Celebrating the Milestone of 1 year for our Neuro ICU at Sagar Hospitals, Jayanagar

September 25th, 2021 marked the milestone of 1 year for our Neuro ICU at Sagar Hospitals, Jayanagar. There was a special function celebrating the milestone. We congratulate the Neuro Team & wish them #success for all their future endeavours.

Managing Healthcare Operations During the COVID-19 Pandemic- A Leader’s Perspective

The first major challenge has been the lack of adequate capacity to manage supplies and patient volumes

The COVID-19 pandemic has served as a powerful reminder of the unpredictable and complex nature of the world we live in. It is a clear illustration of how a surprise and isolated incident in one part of the globe can have a massive impact on the operations of healthcare systems and medical practices around the world. Since the first cases reported in China in December 2019, the novel coronavirus and its variants have resulted in confirmed infections of over 200 million and more than 4 million deaths around the globe. Additionally, the risks and clinical manifestations of COVID-19 continue to grow and gain increasing complexity. The list of symptoms has expanded from flu-like symptoms to impact on organs almost all over the body: lungs, heart, kidneys, eyes, brain, nose, and the gastrointestinal tract can suffer short-term, as well as long-term damage; Long COVID may well prove to be the next health crisis unfolding over time.

Key challenges faced by global medical operations

Covid-19 has presented all the peak challenges of a major health crisis: a complex source, a rapid spread, and an unpredictable scale of impact. In addition to these, the COVID-19 pandemic has presented acute and novel challenges of its own that have strained the capacities of hospitals around the world and tested the ability of national and international health agencies to control it.

The first major challenge has been the lack of adequate capacity to manage supplies and patient volumes. As the coronavirus crisis unfolded, by March 2020, the WHO had declared a pandemic, the United States had declared a public health emergency, and the death toll in China had exceeded that of the SARS crisis. In many places around the world, especially Europe, the burgeoning demand for intensive care units and ventilators far outstripped the existing supply. Italy quickly found itself inundated with cases and its public health infrastructure was quickly overwhelmed in a matter of weeks.

The second key challenge was the urgent need for a rapid redesign of care models for patients and mitigation strategies to deal with the virus. It became critical for hospital administration, doctors, nurses, and other physicians to quickly adapt and discover appropriate measures, treatments, and infrastructure design to combat the highly contagious nature of the virus. These measures would go beyond the scope of hospital premises and serve as guidelines to protect the community at large.

Finally, the third major challenge was protecting the physical and mental health of the frontline personnel. While the struggles of hospitals and clinics to maintain adequate supplies of personal protective equipment (PPE) for their staff made international headlines, frontline medical personnel faced a tremendous risk of infection and mental stress. By April 2020, developed countries such as Italy, UK, and the USA had reported more than 50% of the global physician deaths.

Preparing for the inevitable

As India began its first national lockdown on March 22, 2020, it found itself in an unenviable position of facing an imminent wave of infections while managing a vulnerable public healthcare infrastructure and a large, dense population.

India had already seen how the medical emergency management systems of even the most developed nations had struggled to respond and curb the virus effectively. With uncertainty about the virus’s incubation period, the dominant mode of transmission, and possible treatment, most countries and their health agencies were following the pandemic rather than proactively preventing it.

India’s response to the crisis was proactive and cognizant of the scale and complexity of the problem. Learning from the world, India and its medical institutions developed their own approach and responded to its unique context.

The Indian response

The pandemic response made by India was formulated in the early part of 2020 and was followed through different phases. Graded restrictions across the border over land, sea, and air were followed by a national lockdown.

With India’s population, even a small percentage requiring critical care at hospitals would have overwhelmed the healthcare system. This made the need to curb the virulent transmission across communities and “flatten the curve”. The lockdown was used to “break the chain” of transmission and allow the government and private and public hospitals to ramp up the healthcare infrastructure with the crucial time bought.

Another administrative response was to form eleven Empowered Groups for fast data-driven decision-making and effective implementation of various measures. It was well recognised that a single ministry or agency would not be able to cope with such an unprecedented situation. The Indian government, public and private hospitals, and research organisations collaborated to devise mitigation strategies to reduce the impact of the pandemic in India.

Medical Emergency Management Planning and Execution

Planning early had obvious benefits –by the time COVID-19 cases were beginning to rise in India, hospitals in India had already set up rapid response teams and infection control committees. These administrative teams of medical professionals created response strategies and put out guideline documents, listing scenarios to manage the potential situation on the ground. These scenarios ranged from the rational use of supplies such as masks and PPE, to administrative challenges such as optimal use of existing hospital infrastructure, capacity development of human resources, and management of medical professionals in clinical and non-clinical settings.

This preparedness bought us precious time to strengthen the abilities of our private and public health systems and eventually weather the debilitating first and second waves. Following directives issued by the Ministry of Health and Family Welfare (MOHFW), tracing mechanisms, such as the Aarogya Setu app, combined technology and the alertness of citizens to check the spread of infection.

Private hospitals such as Sagar Hospitals in Bangalore prepared themselves well in line with WHO guidelines, the health department of Karnataka and their own internal strategies. COVID Crisis Task Force teams defined treatment protocols, triaging mechanisms, patient care, infrastructure management, and manpower planning of healthcare professionals. Planning ahead and astute execution of response measures allowed delivery of patient care better than expected.

With a rapidly expanding national vaccination drive, the healthcare sector finds itself better prepared on all parameters—operational readiness, testing and tracing facilities, supplies of PPE—and the availability of intensive care beds and has continuously improved on all fronts.

Although it is difficult to predict the timing and scale of the third wave, the experiences of the first two waves, the nationwide vaccination drive, and the preparedness of a resilient healthcare system have bolstered our defences. With mitigation strategies, processes, and operational readiness of the private health sector and other medical communities of India, India stands prepared for a possible third wave.

Disclaimer: No Asian Age journalist was involved in creating this content. The group also takes no responsibility for this content.

Sagar Hospitals Awarded “Excellence in COVID-19 Management” by Times Business Awards, Bengaluru 2021

Times Business Awards, Bengaluru 2021 has recognised Sagar Hospitals, Bangalore for "Excellence in COVID-19 Management". We are truly humbled for this recognition. Our frontline staff and doctors have braved the pandemic to treat our patients & we would like to dedicate this award to them.

The award was given by Bollywood Actress Bipasha Basu . Dr. Jagadeesha Chandra, VP Medical Services received the award on behalf of Sagar Hospitals in the presence of Bollywood celebrities like Kabir Bedi, Jaqueline Fernandes & other Dignitaries.

COVID Patient’s Miraculous Recovery From A Brain Hemorrhage

A Dire Situation

A 76 year old patient Dr. Meena was being treated for COVID-19 at Sagar Hospitals, Jayanagar. She was recovering well and was about to be discharged. However, on the day of her discharge, she had sudden massive intracranial bleed and became deeply comatose.

Although the survival chances were less, her sons agreed for her surgery. Dr Manmeet Singh Chhabra, Consultant Neurosurgeon at Sagar Hospitals didn’t delay further & performed her surgery.

To quote Dr Manmeet- “Apart from other factors like age and coagulation parameters, the prognosis and survival chances in intracranial hemorrhage depends mainly on the level of consciousness , also known as the Glasgow Coma Score (GCS) before surgery. In Dr Meena’s case, she rapidly slipped into a deep comatose state with a GCS of 4/15 and non-reacting pupils. This condition is known as descending transtentorial herniation which, in general, has a poor prognosis. It requires early diagnosis and prompt surgical intervention to prevent respiratory arrest and death”.

COVID-19 & Neurological Disorders

According to Dr Shobha Naidu, Consultant Physician at Sagar Hospitals, - “COVID-19 can cause a myriad of neurologic sequelae. According to a study, the incidence of intracranial hemorrhage (ICH) was found to be 0.7%. Although relatively uncommon among COVID-19 patients, ICH is associated with a high mortality rate.”

The Miraculous Recovery

Despite her age and one-sided bleeding, she showed remarkable recovery with preserved speech and intact limb movements. With physiotherapy and rehabilitation, she was on her feet soon. It was only with immediate and timely neurosurgical intervention; she recovered completely and was discharged from the hospital.

Dr Santosh Kumar, Consultant Neurologist, Sagar Hospital further explains, “COVID-19 induces inflammation of blood vessels (vasculitis) which is responsible for most of the complications including acute ischemic stroke and rarely, brain hemorrhage. During the course of her treatment, apart from ICH, she also developed a condition known as ‘Cerebral Vasospasm’ which is very rare but fortunately recovered with medications.”

A Heartfelt Message to the People

Dr. Manmeet Singh’s message to the people is, “Doctors across the world are doing their best and risking their own lives trying to save patients with COVID-19. Despite taking necessary precautions, the risk of transmission of infection while operating on a COVID positive patient is very high especially during use of high-speed drills for cranial surgery. However, doctors and hospital staff across the country are selflessly providing their services despite the risks. It is indeed satisfying and heartening to see someone in deep coma recovering so well after surgery. On the flip side, it is equally painful to see incidences of attacks on doctors and hospital staff when some patient expires despite all efforts.” Let us thank the brave doctors for selflessly providing their services and who face risks during the COVID-19 pandemic.

A Ray of Hope During COVID Times

The COVID-19 pandemic has led to organ transplants becoming the last option for hospitals as they are busy setting up covid care centers and ramping up their ICU’s to cater to Covid patients. A 42 year old CKD (Chronic Kidney Disease) patient was one of the many patient’s put on an endless waiting list for a kidney transplant. The burden of mal functioning kidneys & having to undergo haemodialysis twice a week caused her much distress.

A Gift of Life

Sagar Hospitals always believes in the preamble-Transplanting Organs from a beating heart, brain dead donor is one of the greatest gifts one can bestow upon society and mankind!

The Neurology doctors had declared a particular patient as brain dead and the patient’s family members had approached the hospital authorities to donate the deceased patient’s organs. The hospital staff applauded their selfless gesture and sprang into action.

The Sagar Hospitals Transplant Coordination Committee headed by Dr. (Major) Mahendra Kumar, Medical Director informed the Jeevasarthakathe Team (Zonal Coordination Committee of Karnataka) about the organ donation consent given by the deceased patient’s relatives.

After obtaining the necessary consent from the relatives, the organ retrieval teams discharged by Jeevasarthakathe, arrived at the hospital. The Operation Theater team sprung into action in coordinating the organ retrieval process. The kidneys were harvested for transplant at the hospital.

The Nephrology Team consisting of Dr. Aravind and Dr. Sanjeev. K Hiremath, the Transplant team headed by Dr. Dilip. C Dhanpal and Dr. Nagasubramanyam took over. For the kidney transplant, 7 potential recipients from all over the state were selected as per the list maintained by Jeevasarthakathe. All the potential recipients underwent HLA matching to ascertain their fitness for undergoing transplantation, out of which the 42 year old Recipient was best suited immunologically and was immediately prepped for the Renal Transplant.

The new protocol for Covid safety, entailed the donor, recipient and the entire surgical team to undergo immediate RT PCR. After harvesting the organs from the donor, two surgical teams one for the recipient surgery and one for Bench Surgery i.e., to make the kidney surgically optimum for the transplant was formed and surgeries were completed. The ultrasound Doppler done on table showed excellent vascular flow and good perfusion of the transplanted kidney.

The Rebirth

The Recipient was shifted to transplant ICU and monitored continuously. The team at the hospital took extra precautions keeping the covid protocols in mind. She was discharged a few days later and owes her new life to the experienced & dedicated team at Sagar Hospitals.

The whole transplant was possible without a hitch only by the combined team effort of the Neuro Surgical team headed by Dr. Murali Mohan, Neuro Intensivist Dr. Gayathri, Nephro-Uro team of doctors, the transplant coordinator, Operation Theater staff, Kidney Transplant Unit nurses and the Departments of Laboratory and Radiology.

Kudos to Team Sagar for having the courage, experience and the commitment to conduct this emergency transplant diligently during the COVID-19 pandemic.

Mucormycosis: Treatment & management at Sagar Hospitals

Don’t ignore cold & cough caused by weather change, warns doctors

Consult before using oxygen at home, doctors warn

19 year old boy recovered from the deadly Mucormycosis, thanks to expert care at SagarHospitals