Category: Blog

COVID ’19 Update: Hi, I am now available for video consultation. You can book the appointment and get the consultation done through a video call. Please download Docon App from play store for android user https://play.google.com/store/apps/details?id=com.docon.patientapp and iOS users can download from app store https://apps.apple.com/us/app/docon/id1505731925?ls=1

And book your appointment.

Thanks

Thanks Dr Samiran Adhikary

Docon Id – doc24654

Hello,

Check out this practice management software – Docon. I have been using Docon to create printed prescriptions. The app is super easy to use and they offer excellent service. I love it, and most of all, my patients love the experience.

Key features:
– Tap-based interface, no typing required
– Beautiful and detailed prescriptions
– Seamless Queue management for the receptionist

Using Docon, I have been able to digitize my whole practice at my clinic.

Check out their website at www.docon.co.in

Alternatively, you can call at 080 6823 6823

Regards,
Dr. Samiran Adhikary

Through this app I will be at your doorstep right in front of you. Can avoid coming to hospitals till this situation comes under control. It would take sometime. We are treating all medical conditions even during this extraordinary situation. Even in case situation demands surgical intervention, it can be done with proper precautions in place. But early consultation may avoid or postpone surgical intervention. So don’t hesitate to utilise this platform to get all clarification regarding the symptoms or difficulties you may be facing through and primary treatment with some basic tests and few pills which can easily be prescribed on this platform.m

Professor M.S.Seshadri MD, PhD, FRCP
Former Professor of Medicine & Endocrinology
Department of Endocrinology Diabetes & Metabolism
Christian Medical College & Hospital, Vellore
Consultant Physician & Endocrinologist
Honorary Medical Director
Thirumalai Mission Hospital, Vanapadi Road, Ranipet Vellore 632404 &
Professor T Jacob John FRCP (Paediatrics), PhD (Virology), Former Professor&Head,
Department of Clinical Virology,
Christian Medical College & Hospital, Vellore632004
We have learned that recently in 2 hospitals in the country, where emergency surgical procedures were performed on patients and healthcare personnel got infected with SARS- CoV-2. These surgical patients developed COVID-19 pneumonia in the postoperative period, and succumbed. In these hospitals, a large number of health care professionals got infected. This had led to a lock down and containment situation of these hospitals. These incidents have many important lessons for the medical profession, other health care workers , administrators and health ministries.
The message is loud and clear. If asymptomatic (for COVID-19) individuals,who are actually in incubation period, develop COVID- 19 in the postoperative period, there are only 2 possibilities. 1. Their infection was nosocomial; 2. They came in infected, in which case community level spread is already occurring. Actually, nosocomial infection is also

indicative of community transmission, highlighting silent infection in medical staff or other admitted patients.
Italian doctors, after their heart-rending experiences with COVID-19, made a plea in NEJM Catalyst; their article carries the following messages for the rest of the world in the approach to COVID pandemic.

1. The virus is exploiting centralized health care systems of the current era in a large number of countries
2. Once you keep admitting very sick patients with high viral load, the hospital becomes the reservoir of the virus. Health care personnel acquire infection and unwittingly become vectors, whospread the infection to their patients and this leads on to further community spread. So hospitals become hot-beds of SARS-CoV-2 infection.
3. A good number of health care professionals contract and some succumb to the infection they contracted in the hospital
4. The way to deal with this epidemic is to consider the population as the individual patient and do your level best to keep the population healthy, even at the expense of some loss of lives
5. If you do not do this, the human toll becomes huge as in Italy, Spain and the US.
6. They recommend home based care as far as possible (level 1 and level 2 disease)
   with home oxygen if needed
7. There is a place for a fully isolated, well-equipped COVID centre with all tertiary
   facilities manned by a committed team to take care of those who needpositive pressure ventilation.

There is an old saying ‘Physician, heal thyself! ‘ In the current COVID 19 context, this can be rephrased as ‘Health-care worker, protect thyself’. If health-care professionals are depleted because of COVID-19 or if the health-care force is demoralised because of personal risk and fear, the situation can become extremely difficult to handle.
How can we handle a catastrophe of this magnitude? How would a humane,caring person approach this problem?

1. Shut down regular OPDs for chronic illness. These are vulnerable people who should not be coming to hospital – for their own safety, to reduce hospital crowd and avoidable workload of an already stressed group of healthcare staff
2. Mobile telephone/telemedicine based counselling for patients with chronic illness through their usual caregiver with the understanding that if there is a medical emergency they will have to access a safe hospital not frequented by COVID-19 patients
3. Home delivery of medications to avoid elderly coming out of their homes. They should be cocooned (reverse quarantined). When necessary, physicians wearing protective paraphernalia should make home visits — instead of patients coming to hospitals when their illness is of low/moderate severity and not life-threatening. For example acute exacerbation of asthma can be managed at home
4. Multiple hot-linesshould be manned round the clock by appropriate personnel including medical professionals both for medical advice and for counselling for emotional and moral support . Tertiary level and medical college hospitals must serve as resource centres for practitioners in order to guide them in caring for

complex problems. [examples complicated Diabetes/hypertension/community
acquired infections etc]

5. Samples for lab tests should be collected at home , transported to the lab and the
   results of tests communicated to concerned doctors/practitioners .
6. Use a syndromic approach* to diagnose COVID-19 and treat such subjects and prevent spread to their family members using appropriate home isolation and other
   prophylactic measures.
7. PCR or Rapid tests only forconfirming diagnosis when essential for care, or for well-
   designed and ethical studies, so that resources saved can be put to better use
8. Dedicated ambulance services with adequately protected personnel to carry sick
   infected subjects to a dedicated COVID centre
9. Have separate emergency facility for patients with acute respiratory
   problems.Adedicated respiratoryteam should handle this, adopting very effective respiratory and universal precautions. Those needing admission for respiratory failure to have a separate ICU facility for COVID-19
10. Major hospitals in either private or public sector to take on the management of the town and surrounding villages and to set up a model system of referral and management
11. At the same time continue to manageemergencies in non-COVID patients, who needhospitalbased care in a separate facility manned by a different set of healthcare personnel.
12. Every patient coming to hospital for any emergency should be considered to be potentially infected with SARS-CoV- 2and suitable precautions (respiratory and universal) taken by all the staff.
13. Surgicalprocedures must be reserved for emergencies. Each patient going for surgery to have a screening PCR on a nasopharyngeal swab and Ig M antibody and, lab report to be seen before taking up for surgery, similar to the present system in place for hepatitis B , C and HIV. As even this will miss out a proportion (~10 %) of SARS- CoV-2 infected patients, respiratory and universal precautions will be mandatory for every surgical patient and procedure.
14. While we write about the scenario in India, we feel that the above suggestions are equally applicable to all the middle and low income countries which are trying to cope with this pandemic
    The natural history of the pandemic will be the eventual waning of the transmission. This will occur after at least about 50-60, possibly 70 % of the population have gone through the epidemic and developed immunity to the infection. This may take a few to several months.Till such time the priorities should be cocooning (reverse quarantine) the elderly and vulnerable subjects, restoring the confidence of health workers by demonstrating that they have acquired immunity and getting immune subjects from the population quickly back to work so as to resuscitate the economy, save livelihoods and lives.
    We make these suggestions based on scientific evidence and in the hope of bringing about a change in the approach to this pandemic.

Our team of Cadaveric renal transplant from Apollo Hospital Bhubaneswar was felicitated by our Governer Prof Ganeshi Lal and senior secretary MR Promod Meherda on 11/03/2020. We were invited by His Excellency over a launch at Governor House.

We were mesmerised by his words and encouragement

55 years old lady who suffered through CVA and could not revived and declared brain dead on 26th of February and harvesting was done in Apollo Hospital. Her Blood group was O positive Dr samiran Adhikary and Dr Prateek Sahoo did the harvesting and soon after that one kidney was transplanted in 55 years old gentleman who is a Diabetic O positive

I would like to thank many just few names I am writing here without whom this is not possible. The whole hospital works like a TEAM to get this happen.

I must thank my patients

My final year DNB student Dr Pratik Sahoo

Dr Jyoti Parija Ast MS with his guidance

Dr (Brig) P k Sahoo neurosurgeon and Primary Physician for this patient

My dear friend and intensivist whom I often fight with Dr Saroj Pattanaik without whom this was not possible

Dr Bibekananda Panda Nephrology

Dr Nisit Mohanty Nephrology

Dr Debabrata Dash

MR Ashok Nayak Perfusionist

MR Soumya

All OT staff. Geeta Sasmita Sanjukta Reeta Deepak Arnab. just a name a few. There are many supporting staff without whom this was not possible

I cut it is HE who HEALS

The session was graced by Dr Banambar Ray. MR Pravash Acharya. And MR Pravash Acharya stresses on body donation and organ donation. Dr samiran Adhikary spoke on over all situation and role of society and media on this issue. Dr Banambar Ray spoke of details of brain death and role of ICU personnel on maintenance of the brain dead donor.

We thank you all for your participation and active interaction. We had approximately 100people to Attend from different hospital of the Bhubaneswar and CUTTACK.

Apollo Hospital. Care hospital. Sum ultimate hospital. Shanti memorial hospital. Sunshine Hospital. AMRI hospital. And few other hospitals.

I thank MR Ashok MR Satya and MR Mrutunjay and Dr Sambit for supporting me and making this event a successful one

Honourable CM personally expressed his happiness and encouraged all of Us. He is willing to support all of us to help this program. Govt of Odisha has promised to extend his support for providing us air ambulance or helicopter for the above purposes. So I am sure we can extend this to other part of ODISHA.

https://www.ommcomnews.com/odisha-news/odisha-first-cadaveric-transplant-patient-at-apollo-hospitals-discharged-

1st Deceased Donor renal transplant in the state of ODISHA happened in early morning Of 4th February of 2020 in Apollo Hospitals Bhubaneswar

Historical moment for Department of Urology of Apollo Hospital Bhubaneswar and TEAM Apollo

The surgical TEAM consisted of

Dr Samiran Adhikary Chief Surgeon and Team Leader

Dr Sambit Tripathy Final year DNB trainee 1st assistant

Dr Pratik Sahoo second year DNB trainee as 2nd assistant

Supported by

Mr Ashok Nayak. Perfusionist

Mr Soumya Technician urology

Mrs Geeta

Mrs Sasmita

Mrs Mahasweta

Anesthesia Team

Dr Debabrata Dash

Dr Sidharth Mohanty

Critical care Team

Dr Sharmili Sinha who took care of patient in ICU and declared 1st brain death declaration by 5 pm and second brain dead declaration was by Dr Saroj Pattanaik

Neurosurgery

Dr Amit Chanduka under whom patient was admitted

Nephrology

Dr Bibekananda Panda

Transplant co-Ordinator

MR Subrat Sahoo

28 years old lady who met with an accident was declared Brain Dead on the evening of 3rd of February

Life was very unfair for the lady but the bereaved family members took a very selfless decision which is very bold and noble to donate organ and see that these organs surviving through these patients.

retrieval of organ from the cadaveric donor is the most challenging work was done by the apollo team lead by Dr Samiran Adhikary

After the retrieval of organ next important step is perfusion of organ in special fluids. After that the organs are packed in special sterile pack with ice cold solution.

After doing all these above steps one of the kidneys was handed over to SCB doctors at 4.25 AM on 4th February

SCB team only received the organ from us and proceeded to SCBMCH and next step in their hospital for the transplantation.

1st kidney was transplanted in Apollo Hospital in one 45 years old gentleman and second one done in SCB Hospital .

The Patient in Apollo Hospital is doing fine recovering well

1st post operative day.

Creatinine 4.6mg%

Urine Output 6.5litres

2nd post operative day

Creatinine 3.53mg%

Urine output 3.8litres

3rd post operative day

Urine output 3.6litres

Creatinine 1.9mg%

Urine output 2.7litres

4th post operative day

Creatinine 1.4mg%

Urine output 3.7litres

5th post operative day 9th of February

Creatinine 1.2mg%

He is fit to be discharged. He is doing alright. His parameters are normalised. His renal function has improved. His creatinine is 1.2mg% .

Coming forward to donate the organs is very commendable which will motivate all of us to do the same and considering to donate organ and save life of few needy people who are fighting with Death.

So come forward and pledge for organ donation and motivate others to do so. Every opportunity should be used to save someone life.

We should not burry or burn our precious organs. Which are valued at 17 Trillion Dollars

Brain death is diagnosed with complete certainty after the introduction of these criteria, there has been not single case report in published literature of any reversal.

After the brain death the body ceases to function properly and body and organs are perfused only life support system by intensivist or critical care specialists. Eventually heart will stop. So this window period is used to retrieve organs. So you start living again in someone else’s body.

We should have brain dead declarations as a routine practice in all of our ICU. All functioning organ should be retrieved and used to save someone else’s life

Thus we become Immortal

Would like to thank to following people

MR Sudhanshu Sarangi commissioner of police for allowing us to do Post mortem in our premises.

Dr L K Behera for conducting post mortem

DMS Dr Ashish Chandra for extending his full support

CEO MR Sudhir Diggikar for all the support and infrastructure

Ast MS Dr Jyoti Parija who was pillar for our whole operation on that day night. He could co- ordinate with all the stake holders at right time and efficiency

Dr C R KAR nodal officer of SOTTO for giving us the permission

Watch me On Facebook

https://www.facebook.com/496384883764150/posts/2705034212899195/?vh=e&d=n
Or On YouTube

https://youtu.be/9T0FhL9Wsuc

Our team felicitated by “Samaj”

Left to right Dr Sambit tripathy. Saoumya Dr Prateek sahoo. Myself. Dr Samiran Adhikary. Transplant co – ordinator. subrat sahoo. Ashok Nayak transplant perfusionist. Dr Jyoti Parija Ast Medical superintendent. Dr Bibekananda Panda nephrologist