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India

ICT

In Healthcare

Wellness Tourism Destination! Suffering

from Diabetes! Protect your Eyes

Edible Electronics


Pink Medico

CONTENTS 6

32 SUFFERING FROM DIABETES? PROTECT YOUR EYESIGHT

NEWS AND UPDATES

10 EDIBLE ELECTRONICS A JOKE OR A CURE

32 38 ERECTILE DYSFUNCTION

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18 MEDICAL & HEALTHCARE EVENTS

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22 INDIA: WELLNESS TOURISM DESTINATION

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Pink Medico EDITORIAL TEAM: Editor: Prakash Subramanian Sub Editor: Suresh Kumar M Correspondent: Pallavi J DESIGN & DEVELOPMENT TEAM Creative Director: S Vidhyaa Prakash Graphics and Artwork: Dhanush Veerasamy SALES AND MARKETING CORRESPONDENCES: Email: sales@pinkmedico.com Tel: 080 4959 0544 Cell: +91 88610 55444

Owner : Anarghyaa ETech Solutions Pvt Ltd Published At: Anarghyaa ETech Solutions Pvt Ltd No.29, SVS Plaza, 4th Main, Vinayakanagar, Hebbal Bangalore 560 024 Email: info@pinkmedico.com Web: www.pinkmedico.com Tel: 0804959 0544 Mobile: +91 88610 55444 Printed At: Omkar Printlab Pvt Ltd, Bangalore

About : Pink Medico is a pioneering healthcare and Medical aggregator. Its 360º healthcare approach ensures educating people to understand and avail healthcare services easily. It facilitates, promotes doctors, hospitals, diagnostic centres, pharmaceutical companies, etc., through its online and offline presence. It creates awareness by conducting medical & healthcare events, awareness camps, forums, seminars, conferences and fairs in medical and healthcare industry Advertising : Pink Medico’s online and offline presence creates affordable value proposition for brand presence in pan India and across the globe.

Disclaimer: *All the details published in this magazine contain opinions, ideas and experiences of various writers, professionals and sources. It is intended to provide informative material on the subjects contained therein. It is sold or presented with the understanding that the members, managers, writers, publisher and Pink Medico are not engaged in providing medical or health or healthcare services, do not dispense, directly or indirectly, medical advice, or do not prescribe the use of any technique or products as a form of treatment for any medical or similar issues of any kind or nature whether physical, mental or otherwise, and do not recommend any of the product or services directly or indirectly. Pink Medico does not have any intention to provide specific medical advice, readers should not use any Content for diagnosing or treating a medical or health condition. If you have or suspect that you have a medical problem, you should contact your professional healthcare provider through appropriate means. You agree that you will not under any circumstances disregard any professional medical advice or delay in seeking such advice in reliance on any Content provided herein, reliance on any such Content is solely at your own risk. You should carefully read all information provided by the manufacturers of any products advertised or promoted before purchasing and/or using such products Views and opinions expressed in this magazine are not necessarily those of Pink Medico or Anarghyaa ETech Solutions Pvt Ltd (AETSPL) or its publishers and or editors. We at Pink Medico do our best to verify the information published but do not take nay responsibility for the absolute accuracy of the information. Pink Medico or AETSPL does not accept any responsibility for any investment or other decision taken by readers on the basis of information provided herein. Pink Medico or AETSPL does not take any responsibility for returning unsolicited material sent without true postal stamps for return postage. No part of this magazine can be reproduced without our prior written permission of the publisher. Pink Medico or AETSPL reserves the right to use the information published herein any manner whatsoever. *All logos, copyrights, trademarks, patents belong to respective owners. We have used them for information and educational purposes only.

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NEWS & UPDATES

NEWS & UPDATES India’s First Medical Education Centric Mobile based Platform Launched

e

Medicoz, a mobile application for healthcare professionals and medical students to build their professional network and sharing knowledge, was launched in Hyderabad recently. It is now available for both, Apple and Android users bring to reality a unique vision of creating a digital medical community and professional network for students, practicing doctors and healthcare professionals. The app is India’s first medical education centric mobile based platform where doctors and medical students can interact with each other and experts. The platform comprises of discussion forums He further said, ’This app will be particularly useful for all different aspects and fields of medicine. for doctors preparing for various post graduate exams including NEET PG, NEET Super speciality, USMLE, Medical students can get insightful knowledge and PLAB, MRCP, Australian & Canadian exams’. He condiscuss cases/questions on different forum through cluded by sharing his vision to break the barriers that this online space. Budding doctors can get idea about exist for medicos in their learning activities with this latest technological developments in the field of med- digital initiative and probably this is why he has pragicine. With an aim to bridge the gap amongst medical matically named this application, “eMedicoz”. students preparing for various career opportunities at post-doctoral level and provide them a common plat- Global digital health venture capiform it was developed. It is available both for android tal funding up 42 per cent at $7.2 and ios platforms.

billion

On this app various eLearning courses and medical learning videos are available. Some of the courses and video lectures are free and some are on subscription based model. According to the Dr Sumer Sethi, man behind the app who himself is an edupreneur & practicing radiologist,” We aim to disrupt the way medical education based content is consumed by medical graduates.

Venture capital (VC) funding, via private equity as well as corporate, jumped 42 per cent to a record USD 7.2 billion in the digital health sector globally last year through 778 deals, says a report. According to Mercom Capital Group, the sector saw USD 5.1 billion in 622 deals in 2016.

The total corporate funding for Healthcare IT comIn this app we are bringing a concept of blended panies - including debt and public market financing climbed to USD 8.2 billion in 2017, 47 per cent inlearning. Courses will be a blend of live streaming crease from the USD 5.6 billion raised in 2016. & recorded videos which will be followed by post tests. Globally today it is recognised blended learn- Since 2010, the digital health sector has accumulated ing along with support by digital community acceler- USD 26 billion in VC funding in 3,450 deals and alates the learning curve for any student and we want most USD 8.6 billion in debt and public market financing (including IPOs), taking the total to USD 34.3 bilto pioneer this in India.” lion. 6

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Pink Medico "Artificial intelligence and Data Analytics companies had a breakout year with over a billion dollars raised," Mercom Capital Group CEO and Co-Founder Raj Prabhu said. M&A activity, on the other hand, has been declining slightly over the last few years, he said, adding that investors do not want to miss out on the sheer size and potential of this growing market, but the exit path for many companies remains elusive. Notwithstanding a buoyant stock market, companies did not go public. "For the first time in years we did not see any companies issue an IPO in all of 2017," Prabhu noted. The top funded areas in 2017 include Data Analytics with USD 1.1 billion, mHealth Apps with USD 759 million, Patient Engagement Solutions with USD 708 million, Telemedicine with USD 624 million, Appointment Booking with USD 516 million, and Clinical Decision Support with USD 514 million.

WHO awards prequalification to Bharat Bio’s Rotavirus vaccine India’s

vaccine maker Bharat Biotech has announced receiving prequalification from the World Health Organisation (WHO) for its rotavirus vaccine Rotavac, considered the developing world’s first rotavirus vaccine. The vaccine to prevent infant deaths and hospitalisations due to rotavirus diarrhoea was launched by Prime Minister Narendra Modi in March 2015. In a statement, the Hyderabad headquartered biopharmaceuticals firm said the WHO prequalification was necessary for United Nations agencies and Gavi, the vaccine alliance, to purchase the vaccine in partnership with developing countries. It will also help accelerate availability of the vaccine to the developing countries with the highest burden of disease.

India had introduced the rotavirus vaccine into its national immunization program in 2016 with around 35 million doses were delivered so far. “We are honored and delighted to become the first rotavirus vaccine from the developing world and India to be WHO prequalified,” said Dr Krishna Ella, chairman and managing director of Bharat Biotech. “We feel proud to dedicate this innovated in India and Made in India vaccine to the world.” Ella said the rotavirus vaccine was being supplied to low income countries at $1 a dose with feasibility for further price reduction of around 30% based on procurement of around 100 million doses for these countries. Bharat Biotech said the vaccine was developed as a result of a multi country and multi partner collaborative model for over two decades. The public private social innovative partnership included the Government of India’s Department of Biotechnology, the Indian Council of Medical Research, the Indian Institute of Science, the All India Institute of Medical Sciences, the Translational Health Sciences and Technology Institute, the Society for Applied Studies, Christian Medical College Vellore, King Edwards Memorial Hospital Pune, Stanford University School of Medicine, the US National Institutes of Health, the US Centers for Disease Control and Prevention, Johns Hopkins University and PATH.

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Bioengineered robotic hand that will actually feel they remain frustratingly difficult and unnatural for

The sense of touch is often taken for granted. For someone without a limb or hand, losing that sense of touch can be devastating. While highly sophisticated prostheses with complex moving fingers and joints are available to mimic almost every hand motion, they remain frustratingly difficult and unnatural for the user. This is largely because they lack the tactile experience that guides every movement. This void in

the user.

sensation results in limited use or abandonment of these very expensive artificial devices.

grip based on an object’s weight or fragility. But the real challenge is figuring out how to send that information back to the brain using living residual neural pathways to replace those that have been damaged or destroyed by trauma.

So why not make a prosthesis that can actually “feel” its environment? That is exactly what an interdisciplinary team of scientists from Florida Atlantic University and the University of Utah School of Medicine aims to do. They are developing a first-of-its-kind bioengineered robotic hand that will grow and adapt to its environment. This “living” robot will have its own peripheral nervous system directly linking robotic sensors and actuators. The sense of touch is often taken for granted. For someone without a limb or hand, losing that sense of touch can be devastating. While highly sophisticated prostheses with complex moving fingers and joints are available to mimic almost every hand motion, 8

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The research team is creating a living pathway from the robot’s touch sensation to the user’s brain to help amputees control the robotic hand. A neuroprosthesis platform will enable them to explore how neurons and behavior can work together to regenerate the sensation of touch in an artificial limb. At the core of this project is a cutting-edge robotic hand and arm developed in the BioRobotics Laboratory in FAU’s College of Engineering and Computer Science. Just like human fingertips, the robotic hand is equipped with numerous sensory receptors that respond to changes in the environment. Controlled by a human, it can sense pressure changes, interpret the information it is receiving and interact with various objects. It adjusts its

“When the peripheral nerve is cut or damaged, it uses the rich electrical activity that tactile receptors create to restore itself. We want to examine how the fingertip sensors can help damaged or severed nerves regenerate,” said Erik Engeberg, Ph.D., principal investigator, an associate professor in FAU’s Department of Ocean and Mechanical Engineering, and director of FAU’s BioRobotics Laboratory. “To accomplish this, we are going to directly connect these living nerves in vitro and then electrically stimulate them on a daily basis with sensors from the robotic hand to see how the nerves grow and regenerate while the hand is operated by limb-absent people.” Courtesy: https://phys.org


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I

AN INSIGHT

EDIBLE ELECTRONICS A Joke Or A Cure?

mplantable and ingestible (suitable for eating) edible electronic devices that stay inside your frame pose unique engineering challenges. Those have to not only use the firstrate processor however additionally be minimal in size, biocompatible, secure and extremely dependable. Reliability is all the more critical because it often turns out to be a case of life or death!

Despite so many risks and challenges, it is awesome to see how implants have developed since the days of the first pacemaker in 1958. From cardiac pacemakers to cochlear implants, from brain interfaces to retinal implants, there are numerous implantable medical electronic devices available today. Even more exciting is the emerging field of edibles—tiny, capsule-sized electronic devices that are consumed orally for diagnosis and treatment of diseases. Some edibles are designed to remain inside the body for some time, while others do their job and get disposed of within minutes. Today, we have reached a state where inventions like these no longer surprise us because our minds have become tuned to a sci-fi future, and we have started expecting such developments. So let us put aside the wow-factor, and instead look at the current and future state of implants and edibles.

Painless diabetes testing, drug delivery and more With improvements in quality and reliability, there is now a reasonably good demand for cochlear, retinal and cardiovascular implants. Cardiovascular im10

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Image Coutesy: jaikhlong plants have evolved much in recent years, and have overcome past constraints regarding compatibility with imaging systems such as magnetic resonance imaging (MRI). Interestingly, the rise in lifestyle diseases like diabetes has also led to an increased demand for implantable devices like implantable continuous glucose monitoring and implantable infusion pumps. There are also implantable devices for phrenic nerve stimulation to restore breathing function in patients, and sacral nerve stimulation for patients with bladder disorders. Implantable neuro-stimulators, on the other hand, help those with neurological disorders like Parkinson’s disease. With the availability of better biocompatible materials that minimise the possibility of infections, there is greater faith in implants. Researchers at the Graeme Clark Institute have developed an implant that is fitted under the scalp to diagnose and treat epilepsy and even forecast a likely seizure. They are also developing an implantable drug pump for patients with drug-resistant epilepsy. Cochlear implants are used when hearing aids don’t work well—that is, when the patient has severe sensorineural hearing loss due to absent or reduced cochlear hair cell function. The implant basically carries out the function of the cochlea or inner ear, stimulating the auditory nerve directly.


Pink Medico Retinal implants are giving vision to the impaired around the world. Going one step further, the Monash Vision Group is developing Gennaris— a bionic vision system that bypasses damage to the eye and optic nerve to restore functional vision for people who have injured both these or lost sight due to glaucoma and acquired the retinal disease. This system interfaces directly with the brain, bypassing the retina and optic nerve. Elsewhere, researchers are also exploring biocompatible, implantable photonic devices that can improve health monitoring, diagnostics and light-activated therapies. Consider the possibility of biocompatible and wirelessly powered light-emitting diodes (LEDs) and miniature lasers implanted inside the body. Advances in biotechnology, such as optogenetics, will enable these photonic implants to be integrated tightly with neurological or physiological circuits. A good interface between implanted devices and the brain can help in great ways—for example, it can return motor function to amputees and people paralysed due to stroke or spinal cord injury. A minimally invasive electrode called the Stentrode developed at the University of Melbourne might be a step in this direction. Implanted into a blood vessel adjoining the area of the brain that controls movement, it may help control an exoskeleton, enabling crippled or paralysed people to move. The implant can apparently be installed without opening the skull, which is what makes it attractive!

soft enough to sit harmlessly in the brain, and has electrical properties that enable only the targeted part of the brain to receive the electrical stimulus. Brain-computer interface is the future of implantable systems. It can help people with degenerative brain diseases and neurological disorders. However, it must be handled with care because an electrode implanted in the brain can be used both for good and bad purposes!

Rise of edibles for diagnostics and drug delivery When the electronic device needs to stay inside the body forever or for a reasonably long time, it is worth operating on a patient to implant the device. However, if you just want it to stay inside for a few minutes, hours or even days, for the purpose of monitoring a health condition or temporarily dispensing some medicines, operating on the patient doesn’t make sense. This requirement led to the development of in-

Neuralink, a company funded by Elon Musk, is also working on implantable brain-computer interfaces. They are developing syringe-injectable, flexible, sub-micron-thickness substrates that can be used in implantable electronics. The substrate is

The Cost of researching and developing implants continues to be high due to the criticality and complications www.pinkmedico.com

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Pink Medico to the development of ingestible or edible electronics,which industry-watchers expect to create huge waves like wearables did. The electronics that you swallow, encapsulated in a pill, will sit in your gastrointestinal tract for a short time, before being ejected from your body like regular food waste. During this time it can capture videos, release drugs, monitor heart rate and respiration, and perform other such tasks. Proteus Digital Health was one of the pioneers in ingestible tech, and their technology is now used commercially by close to ten health systems. Their solution comprises a pill, a patch that is attached outside to the side of the stomach, and a mobile app/ desktop portal. The pill is made of whatever drugs are required, and fitted with a sensor made of natural, ingestible materials like copper, magnesium and silicon. When a patient swallows the pill, it dissolves like a normal pill in the stomach but leaves behind a sensor, which is activated by fluids in the body. This sensor sends a signal to the patch, which also measures heart rate, body position and time of medication detection. This information is sent to the patient’s or doctor’s mobile phone. Regular drug intake is very important for those undergoing complex medical treatments such as organ transplants. This pill could be very useful for such patients. Proteus has teamed up with Tokyobased firm Otsuka to embed Proteus’ sensors into Abilify—a drug used for serious mental illnesses. Another forerunner in the space is Israel-based Given Imaging. Their PillCam series comprises pills with ingestible cameras, which can help doctors to view different parts of the patient’s digestive system like the oesophagus or colon. It is a painless alternative to tests like endoscopy and colonoscopy. The PillCam Colon, for instance, uses a battery-powered camera to take high-speed photos as it slowly goes down the intestinal tract over a time period of eight hours. The images are transmitted to a recording device worn around the patient’s waist and later reviewed by a doctor. Although the images are not as sharp as those obtained through normal colonoscopy, it is a viable alternative for those who cannot 12

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bear the pain or feel embarrassed by the procedure. Other versions of PillCam help doctors to see the small intestine and oesophagus. The company has also developed SmartPill— an ingestible capsule that measures pressure, pH and temperature as it travels through the gastrointestinal tract. This helps doctors to assess GI motility. Bravo pH is another capsule-based test that helps to test for acid reflux. The miniature pH capsule attaches to the oesophagus and sends pH data wirelessly to a small recorder worn on a shoulder strap or waistband. Information is collected over multiple days, enabling doctors to study the frequency and duration of acid flowing back up into the oesophagus. This helps to confirm the presence of gastroesophageal reflux disease (GERD). This is a totally catheter-free solution, so the patients can go about normal activities and have a normal diet while the pill unobtrusively monitors their acid reflux. They can remove the receiver to take a shower. This type of monitoring under a normal routine gives better results than keeping the patient under observation.

Unique Engineering Challenges The most obvious challenge to edible electronics is, obviously, miniaturisation. It is impossible to implant or consume something that is bulky. With the electronics industry in general moving towards miniaturisation in everything, this goal has become more achievable in implantable devices, too. Unlike the traditional pacemaker, the newer leadless pacemakers are about the size of a large capsule, and can be placed directly in the heart. These can be implanted through a femoral vein puncture in about half an hour.


Pink Medico such patients. Proteus has teamed up with Tokyobased firm Otsuka to embed Proteus’ sensors into Abilify—a drug used for serious mental illnesses. Another forerunner in the space is Israel-based Given Imaging. Their PillCam series comprises pills with ingestible cameras, which can help doctors to view different parts of the patient’s digestive system like the oesophagus or colon. It is a painless alternative to tests like endoscopy and colonoscopy. The PillCam Colon, for instance, uses a battery-powered camera to take high-speed photos as it slowly goes down the intestinal tract over a time period of eight hours. The images are transmitted to a recording device worn around the patient’s waist and later reviewed by a doctor. Although the images are not as sharp as those obtained through normal colonoscopy, it is a viable alternative for those who cannot bear the pain or feel embarrassed by the procedure. gestible or edible electronics,which industry-watchers expect to create huge waves like wearables did. The electronics that you swallow, encapsulated in a pill, will sit in your gastrointestinal tract for a short time, before being ejected from your body like regular food waste. During this time it can capture videos, release drugs, monitor heart rate and respiration, and perform other such tasks. Proteus Digital Health was one of the pioneers in ingestible tech, and their technology is now used commercially by close to ten health systems. Their solution comprises a pill, a patch that is attached outside to the side of the stomach, and a mobile app/ desktop portal. The pill is made of whatever drugs are required, and fitted with a sensor made of natural, ingestible materials like copper, magnesium and silicon. When a patient swallows the pill, it dissolves like a normal pill in the stomach but leaves behind a sensor, which is activated by fluids in the body. This sensor sends a signal to the patch, which also measures heart rate, body position and time of medication detection. This information is sent to the patient’s or doctor’s mobile phone. Regular drug intake is very important for those undergoing complex medical treatments such as organ transplants. This pill could be very useful for 14

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Other versions of PillCam help doctors to see the small intestine and oesophagus. The company has also developed SmartPill— an ingestible capsule that measures pressure, pH and temperature as it travels through the gastrointestinal tract. This helps doctors to assess GI motility. Bravo pH is another capsule-based test that helps to test for acid reflux. The miniature pH capsule attaches to the oesophagus and sends pH data wirelessly to a small recorder worn on a shoulder strap or waistband. Information is collected over multiple days, enabling doctors to study the frequency and duration of acid flowing back up into the oesophagus. This helps to confirm the presence of gastroesophageal reflux disease (GERD). This is a totally catheter-free solution, so the patients can go about normal activities and have a normal diet while the pill unobtrusively monitors their acid reflux. They can remove the receiver to take a shower. This type of monitoring under a normal routine gives better results than keeping the patient under observation.

Unique Engineering Challenges The most obvious challenge to edible electronics is, obviously, miniaturisation. It is impossible to implant or consume something that is bulky. With the electronics industry in general moving towards min-


Pink Medico iaturisation in everything, this goal has become more achievable in implantable devices, too. Unlike the traditional pacemaker, the newer leadless pacemakers are about the size of a large capsule, and can be placed directly in the heart. These can be implanted through a femoral vein puncture in about half an hour. No more bulges or scars, these pacemakers are very unobtrusive and apparently also less prone to infections. The National Heart Centre Singapore (NHCS) began implanting such pacemakers last year. Thermal management is another huge challenge in implantable devices. Like any other electronic device, implantable devices too vent out waste heat. However, this heat should not harm the surrounding tissues. So while designing an implantable device, engineers have to consider thermal properties of biomaterials, the effect of blood flow on temperature distribution, interfacial contact resistance, effect of temperature change on various types of tissues and communication duty cycles of embedded electronic components. Further, the in-vivo electronic device must be biocompatible—it must not cause any adverse reaction inside the body. It must be stable over time, despite the temperature and pH variations in the human body. The biocompatible materials must not contain cancer

causing toxins, and must mostly be made of materials naturally suitable to the human body. The insulation materials must match the texture and smoothness of the surface they interface with, be it tissue, bone or skin. Currently, we have biocompatible polymers for use in drug delivery devices, skin or cartilage and ocular implants; metals for dental and orthopaedic work; semiconductor materials for bio-sensors and implantable microelectrodes; and ceramics for bone replacements, heart valves and dental implants. But, ingestible electronics adds to the constraints, requiring the device and its power source to be made of materials that are part of our diet and can be disintegrated and disposed of easily by the body. The search is on There is a lot of ongoing research on bio-inspired, biocompatible materials and power sources, which can improve the performance and reliability of implantable and ingestible devices. A recent paper by MIT researchers, published in Nature, describes a biocompatible power source that lasts much longer than current options that can power the edible device only for a few minutes or at the most a few hours. This energy-harvesting galvanic cell for continuous in-vivo temperature sensing andwireless communication could deliver an average power of 0.23pWper square-mm of electrode area for an average of 6.1 days, when used for temperature measurements in the gastrointestinal tract of pigs. In yet another development, Dr Christopher Bettinger of Carnegie- Mellon University proposed biodegradable elastomers as structural polymers, and melanin- based pigments as materials for on-board energy storage in implantable and ingestible electronics. His lab focuses on the development of biomaterials-based microelectromechanical systems (MEMS) for use in regenerative medicine, neural interfaces, drug delivery, etc. They have developed edible, biocompatible batteries that use non-toxic materials already present in the body, with available liquids such as stomach acid as the electrolyte. Their cathodes use melanin, while anodes are made of manganese oxide. These electrodes dissolve harmlessly after use. A team of researchers, including Zhaowei Guo and others from Fudan University in China, have developed a family of flexible and biocompatible aqueous sodium-ion batteries for implants. Instead of toxic electrolytes, these batteries use sodium-containing

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aqueous electrolytes such as normal saline and cellculture medium. The cell culture medium comprises amino acids, sugars and vitamins, which is quite similar to the fluid that surrounds cells in the human body. The team made two kinds of batteries. One was a two-dimensional belt-shaped battery made of thin films of electrode material stuck on a mesh made of steel strands. The other used a woven carbon nanotube fibre backbone with embedded nano-particle electrode materials. This fibre-shaped electrode with normal saline or cell-culture medium electrolyte surprised the researchers by accelerating the conversion of dissolved oxygen into hydroxide ions, and changing the pH. While this could be detrimental to the effectiveness of the battery, it could be very useful in biological and medical investigations like cancer starvation therapy. In Stanford, a team led by Zhenan Bao has developed a flexible electronic device that can easily be degraded into non-toxic compounds just by adding a weak acid like vinegar to it. Apart from the polymer and thede gradable electronic circuit, the team has also developed a new cellulose-based biodegradable substrate material for mounting the

electrical components. According to them, this substrate supports electrical components, flexing and moulding to rough and smooth surfaces alike. Bao is not new to this field. Human skin has always fascinated her, and she previously developed a skin-inspired stretchable electrode, which was so flexible that it could easily interface with the skin or brain. However, the electrode’s non-degradability made it unsuitable for implantable devices. Bao says in a media report that they came up with an idea of making these molecules using a special type of chemical linkage that can retain the ability for the electron to smoothly transport along the molecule. But this chemical bond is sensitive to weak acid— even weaker than pure vinegar. So the result was a polymer material that could not only carry an electronic signal but also break down easily to product concentrations much lower than the published acceptable levels found in drinking water. How do sensors made of biocompatible materials compare with those made of food itself? Well, obviously you would prefer the latter. So thought a team of researchers from the University of Wollongong in Australia! In a paper, they reveal that the developwww.pinkmedico.com

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Pink Medico ment of highly swollen, strong, conductive hydrogel materials is necessary for the advancement of edible devices. So they analysed the electrical properties of everyday food products like jelly, Vegemite and Marmite (two popular brands of yeast extract) and harnessed them to make edible hydrogel electrodes. These gels were used to demonstrate a capacitive pressure sensor that can help detect digestive pressure abnormalities such as intestinal motility disorders.

Eat your robot We have biocompatible materials as well as transistors, sensors, batteries, electrodes and capacitors made using such materials. So you might think, why not a robot, too? But, what sets a robot apart from other computing systems is its ability to move—a robot needs an actuator, and attempts at making an edible one have been unpalatable all along! Switzerlandbased research organisation EPFL has made some headway recently. At a conference held this year, researchers led by Dario Floreano presented the prototype of a completely edible, soft, pneumatic actuator made of gelatin, glycerin and water. The design and performance of this new gelatin actuator is comparable to standard pneumatic actuators. Its structure causes it to bend when inflated and straighten out again when pressure is reduced. The main benefits are that it is edible, biodegradable, biocompatible and environmentally sustainable. Since gelatin is melty, the actuator also turns out to be self-healing! The researchers explain several exciting applications for this actuator. The components of such edible robots could be mixed with nutrients or pharmaceutical components to improve healing, digestion and metabolism. These can be used as disposable robots to explore, study the behaviour of wild animals, cure sick animals or train protected animals to hunt. These can also be used in relief measures. In search-andrescue operations, the robot can be sent without a payload to stranded people as the robot itself is food!

But can we pay the bills? A recent Frost & Sullivan report noted that the fastest growing segment amongst the many types of implants 18

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is implantable neuro stimuIators, which help treat neurological disorders such as epilepsy, dementia, Alzheimer’s disease, Parkinson’s disease and dystonia. It is also likely that in the future, these implantable electronics will be digitally connected to improve the scope of remote drug delivery, testing and diagnostics. The cost of researching and developing implants continues to be high due to the criticality and complications involved—and often this cost reflects in the end price points. In the report, Frost & Sullivan industry analyst Bhargav Rajan noted that the constant stream of innovations has attracted substantial private funding to the implantable electronics market, while public funding is expected to improve in the future. He also suggested that technology developers can lower development costs by collaborating with early-stage start-ups and small- and mediumsized enterprises. This will allow them access to cross- industry expertise and cutting-edge innovations, which, in turn, will help lower the price points. A majority of the population seeking implants belongs to low- and middle-income groups. Taking note of this factor, the report also stressed that the growth of this sector depends not entirely on technological development but also the availability of insurance coverage and reimbursements for such devices.


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MEDICAL AND HEALTHCARE EVENTS

INTERNATIONAL MUSCULOSKELETAL MEDICINE CONGRESS 9-10 MARCH 2018 Venue: Dusit Thani, Dubai, UAE Email: info@dimmc.com; Website: http://www.dimmc.com

THE ECONOMIC TIMES HOSPITAL STRATEGIC MANAGEMENT SUMMIT 2018 9 MARCH 2018 | VENUE: : MUMBAI Email:info@et-hsms.com | Website: http://www.et-hsms.com

GLOBAL SUMMIT ON ONCOLOGY & CANCER 12-14 MARCH 2018 | VENUE: SINGAPORE

Email:globalcancer@conferencesworld.org | Website: https://globalcancer.conferenceseries.com/

ASIA PACIFIC GLOBAL SUMMIT ON HEALTHCARE 12-14 MARCH 2018 | VENUE: : SINGAPORE Email:healthcareasiapacific@conferencesworld.org | Website: https://healthcare.global-summit.com

GLOBAL SUMMIT ON ONCOLOGY & CANCER 12-14 MARCH 2018 | VENUE: SINGAPORE

Email:globalcancer@conferencesworld.org | Website: https://globalcancer.conferenceseries.com/

TIMES OF INDIA MEDICAL TOURISM & WELLNESS CONFEX 2018 20-22 MARCH 2018 | VENUE: MUMBAI

Email: info@toi-mtwc.com | Website: http://toi-mtwc.com

WORLD CONGRESS ON EMBRYOLOGY AND INVITRO FERTILIZATION 30-31 MARCH 2018 | Venue: ORLANDO, FLORIDA, USA Email: info@dimmc.com; Website: https://ivf.conferenceseries.com

THE DUBAI INTERNATIONAL DENTISTRY CONGRESS 7-10 APRIL 2018 | VENUE: CONRAD HOTEL, DUBAI, UAE Email: info@di-dc.com | TEL: +971 4 361 9616

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ndia’s medical tourism and wellness sector is dynamic which is why there is an evident competitive advantage. There is a dire need to develop a unanimous ecosystem which can benefit both, Tier 1 (high quality + high pricing) as well as Tier 2 (good quality + economic pricing) players and develop a focused strategy to be #WorldNumber1.

With the recent ease in process for medical visas and initiatives by the government to further entice the cost consciousness consumer segment, there are still many hurdles at various stages which need to be addressed. Regularization of policies, taxation, pricing and commissions, transparency in operational functioning, security and hygiene are topmost on the list of concerns for the Medical Value Travel (MVT) category in India. Today, Africa, GCC and CIS regions, present the maximum opportunity for the Indian healthcare sector, with Chennai, Mumbai, Andhra Pradesh and NCR as the most favoured medical tourism destinations for the floating medical population who avail treatments in India. Over the years, India has grown to become a top-notch destination for medical value travel because it scores high over a range of factors that determines the overall quality of care. The Times Group, as harbingers of change, having recognized this potential, are proud to be associated with the cause of creating a progressive India. 20

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With the intent to help position India as preferred healthcare travel destination globally, TOI are proud to bring to you, the inaugural edition of the ‘Times of India – Medical Tourism and Wellness ConfEX’ (TOI-MTWC). Times of India Medical Tourism and Wellness ConfEX is to be conducted in The Lalit , Mumbai from 20 - 22 March 2018. It is the largest convergence of Medical Tourism Industries in Asia. The event Highlights: • 100+ Medical Facilitators • Hosted Buyers from 15+ Countries • 60+ Speakers • 40+ Exhibitors • One Day workshop by Dr.Prem Jagyasi on Medical Tourism, Wellness Tourism, and Global Healthcare Marketing.


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I

ndian Healthcare has emerged as one of the key sectors in terms of contributing to GDP as well as employment creation. There has been consistent growth and evolution in Indian healthcare as it does not include merely hospitals but all other stakeholders like medical equipment’s, devices, consumables, disposable etc. It also has branched out into Telemedicine, Medical Tourism, Healthcare IT, Ecommerce, Clinical Trails, and Health Insurance etc

tion. It also calls for strategic realignment of priorities when it comes to market expansions, regulatory interventions, and regular technological disruptions. In a nutshell, The Economic Times Hospital Strategic Management Summit 2018 aims at convergence of brilliant thought leaders and stakeholders to discuss 21st Century Healthcare Strategic Management approach amidst disruptions of all nature.

Although the challenges faced by the Hospital industry are grim, there are a lot of opportunities which remain unexplored by the Industry. The Govt has introduced the National Health Policy 2017 which explains the criticality of incorporating digital into public healthcare. Simultaneously Public-Private partnership supported by strong governance at the state and national level can also help boost Hospital healthcare while bringing in investments attuned to people’s need & requirement in healthcare.

Healthcare Journey so far:

The Economic Times believes, an intensive & comprehensive review of hospital management needs to bring our Healthcare system to a world class status. Although we have one of the best doctors in the world, it is the challenges that need to be converted to opportunities for taking this industry to the next pedestal. These dynamics also call for an introspective approach towards the 21st century management as healthcare economics, and demographics have undergone massive changes post liberalisa-

Private hospitals sector entered the India market in 1990s - in sync with economic liberalization

Healthcare ed cautious

Market exploded on riding IT and

Private Sector caters to 70% of urban areas, 63% of rural of areas (National Family Health Survey-3)

Private Sector also accounts for approximately 74% of Indian health spends.

market approach

players till early

adopt2000s

after ITES

2005 Wave

The Economic Times Hospital Streategic Mangement Summit 2018 is to be conducted in Mumbai on 9th March 2018. www.pinkmedico.com

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T

COVER STORY

he potential of wellness systems, developed through centuries of wisdom of this ancient civilization would be fully tapped. This is being done by positioning India as a centre of Ayurveda, Yoga, Sidha, Naturopathy, etc. together with the spiritual philosophy that has been integral to the Indian way of life.

The initiative of accreditation of wellness centre by NABH and AYUSH has been greatly driven be the Ministry of Tourism as also consultation with the Wellness Tourism Service Providers, State Governments and other stakeholders. The country is emerging as a great destination for medical tourism because it has several pull factors like Excellent medical treatment at low cost, easy accessibility, picturesque locations for excellent holiday, etc. Interestingly, medical packages are combined with leisure activities, fun and fitness to make it complete tourism material for the patients across the globe. According to the government’s Make In India report, the wellness industry in India is worth INR 490 billion, and wellness services alone comprise 40% of the market. The AYUSH sector (Ayurveda, Yogam Naturopathy, Unani, Siddha and Homeopathy) has an annual turnover of around INR 120 billion. Patients from various countries are becoming medical tourists to India for low cost and health restorative alternative treatments. 22

February 2018

The Medical Tourists undergo health restorative treatments of a combination of Ayurveda, Yoga, acupuncture, herbal oil massage, nature therapies, and some ancient Indian healthcare methods -such as Vedic care, an alternate healthcare service. Kerela, the state that has emerged as the Ayurveda and Yoga hub in the country, has witnessed average stay back period of tourists going up from 14. 1 to 18 days now, the highest in the country - thanks to Ayurveda and Yoga Tourism. India has lot of tourists from other countries coming for the rejuvenation promised by yoga and Ayurvedic massage.

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Marketing Ayurveda as part of the ‘health tourism’ has brought a new definition to vacationing in India itself. According to the “Make in India” report released by the Indian government, wellness tourism in India is expected to contribute 40% of the revenues generated by medical tourism. The current annual turnover of the AYUSH wellness sector (comprising of Ayurveda, Yoga, Unani, Siddha, and Homeopathy) is around INR 120 billion. This article discusses the growth potential and favourable factors for wellness tourism in India.


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INDIA

INITIATIVES BY GOVERNMENT OF INDIA TO PROMOTE WELLNESS TOURISM

THE WELLNESS TOURISM DESTINATION

Benefits over Surgical and Nonsurgical Treatments Compared to conventional forms of surgical and non-surgical treatments, AYUSH treatments are more safe, non-toxic, and cheaper. These treatment methods provide complete relaxation and rejuvenation for physical and mental health, thus attracting more tourists. This includes tourists, who come to India with critical ailments such as heart ailments and cancer, and following their medical treatment, would like to spend their recovery period undergoing alternative treatment methods. Many Indian hospitals offer End to End medical tourism packages that include hospital treatment with any of the AYUSH forms of treatment.

Ministry of Tourism has drafted guideline for wellness tourism. These guidelines address issues regarding making available quality publicity material, training and capacity building for the service providers, participation in international & domestic Wellness related events, etc.

According to Invest India, India is the second largest exporter of ayurvedic and herbal medicines, with the domestic trade of the AYUSH industry valued at USD 1.3 billion. Medical plants and herb-based products account for exports of about USD 153 million. The wellness industry, comprising mainly of Beauty care, Nutritional care, fitness centers, alternate therapy, and rejuvenation, is expected to grow at an annual CAGR (compound annual growth rate) of 12% to reach an industry value of USD 23 billion by the year 2020. Ayurvedic treatments are expected to grow at almost 30% annually over the next few years.

Mushrooming of wellness centers in the country have given rise to the concern for quality service. The Guideline for Accreditation of wellness centers have been developed by National Board for Accreditation of Hospitals & Healthcare Services (NABH) in consultation with AYUSH. The Ministry of Tourism has also extended its Market Development Assistance (MDA) scheme to wellness tourism service providers including accredited wellness centers. Presently the wellness centers accredited by State Tourism Departments are also eligible for the MDA. After the accreditation guidelines of NABH is in place, all wellness centers seeking MDA would be asked to be as close to the accreditation guidelines of NABH as possible.

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Pink Medico and Yoga hub in the country, has witnessed average stay back period of tourists going up from 14. 1 to 18 days now, the highest in the country - thanks to Ayurveda and Yoga Tourism. India has lot of tourists from other countries coming for the rejuvenation promised by yoga and Ayurvedic massage. Marketing Ayurveda as part of the ‘health tourism’ has brought a new definition to vacationing in India itself.

The Indian government has also sanctioned industrial cluster catering to AYUSH-based services around the country. The state of Kerala in India has gained a reputation for its Ayurveda and Yoga centers, with the average duration of tourist stay in the high range of 18 days. Along with affordable and quality treatments, India offers the following growth factors for wellness tourism: • Over 700,000 registered practitioners of Ayurveda and other AYUSH treatments in India • Availability of a variety of 6200 indigenous plants and 8000 medicinal plants in India • 30-day visa (including visa-on-arrival) for foreign nationals coming to India for medical treatment. • 100% foreign direct investments (FDI) approved by the Indian government in the AYUSH sector. Patients from various countries are becoming medical tourists to India for low cost and health restorative alternative treatments. The Medical Tourists undergo health restorative treatments of a combination of Ayurveda, Yoga, acupuncture, herbal oil massage, nature therapies, and some ancient Indian healthcare methods -such as Vedic care, an alternate healthcare service. Kerela, the state that has emerged as the Ayurveda

24

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According to the “Make in India” report released by the Indian government, wellness tourism in India is expected to contribute 40% of the revenues generated by medical tourism. The current annual turnover of the AYUSH wellness sector (comprising of Ayurveda, Yoga, Unani, Siddha, and Homeopathy) is around INR 120 billion. This article discusses the growth potential and favourable factors for wellness tourism in India. Benefits over Surgical and Non-surgical Treatments Compared to conventional forms of surgical and non-surgical treatments, AYUSH treatments are more safe, non-toxic, and cheaper. These treatment methods provide complete relaxation and rejuvenation for physical and mental health, thus attracting more tourists. This includes tourists, who come to India with critical ailments such as heart ailments and cancer, and following their medical treatment, would like to spend their recovery period undergoing alternative treatment methods. Many Indian hospitals offer End to End medical tourism packages that include hospital treatment with any of the AYUSH forms of treatment. According to Invest India, India is the second largest exporter of ayurvedic and herbal medicines, with the domestic trade of the AYUSH industry valued at USD 1.3 billion. Medical plants and herb-based products account for exports of about USD 153 million. The wellness industry, comprising mainly of Beauty care, Nutritional care, fitness centers, alternate therapy, and rejuvenation, is expected to grow at an annual CAGR (compound annual growth rate) of 12% to reach an industry value of USD 23 billion by the


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year 2020. Ayurvedic treatments are expected to grow at almost 30% annually over the next few years. The Indian government has also sanctioned industrial cluster catering to AYUSH-based services around the country. The state of Kerala in India has gained a reputation for its Ayurveda and Yoga centers, with the average duration of tourist stay in the high range of 18 days. Along with affordable and quality treatments, India offers the following growth factors for wellness tourism: • Over 700,000 registered practitioners of Ayurveda and other AYUSH treatments in India • Availability of a variety of 6200 indigenous plants and 8000 medicinal plants in India • 30-day visa (including visa-on-arrival) for foreign nationals coming to India for medical treatment. • 100% foreign direct investments (FDI) approved by the Indian government in the AYUSH sector. According to the “Make in India” report released by the Indian government, wellness tourism in India is expected to contribute 40% of the revenues generated by medical tourism. The current annual turnover of the AYUSH wellness sector (comprising of Ayurveda, Yoga, Unani, Siddha, and Homeopathy) is around INR 120 billion. This article discusses the growth potential and favourable factors for wellness tourism in India. Benefits over Surgical and Non-surgical Treatments Compared to conventional forms of surgical and non-surgical treatments, AYUSH treatments are more safe, non-toxic, and cheaper. These treatment methods provide complete relaxation and rejuvenation for physical and mental health, thus attracting more tour-

26

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ists. This includes tourists, who come to India with critical ailments such as heart ailments and cancer, and following their medical treatment, would like to spend their recovery period undergoing alternative treatment methods. Many Indian hospitals offer End to End medical tourism packages that include hospital treatment with any of the AYUSH forms of treatment. According to Invest India, India is the second largest exporter of ayurvedic and herbal medicines, with the domestic trade of the AYUSH industry valued at USD 1.3 billion. Medical plants and herb-based products account for exports of about USD 153 million. The wellness industry, comprising mainly of Beauty care, Nutritional care, fitness centers, alternate therapy, and rejuvenation, is expected to grow at an annual CAGR (compound annual growth rate) of 12% to reach an industry value of USD 23 billion by the year 2020. Ayurvedic treatments are expected to grow at almost 30% annually over the next few years. The Indian government has also sanctioned industrial cluster catering to AYUSH-based services around the country. The state of Kerala in India has gained a reputation for its Ayurveda and Yoga centers, with the average duration of tourist stay in the high range of 18 days. Along with affordable and quality treatments, India offers the following growth factors for wellness tourism: • Over 700,000 registered practitioners of Ayurveda and other AYUSH treatments in India • Availability of a variety of 6200 indigenous plants and 8000 medicinal plants in India • 30-day visa (including visa-on-arrival) for foreign nationals coming to India for medical treatment. • 100% foreign direct investments (FDI) approved by the Indian government in the AYUSH sector.


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Corporate Wellness can Save India Inc Revenue to US$ 20 billion: ASSOCHAM Adoption of corporate wellness program can save

India Inc. income up to US$ 20 billion by 2018 through a reduction in absenteeism rate by 1% and at the same time improve chronic and lifestyle diseases of corporates and employees, according to the Associated Chambers of Commerce and Industry of India (ASSOCHAM) latest paper The chamber analysis further reveals that on an average for every rupee being spent on employee wellness programme, employers get Rs 132.33 as a saving on absenteeism cost and Rs 6.62 back as reduced health care costs. These findings are condensed in a paper based on the paper 'Corporate Wellness Programme: Benefits to Organisation and Economy" covered sectors like engineering, FMCG, Financial Services, IT/ITeS, Infrastructure, Market Research/KPO, Media and Real Estate. The paper also found that 83% of respondents are willing to contribute a percentage of their salary in company sponsored wellness program; however 17 per cent are not at all willing to participate in it, adds the paper. On impact of wellness program to corporate employees across sector, the paper disclosed that among IT/ITeS sector employees, 93% feel that company sponsored wellness program act as a motivating factor for them. However 7% feel depressed about the healthcare program. About 60% employees engaged in media sector consider wellness program as a motivating factor, whereas remaining 40% feel that it acts as a depressing factor. However, in case of FMCG, 75% of employees feel that it act as a motivating factor, however, 25% consider it as a depressing factor. In financial sector,

84% of employees favor the wellness program while 16% of respondents not interested to participate in these kind of programs, noted the paper. In rest of sectors 100% of employees consider company sponsored wellness program act as a motivating factor for them. The ASSOCHAM observed that out of top 500 Indian companies that are working towards CSR initiatives, offer healthcare programs and facilities in nearby areas where their factory outlets are located and many are serving in rural blocks/districts/village. But ironically 42% of them ignore employee health care as they do not offer any wellness program to them. However, the chamber noticed that despite the availability of preventive health care benefits through medical plans, most of the respondents do not take advantage for getting routine health care examination. As some are not aware about benefits that exist and some hesitate to ask. Almost 76% of employees deny accepting that "it"- heart disease, cancer, diabetes, or stroke can happen to them. About 48% of respondents informed that their organization offer corporate wellness program. Out of which 62% of the employees feel that the present wellness program run by their organization needs improvement. However, out of the 52% of the employees revealed that their company do not run any wellness program, 51% of the survey respondents say if in future their company initiates any employee wellness program they would surely participate in it.

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ICT in Healthcare HEALTH CARE SECTOR IN INDIA HAS WITNESSED SIGNIFICANT GROWTH DURING THE LAST FEW YEARS, BOTH IN QUALITY AND CAPACITY. RELATIVELY LOWER COST OF HEALTH CARE, AS COMPARED TO DEVELOPED COUNTRIES, COUPLED WITH INTERNATIONAL QUALITY, HAS POSITIONED INDIA AS A MAJOR DESTINATION FOR HEALTH CARE SERVICES. 28

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A

Pink Medico s an effect of the age-

ing of the population in general, the number of citizens with chronic diseases is increasing, especially among elderly people throughout the Baltic Sea Region. This is a great challenge for both the well-being of the citizens and the public health care systems. Health care solutions provided by information and communication technology (ICT), also known as eHealth, offer one solution to this problem.

The tools and services which contribute to eHealth provide better and more efficient health care services for all.

If everyone were to have access to basic IC technology, such as mobile phones and personal computers, the use of ICT in health care is not self-evident. The acceptance of eHealth is varying among both citizens and medical professionals. Without general acceptance of eHealth, the continued generation of innovative health care technologies is not possible. The potential benefits of a range of eHealth systems, evaluating the potential benefits with reference to a range of metrics, including: •

Availability (access, waiting times and better utilization of resources).

Continuity of care (coordination and information sharing among care providers).

Empowerment (patient involvement in their own care activities).

Patient safety (reduced risk of patient harm).

Quality of care (effectiveness and efficiency of care service provision)

There are a number of key technologies which are proven catalysts to significant healthcare improvement, efficiently and effectively meeting the increasing demands of stakeholders in the healthcare environment, patients, professionals and funders. Some of them are as follows: Electronic (EHR):

Health

Records

Electronic Health Records aggregate patient-centric health data from the patient record systems of multiple independent healthcare organizations. An EHR is a longterm record for a patient, detailing his or her involvement with individual healthcare organizations and episodes of care. Many EHRs include detailed clinical data such as individual lab results and prescription refill information. EHRs are commonly used to transfer a patient’s healthcare information between organizations, allowing stakeholders in the patient’s health to access this information remotely. Access to this information allows for continuity of care between different care delivery organizations or other organizations, such as social services, that may

come in contact with the patient. EHRs make information for decision-making available at the point of care and result in less time and effort spent capturing patient data when crossing organizational boundaries. Additionally, ensuring the inter operability of these systems, delivers increased benefit for the patient, clinician and healthcare provider. Chronic Disease Management Systems: Chronic Disease Management Systems, CDMS, rely on the use of evidence-based best practices. They allow doctors to organize and use their chronic care patient information efficiently providing fast, easy access to evidence-based clinical guidelines. It includes, for example, what measures should be checked on each patient visit (e.g. blood) ICT’s Role in Healthcare Transformation Report of the Health ICT Industry Group pressure, weight, activity level), what medications the patient should be taking, which lab tests should be repeated and when, and what self-care reminders the patient should receive. Up to 50% of patients with chronic conditions fail to take their medicines properly. In diabetics alone, 20% with type two diabetes for-

"Acceptance of eHealth is varying among both citizens and medical professionals" www.pinkmedico.com

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Pink Medico get to take their medicines at least once a week, whilst around 80% are unable to test their glucose even once a day because they have not obtained enough testing strips. CDMS provide tools that any member of a patient’s care team can access easily; for example, a nurse, dietician or other care provider may use a patient education report or patient flow sheet from the system to help a patient set and meet self-management goals; similarly, a medical office assistant may use recall reports from the system to pro actively schedule follow-up appointments. CDMS has the potential to reduce costs by improving health outcomes for chronic care patients. Physicians can use CDMS to generate alerts, identify subsets of patients, and track their progress toward goals. By extending this system to the home, patients can also enter their own care management information, and take relevant measurement for their condition, making the registry a complete chronic care record. Computerized Practitioner Order Entry (CPOE) Computerized practitioner/(or physician) order entry (CPOE), also known as Order Communications, is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. Directly entering orders into a computer, at the point of care, has the benefit of reducing errors by minimizing the ambiguity of hand-written orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support (CDS) tools. CPOE supports decision making by improving formulary compliance; cost effective medication ordering; appropriateness of medication administration, route, dosage, duration, and interval; decrease in test redundancy and unnecessary duplication. When combined with Electronic Transfer of Prescription, it also improves clinical processes for ordering, saving time and cost while reducing ambiguity due to illegible handwriting and incompleteness of handwritten orders. Clinical Decision Support Clinical Decision Support (CDS) can assist in the avoidance of medical errors. CDS, in conjunction with CPOE, can help clinicians make complex decisions and can trigger appropriate early notification of possible untoward events. The system can immediately raise an alert if a potential adverse drug event or prescription error could be triggered by a prescription. It can also generate dosage adjustments based for example on advancing age or declining renal function. Similarly, decision support tools can alert a physician to reassess the need for medications such as antibiotics that appear to be used for longer than indicated. Electronic Transfer of Prescription Electronic Transfer of Prescription (ETP) makes it easier for GPs to issue prescriptions and more convenient for patients to col30

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Pink Medico HANDBOOK ON

®

LEADING HOSPITALS IN INDIA Upcoming March 2018 Edition To Advertise. Contact: ads@pinkmedico.com

TOPICS TO BE COVERED

Sustainability in Medical Tourism

Spotlight on India as emerging Medical Tourism destination

Hospitality in Medical Tourism

AYUSH – Potential in Medical Tourism

Path breaking medical feats in treating international patients

Advanced Medical Technology and its impact on Medical Tourism


Pink Medico lect their medication. ETP enables prescription data to be transmitted electronically between the prescribing health professional and the pharmacy, making prescribing and dispensing safer and more convenient for patients. This improves audit trails for medication and reduces errors that can arise from illegible paper based prescriptions. Electronic Appointment Booking Electronic Appointment Booking Systems allow patients to choose the place, date and time of their first outpatient hospital appointment and automates the process by which a GP refers a patient for specialist care. It allows patients to book appointments on site at the surgery, over the phone or over the internet in the way that is most convenient for them. Electronic appointment booking systems can exist as standalone applications but in highly integrated environment can often be found embedded in systems such as Patient Portals, Self Service Applications and Personal Health Records. With an Electronic Appointment Booking system, the referral process in which the GP’s surgery contacts the specialist’s practice who then gets in touch with the patient via post to schedule an appointment is cut down to a single step. Some Electronic Appointment Booking Systems also allow for triage and e-consultations where a clinician in primary care can confirm the need or the speciality to which a patient ought to be referred. 32

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Personal Health Record The Personal Health Record (PHR) is an Internet-based patient owned and patient controlled set of tools that allow people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it. PHR systems can allow patients to manage their own health and the health of others (dependents) through education and monitoring as well as enable the exchange of data with others regarding their health. This technology differs from others in the Healthcare space in that its use and adoption is largely dependent on the patient. In the case of chronic conditions, for example, a patient could update their PHR with their latest readings and make them available online to a clinician or a nurse. PHRs can enable other transactional self service interactions such as booking appointments or requesting a refill of a prescription. Equally, through a PHR, a patient can communicate with their clinician for advice, guidance or e-consultations. Finally, a PHR can help patient access medical information and best practices for the better management of certain conditions. Telemedicine Telemedicine consists of a series of technologies that enable care services to be provided remotely. Telemedicine and other care-at-adistance technologies can enable the sharing of information in the form or records, images, and audio. Telemedicine can be applied in scenarios where the physical presence of a healthcare profes-

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sional is restricted, by distance or time. Whether it is for analysis, diagnosis, consultation or treatment, Telemedicine represents a convenient way for patients to gain access to medical skills in a suitable and timely manner. Home health monitoring has contributed to the reduction of unnecessary visits and clinician appointments as well as the identification of potentially serious situations that would require attention of a clinician. ICT’s Role in Healthcare Transformation. RFID and Bar-coding Radio Frequency Identification (RFID) is a technology that allows traceable chips, called RFID tags, carrying a set of predetermined information to be embedded in objects. RFID readers can pick up radio signals which provide particular information related to the carrier such as identification number, name, and medication requirements. These technologies can be used in a number of ways in a medical setting. For example, Patients can be provided with identification wristbands carrying an RFID tag or a barcode that will be used throughout the patient’s stay in hospital. The tag or barcode would allow caregivers to positively identify and match patients to their care – for example to ensure that the right medicines are going to the right patient. This technology also allows patients to be tracked within the hospital, facilitating bed and service management and timely release of outpatients. Bar-coding/RFID can also be


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Pink Medico used for inventory management and equipment tracking which allows for improved utilization of expensive diagnostic equipment by providing real-time location information. Some hospitals are already using it to track levels of medications and other supplies. Business Intelligence (BI) For Real Time Detection of Hospital Infection Patterns Through the collection, storage, analysis and interpretation of data, business Intelligence systems can generate valuable actionable knowledge for tactical and strategic decision support, trend recognition, forecast, predictive modeling and strategic analysis. Additional capabilities include the ability to distinguish previously unrecognized disease patterns, identify at-risk patients, and review the performance of individual physicians. Business Intelligence and in particular Data Mining are useful tools in the detection of outbreaks when used for the real time detection of infection trends within hospitals. Trend recognition in wards and hospitals can lead to the reduction of outbreaks such as Hospital Acquired Infections (HAIs) if detected at an early stage. These tools are being used to analyze vast amount of data in real time and to help distinguish patterns that could indicate abnormal situations that would require further attention or action from healthcare professionals. Massive efforts are required to promote extensive use of ICT in health sector. Following steps need to be taken in this respect: 1. All public institutions engaged in delivery of health care services in urban and rural areas need to be eenabled urgently to help them to improve the management of their services. Appropriate ICT solutions need to be evolved at all levels of the public health infrastructure, right up to the level of health workers in rural areas. 2. Formulate common national standards for creation and exchange of minimal data sets related to health care services. These standards will have to be 34

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prescribed at the policy level, and a robust regulatory framework also needs to be evolved. National Knowledge Commission Management of Health Sector in India. 3. Launch a massive promotional program to encourage the use of ICT based systems in development of health management. Benefits of ICT in healthcare: Transformed healthcare processes: Build a strong healthcare analytics capability: Increased perception of value delivered from the healthcare service used for inventory management and equipment tracking which allows for improved utilization of expensive diagnostic equipment by providing real-time location information. Some hospitals are already using it to track levels of medications and other supplies. Source: Dr S.Ramanathan, Asia Pacific Journal of Research


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SUFFERING FROM DIABETES?

PROTECT YOUR EYESIGHT

D glaucoma.

iabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and

Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults. Diabetic macular edema (DME). A consequence of diabetic retinopathy, DME is swelling in an area of the retina called the macula. 36

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Diabetic eye disease also includes cataract and glaucoma: Cataract is a clouding of the eye’s lens. Adults with diabetes are 2-5 times more likely than those without diabetes to develop cataract. Cataract also tends to develop at an earlier age in people with diabetes. Glaucoma is a group of diseases that damage the eye’s optic nerve—the bundle of nerve fibers that connects the eye to the brain. Some types of glaucoma are associated with elevated pressure inside the eye. In adults, diabetes nearly doubles the risk of glaucoma. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness.


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Diabetic Retinopathy:

Diabetic Macular Edema (DME)

Chronically high blood sugar from diabetes is associated with damage to the tiny blood vessels in the retina, leading to diabetic retinopathy. The retina detects light and converts it to signals sent through the optic nerve to the brain. Diabetic retinopathy can cause blood vessels in the retina to leak fluid or hemorrhage (bleed), distorting vision. In its most advanced stage, new abnormal blood vessels proliferate (increase in number) on the surface of the retina, which can lead to scarring and cell loss in the retina.

DME is the build-up of fluid (edema) in a region of the retina called the macula. The macula is important for the sharp, straight-ahead vision that is used for reading, recognizing faces, and driving. DME is the most common cause of vision loss among people with diabetic retinopathy. About half of all people with diabetic retinopathy will develop DME. Although it is more likely to occur as diabetic retinopathy worsens, DME can happen at any stage of the disease.

Diabetic retinopathy may progress through four stages: Mild nonproliferative retinopathy. Small areas of balloon-like swelling in the retina’s tiny blood vessels, called microaneurysms, occur at this earliest stage of the disease. These microaneurysms may leak fluid into the retina. Moderate nonproliferative retinopathy. As the disease progresses, blood vessels that nourish the retina may swell and distort. They may also lose their ability to transport blood. Both conditions cause characteristic changes to the appearance of the retina and may contribute to DME. Severe nonproliferative retinopathy. Many more blood vessels are blocked, depriving blood supply to areas of the retina. These areas secrete growth factors that signal the retina to grow new blood vessels. Proliferative diabetic retinopathy (PDR). At this advanced stage, growth factors secreted by the retina trigger the proliferation of new blood vessels, which grow along the inside surface of the retina and into the vitreous gel, the fluid that fills the eye. The new blood vessels are fragile, which makes them more likely to leak and bleed. Accompanying scar tissue can contract and cause retinal detachment—the pulling away of the retina from underlying tissue, like wallpaper peeling away from a wall. Retinal detachment can lead to permanent vision loss.

Risk for diabetic retinopathy People with all types of diabetes (type 1, type 2, and gestational) are at risk for diabetic retinopathy. Risk increases the longer a person has diabetes. Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy, although only about half are aware of it. Women who develop or have diabetes during pregnancy may have rapid onset or worsening of diabetic retinopathy. Symptoms: The early stages of diabetic retinopathy usually have no symptoms. The disease often progresses unnoticed until it affects vision. Bleeding from abnormal retinal blood vessels can cause the appearance of “floating” spots. These spots sometimes clear on their own. But without prompt treatment, bleeding often recurs, increasing the risk of permanent vision loss. If DME occurs, it can cause blurred vision. Detection: Diabetic retinopathy and DME are detected during a comprehensive dilated eye exam that includes: •

Visual acuity testing. This eye chart test measures a person’s ability to see at various distances.

Tonometry. This test measures pressure inside the eye.

Pupil dilation. Drops placed on the eye’s surface dilate (widen) the pupil, allowing a physician to examine the retina and optic nerve. www.pinkmedico.com

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Pink Medico •

Optical coherence tomography (OCT). This technique is similar to ultrasound but uses light waves instead of sound waves to capture images of tissues inside the body. OCT provides detailed images of tissues that can be penetrated by light, such as the eye.

A comprehensive dilated eye exam allows the doctor to check the retina for: •

Changes to blood vessels

Leaking blood vessels or warning signs of leaky blood vessels, such as fatty deposits

Swelling of the macula (DME)

Changes in the lens

Damage to nerve tissue

If DME or severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damaged or leaky blood vessels. In this test, a fluorescent dye is injected into the bloodstream, often into an arm vein. Pictures of the retinal blood vessels are taken as the dye reaches the eye. Prevention and Treatment: Vision lost to diabetic retinopathy is sometimes irreversible. However, early detection and treatment can reduce the risk of blindness by 95 percent. Because diabetic retinopathy often lacks early symptoms, people with diabetes should get a comprehensive dilated eye exam at least once a year. People with diabetic retinopathy may need eye exams more frequently. Women with diabetes who become pregnant should have a comprehensive dilated eye exam as soon as possible. Additional exams during pregnancy may be needed. Studies such as the Diabetes Control and Complications Trial (DCCT) have shown that controlling diabetes slows the onset and worsening of diabetic retinopathy. DCCT study participants who kept their blood glucose level as close to normal as possible were significantly less likely than those without optimal glucose control to develop diabetic retinopathy, 38

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as well as kidney and nerve diseases. Other trials have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss among people with diabetes. Treatment for diabetic retinopathy is often delayed until it starts to progress to PDR, or when DME occurs. Comprehensive dilated eye exams are needed more frequently as diabetic retinopathy becomes more severe. People with severe nonproliferative diabetic retinopathy have a high risk of developing PDR and may need a comprehensive dilated eye exam as often as every 2 to 4 months.

DME - Treatment: DME can be treated with several therapies that may be used alone or in combination. Anti-VEGF Injection Therapy. Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid. Blocking VEGF can reverse abnormal blood vessel growth and decrease fluid in the retina. Most people require monthly anti-VEGF injections for the first six months of treatment. Thereafter, injections are needed less often: typically three to four during the second six months of treatment, about four during the second year of treatment, two in the


Pink Medico third year, one in the fourth year, and none in the fifth year. Dilated eye exams may be needed less often as the disease stabilizes. Focal/grid macular laser surgery. In focal/grid macular laser surgery, a few to hundreds of small laser burns are made to leaking blood vessels in areas of edema near the center of the macula. Laser burns for DME slow the leakage of fluid, reducing swelling in the retina. The procedure is usually completed in one session, but some people may need more than one treatment. Focal/grid laser is sometimes applied before anti-VEGF injections, sometimes on the same day or a few days after an anti-VEGF injection, and sometimes only when DME fails to improve adequately after six months of anti-VEGF therapy. Corticosteroids. Corticosteroids, either injected or implanted into the eye, may be used alone or in combination with other drugs or laser surgery to treat DME. The Ozurdex (dexamethasone) implant is for short-term use, while the Iluvien (fluocinolone acetonide) implant is longer lasting. Both are biodegradable and release a sustained dose of corticosteroids to suppress DME. Corticosteroid use in the eye increases the risk of cataract and glaucoma. DME patients who use corticosteroids should be monitored for increased pressure in the eye and glaucoma. Treatment for PDR : For decades, PDR has been treated with scatter laser surgery, sometimes called panretinal laser surgery or panretinal photocoagulation. Treatment involves making 1,000 to 2,000 tiny laser burns in areas of the retina away from the macula. These laser burns are intended to cause abnormal blood vessels to shrink. Although treatment can be completed in one session, two or more sessions are sometimes required. While it can preserve central vision, scatter laser surgery may cause some loss of side (peripheral), color, and night vision. Scatter laser surgery works best before new, fragile blood vessels have started to bleed. Recent studies have shown that anti-VEGF treatment not only is effective for treating DME, but is also effective for slowing progression of diabetic retinopathy, including PDR, so anti-VEGF is increasingly used as a first-line treatment for PDR.

Virectomy : A vitrectomy is the surgical removal of the vitreous gel in the center of the eye. The procedure is used to treat severe bleeding into the vitreous, and is performed under local or general anesthesia. Ports (temporary water-tight openings) are placed in the eye to allow the surgeon to insert and remove instruments, such as a tiny light or a small vacuum called a vitrector. A clear salt solution is gently pumped into the eye through one of the ports to maintain eye pressure during surgery and to replace the removed vitreous. The same instruments used during vitrectomy also may be used to remove scar tissue or to repair a detached retina. Vitrectomy may be performed as an outpatient procedure or as an inpatient procedure, usually requiring a single overnight stay in the hospital. After treatment, the eye may be covered with a patch for days to weeks and may be red and sore. Drops may be applied to the eye to reduce inflammation and the risk of infection. If both eyes require vitrectomy, the second eye usually will be treated after the first eye has recovered. Source: The National Eye Institute, USA

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Pink Medico

ERECTILE

DYSFUNCTION

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E

Pink Medico

rectile dysfunction (ED), also called impo-

Listed below are some other reasons for ED:

tence, is not being able to get and maintain an erection for long enough to have sexual intercourse.

Obesity, high blood pressure, and high cholesterol

Hormonal problems such as low testosterone

Psychological problems including stress, anxiety, and depression

Nervous system problems including damage to spinal cord or brain

Diabetes can cause ED because it can damage the blood supply to the penis and the nerves that control an erection.

Smoking, drinking too much alcohol, and using some illegal drugs

Some medications such as those taken for high blood pressure and depression

Poorly managed diabetes can lead to erectile dysfunction due to its effects on the bloodstream.

Pelvic injury or surgery on the prostate, bowel or bladder may cause damage to nerves connected to the penis. This nerve damage can also lead to ED.

Tobacco use and Alcoholism and other forms of substance abuse

Sleep Disorders

There are many causes of erectile dysfunction (ED) which can be physical, psychological, or both. One of the most common causes of ED is diabetes.

Studies suggest that 35-75 percent of men with diabetes will go on to develop ED. They will also tend to develop ED some 10-15 years earlier than men without diabetes.

When a man becomes sexually aroused, a chemical called nitric oxide is released into his bloodstream. This nitric oxide tells the arteries and the muscles in the penis to relax, which allows more blood to flow into the penis. This gives the man an erection. Men with diabetes struggle with blood sugar level swings, especially if their condition isn't managed. When their blood sugar levels get too high, less nitric oxide is produced. This can mean that there is not enough blood flowing into the penis to get or keep an erection. Low levels of nitric oxide are often found in those with diabetes.

"A Study suggests that 35 - 75% of men with diabetes will go on to develop Erectile Dysfunction"

Tests and diagnosis Some of the following tests to diagnose ED: •

Blood tests to check for a raised blood sugar level, which may indicate diabetes.

Hormone tests to measure the levels of testosterone and other hormones.

Ultrasound: This test is usually performed by a specialist. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems.

This test is sometimes done in combination with an injection of medications into the penis to stimuwww.pinkmedico.com

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Pink Medico late blood flow and produce an erection. Urinalysis (Urine Tests) to test for sugar in urine, which might indicate diabetes.

desire in men with diabetes. Those who lost weight had increased testosterone levels and blood flow resulting in better erections.

Physical examination to assess the genitals and nerve reflexes in the legs and penis.

Overnight erection test. Most men have erections during sleep without remembering them. This simple test involves wrapping a special device around your penis before you go to bed.

Stress reduction: ED can cause stress and tension in a relationship. Counseling can be helpful even if the origins of sexual dysfunction are physical. People with ED should try to find time for relaxation and get enough sleep every night.

This device measures the number and strength of erections that are achieved overnight. It can help to determine if your erectile dysfunction is related to psychological or physical causes.

Injection of a drug into the penis to check that the blood supply to the penis is normal.

Treatments and Drugs: Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner's preferences also might play a role in your treatment choices. Keeping diabetes under control is a good way to re duce the risk of erectile dysfunction.

A new study also suggests that supplementation with amino acids called l-arginine and l-citrulline may also help to improve erectile function. These acids are known to increase the body's production of nitric oxide, which can increase blood flow to the penis. As stated previously, low levels of nitric oxide are often found in men with diabetes. Treatment of ED will depend on the cause and there is a range of good treatment options. Doctors can switch any prescription medications that may contribute to ED. The most common treatment is with oral tablets. These have been shown to work well in many men with diabetes, restoring sexual function. Certain drugs called PDE-5 inhibitors are used to treat ED. Oral medications: Oral medications are a successful erectile dysfunction treatment for many men. They include:

Erectile dysfunction due to diabetes is much better understood now. Good control of diabetes can reduce the risk of ED.

Sildenafil (Revatio, Viagra)

Tadalafil (Adcirca, Cialis)

Other preventive measures such as stopping smoking and reducing alcohol intake will help lower the risk of developing ED.

Vardenafil (Levitra, Staxyn)

Avanafil (Stendra)

Eating a healthy diet and doing exercise: Studies suggest that men who changed their diet to one low in saturated fat and high in fiber and did moderate physical activity each week were able to improve ED without prescription drugs. Weight loss: Some studies show that even a small weight loss can improve erectile function and sexual 42

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All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.


Pink Medico

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections. The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset. Your doctor will consider your particular situation to determine which medication might work best. These medications might not fix your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

ide mononitrate (Monoket) and isosorbide dinitrate (Dilatrate-SR, Isordil) •

Take a blood-thinning (anticoagulant) medication or high blood pressure medications

Have heart disease or heart failure

Have had a stroke

Have very low blood pressure (hypotension) or uncontrolled high blood pressure (hypertension)

There are several other forms of treatment for ED, some of them are as follows: Hormone therapy: Testosterone replacement therapy is recommended for men with ED who show low levels of testosterone.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor's OK. Medications for erectile dysfunction might not work or might be dangerous if you:

Penile injection therapy: Injection of alprostadil (Caverject) directly into the penis before intercourse has been approved for men who do not respond to oral drug therapy. This hormone injection increases the blood supply to the penis to produce an erection.

Penis pump: A plastic tube connected to a pump (vacuum erection device) is placed over the penis. The pump empties the air out of the tube and this

Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Minitran, Nitro-Dur, Nitrostat, others), isosorb-

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Pink Medico causes blood to be drawn into the penis. A ring is then placed on the base of the penis to maintain the erection during intercourse. The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch. You have to be cautious before you purchase the penis pump, enusre it is made by a reputed manufacturer.

Blood vessel surgery. Rarely, leaking or obstructed blood vessels can cause erectile dysfunction. In this case, surgical repair, such as vascular stenting or a bypass procedure, might be needed.

Penile prosthesis: This is only considered when all other treatment options have failed as it requires major surgery. An inflatable rod is implanted into the penis to make it erect for intercourse. These implants consist of either inflatable or semirigid rods. Inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep your penis firm but bendable.

The Food and Drug Administration (FDA) has issued warnings about several types of "herbal viagra" because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.

Psychological support: If erectile dysfunction is caused by psychological conditions, such as anxiety or depression, the patient may benefit from counseling.

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Alternative medicine: Before using any supplement, check with your doctor to make sure it's safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.

Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for men who take nitrates.


RNI Ref. No.:

MAG(1)/NPT/258/2016-2017

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