awareness and monetary support. People with epilepsy who do not receive treatment suffer from recurrent episodes of seizures. This can affect their studies, their work, and quality of life for them and their families. Also, people with epilepsy and their families suffer from social stigma and discrimination.

Improving public education is very important to fight against epilepsy. International Epilepsy Day is celebrated on 11 February 2019 as an opportunity to raise awareness on epilepsy. Most of the cases of epilepsy are treatable with medicine after proper diagnosis. In some selective cases surgery is needed and has a gratifying result in reduction of seizure frequency and medications.

Dr. Komal Prasad,
Sr. Consultant Neurosurgeon,
Mazumdar Shaw Medical Center,
Narayana Health City
Bengaluru

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Thalassemia Care in India: Where do we stand? In India it is estimated that 10,000 to 12,000 children are added every year to the pool of Thalassemia patients.  So the disease needs immediate attention.

Blood, the life line of our bodies, has three major cellular components: red cells, white cells and platelets.  Red cells provide energy and transport oxygen in the body.  In Thalassemia major, red cells synthesis is insufficient and the life span also is very short.  The disease manifests early in childhood, mostly in the first year of life, and these patients require lifelong frequent blood transfusions (every few weeks) to keep them alive.

Burden of the problem: – 80% of the children with this disease are born in Asian Subcontinent and the Middle Eastern countries.  In India it is estimated that 10,000 to 12,000 children are added every year to the pool.  Parents, usually asymptomatic are the carriers of this disease and there is 25% risk of this disease affecting their children.  The carrier state in Indian population varies from < 1% to up to 17% in some ethnic communities, with an average of 3.3%.  So the disease burden is significant and worth immediate attention.

Challenges with blood transfusion: – Needless to say that these patients need timely supply of safe blood.  It has been estimated that annual requirement of packed red cells is about 2 million units in India. Although patient organizations, Indian Red Cross Society and other regional blood banks have been working relentlessly towards fulfilling this requirement, but the demand is significantly more than the supply.  Lot of families have to struggle month after month in making packed cells available for their children.  In a country of 1.2 billion people, can we pledge today that we donate blood to save precious lives of thousands of thalassemic children.

As blood is potential medium for transmission of infection, it is very important that blood these patients receive in safe.  Although Government of India under NACO programme makes it mandatory to test for blood transmitted disease like syphilis, hepatitis B, hepatitis C and HIV, this is still not universally practiced, especially in smaller town.  Even testing for these infections by traditional methods leaves some children at risk, if blood is collected in “window period”.  Newer methods like NAT testing should be made compulsory and sponsored to minimize the risk of infection transmission in this window period.

Iron chelation:  Repeated packed cell transfusions lead to iron overload, which deposits in important organs like liver, heart and endocrine glands.  This iron overload is usually the cause of death in the second or third decade of life.  These patients need to be on medications to remove this extra iron from the bodies and if adequately chelated, they can have normal life span.  Inspite of freely available drugs, less than 10% of the patients are adequately chelated.  Various factors like ignorance, poor compliance and more importantly unaffordability are major reasons for poor chelation.  Very few state governments have made these drugs available to the patients, but supplies are erratic and inadequate.  There is need of a central legislation making these drugs available freely and free of cost to these patients.

Centres for care of thalassemics: Thalassemia is a multi system problem and in addition to packed cell and iron chelation, need management by a multidisciplinary team.  This team should have hematologist, endocrinologist, cardiologist, nutritionist, nurse practioner etc. for holistic care of these patients.  There are hardly if any comprehensive centres for thalassemia care and a rough estimate is that <5% thalassemia patients receive care in such centres.  There is an urgent need for having such regional centres which can coordinate and monitor thalassemia care.

Bone marrow transplantation:- Bone marrow transplantation is currently the only curative option available for this condition.  Recent data shows more than 90% success rate of bone marrow transplantation in patients who have HLA matched siblings.  Very very small percentage of cases undergoes this procedure.  Factors like ignorance about the procedure, affordability and inadequate centres  where this treatment is available, are some obstacles towards this curative treatment. There is a need of government organizations, non-government organizations and other leaders to come together and support this curative treatment programme.

Preventive measures:  Need of the hour is to have an efficient, countrywide programme for prevention of thalassemia, as the magnitude of problem both economic and social in huge.  Screening for thalassemia carriers, needs to be made compulsory and antenatal testing made freely available in order to detect the disease very early in pregnancy.  If small countries like Cyprus have been able to eliminate this problem by efficient national thalassemia prevention programme, why can’t we?

Need for patient Advocacy groups: Best advocates for change and improvement can be patients / families themselves.  Thalassemia societies in some states have catalysed a tremendous change in the Thalassemia care by virtue of constant advocacy.  There is a need for these patient / family groups to be formed in each city / state.  These advocacy groups can identify the problem areas and bring them in the notice of the political establishment.

In summary, the magnitude of the problem of thalassemia is huge, but unfortunately inadequately addressed.  There is a need for the Ministry of Health to put it on the “priority list” and address to the issues, which are numerous.  There is also a need for the medical experts and the families to get together and be advocates for their patients.  With these collaborative efforts, our thalassemic children shall also get the standard care which they deserve!

Dr. Sunil Bhat
Senior Consultant & Head Pediatric Hematology, Oncology and Blood & Marrow Transplantation
Mazumdar Shaw Cancer Centre, Narayana Health City Bangalore, India

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