InnoHEALTH magazine volume 4 issue 1 - January to March 2019

An Initiative of

VOLUME 4

ISSUE 1

JANUARY-MARCH 2019

INR 100/-

S E T E B A I D H LIVING WUITBERCULOSIS T R O F S T S S D E A T E H C I R T U S O O N N I G A L I L D A M R E S T T I S Y S S FASTE R E D MIND MATDTATIOˉNˉ OF AI-BASE N U O F : T I E R A C H T L A E H

H C R A E S E R S E T E B A I D N I S E H R G O U C O S R H C I T K M A E E D R RECENT B N FOR IMPROVING ACA I A F O D L R O O I W E R A C NUTRIT H T ˉ L S ˉ A N E O I H T N F E O V E R E C T A N F I THE MORPHING LOGIES: HEALTHCARE O N H C E T G N I T A R INTEG

Readers Feedback

A Brief Review on InnoHEALTH Most liked article of the last Issue....

PERSONA THEME TRENDS WELL-BEING ISSUES

It says allow the dealers to compete with each other and provide a fair price to the hospitals based on the terms and conditions of services and payments. There is a need to work towards bundled payment models as used in many other countries to better align incentives for hospitals and their business models. Increase government healthcare spending as a percentage of GDP; India lags behind

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By InnoHEALTH Editorial Team

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India’s strong position on heart stents’ price regime triggered debate and the price war snowballed into tough positions and international players gaped with a bewilderment.

Many institutions and professional 16

bodies flew into action and debated price structures while the country’s federal government unveiled its world’s largest health coverage scheme for millions, virtually creating a colossal potential in the health sector. If the government extends healthcare services to its 1.25 billion population as part of India’s Universal Health Coverage (UHC) agenda, it will be a challenge to devise ways to reduce catastrophic Out Of Pocket (OOP) expenditure on healthcare and ensure affordable access to essential healthcare for the entire population with the limited resource envelope.

Amid ongoing trading tussle between US and China, many apprehend that ripple effect will also percolate down

in India as the latter is going ahead with its price regimes and its moves to bring down stent and knee implant devices had raised many eyebrows.

A section of media has reported that AdvaMed (Advanced Medical Technology Association)in its briefing memo for US Commerce Secretary and US Trade Representative last year had conveyed that “Made in India” scheme has been used by parts of the Indian government to justify protectionist measures such as import tariff hike sand preferential market access policies.

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e are moving into a bold era, defined by advanced medical technologies and artificial intelligence. But healthcare will always remain a human business”.

For Dominic Asquith, British High Commissioner to India that is the crux of current situation, but a razor sharp competitive business in medical devices across the world has a different narrative because of market compulsions vis-a-vis human business.

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The study made a slew of recommendations like cap trade margins and not price to the dealers, should be capped after detailed evaluation of each medical device segment and the role of trade. Trade margins should be fixed differentially for different categories of devices, based on service requirements and role of distributors.

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The study also examined various policies and regulations impacting the industry and attempts to make recommendations on the way forward from the perspective of different stakeholders.

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Medical Devices in India Witness Churning; Price War Escalates

Official sources say big schemes can be ensured with the help of Health Technology Assessment (HTA), which is a widely used methodology internationally for optimization of resource allocation in health. HTA is a method of evidence synthesis that considers aspects pertaining to clinical effectiveness, costeffectiveness, social, ethical and legal implications of the use of "health technology" for healthcare intervention.

“The path to realizing healthcare goals is complex, and various fundamental issues and challenges need to be addressed and solved holistically. Long-term plans need periodic policy and regulatory interventions to ensure fair conduct within the industry while providing the support needed for profitable and sustainable growth. These activities will enable the medical device industry to accelerate rapidly and play a key role in making India healthier and stronger.” Mr. Guljit Singh, Executive Chairman of SKP Business and Abby Pratt, Vice President for Global Strategy and Analysis at AdvaMed said in their foreword of the study. AdvaMed had partnered last year with SKP to

publish the study entitled – Medical Device Industry in India –the evolving landscape, opportunities and challenges.

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The 2014 World Bank Report estimated the OOP spending on healthcare in India to be as high as 89%. India is the only country, out of the major world economies, where out-of-pocket expenses are increasing, despite a concurrent increase in public spending. This effectively means that more people are availing private healthcare services due to rising incomes or are forced to spend due to inadequate public expenditure.

The Indian healthcare industry was valued at over USD 100 billion in 2016 and is expected to reach more than USD175 billion by 2020, resulting in a CAGR (Compound Annual Growth Rate) of 20%. The medical device industry is valued at USD 6 billion. The medical device industry was accorded the status of an independent industry in 2014.

The medical device sector today is clearly small and indicates low penetration in the country.

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advised to play down China’s global dominance in various technological sectors, known as “Made in China 2025”.Such developments indicate that India should also dial down the hype on “Made in India”.

The Economist newspaper recently carried a write-up which quoted China Digital times, a California based website, that Chinese media had been

Volume 3 | Issue 4 | October-December 2018

Volume 3 | Issue 4 | October-December 2018

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Testimonials from the InnoHEALTH October 2018 Conference I BEGIN with a big thanks to you and your team. I have said it before, but I say it again because your consistent ability to deliver never ceases to amaze me, it truly is a pleasure to work with you. Swecare, Sweden CONGRATULATIONS ON successful completion of the InnoHEALTH Conference 2018! It was a pleasure interacting with you there. Indian Institute of Science, India THANK YOU for organizing the meeting. HealthCubed India Private Limited, IKP Eden, India THIS IS a fantastic platform to talk about and discuss the vision of healthcare in India. Clinivantage, India CONGRATULATIONS ON the conclusion of a great conference. IBM Watson Health, United Kingdom

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Volume 4 | Issue 1 | January-March 2019 Volume 2 | Issue 4 | Oct-Dec 2017

IT WAS a delight to meet you all at the recent successful InnoHEALTH 2018 conference. I thoroughly enjoyed the meeting. Thank you again for the invitation and I ‘d be pleased to help in the future if needed. National Association of Primary Care, United Kingdom WE ONCE again would like to thank you for reaching out to us and sharing this opportunity to be the Knowledge partners with your team for the InnoHEALTH 18. Intellecap Advisory Services Pvt. Ltd, India IT WAS indeed a great pleasure to be part of this. Would like to wholeheartedly congratulate the entire team for the great event. Wish you guys the very best for all your future events.

Intellecap Advisory Services Pvt. Ltd, India

EXECUTIVE OPINION

Improvisation, Jugaad, Innovation, Here comes another Indovation and Invention, what it means year of development, IWELCOME 2019!

Innovation has become buzz word and being used by many without even knowing its meaning and difference in improvisation, Jugaad, innovation, indovation and Invention.

It would be appropriate ur best wishes for Year 2019 to all our readers, advisory group and wellto explain these terms for benefit of years and this year has been very wishers. We have completed three many. eventful; we have launched IC Foundation of Healthcare and Excellence

To make everyone aware what innovation means if they need to work on it either by start-up or otherwise we have created a knowledge platform InnovatioCuris (IC) to delineate innovations in healthcare to reduce healthcare delivery cost and yet keep quality.

The dissemination of knowledge (ICFHE), a not-for-profit organisation for social interventions and are now Improvisation: Process of is done through International connected to the community of 40,000 like-minded people. We have put this devising a solution to a requirement InnoHEALTH conference and issue on the theme of "Innovation in Diabetes-Unmet needs"given India has by making-do, despite absence of registered magazine with same 73 million population suffering with Diabetes and 50% people are not even resourcesproperly that might expected name, complimentary webinars, diagnosed whichbe means 7% of the Indian population is diabetic. to produce a solution. training and Innovators’ club. In fact, World’s 18% diabetics are in India, second largest in the world. At present, this issue gives post conference the world has A 425 million diabetics which would become 629 million in the Jugaad: colloquial Hindi-Urdu and club glimpses, which included year 2045. word that can mean an innovative young innovators award and nine fix intend or a simple work-around, used We to handle this menace by conducting awareness programs, find companies of European Union for solutions thattobend or a tools and treatments at lower cost innovative methods bringrules, diagnostic participated to Dr. bring healthcare VK Singh resource can be used as such, with qualitythat & behaviour modification programs for preventive and curative innovations suiting Indian needs. or a person who can solve a complicated issue Editor-in-Chief & MD, measures.

B2B meetings in Delhi and Bangalore were organized, InnovatioCuris The are process learn like from each other’s experiences. In case you The Innovation: life style changes the keyof in translating the treatmentan of idea life styletodisease into a good or service that create value for which missed conference or wishvksingh@innovatiocuris.com to refresh moments this hypertension, diabetes, obesity and select cancers. They cause complications customer will be ready to pay and replicate at issue will update you.

We are also encouraging grass for other parts of the body such as eyes, heart, kidney and foot. People must economic cost.

There are various types of innovations root innovations from far and wide.

The next paragraph be told the importance of diet, exercise and meditation in order to have a like process and product innovations, frugal explains how developed countries take Indian healthy lifestyle.We have taken this initiative and created a website to raise Innovation, reverse Innovation, disruptive innovation, innovations. awareness of the latest scientific interventions www.experimentswithsugar.in IndovationandInnovation Excellence Alexander We intend to publish articles regularly of common interest and would also Blass, CEO of Innovation Institute of Indovation: It is anin this abbreviation Indian America, Inc. and winner of Top Innovator of the Year encourage the professionals field to shareoftheir experiences through innovation, in 2009

by Navi2018, Radjou, states, our magazine.conceptualised Our team participated in ESICON to learnaward latest on the “It is no secret that many of the world’s the executive director of top theexperts.

Centre We for have Indiaalso & Global innovators come from India. Within the past few diabetes treatment from the surveyed top the clinicians Business at Judge Business School, University of decades, India has embarked upon an incredible for their unmet needs and will soon be releasing the findings.

Cambridge transformation from an agrarian-based society to a We plan to have the next issue on the theme Cyber4Health: knowledge-based security and economy. Along with the population Invention: New scientific or technical idea, and the privacy issues linked with health sector and their solutions.

Healthcare growth came survival instincts and the need to be means of embodiment accomplishment. be awareness in providers areitswelcome to share or their articles and help usTo increase different, better and unique.

One can see innovation patentable, invention musttraining be novel, have for utility, this new arena.an Our cyber security programs senior officers of the in India, whether in large game changing everywhere and beForces non-obvious.

To be called an invention, an idea Armed and various healthcare organisations, were very well received. that garner lots of publicity, or in less innovations only needs to be proven as workable. obvious yet important incremental fashions” What is new in the kitty for 2019-a delegation visit to Sweden during month Every interested in innovation to club meetings, of May for person B2B meetings and Vitalis conference;need regular Hence join in many initiatives of IC a knowledge and know that what internetissues age provides...

“Just InnoHEALTH magazine and webinars to about promotehand and holding foster platform to take innovation in healthcare anyone canour have an idea at breakfast, design itconference with innovations; annual international InnoHEALTH in October online CAD software, produce a prototype on a 3D forward which is need and national movement of in New Delhi. printer, receive financing and market analysis from country, buzz word of innovation is to be converted into reality for benefit of community through participation We requestfunding you to site, join in various initiatives and make your contributions a crowd rent supercomputer time from towards a better world.a manufacturer and be done by of all stakeholders.

Amazon, contract lunch without even leaving the table”.

O

www.innovationexcellence.com/blog/2014/05/18/5-thingsmanagers-should-know-about-the-big-data-economy/

Dr VK Singh Editor in Chief & MD, InnovatioCuris Volume 4 | Issue 1 | January-March 2019 Volume 2 | Issue 4 | Oct-Dec 2017

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Global Editorial Board Dr. Shailja Dixit, Chief Medical Officer, Scientific Commercialization, Fellow of Health Innovation & Technology Lab, USA Ronald James Heslegrave, Chief of Research, William Osler Health System, Canada Dr. Ogan Gurel, Chief Innovation Officer, Campus D, South Korea Dr. Chandy Abraham, CEO, Healthcare Project, ITC Limited, India Dr. Sharon Vasuthevan, Group Nursing & Quality Executive at Life Healthcare Group, South Africa Editor-in-Chief: Dr. V K Singh Executive Editor: Sachin Gaur Editors: Alok Chaudhary Dr. Brijender Singh Dhillon Dr. Avantika Batish imisha Singh Verma Aarti Khanna Sr. Designers Suraj Sharma, Ritu Versha Advisors Konda Vishweshwar Reddy, Member of Parliament, India Amir Dan Rubin, Executive Vice President, United Health Group, USA Thumbay Moideen, Founder President, THUMBA Group, UAE

Dr. Kate Lazarenko, Founder and Director, Health Industry Matters Pte. Ltd, Australia Major General (Retd) A K Singh, Advisor, Telemedicine and Health Informatics, India Dr. Sarita Jaiswal, Ex-Research Officer at University of Saskatchewan, Saskatoon, Canada (currently in India) Printed and Published by Sachin Gaur on behalf of InnovatioCuris Private Limited Printed at Lippe Scan Private Limited 89, DSIDC, Phase-1, Okhla Industrial Area, Delhi 110020 Editor: Sachin Gaur DCP Licensing number: F.2.(I-10) Press/2016 R I DELE G 2016 69964 Š InnovatioCuris Private Limited All rights reserved. Neither this publication nor any part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission from InnovatioCuris Private Limited.

Disclaimer: Readers are requested to verify and make appropriate enquires to satisfy themselves about the veracity of the advertisements before responding to any published in this magazine. Sachin Gaur, the Publisher, Printer and Editor of this magazine, does not vouch for the authenticity of any advertisement or advertiser or for any the advertiser’s products and/or services. In no event can the Publisher, Printer and Editor of this magazine/ company be held responsible/liable in any manner whatsoever for any claims and / or damage for advertisements in this magazine. Authors will be solely responsible for any issues arising due to copyright infringements and authenticity of the facts and figures mentioned in their articles. InnoHEALTH magazine is not liable for any damages/copyright infringements.

Volume 4 | Issue 1 | January-March 2019

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Readers Feedback

A Brief Review on InnoHEALTH Most liked article of the last Issue....

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RESEARCH

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FABP biomarker in the bloodstream. ABP is a lightweight protein released quickly from heart muscle into the bloodstream during a heart attack, and therefore, it is an optimal cardiac diagnostic marker.

According to him, doctors may test a patient s blood for FABP if he or she experiences characteristic symptoms like chest pain. However, not all heart attacks make themselves known through easily noticeable signs.

Silent heart attacks, which are becoming increasingly common, are asymptomatic, making them more dangerous than conven-

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Faster diagnostic tests developed for tuberculosis 28 Volume 3 | Issue 2 | April-June 2018

Latest Innovations in Healthcare 30 IDigital recently went through InnoHEALTH, Healthcare 34 vol 3, issue 2. I never expected such nice content in a health magazine.

Really, it s a very good idea to bring innovations from labto design to masses Integrating technologies better through print media. Appreciative of healthcare interventions 38 the idea which in itself is an innovative A unique journey of inspiring one.

I went through the content very 40 carefully enjoyed reading articles moonshotsand in healthcare on wildlife specially the ones on Kanpur zoo and cloned monkeys.

Request you to keep including such innovative ideas specially on wildlife.

I was also intrigued by the article on software as a medical device.

The magazine deserves to be an international magazine on the basis of its contents, printing quality and editorials. Would like to encourage use of symbol of Indian Rupees on the cover page.

Dr. RK Singh Kanpur, India 42

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Volume 43 | Issue 13 | January-March July-September 2019 2018

charged electrical impulse to draw negatively charged ---protein to the surface; If the amount of FABP is high, then the person would need immediate medical attention; People who are at risk are recommended to use the de-

pain and shortness of breath that is indicative of heart attack is not felt.

Akash aims to study cardiology at the country’s premier All India Institute of Medical Sciences in Delhi.

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Volume 3 | Issue 2 | April-June 2018

I read the magazine InnoHEALTH and found very interesting articles which had scientific explanations.

An article on medal winners and their last-minute thought process to annex titles was wonderful and gave an insight of chemistry in chambers of brain during moments of climax.

I appreciate the manner in which plight of animals was highlighted and innovative practices adopted by vets. Personally, we feel it should be monthly if not fortnightly and the language a bit toned for the common man.

Dr. Meena Dhami New Delhi, India

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hour away from his hometown.

He could not afford expensive books and journals so the library visit was the only option left for this enterprising adolescent who had an extra knack to comprehend complexities of cardiology just because of his penchant for the heart diseases studies.

He was chosen for the President’s Innovation Scholar’s In-Residence Programme at Rashtrapati Bhavan.

The 16-year-old says that he investigated a novel concept that could potentially allow patients to detect silent heart attacks by non-invasively sensing the

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he death of his grandfather due to heart attack led Manoj Akash, a class 10th student of Ashok Leyland School in Hosur, Karnataka, to invent skin patch which has to be attached to the wrist or the back of the ear and it will release a small positive’ electrical impulse, which will attract the negatively charged protein released by the heart to signal a heart attack. If the quantity of this protein – FABP -- is high, the person must seek immediate medical attention.

Since class eight he started visiting library of the Indian Institute of Science in Bengaluru – an

Diabetes research New age solutions for diabetic care

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Skin patch to detect ‘silent’ heart attacks Recent breakthroughs in Living with Diabetes: An Occupational Therapy Perspective 20

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Importance of Nutrition for Improving Academic Score 16

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The Morphing Face of Healthcare in the World of AI 12

vice twice a day -- in the morning and at night, before going to bed; The product can soon be seen in the market and would cost around R 900, cheaper than a glucometer symptoms at all.

Diabetes, high blood pressure, high cholesterol levels all put you at risk of a silent heart attack, experts say. Having a silent heart attack puts people at a greater risk of having another heart attack, which could be fatal. Having another heart attack also increases risk of complications, such as heart failure.

Experts say a silent heart attack a heart attack is characterized by chest pain, pain in the left arm or shortness is when of breath. A person who has a silent heart attack may not show these the symptoms like chest

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Sweden-India collaboration in health sector

Internet gave him lot of insight, he admits Clinical trials for the medical device are on and it could be approved for a human trial. The product would be fit to be launched in the market after two months of human trial, assuming nothing goes wrong.

“I have already filed for a patent and I would tie up with department of biotechnology for the trial.

I would want the Government of India to take the project instead of selling it to a private company because it is for the public good,” he says on his website.

A small silicon patch stuck to your wrist or back of your ear can be used regularly to monitor whether there has been a heart attack instead of waiting for a doctor to prescribe a test.

The patch uses a positively

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tional heart attacks.

Patients often "drop dead" while feeling completely normal. This collapse happened to my grandfather on July 3rd 2015 which served as an impetus for me to find a solution to this problem. In these "silent" cases, doctors are unlikely to administer the crucial FABP blood test because there is no visible presentation of symptoms to warrant a diagnostic test. As a result, silent heart attacks go unnoticed.

“I realized that, if at-risk patients could test themselves daily for the presence of FABP in their blood, they would have higher chances of detecting silent heart attacks as they occur.

A method that allows daily selftesting would have to be non-invasive, safe, and easy to use. Ultimately, it would have to involve a transcutaneous blood analysis, which examines the contents of one's blood without penetrating the skin.

In searching for ways to tackle this challenging prospect, I examined the various distinguishing characteristics of blood proteins that would allow them to be identified transcutaneously. I found that proteins have distinctive masses and electric charges in blood.

So, I used a model to test whether different magnitudes of charged electricity, when applied to a thin area of skin, would isolate FABP from the other blood proteins and attract FABP to the capillary walls. My results showed that this is true.

This means that the technique that I investigated can potentially be coupled with transcutaneous UV-protein quantification to non-invasively measure the amount of FABP in a patient s blood and alert him or her of a silent heart attack.”

Help Million Hearts Stay Healthy Is his web page that narrates his vision.

He was frequenting scientific conventions to further his knowledge in the science field.

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Social Isolation in a I went connected through the latest edition digitally world!

44 of your InnoHEALTH magazine Mind Matters 46 and found that many articles were very interesting especially the one highlighting that people Tuberculosis: An Ancientduring Foe tooth 50 feel more depressed ache, head ache and ear pain.

Non-Pharmacological I would encourage the team to Management of Chronic keep highlighting significance of Obstruction Pulmonary Disease 54 our medicinal plant values so that people take advantage of such resources available in India in abundance.ITImarket recall builds a time tested Healthcare saying a tall tree of neem is like a foundation of AI-based tall Hakim standing before you.

Healthcare System 56

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Krishna Gopal A trip to world’s healthiest Uttar Pradesh, India and happiest city: Copenhagen for BIO-Europe 2018 58 DISHA: Need of the hour How crucial is DISHA (Act) for healthcare industry?

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AN INTERVIEW WITH H.E. KLAS MOLIN, SWEDISH AMBASSADOR TO INDIA DONE

BY SACHIN GAUR, DIRECTOR OPERATIONS AT INNOVATIOCURIS.

By Sachin Gaur (for InnoHEALTH Magazine) Q. What is the Swedish interest in India and your priority topics for Indian health sector?

We have a very fruitful bilateral collaboration with India in the health sector, beginning with our development cooperation in areas such as mother- and child health, midwifery and work against communicable diseases.

The cooperation has now increased to mutually beneficial partnerships.

For the past ten years, we have had a Memorandum of Understanding

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Sweden-India collaboration in health sector

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on Health between our countries and next year we are going to celebrate this with an India-Swedish Health Year.

Many collaborations of mutual interests are ongoing and being planned that focus in a wide range of areas like antimicrobial resistance, elderly care, pharmaceuticals, noncommunicable diseases and digital innovations including artificial intelligence, where the emphasis will be on knowledge transfer, capacity

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building and skills training.

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Q. What are the common areas for healthcare research and ongoing

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Q. India and Sweden will complete

Q. What can Indian healthcare businesses gain from Swedish healthcare businesses?

Any suggestions on possible partnerships?

It is not so much what the Indian healthcare system can gain, but rather, how can we join forces to overcome common challenges.

Swedish businesses have been

in India for many years. Within healthcare, we have AstraZeneca, who recently celebrated 40 years in India, and Getinge who has been investing in the Indian ecosystem for many years. Their focus, like many others, has been in building the capacity of their employees and the users of their products to increase efficiency. The businesses also bring with them lessons from Sweden so that we can help India leapfrog outdated technology. Sweden also ranks high in most innovation indexes – it can be argued that our relatively small size makes collaborations outside traditional silos necessary in order to succeed. Public actors, private companies, and institutions often work together in finding innovative solutions to serious healthcare challenges. We would like to work with India to build spaces for similar ecosystems across India.

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Q. An MoU was signed during Prime Minister Modi’s visit to Sweden on 17th April 2018 at Stockholm on “India-Sweden Innovation Partnership for a Sustainable Future”. Can you share the progress with respect to healthcare?

We are in the process of putting out calls and setting up incubators which will encourage close collaboration between the innovators in Sweden and India. Solutions are only sustainable if both sides contribute and share a strong sense of ownership.

Progress has already been made in laying the groundwork for such partnerships within the sectors of clean energy and smart cities, and we hope to launch initiatives targeted to healthcare during the coming year.

The Embassy will be sure to keep you posted.

10 years of Partnership in Health Sector in 2019, any plans in store for 2019?

India and Sweden plan to commemorate the ten years completion of the MoU in 2019. We hope to enhance our collaborations in new areas with new stakeholders like the new AIIMS that have come up in some states. We also hope to have high-level visits from both sides to enhance policy dialogues and bilateral relations. Some of the collaborative partners are also developing new plans to strengthen their cooperation.

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partnerships for both sides to collaborate?

Under the MoU, there are extensive collaborations between public authorities and universities from both countries. For instance, the Swedish Public Health Agency, Medical Product Agency and Forte (the Swedish Research Council on Health, Working Life and Welfare) have ongoing collaboration with their Indian counterparts. There are ongoing discussions on extending collaborations with new players like our National Board of Health and Welfare and E-Health Authority as well as between our medical universities such as Karolinska Institute, Uppsala University and the different AIIMS. Through these collaborations, we hope to demonstrate best practices and technologies. We have research calls in different areas for example with EU in big data and artificial intelligence for monitoring health status and quality of life after cancer treatment, under JPIAMR call on diagnostics and surveillance 2019.

Innovation-the UNNATI way is an India-Sweden Innovators for strategic business development to address global challenges. It is industry supported initiative coordinated by Business Sweden in collaboration with AGNIi-Invest India and ATAL Innovation Mission, NITI Aayog.

Q. You have signed for skilling nurses on infection control, wound care and diagnostics with Govt of Maharashtra in 2016. What is your experience of last two years?

I believe the overall experience has been good. Business Sweden will however be able to provide more information on this as they have been coordinating this activity.

Q. Anti-Microbial Resistance is an important issue right now. How do you propose the Swedish Govt. support in this area?

The Swedish Public Health Agency and the Indian National Centre for Disease Control have an ongoing collaboration

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Parliament house in Sweden with focus on antimicrobial resistance.

Additionally, the Indian Ministry of Health has proposed that Sweden collaborate closely with a newAIIMS and its associated Health and Wellness Centres. AIIMS-Jodhpur has been suggested to us and we are currently considering the scope of such collaboration.

Q. Artificial Intelligence seems to be a focus area for Sweden in Health Sector? Do you see any collaboration in this field with Indian providers?

This is a hot topic all over the world right now. I know India is well ahead in AI technology while Sweden has more long-term experience in extracting relevant information from vast amounts of data. Our patient registries have enabled us to have one of the highest cancer survival rates in the world and that is only one example. I believe we will see some collaborations in the coming year, especially as you are arranging a delegation to Sweden addressing this exact topic in May next year. I will follow this progress closely.

Q. What is your message for InnoHEALTH readers? How can we,

as a platform, support India-Swedish collaboration?

I congratulate InnovatioCuris for collaborating with Swecare Foundation and Swedish Medtech in facilitating innovative and promising solutions for India. Sweden has a long tradition of developing innovations in healthcare. We also have a well-functioning public sector, together with extensive health data registries, biobanks and digital connectivity infrastructure, that provides great opportunities to develop innovative, demand-driven, competitive solutions for healthcare.

Exciting opportunities abound in an environment dedicated to medical innovation, drug discovery and pharmaceutical commercialisation.

Sweden and India have lots to share and learn from each other!

H.E. Klas Molin has been serving as the Ambassador of Sweden to India since 2017. Prior to this, he served as the Ambassador and Chief of Protocol at the Ministry for Foreign Affairs in Stockholm, Sweden. He also held various positions at Ministry for Foreign Affairs in Stockholm. He earned his Masters of Arts in Law and Diplomacy from the Fletcher School of Law and Diplomacy (USA).

ECOSYSTEM PARTNERS Our sincere thanks to all our partners for being a part of our journey of healthcare innovations

InnovatioCuris (IC) Partner List

Bioindustry Park A Science and Technology Park that promotes and develops research in biotechnology and life sciences

Scanbalt Northern Europe’s leading accelerator for inter-regional cooperation

The Consortium of Accredited Healthcare Organisations (CAHO) Promotes collaboration among accredited hospitals and laboratories

Research and Innovation Circle of Hyderabad (RICH) A platform linking research institutions, academia and industry with venture capitalists, angel investors and incubators

Shriram Institute for Industrial Research ISO-9001-2000 certified, NABL accredited, independent and self sustainable Scientific and Industrial Research Institute

Max healthcare India’s leading providers of comprehensive, seamless and class healthcare services

SURATi iLAB, Government of Gujarat Pairs the scattered ecosystem of healthcare innovations under one city umbrella

Swecare, Sweden A member organization where players in the Swedish healthcare sector are gathered

Association of Healthcare Providers (AHPI) A consortium of 10,000 private hospitals of India

CARING Research Mahajan Imaging’s newly christened R&D wing, helping develop world-class clinically relevant products in radiology and genomics

National Institute of Technology, Raipur Reputed Institute known as NIT(s) established by Government of India at number of places

UCrest A leading provider of the most advanced cloud hospital and mobile health services globally

EBD Group/ Bio Europe Europe’s largest partnering conference serving the global biotechnology industry

Team Sweden Team Sweden is represented by the Embassy of Sweden, Business Sweden and the Swedish Australian Chamber of Commerce (SACC)

National Health Systems Resource Centre (NHSRC) Association of Indian Medical Device Industry (AIMED) An initiative of Government of India An umbrella association of indian under Ministry of Family & Welfare to assist manufacturers of medical devices policy and strategy development

Intellecap Focused on developing the entire entrepreneurial ecosystem across the of Asia and Africa continents

Scanbalt Northern Europe’s leading accelerator for inter-regional cooperation

Cosmic Series Offering content and logistical support for events

SURATi iLAB, Government of Gujarat Pairs the scattered ecosystem of healthcare innovations under one city umbrella

The Public Health Foundation of India (PHFI) Organisation created by Government of India for strengthening training, research and policy development in the area of public health

Shriram Institute for Industrial Research ISO-9001-2000 certified, NABL accredited, independent and self sustainable Scientific and industrial research institute

Medical Events Guide A trusted information platform for healthcare and medical events worldwide

Association of Healthcare Providers (AHPI) A consortium of 10,000 private hospitals of India

HealthBiz Insight A healthcare magazine

National Institute of Technology, Raipur Reputed institute known as NIT(s) established by Government of India at number of places

The United Service Institution of India (USI) A national security and defence services think tank

Oncquest India’s largest cancer diagnostic network, also known for its excellence in molecular and clinical diagnostics

World Innovation Health Network Created at Odette School of Business, University of Windsor, Canada

DocMode A platform providing comprehensive and interactive learning programs for health professionals

Scangene A specialty molecular diagnostics and research company

Bionova A company focusing to innovate, collaborate and accelerate the process of delivering products

TALENTGRID Ventures Provides innovative business solutions for the Asia Pacific region

InnoHEALTH Conference Partner List

Startpad Innovation Lab A lab created in the district of Sabarkanta

by Government of Gujarat to incubate innovations

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Innofrugal Healthcare Executive A forum for best practices, policy analysis, India’s foremost digital healthcare business magazine latest thinking and successes in frugal innovations

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The Morphing Face of Healthcare in the World of AI

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By Pratik Pawar

rtificial Intelligence (AI) is a hot topic, simply put - it’s a way of making a computer think intelligently, in a way human think and over a decade now it has managed to be fairly successful.

It has found application in several domains, from consumer electronics like smartphones and smart home devices like Amazon’s Alexa to very niche applications in academic research.

What began as a nascent academic pursuit to enable computers to think and solve problems using human-like cognitive capabilities has now invaded most aspects of human life, medicine and healthcare being no exception.

Modern medicine has discovered 12

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around 60,000 ways things can go wrong with the human body and over thousands of years have probed these illnesses and disorders to better understand and treat them, one drug, one technique at a time. In recent years, however, there has been a dramatic shift in the pace of innovation in healthcare, especially with the advent of artificial intelligence. Artificial Intelligence is an umbrella term used to cover a wide array of algorithms which mimic human cognitive functions and are self-correcting, and can ‘learn’ from a dataset.

A MOUNTAIN OF UNSTRUCTURED DATA One area where AI would do heaps of help to physicians and medical

practitioners is to deal with the insurmountable amount of clinical unstructured data. Nearly 80% of the clinical information is “unstructured” and in a format incomprehensible to health information systems. Thus, getting useful information from these so-called unstructured databases becomes a labor-intensive task. To top that, clinical data is doubling every three years; which leaves the healthcare system with a massive volume of unsorted heterogeneous patient information which may hold answers to several health challenges, but strictly speaking is of little use in its current form. This challenge in healthcare of too much data, too little insight can be alleviated by employing Natural

are vaguely based on biological neural networks, in which a collection of interconnected nodes processes the data like how neurons communicate in a human brain. The potential of NN has been multiplied manifold, thanks to the advent of Deep Learning which is an evolved form of NN, it uses multiple hidden layers that can be used to process complex multidimensional data like a human brain. A huge

huge volumes of data is a tough task for humans, but that’s what Shinjini Kundu, a physician at the University of Pittsburgh Medical Center has been doing. Her AI algorithms examine images like MRI scans for subtle differences which may not be perceptible to the human eye, and she has employed this to study osteoarthritis and to predict its development way before it’s diagnosis with a whopping

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information and make it available for doctors to make smart decisions about their patients.

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Neural Networks, on the other hand, form another major chunk of AI algorithm in healthcare. NN algorithms

Some areas where artificial intelligence surpasses humans is in looking for patterns in data and in making predictions about that data. Processing thousands of images and looking for a subtle discernible pattern within

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portion of NN algorithms is used for diagnostic imaging. Early last year, a study published in Nature used CNN, a type of deep learning NN algorithm to identify skin cancer from clinical images. The algorithm which was trained on 29,450 clinical images, was highly specific and sensitive to detection and was on par with the performance of an expert dermatologist with over 90% accuracy. A 2016 study used a variant of deep learning NN to identify interstitial lung disease using CT scan images with 85.5% accuracy. Google’s artificial intelligence team employed deep learning algorithms to study pictures of the back of the eye, for the detection of diabetic retinopathy, a blinding disorder in diabetic patients. Their results showed above 90% accuracy in both sensitivity and specificity of detection, which is at par with a skilled ophthalmologist.

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from electrography of the heart, brain, and other body parts. Machine learning plays a major role owing to its ability to ‘learn’ and make predictions from data without explicit programming. Of the many machine learning algorithms, two such algorithms have been used extensively in both research and healthcare, namely Support Vector Machine (SVM) and Neural Networks (NN), both use supervised learning models. SVM, in particular, has been useful in tasks involving classification and for novelty detection. For example, a 2012 study used SVM to identify imaging biomarkers of neurological and psychiatric disease. SVM has been used as prediction models for diabetic and prediabetic patients. In 2010, a research group from Korea applied SVM to make predictions about heart failure patients and their adherence rate to their medication. Two researchers from Australia used SVM for diagnosis of cerebral palsy gait with an accuracy rate of 96.8%.

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Language Processing (NLP), a form of AI which identifies key information from spoken or written human input, such as physical examination records, handwritten lab notes, discharge summaries etc. The promise of NLP lies in its ability to turn this big data into smart data. It can be applied to mine big blocks of clinical data and convert that into organized curated easy-forretrieval information, which can make documentation of clinical information more manageable. In 2014, IBM’s Watson collaborated with Epic Systems and Carilion Clinic to analyze massive 21 million records in just six weeks and pulled important information about risk factors and other features from examination notes written by physicians and clinical laboratory results into organized EHR templates, and further used predictive modeling to identify patients at risk to congestive heart failure with an assuring 85% accuracy rate. Similar efforts of using NLP to tackle cancer and genomics datasets are in process. NLP algorithms thus can be employed with much effectiveness to unlock healthcare’s big data crisis to extract clinically relevant

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CAN AI REPLACE A DOCTOR? Another facet of healthcare where artificial intelligence can find use is analyzing structured data namely genetic data, imaging data from X-ray scans, CT scans, MRIs, etc. and electrophysiological data obtained

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INVESTMENT IN AI-CENTERED HEALTHCARE Beyond research laboratories and hospitals, the emergence of AI has caused exponential growth in policies regarding AI and investment in AI around the world. AI-based startups have seen rampant growth. Startup Health, an incubator in US recently reported that there were 7,600 healthcare start-ups around the world working on digital health innovation, a major portion of which involves AI based innovation. An Accenture report published in late 2017 states, “Growth in the AI health market is expected to reach $6.6 billion by 2021 - that’s a compound annual growth rate of

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86.2% accuracy. Similar algorithms can be used to see nuanced differences in electrocardiograms, CT scan images and even in oncology to look for invisible patterns of disease onset and progression. As artificial intelligence algorithms get better after each iteration, routine lab tests like X-rays, CT scans, MRI scans, ECG etc. would fall into the domain of artificial intelligence for more quick and reliable results.

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40%”. Another report by CIS India published this year states that AI could add a whopping $957 billion to the Indian economy by 2035. Even state governments are pushing for growth in AI-based sectors. Government of India aims to increase healthcare spending to 2.5% of the Gross Domestic Product (GDP) by the end of its 12th five-year plan, and to 3% by 2022. Such high rates of adoption are due to several AI start-ups and involvement of major players like Microsoft and IBM. Given the skewed ratio of doctors to patients in India, AI-based healthcare techniques would provide much-needed help in providing healthcare amenities to the masses. Globally, US government have made heavy investments in two of its AI-centered healthcare initiatives, with $1 billion proposed budget to its Cancer Moonshot Program and another $215 million in its Precision Medicine Initiative.

ETHICS AND ISSUES WITH AI IN HEALTHCARE As rapidly as AI has been embraced by the medical and healthcare community, its benefits cannot be actualized without

understanding its ethical pitfalls.

But there are several concerns when applying these algorithms at a large scale to make real clinical decisions.

Algorithms, albeit self-learning are products designed by human and may reflect their biases in the results they produce. These algorithms may reflect the biases of its designer or biases caused by the dataset on which the algorithm was trained. For example, algorithms developed by private sector entities can be biased to ensure outcomes of their interest or healthcare institutes may use AI systems selectively based on say, insurance plan or economic status of that patient or any other parameter.

Even though Deep Learning algorithms can perform sophisticated predictions on imaging data, they are essentially not fed by an explicit code of information but are self-taught systems and even though the prediction score it gives, for example, whether the lesion is malignant or benign are surprisingly accurate when corroborated with the diagnostic report by a doctor, there’s no way to determine how exactly it came to that conclusion, thus rendering AI systems as a black box; with little clarity

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preferred the cloth mother, even when only the wire mother gave them milk.) AI driven care was a sorry version of the real thing.”

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Pratik Pawar is a science writer based in Mumbai. He has a Master’s degree in Biotechnology and currently works as a freelancer writing science-centric pieces with a focus on neuroscience.

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Employing AI to most healthcare activities might also have a negative

Artificial intelligence is going to be pervasive across the spectrum of healthcare. From routine lab tests to offering a clinical decision, AI algorithms will play a major role in the future of healthcare. As deep learning algorithms get stronger and as the workings of the black box are revealed, AI technology will make further strides in healthcare. But advancements in AI-based healthcare doesn’t mean the downfall of human doctors.

Healthcare is a highly emotional and human-centric field and the “human touch” will always play a pivotal role in the delivery of healthcare. Humans, even highly skilled doctors are fallible beings with inherent limitations and artificial intelligence will not sideline these practitioners but augment their abilities, in making an objectively better yet humane decision.

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As demonstrated by several research groups, deep learning algorithms have achieved human-level accuracy and then some more. It can look for patterns which are invisible to the human eye.

Thus, sooner or later, displacing and relegating doctors from their positions, at least in certain areas of healthcare.

This can lead to massive burnouts in doctors as their roles shift drastically and may even lead to gradual attrition of their skills. But there’s more to care than just interpreting blood reports and imaging data of a patient, it has much more to do about understanding the needs of patients, their mental state, etc. The secret of healthcare is not in reading out objective reports, but in the assurance and the warmth, a doctor’s cadence can provide. “Caring is expressed in listening, in the timehonored ritual of the skilled bedside exam - reading the body - in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.”, writes Abraham Verghese, an author and a physician at Stanford.

effect on how knowledge is generated.

Most medical knowledge generated in the past has been curiosity driven. AI systems can tell us whether the lesion is a benign mole or a tumor, but it can’t provide answers to why the tumor has a corrugated surface or white patches etc.

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HUMAN EXPERIENCE IN AN AI ENVIRONMENT The issues mentioned above are all pertaining to the AI system and its functioning, but there are vital concerns about AI’s effect on people involved in care. Several studies have shown that patients prefer AI chatbots and virtual nurses over humans when learning about their diagnosis as they can proceed to learn at their own pace without the embarrassment of not keeping up with the doctor’s speed. Patients are also more open to conversation with a computer than a human being, part of the reason being the diminished shame and fear associated with being vulnerable. But Allison Pugh, a Professor of Sociology at the University of Virginia and a writer for the New Yorker, thinks that virtual nurses and AI bots offer nothing more than the thinnest veil of care. She writes, “[...] automating or using AI to deliver care would be the same as relying on a “cloth monkey”—a reference to a cruel experiment, carried out in 1959, in which infant monkeys were given a choice between two surrogate mothers, one made from welded wire, the other from terry cloth. (The infants

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on how it works. Recently though there have been several predictions to understand how deep learning works, the information bottleneck theory being a prominent one, but the debate is far from settled.

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Microsoft partnered with Apollo hospitals to use AI for early detection of cardiovascular diseases. Healthi, a Bengaluru based startup is deploying machine learning to deliver personalized health plans. Another Bengaluru based startup, Niramai is using AI for pain-free breast cancer screening.

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Importance of Nutrition for Improving Academic Score

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By Kanupriya Khanna

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n today’s times,when exceptional intelligence or gifted child prodigies receive media attention, and 100% cut-off marks are projected as achievable targets; 95% marks in board exams are considered average. Children today are not only having to deal with peer pressure, and body image issues; but also, the pressure of scoring very high grades to get through a good college in their chosen fields.

With mind-boggling competition, everyone wants their children to be exceptional achievers. It is no surprise that the foremost concern of most parents is pertaining to the academic performance of their children.

NUTRITION AND COGNITIVE HEALTH A child belonging to the lower socio16

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economic status, not only has to struggle with lack of educational opportunities, but also lack of healthy nutrition. This child will most likely go through their formative years having a poor diet which lacks most essential nutrients. This may lead to a lower academic performance throughout the school years, which in turn may lead to fewer job opportunities resulting in lower socioeconomic status. When the same child grows up and starts own family, the cycle continues to the next generation.

On the other side of the socio-economic spectrum, a child belonging to an affluent urban family also deals with poor nutrition but in a very different way. More than one-third of such children and adolescents, aged 6yrs to 19yrs, are considered overweight or

obese. This is because these children are overfed but remain undernourished.

Studies show that more than 90% children in the urban areas, belonging to affluent families, consume more than the recommended amounts of saturated fats and added sugars. The consumption of fruits and vegetables in these children is also observed to be less than the recommended intake. Thus, even though they may appear to be well nourished, they have many underlying nutritional deficiencies. Some of these deficiencies impact the performance of these children in academics and extracurricular activities.

RELATIONSHIP BETWEEN BREAKFAST AND ACADEMIC PERFORMANCE There have been many studies that have looked at the relationship between breakfast consumption and academic

RELATIONSHIP BETWEEN SPECIFIC NUTRIENTS AND ACADEMIC PERFORMANCE There are specific micro-nutrients that have been associated with better

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RELATIONSHIP BETWEEN SPECIFIC FOODS AND ACADEMIC PERFORMANCE Interestingly, studies have not just found a positive association with

RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND ACADEMIC PERFORMANCE Physical activity is another very important factor that affects academic performance. Today, many mothers with children as young as 10 years old, feel that enrolling their children in extracurricular activities will take time away from their studies and

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Children who do not eat an adequate breakfast can also suffer from hunger pangs while in school, headaches, and stomach pains due to excessive acid, etc. This, besides being a source of distraction for children, can also lead to absence from classes, which in turn can affect academic performance in school.

result in poorer academic results. On the contrary, studies have shown that students who are physically active, perform better in school, compared to children who are physically inactive.

These kids not only have better grades, but also better attendance and fewer absenteeism, better memory recall, concentration during lessons and lesser disciplinary problems. Physically inactive children who gradually increased their activity, showed improved memory and cognitive function than when they were physically inactive.

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Many similar studies carried out over the years have reported that skipping breakfast was associated with decreased cognitive performance (e.g., alertness, attention, memory, processing of complex visual display, problem solving, etc.) among the students.

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A study done in Norway which looked at 475 high school children, found that those who ate breakfast regularly had less difficulties in learning, especially mathematics, besides improved reading and writing. Another study carried out in China on kindergarten students found that kids who ate breakfast had higher IQs (intelligent quotients). This was independent of the education level of the parents, or the family’s socioeconomic status.

breakfast consumption but also between the quality of meals and academic performance.

A study carried out in Scotland investigated consumption of sugary drinks, sweets, chocolates, pizza, savory snacks and hot dogs with learning abilities. The study found that children who had a higher consumption of these foods had increased mathematical difficulties as compared to children who had a more nutritious dietary intake.

Another study found that children who ate healthier foods with a low glycemic index had better attention span, word recall and reaction time than children who consumed food with a higher glycemic index that lead to high blood glucose levels soon after consumption Sub-optimal intake of foods, such as fruits, vegetables, and dairy products, has also been associated with lower grades among students.

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performance in children, and most have concluded that eating breakfast improves cognitive functions like memory recall.

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Two nutrients, known to have the strongest relation to school performance, are iron and zinc. Iron is an integral part of haemoglobin which is the oxygen carrying molecule in the blood. Deficiency of iron is called anaemia. Symptoms of iron deficiency include fatigue or tiredness, lethargy, slowed growth and development, poor appetite, abnormally rapid breathing, behavioral problems or disciplinary issues and susceptibility to frequent infections.

All these individually and collectively can lead to increased absenteeism and thereby decreased academic performance.

Iron deficiency also directly affects the ability of undertaking physical activity, which in turn can further affect performance in school.

Zinc is mainly needed for the body’s immune system to work properly. In addition, it is involved in cell growth,

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academic performance. Children with deficiencies of micro-nutrients like vitamin A, B6, B12, folic acid, iron, zinc and calcium, have shown to score lower grades and result in higher absenteeism.

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wound healing and for the sense of taste and smell. Symptoms of zinc deficiency are depression and psychological disorders, impaired immunity, impaired growth, diarrhoea, delayed sexual maturation, alopecia or abnormal hair growth, impaired appetite, altered cognitive functions and altered sense of smell and taste. Zinc deficiency also leads to poorer performance in school.

This can be due to the fact that children with zinc deficiency are more prone to catching infection and falling sick, thereby missing classes, their ability to memorize is affected, there are psychological disorders that can affect learning, etc.

So, how can parents ensure that they give their children the best advantage for improving academic performance?

Some of the suggestions are as follows: Give them a nutritious breakfast.

Always have healthy snacks stocked in your pantries, so that kids eat the right foods throughout the day.

Don’t be fooled by "Low Fat" labels.

Such products are usually loaded with sugar.Similarly, “natural" does not always mean whole grain or unrefined ingredients. Educate yourself about reading the labels and identifying what they mean.

Encourage your children to be physically active, it will not only help them improve their academic performance, but also help in building their overall personality.

A good healthy balanced diet will ensure that your children do not suffer from any nutritional deficiencies.

Kanupriya Khanna, a Sr. Consultant Nutritionist & Dietitian specializing in pediatrics, is a private practitioner at Greater Kailash, New Delhi. For over 15 years, she has been working with mothers and children to create more wholesome food habits with least restrictions and disruptions. She pioneers the science of healthy eating, using fresh ingredients and foods that are easily available and can be integrated easily into daily lives.

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Living with Diabetes: An Occupational Therapy Perspective

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lmost half the population of India suffers from diabetes. It is also one of the fastest growing diseases and comes under the category of lifestyle diseases. Diabetes can affect any person, irrespective of age, gender, occupation and region.

It is believed to be a ‘silent killer’ by many as the complications caused by the disease are varied and can affect any part of the body causing major damage, if left untreated or neglected. Most of us believe that only medicines need to be prescribed and the disease will be taken care off.

Though that is a very important aspect of treatment, a person diagnosed with diabetes also needs to have a good quality of life (QOL) in order to ensure healthy living and compliance with treatment protocols.

The field of Occupational Therapy (OT) looks into the daily activities of the person with diabetes and analyzes ‘how’ it is being done. Not only does the activity need to be done using correct posture, it should also not be physically taxing. Over and above, the activity must be done

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By Dr. Monika Kundu Srivastava

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‘safely’. Occupational therapists help by training the person with diabetes modify habits and routines. If required, a new routine and method can be prescribed in order to ensure independence without putting the person at risk.

OT can help patients develop simple, concrete, measurable, and achievable self-management goals consistent with the seven behaviours advocated by the American Association of Diabetes Educators (AADE). These AADE 7™ Self-Care Behaviours are: (1) healthy eating, (2) being active, (3) monitoring, (4) taking medication, (5) problem solving, (6) healthy coping, and (7) reducing risks.

HEALTHY EATING The whole process of ‘eating right’ starts with buying the ‘correct’ food.

Planning and then preparing a meal using suitable ingredients is just as important. Healthy eating is essential.

Cutting down on your favourite sweets may be a real challenge.However, in today’s day and age, there are several substitutes available in the market.

Monitoring carbohydrate intake,

avoiding sweets, sweetened drinks and trans-fats is essential to keeping diabetes under control.

BEING ACTIVE Staying active through physical exercise and continuing to do as many tasks by yourself will not only ensure that your body remains toned up but, will also ensure optimal utilization of the sugar you may have eaten and release of ‘happy hormones’ such as dopamine, serotonin, oxytocin, estrogen and progesterone. Setting realistic and do-able goals will give a sense of achievement, for example ‘today I will tidy up my cupboard’ (dopamine); reducing stress by spending quality time with loved ones and pursuing a hobby, a physical exercise routine (yoga, going for a walk, dancing, etc.) and meditation are some ways to improve the levels of ‘happy hormones’ in the body.

MONITORING AND TAKING MEDICATION This can be easily achieved by encouraging the person with diabetes to have a schedule. Keeping fixed times for meals and medication decreases the chances of ‘forgetting’.

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Dr. Monika Kundu Srivastava is an experienced Occupational Therapist with specialization in Neurologic conditions. She is currently working in a hospital set-up. Besides being a clinician, Monika is also an experienced writer and editor.

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It is essential that any person with a chronic condition such as diabetes continues to lead a normal life. This helps retain a meaning and purpose to their lives. Helping the person with diabetes plan and maintain a routine which has time slots for all essential elements in the care of diabetes such as mealtime, when to take the medication, exercise, work and leisure activities, is one of the most important areas of Occupational Therapy.

Helping the person understand that there are various ways that one can maintain one’s independence without compromising on the quality of life or safety is the key to living with diabetes. All that is required is a little discipline and lots of care.

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Occupational therapists also prescribe, train and educate persons with diabetes on suitable household as well as environmental adaptations.

For example, a person with diabetic retinopathy - a complication when the blood vessels of the retina in the eye get damaged leading to loss of vision - is prescribed, trained and educated in the use of visual aids such as magnifying glasses and using

close circuit TV. The importance of reducing glare, using contrast images, bright colours and appropriate lighting to improve the seeing ability is emphasized. These methods are also incorporated at doors, stairs and other potential fall areas.Organizing things around the house so the patient can easily find things helps not only patients with vision impairments but also patients with memory issues.

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REDUCING RISKS Wound healing takes longer in a person with diabetes. Hence, it is important to reduce the risk of injuries at all times. An occupational therapist can carry out a ‘floor slipperiness’ assessment, incident and injury survey, and hazard surveillance to reduce the risk of an injury or a fall. For example, a person with diabetic neuropathy - complication which causes the nerves to be affected resulting in less feeling in terms of pain, temperature (hot or cold) or pressure (tight or loose). Such a person is at a major risk of getting injured. Burns during cooking are common as the person is unable to feel a ‘hot’ utensil. A simple modification like microwave cooking/heating or using protective gloves can prevent any foreseeable injury. Removing potential hazards such as loose wires and carpets in addition to wearing slip-resistant footwear and placing non-skid mats at strategic places can prevent falls.

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PROBLEM SOLVING A person with diabetes sometimes might even feel helpless. Helping him or her to become a problem solver is an important component to ensure independence for a longer duration of time. This means that instead of always looking around for someone else to do your job or find a solution for a challenge simply ‘DO IT YOURSELF’.

For example, if you are unable to go grocery shopping by yourself, think about home delivery options. So, all you need to do is pick up the phone and call your local grocery seller or order online!

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COPING IN A HEALTHY MANNER Persons with diabetes have to face the challenge of living their lives with the knowledge that their condition is incurable. This can have a major psychological impact on the person.

With information on the disease available freely, a person may be overwhelmed by the complications that might occur. Family members need to be supportive in order to ensure that the person with diabetes follows the treatment prescribed and stays positive about his or her future.

Increasing awareness to the family members is crucial for prevention of complications.

Participating in activities that are purposeful, nurturing a hobby, spending time with loved ones, doing the mundane but important things of life such as ironing, dusting helps maintain a routine and is crucial for a good quality of life.

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Reminders in the form of alarms (phone and clock) are both useful.

Keeping your medicines at a place where you can see them is crucial to compliance. Making a checklist and ticking each item off as you complete the task on a daily basis can also help elderly persons who may have memory issues. Family members too have a major role to play in monitoring and taking medication. ‘Cheating’ on food issues reduces drastically if someone else is monitoring and if the foods to be avoided are kept either out of reach of the person (for example, under lock and key) or not kept in the house at all.

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Recent breakthroughs in Diabetes research

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By Sahana Shankar

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hile the jury is still out on whether diabetes is one disease or a spectrum of metabolic disorders, clinicians mostly encounter cases classified as Type I (where the body’s immune cells attack the pancreatic insulin-producing cells) and Type II (where the pancreatic cells fail to recognize and utilize insulin).

Thanks to multi-national collaborative efforts we now have fairly good knowledge of how either of these types’ manifests, their symptoms and some methods of management. However, it is imperative that we find a more permanent solution to cure the disease.

While Type II is dubbed as a lifestyle disease which can be monitored, managed and reversed in some cases with specific diet, exercise and minimal medication, it is the Type I which is seen in children and younger people, although with a prevalence lower than Type II. It causes severe disruption and affects the patients’ quality of life due to their dependence on insulin injections and risk of hypoglycemia, making a cure much needed to help these patients reclaim their lives.

The scientific community across the world contributed immensely to our understanding of the etiology of the disorder in the 60s and 70s. The 80s and 90s were instrumental in the identification of insulin, glucagon and the recombinant production of insulin for sub-cutaneous administration. Recent research has focused mainly on understanding the way pancreas can be remodeled to improve insulin production and/or its utilization.

It has also improved monitoring and management of diabetes with the use of non-invasive and wearable technology.

Listed below are some of the recent advances in diabetes research.

Smart insulin- the major drawback of Type I is the dependence on regular external doses of insulin. While technology has made it more and more manageable 22

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with insulin pens, it results in the patient’s life to be largely centered around their medication. In 2015, researchers at the University of North Carolina devised a glucose-monitoring, insulin-delivery system using nanotechnology and biomedical engineering. The smart insulin patch consists of an array of tiny needles which can be used anywhere on the body to detect glucose levels and release insulin accordingly. The technology is currently undergoing revision and preclinical testing.

Islet transplant- recovering healthy pancreas from cadavers and transplanting islet cells into the liver of the patient is an experimental procedure in practice since 2008 to assist with Type I. However, the success rate of this intervention is low due to rejection by the patient’s immune system and dependence on immunesuppressants which increase the risk of infection. It also does not completely reverse patient’s insulin-dependence and requires regular low doses of insulin. A variation of this therapy at the University of Miami in 2017 was a successful transplant of pancreatic islet cells into the stomach lining of the patient which resulted in her complete remission from Type I and independence from constant insulin injections.

Stem cell therapy- With the evolution of cell biology techniques, we now have the ability to program immature cells to develop into a specific lineage of cells.

Viacyte, a California based biomedical engineered a direct delivery device in April 2017, which when placed under the skin delivers stem cells into the bloodstream.

These stem cells are programmed to home into the pancreas and develop into mature insulin-producing cells to replace those eliminated by the immune system. While this device is still in its nascent stages of trial, it would be a life-saver for patients with highly variable glucose levels and severe risk of hypoglycemia.

Immature beta cells- another variation

of the stem cell therapy may be derived from our ability to now image the pancreatic tissue at unprecedented resolution. Scientists from the University of California, Davis identified an immature population of beta cells which can produce insulin but, unlike mature beta cells, are unaffected by the presence of glucose in the blood since they do not have glucose receptors. This discovery could lead to a deeper understanding of how beta cells function, and these immature cells can be manipulated to produce more insulin to keep the glucose levels in check. In February 2018, researchers at the University of Miami identified the exact anatomical location of pancreatic stem cells which can be stimulated to be glucose-responsive insulin-producing cells. Subsequently, University of California, San Francisco reported that beta cells can be ‘trained’ to adapt to deficiency in oxygen and nutrients due to exposure before and during the transplantation, ideally ensuring an endless supply of insulin-producing beta cells.

IgM immunotherapy- the antibody IgM has been used as a diagnostic marker for Type I since early 2000s. A team of researchers at the University of Virginia have found a new role for IgM as a vaccine against Type I autoimmunity. Injecting human IgM into diabetic mice resulted in reduction of autoimmune reactivity, restoration of the balance of cells in the pancreas and reversal of Type I. Methyldopa- this is a classic case of serendipity in science. Methyldopa is a clinically approved drug to treat hypertension. Scientists at the University of Colorado and University of Florida screened all FDA-approved small molecules to check if any of them could prevent the autoimmune pathway of Type I from getting activated and Methyldopa was a successful candidate.

After successful experiments on mice and a pilot clinical study, the drug can be developed as a vaccine to prevent Type I in those at risk.

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Sahana Shankar is a PhD candidate in Structural and Molecular Biology at Academia Sinica, Taiwan. When she is not extracting protein, she loves to travel, read and writes scicomm articles.

Her passion is to translate the science in fascinating research papers in health and medicine into common parlance. She believes understanding the science behind the world around us is indispensable to our engagement with it. She has contributed to Brainwave, a children’s science magazine from the Amar Chitra Katha family and Newslaundry, an independent news portal.

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With medical technology advancing fast, we may be looking at a future with the potential to decrease healthcare costs worldwide to deal with diabetes in its diagnosis, management and prevention.

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The Mexican cave fish has been established as a new model organism for studying diabetes. It’s a blind fish that lives deep in the sea with no access to light and food for long periods of time. It has evolved to survive these harsh conditions by having an insatiable appetite and insulin receptors which do not respond in the presence of high blood sugar. As a result, the cavefish is severely diabetic but can function normally. While this physiological make-up is fatal to humans, understanding the function of the glucose regulation in cavefish may be vital to develop novel therapies for diabetes management and cure.

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The DiRECT study from the Newcastle University, UK with 300 diabetics aged 20-65 demonstrated that a severe calorie-restricted diet can result in remission of Type II in around 86% of the patients. This is a very promising result since there is a rapid increase in obesity and Type II. A strict weight loss intervention may be a means of both prevention and cure of Type II diabetes. Interestingly, Lorcaserin, a weight loss drug was reported by Harvard University to reduce the incidence of diabetes and the risk of hypoglycemia in patients being treated for obesity. This is supported by multiple recent findings from the neurobiology community that obesity results in activation of the microglia cells in the brain and results in impaired modulation of hormones and increased glucose levels or resistance to insulin and hence treating obesity would also reduce the likelihood of an array of metabolic disorders.

Wearable technology has translated to better diagnostic and monitoring devices for diabetes. We have had home kits for monitoring blood glucose levels since 1981, but almost all variants require blood by pricking the finger with a lancet. A proof-ofconcept study in South Korea of a wearable glucose monitor in the form of contact lenses has been successfully tested in rabbits. The silicon lens has an outward facing LED which is switched off in response to high levels of glucose in the tears as detected by a sensitive nano-sized glucose monitor. While this technology needs more work before it can be available for humans, it is a step in the direction of real-time, noninvasive glucose monitoring. Another variant of the wearable monitor is a color-changing tattoo ink with liquid biosensors developed by MIT and Harvard Medical School which can detect changes in the glucose levels, pH or salt in the interstitial fluid between the cells. This study is currently in research mode with no plans for clinical trials. However, the possibility of using the human skin as an interactive display for physiological monitoring is extremely attractive for developing noninvasive diabetes management products as is the case with an armband that can monitor the glucose in sweat via an ionic sensor. The simple bioengineered product from University of California, Berkeley is primed for continuous monitoring of not just glucose, but also sodium, potassium, body temperature and other physiological parameters with a fully integrated electronic system that can log and update the data into

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Vaccines- Enteroviral infections are known to cause Type I in newborns by triggering an autoimmune response against islet beta cells. At the University of Finland, scientists have developed a vaccine that can potentially eliminate enteroviruses and thus prevent Type I. Another common vaccine B.C.G. used routinely against tuberculosis has been used by doctors at the Massachusetts General Hospital as a vaccine against Type I. They have been successful in a pilot clinical trial by reducing the insulin dosage to one-third of the patient’s initial requirement even after 5-10 years of the vaccination.

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New age solutions for diabetic care

By Urvashi (Raheja) Bhattacharyya

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iabetes may not have a medically approved cure yet, but it surely can be turned a few knobs down with a well-balanced diet, regular exercise and medication. Of course, one should follow doctor’s advice for a lifestyle change. In the real world though, you look longingly at those French fries and convince yourself a few wouldn’t harm. Or you hit the snooze button and tell yourself, I will go for that long run tomorrow. And on and on you go, till your next visit to the Principal’s office, aka your doctor, where you hope miraculously for an improved report card. You are not alone my friend.

Sticking to a regime requires discipline or an occasional reminder from your wellwishers (if you were me). A sight towards your goal and how far you have come in conquering it helps matters further.

Thankfully, plenty of new-age start-ups are here to make diabetes management and lifestyle changes easier.

Take for instance Life In Control and Wellthy Therapeutics. These digital 24

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platforms connect patients with doctors and coaches and provide personalized care in terms of diet and exercise plan.

Users can create long-term health goals, follow-up daily tasks and keep tabs on their health profile including HbA1C and glucose levels, track medicines intake and understand how their daily routine affect these measures. These start-ups also give doctors the flexibility of reaching out to patients outside their clinical hours as well as to create and coach them on their personalised care plans. In the language of numbers, Life In Control has over 100 doctors on the platform and appears to have helped over a lakh patients with their app. Wellthy Therapeutics took the approach of a pilot program with diabetic patients and claims to have helped reduce both HbA1C levels by a little over 1% and an average weight reduction of 3.4 kgs over 16 weeks. It also got an endorsement by Asia’s largest diabetes association, Research Society for the Study of Diabetes in India. Both the apps are available for download on Android and iOS platforms.

Adding to the growing list of startups are those that detect blood glucose and connect directly to your smartphone. BioSense SYNC, for instance, is a compact Glucometer with Bluetooth connectivity to a user’s phone. It provides detailed analysis of blood sugar data collected over a number of days. Similar to other diabetes management apps, a user can map their glucose data with their eating and exercising habits. Taking these interventions a step further, the start-up BeatO not only provides a smartphone Glucometer, but also a range of diabetic friendly food products to munch upon. Patients can order medicines, sync their fitness devices and count calories on food items consumed. As of today, BeatO has served more than 25000 customers with a daily user add-on of 75-100.

Most of these diabetes management apps can instantly connect a patient to a diabetic coach in case the sugar levels are off, and alert the patient’s family as well on concerning trends.

low cost solutions, so an average user can save money on constant check-ups.

Low costs also allow these start-ups to cater to rural segments of India, where a healthcare worker can refer patients to tertiary hospitals based on initial reports by these devices.

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Given the burden of diabetes in every aspect of life (behavioral, physiological and financial), being handheld into recovery could be motivating for many patients. For maximum impact, we need to reach the furthest demographic

Urvashi (Raheja) Bhattacharyya is a Biomedical Science graduate from Delhi University and a Ph.D. from National Centre for Biological Sciences. When not running behind her toddler, she spends time reading stuff about the brain, AI, ML and latest innovations. Writing keeps her calm.

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The complication of retinopathy, as mentioned above, relates to the slowly progressive disease of the eye and is one of the leading causes of blindness in diabetic patients. This segment is addressed by start-ups like ChironX and Artelus that use artificial intelligence to detect or monitor diabetic retinopathy risks from retinal image scans. Both the start-ups have achieved high accuracy of detection (over 95%) while the technology of AI confers an easy benefit of scanning retinas at a much faster speed to doctors and hospitals. Artelus also boasts to have saved over 3900 eyes so far from diabetic complications.

corners of India, as diabetes has a growing prevalence in all sectors of the country. Infact, why wait for diabetes to knock at your door? One can also mitigate pre-diabetic conditions or reduce the chances of developing diabetes later in life. These startups aim to provide that ecosystem, where a patient can be led into an improved, healthy lifestyle at minimal costs. And just as it is heartening to see the growing awareness of Indians towards their health, it is equally imperative that these solutions are also as democratic as possible. Importantly in a booming start-up scenario, maintaining data integrity, complete transparency between doctors, patients and companies as well as strict adherence to ethical standards would go a long way in ensuring patient trust in this system.

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Complimenting these health management gurus, patients are also likely to benefit if there were devices providing at home diagnosis for diabetic complications, such as neuropathy, kidney malfunction or diabetic retinopathy. Scintiglo

by Cutting Edge Medical Devices, Anupath by PathShodh and Sparsha

by Yostra Labs have created Point of Care (PoC) tests to detect the first two complications. Scintiglo is a small handheld device that detects urinary proteins (should be trace levels in a healthy individual) at a low cost with a remarkable accuracy and connects to a smartphone through a custom app. Anupath uses unique test strips for detection of specific biomarkers of diabetes, while also eliminating the need of usual sample preparation that one sees in clinics. Patients can get a comprehensive reading of their plasma and urine protein levels, HbA1c levels blood glucose and haemoglobin. While Sparsha, as the name suggests, focuses on touch-based tests that can diagnose diabetic peripheral neuropathy and send reports via users’ smartphone. Funded by the Department of Biotechnology grant (BIRAC), these start-ups focus on

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Trends Trends

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Faster diagnostic tests developed for tuberculosis

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By Dr. Divya Khatter

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uberculosis (TB) claims two million lives each year globally. Early detection and treatment are crucial to prevent spread, outbreaks, and development of resistance. Scientists at the Translational Health Science and Technology Institute (THSTI) Haryana and All India Institute of Medical Sciences (AIIMS) New Delhi have jointly developed highly sensitive and rapid tests for detection of tuberculosis infection in lungs and surrounding membranes.

TB spreads from one person to another through inhalation of infected air. When the bacteria attacks the lungs, the disease manifests itself in a pulmonary form. It is the most common form of TB. But about 15% of new patients in 2016 were found infected with extrapulmonary TB where organs other than lungs may be affected. Till now, detection of all forms of TB is mostly based on sputum smear microscopy and culture tests.

While smear microscopy is simple and rapid, it has low sensitivity. Culture test is highly sensitive, but takes 2 to 8 weeks to get results.

Conventional diagnostic tests use antibodies for detection of bacterial proteins in sputum samples. However, such tests suffer with limitations including batch-to-batch variability, limited shelf-life, and cost.

To address these problems, the researchers have now developed two DNA aptamer-based tests - Aptamer Linked Immobilized Sorbent Assay (ALISA) and Electro Chemical Sensor (ECS) for detection of a bacterial protein in the sputum.

Aptamers are DNA, RNA or peptide molecules that bind to specific molecular targets. They are known to bind the right target (which defines 28

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sensitivity) and at the same time rule out any non-specific binding to other targets (specificity). The performance of the newly developed tests was compared with antibody-based tests in 314 sputum samples. ALISA showed 92% sensitivity while the antibodybased method was 68% sensitive.

The research team used ALISA to detect a bacterial protein, HspX. This method, however, took five hours to yield results because it requires sputum immobilization which is a timeconsuming step. So the team made efforts to develop a simplified ECS test. In this, aptamer was immobilized with an electrode and upon binding to HspX in the sputum sample, a drop in the electrical signal was recorded.

The ECS test can be used for screening of samples in the field as it takes as less as 30 minutes to deliver results. It is highly sensitive and could detect HspX protein in 91% of the samples tested in this study. In addition, there is no need for sputum sample preparation which is a complex and time-consuming process.

The aim is to develop aptamers for detection of multiple bacterial proteins simultaneously which is expected to lead a more robust test said Dr. Tarun Sharma, a member of the research team.

The aptamer-based screening tests for pulmonary TB, pleural TB, and TB meningitis hold immense promise for a country like India, where the disease burden in high and primary healthcare is only a dream for many. The ECS platform could be used in a mobile screening van at the point-of-care explained Dr. Jaya Tyagi, who led the research team AIIMS hoping that these tests are adopted by the TB programs in the country.

The group used aptamer-based test also for detection of pleural TB, the second most prevalent form of extrapulmonary TB. Early diagnosis of pleural TB is limited by availability of a sensitive and rapid test. The performance of existing DNA-based tests varies widely due to low bacterial load in pleural fluid sample.

There is no test for making a confirmed diagnosis of pleural TB. Even WHOendorsed Gene Xpert has a poor sensitivity of 22%. On the contrary, the aptamer-based test for pleural TB has showed 93% sensitivity and is cost-effective explained Dr. Sagarika Haldar, a member of the research team.

The research teams were led by Dr. Jaya Tyagi (AIIMS), Dr. Tarun Sharma and Dr. Sagarika Haldar (THSTI) including other colleagues from the institutes. The pulmonary TB results were published in the journal ACS Infectious Diseases and the pleural TB results were published in Analytical Biochemistry. The studies were funded by the Department of Biotechnology, Department of Science and Technology, and THSTI.

By India Science Wire

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MAGAZINE

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LATEST INNOVATIONS! The tailorx study..... about 70% of early stage breast cancer patients can avoid the agony of chemotherapy

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he Trial Assigning Individualized Options for Treatment (Rx) study is the largest ever breast cancer treatment trial that was supported by the United States National Cancer Institute (NCI) and designed and led by the ECOGACRIN Cancer Research Group and was published in the New England Journal of Medicine in June. Breast cancer is the most common cancer in women in India and accounts for 27% of all cancers in women. At an incidence rate of 25.8 per 100,000 it is lower than in some developed countries, but the mortality rate (12.7 per 100,000) is comparable to that in western countries. Data on incidence rates of breast cancer from six major cancer registries of India show that the annual percentage increase in the incidence of breast cancer has been in the 0.46 to 2.56% range. The trial enrolled 10,273 women with breast cancer from 6 countries across the globe. It used the Oncotype DX Breast Recurrence Score® (BRS®) test that assesses the expression of 21 genes associated with breast cancer recurrence to assign women with early-stage, HR-positive, HER2negative, axillary lymph node–negative breast cancer to the most appropriate and effective post-operative treatment.

TAILORx participants with BRS®results from 0 to 10 were treated with endocrine therapy alone based on the prior results from the NSABP B-20 study, which showed no opportunity for chemotherapy benefit. TAILORx participants with BRS results from 26 to 100 were treated with chemotherapy plus endocrine therapy based on the prior results from the NSABP B-20 study, which showed an absolute 30

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benefit of chemotherapy greater than 20%. To more precisely define the effect of chemotherapy for women considered to be at intermediate risk for recurrence, 6,711 women with Oncotype DX BRS® results of 11 to 25, the primary study group in TAILORx, were randomized to receive endocrine therapy with or without chemotherapy.

These randomized patients comprised two-thirds of all patients enrolled in TAILORx and were followed by the investigators for approximately nine years on average.The majority of breast cancer patients diagnosed worldwide have hormone-positive, HER2negative, node-negative cancer. The TAILORx study definitively established that chemotherapy may be spared in about 70% of these patients, including all women older than 50 with BRS® results of 0 to 25 and all women age 50 or younger with BRS® results of 0 to 15. Importantly, 30 percent of earlystage breast cancer patients will derive benefit from chemotherapy, including women of any age with BRS® results of

26 to 100, and in women younger than 50, where a modest (2 percent) benefit from chemotherapy was observed with BRS® results of 16 to 20, which gradually grew as scores increased up to and above 25. This important finding reveals a new level of precision of chemotherapy benefit for younger patients that only the Oncotype DX® test can provide.

The TAILORx findings can spare thousands of women from getting toxic chemotherapy treatment that really wouldn’t benefit them. The medical fraternity will be highly benefited with this breakthrough finding wherein they will be able to identify the right patients who can benefit from chemotherapy and sparing chemotherapy and its toxic side effects in those who will not benefit from its treatment. The only drawback of the Oncotype DX test is its cost which is around Rs. 2.75 lacs in India. allowed us to avoid chemotherapy for certain group of patients. We can select the people who don’t need chemo and administer it to only those who need it.”

Source: www.healthtechnology.com

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IT researchers have developed an Artificial Intelligence (AI) based wireless system that can detect the quality and safety of food items. The system uses Radio-Frequency Identification (RFID) tags or stickers with tiny, ultra-high frequency antennas on many food products to sense potential food contamination. The researchers feel that this is a democratic way to bring about food safety and quality in the hands of the consumers. When an RFID powers up and transmits its signal, it interacts with material in its near vicinity (i.e., inside a container) even if it is not in direct contact with that container.

This interaction is called "near-field coupling," and it impacts the wireless signal transmitted by an RFID. The system, RFIQ extracts features from this signal and feeds it to a machine learning model that can classify and detect different types of adulterants in the container. An initial prototype of the system has been made and tested in two applications. The results have demonstrated the ability to identify fake alcohol with an accuracy higher than 97% and identify tainted infant formula with an accuracy higher than 96%.

Source: news.mit.edu

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Europe over the past five years, to help physicians detect heart attacks faster and more accurately, particularly among women who often have lower troponin levels. Due to the test’s ability to detect very low levels of troponin, the test now can be used to determine cardiac risk in people with no reported symptoms of heart disease.

Using this diagnostic test during the same blood draw of a routine health exam, doctors will be able to look at what's actually happening to the heart and better determine their patients' risk of developing heart disease, such as a heart attack or other cardiac event in the future. With this added information, doctors can help ensure the correct treatment is given to people at high risk and prevent unnecessary testing, medication and costs for lower-risk patients. Since the High Sensitive Troponin-I test can be part of any routine health check-up, it is easier to fit into the existing healthcare practices.Another advantage, in addition to more accurately determining a patient's cardiac risk, this test is designed so that biotin doesn't affect test results.

The vitamin biotin is growing in popularity as a supplement to improve hair, skin and nails. Biotin may interfere with some lab tests including cardiac ones, potentially leading to false positive or false negative results. Having an accurate picture of a patient's cardiac risk can help doctors ensure that each patient is getting the correct treatment. The High Sensitive Troponin-I test is now available to be used on Abbott's ARCHITECT system for cardiac risk assessment in CE marked countries and in countries where regulatory registration is not required for this product.

Source: prnewswire.com

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ardiovascular diseases are the leading cause of death globally.

An estimated 17.7 million people globally die annually from cardiovascular diseases, according to the World Health Organization.

Of those, 7.4 million were due to coronary heart disease. This is a worrisome number and thus makes the focus shift to preventive cardiac care.Abbot’s high sensitive Troponin-I blood test is another diagnostic tool to aid such endeavour in this direction which has recently received CE mark for the prediction of chance of heart attack in apparently healthy adults potentially months to years in advance. Physicians now have a blood test that looks at a biomarker from the heart, so people can confidently take the appropriate lifestyle and medical steps needed to help prevent heart disease. Nowadays many studies are being conducted to evaluate the impact of troponin levels on cardiac health and one such study conducted by the West of Scotland Coronary Prevention Study (WOSCOPS) found that Troponin-I levels were an indicator of an increased risk of coronary heart disease independent of cholesterol levels lowering and identified the patients who benefited most from preventive treatments with a statin. Nick Mills, MD, a cardiologist and researcher at the British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, is the author of another such study that evaluated the impact of troponin tests. Troponin-I proteins are released from the heart and can be found at elevated levels in the blood when the heart muscle has been damaged due to lack of blood flow.

Abbott's ARCHITECT STAT High Sensitive Troponin-I blood test has been used in emergency rooms across

Wireless stickers to detect food quality and safety

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First troponin test to help predict the chance of heart attack in apparently healthy adults

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Tiny robot caterpillar designed to walk through the body to deliver drugs T he Research team at City University of Hong Kong has developed a tiny robot with ‘caterpillar legs’ that could also be used to deliver drugs inside the human body. They say it can move efficiently inside surfaces within the body lined with, or entirely immersed in, body fluids such as blood or mucus. Researchers say that the robot is capable of carrying relatively heavy loads and adapting to adverse environments and could pave the way for medical technology advances. But what makes the ‘milli-robot’ stand out is its hundreds of less than one millimetre long pointed legs that look like tiny hair.

The research was published in Nature Communications. The robot’s body thickness measures around 0.15 mm, with each conical leg measuring 0.65 mm long and the gap between the legs measuring about 0.6 mm, making the leg-lengthto-gap ratio around 1:1. The pointed legs have greatly reduced the contact area thus reducing friction. Laboratory tests showed that the multi-legged robot has

40 times less friction than a limbless robot in both wet and dry environment. The robot is fabricated with a silicon material called polydimethylsiloxane (PDMS) embedded with magnetic particles which enables it to be remotely controlled by applying electromagnetic force. Both the materials and the multi-leg design greatly improve the robot’s hydrophobic property. The robot is controlled by a magnetic manipulator that can move it in both a flap propulsion pattern and an inverted pendulum pattern meaning that it can use its front feet to flap forward as well as swinging the body by standing on the left and right feet alternately to advance respectively. The researchers said ‘the rugged surface and changing texture of different tissues inside the human body makes transportation challenging. Our multi-legged robot shows an impressive performance in various terrains and hence open wide applications for drug delivery inside the body.’ The research team further proved that when facing

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Simba hybrid pillow

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imba hybrid pillow is a perfect combination of technology and material.

It contributes not only to the best night’s sleep but also increases the benefits of sleep for the body and mind. The uniqueness of this pillow lies in the choice of the material with which it is made. The material or filling used is Outlast based on Nanotube technology and is made of memory foam tubes designed to adapt to each sleeper. Each pillow comes with hundreds of nanotubes that can be added or removed to alter the height and firmness of the pillow. These small laser-cut, cylindrical tubes are made from super-soft memory foam which moulds to the shape of your head giving one utmost comfort.

The pillow can be customised to

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be made soft, medium firm or firm by the addition or deletion of nanotubes.Each nanotube adapts to your sleeping position, supporting the complex structures of the head, neck, and spine.To keep the body temperature regulated outlast draws the heat away, trapping it within its fibres and as one cools down it releases the warmth back out. On the reverse side of the pillow is a combination of smart microfiber and premium 300 thread count jacquard cotton. This side is extremely soft, lightweight, breathable and highly durable.Thus, this pillow has the advantages of thermal regulation and height alteration which no other pillow has offered till date. This seems to be the future of comfort sleeping.

Source: www.inshorts.com

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an obstacle ten times higher than its leg length, the robot, with its deformable soft legs, is able to lift up one end of its body to form an angle of up to 90 degrees and cross the obstacle easily and can also increase its speed by increasing the electromagnetic frequency applied. The robot also shows a remarkable loading ability. Lab tests showed that it was capable of carrying a load 100 times heavier than itself, a strength comparable to an ant, one of the strongest creatures in nature or to a human being able to easilylift a 26-seated mini-bus. Before conducting further tests on animals and eventually on humans, the research teams are further developing and refining their research in three aspects, namely finding a biodegradable material, studying new shapes and adding extra features. The team hopes to create a biodegradable robot in the next two to three years, so it will decompose naturally after its meds delivery mission.

Source: https://www.telegraph.co.uk

First ever FDA approved augmented reality presurgical imaging tool

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ovarad HoloLens have collaborated to launch an OpenSight AR system which is the first ever FDA approved Augmented Reality pre-surgical imaging tool.The OpenSight runs on AR technology to give 2D, 3D and 4D patient images which can help doctors plan the surgery ahead more thoroughly as it gives dual side by side image, both of the patient as it is and their internals. Doctors can now use Microsoft HoloLens for specific, pre-operative purposes. The technology is going to be transformative as it will allow the doctors to have a full brief of the patients’ internals before they make the first incision.Novarad has also released the teaching version of OpenSight AR system to ease the medical students into the future. Students or other surgery attendees can witness the AR preparation first-hand, since the HoloLens experience can be shared among multiple headsets. No doubt FDA recognized Novarad’s efforts by clearing the OpenSight system for use. It is a complete medical package, designed to improve the precision and utility of medical practice.

Source: https://www.healthimaging.com/.../fda-approvesaugmented-reality-system-microsoft-...

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Compiled by: Dr. Avantika Batish, working as the Director Strategy and Healthcare at International Health Emergency Learning and Preparedness. She is also a guest faculty for MBA (HR) and MBA Healthcare Management at various B-Schools and is a soft skills trainer.

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than the old net type. The researchers said that if they had scaled-up their trial to the whole of Burkina Faso, they would have reduced the number of malaria cases by 1.2 million.

Female Anopheles mosquitoes are increasingly becoming resistant to the most common insecticides, called pyrethroids, used to treat traditional bed nets. Latest figures from the World Health Organization (WHO) show that after a dramatic decrease in malaria since the start of the millennium, progress has stalled, and the number of people infected with malaria is now going up in some areas, with insecticide-resistant vectors as one of the possible causes of this. The researchers suggest the use of bed nets with a combination of chemicals, to be explored for areas where mosquito resistance is a problem. The ingredients on the nets kill more mosquitoes and reduce the number of infective bites than conventional nets treated only with a pyrethroid. As it is less likely that mosquitoes become resistant to both chemicals in the combination bed nets, they are considered a better alternative to tackling malaria in areas where mosquitoes have become resistant to the single chemical used in traditional bed nets. The latest figures from WHO show that in 2016 malaria infected about 216 million people across 91 countries, up five million from the previous year. The disease killed 445,000 which was about the same number as in 2015. Most deaths were in children under the age of five in the poorest parts of sub-Saharan Africa.

Source: www.indiatoday.in

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pyrethroid insecticide which repels and kills the mosquitoes as well as an insect growth regulator, pyriproxyfen, which shortens the lives of mosquitoes and reduces their ability to reproduce.

In areas with the new combination bed nets, there was a 51% reduction in the risk of a malaria-infective mosquito bite compared to areas with conventional nets. This study is important because malaria control in sub-Saharan Africa has stalled, partly because the mosquitoes are adapting and becoming resistant to the pyrethroid insecticides used for treating the old bed nets. A trial carried out in Burkina Faso where the new types of net, that had a pyrethroid plus an insect growth hormone, was used and it showed significant protection

THEME

novel mosquito net that contains insecticides could prevent millions of cases of malaria, according to a Lancet study. A two-year clinical trial in West Africa involving 2000 children showed that the number of cases of clinical malaria was reduced by 12% with the new type of mosquito net compared to the conventional one used normally. Scientists including those from Durham University and Liverpool School of Tropical Medicine in the UK found that sleeping under the new bed nets were 52% less likely to be moderately anaemic than those with a conventional net. Malaria anaemia is a major cause of mortality in children under the age of two.

The nets used in the study contain a

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Drug-laced mosquito net may prevent help malaria

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Digital healthcare

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By Dr. Deepti Saini

he population curve is swinging upwards and it highlights the urgency for easy and affordable healthcare for all. Age and disease demographics are changing rapidly with increasing number of senior citizens and the rise in chronic disease incidence rates. When everything from a new car to table tennis balls to designer dresses is available online, why shouldn’t healthcare? A rhetorical question, but one that if answered, would obviously show us that the digitalization of healthcare needs to be prioritized for us to push the growth of the medical industry as well as the quality of health and healthcare of our nation as a whole.

The telemedicine boom has already taken off with remote monitors, wearable devices and data processors to augment the conventionally practisced basic medicine. These data processors allow a variety of different applications from the data collected to be efficiently examined, such as 34

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patient medical records, surveys, statistics and complaint registers etc. This may tangentially cause the discovery of more efficient methods of accurate diagnosis and improve the planning and allocation of medical resources for the patient and change our definition of primary care. Setting up appointments and accessing

patient records no longer has to be a hassle.

WHAT IS DIGITAL HEALTH? Put simply, the digitalisation of healthcare means the integration of technology and robotics into the healthcare field. This is a platform for industrial growth as well as a revolution in the way we treat healthcare.

TRACKING HEALTH Patient friendly diagnostic and tracking devices allow patients to monitor their health parameters, like blood sugar levels, blood pressure, etc., much more efficiently. This enables them to be more in-charge of their own well-being. This is not to say that the technology is a replacement of the doctor, but rather an assistant for better medical decisions. The balance between doctor and patient can be less one-sided with the assistance of even their simplistic smartphone.

Doctors will no longer have to utilize

are many, to monitor heart rates and training zones, analyzing exact calorie intake every day to better plan meals and snacks and tracking sleep.

The aforementioned skin sensors that analyze biofluids are showing promising results in assessing stress levels as well. The ability to conduct microsurgery is also something requiring sophisticated hardware technologies and new imaging tools, but the outcome of the surgeries is far more accurate than anything that can be done by human hand.

WELL-BEING ISSUES

We are accepting articles for the upcoming issue of InnoHEALTH magazine scheduled for March 2019. The theme is

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COLLABORATIVE DECISION MAKING Collaborations between experts in computers, behavioral sciences, epidemiology medicine, engineering and clinical research are necessary to make advances in the field. Other than devices, there are also various applicative cloud based or internet technologies, which, and genome focused R&D, as well as alternate medical consultation making the benefits clear to the entire healthcare industry. Digital healthcare facilities can allow growth of specialized

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TECHNOLOGY There is a plethora of interesting technological advancements that have been made in modern day medicine which can intrigue even the most skeptical person. As a by-product of these advances, point of care devices

have been created for patients.

Wearable skin sensors to analyze the electrolytes and biofluids that detect diabetes and cystic fibrosis, biosensors for diabetic patients which show their blood sugar straight onto their smartphone screen, relieving them of the pain of having to prick their fingers, conductive gels and patches which look like fashion accessories but are actually sophisticated technology, are just a few devices which have been created as advances, have been made to facilitate ease of healthcare. Mechanoacoustic skin sensors are being applied to quantitatively measure the rehabilitation in patients recovering from stroke. Pacemakers were always important in cardiology, but their digitalization and remote monitoring has led them to last longer and respond more acutely to the patient’s needs. There are also implants that can electrically stimulate cardiac or brain tissues to treat conditions like irregular heartbeat, motor disorders and cognitive impairments. The advantages for wearable devices

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the Occams razor fallacy when diagnosing a patient, which says that if a patient has certain symptoms, the simplest condition fulfilling the symptoms must be the explanation.

This has led to many misdiagnoses but with the help of effective and accurate digital analysis of the patient, the diagnosis can be done accurately.

As improvements have been made in the field of diagnostic technology, these misdiagnoses have reduced by a large number, which clearly highlights the benefit of a system which can seamlessly integrate previous patient records with current monitored symptoms to assist the doctors in accurately analyzing and diagnosing a condition making it precise and personalized to improve therapy and also and patient adherence.

“CYBER SECURITY - UNMET NEEDS” Deadline February 01, 2019

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MOBILE HEALTH Mobile health is a significant part of the digital revolution and the apps can educate individuals and help them manage chronic diseases. Often when the information spreading via doctor-patient meetings falls short, the use of these mobile apps can

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cognition and memory problems for long-term care. This field of research is being highly noticed with every new company start-up; and even the old pharmaceutical giants are noticing the developments in digital medicine.

The internet is the biggest platform to bring awareness to digitalization in the field of medicine. There are many popular websites on which there is a large penetration of awareness, such as LinkedIn, Facebook, Twitter, and even YouTube with LinkedIn leading in presence of the key players, maybe not so much in activity and utility.

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knowledge among the medical community through advanced networks, technology enabled peerto-peer reviews and emergency medical consultations during emergency due to epidemics with mobile device laboratory capabilities and digital clinical trials.

allow the patients to interact directly with the doctors without any urgent scheduling required. This is not only cost efficient, but convenient to doctor as well as the patient. Mobile health also assists in disease surveillance, keeping track of outbreaks, and aids in supporting treatment.

DIGITAL MEDICINE But when it comes to the actual research happening, there are many fields in which creative growth is occurring, such as the research for targeted deliverance systems which can also reach the difficult to access internal organs and can even cross the blood brain barrier! There is research being done for automated healthcare for those patients which suffer from 36

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Everyone from individuals to big companies are pro-digital health, as it is more efficient, cost friendly, and provides benefits for everyone.

North America is the leader in digital progress and is dominating the market because of the large number of players and increasing partnership between them. Government schemes as well as quick improvements in the IT scene allow large growth of this industry. As with any industry, it will eventually spread globally, uniting the world under a digital health banner.

GROWTH As a model, however, this industry has not taken off to imaginable heights and there is a large scope for growth. Even though there is

potential, the issue arises when there is no integration of private and government sectors. This, however, is also due to high capital expenditure to develop the infrastructure in moderate economies and therefore cloud based systems can be a possible solution. As more and more people use smartphones, the increase in demand for mobile apps provides an ample room for the digital technology bomb to light its fuse. When it is easy to bring about awareness, the actions taken due to that awareness will lead to a positive outcome.

The rural populations access to healthcare services increases and offers them a large scope of point of care diagnostics, teleconsultation and e-prescription facilities. This expansion in rural areas can lead to the increased pace of urbanization and therefore increase progress in any third world country. As integration of these technologies happens with the standard healthcare system, the efficiency will increase, and this can help control the lack of healthcare in the ever growing population, and make healthcare cheaper and more easily available. Eventually, given the right conditions, perhaps healthcare will be seen as a basic human right due to the strides in technology.

After understanding these benefits, it is irrefutable that digital healthcare can help bridge the gap between resource management and human labor in the medical field and is therefore a major key to our future. The world needs digital health, for a better and healthier tomorrow. There is a large scope for global market growth as well as India, and we must take initiative to ensure that the digital healthcare revolution becomes practicable.Accelerating the advancement of digital medicine, will soon make it a way of life and we will then just call it medicine, not just a part of it.

Dr. Deepti Saini is a Ph.D. in Biochemistry from AIIMS. After a decade of academic research and another half decade spent in corporate research, she has ventured into entrepreneurship under the banner of “Protein Design� based in Bengaluru.

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Integrating technologies to design better healthcare interventions

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ge and disease demographics are changing rapidly across the globe. The number of people above 65 years is expected to double and constitute nearly 17% of the world population by 2050. The chronic disease incidence rate is expected to rise to 57% by 2020. These figures highlight the need to enhance quality and efficiency of care with quick response time to health-related emergencies.

Ideas that cut across medicine, biological and engineering sciences, material design, and system innovations are converging to address these challenges.

The shift is going to be from legacy products like pacemaker and imaging systems to wearables for general fitness tracking and gait monitoring. Taking a step further, researchers are now developing and testing more focused miniaturized bioelectronic devices for

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By Dr. Swati Subodh

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recording and analysing health data for detecting determinants of health and for medical interventions.

In diagnostics, non-invasive bioelectronic skin sensors that measure analytes in biofluids like saliva, tears and sweat are showing promising results in assessing stress levels, and detecting conditions like diabetes and cystic fibrosis. Researchers from the All India Institute of Medical Sciences (AIIMS) and Indian Institute of Technology (IIT) Delhi have developed a biosensor for detecting glucose in saliva samples for diabetes detection. The results can directly be viewed on the user’s smartphone.Many such studies are now underway in India.

Conductive gels and patch sensors resembling fashion accessories are also being developed to record cardiac,

brain and muscle activity which could complement the traditional blood analysis and clinical examinations.

Mechano-acoustic skin sensors that measure speech patterns and internal body sounds, like swallowing, are being explored to quantitatively measure impact of rehabilitation in patients, such as those recovering from stroke.

In treatment, miniscule implants placed inside the body can cross the bloodbrain barrier and deliver drug directly at the target site, even in hard-to-reach internal organs. Such devices have shown promising results in laboratory settings in reducing side effects and toxicity while increasing overall drug efficacy. This could also ensure patient compliance, a step further to the recently approved digital pill, especially in patients on long care and those with compromised cognition.

Certain implants can also electrically

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Round-the-clock data collected from bioelectronic devices could replace the present time-point investigations and lead to better management of health condition of patients. In addition, data from multiple people can help develop artificial intelligence algorithms and predictive tools. Such tools have already started showing analytic performance similar, and sometimes better than manual inspection by a specialist

In next few years, health monitoring, neural prosthetics and biochemical prosthetics are expected to drive major developments in this space. Although the monitoring devices have already started testing the market in niche patient segments, it may take the implants another 5-10 years to reach health centres as they make their way through developmental and regulatory checkpoints.

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physician. In countries like India, that suffer from shortage of qualified doctors in remote areas, such devices have immense potential. However, data standardization, data security and privacy protection must be addressed and regulated before rolling out such interventions.

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IIT Kharagpur is setting up a Bioelectronics Innovation Laboratory that aims to develop battery-free implantable miniaturized engineering systems for treatment of brain, nerve,

muscle or spinal cord disorders by restoring missing neural functions. The proposed coin sized implant will be powered wirelessly and will combine brain activity testing like electrical simulation, bio-potential recording and neuro-chemical sensing for use in rehabilitation and prosthesis.

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In India, a lot of work has now started in this sphere. Results from a few studies have started trickling in, with most of them in development or early stages of testing. Research findings in the journal Scientific Reports by researchers from IIT Kharagpur earlier this year reported bioimpedimetric analysis of cancer cells that efficiently distinguishes their aggressiveness by measuring electric field impedance in laboratory conditions. In another study published in the journal Sensors earlier this year, researchers at IIT Delhi developed a novel low-cost prosthesis based on sensors to enable normal gait kinematics, i.e. motion analysis, for lower limb amputees.

To cater to the large patient numbers, care models are transitioning from hospitalcentric care to in-home care. Hospital-based interventions will increasingly cater to acute cases only. Real-time monitoring of a person’s physiological and biophysical parameters, and relaying health information to care providers becomes essential in achieving this.

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stimulate cardiac or brain tissues to treat conditions like irregular heartbeat, certain motor disorders and cognitive impairments. Other implants like, artificial retina and cochlear implants, restore functionalities of damaged tissues. These interventions, being referred to as ‘Bioceuticals’, could restructure conventional therapeutic options for more efficient outcomes.

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By S Venkat Saketh

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nnoHEALTH 2018 brought a unique experience for speakers, delegates and exhibitors with a highlevel networking event coupled with exchange of ideas and solutions. The event came into being with two parallel workshops on 3rd and 4th of October 2018, by renowned experts from Finland, a country which has reinvented itself in just one short century with the stateof-the-art healthcare among the OECD countries and UK; Finland’s healthcare system was ranked the best in the world overall and in the categories like quality of care, access to care, efficiency and equity.

The third InnoHEALTH conference on Inspiring Moonshots in Healthcare was the latest milestone in the series of conferences held since 2016 on quality and cost optimization. A total of 250 delegates participated in this two-day international conference, including prominent speakers and member state representatives of international organizations. The rising concerns about the increasing costs and availability of health and medical facilities was given a prime platform at the conference. The mission was to bring the top healthcare experts around the world, with all the

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A unique journey of inspiring moonshots in healthcare: InnoHEALTH 2018

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possible stakeholders of health sector, and deliberate on interventions, to bring down the cost of healthcare delivery and improve the quality of care.

The opening speech by Surgeon (R) Admiral Dr. V K Singh gave a brief overview of the current technology and scenario on the healthcare innovations and delivery. He presented his idea of 3 ‘P’s i.e. pain, (of) patient, (of) provider to deliver healthcare at an optimum cost, as well as scaling-up the availability of care. InnoHEALTH 2018 dedicated this year’s theme to the ‘missile man’ the former President of India, Dr. APJ Abdul Kalam and his vision. Mr. Srijan Pal Singh, a special invitee to the inaugural session, shared his experiences with Dr. Kalam in the healthcare context. The theme of inspiring moonshotswould have been incomplete without an inspiring context from India. Hence, the organizing team innovatively captured the inspiring moonshots in healthcare of all the delegates.Dr. Singh in his closing remarks dedicated the InnoHEALTH 2018 conference to the vision of Dr. APJ Abdul Kalam towards country’s health sector. Sweden being the country partner, H.E. Klas Molin, Ambassador of Sweden

to India, shared his thoughts about the Indo-Swedish partnership focusing on innovations and the work done in the health sector. He also mentioned the current examples and future possibilities for India and Sweden to cooperate and highlighted the importance of prevention as the secret of healthcare.

As we all know, the current times are very difficult for the Indian health sector. The anxiety in civil society with the rising cost of delivery and slippages in quality of healthcare delivery is well-known. On the other hand, rising epidemics like lifestyle diseases require a focus on preventive rather than curative approach. Hence, we need to reassess the priorities at the level of an individual, family and society, on how we are looking at the topic of health in the country. Dr. Anil Kumar Gupta, a visiting faculty at the Indian Institute of Management, Ahmedabad and Founder of Honey Bee Network, gave the keynote address for the inaugural session and looked at the challenges in the areas of health, provided concrete examples and direction to the InnoHEALTH audience by emphasizing on the inclusiveness of stakeholders when designing solutions.

Another highlight of the conference, the session on Advances in Diagnostics, brought the top industry leaders together sharing their vision about the health sector and also showcasing promising start-ups and technologies.

The panel represents various industry working in cutting edge research in radiology and diagnostics areas from India and Sweden.

Aligning to its broader aim of bringing out innovations in healthcare and to celebrate and encourage innovation particularly in the healthcare sector, InnoHEALTH was back with the third segment of Young Innovators Award 2018. Out of 200+ nominations, the 5 most innovative nominations were called to present in front of a jury with a perfect blend of stakeholders of healthcare industry like investors, policymakers, academic and research experts and medical experts.

The Ultimate Solution for all NonCommunicable Diseases - a discussion which followed the inspiring meditation session, The Divine Google to Health and Happiness, by an Emeritus Scientist Dr. Satish Kumar Gupta, giving a platform to showcase the 3-dimensional approach to healthcare. Dr. Kumar, a renowned personality, has been awarded the Shanti Swarup Bhatnagar Prize for Science and Technology for his contribution to medical sciences.

S Venkat Saketh is a graduate in mechanical engineering from Anna University. He is currently working as a business analyst with MixORG consulting Pvt Ltd. Volume 4 | Issue 1 | January-March 2019

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their innovations, the underlying concept was to empower these budding innovative companies with right advise and linkages. Some of the top experts from Indian health sector shared their feedback on how the companies should work on their India market strategy.

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under the initiative.A few sessions were dedicated towards universal health coverage and insurance led innovations.

Recent policy aiming at Universal Health Coverage, launch of Ayushman Bharat by the Ministry of AYUSH were some of the key discussions in these sessions.

The conference concluded on a note of the paradigm shift of healthcare technological advances. Healthcare delivery optimization, noncommunicable disease prevention, equitable access to health services and innovations were considered the broad strands on which the sessions were structured. But some specific areas of major concern such as Digital health, Make in India opportunities, EU-India collaboration, access and quality of care were also subject to in-depth analysis during the conference. Once again, the content richness and the highlevel networking opportunity was the limelight of the conference.

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During the session on Digital Health - giving birth to new delivery models through Mobile, IoT, Blockchain and Artificial Intelligence, the panelists discussed the topic of digital in three different contexts; policy-makers, IT, Hospitals to an insurance marketplace.

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InnoHEALTH 2018 brought together representatives from seven countries on a single platform for a panel discussion on EU-India collaboration in the Health Sector, start-up opportunities and challenges, providing insights on market development in India, including examples of reverse innovations from India to Europe and back along with legal and IPR challenges.

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The first prize was bagged by the team which represented the excerpt of innovation in LIFEBOXby DevalKaria and Rohit S Nambiar. The second was bagged by Abhishek Venkataram and SanidhyaRasiwasia for the innovation in surgical navigation system named NAVI. Dhananjay KVN who presented his innovation on voxel base analysis for Pediatric Brain Mappingbagged the third prize. The prize money was sponsored

by InnoHEALTH. As the young innovators got the chance to showcase

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One such session was on the topic of Innovations for Hospitalsin which the speakers reflected on different aspects of innovations,stressed on scaling-up of innovations. Chris Lloyd in his keynote address specified the need of bridging the gap between resources and patient needs, emphasized on taking-up the Singaporean model as the master plan.

Another interesting session was on Make in Indiaopportunities which emphasized on the issue of manufacturing medical devices in India highlighting the immense possibilities alongwith the hurdles

SHOUT OUT TO ALL THE STAKEHOLDERS OF THE HEALTHCARE INDUSTRY: SAVE THE DATE FOR INNOHEALTH 2019 - OCTOBER 11-12, 2019, NEW DELHI.

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The conference included series of structured panel discussionswith stakeholders and experts in the fields of health facilitating the discussions.

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By Ayushi Madan

magine being in a living room, witnessing a family spending some time together. It’s a spacious, well lit room-sofa sets, side tables, coffee tables, rugs and throws, and all the luxurious comforts of the modern living. You would imagine they are catching up, possibly having a few drinks together, or perhaps playing a game of cards. No, they are not. You can’t hear a word, even though they are all there. Phone, earphones, tabs, laptops- everyone has their own choice of gadget, shooting down any possibility of real conversation.

Does this look and feel familiar to you?

Have you ever gone to a restaurant and been taken in by the urge to share some selfies on snapchat? Or mid conversation, has instagram ever lured you to take a plunge for a few seemingly brief moments (which were probably extremely long for the person waiting for you to come back to the conversation). Perhaps you were the person waiting for a friend to come back to your conversation.

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Social Isolation in a digitally connected world!

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Gadgets, and gadgets with wifi are the new basic needs. We just cannot do without them and we are addicted to them. Here is the proof. Detox apps on your phones, to keep you away from your phone is the new irony now-adays. The message is clear- the one who oppresses us, holds the power and means to free us, thereby still oppressing us. We are not enough for ourselves!

They generally have a quintessential tree graphic, or something ‘soothing’ as its cover picture. It compels us to think about what we are buying into, as consumers, and what is the kind of world that we are constructing for ourselves.

We want to access a meditative space in ourselves, using an application on our phone as the ‘environment’.

We also live in an economy, where retreats are the new consumables.

There are more and more retreats and workshops coming up which cater to the needs of ‘being with yourself ’ and ‘being with nature’. We are invited into ‘other worlds’, where our mundane, fast

paced, stressful, clamorous and noisy world can’t get to us. What is it that we are running away from?

Two opposing, contradictory worlds are being created by us. And we want to be part of both. Oscillating between different time-scapes.

I then ask you, what makes our digital media so indispensable? When did the need for our gadgets arise? What do they fulfill for us in our personal lives? For some of us, they have always been part of our lives, however, some of us have acquired the taste, and now become completely or partially dependent. They are the new normal because they make entertainment easy, they make time move faster. They make passing time easy for us, because now we are not required to engage with material inside of us, we are not required to make our real selves visible to real people outside of our phones.

We can continue to portray a fragment of ourselves, choose for how long, and in what proportion we would do so. We

In the digital age, we must also not be naive enough to think we want to create a world where gadgets, and advances in technology don’t exist. Watching objects go obsolete perhaps threatens the human mind at a fundamental level, but the pace of the world is a reality we must accept.

Ayushi Madan is a trainee psychoanalytic psychotherapist, with an interest in contemporary discourse. She is also a trained in Odissi dancer and juggles between the two. In her free time, she gobbles books, and explores Hindi poetry.

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It’s only human to look for, and ready ourselves for meaningful and supportive relationships. So, when you feel that thud in your stomach, and you feel anxious and alone, look up and strike a conversation!

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Loneliness has detrimental effects on our health and well-being, it is a cause

It must be noted that, not all use of gadgets isolates us. It has shortened distances. We can connect with our friends, and family anywhere in the world. We can ask our groceries to be delivered to our doorstep, we can communicate faster (while we keep

Conclusively, carrying the burdening feeling of isolation and loneliness is different from solitude. Solitude has known to be an enriching time for ourselves, where we can heal, take care of ourselves, allow our minds to meander, even safely let ourselves drift into boredom, which can provide stimuli for creativity, and reflection. Therefore, not all appearances of loneliness are necessarily grim, some are there to take care of ourselves.

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So, let us break down what happens in today’s social context- we try to make connections, and we don’t hit the bull’s eye. At some point we give up, and that makes us feel quite awful. This vulnerable and uncomfortable feeling should provide us with a diving board to re-integrate with our groups. However, we use the same means, that lack real human connection, and perhaps get stuck in this loop, without meaning to do so, and with our busy schedules we don’t pause to break the pattern.

One, tell yourself that you are going to be away from your gadgets for stipulated amount of time in your day. You need to find your own balance between your own time, and your time for your friends and loved ones.

Two, when you set aside detox time, stick to it. Make realistic goals, start small, and push yourself to a realistic limit. Try not to fall back on your targets.

Three, start noticing how many times you use social media for mindless scrolling. Don’t judge yourself but just watch yourself.

Some instances, you would maybe start seeing that some thought made you uncomfortable, maybe you thought of an upsetting memory, or you wanted to distract yourself from something which is burdening you in some way.

Fourth, trust yourself. Find your own goals, strategies, and find out what you gravitate towards.

getting more and more impatient). But, as we go on with our daily lives, we must take account of our feelings, habits, thoughts and emotional highs and lows, so that their reasons can be examined.

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Social isolation is a state- you could think of it as a description, or a header to what might be going on, but loneliness is the consequent feeling. It is the experience of feeling isolated. Loneliness is a risk factor for depression, which provides humans an impetus to go and rekindle social relationship.

of suicidal ideation and action, high mortality rates and substance abuse.

(Hawkley and Cacioppo, 2010). So here is what you can do-

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The possible truth is, we are disconnected from each other. Social isolation is the absence of a network of positive social relationships. The consequent feeling is loneliness- where the quality of our relationships, and the lack of connection makes us feel like something is amiss, something is lacking, and the void that stares at us, reminds us, that we are disconnected from people in our lives.

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Thus, even though it looks like we are closer to each other, and social media no doubt provides a means, what is happening is quite the opposite- we are not in touch with ourselves, and we are not in touch with the real feelings of people around us. What we are then becoming are a set of isolated people, who are yearning for meaningful bonds, sometimes feeling satiated, yet sometimes missing them, going haywire in our efforts, and constantly chasing them.

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are also not required to say something of our own, since memes offer easy grounds for momentary interactions, and small-time laughs. In short, they hide our vulnerabilities from the world, neatly packaging us into individuals we would like to be at a given point in time.

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Mind Matters

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“FOUND HANGING FROM THE CEILING FAN, SHE WAS STILL WEARING HER DANCING SHOES.”

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By Nishtha Bhargava s likely as this line is to come from fiction, it can find place in a real death report.

Teenage suicide. Did you know that one student commits suicide every hour in India? Often in disbelief, parents of these victims cannot find reasons for such an ‘extreme step’ in their seemingly normal lives.

Most of the mental illnesses today remain unreported, unattended and undiagnosed. Your next-door neighbour, who doesn’t step out of the house for months might be suffering from depression without even realizing it.

Have you ever found your mind playing tricks on you? The devil on your shoulder telling you how unworthy you are, how useless your life is? You are not alone. Many people that you see around you might have felt the same way at some point or the other.

biggest killer, with depression the leading cause of early-age disability globally. In fact, mental disorders are thought to affect more younger people than statistics suggest.

mental disturbances can sometimes be hard to pin-point, passed as simple quirkiness of character than a disorder of the mind. But is the matter really that straightforward?

DATA SPEAKS LOUDLY Mental illness contributes to 7% of global average disease burden. The number of suicides in India is double than the global average of 11 persons per 100,000 population annually.

Mental maladies affect about 15% of Indian (and world) population as per latest estimates. One in six people are victims of mental illness. Depression and anxiety disorders alone affect around 8% of us.

IT’S COMPLICATED People experiencing mental disorders resort to one of several coping strategies: discussing the problem with friends or family, social isolation to escape being noticed, or camouflage true emotions into acceptable actions for fear of being judged or abandoned.

Unfortunately, the latter two are more popular, driving forces being social stigma and taboo. There is little or no support to sufferers and their families.

Surveys reveal that society even feels fearful of the sufferers!

LURKING AROUND DARK CORNERS As a society, we are usually shocked at news of successful, high-performing, wealthy young individuals killing themselves. Celebrities like yesteryears’ actor Guru Dutt and Miss India 1997 turned VJ Nafisa Joseph took their own lives over strained personal relationships. On the other hand, when farmers drowning in debt kill themselves, the reasons are evident and understandable. Similarly, while some mental illnesses are conspicuous, others are not.

Among the young, suicide is the third

Undoubtedly, behaviours that indicate

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Anxiety is a result of an over-active amygdala- the fear centre of the brain, resulting from imbalance between excitatory and inhibitory signals for this area, making sufferers more nervous and fearful than normal people. Severe anxiety disorders such as panic and post-traumatic stress disorder (PTSD) involve the same parts of the brain, only different disturbances in the ongoing signalling.

These findings imply that maladies of the mind are just like those of the body, say cancer or diabetes- complex diseases that manifest upon an interplay of genetic predispositions and environmental triggers- preventable, manageable, treatable.

Basically, balanced neurological circuitry is essential for mental health.

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Interestingly, we have also witnessed that most people tide over adversities, but some are unable to- not every victim of bullies becomes mentally ill.

What determines mental resilience?

Environment? Education? Or simply will power? Studies suggest that a feeling of security, purpose in life and positive experiences are the foundations to mental resilience. The sooner one starts building it, the better, but there is never a wrong time to build resilience. These building blocks are present both within and around us.

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Depression, on the other hand, appears to be more complex. Firstly, the levels of chemical signals (neurotransmitters) called serotonin and dopamine are abnormal. Serotonin signals wellbeing and happiness to our brains while dopamine induces motivation.

Secondly, the brain tissue is sometimes shrunken. Third, the ability to form new neurons and connections or repair and modify old ones is impaired. Lastly, immunity modulators called cytokines, which induce sickness behaviour like staying indoors, sleeping a lot and generally low energy levels are found in excessively high amounts in depressed individuals. Cytokine signalling is

in fact elevated under chronic stress.

Though depression manifests as slow behavioural changes that evade our observation, often simply under the cloak of sadness, it is a serious medical issue.

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IS IT ALL IN OUR HEADS? Brains are complex machines. Scientists have been studying it for years to find neuropsychological causes and genetic bases of mental illnesses, which are many- depression, anxiety disorders, eating disorders, cognitive disability and so on. To understand where the problems lie, researchers dive deep into the workings of the brain. The clockwork includes a huge repertoire of chemical and electrical signals that pass between connected brain cells called neurons. Imbalances in signals between or within different parts of the brain

result in myriad mental anomalies.

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our habits, mood swings or fetishes. Yet, in this fast-paced life in the 21st century, signs of distress escape the friendly radars of our loved ones and our own selves. Besides the lack of free time, our reluctance to understand these complex phenomena, ignorance and social stigma worsen the situation for sufferers. Depressive bouts are confused with laziness, anxiety simply called lack of focus and attention deficit equated to incompetence. Such labels make a negative impact, especially on the young impressionable minds. In fact, half of all mental illnesses begin even before the age of fourteen!

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HAPPINESS IS HEALTH! Preventing chronic negative thoughts is the key to a healthy mind. Children specially need to be allowed more leisure time. Physical activities like exercise, sports and dancing are known to release feel-good hormone endorphin which benefits the brain. Pursuing hobbies, activities that make you happy or fulfilled and content, can keep you motivated in low phases of life, teaching you to celebrate little victories. A hearty laugh works the same way.

Invest time in friends and family. Talking to and confiding in someone trustworthy helps you create a support system that you can summon in times of distress or crises.

Give the children around you their due time and attention. Cuddling with a pet and playing with kids generates oxytocinthe bonding hormone. Above all, sleep well, for it helps your body and mind heal itself. Rejuvenate them both time to time using tools like meditation to keep serotonin and dopamine balanced.

If circumstances still catch you unaware, know that help is out there, if not in your home, at the touch of a button.

Mental health foundations and support groups are at your disposal if only you call them for help. Phone helplines and online counselling portals like “Type a Thought” and “mystruggles.in” – that keep your identity anonymous, exist to resolve your distress. Sometimes simply talking to friends or family is enough to help you tide through. If none of the above helps, tap into professional psychiatrists. Taking medication to relieve yourself of sickness is not a shame. Do you think twice before taking a pill for cold? You might not even need medication. Interventions like Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming 48

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(NLP) can help you learn new thinking patterns, overcoming anxiety and fear.

A LITTLE CHANGE CAN TAKE US FAR If only we as a community realize that mental illnesses are not chosen by those who are ill, like any other ailment, and fulfil our roles as parents, teachers, and caregivers, healthy and happy youth is not a distant dream. If only we would give children enough time, attention and affection, they would not grow up as broken individuals. If only we learn to ask “How are you?” and really mean it; if only someone were to ask us “Are you alright?” at our most terrible times; if only we accepted the differences among people; if only no one shamed the fat teenager; if only we didn’t burden our children with our ambitions and expectations (and maybe instead followed them ourselves), we could save lakhs of lives. And that would be a life worth living. Wouldn’t it?

We must remember, childhood and adolescence are tender, confusing and ruthless, all at the same time. Young minds need a sense of belonging, affection and appreciation to grow up normally with nurture, cautious prodding and guidance at every step. This journey translates into meaning and purpose around which their entire adult life would revolve. Many mental illness victims report feeling unloved, unnoticed, or worse - blamed, bullied, beaten and shamed as youth. So, if we want to save more people from mental disorders, the younger we catch them, the better.

Nishtha Bhargava is a Senior Research Fellow at CSIR-IGIB. When not in the lab, she likes to listen and dance to her favourite music, read books and dream about the future. She believes animals, children and drunk people never lie and that science has the power to change the world.

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Tuberculosis: An Ancient Foe

By Vignesh Narayan

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eepti was sixteen years old, writing her board exams, when she developed a cough that just wouldn’t go away. After conventional treatment for a month, her doctor advised her to get a chest x-ray which revealed that she had contracted tuberculosis (TB). Despite treatment, Deepti’s condition continued to worsen. She had contracted a strain of TB that was resistant to multiple drugs (MDR or multi drug resistant) and would need surgery to remove part of her decaying lungs. She was given six months to live. In stark contrast to the lifestyle of Deepti; Salma, a resident of the Dharavi slums nearby, had gone to twelve different doctors searching for a cure for this disease. The strain she had contracted has been dubbed TDR or totally drug resistant and was resistant to 12 different anti-TB drugs.

The disease ravaged her for two years, costed money she didn’t have and finally, claimed her life.

India bears the dubious distinction of having the world’s largest number of deaths due to TB; 423,000 people in India succumbed to the disease in 2016, accounting for a third of the entire world’s TB mortality. These TB related deaths that have been identified and reported, the real numbers may be far graver. India has an estimated 1.3 million “missing” TB patients, who may not have been diagnosed or who have not returned for a follow-up post diagnosis, untreated and potentially spreading TB to others.

In addition, WHO estimates that India saw 2.7 million new TB cases in 2016.

When compared to the 6.3 million new cases worldwide, Indians accounted for a whopping 25% of all new TB infections.

This is because of the singular and unique ability of the TB bacterium to hide inside the human body in a dormant state without causing the disease or revealing any outward symptoms. Such cases are classified as latent TB infections and can be revealed by diagnostic tests in healthy seemingly uninfected individuals. Studies

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indicate that close to 40% of the Indian population is positive for latent TB and without treatment 5%-10% of these will develop active TB at some point in their lives. Unfortunately, due to the high burden of TB in India, the detection and treatment of latent TB is not prioritized, resulting in a huge reservoir of dormant and potentially infectious bacteria primed to emerge under favourable conditions.

In 2017, 10 million people were infected with TB and 1.6 million died worldwide, surpassing AIDS as the world’s leading

cause of death due to an infectious disease.

WHO has designated March 24t has the World TB Day to raise public awareness about TB and its deleterious effects on health, society and the economy. In 2015, it began to implement the ‘End TB Strategy’ which envisions a world free of TB with zero TB related deaths and zero incidences of the disease. In order to do this, WHO aims to support and promote a patient centric approach to care and prevention, encourage proactive policies and support systems by involving the government and private sector healthcare and finally

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TREATMENT FOR TB Active TB infections are treated with a standard 6-9 months treatment regimen involving four antibiotics: rifampin, isoniazid, ethambutol and pyrazinamide for varying durations. This treatment duration is one of the longest for a bacterial infectious disease, second only to the treatment of leprosy. Side effects like itching, rashes, fever, nausea, diarrhoea and reddish/orange discolouration of body fluids including urine, tears and

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A third technique, which involves the detection of TB DNA using polymerase chain reaction (PCR) and named Xpert MTB/RIF promises results of sample positivity within 2 hours and is currently the gold standard in PCR based TB diagnosis. However, this system suffers from high costs per assay and the requirement for infrastructure and constant electricity, which are not available in many cases.

ISSUES

DETECTION AND DIAGNOSIS OF TB One of the main challenges in the fight against TB is the very first step of diagnosis. Millions of TB cases go undetected and unrecorded all over the world due to the shortcomings of technology. Conventional TB diagnosis is performed by sputum smear microscopy, wherein the sputum of the patient is examined under a microscope for TB bacilli.

However, this approach is only 3643% sensitive which means that many

Sputum smear microscopy also suffers from false positives, as some non-TB bacilli may also pick up the TB specific stain. Therefore, a positive sputum smear needs to be confirmed by culturing the bacilli obtained from the sputum in the lab, which can then be tested to confirm TB. Unfortunately, growing patient strains and analysing them requires resources and technical expertise that are not available in most of the high prevalence countries.

In addition, growth-based confirmation of TB positivity takes a minimum of 21 days since the growth rate of the bacilli is extremely slow.

WELL-BEING

RISK FACTORS FOR TB Being primarily a respiratory disease, TB is disseminated by airborne infection as the bacteria is exhaled from an infected individual and inhaled by another. This often happens in poorly ventilated and over-crowded settings typically seen in crampedhousing where the disease can spread like wildfire. Indeed, earlier TB was thought to be hereditary as it used to wipe out entire households. Weakening of the body’s immune system due to age, substance abuse, air pollution, diabetes, HIV infection and malnutrition, among others, play a major role in increasing susceptibility to TB. Its spread is seen across the socio-economic strata. As Dr. Zarir Udwadia, one of the world’s leading pulmonologists puts it, “TB does not distinguish between the chauffer driving the Mercedes and the CEO sitting at the back!”

cases of TB infection are missed by this method.

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patient’s stomach. However, the cost of such technology is yet to be estimated and given WHO and Govt. of India goals to reduce the economic burden of TB, cost effective ingestible sensors may remain only a distant possibility.

THEME

Several technological innovations have facilitated easier and improved patient monitoring, such as 99DOTS which is a low-cost solution for improving patient compliance during TB treatment. Patients using 99DOTS receive medication in specially packaged blister packs.

Dispensation of a dose reveals a hidden and unique phone number that the patients can call for free and confirm that the medication has been taken. In this way, remote monitoring of patient compliance has been made possible.

Several digital adherence technologies have also been developed as an electronic way to monitor medication and provide reminders. These include digital pill boxes (evriMED, Wisepill etc.) that are given to patients with their medication inside. The digital boxes provide visual cues such as coloured LED lights which turn on and remind the patient of the dose and the medicine that is due. These boxes can also record medication events in real time by logging the opening of the box for each dose, allowing for real time monitoring of patient compliance. Pilot studies are also underway in US for ingestible sensors that are embedded inside each pill, which transmits information that the pill was consumed upon activation inside the

Indian TB research has made recent headway in TB diagnosis, with a research group at the All India Institute for Medical Sciences (AIIMS) developing a rapid and portable aptamer (a DNA molecule that can bind to a specific target) based diagnostic test which is capable of detecting TB with a sensitivity of 93% compared to the 22% sensitivity of Xpert MTB/ RIF, the current gold standard.

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intensify research and innovation in the field of TB treatment, prevention and diagnosis. The Government of India has instituted a similar strategy, the Revised National Tuberculosis Control Program (RNTCP). RNTCP involves adopting WHO guidelines of Direct Observation Therapy (DOT) to the Indian scenario and includes direct monitoring and administration of anti-TB drugs to the patient, rapid TB diagnosis and treatment, and increased partnership between public and private healthcare systems. RNTCP’s objective is to eliminate TB by 2025. The plan outlines four directives – Detect, Treat, Prevent and Build and includes system for free and sensitive diagnostic tests for TB, screening of high-risk population, free TB drugs for all patients, implementation of uniform treatment regimen, increased social support and monitoring and treatment of latent TB. Finally, the plan will work towards translation of political commitment to action through strengthening support structures for surveillance, research and innovation.

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saliva is another cause of worry which takes a physical, emotional and mental toll on the patient.

Since most infected individuals begin to feel better after a few weeks of treatment and the length and side-effects of the drug treatment are arduous, many patients stop the treatment prematurely or skip doses. Rampant patient non-compliance when it comes to completion of anti-TB therapy is one of the main factors for the emergence of a more severe form of the disease, one which is resistance to common drugs!

This is a big reason for TB reactivation and the continued prevalence of this disease even though it is completely curable in most cases.

Drug resistance in TB has been known since the first antibiotics to treat this disease were put into place.

An increasingly larger repertoire of drug resistant strains necessitated and increasingly larger arsenal of drugs to treat the disease. As of today, TB strains resistant to one of the first line of four antibiotics are called resistant strains. Strains resistant to two first line antibiotics are called multi-drug resistant strains of TB or MDR-TB. These are treated with a second line of antibiotics, consisting of fluoroquinolones (levofloxacin, moxifloxacin and gatifloxacin) or injectable drugs such as amikacin, kanamycin and streptomycin. More recently, a third category of strains labelled Extensively drug resistantor XDR-TB has been described with resistance to a fluoroquinolone and at least one of three injectable drugs. A total of 12 drugs are approved today, each of which individually and in combination are used to treat these three categories of TB, MDR-TB and XDR-TB. However, a little characterized fourth type of strain, dubbed totally drug resistant- or TDRTB has been reported in India, Italy, Iran and South Africa. These strains are completely resistant to all known antiTB medication and given the airborne and infectious nature of the disease, are ticking time bombs of catastrophe.

NEWER STRATEGIES IN TB HEALTHCARE The emergence of drug resistance, the persistently high rate of TB incidence 52

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and TB mortality and the challenges associated with patient non-compliance demand improved methods to detect TB with high accuracy, newer drugs to treat resistant forms of TB and increased awareness of the disease.

Bedaquiline and delamanid are two new drugs for TB that have shown promising results in clinical trials after nearly 40 years of failed attempts.

These two drugs have received approval for use in the treatment of MDR- and XDR-TB. Additionally, a new drug combination involving bedaquiline, pretomanid and linezolid is reported to have successfully treated XDR-TB in six months with a lower mortality rate than current treatments. However, these new treatment regimens are yet to enter mainstream clinical practice, with further and larger clinical trials needed to make an accurate cost-benefit analysis of these strategies.

LOOKING TO THE FUTURE Although the current situation of TB in India and worldwide looks bleak, the global TB incidence is falling at the rate of 2% per year. According to WHO, this rate needs to increase to 5% to achieve the WHO Global Plan to End TB milestones of reaching 90% of all people with TB through national TB programmes, reaching atleast 90% of vulnerable high-

risk population through affordable treatment and achieve atleast 90% success in the treatment of all people diagnosed with TB. Achieving both WHO and RNTCP milestones will require a concerted effort by policymakers, healthcare providers, TB researchers, patients and the general public. What we need today is increased public spending on healthcare to make TB therapy affordable and accessible, improvement of research funding and infrastructure and stronger public awareness campaigns to disseminate the reality and requirements of ending TB. Over just the past two centuries, TB is estimated to have killed 1 billion people, which is more than the number of people killed due to AIDS, cholera, influenza, plague and smallpox combined! It is time we take the initiative and responsibility to help the millions that are suffering from this deadly disease.

Vignesh Narayan is a scientist and science writer at the Indian Institute of Science who currently studies the molecular biology of the TB pathogen Mycobacterium tuberculosis in an attempt to understand how the bacterium senses and responds to its environment and develop new drugs and drug targets to combat the disease.

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Non-Pharmacological Management of Chronic Obstruction Pulmonary Disease (COPD)

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By Dr. Sudhir Prasad

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Our 300 bedded L. B. Nagar Hospital consists of sevenoperation theatres with advanced quaternary care facility with state-of-the-art infrastructure certified by NABH, NABL & HALAL. The hospital caters to several key specialties including oncology, neurosurgery, and liver diseases besides various ailments.

It brings advanced technologies that drive new and more effective treatments. Aware Gleneagles Global Hospitals cater to several overseas patients suffering from various disorders such as liver ailments, kidney failures, breast cancer, leukemia, neurological disorders amongst others. We have an international reputation as a center of excellence for advanced clinical care.

COPD is the fifth leading cause of death as per World Health Organisation 2002 report and likely to be the third leading cause by 2030. It is not only deaths, but the financial burden on individuals and the countries is huge. Regular follow-up with the doctor and taking medication regularly is one part.

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C

hronic Obstructive Pulmonary disease (COPD) is a chronic inflammatory condition of the lungs causing obstructed airflow from the lungs (previously known as Chronic Bronchitis and Emphysema). Most common symptoms are chronic cough, sputum production and breathing difficulty. Risk factors for COPD are smoking, indoor air pollution (biomass fuel used for cooking and heating), outdoor air pollution and occupational dusts and chemicals (vapors, irritants and fumes).

Non-pharmacological interventions (Pulmonary rehabilitation) which are 54

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useful in the management are: Smoking cessationmost important, it helps in further decline of lung function and symtom improvement.

Diet- those with high BMI (body mass index) increased work of breathing - should lose weight.

Those with low BMI-with reduced muscle mass will have weakness: nutritonal supplementation advised.

Exerciseincreasing muscle strength, breathing techniques such as Pranayama are proven to be helpful.

Occupational safety- strategies aimed at reducing the burden of inhaled particles and gases.

Vaccination- flu vaccination and pneumococcal vaccines help in reducing excaerbation of COPD. About Aware Hospitals

Gleneagles

Global

Aware Gleneagles Global Hospitals is part of Parkway Pantai, a fully owned subsidiary of IHH Healthcare. In India, we operate as a chain of multi-super specialty hospitals offering tertiary and quaternary healthcare services with over 2,000 beds and state-of-theart, world-class hospitals in Bangalore, Chennai, Hyderabad and Mumbai.

We aim to strengthen and expand our leading market position as a destination for multi-organ transplant for patients from India, Africa, Middle East and South East Asia. We are committed to further our aspiration of making quality healthcare more accessible to all. Website: http:// gleneaglesglobalhospitals.com/ Dr. Sudhir Prasad MD, EDARM Senior Consultant Pulmonary & Sleep Medicine Aware Gleneagles Global Hospital

Newscope Trends

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Healthcare IT market builds the foundation of Artificial Intelligencebased Healthcare System and creates lucrative Job Opportunities

By Nikhil Bhusare

E

valuation–Diagnosis–Treatment.

This is the traditional and generally accepted method of a medical procedure. However, the healthcare sector has evolved over the last couple of years. Today’s healthcare is using a new, digital companion to determine how patients feel based on much more than their present medical condition.

Healthcare information technology or healthcare IT is widely used by doctors, surgeons, and pharmacists to understand medical information of patients and improve communication between doctors and patients.

WHAT IS THE USE OF HEALTHCARE IT? The major advantage of the healthcare IT is that it reduces the communication gap between a patient and a doctor as the

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New Job opportunities, the reduced communication gap between a patient and a doctor, the artificial intelligence-based healthcare system, and the digitization has surely created an amazing era of healthcare IT.

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healthcare IT collects and converts the patient’s information from paper records and medical charts to electronic data.This migration provides direct access to patient’s information to doctors irrespective of their location and enables to share knowledge with other doctors than the current medication providers. Moreover, the doctor-recommended prescriptions can be transmitted electronically owing to the healthcare IT, which has improved efficiency and reduced the valuable time.

Healthcare IT is much more than just an electronic version of paper medical records.

It includes previous maintained medical images by radiology departments and opinions of specialists on a certain method of treatment. In addition, the digital messages including emails, healthcare tips,

chat logs, the day-to-day medical progress of a patient, and financial factors such as scheduling and billing fall under the sky of healthcare IT. However, these records must be stored and maintained carefully to prevent invasion of privacy. On the other hand, the technological advancements and easily accessible facilities fuel the demand for healthcare IT. Roughly, twothird Americans have instant access to the internet, which eliminates a patient’s restrictions with medical consultants.The tech giants such as Microsoft, Apple, and other new start-ups are developing up-tothe-minute opportunities in the healthcare IT market by improving access to digital applications and providing efficient security features. This has increased demand for healthcare IT services, boosting the growth of the healthcare information technology

WELL-BEING Nikhil Bhusare is an Executive with Allied Market Research.

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The prime motive behind the project is to find a way to shift healthcare data to the cloud without jeopardizing its confidentiality. This new team will be a part of Microsoft’s AI research division. Peter Lee, the head of Microsoft healthcare, explained, at Microsoft, we’re confident that many aspects of the IT

foundations for healthcare will move from on-premise doctors’ offices and clinics to live in the cloud. We are taking concrete steps with an initial blueprint intended to standardize the process for the complaint, privacy-preserving movement of a patient’s personal health information to the cloud and the automated tracking of its exposure to machine learning and data science. The company wants to pave the way to create an open architecture that eventually helps doctors, nurses and healthcare service providers, and to allow more time for patients to spend face-to-face with the doctors. The new platform will open new opportunities for healthcare data to be shared and to protect its privacy. Such innovative projects and huge investments in healthcare AI proves that the incorporation of AI in healthcare IT will be a fruitful investment for the healthcare providers, and no doubt it will be a key to the bright future of healthcare sector.

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of the largest information technology companies, has been working on several healthcare-related projects. Recently, Microsoft made clear its exact intentions behind developing a Microsoft healthcare team. The company aims to create a cloudbased patients’ profile, push doctors to use more cloud-based services, and eventually develop an AI to analyze the huge data.

Microsoft hired two industry past masters: Jim Weinstein and Joshua Mandel to help achieve this goal. Jim Weinstein, former CEO of Dartmouth-Hitchcock Health System, will help the migration of healthcare data to the cloud. Joshua Mandel, ex-Google employee, will assist in building open cloud architecture for all healthcare service providers.

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INTEGRATION OF ARTIFICIAL INTELLIGENCE IN HEALTHCARE IT It is no secret that the healthcare sector holds a humongous amount of data; if incorporated with artificial intelligence (AI), it will open innumerable opportunities in future. Microsoft, one

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Recently, Javara Inc., a clinical research service organization, launched a platform that is focused on compelling innovative research partnerships, service, and technology to healthcare systems. Jennifer Byrne, the co-founder, and CEO of Javara stated that the new healthcare IT platform will bring better outcomes for patientcentered care, better economic results, and easier research delivery model to the biopharmaceutical sector.

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HEALTHCARE IT GENERATES JOB OPPORTUNITIES The growth of healthcare IT has created a surge in job opportunities in IT sector. According to the U.S. Bureau of Labor Statistics, by the end of 2024, the need for healthcare and medical managers will boost by about 17 percent.

The healthcare IT management jobs oversee the entire system process and its day-to-day operations. Healthcare providers are finding hard to pick employees for the job positions such as development, analytics, coding and research. Moreover, just collection of healthcare data is not enough. Once that data is received, it needs to be analyzed by skilled professionals and constantly updated and improved. Therefore, coding experts are extremely essential to smoothly transfer the individual records of patients to a central hub, by changing the codes that could otherwise interrupt the transfer of information. It is estimated that the requirement of such new codes is nearly 130,000. Moreover, the IT specialists assist healthcare service providers to obey the federal guidelines for records, a collection of data and share to protect a patient’s privacy. Due to such requirements, there are ample IT companies and even start-ups that are launching new platforms to develop a sustainable healthcare IT department.

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market. According to a report published

by Allied Market Research, the market is expected to register a CAGR of 13.2 % in the period 2014–2022.

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A trip to world’s healthiest and happiest city: Copenhagen for BIO-Europe 2018

By Parthvee Jain

O

n the windy streets of Copenhagen, children, young adults and older people are all on bikes, with parents and their children on cargo bikes (a quarter of families in Copenhagen own one). It may look as though Copenhageners crave the outdoors, get a kick out of exercise, want to be fit and healthy. It may or may not be the reason. May be, it’s just the easiest way to get anywhere.

Admiring all this and more, we at InnovatioCuris, attended the 24th Annual International partnering conference BIO-Europe 2018.

BIO-Europe, scheduled for 5th – 7th November 2018 in Copenhagen, Denmark, a pre-eminent conference for the life sciences, is Europe's largest partnering conference that serves the global biotechnology industry. It brought together the thought leaders and international decisionmakers from the whole healthcare sector including biotechnology, pharmaceutical, investors and policymakers, offering networking opportunities, workshops & panel discussions, high profile exhibition and B2B meetings. It provided an excellent networking platform for strategic partnerships.

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in order to bring down the healthcare delivery cost and improve the quality of care.

It was an exception experience coupled with reinforcing existing partnerships and scouting new stakeholders / global experts in the healthcare space.

We came back home with warm memories and new friends. We look forward to creating an impact together by fostering innovations in the health sector.

Parthvee Jain is an engineering graduate with specialization and interests in fields like Biotechnology, Healthcare, Food Processing and Nutraceuticals. Connecting European Healthcare innovation leaders with the Indian healthcare system and pioneers, she heads the market access program and partnerships at InnovatioCuris: impacting organizational performance through expert research, analysis and evaluating market competitive conditions, current and emerging trends, and industry-specific solutions.

Why

What

To help one million diabetic people in India in either curing or better managing diabetes by the end of September 2021, through open and accessible remedies and methods which are scientifically tested.

We initiated a project ExperimentsWithSugar (EWS), a project under the not for profit organisation InnovatioCuris Foundation of Healthcare & Excellence (ICFHE), with its volunteering team having first hand experience of sufferings of the diabetic condition and has motivated an achievable belief of eradicating the diabetic epidemic which can be achieved by right information and behaviour change.

How

Identifying innovations for treatment of Diabetes, Scientific Validation and Clinical trials by volunteers.

End Goal

The project aims to provide a low cost preventive strategy for India to handle the epidemic of diabetes with a holistic outlook towards life. The project is planned on a three year timeline.

For more information, visit experimentswithsugar.in Interested in volunteering for the cause?

Write to us at sachin@innovatiocuris.com or call at (+91) 999-997-9349

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DISHA: Need of the hour How crucial is DISHA (Act) for healthcare industry?

By Dhruv Singh

"A

journey of a thousand miles begins with a single step." The Digital Information Security in Healthcare Act ('DISHA') is that firm first step taken by the Indian Government in the long journey to secure the healthcare data of patients in India. The question we need to ask ourselves is that why DISHA is the need of the hour? Why we need to safeguard the electronic health records in hospitals?

The draft of the Act was made public in November 2017 by the Ministry of Health and Family Welfare. The word ‘DISHA’ means direction, the GoI has taken the first step in the direction of safeguarding the digital health records.

For this InnovatioCuris has also taken the first step towards having a concrete discussion about ‘Challenges in the implementation and opportunities for making health sector DISHA and data protection ready’. There were panelists from various renowned government and private hospitals and healthcare IT firms.

The first session was about the ‘Challenges in the implementation of DISHA’. The panelists were happy that InnovatioCuris has taken up this initiative to critically discuss the challenges a hospital will face once the Act becomes the law. The panelists agreed that the Act lacks various aspects.

Few concerns that bother the clinicians are, that who will give the consent if the patient is unconscious. The ambulances have the capability that it sends the health records from the ambulance to hospital before the patient reaches the hospital for doctors to study the emergency cases. In this scenario, what should be done if a patient denies the consent for sharing the data at a later stage. Should the clinical establishments discard the 60

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already shared health record or should they handover the same to the owner (in this case, patient) or what should be done. There are no set protocols defined in the Act for such cases.

A question was put forward, does the patient has the authority to edit their health record, or can they view, who has seen their health record. A healthy discussion took place where we got to know that citizens of Estonia have chip cards, where one can see their health record and can also see the detailed logof who have accessed their health record. This made us realize, that India as a nation state, can use Aadhar card as a mechanism, where we can login into a portal and get access to health records.

Third challenge that came forward was interoperability of health records. As the record lies with the custodian not the patient, editing and viewing of it can be done by the clinical establishments. The health record can be shared by the clinical establishments to another, but there is no standard on how to transfer it. Data integrity is a point of concern, which is not mentioned in the Act.

One of the challenges that came into light was according to ‘Clinical Establishment Act Standards for Hospital [1], the hospital has to keep health information and statistics in respect of national programmes, notifiable diseases and emergencies/disasters/epidemics and furnish the sameto the district authorities in the prescribed formats and frequency.

The question is what if the patient does not give consent. The proposed Act should have a provision where the clinical establishments are liable to take the health data.

As we have unstructured healthcare facilities in India, the Act should also empower the clinical establishments by various means to keep the data safe. As of now the DISHA is a proposed Act, not a law and has lots of loopholes. It also lacks in many aspects discussed earlier. This is just a start and government should take necessary steps to improve it.

The second panel discussed ‘Opportunities for making health sector DISHA and data protection ready’. The panelist consisted of CIO of pathlabs, owners of healthcare IT firms, who

PERSONA THEME It is a huge opportunity for the stakeholder to bring standards in the Act. DISHA might have only completed its first round of comments from the public and stakeholders, it can be expected that the revisions made based on the feedback will churn out a more refined version of the Act. In any case, it is evident from the draft that the government has really pushed to provide additional security, privacy and confidentiality for individuals, with respect to their digital health record.

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With over 20 successful projects under his belt, Dhruv Singh is a seasoned project manager. Specializing in Project Management, after his Bachelors in Engineering, he started his work journey with a bunch of young innovators and entrepreneurs in a budding start-up. Currently, he is working as a cybersecurity analyst with a well-established organisation conducting various cyber security training bootcamps for government, defense organizations and various accredited hospitals of India.

RESEARCH

[1]http://clinicalestablishments.gov.in/ WriteReadData/147.pdf [2]https://newsroom.ibm.com/201807-11-IBM-Study-Hidden-Costs-ofData-Breaches-Increase-Expenses-forBusinesses

ISSUES

One of the challenges in the DISHA is that, the owner of the data must be informed of any breach of privacy or confidentiality of their digital health record within three days. But according to IBM report it takes on an average of 197 days to detect a breach [2]. How can the healthcare IT companies safeguard the health record and let the owner know about the breach? The solution is

to encrypt the tables in the database, but that might hamper the performance.

WELL-BEING

The imminent threat is in the software which are already in place and have not been patched or the system has not been

upgraded. The good news is that many have an audit trail in-built in their system, which tracks the CRUD (creation, read, update, delete) of the records. The discussion contributed a fruitful thought: DATA AT REST IS NOT ENCRYPTED. The question that arises is what is preventing the healthcare IT companies to encrypt the data at rest.

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shared relevant thoughts and comments.

The panel started the discussion on why we need the Act and what are the benefits of the Act.Panelists highlighted that the clinical establishments will take steps to increase the safety of the health record.

The gaps in the technology for generation, storage and transmission will be lowered down. Sectors such as banking, financing and insurance have structured their data, but this lacks in healthcare. Detailed scope of security features is missing from the Act, this would help the companies to design the software from the ground up by using security as an important consideration.

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Reviewed by Sachin Gaur, Executive Editor, InnoHEALTH Hans Rosling is a world-famous figure and if anyone has been a ban of ted talks would have surely enjoyed his ted talks. The book Factfulness came to me through my friend Shampa Bari, who lives in Stockholm. The book is a must read in today’s time when we struggle so much with fake news and misinformation campaigns.

The book is easy to read as Hans has written many personal incidents that shaped his life.

Book Review: Factfulness Publisher: Spectre Author: Hans Rosling It is also interesting how Hans links the better understanding of the world to better businesses for brands. Indeed, once you read the insights and misconceptions of all walks of life about the world!

The ten instincts that he mentions bring misconceptions in our understanding of the world are: gap, negativity, straight line, fear, size, generalization, destiny, single perspective, blame and urgency. Care to know more about these instincts and business opportunities with better understanding of the world.

Reading the book you feel privileged after knowing that this book project was only thing that mattered to him during the last days alive! In his own words, “This book is my last battle in my life-long mission to fight devastating ignorance and my final attempt at making an impact on the world.”

Reviewed by Dr. VK Singh, Editor-in-Chief, InnoHEALTH The bookstores world over are stuffed with sci-fi novels, but regrettably nothing substantial has come out in this genre from India. But maybe with publishing houses coming to the fore, this situation is about to change for good. This latest sci-fi book by Saket titled, The Transfer Protocol is a step in the right direction, I would say.

This novel is about Dr. Almast who is trying to develop a super-being that will have telepathic and telekinetic powers. Went above your head, did it? The super-creature can predict future actions of humans and control objects with its brain. The brilliant scientist is looking for someone who can fund his advanced research work and that is where Dr. Toros comes in the form of a saviour. But all is not as it appears, Dr. Almast would soon find out. Mixed into the fray is the doctor’s loving and vulnerable family. All the ingredients blend to give us a survivor, a fighter, and a hero that we can’t help but cheer on.

The futuristic ideas that are being portrayed are all outrageous, to be honest, but the way in which the scientific mumbo-jumbo has been

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situations. Certain places in the story, for example, when Dr. Almast hides in a fish tank and the fishy smell saves him from getting detected are humorous.

Again, humour rises when he hides in a detergent tub in a ladies’ room to save himself and then nearly chokes. These doses of humor, interspersed with all the serious drama work, is a nice relief and enhance the quality of the plot.

The Book: “The Transfer Protocol” Published by: notionpress.com in 2016 Author: Dr. Saket Chattopadhyay explained is so simple that there is never any trouble in understanding the ongoing drama. Not to mention, the humor that is latent in some serious

The narrative flows so fast that it becomes impossible to predict what’s going to come next and that is what creates the magic in this novel. The story has been placed in America and yet the Indian-ness of the characters strikes you and helps you relate better to them.

The Indian book market is flooded with love stories today. I have nothing against the love stories and their writers. But for the overall growth of the publishing industry and for luring a wider array of readers, we need stories from different genres. Sci-fi has always been a very lucrative and successful genre and it’s something that needs to be nurtured and developed right now in India. The author has done well in this direction.

InnovatioCuris’ (IC) Advisors and Global Editors We are glad to have you all as our advisors and editors, thank you for all your support InnovatioCuris (IC) advisors Dr. Anne Snowdon Professor and Chairperson World Health Innovation Network, Odette School of Business, University of Windsor, Canada

Dr. Kate Lazarenko Founder and Director Health Industry Matters Pte. Ltd, Australia

Chris Lloyd Senior healthcare advisor IBM Watson Health, UK

Major General (Retd) A K Singh Advisor Telemedicine and Health Informatics, India

Paul Lillrank Professor Aalto University, Finland

Dr. Sarita Jaiswal Ex-Research Officer at University of Saskatchewan, Saskatoon, Canada, (currently in India)

Dr. Shiban Ganju Chairman, Atrimed Pharmaceuticals Founder, Save A Mother Foundation, USA

IC InnovatorCLUB advisors

Dr. Suman Kapur Dean and Senior Professor and HOD BITS Pilani, Hyderabad, India Steven Yeo Founder and CEO TalentGrid Ventures, Singapore

InnoHEALTH magazine advisors and global editors Advisors Konda Vishweshwar Reddy Member of Parliament, India

Brigadier (Hony) Dr Arvind Lal Chairman and Managing Director Dr Lal PathLabs, India Dr Ajoy Kumar Country Head JSS Medical Research India Ltd, India Aravind Chinchure Chair Professor of Innovation & Entrepreneurship Symbiosis International University, Pune, India Pradeep Jaisingh Founder and Managing Trustee Outcancer, India

Amir Dan Rubin Executive Vice President, United Health Group, USA

Premkumar. S Senior Executive – HCL Corp.

Executive Vice-Chairman & Managing Director, HCL Infosystems Chief Mentor, HCL TalentCare, India

Thumbay Moideen Founder President THUMBAY Group, UAE

Sharda Balaji Founder NovoJuris Legal, India

Prof. Prabhat Ranjan Executive Director Technology Information Forecasting and Assessment Council, India

Atul K. Sethi Managing Director Shree Pacetronix Ltd, India

Global Editors

Partha Dey Healthcare Leader and SME IBM, India & SA

Dr. Shailja Dixit Chief Medical Officer, Scientific Commercialization, Fellow of Health Innovation & Technology Lab, USA Ronald James Heslegrave Chief of Research William Osler Health System, Canada Dr. Ogan Gurel Chief Innovation Officer Campus D, South Korea Dr. Chandy Abraham CEO ITC Hospital division, India Dr. Sharon Vasuthevan Group Nursing & Quality Executive at Life Healthcare Group, South Africa

Prof. Rishikesha T. Krishnan Director and Professor of Strategic Management Indian Institute of Management Indore, India Sandipan Gangopadhyay President and COO GalaxE.Solutions Inc, USA Dr. Shirshendu Mukherjee Mission Director Programme Management Unit (PMU) Jointly Supported by DBT-BIRAC-BMGF-Wellcome Trust,India Adarsh Sharma Independent Financial Services Professional Adarsh Sharma & Co. India

RNI: DELENG/2016/69964

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