For more than 32 years, Dr. Dinesh Kacha has led the health care industry with innovative products and discoveries. Known as the 'Follower of Ayurveda , Dr. Dinesh Kacha compiles traditional blend of ancient wisdom with modern-day Science to develop research based formulations for patients across generations and geographies with his deep-rooted philosophy of creating perfect health for everybody.

Dr. Dinesh Kacha addresses the root cause of insulin resistance and lack of insulin, reversing diabetes through ayurvedic lifestyle & fixing the metabolic damage  that will not just prevent the disease but also reverse it as his researches believes that focus on lifestyle through the approach of Aahar Vihar Ausadh  based on ayurvedic principles and processes will help the management of disease.

The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have, it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious health problems. To understand diabetes, first you must understand how glucose is normally processed in the body.
Glucose comes from two major sources: food and your liver.

Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
Your liver stores and makes glucose.
When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Metabolic damage occurs when our body’s metabolism (essentially how our bodies utilize energy) has adjusted into “survival mode� from periods of intense restriction, exercise, and/or stress. It’s actually better described as ‘metabolic acclimation’ because it has acclimated or gotten used to the new ‘norm’ of energy utilization it is experiencing.

Research suggests that people who are obese are up to 80 times more likely to develop type 2 diabetes than those who are not. In obese persons, cells of fat tissues have to process more nutrients than they can manage. The stress in these cells triggers an inflammation that releases a protein known as cytokines.

Studies suggest that abnormal fat causes fat cells to release
‘pro-inflammatory’ chemicals, which can make the body less sensitive to the insulin it produces by disrupting the function of insulin responsive cells and their ability to respond to insulin.
Diabetes cases in the world have increased due to drastic change in lifestyle, unhealthy eating habits and high stress levels. People with diabetes are 2 to 4 times more likely to suffer from heart disease or a stroke as compared to those who do not have diabetes. Diabetes is a condition that hinders your body's ability to respond to insulin that eventually leads to abnormal metabolism of carbohydrates, leading to spiked blood sugar levels
Ayurveda can control diabetes. Since the disease is an acquired lifestyle disorder, Ayurveda can trigger the remission process. The focus must be to reduce the dependency on medication (Ayurveda/Allopathy) and to adapt to a newer, improved lifestyle. Efforts must be made to improve your diet, daily routines, yoga or exercise schedule, and stress management techniques.

Body contouring with liposuction surgery is a popular procedure for removing fat from areas such as the waist, abdomen, hips and thighs. Liposuction is especially effective for people with localized pockets of fat that diet and exercise cannot seem to remove. For those looking for Liposuction near me, there are many experienced surgeons in Delhi who specialize in body contouring with liposuction.

Liposuction is a surgical procedure that sucks fat from the body by using a suction device. Local, or general anesthesia can be used depending on the area and size of the area being operated on. The procedure involves making small incisions in the targeted area and sucking out the fat cells to contour the body. It usually takes 1-2 hours depending on the extent of the operation.

When performed by a qualified surgeon, liposuction will remove fat cells permanently. Patients should be aware that some amount of fat may come back if they are not aware of their diet and exercise regime. After surgery it is important to keep the affected area clean and dry to allow the area to heal properly.

Overall liposuction is a safe and effective way to improve body shape and contour.

To avail the benefits of liposuction in Delhi, book a consultation with Dr. Ashish Khare today!

Get more info at: https://www.kalosaaesthetics.com/liposuction/

Disclaimer: All the text, videos, techniques, and images available on this post are for awareness purposes only. It must not be considered as a substitute for medical advice. Results may vary from person to person, depending on the medical needs.

6 Signs You Need to See an Orthopedic Doctor
Do you have knee or back pain daily? Do you feel sore after sleeping or inactive for a long time? Do you have an injury that doesn’t seem to be healing? These are some common 6 Signs You Need to See an Orthopedic Doctor. But what are some other reasons? An orthopedic doctor specializes in the treatment of the musculoskeletal system. The musculoskeletal system includes bones, joints, tendons, muscles, ligaments, and cartilage. Orthopedic doctors treat injuries through both surgical and non-surgical means and will help you decide the right course of treatment. Let’s get over some of the common reasons explained by Dr. Ashwini Gaurav about When you need to see an Orthopedic Doctor. He is known as the Best Orthopedic Doctor in Patna.

You have difficulty performing everyday activities:
Bad posture, age, and overall lifestyle can bring bone and joint pain, which can be a block to your daily activities. You may struggle to do the easiest of tasks like climbing stairs or even walking. Orthopedic issues may cause difficulty in walking or standing. If you have instability or feel shaky when walking, standing up, sitting down, or remaining standing, an Orthopedic doctor can help diagnose the problems and treat them. They may recommend physical therapy or surgery to improve your quality of life and restore your ability to perform essential activities
You have a fracture:
Orthopedic surgeons can fix broken bones and injuries to tendons and muscles and help improve function and decrease or eliminate pain. If you have serious fractures or breaks, you have referred to an orthopedic surgeon to have the right treatment. Some fractures can be fixed by wearing a cast or splint to immobilize the area, but other fractures are more complex, such as compression fractures or stress fractures. Fractures in the wrists, hips, vertebrae, and kneecaps are not as easy to treat as a simple fracture in the arm. An orthopedic doctor can treat these types of fractures with surgery or other methods.
You have soft tissue injury not improved in 48 hours:
Have you just suffered from a soft tissue injury, such as a twisted knee, sprained ankle, or busted wrist? Use the RICE method to see if the pain and swelling decrease within two days. If you have not noticed any major improvements after the first 48 hours, you .should seek medical attention. If there is an injury to the muscles, tendons, ligaments, or bones, Orthopedic doctors can diagnose and treat the problem.
Your range of motion is limited:
Are your joints supposing tighter and tighter as the days go by? If pain and stiffness are keeping you from moving freely, then orthopedic doctors can help with that. Limited motion is often a symptom of arthritis, injury, and other joint conditions. You should seek treatment when you notice that you are losing range of motion so that the condition does not get more destructive and require more aggressive treatment.
You experience orthopedic trauma:
If you are in an accident, have a fall, or have a sports injury, you may show signs or symptoms consistent with a traumatic injury. You should be examined and monitored by an orthopedic doctor promptly to confirm that there is no irreversible harm to your bones, joints, or muscles.
You have chronic pain:
Chronic pain is defined as any pain staying more than 12 weeks. Experiencing a few days of pain is one thing but after several weeks and months of it. that’s a sign you should see a doctor.
How to Book An Appointment?
If you face any problem regarding joint pain then you must visit the best orthopedic doctor in Patna. For more information about our comprehensive treatment options, or to request an appointment with Dr. Ashwini Gaurav, call 9386737895 or Click on Book Appointment for online booking.

Bariatric surgery is considered the most effective treatment for obesity in terms of long-term weight loss and improvement in obesity-related co-morbidities.
<a href="https://drsaggu.com/best-bariatric-surgeon/">Best Bariatric Surgeon in Delhi</a> procedures cause weight loss by limiting the amount of food that can be held in the stomach, causing malabsorption of nutrients or a combination of gastric restriction and malabsorption. Bariatric procedures also bring about desirable hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

How do I know if I am eligible for slimming surgery?

Weight loss surgery is only recommended if you can't lose a lot of weight and keep it off with diet, behavior changes, and exercise alone. Doctors often use body mass index (BMI) and health conditions such as type 2 diabetes and high blood pressure to determine which patients are most likely to benefit from weight loss surgery. Patients with concomitant comorbidities such as diabetes, etc., or with a BMI greater than 37.5 kg/m2, with or without concomitant comorbidities.

Original Research
Efficacy of surgical techniques and factors affecting residual stone rate in
the treatment of kidney stones
Dr. Anil Haripriya


1Associate professor, Department of General Surgery CIMS, Bilaspur (C.G.), India;
2Associate Professor, Department of General Surgery, NSCB Medical College, Jabalpur (M.P.), India
ABSTRACT:
Background: The present study was conducted to assess efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. Materials & Methods: 102 patients of kidney stones of both genders were divided
into 3 groups. Group I patients underwent open stone surgery, group II patients underwent percutaneous nephrolithotomy
(PNL) and group III underwent retrograde intrarenal surgery (RIRS). Surgical techniques complications were evaluated.
Results: In group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9 cm2
. The mean
operative time in group I was 84.2 minutes, in group II was 118.4 minutes and in group III was 78.6 minutes. There were 9
cases in group I, 7 in group II and group III was 5 cases. There were 7 cases of fever in group I, 4 in group II and 2 in group
III, infection 2 in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II.
The difference was significant (P< 0.05). Conclusion: PNL and RIRS have been seen as safe and effective methods as
compared to open method in case of kidney stones.
Key words: Percutaneous nephrolithotomy, Retrograde intrarenal surgery, Kidney stone.
Received: 13 September, 2020 Accepted: 18 November, 2020
Correspondence: Dr. Arvind Baghel, Associate Professor, Department of General Surgery, NSCB Medical College,
Jabalpur (M.P.), India
This article may be cited as: Haripriya A, Baghel A. Efficacy of surgical techniques and factors affecting residual stone
rate in the treatment of kidney stones. J Adv Med Dent Scie Res 2020;8(12):55-58.
INTRODUCTION
Urinary system stone disease is one of most
frequently encountered diseases in the urology
practice. The stones are frequently observed in the
renal localization, and most of them require
intervention.1 Kidney stone disease, also known as
urolithiasis or renal calculi contributes to one of the
most common health problems in the daily lives of
men and women. It occurs when a solid piece of
material (stone) forms in the urinary tract.2
Approximately 12% of men and 6% of women in the
USA and 10 to 15% of people in Europe and North
America are affected by it. Calcium oxalate (CaOx) is
found to one component of the most common kidney
stones. It has been proposed that the most likely stone
formation mechanism for people with idiopathic
CaOx stones is caused by CaOx overgrowth in renal
papillary Randall’s plaque.
3
Preventive measures such
as dietary therapy and therapeutic treatments such as
drugs and surgical techniques have been verified to be

effective in the treatment of renal calculi. Dietary
modification is a safe and economical preventive
measure for dietary therapy, and in some cases, drugs
are important to reduce the risk of stone formation.
Unfortunately, since the 1980s, there have been no
new drugs developed for the prevention of renal
calculi after the introduction of potassium citrate.4
Some of these methods include percutaneous
nephrolithotomy (PCNL), extracorporeal shockwave
lithotripsy (SWL), retrograde intrarenal surgery
(RIRS), etc. Extracorporeal shock wave lithotripsy
(ESWL) into clinical practice after 1980s, a new era
had begun in the treatment of urinary system stone
disease. In recent years, percutaneous
nephrolithotomy (PNL) has taken increasingly greater
part in the treatment of stone disease with success
rates nearing to 80 percent.5 The present study was
conducted to assess efficacy of surgical techniques
and factors affecting residual stone rate in the
treatment of kidney stones.
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies NLM ID: 101716117
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Index Copernicus value = 85.10

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Haripriya A et al. Treatment of kidney stones.

56

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
MATERIALS & METHODS
The present study was conducted among 102 patients
who underwent surgical treatment of kidney stones of
both genders in the department of general surgery in a
medical college hospital. All were informed regarding
about the study and their consent was obtained.
Data such as name, age, gender etc. was recorded.
Patients were divided into 3 groups. Group I patients
underwent open stone surgery, group II patients
underwent percutaneous nephrolithotomy (PNL) and

group III underwent retrograde intrarenal surgery
(RIRS).
Endoscopic stone surgery was performed for stone
fragmentation in all patients using pneumatic
lithotriptor or Holmium: YAG laser. Surgical
techniques complications were evaluated. Stones
equal or larger than 4 mm were considered as residual
stones. The dimensions of the stones were calculated
and measured in cm2

. Results thus obtained were
subjected to statistical analysis. P value less than 0.05
was considered significant.

RESULTS
Table I Distribution of patients

Groups Group I Group II Group III
Methods Open stone surgery PNL RIRS
M:F 34 34 34

Table I shows that group I patients underwent open stone surgery, group II patients underwent PNL, and group
III underwent RIRS. Each group had 34 patients.
Table II Assessment of parameters

Parameters Group I Group II Group III P value
Stone burden (cm2

) 3.2 2.5 1.9 0.01
Operative time (mins) 84.2 118.4 78.6 0.001
Length of hospital stay 3.2 3.0 1.4 0.05
Cases with residual stone 9 7 5 0.02
Table II shows that in group I mean stone burden was 3.2 cm2

, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative timein group I was 84.2 minutes, in group II was 118.4 minutes and in group III was
78.6 minutes. There were 9 cases in group I, 7 in group II and group III was 5 cases. The difference was
significant (P< 0.05).
Table III Assessment of complications in groups

Complications Group I Group II Group III P value
Fever 7 4 2 0.02
Infection 2 0 3 0.05
Urine leakage 0 0 5 0.05
Persistent pain 6 1 0 0.001

Table III, graph I shows that there were 7 cases of fever in group I, 4 in group II and 2 in group III, infection 2
in group I and 3 in group III, urine leakage 5 in group III and persistent pain 6 in group I and 1 in group II. The
difference was significant (P< 0.05).
Graph I: Assessment of complications in groups

0
1
2
3
4
5
6
7

Fever Infection Urine leakage Persistent pain
7

2

0

6

4

0 0

1

2

3

5

0

Group I
Group II
Group III

Haripriya A et al. Treatment of kidney stones.

57

Journal of Advanced Medical and Dental Sciences Research |Vol. 8|Issue 12| December 2020
DISCUSSION
Currently, a diverse range of non-invasive, minimally
invasive and invasive methods have been reported as
treatment approaches for renal calculi. Recent studies
have reported that flexible ureterorenoscopy
(URS)/holmium laser lithotripsy can be an alternative

treatment for patients with renal calculi. The micro-
percutaneous nephrolithotomy (microperc) is a

recently described technique in which percutaneous
renal access and lithotripsy are performed in a single
step. Microperc has been found to be safe and
effective in removing small renal calculi in the adult
and pediatric populations with a high stone-free rate
and lower complication rate.6 Despite all the new
approaches, shock wave lithotripsy (SWL) remains
the first line treatment modality that is widely used for
renal, ureteral and intermediate-size renal calculi. Its
success rates from contemporary series vary from 60
to 90%. However, during an SWL procedure,
physicians should consider the association between
SWL-related pain and patients’ positioning, which
may negatively affect the SWL success rate as well as
its potential complications. PCNL can be divided into
two types: minimally invasive percutaneous
nephrolithotomy (mini-PCNL) and standard
percutaneous nephrolithotomy (standard PCNL).7
Mini-PCNL has a higher efficacy and better safety in
the management of small renal calculi, while standard
PCNL is still regarded as the conventional technique
for the treatment of large renal stones in the upper
urinary tract. However, in the recent years, there has
been a shift in trend to favor a mini-PCNL approach
in order to reduce the morbidities.8The present study
was conducted to assess efficacy of surgical
techniques and factors affecting residual stone rate in
the treatment of kidney stones.
In present study, group I patients underwent open
stone surgery, group II patients underwent PNL, and
group III underwent RIRS. Each group had 34
patients. Ayedemir et al9

included records of 109
cases of kidney stones. Patients were divided into
three groups in terms of surgical treatment; open stone
surgery, percutaneous nephrolithotomy (PNL) and
retrograde intrarenal surgery (RIRS). Patients’ history,
physical examination, biochemical and radiological
images and operative and postoperative data were
recorded.The patients had undergone PNL (n=74;
67.9%), RIRS (n=22;20.2%), and open renal surgery
(n=13; 11.9%). The mean and median ages of the
patients were 46±9, 41 (21–75) and, 42 (23–67) years,
respectively. The mean stone burden was 2.6±0.7 cm2
in the PNL, 1.4±0.1 cm2 in the RIRS, and 3.1±0.9
cm2 in the open surgery groups. The mean operative
times were 126±24 min in the PNL group, 72±12 min
in the RIRS group and 82±22 min in the open surgery
group. The duration of hospitalisation was 3.1±0.2
days, 1.2±0.3 days and 3.4±1.1 days respectively.
While the RIRS group did not need blood transfusion,
in the PNL group blood transfusions were given in the
PNL (n=18), and open surgery (n=2) groups. Residual

stones were detected in the PNL (n=22), open surgery
(n=2), and RIRS (n=5) groups.
We found that in group I mean stone burden was 3.2
cm2
, in group II was 2.5 cm2

and in group III was 1.9

cm2
. The mean operative time in group I was 84.2
minutes, in group II was 118.4 minutes and in group
III was 78.6 minutes. There were 9 cases in group I, 7
in group II and group III was 5 cases. Stone-free rate
in percutaneous nephrolithotomy can vary dependent
on the stone location, and size, as reported in the
literature, it increases up to 90 percent. In the AUA
guideline, this rate has been given as 78 percent. In
our study, in 74 patients, a 70.3% stone-free rate has
been detected. Size, location, composition of the
stone, anatomy of the affected kidney, and experience
of the surgeon are effective on success, and
complications of PNL.10
We found that there were 7 cases of fever in group I, 4
in group II and 2 in group III, infection 2 in group I
and 3 in group III, urine leakage 5 in group III and
persistent pain 6 in group I and 1 in group II.
Lingeman et al11reported 88–91% success rates for
stones with a diameter of 1–3 cm, mean success rate
decreased to 75% in stones larger than 3 cm in
diameter. Still Clayman et al12reported success rates
as 89.2, and 97–100% for stone with a stone burden of
>2, and <2 cm2

, respectively.
CONCLUSION
Authors found that PNL and RIRS have been seen as
safe and effective methods as compared to open
method in case of kidney stones.
REFERENCES
1. Karatag T, Buldu I, Inan R, Istanbulluoglu MO: Is
MicropercutaneousNephrolithotomy Technique Really
Efficacicous for the Treatment of Moderate Size Renal
Calculi? Yes. UrolInt 2015;95:9-14.
2. Kim BS: Recent advancement or less invasive treatment
of percutaneous nephrolithotomy. Korean J Urol
2015;56:614-623.
3. Hyams ES, Munver R, Bird VG, Uberoi J, Shah O:
Flexible ureterorenoscopy and holmium laser lithotripsy
for the management of renal stone burdens that measure
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2010;24:1583-1588.
4. Sabnis RB, Ganesamoni R, Ganpule AP, Mishra S,
Vyas J, Jagtap J, Desai M: Current role of microperc in
the management of small renal calculi. Indian J Urol
2013;29:214-218.
5. Knoll T, Buchholz N, Wendt-Nordahl G: Extracorporeal
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Arab J Urol 2012;10:336-341.
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HH, Jeong CW: Clinical Nomograms to Predict Stone-
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and Internal-Validation. PLoS One 2016;11:e0149333.

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8. Kang JH, Lee SW, Moon SH, Sung HH, Choo SH, Han
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staghorn calculi: is shockwave lithotripsy necessary? J
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Mertz JH, Mosbaugh PG, et al. Comparison of results
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WB Saunders; 1998; 2789–874.