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17 Mar 2020
Medical services

Medical Services that you can trust | Know patient feedback

Mr. Rajesh Desai, a 45 yr old male was transferred to Apex Multispecialty Hospital, on 23/01/2020. Before getting referred to our hospital, he was treated at multiple various corporate hospitals across. Thane and Mulund & was on mechanical Ventilator for more than 45 days and had many failed attempts of extubation and hence was tracheostomised and continued to be on a mechanical ventilator. At the outside hospital, he also developed VAP( Ventilator associated pneumonia ) with Multi-Drug resistant Klebsiella pneumonia & MRSA (Methicillin resistant staphylococcus aureus) bacteria which was resistant to all carbapenems and beta-lactam antibiotics except colistin only. Also when we received the patient, he was in septic shock on Norad infusion and had a multiorgan failure. The patient had Renal shutdown outside and was on maintenance dialysis. Also, there was thrombocytopenia (PT count 90,000)  and raised WBC counts. His 2decho was done outside and was found to have severe LV dysfunction, hence was shifted to Apex Multispecialty hospital Mulund under the care of Cardiologist Dr. Mayur Jain who is DM cardiology (Gold Medalist)for getting a Coronary angiography. His Angiography turned out to be normal  and his LV dysfunction could only be explained due to cardiomyopathy secondary to alcohol or severe sepsis. Then the patient was shifted to ICU under the care of Dr.Mayur Jain & Intensive critical care treatment of the patient was done by Dr. Nitin Kumar Reddy who has vast experience in critical care and also recently finished his course training in DNB cardiology.Our first and foremost Goal was to treat sepsis, improve his blood pressure/tissue perfusion  and early weaning off the ventilator as he already started developing critical illness neuropathy as he was on a ventilator for more than 45 days.What we did differently which saved patient life.

  • First, as soon as the patient was received to us a detailed evaluation of his blood reports and multiple antibiotics he received in various outside hospitals were reviewed. We reduced his number of antibiotics and used only rational combinations as per bacterial culture sensitivity reports.
  • Coronary angiography was performed on the same day of admission to rule out the correctable cause and a possible reason for the inability to wean the patient off the ventilator considering recurrent LV failure secondary to ischemia as the patient had severe LV dysfunction. But to our surprise and to make thing even difficult for us his angiography was normal and the only another possible explanation for his severe LV dysfunction was cardiomyopathy secondary to severe sepsis/ alcoholic cardiomyopathy ( A condition in which the heart muscle becomes weak in spite of having normal circulation and difficult to treat)
  • Post angiography we kept the patient in ICU for further treatment of his medical condition. We gave him two sessions of dialysis on consecutive days to clear off the dye and treat his uremia secondary to his Renal shutdown.
  • Meticulous selection & calculation of each and every antibiotic dose was done as per creatinine clearance and also every time patient was given dialysis we made sure that post-dialysis patient received full loading dose of all those antibiotics which were dialyzable. Also the mode of administration of antibiotics was modified based on pharmacokinetics of each antibiotic to have maximum bioavailability. For eg., Drugs like Meropenem which has time dependent pharmacological action was given as an infusion over 3 hrs.
  • Every day in morning treating consultant doctor had a detailed discussion with dietician to calculate is a total calorie and protein requirement and every day the fluid intake, feeds and calories given to the patient was monitored.
  • Since the patient had developed respiratory muscles weakness due to long duration ventilator support, we got a dedicated physiotherapist for him who started him on passive bed exercises and breathing exercises to strengthen his respiratory muscles.
  • Meticulous Nursing care was done like 3 hourly changing turning the patient in the bed and back care to prevent bedsores.
  • During the course of treatment, we observed that since the patient had severe LV dysfunction (EF=20%) he was given less fluids but when we scanned his IVC (inferior vena cava) and found that it was completely collapsed which was suggestive of severe dehydration and we started to give him a lot of IV fluids to correct his dehydration and withheld his dialysis. Eventually after 6 liters of IV fluids infusion over a period of 2 days patient started pouring out urine and his vital parameters also started improving. Gradually his acidosis corrected, Norad infusion got weaned off and stopped, the patient became independent of dialysis and started pouring urine with iv diuretics.
  • When the patient’s vitals were stabilizing, we started to wean the ventilator and we believed in early mobilization and made him out of bed to sit on a chair while being on the ventilator.
  • Eventually patient was on T-Piece on 5 th day. After 24 hrs of T-piece we decannulated the tracheostomy of the patient and was maintaining good saturation and normal ABG even on room air.
  • On 6 th day we shifted the patient to the room and started to mobilize him with walker and with support.
  • On 8 th day patient could manage to get up and walked on his own without support and he his wbc counts got normalized, his platelet counts improved.
  • On 10 th day we discharged the patient and now he comes to our opd for regular follow-ups and check-ups.
  • Achieving this incredible feat of success in treating such difficult case wouldn’t have been possible without Dr. Mayur Jain, Dr. Nitin Kumar Reddy, Physiotherapist , Dietician ,ICU doctors ,Nursing staff and other supportive staffs who really worked very hard in making this patient well and giving him a new life to live when all his family member have lost hopes.
09 Jan 2020
Distal Radial Access

DRA (Distal Radial Access)

Distal radial access for angiography and angioplasty is now the buzz. It is done by very few cardiologists in India.
Interest in distal radial artery access (DRA) is growing rapidly. Among the benefits of DRA are the low risk of entry site bleeding complications and the low rate of radial artery occlusion
At Apex hospital Mulund now Dr Mayur Jain does many of the diagnostic procedures from distal radial artery.
The advantages of this technique include:
1. Minimal Risk of Hand Ischemia Due to Preservation of Blood Flow in the Forearm
2. Advantages for Hemostasis
3. Reduction in Nursing Staff Time
4. Greater Comfort for the Patient and the Operator
5. The Sheath is Secured with Less Movement in the Distal Segment
6. DRA Leaves Additional Arterial Access Options Open for Crossover
Dr Mayur Jain a gold medalist in DM cardiology is well known for his innovative work and complex angioplasty. He is now available daily for procedures at Apex hospital, Mulund.
We promise better patient care, patient safety and patient comfort by using new technology at our hospital.
09 Jan 2020
Optical Coherence Tomography

OCT (Optical Coherence Tomography)

OCT is an imaging technique that uses low-coherence light to capture micrometer-resolution, two- and three-dimensional images from within optical scattering media (e.g., biological tissue)
It is an imaging tool used in angioplasty to give precise results and to prevent complications.
This imaging method helps the cardiologist to use proper size of stent and to see the details of the stent to the level of 200 microns so that all the complications related to stent opposition can be avoided.
It is a very small catheter which is negotiated in the coronary arteries to get these images from within the coronary artery.
This technology is now available at Apex hospital during angioplasty.
Dr Mayur Jain, DM cardiology, Gold medalist has learnt this technique at Cleveland clinic USA, and in multiple OCT workshops to make his angioplasty results even better. He is available daily at Apex hospital Mulund for the procedures.
All Multi specialty & Super specialty hospitals of Apex Group is delivering total patient care in an ethical and open environment with state-of-the-art equipment.
It is a chain of Hospitals managed and run by expert Medical Professionals with experience of 25 years. Currently we are managing more than 350+ beds and providing qualitative healthcare services to the people of Mumbai and surrounding areas.
27 Dec 2019
Ectopic Pregnancy

Ectopic pregnancy – A Life Threatening Event

A pregnancy which grows in any other place outside the uterus is called an Ectopic pregnancy. The commonest site for an ectopic pregnancy is in the tube. The pregnancy continues to grow there but as the tube can’t expand beyond a certain limit, it ruptures. This leads to torrential internal bleeding, which may not be visible externally at all. At times when the pregnancy test is positive, most women safely take it for granted that all must be well. However, a few women who actually experience an ectopic pregnancy in their lifetime will vouch that it is not safe to assume so.

When a woman misses her monthly period, and the pregnancy test is positive, the site of the pregnancy must be confirmed by an examination or an ultrasound.

We present a patient who was pregnant and who has bleeding after 6 weeks and assumed that she had a miscarriage. However, this mild bleeding is also seen in an ectopic pregnancy. The pregnancy continued at the junction of the uterus and her tube and one fine day, 7 weeks later, burst!!

She reached the hospital in pain and in a breathless condition. The symptoms were only for a few hours but she looked very pale. Ultrasound was not Confirmatory. Dr. Siddesh Iyer, the consultant Gynaecologist immediately diagnosed the case as ectopic pregnancy on history and clinical examination. When urine pregnancy test was done, it still was positive (which should have been negative assuming she had a miscarriage 3 weeks ago) , and the diagnosis was confirmed.

  • She was immediately taken for emergency surgery. She had 3 and half liters of blood in her abdomen. Including 100 grams of blood clots. The tube had burst at the cornual region (junction of the tube and the uterus) and was still bleeding profusely.
  • The bleeding was controlled and the condition started to improve.
  • She needed 3 bottles of blood and 4 fresh frozen plasma. She stayed in the ICU for 2 days..
  • She was kept in wards for another 2 days and was discharged on day 4.
  • Stitch removal was done on day 9 and the stitches were healthy.
25 Nov 2019
Heart Healthy

Simple Steps to Keep Your Heart Healthy

Heat diseases are not something to be taken lightly. It is always better to keep your heart healthy and prevent heart diseases instead of treating them. Here are some steps you can take to achieve this:
Have a yearly checkup of your cholesterol, blood pressure and glucose level. Take recommendations from a professional regarding keeping your heart healthy.

  • Exercise at least 15 minutes a day.
  • Drink lots of water to stay hydrated.
  • Have more fruits and vegetables instead of junk, processed food.
  • You need to keep a check on your cholesterol level. Eat food that is low in trans and saturated fat.
  • Lower your salt intake to regulate your high blood pressure.
  • Quit Smoking
  • Maintaining a healthy weight is important as excessive weight puts your heart at risk.
  • If you get off track, don’t lose hope and stay positive.
  • Give yourself some credit when you can successfully maintain your momentum

Keeping your heart healthy is simple when you look at the big picture: Get exercise. Eat right. Stress less. Watch your weight. Don’t smoke.

Follow these tips and you’ll be doing your heart a favor. You’ll feel better and be able to stay active with a heart-healthy lifestyle.


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