Intensive Care Unit (ICU)

What is an ICU?

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ICU cares for people who have life-threatening conditions, such as a serious injury or illness, where they receive around-the-clock monitoring and life support. It differs from other hospital wards in that:

• ICU provides 24-hour care from a highly-trained team of specialists
• there are fewer beds, with lots of equipment to monitor and care for critically ill patients
• fewer visitors are allowed

History of ICU

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The concept of ICU was first developed in 1854, during the Crimean war where seriously injured patients were separated from less injured persons by Florence Nightingale^[1]. This simple step reduced mortality from 40 percent to 2 percent on the battle field. The first Intensive Care Unit in the world was formed in Copenhagen in 1953^[2]. The pioneer was the Danish anesthetist, Bjorn Ibsen. This was developed when an epidemic of polioout-break happened in Denmark.

When intensive care is needed

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Intensive care is needed if someone is seriously ill and requires intensive treatment and close monitoring, or if they’re having surgery and intensive care can help them recover.

Most people in an ICU have problems with 1 or more organs. For example, they may be unable to breathe on their own.

There are many different conditions and situations that can mean someone needs intensive care.

Some common reasons include:

• a serious accident – such as a road accident, a severe head injury, a serious fall or severe burns
• a serious short-term condition – such as a heart attack or stroke
• a serious infection – such as sepsis or severe pneumonia
• major surgery – this can either be a planned part of your recovery, or an emergency measure if there are complications

Admission criteria for ICU

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The ICU is a special area of the hospital where the focus is on intense observation and treatment with increased staff and resources. This helps healthcare providers to respond immediately during emergency conditions. The trained doctors and nurses with the help of a multi-disciplinary team makes sure that the critical patient recovers rapidly and goes home. Patient who needs close monitoring and treatment are admitted to an Intensive Care Unit (ICU). Some examples of patients needing ICU care include:

• Patients with difficulty in breathing needing special machines called, ventilators
• Patients with low blood pressureneeding monitoring and medicines to treat it
• Patients with infections causing septic shock
• Patients who need close observation after certain surgeries, such as brain surgery, heart bypass and trauma surgery.

ICU is a place where patients are monitored acutely. ICU patients are monitored and treated by critical care team which include critical care specialists (intensivists), resident doctors, nurses, respiratory therapists, etc. Other staff at ICU include dieticians, physiotherapists, clinical pharmacists and other supportive staff like cleaning staff, security guards, etc. Fortunately, modern technology has progressed a lot and we can get intricate details of a patient’s vital parameters like heart rate, breathing rate, oxygen level and blood pressure. This is done by making use of multiple devices with numerous wires that are seen, which are constantly monitoring the patient.

Types of Intensive Care Units (ICUs)

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Intensive care units can be organised based on the pathologies/conditions treated (e.g. neurological, trauma, burns, medical or surgical ICUs) or by the age group of the patient admitted (adult or paediatric).^[2] Specialized intensive care units include medical, surgical, pediatric and neonatal intensive care units.

Medical intensive care unit

The medical intensive care unit is dedicated to the care of adult patients with medical conditions requiring frequent observation, specialized monitoring and medical treatment. These include illnesses such as diabetic ketoacidosis, gastrointestinal bleeding, drug overdose, respiratory failure, sepsis, stroke and cancer.

Surgical intensive care unit

The surgical intensive care unit is dedicated to the management of postoperative patients, including postoperative patients who have undergone major abdominal surgeries, craniotomy patients, thoracotomy patients, unstable multiple trauma patients and any surgical patient who requires continuous monitoring or life support.

Pediatric intensive care unit

Critically ill children are managed in the paediatric intensive care unit. Children who had just undergone surgery and are at risk of deterioration are also managed in the pediatric intensive care unit.

Neonatal intensive care unit

The neonatal intensive care unit is responsible for the management of premature, high-risk and critically ill infants.^[9] Neonates with congenital disorders and birth complications are also managed in the neonatal intensive care unit.

Why are people admitted to the ICU?

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A person is likely to be admitted to ICU if they are in a critical condition and need constant observation and specialised care. This can happen:

• after major surgery
• following an accident (e.g. car accident, severe burn)
• during a chronic or terminal illness (e.g. heart or kidney failure, stroke, heart attack)
• during a serious infection (e.g. pneumonia, sepsis)
• if a baby is born prematurely or with a serious illness – there is usually a special ICU for babies called the neonatal intensive care unit, or NICU

What happens in the ICU?

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ICU can be daunting to both the person being admitted and their visitors due to the lines, tubes, wires and monitoring equipment.

ICU patients can be connected to a wide range of machines, the most common being a heart monitor and artificial ventilators (when patients can’t breathe for themselves). Many ICU machines beep and make loud noises and alarms to let staff know if a patient’s condition changes.

There are also likely to be several tubes either putting fluid and nutrients into the patient or taking other fluids out.

There are many medical staff in ICU. Each patient usually has a dedicated specialist nurse, who regularly checks the equipment and any life support systems.

The ICU healthcare team understands how distressing ICU can be and is available to support immediate family.

Advin ICU Products

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• Advin ICU Products

Hemodialysis

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In haemodialysis, a machine filters wastes, salts and fluid from your blood when your kidneys are no longer healthy enough to do this work adequately. Hemodialysis (he-moe-die-AL-uh-sis) is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.

With haemodialysis, you’ll need to:

• Follow a strict treatment schedule
• Take medications regularly
• Make changes in your diet

Haemodialysis is a serious responsibility, but you don’t have to shoulder it alone. You’ll work closely with your health care team, including a kidney specialist and other professionals with experience managing haemodialysis. You may be able to do haemodialysis at home.

Why it’s done

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Your doctor will help determine when you should start hemodialysis based on several factors, including your:

• Overall health
• Kidney function
• Signs and symptoms
• Quality of life
• Personal preferences

You might notice signs and symptoms of kidney failure (uremia), such as nausea, vomiting, swelling or fatigue. Your doctor uses your estimated glomerular filtration rate (eGFR) to measure your level of kidney function. Your eGFR is calculated using your blood creatinine test results, sex, age and other factors. A normal value varies with age. This measure of your kidney function can help to plan your treatment, including when to start haemodialysis.

Haemodialysis can help your body control blood pressure and maintain the proper balance of fluid and various minerals — such as potassium and sodium — in your body. Normally, haemodialysis begins well before your kidneys have shut down to the point of causing life-threatening complications.

Common causes of kidney failure include:

• Diabetes
• High blood pressure (hypertension)
• Kidney inflammation (glomerulonephritis)
• Kidney cysts (polycystic kidney disease)
• Inherited kidney diseases
• Long-term use of nonsteroidal anti-inflammatory drugs or other medications that could harm the kidneys

However, your kidneys may shut down suddenly (acute kidney injury) after a severe illness, complicated surgery, heart attack or other serious problem. Certain medications also can cause kidney injury.

Some people with severe long-standing (chronic) kidney failure may decide against starting dialysis and opt for a different path. Instead, they may choose maximal medical therapy, also called maximum conservative management or palliative care. This therapy involves active management of complications of advanced chronic kidney disease, such as fluid overload, high blood pressure and anemia, with a focus on supportive management of symptoms that affect quality of life.

Other people may be candidates for a pre-emptive kidney transplant, instead of starting on dialysis. Ask your health care team for more information about your options. This is an individualized decision because benefits of dialysis may vary, depending on your particular health issues.

Haemodialysis Procedure

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During treatments, you sit or recline in a chair while your blood flows through the dialyzer ― a filter that acts as an artificial kidney to clean your blood. You can use the time to watch TV or a movie, read, nap, or perhaps talk to your “neighbours” at the centre. If you receive haemodialysis at night, you can sleep during the procedure.

• Preparation: Your weight, blood pressure, pulse and temperature are checked. The skin covering your access site — the point where blood leaves and then renters your body during treatment — is cleansed.
• Starting: During haemodialysis, two needles are inserted into your arm through the access site and taped in place to remain secure. Each needle is attached to a flexible plastic tube that connects to a dialyzer. Through one tube, the dialyzer filters your blood a few ounces at a time, allowing wastes and extra fluids to pass from your blood into a cleansing fluid called dialysate. The filtered blood returns to your body through the second tube.
• Symptoms: You may experience nausea and abdominal cramps as excess fluid is pulled from your body — especially if you have gained a significant amount of fluid in between dialysis sessions. If you’re uncomfortable during the procedure, ask your care team about minimizing side effects by such measures as adjusting the speed of your haemodialysis, your medication or your haemodialysis fluids.
• Monitoring: Because blood pressure and heart rate can fluctuate as excess fluid is drawn from your body, your blood pressure and heart rate will be checked several times during each treatment.
• Finishing: When haemodialysis is completed, the needles are removed from your access site and a pressure dressing is applied to the site to prevent bleeding. Your weight may be recorded again. Then you’re free to go about your usual activities until your next session.

Benefits of haemodialysis

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Aside from allowing people to continue living a relatively normal life, haemodialysis has other benefits, such as:

Haemodialysis requires less time than peritoneal dialysis

Haemodialysis treatments may occur at a hospital, dialysis center or your own home three times a week, with each session lasting between three and five hours. This leaves most of the week dialysis-free. By contrast, peritoneal dialysis takes between 10 and 12 hours every day.

Haemodialysis carries a relatively low risk of infection

Haemodialysis uses and arteriovenous (AV) fistula, which is the gold standard vascular access used to access a person’s blood. Common complications of peritoneal dialysis include infections of the abdominal lining or at the site where the catheter is inserted to carry the cleansing fluid.

Haemodialysis requires less surgical interventions

AV fistulas for dialysis last many years, longer than transplanted kidneys and catheters for peritoneal dialysis. This type of dialysis does not typically require additional surgeries.

Advin Hemodialysis Setup

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• Advin Haemodialysis Machine
• Dialysis chair
• Dialysis Reprocessing Machine
• Dialysis Consumables
• Dialysis Concentrates
• Dialysis Disinfectant

Diagnostic Radiology

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Radiology, also known as diagnostic imaging, is a series of tests that take pictures or images of parts of the body. The field encompasses two areas — diagnostic radiology and interventional radiology — that both use radiant energy to diagnose and treat diseases. While there are several different imaging exams, some of the most common include x-ray, MRI, ultrasound, CT scan and PET scan.

A radiologist will look at the outcome of a certain imaging test to find a relevant image that evaluates and supports a diagnosis. These individuals are usually medical doctors (MDs) with highly specialized training focused on the interpretation of medical imaging. Radiologic technologists also aid in this process, as they use and manage the machines in the course of producing an image. After a patient undergoes imaging tests, radiologists will give reports of their interpretations to the referring clinical doctors.

History of Radiology

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Radiology began in Germany in 1895 when Wilhelm Conrad Röntgen made an energized, lightproof cathode ray tube that started to fluoresce when situated a couple of feet away from a screen painted with fluorescent material. He knew the screen was responding to unknown rays transmitted throughout the room, which he called “x-rays.” After Röntgen’s discovery, people began creating radiographic images that started as a burst of ionizing radiation and created a contrast image on a piece of film.

What Is Radiology Used for?

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Radiology is used for a wide range of conditions, and is classified depending on the type of radiology and the exact imaging test used. The various imaging exams include:

• Radiographs: X-rays to look at bones, the chest or the abdomen.
• CT (Computed Tomography): A CT captures multiple x-ray angles of the patient using a doughnut-shaped machine, then creates computer-processed images.
• MRI (Magnetic Resonance Imaging): An MRI uses magnetic fields and radio waves with computer processing to create images.
• Mammograms: Specially powered x-rays that look at breast tissues.
• Ultrasound: An ultrasound uses sound waves to create moving images that display on a monitor, commonly used for echocardiograms and examining the womb during pregnancy.
• Fluoroscopy: X-rays that make moving images of the body in real time. This imaging is crucial for many procedures, especially those involving the gastrointestinal tract.
• Nuclear medicine: These are short-acting radioactive substances that generate light from bodily processes. A camera collects the light, so a computer can process it and develop an image.

Diagnostic radiology uses these imaging results to identify a wide range of problems, from broken bones to heart conditions and blood clots. Interventional radiology also uses imaging such as CT scans, MRI and ultrasounds to guide medical procedures. Patients are typically awake during these procedures, whether it’s treating cancer, back pain, or liver and kidney problems. In some cases, interventional radiology eliminates the need for surgery and scopes.

Diagnostic Imaging

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Diagnostic radiology refers to the field of medicine that uses non-invasive imaging scans to diagnose a patient. The tests and equipment used sometimes involves low doses of radiation to create highly detailed images of an area.

Examples of diagnostic radiology include:

• Radiography (X-rays)
• Ultrasound
• Computed Tomography (CT) Scans
• Magnetic Resonance Imaging (MRI) Scans
• Nuclear Medicine Scans

Diagnostic radiology can be used to identify a wide range of problems. Broken bones, heart conditions, blood clots, and gastrointestinal conditions are just a few of the problems that can be identified by diagnostic imaging.

In addition to identifying problems, doctors can use diagnostic radiology to monitor how your body is responding to a current treatment. Diagnostic radiology can also screen for diseases such as breast cancer and colon cancer.

Technology Used in Radiology

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The technology and machinery used in radiology varies from method to method. Some use radiation while others do not.

The most common machines used in radiology are:

• X-ray Machine: Uses X-rays, a type of electromagnetic radiation, to produce images of the interior of the body without having to make any incisions.
• CT Scanner: Uses X-ray equipment to create a sequence of cross-sectional images of the body. Often used when a doctor needs highly detailed images to study in order to identify the source of a problem, especially on soft tissue.
• MRI Machine: Uses a magnetic field instead of radiation to produce images of the inside of a body. Used for parts of the body that CT scanners cannot produce clear images of, such as bones.

Some of the diagnostic tests may require compounds to be ingested or chemicals to be injected for a clear view of your blood veins. Other tests may require anaesthesia and a scope in order for a doctor to clearly determine the problem.

Interventional Radiology

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Interventional radiology uses imaging technology such as CT scans, MRI, and Ultrasounds to help guide medical procedures. This technology eliminates the need for surgery and scopes to diagnose and treat certain conditions. Instead, patients are often awake during the procedure or under very mild sedation.

Common uses for interventional radiology include:

• Treating cancers
• Treating blockages in arteries or veins
• Treating back pain
• Treating liver and kidney problems

Interventional radiologists are highly specialized radiologists who have extra training and experience to safely and accurately perform these procedures.

Advin Radiology Product

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• Radiology Products

 

Circumcision

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Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common for newborn boys in certain parts of the world, including the United States. Circumcision after the newborn period is possible, but it’s a more complex procedure.

For some families, circumcision is a religious ritual. The procedure can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring.

Why it’s done

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Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care.

Sometimes there’s a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. In other cases, particularly in parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.

Circumcision might have various health benefits, including:

• Easier hygiene.Circumcision makes it simpler to wash the penis. However, boys with uncircumcised penises can be taught to wash regularly beneath the foreskin.
• Decreased risk of urinary tract infections.The risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later.
• Decreased risk of sexually transmitted infections.Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.
• Prevention of penile problems.Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.
• Decreased risk of penile cancer.Although cancer of the penis is rare, it’s less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

The risks of not being circumcised, however, are not only rare, but avoidable with proper care of the penis.

Circumcision might not be an option if certain blood-clotting disorders are present. Also, circumcision might not be appropriate for premature babies who still require medical care in the hospital nursery or for babies born with abnormalities of the penis.

Circumcision doesn’t affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.

How you prepare

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Before circumcision, the doctor will explain the risks and benefits of the procedure. Whether you’re planning to have your son circumcised or you’re pursuing circumcision for yourself, you’ll likely need to provide written consent for the procedure.

What you can expect

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During the procedure

New-born circumcision is often done in the hospital nursery, usually within 10 days after birth.

For new-born circumcision, your son will lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an aesthetic will be injected into the base of the penis or applied to the penis as a cream. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed.

Afterward, the penis will be covered with an ointment, such as a topical antibiotic or petroleum jelly, and wrapped loosely with gauze. The procedure generally takes about 10 minutes.

Circumcision is similar for older boys and adults. However, the procedure might need to be done under general anaesthesia, recovery might take longer and the risk of complications might be greater when done later in life.

After the procedure

It usually takes seven to 10 days for the penis to heal. The tip of the penis is likely to be sore at first, and the penis might look red, swollen or bruised. You might notice a small amount of yellow fluid on the tip of the penis as well.

If your new-born is fussy as the aesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis.

It’s OK to wash the penis as it heals. For new-borns, change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. Change your baby’s diaper often, and make sure the diaper is loosely fastened.

If there’s a plastic ring instead of a bandage, it will drop off on its own — usually within about a week. Once the penis heals, wash it with soap and water during normal bathing.

Problems after circumcision are uncommon. Contact the doctor if:

• Normal urination doesn’t resume within 12 hours of the circumcision
• There’s persistent bleeding
• There’s foul-smelling drainage from the tip of the penis
• The plastic ring remains in place two weeks after the circumcision

What are the benefits of circumcision?

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Circumcision has several benefits. Not only does it help aspects of penis health, but it can improve hygiene. That’s because a circumcised penis is simpler to clean and wash, especially for children.

The specific health benefits of circumcision include a lower risk of:

• Certain penis conditions: · These penile disorders include balanoposthitis (inflammation of the glans and foreskin), paraphimosis and phimosis, when the foreskin gets stuck out of place.
• Cervical cancer for partners: Female sex partners of circumcised men are less likely to get cervical cancer.
• Penile cancer: Men who had circumcisions are less likely to get cancer of the penis.
• Sexually transmitted infections: Men who had circumcision have a lower risk of certain STIs, including HIV.
• Urinary tract infections: UTIs are more common in uncircumcised males.

Advin Instrument Use In Circumcision

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• Metzenbaum Scissors
• Adson Forceps
• Tissue Forceps
• Kelly Forceps
• Mayo Hagar Needle Holder
• Allis Tissue Forceps
• Tissue Forceps
• Mosquito Forceps
• Scalpel Handle
• Plastibell Circumcision
• Circumcision Stapler

What are kidney stones?

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Kidney stones are hard, pebble-like pieces of material that form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional.

Kidney stones vary in size and shape. They may be as small as a grain of sand or as large as a pea. Rarely, some kidney stones are as big as golf balls. Kidney stones may be smooth or jagged and are usually yellow or brown.

A small kidney stone may pass through your urinary tract on its own, causing little or no pain. A larger kidney stone may get stuck along the way. A kidney stone that gets stuck can block your flow of urine, causing severe pain or bleeding. Learn more about your urinary tract and how it works.

If you have symptoms of kidney stones, including severe pain or bleeding, seek care right away. A doctor, such as a urologist, can treat any pain and prevent further problems, such as a urinary tract infection (UTI).

Do kidney stones have another name?

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The scientific name for a kidney stone is renal calculus or nephrolith. You may hear health care professionals call this condition nephrolithiasis, urolithiasis, or urinary stones.

What type of kidney stones do I have?

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You probably have one of four main types of kidney stones. Treatment for kidney stones usually depends on their size, location, and what they are made of:

Calcium stones

Calcium stones, including calcium oxalate stones and calcium phosphate stones, are the most common types of kidney stones. Calcium oxalate stones are more common than calcium phosphate stones.

Calcium from food does not increase your chance of having calcium oxalate stones. Normally, extra calcium that isn’t used by your bones and muscles goes to your kidneys and is flushed out with urine. When this doesn’t happen, the calcium stays in the kidneys and joins with other waste products to form a kidney stone.

Uric acid stones

A uric acid stone may form when your urine contains too much acid. Eating a lot of fish, shellfish, and meat—especially organ meat—may increase uric acid in urine.

Struvite stones

Struvite stones may form after you have a UTI. They can develop suddenly and become large quickly.

Cystine stones

Cystine stones result from a disorder called cystinuria that is passed down through families. Cystinuria causes the amino acid cystine to leak through your kidneys and into the urine.

How common are kidney stones?

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Kidney stones are common and are on the rise.

Who is more likely to develop kidney stones?

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Men are more likely to develop kidney stones than women. If you have a family history of kidney stones, you are more likely to develop them. You are also more likely to develop kidney stones again if you’ve had them once.

You may also be more likely to develop a kidney stone if you don’t drink enough liquids.

People with certain conditions

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You are more likely to develop kidney stones if you have certain conditions, including:

• a blockage of the urinary tract
• chronic, or long-lasting, inflammation of the bowel
• cystic kidney diseases, which are disorders that cause fluid-filled sacs to form on the kidneys
• cystinuria
• digestive problems or a history of gastrointestinal tract surgery
• gout, a disorder that causes painful swelling of the joints
• hypercalciuria, a condition that runs in families in which urine contains unusually large amounts of calcium; this is the most common condition found in people who form calcium stones
• hyperoxaluria, a condition in which urine contains unusually large amounts of oxalate
• hyperparathyroidism, a condition in which the parathyroid glands release too much parathyroid hormone, causing extra calcium in the blood
• hyperuricosuria, a disorder in which too much uric acid is in the urine
• obesity
• repeated, or recurrent, UTIs
• renal tubular acidosis, a disease that occurs when the kidneys fail to remove acids into the urine, which causes a person’s blood to remain too acidic

People who take certain medicines

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You are more likely to develop kidney stones if you are taking one or more of the following medicines over a long period of time:

• diuretics, often called water pills, which help rid your body of water
• calcium-based antacids
• indinavir, a protease inhibitor used to treat HIV infection
• topiramate, an anti-seizure medication

What are the complications of kidney stones?

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Complications of kidney stones are rare if you seek treatment from a health care professional before problems occur.

If kidney stones are not treated, they can cause

• hematuria, or blood in the urine
• severe pain
• UTIs, including kidney infections
• loss of kidney function

What is urodynamic testing?

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Urodynamic testing is any procedure that looks at how well parts of the lower urinary tract—the bladder, sphincters, and urethra—work to store and release urine. Most urodynamic tests focus on how well your bladder can hold and empty urine. Urodynamic tests can also show whether your bladder is contracting when it’s not supposed to, causing urine to leak.

• leak urine
• go to the bathroom frequently
• feel pain while urinating
• feel a sudden, strong urge to use the bathroom
• have trouble starting to urinate
• have problems emptying your bladder completely
• have repeated urinary tract infections

What urodynamic tests do health care professionals use?

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• uroflowmetry
• postvoid residual urine measurement
• cystometric test
• leak point pressure measurement
• pressure flow study
• electromyography
• video urodynamic tests

Uroflowmetry

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Uroflowmetry measures how much urine is in your bladder and how fast the urine comes out, also known as flow rate. The results of this test can show if your bladder muscles are weak or if urine flow is blocked.

During a uroflowmetry test, you urinate into a special toilet or funnel that has two parts: a container for collecting the urine and a scale. The uroflowmetry equipment creates a graph that shows changes in the flow rate while you urinate. Your health care professional uses the graph to see when the flow rate is the highest and how many seconds it takes to get there.

Your flow rate can also be measured by recording how long it takes to urinate into a special container that accurately measures how much urine you release.

Postvoid residual measurement

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This urodynamic test measures how much urine is left in your bladder after you urinate. If you have 100–150 milliliters of urine or more left in your bladder, your bladder is not emptying completely. This test can be conducted with an ultrasound or by feeding a catheter into your bladder to drain and measure remaining urine.

Bladder ultrasounds are performed by a specially trained technician in a health care professional’s office, radiology center, or hospital.

Hernia Surgery

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A hernia is usually treated with surgery. The three main types of hernia surgery are open repair, laparoscopic (minimally invasive) repair, and robotic repair. This article provides details of each procedure.

What is a hernia?

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A hernia is the protrusion of an organ through the structure or muscle that usually contains it. The condition occurs most often in the abdominal wall, when the intestine pushes through a weak spot in the wall. The most common abdominal wall hernia is an inguinal hernia.

What is open hernia repair surgery?

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Open hernia repair is where an incision, or cut, is made in the groin. The hernia containing the bulging intestine is identified. The surgeon then pushes the hernia back into the abdomen and strengthens the abdominal wall with stitches or synthetic mesh. Most patients will be able to go home a few hours after surgery, and feel fine within a few days. Strenuous activity and exercise are restricted for four to six weeks after the surgery.

What is laparoscopic (minimally invasive) hernia repair surgery?

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Laparoscopic (minimally invasive) hernia repair uses a laparoscope, a thin, telescope-like instrument that is inserted through a small incision at the umbilicus (belly button). This procedure is usually performed under general anaesthesia, so before the surgery, you will have an evaluation of your general state of health, including a history, physical exam (and possibly lab work) and an electrocardiogram (EKG).

You will not feel pain during this surgery. The laparoscope is connected to a tiny video camera, smaller than a dime, that projects an “inside view” of your body onto television screens in the operating room.

The abdomen is inflated with a harmless gas (carbon dioxide), which creates space to allow your doctor to view your internal structures. The peritoneum (the inner lining of the abdomen) is cut to expose the weakness in the abdominal wall. Mesh is placed on the inside to cover the defects in the abdominal wall and strengthen the tissue.

After the procedure is completed, the small abdominal incisions are closed with a stitch or two or with surgical tape. Within a few months, the incisions are barely visible.

Benefits of laparoscopic hernia surgery include three tiny scars rather than one larger incision, less pain after surgery, a quicker return to work and a shorter recovery time (days instead of weeks).

How can I reduce and manage pain after hernia surgery?

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surgeon will provide you with a specific plan but may not be able to give you an exact time frame in advance. Doctors usually cannot fully diagnose the severity of a hernia until they perform the surgery.

Hernia procedures are usually outpatient surgeries. In general, the sooner you can start moving afterward, the better. This movement helps prevent constipation and blood clots. Be sure to adhere to the doctor’s instructions about what you can lift, how to lift, and how long to remain on any restrictions; some may be permanent.

Advin Hernia Surgery Instrument Set

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• Multi-Function Trocar
• Port Closer
• Suction irrigation Set
• Grasper
• Bipolar Forceps
• Vessel Sealer with Cutter
• Monopolar Electrodes
• Hernia Mesh
• Needle Holder
• Knot Pusher
• Veress Needle
• Laparoscope
• Advin Electro+
• HD Camera System
• Vessel Sealer Cautery machine
• LED Light Source

Hospitals are also an essential part of health system development. Currently, external pressures, health systems shortcomings and hospital sector deficiencies are driving a new vision for hospitals in many parts of the world. In this vision, they have a key role to play to support other healthcare providers and for community outreach and home-based services and are essential in a well-functioning referral network.

Hospitals matter to people and often mark central points in their lives. They also matter to health systems by being instrumental for care coordination and integration. They often provide a setting for education of doctors, nurses and other health-care professionals and are a critical base for clinical research.

Health care is the basic need and right of every citizen of our country. Hospitals, nursing homes, clinics, medical camps etc form the platform for this healthcare delivery, assisted by doctors, nurses and other medical staff. This is far below the world average of 30 hospitals per 10,000 population.

Setting up a hospital requires skills that are not taught in medical schools – devising a sustainable business plan, obtaining necessary finances, being more visible to potential patient, and the sorts. The Process is undoubtedly long-drawn and, without prior know-how, can be a series of trials and errors before bearing fruit. Following are the pointers one needs to keep in mind and set in place for setting up a private hospital:

Location of the hospital

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This has to be chosen well, because if there are already some hospitals in the locality, then it will be difficult to pool in patients. Also, the hospital needs to be set up in an area which has good transportation facility or is close to a railway station. Considering the cost of real estate, a huge financial investment is required.

Facilities your hospital offers

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One has to be sure what set-up is planned and what infrastructure is required. A paediatric, orthopaedic, gynaecologic, oncology, pathology, imaging, etc facility in the hospital all require different facilities.

Permits for your hospital

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1. Land and construction

Land allotted for agriculture cannot be used. To start building the hospital wing, several permissions from local authorities need to be taken. Numerous documents need to be approved, like land deed, architect’s plan, etc.

An occupation certificate is obtained after clearing all formalities.

2. Electricity and water

As per the requirements of the hospital, permission has to be taken from the local governing body to obtain electric meters and water supply. Water requirement has to be calculated, which for any setup is approx. 100 litres per day.

3. Sewage

Proper disposal of waste requires a well-planned sewage and drainage system, which is done after permission is sought from the local board.

4. Biomedical waste

This is very vital aspect and permission of Municipal Corporation/ Government is required for installing incinerators required to dispose of medical waste and body parts.

5. Fire and Health Licence

A Fire licence is necessary to prove that the hospital will not cause any damage or loss of life and needs to be procured from the local municipal council.  Procuring a health licence is vital to provide health care to the patients.

Planning your hospital infrastructure

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Take care of all these:

• Doctors, their qualifications and registration numbers recorded
• Nurses and working shifts discussed and set
• Medical equipment and instruments purchased
• Computers and other hardware devices set up

Engineers and staff required for maintenance, plumbing, medical gas pipelines, air conditioning, etc. set

Multiple medical laws and ethics must be followed at every step. A set of guide lines and eligibility criteria have been put forth by government for hospitals, which provide services to central government health scheme beneficiaries.

A tremendous amount of planning, large finances, approvals, certifications, licences and guide lines need to be followed while setting up a hospital as per country. It might be well worth it at the end, but needs ample time and mammoth effort to pool together the resources in place.

Medical devices play an important role in helping patients manage their medical conditions. They also provide doctors and health practitioners with the information they need to follow their patient’s progress long after the office visit is over. Technology is ever-evolving to bring new, advanced developments in how patients and physicians can track medical conditions.

Medical devices do more than help a doctor or facility diagnose what is happening — they add a level of convenience for the patient that they never experienced before. A modern medical device could reduce the amount of time a person needs to spend at a doctor’s office, medical clinic, or hospital undergoing tests. Many diagnostics that used to be only performed in a clinic can now be measured remotely while the individual goes about their daily life. Let’s take a closer look at some current medical device trends and how they are impacting the healthcare sector.

Mobile Health Apps and Privacy

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Regardless of the condition and device, going digital is an important aspect of the latest medical devices. Wearable tech or medical devices can monitor a patient’s health and track symptoms, but the information the device is recording is best managed by a medical professional. Apps can keep medical practitioners connected so they can keep abreast of how their patients are doing, without as many follow-up visits needed.

Patient confidentiality and privacy is critical. The Health Insurance Portability and Accountability Act (HIPAA) mandates that medical facilities and practitioners must safeguard the privacy of their patients’ confidential information. Do patients expose themselves to privacy violations if they’re using mobile phone apps to monitor, track, and share their medical data? It’s unlikely.

Long gone are the days when mobile phone apps were primarily for smashing cartoon pigs, much less simply making phone calls. Helpful apps are now central to many people’s daily lives.

According to Statista data, Apple App Store carries 2.2 million apps for iPhone users, and Google’s GooglePlay store offers 3.48 million apps for users of phones with the company’s Android operating system.

Among these are an estimated 99,366 medical, health, and fitness apps. Collectively, they are referred to as mHealth apps.

The connectedness and convenience that mHealth — and most other facets of eHealth — provides have the potential to greatly improve quality of life and ease of care when used appropriately.

From improved medication adherence to aggregated patient data, the benefits are plenty.

As people become more mobile and travel becomes more accessible, patients will increasingly expect the healthcare record system to provide essential health information via mobile devices, which will give their treating physician basic information such as medical condition and drug/allergy information. Demographics, insurance data, medications, allergies, alerts in respect of new symptoms, and vital signs are some of the records recommended to be provided in at least read-only format and to the extent relevant for emergency care and quick reference. It is also possible that the patient will be able to provide certain clinical readings (BP, temperature, glucose count) and lifestyle data (steps walked, distance run, sleep duration and quality), which will serve as key clues and information on her/his overall health status. Notwithstanding a shadow of uncertainty in respect of the applicable rules and regulations of such mobile applications, the guidelines for their governance are clear.

New Tech Advancements for Diabetes

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Diabetes is at the forefront of medical devices that track and monitor illnesses. For many diabetics, the disease interferes with their quality of life because of the demanding daily requirements to keep the condition under control. Many diabetes sufferers must take daily blood sugar readings, sometimes many times each day, to monitor blood sugar levels. More severe cases may need to perform the blood sugar readings as often as 10 times per day. The testing can be taxing, especially because of the pinpricks required to draw blood.

Then there’s the medication. Many patients take diabetes medication such as Toujeo, a form of insulin that must be injected, at least daily. In the case of testing and taking insulin shots, it’s all too easy to forget and accidentally skip a dose or reading. That’s where new technology comes in.

A new device is under development that could regulate Type 1 diabetes more effectively by delivering insulin automatically as needed. Known as a closed-loop delivery system, this technology is not a new concept. The FDA approved the first hybrid artificial pancreas version in 2016. The latest device under testing is known as Control-IQ system. It will use algorithms to adjust a patient’s insulin doses automatically so they no longer have to repeatedly test their blood sugar levels and remember to take their insulin injections.

Diabetes smartphone apps Yes, there’s an app for that — many of them, in fact. Nowadays, diabetes apps can track your blood sugar levels and show trends; monitor your diet and suggest recipes; log your exercise; and provide support from other people with diabetes. “Coaching apps can also give you access to highly trained diabetes educators and fitness coaches,” Porter says.

Continuous glucose monitoring (CGM)

CGM, commonly known as blood sugar monitoring, automatically tracks blood glucose levels throughout the day and night through a button-like device that is fixed to a person’s arms.

You may view your glucose level at a glance at any moment.

You may look at how your glucose levels fluctuate over a few hours or days to determine if there are any diet or activity changes.

Seeing your glucose levels in real-time can help you make more educated decisions about how to balance your meals, physical activity, and medications throughout the day.

CGM works by inserting a small sensor (almost painless cannula) beneath your skin, commonly on your abdomen or arm. The sensor detects interstitial glucose, which is glucose contained in the fluid between cells. Every few minutes, the sensor checks the glucose level. Data are wirelessly sent to a monitor by a transmitter.

CGM devices have evolved throughout time, with significant advancements in accuracy, dependability, and simplicity of use. However, there are several key distinctions between the two primary types of CGM—real-time and intermittently scanned—that you should consider when selecting the proper system for you.

Heart Failure Detectors

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Patients who are at high risk for heart failure are often implanted with a small device known as an ICD (Implantable cardioverter-defibrillator) or CRT-D (Cardiac Resynchronization Therapy Device). Boston Scientific’s Heart Logic device can be included in either ICD or CRT-D to predict heart failure weeks in advance. The Heart Logic device’s sensors monitor for the warning signs leading to heart failure. The tiny device is fitted with sensors that can track a patient’s vitals and heart rate, listen for changes in heart sounds, monitor respiration, and watch for shortness of breath.

Besides the Heart Logic device, there are other options using wearable tech that could track heart activity. For patients with less severe heart conditions, wearable tech, such as the Fitbit and Apple Watch, can track vital signs like heart rate. The tech may detect irregular heart rhythms which can lead to stroke or heart failure.

Another interesting medical device innovation: There is now a lung fluid vest available that measures the level of fluids inside a person’s lungs and monitors lung congestion levels to reduce the risk of heart failure. The alternative would be regular (and more invasive) chest X-rays. The wearable vest is more effective at identifying the condition before it’s too late without causing the patient too much inconvenience.

3D print technology helping save lives

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Another emerging technology that is expected to gain a lot of traction in the medical device industry is 3D print technology. 3D printing is the process of making 3-dimensional solid objects from a digital file. When used in the medical device industry, 3D rendering technology has remarkable capacity to create a positive impact and save lives. With 3D print technology, it is possible to generate prosthetics that are customized to patients, produce custom-made organs and tools used for surgical procedures. In addition to this, these printed objects can also be used for the development of prototypes and for purposes of research. Moreover, 3D print technology is also used for the enhancement of design in dentistry and orthodontics.

Medical wearable technology is becoming popular

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One of the most significant advancements in the healthcare industry is the advancement of wearable technologies. Smart wearable medical technology has made it possible to monitor the status of a patient or monitor their own status, which is incredibly valuable. The trend for consumer smartwatches is set to become more widely adopted and their potential to be used in healthcare applications must be noted. In addition to this, smartwatches are also improving in their ability to provide more precise blood vitals in their users.

Smart watches are not the only technology that will see a growing curve in the coming years. Bio patches and small hearing aids have similar levels of impact when it comes to promoting overall health and wellness and optimize healthcare given to patients.

The Indian healthcare system continues to be impacted by aspects of availability, affordability and quality of health services. Given these, India lags behind averages of BRIC Countries. A key area of concern for India is the proportion of non-communicable diseases which is expected to rise in the next decade. The total healthcare expenditure in India was only 3.9% of GDP, compared to 8.9% for Brazil, 6.2% for Russia and 5.2% for China. Out-of-pocket expenditure is as high as 61%, with only 25% of the population being covered by health insurance.

While the government and value chain participants have undertaken several steps to address the issues of healthcare access, quality and affordability, these have been executed in silos. Specifically, while medical device companies have focused largely on extending life expectancy and improving quality of care, there is a need to increase affordability for a widespread impact. The challenge therefore for companies in India is to produce medical devices that are both cost competitive and effective to increase penetration and use. It is in this context that the Make in India initiative becomes significant for the medical devices industry.

Medical devices play a role not only in screening, diagnosing and treating patients but also in restoring patients to normal lives and in regularly monitoring health indicators to prevent diseases. With technological advancements, the role of medical devices is now expanding to improve quality of care across each stage of the healthcare continuum:

Screening and diagnosis:

Both accuracy and complexity of screening and diagnosis are increasing. Point-of-care / portable diagnostic devices provide care at home resulting in improved outcomes, patient satisfaction and, increased access to care in under-penetrated and remote regions, while facilitating treatment outside health facilities.

Treatment/Care:

Advanced surgical equipment is not only enabling doctors treat highly critical and complex cases but also reducing length of hospital stays. It is increasingly allowing elective but complex surgeries like knee replacement, bariatric, pain management, etc. to be shifted to outpatient / short stay surgery centre.

Restoration:

Hospitals and physiotherapy-rehabilitative centres are now enabling patients to restore their health faster and return to normal productive lives through the use of advanced assistive and rehabilitative device.

Monitoring:

Health screening devices are enabling patients to take charge of their health at home and regularly monitor health indicators. Further, devices are being used to monitor patients remotely for early diagnosis thus minimizing hospital visits and reducing pressure on the country’s over-burdened medical resources.

Overall growth in healthcare infrastructure

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There is a significant increase in the number of hospitals and hospital beds in India. Bed strength had increased from 0.8 million in 2002 to 1.6 million in 2012, and is further expected to increase to around 2.9 million by 202513. This increase has been driven primarily by growing presence of corporate hospital chains, international companies and service providers entering tier 2 and tier 3 cities.

• There is an increasing presence of diagnostics laboratory chains focusing on imaging and pathology. It is estimated that there are more than 100,000 diagnostic laboratories across the country, with the number expected to grow at a rate of 15% – 20%.
• The healthcare industry is also witnessing the emergence of new formats like chains of multispecialty outpatient clinics, mother-and-child hospitals, short stay surgery centres, IVF centres, etc; which are driving demand for medical devices.

Increasing focus of healthcare providers on quality and accreditation

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There has been a strong focus on upgrading medical technology by hospitals and laboratories to comply with accreditation requirements. Around 285 hospitals in India are NABH accredited with 472 additional proposals submitted for accreditation. Similarly, 347 laboratories in India are NABL accredited with 150 additional proposals submitted.

While the potential of the medical devices sector is acknowledged with its inclusion in the ‘Make in India’ initiative, it is essential to leverage the initiative to kickstart indigenous manufacturing and realize the twin objectives of accessibility and affordability.

Advin Health care is aimed at understanding the context, Constraints and opportunities for medical device Players, healthcare provides and key policy makers; Exploring the significance of India and other global manufacturing destinations; and aligning ‘Make in India’ fo medical devices with other key government supports.

Current landscape and key considerations for growth

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The medical devices market grew at a 10% CAGR in the past five years, reaching a value of USD 3.7 billion16 in 2014. From 2014 levels, if the industry continues on its organic growth trajectory, it is expected to reach USD 8.6 billion in size by 2020, growing at a CAGR of around 15% against the expected global industry growth of 4-6%.

In this scenario, the focus on augmenting healthcare infrastructure due to increased demand and improved access is expected to provide the requisite industry growth. Currently, the Indian medical devices industry represents just over 1.3% of the global medical devices market of USD 335 billion, which is dominated by USA (USD 134 billion in 2014). With an enabling policy framework and ecosystem support, industry estimates indicate a potential to grow at ~28% to USD 50 billion by 202519. This growth is expected to be driven by indigenous manufacturing and exports and, sales from local innovation.

Export Scenario

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India has a 75-80% import dependency on medical devices. Export of medical devices from India stood at US$ 2.53 billion in FY21, and are expected to rise to US$ 10 billion by 2025.

To increase export of medical devices in the country, the Ministry of Health and Family Welfare (MOHFW) and Central Drugs Standard Control Organisation (CDSCO) implemented the following initiatives:

Re-examination and implementation of Schedule MIII (a draft guidance on good manufacturing practices and facility requirements) System for export labelling Clinical evaluation and adverse reporting clarification State licencing authority to extend free sales certificate validity from 2 years to 5 years to allow exports Create a list of manufacturers with export licencing for easy access to regulatory authorities worldwide.

The Medical Devices Virtual Expo 2021 showcased Indian products and enabled direct interaction between Indian suppliers and buyers/importers from participating countries; 300 foreign buyers from the healthcare sector participated in this event.