Don't delay surgery-if required-Says Dr. Dewan

[17:23, 2/3/2018]

CME held at Dewan hospital Ludhiana

Ludhiana: 3rd February 2018: (Punjab Screen Bureau):: 

A CME was held at Dewan Hospital and Advanced Laparoscopic Surgery Center, Ludhiana on the topic of "Complications caused by delay in the surgery of Gall Stone Disease". Dr Narotam Dewan, consultant General and Laparoscopic Surgeon, Dewan Hospital and Advanced Laparoscopic Surgery Center said.

1. Surgery is not necessary if you come to know incidently that you are suffering from gallstones in your gallbladder.

2. When these stones start causing any problem the surgery becomes necessary. These problems may be mild pain, indigestion, vomiting, heaviness, fever or excessive gas formation due to gallstone disease. These problems can be considered as an alarm that now is the time to get gallstones out by submitting yourself to surgery.

3. Those patients who delay surgery when it is indicated can fall in the trap of some very serious and life-threatening disease.

4. One of the most dangerous complications of gall stones is "Cholangitis". This is the infection of and pus formation in the bile ducts. Due to obstruction by a gallstone the bacteria start growing in the bile duct and enter blood through veins of liver. The bacteria and their toxins spread throughout the body. The patient starts having very high fever with rigors and chills, jaundice, pain in abdomen and may become semiconcious. As the disease advances the kidnies fail and blood pressuer falls. The toxins of the bacteria push the person into septic shock and multiple organ failuer which may lead to death. Few decades back the prognosis of this disease was grim and it use to lead to 100% fatality. Even now a days if the disease is fulminating and paient has comorbidities the death rate inspite of best treatment is about 7%. Patient needs high antibiotics, lots of IV fluids and supportive care.

5. Secondly the patient who delay the treatment of gall stones can fall victim to dreaded disease named "Gall Stone Pancreatitis". A small stone slipping from gall bladder and passing to the intestine through bile ducts pushes bile in to the ducts of pancreas. This entering of bile in the pancreas activates highly potent digestive enzymes of pancreas within the pancreas and start autodigestion of pancreas. As the ducts and cells of pancreas get damaged more digestive enymes get leaked and some portion of pancreas may get inflamed or dead. At time bacteria invade this portion of pancreas leading to pus formation. This pus of pancrease is not easy to remove and multiple surgeries may be requiered with prolonged hosptialization over many months in intesive care units. At other timew these pancreatic enzymes enter the blood and damage lungs causing blockage in the exchange of oxygen and carbondiaoxide ( Acute Respiratory Distress Syndrom ) or may damage kidneys. These can also lead to clotting of blood with in the blood vessels. At times the pancreas start bleeding or there can be bleeding from other vessels digested by the digestive enzymes. Patient comes with very sever pain in the tummy and vomitting. The abdomen is found hard as a wooden board. The patient requires urgent fluids and supportive treatment. If the pancreatitis is sever the patient may go into shock and multiple organ failuer and die. There is about 4.5% mortality rate inspite of aggressive treatment in such cases.

6. Obstructive jaundice is another complication which is due to slipping of a gallbladder stone into bile ducts and leading to blockage. The patient devolopes jaundice, eyes and skin becomes yellow. The bile from liver enters the blood and is passed in urine so urine to becomes yellow. Since the bile no more goes to the intestine so the stools loose their colour and become light coloured. The patient has lot of itching of skin. Deficiency of Vit K developes and leads to decrease in clotting of blood.

7. Due to inflamation of gall bladder, the adjoining organs like intestine get stuck to the gall bladder and it forms a mass abdomen. If the mass is hard, it is dangerous to operate and the patient is admitted for antibiotics and IV fluids. Patient has to be on treatment for about two monts before the patient can be taken up for surgery.

8. A single large stone staying in the gall bladder is known to lead to the formation of cancer in the gall bladder. Due to proximity of gall bladder to the liver, this cancer invades liver at an early stage and so pushes the cancer to an advanced stager. This is potantially fatal cancer.

9. The delay is gall stone surgery often leads to formation of pus in the gallbladder. This pus can rupture in the abdomen. The gall bladder may rot and becomes gangreeous. Thses are serious complications increasing the risk of the disease and making the treatment and surgery difficult. 

The discussion was heald among the present doctors and public and it was concluded that the patients need to be educated about when they can wait and when they must immidiatly submit themselves to the surgical treatmetn of gall stone disease to avoid life threatning, painfull, distressing and costly complications.

Dt. Neeta Dewan, Diet and Nutrition consultant welcomed the audience and introduced Dr Narotam Dewan.

Dr Narotam Dewan

70th Anniversary of atomic bombing on Nagasaki

Over 350 delegates attended the CME

Ludhiana: 11 August 2015: (Punjab Screen Bureau):

There is need for collective effort to prevent the biggest ever health tragedy as atomic bombing on Hiroshima and Nagasaki killed over two lakh people in a matter of minutes. Doctors are duty bound morally and ethically to work for the development of society through health. This was the message that emanated from the Continuous Medical Education programme organized to commemorate the 70^th Anniversary of atomic bombing on Nagasaki in Japan on 9^th August 1945, by the department of Community Medicine, Government Medical College, Amritsar in collaboration with Indian Doctors For Peace And Development (IDPD) & Social Medicine Association on the Theme “Health, Development & Ethics”.

The event discussed several related subjects viz: Humanitarian Impact of Nuclear Weapons; National Health Policy; Medical Ethics and Food Security Act  - Strength and Limitations.

Principal GMC, Amritsar Dr. Santokh Singh inaugurated the CME followed by welcome speech by Dr. S.S. Deepti.

Dr. Tejbir Singh, Head of the department of Community Medicine, GMC Amritsar highlighted the importance of the conference and invited Dr. S.S.Soodan (Vice President IDPD) who gave a brief history of the idea behind the formation of IDPD and also about the work being done so far concerning the peace in various nations around the world.

Dr. Amarjit Singh Sidhu from School of Buisness, Guru Nanak Dev University, Amritsar started with his first session on Food Security Act; he stressed that the need of this act is because of the inequalities in wealth and total income. Only 2.5% of the people own 83% of global wealth. He further elaborated regarding the various entitlements and beneficiaries covered under the act. Following this, Dr. G.S.Grewal (President, Punjab Medical Council) emphasized the importance of principles in life, particularly the role of ethics in medical profession. He said that it’s a noble profession and all doctors should commit themselves not to indulge in any malpractices. To regulate the medical profession in the state the PMC has to take several steps  to stop the practice of cuts and commissions and advertisements to entice the patients, he said.  

In the second session, Dr. Bharti Uppal; National Finance Secretary, IDPD discussed about Wars and its devastating long term consequences on health. Then Dr. Arun Mitra (Gen.Secretary IDPD) gave a brief note on medical ethics and its falling standards.

After this in the end, Panel discussion was conducted on “National Health Policy (Draft) 2015” by Dr. A.S. Padda, Ex-Principal & Head Department of Community Medicine, GMC as moderator. The first panelist Dr. Shakeel ur Rehman (Secretary IDPD) highlighted that privatization of secondary and tertiary health services should not be there and he said that 2% of Indian population is going below the poverty line every year due to out of pocket expenditure on health. After this Dr. Karanjit Singh (Ex-Director Health Services Punjab) discussed about mother & child health component of the policy and the progress made so far. Dr. Vitull K. Gupta (Associate professor Medicine, AIMSR, Bathinda) emphasized that there is total disconnect between ground level reality and the implementation of the policy. He further enlightened that there is need to implement what is being written in the draft.

The last topic of discussion was by Dr. Amritpal Kaur Dhillon (Associate Professor Obst & Gynae, GMC Amritsar) regarding women health issues addressed in the policy.

Over 350 delegates attended the CME. The session concluded with the valedictory function and vote of thanks by Dr. Sanjeev Mahajan.

A spl. GBM & CME held in IMA House Ldh.

Sun, May 25, 2014 at 11:47 AM
Constitution of IMA Ludhiana also passed and presented

Ludhiana: 25th May 2014: (Punjab Screen Bureau):
A spl. GBM & CME was held in IMA House on 24th May 2014 (Saturday). Dr R.K Sharma President IMA Ludhiana presented constitution of IMA Ludhiana which was passed by the House.

The CME organised by Medanta-The Medicity Gurgaon was on urogenital cancers and cyberknife -a tool to cure cancers

Dr N.P Singh and Dr Tejinder Kataria spoke about Robotic Surgery and Cyberknife, two very recent modalities to treat cancer which are available only at very few places in big Metropolis. The Sessions were chaired by Dr B.S Aulakh, Dr G.S Sidhu, Dr Deepak Parasher & Dr Gurdeep Singh.

A two days symposium started in CMC

The symposium inaugurated by Shri S.S. Bajaj

Ludhiana, 14^th Feb, 2014: (Shalu Arora and Rector Kathuria):

A two days symposium on “Applications of Radioisotopes and Radiation Technology in modern medicine: diagnosis, therapy and research” started today. Christian Medical College, Ludhiana is hosting this event. The symposium is being jointly organized by Board of Radiation and Isotope Technology (BRIT), Mumbai, National Association for Applications of Radioisotopes and Radiation in Industry (NAARI) Mumbai), and Christian Medical College (CMC), Ludhiana. The symposium, was inaugurated by Shri S.S. Bajaj, Chairman, Atomic Energy Regulatory Board (AERB), Govt. of India, emphasizes on the applications and the latest developments in the fields of Nuclear medicine and Radiotherapy.

The latest developments in the use of radioisotopes in diagnosis and therapy of a number of diseases, particularly cancer, would be discussed during the conference. The two day symposium is planned to create awareness about the new technologies and would provide a platform for fruitful interactions between potential users with scientists and technology providers. Key note address was delivered by Dr. Arun Malhotra.

A new blood irradiator developed by Bhabha Atomic Research Center (BARC), first of its kind in India,  inaugurated by S. Maheshinder Singh Grewal, Adviser to Chief Minister, Punjab on 14^th February.  

Irradiation of blood & blood products by gamma rays is a new and safe method to eliminate the risk of reaction, known as Graft vs Host Disease (T-GVHD), at the time of blood transfusion particularly in patients going for bone marrow transplant or tissue transplant.

Although widely practiced world over in hospitals and blood banks, the technology is new to India. The irradiator has been procured by a grant from Board of Radiation and Isotope Technology (BRIT) and has greatly helped CMC hospital in its successful bone-marrow transplant programme. About 300 eminent faculty from India are arrived here to attend the two days CME program. 

CME on Neurological update held in IMA House

More than 125 other IMA Members attended the CME

Ludhiana: 2nd February 2014:(Rector Kathuria//Punjab Screen//Camera: Ravi Nanda)::

Video:      Dr. Manoj Sobti talking to media about CMEon the occasion 

It was cold night of 2nd February but the hall was hot due to some medical debates. Speakers were presenting their point of view in the CME which was held on Neurological update in IMA House, BRS Nagar, Ludhiana in view of continuous upgrading and updating the knowledge of doctors. The new experiences and challenges were being discussed and even objections were also raised. In fact it was a real and full of life CME. 
Video:     Dr. Narjeet Kaur explaining the motive of this medical event 

Dr. Jeyaraj Durai Pandian - Prof. & Head of Deptt of Neurology CMC &  Hospital Ludhiana delivered a lecture on "Approach to patient with peripheral Neuropathy". Acoording to his known routine he discussed each and every factor of the issue.

Video:    Dr. Raj Kumar Sharma telling about the CME by IMA

Dr. Manikant Singla - Associate Prof. DMC & Hospital educated doctors on "Current concept and treatment of Diabetic Neuropathy". Dr. Arun Mitra, Dr. Manoj Sobri, Dr. Raj Kumar Sharma, Dr. Narjeet Kaur and more than 125 other IMA Members also attended the CME.

CME at CMC on Neurological Diseases

Sun, Nov 17, 2013 at 4:00 PM
A Leading Cause of Disability in India

Ludhiana, 17th November, 2013: (Shalu Arora and Rector Kathuria): India, the world’s second most populous country, is facing the emergence of a “hidden” epidemic: disability due to neurologic diseases. The rapid economic, demographic, and social transformation of India in recent decades has already resulted in the double burden of unresolved epidemics of infectious diseases (e.g., malaria, tuberculosis) coupled with rising rates of chronic diseases (e.g., stroke, heart attack). This was stated by Professor Gourie Devi, former Director and Vice-Chancellor of National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore in the 31st Dr LH Lobo memorial oration. She said stroke, epilepsy, and traumatic brain injuries due to road traffic accidents are the major causes of disability in India.  She spoke also about the delivery of neurological services at different levels of care in India.

Dr LH Lobo memorial trust, Ludhiana has been organizing the Dr LH Lobo Memorial Oration and Scientific symposium for the last 30 years, in memory of the late Dr LH Lobo, an eminent and renowned Orthopaedic Surgeon and Former Head of Orthopaedic department and Principal of Christian Medical College (CMC), Ludhiana.   This year the 31st Dr LH Lobo Memorial Oration was organised by the department of Neurology, CMC on November 16th in the hospital auditorium. The inaugural function and the oration were conducted by Shri Sukhpat Rai Wadehra, President, Dr LH Lobo Memorial Trust and Dr MK Mahajan, Secretary, Padma Bhushan Prof JS Chopra, from Chandigarh was the Guest of Honour. Dr S Chopra gave the vote of thanks.

After the oration a CME on ”Management of Central Nervous System Infections” was organised by the department of Neurology, CMC Ludhiana. Prof Satishchandra Director and Vice-Chancellor of NIMHANS Bangalore gave a talk on the neurological manifestations in HIV patients.  Dr S Prabhakar, Head of Neurology, PGIMER, Chandigarh, updated the audience on the recent management of Bacterial meningitis. Prof Mathew Alexander HOD, Dept of Neurology, CMC Vellore spoke about the brain infection following measles virus. Prof Gourie Devi discussed about the various types of TB infection that can affect the brain.

Prof Yashpal Singh briefly talked about the common viral infection of the brain called Herpes simplex encephalitis. Prof Gagandeep Singh discussed various treatment options for Neurocysticercosis(tape worm) affecting the brain. Dr Jency Koshy gave a lecture on neurological complications that can occur due to Dengue fever. Dr DivyaDeodhar spoke about the current treatment of TB infection affecting the brain. Dr Vikas Loomba talked about the emerging infection called Scrub Typhus and its neurological manifestations. A PG Quiz on the Neuroinfections was held during the program. More than 200 delegates attended the program. The CME was organised by Dr Jeyaraj D Pandian and Dr Yashpal Singh.        CME at CMC on Neurological Diseases

Gall stones is 8% in population above age of 40

"We should take it as a signal or alarm-Dr Dewan"

Ludhiana: 16 September 2013: Dewan Hospital is organizing a series of twenty one CME and Public Education Programmes during its Silver Jubillae Celebrations. In the first  CME programme held yesterday evening at hotel A Dr Narotam Dewan spoke about “Pain Abdomen and Gall Stone disease”. Dr Dewan said that these diseases are very common in our society. One can hardly find a person who will not have suffered from pain abdomen and the incident of gall stones is about 8% in population above the age of 40 years. 
About Pain Abdomen Dr Dewan said that we should take it as a signal or alarm about some thing requiring attention and correction inside our body. He said it could be due to some ordinary and simple problem like gastritis, worms in the intestine or amoebiasis or it could be a tip of the ice berg and indication of a very serious problem. Dr Dewan said that sever sudden onset of pain especially that which does not go off quickly and awakes the patient from sleep should indicates a complicated problem. He said the pain abdomen is usually due to some problem with organs in side the abdomen but it could also be a refered pain, the patient may have a heart attack, pneumonia, diabetic ketoacidosis or disc problem and present to a doctor with pain in abdomen, all clinicians and  public should be alert to this possibility.   Dr Dewan enumerated common causes of pain abdomen requiring surgical attention prevalent in our society like liver abscess, gall stones, kidney stones, perforation of intestine, gangrene of intestine, strangulated hernia, appendicitis, ectopic pregnancy, torsion of ovarian cyst, torsion of teties, pancreatitis, intestinal obstruction etc. He emphasized that proper investigations done timely and quick surgical intervention when needed can prove life saving.
About gall stone he demonstrated all the complications of gall stone disease like acute swelling in gall bladder, chronic infection and inflation of gall bladder with thickening of its wall, pus in gall bladder, obstructive jaundice, pancreatitis, ascending cholangitis, cancer of pancreas. Dr Dewan said that gall stones without symptoms should not be operated upon except in special conditions but once a patient experiences a complication she/he should go for the surgery at an early date to avoid life threatening complications of gall bladder stones like acute pancreatitis and ascending cholangitis. The contraindications and complications of gall stone surgery were discussed. Dr Narotam Dewan said that we should always endeavour to treat of patient as a whole and not a specific disease alone, this way we are able to detect accompanying or associated diseases which must be treated simultaneously. He said that all doctors and surgeons should remain alert about the patient being diabetic, having high blood pressure, having heart disease, having asthma, having coagulation disorders, hepatitis, kidney disease, AIDS and even psychological problems. He said that timely diagnosis of all these associated diseases and the simultaneous management alone can give a favourable outcome. He said that meticulous attention to the surgery details are required to avoid injury to bile ducts, duodenum, colon and omental vessels during laparoscopic surgery of gall bladder.

Dr Atul Mittal Mch urology, urologist at Dewan Hospital spoke on Prostate disease and kidney stones by minimall invasive methods available at Dewan hospital. He said that TURP is still a gold standard procedure for senile prostate enlargement. He demonstated the technique of removing big kidney stones by a key hole surgery of PCNL. 
Mrs Neeta Dewan, Director of the hospital gave details of various facilities at Dewan Hospital and announced registration of charitable society in the memory of its founder Dewan Jagdish Chandra, Freedom fighter, first MLA of Ludhiana and advocate & Smt Sheela dewan. She said that earlier Dewan Hospital use to organize month long surgical camps now a charitable ward of four beds has been established at Dewan Hospital to cater to economically challenged patients.