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Editorial

Inclusive healthcare through IT

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Keen to know how the recent technologies and latest advances in hile the healthcare sector in India faces daunting challenges on one hand, it promises material sciences are leading to breakthrough of sorts in dentistry? myriad compelling opportunities on the other. The ‘Specialty Scope’ digs deeper into it. With the ever growing needs of the planet for energy, one cannot From providing outstanding infrastructure to developing state-of-the-art diagnostic and medical equipment, help but wonder about the sustainable source for continued supply and from offering highly economical clinical trials to delivering in the future. To this, if we add parameters such as economy, impact telemedicine at the farthest corners of the country, the healthcare on ecology, scaleability etc, the potential solutions do not get simpler. sector is at an inflection point. In this watershed moment, the Amid this scenario, the nuclear energy provides a silver line of hope by being not only economical but also by being relatively clean. role of Information Technology (IT) can be crucial. However, the recent nuclear predicament in Japan has once again To begin with, hospitals can leverage IT towards need-based storage, organisation, management, analysis, on-demand prompt raised eyebrows and drawn the world’s attention on the preventive retrieval and use of data such as images and electronic medical safety mechanisms as well as the preparedness to effectively deal record. Moreover, with the leapfrog of technology, telecardiology, with any such incident. Prima facie, there is an ardent need for a teleradiology, telepsychiatry, telepharmacy and telesurgery are multi-pronged strategy that should include creating mass awareness, predicted to be regular medical procedures sooner than later, putting in place a functional regulatory ecosystem and ensuring which would herald the era of inclusive healthcare. The next availability of adequate number of trained professionals in the phase may involve making healthcare more patient-friendly by time of need, among others. The ‘Roundtable’ offers several expert perspectives on nuclear radiation contamination and beyond. virtue of online patient portals and even e-hospital! In short, IT can not only integrate and optimise the available resources in healthcare but also decongest the vital infrastructure unique to healthcare centres. All said and done, there is a need for robust regulatory guidelines for data capturing and for Manas R Bastia portability & confidentiality of the data. Turn to ‘Sector Watch’ Editor manas@infomedia18.in for a glimpse of how IT is aiding and shaping healthcare.

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Contents

23 Experts Speak Dr Naresh Trehan Chairman & Managing Director, Medanta

40 Sector Watch IT in healthcare: Welcome to the world of opportunities!

46 Specialty Scope Advancements in dentistry: Em‘bracing’ a perfect smile

28 Roundtable Radiation contamination: Are we equipped to face any eventuality?

REGULAR SECTIONS 6

Editorial

10

National News

18

World News

34

Hospital Monitor

Policy Matters Dwindling sex ratio: A matter of concern

Bombay Hospital and Medical Research Centre: Bringing medical education to the forefront

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Health Chip Semiconductors in patient monitoring systems: A new paradigm in treatment and diagnosis Rakesh Joshi, General Manager – Business Development (Medical), Texas Instruments India

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Dr Sanjay Gupte, MD, DGO, FICOG, FRCOG, LLB, President FOGSI 2010

56 Imaging Diagnostics Biograph mMR™: A milestone in diagnostic imaging Courtesy: Siemens Healthcare, Siemens Ltd

Facility Visit Ree Laboratories Pvt Ltd: ‘Ree’juvenating hope

66

Events Calendar

70 79 83 86

Product Update Rx Product Index Advertisers’ List

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Highlights of Next Edition Sector Watch: Clinical Research Specialty Scope: Neurology Note: ` stands for Indian rupee, $ stands for US dollar and £ stands for UK pound, unless mentioned otherwise Cover photo: Shamik Banerjee

I May 2011


National News

In Brief Dr Arvinder Singh Soin honoured with RD Birla National Award Padma Shri Dr Arvinder Singh Soin, Chief Liver Transplant and Hepatobiliary Surgeon, Chairman, Medanta Institute of Liver Transplantation and Regenerative Medicine, The Medicity, Delhi NCR, was awarded the twentysixth Rameshwardas Birla (R D Birla) National Award for outstanding clinician. The award was presented on April 2011, by Hon’ble Shri Ashok Gehlot, Chief Minister, Rajasthan. Along with being the first Indian to qualify and obtain an Intercollegiate FRCS in transplant surgery, Dr Soni has also performed the maximum number of liver transplants in India. Besides, he conducted India’s first successful cadaveric liver transplant in November 1998 and the country’s first successful adult-adult (living donor) right lobe liver transplant in March 2000. He was selected for the R D Birla National Award by a distinguished jury headed by Justice P N Bhagwati, former Chief Justice, Supreme Court, India. The award consists of a memento, a citation and a cheque of ` 5 lakh.

Telerad Tech’s RADSpa™ bags NASSCOM award and the company launches RADSPA-DITM TeleradTech India Pvt Ltd was awarded the ‘Best Picture Archival and Communication System’ for their product RADSpa™ by National Association of Software and Services Companies (NASSCOM) in collaboration with KPMG at the first Healthcare IT Awards held in Hyderabad. The awards were presented by Kiran Reddy, Chief Minister, Andhra Pradesh and Harsh Manglik, Chairman, NASSCOM. RADSpa™ is FDA and CE approved and has customers across geographies in the USA, Europe and India. According to Ricky Bedi, CEO, Telerad Tech, “TeleradTech developed RADSpa™ is the next generation radiology workflow intelligence system developed by radiologists ‘for radiologists’.” In another development TeleradTech, the technology division of Teleradiology Solutions announced the release of its dental imaging workflow platform RADSPADITM. RADSPA-DITM addresses the unique requirements of dental imaging workflows while it retains the robust and fast image management and sharing technology of its flagship Radiology imaging workflow platform, RADSpaTM.”

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Hinduja becomes third in the world to receive ISO 27001:2005 One of the world class leaders in healthcare delivery, Hinduja Hospital, Mumbai, has received the ISO 27001: 2005 certification from ISOQAR (UKAS accredited certification body) after successfully completing all the requirements set by the ISO 27001 standard under UKAS Accreditation. It has become the third hospital in the world to receive this certification. It is the world’s highest accreditation for information protection and security with regard to its IT information assets utilised by various functions of the hospital for providing healthcare services. The ISO 27001:2005 certification ensures complete confidentiality, integrity of a patients’ medical and personal information in all aspects of patient care and safeguards patient privacy through tight security performance in information handling practice. The hospital had to undergo a rigorous schedule of training, audits and process optimisation for six to seven months to receive this official recognition. Mahesh Shinde, Deputy Director – IT, Hinduja Hospital, commented, “An intricate hospital environment has information that needs to be classified. ISO 27001:2005 helps our hospital in implementation of effective information management system. Information Security protects information from a wide range of threats while Information Security Management System (ISMS) is a systematic approach to managing sensitive hospital information so that it remains secure.”

Fortis receives in-principle approval to acquire strategic stake in SRL Fortis Healthcare (India) Ltd, one of the fastest growing chain of hospitals in India, has received an in-principal approval from its Board of Directors in its meeting held recently to acquire 86 per cent stake in Super Religare Laboratories Ltd (SRL), one of the largest and leading diagnostic services companies, offering diagnostic testing, preventive care testing and clinical research trial testing. In addition to the two recently launched verticals, C-Doc for diabetes & metabolic diseases and stem cell therapy centres, the Board in its meeting approved the setting up of standalone dialysis centres and a foray into standalone & in-hospital diagnostic centres. The in-principle approval to acquire stake in SRL is a step in this direction. In its current phase of growth, Fortis is focussed on ‘medical inclusion’, which would mean more comprehensive healthcare services that extend beyond India’s metros, into the smaller cities. Besides the stated target of at least 25 hospitals in India’s tier-II and tier-III towns over the next two years, Fortis is adding new verticals focussed on medical specialities. SRL provides routine, specialised and esoteric tests, and after acquiring the Piramal Diagnostic Services Pvt Ltd (PDSPL) in August 2010 has now become the largest radiology service provider in the country. Commenting on this acquisition, Shivinder Mohan Singh, Managing Director, Fortis Healthcare (India) Ltd, said, “The new structure is a meaningful step toward medical inclusion in India and will help us offer value-based medicine.”


National News

In Brief First International Patient Safety Congress inaugurated The first International Patient Safety Congress, a two-day conference hosted by Apollo Hospitals Group was inaugurated by Preetha Reddy on April 21, 2011 in Hyderabad. Speaking at the occasion, Reddy emphasised, “We have come together to address this issue, which focusses on the reporting, analysis and prevention of medical errors that might lead to adverse situations. A challenging global issue, both for the developed and developing countries, patient safety also helps in defining quality healthcare.” Elaborating on patient safety, Ann Jacobson, Executive Director, JCI, said, “To promote patient safety, practitioners should identify problem areas in a hospital and thereafter develop practices to correct these errors. JCI-accredited hospitals have a mandate to conduct a root cause analysis of any sentinel event within 45 days of occurrence.”

VLCC Pritikin Longevity Program now in India VLCC Health Care Ltd has introduced in India the world’s most effective diet, exercise and lifestyle change programme, Pritikin Longevity Program. The first Pritikin Longevity Center and Day Spa, located in New Delhi will introduce to India scientifically documented diet, fitness, and healthy living programme. The center and day spa offers health, lifestyle, spa and wellness packages for prevention & management of conditions like diabetes, heart disease, hypertension and overweight/obesity.

Carestream sells 100th CR system Carestream Health India sold its 100th DIRECTVIEW Vita Computed Radiography (CR) system since its launch in October 2010 and globally Carestream has shipped almost 1000 DIRECTVIEW Vita CR systems. The system weighs 36 kgs and its durable design holds up in extreme conditions and is easy to transport. It is being purchased by imaging centres, clinics, multi-physician offices and orthopaedic facilities. “These facilities want to implement digital imaging technology and many are choosing the Vita CR platform to make that conversion,” Prabir Chatterjee, Managing Director, Carestream Health India.

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Apollo launches first-of-its-kind, digital mammography with tomosynthesis (3D) in South Asia South Asia’s first-of-its-kind, full-field digital mammography with tomosynthesis (3D) system was inaugurated at Apollo Speciality Cancer Hospitals, Chennai, by Dr Prathap C Reddy, Chairman, Apollo Hospitals Group, in the presence of Jack Cumming, Chairman, Hologic Inc, USA and Dr G S K Velu, Founder & Managing Dr Prathap C Reddy, (right) inaugurates the full field Director, Trivitron Healthcare. Digital mammography with tomosynthesis digital mammography with (3D) is the latest technology for breast tomosynthesis (3D) system in cancer offering exciting opportunities. Dr presence of Jack Cumming, (extreme left) and Dr G S K Velu, Reddy remarked, “The contemporary digital (second from right) mammography with tomosynthesis (3D) technology will enable faster and accurate stereotactic biopsies. This technology needs shorter examination time for diagnosis of breast cancer and also significantly improves patient comfort and convenience and will certainly motivate early detection.” Other benefits of digital mammography may include, low dose of radiation, availability of large database since information is stored digitally, all images are archived and stored digitally, and hence loss or damage of films will not affect patient care during follow-up and the information can be sent electronically to other centres.

Health insurance penetration key to ensure healthcare access in India: Experts A whitepaper released by PricewaterhouseCoopers and India Health Progress recommends health insurance as one of the key pillars to increase access to healthcare in India especially among the economically challenged patients. Less than 15 per cent of the Indian population is covered under some form of health insurance, including government-supported schemes. Only around 2.2 per cent of the population is covered under private health insurance, of which rural health insurance penetration is less than 10 per cent. Sujay Shetty, Leader - Pharma Life Sciences, PricewaterhouseCoopers said, “India’s diverse population has limited purchasing power. Penetrating this market, therefore requires innovative insurance products at multiple price points. But innovation in the current Indian health insurance market needs to evolve considerably. Low-priced insurance products can play a big role in ensuring higher healthcare access for poor sections of the society.” The whitepaper is the outcome of a roundtable meeting held on January 24, 2011 on Health Insurance at India Islamic Cultural Centre, Delhi. The conference was attended by various governemnt and industry leaders from insurance, pharmaceutical and health sector as well as doctors. Public-Private Partnership (PPP) would be best to meet these meet the country’s health insurance needs. “Affordability of healthcare by low income sections of the society is a matter of concern when it comes to healthcare access. Also, the out of pocket spending by middle income families on healthcare leads to economic depletion hence affecting their overall health needs. Health insurance help in a long way to solve this issue,” said Aman Gupta, Principal Advisor, India Health Progress.


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National News

In Brief 300 Trivitron employees paint government school as a CSR activity The students of St Thomas school in Uthandi were indeed a happy lot when the government school got a colourful facelift. Around 300 employees of Trivitron Healthcare visited St Thomas government school located on the outskirts of Chennai and volunteered to beautify the school campus by painting the school walls with different hues. Highlighting the initiative Dr G S K Velu, Founder and Chairman, Trivitron Group of Comapanies, said, “As a key healthcare player for the masses, we believe in a healthy and stress-free environment. Looking at the impact caused by a dusty habitat upon children, it was necessary for the school to renovate the school beams and walls, and thus create clean and airy surroundings. We are happy to contribute to the healthy progress of these children and let them breathe in a disease-free environment” The 300 employees who came from various divisions of Trivitron Healthcare cleaned the campus, thereby reinforcing the statement - ‘A healthy school means a healthy mind.’

Piramal Group’s HMRI wins NASSCOM award HMRI has won the NASSCOM and KPMG Healthcare IT Awards 2011 under the Best Technology Solution for Healthcare Inclusion category for its telemedicine solution. This award recognises projects that have helped in greater outreach by taking the healthcare solutions to sparsely populated regions or to low-income groups. HMRI’s solution is a unique multi-parameter, patient centric telemedicine solution in India. This solution is a comprehensive digital solution integrating patient records, diagnostics, physical examination and clinical outcomes. It has been successfully deployed and is operational in Vallabhi village of Khammam district and the tribal belt of Araku valley in Andhra Pradesh. HMRI a not-for-profit organisation, supported by the Piramal Group, endeavours to strengthen existing public health systems and leverage Information, Communication and Technology (ICT) tools to augment healthcare delivery by providing access to low-cost physical and virtual healthcare services to the rural population.

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Prayas for (HER2) breast cancer patients by Tata Memorial Tata Memorial Hospital recently launched Prayas, an initiative aimed at providing better access to treatment for Human Epidermal Growth Factor Receptor-2 (HER2) positive breast cancer patients from the lower income strata who will receive some medications L-R: Dr Rajendra Badwe, Dr Franz B Humer free of cost. and Deveika Bhojwani, Vice President, “Of the 100,000 new cases of Women’s Cancer Initiative breast cancer diagnosed every year in India, around 20-25 per cent are estimated to be (HER2) positive. This form of breast cancer is relatively resistant to hormonal treatment and has a higher rate of recurrence. The outcome for this subtype of breast cancer has improved considerably in recent years with the use of chemotherapy and targeted therapy. ‘Prayas’ aims to extend the benefits of this treatment to the economically disadvantaged women with breast cancer, who have an excellent chance of being cured of the disease. Roche India is supporting this initiative,” said Dr Rajendra Badwe, Director, Tata Memorial Centre at the inauguration of Prayas with Dr Franz Humer, Chairman, Roche.

State-of-the-art IVF centre now at Hinduja Hinduja Hospital, inaugurated a state of-the-art IVF centre recently to celebrate its diamond jubilee year. The IVF centre offers consultations, standardised and transparent care delivery protocols, diagnostic services, hand-holding every step of the way from pre-conception to post delivery and treatment facilities. The facility includes latest equipment along with audio visual systems, with advance technique including Physiological Intracytoplasmic Sperm Injection (PICSI) to treat male and female infertility including Preimplantation Genetic Screening, ie, PGS Announcing the launch of IVF Centre, Pramod Lele, CEO, Hinduja Hospital, said, “With the expertise of Dr Indira Hinduja and Dr Kusum Zaveri, who are legends in the field of infertility treatments, and the assurance of best treatment practices that comes associated with Hinduja Hospital, we aim at providing a holistic view to healthcare.”

Lilavati to start TAVI procedure for the first time in India Lilavati Hospital will be starting the unique Transcatheter Aortic Valve Implantation (TAVI) procedure for the first time in India. The implantation of heart valve by non-surgical technique similar to stent implantation will benefit thousands of patients who are seriously ill with critically narrowed aortic valve and are at high risk to undergo open heart surgery. Until now, 10,000 cases have been performed the world over and clinical trials in the last seven years are very encouraging on the durability of the valve. The hospital will be doing the percutaneous prosthetic valve in India by mid 2011. Although the costly procedure is likely to be an issue in India, with time, it will become affordable. The hospital is awaiting DGCA government approval. The present cases for this novel heart valve treatment are for elderly patients with severe, degenerative narrowing of the aortic valve who are at high risk for open heart surgery. Once the durability of the valve is proved over the next 5 to 10 years, it could be a non-surgical option in younger patients with severe aortic stenosis of congenital or rheumatic heart disease.


World News

In Brief EU Clinical Trials Register launched The European Union (EU) Clinical Trials Register was recently launched by the European Medicines Agency (EMA). The online register aims to give the public access, for the first time, to information on interventional clinical trials for medicines authorised in the 27 EU member states and Iceland, Liechtenstein and Norway. Further, the database will also allow the public to search for information on clinical trials authorised to be carried out outside the EU, if these trials are part of a paediatric investigation plan. The information contained in the EU Clinical Trials Register is extracted from EudraCT, the EU clinical trials database based in London. It is provided by the sponsor of the clinical trial, and is a component of its application to a national medicines regulatory authority for authorisation to conduct a trial.

Scientists discover a way to kill tumours in cancer treatment Scientists from the School of Pharmacy, Queen’s University, Belfast and Almac Discovery Ltd have developed a novel way of treatment for cancer. Rather than attacking tumours directly, this method prevents the growth of new blood vessels in tumours, starving them of oxygen and nutrients, thereby preventing their growth. Professor Tracy Robson and her research team at Queen’s, in collaboration with researchers at Almac Discovery, developed a new drug in order to disrupt the tumour blood supply. They have demonstrated that this leads to highly effective inhibition of tumour growth in a number of models as reported this month in Clinical Cancer Research, a journal of the American Association for Cancer Research (AACR). Almac Discovery is developing the drug candidate and expects to start clinical trials within the next year. Speaking at the ocassion, Dr Stephen Barr, President and Managing Director, Almac Discovery, said, “This is a first class example of collaboration between a university and industry to produce a novel approach to cancer therapy that has a real chance of helping patients.”

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Roche launches next-generation HLA typing solution for 454 sequencing systems 454 Life Sciences, a Roche Company, recently declared the introduction and immediate availability of the new GS GType HLA Primer Sets for high- and medium-resolution genotyping of class I and class II loci of the Human Leukocyte Antigen (HLA) genes. The primer sets are designed for use with the company’s bench top GS Junior and GS FLX next-generation sequencing systems that aims to enable high-resolution typing and unambiguous allele assignment in a single run. The solution represents a major advance in speed and quality of characterisation of this immunologically important and highly variable region of the human genome. The HLA genes encode for the immune system proteins that recognise foreign cells and other antigens. Again, accurate characterisation of an individual’s HLA type is important for research in tissue transplantation matching, while variations in these genes have known association with a wide variety of autoimmune diseases, infectious diseases and some cancers. “We have sequenced thousands of samples and found more than 99 per cent concordance rate, increased throughput and significant reduction of ambiguity, which is far superior than the Roche GS FLX System over Sanger-based approaches,” said Elizabeth Trachtenberg, Study Author and Director, HLA/Immunogenetics Laboratory, Children’s Hospital & Research Center Oakland. “454 Sequencing Systems offer a major advance for high-resolution, high-throughput HLA typing,” explained Henry Erlich, Senior Study Author and Director of the Department of Human Genetics, Roche Molecular Systems. “The ability to quickly achieve such high accuracy and resolution will have a significant impact on research and, ultimately, on clinical application of HLA typing.”

Bosch Healthcare advances telehealth systems Robert Bosch Healthcare, Inc, one of the leaders in telehealth systems and a division of the Bosch Group, recently declared that new advances in telehealth systems aim to create efficiencies for healthcare professionals, and thereby improve patient care. Further, the new advances were developed to address the current and future needs of hospitals, health systems and managed care facilities that use telehealth in disease management programmes. “Robert Bosch Healthcare is dedicated to advancing telehealth technology. We have evolved the company’s technology platform to address the current and future needs of healthcare providers and the patients they care for,” said Dr Jasper zu Putlitz, President, Robert Bosch Healthcare. Dr zu Putlitz, said, “Our team of clinicians and engineers is committed to advancing telehealth to positively impact both patient care and cost.” He further added, “The renewal of our contracts with the Department of Veterans Affairs is further confirmation of the benefits telehealth can have when managing chronic conditions.”


World News

In Brief Innovation in medical devices would respond to EU’s healthcare challenges A Brussels conference has examined the (European Union) EU’s medical device legislation, that analyses how to ensure that manufacturers can bring equipment to the market as quickly as possible and ensure that all medical devices in the European market are efficient. The outcomes of the conference are expected to feed into concrete initiatives, in particular to the recently launched European Partnership on Innovation. This conference was a follow-up to the exploratory process on the future of the medical device sector launched in 2009 – where stakeholders including patients, consumers, healthcare professionals, insurers and the medical device industry, endorsed the need for a clear political vision of the role of the medical device sector in the health of citizens and the economy. The focus of the conference was on how innovation in medical devices could respond to Europe’s healthcare challenges. Medical devices are important in the context of an ageing population, increased incidence of chronic diseases and sustainability of healthcare systems.

Rational use of antibiotics is critical to fight infectious diseases, says WHO On World Health Day, April 7, 2011, World Health Organization (WHO) has urged intensified global commitment to safeguard antibiotics for future generations. Growing resistance by microbes to antibiotics threatens the continued effectiveness of many medicines. WHO has therefore made antimicrobial resistance the theme of this year’s World Health Day. “The time for sustained action is now, since we are slowly but surely moving towards a reversion to the dreadful pre-antibiotic era,” said Dr Samlee Plianbangchang, Regional Director - South-East Asia, WHO. “If that happens, death and disease due to untreatable infectious diseases will become the biggest obstacle to poverty alleviation, development and global efforts to make the world a better and healthier place.”

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Michael Dell shares healthcare vision Michael Dell, Chairman of the Board of Directors and Chief Executive Officer, Dell, recently shared his thoughts with healthcare executives on how Information Technology (IT) is being used in order to improve the efficiency and quality of care, and how IT can support future innovations in prevention, wellness and personalised medicine. Speaking at the Health Evolution Partners Leadership Summit, Dell encouraged healthcare organisations to expedite adoption of Electronic Medical Records (EMRs) and cloud computing to create new information-driven efficiency and care advantages. Further in this regard, he encouraged public and private healthcare leaders to enhance digitisation and the management and sharing of patient information. This aims to help in eliminating information silos between patients, providers and payers. Today, Dell is providing EMR solutions to 40,000 clinicians through 20 hospital-affiliated programmes. Again, IT implemented at the point of care can empower caregivers, and thereby enhance their productivity. Further, updated processes combined with the right technologies can improve the business of healthcare to help hospitals reclaim time and money in a challenging economy. For example, his company Dell has helped hospitals recover $15 billion through revenue-cycle process and technology improvements over the last seven years, he added.

Asia HealthPartners and GE Healthcare strengthens strategic partnership with CT Technology Asia HealthPartners (AHP) and GE Healthcare have strengthened their strategic partnership with the order of VEO, one of the most advanced dosereducing technology option in GE Healthcare’s Computed Tomography (CT) portfolio. AHP is one of the first medical centres in the world to order VEO with the Discovery™ CT750 HD, GE Healthcare’s high-definition CT technology. VEO is able to improve image resolution by up to 50 per cent and also reduce noise while using as little as one-eighth of the normal dose as compared to a standard CT image. This move seals AHP’s designation as a global luminary demonstration site for showcasing the latest in GE Healthcare’s CT equipment. David Utama, President and CEO, GE Healthcare, ASEAN, said, “AHP has long been a partner of GE Healthcare in setting the industry benchmark for high-resolution CT and low-dose images.” AHP and GE’s relationship started in 2006 with the acquisition of the GE Signa® HDxt, the first high definition MRI scanner in Asia Pacific. This was followed by the acquisition of the GE LightSpeed™ VCT XT, the first low dose CT heart scan in the world, in 2007. Early this year, AHP became the first in Singapore to acquire the GE Discovery™ CT750 HD. VEO is one of the world’s first model-based iterative reconstruction product that delivers high resolution images, improved low contrast detectability and artifact suppression at low doses. Radiologists benefit from this clearer, better-defined images, enabling faster and more accurate diagnosis.


World News Telemedicine for local prisons with Polycom® Telepresence in Korea Polycom, Inc, a global leader in unified communications solutions, recently declared the establishment of a highly effective telemedicine network in four correctional facilities across Korea in the Daegu, Jinju, Gongju and Cheongju female prisons, in partnership with Yoosin C&C, Korea’s leading ubiquitous healthcare solution provider. Further, the telemedicine network is designed to support the facilities to connect prisoners with their local hospitals for remote patient Hyosung Hospital doctors are care in an effort to reduce providing telehealth services to clinic and hospital waiting Cheongju female prison times, improve public safety and lower travel costs associated with patient transfers and doctor’s visits. The Polycom solution has enabled the Korean Correctional Facilities to not only save a significant amount in transportation costs associated with doctors’ visits, without sacrificing on quality of care, but has also ultimately allowed the department to channel their focus on the administrative functions for their prisoners by being able to forego unnecessary transportation to hospitals located outside of the facilities. This, in turn, has contributed to overall public safety levels by reducing the risk associated with prisoner transfers and reduced hospital and clinic waiting times, whilst ensuring the accountability of all patients and facilitating coordinated sharing of information and access to specialty medical care consultation. According to Korea Correctional Facilities, a major benefit of the Polycom system is its support for H.264 High Profile – a powerful, standards-based video compression technology that reduces bandwidth requirements for high-definition telepresence and video by up to 50 per cent, for more cost-effective communications across the organisation, resulting in a faster return on investment.

USGBC introduces LEED for Healthcare With US Green Building Council (USGBC) introducing Leadership in Energy and Environmental Design (LEED) for Healthcare medical centres, hospitals and other healthcare facilities hope to get help to reduce their energy and waste costs while creating healthier buildings for patients. The latest in the series, LEED for Healthcare is the culmination of seven years of close collaboration between the Green Guide for Healthcare and USGBC. Green Guide conducted a pilot programme with over 100 health care facilities, which assisted in developing the new rating system to meet the unique needs of healthcare facilities. Hospitals have huge energy costs because they operate 24 hours a day, 365 days a year. Hospitals use twice the energy of a typical building and spend nearly $8.8 billion on energy each year, according to the US Energy Information Administration (EIA).

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‘I want to move the upper end of healthcare in India, not the commercial end’ ...says Dr Naresh Trehan, one of the leading heart surgeons in the world, with national awards like the Padma Shri and Padma Bhushan in his kitty. He has conceived and built the state-of-the-art multi super-specialty hospital, Medanta- the Medicity. Prior to this, Dr Trehan was the founder, Executive Director and Chief Cardiovascular Surgeon at Escorts Heart Institute and Research Center (EHIRC). He narrates the evolution of the Indian healthcare sector and some thoughtful reflections of his life… Arshia Khan All that I read about Dr Trehan being curt was totally outdone when I met him recently at Medanta – The Medicity. He greets us with a very confident smile as he reads about one of his friends and competitors featured in our magazine. “People call me an angry young man, but I think what describes me best is ‘an old man in a rush’,” he says as he flips through the reports on his desk. “We are nowhere in healthcare in India. We are late starters and have already lost 60 years. We have no time to waste. We have to take action quickly if we want a healthy India,” says the 64-year-old confidently. Dr Trehan who practiced medicine in the United States beams that he has been a part of the earliest developments of coronary

bypass surgery where he along with his team invented many new operations.

A reflection This surgeon is backed by strong family values and has some interesting tales to narrate. He has two daughters. One is a lawyer and the other is an architect, and his parents were from Pakistan (Faisalabad, Lahore). But after partition they came to India and stayed at a three BHK, which was allotted to them by the government in Connaught Palace, Delhi. Dr Trehan has memories of those days. He reiterates, “We stayed in a three BHK where each of my parent practiced medicine, and my sister and I studied in the other room. We observed a very intense and interesting interaction while we were growing up.” Dr Trehan recalls, “At that time people did not have money and many of them were refugees, hence

my father would not charge them, so they would get some gifts and sweets when they came the next time. There was a very humane interaction.” This to a large extent has influenced his attitude towards money and towards dealing with patients. As the sultan of the scalpel says, “I never resent spending time with a patient. Even after I see him/her for 4 hours, I can continue for 24 hours and still go on and on and be happy.” He

Photo by: Shamik Banerjee

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Experts Speak performs around 10-12 surgeries a day and owes the credit to the training that has been provided to him. Dr Trehan says, “For seven years we were trained like commandos and we did not sleep for more than 3-4 hours a day. I have been toughened by my training.” Amidst a phone call, he stresses, “We were forced by circumstances and put in the time then. What I am today is a reflection of my past. It is not that I was thinking about it back then but it has a big influence on me today.” Dr Trehan feels that the profession of being a doctor is to deal with patients in a very meaningful and compassionate manner. As a doctor you are interacting with patients and their families when they are in grief. At a very base level, this touches you. He says, “When I came to India from the US in 1988, a new standard of cardiac treatment was launched, which was based on critical care. India needs to have its institutions, delivering all the components of healthcare on the lines of Harvard and Imperial Medical College, which are considered fountain heads of new knowledge.”

Evolution of Indian healthcare Broad is the road, but narrow is the way. “The problem with India is that we often follow and copy healthcare from the US. The US spends $ 2.2 trillion annually on healthcare, which is not the scene in India,” notes Dr Trehan. So how do we solve this problem? As the samurai with one of the best swords avers, “Medanta has been conceptualised to answer this! Gene mapping has shown the precise requirements of patients. What is good for the West need not be good for us.” This is why Dr Trehan’s Medanta is planning to start the Institute of Integrated Medical Services and Holistic Therapy. And he believes, “This institute will not only be comparable to the best in the world but will also be a platform to create the highest standards in medical research. We need research to develop cheaper medicines and better cure, reduce cost and eliminate suffering.”

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So was Medanta conceived, after leaving Escorts? Dr Trehan answers that with enthusiasm. “No, No! Not then. It was always on my mind. I left Escorts because people did not understand what we were doing.” Dr Trehan thought about Medanta in 2003. He had a 10 per cent stake in the Escorts Heart Institute and Research Centre but he left in 2007 after it was taken over by Fortis Healthcare. Dr Trehan highlights, “We keep harping about India and its growth, liberalisation, etc. But I always feel that if you want to be called a developed nation then you do not need to have a ‘prefix’. We never say America - a developed country, we just say America! So India should be called as ‘India’ and not India - an emerging market!”

Quick Bytes Picks If I study your being today, I should be able to map your life and say that at this stage you are prone to this disease. If I am able to offer customised health, I will be able to make a huge difference to each individual. It can be called as contractual healthcare. One thing noticeable about Dr Trehan is his enthusiasm and eagerness to share with us what his experience has taught him, which very few people would do. As he got busy with patients, we caught up with him after sunset. A relaxed Dr Trehan continues, “I think if we work like this in the next 20 years it will reverse itself. If you recall, India was the dominant region in the world. But the Europeans and Americans came and turned it upside down. Now it is the right time, it is our day and I believe in it. I just wish that people would not take shortcuts. It is in our culture that we do not want to take the straight path, everything is done with a twist.” At Medanta, ` 300 crore has been invested only in technology till date,

informs Dr Trehan. With 20 super specialties, Dr Trehan aims to do everything with compassion and affordability. He says, “Research has already started in traditional medicines by combining the power of modern medicine and Ayurveda. In future, this combination will be available at half the cost it commands currently.” He notes that there is much more knowledge than what we practice in modern medicine. On the same lines, Medanta has recently signed a Joint Venture (JV) with Duke University to develop new research ideas for India. Medanta is also into the concept of tele medicine, which uses technology to detect problems at the early stages and give advice remotely. These free consultations are mainly organised in villages and small towns, however, Medanta has also established mobile vans and other systems where doctors travel to remote areas to treat patients. “This should go a long way in taking healthcare to the villages. To make such units functionable, support from the government and also through Public Private Partnership (PPP) models is required,” says Dr Trehan. At the village level, Association for Social and Health Advancement (ASHA) collects and furnishes data to them. They cross subsidise, thereby bringing down the cost.

Aiming for quality healthcare Dr Trehan’s priority is care for people. He believes it will also benefit the government, if it considers this. As he says, “We must learn to care. Better healthcare for people will translate into votes. Today, even the poorest demand quality healthcare and if the government is willing to answer their calls, they will get more votes.” Talking specifically about Medanta, the heart surgeon avers, “We must contribute to the society. We have a large base of patients. If we amortise the cost of patients and operate efficiently, costs can be brought down substantially. We charge 15 per cent less than what we could have charged. If enough people come to us for treatment, our margins are met, and then more people will come to us in the future.” As Dr Trehan beams


Experts Speak

The man behind the surgeon Surgery techniques that you would like to suggest to students… One must enjoy their work and life and never let negative thoughts enter their mind. Because if one does that they will possibly steer their life through the myriads of hurdles that come their way in the best possible manner. So sincerity of thoughts is one word that everyone should have. I always advice my students to have a plan, because there is no such thing as simple operation, there are only simple minded surgeons. No matter how rich or poor the patient is, one must take it equally seriously. with ideas and plans, we question him about money matters. Have you broken even? And he replies, “Yes! We have. We have not made profits yet, but we have paid off the loans and interest, which is a good thing.” How do you plan to reach the peak then? He pauses for a minute and answers, “Basically, we have built an institution like Harvard, Cleveland Clinic or Mayo Clinic. These are institutions where major investments are on clinical services. Second, they spend heavily on intellectual capital so that they become knowledge leaders and last but not the least on research and new technology frontiers. Our next step would be to set up medical, paramedical and nursing schools.” Besides, Dr Trehan wants to build a research institute with the highest healthcare and ethical standards that there are and also lead the way to create a new solution for India as India’s healthcare problems have to be solved in India by Indians. He reminds us, “This is not going to be easy as it is not a single thought process. It requires multiple approaches but I am sure it can be done.” We ask him the reason for his anxiety about the healthcare segment and he replies, “There is an inner anxiety in my mind about India and this stems from the fact that I know that 50 per cent of our population is young and more than 10 billion people are going to come on the job market every year. How are we going to provide them with the jobs that they need?” He warns, “If we are unable to help them, the repercussions are going to be bad.” He doubts if many people are aware of this, so he says, “We ‘must accelerate’ our thought process, as time has already run out. We are late starters in healthcare. We must double, triple

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or rather quadruple our efforts with immediate effect.” He certainly has a point here as this will not only give health to the people but will also help solve problems of unemployment, as every healthcare worker is a tax payer. The surgeon notes another point, “Healthcare is a very important pillar, which has not taken centre stage yet. The government has spent on education, and right things are being done but healthcare is neglected in India. He perpetuates, “Another thing that worries me is the ethics of medicine. It is very important that we restore the dignity and ethics of medicine, especially as it relates to the commercialisation of healthcare. Making money in healthcare is not a crime but in healthcare the quantum of money one makes has to have a reasonable proportion. Ultimately, it is the sick and ailing person who is already disadvantaged and will have to pay from his pocket. So, we as physicians should understand this and be honest to our profession.”

Thinking beyond Medanta As he plans for a movie with his family, we put forth another question. He answers this with controlling possession of his mind and the same tone, though it is late evening and he must have had a long day. What are the other opportunities that you see in the healthcare sector, besides Medanta? “I believe healthcare has not even started yet. The story is just at its very nascent stage. This sector can only double every five years. It has to because where is health? Nobody has access to health except for the top 2-3 per cent of the people in the country. People are paying a lot for healthcare but are not getting it, or are getting third-grade stuff.”

He predicts, “As we move forward, more and more people will come under the ambit of accessibility to healthcare. There will be health insurers, self employers, better policies and many kinds of healthcare plans.” Dr Trehan asks us to think about the people who do not have access to affordable healthcare. “I almost cry everyday when I see what people have to do to pay for healthcare.” How can this issue be solved? He replies instantly, “Unfortunately, we need to make money to run the place, but if somebody gave me subsidy to cover my costs I would provide healthcare for free.”

On the move… Dr Trehan’s obsession for healthcare is beyond comparison. He shares his plans for healthcare, “We became doctors as disease managers, and then we thought that we are very smart and we should do prevention and early detection. Now I realise that before all this there is a huge space and that is health. So if I study your being today, your genetic patterns, your physical state, your biochemical propensity, etc, I should be able to map your life and say that at this stage you are prone to this disease. If I am able to offer customised health, I will be able to make a huge difference to each individual. It can be called as contractual healthcare. At Medanta we have already made a plan and we will be launching it soon. That is my new mantra.” When we asked him whether he would go for an IPO, he remarks, “Right now I have not thought of anything. Our team of doctors is focussed on patient care and growing Medanta and we are enjoying doing it. If it needs to be an avenue, I am open to it and if it helps us achieve what we are aiming at, then why not. My obsession is not really numbers; my obsession is ‘Quality’. Somebody had asked me once how many Medantas will there be in the next five years, I said possibly one, but the best.” He signs off citing the reason, “I want to move the upper end of healthcare in India, not the commercial end.” (arshia.khan@infomedia18.in) With inputs from Anvesh Koley


Roundtable

Radiation contamination

Are we equipped to face any eventuality? With the recent Japan nuclear meltdown, the issue of radiation contamination is leading the list of debates. After the effects observed at Chernobyl and Bhopal, radiation contamination is feared worldwide and considered to be the major factor for causing various health hazards in future. Let us have a look at what experts say on this matter. Dr Asma Mohd Yousuf

R

adiation is a form of energy that is naturally present around us. Different types of radiations exist, some of which have more energy than others. However, the concern arises when radiation becomes a source of human contamination. And the matter is on high alert, when they are emitted from nuclear radioactive substances. Presently, nuclear power is probably the most economical way of producing electricity. Nuclear power also reduces emission of the gases responsible for global warming. Even the Indian government has plans of acquiring nuclear power for making energy available at reduced prices. However, after the nuclear crisis in Japan, people fear the establishment of nuclear power plants. Over the years, nuclear medicine, which also uses various radioisotopes, has helped in saving many lives. Everyday, millions of people undergo some or the other kind of diagnostic procedures that involve the use of radiation. But people are not that scared of these radiations. A person exposed to radiation is not necessarily contaminated with radioactive material. But a person, who is contaminated, will have radioactive material on or inside of his/her body. There is a difference that people need to understand. In the times of inflation, with adequate awareness, strong governing laws, efficient healthcare professionals and appropriate measures taken, nuclear power can bring various solutions to emerging economies like India.

Dr A K Anand Chief – Radiation Oncology, Max Healthcare, New Delhi A person can get exposed to radiation in a department using unsealed sources like nuclear medicine departments of the hospital. They use liquid radioactive sources under strict radiation protection regulations. Radiation exposure can happen to radiation workers in nuclear reactors. If there is a big radiation leak from a nuclear reactor, it can affect the growing plants and higher levels of radiation can be detected in the crops, vegetables and poultry products. This has been recently reported from Japan after the recent nuclear accident. All radioactive aliments are harmful to the human being; however, the magnitude of damage depends upon the dose of radioactivity released. The limit for

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radiation exposure for general public is 1 msv/year and for radiation worker it is 20 msv/year. The nuclear explosion and subsequent radiation leak in Japan is a catastrophic event, which can not be compared to the medical use of radioactive substances in the hospitals. The amount of radiation leak in Japan was of high intensity, which can contaminate water and soil for very long distances. It can expose a wide population for several kilometers around the nuclear reactor which can have serious repercussions on the health of the people exposed. Depending on the dose of radiation delivered to the population it can cause acute effects like nausea, vomiting, radiation burns, etc. Long- term side effects like low blood counts, hypothyroidism and second cancers can be reported depending on the dose and duration of radiation exposure.


Roundtable Dr Ganapathi M Bhat Consultant Medical Oncologist & Stem Cell Transplant Physician, Jaslok Hospital and Research Centre, Mumbai Even in this age of technology, we remain unaware about the extent of radioactive contamination or the imminent damage due to radioactive substances. One would not want to believe it, but truly inhalation of a single particle of plutonium or uranium can, and does, cause lung cancer. Also, radiation exposure is cumulative over the duration of a person’s lifetime and radiation can cause genetic mutations that can be passed to offspring, increasing the risk of cancer across generations. Therefore, we need to understand that there is no safe level of radiation exposure, so any exposure, regardless of how small, increases the risk of cancer.

About 16 per cent of all cancer deaths and about 25 per cent of the excess or radiation-related cancer deaths for the period from 1950 through 1990 occurred from 1986 to 1990. Significant radiation associations were observed for stomach, colon, lung, breast, ovary, urinary bladder, thyroid, liver and non-melanoma skin cancers. Radiation Effects Research Foundation (RERF) researchers are now examining individual types of cancer more carefully to determine what role radiation plays in the mechanism of cancer causation and how it might interact with the other cancer risk factors. India needs to re-examine the ability of its nuclear power plants to withstand disasters and its policies to handle their repercussions in the wake of the horrific natural disaster in Japan.

Dr Karuna Luthra Nuclear Medicine Consultant and Radiation Safety Officer (RSO), Department - Nuclear Medicine, Lilavati Hospital & Research Centre, Mumbai When there is presence of radioactive material at a place where it is not intended to be, then it causes radiation contamination. Radiopharmaceuticals have been used in routine clinical practice for many decades now. Each new isotope or technique goes through extremely stringent tests and monitoring, and only when it is found suitable it is available to qualified doctors or technologists. In India, all doctors or technologists handling these isotopes must undergo training and obtain license from Atomic Energy Regulatory Board (AERB) before they use radioisotopes. However, all radioactive elements can cause radiation exposure. But radiation contamination is extremely rare since the personnel handling it are always cautious not to

cause contamination. One comes in contact with these elements only during a radiation accident and not during standard operational practices. In India, the AERB is a stringent body and works in association with the International Atomic Energy Agency (IAEA). It keeps a very close check on all aspects via its radiation safety division, and there are many acts that govern the use of radioactive substances. However, a nuclear emergency will not be any different from any other disaster like a massive earthquake, floods, explosions, etc, in terms of handling the casualties in India. Moreover, nuclear power must be harvested to its full potential since it can help to reduce a whole lot of other hazards that are threatening our lives and our planet, like global warming, pollution and toxicities due to the heavy use of fossil fuels.

Dr K N Prakash Director Medical Services, BGS Global Hospitals, Bengaluru A person gets contaminated with radiation, externally, with background radiation or the radiation exposure from the radiation-generating machines. The radioactive materials used in medical procedures include FDG (Fluorodeoxyglucose) in Positron Emission Tomography-Computed tomography (PET CT), Technetium Tcm-99 in gamma camera procedures, iodine low dose Iodine131 (I-131) for thyroid scan and high dose I-131 for thyroid therapy. They are in capsule, liquid or in the form of IV fluids. However, the radioactive elements that pose health risks are Caesium-137 (Cs-137), I131, Iodine-121 (I-121) and gamma rays. Radiation exposure can have delayed effects like malignancy and

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hereditary effects. The radioisotopes affect various processes by delayed cell division and cell death. The recent Japan radiation accident was due to technical mishaps at the atomic reactor. To prevent further radiation contamination, safety measures should be strictly implemented and maintained in the reactors. There should be enough availability of staff such as physicists, RSOs, reactor physicists, health physicians, etc. India is well equipped to deal with nuclear emergencies. Various kinds of dosimetry radiation monitoring systems are available that assist in evaluating radiation exposure. But there is a need to create public awareness regarding the effects and steps to be taken following during an overexposure to radiations.


Roundtable Dr Parul Sehgal Gynaecologist and IVF Consultant, Maharaja Agrasen Infertility & ART Centre, Maharaja Agrasen Hospital, New Delhi Radiation contamination occurs when the radiation dose available in the atmosphere is more than the permissible limit. The instruments used to monitor human radiation exposure are survey meter and Thermolumicent Dosimeter (TLD). They are used to access the exposure to occupational workers. Most of the Indian hospitals have TLD, however, the cost limits restricts its use as a survey meter. The recent Japan incident is an unfortunate and shocking event that warns us again that nature is very powerful. Nuclear disaster not only impacts the

present but sadly carries its destructiveness into future through generations India is maintaining standards under supervision of AERB and Bhabha Atomic Research Center (BARC), which are Indian bodies for providing guidelines to follow safety norms for radiation control. Today, we are well informed and communication is at a fast pace. So in case of any such emergency, following the basic norms like evacuation, prevention and cessation of leakage can be applied. Also, it should be remembered that radiation follows an inverse square law, so the further the person moves away from the radiation source, the lesser will be the effect of radiation.

Dr Rasika G Bhat Medical Geneticist and Lecturer - Medical Genetics, Institute of Nursing Education; J J Hospital; and Bombay Hospital College of Nursing, Mumbai Radiation presents as an intangible danger with effects that may impact the immediate present, the next decade or may show up later in the century. The greatest threat of radioactivity to life is no doubt the damage to the gene pool. Among the approximately 3,000 in utero-exposed atomic bomb survivors from atomic bombing of Hiroshima and Nagasaki, the effects noted on an average were reduction in Intelligent Quotient (IQ), higher incidence of mental retardation among the heavily exposed and some impairment in the rate of growth and development. Many of these effects seem to be particularly pronounced among individuals, who were exposed between the 8th and 15th weeks of gestation. Efforts to detect genetic effects were started in the late 1940s and continue to this day. In Nagasaki,

500-800 babies were examined in their homes. No evidence of genetic injuries was detected at that time. But today, in 2008, new studies conducted on survivors and their offspring are revealing conclusive DNA genetic changes and malformations. Recent advances in molecular biology may make it possible to detect genetic changes at the gene (DNA) level at some time in the future. RERF scientists are working to preserve blood samples that can be used for such studies. The radioactive emergency in Japan has once again reminded the world of the effect of radioactive radiations on mankind. Despite the impressive progress in DNA-oriented systems, the documentation of congenital defects, genetic diseases and child survival would still be an essential component of any future study.

Dr Uma Ravishankar Senior Consultant, Department - Nuclear Medicine, Indraprastha Apollo Hospital, Delhi Nuclear energy is produced by splitting the nucleus of a uranium or plutonium atom. This creates other unstable nuclei or isotopes, including I-131 and Cs-137, which continue to decay into other nuclei until they eventually reach a stable form. Decay emits radiation in the form of beta and gamma rays that can pass through human tissues, where they collide with other atoms, breaking up molecules and potentially damaging the DNA inside the cells. When the body tries to repair the damage, mistakes may occur, creating the potential for cancer. The time it takes for the radioactivity to drop to half the starting level is called the half-life of the isotope. In the natural world, there is no such thing as zero radiation. Not only is the entire world constantly

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bombarded by cosmic rays, but every living creature on earth contains significant quantities of Carbon-14 (C-14) and most (including humans) contains significant quantities of Potassium-40 (K-40). In India, the safety standards formulated by AERB are at par with those recommended by the international bodies such as the IAEA and the International Commission on Radiological Protection (ICRP). The mission of the board is to ensure that the use of ionising radiation and nuclear energy in India does not cause undue risk to health and the environment. There is virtually no risk to India from the nuclear accident in Japan, and India has already placed restrictions on the import of foodstuffs from Japan. Further, import of hardware like auto parts, etc, from Japan should be tested for radioactivity.


Hospital Monitor

Bombay Hospital and Medical Research Centre

Bringing medical education to the forefront Photo by: Priyanka Kumble

With unmatchable commitment and dedication, the Bombay Hospital and Medical Research Centre lives up to the expectations of the different strata of the society. Without compromising on the quality of treatment and services, everyone is treated under the roof with utmost care. Chandreyee Bhaumik

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he Bombay Hospital Trust was constituted on September 6, 1949 as a Public Charitable Trust registered under the Bombay Public Trust Act, 1950, with the primary purpose of establishing a hospital. In this context, donations were collected from individuals and institutions and the Chairman, Shri Rameshewardas Birla, the doyen of the Birla family - a leading industrialist in India - himself organised substantial funds from companies and trusts in the Birla group of industries, as also from other business houses and friends. The main objective for framing the trust was, in Shri Birla’s words: “The rich can get medical care anywhere because they can afford it, the poor obviously cannot pay for it. Therefore, it should be the endeavour of Bombay Hospital to render the same level of service to the poor that the rich would get in a good hospital.�

Not treading the commercial way It is not the commercial advantages that have initiated the progress path of the hospital. One of the main concerns was to provide, establish, furnish and thereby manage hospitals particularly in Mumbai and also elsewhere in India. The Trust also concentrated on providing for, educating and training medical students and nurses. The Trust has always believed in establishing and maintaining nursing hospitals, homes or wards, nursing institutes and convalescent homes along with institutions for promoting medical research work. Indeed it was a far-sighted approach.

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Hospital Monitor Commenting on the dedication of the hospital, Shri BK Taparia, Chairman, Bombay Hospital Trust, says, “Charity and pursuit of excellence have always been the two fundamental ideals that offered the impetus to focus on the well being of the patient who is the primary responsibility. Again, the hospital has an obligation to provide the best possible treatment, delivered most efficiently, in the shortest possible time span and at minimum cost.”

Success avenue On this bedrock of charity, the hospital is relentlessly building reputation by continuously refurbishing its spaces, installing few of the most advanced medical equipment. Further, it is also seen that professionalism and dedication of the management team is not hampered. Thus, world class doctors in the hospital can perform their duties and responsibilities in an academically stimulating and also hassle-free environment. The Trust of the hospital functions on the basis of cross subsidy, charging those who can afford to pay, and providing virtually free treatment to those who cannot. However, the hospital does not let this distinction come in their quality of the treatment. Usually expansion plans of any entity are focussed on the commercial end. But, Bombay Hospital has its expansion plans set in place such that it can extend its helping hand towards a wider section and therefore cater to more people who are in need.

Diagnostic tests being conducted in the hospital

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We have our education programmes for medical post graduate doctors, nursing and training of the para medical staff. Dr Rajkumar V Patil Joint Director, Medical Services, Bombay Hospital

We cater to patients from all sections of the society. In our hospital, poor patients as well as the richest of the richest come under one roof. Recovery is never compromised in our hospital. Dr D P Vyas Medical Director, Bombay Hospital & Medical Research Centre

Discussing the expansion plans, Dr Rajkumar V Patil, Joint Director, Medical Services, Bombay Hospital, says, “We are expanding to other cities. We have already expanded to Indore and now we have plans to expand to Jaipur.” Bombay Hospital presently ranks among the finest multi-specialty tertiary level medical centres in the country. Further, the hospital boasts of internationally renowned panel of doctors and consultants in every field of specialisation along with highly trained and professional nursing staff. The hospital attracts patients from all over India as well as overseas. Commenting in this regard, Dr Patil, says, “It caters to every strata of society, be he/she an agriculturist from rural India, a factory worker, a high-flying executive from a multinational company or the likes of a Prime Minister or Governor of Maharashtra.”

Today, the hospital has grown to house over 750 beds, spread over four multi storeyed buildings with a 500,000 sq ft built-up area. With some of the most advanced diagnostic & surgical equipment available, the hospital aims to offer a comprehensive range of medical services. Again, the free Out Patient Department (OPD) at the hospital claims to successfully treat in excess of 1,00,000 patients each year. Some 300 beds are in the general ward, where no charges are levied for bed, food or even doctors’ fees.

Empowering research Being one of the leading hospitals in the country wherein patients from all over India have been flocking ever since it its establishment, the hospital has developed an extensive wealth of medical material and data that would provide the ideal basis

Patient care at the hospital


Hospital Monitor

A case study Sagarbai Baxi, 103-year-old, a retired teacher from Rajasthan who stays at Thakurdwad in Mumbai, had a serious fall that broke her right knee. Dr H R Jhunjhunwala, orthopaedic surgeon, Bombay Hospital, along with his team performed a difficult surgery on this centenarian. In this regard, Dr Pravin Amin, ICU Head (Intensivist) had to first stabilise Baxi, who was admitted with low blood pressure and was extremely dehydrated. Further, the patient’s asthmatic condition made the doctors opt for spinal anaesthesia in order to avoid the risk of pneumonia. After mobilising her, successful surgery was performed. Strategically, the surgery was kept to a minimum of only 45 minutes considering her age and blood loss was only 5 cc due to the surgical skills. With this level of commitment and sincerity, the dedicated professionals of the hospital accomplished their work with efficiency. for carrying out research. The Medical Research Centre was, therefore, set up in the year 1969 and is one of the very few research centres approved by the Indian Council of Medical Research, Government of India. Elaborating on this aspect, Dr Patil adds, “Extensive research is carried out in the medical field, providing excellent clinical and research material, and thereby making valuable contributions to the growth of medical expertise in the country.”

A glance of the set up at the hospital

Library at the hospital

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Laying the education path The post-graduate course at stand alone Bombay Hospital Institute of Medical Sciences is one-of-its-kind course in the private sector. The Medical Council of India has recognised all the MD/MS courses as well as DM/ MCh courses conducted here. The Institute was affiliated to the University of Mumbai from the academic year 1989-1990 and since the academic year 2006-2007 it is affiliated to the Maharashtra University of Health Sciences, Nashik. Dr Patil informs, “We have our education programmes for medical post-graduate doctors, nursing and training of the para medical staff.” Bombay Hospital Institute of Medical Sciences started enrolling students for MD/MS courses from June 1990 and for DM/MCh courses from April 1991 under the able leadership of Dr BK Goyal as Dean, who is an internationally renowned Cardiologist and is the Honorary Consultant Cardiologist to Texas Heart Institute, Houston, USA. Every year 15 students are admitted for MD/MS courses, whereas 10 students are admitted for DM/MCh courses. Students are admitted strictly on merit through the Common Entrance Test (CET) conducted by the state government for MD/MS courses and All India Common Entrance Test

(AICET) for DM/MCh courses also conducted by the state government. Apart from providing the students unparalleled post-graduate training facilities, they are getting abundant opportunities to equip themselves with the latest advancements in medical science. It is a privilege to them that many students have been absorbed as consultants in many hospitals in India & abroad. The National Board of Examinations, New Delhi, The College of Physicians and Surgeons Mumbai, Indira Gandhi National Open University have also recognised the Institute, and students are enrolled for their various training courses.

Treading ahead… Patients from the central part of the country, who are often in dire need of expert medical care have to go to either Delhi or Mumbai. Considering this, the Bombay Hospital Trust has decided to establish a state-of-the-art 600-bed hospital in Indore, Madhya Pradesh, catering to all the medical specialities. Discussing the USP of the hospital, Dr D P Vyas, Medical Director, Bombay Hospital & Medical Research Centre, said, “We cater to the patients from all sections of the society. In our hospital, poorest of the poor as well as richest of the rich patients come under one roof. Patient care is never compromised in our hospital.” Thus, the Bombay Hospital has come a long way since its establishment, and the future looks bright. (chandreyee.bhaumik@infomedia18.in)


Sector Watch

IT in Healthcare

Welcome to the world of opportunities! Introduction of Information Technology (IT) in healthcare sector has helped in maintaining medical records and hospital management along with increased customer satisfaction. Besides, it plays a crucial role in computers-assisted surgeries, robotic surgeries, teleradiology and telesurgery, simplifying the life of both the healthcare professional and patient. But has ‘IT’ penetrated rural India?

Photo by: Neha Mithbawkar

Dr Asma Mohd Yousuf

I

T has evolved Indian healthcare sector in the recent past, especially in the areas of medical technology and health management information. IT has helped the Indian healthcare industry keep pace with technological advancements in developed countries. Today, most of the major players from the West are eyeing the Indian healthcare sector due to its large customer base. Discussing the acceptance and adoption of IT in the Western countries

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in comparison to that in India, Mahesh Shinde, Deputy Director, IT and Telecom, Hinduja Hospital, Mumbai, says, “Doctors in the West are trained in hospitals with advanced Hospital Information System (HIS) solutions, hence the aptitude for IT is inculcated in the initial stages of their career. Whereas Indian doctors lack any form of IT training during the early stages of their career, thus, the late adoption and change in the management becomes difficult.” Moreover,

he adds, “Since most healthcare consumers in the West are sponsored by insurance policies, cost of increasing healthcare is never a concern. Hence, the adoption of technology has been commensurate with latest advancements, research and development.” It is worth observing how India faces a contrast of the situation in this case. Some figures are rather astonishing. As Shinde informs, “Due to constraints such as R&D expenditure, the available


Sector Watch software and hardware in India do not match with those of the Western countries. The estimated IT budget for Indian hospitals is capped at about 5-10 per cent of the gross revenue, while that for Western hospitals is estimated to be about 40 per cent.” He explains, “In India, since over 80 per cent of healthcare expenditure is borne by the patients, price sensitivity is quite high and high-level healthcare facilities are not within the reach of the patient. Therefore, Indian hospitals do not generally invest in high-end IT infrastructure.”

Simplifying doctor’s life With the range of solutions it provides, IT has pleased several professionals in the industry. As Avinash Chander, Assistant Manager - Medical Operations, S L Raheja (a Fortis associate) Hospital, Mumbai, says, “Role of IT is multi-faceted. At one end, it helps in retention of medical records and patient demographics aiding the healthcare professionals in better care provision, and on the other hand, it helps administrators and healthcare facility planners in better planning in order to meet the needs of the population. As it is often said ‘people die, but records do not.’ The documentation and storage of information has become so easy for the providers with minimum need to maintain paper-based records.” However, doctor’s inclination towards adopting these new techniques also plays a major role. Also, with time, the medical fraternity is seeing the benefits, and is eager to adopt the same. Says Chander, “We still find nearly 70-80 per cent doctors struggling to utilise the capabilities of HIS. However, the accuracy of medical equipment, prevention of human errors due to erroneous transcriptions, and legibility of communication and notes are just a few benefits of IT-based solutions. Instead of boggling their heads into yellowed, crumpled and illegible documentations from the past, doctors can now go through systematic and sensibly arranged legible records of the patients in less than one tenth of the time taken before.” Avers Dr Neena Pahuja, Chief Information Officer, Max Healthcare Institute Ltd, New

The estimated IT budget for Indian hospitals is capped at about 5-10 per cent of the gross revenue, while that for Western hospitals it is estimated to be about 40 per cent. Mahesh Shinde Deputy Director, IT and Telecom, Hinduja Hospital, Mumbai

Delhi, “Systems with alerts and notifications provisions have helped ensure availability of knowledge management systems to the doctors. Second opinion and collaboration for a patient along with clinical prognosis is now possible with IT systems across the globe.” Today, with IT advancements, availability of Clinical Decision Support System (CDSS) with past Electronic Medical Records (EMR) has ensured adherence to principles of evidence-based medicine that has helped in reinforcing patient’s credibility towards the doctor and trust in the treatment.

The power of computerisation Computerisation improves the accuracy of diagnostic and treatment procedures and gives options to save, edit, mark, measure and take snapshots along with various other options so as to make the investigation or procedure meaningful. Chander explains, “Computerisation has helped in operating the equipment at any point/location and transferring the data through simple Local Area Network (LAN) cables to the server. Systems like Laboratory Information System (LIS) and Radiology Information System (RIS) help in relating the orders to the actual investigations, thereby preventing human errors, and also linking the orders with the results/reports along with an instant remote viewing option.”

The ultimate aim of any new technology is to make human life more convenient. To this effect, computerisation helps the hospitals with proper storage, organisation, management, analysis, on-demand prompt retrieval and use of data like images and EMR. Agrees Dr Vishal Goyal, Chief Operating Officer, BGS Global Hospitals, Bengaluru, “EMR is yet to be legally accepted in India. But software/enablers are already available and used by the service providers to some extent in the country. Earlier the gap of launching advanced technology in India compared with the world was high, but with increased demand and paying capacity, now it is made available pretty soon.” In this information age, there is hardly any new research that does not use computerised analysis. Shinde elaborates, “New research involves use of stem cells for treating paraplegics, coral in the treatment of non-union fractures and other pharmaceutical advancements are carried out with the aim of making human life better and more convenient. Robotic surgery facilitates complex surgeries using the remote access route, while enhancing precision in certain surgeries, like microvascular and neuro surgeries. Minimal Access Surgeries (MAS) have been possible with the use of the lumen camera relaying images to the screen that guides the surgeons. These archived images

Systems like Laboratory Information System (LIS) and Radiology Information System (RIS) help in relating the orders to the actual investigations, thereby preventing human errors. Avinash Chander Assistant Manager - Medical Operations, S L Raheja (a Fortis Associate) Hospital, Mumbai

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Sector Watch Second opinion and collaboration for a patient across the globe is now possible. Also, clinical prognosis is now possible with IT systems. Dr Neena Pahuja Chief Information Officer, Max Healthcare Institute Ltd, New Delhi

also serve as a basis for evidence-based medicine and can come in handy in case of a medico-legal negligence.”

government is to explore, and hence, promote initiatives like these by using Public Private Partnerships (PPP).”

Tele techniques

Private vs government hospitals: Are they IT’ed?

Today, mobile health (m-health) and telemedicine are making rounds in the medical world. Telemedicine is a rapidly developing application of clinical medicine. It helps in transferring medical data through interactive audio-visual media for the purpose of consulting, and sometimes remote medical procedures or examinations. Telecardiology, teleradiology, telepsychiatry, telepharmacy and telesurgery are some terms associated with telemedicine. Expressing his views on the importance of teleradiology, Shinde says, “One of the various low-cost innovative technologies is the Trans-Telephonic Electrocardiogram (TTECG). TTECG makes use of the regular telephone landline for transmission of ECG signals from the remote outreach centres to nodal centres of excellence. Private and trust hospitals like Narayana Hrudalaya, Manipal Hospitals, Gangaram and Apollo Group of Hospitals have rural outreach programmes that connect remote areas accessed from fixed stations or mobile vans via Integrated Services Digital Network (ISDN)/broadband network to nodal centres. Since these rural outreach initiatives are not highly financially rewarding for the private hospitals, the need of the hour for the

Most of rural India is still dependent on the government for their healthcare needs. Informs Dr Goyal, “Primary healthcare centres located in the rural areas are now getting funded by the government and will soon see a surge of new technology at basic level. Secondary healthcare centres will be getting equipped with advanced imaging and laboratory equipment.” As per Chander, “So far, there is more development in the private sector. The initiation and development of an HIS requires inputs as well as efforts in customisation based upon the requirements of the organisation. May be this is a reason for the government hospitals to adopt the technology, as there is lack of initiative, complex approval procedures, and also, lack of interest by the senior users, who are possibly computer-phobic. Most of the unit, whether government or privately managed, are however using the technology for billing purposes so as to have accuracy in accounts and finance field.” However, Shinde says, “A general perception is that only private hospitals have a good IT infrastructure. In reality, though private hospitals were first to jump on the IT bandwagon, the government, government aided,

Earlier the gap of launching advanced technology in India compared with the world was high, but with increased demand and paying capacity, now it is made available pretty soon Dr Vishal Goyal Chief Operating Officer, BGS Global Hospitals, Bengaluru

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semi-government and autonomous hospitals were not much behind. For example, Tata Memorial Hospital, Christian Medical College (CMC) Hospital and All India Institute of Medical Sciences (AIIMS) were the pioneers to use IT in healthcare. Other government hospitals are also adopting the route of the statewide Hospital Management Information System (HMIS) network such as the recent initiative by the state governments of Karnataka, Gujarat, Goa and Delhi.”

Rural and urban India Further, discussing the developments that have taken place in urban and rural India, Shinde informs, “By undertaking Corporate Social Responsibility (CSR) initiatives, private sector is helping in the development of IT in the rural areas. Confederation of Indian Industry (CII) is in discussions with government machinery that plans to make CSR initiatives mandatory. Due to the success of various pilot studies and CSR initiatives, there are islands of excellence in terms of India’s rural IT infrastructure.” However, he also admits that due to various reasons, the implementers of the pilot studies have failed to replicate the successful model to other geographies. But with the advent of nationwide Worldwide Interoperability for Microwave Access (WiMAX) services from Bharat Sanchar Nigam Ltd (BSNL), information inclusion is becoming a reality in the remotest parts of the country. General Packet Radio Service (GPRS) use on mobile phones is also increasing. These developments will be exploited by service organisations like banks and hospitals, thus ensuring inclusive growth and development of the country.

Moving ahead IT can be used as an engine to integrate and optimise the available resources in healthcare. “Today, even though India has IT-enabled hospitals and other tertiary healthcare services especially in the metros, a similar infrastructure is lacking in smaller towns and rural areas, thereby depriving the population in these areas of modern healthcare facilities. This gap can be bridged effectively by integrating healthcare services through a robust information technology


Sector Watch

Future of IT in Indian healthcare a. Standards and integration Standards like Health Insurance Portability and Accountability Act (HIPAA) will set the guidelines for data exchange and access within the organisation using suitable physical and logical barriers. The same would also apply to sharing of information between different information systems such as one hospital to another; hospital-to-government bodies and so on With the adoption of standards like HL7, the integration of various HIS will become a reality The concept of state-wide information health highway integrating with the national health highway is increasingly becoming a reality The registration number of patients in each hospital will link to the state-wide information health highway using unique standard markers for each patient Once the national information highway is in place, data mining, such as accurate demographic and epidemiological data would be possible. Medical insurance companies will link to the HMIS for faster pre-authorisation and claim processing This would also ensure trust in the hospital in terms of the healthcare treatment imparted, thus alleviating issues of disagreement between the hospital and insurance companies Since medical records of one hospital will be available

from any other hospital, the end outcome of treatment will be holistic and more reliable b. Availability of IT infrastructure Completely flexible/customisable locally relevant HMIS products will be available that will meet the maximum functional requirements possible, thus bringing down the initial cost of implementation. These features will not only decrease the implementation time but will also decrease the need for personalisation and customisation of the software at all sites of implementation The flexibility offered would be robust to the extent that the software remains relevant to the future needs of the organisation in terms of government regulations, data mining, functional requirement and equipment integration/ upgradation of the various software and hardware platforms Cloud computing will host e-mail, HMIS application and database, thus decreasing the cost of data management on premises of the hospital. The software will be accessible from within the hospital or outside permitting multi-location implementation Comprehensive and robust system monitoring, control, audit reports, data mining and access rights definition will be a regular feature of the software Adoption of universal standards like HL7 will help in easy integration of third party software that may be adopted in the future Source: Mahesh Shinde

network,” says Ajit Dixit, Vice President - IT, Metropolis Healthcare Ltd, Mumbai. Soon, the healthcare industry will be moving in the direction of using IT for capturing and storing the patient information for indefinite periods for faster access to service provision in future and also to utilise the patient information in terms of better patient care planning and administration. Chander adds, “The next level will be healthcare at the door steps of the patients with the help of facilities like online patient portals as well as e-hospital, which will ultimately reduce the traffic at

the healthcare delivery centres, except in case of critical care patients as treating them requires special infrastructure unique to healthcare centres.” Also, India should adopt model as followed in the Western world that enables effective communication between different IT systems across locations through common protocol/specifications as defined by Integrating the Healthcare Enterprise (IHE), feels Dixit. Moreover, a lot of progress needs to take place in tele-health, m-health and home health scenario. Such advanced techniques will

Today, even though India has IT-enabled hospitals and other tertiary healthcare services especially in the metros, a similar infrastructure is lacking in smaller towns and rural areas. Ajit Dixit Vice President - IT, Metropolis Healthcare Ltd, Mumbai

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reduce hospital stay, and thus, hospital beds can be utilised for treatment of many more patients. Moreover, the data captured will provide effective analysis on the disease trends, clinical studies, disease profile and impact of various remedial measures. And thus, gradually, prevention will become a major focus area. However, no economy can cater to the needs of such a huge population as ours without appropriate healthcare policies. Therefore, government support is a must to make IT in the Indian healthcare set-up as competent as that in the developed countries. With proper guidelines and adequate investments in terms of finance, research and manpower, IT has, and in the near future, will further reform the Indian healthcare scenario not just to find health solutions for medical tourists, but also for the common man residing in the remotest location of our country. (asma.yousuf@infomedia18.in)


Specialty Scope

Advancements in dentistry

Em‘bracing’ a perfect smile Orthodontics has helped in perfecting many smiles by taking care of dental malocclusions. Braces have evolved over the years from the traditional metal or wire braces to the latest invisible dental aligners. An overview…

Dr Asma Mohd Yousuf

‘A

smile is an inexpensive way to change your looks.’ - Charles Gordy However, rectifying misaligned teeth can be an expensive affair. Anything well organised looks good, and when it comes to teeth, then besides looking good, it also boosts one’s self confidence. In the hands of an expert, malocclusions occurring due to irregular teeth or disproportionate jaw relationships can be treated, and the end

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result of orthodontic treatment can be simply stunning. Orthodontics is the branch of dentistry that deals with the diagnosis, prevention and treatment of dental and facial irregularities. Braces, aligner and other appliances/devices are used to make these corrections by moving teeth and bones. “Braces have a glorious history of one hundred years of R&D. They were first introduced over hundred years ago in the US. In India, treatment with braces was introduced in the late 60s, and since then has progressed by leaps and bounds being first patronised by the metros, and now by population in the smallest of towns,” informs Dr Sridhar Kannan, Senior Consultant Orthodontist, Indraprastha Apollo Hospitals, Delhi. He further adds, “The present technology has evolved by incorporating recent advances in material sciences and technology. Braces today incorporate the use of very advanced alloys and composite adhesives for aligning teeth.”

Smiles and more Orthodontics is not only about cosmetic reasons. The scope of orthodontics is beyond just providing a good smile. Dr Lavkesh Bansal, Director and Chief Dental Surgeon, Durga Dental Care & Research Centre, Mumbai, clarifies, “People perceive orthodontics to be a treatment for bad smile alone. Unfortunately, it is not considered to be the treatment for a healthy bite.” He further adds, “One should have perfectly aligned teeth as well aligned teeth are easier to clean, which translates into fewer dental complaints in terms of caries or periodontal problem. Irregular placed teeth predispose the dentition to occlusal trauma, deviated occluding pattern and gum recession. Orthodontic treatment rectifies and saves one from these problems.” Crooked and crowded teeth are hard to clean and maintain that can result in tooth decay, worsen gum disease and lead to tooth loss. Other orthodontic problems can contribute to abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and bone that supports the teeth, or misalignment of the jaw joints. These can lead to chronic headaches and face or neck pain. Dr Kannan explains, “During chewing, a tremendous force is exerted on the teeth. It has been measured at 250 lb/square inch at the molar teeth. It would not be out of place to give you an idea of this force value, if this force were to fall on your finger it would be compressed to the thickness of your newspaper.” He further elaborates, “When the teeth are not straight or


Specialty Scope properly arranged with the bone in respect to their long axis, the force is misguided and destroys the supporting structures of the teeth, loosening them and hastening their fall. We have all had the experience of driving a nail into the wall, so long as the stroke from the hammer travels along and long axis of the nail, everything is great, but the plaster falls off the moment a stroke is misdirected. This is the closest example in everyday life that can be offered to explain the effect of force on supporting structures.” He also informs that as one gets older, the roof of the mouth can sometimes partially block the air passages in the nose. This can result in snoring loudly, and may contribute to a condition called sleep apnoea. However, by getting orthodontic treatment, one can avoid this possibility.

Treatment modalities Initially, it is always an individual’s or his/ her family’s observation of the smile that makes him/her realise that something is not right. Only after this observation, one visits a dentist or orthodontist with clinical expertise to name this deviation. Besides clinical examination, dental radiographs like Orthopantomogram (OPG) and lateral cephalogram, cone beam Computed Tomography (CT) scan, dental arch study models and intra and extra oral photographs are used in making the right diagnosis by the treating dentist. Dr Bansal explains, “Evaluation of these diagnostic tools is done with different set of analysis and predefined norms for an ideal occlusion and smile. After diagnosis, a through treatment plan is charted out, which is balancing decision between clinical, radiographic, patient’s personality, his/ her expectation and achievable final outcome. A detailed consultation with patient about different options is done and then the accepted treatment plan is executed. The treatment can take anywhere between 6 months to one and half year to complete, followed by retention phase.”

In India, treatment with braces was introduced in the late sixties and since then has progressed by leaps and bounds. Dr Sridhar Kannan Senior Consultant Orthodontist, Indraprastha Apollo Hospitals, Delhi

Beyond braces

Role of orthognathic surgeries

Treatment in orthodontics can be done with removable or fixed appliance therapy. Fixed therapy involves braces, wires and elastics. Braces have options like metal, ceramic and lingual. Most important development is the use of mini implants that aid in the anchorage to get much better and faster results with straight wire technique. Dr Bansal agrees, “Use of micro/mini implants that are used to aid in anchorage has really boosted the scope of using basic orthodontic principles for correction of different dental or orodental problems.” Meanwhile, Dr Pratap Raut, Dentist, S L Raheja (a Fortis associate) Hospital, Mumbai, informs, “Myofunctional appliances are used to correct or guide jaw development so as to enhance orthodontic treatment. Extraoral appliances are also used but they are used very rarely nowadays. Besides, fixed appliances comprise mainly brackets and wires. Newer advances in materials like the use of NiTi wires and ceramic brackets have enhanced orthodontic care.” Further, Dr Ajay Sharma, Senior Consultant Dental Surgeon, Prosthodontist and Oral Implantologist, Max Healthcare, New Delhi, adds, “Generally, children from 7 to 18 years come to us most often for orthodontic treatment, but today it is possible to treat these problems at any age. Crowding of the teeth is treated with removable or fixed orthodontics, often with tooth extraction or serial extraction, followed by growth modification in children or jaw surgery or orthognathic surgery in adults.”

Orthognathic surgeries are performed to rectify conditions of the jaw and face related to structure, growth, sleep apnoea, Temporomandibular Joint

Aetiology Developmental anomaly: Cleft lip/palate, congenital missing or supernumerary teeth, etc Trauma: During or after birth that has affected the growth of jaw and/ or teeth Anatomical: Hypo/hyper tonic lips/tongue, excessive horizontal or vertical growth of upper, lower or both jaws, etc Caries: Rampant caries, early extraction of milk teeth, nonrestored carious milk teeth, etc Habits: Thumb/finger sucking habit in childhood, tongue thrust, etc Oral health: Poor periodontal health, loss of permanent teeth and no replacement of lost teeth, etc Source: Dr Lavkesh Bansal

Dental conditions that can be treated in orthodontics Malocclusion or malaligned teeth Crowded teeth Tooth size - jaw size discrepancies Aesthetics and functional problems due to malaligned teeth Unnatural bite problems Unerupted teeth or impacted teeth Too little or too much space for teeth Skeletal discrepancies Facial discrepancies Source: Dr Ajay Sharma

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Specialty Scope

People perceive orthodontics to be treatment for bad smile alone. Unfortunately, it is not considered to be the treatment for a healthy bite. Dr Lavkesh Bansal Director and Chief Dental Surgeon, Durga Dental Care & Research Centre, Mumbai

(TMJ) disorders, malocclusion problems owing to skeletal disharmonies or other orthodontic problems that cannot be easily treated with braces. It is also used in treatment of congenital conditions like cleft palate. Dr Kannan informs, “Surgery is a new dimension that has been added to orthodontics. This is a combination procedure carried out by the orthodontist and the oral & maxillofacial surgeon to produce the best possible result for the patient. There are some defects that may require surgery to correct to perfection. These are generally related to large jaws and open bite cases.” He further adds, “With the number of cases of adult treatment rising for orthodontic treatment, the number of cases going for final surgical correction is also increasing. Teeth can be moved with braces. But when the problem involves the bones of the face, they have to be set surgically. The need for final correction with surgery is generally determined at the diagnosis stage. However, it is always treatment with braces before surgical correction.” Further, discussing the possible complications associated with these surgeries, Dr Sharma adds, “Some of the contraindications to this surgery include conditions, such as medical problems, psychological problems, radiotherapy and unrealistic expectations. Like any other surgery, in orthognathic surgeries also there can be some complications like bleeding, swelling, infection, nausea and vomiting. There could also be some numbness in the face due to nerve damage. The numbness may be either temporary, or, more rarely, permanent. If the surgery involved the upper jaw, then the surgery could have an effect on the shape of the patient’s nose. This

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can be minimised by careful planning and accurate execution of the surgical plan.” However, he admits, “In general, complications of this surgery occur, but not frequently.”

abnormal positions. If the tooth relations cannot be made normal by orthodontics alone, a combined approach of both orthodontics and surgical repositioning of the jaws is necessary. Such surgery is usually performed after the pubertal growth spurt is completed. While treating congenital anomalies like co-ordination of treatment between the surgeon and dental specialist is important since several procedures may be completed under the same anaesthesia. Also, restorations or dental extractions can be scheduled at the same time as other surgery.

Craniofacial orthodontics This is a division of orthodontics that focusses on the multidisciplinary and interdisciplinary treatment of patients with birth defects, such as cleft lip and palate. These conditions often require co-ordinated surgical and medical interventions or extraordinary behavioural management to make

There is lot of scope for orthodontics in India as it is the most demanded field of super specialisation after completion of basic dental programme. orthodontic treatment practical and effective. Dr Sharma avers, “Braces treatment for cleft lip and palate patients tends to be more complex, takes more time and clinical resources, and requires working with multiple dental, surgical and medical providers to get the best results. The evaluation of the new born by the orthodontist, whose specialty is the growth and development of the craniofacial complex, will help in determining the timing of the required surgeries as the child develops.” He further informs that when the child approaches adolescence the orthodontist and surgeon again coordinate their efforts if the teeth do not meet properly because the jaws are in

Cost factor Orthodontic treatments are considered expensive the world over. Elaborating on the reason for the high cost involved, Dr Kannan says, “The experience of the orthodontist, quality of the braces and problem to be treated decides the cost of the treatment. One could choose outdated, low technology, cheaper braces, but will end up paying more in terms of hidden costs, such as extra visits, longer treatment time, more discomfort and poor results. Cost of treatment varies from city to city. There is no standardisation of charges for treatment.” He further adds that treatment with braces is purely result oriented. Moreover, it is a highly skilled job requiring expensive materials.

Indian scenario There is lot of scope for orthodontics in India as it is the most demanded field of super specialisation after completion of basic dental programme. However, there are still many myths related to orthodontics and its role in dentistry among the common masses that need to be solved. Moreover, currently in India such specialised services are available only in high profile hospitals. In agreement, Dr Raut says,“Today, adult orthodontics is also becoming increasingly popular. Although the awareness on orthodontics is increasing in India, but sadly rural India cannot benefit from


Specialty Scope modern orthodontic treatment due to high costs.” However, Dr Sharma feels, “There is not enough awareness among the Indian population about the role of orthodontics. Therefore, some steps like making dental care a part of school health programme would help in addressing dental problems at an early age. Also, to overcome challenges, government should emphasise on oral care programmes more aggressively, especially outside metro cities. Primary healthcare centres should have dental care facilities in rural areas. Further, media should also put efforts in making people aware about these problems and ways to rectify them.” Describing the present and future of the developments related to braces, which is a major component of orthodontic treatment, Dr Sharma says, “Conventional braces on the left are tied in with elastics, which cause friction and pressure, making treatment slower and less comfortable.

Generally, children from 7 to 18 years come to us most often for orthodontic treatment but today it is possible to treat these problems at any age. Dr Ajay Sharma Senior Consultant Dental Surgeon, Prosthodontist and Oral Implantologist, Max Healthcare, New Delhi

But self ligating braces use a slide mechanism to hold the wire that allows teeth to move more freely, quickly and comfortably. However, pre-programmed invisible braces using Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technology will be the future of orthodontics.” A visit to a dentist always brings a frown despite the fact that it can provide one with a beautiful smile. With the mention of a dentist, images of pointed instruments poked into the gums, mouth stretched open beyond the point of endurance and blood-soaked cotton balls are the

visuals that come to one’s mind. However, Information Technology (IT) has transformed the medical world, dentistry not being an exception. The adoption of CAD/CAM technology in dentistry is a step towards creating easy solutions for orthodontic problems. Today, even invisible braces are available, which can save one from the uneasiness caused by metal or wire braces. Hopefully in future, with technological developments, there may be a less painful method of treating teeth malalignments that will possibly be resolved within one or fewer visits to a dentist. (asma.yousuf@infomedia18.in)

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Health Chip

Semiconductors in patient monitoring systems

A new paradigm in treatment and diagnosis Semiconductor technology is having a profound effect on the healthcare industry. It improvises aspects of healthcare by providing devices that are more flexible, affordable and accessible. an in-hospital network to those who need it. With the increasing demand to reduce cost, industry is cutting down on staff, equipment, power consumption, etc. But how much does this cost the patient? It is a challenge, and healthcare providers are counting on technology to help meet this challenge of better care at a reasonable cost.

Quality and affordable healthcare

S

emiconductor technology is here to revolutionise the healthcare industry. Patient monitoring, drug dispensing and many other applications can enhance the capabilities of scarce manpower resources by capturing information on patients, rapidly processing the data and then distributing critical information through

Rakesh Joshi General Manager Business Development (Medical), Texas Instruments India

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The need for providing quality and affordable healthcare is ever increasing. With advancing medical science, the role of technology is becoming increasingly important to provide preventive care, early diagnosis and quality treatment to patients. This is especially true in developing countries like India where there is a demand-supply gap for quality healthcare facilities. Most observers agree that India is a key future market for medical devices & equipment. Changing demographic profile with increasing old age population, increasing incidences of life style diseases like cancer, diabetes, etc are some of the other relevant factors. According to a 2010 ISA Frost & Sullivan Report, the Indian healthcare industry contributed 5.6 per cent of Gross Domestic Product (GDP), which is estimated to increase to 8-8.5 per cent by FY 2013. According to ISA, medical electronics is valued at ` 3,850 crore of the overall Indian healthcare market of ` 300,000 crore. Annually, medical

equipment worth ` 2,450 crore ($520 million) is manufactured in India, out of which ` 350 crore ($75 million) is exported.

Why patient monitoring? Monitoring equipment can provide valuable information and act as an extension of the anaesthetist’s own senses. There are opportunities in the development of non-invasive patient monitoring, bringing healthcare to the home. A large chunk of older adults are challenged by chronic and acute illnesses and/or injuries. Patient monitoring technologies have proved to be effective in helping to manage chronic disease, post-acute care and monitoring the safety of the older adult population. An ongoing need to minimise healthcare costs is initiating the thrust towards patient treatment and monitoring outside of the hospital. This shift is placing an emphasis on remote patient monitoring and telemedicine solutions that enable providers to treat patients in highly populated, rural and remote areas in emerging economies. Patient monitoring equipment market in India is quite large. Since the introduction of the monitoring standards in the anaesthetic practice, a gradual increase in the patient monitoring equipment market is being seen. Even small nursing homes are going in for patient monitoring equipment and hence the market is gradually increasing. A variety of portable, single-parameter monitors have emerged over the last few years that measure blood pressure, glucose levels, pulse, tidal carbon dioxide and other biometric values. Most important features of today’s patient monitors


Health Chip are mobility, ease-of-use and effortless patient data transfer.

Role of semiconductors Semiconductors have emerged as the champions for a critical cause: that of taking healthcare to the masses across the country and changing the paradigm of diagnosis and treatment. The scope of semiconductors is such that it has brought simple medical tools right to the common man’s doorstep through a number of portable devices like electronic thermometers, blood glucose meters, digital hearing aids, blood pressure monitors, etc. On a macro scale, they are finding increased viability in high-end medical devices like Medical Resonance Imaging (MRI) scanners, Computed Tomography (CT) scanners, digital X-ray machines, heart rate monitors, insulin pumps, etc.

Solution providers Emerging technological trends are posing both challenges and opportunities for this industry. The need for providing quality healthcare to humanity is ever increasing. With advances in medical sciences, the role of technology is becoming increasingly important to provide diagnosis and treatment to patients. Innovation, deploying latest technology, shortening of development time, providing high quality after sales service become critical success factors for this industry. Customer satisfaction and loyalty have special significance in this industry as healthcare professionals are a closely knit community. Quality, reliability and product longevity are key concerns of medical customers. Solution providers like Texas Instruments (TI) are committed to addressing these concerns, for which we leverage our knowledge in supporting highly regulated industries, our global manufacturing strength, process technology expertise and industry involvement. With an extensive on-ground support through its 14 sales and marketing offices in India, TI believes in delivering the highest quality of services and solutions to its customers. Medical market has always been a market that demands highest standards

of quality and reliability of its suppliers and that cares about longevity of products as do other high-reliability markets. Supplying to the medical market means that one must offer outstanding quality consistently. TI offers a few innovative semiconductor solutions that offer a lot of benefits. TI makes advanced medical devices more flexible, affordable and accessible. It also addresses the growing need for portability, wireless connectivity, energy efficiency, performance and precision.

Going the green way In the current scenario, where energy conservation and efficient battery management solutions find increased importance, such semiconductor chips are bringing in devices that consume

Semiconductor chips are bringing in devices that consume lesser power and have lower error margins that translate into more accurate results, extended battery life and superior image quality.

stethoscopes and pulse oximeter products. These kits are based on TI C5505 and provide a great evaluation platform to help medical device manufacturers focus on product differentiation, like algorithm development and feature enhancement. They also lower the barrier for novice developers who want to enter the medical industry quickly. The TI C5505 fixed-point DSP is based on the TMS320C55x™ DSP generation CPU processor core. The C55x™ DSP architecture achieves high performance and low power through increased parallelism and total focus on power. TI has a complete portfolio of products that includes amplifiers, data converters, interfaces, power management, logic, DSPs, ultra low-power and ARM based microcontrollers (MCUs), wireless connectivity, audio and video ICs. Another key product is the TI ADS1298, a 8-Channel, 24-Bit ADC with integrated ECG front-end solution that addresses the challenge of affordable solutions in markets like India. TI has also launched a set of medical application development tools with complete signal chain designs and software for ECGs, digital stethoscopes and pulse oximeter products.

Opportunities galore... lesser power and have lower error margins that translate into more accurate results, extended battery life (for devices like ECG, EEG, EMG) and superior image quality. The need for low power is the same across the industry. For medical, it may even go a step ahead when medical electronics are placed inside the human body, eg, pacemakers. One does want to make sure these batteries last as long as possible to reduce the need for new surgeries to exchange the battery. Today, Original Equipment Manufacturers (OEMs) need to deliver solutions at a fast pace to meet consumers’ growing need for devices that are more portable, consume less power and provide more sophistication, all at a lower cost. To answer these needs, TI has launched a set of medical application development tools with complete signal chain designs and software for electrocardiograms, digital

Huge opportunities exist across the Indian medical health sector especially in patient monitoring services. There is also a great opportunity in further driving integration and optimisation in medical imaging and medical diagnostic instruments as well as in surgical instruments. The potential is vast and India has several providers who are uniquely positioned to address the needs of medical electronics manufacturers across the broad and diverse medical market with the industry’s broadest and most diverse product portfolio, global manufacturing strength, process technology expertise and profound systems understanding in areas such as ultrasound, ECG or blood glucose meters. The impact of semiconductor companies’ dedicated involvement in the medical device industry will be interesting to observe in the near future. (ticontrib-in@ti.com)

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Policy Matters

Dwindling sex ratio

A matter of concern The 2011 Census brought some good news with no high increase in the population of India; however, the condition of the girl child remains the same. Despite certain policies, the number of girl child below six years of age is poor. Is this skewed ratio a result of poor nutrition and neglected healthcare for the girl child? These numbers call for some strict measures.

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he biggest exercise in the history of any democracy took place this year. Census was conducted in India - a country with a population of billion. Although the nation is entering the ‘demographic dividend’ phase, which refers to the greater part of population belonging to the working class (spurring economic growth), child sex ratios have unarguably shocked and shamed the nation. In spite of the presence of laws to prevent female foeticide and government schemes to encourage families to have girl child, the

Dr Sanjay Gupte MD, DGO, FICOG, FRCOG, LLB, President, FOGSI 2010

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female sex ratio has declined from 927 females in 2001 to 914 females in 2011 against every 1,000 males. The United Nation’s Children Fund (UNICEF) expresses concern that the low sex ratio remains one of the most disquieting features of India’s population growth. In a country where 90 per cent of marriages are arranged, women have limited power of expression, thereby starting a cascade of acts of male dominance. With traditional aspects such as dowry system, family name, lineage, family wealth and religion, society has always preferred a male heir. Since the demand is from the common families and fulfilled by unethical doctors for commercial interests, despite having strict laws, it is very difficult to catch the culprits. Firstly, there is no complainer, and the crime is done

with consent. And this trend continues to churn generation after generation of female discrimination. The Pre-conception and Pre-natal Diagnostic Technique (PCPNDT) Act was initiated in 1984 and it gave a legal voice to this issue. Pre-natal sex determination has been banned in India since 1994. There are certain rules and regulations formed under this law for genetic centres but implementation and monitoring is far from expected. Unfortunately, female foeticide is not treated as murder and there is no social or moral resistance towards unwanted sex-selective abortions. Also, extensive misuse of the technology such as ultrasound machine to easily identify the sex of the foetus has become a common technique, and also an unethical practice for the black sheep among doctors and radiologist to earn easy money. Earlier, lack of awareness and education were deemed culprits for the skewed ratio. But the latest census reveals another stupefying fact – the infrastructure-wise weaker north eastern states have a much healthier ratio (971 females against 1,000 males) compared to the other states. Haryana’s Jhajjar (774 females) and Mahendragarh (778 females) districts have the lowest sex ratio countrywide, while Lahul and Spiti district of Himachal Pradesh have the highest sex ratio (1,013 females). Prenatal determination of sex is not restricted to educational status or to socio-economic status. In fact, with awareness, sex determination is predominantly more significant in urban than in rural societies. Since independence, there was never a more urgent need to tackle the serious


Policy Matters challenges posed by the neglect of the girl child, high maternal mortality, sex-selective female abortions and female infanticide. Misuse of advanced prenatal diagnostic techniques has led to sex selection with the widespread unregulated termination of female foetuses, contributing to a rapidly declining girl to boy child sex ratio.

Tackling the issue The removal of prenatal sex determination practice in Indian society is a serious challenge. According to Dr Indu Grewal, Senior Medical Officer, Directorate of Health Services, Delhi, it must involve: Empowerment of women and strengthening of women’s rights through campaigning against practices such as dowry, and ensuring strict implementation of existing legislation. Ensuring the development of and access to good healthcare services. Simple methods of complaint registration, accessible to the poorest and most vulnerable women. Wide publication in the media of the scale and seriousness of the practice. Non-government Organisations (NGOs) should take a key role in educating the public on this matter. Regular assessment of indicators of status of women in society, such as sex ratio, female mortality, literacy and economic participation. It is only by a combination of monitoring, education campaigns and effective legal implementation that the deep-seated attitudes and practices against women and girls can be eroded.

Awareness and education The government is taking several steps towards increasing awareness and educating people about the effects of skewed sex ratio. Moral and social perceptions should be changed radically so that every citizen can evoke and implement action. The United Nations has designated November 25 as a day to bring awareness to acts of violence targeted at women across the globe. Female foeticide and infanticide are

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considered forms of violence against women and one of the most serious crimes in India today.

Capturing the culprit The PCPNDT Act though right in its spirit, has a lot of ambiguities, and many doctors and radiologists find that it is variously interpreted, by all concerned. A device has now been developed to intercept ultrasound procedures and track suspects. The system is implemented in two phases, Online Portal and fitting a video capture device to the Ultrasonography (USG) machine.The development of this device can significantly help stricter implementation of the Act. The project was successfully implemented at District Administration, Kolhapur and has effectively controlled the female foeticide issue by raising the sex ratio of 839 (as per 2001 census) to 876.

Advantages of online portal If there is an online system, the centres could easily fill the complete information of each USG. The system should work in such a way that incomplete forms are not submitted. This will not only help the authorities but is more advantageous to the genetic centres as they can rely upon their support staff to submit information, exactly following the guidelines of the PCPNDT Act. The genetic centres will have minimal risk of legal action resulting from incomplete documentation (Form F). Especially, if physical filling of Form F is done away with the help of online reporting it will also be more acceptable to the doctors. Currently, such portals do exist. Appropriate authorities can access the reports of each USG immediately through online system, which they can cross check, monitor or track easily and from anywhere with the use of PC with Internet connection. Such data can be further utilised for analysis and report generation. The data collected from each USG can be systematically processed by various indicators such USG as per age group, USG as per number of weeks of Pregnancy, Antenatal care Tracking, Medical Termination of Pregnancy

reports with less and more than 12 weeks or pregnancies, delivery reports with intrauterine devices, minor USGs and many more. These reports can help for monitoring the sex selection suspected cases and for implementation of the various health schemes.

Ultrasound interception device Under-reporting or hiding sex determination reports or telling reports verbally is another major hurdle faced by administrators of the PCPNDT Act. Now, a device has been developed to tackle this problem. The device is fitted to the USG machine externally through cables and it captures all the video images of the USG and stores it in the local hard drive. Every time a USG machine is turned on, the device also gets turned on and immediately starts the video recording even if the machine is idle. This General Packet Radio Service (GPRS)-enabled device can check for actions such as any tampering attempts. The GPRS is integrated with the online portal and from the portal a single user can manage about the functioning of the device. Thus, it helps in terms of security, monitoring, support and control on the devices and centres.

In the next phase Female foeticide is an extreme manifestation of violence against women. More women are likely to be exploited as sex workers. Increases in molestations and rape are an obvious result. Creating awareness and promoting the idea of gender equality alone may not be enough to control the rampant practice of prenatal sex determination. On the other hand, creating and implementing laws may also not be enough to check the rapid spread of the issue. The complexity of the problem lies in the intricate nexus between the immoral user of such facilities and the unethical operator. The Census of 2011 has brought another challenge to the fore – every effort should be made to make gender equality a reality and preventing prenatal sex determination is the first step. (mmedit@infomedia18.in)


Imaging Diagnostics

Biograph mMR™

A milestone in diagnostic imaging Since the mid 80s, physicians and medical physicists have been dreaming of the tremendous possibilities simultaneous Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) can offer in an integrated whole-body system. With Biograph mMR, Siemens now turns this dream of molecular MR imaging into reality for the first time.

Figure 1: (L-R): Prof Dr Harald H Quick, Head-MR Imaging, IMP, and Dr Jens-Christoph Georgi, Product Manager, Biograph mMR, Global Siemens, besides the MR-PET system at IMP in Erlangen

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o implement a highly complex development such as the Biograph mMR™ integrated MR-PET hybrid system, the developers at Siemens have broken new ground at different levels. This technological milestone was made possible through the close co-operation of two Siemens business units ‘Magnetic Resonance’ and ‘Molecular Imaging’ as well as the early involvement of partners for the pre-development and clinical application [University Hospital of Tuebingen, University Hospital ‘Klinikum rechts der Isar’ of the Technical University of Munich, Massachusetts General Hospital in Boston, Section for MR Imaging (Prof Dr Harald H Quick,

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PhD) at the ‘Institut für Medizinische Physik’ (Institute of Medical Physics, IMP) of Friedrich-Alexander-University of Erlangen-Nuremberg]. The IMP was the partner of choice for the early system tests. Due to the close affiliation of IMP with the University Hospital of Erlangen, it was possible to scan the first test individuals as early as during the late stages of the development. The subjects were examined with the Biograph mMR prototype without an additional tracer injection following an indicated PET-Computed Tomography (CT) examination. The technical system tests performed at the IMP in Erlangen (Figure 1) primarily focussed on comprehensive physico-technical examinations to evaluate

the MR and PET image quality as well as the combined use of the two modalities. This was finally followed by combined MR-PET hybrid imaging of the first test subjects. Again, these system tests conducted at IMP focussed on evaluating image quality and optimising the simultaneous workflow. “With simultaneous MR-PET hybrid imaging, we open the door to entirely new diagnostic and technical possibilities in medical imaging,” said Prof Dr Harald H Quick, Head - MR Imaging, IMP, Erlangen. “As the system already is in a sophisticated state and the two imaging modalities have been elegantly integrated into one system, the clinical trial and scientific evaluation of this new technique can now take place without delay. We can now simultaneously acquire MR and PET data across the whole body, ultimately allowing for better diagnosis of the patient,” he added.

The outstanding results First scans of test subjects performed at the IMP showed promising results and demonstrated the diagnostic potential of the new technique to combine the high spatial resolution and excellent soft-tissue contrast of MRI with the high sensitivity to tumour cells of PET imaging (Figures 2 and 3). Based on years of preliminary work with four PET head inserts, the so-called BrainPETs, for the 3 Tesla MR system MAGNETOM Trio, A Tim (Total imaging matrix) system, with Biograph mMR™ Siemens introduced the first system worldwide to combine the advantages of MRI with the strengths of PET. MRI offers the advantages of good soft-tissue contrast,


Imaging Diagnostics 2

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Figure 2: Whole-body mMR examination of a test subject with lymph node metastases: Superimposition of metabolic data [(18F) FDG PET] on the simultaneously acquired MR image, which is characterised by excellent soft-tissue contrast, for easier detection of the extent of lymph node metastasis Figure 3: Detailed image of the pelvis for precise evaluation of individual lymph nodes and their location in relation to important anatomic landmarks for therapy planning. By simultaneous acquisition of PET and MRI data during the mMR examination, incorrect registrations such as can occur in sequential measurements, eg, due to different fill states of the bladder, can be prevented

high spatial and temporal resolution in anatomical and functional imaging and the absence of radiation exposure, while PET is characterised by its high sensitivity in metabolic imaging. One of the main objectives was to fully exploit the potential of both modalities.

Advantage technology Compared to a PET-CT system, the PET detector ring, which is exactly at the level of the magnet isocentre, had to be adapted so that its operation would not be disturbed by the strong constant magnetic field (3 Tesla) or the gradient fields of the MR scanner and that it would not interfere itself with these fields. A critical component typically used in PET-CT systems is the Photomultiplier Tube (PMT), which converts the light signal from the scintillator crystals of the detector into electrical signals and is severely disturbed by the constant magnetic field of the MR scanner. Drawing on experiences made with the BrainPET prototype, the developers at Siemens solved this problem by replacing the PMT with Avalanche Photodiodes (APD), special semiconductor devices, which are proven to be successful in the BrainPET prototypes. Their advantage is that they are not only insensitive to the magnetic fields but also considerably smaller than the PMT. Thus, it was possible to implement a magnet bore of 60 cm after integrating the PET detector ring into an MR scanner.

The PET detector also sets entirely new standards by its size in the axial (z) direction: with an Fixed Volume (FV) of 25.8 cm, it is the longest industrially manufactured PET detector. This offers a dual advantage; due to the large coverage, fewer bed positions need to be acquired during whole-body examinations. In addition, the large solid angle covered allows for a very high volume sensitivity, which translates directly into low-noise images. On the MR side, too, the system is a fully fledged, state-of-the-art 3T system with the same gradient specification as all the other 3T MR scanners from Siemens (45 mT/m, 200 T/m/s). Together with the Biograph mMR local coils (Siemens Tim™ coil technology) especially optimised for simultaneous MR and PET imaging, it is possible to perform not only the standard imaging sequences but also all the advanced functional MR sequences that one want to combine with PET imaging: functional MRI, diffusion-weighted MRI, MR spectroscopy, Diffusion Tensor Imaging (DTI) and fiber tracking - all this across the whole body and, thanks to Tim coil technology, without changing coils or repositioning the patient. For Siemens, based on experiences gained with the BrainPET scanners, it was also possible to solve the problem of photon attenuation and scattering in PET imaging. Biograph mMR provides automatic attenuation and scattering correction for PET images

Figure 4: Owing to its compact, integrated design (system length of 1.99 m), the 33 metre square space requirement of the Biograph mMR corresponds to that of a conventional 3 Tesla MR system

Figure 5: The simultaneous acquisition of MR and PET data is a great advantage for patient comfort and diagnosis. The information obtained by the step-by-step MRI acquisition of anatomical and functional data and simultaneous PET capture of the metabolic activity of the tissue can then be merged into MR-PET whole-body datasets. During this process, it is not necessary to reposition the patient or to change coils. First examinations have shown that a whole-body MR-PET scan can be performed in less than 30 minutes.

based on special MR sequences that are acquired simultaneously with the PET data.

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Imaging Diagnostics One advantage of an integrated system as compared to two separate systems is that it requires about 50 per cent less space. With a total of 33 meter square, the footprint is similar to that of a conventional 3T MR scanner (Figure 4). For the IMP in Erlangen, this was an important factor and a necessary requirement for sitting and placement of the system in the institute’s buildings. In addition to its low space requirement, an integrated system also offers considerable advantages in clinical operation. Acquiring a single exam with an integrated system, controlled by one technologist via one control unit, dispenses with the necessity of coordinating two examination dates for two systems in different departments. This saves the hospital unnecessary work and leads to faster examination results for patients. Another benefit from this special feature of the system is the fact that PET and MR data are acquired simultaneously (Figure 5). Simultaneous MR and PET imaging also opens up entirely new possibilities with regard to image quality, and thus diagnosis,

precise spatial and temporal registration of anatomical, functional and metabolic image data, simultaneous acquisition of PET and MR data for attenuation correction, MR imaging for motion correction in the PET data.

Money matters Hybrid imaging is already considered an important forerunner of personalised medicine. Therefore, the MR-PET combination is expected to provide great benefit for research and clinical application according to Dr Werner Broecker, Head of the Division of Scientific Instrumentation and Information Technology, ‘Deutsche Forschungsgemeinschaft’ (German Research Foundation, DFG). Consequently, the first systems worldwide were funded at federal (Federal Ministry of Education and Research, BMBF) and state level or by organisations promoting research such as the DFG. Following the first installation for clinical application tests in the Clinic for Nuclear Medicine at the Klinikum rechts der Isar (Technical University Munich Medical

Center) in November 2010, the second system will be installed at the University Hospital of Tuebingen in Spring 2011. Under the coordination of the DFG, the funded institutions, which further include the University Hospital of Essen, the University Hospital of Leipzig and IMP in Erlangen as an associated partner, will together explore the possibilities and limits of the system, especially in the areas of oncology, neurology and cardiology, in order to identify those applications where patients will benefit the most from the new imaging modality. Here, an open, trusting exchange between academia and industry allows the experiences and knowledge of early clinical users to be incorporated in the future development roadmap of the system, which is of particular value to all participants. Thus, the dream of molecular MR imaging also becomes reality for those who are to benefit from it the most - the patients. Courtesy: Siemens Healthcare, Siemens Ltd (mmedit@infomedia18.in)

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Facility Visit

Ree Laboratories Pvt Ltd

‘Ree’juvenating hope For people suffering with incurable diseases, stem cell therapy provides an alternative, a hope for something to look forward to, something substantial. And Ree Laboratories Pvt Ltd aims to offer curative stem cell therapies, as opposed to supportive therapy, for most incurable disorders. Let us have a look how it is done. Dr Asma Mohd Yousuf

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enew, repair and regenerate are the basic properties of stem cells sharing the prefix ‘Re’. And that is how this

stem cell banking and research facility got its name Ree Laboratories Pvt Ltd or ReeLabs as it is commonly denoted. Stem cells have the potential to

treat and possibly cure various disorders like diabetes, heart failures, liver cirrhosis, spinal cord injuries, muscular dystrophy, cerebral palsy, osteoarthritis, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, autism and renal failures amongst many others. However, early identification, intervention and treatment are essential in maximising the effect of stem cells therapies in these disorders, helping to prevent major problems in the future and avoiding life-long expensive yet ineffective care. Ree Laboratories Pvt Ltd is one such stem cell banking and research unit that offers proven therapies that attempt to first cure the patients of the disorder, and if not, then minimise the adverse impact of the disorder during his/her lifetime and improve quality of life manifold. Presently, ReeLabs is a zero debt company, which has recently ventured into cord blood banking and stem cell research and therapy.

The facility “The stem cell market has a high potential but is not adequately tapped. This industry needs a boost. At ReeLabs, we provide 3-in-1 services; banking, therapy and R&D,” says Sunil Pophale, Managing Director & Chief Promoter, Ree Laboratories Pvt Ltd, Mumbai. Discussing the establishment of ReeLabs, Pophale says, “In Feb 2009, ReeLabs was started in Mumbai. Currently, our premise at Andheri is spread at 3500 sq ft. But soon, ie, by 2012, we will be shifting to

Various units at Reelabs

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Facility Visit 16,000 sq ft premises in Goregaon. We are proud to be the first stem cell facility in Mumbai.” The stem cell samples in ReeLabs are collected, processed and stored as per international standards that ensure optimum yield of stem cells. ReeLabs is a highly sophisticated, state-of-the-art stem cell facility that employs a quality management system based on continuous improvement, to ensure that all aspects of its services are consistently carried out and meets International Cellular Therapy (ICT) standards. The laboratory is certified with Good Laboratory Practices (GLP) and Good Manufacturing Practices (GMP), and is in accordance with American Association of Blood Banks (AABB). Pophale informs, “Our state-of-the-art machinery for extraction and storage of stem cells, manufactured and supplied by global giants, gives us a strong technological platform to build our business. These cryogenic storage vehicles use the latest technology to ensure the safety, potency and viability of stem cells procured and stored in our facility.” He further adds, “However, machines would be worthless without the people who operate them. Therefore, our lab biotechnologists, equipment operators and support staff receive intensive training on operation of every machine during the induction programme. We also teach and enforce industry-leading best practices for processing and storing stem cells. Regular workshops are held to educate the team on recent advances in this sector.” The laboratory is manned 24 x 7 by a well-qualified, highly competent and skilled staff to collect, process and store stem cell samples from all possible sources. The processing is done in a specifically designed clean room that has international levels of sterility and hygiene. Further, ReeLabs has the requisite craft, technology and expertise to process stem cells from cord blood, cord, bone

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The future of stem cell market is indeed bright. And multiple centre establishments, is what we aim for. Sunil Pophale Managing Director & Chief Promoter, Ree Laboratories Pvt Ltd, Mumbai

marrow, amniotic fluid, placenta, bloodstream, adipose tissue and other suitable sources as need be. Hence it’s a complete stem cell banking unit vis-à-vis ‘another’ cord blood bank.

The ‘Ree’ advantage ReeLabs has a dual advantage of having two indispensible arms – ReeCord, for stem cell banking and ReeCure, for stem cell treatments for various congenital, developmental, degenerative and malignant disorders.

The stem cell samples in ReeLabs are collected, processed and stored as per international standards that ensure optimum yield of stem cells. They work symbiotically to encompass all aspects of stem cell medicine inorder to provide the end user a mix of unparalleled stem cell banking facility and elite treatment options. ReeCord: ReeCord effectively processes and stores various types of haematopoietic and mesenchymal stem cells for all its clients. Dr Abhijit Bopardikar, Director and Pathologist, Ree Laboratories Pvt Ltd, says, “Having more cells available for treatment is important because a larger number of stem cells can help a patient recover faster, experience fewer complications and ultimately, increases chance for survival.” He further adds, “Another significant advantage is that with the virtue of ReeCord’s unique proprietary logistics

systems, it promises customers with initiation of processing in the first six hours of collection of the cord blood/cord sample. This ensures an unbeatable count, viability and potency of the processed stem cells. Also, our proprietary Stem Cell Improvement System, including proprietary collection kits and superior processing technology, has the highest published cell recovery rate in the industry, ie, 99 per cent. ReeCord’s unique system saves 25 per cent more cells on an average compared to other common methods. Further, we have the technology to process stem cells from any available source as per the client’s desire.” ReeCure: ReeCure specially emphasises on providing safe, effective stem cell treatments to the hitherto incurable congenital, developmental and degenerative disorders. Dr Bopardikar informs, “The type, dosage and mode of administration of stem cells is decided by thorough patient selection protocol, comprehensive deliberation of the condition by ReeCure’s distinguished team of doctors & researchers, our ethics committee, and detailed examination of the patients followed by meticulous counselling on the further course of action.” Explaining the details, he says, “Further, each and every stem cell sample is screened by Polymerase Chain Reaction (PCR) to neutralise the ubiquitous errors by conventional Enzyme-Linked Immunosorbent Assay (ELISA) systems in identifying window periods for Human Immunodeficiency Virus (HIV) or hepatitis infections to make


Facility Visit

transplants safe and convenient transplants. ReeCure uses proprietary technology to segregate stem cells from various sources like the bone marrow, cord blood, fat, bloodstream, etc. A relevant Certificate Of Analysis (COA) mentioning all details of stem cells is handed out prior to any transplant.”

Research and development “Stem cell science is still in the experimental phase. Therefore, R&D is a must. Every day some new detail discovered helps in better understanding, and thus improved treatment options,” informs Dr Bopardikar. He further adds, “R&D is the backbone of our organisation. For four years, R&D was done before setting up this facility in Mumbai. Over the past two years of exhaustive and increased R&D activities in the company, a growing number of successful stem cell treatments have emerged. We are right now concentrating on regenerative medicine. We are focussing on incurable diseases like diabetes, cardiac disorders, chronic renal failure, liver cirrhosis, spinal injuries, multiple sclerosis, muscular dystrophies, Alzheimer’s disease, Parkinson’s disease, autism, cerebral palsy, stroke, etc. We shall be starting Drug Controller General of India (DCGI)-approved clinical trials in these disorders shortly.” Further, discussing the investment plans in R&D, Pophale says, “Right now we are investing in clinical trial from our funds. We are also investing in the new facility, which is between ` 10 to 15 crore. This will include lab, R&D set-up, Operation Theatre (OT) as well as therapy set-up. Since we will have the set-up within our premises, this will also help us in cost management.”

Some obstacles in the path Talking about the challenges in the stem cell market, Dr Bopardikar says, “The industry is continuously evolving. Radical differences keep coming. As

The industry is continuously evolving. Radical differences keep coming. As R&D evolves, we evolve. Nothing is constant in the stem cell market. Dr Abhijit Bopardikar Director and Pathologist, Ree Laboratories Pvt Ltd

R&D evolves, we evolve. Nothing is constant in the stem cell market.” He further adds, “As of now, there are no clear guidelines in India. The regulation sector is a grey zone area. There are no fixed guidelines that what and who falls under which jurisdiction. Drug inspectors are still in the learning process. Currently, the inspection and approvals are based on the regulations for blood bank collection and storage. The guidelines for stem cell bank do not come under the Drugs and Cosmetic Act as yet.”

Future prospects Current researches have proved and have increased hopes that stem cells

Current researches have proved and have increased hopes that stem cells will bring cure to many diseases that are considered incurable today. will bring cure to many diseases that are considered incurable today. “About 80 to 85 per cent success has been achieved in diabetics with the help of stem cells. Stem cells can help in formation of new islets, which produce non-resistant insulin, thus helping diabetics. Many patients have been off insulin and oral hypoglycaemias as well. Besides diabetes, stem cells have helped in improving ejection factor in several cardiac disorders. Also, in case of multiple sclerosis, nerve conduction has improved with the use of stem cells,” elaborates Dr Bopardikar. He also informs,

“Our collection for R&D has been 1500-2000 units per year. Right now, we are even equipped to give specialised stem cell technology to others.” Taking the topic further, Pophale says, “We strongly believe that stem cells can bring change for a better cause, therefore we are here today. However, right now the market is expensive. But so was the case when mobile phones were introduced few years ago, wherein only a few where able to afford this luxury. However, the scenario is different today. Same thing applies to the stem cell market. Once things get standardised and after the launch of stem cell treatment as an approved form of therapy like any other Over-The-Counter (OTC) drug, the prices will definitely come down.” ReeLabs aims to establish a leadership position in stem cell banking and treatment by being sensitive to quality standards and proprietary cell processing methodologies. “Right now, we are based in Mumbai and the samples are collected from Mumbai, Nashik and Pune – places from where samples can reach within six hours. The cell viability decreases to half within 12 hours and reduces by one third in 24 hours. Therefore, our aim is to have processing unit every place, where we plan to market. Stem cell banking is akin to blood banking, where as per Food and Drug Administration (FDA) and DCGI regulations processing time within six hours is mandatory,” states Pophale. With a positive note, he concludes, “The future of stem cell market is indeed bright. And multiple centre establishments, is what we aim for.” (asma.yousuf@infomedia18.in)

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Events Calendar

NATIONAL Hospital Management Conference

technology showcasing innovative medical products & systems in India. The event aims to take a step forward in contributing to the quality of healthcare.

Hospital Management Conference (HMC) is a research based content driven conference programme that aims to bring up-to-date worldwide hospital management thinking and experience to senior hospital and healthcare managers in India. There will be case studies; interactive panel discussions on trends, challenges, solutions and technologies that will help keep the industry in line with current and future progress.

Date: July 2-4, 2011 Venue: Palace Grounds, Bengaluru Organiser: Orbitz Exhibitions Pvt Ltd Tel: + 91 22 2410 2801/02/03/04 Fax: + 91 22 2410 2805 Email: info@meditec-clinika.com Website: www.meditec-clinika.com

Healthex 2011

Date: May 27-28, 2011 Venue: Hotel The Westin, Mumbai Organiser: UBM Medica Tel: + 91 9819166942 Email: shalu.chopra@ubm.com Website: www.hmcindia.in

Healthex 2011 is an international exhibition on hospital, medical and surgical equipment, materials, supplies and allied services, which aims to showcase the latest innovations in the field of medical technology to the medical experts from all over the world.

International Scientific Meeting 2011- ISUOG With its reach-out programs, annual conferences and web based education; the International Society of Ultrasound in Obstetrics and Gynecologists (ISOUG) has made a difference in clinical practices worldwide. International Scientific Meeting 2011 will help experts interact in a multi-disciplinary manner, with sessions on gynecologic applications of ultrasound, echo-cardiography, CNS and abdomen in fetal imaging. This conference will discuss problem areas and develop ideas about best practices.

Date: June 17-19, 2011 Venue: NIMHANS Convention Centre, Hosur Road, Bengaluru Organiser: MUSK (Medical Ultrasound Society of Karnataka (MUSK) Tel: + 91 080 6454 9562, +91 95386 63420, SMS – ‘ISM’ to 56767 Email: helpdesk@cigmaevents.com Website: http://ism2011.in/index.html

Date: August 5-7, 2011 Venue: Bangalore International Exhibition Centre, Bengaluru Organiser: Bangalore International Exhibition Services Pvt Ltd Tel: + 91 80 65833234 Email: suresh@bies.co.in Website: www.healthex.co.in

Medicall 2011 Meditec Clinika 2011 Meditec Clinika is the third international trade fair for medical equipment and

RUDRAPUR: Uttarakhand, Sept 23-26, 2011, Gandhi Park AHMEDABAD: Gujarat, Nov 14-17, 2011, Gujarat University Exhibition Hall PUNE: Maharastra, Nov 18-21, 2011, Auto Cluster Exhibition Centre CHENNAI : Tamil Nadu, Dec 8-11, 2011, Chennai Trade Centre

The event aims to attract the healthcare industry exhibiting a wide range of products including hospital equipment, surgical equipment, rescue and emergency equipment, facility management and support services. This event aims to bring all the exhibitors under one roof thus providing an opportunity for a wide range of product portfolio and help in knowledge transfer.

INDORE: Madhya Pradesh, Jan 6-9, 2012, Poddar Plaza, Nr Gandhi Hall AURANGABAD: Maharashtra, Feb 17-20, 2012, Garware Stadium India’s premier industrial trade fair on products and technologies related to Machine Tools, Hydraulics & Pneumactics, Process Machinery & Equipment, Automation Instrumentation, Packaging & Auxiliaries, IT Products, Electrical & Electronics, Material Handling and Safety Equipment.

For details Infomedia 18 Ltd, Ruby House, 1st Floor, J K Sawant Marg, Dadar (W), Mumbai 400 028. • Tel: 022 3003 4651 • Fax: 022 3003 4499 • Email: engexpo@infomedia18.in

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Date: August 12-14, 2011 Venue: Chennai Trade and Exhibition Centre, Chennai Organiser: MedExpert Tel: + 91 9840326020 Email: medexpert@medicall.in Website: www.medicall.in


Events Calendar

INTERNATIONAL IHE USA 2011 This event aims to be an ideal platform for companies and associations specialising in healthcare and medical industry and all other related industries to showcase and exhibit their products and expertise all under one roof. The trade show will offer its exhibitors an excellent opportunity to increase their brand awareness and promotion. Date: May 10-12, 2011 Venue: Charlotte Convention Center, Charlotte NC, USA Organiser: Arosa Exhibitions Ltd Tel: +1 980 219 8449 Fax: +1 980 219 8449 Email: gviniconis@arosa-group.com Website: www.arosa-exhibitions.com

OMTEC 2011 The Orthopaedic Manufacturing & Technology Exposition and Conference (OMTEC) is an annual orthopaedic specific educational conference and exposition. This event aims to focus on helping professionals at every level of the supply chain. It also hopes to offer knowledge for everyone involved in the process of getting devices to market and the attendees will be able to gain access to the education, people and the resources required to thrive in the atmosphere that demands precision, speed, and most importantly new ideas and solutions. Date: June 15-16, 2011 Venue: Donald E Stephens Convention Center, Chicago, USA

Organiser: Orthoworld Inc Tel: +1 440 543 2101 Fax:+1 440 543 2122 Email: alison@orthoworld.com Website: www.orthoworld.com

Taiwan Health 2011 An international exhibition that aims to showcase hospital equipment and supplies, electromedical equipment,

commodities and consumer goods for surgeries and hospitals, lab equipment, glassware and lab chemicals and many others. This event hopes to bring all the players under one roof. Date: June 23-26, 2011 Venue: Taipei World Trade Center Exhibition Hall 1, Taipei, Taiwan

Organiser: Taiwan External Trade Development Council Tel: +886 2 2725 5200 Fax: +886 2 2757 6245 Website: www.taihealth.com

FIME International Medical Expo An international exhibition that aims to showcase allergy products, biopsy needles, cardiology equipment, blood pressure equipment, blood bags and many other things. The event hopes to attract buyers and sellers from all over the world. Date: August 10-12, 2011 Venue:Miami Beach Convention Center, Miami, USA Organiser: FIME International Medical Exposition, Inc. Tel: +1 941 3662554 Fax: +1 941 3669861 Website: www.fimeshow.com

BioProcess International China BioProcess International China will be organising its 3rd annual event and will focus on topics like Cell culture, cell line engineering, purification and recovery, process charaterisation, process analytics, formulations and disposables technologies, which will be presented by top notch scientists and executives from all around the world. The objective of the event is to provide China and the regional countries with high quality presentations, case studies and strategies that will help the region’s burgeoning bioprocessing and manufacturing industries achieve their potential faster and more efficiently.

Date: August 22-24, 2011 Venue: Grand Hyatt Hotel, Shanghai, China Organiser: IBC Life Sciences Tel: + 816 472 0701 Fax: + 65 6508 2407 Email: mlangley@ibcusa.com Website: www.ibclifesciences.com/ BPIChina/overview.xml

Medical Fair Thailand 2011 This event aims to showcase the best in the business of hospital, diagnostic, medical and rehabilitation equipment and supplies. The event hopes to be a platform for medical suppliers, hospital administrators, doctors, nurses and other healthcare professionals. Date: September14-16, 2011 Venue: Queen Sirikit National Convention Center, Bangkok, Thailand Organiser: Messe Duesseldorf Asia Pte Ltd Tel: + 65 6332 9620 Fax: + 65 6332 9655 Email: medicalfair-thailand@mda.com.sg Website: www.medicalfair-thailand.com

Asia Medical 2011 This event aims to be a forum for the suppliers of medical technology and equipment as well as medical professionals from both the private and the public sector. This trade event will seek to provide a professional platform for the world medical equipment and devices community to target and do business with the rapidly expanding Malaysian health care sector. Date: October 5-7, 2011 Venue: Putra World Trade Centre, Kuala Lumpur, Malaysia Organiser: Malaysian Exhibition Services Tel: +603 4041 0311 Fax: +603 4043 7241 Email: enquiry@mesallworld.com Website: www.asiamedical.org

The information published in this section is as per the details furnished by the respective organiser. In any case, it does not represent the views of 68

I May 2011


Product Update This section offers an overview of the latest medical/surgical equipment available in the worldwide market. If you wish to have your products featured in this section, send us the details at mmedit@infomedia18.in. Also gain added advantage through our ‘Product index’ and ‘Advertiser’s list’ to facilitate your business.

NATIONAL

Bariatric surgery table

Thermal imaging camera FLIR Systems has unveiled its new generation E-series range of thermal imaging cameras. The new E-series line comprises of three compact thermal imaging cameras that offer superior infrared diagnostic capabilities coupled with industry-first innovations. The Eseries models are designed to provide advanced thermal diagnostics for applications in the field of electrical, industrial, energy auditors, HVAC, structural inspectors and professional thermographers, helping them find problems more quickly and easily, and communicate issues more effectively with state-of-the-art tools. The E-series cameras are small, light and rugged thermal imagers that offer a wide 3.5” full-view touchscreen, up to 76,800 pixels (320 × 240) of infrared resolution, 4x digital zoom lens, 60-Hz refresh rate, 3.1 megapixel digital visible light camera with built-in LED lamp, thermal fusion capabilities to overlay thermal and visible light images, large backlit buttons and controls, 6 invertible palette choices, video recording and streaming capability, and composite video jacks. FLIR Systems India Pvt Ltd - New Delhi Tel: 011-4560 3555, Fax: 011-4721 2006 Email: flirindia@flir.com.hk

Magnatek Enterprises offers Obesomatic (350 kg) bariatric surgery table. It is a specialised automatic table, which is designed and manufactured for bariatric procedures, to make surgeries precise, convenient & time saving. This surgery table is equipped with table top slide with remote control and dual control console. Its features include extra low height of 25”, steep reverse trendelenberg tilt for near sit up position, specialised attachments for easy bariatric positioning, zero auto levelling and non-hydraulic leak proof maintenance free construction. It has a specially designed tilting buttock support attachment, which can be tilted & locked at any desired position for ease of surgery. A patient sit up ‘V’ position can be achieved. It has a special tilting, swivelling, turning & telescopic lithotomy leg holder set wherein there is normal lithotomy position with a brake & lock arrangement, so that leg position can be easily maneouvered single handedly without its falling down. Patient legs can also be spread out horizontally, giving wide and easy access between the legs. Magnatek Enterprises - Hyderabad - Andhra Pradesh Tel: 040-6666 8036/ 6550 1094, Fax: 040-6666 8037 Email: magnatek@gmail.com

Portable ultrasound scanner

Endolite India offers carbon fibre made brace for knee ligament injuries (Defiance III). It is the most advanced custom knee ligament brace, ideally suited for extreme, water, contact, and noncontact sports from Donjoy, USA, the leader in knee bracing worldwide. Defiance III includes reinforced carbon frame. It consists of medial swooping thigh cuff for inner thigh clearance and bilateral brace use. It has swiveling strap tabs to accommodate leg movement. It is lightweight carbon fiber frame and has ACL, PCL and CI strapping configurations. It has Supra Condyle Pad to promote brace suspension along with anti-migration calf strap. It is available in three different lenghts and multiple colours.

Scientech Technologies offers digital portable ultrasound scanner (Caddo 11B). It is a dynamic medical imaging device used to visualise internal parts of the human body. It is used for the diagnosis & analysis of gall bladder, liver, kidney, spleen, pancreas, ovary, uterus, urinary bladder, small parts etc. It is based on Windows XP Operating System, which comprises of many features like Digital Beam Former (DBS), Real Time Dynamic Aperture (RDA), Dynamic Frequency Scanning (DFS), Real Time Dynamic Filtering (RDF), Dynamic Receiving Focusing (DFR) & Tissue Harmonic Imaging Technology (THI). The machine is very portable, only 11 kgs in weight and user friendly. The USP of Scientech Medicare’s Caddo 11B is price. The company has kept pricing very affordable for doctors, diagnostic centers, and practitioners.

Endolite India Ltd - Delhi Tel: 011-2579 8380/81, 3092 6870, Fax: 011-2589 1543 Email: endolite@vsnl.com

Scientech Technologies Pvt Ltd - Indore - Madhya Pradesh Tel: 0731-421 1100, Fax: 0731-255 5643, Mob: 98932 70301 Email: info@scientech.bz

Knee ligament brace

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Product Update Pendant Magnatek Enterprises offers a wide range of imported OT and ICU pendants, surgical pendants, endoscopy/ abdominal pendants, anaesthesia pendants and bridge pendants. Magnatek pendant is single or double arm pendant. It has motorised and pneumatic options. Magnatek Enterprises - Hyderabad - Andhra Pradesh Tel: 040-6666 8036/ 6550 1094, Fax: 040-6666 8037 Email: magnatek@gmail.com

Respirator Thea-Tex Healthcare (India) offers Duck bill shaped N95 particulate respirator. It is 100 per cent ultrasonically machine-manufactured without any manual intervention. Its automated production technology provides cost efficiencies that are passed on to the customer so ultimately the end-user benefits. Its ergonomic design permits perfect fit on any face shape, with minimal face contact leading to less irritation. It is lightweight due to use of high performance raw materials and electrostatically charged filter medium from a USA production line. Its greater respiration area allows easy breathing, so it can be worn for longer durations without discomfort & the user can perform better and has enhanced visibility for users wearing specs/goggles. There is no requirement of valve due to excellent inhalation and exhalation performance, thereby saving weight, cost and potentially dangerous valve leakage. Air leakage is prevented by soft and malleable nose clip. Thea-Tex Healthcare (India) Pvt Ltd - Thane - Maharashtra Tel: 0250-6450 283, Fax: 0250-2480 2579 Email: contact@thea-tex.com/theatex.healthcare@gmail.com

Ultrasound system Trivitron offers two new models of ultrasound systems, F 75 and I 4. ProSound F 75 has excellent refined image quality, comes with natural ergonomics, wide range of probes and preset functions. F 75 is user friendly for all clinical settings. ProSound I 4 gives multitasking more meaning. It comes with pure harmonic detection, multi beam processing, dual dynamic display, quint frequency imaging and many more excellent and unique features. Trivitron Medical Systems Pvt Ltd - Chennai - Tamil Nadu Tel: 044-2498 5050, Mob: 099620 40668 Email: skraman@trivitron.in

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Product Update Ice flakers Sigmatech Scientific Products offers ice flakers manufactured by Pooja Lab Equipments. It produces clear, hard, slow melting uniform quality flake ice. By using environment friendly refrigerant, it offers utmost reliability and performance. Higher capacity industrial cooling system is provided with hermitically sealed super performance and trouble free compressor of Kirlosker Copeland (CE approved) coupled with air-cooled condenser and direct expansion. The machine offers self-contained ice producer with well-insulated ice storage bin and a variety of capacities. Ice flaker system MOC in non-GMP bin are corrosion resistant, SS-304 mirror finish and exterior is MS powder coated. In GMP bin is SS-316 and exterior is SS-304 mat finish. Guaranteed Ice production at 20ยบC air and 15ยบC DM water temperature. This is supplied with water filter and water failure protection device by considering that the unit will not run in case of failed water supply and starts automatically the supply resumes at an extra cost. Sigmatech Scientific Products, Hyderabad - Andhra Pradesh Tel: 040 - 6453 4491, 098496 32904, Fax: 040-4003 1896 Email: s_tech07@yahoo.com

Alcohol swabs and lancet needle Amkay Products offers alcohol swabs and lancet needle. The alcohol swabs are saturated with isopropyl alcohol to provide maximum hygiene to the patients. This product is used in hospitals. The material used for packaging of the product helps keep the swabs moist by preventing the alcohol from drying. The premium alcohol swab is available with high quality swabs and best isopropyl alcohol. The company also offers lancet needle, that are sterilised steel needles packed individually. The sharpness of the point of these needles has been kept such, that they allow easy penetration in the body, thereby minimising patient trauma. The needle offers fine grip and can be easily disposed off. The company also offers plastic lancet with fine point 28 gauge needle. The point of needle is very sharp and allows easy penetration. The lancet fits into all glucometer pens. Amkay Products Pvt Ltd - Mumbai - Maharashtra Tel: 022-6131 7600, Mob: 093206 77998 Email: info@amkayproducts.com

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Product Update

INTERNATIONAL Personalised cancer care tool EviMed Online offers web-based Oncology Information System comprising of two components: the Patient Management system to help physicians stay informed about the latest cancer treatments and connect with open clinical trials for their patients, and the Trial Management system that helps study groups and clinical research organisations manage their trials and patient recruitment. It is tedious and inefficient for oncologists to filter through the vast information available with traditional search methods – surfing the net and calling colleagues. The founders of EviMed understood the importance of finding treatments based upon the genetics and individual patient tumour characteristics for the best possible outcome, so they created a team composed of international industry experts in oncology, healthcare and technology to create the solution - a novel software that provides personalized cancer care. Oncologists or the study nurse enters or import the patient’s cancer type, stage, histology, genetic markers, clinical lab parameters information; and EviMed’s special search engine instantly retrieves a selection of open clinical trials, published clinical trials and guidelines based upon the patient data from its database. Evimed Online GmbH - Cologne - Germany Tel: +49-221-67777490, Fax: +49-221-67777499 Email: info@evimed.com, Website: www.evimed.com

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Product Update Disposable probes Keeler offers single-use disposable probes for its cryomatic cryogenic surgery unit. These disposable probes are used with a disposable adaptor for single surgery use or as a backup for high-performance reusable probes. Important features of these probes include the following: it does not require cleaning or sterilisation , single use eliminates the possibility of cross infection or tip blockages due to dust and debris, saves time and ensures surgical reliability. The company’s cryomatic is engineered to create a simple to use system with a reliable freeze. The intuitive console automatically configures itself according to the probe’s characteristics, removing the need for manual set up. To simplify the set up pre-surgery procedures, the gas pressure is automatically set by the console for carbon dioxide (CO2) or nitrous oxide (N2O). The control console provides clear, digital readouts of probe activity, temperature, time elapsed and gas pressure. Probe operation is controlled by a footswitch, leaving the user’s hands free at all times. The whole system is quick and easy to set up, a major advantage if experienced staff are not always available. Keeler Ltd - Windsor - UK Tel: +44-1753 857 177, Fax: +44-1753 827 145 Email: info@keeler.co.uk

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Product Update Dental suction unit RMS Medical Products offers ‘Dental-Evac’ hand held dental suction unit. This reusable suction unit consists of two canisters with a suction pump, filter, wide bore soft yankauer, saliva ejector, carry bag, etc. It is ideal for the use in emergency back-up suction, surgery, anaesthesia, retrieving a lost crown, and during lobby emergencies. The suction pump weighs 143 grams, and has a volume per stroke of 30 ml and the peak pump vacuum > 600 mmHg (>24” Hg). The peak air flow is 20 L (50 ms). The canister is available in 300 ml, L152.4 mm (6”) size. The filter blocks all known fluids and pathogens for total protection. It meets Osha 29 CFR1910.1030 Occupational Exposure to Bloodborne Pathogens and CDC guidelines for SARS. RMS Medical Products - New York - USA Tel: +1-845-469 2042, 800-624 9600 Fax: +1-845-469-5518 Email: info@rmsmedicalproducts.com

Cardiotest line Seca GmbH & Co offers ‘CT8000L Interpretive’ cardiotest line, which provides paperless ECG options when combined with Seca Achimed Passport Patient Record Software, allowing transmission of ECG traces into all leading clinical record systems, eg, EMIS, Vision, System One. It is equipped with 12-channel interpretive ECG with LCD screen for menu navigation and alpha-numeric keyboard and bundled with adult and paediatric interpretive software. It has easy selection of traces from 12 x 1, 6 x 2 or 4 x 3 plus Rhythm Strip one page report. All parameters including filters are easily programmed through the on-screen menu for a one-touch ECG. The features of the cardiotest line include on-screen lead test and lead-off indication, one-touch automatic or instant real-time operation, digital filters for clear traces, internal memory for up to 45 stored ECG records, etc. Seca GmbH & Co KG - Hamburg - Germany Tel: +49-40-2000 0000, Fax: 49-40-2000 0050 Email: marketing.de@seca.com The information published in this section is as per the details furnished by the respective manufacturer/distributor. In any case, it does not represent the views of

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May 2011 I

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Product Index

To know more about the products in this magazine, refer to our ‘Product Index’ or write to us at mmedit@infomedia18.in or call us at +91-22-3003 4684 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better. Sl No Product

Pg No Sl No Product

Pg No Sl No Product

Pg No

1

Accreditation programme......................... 55

24

Cardiotest line............................................... 78

48

Exhibition - Healthex 2011 ......................... 22

2

Adult/ paediatric transport ventilator........ 19

25

Cardiothoracic surgery system ................... bc

49

Exhibition - Medicall 2011.......................... 58

3

Air conditioner ............................................. 35

26

Catheter holder............................................. 80

50

Financial services........................................ 21

4

Alcohol swabs and lancet needle................ 74

27

Colour doppler ............................................. 79

51

Foetal monitor ..................................19, 25, 66

5

Anaesthesia system ....................................... 13

28

Conference - Hospital Management

52

Fogging machine .......................................... 80

6

Anaesthesia workstation .............................. 27

Conference 2011......................................... 76

53

Fumigation .................................................... 80

7

Analyser ........................................................... 5

29

Countersink................................................... 31

54

Gastroenterology system........................... bc

8

Anasept antimicrobial skin and wound

30

Custom fabrication....................................... 11

55

Gluco monitor .............................................. 79

31

Dental suction unit .................................... 78

56

Gun drill ........................................................ 31

32

Desktop pulse oximeter ............................... 19

57

Gynaec examination coach ......................... 59

gel ................................................................ bic

33

Diamond tool................................................ 31

58

Gynaecology system ..................................... bc

10

Antimicrobial skin & wound gel............... bic

34

Disinfectant product .................................... 87

59

Halogen light............................................... 14

11

Aspirator ........................................................ 90

35

Disposable probe .......................................... 77

60

Hospital bed............................................80, 90

12

Audio/ video mounting system .................. 11

36

Distribution transformer............................. 35

61

Hospital consultancy.................................... 77

13

Audio-visual auscultation device..........25, 66

37

Doppler....................................................25, 66

62

Hospital curtain.............................................. 7

14

Automatic voltage regulator........................ 35

38

Drilling tool................................................... 31

63

Hospital furniture & accessories...........59, 77

15

Banking services......................................... 21

39

Dual syringe infusion pump....................... 19

64

Hospital furniture/OT equipment ............. 37

16

Bariatric surgery table.................................. 70

40

ECG ........................................................ 25, 66

65

Hospital human resource consultancy ...... 77

17

Bed-head panel ............................................. 80

41

ECG machine................................................ 79

66

Hospital information system ...................... 77

18

Biomedical waste solution........................... 53

42

Electronic patient recorder.......................... fic

67

Ice flaker....................................................... 74

19

Bipnasic defibrillator.................................... 19

43

EMR ............................................................... fic

68

ICU bed ......................................................... 59

20

Blood glucometer ......................................... 61

44

Endocrinology system.................................. bc

69

Imported cardiac OT table.......................... 71

21

Blood pressure monitor............................... 61

45

Endoscope machine ..................................... 33

70

Imported general surgery OT table............ 71

22

Blood pressure recorder............................... 19

46

Engineered woodfloor ................................. 29

71

Imported hospital furniture/equipment.... 90

23

Cardiology system...................................... bc

47

Exhibition - Engineering Expo 2011 ......... 85

72

Imported laparoscopy OT table ................. 71

cleanser ....................................................... bic 9

Anasept antimicrobial skin and wound

May 2011 I

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Product Index Sl No Product

Pg No Sl No Product

Pg No Sl No Product

Pg No

73

Imported LED light...................................... 71

103 OT / examination light................................ 90

132 Refurbished goods........................................ 33

74

Imported neurosurgery OT table............... 71

104 OT air conditioner ....................................... 75

133 Respirator ...................................................... 72

75

Imported orthopaedics OT table................ 71

105 OT and ICU pendant .................................. 80

134 Respiratory humidifier................................. 79

76

Imported OT light........................................ 71

106 OT solution ................................................... 49

135 Scandoc DICOM workstation .................. 17

77

Imported OT table ....................................... 71

107 OT table...................................................14, 90

136 Scopy doc endoscopy IMS .......................... 17

78

Infusion pump stand ................................... 80

108 Outdoor wood floor..................................... 29

137 Self-adhesive tapes........................................ 72

79

Intensive care units....................................... bc

109 Oxygen flowmeter ........................................ 90

138 Sensor controlled suction system ............... 15

80

Intensive care ventilator............................... 19

110 Oxygenator..............................................25, 66

81

Isolation transformer ................................... 35

111 Patient information & entertainment

82

IV pole ........................................................... 80

system......................................................... 80

83

Knee ligament brace................................... 70

112 Patient monitoring system ....................25, 66

84

Laboratory medicine.................................. bc

113 Patient privacy system.................................. 11

85

Laminate floor .............................................. 29

114 Patient transfer system................................. 71

86

LED lights with multi colour...................... 14

115 Pedal suction ................................................. 67

87

Medical equipment .................................... 73

116 Paediatric ....................................................... bc

88

Milling cutter ................................................ 31

117 Pendant..............................................14, 71, 72

89

Mobile light................................................... 14

118 Pergolas & outdoor cladding ...................... 29

90

Modular tooling system............................... 31

119 Personalised cancer care tool ...................... 75

91

Multi parameter defibrillator...................... 19

120 Plasma steriliser ............................................ 75

92

Multipera monitor........................................ 79

121 Portable colour doppler............................... 79

93

Nebuilser.......................................... 25, 45, 66

122 Portable ultrasound scanner ....................... 70

94

Neonantal transport ventilator ................... 19

123 Portable ventilator ........................................ 79

95

Neonatology ................................................. bc

124 Powder coated & stainless steel furniture.. 80

96

Nephrology system....................................... bc

125 Power columns.............................................. 80

156 Urology system ............................................. bc

97

Neurology operating room system ............ bc

126 Prosthetic and orthotic services.................. 39

157 Ventilator............................................... 72, 79

98

Nuneb PRO nebuliser.................................. 45

127 Pulse oximeter & NIBP monitor................ 79

158 Vinyl floor...................................................... 29

99

Nurse call system .......................................... 80

128 PW ultrasound scanner............................... 79

159 Vital signs monitor....................................... 79

100 Online B2B marketplace ....................... 9, 83

129 Rapid endotoxin detection system........... 79

160 X imager C-arm memory.......................... 17

101 Operation table............................................. 59

130 Reamer........................................................... 31

161 X-ray machine...................................25, 66, 79

102 Ophthalmology system................................ bc

131 Recovery bed ................................................. 59

162 X-ray viewer .................................................. 90

139 Servo stabiliser .............................................. 35 140 Slid wood floor ............................................. 29 141 SME finance ............................................21, 43 142 Sphygmomanometer.................................... 90 143 Spot light ....................................................... 14 144 Surgical diathermy........................................ 15 145 Surgical instrument...................................... 90 146 Surgical light.................................................. 15 147 Surgical pump............................................... 15 148 Surgical/ ICU pendant................................. 90 149 Taps............................................................... 31

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150 Thermal imaging camera ............................ 70 151 Tourniquet..................................................... 69 152 Transformer................................................... 35 153 Ultrasound scanner........................ 25, 66, 79 154 Ultrasound system................................ coc, 72 155 ULV fogging machine.................................. 80


Advertisers’ List

To know more about the advertisers in this magazine, refer to our ‘Advertiser’s Index’ or write to us at mmedit@infomedia18.in or call us at +91-22-3003 4640 or fax us at +91-22-3003 4499 and we will send your enquiries to the advertisers directly to help you source better. Advertiser’s Name & Contact Details A R V S Equipments Pvt Ltd

Pg No 53

Advertiser’s Name & Contact Details Endolite India Ltd

Pg No 39

Advertiser’s Name & Contact Details Kannu Impex (India) Pvt Ltd

T : +91-11-41044444

T : +91-11-45689955

T : +91-124-4086745

E : vishvesh@arvsequipments.com

E : endolite@vsnl.com

E : verma@kannu-impex.com

W : www.sharpsandwastecontainers.com

W : www.endoliteindia.com

W : www.kannu-impex.com

Aavanor Systems Pvt Ltd

FIC

Engineering Expo

85

T : +91-09920401226

T : +91-44-26208920

79

75

T : +91-22-66669381

E : engexpo@infomedia18.in

E : enquiry@aavanor.com

Kohinoor Surgicals

Pg No

E : kohinoorsurgicals@hotmail.com

W : www.engg-expo.com W : www.aavanor.com

W : www.kohinoorsurgicals.com Genuine Medica Pvt Ltd

Anand Medicaids Pvt Ltd

67

33 Lonza India Pvt Ltd

T : +91-11-40513401

T : +91-11-25225225

E : genuine@ndf.vsnl.net.in

T : +91-22-43424000

E : sales@anandind.com

W : www.genuinemedica.com

E : prajakta.sonavane@lonza.com

W : www.anandind.com

Guhring India Private Limited

Bangalore International Exhibition Centre

22

31

T : +91-80-40322500

T : +91-80-65833234

W : www.lonza.com M.S.Enterprises

E : info@guhring.in

87

90

T : +91-866-2442786

W : www.guhring.in E : suresh@bies.co.in

E : moinmsent@yahoo.co.in Hi-Tek Medical Solution

W : www.healthex.co.in

49

W : www.accura-healthcare.org

T : +91-11-26801059 BPL Limited

25, 66

T : +91-80-22270134

Magna Tek Enterprises

E : hitekmedical@yahoo.co.in Hospaccx India System

77

T : +91-40-66668036 / 65501094

E : sales.healthcare@bpl.in

T : +91-22-41232233

E : sales@magnatekenterprises.com

W : www.bpl.in/healthcare

E : tarun.k@hospaccx.in

W : www.magnatekenterprises.com

Charles River

79

W : www.hospaccx.in IndiaMART InterMESH Limited

T : +91-80-25588175

Medexpert Isha Homes 9, 83

T : +1800-200-4444 / 91-120-3911000

E : india.customercare@crl.com

14, 71

58

T : +91-9840326020/9360707022 E : :info@medicall.in

E : pr@indiamart.com W : www.charlsriverindia.com

W : www.medicall.in W : www.indiamart.com

Compamedic Instruments Pvt Ltd

79

Industrial Electronic & Allied Prod

69

Meditech Engineers Pvt Ltd

T : +91-11-43085193

T : +91-20-24222538

T : +91-11-65172376

E : sales@compamedic.com

E : ieap@vsnl.com

E : meditechengineers@gmail.com

W : www.compamedic.com

W : www.diamondbp.com

W : www.meditechengineers.com

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Advertisers’ List Advertiser’s Name & Contact Details Meditech India

Pg No 73

Advertiser’s Name & Contact Details Radiant Enterprise

Pg No 80

Advertiser’s Name & Contact Details Sreelakshmi Traders

T : +91-11-45545238

T : +91-79-26449120

T : +91-44-24343343

E : marketinguk@meditech-india.com

E : radiant_enterp@rediffmail.com

E : sreelakshmitraders@gmail.com

W : www.fogstarindia.com

W : www.sreelakshmitraders.com

W : www.meditech-india.com Meditek Engineers

59

Rational Health Care Systems

79

T : +91-40-3072 7676 / 098497 86323

T : +91-09822092808

72

21

T : +91-22-39401616

E : rational_hcs@yahoo.com

E : meditekfur@hotmail.com

Standard Chartered Bank

Pg No

E : sme.custoercare@sc.com

W : www.rationalhs.com Medsynaptic Pvt Ltd

W : www.standardchartered.co.in

17 Sanghvi Eurotech Pvt Ltd

T : +91-20-25443349

State Bank Of India

T : +91-20-41242691

E : sales@medsynaptic.com

E : contactcentre@sbi.co.in 80

Schiller Healthcare India Pvt Ltd

19 W : www.sbi.co.in

T : +91-20-24262562

T : +91-22-66920520

E : sales@meelanhospicare.com

E : rita@schillerindia.com

Stephan Design & Engineering Ltd

W : www.meelanhospicare.com

W : www.schillerindia.com

T : +91-40-2370 6355 / 2370 6366

MRK Healthcare

45

Servomax India Ltd.

35

T : +91-99124 42510/99126 75399

W : www.stephanmed.com

E : info@mrkhealthcare.com

E : dharmesh@servomax.net

Transasia Bio-Medicals Ltd

W : www.mrkhealthcare.com

W : www.servomax.net

T : +91-22-40309000

37

Sonosite Inc

T : +91-11-42463777

T : +91-124-2881100

E : ptn@medikraft.com

E : india@sonosite.com

W : www.medikraft.com

W : www.sonosite.com

ORO Plus Health Care (P) Ltd

BIC

Space Labs Health Care

T : +91-80-41491108

T : +91-40-3980 3687,+91-98497 86323

E : oroplusindia@gmail.com

E : info@spacelabs.com

Quality Council Of India

55

COC

5

E : transasia@transasia.co.in W : www.transasia.co.in Trivitron Healthcare

BC

T : +91-44-24985050 13

E : skraman@trivitron.in W : www.trivitron.com UBM Medica India Pvt Ltd

W : www.spacelabshealthcare.com

76

T : +91-22-66122658

T : +91-11-23379321

Spark Meditech Pvt Ltd

E : sg@qcin.org

T : +91-484-2341335

W : www.qcin.org

E : sparkmeditech@gmail.com

15 E : yogeeta.sant@ubm.com

R D Plast Pvt Ltd

11

Square Foot (Classic Floorings & Interiors Pvt Ltd) 29

W : www.ubm.com Window Techs T : +91-11-29992146

T : +91-11-25891219

T : +91-22-40476211

E : rdplast@bol.net.in

E : sucheta@squarefoot.co.in

E : window_techs@yahoo.co.in

W : www.rdplast.in

W : www.squarefoot.co.in

W : www.hospitalcurtains.in

88

80

E : sales@stephanmed.com

T : +91-22-23748371

Narula Udyog (India) Pvt Ltd

43

T : +1800 11 22 11/ 18004253800

W : www.sanghvieurotech.com

W : www.medsynaptic.com Meelan Hospital Steel Furniture

61

I May 2011

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An invite that rewards as well...

Dear Reader, ‘Modern Medicare’ solicits original, well-written, application-oriented, unpublished articles that reflect your valuable experience and expertise in the pharmaceutical industry. You can send us Technical Articles, Case Studies and Product Write-ups. The length of the article should not exceed 2000 words, while that of a product write-up should not exceed 200 words. The articles should preferably reach us in soft copy (either E-mail or a CD). The text should be in MS Word format and images in 300 DPI resolution & JPG format. The final decision regarding the selection and publication of the articles shall rest solely with ‘Modern Medicare’. Authors whose articles are published will receive a complimentary copy of that particular issue and an honorarium cheque. Published by Infomedia 18 Ltd, ‘Modern Medicare’ is India’s leading magazine on healthcare, and related equipment & technologies. This monthly magazine was launched in December 2004 and provides the latest and most apt updates exclusively for the medical fraternity. Moreover, ‘Modern Medicare’ acts as a sourcebook that facilitates buying decisions for this key sector - hospitals, specialty clinics, pathology labs, nursing homes and doctors - and brings out highly useful business information on various healthcare facets such as surgeries, procedures, technologies, equipment et al. So get going and rush your articles, write-ups, etc… Thanking you, Yours sincerely,

Manas Bastia Editor Infomedia 18 Limited ‘A’ Wing, Ruby House, J K Sawant Marg, Dadar (W) Mumbai 400 028 India

D +91 22 3003 4669 T +91 22 3024 5000 F +91 22 3003 4499 E manas@infomedia18.in W www.modernmedicare.in


Vol 7 No 6

RNI No: MAHENG 2007 / 21987 Postal Regd No:G2 / NMD 73 / 2011-13 Posted at Mumbai PatrikaChannel Sorting OfďŹ ce- GPO, Mumbai 400 001, On 11th & 12th of Every Month. WPP Licence No: MR / Tech / WPP-352 / Navi Mumbai 2011-12 Date Of Publication: 8th Of Every Month

MODERN MEDICARE May 2011

92

RNI No: MAHENG 2007 / 21987 Postal Regd No:KA / BG GPO / 2563 / 2011-13 Posted at MBC, Bangalore GPO, On 13th & 14th Of Every Month Date Of Publication: 8th Of Every Month


Modern Medicare - May 2011