CIMS News Care & Cure

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1 Price : s. 5/- Iside pages / ytëhlkk ÃkkLku... MICS/{eõMk MðkMÚÞ y u MðkË 7... fmkhík fhðe y½he LkÚke 7... MkeÃkeykh

2 Miimally Ivasive Cardiac Surgery (MICS) The world is chagig has chaged from Macro to Micro ad so has cardiac surgery from maximally ivasive to miimally ivasive surgery. If we read the history of cardiac surgery, the we fid it to be just 100 yrs old. Log icisio ktçkku fkãkku 4 ich cut 4 #[Lkku fkãkku First successful heart operatio : eh,1896,sutured first heart woud First PDA closure by Gross i 1938 First ASD closure by oss i 1948 First use of heart lug machie i 1953 First successful bypass surgery i 1963 First robotic surgery by Carpetier i The heart is a very dyamic ad cotiuously movig orga alog with beig a very sesitive ad importat orga for the body. A very precise job is required durig cardiac surgery. Hece, till ow edoscopic or thoracoscopic cardiac surgery has ot developed as highly as laproscopy surgery. Cardiac surgery is a zero error surgery. Sice 5 years, miimally ivasive cardiac surgery has arrived o the horizo with promisig results. More ad more cardiac procedure are beig doe through MICS. Sice MICS takes a log time to be leart ad because it is techically demadig, it has ot gaied wide acceptace the world over. I Idia, also, sice last 1-2 years it has gaied mometum ad has slowly started to become a part of the cardiac surgery spectrum. Traditioal Approach to Heart Surgery Stadard midlie sterotomy icisio where the (breast boe) is split i full from the eck to the upper abdome. Usually 8 to 12 iches log midlie icisio is made. Advatages of traditioal approach 1. Heart is i surgeos Had ad hece situatio is uder total cotrol. 2. Surgeo ca do all multicomplicated ad high risk procedure. 3. Ca deal with ay sort of complicatios o the operatig table. 4. Comfort level of surgeo is maximum sice the traiig of past surgeos have bee with this approach. Disadvatages of traditioal approach 1. Pai due to rib fractures ad pai o the back due to stress o the vertebrocostal joits. 2. Higher rate of woud complicatios ad chest boe ifectio. 3. Cuttig of the breastboe ca be cosidered as a fracture ad hece adequate rest for 3 moths for its complete recovery ad {elke{ e LðuÍeð fkšzþkf Mksohe ({eõmk) su{ rðï rðþk {ktúke LkkLkwt çklke hìkwt Au íku s heíku fkrzpþkf Mksohe Ãký {uõmke{ e ELðuMkeð{ktÚke r{lke{ e ELðuMkeð çklke he Au. ykãkýu òu fkšzþkf MksoheLkku EríkkMk òueyu íkku sýkþu fu yu {kºk 100 ð»ko s sqlkku Au. WËk. òueyu íkku, «Úk{ MkV kxo ykuãkhuþlk: hulk,1896, kxolkk s¾{{kt «Úk{ ð¾ík xktfk uðkþk «Úk{ Ãkezeyu õ kuíh økúkumk ÿkhk 1938{kt «Úk{ yuyumkze õ kuíh hkumk ÿkhk 1948{kt kxo tøk {þelklkku «Úk{ ð¾ík ðãkhkþ 1953{kt «Úk{ MkV çkkþãkkmk Mksohe 1963{kt «Úk{ hkuçkkuxef Mksohe fkhãkulxeþh ÿkhk 1998{kt kxo yuf Mkíkík økríkþe ylku r Þkþe ytøk Au ylku MkkÚku MkkÚku íku þheh {kxu ¾qçk MktðuËLkþe ylku {íðlkwt ytøk Au. fkšzþkf Mksohe ËhBÞkLk ¾qçk [kufmkke sáhe Au, {kxu yíþkh MkwÄe yulzkumfkuãkef yúkðk ÚkkuhkfkuMfkuÃkef fkšzþkf Mksohe u«kumfkuãke Mksohe sux e rðfrmkík LkÚke ÚkE. fkšzþkf Mksohe{kt økv íklku MÚkkLk LkÚke. 5 ð»koúke {elke{ e ELðuMkeð fkšzþkf MksoheLkku WËÞ ÚkÞku Au su{kt ykþkmãkë Ãkrhýk{ {éþkt Au. ðäw Lku ðäw fkšzþkf «r Þk yk yu{ykemkeyumk (MICS) ÿkhk ÚkkÞ Au. yu{ykemkeyumk þe¾ðk{kt ktçkku Mk{Þ køkíkku kuðkúke ylku xufrlkf e rz{klzªøk kuðkúke rðï Míkhu íkulku ÔÞkÃkf {klþíkk { e LkÚke. ¼khík{kt Ãký 1-2 ð»koúke s íku{kt ðuøk ykôþku Au ylku Äe{u Äe{u fkrzoþkf Mksohe ûkuºklkku ¼køk çklke hìkwt Au. kxo MksoheLkku ÃkhtÃkhkøkík yr¼øk{ MxkLzzo r{z kelk MxLkkuoxku{e [ehku fu su{kt (AkíkeLkwt kzfwt)økhëlkúke WÃkhLkk Ãkux MkwÄe íkulku ÃkqÁt [ehðk{kt ykðu Au. Mkk{kLÞÃkýu 8 Úke 12 #[ ktçkku {ez kelk [ehku {qfðk{kt ykðu Au. ÃkhtÃkhkøkík yr¼øk{lkk VkÞËk 1. kxo MksoLkLkk kúk{kt Au yux u ÂMÚkrík rlkþtºký ux hu Au. 2. MksoLk ík{k{ srx ylku òu¾{e «r Þk fhe þfu Au. 3. ykuãkhuþlk xuçk Ãkh W¼e Úkíke fkue Ãký Mk{MÞkLku ÃkkU[e ð ðk Mkûk{ Au. 4. ¼qíkfk Lkk MksoLkLke íkk e{ yk yr¼øk{ MkkÚkuLke kue MksoLk MðMÚk ylku ykïmík kuþ Au. ÃkhtÃkhkøkík yr¼øk{lkk økuhvkþëk 1. ÃkktMk elkk uf[hlku fkhýu Ãkezk ylku ðxoçkúku fkumx MkktÄk{kt ËçkkýLku fkhýu ÃkeX{kt Ãkezk 2. ½k{kt Mk{MÞk ylku AkíkeLkk kzfk{kt [uãk køkðklkku ô[ku Ëh 3. AkíkeLkk kzfklku fkãkðwt uf[h økýkþ Au ylku íkuúke MktÃkqýo rhfðhe {kxu 3 {kmklkku Ãkqhíkku ykhk{ ykãkðku Ãkzu Au ylku íkuúke s ykuãklk kxo MksoheLkk 2

3 hece all restrictio that are advised to ope heart surgery patiets. 4. Prologed ICU ad hospital stay due to delayed mobilizatio ad slow recovery. 5. Cosmetic issues, especially i youger patiets. 6. Large Scar related problems like keloids, wire siuses, eurological pai, etc. Idea behid Miimally Ivasive Cardiac Surgery (MICS) The idea for Miimally Ivasive Cardiac Surgery is to decrease the morbidity related to by traditioal methods of cardiac operatios. To decrease morbidity, we mea that the effect o a patiet due to operatio will be reduced. Defiitio of MICS Miimally Ivasive Cardiac Surgery is defied as cardiac surgery without cuttig the chest boe or partially cuttig the breast boe with small icisio. There are several ways that the effect OHS surgery ca be reduced. outie Surgery ÃkhtÃkhkøkík Mksohe Latest MICS Surgery yíþkäwrlkf {eõmk Mksohe Four Ich [kh $[ (a) Oe way is to avoid cuttig the chest boe. By doig this, the patiet returs to work or ormal activity sooer, has less pai ad chest boe ifectio chace is reduced. The sterotomy ca be avoided i most valvular operatios, ad i some coroary bypass operatios. Oly the soft tissue has to heal i place of boe healig, ad hece pai is less ad postop recovery is very fast. (b) Aother way to reduce the effect of cardiac surgery is to avoid the use of the heart lug machie, kow as the cardiopulmoary bypass machie. The use of the heart lug machie is associated with some complicatios, such as stroke, memory loss, kidey failure, lug failure, ad bleedig. Although the heart lug machie is idispesable for may heart operatios, such as valve replacemet, ASD closure or cogeital heart disease, it ca be avoided for other operatios, such as coroary artery bypass operatio, the most commo cardiac operatio. Off-Pump Coroary evascularizatio with EdoScopic Vessel Harvestig Beatig Heart CABG + Edoscopic Vei Harvest or radial artery harvestig. Comprehesive Approach to educig CABG Morbidity Less-Ivasive Optio for Surgical evascularizatio ËËeoykuLku ¼ k{ý fhkþu k ík{k{ rlkþtºkýku 4. Äe{e rhfðhe ylku Lk[ Lk{kt rð tçklku fkhýu ykemkeþw ylku kuâmãkx {kt ktçkw hkufký 5. fkum{urxf Mk{MÞkyku ¾kMk fhelku ÞwðkLk ËËeoyku{kt 6. {kuxk zk½ MktçktrÄík Mk{MÞkyku suðe fu fu kueztmk, ðkþh MkkÞLkMk, LÞwhku kursf Ãkezk ðøkuhu {elke{ e ELðurMkð fkšzþkf Mksohe (yu{ykemkeyumk)ãkka Lkku uíkw {elke{ e ELðurMkð fkšzþkf Mksohe ÃkkA Lkku uíkw fkšzþkf ykuãkhuþlklke ÃkhtÃkhkøkík ÃkæÄrík MkkÚku MktçktrÄík WËkMke ½xkzðkLkku Au. WËkMke ½xkzðkLkku y{khku yúko Au ykuãkhuþlklkk fkhýu ËËeo WÃkh Úkíke ymkhku ykuae fhðe. yu{ykemkeyumklke ÔÞkÏÞk {elke{ e ELðuMkeð fkšzþkf Mksohe yux u AkíkeLkk kzfklku fkãþk rðlkk yúkðk LkkLkk [ehk ÿkhk AkíkeLkk kzfklku ytþík: fkãkelku fhkíke fkšzþkf Mksohe. MksoheLke ymkhku ykuae fhðklkk fux ktf WÃkkÞ Au. 1. yuf {køko Au AkíkeLkk kzfklku fkãkðklkwt xk ðw. yk{ fhðkúke ËËeo fk{ Ãkh fu Mkk{kLÞ «ð]ríkyku Ãkh sõëe [Ze þfu Au, Ãkezk ykuae ÚkkÞ Au ylku AkíkeLkk kzfklku [uãklke þõþíkk ykuae ÚkkÞ Au. {kuxk ¼køkLkk ðuõôþw h ykuãkhuþlk{kt ylku y{wf fkuhkulkhe çkkþãkkmk ykuãkhuþlk{kt MxLkkuoxku{e xk e þfkþ Au. yk{kt AkíkeLkk kzfklku fkãkðklkwt Lkª kuðkúke kzfklke søþkyu fku{ xe~þwykulku s YÍkððkLkk hu Au, Ãkrhýk{u Ãkezk ykuae ÚkkÞ Au ylku ykuãkhuþlk ÃkAeLke hefðhe ÍzÃke ÚkkÞ Au. 2. fkšzþkf MksoheLke ymkh ykuae fhðklkku ylþ {køko Au kxo tøk {þelk yux u fu fkšzþkuãkõ{kulkhe çkkþãkkmk {þelklkku WÃkÞkuøk xk ðklkku. kxo tøk {þelklkk WÃkÞkuøk MkkÚku y{wf Mk{MÞkyku suðe fu, MxÙkuf, ÞkËþÂõík ykuae Úkðe, rfzlke VuEÕÞkuh, tøk VuEÕÞkuh ylku hõík kð Mktf kþu e Au. òu fu kxo tøk {þelk ðkõð rhã umk{ulx, yuyumkze(asd) õ kuíh yúkðk sl{òík kxo hkuøkku suðk ½ýk kxo ykuãkhuþlk{kt ykð~þf Au, íku{ Aíkkt MkkiÚke Mkk{kLÞ fkzeoþkf ykuãkhuþlk-fkuhkulkhe ykxohe çkkþãkkmk ykuãkhuþlk suðkt ylþ ykuãkhuþlk{kt íkulku xk e þfkþ Au. ykuv-ãktãk fkuhkulkhe heðkmfþw hkeíuþlk ðeúk yulzkumfkurãkf ðumk kðuomxªøk çkexªøk kxo MkeyuçkeS+yuLzkuMfkurÃkf ðuelk kðuomx yúkðk hurzþ ykxohe kðuomxªøk MkeyuçkeS (CABG) MkkÚku MktçktrÄík [íkk ½xkzðk Mkðoøkúke yr¼øk{ MkŠsf heðkmfþw hkeíuþlk {kxu ykuae fkãk-fqãkelkku rðfõãk LkkuLk-MxLkkuoxku{e yr¼øk{ yk yr¼øk{{kt Ãkqhe tçkkelke r{z kelk MxLkkuoxku{e xk ðk{kt ykðu Au. yulku çkë u ÃkktMk eyku ðå[u/ Úkkuhkõxku{e yr¼øk{lkku WÃkÞkuøk fhkþ Au su{kt fkue 3

4 No-Sterotomy Approach Uder this approach full legth midlie sterotomy is avoided ad istead, betwee the ribs / thoracotomy approach is used where there is o boe cuttig or partial sterotomy is doe with average icisio legth of just 3-4 iches. Procedure that ca be doe usig MICS approach 1. Atrial septal defect closure through right thoracotomy. (Hole i Heart sice birth) 2. Mitral valve repair or replacemet through right thoracotomy. (Valve disease) 3. Aortic valve replacemet through upper partial sterotomy or right small thoracotomy 4. Sigle or double vessel beatig heart CABG through left 4-5 itercoastal space usig left iteral mammary artery ad radial artery. Modificatio for this surgery I ope heart procedure i MICS, cardiopulmoary bypass (CPB) is established through differet routes tha traditioal direct caulatio of ascedig Aorta ad ight atrium. Here, the SVC is caulated from a eck pucture ad IVC ad Aorta are caulated through femoral approach. This techique requires special istrumets ad caulas ad Tras Esophageal Echocardiogram (TEE), i the operatio room ad requires special traiig. Sice all the caulas are outside the operative area, oly workig space is required for the surgery ad hece ca be doe through 3-4 ich icisio with special log istrumet. Advatages of MICS approach Less ivasive procedure, so less pai. Shorter ICU ad hospital stay. Preferable i high risk patiets like patiets with bad lugs or stroke etc. Early mobilizatio, particularly importat i post stroke patiets. Faster recovery leads to early resumptio of day to day activities ad hece a daily wager like electricia, carpeter, driver, etc ca resume their work i 1 moth ad ear their livelihood. Better cardiac rehabilitatio. Better cosmetic icisios BIKINI SCA as i females the scar is i the breast crease ad i the thigh fold, so practically the scar is ivisible. Youg females ca have this surgery with full cofidece ad eve ca wear the most fashioable clothes without ay iferiority complex. Patiet selectio criteria for MICS approach Youg age, preferably. Normal peripheral vascular system. Absece of associated co pathology ad here proper preoperative evaluatio is very importat, so that o surprises arise o operatig table. Patiet demad 4 kzfwt fkãkðklkwt huíkwt LkÚke yúkðk Mkhuhkþ {kºk 3-4 #[Lkk [ehk MkkÚku ytþík: MxLkkuoxku{e fhkþ Au. yu{ykemkeyumk yr¼øk{lkku WÃkÞkuøk fhe Úkíke «r Þk 1. hkex Úkkuhkõxku{e ÿkhk ykrxùþ MkuÃx rzvuõx õ kuíh (ÓËÞ{kt sl{úke s fkýwt) 2. hkex Úkkuhkõxku{e ÿkhk {kexù ðkõð rhãkuh yúkðk rhã umk{ulx(ðkõðlkku hkuøk) 3. ytþík: yãkh MxLkkuoxku{e yúkðk LkkLke hkex Úkkuhkfxku{e ÿkhk yuykuxeof ðkõð rhã umk{ulx 4. zkçke ELxhLk {u{khe ykxohe ylku hurzþ ykxohelkku WÃkÞkuøk fhe zkçke íkhv 4-5 ELxhfkuMx ÿkhk Mkªøk yúkðk zçk ðumk çkexªøk kxo MkeyuçkeS. yk Mksohe {kxu ÃkrhðíkoLk yu{ykemkeyumk {kt ykuãklk kxo «r Þk{kt ÃkhtÃkhkøkík MkeÄe WÃkhe yuykuxko ylku s{ýk yuxùeþ{lkk fulþw uþlklku çkë u fkšzþkuãkõ{kulkhe çkkþãkkmk (CPB) rðrðä {køko ÿkhk MÚkkÃkðk{kt ykðu Au. yª (SVC) yumkðemke økhëlk{kt Ãktf[h fhe fulþw ux fhkþ Au ylku (IVC) ylkuyuykuxko Vu{h {køkuoúke fulþw ux fhkþ Au. yk xufrlkf{kt rðþu»k MkkÄLkku ylku fulþw kmk íkúkk Tras Esophageal Echocardiogram (TEE) Lke ykuãkhuþlk Á{{kt sáh Ãkzu Au ylku rðþu»k íkk e{ {ktøke u Au. ík{k{ fulþw kmk ykuãkhuxeð yurhþklke çkkh kuðkúke Mksohe {kxu {kºk ðfeoøk MÃkuMkLke syh Ãkzu Au ylku íkuúke rðþu»k ktçkk MkkÄLk ðzu 3-4 #[Lkk [ehk ÿkhk ÚkE þfu Au. yu{ykemkeyumk yu«ku[lkk VkÞËk ykuae ðkz-fkãkðk e «r Þk, íkuúke ykuae Ãkezk ykemkeþw ylku kuâmãkx {kt xqtfw hkufký ô[w òu¾{ Ähkðíkk ËËeoyku fu su{lkk VuVMkkt ¾hkçk kuþ yúkðk MxÙkuf ykôþku kuþ íku{lkk {kxu EåALkeÞ s Ëe Lk[ Lk, MxÙkuf ÃkAeLkk ËËeoyku {kxu ¾kMk fhelku {íðlkwt ðu e rhfðhelku eäu hku sëe «ð]ríkyku {kt ðu k køke þfkþ Au. {kxu E ufxùeþeþlk, MkwÚkkh, zùkeðh ðøkuhu suðkt hkus{ëkhku yuf {rlkklke ytëh s íku{lkwt fk{ þá fhe yksrðfk f{ke þfu Au. MkkÁt fkšzþkf rhuçke exuþlk MkwtËhíkkLku ûkríkøkúmík fþko rðlkklke Mkkhðkh-{r kyku{kt çkúumx eí Ãkh ylku ÚkkE VkuÕz Ãkh s¾{lkku zk½ Ãkzu Au. {kxu, zk½ Ëu¾kíkku s LkÚke. ÞwðkLk {r kyku Ãkqhk rðïkmk MkkÚku yk Mksohe fhkðe þfu Au ylku fkue Ãký «fkhlke ½wíkkøkútÚke rðlkk VuþLkuçk ð ku Ãkuhe þfu Au. yu{ykemkeyumk {kxu ËËeoykuLke ÃkMktËøkeLkku {kãkëtz ík{k{ rlkëuorþík ËËeoyku, yøkkw [[ko fhe íku ík{k{ ÞwðkLk ðþ EåALkeÞ Mkk{kLÞ ÃkurhVh ðkmfþw h rmkmx{ MktçktrÄík fku-ãkuúkku kuslke økuhkshe ylku yª ykuãkhuþlk yøkkwlkwt

5 Is MICS possible for all? MICS is ot possible i followig category of patiets with Multiple pathology. Peripheral vascular disease. Associated cogeital aomalies. Multivessel disease i cases of CABG as graftig o the right system is difficult. Grossly obese patiet are difficult for thoracotomy. Our experiece at Hospital First official ceter to lauch fully equipped MICS programme i Ahmedabad ad Wester Idia. Oly ceter to perform direct IJV/SVC caulatio i wester Idia. Performed aroud 100 cases successfully of MV, ASD ad CABG i less tha 2 years. Hybrid bypass performed first time i Idia. Stadard result i compariso to other cetre i patiets operated by MICS approach. Summary I coclusio, ew techology is available to surgeos ad therefore to patiets, that ca sigificatly reduce the pai ad recovery time for selected patiets udergoig heart surgery. MICS is a real boo for cardiac patiets thereby r e d u c i g m o r b i d i t y a d improvig the outcome i youg patiets. Defiitely, this caot be offered to all patiets but i selected patiets it is a good o p t i o. T h e r e a r e e w approaches to old surgery ad there are completely ew operatios, that have the potetial to improve the outcomes of thousads of patiets every year. This tred will cotiue ad will parallel the developmet of ew techology authors / u¾f Dr. Dhire Shah Dr. Dhaval Naik Dr. Dipesh Shah I specially came from USA for MICS Bypass. Without boe cuttig through 4 ich cut, my surgery was doe. Now, I feel very happy & healthy ad I am back to New Jersey ad workig withi oe moth. - Vrushak Desai (New Jersey, USA) Patiet's Feedback íkkhý ytík{kt yux wt s fu, MksoLkku ÃkkMku Lkðe xufrlkf ykðe Au ylku íkulkku VkÞËku ËËeoykuLku Au. yuðe xufrlkf fu su kxo Mksohe Lkk ÃkMktËøkeLkk ËËeoyku{kt Ãkezk ylku rhfðhe Mk{Þ{kt WÕ u¾lkeþ ½xkzku fhu Au. yu{ykemkeyumk fkšzþkf ËËeoyku {kxu fefík{kt ðhëklk Au fu su ÞwðkLk ËËeoyku{kt [íkk ykuae fhe Ãkrhýk{ MkwÄkhu Au. [ku MkÃkýu yu çkäkt s ËËeoyku {kxu LkÚke Ãký ÃkMktËøkeLkk ËËeoyku {kxu yu yuf Mkkhku rðfõãk Au. sqlke Mksohe Mkk{u Lkðku yr¼øk{ Au ylku Lkðk ykuãkhuþlk Au, su{kt Ëh ð»kuo òhku ËËeoykuLkk Ãkrhýk{ MkwÄkhðkLke ûk{íkk hu e Au. yk «ðk òhe huþu ylku MkkÚku òhe huþu sqlke Mk{MÞk {kxu Lkðe xuflkku kuslkku rðfkmk ylku Lkðk Wfu. Cardio-Vascular Surgical Team Cardiac Surgeos Dr. Dhire Shah Dr. Dhaval Naik Dr. Dipesh Shah Vascular & Edovascular Surgeo Dr. Srujal Shah ÞkuøÞ {qõþktflk ¾qçk sáhe Au fu suúke ykuãkhuxªøk xuçk Ãkh fkue yýäkhe ½xLkk Lk çklku. ËËeoLke EåAk þwt yu{ykemkeyumk çkäk {kxu þõþ Au? yu{ykemkeyumk rlkblkr r¾ík ËËeoyku {kxu þõþ LkÚke fu su{lku : {ÕxeÃk ÃkuÚkku kus kuþ ÃkurhVh ðkmfþw h hkuøk MktçktrÄík «f]ríkë k rð ûkýíkk s{ýe çkksw økúkvxªøk {w~fu kuðkúke MkeyuçkeSLkk fumk{kt {ÕxeðuMk hkuøk ¾qçk {uëmðe ËËeoyku Ãkh Úkkuhkfxku{e fhðe {w~fu kuþ Au. MkeBMk kuâmãkx {kt y{khku ylkw¼ð y{ëkðkë ylku Ãkrù{ ¼khík{kt MktÃkqýo MkwMkßs yu{ykemkeyumk «kuøkúk{ þá fhlkkh «Úk{ yräf]ík MkuLxh Ãkrù{ ¼khík{kt MkeÄwt s IJV/SVC fulþw uþlkfhlkkh yuf {kºk MkuLxh 2 ð»koúke ykuak Mk{Þ{kt MV, ASD ylku CABGLkk 100 sux k MkV fumk ¼khík{kt Mkki «Úk{ keçkúez çkkþãkkmk yu{ykemkeyumkúke ykuãkhux fhkþu k ËËeoyku{kt ylþ MkuLxhLke Mkh¾k{ýeyu Wå[ økwýð kk ðk w (MxkLzzo) Ãkrhýk{ Pediatric Cardiac Surgeo Dr. Shauak Shah Dr. Ashutosh Sigh Cardiac Aaesthetist Dr. Nire Bhavsar Dr. Hire Dholakia Dr. Chita Sheth I came from South Africa for gettig ASD closure by MICS procedure ad I have started playig cricket after oe moth. - Nafuil Shaikh (South Africa) 5

6 News at {ýelkøkh MkeBMk Âõ rlkf Lkwt þw¼ WËT½kxLk òlþwykhe 29, 2012Lkk hkus {klklkeþ e yrmkík ðkuhk - {uþh e, y{ëkðkëlkk þw¼ Míku MktÃkLLk ÚkÞw fkšzþku kus (ÓËÞLkk hkuøk) fkšzþkuúkkuhkmkef ylku ðkmõþw h Mksohe exef fuh.yulk.xe. økumxùkuyulxùku kus slkh Mksohe / S.yk. Mksohe økkþlkufku kus ylku ykuçmxuxùeõmk LVuÂõMkÞMk rzmkes LkeykuLkuxku kus(lkðòíkþeþw) ylku ÃkerzÞkxÙeõMk(çkk fkulkk hkuøk) Lku ku kus (fezlkelkk hkuøk)/zkþk emkemk 6 {ýelkøkh MkeBMk Âõ rlkf{kt WÃk çä ykuãkeze Mkuðkyku LÞwhku kus ({økslkk hkuøk) LÞwhkuMksohe ykuçkumkexe / çkuheþkxùef Mksohe (MÚkq íkk rlkþtºký) ykulfku kus (fulmkhlke çke{khe) ykulfku Mksohe ykuúkkuoãkurzõmk / òulx rhã umk{ulx ÃkuLk {ulkus{ulx ÃkerzÞkxÙef fkšzþku kus (çkk fkulke ÓËÞLke çke{khe) At... we care zkçkuúke : zkì. òuþ þk, e yrmkík ðkuhk ({uþh), e MktsÞ Ãkxu, zkì. yrlkþ [tëkhkýk, zkì. fuþqh Ãkhe¾ økt¼eh ËËeoyku {kxu {ýelkøkh Úke MkeBMk kuâmãkx kððk yubçþw LMkLke MkwrðÄk WÃk çä Au ÃkerzÞkxÙef Mksohe Ã kmxef Mksohe ÃkÕ{kuLkku kus (VuVMkkLkk hkuøk) MÃkkLk Mksohe (fhkuzhßsw ylku {ýfklkk hkuøk) xùku{k Mkkhðkh Þwhku kus y u ÞwhkuMksohe (ÃkÚkhe, «kumxux ylku rfzlkelkk hkuøk) ÃkuÚkku kus hurzþku kus ÃkuÚkku kus, MkeS, fkufkšzþkuøkúkve, xeyu{xe íkúkk ylþ ½ýe çkäe Mkøkðzku MkeBMk Âõ rlkf Ãku ku {k, þktíkk«¼k kxtmk, LzMk Lz çkulflke WÃkh, ðõ ¼ ðkze Mkk{u, sðkh [kuf LkSf, ¼ihðLkkÚk hkuz, {ýelkøkh, y{ëkðkë yuãkkulx{ulx {kxu VkuLk (Mkðkhu 10 Úke Mkktsu 5) : VkuLk : (3 Lktçkh) VuõMk :

7 MðkMÚÞ y u MðkË xku{uxku ylku {MkqhLke Ëk Lkku MkqÃk Mkk{økúe : 1/2 fãk {MkqhLke Ëk / {øklke Ëk 5 fãk Ãkkýe 1 2/2 fãk fkãku k zwtøk e (Íeýk ÃkkMkk{kt) 1 1/2 fãk fkãku k økksh (Íeýk ÃkkMkk{kt) 1 xe MÃkqLk ykuhuøklkku 1 1/2 fãk xk{uxklke ÃÞqhe 2 fãk ðusxuçk Mxkuf {exwt {he Ãkkðzh, 1 xe MÃkqLk íku heík : yuf ðkmký{kt 35 Úke 40 r{rlkx MkwÄe {MkqhËk Lku Ãkkýe{kt Wfk ðe fu ßÞkt MkwÄe íku Ãkku[e Lk ÚkE òþ. Ãkkýe VUfe Ëuðwt ylku íku{ktúke {kºk 3/4 fãk sux wt Wfk u wt Ãkkýe MkkEz{kt {qfe hk¾ðwt. 1 xe MÃkqLk íku {kt zwtøk e- Mký Lkk¾e kððwt. íþkhçkkë økksh, ykuhuøklkku Lkk¾e Mkkhe heíku Äe{e ykt[u Úkðk Ëuðwt fu ßÞkt MkwÄe økksh Ãkku[k Lk ÚkkÞ. íþkhçkkë íku{kt Ëk ylku xk{uxklke ÃÞqhe Lkk¾ðe ylku íkulku Ãkkík k fhðk 3/4 fãk MkkEz{kt hk¾u wt Ãkkýe ylku 2 fãk ðusxuçk Mxkuf Lkk¾ðwt. 15 r{rlkx MkwÄe Wf ðk Ëuðwt. íþkhçkkë íku{kt {exwt ylku {he Ãkkðzh MðkËkLkwMkkh W{uhðk. yk MkqÃk{kt Ëk Lkku WÃkÞkuøk ÚkÞku kuðkúke íku{ktúke çkeò Ãkku»kf ík ðku WÃkhktík «kuxelk Ãký Mkkhk «{ký{kt { þu. íkuúke ðäkhu {uë Ähkðíkk ÔÞÂõík {kxu MktÃkqýo ykkh økýkþ. {uëmðe kufku íkulkku WÃkÞkuøk çkãkkuhlkk s{ýlke søþkyu fhe þfu. fmkhík fhðe y½he LkÚke fmkhík fhðklkk VkÞËkyku : ÓËÞhkuøk yúkðk MxÙkufÚke {]íþw Ãkk{ðkLkk ¾íkhkLku ykuaku fhe þfkþ Au. ÓËÞhkuøk, MxÙkuf, ke ç z«uþh, fku kulk fulmkh ylku zkþkrçkxemklkk ¾íkhkLku ½xkze þfkþ Au. ke ç z«uþhlku Lke[wt kðe þfkþ Au. {kuxe ô{hlkk kufkulku Ãkzðk-yk¾zðkÚke ylku kzfkt ¼ktøke sðk{ktúke hûký { u Au. y{wf «fkhlkk fulmkh{kt (suðk fu MíkLkLkwt fulmkh) hûký { u Au. rlkþr{ík þkherhf { fhðkúke fkueãký ÔÞÂõíkLku íktëwhmík kuðklke køkýe WíÃkLLk ÚkkÞ Au, fkhý fu : r[tíkk ylku íkkþklke køkýelku ykuae fhu Au ylku {qz' Mkkhku çklkkðu Au. íkkýlku ÃkkU[e ð ðk{kt {ËËYÃk ÚkkÞ Au. ðslklku fkçkw{kt hk¾ðk{kt {ËËYÃk ÚkkÞ Au. MkktÄkLkk MkkuòykuLku ylku ykúkúkoexemklkk ËËoLku fkçkw{kt hk¾ðk{kt {ËË fhu Au. WíMkk ylku þâõíklke køkýe ðäu íku{kt {ËËYÃk ÚkkÞ Au. Mkkhe Ÿ½ kððk{kt {ËËYÃk ÚkkÞ Au. òík «íþulkku yt¼kð ðäw Mkkhku ÚkkÞ Au. ÔÞÂõíkyu yxðkrzþklkk ºkýÚke Ãkkt[ rëðmk, 30 Úke 45 r{rlkx MkwÄe Mkk{kLÞ fmkhík yúkðk þkherhf { fhðklkwt þy fhðwt òueyu, yúkðk yxðkrzþklkk çkäk s rëðmkkuyu Mkk{kLÞ ðe fmkhík þy fhðe òueyu. yuhkurçkf fmkhíkku suðe fu òu økøk, MkkÞf øk, xùuz{e WÃkh [k ðwt ylku ÂMð {øk yu {uëâmðíkkúke Ãkezkíkk ËËeoykuLku {ËËYÃk ÚkkÞ Au. òufu yuhkurçkf fmkhíkku þy fhíkkt Ãku kt 10 r{rlkx ðku{o yãk' {kxu ylku Ãkqhe ÚkkÞ yux u 10 r{rlkx fw zkwlk' {kxu hk¾ðe yrlkðkþo Au. Vk{kofku ÚkuhkÃke : {uëmðeãkýk {kxu {kfuox{kt ½ýe çkäe Ëðkyku ykðu e Au Ãký íku ËðkykuLke ykz ymkhkulkk fkhýu Ëhuf ËËeo {kxu íku ðkãkhðe ríkkð LkÚke. SðLkþi e çkë ðkúke Úkíkku VkÞËku fkuãký þtfk ðøkh Mkkrçkík ÚkÞu ku Au íkuúke ykãklkk Mkki {kxu SðLkþi e çkë ðk rmkðkþ çkeòu fku ÃkÞkoÞ LkÚke. 7

8 egistered uder NI No. GUJBIL/2010/39100 th th Permitted to post at PSO, Ahmedabad o the 30 to 5 of every moth uder st Postal egistratio No. GAMC-1813/ issued by SSP Ahmedabad valid upto 31 December, 2013 th Licece to Post Without Prepaymet No. CPMG/GJ/102/2012 valid upto 30 Jue, 2012 If udelivered Please etur to Hospital Nr. Shuka Mall, Off Sciece City oad, Sola, Ahmedabad Phoe : (5 lies) Mobile : , Subscribe : Get your, the iformatio of the latest medical updates oly ` 60/- for oe year. To subscribe pay ` 60/- i cash or cheque/dd at Hospital Pvt. Ltd. Nr. Shuka Mall, Off Sciece City oad, Sola, Ahmedabad Phoe : / Cheque/DD should be i the ame of : Hospital Pvt. Ltd. Please provide your complete postal address with picode, phoe, mobile ad id alog with your subscriptio rlk:þwõf MkeÃkeykh þe¾ku ylku yuf rstëøke çk[kðku (fkšzþkuãkõ{kulkhe humkmkexuþlk / fkšzþkf {Mkks) þwt ík{khe yksw-çkksw fkulkwt ÓËÞ yufkyuf çktä Ãkze økþw Au? fku çkukuþ Úk økþw Au? fkulkku ïkmk YtÄkE økþku Au? Prited, Published ad Edited by Preeta Chag Prited at High Sca Pvt. Ltd., 'Hi Sca Estate', Sarkhej-Bavla Highway, Chagodar. Ahmedabad Published from Hospital, Nr. Shuka Mall, Off Sciece City oad, Sola, Ahmedabad MkeÃkeykh yux u ÓËÞLke økrík çktä Ãkze kuþ íkuðk ÔÞÂõíkLku ykãkðk{kt ykðíke íkkífkr f Mkkhðkh «r Þk fu su fkuãký Mkk{kLÞ ÔÞÂõík þe¾e ylku yãklkkðe þfu Au. MkeBMk kuâmãkx Ëh {rlkklkk Ãku k hrððkhu 2 f kf {kxu rlk:þwõf MkeÃkeykh Lkk õ kmklkwt ykþkuslk fhu Au. Mk{Þ : Mkðkhu 10 Úke 12 hsmxùuþlk {kxu MktÃkfo fhku ({ku) MkeBMk kuâmãkx, þwflk {ku LkSf, ykuv MkkÞLMk Mkexe hkuz, Mkku k, y{ëkðkë {u : ifo@cims.me ðuçk: