The Tribune, Chandigarh, India

HEALTH

BODY & MIND
Air medical evacuation – a new lease of life
Tripti Nath

Unwilling to accept the physician’s final opinion on the irreversible condition of patients, relatives are now exploring the best possible option of medical air evacuation. Leaving no stone unturned in saving the life of their kith and kin, persons across the country are opting for the best in emergency medical services by committing payments to packages covering return fares by private taxis and expert medical attention during the evacuation. Prominent hospitals and organisations offering medical evacuation in Delhi, are the Indraprastha Apollo Hospital, the Escorts Heart Institute and Research Centre (EHIRC), the East West Rescue Centre, Meera Rescue, Goodman’s and International SOS. Besides, the Apollo Group of Hospitals has also been doing medical evacuation for sometime now.

The service has several takers as evidenced by the fact that in the last two weeks, Indraprastha Apollo Hospital, Delhi, has handled ten cases of air medical evacuations. On Saturday morning, doctors at Apollo Emergency evacuated Vikas Maheshwari, a 22-year-old victim of road accident from a private nursing home in Lucknow.

Dr Asif Ali, in-charge of emergency services at Indraprastha Apollo Hospital, says that although their written prognosis to the victim’s family mentioned bleak chances of survival, his parents wanted to do their best. A three-member team of Apollo, led by Dr Ali, monitored the patient’s condition during the one-hour and ten-minute journey from Lucknow to Delhi in a single engine eleven-seat aircraft of Deccan Aviation Private Limited.

Vikas was thrown off his motorcycle in a head-on collision with an ambassador car on Friday. For want of portable CT scan, his CT scan could not be done at Lucknow. Dr Ali said that the patient’s condition is static. When he was brought to the hospital, he was deeply comatose, had multiple poly trauma, head injury, minimal reflexes and sluggish pupils.

He said that a CT scan would enable doctors decide if his skull can be opened.

Dr Ali says that air ambulance service is a part of emergency medicine. “The basic requirement of emergency care-airway breathing circulation is maintained by the state-of-the-art portable transport ventilators, monitoring equipment, defib monitors with pulse oxymetry and transcutaneous pacing capabilities, equipment to carry the patient as scoop stretchers, syringe pump and vacuum mattresses.”

After getting a call, doctors on emergency service confirm the authenticity of the call and check the patient’s condition with the doctor. The costs are worked out on the basis of the availability of the aircraft and the paying capacity of the patient’s attendants.

Arrangements are also made to ensure cent per cent payment upfront. ``Sometimes, we ask the patient’s relatives to transfer the money to the hospital account. At other times, we ask the hospital at the other end to collect the money from the patient’s relatives and inform us,’’ says Dr Ali.

Having handled 170 cases of air evacuation, Dr Ali is convinced that people can afford the costs involved. In the Lucknow case, for instance, air evacuation has cost Rs 1.5 lakh. Of this, 90 per cent goes to the air charter.

The Apollo team recently evacuated a four-month-old American child suffering from encephalitis from Dhaka at a cost of Rs 4.5 lakh. The child is on ventilator at Apollo.

Dr Ali, however, does not claim any miracles. “Despite world class facilities, there is not much we can do. Unfortunately, relatives bring patients when they are on the verge of multi-organ failure. Co-ordination takes time. The taxi operators also need permission from flying authorities. Due to governmental regulations, flights may be delayed, as additional permission is required for certain airstrips from defence authorities. Every minute counts in such critical cases. Chances of survival are fifty per cent. Factors as age, severity of injuries, late transfer, underlying co-morbid conditions as diabetes and hypertension result in death of patients,’’ he says.

Dr Ali says that a lot of factors contribute to the recovery of a patient. “Most countries have allowed hospitals to set up a helipad on the terrace. Apollo, Hyderabad, has a helipad next to the ICU. Apollo, Delhi can’t have a similar helipad because it falls under the air corridor.’’

The hospital has evacuated patients from Allahabad, Chandigarh, Kanpur, Kolkata, Kullu, Ludhiana, Lucknow, Purnia, Raja Mundry besides Dhaka and Nepal.

Captain R.K. Kaura, Senior pilot-in-command during the return journey from Lucknow on Saturday morning, says that Deccan Aviation Private Limited handles about four evacuations every month. In the last one-and-a-half years, Captain Kaura has flown forty critical patients from various destinations to Chennai, Delhi and Mumbai. He says that his company charges Rs 50,000 to Rs 60,000 per hour for air evacuation.

But, the evacuation process involves several hurdles. After knowing the destination, the pilots check the operating hours of the airfield and get special permission from the authorities. Since every airfield does not have might landing facility, evacuation is sometimes delayed.

Captain K.J. Samuel, the Executive Director of Deccan Aviation Private Limited, says that they started with charter flights with one helicopter in 1997. ``Now we have eight helicopter and two fixed wing aircraft. So far, we have done about fifty medical evacuations for Apollo Hospital, Delhi, Chennai and Hyderabad, Manipal hospital in Bangalore, St John’s Hospital in Bangalore and International SOS.

Organ donation

“Persons declared brain dead (irreversible brain damage) are ideal candidates for organ donation,’’ said Dr Sameeran Nundy, Head of the Department of Gastro Intestinal Surgery, Ganga Ram Hospital, while moderating a discussion on organ donation at Constitution Club here recently.

Dr Nundy, a member of the expert committee that drafted the bill on Transplantation of Human Organs, stressed the need for encouraging cadaver organ donation.

He said that not many relatives come forward to donate organs of brain dead patients due to lack of awareness about organ donation. Religious taboos and fears about mutilation of the body and delay in last rites also discourage people from giving consent for organ donation. He cited the example of Chennai, which has been moderately successful in promoting cadaver organ donation. Dr Nundy said that 88-cadaver organ donations were reported from Chennai in the last four years. He said that a majority of transplants in Eastern countries is done from living donors - this means putting the donor at risk. He drew attention to misuse of provision in the Act, which allows emotionally related living donors to donate organs.

Dr A. S. Soin, Transplant Surgeon at Ganga Ram Hospital and one of the trustees of Human Organ Procurement Education (HOPE) Trust, outlined the current status of cadaver organ donation in the country. “We have had only 250 cadaver donors in the last eight years. This works out to only 35 cadaver donors a year across the country. You are looking at a country of 1.1 billion. This compares very poorly with developed countries like US, which have an organ donation rate of 21 per million and Spain, which has an organ donation rate of 28 per million. It should be at least 15 per million.

Two lakh persons need transplants every year, but only one-third can actually afford lifelong treatment following the transplant.”

Dr Subhash Gupta, Transplant Surgeon at Ganga Ram Hospital, spelt out the reasons why cadaver organ donation has not picked up in India. Dr K.C. Mahajan, Chairman of the Department of Academics at the Ganga Ram Hospital, suggested large-scale media publicity for promoting organ donation.

Dr Soin also answered questions about the role of Transplant Coordinators who can liase between Doctors, brain dead patients, families and other Hospitals.

Slim sanitary napkins: Gufic Biosciences Ltd (GBL) has launched ‘Acti-Slim’, an ultra slim range of sanitary napkins designed especially for active women. A pack of eight napkins is priced at Rs 55.

Good news! Leucoderma is curable now
Tribune News Service

Before

After

A major breakthrough has been achieved in the form of Laser assisted Melanocyte (Pigment cells) transplantation to treat leucoderma. Now patients with large and stable patches of leucoderma, which were not responsive to medical therapy and were thought to be incurable, can look forward to get back normal skin colour.

Appearance of any white spot anywhere on skin is enough to send chill through the spine. The mere thought of suffering from leucoderma is enough to cause mental collapse. There is a tremendous social stigma associated with the disease. The worst affected are girls of marriageable age suffering from it. In addition, one may experience isolation in society, lack of self-confidence and inferiority complex. It is associated with myths and stigma even today for e.g. white coloured foodstuffs cause vitiligo. It is transmitted to the third generation etc.

According to Dr Munish Paul, Dermatologist and Laser Surgeon practising at Skin Laser Centre, Paschim Vihar, New Delhi, leucoderma also known as “white patches” is not contagious i.e. It cannot spread by touching someone or even by handling personal belongings or food. It affects at least 1 per cent of the population both males females are equally affected. The age of onset can be from birth to old age. Even though most people with vitiligo are in good health, they face a greater risk of having thyroid disease, anaemia, and alopecia.

Existing treatment of vitiligo consists of medical in the form of corticosteroids, PUVA and levamisole and surgical in the form of tattooing, split skin grafting, blister roof grafting and punch grafting.

Dr Paul says that Laser assisted Melacocyte Transplant is a novel and latest development in the management of vitiligo, which is being started for the first time in association with Senior Dermatologist and Vitiligo specialist, Dr Sanjeev Mulekar, from Pune, who has received training at Uppsala University, Sweden in Melanocyte Cell Transplantation.

The technique involves taking a very thin skin sample from normally pigmented area, preferably buttocks. The skin sample is of size approx. 4cm x 2cm. This size enables to treat 100-sq cm of white area. A pigment cell suspension is made from the skin sample in about 1.5 to 2 hours.

In the next step, only the upper layer of the skin (Epidermis) is removed, precisely with the Erbium - YAG Laser, the Melanocyte suspension is then evenly spread on scraped area and covered with special collagen dressing. Dressing is removed after 6 days. Earliest pigmentation is noticed a 4 weeks and is usually complete in about 2 to 4 months.

According to Dr Paul, it is important that vitiligo is stable (i.e. the patient’s white patches shouldn’t be spreading) before the surgery. If the disease is active it has to be made stable by the use of modalities as phototherapy (PUVA, UVB), medicines etc.

Melanocyte cell transplantation is extremely effective in stable, non-progressive vitiligo. The main advantages of melanocyte transplant are that it’s a Day-care procedure. Patient does not require admission. Secondly, large areas can be treated with small donor site. The procedure has good cosmetic results, re-pigmentation occurs within 2 to 4 months and the possibilities of side effect like scarring minimal all sites excluding palms and soles can be treated.

SPORTS

Dushyant, Priyanka lift gold for Delhi
Our Sports Reporter

New Delhi, December 7
Dushyant Dahiya of Delhi lifted the 52-kg gold in the 13-18 years age category for boys while Priyanka Deshbandhu struck gold in the 22-28kg weight in the girls section in the 17th National Taekwondo Championship held at the Talkatora Indoor Stadium.

Pardeep Deshwal of Haryana won the gold in the 36-42kg weight category in the boys section, while Poonam Malik from the State emerged on top in the 34-40kg category in the girls section.

Following are the results:

Girls: 22-28kg: Priyanka Deshbandhu (Delhi), Rachna Wasnik (Maharashtra), Patel Brijesha (Gujarat) and Chetna (Jammu and Kashmir).

28-34kg: Mayuri (Maharashtra), Rashmi Verma (Delhi), Nitika Grover (Delhi) and A Lalitha (Delhi).

34-40kg category: Poonam Malik (Haryana), Sonam (J and K), Roshni Patel (Gujarat), Ohelito (Nagaland).

40kg and above: Swati S Chauhan (Uttar Pradesh), Ileusuilng Zeliang (Maharashtra), Namita Chakravarty (Delhi), Ishita Matharu (Delhi).

Boys: 24-30kg: Suprit Thakre (Mah), Muvuthung (Nagaland), Siddharth Sahoo (Orissa). 30-36kg: Rivato (Nagaland), Mayur Patel (Maharashtra), Patel Atit (Gujarat) and Rohit Sankar (Chandigarh).

36-42kg: Pardeep Deshwal (Haryana), Sandeep Kumar (J and K), Prateep Aggarwal (Delhi) and Varun Saroa (Maharashtra).

Boys 13-18 years: Below 52kg: Dushyant Dahiya (Delhi), Devender Pal (UP), Chumbemo (Nagaland), Babloo Singh (Chandigarh). 52-58kg: Nishant Samal (Orissa), Firoz Basha (Karnataka), Abhijit Chander (Maharashtra) and Ajay Guleria (Himachal).

58-64kg: Bhupinder Singh (Uttranchal), Sagar Jain (Delhi), Ram Muktan (Har) and Manoj Kumar (UP).

Ram, Pavneet emerge best athletes
Our Sports Reporter

New Delhi, December 7
Ram Niwas of Dyal Singh College and Pavneet Kaur Chimni of Jesus and Mary College, emerged as the best athletes in the men’s and women’s section respectively in the three-day Inter-College Athletic Meet of the Delhi University, which concluded at the Jawaharlal Nehru Stadium, on Saturday.

Pavneet Kaur, who won five golds and one silver, including the 400m gold on Saturday, gave a standout performance, and has shown the promise of blossoming into a top-grade athlete, given proper training and guidance from now onwards.

This talented girl brooked no opposition as she strode to five golds and one silver. Ram Niwas also put up an equally good performance to put Dyal Singh College’s name in the top bracket.

However, Dyal Singh College, which topped the points table at the end of the second day on Friday, slipped down by two points due to their inability to field a team in the men’s relay competition. They had to be satisfied with the third position in the overall team standing with 42 points, while Bhim Rao Ambedkar College of East Delhi and Khalsa College (Evening) took the first and second position, securing 44 and 43 points, respectively.

Dyal Singh College reader in physical education Mrs Nirmal Taneja said hard work and proper encouragement from the college authorities had helped the athletes from the college put up a commendable performance. Deputy director of physical education of Dyal Singh College Sandeep Mehta said the college has been making serious efforts to develop sports facilities and improve the standard of the sportspersons of the college, with the full support and encouragement of the principal.