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EDITOR’S NOTE The DNA factor

A

Volume 2 Issue 3 & 4 | April 2013 Editor Ravi Deecee Head-Operations M Kumar Assistant Editor Dipin Damodharan Chief Copy Editor K S Rajagopal Senior Reporters Lakshmi Narayanan Prashob K P RESPONSE TEAM Coordinating Editor Sumithra Sathyan Reporters Tony William Shalet James Neethu Mohan Design & Layout Kailasnath Anil P John Web Manager Sreenath S

ADVT SALES Senior Managers Kainakari Shibu Rajasree Varma Anu P M Biju P Alex K S Syam Kumar M K Haridas Vinod Joseph ( Delhi) Rohil Kumar A B (Bengaluru) Managers Febin K Francis Bipin Kumar V S MARKETING Sr Manager Sabu Varghese Mathew Assistant Managers Priya P A Mobin E Mathew Liju P John Circulation Athul P M Sone Varghese Vishnu

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www.futuremedicineonline.com Published from DC Books Pvt Ltd, D C Kizhakemuri Edam, Good Shepherd Street, Kottayam – 686001, Kerala, India and printed at Five Star Offset Printers, Nettoor, Cochin – 40 for DC Press Pvt. Ltd., Industrial Development Area, Poovanthuruth, Kottayam – 686012, Kerala, India. Printed, published & owned by Ravi Deecee

DC Media Publication 4 FUTURE MEDICINE I April 2013

detailed story on the DNA sequencing and genome research in the West as well as in the Asian countries deserves to be the cover story of this issue of Future Medicine. Since DNA sequencing is the future of medicine, lots of research are ongoing, mainly in the West, investing millions of dollars. As you know, the whole world remains anxious to know about the latest developments in the area. So it is our privilege to keep the enthusiastic readers of this magazine informed about the advancements in genome research and its immense possibilities in the future.

The interesting news is that China has also made an entry into the field with huge investments. However, India is yet to take initiatives to make its presence felt in the emerging area of modern medicine. The genome industry in the country is still in its infancy. SciGenom is one of the few firms involved in research in the field. Sam Santhosh, Chief Executive Officer of the Kochi-based company, opines that genomics will fuel the next revolution in medicine.

The cover story also includes an exclusive interview of Somasekar Seshagiri, Principal Scientist, Molecular Biology at Genentech Inc, one of the largest biotech companies in the world. He gives us an exact picture of genome research and its current status. Even a layman could be able to understand what is DNA sequencing and genome research and how it will impact the treatments in the days to come. Be aware that chances are very high for misuse of the individual information collected through DNA sequencing. Another topic discussed in detail in this issue is diabetes. An increasing number of people in India and abroad are falling victims to the menace these days. Blame it on our lifestyle. A couple of articles and interviews presented here provide you sufficient information regarding the disease, its prevention and treatments. The more you know about the condition, the better. Diabetes affects all vital organs of the body, including heart and kidney. Sexual life of people also suffers due to diabetes. Treatments are always a long process and still recovery depends on the level of damage it has caused to various organs and veins. One should know how to avoid diabetes and the ways to control blood sugar level. Take down the tips provided in these pages and make use of them for a diabetes-free tomorrow. To save the next generation from the twin burden of diabetes and heart disease, a team effort by the family, neighborhoods, schools, healthcare providers, governments and the media is mandatory.


COVER STORY

CONTENTS 18 21

Genome Research Somasekar Seshagiri, Principal Scientist, Molecular Biology at Genentech Inc;

“It is the minor difference between our genomes that make each one of us unique.”

25

It’s your

DNA after all

‘Genome man’ of India Sam Santhosh, CEO, SciGenom, Kochi,

Columns

Says that genomics will fuel the next revolution in medicine

12 16 28 55 34 38

Hair Care Dr Divya Ramkumar

Clinical Research Dr Apurva Shah

Spine Care Dr Ramkumar Menon

Menstruation Dr N P Vijayalakshmy

Know Diabetes Better Dr Jothydev Kesavadev

Diabetes & Sex Dr Ramesh Goyal

6 FUTURE MEDICINE I April 2013

DNA sequencing and genome research is the future of medicine as it can rectify health issues at the individual level by using a patient’s genetic information. However, like any other scientific inventions, genomic medicine also has a negative side, mainly handling of personal genetic information

64

Indian Hospital Focus

The Madras Medical Mission With quality healthcare, equity and compassion for all people, The Madras Medical Mission has become a hallmark of charitable medical care

30

Pharma CSR Activities

Bristol-Myers Squibb Corporate major Bristol-Myers Squibb India has been involved in mitigating healthcare problems at the grassroots level for quite some time now


58 Pharmapreneur Healer with the Nutrients

Dr Muhammed Majeed is a pharmacistturned-entrepreneur who loves to study drug molecules and plans Ayurvedic means of healing. He knows how to blend traditional and modern medicines together through his nutraceutical-cumpharmaceutical company, Sami Labs Ltd, and its US arm, Sabinsa Corporation

33

Disease Special Be Aware of Diabetes It is our lifestyle that leads to an alarming health situation where more and more people fall prey to diabetes

56

Health Hazards Smokeless tobacco products The goal of a ‘tobacco-free world’ has been hampered by the globalisation of tobacco marketing, trade, research and industry influence

50

Art and Medicine Art therapy can reduce pain, anxiety Cleveland Clinic’s research in art therapy has shown positive results. Its art therapy results in a decrease in pain and anxiety

Corrections and clarifications In the article titled ‘Needed, a spine care system’, (Future Medicine, February 2013 edition) we misrepresented Dr Arvind G Kulkarni as Consultant neurosurgeon, Bombay Hospital, Mumbai. Dr Arvind G Kulkarni is Consultant spine surgeon, Bombay Hospital April 2013 I FUTURE MEDICINE 7


MEDICAL DIGEST

Over 61 million Indians suffering from diabetes NEW DELHI: The International

Diabetes Federation estimates that 61.3 million people aged 20 years and above in India had diabetes

in 2011, Union Health Minister Ghulab Nabi Azad said.

According to World Health Organisation (WHO), factors responsible for the increase in non-communicable diseases, including diabetes, are unhealthy diet, lack of physical activity, harmful use of alcohol, obesity

and tobacco use, the minister said in a written reply in the Lok Sabha.

The minister said the government launched a national programme for prevention of cancer, diabetes, cardiovascular diseases and stroke during the 11th five-year plan in 100 districts with the aim of prevention and control of noncommunicable diseases, including diabetes, through awareness generation, behaviour and lifestyle changes.

The programme also provides for screening of persons above 30 years for diabetes and hypertension in various healthcare facilities like district hospitals, community health centres and sub-centres and their referral to higher facilities for appropriate management of these diseases, the minister said.

HCG Awarded the Best Place to Work in Indian Health Care BENGALURU: HealthCare

Global Enterprises Ltd, The Specialist in Cancer Care, one of the best cancer care treatment centres in India, has been awarded the best place to work in Indian HealthCare. The award was

constituted by People Strong & HOSMAC. Dr B S Ajaikumar, Chairman, HCG Group, said, “as a healthcare provider that seeks to 8 FUTURE MEDICINE I April 2013

attract the finest talent, this award holds significant importance, as no other organization is people intensive. When the patient walks into the hospital, he believes that his life is in his our hands. However modern technology can be, it can never replace the human intervention in healthcare. HCG has always believed in inclusive growth.” HCG headquartered in Bangalore with over 26 cancer centers is Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision.

‘Incidence of Thalassaemia in India is very high’ NEW DELHI: In order to spread

awareness about Thalessaemia, a life threatening blood disorder, and to celebrate the Human Values Quarter, the Rotary Club of Amity Institute of Physiotherapy in association with Rotary Club of Delhi, North Centre, organised a day-long Thalessaemia screening camp on Amity campus, sector-125, Noida, where more than 130 students and faculty members were screened for Thalessaemia. Thalessaemia is a disease which can be transmitted to the next

generation if the parents are carriers of the disease and the children born to them may have to undergo very expensive and troublesome treatment to survive. On the occasion, Dr Harshita Shatma, Acting Head and Deputy Director, Amity Institute of Physiotherapy, stressed that the incidence of Thalassaemia in India is very high. Every year, 10, 000 Thalassaemia majors are born in India and the average incidence of Thalassaemia minors in India is 3.9 per cent, which implies that 1 in every 25 Indians is expected to be a Thalassaemia minor. She said that Thalassaemia minors are healthy and symptom free. Dr Tejender Singh, Head, Thalessaemia Committee, Rotary Blood Bank, Delhi, stressed that the birth of Thalassaemia major child in the family can be prevented by getting screened for Thalassaemia on time, which should be ideally done before marriage and certainly, before planning a child.


MEDICAL CONFERENCE

2nd International Fellowship on Health Technology Assessment CHENNAI: The 2nd International Fellowship

on Health Technology Assessment (HTA) organised by Healthcare Technology Innovation Centre, IIT-Madras, will be held in IIT Research Park from March 31 to April 6. Hospital and healthcare administrators, bio-medical and clinical engineers, quality and patient safety officers, post graduate students and researchers are expected to participate in the programme.

Indian Institute of Technology - Madras and other experts on the subject. Academy of Hospital Administration is an academic partner of this programme.

The programme is conducted by HTIC, IITMadras, in collaboration with WHO (Country Office for India), NHSRC (National Health System Resource Centre), Quality Council of India and Joanna Briggs Institute (University of Adelaide, Australia). Faculty includes national and international experts from University of Toronto, University of Liverpool, University of Adelaide, All India Institute of Medical Sciences, Public Health Foundation of India,

10th International Congress on Coronary Artery Disease ITALY: The 10th International Congress

on Coronary Artery Disease (ICCAD 2013) will be held in Florence, Italy, from October 13 to 16. A CME-accredited forum, ICCAD 2013 is aimed at researchers and clinical practitioners in cardiovascular disease. The participants will be provided with a platform to exchange ideas and new information with key opinion leaders and leading minds in the field. The 2013 Congress will provide a comprehensive update on all aspects of coronary disease – from prevention to intervention and from bench to bedside. It will also include focused discussions on the new challenges regarding structural heart disease and valve disease. The conference will be a platform

to learn about the latest data that has emerged from basic research laboratories and clinical centres around the world.

April 2013 I FUTURE MEDICINE 9


CHARITY Dr Azad Moopen

Dr Moopen’s Foundation extends its charity works to the Philippines MANILA/DUBAI: Dr Moopen’s Foundation, the not-for-profit arm of DM Healthcare, a leading healthcare conglomerate in the Middle East and India, has extended the reach of its charitable activities to the Philippines as part of its ‘Care Beyond Boundaries’. Under the label of ‘Healing Touch’, the organisation has undertaken free medical services to the needy with the launch of its ‘Save The Little Hearts’ programme in the

donor children and their guardians.

Commenting on the initiative, Moopen said: “This is a small step to begin with and the first of our activities planned towards enhancing health and wellbeing of the community at large.” “We thank the authorities in the Philippines whose support has made it possible. Pediatric cardiology is a critical area of medical care. We are

that can be treated in the Philippines will be carried out under complete supervision of the Foundation. Patients sent to India will be rendered comprehensive medical care at a hospital under the DM Healthcare network, including MIMS (Malabar Institute of Medical Sciences Ltd), tertiary care referral hospital in Kerala. Two patients were successfully treated for congenial heart defects (CHD) at Philippine General Hospital and a number of patients have been selected for cardiac surgery.

A leading organisation involved in many charity works in the GCC and India, it is part of DM Healthcare, a leading healthcare conglomerate with presence across the GCC and India.

Dr. Azad Moopen with dignitaries from Philippines at the launch of Healing Touch country. Through this initiative, Dr Moopen’s Foundation will provide free pediatric cardiac surgery to 50 patients in the Philippines.

The announcements were made by Dr Azad Moopen, Chairman of DM Healthcare and founder of Dr Moopen’s Foundation, at an event held at Makati Shangri-La Hotel in Manila. The event was attended by Enrique Ona, Secretary of Health, Philippines, Amit Dasgupta, Ambassador, Indian Embassy to Philippines, senior officials of the Philippine government, senior officials of DM Healthcare and the 10 FUTURE MEDICINE I April 2013

glad that through this initiative, we could be able to extend this care to those who need it. We plan to extend our not-for-profit activities here with a large gamut of services aiming to promote overall wellness in the Philippines,” Moopen added. As part of this initiative, the Foundation will work closely with some government hospitals in the Philippines to select young patients with heart diseases based on their critical need for treatment. The patients will be recommended for treatment at a hospital under the DM Healthcare network. Minor surgeries

Dr Moopen’s Foundation is a charitable and CSR division of DM Healthcare. The Group has been involved in various health awareness campaigns under ‘Healing Touch’ in the Gulf countries. Some of the ongoing and planned not-for-profit activities of the DM Foundation and Charities are the establishment of community dialysis centres, cancer radiation centres, early cancer detection centres, free pediatric and adult cardiac surgeries, establishment of special needs schools for the physically and mentally challenged across Kerala. The goals of the organisation include extending support to the North Indian states as well as to African countries, where there is acute requirement for intervention in the delivery of healthcare to the poor.


HAIR CARE

Dr Divya Ramkumar Dermatologist & cosmetologist

Dandruff no full stop to treatments Everybody is worried about dandruff and thinks about how to get rid of the menace

D

andruff is the shedding of dead skin cells from the scalp. Dandruff should not be confused with a simple dry scalp. It is a common scalp disorder affecting almost half of the population at the post-pubertal age and of any sex and ethnicity, and often causes itching.

As the epidermal layer continually replaces itself, cells are pushed outward where they eventually die and flake off. For most individuals, these flakes of skin are too small to be visible. However, certain conditions cause cell turnover to be unusually rapid, especially in the scalp. The result is that dead skin cells are shed in large clumps, which appear as flakes on the scalp. The condition can be called Seborrheic dermatitis when flaky white to yellowish scales form on oily areas such as the scalp, inside and behind the ear, back and chest and in some cases over eye lashes and nasolabial folds. Generalised erythroderma (almost whole body involvement) can occur in patients with immunodeficiency or with certain neurological conditions. Dry, thick, well-defined lesions consisting of large, silvery scales may be referred 12 FUTURE MEDICINE I April 2013

to as scalp psoriasis. A condition existing in between may be termed as sebopsoriasis. The disorder occurs as a result of sebum or sebaceous secretions, the metabolic byproducts of skin micro-organisms (most specifically Malassezia yeasts) and individual susceptibility.

Older literature cites the fungus Malassezia furfur (previously known as Pityrosporum ovale) as the cause of dandruff. While this species does occur naturally on the skin surface of both healthy people and those with dandruff, in 2007 it was discovered that the responsible agent is a scalp specific fungus, Malassezia globosa, that metabolises triglycerides present in sebum by the expression of lipase, resulting in a lipid byproduct oleic acid (OA). During dandruff, the levels of Malassezia increase by 1.5 to 2 times its normal level. Penetration by OA of the top layer of the epidermis, the stratum corneum, results in an inflammatory response in susceptible persons which disturbs homeostasis and results in erratic cleavage of stratum corneum cells. There is some evidence that excessive perspiration, climate, stress, obesity and immune status have significant roles in the

pathogenesis of dandruff. Severe dandruff is a distressing condition especially for adolescents and it leads to an exacerbation of acne and can also lead to increased hair fall. Treatment You can treat flaking and dryness with over-the-counter dandruff or medicated shampoos. Shampoo the hair vigorously and regularly (preferably twice a week to start with and then continue once a week). Loosen scales with the fingers, scrub for at least five minutes, and rinse thoroughly. Shampoos use a combination of ingredients such as salicylic acid and sulphur to loosen the attachments between the corneocytes and allow them to get swiped off. Shampoos or lotions containing selenium sulphide, zinc pyrithrone, ketoconazole, ciclopirox or corticosteroids may be prescribed for severe cases. Lesions on face or chest are treated with topical antifungals and steroids. Recently, creams classified as topical immune modulators are being used. Severe unresponsive cases are treated with oral antifungals.

Household remedies and practices in traditional medicine that have been practised over the centuries are application of vinegar, egg, oil, neem etc. Black pepper contains the dandruff fighting minerals zinc and selenium and in Ayurveda, powdered black pepper has been used to treat dandruff. Application of an emulsion prepared with the oil of sandalwood and lemon juice has been proven effective to cure dandruff. Its main component beta-santalol has antimicrobial properties.


FACIAL SURGERY

Facial aesthetic surgery

Of looking new,

feeling good Facial aesthetic surgery has solutions to help you look better and feel more confident. Whether you have concerns related to aging or you have features that you feel are out of balance, modern medicine and surgery can help you obtain beautiful, natural and gratifying results

Dr Ravi R Hebballi

T

Consultant Oral & Maxillofacial Surgeon

he face is a reflection of your personality. Facial expressions allow us to interact and communicate with each other. Our appearance also has an impact on how others perceive us. Unfortunately, face is one of the first areas to show signs of aging owing to the more delicate nature of the facial skin, along with constant exposure to the Sun and repeated facial expressions.

Facial aesthetic surgery has solutions to help you look better and feel more confident. Whether you have concerns related to aging, or you have features that you feel are out of balance, modern-day medicine and surgery can help you obtain beautiful, natural and gratifying results. Corrections of the face may be desired by some people to improve certain aspects about their face or by others who are born with facial abnormalities, or birth defects. Signs of aging owing to various reasons or people with facial trauma on the face seek aesthetic (cosmetic) correction, which can be done through procedures performed by a facial aesthetic surgeon. In recent years, however, a growing number of men and women of all ages are choosing facial aesthetic surgery to improve their appearance and reduce the signs of aging. Types of facial surgeries There are many types of facial cosmetic surgeries a person can undergo. Some of the available facial procedures are eyelid lifts, cheek reductions, chin reductions, and nose surgeries. A person may also opt for a facelift, cheek implant, jaw implant, or ear surgery.


Among the most commonly performed procedures are facelifts, eyelid surgeries, brow lifts, and nose surgeries. Facelift is the first procedure people think of when they hear about facial cosmetic surgery. This procedure, which is also called rhytidectomy, is used to tighten the facial muscles and remove extra fat from the face to give the person a more youthful appearance. Not only does it make a person look younger but it also tightens sagging skin and corrects double-chin.

Blepharoplasty, or eyelid surgery, is used to improve droopy eyelids. Drooping eyelids can dramatically affect the appearance of a person’s face by making him/her look years older and worn out. They may even affect a person’s vision. A cosmetic surgeon may perform either upper or lower eyelid surgery, removing extra fat, skin and even muscle tissue with the intention of making the person look younger and see better.

A brow lift procedure, also known as forehead lift, is fast gaining popularity in the cosmetic field and is used to lessen forehead wrinkles as well as deep lines that develop on the higher part of the nose. This procedure corrects frowning and the sagging forehead skin and droopy eyebrows.

Nose surgery (nose jobs), also called rhinoplasty, is another commonly performed facial aesthetic surgery to improve the appearance of the nose, altering its size, shape, making it less pointed, or narrower, or correction of ‘humped’ nose. Surgery may also be done to reshape a person’s nostrils. However, nose surgery is also done to correct problems with the structure of the nose that lead to breathing difficulties. To remove the excess fat under the chin – commonly known as ‘doublechin’ – or in the neck, liposuction is done. Facial implants with inert and safe materials are used to make certain areas of the face more prominent – like the cheek, lips and chin.

Skin treatments Several techniques are available for treating skin that is wrinkled, scarred or damaged. Results and improvement

varies and depends on the condition of the patient’s skin prior to treatment and also on the procedure performed. Botulinum Toxin - A (Commonly referred to as Botox) injections can reduce the signs of aging. Muscle activity and wrinkles of the eyebrow and forehead are reduced by this injection, thus effectively reducing frown lines.

Chemical peel involves the application of a solution that causes the wrinkled or damaged top layers of skin to peel, revealing new, healthier skin after healing. There are several types of chemical peels: a light peel to remove superficial wrinkles, a medium-depth peel, and a deep-peel for more severe conditions. Dermabrasion smoothes surface irregularities to produce a more uniform appearance of the skin.

Laser is much sought-after to treat skin issues. The outer layers of the damaged or wrinkled skin are removed with lasers, and the new skin appears healthier and smoother, giving a rejuvenated youthful appearance. The surgeon can also use laser devices to correct sagging skin in the neck region and to tighten the muscles within the neck. Injectable fillers are synthetic or naturally occurring materials that are placed with small needles to plump wrinkles, furrows or grooves in the skin. These results are instantaneous though the longevity varies with the material chosen.

Pre-surgical procedures While opting for a facial aesthetic surgery, your surgeon should first discuss the procedure, risks, benefits, alternatives, and recovery with you. Knowing what to expect will put you more at ease. You should also know what pre-surgical preparations you need to make, how long the procedure will take, and any associated risks. Some common complications might include numbness, bleeding, infection, delayed or improper healing and adverse reactions to the anesthesia. A thorough clarity and understanding of all associated costs and available payment options is necessary before undergoing any procedure.

Most aesthetic procedures will not require a long hospital stay. Depending

on the extent of your surgery, some procedures can be performed on an outpatient (day care) basis. This means that you might not require a hospital stay. Some procedures may require a short hospital stay. It is imperative to follow your surgeon’s advice about post-surgical medication, diet and any restrictions for uneventful and safe recovery to avoid complications. Not a new face Facial cosmetic surgery does not give a person a new face or a new life. Such a surgery may only refine or enhance existing features. Many factors such as age, general health, skin texture, underlying bone structure, individual healing capacity and personal habits such as smoking or alcohol consumption may affect the post-surgical outcome. A more youthful and pleasing appearance may be achieved through aesthetic surgery which will improve the self-esteem and confidence of the person. It is very important to review with your surgeon the risks and complications that are associated with the procedure before making a final decision to go ahead with facial aesthetic procedures.

Dr Ravi R Hebballi is a Consultant Oral & Maxillofacial Surgeon based in Bengaluru, Karnataka

April 2013 I FUTURE MEDICINE 15


CLINICAL RESEARCH

Clinical research in India comes of age Clinical research in India has come of age and with introduction of new and cost-effective drugs, the clinical research industry can assist in achieving the goal of ‘health for all’

C

linical research has played a vital role in India in the introduction of new drugs and improving health statistics. Today, India is at par with the rest of the world as advancements in this industry have drastically reduced brain drain, therefore, retaining the best of the doctors providing worldclass treatment to the Indian patients.

The decline in clinical trials in the US has led to an increase in trials across emerging countries, making the industry progressively competitive. The Indian clinical research industry witnessed a slowdown in 2011 due to decline in revenue and the decreasing number of clinical trial approvals further compounded the situation. On the positive side, these challenges geared the industry into action and acted as a channel for the industry, regulatory bodies and other key stakeholders to synergise as well as discuss issues important to the industry.

There is huge potential for the clinical research industry in India, which offers attractive opportunities for contract research organisations. The clinical trials industry in India was estimated at $485 million in 2010 by Frost & Sullivan and is anticipated to grow at 17 per cent CAGR from 2009-15, remaining the largest clinical trial market in Asia after Japan. The growth is accelerated not only by the global majors but also the domestic companies that have seen a rapid growth over the past three years. 16 FUTURE MEDICINE I April 2013

India has a varied genetic pool and a significant number of Indians suffer from acute chronic diseases. This can be win-win situation: for patients who don’t get or can’t afford good treatment and pharma companies who need patients to conduct clinical trials to develop new medicines. The cost of a phase I trial is estimated to be 50 per cent cheaper in India, while that of phase II is 60 per cent less in terms of direct cost and estimated time savings. The vast healthcare system makes it easier for international clinical research organisations to conduct studies in the country.

Moreover, India has about 600,000 doctors, 45,000 hospitals and around 900,000 beds in both private and public hospitals, with most having electronic medical record facilities. All this makes it easier for international clinical research organisations to conduct studies in the country. The Indian clinical research industry

Dr Apurva Shah Chairman, ACRO

grew to about Rs 8,000 crore in 2010-2011. According to ASSOCHAM, it is expected to employ 50,000 professionals in the next five years. Indian companies are expected to conduct over 15 per cent of global trials, which can increase the employment opportunities for life science and medical graduates four-fold. But the industry faces a few challenges for these targets to be met. There have been inadequacies in the clinical trials publication practices wherein trials with only positive results are published while the failures or ineffectiveness of drugs are not publicised.

The Clinical Trials Registry of India was launched in 2007 to address this gap. It aims to make the process transparent by encouraging the registration of all clinical trials before the enrolment of the first volunteer. This will help the industry observe the prescribed stringent norms, protocols, and practices. The regulators have started making a lot of good changes for better control. Some of them being: compulsory registration of all clinical trials before any dosing starts. This will help in stopping illegal trials. Moreover, the Ethics committees also need to be formed in the right manner and need to be registered with the CDSCO for better governance. Given the importance of clinical research in modern medicine, India would do well to streamline its regulatory norms and align these with global standards so that it can emerge as the global hub for clinical research.


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COVER STORY

Genomic medicine

It’s your DNA

after all DNA sequencing and genome research is the future of medicine as it can rectify health issues at the individual level by using a patient’s genetic information. However, like any other scientific inventions, genomic medicine also has a negative side, mainly handling of personal genetic information

O

ne of the headline making international acquisition stories in 2012 was that of a Chinese DNA sequencing firm (BGI-Shenzhen) taking over an American DNA sequencing firm (Complete Genomics).Worry not! This is not a business story about acquisition. This deal could provide us a delicious menu for thought. At present, the Chinese are more like yesteryear Jews. They are very careful with their investments and have placed their hands on everything that sounds very much promising and futuristic, be it renewable energy, biotechnology or cloud computing. And this deal easily translates the Chinese confidence in the future of DNA sequencing and genome research. Experts in the area concur with the Chinese decision. Almost all speak without any ambiguity or diffidence, “Yes, the future lies in genome.” Efforts are on, especially in the developed world, to enhance their healthcare by integrating genomic medicine into the mainstream medical

18 FUTURE MEDICINE I April 2013

practice. On finding success, this effect can easily trickle down to the healthcare scenario of the developing countries. What is this phenomenon of genomic medicine and what could be its possible implications on medicine? Genomic medicine is the most intense method ever invented in the medical history to rectify health issues at the individual level by using a patient’s genetic information. After identifying the genetic factors associated with the disease, experts say, it will be much easier to prescribe more effective treatments. It also helps in identifying and monitoring individuals who are at high risk of a particular disease or a few diseases. Doctors can also avoid adverse drug reactions if the genetic information is known prior to the treatment. For instance, an individual, X, gets his genome sequenced to check in order to analyse whether he is predisposed to heart diseases. Suppose the analysis finds that X has three alleles predisposing him to an increased risk of

By Sreekanth Ravindran

heart disease at a young age. An allele is an alternative form of a gene (One member of a pair) that is located at a specific position on a specific chromosome. He can be put on a drug called Relaxin, a drug designed to reduce the risk of a heart attack in people who have similar genetic profiles. This directly increases his longevity. Today, the buzzword in the area of oncology is Cancer Genomics Research (CGR). A growing area of research, CGR


compares genes found in tumours and genes found in healthy tissues in order to make out how the genes differ from each other. For this, researchers collect samples from all kinds of tumours to find out a tumour’s genetic “fingerprint” and then compare it to the fingerprints of healthy tissues from the same person. Different genes are involved in various tumours, and understanding what genes are important to the development of cancer could directly lead to improvements in detecting, diagnosing, and treating cancer.

Development in DNA sequencing technologies has also positively contributed towards genome research. American innovator Dr Jonathan Rothberg’s Ion Personal Genome Machine (PGM) is an important step in this progress. The machine, which is only 24

inches wide, 20-inch deep and 21-inch high, can read about 10 million letters of genetic code in two hours, that too with high degree of accuracy. The Ion PGM is now the fastest-selling sequencer in the world. In July, 2012, Ion Torrent (Dr Rothberg’s company) had entered the Genomic X PRIZE competition with a new sequencer, Ion Proton, that is designed to sequence human genome in a day for less than $1,000. In an exclusive interview with Future Medicine for its October edition cover story, he had said: “For the same reasons that desktop computer eventually replaced minicomputers and mainframes, semiconductor

sequencing is an ideal solution for any biomedical researchbased application; the combination of affordability, simplicity, scalability and performance brings an unparalleled advantage compared to other market alternatives. Due to the scalability inherent in semiconductor devices, my technology is breaking the $1,000 genome barrier and further fuelling the uptake of sequencing in healthcare, agriculture, and the direct-to-consumer markets.” Another area of rapid development is Pharmacogenomics. This discipline, which combines pharmacology and genomic studies,

April 2013 I FUTURE MEDICINE 19


COVER STORY

Genomic medicine

Another area of rapid development is Pharmacogenomics. This discipline, which combines pharmacology and genomics studies, shows how genes affect a person’s response to drugs

shows how genes affect a person’s response to drugs. This is an important milestone in attaining the objective of personalised medicine. In future, genomic researchers will be able to develop safe, effective and required doses of medicine according to an individual’s genetic makeup.

However, these developments are not free from concerns. Handling personal genetic information should be strictly regulated and failing to do so can invite dire consequences. There are also social and ethical issues involved. Will insurance companies start demanding genetic information before insuring a customer? Should all patients be forced to undergo genetic test? What if pharma companies decline to manufacture drugs that are only required for a small segment of the population? These issues demand debates involving policy-makers, researchers and social representatives. Like two sides of a coin, every development also has its own negative impact on the mankind. Consensus is the future forward. Although the West and a few Asian countries, including China, have made great strides in the field of genomics, India remains far behind in this area. Though there are

20 FUTURE MEDICINE I April 2013

standalone researches by Centre for Molecular Biology in Hyderabad and SciGenom, an initiative of Sam Santhosh based in Kochi, significant advances in this area will only occur if our policy-makers effectively promote this research. Sam was a successful Information Technology entrepreneur. He had quit the lucrative IT business to kickstart his genome company. To quote Malcom X, late American civil rights activist, “The future belongs to those who prepare for it today.”


COVER STORY Somasekar Seshagiri

‘DNA sequencing is a technique used to determine bases’ Somasekar Seshagiri is the principal scientist, Molecular Biology, at Genentech Inc, one of the largest biotech companies in the world. In an email communication with Future Medicine, he spoke about genome research and its current status. He says that 97-98 per cent of our genomes are identical and it is the minor difference between our genomes that make each one of us unique Bureau

What was the purpose of the human genome project? How long did it take to complete and what is its current status? The goal of the human genome project was to decode the three billion bases that constitute our genome. The task of sequencing the genome took about 10 years, with much of the actual decoding work happening in the last few years of the project. The sequencing work and the draft human genome were announced in 2001 and the complete reference human genome was published in 2003.

What is DNA sequencing? The alphabets of the DNA word are chemicals called bases. Four types of bases, A, C, G and T exists in the DNA world. DNA sequencing is a technique used to determine bases and the order in which they occur in a given DNA molecule. The sequencing technique was developed by Frederick Sanger and colleagues in 1977. Using Sanger sequencing, the three billion bases that make up the DNA in the human genome were determined. How has the sequencing technology evolved since the human genome project? April 2013 I FUTURE MEDICINE 21


COVER STORY Somasekar Seshagiri

For close to 30 years, Sanger sequencing remained the major technique for decoding DNA. Starting in 2005, new sequencing technologies termed next generation sequencing (NGS) have significantly reduced the cost of sequencing while increasing the throughput. With the application of NGS, it is possible to sequence a human genome in less than two weeks at a cost of $5,000.

us to identify defective disease causing genes (Segment of DNA that code for proteins) in a number of inherited human diseases. These technologies have now been applied to study cancer genomes which fundamentally are mutated normal genomes that result in cells growing uncontrollably. Understanding the lesions in cancer genomes has aided in developing targeted therapeutics. The

What is the impact of the next generation sequencing on medical research and drug development? Compared to 10 years it took to sequence the first human genome, the dramatic speed and cost reduction achieved by NGS technologies have revolutionised the area of genomics. Though 97-98 per cent of our genomes identical, the small differences between our genomes are what that make each one of us unique. Using NGS individual genomes today are routinely sequenced to identify variations that predispose one to diseases. The NSG technologies have allowed

NGS machines are now making their way to the clinic and are poised to revolutionise the practice of medicine. In the future, even before a new-born baby comes home from the hospital, his or her DNA sequence will be decoded and be available for doctors to provide a personalised therapy based on the variations. In short, we are in the midst of a genomic revolution with genetics/genomicsbased medicine impacting agriculture, animal sciences and other areas of biology. What are the territories in terms of genome research and sequencing that remain uncharted?

22 FUTURE MEDICINE I April 2013


We are in the midst of a genomics revolution that apart from enabling genetics/genomics based medicine is impacting agriculture, animal sciences and other areas of biology Though we have obtained the complete sequence of (code for) the human genome, we only understand a small part of this code. Our understanding of the non-coding part is modest and we are just beginning to scratch the surface using the next generation sequencing technologies. While the

next generation sequencing has brought the cost of sequencing down and increased throughput, the time it takes to generate data, the length of the sequences produced and the bioinformatics analysis are the areas yet to improve. In particular, the bioinformatics is an area where rapid analysis will be critical in clinical setting. Do you agree with the observation that “there is no privileged level of causation: an organism is not defined by its genome”? In decoding, we are trying to understand the code that has evolved over billions of years. There is no doubt that this code is fundamental to the development of the organism. The output of the genetic code can be viewed as a ‘parts list’ and how these parts interact and also influence generation of parts is an important aspect that is explored by systems biology approaches. Synthetic biology expert George Church of Harvard University believes that DNA will become the building material of the future by helping create virus-resistant human beings. He says lost species like the Neanderthal can be brought back to life. What’s the basis of this positivism?

I think synthetic biology work from Craig Venter has shown we can synthetically make genomes of bacteria and they function at least in part as expected when placed in a cellular environment. However, trying to generate complex multi-cellular organisms is not trivial. The complete sequence of the Neanderthal genome is far from perfect. Even if we have an ideal genome, the manipulations needed to generate an egg cell that contains the Neanderthal genome are quite challenging, given the current state of technology. Similarly, manipulating a human egg cell to generate virus resistance will be fraught with side-effects. So, while some of these ideas Dr Church and others have put forward seem simple, the state of

technology is far from perfect to achieve them. Even if the technology is mature, the ethical and social issues surrounding them will be vigorously debated by the community. I do not see any of these happening in the near future. There is a debate in the West over the availability of genetic information of people in the public domain. Some fear that this may lead to prejudices or discrimination. How genuine are such concerns? Are these issues relevant to India? This is a real and valid concern. In the West, healthcare insurance companies play an important role in the healthcare system. If the insurance companies use the genetic information of an individual to decide if they want to insure him or her, more often they are likely not to insure people who may have variations in their genome that might predispose them to disease. Similarly, employers using such information may discriminate April 2013 I FUTURE MEDICINE 23


Somasekar Seshagiri

COVER STORY against individuals in hiring. Though this is not an immediate concern in India, in the future this will be a concern here too. Also, in India, given the social and cast structures, discrimination based on genetic information could have far

to be debated and appropriate laws to protect individuals against discrimination ought to be put in place. Do you think the movie Gattaca is merely a cinematic expression? Or does it offer any real lessons?

China has built one of the largest genome centres where they have over 150 state of the art sequencing machines. They sequence anything and everything more discriminatory effects if information about genetic variations liked to disease susceptibility, intellect, longevity etc, is misused. In any responsible society, these issues need 24 FUTURE MEDICINE I April 2013

It speaks about genetic discrimination that can happen if as a society we do not discourage the misuse of genetic information through education and legislation.


COVER STORY Sam Santhosh

‘Genome man’

of India Sam Santhosh is the Chief Executive Officer of SciGenom, a genome company based in Kochi, which specialises in DNA sequencing. In an exclusive interview with Future Medicine, he says that genomics will fuel the next revolution in medicine By Sreekanth Ravindran What inspired you to start SciGenom? The completion of the first draft of the human genome by the International Human Genome Project in 2001 originally attracted me to this field. With my background in software engineering, I was intrigued by the opportunity produced through understanding and leveraging the genomic source code which is the language of life for all living beings. However, I had no connection with biology after high school and so it took a few years of reading and evening classes to get a thorough grasp of the subject. During this period, the DNA sequencing technology went through a revolution by exponentially reducing sequencing cost while increasing processing speed. For example, sequencing the first human genome took 10 years and cost about $3 billion while today one can sequence a human genome in two weeks for $5,000.

With the advent of these new technologies called Next Generation Sequencing (NGS), I saw the opportunity of creating a company for genome sequencing and data analysis. Genomics can create dramatic changes in healthcare, agriculture, environmental protection, bio-fuel, and so on. Understanding the ‘language of life’ now is a momentous turning point just as the development of language

itself becuase communication was a major turning point in the history of our species about 30 to 40 thousand years ago. By deciphering the genome, humanity will be able to move to the next level of evolution. This belief gave me the inspiration to start SciGenom– the name meaning ‘Science of the Genome’. Though I have been living in the US for the last 20 years, I felt that with the changing global economic climate, I should start my new company in India and since I am from Kerala, I chose Kochi as the starting location. How progressive and developed is the Indian genome industry and what are the advantages and shortcomings in comparison with the West? The Indian genome industry is still in its infancy and has yet to fully develop. At the same time, we have many advantages compared to the West, including lower manpower cost, strength in information technology and a growing economy which makes us unique. The disadvantages are lack of scientific leadership and research expertise, and unpredictable regulations by populist politics. The first can be overcome by attracting Indian NRI scientists back to India and by collaborating with other research institutions in different parts of the world. The second requires time and improvements in education

throughout India. What are the ethical issues preventing genome research companies from going the whole hog? A critical issue is patient confidentiality and ensuring the individual understands what their genetic results mean. Another dilemma is ownership of genomic data. With advances in genetic testing for disease prediction, a major question is what becomes the information and who determines its use. Tell us about your tie-ups with international companies, agencies and government bodies, and your areas of research. Are you faced with any policy bottlenecks? We have research collaborations with Dr Schuster’s lab in Penn State College, Pennsylvania, and with the University of Toronto in Canada. Our areas of research are in molecular diagnostics, cancer treatment and metagenomics. In molecular diagnostics, our goal is to reduce the cost of genetic tests and make it affordable to all people. In cancer, we are looking at familial cancer and some forms of cancer that are more prevalent in India and hence have not attracted much attention in the West. In metagenomics, we are exploring the microbial communities in several water sources and soil samples to better understand the effect of bacteria April 2013 I FUTURE MEDICINE 25


COVER STORY

and other microbes on human health and society.

Policy bottlenecks have not significantly affected our operations till date. However, some outdated rules like the restriction on sending human samples abroad as well as lack of regulations in medical diagnostics create confusion in the field. Were any Indian companies or individuals part of the international human genome project? How much of the research findings have made it to the mainstream medical practices so far and how far is India in making these solutions available to the common man? India was not part of the original human genome sequencing project. However, CSIR sponsored Human Variome Project starting in 2003 mapped variations in 1,000 medically important genes across various groups in India. Currently, India is part of the International Cancer Genome project where scientists from across the world are using sequencing technologies to understand cancer. Research findings from the

26 FUTURE MEDICINE I April 2013

Sam Santhosh

human genome project and the cancer genome projects are starting to make personalised medicine a reality. However, given that such applications are in its infancy, it will be sometime before all the information is fully applied in mainstream practice of medicine. For those interested further on this topic, I would urge them to read “The creative destruction of medicine” by Dr Eric Topol. Is India lagging behind in streamlining genomic education and research? Do you have any suggestions? India is definitely lagging behind in genomic education and research. In this regard, I have a few suggestions to make. When it comes to research, we need to follow the US model which has proved to be successful. The Indian government has already done well in the area of funding by providing grants and creating public-private partnership schemes. What we need to do is attract not only NRI scientists to come back but also foreign scientists to set up labs in India and provide them sustained support with grants covering longer periods.

In education, we need to develop our own model. With the world’s largest youth population, poor infrastructure, lack of qualified teachers, etc, we have significant challenges. One way to solve this gap is by leapfrogging over older models as we did with computers and telecommunications. We need long distance learning, leveraging the internet and modifying the education system so that what the student learns matches the industry requirements. Further, greater emphasis needs to be given to science – I would even recommend having a science track in MBA programmes like they have for Finance, Marketing, HR, IT etc. This will generate more business managers with proper understanding in science who can lead our country into the next decade. What are your future plans? SciGenom will continue to build its current offerings in DNA sequencing, bioinformatics and medical diagnostics. Later this year, we plan to spin off our medical diagnostics division (MedGenome)


as a separate company with a CLIA certified central lab in Chennai and satellite labs in all major cities throughout India. We plan to raise about $5million for this expansion. Do you think India can emerge a leader in the area of genomics with its scientific manpower edge over others? How can we arrest brain drain and make brain gain in this field? It will be difficult for India to take leadership in this field, but we can become a strong player if we play our cards well. At present, we don’t have an edge in scientific manpower– we lack expertise and leadership. However, brain drain in the short term still works well for us, as we lack the facilities to teach them all, our youngsters can go out and learn in the best labs across the globe. What we need to do is to attract them back, along with already-trained NRI scientists, with opportunities in India. We also have to have a realistic understanding of where we stand today. India, at present, has less than 5,000 qualified biology scientists in the whole country. The US, on the other hand, has that number in one of their larger universities and they have hundreds of such universities. Their spending on research is also astronomical compared to what we can afford. So we need to be clever in developing a strategy. It will be good for India to understand how smaller countries like South Korea and Singapore are contributing by focusing on a specific area critical to their national interest. For example, Singapore faces a shortage of fresh water – about 70 per cent of it comes from Malaysia. Singapore

has made it their goal to become self sufficient within the next five years. They aim to do this by achieving 100 per cent reuse of waste water, by using genomic technologies in waste water treatment. Arguably, they can achieve world leadership in that field. India can learn much from these approaches. Do you think Indian hospital and healthcare chains are at par with their Western counterparts in the field of genomics? Is there a difference between the Indian and Western approaches towards this emerging science? Applying genomics to healthcare is new everywhere in the world. However, the West is adopting it much faster than us but they also have their own challenges due to the more complex healthcare systems and role played by insurance companies. The problem with our approach is that we lack a clear plan. We have to make a cohesive approach taking into account our genetic heritage, diversity and challenges. Is the common man in India aware of the real benefits of genomics? Do you think there should be awareness campaigns to generate more interest in this subject? Even in the West, the common man has yet to become aware of the full benefits of genomics. In India, we definitely need to have awareness campaigns and other schemes for all sections of society to understand and take advantage of this knowledge. For example, farmers can breed better varieties of crops if they understand the genes that affect many of the traits that they are looking for.

April 2013 I FUTURE MEDICINE 27


SPINE CARE

Dr Ram Kumar Menon Consultant neurosurgeon

Steps to lessen

spinal injuries T he spinal cord runs down the back of head and neck and is protected by the vertebrae. Spinal injuries are always serious and must be treated with great care. It may lead to paraplegia or quadriplegia and taking simple safety precautions can greatly lessen the chances of suffering serious injury. About 50 per cent of these injuries are caused by road traffic accidents, with the remaining occurring in the sporting, occupational and domestic environments. In many cases, these injuries could have been prevented.

Some of the simple precautions to be taken are wearing the seat belt during driving, wearing protective helmet while riding twowheelers and in sports. Wear protective gear at work site. Check the water depth before diving into a swimming pool, lake or river.

Spine injuries may or may not be associated with head injuries. 28 FUTURE MEDICINE I April 2013

Spinal injuries may turn fatal unless they are treated with great care and of course, precautions can prevent severe injuries to spinal cord to a great extent

In suspected head injuries, place patient in a comfortable position with head and shoulders slightly raised. Support patient’s head and neck during movement; avoid twisting movement. If blood or fluid comes from ear, cover it with a dressing. Control bleeding but don’t apply direct pressure to the skull. Causes of spinal injuries include fall from a height, high speed accidents, direct blow to the spine, hit from above by falling objects, diving or surfing accident and penetrating injuries such as a gunshot or knife wound. If a patient is conscious, signs and symptoms of spinal injury may include: • • • •

Pain at or below the site of the injury. Tenderness over the injury site. Absent or altered sensation (e.g. tingling in hands or feet) Loss of movement or impaired movement below the site of the injury.


Take extreme care at all times to maintain alignment of neck and spine Spine board for transporting the patient

Head immobiliser for keeping the head stable and avoid movement while transporting. It is strapped to the patients head and to the spine board as well.

In an unconscious patient with suspected spinal injury • Follow Basic Life support (DRSABCD) • Place unconscious patient in

In a conscious patient with suspected spinal injury • Calm the patient. • Loosen tight clothing. • Do not move patient unless in

An adjustable cervical collar to accommodate necks of different sizes to splint the neck of cervical spine injury patients. helmet should only be removed if absolutely necessary – if you are unable to manage a patient’s airway or if resuscitation is required. Removal of helmets should be performed by two people: • Place the patient on their side, supporting head and neck to avoid any twisting during movement. • Unfasten the chin strap, grasp each strap at the root of the helmet and pull in opposite directions to open up the neck (rim) of the helmet. • While holding the helmet in the pulled open position, gently tilt the helmet back to pass over the chin. • Gently tilt the helmet forward to pass over the back of the head. • Continue to tilt the helmet backwards and forwards until it is off the patient’s head. • Be careful not to catch the helmet on the patient’s ears or nose. • Place the helmet next to the patient so that it can be given to the ambulance personnel. Do not remove the person from the water if he or she has been in a diving accident. Float the person face up in the water until help arrives.

Call other emergency services to transport the injured person if you think he or she may have a spinal injury. This will reduce the risk of aggravating injury to the spinal cord.

• • •

recovery position supporting neck and spine at all times. Maintain a clear and open airway. Hold head and spine steady with supports to prevent twisting or bending movement. Call ambulance.

• •

danger. Support head and neck. Call ambulance.

Take extreme care at all times to maintain alignment of neck and spine. In managing a patient who is wearing a motorcycle helmet, the

(Dr Ram Kumar Menon, MS, DNB, MCh, has settled down in Thrissur, Kerala, where he works with Elite Mission Hospital and Care Well Clinical Centre as a consultant neurosurgeon) April 2013 I FUTURE MEDICINE 29


CSR INITIATIVES BMSF Pharma

BMSF committed to

healthcare cause

Corporate major Bristol-Myers Squibb India has been involved in mitigating healthcare problems at the grassroots level for quite some time now. Its corporate social responsibility wing, Bristol-Myers Squibb Foundation (BMSF), is engaged in improvement of community healthcare models through active people participation and integration of disease management services with local support structures. In an Interview with Future Medicine, Kanchana TK, Director of Corporate and Public Affairs & Philanthropy of Bristol-Myers Squibb India, talks more about the initiatives of the Foundation Bureau What are your key philanthropic initiatives? Our commitment to corporate social responsibility has remained consistently strong since the Bristol-Myers Squibb Foundation (BMSF) was established in 1955. Since then, our company has invested in a broad range of programmes that reflect our values and serve the needs of society. The mission of the

Bristol-Myers Squibb Foundation is to promote health equity and improve the health outcomes of people disproportionately affected by serious diseases and conditions, by strengthening community-based healthcare worker capacity, integrating medical care and community-based supportive services, and mobilising communities in the fight against diseases. The Foundation engages

30 FUTURE MEDICINE I April 2013

partners to develop, execute, evaluate and promote innovative programmes to improve the health outcomes of people disproportionately affected by type 2 diabetes in the US, China and India; HIV/AIDS in Africa; cancer in Central and Eastern Europe; hepatitis B and C in Asia; and serious mental illness in the US. You have received national and international recognitions for CSR/

philanthropic activities. Bristol-Myers Squibb was ranked No. 1 on Corporate Responsibility magazine’s 2012 list of the “100 Best Corporate Citizens,” a benchmark for socially responsible investors and other stakeholders. Bristol-Myers Squibb was ranked among the top 10 in the last four years and No.1 in 2009. Bristol-Myers Squibb is the only company to achieve the No. 1 ranking twice. Delivering Hope

programmes was recognised by CMO Asia with an Asia’s Best CSR Practices Award in the category of Concern for Health in July 2012. What’s your company’s social outreach in India? The Bristol Myers Squibb Foundation partners with NGOs and health organisations in India on projects to improve the health outcomes of people disproportionately affected by Type 2 diabetes and Hepatitis B and C. Delivering Hope TM, an umbrella programme for the Bristol-Myers Squibb Foundation’s efforts in the areas of Hepatitis B and C awareness, prevention and care, has in the past five years expanded its efforts considerably across India, providing more than Rs 20 crore to support 18 grants in many states of the country. The works of the Delivering Hope grant recipients have greatly impacted their communities. As part of ‘Together on Diabetes’, the BMSF has announced grants to six institutions in India that will help improve diabetes education, prevention and care


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CSR INITIATIVES BMSF Pharma

becoming aware of Hepatitis B and how to prevent the infection.

and increase healthcare worker capacity in rural and tribal areas, and among the urban poor. The BMSF India grants will test new ideas about how diabetes control efforts can be best designed and implemented to help individuals in a variety of settings. How do you ensure active participation of the community in your development and empowerment programmes? BMSF has developed a unique philanthropic model supported by three pillars that ensure active participation of the community. This includes serving local needs where BMS has strong expertise, building sustainable models by helping to build capacity for local BMSF partners, and by using an integrated and comprehensive approach in the prevention and control of disease. The Foundation also convenes Centres of Excellence conferences that provide a platform for all Foundation partners in India to share insights and best practices that can be implemented in local communities. What are your major patient assistance programmes in rural India? In the past five years, the Bristol-Myers Squibb Foundation has expanded its efforts considerably across India. The works of the Foundation’s Delivering Hope grant recipients have greatly impacted their communities.

The Health-Oriented Programmes and Education (HOPE) initiative in partnership with BMSF has conducted an awareness, screening and education programmes across 10 districts in Uttar Pradesh. The Hepatitis Foundation of Tripura (HFT), with funding from BMSF, has initiated projects to support institutional strengthening and systemic community outreach and education activities. This resulted in at least 70 per cent of the adult population in Tripura 32 FUTURE MEDICINE I April 2013

The Liver Foundation, West Bengal, with financial support from the BristolMyers Squibb Foundation, carried out training programmes with the broader objectives of educating rural healthcare practitioners (RHCPs), improving their knowledge, attitude and practices with regard to the services they provide, and more importantly involving them in various community-level public health programmes. Mamta Health Institute for Mother and Child, an organisation based in New Delhi and with operations in 14 states, will receive a grant over three years to pilot a study to determine the feasibility of involving India’s lay community health workers (Accredited Social Health Activists) and integrating various systems of medicine, including modern and AYUSH, to prevent and control non-communicable diseases, such as Type 2 diabetes. The All India Institute of Diabetes and Research in Naranpura and Swasthya Diabetes Hospital in Ahmedabad will receive a grant over two years to develop and test a three-setting model to improve access to diabetes education, prevention and care for the poor in rural, tribal and urban settings.

The Sanjivani Health and Relief Committee in Ahmedabad will receive a grant over four years to conduct a household-by-household study in 348 villages to identify Type 2 diabetes and ensure early diagnosis of undetected diabetes among those with pre-diabetes or at high risk of developing diabetes. How many lives have you impacted? More than 26 million individuals living in areas disproportionately impacted by hepatitis across Asia have benefitted from the BMSF’s Delivering Hope-related education and awareness programmes which include training of more than 163,000 health workers and vaccinations of nearly 600,000 people.


Disease Special

BE AWARE OF DIABETES Diabetes is a health condition that affects people in all age groups. It is our lifestyle that leads to an alarming health situation where more and more people fall prey to the disease. All vital organs in the body, including heart and kidney, and veins fail to function propoerly leading to a host of health problems


Know Diabetes

better Jothydev Kesavadev, MD, CEO & Director, Jothydev’s Diabetes Research Centre, Trivandrum

There are at present 63 million persons in India with diabetes. Over half of these people with diabetes do not know that they have the disease. Globally, 1 in 4 deaths due to diabetes occurs in the South-East Asia region. Every 8 seconds, a person dies of diabetes, and every 8 seconds, 2 people develop the disease. Every 30 seconds, a leg is being amputated because of diabetes. There is a 3-fold to 4-fold higher occurrence of heart attacks in diabetics patients. Diabetes remains the commonest cause of blindness in the world

34 FUTURE MEDICINE I April 2013

D

iabetes is a complex metabolic disorder. Though there are several types of diabetes, Type 2 diabetes is the commonest form seen in the population. The global prevalence of Type 2 diabetes, according to the International Diabetes Federation Diabetes Atlas 2012, is over 371 million. In the South-East Asia region, it is 132 million. At present, in India, there are 63 million persons with diabetes. Over half of these people with diabetes do not know that they have the disease. Globally, 1 in 4 deaths in diabetes occurs in the South East Asia region. Every 8 seconds a person dies of diabetes, and every 8 seconds, 2 people develop the disease. Every 30 seconds, a leg is amputated because of diabetes. There is a 3-fold to 4-fold higher occurrence of heart attacks in diabetes patients. Diabetes remains the commonest cause of blindness in the world. The statistics given above reveals the need for early detection of diabetes and prevention of its devastating complications. The significance with diabetes is the absence of

symptoms for as long as 7-8 years even after its occurrence. This is why diabetes is usually termed ‘the silent killer.’

For the common man, diabetes is simply a ‘disease of sugar.’ However, it is not that simple.

If diabetes is not treated and evaluated properly, gradually the disease will start affecting blood vessels all over the body. This will gradually result in retinopathy, nephropathy and neuropathy. Retinopathy may result in blindness. Nephropathy may result in kidney disease, requiring dialysis and renal transplantation. Neuropathy results in numbness, tingling and excruciating pain in the lower extremities. The involvement of bigger vessels, termed macro vascular complications, results in heart attacks and strokes. Thus diabetes gradually evolves into a complex, multi-organ disease extremely difficult to manage, incurring huge losses to the patient, family and eventually for the country. Diabetes, at present, is imposing a huge burden on the economy of nations


globally. According to the most recent statistics by the International Diabetes Federation Diabetes Atlas, 4.8 million people died and $471 billion was spend on account of diabetes in 2012.

Types of diabetes

Diabetes can be of different

types. The commonest one is Type 2 diabetes seen in overweight/ obese adults. Type 1 is less common,constituting only 5% of the total diabetes population. Type 1 diabetes patients are totally dependent on insulin injections and it commonly occurs in the younger

age group.

Gestational diabetes mellitus (GDM) is the type of diabetes that occurs, for the first time, during pregnancy. If not aggressively treated, GDM can result in recurrent abortions, congenital malformations in the offspring and even occurrence of diabetes later on in those children.

Diabetes can also result from certain drugs like steroids, betablockers, diuretics, etc. Steroids are a group of life-saving drugs prescribed for a shorter period of time, but, in certain cases of cancer, arthritis, skin and respiratory diseases, steroids are given for a longer period of time. In such cases, if diabetes is induced by the drug, it becomes imperative to treat diabetes along with the original disease. However, in the general population, it is seen that, many a time, patients self-medicate with steroids and continue it without a prescription from the doctor.

Pathophysiology of diabetes

How does diabetes appear? The pathophysiology, or aetiology, of diabetes is complex. The commonest type of diabetes is Type 2 diabetes. This occurs as a part of obesity and insulin resistance. Abdominal accumulation of fat is supposed to be the most important causative factor for Type 2 diabetes. This is otherwise termed apple-shaped obesity. In Indian men with normal body weight, abdominal April 2013 I FUTURE MEDICINE 35


DISEASE SPECIAL Diabetes, Dr Jothydev Kesavadev

Continuous Glucose Monitoring

accumulation of fat is supposed to be a major causative factor for very high prevalence of diabetes. In early stages of diabetes, when the blood sugars go up, there is a compensatory increase in the secretion of insulin, and, this phenomenon is called hyperinsulinemia. If lifestyle modifications like 30 minutes of walking dailyand avoidance of excess fat and sugar in the diet is practised, this stage of diabetes is completely preventable. Subsequently, as diabetes sets in clinically and the blood sugars

are very high, the beta cells, which produce insulin, could have declined by over 50%. This is the most threatening process during the natural history of progression of the disease. Subsequently, in the next 10-15 years of Type 2 diabetes progression, the production of insulin from the beta cells in the pancreas gradually and consistently declines, resulting in insulinsecretory deficiency. This explains why insulin should be ideally started early in the treatment of Type 2 diabetes, though these patients do not essentially require insulin in the management in the early years, so asto preserve the beta cell population.

The aetiology behind Type 1 diabetes is totally different. The insulin-secreting beta cells in the pancreas are almost totally destructed, which could be the result of an immunological or a viral infection. The insulin secretion can be measured using the c-peptide test. Whatever bethe causative factor of Type 1 diabetes, eventually the treatment remains the same, that is, multiple doses of insulin injections daily or insulin pump therapy.

Why does treatment fail?

Though diabetes is an ancient

36 FUTURE MEDICINE I April 2013

disease, probably described 5,000 years ago, the treatment is still failing globally. The discovery of insulin dates back to 1921. This was the landmark event in diabetestreatment, and now we have different types of insulin and oral drugs, which could address not only the symptoms of diabetes but also prevent the complications.

Still why is the treatment of diabetes a failure globally? ‘Diabscreen Kerala,’ a major project of P Kesavadev Trust, has conducted over 460 free diabetes screening, education and treatment camps across Kerala. The shocking statistics from these camps reveal that even patients on treatment for diabetes have an average HbA1c of over 9.4 per cent (HbA1c is the average blood glucose for the past three months. In those without diabetes, it is less than 5.7 per cent. In general, if the value is less than 7 per cent, diabetes is considered to be under good control, and, strictly speaking, less than 6 per cent is the best value). The challenge in the treatment of diabetes is regarding fear of low sugars both with the physician and with the patient. The major reasons for the failure of diabetes treatment are the following: • Patients are reluctant


to evaluate and comprehensively treat diabetes unless symptoms and other complications appear; by the time it is realised, it will be late and the expenses will be greater. Even at the time of diagnosis of diabetes with the appearance of symptoms like loss of weight, hunger, thirst, tiredness, etc., over 25 per cent of patients will have either involvement of the eye, kidney or the heart or multiple organs. Diabetes is a silent killer. Whether you are a patient or a healthy individual, comprehensive laboratory and physical evaluation at least once in a year is essential; otherwise the diagnosis of diabetes may easily be missed. In conventional diabetes management, blood sugar or cholesterol will be measured onlyoccasionally and treated accordingly. This does not take care of comprehensive evaluation or prevention of complications. Modern comprehensive evaluation – which includes hundreds of laboratory investigations and treatment – involves not only multiple drugs but also periodic evaluation of lifestyle modifications. Insulin injections are indispensable and have to be included sufficiently early in the treatment of diabetes.

Evaluation of subjects with diabetes

Lab test Laboratory measurements are vital not only in the diagnosis of diabetes but also in the treatment of the disease. The quality of lab is of utmost significance since all treatment

decisions in diabetes is taken based on different laboratory parameters and not based on symptoms. The routine measurement of fasting blood glucose and a post-breakfast sugar as a part of conventional diabetes management, in the long run, will never help prevent the expensive and disgusting complications of diabetes. A scientific evaluation and treatment of diabetes will require a battery of investigations to evaluate head-to-foot involvement of diabetes. HbA1c is the average blood glucose of the past three months. In those prone to diabetes, this is a valuable evaluation. An A1c value between 5.7 and 6.4 per cent

denotes pre-diabetes. A complete lipid profile, kidney function test, liver function test, serum vitamin D levels, thyroid function test, electrocardiogram, examination of foot via biothesiometry, Doppler, monofilament, etc., are some of the investigations that are mandatory. A picture of retina will help identify involvement of the eye. Depending on the literacy level, compliance, comfort and affordability, patients can undergo laboratory measurements which may include other tests for determination of involvement of organs, cancer markers, c-peptide antibodies, ultrasound scan of the abdomen, ultrasound scan of the neck, etc.

April 2013 I FUTURE MEDICINE 37


DISEASE SPECIAL Diabetes & Sex

Erectile dysfunction

S

Normally, a healthy man has erection lasting 20 to 30 minutes. Erectile problems in diabetics can be due to physical problems caused by diabetes itself, as well as due to psychological stress. A person not having normal erection in sleep every one-anda-half hours may have some physical problems. Dr Ramesh Goyal, Consultant– Endocrinology at Apollo Hospitals in Ahmedabad, explains how diabetes affects sexual life of people 38 FUTURE MEDICINE I April 2013

ince diabetes is a lifelong disease, it can be kept under control by a healthy lifestyle and proper medication only. However, the damage caused by the high level of glucose in the blood cannot be altogether stopped. Whether one develops diabetes during childhood - juvenile diabetes or it is acquired later in life, it definitely seems to have some effects on a person’s sexual life.

In men, the most common problem is erectile dysfunction. Eventually, most diabetics develop an inability to maintain an erection for long. This definitely has its effect on the length of sexual intercourse, which in turn can cause a lot of conflict between the partners. If the disease is not diagnosed at a proper time and adequate medication not taken, it can lead to severe stress and even to marital disharmony.

How does it happen over a long period of time? Diabetes damages the small nerves of the penis, which are essential for erection. Diabetes also speeds up the process of atherosclerosis. As a result, the blood vessels get coated from within with fat, and the lumen of the blood vessels

to the penis gets narrowed. This reduces blood flow to the penis.

The erectile problems in a person, can in turn affect a person’s psychology so tremendously that he may get nervous and anxious resulting in no erection. Thus, it becomes a vicious cycle. Sometimes, other associated diseases like pneumonia, high blood pressure or kidney disease may put the blood sugar out of control, which can again give rise to erection issues.

First, it is necessary to find out the exact cause of the erectile problems. Even if a person is a confirmed


in men

diabetic, an NPT (Nocturnal Penile Tumescence) test should be done. This test measures the number and strength of erections a person has during his sleep.

Normally, a healthy man has erection lasting 20 to 30 minutes. Erectile problems in diabetes can be due to physical problems caused by diabetics itself, as well as due to psychological stress. A person not having normal erections in sleep every one-and-a-half hour may have some physical problems.

In women, sexual problems caused by diabetes are comparatively less. Diabetes may affect the blood vessels and nerves of the vagina, thereby reducing vaginal lubrication in some women. However, diabetic women are prone to vaginal infections, fungal infections and secondary bacterial infections. Controlling diabetes with proper medicines is essential. Regular monitoring of the blood sugar is also very important. Eating a low fat, low cholesterol diet with lots of fibre, drinking plenty of water and good exercise are mandatory for maintaining good health.

April 2013 I FUTURE MEDICINE 39


DISEASE SPECIAL Diabetes & Cardiovascular Disease

‘Diabetes increasing

risk of CVD’ By Sumithra Sathyan

Patients with diabetes are known to have a twoto-four times increased risk for developing cardiovascular disease (CVD). The risk factors include aging, smoking, and a family history of coronary artery disease. In an interview with Future Medicine, Dr Arpandev Bhattacharya, Consultant Physician in Diabetes and Endocrinology, Manipal Hospital, says how diabetes affects our heart 40 FUTURE MEDICINE I April 2013

How does diabetes lead to cardiac disease and what is the present scenario in our country? Current estimates indicate that 8.3 per cent of the adult population or 71.4 million people in the world have diabetes in 2011, of them 61.3 million are in India. The region has a high number of deaths attributable to diabetes with 1.16 million deaths in 2011. India is the largest contributor with 983,000 deaths. Phase I results of the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB) study shows 62.4 million people with diabetes and 77.2 million with pre-diabetes in India.This study also projects that the prevalence of diabetes and pre-diabetes is higher in both urban and rural areas of India compared to earlier studies. With greater urbanisation, growth of the middle class and ageing of the population, a huge increase in the number of people with diabetes in India is expected in the future. What are the risk factors? How can we define them? Patients with diabetes are known to have a two -to -four times increased risk for developing cardiovascular disease. The

identified risk factors include aging, smoking, and a family history of coronary artery disease. Type 2 diabetes is a part of the insulin resistance cluster or metabolic syndrome, which is a consortium of hyperglycaemia, obesity, dyslipidaemia, and hypertension. It may increase the risk.

The ‘common soil’ hypothesis proposed common genetic and environmental antecedents for the development of diabetes and its macrovascularcomplications. They spring from a “common soil”. Family history of cardiovascular disease (CVD) increases the risk of common predispositions of obesity, hypertensionmetabolic syndrome, and other pathways. To summarise, infection, inflammation, hyperglycemia, insulin resistance, dyslipidemia, and thrombosis have all been implicated in the development of atherosclerosis and subsequent adverse CV events in patients with diabetes mellitus. Cardiovascular disease continues to be the major cause of morbidity and mortality in diabetes, the understanding that


“multiple risk factor intervention is the cornerstone of diabetes management is leading to significant benefits for patients�.Aggressive goal setting for modifiable cardiovascular risk factors that cluster in patients with diabetes, such as dyslipidemia, hypertension, and a procoagulant state, and judicious selection of efficacious therapies have been

shown to produce significant reductions in cardiovascular events, and in some cases mortality, in controlled clinical trials. What is the role of insulin in the treatment of diabetes? Insulin treatment reduces inflammatory markers and improves mechanisms of vasodilation and atherogenic plasma lipid patterns. Also intensive insulin therapy targeting normoglycaemia reduced the longterm risk by about 50 per cent in people with Type 1 diabetes. ORIGIN (Outcome Reduction with an Initial Glargine Intervention) study was designed to determine whether providing sufficient basal insulin (insulin glargine) can safely achieve fasting normoglycaemia, reduce the incidence of fatal and nonfatal when compared to standard glycaemic approaches in people with a modest degree of glucose elevation and high cardio vascular risk. Treatment with insulin glargine failed to reduce the risk of the primary composite end point of myocardial infarction,

stroke, or death from cardiovascular causes. Other event rates, including total mortality, total strokes, death from cardiovascular causes, hospitalisations for heart failure, and revascularisation, among others, were not significantly different in the insulin glargine and usual-care study arms. Although it reduced new onset diabetes, insulin glargine also increased hypoglycaemia modestly and increased weight. What are the major researches in this field? The researchers had expected that an intervention designed to target prandial hyperglycaemia would be more beneficial than one that targeted basal hyperglycaemia and they found little difference between the two treatments. However, it must be emphasised that though these two trials (ORIGIN and HEART2D) failed in their primary objectives, they have nevertheless provided evidence for two very important principles of insulin therapy in Type 2 diabetes. Early treatment should be implemented in patients with Type 2 diabetes mellitus as soon as glycaemic control with oral hypoglycaemic agents fails to meet target levels of HbA1c. The major objective of anti-diabetic therapy should not be to target either basal glucose levels or postprandial glucose levels, but instead to target both glucose disorders to achieve the recommended HbA1c level.

April 2013 I FUTURE MEDICINE 41


DISEASE SPECIAL Diabetes & Heart

Three key steps to prevent heart disease in diabetics By Dr Ranjani Harish and Dr V Mohan Control blood sugar

As duration of diabetes increases, high blood sugar can damage large blood vessels and increase the risk of heart attack and stroke, as well as other complications of diabetes. . The best way to assess one’s long term diabetes control is by performing the hemoglobin A1c (HbA1c), which measures average blood Dr V Mohan glucose over the past three months. HbA1c, should be checked twice to thrice annually.

Control blood pressure

High blood pressure or hypertension can lead to a range of heart problems not only for people with diabetes but also those without this ailment. Over time, uncontrolled hypertension can damage arteries, making them harden, thicken and narrow because of the buildup of plaques (atherosclerosis). Increased levels of blood cholesterol and triglycerides can cause heart disease in those with or without diabetes. But the damage 42 FUTURE MEDICINE I April 2013

is more and occurs more rapidly when one has diabetes. Abnormal levels of blood cholesterol and triglyceride increases the risk of a heart attack and stroke by blocking blood flow through major arteries.

Control blood fats

Increased levels of blood cholesterol and triglycerides can cause heart disease in those with or without diabetes. But the damage is more and occurs more rapidly when one has diabetes. Abnormal levels of blood cholesterol and triglyceride increases the risk of a heart attack and stroke by blocking blood flow through major arteries. Individuals with diabetes most commonly have decreased level of high-density lipoprotein (HDL) cholesterol [“good” cholesterol] and increased level of low-density lipoprotein (LDL) cholesterol [“bad” cholesterol], which blocks the vital blood vessels. In addition, other risk factors, including central obesity and smoking, for heart disease should also be taken care of. Central or abdominal obesity means carrying extra weight around the waist. A waist measurement of more than 90 cm for men and more than 80 cm for women means one has abdominal obesity.

Prevention

Prevention of diabetes and heart disease is actually a societal problem. To save the

next generation from the twin burden of diabetes and heart disease, a team effort by the family, neighborhoods, schools, healthcare providers, government and media is mandatory. The emphasis should be on changes in lifestyle stressing optimal caloric intake and increasing physical activity. This would include revival of physical training in schools encouraging sports, games and other leisure time activities especially in children and youth and reducing weight in overweight individuals. To prevent/control heart diseases • High blood sugar can damage the blood vessels. Keep blood sugar within optimal level • Hypertension or high blood pressure can lead to heart disease. Maintain your blood pressure at 130/80 mm/Hg • Restrict intake of egg yolk, mutton, organ meats and fried & salty foods • Do regular exercise for a minimum of 150 minutes/ week • Do not smoke or chew tobacco.

( Dr Ranjani Harish and Dr V Mohan, Dr Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation, Gopalapuram, Chennai)


DISEASE SPECIAL

a ing

Diabetes & Kidney

k l l a o T avy t he

It is our lifestyle that leads to an alarming health situation where more and more people fall prey to diabetes, a condition that affects all vital organs of the body By Sumithra Sathyan

D

Dr Vijay Viswanathan, MD in Internal Medicine, is Head of the WHO Collaborating Centre for Research, Education and Training in Diabetes. He has been awarded PhD in Medicine by Dr MGR Medical University, Chennai, for his study on diabetic nephropathy in Type 2 diabetes. He was conferred the Fellowship of the Royal College of Physicians, London/Glasgow in 2009/2010.

iabetes is becoming a major public health problem in India because currently about 63 million people are believed to have diabetes.Morbidity due to complications is the main reason for this severe problem. Diabetes results in a variety of complications affecting heart, eye, kidney and feet as it damages all the blood vessels in the body.Two common and dreaded complications are those pertaining to kidney, called diabetic nephropathy, and feet called diabetic neuropathy. Diabetic nephropathy is a condition where there is a leakage of protein in the urine. This protein starts as a very small amount and increases gradually till the

kidney is completely damaged. In the final stages, the blood urea and creatinine increase to high levels and the patient needs either dialysis or kidney transplantation.In an interview with Future Medicine, Dr Vijay Viswanathan, Head and Chief Diabetologist, MV Hospital for Diabetes,and Prof M Viswanathan Diabetes Research Centre, Chennai,talks about how diabetes damages kidney. Is it possible to detect kidney damage at an early stage? Yes,it is possible to detect kidney damage at an early stage by checking the early morning urine for albumin, a test called microalbuminuria.


DISEASE SPECIAL Diabetes & Kidney How can we prevent damage to kidney? Once the person is detected to have micro albuminuria, it is very necessary to control diabetes and blood pressure to the best extent possible and also reduce the salt intake by 50 percent.There is also a class of medicine called ACE inhibitors which can reduce the albumin leakage and prevent further kidney damage. Do patients with kidney damage need insulin injections? In the early stage of kidney disease, one can continue with the tablets for diabetes, but when the kidney damage becomes more pronounced and the creatinine levels increase, insulin treatment should alone be given for the patient. Are all diabetics likely to develop kidney disease? Diabetes kidney disease runs in families. The patients who belong to such families should be more careful.Apart from this,high salt intake, high blood pressure and cigarette smoking can cause kidney disease. What is diabetic neuropathy? Diabetic neuropathy is a condition where the nerves in the feet are affected and the person has no sensation in the legs and feet. This condition affects people who have uncontrolled diabetes and high cholesterol levels, and those who smoke cigarettes. What is the danger of diabetic neuropathy? Diabetic neuropathy can lead to serious problems in the feet like foot infection because patients tend to ignore injuries since they have no sensation.People who undergo massage of their legs and feet can develop severe infection.Diabetic neuropathy can lead to amputation if the person develops foot infection. What are the latest methods available to treat diabetic foot infection? A number of modern wound dressings are available with companies like Convatec who manufactures dressings using hydrofibre technology.With the negative pressure wound therapy from KCI, it is now possible to heal the wounds much faster.Stem cell injections from the bone marrow areavailable in India for the people who have reduced blood circulation in the wounds. What about the diabetic footwear? MV Hospital for Diabetes, Royapuram Chennai, has developed a number of diabetic footwear in collaboration with CLRI. Thefootwear is meant for the people who have diabetic neuropathy. Special footwear using customised footwear insole is also prepared for the people who have neuropathy and deformities in the feet.The ordinary footwear costs about Rs750while the customised footwear insoles cost about Rs 2000. Any message for the people with diabetes? • Control diabetes • Stop smoking • Control blood pressure • Reduce salt intake • Do regular exercise • Have a balanced and proper diet control • Check blood sugar level regularly and report to the diabetologist 44 FUTURE MEDICINE I April 2013


DISEASE SPECIAL Ways to stay away

Tips to avoid

diabetes

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which a person has high blood glucose (blood sugar) because insulin production is inadequate or the body’s cells do not respond properly to insulin, or both. The patients with high blood sugar will typically experience polyuria (frequent urination). They will become increasingly thirsty (polydipsia) and hungry (polyphagia)

P

roper control of diabetes will help you avoid diabetes complications such as heart problems, nerve pain and neuropathy, and foot problems. Here’s what you can do to avoid diabetes. Reduce weight if you need to. About 80 to 90 per cent of people with Type 2 diabetes are overweight. Losing the excess weight helps control blood sugar.

Monitor your blood sugar closely. Check glucose level two or more times a day. Keep your blood sugar level as close to normal as possible or within the range advised by your doctor. It helps to keep a log so you can track progress and determine the effect of diet and activity.

April 2013 I FUTURE MEDICINE 45


DISEASE SPECIAL Ways to stay away Know that high blood sugar levels can wreak much damage, including damaging the blood vessels that feed the eye’s retina, leading to diabetic retinopathy, which can result in blurred vision and eventually blindness. High blood sugar levels can damage the kidneys, too. Get regular tests, called A1C, to find out your average blood sugar for the past two to three months. Most people with Type 2 diabetes should aim for an A1C of 7 per cent or lower. Ask your doctor how often you need to get an A1C test.

Keep moving. Regular exercise can help keep weight under control. It also helps control blood pressure, cholesterol, and triglyceride levels, and also reduces stress. Aim for at least 30 minutes a day of aerobic exercise five days a week. Start out more slowly if you have been sedentary. Exercises for diabetes control can include walking, dancing, low-impact aerobics, swimming, tennis, or a stationary bike. You can break up the 30 minutes -- by taking a 10-minute walk after every meal, for instance. Strength training and stretching are also recommended.

Get sufficient sleep. When you are sleep deprived, you tend to eat more, and you can put on weight, setting you up for complications. People with diabetes who get enough sleep often have healthier eating habits and improvement of blood sugar.

Manage stress. Stress and diabetes don’t mix. Excess stress can elevate blood sugar. Learn stress reduction techniques that work for you. Among them: Sitting quietly for 15 minutes, meditating, practicing yoga.

46 FUTURE MEDICINE I April 2013

Pay attention to your carbohydrate intake. Keep track of how many carbohydrates you eat, and how often. Managing your carbs can help keep blood sugar under control. Aim for high-fiber, complex carbs such as green vegetables, fruit, legumes, and whole grains.

See your doctor at least yearly. Doctors will give you a dilated eye exam, blood pressure check, foot exam, and screen for other complications such as signs of kidney damage, nerve damage, and heart disease.


HEALTH STUDY

Low Vitamin D levels may increase

risk of Type 1 diabetes: Study A

new study by the researchers at Harvard School of Public Health (HSPH) has proved that low Vitamin D levels may increase risk of Type 1 diabetes. Type 1 diabetes is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. Frequent urination or polyuria, increased thirst or polydipsia, increased hunger or polyphagia and weight loss are the important symptoms of Type 1 diabetes. Adequate levels of Vitamin D during young adulthood may reduce the risk of adult-onset Type 1 diabetes as much as 50 per cent, a press note released by the Harvard School of Public Health stated. According to the researchers, the new findings could lead to a role for Vitamin D supplementation in preventing this serious autoimmune disease in adults.

“It is surprising that a serious disease such as Type 1 diabetes could perhaps be prevented by a simple and safe intervention,” said lead author Kassandra Munger, research associate in the Department of Nutrition at HSPH.

In Type 1 diabetes (Once called juvenileonset or insulin-dependent diabetes), the body’s immune system attacks and permanently disables the insulin-making cells in the pancreas. About 5 per cent of the estimated 25.8 million people in the US with diabetes have Type 1, according to the American Diabetes Association. Although it often starts in childhood, about 60 per cent of Type 1 diabetes cases occur after age 20. Previous studies have suggested that a shortage of Vitamin D might boost Type 1 diabetes risk, although those studies mostly examined the link between Vitamin D levels in pregnancy or childhood and the risk of Type 1

diabetes in children. Other research, in young adults, uncovered an association between high Vitamin D levels and a lowered risk of multiple sclerosis—an autoimmune disease genetically and epidemiologically related to Type 1 diabetes—suggesting that inadequate Vitamin D in adulthood may be an important risk factor for autoimmune diseases in general.

The researchers conducted a prospective case-control study of the US military personnel on active duty, using blood samples from the Department of Defence Serum Repository, which contains more than 40 million samples collected from 8 million military personnel since the mid1980s. Identifying 310 individuals diagnosed with Type 1 diabetes between 1997 and 2009, the team examined blood samples taken before onset of the disease, and compared the samples with those of 613 people in a control group.

The researchers found that white, nonHispanic, healthy young adults with higher serum levels (>75 nmol/L) of Vitamin D had about half the risk of developing Type 1 diabetes than those with the lowest levels of Vitamin D (<75 nmol/L). Although the researchers found no significant association among Hispanics and blacks, the authors said this may be due to the small number of individuals in these groups. April 2013 I FUTURE MEDICINE 47


MEDICAL TERMS Osteoarthritis

Swelling &

joint pain Aging and excessive use of joints are the main causes of osteoarthritis. Swelling and joint pain are the common symptoms of the disease

O

By Neethu Mohan

steoarthritis is a form of arthritis that features breakdown and eventual loss of the cartilage of one or more joints (Cartilage is a protein substance that serves as a cushion between the bones of the joints). Among the over 100 different types of arthritis conditions, osteoarthritis is the most common. Osteoarthritis occurs more frequently as we age. Before age 45, osteoarthritis occurs more frequently in males. After 55 years of age, it occurs more frequently in females. Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or degenerative joint disease (DJD). Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Osteoarthritis usually has no known cause and is referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis.

Causes Primary osteoarthritis is mostly a result of natural aging of the joint. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced osteoarthritis, there is a total loss of the cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new

bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition.

Secondary osteoarthritis is a form of osteoarthritis that is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes and other hormone disorders. Obesity causes osteoarthritis by increasing the mechanical stress on the joint and therefore on the cartilage. In fact, next to aging, obesity is the most significant risk factor for osteoarthritis of the knees. The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players and army military personnel. Interestingly, studies have not found an increased risk of osteoarthritis in long-distance runners. Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth.

Hormone disturbances, such as diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Osteoarthritis facts • • • • •

48 FUTURE MEDICINE I April 2013

Osteoarthritis is a joint inflammation that results from cartilage degeneration. Osteoarthritis can be caused by aging, heredity and injury from trauma or disease. The most common symptom of osteoarthritis is pain in the affected joint (s) after repetitive use. There is no blood test for the diagnosis of osteoarthritis. Treatment in osteoarthritis is to reduce joint pain and inflammation


ARTS & MEDICINE

‘Art therapy can reduce

pain, anxiety’ By Neethu Mohan

“C

leveland Clinic’s research in art therapy has shown positive results. Its art therapy results in a decrease in pain and anxiety, improved coping skills, and enhanced self-esteem,” said Dr Fattorini, Managing Director and Chairperson of the Global Arts and Medicine Institute, Cleveland Clinic. Fattorini was giving an overview of a

see that nobody has introduced a combination of arts and medicine. Arts and medicine is a challenging combination which can reduce diseases. People have accepted it in a positive manner and I think in the coming days, arts and medicine can attain a huge growth,” said Bose Krishnamachari, Curator of Kochi-Muziris Biennale.

Looking into the history of biennales, we can see that nobody has introduced a combination of arts and medicine. Arts and medicine is a challenging combination which can reduce diseases. People have accepted it in a positive manner and I think in the coming days, arts and medicine can attain a huge growth Bose Krishnamachari, Curator of Kochi-Muziris Biennale symposium organised by Cleveland Clinic, a leading multi-specialty academic medical centre in the US, at Aspinwall House in Fort Kochi recently.

The symposium, ‘Arts and Medicine for India’, held as part of the ongoing Kochi-Muziris Biennale, discussed healing through fine arts and the concept of arts and medicine. “The sessions were also held in order to educate the artists and physicians on the methods and benefits of applying arts in patient care,” said Fattorini. “The event was also aimed at developing an inventory of existing programmes in India to further promote the implementation of arts and medicine programmes in their hospitals,” he said. “Looking into the history of biennales, we can

50 FUTURE MEDICINE I April 2013

Ravi Nair, chair of Cardiology of Cleveland Clinic, Abu Dhabi, spoke on ‘Cardiologist’s Story & Perspective’. Speeches on ‘Medicine for Healing Heart’ by Manish Kohli, Chief of Medical Informatics, Cleveland Clinic, Abu Dhabi, and Meharoof Raj T P, Medical Superintendent, DMWayanad Institute of Medical Sciences, were held at the programme.

Cleveland Clinic’s fine arts collection includes over 4,500 pieces. Offering over 300 performances and events every year, the Arts and Medicine Institute utilises public spaces for music, theatre, and dance, and is dedicated to providing a variety of educational platforms, including high-level seminars, lunch-hour lectures and collaborations with local, national, and international arts organisations.


Healthy Diet

WELLNESS

Fighting the Summer Heat Summer is here with unbearable heat and only a healthy diet can help you remain active during these difficult months. Exhaustion and dehydration are common among people, especially those who work outdoor. A diet of more vegetables and fruits is the only way to fight the summer heat Watermelons

With the water content of 90 per cent, watermelons play a vital role in the healthy diet, especially in the hot summer months. Packed up with excellent levels of Vitamins A and C and a good level of Vitamin B 6, watermelons will boost your immunity by enhancing the infection-fighting actions of white blood cells called lymphocytes and optimal eye health. Having Viagra-like properties, watermelons would reinforce sex in a personâ&#x20AC;&#x2122;s life. Maintaining normal nerve function, watermelons would form red blood vessels and help the immune system produce antibodies. Being good for heart and kidney, they will help prevent cell damage, strengthen healthy teeth and gums and brain function and helps convert protein to energy. Watermelons can be considered as the powerful energy drink as well.

Tomatoes

Being a good source of Vitamins A, C, K and B6, folate, potassium, magnesium, phosphorus and copper, the inclusion of raw tomatoes will provide a healthy balance in our diet in the scorching summer. Being the nutritional powerhouses with high water content, eating plenty of tomatoes protects the body from high blood pressure, high cholesterol, strokes, and heart disease. Tomatoes help protect skin from UV light damage which would lead to wrinkles and to strengthen and repair bones. They can reduce the risk of cancers, including prostate, cervical, mouth, pharynx, throat, esophagus, stomach, colon, rectal, prostate and ovarian cancer.

Berries

Berries, including strawberries, blueberries, blackberries, raspberries and gooseberries, have low calories, are high in Vitamin C and a good source of antioxidants and fiber. Berries may be good for your heart reducing HDL cholesterol and lowered blood pressure and it will strengthen your bones as well. Blueberries, known for their anti-inflammatory and anti-bacterial properties contain anthocyanins which would be useful to keep sharp memory. They are rich in Vitamin B, fiber and Vitamins C, E and K. Raspberries are also great sources of the vitamins and minerals riboflavin, niacin, folate, magnesium, potassium, copper, manganese and Vitamin C. Blackberries that contain Vitamins C and E and fiber, protect eyesight and help fight minor infections too. Strawberries which include a rich source of Vitamin C, folate, fiber and Vitamin B, pack phytonutrients and anti-oxidants such as phenols which would help in heart-protecting, antiinflammatory, and anti-cancer properties. April 2013 I FUTURE MEDICINE 51


WELLNESS YOGA Vrkasana (Tree pose) How to do?

Stand straight. Place palms together and bend right leg at knee. Place sole on the inside of left thigh. Focus on a spot in front of you to hold the pose longer. Breathe normally. Then release right foot back to ground. Repeat sequence for left side.

Benefits • • • •

Develops self confidence Good for emotional management Strengthen limbs Control fight anger, shyness and anxiety

Supta pawan muktasana (Lying energy release pose) How to do?

Lie on your back and inhale. Fold up your right leg at the knee. Then exhale, hug it closer to the chest. Hold it firmly, breathing naturally. Release.

Benefits • • • • •

Strengthen your spine Removes digestive mess-up Removes tension Used to relieve flatulence Will correct all digestive disorders


Sarvangasana (Supported Shoulderstand Pose) How to do?

Lying on the back with the hands under the mid-back, the legs and lower body are lifted so that the weight of the body is supported on the head, neck, shoulders and upper arms. The gaze is towards the toes and the sagittal and transverse line of the head is perpendicular with the midsagittal and midfrontal line of the body.

Benefits • • • •

Make thyroid gland active Cures problems related to various glands like pituatary, adrenal and genitial Beneficial for lungs and cure second & third stages of asthma Will strengthen abdominal organs as blood flows towards head and abdomen gets relief for that period of time.

(Note: Asanas described here should be practiced strictly under the guidance of Yoga teacher or under the supervision of yoga expert only)


WELLNESS

Beauty Tips

Tips to survive

summer

And the summer is back. Excessive exposure to sunlight and dust can destroy your skin during this season. Here are some tips to protect your skin from the scorching sun

Drink fresh juices

This is another way of keeping your skin healthy. Always pick nutrient filled fruits that are rich in vitamins and minerals. The list may include apple, orange and watermelon.

Drink lots of water

During summer, drink at least seven to eight glasses of water a day as we lose more water than usual. The best way to protect your skin is to drink enough quantity of water.

Eat leafy vegetables

They are highly rich in antioxidants which will help to fight free radicals. They are also rich in other nutrients that provide better health.

Donâ&#x20AC;&#x2122;t skip moisturiser

Your skin may be less dry these days, but donâ&#x20AC;&#x2122;t banish moisturiser. Instead, switch to lighter, waterbased formulas for both face and body, and swap your heavy eye cream for a lighter serum.

Exfoliate regularly

Sunlight, sand, sweat, and sunscreen only increase the amount of dead skin cells that build up on your face and body. Slough them off with an exfoliating scrub or loofah a few times each week.

54 FUTURE MEDICINE I April 2013

Apply sunscreen

Choose products that provide broad-spectrum protection (They block both ultraviolet A (UVA) and ultraviolet B (UVB) rays) with a minimum sun protection factor (SPF) of 15. Apply sunscreen every day and reapply every two hours.


MENSTRUATION

Dr N P Vijayalakshmy Chief Medical Officer of Vijaya Institute of Medical Sciences

Common chromosomal anomalies

I

n continuation to my previous article where I have mentioned about the amenorrhea due to hormonal dysfunction and genital out flow problem, I would like to highlight some of Chromosomal anomalies commonly seen.

Turnerâ&#x20AC;&#x2122;s syndrome is a condition where the chromosome pattern is 45 XO. The woman has uterus, but ovaries are dysfunctional. Usually, it is called streak ovaries, later become fibrosed. The characteristic features are primary amenorrhea, premature ovarian failure, streak gonad and infertility. Mullerian agenesis is a congenital malformation characterised by a failure of the Mullerian duct to develop. This results in the absence of uterus, fallopian tube and upper portion of vagina.

Androgen insensitivity syndrome or testicular feminisation is a condition where the person is genetically male XY but resistant to male hormone called androgen. A person with complete AIS appears to be a female but has no uterus, and has very little armpit and pubic hair.

Premature ovarian failure is the loss of function of the ovaries before age 40. A commonly cited triad for the diagnosis is amenorrhea, hyper gonadotropism, and hypo estrogenism.

Between 5 and 10 per cent of women with POF may spontaneously become pregnant. Currently, no fertility treatment has officially been found to effectively increase fertility in women with POF, and the use of donor eggs with In-Vitro Fertilization (IVF) and adoption have become more popular as means of becoming parents for women with POF. It is important to initiate hormonal replacement once the diagnosis of POF is made, because untreated patients are at a risk of bone loss. Most patients develop symptoms of oestrogen deficiency like vasomotor flushes, vaginal dryness.

To conclude management of amenorrhea has to be taken from different aspects. Amenorrhea due to hormonal imbalance, need thorough investigation and treatment, genetic causes have to be dealt with proper counselling. Conditions where the uterus is present with non functional ovaries, oocyte donation is one option. Mullerian agenesis patients need a surrogate to carry their babies to term and deliver.

Dr N P Vijayalakshmy MD, DGO, is the Chief Medical Officer of Vijaya Institute of Medical Sciences, Kadavanthra, Cochin, Kerala

April 2013 I FUTURE MEDICINE 55


HEALTH HAZARDS Smokeless tobacco products

Endgame for

e c a n e om

c c a tob India is the second largest consumer and the third largest producer of tobacco globally, and the myriad varieties of tobacco products present unique challenges for its regulation. The goal of a â&#x20AC;&#x2DC;tobacco-free worldâ&#x20AC;&#x2122; has been hampered by the globalisation of tobacco marketing, trade, research and industry influence. An international conference to be held in September will address all these problems

T

obacco use is one of the major risk factors for non-communicable diseases globally, with the greater burden on resource-poor low and middle-income countries (LMICs). As tobacco use continues to increase, especially among vulnerable populations including women and the youth, these countries will experience a disproportionate amount of tobacco-related illness and death. More alarming is the shift in the pattern of nicotine consumption, with aggressive globalisation of smokeless tobacco and alternative nicotine delivery systems like e-cigarettes. As LMICs share the larger burden of tobacco use compared to the developed 56 FUTURE MEDICINE I April 2013

countries, tobacco control efforts need to be more focused and designed to address the burden in LMICs.

India faces a huge burden of tobacco use with 34.6 per cent of the population using tobacco in some form or the other. Out of these, 8.7 per cent use smoked tobacco, 20.6 per cent use smokeless tobacco and 5.3 per cent use both smoked and smokeless tobacco. There is a double fold increase in tobacco use by women from earlier surveys and an early age of initiation with about 15.7 per cent of the tobacco users starting tobacco use before the age of 15 years in India, while nearly 15 per cent of youth in


the age group of 13-15 years use tobacco in some form. Sixth grade students are two to four times more likely to consume tobacco as compared to eighth grade students. Gender gap is narrowing with more young girls starting to use tobacco.

In India, more than one million deaths annually are attributed to smoking alone. Tobacco use contributes to approximately 60 per cent of all CVD death in India, and 42 per cent and 18 per cent of cancer death among men and women respectively are due to tobacco use. Tobacco use is not only a health burden but huge economic losses are incurred due to massive expenses on the treatment of diseases. It is estimated that direct expenditures on tobacco use and out of pocket expenditures on healthcare cost, which otherwise could be spent on food or education for children, impoverishes roughly

15 million people in India.

In India, tobacco products are available in many forms. Smokeless tobacco users in India consume more than 22 types of smokeless tobacco products. These include gutka, khaini, zarda, mawa, kharra (Chewed forms of tobacco), dry snuff and liquid snuff and mishri, gul, gudhaku creamy snuff and bajjar as applied forms. Most of the tobacco products are manufactured in informal and unorganised sectors, which make it extremely cumbersome for regulation. The

poor working conditions and low wages of tobacco workers mostly in the unorganised sector including bidi rollers, tendu leaf pluckers, tobacco farm labourers compounds the anomalies of tobacco use and production in India and several other similarly placed LMICs.

India is the second largest consumer and the third largest producer of tobacco globally, and the myriad varieties of tobacco products present unique challenges for its regulation. The differential rates of taxation on similar tobacco products and exemption from taxes on certain tobacco products further aggravates the problem in India. However, The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act (COTPA) was enacted in 2003 as a comprehensive tobacco control

law. In force since 2004, with effective regulations from time to time, COTPA has strengthened the tobacco control scenario in the country. • Smoking in public places, including workplaces • Any kind of direct or indirect tobacco advertisement, promotion and sponsorship • Sale of tobacco products by minors and within 100 yards of educational institutions • Sale of tobacco products without pictorial health

warnings Glamorisation and promotion of tobacco use in films and television programmes

During the 11th Five-Year Plan, MoHFW launched the National Tobacco Control Programme in 2007 as a pilot project that currently covers 42 districts of 21 states in the country. The programme spearheads implementation of COTPA and the tobacco control initiatives at the grassroots level in the country. Taking the fight of tobacco control to the grassroots level, many villages and panchayats in the country have forbidden the sale of any tobacco products within their jurisdiction. With concerted efforts from the community led interventions by Public Health Foundation of India in Andhra Pradesh, Pongalipakka village was

declared tobacco-free on the World No Tobacco Day on May 31, 2012. Several other villages in Andhra Pradesh and Gujarat are now committed to outlaw tobacco use. Villages in Uttar Pradesh (Sarfabad), Haryana (Sankarpura), Himachal Pradesh (Tashi Jong) and Madhya Pradesh (Samnapur) have already become tobacco free while cities like Chandigarh, Shimla, Bhubaneshwar, Coimbatore, Kottayam, all divisions of Indore District, the state of Sikkim and Mizoram are smokefree with no smoking in public places. April 2013 I FUTURE MEDICINE 57


PHARMAPRENEUR Dr Muhammed Majeed

Healer with the Nutrients

Dr Muhammed Majeed is a pharmacist-turned-entrepreneur who loves to study drug molecules and plans Ayurvedic means of healing with focus on the nutrient value of herbal plants. He knows how to blend traditional and modern medicines together through his nutraceutical-cumpharmaceutical company, Sami Labs Limited, and its US arm, Sabinsa Corporation By Prashob K P 58 FUTURE MEDICINE I April 2013


D

r Muhammed Majeed is not an old economy businessman. He knows the new economy quite well. The fact that his business is built on the age-old science of Ayurveda never betrays the logic of a healer who is seeking to bridge the gap between traditional and modern medicines. It prompted Dr Majeed, a pharmacist-turned-entrepreneur, to establish a nutraceutical-cumpharmaceutical company, Sami Labs Limited (SLL). Dr Majeed, the founder and Managing Director of Sami Labs Limited, was born and brought up in Kerala. After obtaining a degree in pharmacy, he proceeded to the US in 1975 to complete his MS in Industrial Pharmacy from Long Island University, New York. After that, he took PhD in the same subject from St John’s University, New York. His stints at Pfizer Inc, Carter-Wallace and Paco Research fuelled his entrepreneurial dreams.

In 1988, Dr Majeed established Sabinsa Corporation in New Jersey, US, with the objective of importing and marketing generic drugs in the US to make the drug molecules come off patent. However, because of the generic drug scandal in 1989 in the US FDA (Food and Drug Administration), the focus shifted and a new line of products was introduced in the US, based on Indian herbal plants. Dr Majeed utilised innovative technology of industrial pharmacy to convert Indian herbs into modern drugs. Through Sabinsa, he introduced Americans to Ayurveda. That was a time when Americans were very conscious about eating habits. The message of ‘look good and feel good’ spread everywhere. They started recognising the

potential of Ayurveda and termed it as alternative medicine. At the same time, Dr Majeed began to concentrate on nutraceuticals, a combination of nutrients and pharmaceuticals; upon realisation that there were absolute cures in Ayurveda for various ailments that Americans had been suffering from.

Photochemistry, Synthetic Chemistry, Biotechnology and Formulations Division. Today, the main focus of Sami Labs is on new product development and market-oriented research. Sabinsa Corporation is the marketing arm of SLL. Further, SLL has three wholly-owned subsidiaries-Hanbury FZE, Dubai, Sabinsa Australia Pvt. Limited, Australia, Sabinsa Japan Corporation, Japan, and one step-down subsidiary Sabinsa Corporation, US. SLL holds 80

in Bengaluru as a research and development facility. SLL is a 100 per cent export oriented unit (EOU) primarily engaged in manufacturing nutraceuticals, cosmeceuticals, standardised extracts and speciality chemicals. SLL currently operates four manufacturing units in India, with three units in Bengaluru and one in Hyderabad. SLL has the stateof-the-art research and development centre in Bengaluru.

international patents (IPs) and 65 are in the pending list.

To expand his network globally, Dr Majeed established Sami Labs Limited (Formerly known as Sami Chemicals & Extracts Limited) in 1991 at Singasandra

The research and development centre has a Natural Drug Division,

Global presence

The various products manufactured by SLL are broadly classified into three categories Herbal Products, Fine Chemicals, Cosmetics and Capsules. Gugulipid, a standardised extract, was the first product that Sami labs marketed globally in 1991. Citrin was the first commercially produced standardised extract of Sabinsa Corporation. It is extracted from Garcinia Cambogia April 2013 I FUTURE MEDICINE 59


PHARMAPRENEUR Dr Muhammed Majeed

SABINSA CORPORATION

(Malabar Tamarind) and was launched in 1991. Citrin achieved worldwide recognition for its weight management capabilities and received US patent in 1998. Majeed continued research activities to explore the potential of Ayurveda further. SLL’s major herbal products are Forskohlin and Curcumin. Forskohlin is an extract prepared from the herb, Coleus Forskoholii (VanaTulsi) of the mint family. Curcumin is a drug used for weight loss and diabetes, and the raw material used is turmeric. Sornip, a drug extracted from Boswellia Serrata (Indian frankincense) is an excellent anti-psoriac agent. Sami Labs holds patent and drug manufacturing rights from Drugs Controller of India for this product. Pharma major Cipla is marketing the product as an allopathic medicine. Forslean is another product that the company sells as a potential drug that manages body weight and enhances lean body mass. Bioperine is a piperine composition derived from the black pepper extract which is clinically proven to enhance the bioavailability of co-administered nutrients in formulations. Ocufors helps combat glaucoma which is affecting millions of people globally. The Drugs Controller General of India granted Majeed the right to manufacture and market Ocufors. For the first time, the Government of India approved a product developed by an Indian company from natural sources, for use as a pharmaceutical grade drug. The Sami and Sabinsa companies have been formulating and creating dozens of health guaranteeing nutraceuticals and cosmeceuticals for more than two decades. The company is also planning to introduce a line of biostandardised clinically tested cosmeceutical formulations under the brand name Johara cosmetics. These products now reach the discerning consumer in India through their marketing arm Sami Direct. The research team is constantly studying and formulating newer products based on Ayurveda which assures a safe and effective supplement to address a multitude of the human body’s 60 FUTURE MEDICINE I April 2013

Sabinsa South Africa

Organica Aromatics India

Sabinsa U A E

Sabinsa Vietnam

Sabinsa China

Clin World Inc. India/USA

Sabinsa Australia

Sami Direct India Sabinsa South Korea

Sabinsa Europe (Germany)

Sabinsa USA NJ & Utah

INDIA

SAMI LABS

Edakal Corporation/ India

Sabinsa Japan

AFI’s USA

physical and chemical needs. The R&D of Sami Labs works closely with the Government of India and the Indian Pharmacopoeia Committee on the preparation of Standard Operating Procedures for Ayurvedic herbs and monographs for Indian herbs. The company’s manufacturing unit focuses on specific areas like biotechnology, development of new products, super critical fluid extraction, continuous solvent extraction plant and formulation support to the organisation. The future of nutraceuticals depends on the availability of the herbs. Of 460 plants in Ayurveda, 400 are facing extinction. Foreseeing this, Majeedis cultivating these herbs in his farm. Apart from entrepreneurial thoughts, he is also dedicated to preserve, sustain and disseminate the ancient form of healing Ayurveda.

Awards and recognitions • • • • •

• • •

1994-National Award for Quality Products (Basic drugs) 1996-Certificate of Merit for Outstanding Export Performance in spice products, fine chemicals, extracts and oleoresins,vegetable extracts. 2001-Forslean wins the Nutracon Best New Product Award of the Year. 2002-Award for R&D efforts in industry in the category of chemicals and allied industries. 2004-Sabins Corporation receives the Thomas Alva Edison Patent Award for Forslean from Research and Development Council of NewJersey, US 2005-Sabinsa Corporation receives the Thomas Alva Edison PatentAward for Tetrahydropiperine from Research and Development Council of NewJersey 2006-Sami Labs Ltd getsGolden Award of Excellence in Exports from the governmentof Karnataka for the year 2005-06 2009-Sabinsa Corporation receives American Herbal Products Association’s herbal industry leader award 2010-Sabinsa achieves ISO 22000 certification


Riding on innovation, traditional knowledge Sami Labs consistently strives to draw strength from traditional knowledge of medicine. After making a strong global presence, the company now enters the Indian market with its direct selling company Sami Direct. Talking to Future Medicine, Dr Muhammed Majeed revealed his companyâ&#x20AC;&#x2122;s current projects and those in the pipeline

Key strengths, focus

Sami Labs is a leading global innovator and a market pioneer in the area of phyto nutrients, standardised herbal extracts and functional foods. It enjoys a formidable market presence and recognition in key nutraceutical markets like the US, Japan and Europe with wellness and life science companies. With its diverse and growing intellectual property portfolio and a pipeline of new products, Sami Labs continues to draw strength through the traditional knowledge of medicine. What sets Sami Labs apart is that it has been a constant and strong advocate of quality, research, science and clinical studies in its commitment to provide alternative and complimentary natural products. Therapeutically, the focus areas of Sami are anti-oxidants, cardio vascular adjunctives, liver support, blood sugar management products, antiobesity, oncological adjunctives etc.

Current projects

After making a strong presence in the international market, Sami Labs in the last couple of years has strategised to make a strong entry into the domestic market with its

direct selling company, Sami Direct. Launched in the year 2010, Sami Direct brings an entire range of nutraceutical and cosmeceutical products with therapeutic benefits. The rich, proprietary knowledge of Sami Labs, developed in the last 25 years in the form of various phyto nutrients and functional foods, has been converted into a vast range of tablets, capsules, protein powders, creams and lotions. The positive response the company has received in the market demonstrates not only a vibrant market but also the need for scientifically validated supplements and cosmetics. Sami Direct is on an excellent growth trajectory and aims to reach a Rs 1,000-crore mark in the next few years.

Track record

The group is currently celebrating its 25th anniversary. Set up in 1988, by Dr Muhammed Majeed, a sheer visionary and technocrat, the group initially focussed on the development of natural products based on Ayurveda to expand its nutraceutical market in the US. Emphasis was given to do research and development on products having potential for use as traditional medicines as an alternate form of therapy. April 2013 I FUTURE MEDICINE 61


PHARMAPRENEUR Dr Muhammed Majeed

The company started manufacturing in India in 1991. The R&D centre, the backbone of the company, was started in 1995. The basic idea was to offer dietary supplements that can assure a healthy life.

As the company started growing, the R&D efforts were directed towards the development of fine and speciality chemicals, biotechnology products, tissue cultured plant raw materials, cosmetic ingredients and food additives. Now the group holds nearly 80 patents worldwide. The major production facility was started at Kunigal near Bengaluru in 1996. The corporate

The basic underlying idea was to offer the people, dietary supplements that can assure them of a healthy life and help them to enjoy a healthy life style, especially at an age when the human body needs these essentials

Muhammed Majeed, Founder & Managing Director of Sami Labs, receiving the prestigious National Award for R&D instituted by FICCI in Hyderabad last year. R&D centre and offices at Peenya Industrial Area in Bengaluru started functioning in1998. The Biotechnology Unit was started in 2000 followed by the Supercritical Fluid Extraction Facility at Nelamangala.

A Continuous Extraction Facility was set up in 2007 at Dobaspet and this factory became operational in 2008. During the same period, another manufacturing facility was started in Hyderabad. Massive cultivation activities in India for important medicinal plants started in 2005. Drug licences from DCGI were obtained for two drugs developed by the company in 62 FUTURE MEDICINE I April 2013

2006/2007.

The company has received many awards for excellence in exports. In 2002, it won the National Award from DSIR for excellence in Industrial R&D. A facility to manufacture tablets, capsules and dietary supplements was set up in Utah, US in 2007. All production facilities in India received GMP certification from NSF (US) in 2007 and also successfully passed USFDA inspection in 2011. Offices were set up in Japan, Germany, Australia, China, South Africa, Dubai and Vietnam to do more business and local herbal procurement worldwide.


Swing on the water & make life in full swing

Thrikunnapuzha, Alappuzha, Kerala, India

Marari Beach, Alappuzha, Kerala, India

Alappuzha, Kerala, India

Administrative & Sales Office:

EDAKKADU GROUP OF COMPANIES

ATDC Alleppey, 2nd Floor, Municipal Library Shopping Complex, Thathampally P. O., Alleppey 688 013, Kerala, India Tel: +91 477 2264462, 2261693, 2230583, Tel/Fax: +91 477 2231145 E-mail: info@atdcalleppey.com I Web: atdcalleppey.com

Kerala Backwaters Pvt. Ltd., Alappuzha Coir Village Lake Resort Pvt. Ltd., Alappuzha Fishermen Village Beach Resort Pvt. Ltd., Marari Pepper Village Hill Resort Pvt. Ltd., Thekkady


INDIAN HOSPITAL FOCUS The Madras Medical Mission, Chennai

A hallmark of With quality healthcare, equity and compassion for all people, The Madras Medical Mission has become a hallmark of charitable medical care. Having less than two per cent mortality rate, the Mission has been making spirited efforts to ensure accessibility and affordability in quality healthcare in accordance with international standards

By Prashob K P

W

hat do The Madras Medical Mission (MMM) and the Greek God of Mysteries and Healing Dionysus have in common? A healing touch in their deeds. Madras Medical Mission took shape in 1982 with Bishop Zachariah Mar Dionysius’ initiative to promote a healthcare model based on compassion, care, and love. The Mission’s effort to set up a healthcare organisation came to fulfillment in June 1987 with the establishment of a cardiac care unit on the rented premises of another hospital in Chennai. After eight years, the Mission moved to its own premises at Mogappair, a suburb of Chennai city in 1995. And it made a grand entry into the healthcare sector with the inauguration of an eight-storey building by J Jayalalithaa, Chief Minister of Tamil Nadu, in the presence of Dr Christiaan Barnard, the world’s first heart transplant surgeon, Dr Pantpis Sakornpant, a record-holder in terms of heart and lung transplants in Asia, and several doyens of the cardiac world such as Dr Dominique Metras of France, Sir Terrence English of the UK, Dr Richard Engelmen of the US, and Sir Donald Ross treatment much more than of the UK. anything else. “Irrespective With a combined effort of health experts and of financial background, we practitioners and proper management guidance, this ensure quality treatment ISO 9001:2000 certified organisation has transformed for all and that makes the itself into a centre of excellence in three decades. difference. Making profit is Today, it promotes some of the finest super specialty not our motto, but profit is tertiary care medical institutions in India, with cutting inevitable to meet quality,” edge technology and accomplished professionals. says George Cherian M, The reason why this organisation stands out in the Director, Administration, The Mecca of India’s healthcare is that they rate qualitative Madras Medical Mission.

64 FUTURE MEDICINE I April 2013

The hospital has a strong management committee which comprises President, Vice President, Honorary Secretary and Honorary Treasurer. Policy decisions taken in the management committee are discussed in the board of directors’ meeting which includes 21 members, adds George.


quality healthcare

World class facilities The 256-bed Madras Medical Mission complex provides a tranquil environment with all sophistications, the state-of-the-art technology, high standards of cleanliness and hygiene. The hospital is equipped to treat everyone - from neonates to nonagenarians. As we stepped into a beautiful prayer hall with its windows adorned with the symbols of 13 religions

of the world, it became amply clear that the Mission offers healing of the spiritual kind as well. The magnificent new building resembles world class healthcare organisations. Operation rooms and intensive care areas are spacious and well equipped.

â&#x20AC;&#x153;The only challenge we are facing is the space constraints. The number of patients is increasing day-by-day and the hospital is facing constant challenges in

accommodating them, especially in critical care,â&#x20AC;? says George. The equipment installed here are the latest and upgraded versions. The symbiosis of the work force is the key strength of the entire organisation. From the top to the bottom level, the entire focus is on patient safety and quality improvement. The organisation attracts patients from over 35 countries and India. The hospital is backed by the most advanced NABL accredited performing complete range of investigative tests in the field of Nuclear Medicine, Radiology, Bio-chemistry, Hematology, Transfusion Medicine and Microbiology. The hospital has a vast computer network of over 300 nodes linked through Ethernet, utilizing the latest IT tools to support the best care and service to the patients. Institute of Cardio Vascular Diseases The Interventional Cardiology Department through its three state-of-the-art cineless catheterisation laboratories has performed approximately 35,000 procedures. The endstage heart failures are managed by Cardiac Electro Physiology Laboratory which is one of the few in India. More than 33,000 operations are named in the credit list of The Adult and Pediatric Surgical Departments, a rare achievement in the world. Off Pump Coronary Artery Bypass (OPCAB) has become an important and common means of surgical revascularisation here. The Paediatric Cardiac Surgical Department is a unique facility that handles the entire spectrum of congenital cardiac

April 2013 I FUTURE MEDICINE 65


INDIAN HOSPITAL FOCUS The Madras Medical Mission, Chennai

anomalies from neonates to infants and newborns to adolescents. The independent adult and paediatric intensive care units with its modern facilities of pendant systems, cardiac output monitoring and haemodialysis are comparable to the best in the world. The operation rooms and intensive care units are also equipped with the most modern infection control measures. Institute of Reproductive Medicine & Women’s Health Patients for all types of gynaecological management, including

Centre, renamed IKUOT (Institute of Kidney Diseases, Urology and Organ Transplantation) has successfully completed more than 650 transplantations. Nephrologists have started a peritoneal dialysis training programme, a first of its kind in Chennai. The Haemodialysis department has shown marked increase in the number of dialysis.

management of sub-fertility for both men and women, are taken care of with empathy, understanding and emotional support. “The best embryology lab in the country is here to provide high techniqueassisted treatment for couples. The Assisted Conception Clinic which is a forerunner of hope for childless couples functions in keeping with the international code of ethics with high success rates. In the short span of five years, the institute has 350 successful IVF (In Vitro Fertilisation) cycles to its credit,” says George. Institute of Kidney Diseases, Urology & Organ Transplantation. The Chennai Transplant

congenital anomalies, Laparoscopic equipment with the latest 3 chip HD video technology and ultrasonic dissectors are used for the state-ofthe –art key-hole urological extirpative and reconstructive surgeries on the kidney, bladder and prostate. The unit is equipped with the latest bipolar device to vaporise prostate with very minimal blood loss. Institute of Gastroenterology and Liver Diseases This institute is a centre of excellence providing comprehensive, compassionate care at optimal cost for prevention, diagnosis and treatment of patients with gastrointestinal and liver diseases. The institute is

66 FUTURE MEDICINE I April 2013

Infrastructure of the urology department has been obtained to surgically treat diseases of the genitourinary system, including urinary tract stones, cancers and

equipped with the state of the art technology which includes endoscopic ultrasound (Cancer staging, diagnosis and treatment of diseases of bileduct and pancreas) capsule endoscopy (Evaluation of small intestinal diseases) argon laser (Treatment of stomach and intestinal bleeding) high resolution manometry, pH, impedance(Diagnosis of refractory heartburn and motility disorders of esophagus), ERCP with C-arm(Treatment of bile duct and pancreatic diseases) and standard endoscopes for diagnosis and treatment of diseases of esophagus,

stomach and large intestine.

The Institute has a competent multi-disciplinary team which includes medical gastroenterologist, surgical gastroenterologist, intensivist, GI pathologist, and GI radiologist and support staff.

The third cathlab installed at MMM, Innova IGS 520, is the first fully loaded, state of art cathlab from GE Healthcare in South Asia. This is a fully integrated imaging system that meets a wide range of clinical needs for interventional and diagnostic imaging with excellent image quality, extensive real-time processing, innovative dose management, ease of positioning,


improved workflow and image management for excellent clinical versatility without compromise. Educational programmes under MMM Apart from the healthcare, MMM is moulding young minds for exploring the future needs of medicine through its educational programmes. “The Pondicherry Institute of Medical Sciences imparts comprehensive and quality medical education with ethical values. The institute is steadily making progress in its quest to provide commendable health care services to the needy and

provided theoretical knowledge, alongside functional domain exposure.

to its credit several major pioneering and innovative achievements in the field of multi-organ transplantation and transmyocardial revascularization, including the first heart transplant in the private sector, India’s first bi-lateral lung transplant, the country’s first paediatric heart transplantation, India’s first heart and lung transplant and small bowel transplant. Extending beyond the national boundaries of India, international collaborations with the developing countries to participate in their healthcare delivery and that

to train students to become worldclass physicians,” says George.

Healing touch “Out of our total revenue, seven per cent is utilised for charity and social welfare activities. Regular health campaigns and awareness seminars are conducted under the guidance of specialist doctors. Fully equipped mobile diagnostic clinics are running through the rural areas for providing treatment,” adds George. Most of the doctors are very keen on these kinds of activities apart from their routine work. Social activities are managed by medical social work department which is headed by two chapalin.

of developed countries are becoming the norm for The Madras Medical Mission. The Mission also entered into a public–private partnership with the Ministries of Health and Family Welfare of several countries, including Tanzania, Seychelles, Bangladesh, Fiji, Bahrain, Maldives and Rwanda for treatment of their patients, and also for training of their medical as well as paramedical professionals.

The MMM College of Health Sciences (CHS) is an educational unit of the MMM excelling in the conduct of regular UG and PG allied health sciences courses.

The MMM college of Nursing aims at preparing graduates to assume responsibility as professional, competent nurses and midwives in providing promotive, preventive, curative and rehabilitative services. CHS and nursing college are affiliated to The Tamil Nadu DR MGR Medical University. Scholars of CHS are

A year round Work Integrated Learning Programmes (WILP) in all sectors of healthcare industry ensures their industry worthiness and industry reduction. Distance learning programmes by the MMM College of Health Sciences in collaboration with Sikkim Manipal University helps working professionals to update their knowledge enhancement, job enrichment and also helps for promotional opportunities.

The Madras Medical Mission has

Apart from all theories and practices of industrious work force, a spiritual atmosphere of the organisation creates a great healing touch.

April 2013 I FUTURE MEDICINE 67


FOCUS Malabar Hospitals Ltd Palakkad

A centre for Bone healing

With experienced professionals and a dedicated work force, Malabar Hospitals Ltd Palakkad provides quality healthcare services in par with global standards. Dedicated to the people of Palakkad, the hospital offers a comprehensive care of fractures. Having 24hour trauma care, the hospital is fully equipped to deal with all kinds of accident cases Bureau 68 FUTURE MEDICINE I April 2013


quality healthcare. We have all modern facilities which we offer at reasonable rates,” says Dr Sunil Sreedhar, Chief Medical Director, Malabar Hospitals. It was in 2004 that a group of Palakkadbased medical professionals and businessmen started this hospital. Situated on the banks of Bharathapuzha and by the side of NH-47 in Palakkad, this healthcare hospital is a centre for orthopedic traumas.

all joint replacement cases, we do cement gun for pressurising during cementing, vacuum mixing of the cement, pulsatile lavage, pneumatic and cordless power saw/reamer system and a complete system for primary and revision arthroplasty. A computer navigation system is also part of the joint replacement armamentarium,” says Dr Sunil. The urology department is

“All types of orthopedic procedures are performed here which includes keyhole orthopaedic surgery (Arthroscopy) and hip and knee replacement surgery. The hospital has an advanced physiotherapy centre where post surgical patients are treated under the guidance of qualified physiotherapists,” says Dr Sunil.

A dedicated group of specialised doctors and trained work force are the core strength of this 50-bed hospital. The orthopedic surgeons at Malabar Hospitals have diverse expertise and are committed to provide effective solutions to orthopaedic problems.

S

ticking to quality, Malabar Hospitals Ltd Palakkad aims to provide world class healthcare at an affordable cost. Dedicated to the people of Palakkad, this specialty centre for bone and kidney is supported by a team of highly qualified medical professionals and paramedical staff. “Our main focus is on providing

“We do all kinds of Fracture fixations using the latest state-of-the art equipments and instruments. Ours is the first centre in Palakkad to do keyhole surgery for knee and shoulder problems. We do all complex shoulder, hip and knee replacement surgeries. We also treat spine fractures and deformities specialists trained in spine and pediatric orthopedic surgery do corrective surgeries” says Dr Sunil.

The centre offers all types of joint replacement to restore freedom of movement and relieve the pain of degenerated and diseased joints. Surgery often provides dramatic improvement in daily functioning of people with arthritis. Medications and physical therapy services are helpful add-ons. “For

Dr Sunil Sreedhar, Chief Medical Director, Malabar Hospitals undertaking all types of urological procedures, including stone treatment-ESWL (Extracorporeal Shock Wave Lithotripsy) PCNL (Percutaneous Nephrolithotomy) and endo urological procedures. Plastic and reconstructive surgery, rheumatology, maxillofacial surgery, neurology, radiology and general surgery are also available at the hospital. The hospital is fully equipped to deal with all kinds of accident victims round the clock. Malabar Hospitals is engaged in the health care services like medical laboratory services, ultrasound and color Doppler, digital X Ray, whole body CT scan, neurology and epilepsy care. With all this facilities Malabar Hospitals draws special attention with its quality services in par with international standards at an affordable cost.

April 2013 I FUTURE MEDICINE 69


FOCUS Trinity Eye Centre, Palakkad

Eye care par

excellence

‘Of all the sense, sight is the most delightful’

Y

Helen Keller

es, vision is the most delightful sense and eyes are the window to the soul. Eyes are at work from the moment we wake up to the moment we go to sleep. They take in tons of information about the surroundings that include shapes, colours and movements. But we often neglect its care even if it is facing unsafe conditions. It is high time we take extra care of eyes. Providing advanced and sophisticated eye care at an affordable cost is the mission of Trinity Eye Centre in Palakkad, Kerala.

This specialty hi-tech eye hospital provides a holistic approach towards eye care. “Even though this centre is dedicated to the people of Palakkad, our quality service gains the attention of people in other districts and the neighbouring states,” says Dr Mridula Sunil, Chief Medical Director.

Trinity Eye Centre is redefining the term ‘vision care’. Sticking to global standards, Trinity offers treatments at an affordable cost. With highly qualified, experienced and efficient ophthalmologists, paramedics and support staff, the hospital provides quality eye care Bureau

The hospital was started in 1999 as Trinity Medical Centre which was a small clinic. Later, the centre began to focus on eye care. Some of the equipments have been imported from the US. The centre adopts the latest technologies and practices in prevention, diagnosis and treatment with a strong commitment. “We provide a comprehensive range of facilities for the benefit of patients suffering from eye diseases. The centre assures maximum ophthalmic care with the highest level of expertise, competence and concern. We are the first centre in Palakkad to introduce phaco surgery and also experts in grafting with glue technique also,” says Dr.Mridula. Modern facilities Trinity provides all the amenities under

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one roof. The institute provides quality eye care with highly qualified, experienced and efficient ophthalmologists, paramedics and support staffs. “The centre has a well equipped modern laboratory, ultramodern theatre complex that consists of two well equipped operation theatres manned by qualified and competent staff. Optical Coherence Tomography (OCT) imaging technique is used for refined scanning,” Dr.Mridula adds. Another speciality is the electronic medical recording system. All data, including prescriptions, are digitally recorded that means the hospital is paper less. Trinity is using high end machines which are capable of updating for diagnosis and treatment. The centre is using the world phaco system with infiniti ozil technology by Alcon US. It is the only centre in Palakkad Dr Mridula Sunil, Chief Medical which acquires Director, Trinity Eye Centre the system and provides the safest and perfect cataract surgery. “Ozil technology employs torsional phaco working on oscillatory movement of the needle cutting cataract, unlike traditional ultrasound that works on the to and fro movement of the needle. This along, with extraordinary fluidic management system of the infiniti machine, helps achieve better outcome in cataract surgeries,” explains Dr. Mridula. The new infiniti vision system is the world’s first tri-modal cataract removal surgical instrument.

Key Facilities Advanced Micro-Pjaco with foldable (pin hole surgery) Pterygium excision-grafting with glue Retinal Laser, FFA Diabetic eye check-up Glaucoma field analyzer Yag laser Master Eye Check-Up Contact lens clinic Clinical Laboratory With infiniti technology, phaco emulsification surgery is made very safe and predictable for better patient outcome, Dr.Mridula adds.

Trinity assures specific and exclusive treatment for various eye ailments. “We do painless and injection free cataract surgery using topical medication which means faster recovery without eye-patch, early return to work and avoidance of needle phobia. Our services include cataract, glaucoma, diabetic retinopathy, oculoplasty, pediatric ophthalmology and computer vision syndrome. Today, with the state of art facilities and experienced ophthalmologists, Trinity Eye Centre became the number one hospital in Palakkad. The centre is very keen on updating the equipment. Apart from the vision care, Trinity also offers one-year certificate courses in optometry, ophthalmic assistant, optical fittings. The centre also plans many national and international conferences, seminars and workshops under Trinity Charitable Trust for the benefit of the medical fraternity.

April 2013 I FUTURE MEDICINE 71


FOCUS Sree Sanjeevini Solutions, Bengaluru

Cold Lasers

make treatments

easy Cold Lasers are the new healers. Painless and incision-free Cold Laser surgeries are all set to replace conventional methods of treatments. With clinical precision, faster recovery and no post-surgery medication are the added advantages of Cold Laser treatments. Bengaluru-based Sree Sanjeevini Solutions offers a full spectrum of treatments using Cold Laser therapy Bureau

C

old Laser treatments are known for its clinical precision. Cold Laser is increasingly used to make treatment process non-surgical and painless. Cold Laser therapy or low Cold Laser therapy is an

innovative way of treatment. It is a non-invasive procedure and it does not require surgical incision and medication. Studies so far have found that cold Cold Laser therapy does not have serious side-effects when used properly by a doctor.

Sree Sanjeevini Solutions introduced the cold Cold Laser therapy for the first time in the country. Based in Malleswaram, Bengaluru, Sree Sanjeevini Solutions offers a full spectrum of Cold Laser treatments. It was

Certified Cold laser therapy specialists of Sanjeevani Dr Harish Kumar 72 FUTURE MEDICINE I April 2013

Dr Sindhu M

Dr Farahan Ahmed

Dr Harini Chilka

Dr Rashmi Solanki


mobility, increase tissue integrity and promote cell regeneration,” says Ramesh, CEO.

Sanjeevni knows how to provide optimal patient care through cold Cold Laser therapy. The team includes experts in Cold Laser technology, de-addiction, orthopedics and sports medicine, physiotherapy, psychologists and counselors. “Our core team has expertise over 60 years in handling severe cases of drug addiction. The team members monitor closely till the entire process is completed,” says Ramesh. The Cold Laser equipment at Sanjeevini supplies energy to the body in the form of billions of photons of light. The body absorbs this Cold Laser light on a cellular level and transforms it into chemical energy, which the body uses to commence its own tissue repairs. The bio stimulating effect of Cold Laser therapy causes a decrease in inflammation and pain and an increase in tissue regeneration and healing. “Our dual wavelength super pulsing technology is the only Cold Laser that penetrates up to four inches into tissue activating all three known cellular pathways,” adds Ramesh.

in 2010 that Lakshmi, director of the firm, met with a road accident. The blood supply to her leg was hampered and doctors suggested amputation. Then she tried the Cold Laser technology from Canada and restored the complete blood supply. This incident itself is an example of the credibility of this treatment. “With our cutting edge technology, we penetrate further, heal faster, and relieve the pain of patients. Our therapeutic Cold Laser treatments provide patients with a safe, effective and painless therapy that uses the body’s own natural healing systems to relieve pain, increase joint

Sanjeevini focuses on pain management such as repetitive strains, disc prolapse, neck/low back spondylitis, ankylosing spondylitis, frozen shoulder, sports injuries, diabetic neuropathy, phantom limb pain, rheumatoid arthritis, sports injuries, migraine/sinusitis, stress/ sex problems, disturbed sleep, inner ear diseases and tinnitus. Cold Cold Laser therapy is widely used in ‘quit addiction’ programs aimed at chronic smokers, drug users, and consumers of other harmful substances. There is also a therapy for wound management in cases like foot ulcer, psoriasis, varicose veins, and post-surgery wounds. “Medical practitioners across North America have discovered a technology that heals injuries safely and effectively at the cellular level. This medical technology

is our line of therapeutic medical Cold Laser systems. Cold Laser energy helps repair damaged cells by accelerating the body’s natural healing mechanisms,” says Ramesh. Sree Sanjeevini plans to expand its network all over India. In near future cold Cold Laser therapy will create a great development in pain management.

Sree Sanjeevini’s business operations have grown manifolds since its inception. It began its first center at Malleswaram with two employees and today, it has spread its wings to two more locations in Bengaluru and shortly new centers will be established in other states of India and at abroad in a country like Russia. The main reason for the success of Sanjeevini is that the organisation is managed and supported by experienced entrepreneur and mentor BS Vishwanath and a dedicated team of Cold Laser specialists, doctors and satisfied patients’ canvassing and referencing.

Benefits of Cold Laser therapy • • • • • • • • • • • •

Non-toxic Decrease/eliminate pain Reduce inflammation Promote new blood vessels and tissue growth Promote nerve axon growth Faster wound healing and closure Virtually painless Non-invasive Highly effective and no side-effects Drug free Completely safe Easy to apply

April 2013 I FUTURE MEDICINE 73


FOCUS New Alma Hospital, Palakkad

Low cost modern treatment facilities at your doorstep

The New Alma Hospital, Mannarkkad in Palakkad was started as a humble venture by Dr K A Kammappa with just 14 beds and 15 staff in 1995. Since then, the hospital has made great strides in management efficiency, safety aspects and in providing modern treatments to become a leading gynecology hospital in Kerala. In an interview with Future Medicine, Dr Kammappa talks about the growth of Alma Hospital, its current status and future plans By Mukesh Venu 74 FUTURE MEDICINE I April 2013

K

ammappa began his career in the government service at Mannarkkad Taluk Hospital in 1986 and continued till the early 90s. In 1995, he started Alma Hospital in partnership with his friend and colleague Dr Ananthanarayana as a small general hospital to serve the people of his locality. “I was a well-known gynecologist in the locality and naturally gynecology became the speciality of the hospital though pediatrics and ENT services were available there,” says Kammappa .

Within five years after its inception, Alma Hospital registered a steady growth to become a wellequipped, 60-bed hospital with full

time service of around 12 doctors. Taking into account the growing need of space and infrastructure facilities, the hospital was shifted to a new location in the town and was renamed New Alma Hospital. “The land, building and equipment of this hospital belong to me,” says Kammappa. “But the partners are still there. A rent for the building is paid to me by the management,” he adds.

“There is a lack of good speciality hospitals in Mannarkkad. We are planning a good trauma care centre in the hospital. We are doing exceptionally well in gynecology with 4D scans and a neonatology care section. The hospital has a good laparoscopic


centre and well equipped laboratories with hi-definition cameras,” he adds.

Kammappa says: “We have just 27.61 per cent LSCS while the state average stands above 50 per cent. I prefer and advocate natural birth and we take care to make women understand the value and benefits of the natural birth in this hospital.” The number of cesarean births in the state has gone up steeply during the last 15 years. It is because of the wrong notion that cesarean procedure is safer than natural delivery. But Kammappa contradicts this view, saying, “It is a misconception that cesarean is safer than natural birth. If you take the instances of complications or even death while giving birth, you can find that there are more complications in cesarean procedures. The fact is that after doctors were included in the Consumer Protection Act in 1995, every patient is seen as a potential

management. Anesthesia was always there, but it was a very troublesome procedure and risky as well. Nowadays, we use oxynox - a gas mixture of oxygen and nitrous oxide -which the patient can use on her own. When the pain comes, the patient just breathes it in. It has shown wonderful results by effectively bringing down the number of cesarean births. Firsttime mothers are often nervous and it causes delay in dilatation. If there is no pain, the patient will not be anxious and dilation happens ensuring a smooth delivery. The delivery interval is also very much reduced through this process. Previously, it used to take up to six hours, but with oxynox we have been able to cut it down to below three hours, ” says the doctor. “We stand first in Kerala in pollution control amongst small hospitals. We received an award on the Environmental Day, June 5 last year from Chief Minister Oommen

Birth statistics at New Alma Hospital for 2012 Total births– 4,346 Normal deliveries – 3,146 Lower section cesarean section (LSCS) – 1,200 (First CS – 795, Repeat CS - 405) litigant. Cesarean is actually a defensive medicine as doctors want to be on the safer side. Waiting for a natural birth is risky because doctors cannot see the outcome. So they prefer a safe mode and suggest cesarean rather than waiting for natural birth.” The latest technology has also helped New Alma Hospital in reducing the number of cesarean cases. “The most important thing that has come to aid the process of natural birth is effective pain

Chandy. We are very particular about effective waste management, more so as the hospital is situated in thickly populated area. “Another honour for the hospital was a visit by Prof K B Ramani of IIM- Ahmedabad, the only institution in India that awards MBA in Hospital Management. Last year, we got selected for the annual workshop conducted by the IIM on hospital management. At the workshop, we explained our activities and presented the statistics. The hospital was rated one of the low cost hospitals in the

Dr K A Kamappa, Medical Director, New Alma Hospital country that provides exceptionally good treatment and care to patients. For instance, a normal delivery, in the case of a general ward patient, costs around Rs 3,000. For cesarean, it comes to around Rs 9000, which is less than that of the government hospitals,” he adds.

“Last year, the hospitals that IIM-A studied included CMC Vellore, Apollo Hospital Chennai and Bangalore Baptist Hospital. Our bed utilisation ratio is higher than these hospitals. It simply means that our hospital management system is as excellent as the treatment we provide here,” says Kammappa.

And the future looks more exciting for New Alma Hospital as Kammappa unveils his plan to blend traditional and modern medicines. “We are planning to start an Ayurveda clinic in our former hospital building in association with Vaidyaratnam. In this part of the world, it is commen that all women, after delivery, take Ayurveda treatment. Spurious activities and malpractices are taking place in many cases leading to complications and sometimes even death. So if we start an Ayurveda centre, it will be a perfect blend of Allopathy and Ayurveda and we would have an ideal set-up in gynecology,” he says. April 2013 I FUTURE MEDICINE 75


FOCUS Rayirath Heritage

A name to be

reckoned with

Rayirath Gardens of late has entered the hospitality industry with the launch of Rayirath Heritage which is situated in the middle of the garden. The resort offers various services, including body immunisation, body slimming, skin and beauty care, de-stress, body and mind relaxation By Tony William

I

f you are a frequent traveller and happen to pass through Mannuthi, a village located on NH-47 between Thrissur and Palakkad, you can’t refrain from noticing several nurseries on both sides of the highway. Mannuthi, acclaimed for the most number of nurseries in Kerala, also hosts the Kerala Agricultural University.

Near Mannuthi, in the canyon of Vellani Hills, lies Rayirath Gardens. A nursery noted for its wide variety of medicinal plants, Rayirath Gardens has entered the hospitality sector with the launch of Rayirath Heritage. Clubbing the idea of garden and resort, Sudhakaran Rayirath has managed to create a unique business model. It functions as an Ayurvedic resort with technical

76 FUTURE MEDICINE I April 2013

support from the Amrita Life and is the lone brand partner of the latter, which is a subsidiary of Mata Amritanandamayi Math. “We consider this partnership with Amrita Life as a special privilege,” says Sudhakaran, a farmer as well as a botanical expert.

Stationed in eight acres of medicinal plant garden, the resort enjoys a symbiotic relation with nature and provides its occupants a fine ambience, away from the hustles and bustles of city life. “We give special attention to maintain the serenity of nature. Our cottages are eco-friendly,” says Sudhakaran. Packages at Rayirath Heritage include body immunization, anti-cellulitis programme, body slimming, skin and beauty care, destress, body and mind relaxation. “Our OP is free on all days except Sundays. We are spreading the vision of Amma to people through this,” says Sudhakaran, who is a devotee of Mata Amrithananda Mayi. Rayirath Gardens situated on the premises of Rayirath Heritage also requires a special mention. Sudhakaran established Rayirath Gardens in 1982 with a focus on cultivation of fruits, gardening, ornamental, tissue culture and rare medicinal plants. “Among nurseries, we wanted to be different. Sudhakaran Rayirarth, MD, So we focussed on Rayirath Heritage medicinal plants and identified the need for it in the future. It was a turning point,” says Sudhakaran. It is the only GMP certified nursery in Kerala. He has also the credit for setting up herbal parks in prominent universities, colleges, schools, departmental firms and leading Ayurvedic resorts of Kerala.

When asked about the various roles he does-that of a farmer, botanical expert, resort owner etc-he says, “I don’t want to limit myself into a single field. The true challenge lies in conquering unchartered terrains.” He has also published a book titled ‘A farm guide for healing plants’ for the herbal lovers. He is also into the creation of a large herbal park to help the research scholars and students. He has received many awards and accolades, including Punarnava Award, Gandhi Award and International Business Achievement Award, sponsored by Kairali TV.

Several visitors, including foreigners, have been flocking to Rayirath Resorts. Well-known personalities who are regular visitors here include Carnatic musician and composer V Dakshinamoorthy and ISCON Vedic priest Anandamaya Dasa.


MEDICAL FILMS

Here is a synopsis of a few foreign films which portray characters with diseases like cancer and very strong medical problems

The Doctor

Released in 1991 The Doctor is a drama film loosely based on Dr Edward Rosenbaum’s 1988 book A Taste of My Own Medicine. The film stars William Hurt as Jack MacKee, a doctor who undergoes transformation in his views about life, illness and human relationships after he was detected with cancer.

Body Parts

Body Parts is a horror thriller film directed by Eric Red. The movie depicts the story of a criminal psychologist who loses his arm in a car crash, and becomes one of three patients who have their missing limbs replaced by those belonging to an executed serial killer. One of them dies and disturbing occurrences start happening to the surviving two.

Blindness

Blindness, a 2008 movie, is an adaptation of the novel of the same name written by the Portuguese Writer Jose Saramago. The film is written by don McKellar and directed by Fernando Meirelles. Julianne Moore and Mark Ruffalo played the lead roles.

Awake

Awake is a 2007 American movie written and directed by Joby Harold. The story focuses on a man who suffers “anesthetic awareness” and finds himself awake and aware, but paralysed, during heart surgery. His mother must wrestle with her own demons as a drama unfolds around them, while trying to unfold the story hidden behind her son’s young wife

Blessed

Blessed is a 2004 British/Romanian horror film directed by Simon Fellows starring Heather Graham and James Purefoy. The movie depicts the story of a woman who visits a fertility clinic . The visit becomes an unfathomable nightmare for her after she is impregnated with the devil’s DNA.

Prepared by Neethu Mohan

April 2013 I FUTURE MEDICINE 77


INSPIRATION

ON A MISSION: M S Athirup (Centre) at Technopark

A bicycle ride to

healthy life

R

ushing to offices in luxury cars, gobbling up junk food and lack of exercise are what we often come across in big cities. Bequeathing a great sigh of relief to those who are struggling with a hectic schedule, Athi’s Bicycle Club (ABC) is on a health ride providing bicycles in the major cities of Kerala for Rs 2 per hour.

A cycle enthusiast since childhood, it was M S Athirup’s dream to start a Cycle Club in Kerala. In 2011, the software engineer kick-started ABC in the capital city of Kerala. With about 2,500 users, the club also has services in Kochi. The SMS-driven club has cycle racks at 15 major points in Thiruvananthapuram and 14 major points in Kochi and a few at Technopark.

Anyone with a mobile phone can become a member of the club by sending an application via SMS (Type form to receive the application form) to 96455-11155. ABC charges a membership fee of Rs 500, and Rs 50 monthly. Members can take a bicycle from any rack and return it to any rack. Entire operations are through mobile phones and payments can be made by depositing cash in a drop box at any rack. “As the people living in cities have a sedentary lifestyle, there are many health problems. ABC will be a great help for the people to stay healthy and our city will be

78 FUTURE MEDICINE I April 2013

By Shalet James

also pollution-free,” says M S Athirup. ABC also plans to meet shopping complexes, banks, railway stations and bus terminals seeking their help to promote cycling culture and permission to set up bicycle racks. ABC is now gearing up to start operations in Thrissur soon.

Health benefits • • • • • •

Improves cardiovascular fitness Helps in toning and building your muscles Keeps weight gain down Increases longevity Improves mental health Strengthens immune system


Moving is the best medicine. Keeping active and losing

weight are just two of the ways that you can fight osteoarthritis pain. In fact, for every pound you lose, thatâ&#x20AC;&#x2122;s four pounds less pressure on each knee. For information on managing pain, go to fightarthritispain.org.


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