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EDITOR EVENT SPEAK

World Heart Day 29th September

Healthy Heart Choices for Every one, Every where……. The majority of cardiovascular disease (CVD) is caused by risk factors that can be controlled, treated or modified, such as high blood pressure, cholesterol, overweight/obesity, tobacco use, lack of physical activity and diabetes. However, there are also some major CVD risk factors that cannot be controlled. In terms of attributable deaths, the leading CVD risk factor is raised blood pressure (to which 13 per cent of global deaths is attributed), followed by tobacco use (9 per cent), raised blood glucose (6 per cent), physical inactivity (6 per cent) and overweight and obesity (5 per cent). Small Steps to Secondary Prevention of Cardiovascular Disease (CVD) aims to encourage people who have experienced a cardiac event to take small ‘heart healthy’ steps to help mitigate the risk of a subsequent cardiac event. Recognising the complexity of the rehabilitation process following a cardiac event, patients can benefit enormously from taking one small step at a time to make favourable lifestyle modifications and improve adherence to treatment programmes, which can lead to positive behavioural changes and reduce the risk of experiencing a repeat cardiac event.

magazine Volume - VI Issue - III Sept.-Oct. 2015

Editor Chief Editor Editorial Advisor

The medical tourism industry is growing by 15-20% annually. Is your hospital business growing at the same pace? If it isn’t, you need to invest to grow your program more international tie-ups.   FICCI is organizing Advantage Healthcare India 2015 to encourage Medical tourism & International business with International summit on Medical Value travel. Every industry changes and adapts in order to be successful.  One factor sets apart the most successful medical travel players today: planning, strategy and execution are factors that create the most successful medical travel players today. Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m

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www.m e d e g a t e t o d a y. c o m Sept.-Oct. 2015

Dr. Pradeep Bhardawaj GP Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia

National Head

Afzal Kamal

Asst. Manager

Deepti Tripathi

Sales & Marketing

Cheif Correspondent

Sales and Marketing Subscribtion & Cirrculation

Rizan Khan

Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Nizamuddin Alam Jagruti Diddi All right Reserved by all everts are made to insure that the information published is correct ‘Medgate today’ holds no responsibility any unlikely errors that might occur.

India Now emerging hot spot for Medical Tourism Industry Gone are the days when doors are opened and patients are expected to walk in. Programs cannot succeed today without a proper plan, roadmap, longterm strategy and, more importantly, execution through business development.

Dr. ma Kamal

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Contents News

Fortis Escorts Heart Institute (FEHI) performs India’s first on “ Pharma Exports: API Challenges” Left Ventricle Aneurysm and LVAD implant on the oldest National Conference th on July 24 2015 at PHD House, New Delhi 16 patient in India 8 ™ Community Health Workers from India and China Medtronic LAUNCHES Resolute onyx Drug-Eluting 18 empowered to provide cardiovascular disease (CVD) care stentIN India through Smart Mobile App 10 Paras Hospitals, Gurgaon initiates “Friendly public 25 years of continued success in treating Heart Diseases breastfeeding” Urges government to build breastfeeding 20 spurs Fortis Escorts to launch the Fortis Escorts Liver and rooms in public Digestive Diseases Institute 12 Breast Cancer Can Re-occur: You Can Now Know Your 22 First of its kind combined transplant at Medanta on World Chances of Relapse Organ Donation day

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World Heart Day Feature

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Doctor Speak

Cover Story

World Heart Day

40-47

Dental Section Gum problems in pregnancy could lead to premature babies 38

Diagnosis and Management of Dengue Fever in Children 30 Hair and Skin Care in Rainy season 34 Game Teaches Doctors How to Communicate Better With Patients 36

Interviews 56

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54 48 Dr. Purshottam Lal

Dr. M.A Chisti

Chairman Metro Group of Hospital

Chief Cardiac Surgeon Mahatma Gandhi Hospital, Jaipur

Dr. Pratap C. Reddy

Dr. Ashok Seth Chairman, Fortis Hospital

Chairman & Founder of Apollo Hospital

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53 Dr. T.S. Kler

Director & HOD Cardiology Fortis Escort Hospital, New Delhi

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Mr. Suresh Vazirani

Chairman & Founder of Transasia Bio-Medicals Ltd.

www.m e d e g a t e t o d a y. c o m May-June 2015

Dr. Jagdish Prasad

Director General of Health Services

Dr. Dinesh Batra

Director Cygnus Group of Hospital


PPP, technology the only solutions to healthcare challenge in India - CII Healthcare Conclave

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xperts from Healthcare Industry called for active industry participation under PPP mode, and focus on technological advancements as the only solution to vast prevailing disparity in healthcare at the CII Conclave on NextGen Healthcare - Roadmap: Quality Healthcare for All, organized by Confederation of Indian Industry at New Delhi, here today. They also stressed upon the need for active collaboration and support of various stakeholders like the industry, cooperatives and the NGOs in strengthening healthcare delivery systems, drugs distribution, use of Information Technology (IT), latest technologies and enhanced pharma supply chain management.  “Integration of working of five key ministries i.e the Ministry for Rural Development, Women & Child welfare, Water, Urban sanitation, Education and health is quite imperative”, said Mr Dr Dinesh Batra, Co-Chairman, CII Healthcare & Director, Cygnus Hospitals.  “If these five ministries can derive coordinated campaigns and launch joint schemes, then they would be far better equipped to provide quality healthcare to each and every individual of this country”, he added.

spend on healthcare while government spends 30 %. What we also need is the maximum utilization of the funds”, shared Mr Dr Dharmendra Nagar, Managing Director, Paras Healthcare. “It is very disheartening that still, 45 % of the Indian children are malnourished, our mothers are anemic, our villages have poor hygiene, while around 400 million abject poor are deprived of any healthcare services in India. Hence, we need to gear up our healthcare delivery mechanisms and for this, partnership is the only solution. There is a 160 billion USD untapped potential by 2017 in healthcare including hospitals, pharmaceuticals and delivery systems etc in India, which industry can really benefit from. With latest technologies, we can reach out to even the last man in remotest area in the present day Digital India, since 900 million people in India are accessible through mobile phones while another 120 million through internet. CII would consider creating a group on this state subject and take it further at state level”, Dr Dinesh Dua, Vice Chairman, CII Chandigarh Council and CEO and Director, Nectar Lifesciences Ltd.

“Some key issues that need to be addressed include like lack of infrastructure and manpower, inaccessibility of healthcare services, shortage of medical specialists and inefficiency of public healthcare providers. Though, in major urban areas, healthcare is of adequate quality and accessible, but its access is limited or unavailable in most rural areas and Tier II & Tier III cities, for which technology and partnership is the answer”, shared “Each year 39 million people in India enter BPL category Mr. Amit Mookim, Country Principal, South Asia, IMS Health. due to poor delivery of healthcare services. To confront this, industry has to by-pass the rules and regulations and bureaucratic bottlenecks  and find out innovative ways or build confidence with Chief Ministers and get MC regulations eased, to build world class hospitals and strengthen healthcare delivery system in India. For this, the key is good intent and strong political will of the government”, emphasized Mr Batra. “This is because some of the challenges lie outside healthcare policy. Two-thirds of the health problems can also be solved by providing safe drinking water and sanitation. Even if we concentrate on these basic facilities, we can control many waterborne and airborne infectious diseases”, he informed.

“Though the share of Healthcare sector has increased from 0.9 % to 2.5 % of GDP in the 12th Five Year Plan, but still it is far low as compared to other countries, considering the diverse challenges of our vast country. For example, US spends 20 % of its GDP on healthcare. Hence we need support of all stakeholders like the Industry, NGOs, cooperatives etc. Industry presently spends 70 % of the total w w w.medegatetoday.com Sept.-Oct. 2015

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NEWS Update

National Conference on “ Pharma Exports: API Challenges” on July 24th 2015 at PHD House, New Delhi •

Industry to be consulted for Pricing with NPPA: Shri Hansraj Gangaram Ahir, MoS, Ministry of Chemicals and Fertilizers

Rs 500 crores TUFS for Pharma Sector: Dr V. K Subburaj, Secretary, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers

The Chamber in association with Department of pharmaceuticals, Ministry of Chemical and Fertilizer organized a Conference on Pharma Exports: API Challenges on 24th July 2015 at PHD House, New Delhi. The Chief Guest of the Conference was Shri Hansraj Gangaram Ahir, Minister of State for Chemicals and Fertilizers, Dr V.K. Subburaj, Secretary, Department of Pharmaceuticals, Ministry of Chemical and Fertilizer was the Guest of Honour; H.E. Prof. Sudharshan Seneviratne, High Commisioner, High Commissioner of Sri Lanka and Mr. Boujdaria Jamel, Charge d’ Affairs, Embassy of Tunisia were the Special Guests. Shri Hansraj Gangaram Ahir, Hon’ble Minister of State, Ministry of Chemicals and Fertilizers, Chief Guest in his Inaugural Address announced that Industry would be consulted on pricing with NPPA. He highlighted that government is going to implement key points from the Katoch Committee’s report. He indicated that in the proposed API policy, the issue of API imports from China would be more than adequately addressed and all the legitimate issues and concerns of the Pharmaceutical Industry would be taken care of to the best of its satisfaction. He pointed out that the Indian Pharmaceutical Industry is one of the most successful industries of India. He stated that the ministry will extend their full support to the industry. He highlighted that the Indian Pharmaceutical Industry has made its presence in more than 150 countries in the world. He stressed the innovation required in this industry. He stated that the Indian Pharmaceutical industry should maintain WHO standards and there is need to sustain it. There is tremendous scope for this industry world-wide for which there is a greater need for investments in R&D. He emphasized that India should be self dependent for APIs and we should not depend on China for APIs or Bulk Drugs. He also stressed to implementation of Jan Aushadhi scheme more aggressively under which Ministry is planning to open around 50000 Jan Aushadhi centres across India. 18

www.m e d e g a t e t o d a y. c o m Sept.-Oct. 2015

Dr V. K. Subburaj, Secretary, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, was the Guest of Honour. He announced that the government would shortly put in place Pharma Manufacturing Technology Upgradation fund worth Rs 500 crores on lines of TUFS in textile industry to enable domestic Pharma companies, especially the SME segment to make quality drugs. He also stated that the necessary consultations have already taken place with the concerned stakeholders in the government as well as industry and only approval related formalities remain to be fulfilled before the final document relating to the two policies – Bulk Drugs policy & API policy are put in domain. He pointed out that only 14-15% of domestic Pharma manufacturers out of close to 10,000 Pharma manufacturers are making quality drugs of world standards due to non availability of finances. He emphasized that India’s growth in the past ten years has been tremendous in the field of overall production and exports. Pharmaceuticals; 50% of whole for domestic consumption and 50% is for exports. He talked about the Indian Pharmaceutical industry has grown in terms of volume and in terms of value we are lagging behind; therefore there is need of developing cost


NEWS Update EVENT

Breast Cancer Can Re-occur: You Can Now Know Your Chances of Relapse

Patients who are at a high risk of cancer recurrence are found to benefit extremely from adjuvant chemotherapy. Knowing the risk of recurrence can enable doctors to decide whether to opt for adjuvant chemotherapy or not, writes Mr. Anand Gupta, Founder & CMD, iLife Discoveries

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reast cancer is the most common cancer in women, and is the leading cause of cancerrelated deaths in the fairer sex across the world. According to estimates of the World Health Organization, over 508,000 women died in 2011 due to breast cancer. It is a largely held belief that breast cancer is a disease of the developed world. However, this is a major misconception. As of today, almost 50% of breast cancer cases are being diagnosed in developing countries such as India, which also account for a higher mortality due to the disease, largely because of late diagnosis as well as by the lack of adequate diagnosis and treatment facilities. The rising incidences of breast cancers in India have in recent years forced the medical fraternity to turn special focus on the disease and its occurrence trends. Oncologists in India are working to devise better treatment strategies and better diagnostic mechanisms to improve survival rates. When it comes to cancer, a relapse or recurrence remains a major area of concern. Some women will go on to live healthy and productive lives after defeating breast cancer; but in some others, the deadly disease will return after a few years of remission. Breast cancer can recur at any time but most recurrences happen in the first 5 years after treatment. The disease may recur even after a mastectomy has been conducted. It may come back as a local recurrence or somewhere else in the body, causing more complications and problems. Patients who are at a high risk of cancer recurrence are found to benefit from adjuvant therapy or additional intensive treatment. But, we do not know what course which cancer will take, and which cancer will eventually recur. Given this lack of ability, doctors are currently forced to practice a blanket approach in treating all patients. This blanket approach may now be up for a change with the introduction of new path breaking gene tests that can predict with high degree of accuracy the chances of the cancer’s recurrence and indicate thereby whether intensive treatment is needed or not. iLife Discoveries recently introduced revolutionary new gene tests in India that will help oncologists get a

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NEWS Update

World Heart Day Feature

By Dr KK Aggarwal

The heart is the only organ in the human body, which once it starts beating, continues to beat with a speed of around 72 beats per minute till the last breath. Being the most precious organ, it needs uttermost respect and care. Disorders of the heart can either be acquired through lifestyle irregularities or can be present at birth (congenital heart disease).   A few tips, which I always give my patients, include the following: • An ideal diet should also be low in sodium, and no person should consume more than 6 gm of sodium chloride in a day. • The consumption of trans fat, which is found in hydrogenated oils or vanaspati ghee, should be minimal as it is bad for the heart and reduces the good HDL cholesterol levels and increases the bad LDL cholesterol. • A person should avoid eating out as much as possible since the food in most restaurants and hotels is high on trans fat and usually will be bad for the heart • Refined carbohydrates like white bread, white flour, white rice and refined sweetened cereals and white sugar should be avoided and replaced with options like whole grain flour, healthy green cereals and oat meal • Any sweet item containing more than 10% sugar should be limited. On an average the sugar content in soft drinks is 10%, Indian sweets are 30-50% sugar My formula of 80 to live a healthy life till the age of 80 years • Keeping ones abdominal circumference less than 80cm Abdominal Circumference also called the adiposity, or male type obesity is associated with an increased risk of morbidity and mortality. People with abdominal obesity are more likely to develop heart disease; diabetes, hypertension and dyslipidemia in comparison to those who are suffering from overall obesity. One can measure abnormal obesity by measuring a person's body mass index (BMI) and waist circumference. The waist circumference is measured with a flexible tape placed on a horizontal plane at the level of the iliac crest as seen from the anterior view. In adults with a BMI above 23 kg/m2, waist circumference >80 cm is associated with a greater risk of hypertension, type 2 diabetes, dyslipidemia (abnormal cholesterol levels), and heart disease. Dr. K.K. Aggarwal

President, Heart Care Foundation of India, Honorary Secretary General Indian Medical Association

• High blood pressure and its risks, keeping the lower reading at 80 High blood pressure is a common lifestyle condition in which the flow of blood against the artery walls is very high and eventually causes major health problems. Blood pressure is determined by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood the heart pumps and the narrower the arteries, the higher your blood pressure. Often known as a silent killer with no symptoms for up to two decades, if not controlled over a period, it may lead to permanent damage to the heart, brain, kidney and eyes. If a person is diagnosed with high blood pressure, he or she should seek immediate medical advice. • Keeping one's blood sugar below 80mg Fasting blood sugar above 80 mg% increases the risk of macrovascular diseases (heart attack, paralysis, and peripheral vascular disease). For any prevention of cardiovascular disease, the blood sugar should always be below 80 mg%. • Bad cholesterol levels should be lesser than 80mg The optimal value for LDL bad cholesterol is < 80 mg% in Indians. • Keeping the pulse lower than 80 beats per minute Higher the resting heart rate more the chances of sudden death. The ideal situation is keeping one's pulse rate it lower than 80 beats per minute.  • Eating a balanced diet and avoiding cereals for 80 days in a year Vedic science states “lesser you eat the more you live” The age old book of science also writes that one should avoid cereals (wheat, rice) for at least 80 days in a year, from wherein the concept of fasting came into being. Eating cereals every day especially the refined carbohydrates (white sugar, white maida and white rice) causes high insulin levels and insulin resistance. Eating fewer calories have shown to reduce the chances of developing heart attacks. One should not eat more than 80g or 80 ml caloric food for any meal • Getting at least 80 minutes of exercise in a day Adequate exercise is very necessary for 80 minutes per day. Cardiovascular training exercises involves walking 80 steps a minute for 80 minutes a week.  Cardiovascular exercise involves attaining 80% of target heart rate (220- age is 100% target heart rate). • Consuming alcohol in moderation For males those who consume alcohol socially, the intake should be less than 80g every 1 week. For women, it is recommended that they should not consume more than 80g of alcohol in 2 weeks.

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DOCTOR SPEAK

Diagnosis and Management of Dengue Fever in Children

Accurate and timely diagnosis of dengue virus is important for early detection of dengue virus infection. In this study, the usefulness of the dengue NS1 antigen test was evaluated as a routine, rapid diagnostic test for dengue virus infection.

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engue is the most common arthropod-borne • Severe myalgias: Especially of the lower back, arms, viral (arboviral) illness in humans. It is and legs transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical • Arthralgias: Usually of the knees and shoulders • Nausea and vomiting (diarrhea is rare) and tropical areas of the world. Dengue fever is typically a self-limiting disease with • Rash: A maculopapular or macular confluent rash over the face, thorax, and flexor surfaces, with islands a mortality rate of less than 1%. When treated, dengue of skin sparing hemorrhagic fever has a mortality rate of 2-5%, but when left untreated, the mortality rate is as high as 50%. • Weakness • Altered taste sensation Signs and symptoms Many patients with dengue experience a prodrome of • Anorexia chills, erythematous mottling of the skin, and facial • Sore throat flushing, which may last for 2-3 days. Children younger • Mild hemorrhagic manifestations (eg, petechiae, than 15 years usually have a nonspecific febrile syndrome, bleeding gums, epistaxis, menorrhagia, hematuria) which may be accompanied by a maculopapular rash. • Lymphadenopathy Accompanying symptoms in patients with dengue may Diagnosis include any of the following: Laboratory criteria for the diagnosis of dengue include 1 • Headache or more of the following: • Retro-orbital pain • Isolation of the dengue virus from serum, plasma, leukocytes, or autopsy samples

Dr. Rajiva Kumar

Child Specialist, Muzzafarpur

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Demonstration of a fourfold or greater change in reciprocal immunoglobulin G (IgG) or IgM antibody titers to 1 or more dengue virus antigens in paired serum samples

Demonstration of dengue virus antigen in autopsy tissue via immunohistochemistry or immunofluorescence or in serum samples via enzyme immunoassay (EIA)


EXPERT VIEWS

Game Teaches Doctors How to Communicate Better With Patients

Scenarios help physicians explain diagnoses clearly and listen more carefully

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f you or a family member has ever had a serious medical problem, you know how important it is to have doctors with good communication skills. They should be able to explain their diagnoses clearly and describe the procedures they propose using terms you can understand, and they should listen to your concerns and treat you with courtesy and respect.

COMMUNICATION MODULE

The game is targeted at general practitioners and medical students doing internships in general medicine. The story line is that of a new doctor fresh out of medical school, referred to as “the player,” who has just set up a practice. The player can choose a female or male avatar. There are also virtual nonplayer characters such as patients, office However, studies show physicians tend to overestimate staff members, and other doctors. the effectiveness of their bedside manner. In their defense, Medical experts, including physicians, educators, and doctors point out they have limited insight into how they psychologists, developed the rules of the game. These come across to patients and lack feedback mechanisms to determine if actions taken by the player have beneficial help them. or detrimental effects on a patient. The researchers also To teach communications skills to medical personnel, a worked with general practitioners who teach medical trio of researchers at the Toulouse Institute of Computer students and supervise interns.A trio of researchers from Science Research in France have come up with a video France developed this video game prototype, which game. The game, at the prototype stage, relies on provides feedback to general practioners and medical traditional medical consultation scenarios and the latest students on how they communicate with patients. e-health technologies. Their article, “Design of a Serious The game includes three modules: communications, Game in Training Nonclinical Skills for Professionals in electronic health records, and telemedicine. the Health Care Area,” was presented at the 2014 IEEE Third International Conference on Serious Games and The player’s first activity is to conduct a consultation Applications for Health and is now available in the IEEE session witha new male patient in his 50s who has type 2 diabetes and wants his prescription renewed. The Xplore Digital Library. session has four phases. In the first, the player prepares The authors are IEEE Member Remi Bastidée, a professor for the session, greets the patient, introduces herself, and of computer science at the Université Champollion, in identifies the reasons for the consultation. Albi; Jing Guo, a Ph.D. student in computer science and technology at Toulouse Institute; and Nicolas Singer, The next phase concerns gathering information, with or a professor of engineering with the ISIS School of without a physical exam. The third consists of providing a treatment plan and explaining it to the patient, making Engineering, in Castres. sure he understands what is expected. In the last phase, the As in most games, there’s a story line, and there are goals, player must summarize the session for the patient, make challenges, the awarding of points, and rewards. The the next appointment, and say goodbye. Other activities game runs on a Web server and presents preprogrammed introduced along the way may include having to answer a questions for the player to answer. The player chooses phone or adding to a patient’s electronic health record in her answers from a computer-generated list of multiplethe EHR module. choice responses. Right now it’s all in French, but translations to other languages could come in the future. At every step, the player chooses a preprogrammed

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EXPERT VIEWS

question or action from among those suggested by the game engine and spelled out on the screen. The researchers call these general steps taken during a consultation microsequences. The patient responds to what the player says or does with his own set of preprogrammed responses. Completing the microsequences advances the player to the next phase. At the end of each phase, a screen summarizes the actions the player has taken and identifies any incorrect actions—or wrong answers selected—along with the correct ones. Since no two patients are alike, and to make the game more enjoyable, the developers created patients with different medical histories, diseases, and personality traits. For traits, the patient can be confident or aggressive. Each trait influences certain attributes of the patient’s sentences, thus changing behavior. The player selects a patient profile and a topic to discuss. Actions taken by the doctor during the consultation can affect the patient’s behavior. To deal with this, the game proposes different sentences so players learn how to adapt their own language accordingly. Each sentence reflects a set of attributes such as politeness, clarity, or empathy. When it is the patient’s turn to respond to the doctor, the game chooses a sentence according to the patient’s profile. For example, if the patient likes to talk a lot, his sentence may be long and not directly relevant to the topic at hand. The doctor then must decide what action to take; participating in irrelevant conversations earns the player negative feedback, so players can learn to adapt their language. The developers addressed complaints from doctors about the lack of a feedback mechanism to gauge their bedside manner and how it affects the patient. The researchers provide a gauge by reflecting stress levels in the virtual patient’s facial expressions. How a player handles a patient’s stress is one of the key elements of the game, according to the researchers.

with EHRs and how they can make both patients’ and doctors’ lives easier,” the researchers say. “As e-health systems, computers, and smartphones become common in people’s daily lives, they have to be considered because of their many advantages over traditional education.” Players gain access to the modules for EHRs and telemedicine when they take certain actions during a consultation. For example, choosing to review a patient’s medical history opens up an EHR module. The module presents the patient’s medical history, and the player can add information obtained during the consultation, which the game engine then summarizes. In this module, a written tutorial explains the reasons for using an EHR as well as the laws that protect the privacy and confidentiality of such records and the steps doctors need to take to secure the integrity and availability of information in an EHR system. The need to consult with a colleague in another location or schedule an appointment for a patient in another city gives a player access to the telemedicine module, which is still being developed. According to Guo, one of the ideas here is to highlight the variety of devices that a doctor can use, such as Web cameras and remote measurement instruments. SCORING THE GAME Because this is a role-playing strategy game, several indicators are used to compute different scores. One score reflects the confidence level the virtual patient has with the player. The researchers also developed what they call a “familiarity value” that measures the player’s knowledge of EHRs and telemedicine. After reaching certain point levels, medals are awarded each time one of the four phases is completed. NEXT STEPS

The game prototype, still under development, is not yet ready for testing. For example, it has yet to be enhanced with more-intelligent virtual patients, E-HEALTH TECHNOLOGY giving the player more scenarios to deal with. The The past decade has seen the implementation of e-health developers can’t say when their prototype will be records in hopes of improving the quality of health care complete. and reducing costs. But the success of EHRs depends on “A good serious game requires a great amount of effort by the medical professionals using them knowledgably and a multidisciplinary team, and development phases can be integrating them into their practices. very long,” points out Guo. “Our game presents an overview of what can be done

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COVER STORY

Is your heart skipping a beat? It could be a heart rhythm disorder. Mrs. John, a 65 year old homemaker, grandmother to and “in-charge” of raising up her son’s two children, had been feeling fatigued for the last one month or so. She was becoming a little short of breath on performing routine activity at home, but after resting for few minutes she would feel fine. Life was never like this before. An ECG revealed the problem. Her heart beat, at around 40 beats per minute, was too slow. It was sufficient for her while she rested, but would not increase when she became active. The net result was that the amount of blood being pumped out was simply insufficient to sustain her during increased activity. Medicines were tried, but without any significant benefit. The solution was a “pacemaker”.

beyond the age of sixty; the incidence keeps increasing with age. A very small minority are present since birth, in people born with an abnormal electrical system in the heart. Some of these electrical abnormalities can occur in association with other heart ailments like a heart attack, or be precipitated by medicines. In a minority of people with slow heart beat, medicines can improve the situation. In the vast majority, the degenerated electrical system of the heart never grows back. Such patients need a pacemaker, which is small device placed under the skin under the collar bone after a numbing medicine. Supplementing the heart’s electrical system: Different types of “pacemakers” Permanent “pacemakers” have been used since 1958 to supplement the faulty electrical system of the heart. There are three types of pacemakers, depending on the number of cardiac chambers where stimulation is provided. •

Single chamber pacemakers stimulate only the right lower chamber of the heart.

Dual chamber pacemakers stimulate the right upper and right lower chambers.

Triple chamber pacemakers stimulate the right upper and both lower chambers (Figure 2). A triple chamber pacemaker is also called a “Cardiac Resynchronisation Therapy” (CRT) pacemaker. Stimulating more number of cardiac chambers translates to better synchrony between the various chambers of the heart, and ensures better working efficiency of the heart. In certain patients, a minor loss of cardiac efficiency may not make a significant difference; however, in some others, even a minor drop in efficiency may produce a considerable difference.

Figure 1: The electrical system of the normal heart Common abnormalities in the heart’s electrical system With Mrs. John, the “sinus node” – the area that generates the electricity was not increasing the heart rate sufficiently to support her body’s requirement during activity. • People with a normal, healthy heart or those who “feel fine” could develop such abnormal heart rhythms, called “arrhythmias” in medical parlance. The majority of such wear-and-tear cannot be prevented. Though these can surface at any age, most such abnormalities manifest 42

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Some pacemakers only prevent the heart beat reducing below a particular rate, regardless of the patient’s activity status. Such pacemakers are called fixed rate pacemakers. However, our heart rate also needs to increase during exertion. Pacemakers that can sense physical activity, and increase the heart rate propor-


COVER STORY

Heart Failure What is Heart Failure? Having heart failure means that for some reason your heart is not pumping blood around the body as well as it used to. The most common reason is that your heart muscle has been damaged, for example after a heart attack. It can be very frightening to hear that you or a person close to you has heart failure. Accurately speaking it should not be termed ‘Heart Failure’, it should rather be called ‘Heart Impairment’. Do not fear heart failure as it can be treated with modern treatments. There are lots of reasons why you might be diagnosed with heart failure. It can be sudden or it can happen slowly over months or even years. What causes heart failure? The most common causes are: Heart attack High blood pressure Cardiomyopathy (diseases of the heart muscle. Sometimes these are inherited from your family and sometimes they are caused by other things, such as viral infections). Heart failure can also be caused by: Heart valve problems Alcohol or recreational drugs Abnormal Heart Rhythm (arrhythmia) Congenital Heart Defects  (ones you’re born with) Viral infection affecting the heart muscle Some cancer treatments.

Dr A B Gopalamurugan

Consultant Interventional Cardiologist Director, MIOT Hospitals, Chennai

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What are the Symptoms of Heart Failure? The main symptoms are: • shortness of breath • swelling • fatigue • Chest Pain • Loss of consciousness (if you develop dangerous heart rhythms which is common in heart failure) Symptoms occur because the heart does not have enough strength to pump blood all the way round the body efficiently. This can cause fluid to pool in the feet and legs. If this fluid is left unmanaged, it can build and spread to your stomach area and sit beneath your lungs. This reduces their ability to expand and makes you short of breath. Medication and making changes to the way you live can make a real difference to these symptoms. People with heart failure experience different symptoms and everyone copes in different ways, so speak to your cardiologist and your heart failure specialist about what is best for you. How is heart failure diagnosed? To diagnose heart failure, your doctor will ask you questions about your medical history, talk to you about your symptoms and do a physical examination. In most cases you will also have further tests to confirm the diagnosis and guide how your symptoms are controlled. These include blood tests, an electrocardiogram (ECG), a chest x-ray, an echocardiogram and a coronary angiogram. You may hear your doctor talk about the ‘ejection fraction’ of your heart. This refers to the amount of blood that is pushed out of your left ventricle every time your heart beats. It’s usually expressed as a percentage. A normal ejection fraction is around 50-65 per cent, as there is always some blood left in the heart after each heartbeat. Some people with heart failure have a normal ejection fraction, so ejection fraction is used alongside other tests to help diagnose heart failure. Diagnosing accurately is crucial as that determines the treatment your require. Therefore it is crucial you are seen by an expert cardiologist with dedicated teams for managing heart failure.


INTERVIEW Putting forward the healthcare agendas in the Government in order to uplift the present healthcare system of India. Dr. Jagdish Prasad unveils variuos plans and policies of the government which would be boosting the healthcare of the country. “We have started treating Diabetes and hypertension in our country and so far i the 100 districts, and we have screened around 65 million population and we have found that diabetes is 3.4.-7 percent, and in some places 9 percent and they have diagnosed and treatment is being done, then hypertension patients also it varies from 3.5-5 percent so it has been detected and put on treatment.” Please tell us your journey in the Healthcare Industry ? My journey is a very fruitful journey so far and we have done many things so far like maternal mortality and infant mortality has come down tremendously. We have developed the millennium development goal and not only that we have reduced tuberculosis as well as Rntcp tuberculosis has come down. If You compare to 1990 where there was more than 462 tuberculosis patients per lac population now it is has come down to 176 per lakh population. Leprosy has been eliminated at the state level and district level also we are on the verge of elimination 172 districts are left. Kala-azar we are now nearly verge of elimination by 2015 but it extended up 2016 because of other asian countries like Bangladesh. We all are planning that we will eliminate together. We have developed national trauma programs and in these programs we have developed 116 national trauma centers to control the trauma. We have 4 trauma care centers like one is L4 we have made available ambulance every 50 kms on the highway and every 25 km in the hilly areas. In L3 level we have made available ambulance every 50 km district hospital and we have upgraded to tackle the emergency problems. Then we have L2, it has been developed every 100-150 km and then about 350 to 700 km develop a tursrey care centre for the trauma. So in the 11th plan we are having 116 such centers like there and n the 12th plan we are developing 78 more and it is in the process. WE have started treating Diabetes and hypertension in our country and so far in the 100 districts and we have screened around 65 million population and we have found that diabetes is 3.4-7 percent and in some places 9 percent and they have diagnosed and treatment is being done and then hypertension patients also it varies from 3.5-5 percent so it has been detected and put on treatment. There NCG program in which we are developing NCG clinic in every district and in CSC. We also see that any patient coming for cancer then they will be treated as the government of India has planned per district 1 crore rupees for giving chemotherapy. What’s the state of Cardiology in India according to you as compared to abroad? It is as good as any European or American country as the cardiology is concerned because whatever is available in the

European and American countries is very much available in India now. Cardiology operations in India are very cost effective also. What are the various developments that has been done in Cardiology in India.Please enlighten us? If you see public sectors a then out of 640 districts, we have already established cardiac clinics in 350 districts. We have made the cardiac ICCU in the district level then at the tertiary level ,under the prime minister swastha yogna we have given money to state government to develop the super specialty cardiology and other wings that is more than 74. If you see private sector then there are many corporate hospitals which has come up and are doing well in the cardiology set up. As the last years health budget was not at all adequate for the Health fraternity .What do you think about the health budget for the coming year? We can’t say that health budget was inadequate because already we have a lots of fund lying with the state governments which they have not utilized. Like last year 18000 crore has been used. Whatever money has been sent to the state they should utilized. But definitely government have to increase the fund in the public sector. More fund is required for the health industry. What are the various government policies and agenda for the health industry for the coming year? We should give free medicines because the most of the expenditure on the public health goes in the medicines as they are more expensive. We are planning that poor patients should get free medicines. The government of India is doing free tuberculosis treatments, leprosy treatments, kalajar, I communicable diseases are treated for free, malaria is free in the whole country. The policy is to strengthen our public health system so that more people can use public health facilities and I think we are going to put more money in public sectors. 6 Aims has come up and we are planning to make more aims for tursery care. We are also planning to increase the Health budget for the coming year. Please share your message for the World Heart Day? There are modifiable factors through which you can prevent the disease like no smoking, no alcohol, proper physical exercise should be done and should keep healthy food habits. Proper lifestyle should be maintained and try to avoid junk food.They should do meditation and yoga to decrease the stress. Dr. Jagdish Prasad Director General of Health Services

Medgate is doing a good job as they are spreading awareness in the health industry. Health is an important subject in our society and I think magazines like Medgate connects the doctors ,hospitals and patients by their stories and information. w w w.medegatetoday.com Sept.-Oct. 2015

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INTERVIEW Dr. Batra is the man behind Cygnus Hospitals who aims for delivering better healthcare today in order to make a healtheir tommorow for India

The Idea is to provide services in those sectors where they do not exist and time is very critical. How is your journey till now in the Healthcare business? Please enlighten us ? We started our journey in 2011, and today we are 10 hospital company with many district town hospitals in Delhi, Punjab and Haryana. We have around 2000 employees working with us, and 1000 beds we cater. Whats your vision for Cygnus hospitals and are you looking for any further expansions ? We have a huge expansion plan which is supported by Fidelity and Somerset. We are planning to buy more hospitals by 2016 March, so this will be a 15 hospital company. We are expanding to neighboring states of Punjab and Rajasthan and by 2018 March it will be a 50 hospital company. Whats your business model and on what grounds you operate Cygnus? The idea is to provide services in those sectors where actually they do not exist .For example in most of the districts of india, today those services are not available where time is very critical .For example if you talk of Cardiology, if there is a heart attack to a patient he will die on the road because the nearest centre would be around 100 kms away, if you talk of trauma there is no neurosurgeon in any of the districts, most of the districts lack trauma care and when I say trauma it’s a comprehensive survey, where you require many doctors under one roof. For example you will require a neurosurgeon, orthopedic surgeon, general surgeon, intensive care specialis , radiologist and you will be needing equipments like Citi scan, a good infrastructure in intensive care, monitors, ventilators etc. and people of sufficient expertise to manage these facilities round the clock to take care of sick patients and thirdly a medical intensive care is not available in most of these towns. The idea of Cygnus is to identify those patients where time is very critical and where services are not available. So we have left three districts of Haryana for example Hissar, Faridabad and Gurgaon where these facilities already exist but rest of 18 districts are lying vacant. Similarly in Punjab there is a belt like Sangrur, Mansard, Abohar Fazilika where these services are not existing. So this is the idea and our strategy. What are the various obstacles that you face in the process of planning and management ? It’s a huge challenge to convince doctors to work in peripheral areas, and particularly those doctors who are super specialist in their fields. For example its difficult to make a cardiologist stay in a district town, and make a neurosurgeon ready to work in a

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district town and its a biggest challenge. But we have provided them a very good back up for their children, families and we pay them handsome salaries, we also provide them independence of working including branded ambience. So these are reasons and they have to deal with doctors, as most of the managing staff in this company are doctors, so it provides them a comfort zone and we understand their needs well, and it’s a biggest challenge .Then there are certain regulatory issues in peripheral areas which are a challenge as well for example like in US even technicians are allowed to do Ultrasounds but in india even MBBS doctors are not allowed to do ultrasound which is a huge challenge. Then you have to keep intensive stationed in ICU and huge manpower of AYUSH doctor is available who are expert in the procedure which are required in the ICU but the government does not allow. What is the success rate of the operations that have been done in Cygnus since inception? It’s at par with national and international figures we do not claim to do everything but whatever we do is at par and is of the national standard .For example if we are doing the joint replacement at our centre, it will have a infection rate between 1 and 2 so this is same across the country and if you are doing any neurosurgery the complication would not exceed because most of these people have come from the corporate hospitals in Delhi. We have infrastructure, expertise and ambience ,so everything put to together there is no change, as far as the outcome is concerned . How do you see India as a Medical Destination and What’s the take of Cygnus on it.? Practically speaking since we are into peripheral areas, we do not aim to have medical tourism because there is so much to do for our own country, and how can you expect a person coming from a different country, will go to Panipat or Sonipat for treatment. He will go to a five star hospital in Delhi, Mumbai, Bangloru and Hyderabad. We don’t plan for medical tourism and this segment is for everyone and there are bigger players for this. We love to serve our countrymen rather than focusing on outsiders.

Dr. Dinesh Batra

Director Cygnus Group of Hospital

Medgate today is a wonderful magazine, and I have been in touch with them for last 3 years. I am having special affinity for senior management particularly Mr. Afzal, as we also stay in touch not only professionally but informally as well. We keep on discussing the challenges of Healthcare and how do we overcome those challenges through media like Voice of Healthcare came up really well. So Medgate Today is an extended family for Cygnus.

www.m e d e g a t e t o d a y. c o m Sept.-Oct. 2015


INTERVIEW Making it Happen in India is not a fantasy but a reality as Transasia takes the lead in Medical technology and focuses on affordability Please tell us your journey with Transasia since inception? We are proud to be an Indian multinational, as you know some people say multinational has be to be foreign but we are an Indian Multinational. We operate in more than 100 countries worldwide. We have our offices in 8 countries across the world. These are mostly acquisition companies, what we have acquired and we have acquired 11 companies in last 6 years, which has given access to many technology but also to markets. The US company that we acquired is very good in the field of immunology. I started this company with 250 rupees capital .Meeting people’s expectations, giving people what they need and we are very conscious on affordability issues in India, because you might give a high technology but if people can’t afford it then it’s of no use. We are also very conscious about after sales service, so we have 250 service engineers based in all over India ,which is more the number if you put all competitors together. So any town you call transasia would be there. In India after sales service is more important than other countries.

Driving force is to make in India a success, as I am an enthusiastic and a passionate Indian. I also believe that “hum kisi se kam nahi.

There are so many challenges to deal in india now ,this Make it Happen in india is a fantasy or a reality? Whats you take on this ? It is hard and we are working on it to make a reality. If you talk about problems then connectivity is one issue, traveling is the other. If I want to send one spare part to the hospital in Kolkata, I cannot just do it with a courier or something like that because taxation and entry permit is there, it’s so silly and India is not one market as rest of the world is one market in this context. If I want to

send any part to Patna, I cannot do it because of so many formalities like entry permit and all, so there are too many obstacles here. Hopefully GST will solve this but now it’s hard situation. Whats the driving force for Transia despite of so many challenges in India? Driving force is to make in India a success, as I am an enthusiastic and a passionate Indian. I also believe that “hum kisi se kam nahi”. There is a stereotype in India about technologies which are made in India are cheap and doest not follow international standard as china and India are in the same list. How you will break this stereotype. In india everyone wants foreign products. We really have to work hard for breaking this barrier. We are as good as US and UK.In India we have 25000 customers who use our technology in labs and hospitals. We have 4 factories in india and three factories overseas which are USA, Italy, Czech Republick. How do you see Indian Healthcare system as compared to other developing countries? Today only 20 percent people have access to healthcare in India .80 percent people don’t have access to it. Indian government just spends only 1 percent of GDP on healthcare which is nothing even Bangladesh spends more than india, Srilanka spends more than india. How come china is ahead of India in the Global context? Chinese government spends 8 percent GDP on healthcare and I think Indian government is yet to wake up to realize that healthcare is important. Mr. Suresh Vazirani

Chairman & Founder of Transasia Bio-Medicals Ltd.

It’s really good to keep the doctors informed about Healthcare and medical technology. As in India most of the time people don’t know what is happening here. Medgate is playing a very important role in Health fraternity as they are keeping doctors aware and to let them know whats happening in the wolrd. As normally doctors are busy people they hardly have time to attend seminars and all, so this Medgate today magazine they can read it, which provides a holistic view of healthcare industry.

w w w.medegatetoday.com Sept.-Oct. 2015

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INTERVIEW An investment of 600 crores for the equipment proton for treating Cancer, people call him crazy but he is the man behind Apollo Hospitals. Dr. Pratap Reddy

Dr. Pratap Reddy explains his vision about Healthcare in India. Tell us about yourself and journey with Apollo Hospitals? As I am a doctor and I come from a small village but for all of us if you look inside and check, is it satisfying what we are doing and is good enough or there is something more that we can do. I think it is a wakeup call that I had several years ago, when I lost a young man who could not afford to go to U.S for the heat surgery, as I used to send my patients abroad because there were no advance heart surgery progammes in the country at that time. People called me crazy when I said ,that we will bring the best Healthcare in india from around the Globe. What inspired you for building Apollo hospital and what was your vision ? It was not easy but finally the first hospital was inaugurated in 1983 and now we have 55 hospitals and covering almost all places. More importantly people ask me are you Mayo clinic, or Cleveland clinic, I tell them that I am not one of those, and they are not what I am because I am the only healthcare player who is in total space of health like from awareness to education, preventive health checks, insurance and hospital administration. In the Healthcare

last year Apollo was the world number one in kidney heart and liver transplant and we will do many things as far as this is concerned because there is a great motivation and we support the teams in terms of process protocol and lab equipments as they want technology for example people will call me crazy because for one equipment proton I am investing 600 crores for treating cancer, so we have done full support and my teams are ready for everything. So I think there is nothing that Apollo will not do or attempt and we want perfection as we want to live up beyond the expectations of the people in Apollo. How do you take India as a medical destination and whatâ&#x20AC;&#x2122;s the role of Apollo? I wanted to give my people all the facilities so that they should not go abroad for the treatment and now more than 150 countries are coming to us and believe me mark my words, India will become the global destination for Healthcare What are the possible plans of expansion in the Healthcare Industry by Apollo hospitals . We are expanding continuously and this year we are having 1000 bed and we will add another thousand bed next year and we are doing many more new things like this today we are connecting 60,000 villages ,so you can imagine what impact it will have on the healthcare of the country .

Dr. Pratap C. Reddy Chairman & Founder of Apollo Hospital

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MEDICAL TOURISM

India is becoming Emerging Medical Tourism Destination in World’s Map No one could imagine that this third world country can be a choice of international patients for the treatment, Its India who is taking a lead as a medical destination and would be surpassing Singapore and Thailand in coming years. After Being one of the most populous country, the major challenges comes to the Healthcare Industry because when it comes to health then everyone is equally entitled to access the Health services.Health is one of the millennium development goal,One can say that India is progressing by leaps and bounds in order to achieve Healthcare standards as a millennium development goal.

lives in abject poverty, so the public healthcare system in india provides services at a very low lost to the poor people but the corporate hospitals takes the lead in the Healthcare business in india as the international patients from the subcontinent like Bangladesh, The Middle East, East Africa are arriving in india in big numbers and not only these, patients from America,United Kingom, Canada and from other European countries travel to India Its not an Indian propaganda about promoting india’s particularly for more expensive cardiac and orthopaedic healthcare in the world. It’s the fact that the tourist are surgeries in which health travelers can save thousands of flocking in india for medical treatments from across the dollars in the treatment compared to the cost back home. borders therefore making india as an emerging medical hotspot . There are many reasons which are making India a medical tourist hub, its not just only medical facilities that There are various factors which influences India’s medical attract patients from far across international borders, but tourism market and therefore makes India a destination also the soft power of India which includes the cuisine, of choice for the foreign patients Whilst India’s tourism culture, exotic locations and entertainment Industry .The market is expected to reach $6 billion(36000 crore) by emergence of Ayurveda In India has also captivated many 2018. Presently medical tourism market is more than$3 foreign patients and it’s serves as a global attraction . billion as estimated and tourist arrivals are estimated around 230,000 according to the( Punjab Haryana Delhi How Ayurveda is acting as a catalyst for the medical Chamber Of commerce report). tourism in India. After all what makes india a medical Destination.

Many people wonder what ayurveda is all about in India.Ayruveda is knowledge of life or the science of If we talk in terms of medical professionals then, india life.Its essentially the science, through which one can is a home to some of the most dexterous Doctors acquire knowledge about the lifessignetyles one get the even recognized around the world. The talent pool of knowledge about the useful and the harmful ways of life Doctors holding expertise in various specializations in india is enormous. India provides World class facilities Infact Loads of foreign direct investment FDI of worth in Hospitals in terms of skilled professionals, Doctors, US$ 2,793.72 million has been pumped in various nurses and also promotes anti- xenophobia which provides Healthcare centres in India between April 2000 to January comfort zone to the medical tourists. India has a two tier 2015 according to the reports revealed by Department of healthcare delivery system because the other half of India Industry and Policy promotion.

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MEDICAL TOURISM

Goa: A Destination for Medical Tourism

W

hen you have to recuperate from a medical procedure few can argue about the healing benefits of the sun, sand and sea nearby. Add to this, world-class medical facilities, trained professionals and top quality infrastructure – all this makes Goa the place for medical tourism. Interest in this form of tourism has slowly witnessed a rise especially from tourists in the Middle East, South East Asia and even parts of Europe. The state-of-the-art medical institutions set up in Goa regularly promote medical tourism and wellness packages. Even the government-run Goa Medical College, offers specialized treatments that attracts patients from all over the world. The interest in medical  tourism  is  stepping up as many  specialized faculties  by  renowned  medical  institutions  have been set up  here  in the  State.  Right from Cardiac, Dental, Orthopedics, Oncology and so on, there are a wide variety of facilities.  “The  government and the  health ministry  are already  engaged  in  ensuring  top class medical  facilities  are  brought to the State and all credentials  are  verified  and   examined  before  any institution  open its  doors  for  medical treatments  whether  to  tourists  or  the  general public. Goa Tourism  is  proud  to  state that  we are gaining recognition  for  Yoga  and Wellness

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Tourism   which  has  synergies   with  medical tourism. We  recently  bagged  the  IITM  2015 award  in Chennai  as  the  Wellness Destination of the  Year  which  is  an indication that  everything  is  working well on this  front,” says Mr. Nikhil Desai, MD, Goa Tourism Development Corporation. Medical Tourism has traditionally been associated with cancer treatment, heart ailments & joint replacement surgeries; it is being observed that ‘Cosmetic treatments’ i.e. cosmetic surgeries are getting increasingly popular among international tourists & locals, alike, in Goa. Contrary to the popular perception that it is only foreign tourists, who are coming in for cosmetic surgery, analysis shows, that an equal number of Goan locals are also increasingly going in for cosmetic treatments. The people in Goa are very cosmopolitan in nature and are aware of the latest trends. With the maximum number of foreign tourists flocking to Goa every year, Goa is one of the prime destinations for medical tourism in India. According to reports the reason behind India’s success as a destination for medical tourism can be attributed to the fact that cost of treatment and medicines here is among the most reasonable in the world, especially when matched with the international standard facilities that are being provided by hospitals and medical institutions.


WINDOW Advt.

w w w.medegatetoday.com Sept.-Oct. 2015

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