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Dr Arvind Kohli Beating-heat surgery is a way to perform surgery with- out stopping the heart. The heart continues to beat and circulate blood to heart muscle during the operation. Surgery on a beating-heart helps reduce the risk for com- plications associated with temporarily stopping the heart during surgery. Now individuals who have medical con- ditions such as diabetes, history of stroke, or poor phys- ical health, can undergo cardiac surgery with lower risk for developing complications Beating heart vs Traditional by Pass Surgery Beating Heart by pass surgery is different from tradi- tional bypass surgery because it is performed while heart is still beating. Surgeon does not use the heart-lung machine to stop need to use the heart-lung machine dur- ing the operation. A prefusionist (a stand by during your operation). * While not all procedures can be performed on beat- ing heart, with advances in heart support system many techniques have developed that make beating-heart sur- gery an option for even complex procedures on the inside of the heart including valve repair. Some of the procedures performed on beating heart include: * Coronary artery bypass graft surgery (including TECAB, a minimally invasive option performed without cutting the breastbone, as well as open-chest, beating heart bypass) * Surgery for atrial fibrillation * Treatment of some congenital heart defects, such as closure of atrial septal defect * Value repair (mitral, pulmonary, or tricuspid) * Value replacement (mitral or tricuspid) Clinical Benefits of Beating Heart Bypass Surgery Complete recovery from a traditional bypass surgery ranges from four to six weeks. In contrast, recovery time for patients with beating heart surgery has been reported to be as short as three to four weeks. Patients are often awake much earlier after surgery and experience quick- er recoveries than patients who have been placed on a heart-lung machine. Hospitalization is generally shorter when compared to traditional operations using cardiopul- monary by pass. Best, of all, the risk of stroke and the need for blood transfusions is substantially reduced with beating heart CABG surgery. The fatty emboli which cause brain damage are generated when the large artery from the heart (aorta) is manipulated and although these are reduced in most off-pump coronary bypass surgeries they are not eliminated because the aorta is still used as site to attach some of the grafts. A growing number of OPCAB surgeons, however, are avoiding the aorta com- pletely, known as "anaoritc" coronary bypass surgery, by taking all their grafts from sites other than the aorta (e.g the internal mammary arteries.) This results in a very low risk of stroke, actually less than occurs during percuta- neous coronary intervention. SURGERY Beating heart surgery, also called off-pump bypass surgery (OPCAB), reduces the risks associated with the use of the heart-lung machine. During a beating heart CABG surgery, the heart continues to beat while the sur- geon delicately grafts the bypass. The surgeon uses a stabilization device to still the small area of the beating heart where the bypass is being grafted. The stabilization device utilizes small suction pods that gently attach to the surface of the heart. The pods work by lifting, not pushing down on the tissue, to stabi- lize the area where the surgeon will graft the bypass. The device is flexible so that it can be positioned on the heart vessels, yet sturdy so it can steady a portion of the beat- ing heart while minimally affecting heart function. Beating -heart surgery is technically demanding, requiring specialized skills and training. Therefore, many surgeons prefer not to do surgery on a beating heart. However, since the late 1990s, beating-heart surgery has gained favour among leading surgeons around the world, especially for coronary artery bypass surgery. Future of Beating Heart Surgery 'Beating heart' technology could revolutionize field of heart transplantation. The concept of transplanting a donor heart in a beating state is revolutionary. This prom- ising technology may improve the function of the donor heart, because it remains in a near-physiologic state. It can also help us better assess the suitability of a poten- tial donor. Taran Adarsh With every film, Sanjay Leela Bhansali [SLB] takes the audience expectations to a higher altitude. The expectations from GOLIYON KI RAASLEELA RAM- LEELA are no less. The effervescent colors, the atten- tion-grabbing visuals, the intense drama ingeniously intertwined in the screenplay, the alluring soundtrack and the electrifying chemistry between the lead pair has caught the attention of one and all. With GOLIYON KI RAASLEELA RAM-LEELA, SLB, one of the finest story- tellers of our times, is all set to outclass himself...and also prove the skeptics and cynics wrong, who may've felt that he has lost his way while trying to court triumph. You do know what to expect from an SLB film, since the supremely talented storyteller emits the right signals via the promos of his films. It's no different with GOLIY- ON KI RAASLEELA RAM-LEELA: SLB has stirred the audience imagination by attempting a love story amidst guns and roses. Sure, SLB is inspired by William Shake- speare's love saga 'Romeo and Juliet', but SLB makes sure he narrates the passionate love story of star-crossed lovers from warring families in his trademark individual- istic style. Set in Gujarat, GOLIYON KI RAASLEELA RAM- LEELAis SLB's most 'commercial' film as a director. Also, his best work so far. Undoubtedly! It's the kind of film that you carry back with you. The hi-octane drama, the blaz- ing guns, the passionate romance, the haunting melodies, the heart-melting emotions... SLB is an excep- tional director with a remarkable vision and GOLIYON KI RAASLEELA RAM-LEELA only bolsters the actuality. GOLIYON KI RAASLEELA RAM-LEELA narrates the story of Ram [Ranveer Singh] and Leela [Deepika Padukone]. The hostility and resentment between their families is an open secret, but as luck would have it, Ram and Leela fall in love. When truth dawns upon the respec- tive families, a storm ensues, their worlds collide and a bloody battle occurs...Can Ram and Leela carve their destinies amidst abhorrence and slaughter? Agree, we have witnessed Shakespeare's adaptation of 'Romeo and Juliet' innumerable times in the past, but SLB makes sure the execution of the written material -- also the way the screenplay [Siddharth-Garima and SLB] progresses -- is way diverse from similar storylines helmed by dream merchants here. The unconventional- ity he brings to every sequence, the colors he infuses in his frames, the aggressive lingo his characters mouth, the passion and sensuality he brings about in his char- acters, GOLIYON KI RAASLEELA RAM-LEELA not only has a spellbinding effect, but it ships you to an unfamil- iar world absolutely. You may have an inkling of the plot, but you definitely don't know how SLB will give an alto- gether innovative twirl to the premise. Celebrated for being a stickler for exactness and metic- ulousness, SLB makes sure his vision of narrating a sto- ry belonging to two warring families is never diluted by unwanted sub-plots or characters. One can gauge the premise at the very outset, but SLB never loses the focal point or deviates from it till the culmination. What unfurls is certainly going to catch a lot of people unaware, for sure. Hiccups? Yes, the length could've been controlled, towards the latter reels specifically. However, it's a minor hiccup when one looks at the kind of effort that has gone into making every frame come alive. One of the highpoints of GOLIYON KI RAASLEELA RAM-LEELA is, without doubt, its musical score [SLB, again]. Known for delivering musical gems in the past, the soundtrack of GOLIYON KI RAASLEELA RAM- LEELA is mesmeric, to put it in one word. Each of the songs befits the setting of the film, besides being seeped in melody. The fact that the tunes are on the loop says it all. 'Lahu Munh Lag Gaya', 'Nagada Sang Dhol Baaje', 'Ishqyaun Dhishqyaun', 'Tattad Tattad', 'Ang Laga De' and 'Ram Chahe Leela' are sure- fire hits already. Visually too, each of those songs is distinctively resplendent, with the choreogra- phy catching your eye as well. The background score [Monty Sharma] is top notch. The DoP [Ravi Varman] captures SLB's vision exquisitely and every frame has the unmistakable stamp of flawlessness. The production design [Wasiq Khan] is striking. Action [Sham Kaushal] is absolutely in sync with the demands of the script. Who would've ever imagined Ranveer Singh and Deepika Padukone to set the screen ablaze when GOLIYON KI RAASLEELA RAM-LEELA was announced? But the chemistry between the two is defining in every sequence, with the actors complimenting each other fantastically. Ranveer, seen in a completely new avatar, had impressed in his earlier endeavors, but he outshines himself in this one. He has surfaced as a much better actor than he ever was, letting himself free of his inhibitions and experimenting with a role that's actually intricate. He's simply flawless. This is Deepika's year, for sure. Post RACE-2, YEH JAWAANI HAI DEEWANI and CHENNAI EXPRESS, Deepika pulls yet another ace this time. Looking gorgeous as ever and cast in the most demanding role of her career thus far, she wins you over with an act that's unblemished. Actually, the confi- dence she radiates while portraying this part makes you wonder whether SLB and his writers Siddharth-Garima had penned this character keeping Deepika in mind. The audi- ence is sure to go into raptures while watching Deepika in GOLIYON KI RAASLEELA RAM-LEELA. Every actor in the supporting cast is simply wonder- ful. Supriya Pathak [outstanding], Homi Wadia [super], Gulshan Devaiah [brilliant], Richa Chadda [fantastic], Abhimanyu Singh [first-rate], Sharad Kelkar [competent], Barkha Bisht [very good] and Raza Murad [competent], each actor gives his/her best to the enterprise. Priyanka Chopra sizzles in the item number. On the whole, GOLIYON KI RAASLEELA RAM- LEELA ought to be watched for multiple reasons: the electrifying chemistry between its lead actors, the strong dramatic content, the scintillating musical score, the vio- lent streak in the narrative and of course, Sanjay Leela Bhansali's execution of the material. This is Sanjay Leela Bhansali's most accomplished work to date. It's a work of outstanding artistry. No two opinions about it. A mas- terpiece by the master craftsman Sanjay Leela Bhansali! http://www.bollywoodhungama.com/ Dr Richa Sharma This procedure of egg donation is a blessing in disguise to all those couples where they are not getting pregnant either because they have no eggs in their ovaries or due to poor egg quality. Oocyte donation remains one of the ways of bringing the joy of parenthood to many couples who cannot conceive naturally. Hereby I am quoting com- mon queries in minds of cou- ples with all myths and facts to make things easier What' egg Donation ? Egg donation is a type of Test Tube Baby procedure where an egg is taken from a fer- tile young lady prefer- ably under 30yrs and sperm is taken from intending husband and both are united outside the body in laboratory and the resulting embryo (baby) is transferred into the uterus of the intending woman. Egg donor- is woman who donates eggs Recepient- woman who receives eggs in form of embryos(Bhrun) being transferred into her womb(Garb- hasay) Innovation - Trounson and colleagues from Australia first reported an egg donation cycle in 1983 This concept has enabled millions of woman all round the globe to get pregnant who are not able to get pregnant using their own eggs.Egg donation has brought a new hope to many couples who otherwise would have remained childless. Who all in need of Egg Donation ? 1)Premature ageing of ovary(Premature ovarian failure)-when there is early ageing or lack of eggs, rea- sons can be- Idiopathic (unknown), after ovarian sur- gery like removal of ovaries prematurely due to multi- ple reasons, In cancer patients after chemotherapy ,Radiotherapy 2) Genetic reasons like- Thalassemia, galactosemia 3)Down syndrome or any other chromosomal disorders translocations(karyotyping) 4)Repeated IVF failure due to poor egg quality 5)Menopausal , perimenopausal(females who are not getting monthly periods) Oocyte donation is the most successful technique for achieving pregnancies in perimenopausal women. How female differs from male in fertility- Do you know that ? A women is born with a fixed no of eggs in her ovaries and these get depleted in the course of her reproductive years(15-45yrs) unlike men whose sperms(shukranoo) are formed every 3months so a man even of 80yrs can make a lady pregnant unlike a woman after 45yrs has get almost nil chances to get pregnant as her own eggs are exhaust- ed because her eggs are formed only once in her life time(at the time of birth) . New egg formation does not occur after birth and there are no medication or injection for new eggs to form( Concept of stem cells on research and DHEA with vari- able evidence) What's the success rates and how it differs from normal preg- nancy?Anything to worry ? The pregnancy after an egg donation cycle is like a normal pregnancy follow up. The success of egg donation cycle is approxi- mately 45-50% p e r attempt . The suc- cess is not 100% because the implantation (Growth of the baby inside the womb) is under God's control and there are no med- ication at present which would assure 100% implantation. The process of IVF can make babies outside the human body till 2-3days max 5days and there after the babies (Embryos) are transfer back inside the womb and the fur- ther growth inside is dependent on God wish . Is it safe to go for donor and what all screened ? The egg donors are screened for infectious disease,genetic diseases along with baseline workup along with detailed psychological evaluation . What are legal issues? The recepient couple should be aware that they would become the legal parents of any resulting children/child. Donor selection is based strictly as per ICMR guidelines and ART Bill(law of land) Risks to baby born ? The children / child born through a egg donation cycle does not carry any increase inchance of abnormal child. The ethical, moral , legal and medical issues have been addressed time and time again, yet the debate goes on. Strict guidelines and protocols are necessary. Within the complexity of these issues, continued efforts have to made to improve the outcome of egg donation program for both recepient and donors. SUNDAY, NOVEMBER 17, 2013 (PAGE-4) A work of outstanding artistry Egg donation HEALTHLINES BOLLYWOOD BUZZ HEALTHLINES Beating heart surgery Dr Raj Shree Dhar In this world, two realities produce inexpressible awe in me. One is the starry heaven and the other is moral con- science in Man. During the night, when I behold star- stud- ded heaven, my mind exclaims: Who thou art playfully cre- ating worlds and keeping them on their path. How supreme Thou art and how trivial I am. When I ponder over the chasm between the Supreme and my insignificant being, I am struck with awe."- Kant We humans are mostly engaged in petty affairs but, nev- ertheless, our achievements in the exploration of the Uni- verse are in no way insignificant. The knowledge garnered through centuries has brought home to us that knowledge is power and is indispensable for survival. The dimensions of the Universe are so infinitely vast that units of measure- ment prevalent on the Earth will serve no purpose. For measuring astronomical distances, our unit is light year. It is the distance travelled by a ray of light in one solar year and its value is 10 trillion kilometres. A ray of light travels 300,000 kilometres in one second. It means that the light of the sun takes about 8 minutes to reach the earth. The earth is a special entity because of its atmosphere, oceans and continents, animals and vegetable kingdoms. The sky appears blue because of the atmosphere but the interstellar space is an unimaginably cold and dark vacu- um. An enormous global interest exists in the exploration of the planets and in many mathematically scientific topics- the origin of life, the Earth, and the Cosmos, the concept of 'I', the self, our connection with Universe. Today we have discovered a powerful and elegant way to understand the Universe. The methods involved are indissolubly bound up with Mathematics and Sciences. Mathematics is a delight because it initially enabled us to count different articles and various entities. It took mankind ages to understand zero and more than 11/2 thousand years to measure infinitesimally small quantities. Stupen- dous collective labour of mankind has enabled us to acquire mastery in conquering space and produce goods and mate- rials which makes life a delightful of meaningful signifi- cance. The infinite space surrounding the earth is abounding in roving galaxies consisting of galactic dust and gas, stars, supernovae, novae, pulsars, quasars and black holes. If we watch the night-sky, we find milky floating patches and faint tendrils of light. Some are solitary wanderers, some are clusters and some appear huddled together, ever wan- dering in the cosmic space. These are all galaxies. A galaxy is an immensely vast stretch of billions upon billions of stars and galactic dust and gas. There may be planetary systems somewhere millions or thousands of light-years from us. Some planets may be teeming with life like our Earth. There may be intelligent beings somewhere. For the present we have no possibility to reach them. There are some hundred billion galaxies each with a swarm of 100 billion stars on the average. Our galaxy is a spiral galaxy having some 400 billion stars. Cosmic space is so vast and the total number of galaxies so insignificant that if we had the power to be somewhere in space to search for a planet the chances will be one in billion trillion trillion. Therefore, the earth on which we live is most precious. Einstein predicted in the twenties of this century that a ray of light falling on a non-luminous body will not be reflect- ed back if the gravitation of the body increases tremen- dously. It was experimentally found to be correct. The earth attracts all other bodies towards its centre and this special case of gravitation is called gravity. Gravity causes accel- eration in faling bodies and its value is 10 metres per sec- ond. It is denoted by 'g'. Its value on the Moon is l/4th of 'g' on the Earth. Therefore, 1 kg on Moon will weigh only 250 gms. Consider now on Earth the value of 'g' becomes 100,000 times. Everything on Earth will be compacted with tremendous pressure and force towards its centre. Earth will be reduced to a compact small ball and if a ray of light falls on it from outside the universe it will not be reflected back. The Earth will become invisible. If any other body enters the proximity of the Earth, it will also be sucked in. In short, the Earth will become a black hole. Imagine such a thing happening to a star 1000 times bigger than our Sun when it suffers supernova explosion. With value of 'g' becoming even 1 billion times, it will become a black hole. A black hole can suck an enormous galaxy into it. Black hole is supposed to be a bottomless pit. Some say that if somehow we are able to fall into it without suffering any change or in an ethereal body such as we have in a dream we may find ourselves in a different universe. Black holes were first thought of by the English astronomer John Michell in 1783. Some astronomers inferred from the quasars that the universe is expanding. But other facts have come to light which put a question mark on the doctrine of expanding universe. If there is insuf- ficient matter to prevent the Universe from expanding for- ever, it must have an open shape with a surface extending to infinity in our three dimensional analogy. If there is enough matter, then it has a closed shape curved like a sphere in our three dimensional analogy and light cannot escape from it, then Universe will be described as a black hole. What inside a black hole, a mystery. According to the Sankhya philosophy , man is beyond everything. It means that it will not be possible to investigate into the nature of man with the help of microscope, telescope, spectroscope or by applying mathematical logic. Leibnitz's doctrine of individual forces has something in common with the Sankhya philosophy. According to Leib- nitz, every being is a unit called monad. Every monad is a living mirror of the Universe, a microcosm. God is the supreme monad responsible for maintaining the order and the continuity of the Universe. It appears that Leibnitz might have been influenced by the Sankhya philosophy. A few million years ago there were no humans. Who will be here a few million years hence? But now tiny explorato- ry spacecrafts from Earth are moving, glistening and ele- gant through the solar system and at this dangerous moment of technological adolescence we are managing to avoid self- distruction. ( The author is Nodal Officer, J & K Institute of Mathematical Sciences, Jammu office presently at MAM College) Mathematics - Cosmic perspective
