Page 1

Vol.4 Issue 3

APRIL - JUNE 2018

THE DIAGNOSTICS NEWS JOURNAL

Published at Agappe Diagnostics Limited on April 01, 2018 | 62 Pages | ` 20

INNOVATION & AFFORDABILITY IN PRE-ANALYTICS AN AGAPPE INITIATIVE Mr. Thomas John

CARDIAC BIOMARKERS: AN OVERVIEW Dr. D. M. Vasudevan

“TREAT MEDICINE AS YOUR SERVANT”: AN INTERVIEW Dr. S.I. Padmavati

QUALITY HEALTHCARE AT AFFORDABLE COST: ORBITO ASIA Dr. Dharani Subramaniam

INTERVENTIONAL CARDIOLOGY: RECENT ADVANCES AND TRENDS Dr. Mathews Paul

with love

HEART TRANSPLANT: AN OVERVIEW Dr. Jose Chacko P.

CARDIOLOGY Summarizes Cardiovascular Diseases with Diverse Articles & Success Stories


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CONTENTS ○

7

Volume 4 | Issue 3 | April-June 2018 ○

Thy Heart of Gold

12-15 Cardiac Biomarkers - An overview 20-23 Dr. S. I. Padmavati - India’s First & Oldest Woman Heart Specialist... 24-25

Monitoring and maintaining healthy lipid levels in the blood is Crucial to Stay Healthy

26-29 An overview on Heart Transplant 34-36 Quality Healthcare at Affordable cost

16-19

The ‘STENT MAN’

37-39 Flying without wings - The Story of Risabh 40-43 Recent Advances and Trends in Interventional Cardiology 44-46 Cor is Your Core Organ, Pay attention to it... 47-49 Importance of Hardware Calibration in Clinical Laboratory

08-11 INNOVATION & AFFORDABILITY IN PREANALYTICS AN AGAPPE INITIATIVE 52-53 Brand Reach-Customer Speaks 54

Engagements - Exhibitions & Conferences

55

Engagements - Special Days

58

Moments-Awards

59

AGPrivilege

60

Medical Quiz and Editorial Submissions

30-33

BORN AGAIN, TWICE

Views and opinions expressed in this magazine are not necessarily those of Agappe Diagnostics Limited, its publisher, or editors. We do our best to verify the information published but do not take any responsibility for the absolute accuracy of the information. We do not take responsibility for returning unsolicited material sent without due postal stamps for return postage. No part of this magazine can be reproduced without the prior written permission of the publisher. Techagappe publishers reserve the right to use the information published herein in any manner whatsoever. Caution: After going through the techniques, procedures, theories, and materials that are presented in Techagappe, you must make your own decisions about specific treatment for patients and exercise personal/professional judgment for further clinical testing or education and your own clinical expertise before trying to implement new procedures. Contact info: The Manager-Corporate Communication, Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. www.agappe.com Contact: Ph: + 91 484 2867065, Mob: +91 9349011309. Published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. Contact: Ph: + 91 484 2867000, Fax: + 91 484 2867222; Printed at Five Star Offset Printers, Nettoor, Cochin-40, for Agappe Diagnostics Limited Printed and Published by Ms. Meena Thomas on behalf of Agappe Diagnostics Limited and Printed at Five Star Offset Printers, Nettoor, Cochin-40 and published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas.

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○ ○

From The Chief Editor’s Desk

THE DIAGNOSTICS NEWS JOURNAL

○ ○

○ ○ ○ ○

FOCUSES ON CVD I

am very pleased to place before you, this latest issue of TechAgappe, the quarterly review of health and laboratory medicine. Different themes were elaborated in previous editions on each issues, such as Renal illnesses, Hepatic ailments, Pancreatic disorders, Cancer, Neurological disorders, Gastroenterological complaints, Gynaecological maladies, Clinical haematology, Lung diseases, Musculoskeletal disorders, Eye diseases, Skin diseases etc. This magazine is now regular in publication at intervals of three months. I am also happy to report that the laboratory community has warmly welcomed the previous issues of the magazine. The present issue focuses on diseases affecting cardiovascular system.

○ ○ ○ ○ ○ ○ ○

We have three medical articles. The first scientific article describes the cardiac markers, which will be very relevant to the clinical laboratories. The second cover story is from Dr. Jose Chacko, Lisie Hospital, Kochi - an authority on the subject. He has written on the matters related to heart transplantation. The third cover story is by Dr. Mathews Paul from Moulana Hospital, Perinthalmanna, highlighting the latest trends in interventional cardiology. As usual, we have added three life stories. The first life story is about Mr. Girish Kumar from Palakkad who had heart failure. He is the one who faced dual heart transplant in India for the first time under the supervision of Dr. Jose Chacko in Lisie Hospital. Second story is about Mr. Rishabh Puri from Chandigarh who had been suffering from cardiac issues. He had Hyperlipidemia from child hood onwards and he faced frequent cardiac arrests. But he could overcome all those challenges and could become a great writer and entrepreneur. He is the writer of famous book ‘Flying without wings’. The third story is from Mr. K. J. Joseph, Chairman of Thejo Engineering Ltd, Chennai. He is known as the ‘Stent Man’ as he has around 9 stents in his body followed by many heart valve issues and surgeries. He successfully manages his health condition and is a living example for motivating other persons who faces cardiac diseases.

○ ○ ○

In this issue, we have included two interviews. One is with Dr. S. I. Padmavathi, the oldest and first woman cardiologist in India, who now heads the National Heart Institute, New Delhi. The second interview is with Dr. Dharani of Orbito Asia’s Diagnostic, Coimbatore, who is sharing his knowledge about recent trends in IVD industry.

○ ○ ○ ○ ○ ○ ○

I am sure, this issue of the TechAgappe will give useful insights to the problems of cardiac diseases and certain special aspects of laboratory practices. I am proud to announce that the ensuing issues of TechAgappe will cover other important topics. Your constructive criticisms to improve the contents will be greatly appreciated. With warm personal regards,

We have a technical article in this edition about ‘Importance of Hardware Calibration in Clinical Laboratory’ which makes the magazine more useful and attractive to its readers engaged in IVD industry.

○ ○ ○

Subscription-For subscription queries, write to techagappe@ agappe.in or call us at +91 484 2867065. Permissions-For permissions to copy or reuse material from Techagappe, write to techagappe @agappe.in Letters to the editor-Email: techagappe@agappe.in Postal address: The Manager-Corporate Communication, Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district, Kerala-683 562, India. Advertisement QueriesEmail: techagappe@agappe.in

EXECUTIVE DIRECTORS Meena Thomas Sangeeta Joseph Mary Baby Meleth Dr.D.M.Vasudevan

MANAGING DIRECTOR Thomas John

CHAIRMAN Prof. M.Y. Yohannan

BOARD OF DIRECTORS

PHOTOGRAPHY Nelson Thomas

WEB MANAGER Sanjaymon K.R

DESIGN AND LAYOUT M.T. Gopalakrishnan Dezign Centre, Kochi. 9947144570

PUBLISHING COORDINATOR Jayesh Kumar

LEGAL ADVISORY BOARD Adv. Denu Joseph

EDITORIAL ADVISORY BOARD Rajesh M. Patel Dr. C.S. Satheesh Kumar Sudhir K. Nair Jofy Paul Gopalakrishnan R. Sanjaymon K.R Vijith Kumar V. Mallya Bintu Lijo

CONSULTING EDITOR Rarima N.S

CHIEF EDITOR Dr. D.M.Vasudevan

EDITOR Meena Thomas

EDITORIAL BOARD

Volume 4 | Issue 3| April-June 2018 ○

Dr. D.M. Vasudevan

TECHAGAPPE

APRIL-JUNE 2018

5


LETTERS TO THE EDITOR

Remarkable Content and a Reliable Source of Reference TechAgappe is overall a well-

presented and edited magazine. The look and feel and the articles presented are marvelous. Colored photographs are pleasing and clear. The magazine is remarkable with ample of material presented. Health tips are decently well-placed which touches the natural way of living and caters to our healthy life solutions. The technical article about preanalytics is highly appreciated as it is interestingly very important for lab diagnostics and the information is saved and kept with us as a reference point. Thanks Agappe for your whole hearted efforts to helps us better with ‘TECHAGAPPE’. Chandresh Dagha

Anant Pathology Lab, Mulad, Mumbai

A True Motivating Mirror Reflecting Real Life, Health and Fitness It is the right time to express my gratitude towards Agappe’s d iagnostic news journal ‘TECHAGAPPE’ which have inspired us very much. When reading through each topic, I would proudly say that the topics presented were creatively focused on human health and fitness with ample emphasis on living health style syndromes and its diagnosis. The three life stories related to Psoriasis, Vitiligo and eradicating leprosy were motivating channels to those people who suffer and give hope to them by informing how to overcome chronic diseases with a sheer determination. I would like to congratulate the entire publishing crew for their enduring contribution to help us better with ‘TECHAGAPPE’. Mr. Prasanth A S, Biochemistry Head, Anathapuri Hospital, Trivandrum

Very Informative Content

In this edition, the life story and medical articles especially the health tips are very much informative to the students and supporters of the patients who suffer psoriasis, leprosy and vitiligo. The description of the diagnostic tests and the safety precautions in the technical article session is also very useful. Ambujam M. B, Kottayam

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Amazing Content and PresentationInformative and Inspiring!

Happy to know about the life of Kartiki Bhatnagar - the dreamy

life designer through ‘TECHAGAPPE’. That was a realistic thought-provoking life story, such an article is very rare to read in any other magazine, now a days. These days, we are able to get many diversified magazines, but within a little time of reading through them, we find that the content is mediocre. Sometimes, it’s like wasting our precious time. TechAgappe is different in this segment. This journal contributes knowledge sharing in medical science, recent developments, patient success and motivating stories along with very useful literature and what else to say, I would say, the whole list of contents are wrapped up nicely and precisely. Congrats to editorial team. Keep it up. Mr. Davies K J,

General Manager, Pharmacy, Thangam Hospital of PMRC, Palakkad

Unique and Inspiring Life Stories

The diagnostic news journal

‘TECHAGAPPE’ is very useful guide for health professionals like me. The magazine is very informative and useful. Success stories of people are something unique and inspiring. In the dermatology edition, the stories of Alka Dhupkar and Kartiki Bhatnagar are inspiring us. How beautiful ly they do walk in their life with the illness. The team of ‘TECHAGAPPE’ deserves a pat because of your passion to find and present such beautiful and self-identified stories for the public

awareness. God bless the entire team of ‘TECHAGAPPE’. Sr. Sudhanya MSJ, St. Joseph Hospital, Kozhikode

Magazine Par Excellence

I am happy with the contents

given in the magazine ‘TECH AGAPPE’ and I appreciate the team of ‘TECHAGAPPE’ in their efforts to publish such an international magazine. The platform for quiz is really interesting to us which push us to refer the books for finding the answers and helps to update our knowledge. Thanks to the entire team. Jaineel K Shah, Ahmedabad


Cover Story

Poem on Heart

Thy Heart of Gold Am thy heart, the heart of you, my dear,

Am the most resounding part of constitution & thy life, Am your centre of circulation, the linchpin of dynamism & life, Have countless faces in this universe, so rife in meanings! Heart touching, heartfelt & whole hearted - for the compassionate souls Bleeding heart, all heart, heart full and heartburn - it for mom on you Whole hearted, with all my heart, all heart - in whole & generous way Bottom of my heart, sweet heart, heart to heart - the closeness measure. Big heart, heart of gold, steals heart, close to heart - all the positive side, Heart in your mouth when nervous, but judge before taking your heart to your shoulder, Heartless, heart of stone, the acrid side of you, unlike the heavy heart, Heartbroken, heart attack & heart failure, everybody knows, but nobody longs. Working zero downtime, restlessness & emotional outbreaks mangle me, Stress that gashes me atop, obesity ripping me apart, Sedentary style and littlest exercise cripple me; smoking smothers me, Insomnia, diabetes, hypertension torture me, distorting the nodal tissue & ECG @PQRST

Dr. C.S. Satheesh Kumar, Vice President-Operations, AGAPPE. (Retd. Drugs Controller, Kerala)

Yoga, weight reduction, jubilation & social activism relieve me, Fibrous veggies, fruits, fish with less salt & fat encourage me dear, Anywhere and everywhere, it’s me the heart of your very existence, For, health is wealth, and heart that all matters, the heart and soul of you.

TECHAGAPPE

APRIL-JUNE 2018

7


Agappe MD’s Desk

INNOVATION & AFFORDABILITY IN

PRE-ANALYTICS

AN AGAPPE INITIATIVE

Thomas John, Managing Director, AGAPPE.

From the day of inception, Agappe aimed to give affordable

and quality solutions to the IVD industry. When we look back our journey of the last 22 years, we can see many mile stones which revolutionised the Indian IVD industry. The lipids revolution in India started with the introduction of affordable HDL and LDL direct reagents from Agappe a decade ago. We are the first Indian Company to manufacture immunoturbidimetry reagents. We are the first to introduce dual reagent HbA1c which

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is now the bench mark for HbA1c testing. When it comes to specific protein testing, we are proud to say that we are first Indian Company to introduce semi-automated nephelometry systems designed, developed and manufactured in India. Once controlled only by the Multinational Companies, specific protein testing was not affordable to the common laboratories due to its high cost. The Mispa -I series of nephelometry systems changed specific protein testing not only in India, but it changed the global perspec-


tive. Today Agappe is proud to announce the launch of 4th generation Fully automated specific protein system in Oct 2018. Our mission is to expand and continuously improve our products and services and always look for new opportunities and provide innovative and affordable solutions to become the best partner in diagnostics. The IVD testing can be divided in to Pre-analytical, Analytical and Post Analytical stages. Where pre-analytical stage is the phase where the sampling is performed, analytical stage where the tests are performed and post analytical stage where the reporting is done. When you look at the current scenario, introduction or im-

"Our mission is to expand and continuously improve our products and services and always look for new oppor tunities and provide innovative and affordable solutions to become the best partner in diagnostics".

provement is always happening majorly in the analytical sector. Today analytical automation systems are available from 60 Tests/ hour to 2000 Tests/ hour covering the complete range of IVD testing. The multinationals and Indian manufacturers are doing their best to provide compact and affordable systems in Clinical Chemistry, Immuno-chemistry and Haematology automation. This is one of the reason for the exponential growth in the entry level clinical chemistry automation in India. Today highly affordable systems are available in the haematology segment, thanks to the advancements of electronics, imaging, microfluidics, mechanics and information technology. When we consider the analytical stage, there are multiple check points starting from Internal Quality Control (IQC)testing and peer group testing to assure the quality of the tests performed. The major concern in the Clinical laboratory is to control the pre-analytical errors (majorly sampling errors). It is estimated that 70% of the error in the clinical diagnosis is due to pre-analytical variables. This is mainly due to human errors that can crept in when the blood is taken, transferred to the test tube and labelling is done. In Indian scenario, the highest population of testing is performed in the class B and C (middle and small) laboratories where 60% of the total tests in IVD are performed. This segment accounts to more than 25,000 laboratories, which is approximately half of the total laboratories in India. Due to the lack of pre-analytical automation, these laboratories are spending more time and money to assure the test quality which in

TECHAGAPPE

APRIL-JUNE 2018

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Agappe MD’s Desk

Agappe’s answer to an afford Agappe is proud to announce the in-

troduction of “Mispa Label” the affordable pre-analytical platform to the Indian IVD industry. The system is designed considering the Indian scenario and is one of the most compact system available in the market. The system is with a strong software which is easy to connect with most common LIS/HIS platforms and is also capable for reading 2D barcodes using the hand held reader. We have made the system compact considering the space constrain of the laboratories in India and uses the gravity drop technology to reduce the robotics. The system is having touchscreen graphical user interface with wide connectivity options including WiFi connectivity. Our system is having 6 different channels to keep the

turn is transferred to the common man and is one of the reason for making the test cost high. The pre-analytical platforms currently available from multinationals are not affordable to these small laboratories due to the high investment cost and high recurring cost. Space is another limiting factor in India especially in urban cities. An affordable system with minimal

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space requirement and minimal robotics is the need of the day. At present the pre-analytical automation in India is in the nascent stage and only multinational companies are present in this segment. Their systems are very big and requires huge workload and investment. All these systems should be imported and hence are highly depending on the forex rates. Moreover, recurring cost for


Intelligent Tube Labeling System

able Pre-Analytical Automation test tubes and is capable of accommodating tubes of two different heights. With 6 d ifferent tubes, we can accommodate most of the common tubes used in the phlebotomy station. The system is having Clear Space Detection technology to make sure that the

labels are pasted on the same way in tube after tube without blocking the clear area for visual inspection which is critical in phlebotomy. Mispa Label is capable of handling most of the common barcodes used in the laboratory. It is also possible to customise the

size & location of the barcode, the details printed on the label as per the customer need. We are also in the process of launching a mobile tube labeller platform to support the inpatient sample collection, and a complete phlebotomy station to address the outpatient sample section in hospitals. I am proud to announce that we have received wide appreciation for our tube label ler system in prestigious international IVD conferences held in Medica, Germany in November 2017 and Medlab , Dubai in Feb 2018. We believe that like the Mispa-i series which revolutionised the specific protein testing, Mispa Label is going to change the Pre-analytical automation in the Indian IVD segment and to make the reality of “Complete Automation” in IVD testing.

these imported systems are high. The most common pre-analytical automation system is called as a “Tube Labeller Systems”. These systems are robotic systems usually installed in the phlebotomy stations or in the nursing stations in which primary blood collection tubes are prefilled in the specific compartments. These automated systems are connected to the LIS or HIS interface and

delivers the specific tubes (primary tubes) with barcoded sample ID and Patient demographics when the patient ID is entered manually or using a barcode reader. Since the system communicates with the LIS/HIS interface it makes sure that the proper volume of sample is collected based on the tests requested by the physicians and the sample traceability is also attained.

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Cover Story Cardiac Biomarkers - An Overview

CARDIAC Dr. D. M. Vasudevan, MBBS, MD, (Biochem), FRCPath, Technical Director, AGAPPE.

BIOMARKERS A biomarker is defined as one naturally occurring molecule, gene or characteristic by which a particular pathological process, disease etc. can be identified. Cardiac markers are used in the diagnosis and risk stratification of patients with cardiac diseases, chest pain and suspected acute coronary syndrome (ACS).

A biomarker is defined as one naturally occurring

molecule, gene or characteristic by which a particular pathological process, disease etc. can be identified. Cardiac markers are used in the diagnosis and risk stratification of patients with cardiac diseases, chest pain and suspected acute coronary syndrome (ACS). The cardiac troponins, in particular, have become the cardiac markers of choice for patients with ACS. Indeed, cardiac troponin is central to the definition of acute myocardial infarction (MI) in the consensus guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC): These guidelines recommend that cardiac biomarkers should be measured at presentation in patients with suspected MI, and that the only biomarker that is recommended to be used for the diagnosis of acute MI at this time is cardiac troponin due to its superior sensitivity and accuracy. These cardiac markers are shown in Table 1. Please see Table 2, where the markers are tested.

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ATPase inhibitory subunit) and troponin T (tropomyosin binding Name of the marker Reference value subunit). Cardiac iso form is specific for carA. Markers for Myocardial infarction diac muscle. They are generally identified and 1. Cardiac troponins (cTnT and cTnI) TnT values below 0.01 microgram/litre quantitated by immunological (ELISA or TnI values below 0.10 microgram/litre immunoturbidimetric) reactions. Troponins 2. High sensitivity troponin (hsTnT) Less than 14 nanogram / litre are seen in skeletal and 3. Creatinine kinase (CK) 15–100 U/L for males and 10–80 U/L for females cardiac muscles, but not in smooth muscles. B. Mark ers ffor or card iac failure or v entricular dysfunction Markers ventricular The cTnT and cTnI 1. BNP demonstrate similar diagnostic ability in deLess than 400 ng/L 2. NT-proBNP tection of myocardial C.Mark ers ffor or Risk of Card iac d isease (pred iction) C.Markers damage despite analytical differences. Both 1.Total cholesterol level in serum 150 to 200 mg/dL the Joint ESC/ACCF/ Under 130 mg/dL 2. LDL cholesterol AHA/WHF Task Force for the Universal Defi40-60 mg/dL 3. HDL cholesterol nition of Myocardial InLess than 130 mg/dL 4. Apo B100 level farction and the National Academy of Clini5. Apo A1 level More than 120 mg/dL cal Biochemistry rec6. Ratio of Apo B : A-I Ratio of 0.4 ommend a 20% change from an elevated cTn Values between 100-130 mg/dL 7. Non-HDL cholesterol value as indicative of 8. Plasma hsCRP 0.1 mg /dL additional myocardial necrosis. This 20% 9. Lp(a) level Less than 30 mg/dL change represents a 10. Serum Triglycerides 50-150 mg/dL significant (>3 standard deviations of the variation associated with an Accordingly, some have advocated relying solely on troponin elevated baseline concentration) change in cTn on the basis of a and discontinuing the use of CK-MB and other markers. Neverthe- 5–7% analytical total CV. Cardiac troponin elevations at lower less, CK-MB and other markers continue to be used in some Table 2: Cl inical c ond itions hospitals to rule out MI and to monitor for additional cardiac cond muscle injury over time. where the markers are tested

Cardiac Biomarkers

Note that cardiac markers are not necessary for the diagnosis of patients who present with ischemic chest pain and diagnostic ECGs with ST-segment elevation. These patients may be candidates for thrombolytic therapy or primary angioplasty. Treatment should not be delayed to wait for cardiac marker results, especially since the sensitivity is low in the first 6 hours after symptom onset. ACC/American Heart Association (AHA) guidelines recommend immediate reperfusion therapy for qualifying patients with ST-segment elevation MI (STEMI), without waiting for cardiac marker results.

CARDIAC TROPONINS (CTI / CTT) Troponins are specific markers for myocardial infarction. Measurement of cardiac troponins has become one of the main tests in early detection of an ischemic episode and in monitoring the patient. The troponin complex consists of 3 components; troponin C (calcium binding subunit), troponin I (actomyosin

Cardiac Markers are tested in 1. Any chest pain 2. Unstable angina 3. Suspicious ECG changes 4. History suggestive of myocardial infarction 5. Following surgical coronary revascularization

When should check Lipid Profile? 1. Suspected cardiovascular disease, coronary artery disease and peripheral vascular disease 2. All patients with diabetes mellitus, at least once in 6 months. 3. Thyroid, liver and renal diseases, where lipid metabolism may be altered.

6. Patients with hypotension 4. All persons above 40, should and dyspnea be checked once in a year

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Cover Story Cardiac Biomarkers - An Overview concentrations than the 99th percentile value used for MI diagnosis may identify patients who have not had an MI but still have a risk of having an adverse cardiac event.

with myocardial infarction. Increase may not be seen if patients present 24 hours after development of symptoms. The reporting units for hsTnT should be ng/L.

Troponin I is released into the blood within 4 hours after the onset of symptoms of myocardial ischemia; peaks at 14-24 hours and remains elevated for 3-5 days post-infarction. Therefore, CTI is very useful as a marker at any time interval after the heart attack. It is not increased in muscle injury; whereas CK2 may be elevated in some muscle injury. Cardiac isoform of CTnT and CTnI are mainly (95%) located in myofibrils and the remaining 5% is cytoplasmic. The initial increase is due to liberation of the cytoplasmic fraction and sustained elevation is due to the release from myofibrils.

CREATINE KINASE (CK) Normal serum value for CK is 15–100 U/L for males and 10–80 U/L for females. CK value in serum is increased in myocardial infarction. The time course is shown in Table 3. The CK level starts to rise within 3-6 hours of infarction. Therefore, CK estimation is very useful to detect early cases, where ECG changes may be ambiguous. A second peak may indicate another ischemic episode.The area under the peak and slope of initial rise are proportional to the size of infarct. Iso-enzymes of CK CK is a dimer; the subunits are called B for brain and M formuscle. Therefore, three iso-enzymes are seen in circulation. Normally CK2 (heart iso-enzyme) is only 5% of the total activity. Even doubling of the value of CK2 (MB) iso-enzyme may not be detected, if total value of CK alone is estimated. Hence the estimation of MB isoenzyme is the best diagnostic marker in myocardial infarction. CK and Muscle Diseases The level of CK in serum is very much elevated in musculardy strophies (500 -1500 IU/L). CK level is highly elevated in crush injury, fracture and acute cerebrovascular accidents. Therefore, estimation of total CK is employed in muscular dystrophies and MB isoenzyme is estimated in myocardial infarction. Brain Natriuretic Peptide (BNP)

Serum level of Troponin T (TnT) increases within 6 hours of myocardial infarction, peaks at 72 hours and then remains elevated up to 10-14 days. Elevated cTn levels indicate cardiac injury, including acute coronary syndrome (ACS), stroke, pulmonary embolism, sepsis, acute perimyocarditis, acute heart failure and tachycardia. Therefore more precise tests are needed. To satisfy this necessity, High sensitive TnT (hsTnT) has been developed. It enables determination of very low cTn concentrations. The higher sensitivity of this assay has allowed for improved identification of patients with AMI presenting in the first 3 hours following symptom onset. Even small increases are associated with a higher risk of death and other adverse outcomes. Two measurements of hsTnT are required for the assessment of patients with chest pain; the first measurement should be at presentation and the second sample should be measured 3 hours after. However, if the second sample does not show an incremental rise yet and clinical suspicion remains, then a further sample should be taken 12 hours after presentation. A rise of 20-100% is equivocal and needs further evaluation. Greater than 100% rise is consistent

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The natriuretic peptide family consists of three peptides: atrialnatriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). The clinical significance of CNP is not clear. ANP is produced primarily in the cardiac atria. BNP is present in human brain, but more in the cardiac ventricles. Human pro– BNP contains 108 amino acids. It is cleaved by enzymes within cardiacmyocytes into the active C-terminalBNP (32 amino acids) and an inactive peptide (proBNP 1–76). Both are seen in circulation. These natriuretic peptides defend against excess saltand water retention. BNP and NT-proBNP are released by the cardiac muscle in response to various stimuli such as increased cardiac wall tension from pressure and volume overload in the heart. Patients with congestive heart failure have high plasma concentrations of ANP and BNP. The concentrations are correlated with the extent of ventricular dysfunction. High concentrations of BNP predict poor long-term survival. In breathlessness, BNP test helps in the differentiation of the cause as a heart failure or an obstructive lung disease. Patients with COPD and worsening of their cor pulmonale with signs of RV volume overload (including edema and ascites) had increased BNP


Table 3 Time course of markers of Myocardial infarction Marker

Onset

Peak

Duration

Troponins

4-10 hr

18-24 hr

8-14 Days

CK-MB

3-6 hr

18-24 hr

36-48 hr

Myoglobin

1-4 hr

6-7 hr

24 hr

levels, and indeed, these patients had increased mortality. The best marker of ventricular dysfunction is pro-BNP. Commercial kits are available to assess the level of BNP as well as the amino terminal of the prohormone (NT-proBNP). Normal level of NT-proBNP is less than 400 ng/L. Less than 250 ng makes heart failure highly unlikely. RISK FACTORS FOR ATHEROSCLEROSIS Serum Cholesterol Level: In healthy persons, cholesterol level varies from 150 to 200 mg/dl. If other risk factors are present, cholesterol level should be kept preferably below 180 mg/dL. Values around 220 mg/dL will have moderate risk and values above 240 mg/dl will need active treatment. Females have a lower level of cholesterol which affords protection against atherosclerosis. Plasma cholesterol levels would tend to slowly rise after the 4th decade of life in men and postmenopausal women. For every 10% lowering of cholesterol, CHD mortality was reduced by 13%. Serum cholesterol level is increased in Diabetes mellitus, Obstructive jaundice, Hypothyroidism, Nephrotic syndrome and in Familial hyper lipoproteinemias. LDL-Cholesterol Level: Blood levels under 130 mg/dl are desirable. Levels between 130 and 159 are borderline; while above 160 mg/dl carry definite risk. Hence, LDL is ‘bad’ cholesterol. Recently, simple homogeneous assay for sd-LDL-cholesterol has been developed. HDL-Cholesterol Level: HDL level above 60 mg/dL protects against heart disease. Hence HDL is ‘good’ cholesterol. A level below 40 mg/dl increases the risk of CAD. For every 1 mg/dL drop in HDL, the risk of heart disease rises 3%. If the ratio of total cholesterol/HDL is more than 3.5, it is dangerous. Similarly, LDL: HDL ratio more than 2.5 is also detrimental. Apo-B-100 : It is the specific apopro tein present in LDL. Therefore, estimation of Apo-B concentration is a better way of identifying LDL level. Apo-A-1: High density lipoproteins trans-

port cholesterol from peripheral tissues to the liver. The major apoprotein in HDL is Apo-A. Therefore, estimation of Apo-A concentration is a better way of identifying HDL level. Apoprotein Levels and Ratios: Ratio of Apo B: A-I is the most reliable index. The ratio of 0.4 is very good; the ratio 1.4 has the highest risk of cardiovascular accidents. Non-HDL Cholesterol : Non HDL cholesterol or Atherogenic cholesterol is calculated as (LDL+ VLDL+ IDL+ Lpa). Values between 100-130 mg/dl carries very little risk, those of 130-160 mg/dl have border risk, values 160-190 mg/dl have high risk, while values more than 190 mg/dl carries very high risk. Lp(a) : Lipoprotein (a) or Lp(a) should not be confused with Apo-A. Lp(a) is very strongly associated with myocardial infarction. Lp(a),when present, is attached to LDL. In 20% of population, the Lp(a) concen-tra-tion in blood is more than 30 mg/ dl; and these persons are susceptible for heart attack at a younger age. Indians have a higher level of Lp(a) than Western populations. Lp(a) impairs fibrinolysis, leading to unopposed intravascular thrombosis and possible myocardial infarc-tion. Levels more than 30 mg/dl increase the risk 3 times; and when increased Lp(a) is associated with increased LDL, the risk is increased 6 times. Nicotinic acid will reduce serum Lp(a) level. High Sensitivity C Reactive Protein (hsCRP): It is also called ultra-sensitive CRP. It is a marker for risk for atherosclerosis and is used as a predictor for future myocardial infarction within the next 12 months. Less than 1 mg/L (0.1 mg /dl) is considered as low risk and single measurement is sufficient. Levels between 1-3 mg /L are border line, indicating some risk, and will need assessment of serial samples at one-week intervals. Levels more than 3 mg/L is having high risk for future MI and will need active medical intervention. Atherosclerosis has an inflammatory component, which causes production of CRP in small quantities. The CRP binds selectively to LDL, activates complement, resulting in plaque formation. Statin therapy is found to reduce hsCRP level as well as the incidence of MI. If the hsCRP value is more than 10 mg/L, it indicates significant acute phase reaction and is not indicative of any cardiac pathology, but indicates infections somewhere else. Thus, hsCRP is tested only when other inflammatory conditions are ruled out. If the hsCRP value is more than 10 mg/L, it indicates significant acute phase reaction and is not indicative of any cardiac pathology, but indicates infections somewhere else. Serum Triglyceride: Normal level is 50-150 mg/dL. Blood level more than 200 mg/dL is injurious to health.

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Life Story K.J. Joseph (Industrialist)

THE

‘STENT MAN’

K .J. Joseph, the Chairman of Thejo Engineering Limited, Chennai is known as Josephettan/Joe for the people around. However; to Padmasree Dr. K.A.Abraham, Cardiologist who also happens to be a close friend of Joseph, likes to call him the ‘stent man.’ It’s not a joke! Joseph has got as many as nine stents inserted in his body at several periods of time. Not many people in India have got as many stents as he has inside his body. It was after 2 bypass surgeries.

Born at Nedumkunnam, Changanacherry in Kottayam dis-

trict into a family which had been into farming, film distribution and film theatre ownership, Joseph has a brother and five sisters at home. Joseph completed most of his schooling in and around Nedumkunnam, and Col lege at Changanacherry. For his Engineering studies, he joined Government Maharaja’s Technological Institute , Thrissur and completed his studies in 1961. Watching the uncertainties of the film world from close quarters, Joseph was never interested in joining the family business. So, he jumped at the opportunity of one-year apprenticeship at Enfield India Ltd; in Chennai. His previous unscheduled apprentice training at Cochin Port Trust was not so pleasant. The experience was humiliating and their attitude of paying no respect to the colleagues also sad-

K. J. Joseph

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dened him much. But his experience at Enfield was quite different. “They were very considerate and helpful including the local management people and the foreign representatives. “My Enfield apprenticeship made me work at different departments earning valuable experiences,” says Joseph about his choice to stay at Chennai. After the seventh month of internship, Joseph and his friends heard of a Defence recruitment happening nearby. The recruitment was for paramilitary Wing-(General Reserve Engineering Force) and Joseph, along with his friends, made it to the selection. The training was at Roorkee, Uttarakhand and it lasted for around four to five months. After the training, Joseph and his friends moved to forward areas for border road construction. He served in the construction of road to Shimla-Tibet Border via river Satluj. After serving the nation for two years, during the Chinese war, braving the harsh climate and difficult conditions, Joseph left the army as he felt his calling was not in it.

ployees as manpower. It was a German technique. We became the pioneers of cold vulcanizing technique in India. It provided the company much acceptance in the market. The company grew into foreign markets like Australia, Saudi Arabia, Chile, Brazil, Germany and USA. In the true sense, our company has grown into an MNC. Today, the company has been able to feed more than 2500 families,” Joseph beams with pride saying this.

Pioneer Equipments at Chennai, a company engaged in Foundry Mechanization hired Joseph in his second stint. It was under his leadership, the company successfully implemented the mega project of HAL Koraput which costed around Rs.42 lakhs, a huge sum in those times. In 1966, he got married to Rosamma. After a short stint at Kirolskar, Pune, as marketting head, he came back to Chennai to join FAME (Foundry and Mining Equipment Company) as the Regional Manager in 1971. Joseph excelled in all roles and yearly targets did not even pose the slightest challenge. In 1974, Joseph established Thejo Engineering Services at Chennai along with another partner. From a turnover of just Rs. 75,000 in 1975, they worked hard to take the company into new heights and the current turnover of Rs.300 crores. The story in Joseph’s words is as follows - “Within four years, Thejo spread its wings and became an All India company. The turning point came to us in the form of technological adaption. The process used for conveyor belts jointing till then was hot vulcanizing procedure which needed more manpower, machines, power, chemicals and time. We came upon a process called cold vulcanizing which required no machines, power and just nominal em-

K. J. Joseph and Rosamma

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Life Story K.J. Joseph (Industrialist) The Disease History Before his heart problems emerged, Joseph had Gastroesophageal Reflux Disease (GERD). For four to five years, it became an arduous problem for Joseph. He even went for treatment at Melbourne, Australia for it. Joseph points out that it was an Indian doctor who diagnosed it correctly in 1984. The doctor advised Joseph to never go to bed immediately after the food, avoid high fat food, spicy foods and so on. During 1995, the company was in an expansion mode with many projects and commitments. By then, in the industry, Joseph had earned a name for his commitments. He was not ready to trade it with anything else. On the other hand, the business tension became unmanageable for Joseph. One-night Joseph woke up around 2.30 am after he felt chest discomfort. Since the situation didn’t change after a while, Joseph decided to seek medical attention. Till then, he had no other health problems other than GERD. But the check-up showed signs of diabetics, cholesterol and blood pressure. Apart from prescribing medicines for it, they put Joseph for 10 days observation. Upon the advice of his relatives, Joseph took a second opinion and after examination, the doctor told him that it was unstable angina. He advised him to undergo angiogram. While undergoing angiogram, he experienced a severe shivering. “What happened next was something my wife told me after I became conscious.

What is a stent? A stent is a tiny tube that your doctor can insert into a blocked passageway to keep it open. The stent restores the flow of blood or other fluids, depending on where it’s placed. Stents are made of either metal or plastic. Stent grafts are larger stents used for larger arteries. They may be made of a specialized fabric. Stents can also be coated with medication to help keep a blocked artery from closing.

Why would you need a stent?

After the incident, the doctors put down two options before Joseph - either angioplasty or bypass surgery. Since the success rate of the former was very less in those days, the doctor suggested going for bypass surgery. In September 1995, Joseph had his bypass surgery. After 10 days, he got discharged. He remembers that the pain he went through was not at all tolerable. Even though the doctor was an expert on valves, he wasn’t the best in bypass surgeries, a fact which Joseph came to know only later. In 1998, Joseph began to experience angina after his regular exercise. Joseph had a habit of walking a few kilometres as part of his exercise. He consulted his doctor and the doctor found that it was aneurysm (ballooning in the artery) which is also regarded as a

Stents can also be useful to prevent aneurysms from rupturing in your brain, aorta, or other blood vessels. Besides blood vessels, stents can open any of the following passageways: bile ducts, which are tubes that carry bile to and from digestive organs bronchi, which are small airways in the lungs ureters, which are

You may need a stent during an emergency procedure. An emergency procedure is more common if an artery of the heart called a coronary artery is blocked. Your doctor will first place a

TECHAGAPPE

Joseph’s wife Rosamma was present in the lab while her husband was undergoing angiogram. “Since we knew the doctor well, he allowed me and a relative of us to watch the process from the next room. I could see Joseph looking at the screen. Slowly, I saw him going unconscious. Doctors and nurses became vigilant and we knew that it was an emergency. We saw them providing CPR to Joseph to revive him. For a moment, I felt my world turning topsyturvy.”

catheter into the blocked coronary artery. This wil l al low them to do a bal loon angioplasty to open the blockage. They’ll then place a stent in the artery to keep the vessel open.

Stents are usually needed when plaque blocks a blood vessel. Plaque is made of cholesterol and other substances that attach to the walls of a vessel.

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My heart stopped for a couple of minutes. The doctors tried hard to revive it and finally succeeded in it. Later, I came to know that to certain people the dye which they use may cause troubles and my case was no different,” recollects Joseph.

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tubes that carry urine from the kidneys to the bladder. These tubes can become blocked or damaged just like blood vessels can.

How is a stent performed? There are several ways to insert a stent. Your doctor usually inserts a stent using a minimally invasive procedure. They will make a small incision and use a catheter to guide specialized tools through your blood vessels to reach the area that needs a stent. This incision is usually in the groin or arm. One of those tools may have a camera on the end to help your doctor guide the stent. During the procedure, your doctor may also use an imaging technique called an angiogram to help guide the stent through the vessel. Using the necessary tools, your doctor will locate the broken or blocked vessel and install the stent. Then they will remove the instruments from your body and close the incision.


ticking time bomb, considering the seriousness of it. The doctor explained to him that it could possibly be the result of his bypass surgery, which he underwent earlier. They also informed him that there was no other option than surgical intervention for this. Dr.V.V. Bashi, one of the best Cardio Vascular Surgeons under took the corrective surgery successfully. The open-heart surgery took around six hours. At first, they had to correct the pumping. Then Dr. Bashi did the grafting. One of the highlights after the surgery which Joseph recalls is that he was relieved from the constant pain associated with his first surgery. He even went to the extent of asking its secret to which the doctor replied, “After cutting and rejoining the sternum, there shouldn’t be any gap because even a small gap could give you pain.” The doctor also put a rib brace for extra protection. In 2004, the problems re-emerged. Joseph felt the angina reappearing after walking. By then, the doctors had told Joseph on how to distinguish the pain of gas/acidity from heart related pain. “If you can spot out the pain emanating from a particular body side or part, it is due to gas problems. If you can’t, most probably it could be heart-related. The chest always tends to mislead us and wouldn’t give us a correct spot of the origin of pain.” Joseph again sought medical attention and since the doctor knew him well enough, they expected only one or two more blocks. But there were altogether six blocks and most of them were above 98% ( triple vessel disease). All the arteries were affected. After a detailed examination, the angioplasty was fixed on 7th February 2004. Since the risk factor was high, Dr. Mathew Samuel himself came as the surgeon. By then, as medicated stents had been introduced in the market and their success rates increased to 98%, the doctor fraternity unanimously opted for it. The cost of one stent was around Rs.1.5 lakhs then and he needed six stents. Dr. Mathew also asked a favour from Joseph as his surgery coincided with the Joint Interventional Meeting (JIM) of worldwide cardiologists in Rome. As his was a rare case, Dr. Mathew sought his permission to broadcast the surgery to 5,000 cardiologists who had assembled for JIM. The fact that he will be able to help the medical fraternity made him happy and he agreed to do so. He recalls that expert doctors from Bangalore, Mangalore, Mumbai and other centres came for the surgery. In half an hour, they concluded the surgery. The costs of the stents were waived off to half for his contribution to the medical fraternity. After 11 years, in 2015, Joseph had again experienced the same problems once again. He went straight to Dr. Abraham and the doctor found out that there were three more blocks. Three more stents were put into his body through another surgery. With an experience of undergoing complicated surgeries, Joseph is much sought after by fellow patients for inspiration. His simple message to those who face such diseases is that to approach the disease with confidence. ‘Don’t be afraid. It will lead you nowhere. If you are courageous before the disease, the confidence level itself works as a medicine. Also, when we get symptoms of a disease, don’t just ignore it. Give it the required priority. Seek im-

mediate medical attention,’ Joseph rightly points out. “I believe that my husband defeated this disease more with his confidence and attitude than those medical procedures. For the doctors, he was always a good patient who respected and followed their prescriptions and advices. After those complicated surgeries, Joseph always acted normal often reminding us of a person who has successfully rectified his problems. He was always enthusiastic,” certifies Rosamma. Joseph mocks the way Keralities treat a patient. People tend to become extra cautious and label them as a ‘forever patient’ even if he recovers. To Joseph, faith and hope are two medicines which have got the ability to cure diseases. Joseph believes that a positive attitude can bring wonders in life and business. He has also published four books and is working on his autobiography now. In 2007, he published ‘You too can!’ as a sort of self-help book. He is also credited for authoring the first technical book which deals with conveyors in India. History of Thejo Engg.Ltd; was published titled “The Banian Spread”. Also he wrote another Book on his mother “Ammackorumma”. According to Joseph if you can have a heart free of tension, genetic problems, erratic food habits, smoking, diabetes etc; then only you can think of a trouble free heart! “Is it possible today”, he asks?

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Interview Dr. S.I. Padmavati Dr. Sivaramakrishna Iyer Padmavati commonly known as S. I. Padmavati (born on June 20, 1917) is an eminent Indian cardiologist. She is the founder and head of the National Heart Institute, Delhi and the founder president of the All India Heart Foundation. Dr.Padmavati, an elected fellow of the National Academy of Medical Sciences, was the first woman cardiologist in India in 1954 who established the first cardiac clinic and cardiac cath lab in North India. She was the President of 5th World Congress of Cardiology, New Delhi (1966) and was awarded India's second highest civilian honour the Padma Vibhushan in 1992. Here, TechAgappe readers can read her experiences which was shared with AGAPPE.

"TREAT MEDI Dr. S. I. Padmavati

"S

India’s first and

he is not just the mother figure or God figure, but she is the God of cardiology in India,” says renowned cardiologist Dr. Ashok Seth of Fortis Escorts Heart Institute about Dr. Sivaramakrishna Iyer Padmavati, who, at age 101, is as active now as she was when she started treating patients in India 64 years ago. A recipient of the Padma Vibhushan, the country’s second highest civilian award and Padma Bhushan, Padmavati not only trained herself in cardiology from the UK and the US in the late 40’s and the early 50’s, but also taught several of India’s best cardiologists. “She is profoundly knowledgeable. She created the whole concept of heart treatment in India from scratch”, comments Seth. “I have seen the world of cardiology grow under my eyes,” says Padmavati, seated in her office in the hospital. The cardiology veteran has many ‘firsts’ to her credit- she is India’s first woman cardiologist; she set up the country’s first cardiology clinic; she created the first cardiology department in an Indian medical college and she founded India’s first heart foundation meant to spread awareness about diseases of the heart. A Long Journey She was born in Burma (now called Myanmar) in 1917, in the year of the October Revolution that redrew the world’s political map, in the year the late Indian Prime Minister, Indira Gandhi, was born and a year before anti-apartheid icon Nelson Mandela’s birth. Her father and elder brother were barristers and she grew up in Mergui, near the oil fields of Burma. A brilliant student, she stood first in the province in her final school examination. Thanks to her exemplary performance, her local school was ‘upgraded’, she recollects. And then, she went on to study medicine at the Rangoon Medical College where she was the first female student. The young maverick completed her MBBS magna cum laude,

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CINE AS YOUR SERVANT" oldest woman cardiologist

Dr. S. I. Padmavati with Ketan Salgaonkar, General Manager, AGAPPE. earning the best outgoing student medal and several other distinctions. “I won so many honours that I can’t remember all of them,” smiles Padmavati, who picked up what she calls her ‘craze’ for swimming during her ‘Burma days’. She swims every day for six months a year at the Ford Foundation’s exclusive swimming pool in Delhi. In Delhi’s winter and for the rest of the months of the year, she prefers long wal ks.

She learnt the art of reading from her dad whom she says was devoted to books. “I am the custodian of the library here (at the National Heart Institute in south Delhi) and reading helps me keep abreast of the latest developments in cardiology,” She comments with the vigour of a woman in her twenties. Enduring the War Just after she completed her medical studies in Rangoon,

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Interview

Dr. S.I. Padmavati

Japan invaded Burma at the height of World War II and she had to return to India. “We had to run for our lives, literally,” says the noted cardiologist. “My parents were told to vacate the house in 24 hours. My father was there for many, many years. Then we had to fly out from Mergui by the last flight. The men were left behind and only the women went. Things were quite bad”, she recalls. Padmavati, her sister Janaki and their mother came to Tamil Nadu and bought a home in Coimbatore. For the next three years, until 1945, there was no news of the men of the family. When the war ended, the family was reunited. Padmavati left for postgraduate studies in London. Soon, she became a fellow of the Royal College of Physicians, London and of the Royal College of Physicians of Edinburgh. Matters of the Heart Padmavati remembers that she was deeply attached to her family but also wanted to study medicine under the masters. She joined Johns Hopkins University in the US to train under Dr.

After retirement from government service in 1981, she helped to set up the National Heart Institute (NHI) in Delhi. As director, she had no doubts about her role - to promote research and spread awareness about diseases of the heart. Helen Taussig who performed the first surgeries on blue babies, children born with a congenital defect of the heart, which was a milestone in modern cardiology. Having finished her stint at Johns Hopkins, Padmavati went to study under Dr. Paul Dudley White at the Harvard Medical School in Boston for the next four years. White is widely regarded as the father of modern cardiology. She also studied in Sweden before returning to India in the early 1950s. She points out that it was Swed ish scientists who pioneered the concept of the echocardiogram (used for scanning movements of the heart), drawing inspiration from equipment used in deep-sea diving. “I missed my parents a lot. I came to Del hi and started staying with my sister (Janaki) whose husband was a career diplomat,” Padmavati says. India Cal ling She had plans to return to the US to start her practice but she decided to try her luck in India. She sought an appointment with Rajkumari Amrit Kaur, the then health minister, who offered her a lecturer’s position at Del hi’s Lady Hardinge Medical College. She accepted the offer. “Lady Hardinge used to be a primitive place then. They had only girls. There were no male patients at that time. Anyway, I decided to stay back,” she says, emphasizing that she was enamoured of the ‘Gand hian qualities’ of the leaders and ministers of the time. Within a year of joining, in 1954, she was promoted to professor of med icine and she also set up north Ind ia’s first catheterisation lab, which housed diagnostic imaging equipment for inspecting the arteries and chambers of the heart for abnormalities. Men also started visiting the hospital, much to the anguish of the ‘old-timers who bristled with anger, laughs Padmavati who is glad that many of her students of the time are now heads of cardiology departments in various institutes including Savitri Jain (in the US), Saroj Prakash at Del hi’s Maulana Azad Medical College (MAMC) and Santosh Sud, cardiologist at Auburn University, Alabama.

Dr. S. I. Padmavati receiving Padmabushan from Sree S. Radhakrishnan, former president of India.

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Lady Hardinge was where she did most of her research because she was shocked by the number of diseases that she could discover outside the medical textbooks. “I got awards for that — I got money from the Rockefeller Foundation to do research in such diseases,” she maintains adding that she received ‘PL 480


money’ to do medical research. Through this scheme, India bought grains from the US and the money was given back to India; part of the proceeds was used for medical research. “I did a lot of work on rheumatic fever and lung diseases. There was no cardiology then. It was I who started the first cardiac clinic at Lady Hardinge”, she comments with a graceful smile. More Responsibilities Thanks to her pioneering research in cardiology, Padmavati was much in demand as a professor and an administrator. In 1967, the government of India asked her to take over as the DirectorPrincipal of MAMC where she also set up a cardiology department. She also helped set up the cardiology department at GB Pant Hospital, which was on the campus of MAMC. She also held additional charge of Delhi’s Irwin Hospital (now called Lok Nayak Jai Prakash Narayan Hospital). MAMC had 26 departments and it was Padmavati who introduced the DM course in cardiology, which admits postgraduates. “It was a big undertaking”, Padmavati recalls. But then, times were different and things much less complicated back then, she adds. Padmavati feels that the bureaucracy was bad then and is worse today. What helped was her direct access to the Lt. Governor of Del hi, A N Jha, who helped her tide over the bureaucratic red tape. Mission Possible After retirement from government service in 1981, she helped set up the National Heart Institute (NHI) in Del hi. As director, she had no doubts about her role - to promote research and spread awareness about diseases of the heart. She has been the FounderDirector of the All India Heart Foundation, a sister concern of NHI since 1962. In India’s rural areas, the foundation holds heart camps to familiarise people with the disease and its causes. It was India’s, and Asia’s, first exclusive heart institute; its rich successor Escorts Hospital was built in 1988. According to WHO, 17.3 million people died worldwide from cardiovascular diseases in 2008. Of this, 80% of deaths take place in low- and middleincome countries, especially in India, which accounts for 21% of the world’s disease burden. From 20 beds, the institute has now grown to 100 beds. “But it can grow further. Unlike many new hospitals, we don’t have money from elsewhere. We get money from what we earn,” she says mat-

With regard to the use of medicines to treat hear t ailments, this renowned cardiologist, who is also an expert in non-invasive surgery, says, “Treat medicines as your servant. You shouldn’t let them become your master.”

Dr. S. I. Padmavati receiving Padmavibushan from Sree R. Venkataraman, former president of Ind ia. ter-of-factly. She didn’t elaborate. She finds it heartening that though heart diseases are on the rise in India due to a variety of reasons, technology and biochemistry have shown rapid growth in combating the menace. “I still touch and use my eyes and ears to treat patients but I have to know technology too. You can’t stop the march of technology”, declares Padmavati, who says she attends at least two global heart conferences a year to keep herself ‘updated’. With regard to the use of medicines to treat heart ailments, this renowned cardiologist, who is also an expert in non-invasive surgery, says, “Treat medicines as your servant. You shouldn’t let them become your master.” Padmavati sees patients 12 hours a day for five days a week. She is a polyglot who speaks Hindi, Tamil, Burmese, a smattering of German and French besides Telugu and Mayalayam. “I never married, but I never felt bad about it either because I am always busy with patients and my research,” sums up Padmavati whose paternal grandmother lived up to age 103. She attributes her longevity to genes, luck and hard work.

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Promotion Importance of Lipid Profile

Monitoring and maintaining healthy lipid levels in the blood is

CRUCIAL TO STAY HEALTHY

Bintu Lijo, Manager - Customer Support, AGAPPE.

L

ipid profile test or lipid panel measures the specific levels of lipids in blood. The lipid profile test is usually performed as a screening test in healthy people to estimate their cardiovascular risk (of heart attack or stroke). Today, it is estimated that 50% of the population have cardiovascular disease. With all our sedentary lives, bad dietary choices, genetic predisposition and of course diabetes, there is a build-up of cholesterol. This cholesterol colludes with fat and calcium and forms a deadly mixture called plaque that tends to obstruct the blood flow in the arteries.This leads to serious complications like atherosclerosis, coronary heart disease, cerebrovascular disease, peripheral artery disease and heart attack. In order to avoid this congestion, we do a Lipid Profile Test. It is a good diagnostic test that can forewarn us to take precautionary measures. Diabetic patients need to get periodical lipid profile tests. Why? Diabetes may lead to a condition called diabetic dyslipidemia. It is a condition coupled with high cholesterol and high blood sugar levels having a detrimental effect on diabetes control and overall health.

Along with blood sugar control, people with diabetes need to have an eye on their cholesterol levels. What should be the frequency of Lipid profile check? AACC recommendations: Screening when no risk factors present: for adults, every four to six years; for youths, once between the ages of 9 and 11 and again between ages 17 and 21. Monitoring needed at regular intervals when risk factors are present, when prior results showed high risk levels, and/or to monitor effectiveness of treatment. Complete Lipid Profile can be divided to three and it includes: Standard Lipid Profile: Cholesterol, Triglycerides, HDL, LDL Extended Lipid Profile: Apo A & Apo B Emerging Risk Factors: CRP ultra & Lipoprotein (a) Total cholesterol —This test measures all the cholesterol in all the lipoprotein particles. Directly linked to risk of heart and blood vessel disease. Triglycerides — Elevated in obese or diabetic patients. TGL level increases from eating simple sugars or drinking alcohol. It is associated with heart and blood vessel disease. High-density lipoprotein cholesterol (HDL-C) — This mea-

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Lipid Profile Test Parameters From AGAPPE Cholesterol

Apo A1

z Time tested CHOD – PAP Methodology

z ImmunoTurbidimetric assay method

z Lipid clearing agent to reduce interference

z No Prozone effect up to 5500 mg/dL

z Wide measuring range 4-300 mg/dL Apo B

z Offers Linearity of 600 mg/dL

z ImmunoTurbidimetric assay method

Triglycerides

z Wide measuring range 8-330 mg/dL

z Stable GPO – TOPS Method

z No Prozone effect up to 5000 mg/dL

z Contains Lipid Clearance factor

Lipoprotein (a)

z High Linearity of 1000 mg/dL & high shelf life

z Latex Enhanced immunoturbidimetry method

AGHDL

z

Wide measuring range of 12 - 80 mg/dL

z

No Prozone effect up to 250 mg/dL

z Selective Inhibition method (without Mg+) using ions z High correlation with Ultra Centrifugation Method z CDC Reference for Standardization ensure high level accuracy

AGLDL

CRP Ultra

z Selective Solubilization method z Highly correlated with Ultra Centrifugation Method z Accuracy traceable to CDC reference

sures the cholesterol in HDL particles; often called ‘good cholesterol’. High levels linked to a reduced risk of heart and blood vessel disease. Low-density lipoprotein cholesterol (LDL-C) — This measures the cholesterol in LDL particles; often called ‘bad cholesterol’. High levels are linked to an increased risk of heart. LDL level is a major treatment target for cholesterol-lowering medications. Apo A - It is a component of HDL particles and is often used as a biomarker for prediction of cardiovascular diseases. This test is important especially a person has low level of high-density lipoprotein (HDL-C).

z

Latex Enhanced Immunoturbidimetry method

z Wide measuring range of 0.13-10 mg/L z No Prozone effect

Apo B -It is a component of LDL particles and it may even tually prove to be a better indicator of risk of cardiovascular disease (CVD) than LDL-C. The ratio of Apo B/Apo A has a stronger correlation with myocardial infarction event rates than lipid and lipoprotein concentrations. CRP ultra – This test accurately measures low levels of C-reactive protein to identify low but persistent levels of inflammation and thus helps to predict a person’s risk of developing CVD. Lipoprotein(a)- As high levels of Lp(a) travel through the bloodstream, it collects in the arteries, leading to gradual narrowing of the artery. It can increase the risk of blood clots, heart attack or stroke. A lipid profile is a fast, efficient way to stay healthy and deal with any future heart disease or stock.

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Cover Story Heart Transplant - An Overview

An Overview on

HEART TRANSPLANT

The first heart transplant in the world in human beings was done in South Africa in 1967 by Dr. Christiaan Barnard. Unfortunately, the man who underwent the heart transplant lived only for 18 days. After the first human heart transplant, even though a few more transplants took place in the world, the popularity of heart transplant didn’t increase much as the life span after the transplant Dr. Jose Chacko Periappuram was comparatively less. There were many reasons for hear t Cardiac Surgeon, Lisie Hospital, Ernakulam transplants to be a failure on those days.

O

ften human heart is compared to an efficiently designed pump owing to its property of pumping blood to the body. When this heart fails to pump blood, the cardiac surgeons play a role. Our role is similar to that of a motor ‘mechanic’ but we fix the fault in the heart and do it when the heart is still running! Comparing the past, organ transplants have got more popularity and heart transplants also have got a share in it. Even though

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it is just another surgery for a cardiac surgeon, it isn’t free from complications. In simple words, Heart transplant is removal of the affected existing heart with a donor heart from a brain dead donor, with matching blood group and body size. The first heart transplant in any animal is credited to Vladimer


Demikhov. Working in Moscow in 1946, Demikhov switched the hearts between two dogs. The dogs survived the surgery. The first heart transplant in the world in human beings was done in South Africa in 1967 by Dr. Christiaan Barnard. Unfortunately, the man who underwent the heart transplant lived only for 18 days. After the first human heart transplant, even though a few more transplants took place in the world, the popularity of heart transplant didn’t increase much as the life span after the transplant was comparatively less. There were many reasons for heart transplants to be a failure on those days. One among them was the lack of technology to preserve the donor heart in a healthy way. Another thing was the lack of medicines of that time to suppress the rejection of a foreign element by the body. It was only by 1980’s effective immunosuppressants came into the market. It fuelled the number of heart transplants as patients could expect to live more. The first heart transplant in India took place at All India Institute of Medical Sciences (AIIMS) New Del hi in 1994. South India also had its share as Dr. K M Cherian, a Keralite, handled the first heart transplant in our neighbouring state Tamil Nadu, at Madras Medical Mission in 1996. It was also the second heart transplant to take place in India. Kerala had its first heart transplant in 2003 at Medical Trust Hospital, Cochin. India still lags behind in the number of heart transplants with the total number of heart transplants at 800-900 while the average heart transplants conducted in the world a year is around 3000-4000. Heart failure is the primary reason why a patient requires a heart transplant. There are several stages in heart failure. Towards the first stage, the doctors will use medicines to treat heart. By effectively reorganising lifestyles of the patient, they will try preventing it. The next stage of treatment includes stronger medicines to treat heart failures. The use of pacemakers and other devices is for further complicated stage. Each treatment works only for a certain period of time in the case of heart failure patients. Only when the heart fails to respond to all these treatments, doctors will look for heart transplant as an option.

The procedures include identifying the right patient. Before going on for a heart transplant, doctors must try optimisation of medicines on such patients. If it fails to change the situation, the doctor should explain to the patient the need of heart transplant. It includes separate counselling to the patient, life-partner of the patient and other family members. This counselling is also important for the doctors as it is through this the doctor comes to know the social, economical background of the patient and to ensure that the patient gets proper care after the transplant. If found positive, the doctor will conduct all the medical tests related to heart transplant so as to ensure them fit for transplant. There are possibilities of other organ failures like kidney or lungs for heart patients. If no other problems are found, the patient’s name is registered in the list of Kerala Network of Organ Sharing (KNOS), an organisation under Government of Kerala’s ‘Mrithasanjeevani’.

Heart failure is the primary reason why a patient requires a heart transplant. There are several stages in heart failure. Towards the first stage, the doctors will use medicines to treat hear t. By effectively reorganising lifestyles of the patient, they will try preventing it.

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Cover Story Heart Transplant - An Overview Details like patient’s blood group, body weight etc. are also shared. Many hospitals are also registered under this organisation and if a brain death is reported and the relatives wish to donate the organ, the hospital shares it with KNOS. The organ sharing works on the priority basis - the patient who requires it the most will be considered first. Sometimes, it also works based on the rotation manner of hospitals. The information from KNOS is shared with the doctor who will inform it to the patient and if he is ready, will go ahead with transplant. The result of a transplant is influenced by the condition of the patient. If the patient prolongs the transplant surgery for any reason, the chance of success will become less. It is advisable to do transplants, be it any organ and not just heart, before matters turn worse. The surgery is considered as a success if the patient is discharged from the hospital after transplant and he leaves home in a stable condition. However, there is also another criterion known as survival of the patient after the transplant. The criterion to consider the success rate of survival is one year survival of up to 85% patients. 75% of transplant patients should live up to 5 years. After 10 years, 40% transplant patients must be alive. You may think, it as a small time frame. But if the patient hadn’t undergone transplant surgery, they would have died within 3 to 9 months. We are actually extending their life by providing a better life. Heart failure patients can be compared to patients who have cancer. You can’t completely cure majority of cancers. You can treat and reduce the pain of the disease and relieve the symptoms of the

The common complication found after heart transplants is rejection. Hyper acute rejection is what we call of a rejection within 24 or 48 hours after the transplant. Acute rejection is something which happens in the first one week. The rejection of heart after one year is called as chronic rejection. disease to a certain extend. It is extending the quality and quantity of life. Just like this, a transplant is something which provides the same and is not a guarantee for a long life ahead. Most of the deaths in heart transplant patients occur in the first one year. It is because of the high-dose of anti-rejection medicines provided to the body to prevent it from rejecting the transplanted heart. These medicines will reduce the immunity power which makes it prone to attack from other infections. The body resistance power will be less and the patient can easily get affected by viral and bacterial infections. After one year, the dose of anti-rejection medicines is reduced. The common complication found after heart transplants is rejection. Hyper acute rejection is what we call of a rejection within 24 or 48 hours after the transplant. Acute rejection is something which happens in the first one week. The rejection of heart after one year is called as chronic rejection. The second complication is infections. Apart from various infections, the heart transplant patients should also fear of cancer after 2 or 3 years. The cancer could be of any type- skin, blood etc. and are related to immunity suppressants and side effects of it. Keeping in touch with the doctor periodical ly is very important. Symptoms like unusual tiredness of the

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body, fever etc. should be consulted immediately. Regular biopsy of heart is conducted to ensure that body doesn’t reject it. The time gap of biopsy increases later as in one week, one month, six months and so on. Another major problem could be blocks in arteries. There are also occasions when card iac surgeons will have to do retransplant. It means putting up another heart as the transplanted heart was rejected or not functioning properly. I had the opportunity to do such a re-transplant to a patient named Gireesh Kumar from Palakkad. Dilated Cardio Myopathy (DCM), played a villain in his case. As the situation worsened, he was advised to undergo transplant. In 2013, he underwent his first heart transplant surgery. Everything was fine until February next year. An irregular tiredness made him seek medical attention and it was found out that the tricuspid valve had been infected. Things become further complicated as he had two heart attacks after he was admitted to the hospital. Thus a second transplant was suggested which he underwent successfully. He is leading a healthy life for the past 4 years. In different countries, the rate of organ donation and transplants differ. When it comes to world, the highest number of organ transplants happens in Spain. In India, Tamil Nadu tops the

In my opinion as long as donor hearts are available, the future of transplants will be good. To replace a heart till now, we don’t have any better option other than transplant. Even though artificial hearts are there, it is used only in circumstances when donor hearts aren’t available.

AGAPPE’s ALP IFCC method with pNPP buffer is the most preferable one for the estimation of Alkaline Phosphatase due to its high linearity of 2000 U/L and high reagent stability.

list. In most cases, the relatives of brain death patients will donate all other organs. In Kerala, however, the number of heart transplant seems to have been reduced. In 2016, 16 heart transplants occurred in Kerala. But in 2017, the number reduced to just 4. Apart from religious believes about organ donation, the recent speech by a noted celebrity in Kerala against organ donation has also influenced people from donating organs. The celebrity in his speech alleged that doctors were ‘creating’ brain death patients. All such allegations are baseless. A doctor is a protector of life and not a destroyer of it. In every country at certain point of time, controversies have erupted about organ donation. Government is taking necessary steps to rectify the problems and to make the process more transparent. We are now forced to ask patients to register at neighbouring states for transplants owing to the disinterest in people of Kerala about organ donation. In my opinion as long as donor hearts are available, the future of transplants will be good. To replace a heart till now, we don’t have any better option other than transplant. Even though artificial hearts are there, it is used only in circumstances when donor hearts aren’t available. The cost is also several times higher. The pre-manufactured artificial hearts are equipment that promises results of a regular heart. In the western countries, the result is very much similar to regular heart transplants. Although Kerala is yet to experiment with artificial heart, other states have experimented with artificial heart. Even then, I believe that there are restrictions in creating artificial organs and they can never achieve the perfection of human organs.

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Life Story Girish Kumar (IT Specialist)

BORN AGAIN, TWICE! Organ transplants have become a commonplace issue for us now - be it heart, lungs or kidney. However, Girish Kumar (42), who hails from Nenmara, Palakkad is credited as the first patient to undergo a successful re-transplant of heart in India- that too in a span of eight months. This is one among the rarest of the rare events in medical history. Girish is the only human being in India living with a third heart at the time of writing this.

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rgan transplants have become a commonplace issue for us now - be it heart, lungs or kidney. However, Girish Kumar (42), who hails from Nenmara, Palakkad is credited as the first patient to undergo a successful re-transplant of heart in India- that too in a span of eight months. This is one among the rarest of the rare events in medical history. Girish is the only human being in India living with a third heart at the time of writing this. After completing his schooling and higher studies from Nenmara, Girish joined a Diploma course, which provided him a job opportunity in ICICI Infotech, Mumbai. After a stint of one year, Girish moved to Chennai by joining Satyam Computers. He was later transferred to Bengaluru and in 2010, began working with Wipro and is currently a Solution Architect.

Girish Kumar

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The first ever cardiac uneasiness happened to Girish in 2012. His mother was sick and was admitted in the hospital. She was diabetic but later developed cardiac issues. During those days, Girish came to pay a visit to his mother from Bengaluru. Girish remember having a severe cough during those days when he was waiting in front of the ICU where his mother was under medical observation. Later, at home when his mother got discharged from the hospital, he continued to have the severe cough. “If I lie down in bed, I will have cough and it will continue until I get up and sit upright. My mother used to get up from her bed and come to my room with a worrying look whenever I cough non-stop. So to avoid this, I stopped lying on bed, instead started sitting in the sofa through out the nights as if I am doing some official work. Along with this, I had also a body pain and had been undergoing ayurvedic treatment for the same. My cough became a problem that they had to


discontinue the ayurvedic treatment and asked me to consult the Diabetes wing of the same hospital”, recalls Girish. At the hospital, the doctor felt something abnormal and referred him to a larger hospital where his mother was undergoing treatment for her d iabetes turned cardiac issues. After doing an ECHO check up there, they confirmed that he had dilated cardio myopathy (DCM). There were no symptoms of any disease during those days apart from the discomfort associated with cough. However, the doctor assured him that since the disease was in the early stage it could be cured if he took medicines regularly. Upon agreeing this, he went back to Bengaluru. To facilitate easy consultation, Girish went to another hospital at Bengaluru. The doctor there also suggested that regular medications would be enough to recover from this state. However, frequent hospitalisations followed. He recalls how the hospital at Bengaluru had kept one special room blocked for him because by then, he had become a regular patient. “Most often I had to go alone from my place to the hospital during nights as cough wouldn’t stop. But an injection from the hospital used to cure it soon. Even so, they will keep me in observation for one day. The intervals between my hospital visits began to lessen and it became a serious problem”, Girish recollects. In the month of May 2012, Girish took his mother to Bengaluru for better treatment as her condition was very critical and was admitted in the same hospital where he was undergoing the treatment for DCM. But nothing could save his mother. Girish was admitted in the same hospital, when his mother had her last breath after 15 days of her struggle inside the ICU. He remembers how painful it was when the hospital staff took him to ICU in wheel chair to see his mother’s body. It was then the doctors suggested him to go for a transplant. Girish wondered why he had got this particular disease. He never had a single problem related to heart or anything prior to this. Genetic history also showed negative. Moreover, Girish never smoked or used liquor. Even though his mother had diabetics turned DCM, he had no traces of it. “I had no heart attacks or something like that. When I was admitted in the hospital, I had a slight BP variation. Nothing else! No problem with lungs. Still now, the reason for the disease is quite unknown,” he states. Since both his left and right ventricle had complaints, they had only one option left- to undergo an organ transplant. Transplants, especially heart transplants, weren’t much common those days.

Dr. Jose Chacko Periappuram Also, people had to wait for a matching donor. Girish wasn’t very serious about the transplant as he doubted how long he would have to wait for a matching donor. The doctors at Bengaluru suggested their own Transplant Specialist. Meanwhile, Girish had constant body pain due to Ankylosing spondylitis. The only symptom he had of the disease was the pain on the neck. Since it was common to all professionals related to IT field, as they have to spend more time in front of the computers, he didn’t take it seriously. When he began taking medicine of DCM, he skipped the medicine for Ankylosing spondylitis and it caused difficulty for him to walk even shorter distances. In the last week of May 2013, Girish visited Palakkad to attend his mother’s first death anniversary. Noticing his difficulty in walking and other problems, one of his sisters suggested consulting Dr. Jose Chacko Periappuram of Lisie Hospital, Ernakulam. Soon, he found out that the doctor was very well-known and reputed. “I thought of taking a second opinion from him. His opinion was not much different from what the

Noticing his difficulty in walking and other problems, one of his sisters suggested consulting Dr. Jose Chacko Periappuram of Lisie Hospital, Ernakulam. Soon, he found out that the doctor was very well-known and reputed.

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Life Story Girish Kumar (IT Specialist) other doctors suggested. But after talking to him just for 15 min, I become very comfortable. He was very friendly. He explained to me in detail and I was impressed. He asked me to come next week for a preliminary check up” Girish recalls. Doctor had mentioned that it was the right time to do the transplant as DCM patients are more prone to kidney failure or multi-organ failure in the next stage. So, before things turn worse, it was better to do the transplant at that time. Girish filled up the form for organ transplant. On June 3rd 2013, just after two days of his visit to the hospital Girish was surprised to receive a call from the doctor informing him that there was a heart available. After he expressed his interest to undergo the surgery, he was taken to the hospital immediately. The doctor had to go to the hospital at Kothaman galam for the surgery and bring the heart to the hospital to do the transplant. Dr. Jose and his team went to get the donor heart as it was the procedure. Before leaving, Dr. Jose came to Girish and said “Let’s pray for the best and get prepared. If the donor heart is healthy and matches for you, then only we can proceed” After that, everything happened like in the much acclaimed Malayalam movie, ‘Traffic’. “I remember the doctors here asking over the phone whether the vehicle carrying heart has started its return journey and were waiting for doctor’s order to give me the sedation. The last thing I remember was doctors giving me the sedation dose. Everything was over when I woke up the next day, almost 23 hours”, his memories of the first surgery is only that much.

He had to spend almost one month at the hospital. Since Girish was the second person to undergo a heart transplant at Lisie Hospital, they provided extra care to him. Apart from the discomfort with the cables attached to his body during the first few days, he had no other difficulties especially any pain after the transplant. Girish remembers the support his company extended to him in the time of need. It was also helpful that he had insurance coverage. The expense related to transplant does vary depending on the complexity of the case. If it is multiple organ transplants, the expense could go up as it often needs much more time and resources. Another surgery within 5 months of heart transplant The problems with Ankylosing spondylitis led him to seek medical assistance in a leading hospital group at Ernakulam after 6 months. After check-up, the doctor suggested him to undergo hip replacement as his wal king will be more difficult in the coming days. When Girish sought the opinion of Dr. Jose, the latter also suggested going for that. But there was a hidden risk in it. Giving general anaesthesia to people who had undergone heart transplant is a risky affair. Girish obviously wasn’t aware of the risk (later he said he would not have changed his mind even if he was told about the risk). The hospital provided special care and attention to Girish as he had been a heart transplant receiver. An isolated ICU was provided to him to avoid the risk of infection. Thus, his right hip was replaced in a surgery when he was 37. Dr. Jose along with Dr. Jacob, the head of cardiac anaesthesia from Lisle hospital was also present in case of any emergency. “It was just five months since I had my heart transplanted. For 15 days, I remained in the isolated ICU. But by then, I had started working from the hospital as they allowed me to use the system. Later, I was discharged and went home”, Girish recal ls vividly.

Girish Kumar, Dr. Jose Chacko (centre), Dr. Jacob (extreme right), Mr. Rajesh, Lisie Hospital P.R.O.(extreme left) with other heart transplant receivers during Dr. Jose Chacko’s birthday in 2017

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In February 2014, Girish went for a regular check up at the hospital and he felt tiredness and cough. After the check up, they expressed a doubt whether the tricuspid valve had been infected. He got admitted in the hospital and ECHO tests followed. Later, it was


confirmed. But then, the doctors were confident that it could be controlled using antibiotics. The two weeks of antibiotics treatment failed to provide any result. The Re-transplant Things took a different course after that. One day, while admitted in the hospital Girish felt a strange urge to sleep. He asked his sister not to disturb him even if someone pays a visit. “I don’t remember anything after that. Later, my sister told me what happened. I had a cardiac arrest during the sleep. Since most doctors were in the operation theatre nearby, they came immediately. It took almost 45 minutes of CPR (Cardio Pulmonary Resuscitation) to bring me back to life. I remained in the ICU after that and doctors informed me that I had to either replace tricuspid valve or further undergo another heart transplant. I made my Girish Kumar during his office hours decision to undergo another heart transplant under Dr. Jose. While remaining in the ICU, I had an- are looking at me if they are standing a little far. It has affected other cardiac arrest and doctors had to try harder to bring me my confidence in going out from home alone”, reveals Girish. back to life again”. As a patient who underwent re-transplant, many patients Two times cardiac arrest to a patient, especially to one who call Girish to gain confidence. “Two things make people doubtunderwent a heart transplant, was not a good thing. The divine ful about organ transplant- firstly, it is a major operation and intervention came in the form of news that a matching donor secondly, the expense, including post surgery expense. The expense varies according to the patient’s condition. My advice heart was available at a hospital nearby. to DCM patients is that they should undergo transplant at the The second transplant took almost 8 hours to complete at Lisie earliest if the cardiologist recommends. If it gets complicated, it Hospital. The two cardiac arrests had taken a toll in his body as the will lead to multiple organ failures. It is also good to see that blood circulation to eye through the nerve was affected. A condition many groups and individuals through social media often raise called Optic atrophy, an end stage that arises from myriad causes funds for organ transplants”. Also, many patients wanted to of optic nerve damage anywhere along the path from the retina to know why he underwent the operation at Kerala while he could the lateral geniculate. Since the optic nerve transmits retinal inforhave done it in Bengaluru. “I tell them with confidence that now mation to the brain, optic atrophy is associated with vision loss. “I our state has hospitals and doctors ad hering to international had a problem with a vision after that. But the doctor said that it will standards and the service they provide is excellent”, Girish soon get cured. That was the only discomfort I had after the second flashes a smile that sticks to his face like an alter ego now. heart transplant. Almost one month I was in the hospital. By April 2014, I came back to the comforts of home. After around six months, Family Support I began working from home again and went only twice to my A family is not just an important thing, but it’s everything Bengaluru office for client meets”, states Girish. for a man. For Girish, the family is quite big one consisting of Looking back, he says that the last four years had been going four sisters, their husbands and kids, and one brother, his stable. He even went to Munnar for a trip without any discom- wife and kids – yes, a family of families. All the decisions he forts. There is no restriction in food. He had also visited shopping took for his treatment were fully backed by his family. He is malls many times. “The only problem is that I’m yet to get back blessed with such in-laws who looked after him turn by turn my complete vision. Even though I can see people around me, I during and post his hospitalization. Even after four years, they wouldn’t be able to identify them. I can’t understand whether they continue to treat him with the same care and love

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Interview

Dr. Dharani Subramaniam (Orbito Asia)

“QUALITY

HEALTHCARE AT “ AFFORDABLE COST Dr. Dharani Subramaniam, Managing Director, Orbito Asia, Coimbatore.

Read on the excerpts from an interview with Dr. Dharani - A man of mettle and purpose. He topped every academic field he pursued and the zest of a true humanitarian in him makes him step into the field of diagnostics with ardour. Orbito Asia Healthcare and Diagnostics has been conceptualized by Dr. Dharani, a distinguished Radiologist and Alumini of Sri. Ramachandra Medical University along with Shri. C. Subramaniam, the Chairman of Mehala Group. This is a new initiative from the House of Mehala, which has its presence throughout India and neighbouring countries in South East Asia. Orbito Asia Healthcare and Diagnostics was started with intent to provide international quality diagnostic and imaging services to all segments of the population at an affordable pricing. Their Coimbatore facility has been equipped with the state of the art equipments in laboratory medicine and diagnostic radiology. Apart from Coimbatore, Orbito Asia has its presence in Chennai, Trichy, Erode, Pollachi, Tirupur and Vilupuram in Tamil Nadu and in the neigbouring states of South India. AGAPPE: Could you please explain the growth path of Orbito Asia? Dr. Dharani: Orbito Asia diagnostics started in 2010 with just 3 employees and has grown to a 100 people-

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Dr. Dharani Subramaniam


strength company. We focus on preventive care and do a lot of special ised tests in preventive care. We are the first lab in India to do the smal l dense LDL and HDL3 markers in India. We specialise in providing preventive care profiles at homes of people at the most affordable cost and we take pride in beDr. Dharani Subramaniam with his team at Orbito Asia, Coimbatore ing the lowest cost lab in the world, despite giving the utmost quality. Our motto is - eter repeatedly with the same device. A good analogy for un“Say yes to wellness and No to illness”. derstanding accuracy and precision is to imagine a basketball player shooting the ball into the basket. If the player shoots AGAPPE: What are the accreditations for your laboratory now? with accuracy, his aim will always take the ball close to or into Dr. Dharani: We have ISO, NABH and are awaiting NABL accredi- the basket. If the player shoots with precision, his aim will tation. always take the ball to the same location which may or may not be close to the basket. A good player will be both accurate AGAPPE: Since your entry into the diagnostic industry, as a and precise by shooting the ball the same way every time and result of continuous research and development by IVD each time making it into the basket. In today’s world, most corporates like Agappe, the industry has undergone a lot of decisions are taken by the laboratory results and so it bechanges. What are the major changes you have noticed in the comes much more necessary to be both accurate and precise. last decade as an IVD business entrepreneur and how do you find these changes helping the needy patients in Ind ia? Linearity studies are performed to determine the linear reportable range for an analyte. The linearity for each analyte is Dr. Dharani: Increasing number of lifestyle disorders like heart assessed by checking the performance of recovery throughdisease, hypertension and cancer has seen a rise in the past deout the manufacturer’s stated range of the testing system. cade. The rising awareness of prevention of these lifestyle disorThis is done using a set of standards containing varying levels ders in the population of our country has forced innovation in of an analyte in high-enough and low-enough concentrations minimally invasive and non-invasive diagnostics and this has so as to span the entire range of the test system. Linearities emerged as positive triggers in positioning India as a rapidly rising are performed whenever a new analyzer, analyte or method is market for IVD devices. The demand for clinical chemistry prodintroduced into the laboratory or an analyzer is replaced. ucts is anticipated to be vastly bolstered by advances in self-moniLinearities may also be performed for troubleshooting purtoring methods for diabetes and patient screening techniques along poses when quality control is unacceptable and deviations from with the increasing use of point-of-care systems, which offer acceptable data cannot be explained or either a major analyzer greater diagnostic accuracy and quicker results. repair or replacement of components has taken place. AGAPPE: What are your expectations from an IVD company AGAPPE: What are the facilities you are providing to pubfor the need for efficient R&D, competent manufacturing falic from your world class laboratory facilities? cility and qualitative delivery of its products and services? Dr. Dharani: Orbito Asia Diagnostics is a comprehensive Dr. Dharani: My expectation from IVD companies is to introduce newer paramaters which are available worldwide in a fast and efficient manner. That is from plan to execution and to ramp up "Orbito Asia Diagnostics is a in- house R&D facilities to be able to provide these tests at an affordable cost to our consumers. comprehensive healthcare AGAPPE: As an end user, how do you define the need for reagent’s precision, accuracy and linearity? Dr. Dharani: Accuracy describes the difference between the measurement and the parameter’s actual value while precision describes the variation you see when you measure the same param-

facility for imaging and diagnostic facilities, under one roof" Dr. Dharani says proudly.

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Interview

Dr. Dharani Subramaniam (Orbito Asia)

healthcare facility for imaging and diagnostic facilities, under one roof. It houses the latest infrastructure, the best possible medical facilities including MRI, CT, ultrasound and laboratory services, which include biochemistry, pathology, immunology, serology, microbiology and molecular biology including genetics. These facilities are accompanied by the most competitive prices and thorough individual care so that the customer can have the diagnostic tests done at the most efficient and cost effective means at a single point by our experienced and certified doctors and friendly supportive staff. We have collection points in more than 100 locations in South India including Tamilnadu, Kerala, Karnataka and And hra Pradesh. We have recently set foot in Sri Lanka and the Middle East. AGAPPE: What are the emerging trends you have been watching recently in IVD industry, which wil l guide the near future? Dr. Dharani: The increasing use of point-of-care systems which offer speedier and greater diagnostic accuracy is one of the major emerging trends. Another emerging trend is that the molecular diagnostics products market is expanding rapidly as they possess higher precision and allow for speedy detection of AGAPPE: Orbito Asia has been dea ling with Agappe for many years with many parameters and equipment. What is your overall experience with Agappe? Dr. Dharani: Agappe has continuously increased its parameters over the years and we have noticed that Agappe source their antibodies from the best manufacturers of the world and our experience with their products was always exceptional. We would experimentally say that Agappe’s glucose hexokinase, enzymatic creatinine and enzymatic

Dr. Dharani: Our vision is ‘Quality Healthcare at affordable cost’ with a vision to provide exceptional preventive healthcare built on a foundation of inclusion, compassion, respect and affordability – for our customers and for each other. Programs for the public - Yes, we are a pioneer in the Paleo diet blood tests. We have innovated tests for the common public where we offer around 102 tests at a very affordable price of Rs. 1400. We have witnessed many people lose weight dramatically, reverse their type 2 diabetes mellitus and hypertension and become nondrug dependent. We ensure that these people get a diet chart and follow the diet strictly and reverse their problems. AGAPPE: Agappe takes pride in claiming that we are “the best partner in diagnostics”. We strive hard to retain it. What is your advice to Agappe to enable us to useful ly fil l the slot as “the best partner in diagnostics”?

maximum perfection.

Dr. Dharani: My advice to Agappe would be to bring in the latest chemistry assays into our country with more focus on preventive care, which includes cardiac disease and cancer as its priority. More and more innovation is happening worldwide in cardiac health and a lot of newer markers with very big sensitivity and specificity are being developed, It’s high time companies like Agappe focus in bringing these newer markers into our country.

On the whole, working with Agappe was a rewarding experience with your excellent service backup.

AGAPPE: What would be your advice to the IVD professionals and to the diagnostic companies as a whole?

AGAPPE: What is your view on Preventive Diagnosis? Being a part of India’s biggest laboratory equipment chain, how does your organization help your local public to make them aware of the importance of preventive diagnosis? Dr. Dharani: View on preventive diagnostics - Treatment without prevention is simply unsustainable as an ounce of prevention is worth a pound of cure. According to Thomas Alva Edison, “The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.”

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AGAPPE: What is your vision with your team for another 10 years? Do you have any programs for the public support and their health welfare?

bilirubin are one of the best reagents we have used. Manufacturing IVD reagents with good stability, specificity and sensitivity is not an easy task, Agappe do it with

infectious diseases, genetic disorders and cancers at an early stage of development.

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View on public awareness - We actively engage in Facebook and other social media to communicate with the public. I am also a speaker at various preventive healthcare events and through these media, we reach out to the public. We actively participate in various camps. We are the only diagnostic lab in India who can simultaneously conduct camps in 100 different locations in the same time and on the same day.

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Dr. Dharani: The medical devices industry in India is still in a nascent stage and its efficacies are largely restrained by a fragmented infrastructure and its import-centric nature. The Indian IVD sector comprises small and medium players who have a limited R&D budget and whose manufacturing capabilities are limited to making low-cost high-volume products like medical disposables. The demand for high-end test kits is broadly sourced by imports from global MNCs. There is an urgent need from the diagnostic companies to invest in R&D and to invest in innovation. It is important to utilize and broaden the contours of the ambitious ‘Make in India’ program of Indian government and make it a commendable tool for bolstering the manufacturing efficacies of the Indian IVD industry thereby indigenize its capacities and capabilities.


Life Story Risabh Puri (Author & Entrepreneur)

FLYING WITHOUT WINGS

THE STORY OF RISABH

Risabh stands tall as a paragon for those who grimace and complain about the little sorrows of life. He faces life cheerfully even after being tested several times by the Almighty and his life was never normal. “As a child I could never enjoy the comforts of childhood. I don’t know the fun of building sand castles on the beaches. The joy of hide and seek is something I haven’t enjoyed during my childhood days,” he recollects sadly.

R

isabh stands tall as a paragon for those who grimace and complain about the little sorrows of life. He faces life cheerfully even after being tested several times by the Almighty and his life was never normal. “As a child I could never enjoy the comforts of childhood. I don’t know the fun of building sand castles on the beaches. The joy of hide and seek is something I haven’t enjoyed during my child hood days,” he recollects sadly. Under constant health problems, Risabh’s life was divided between hospitals and home, under constant care. When he was 11, he took part in a school sports event and half way, he fainted. He felt short of breath after that and doctors revealed that it was very uncommon to have a kid with these health conditions. Later they told them that it was the high cholesterol levels which paved the way to a leak in the valve.

Risabh Puri

But that’s not the complete story. Risabh’s inseparable life with hospitals began soon after his birth. At just six months old, the kid was diagnosed with Hyperlipidemia — a condition that leads to increased levels of any or all lipoproteins in the blood. At the age of 10, another diagnosis revealed that there is a leak in the aortic valve of his heart. By replacing the valve constantly the doctors saved the kid. Eventually, they did a heart surgery when he turned 18. The following year he had a bypass surgery to remove the blockages in his heart.

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Life Story Risabh Puri (Author & Entrepreneur)

Risabh Puri And the last in the league came in the form of avascular necrosis (the death of bone tissue because of the lack of the blood supply), diagnosed after he had a car accident when he was 27. Hip replacement followed suit. A life completely in the hands of doctors and nurses, isn’t it? But all this couldn’t blow out the positive spirit inside Risabh Puri, a well-known entrepreneur and author. Born in Chandigarh, Risabh is a Punjabi-Hindu. He was taken to Nigeria by his mother when he was six months old. His father Harish Puri was engaged in business there. He also had a younger sister. The fondness to travel seems to have blended into Risabh’s blood from his child hood itself. Today, he travels extensively between Chandigarh, Dubai and Singapore for both his business trips as well as to take care of his health. Every quarter of the year, he visits India for the fol low up of his heart and Singapore, for his hips. It seemed that peace returned to Risabh’s life after the heart surgery when he was 18. He went back to Africa and spent on

Risabh’s LDL cholesterol range is around 650 mg/dL and total cholesterol at 730 mg/dL. To bring it under 200, he takes an expensive treatment at USA and travels there in every two months. He says that it is not a hereditary disease.

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almost 9 months of a healthy, beautiful life. Then it was diagnosed that he had block in his arteries and had to undergo a bypass surgery. “My arteries are a little bit thin and my legs, arms are not as bul ky as it should have been. My heart is very small in size. My valves were specially made for me as they had no size fit for me,” he adds an element of humour to his condition. Risabh’s LDL cholesterol range is around 650 mg/dL and total cholesterol at 730 mg/dL. To bring it under 200, he takes an expensive treatment at USA and travels there in every two months. He says that it is not a hereditary disease. “My father had mild cholesterol and my mother had the same. It just got infused. That is not very common. The reason for hyperlipidemia is genetic.” Unfortunately, all his treatments cannot be done at India. Some of them are not available in India and some are very expensive. “I’ve began taking insulin shots called PSSCT 9, which is not available in India and is very expensive. It costs around $550 for a single shot and I have to take three. The medicine helps to lower the cholesterol rates to 200 and lasts for almost a couple of months before it shoots up again,” adds him. Tal king about the accident occurred when he was 27, he points out that it just triggered the pain in his right hip. His uncle was also hospitalised at the same time and so there was a lot of running around. There were days he had to drive around 150- 200 km on a single day. Lack of rest increased the pain. When he reached back Nigeria in November 2014, he couldn’t even put his feet on the ground. “The pain was so severe that I couldn’t wal k. I was carried to a local doctor there. He asked me to get an MRI done which confirmed avascular necrosis and I was bed-ridden followed by it. I used to go Florida, USA for stem cells treatment where they


injected my spine with a 30m long needle which would suck up my fat centrifuging and creating stem cells which later got injecting into my pelvis. I will be able to wal k for a month if I undergo that treatment,” Risabh recollects some hard facts. After one month, the effect of the medicine will wear down and he will have to take the next dose so as to walk again. The stem cell treatment is a rejuvenating medicine and widely used in sports medicine. Even though a person who is to undergo a hip replacement surgery need not take this treatment, Risabh wanted some time so that his mind could adjust to the fact that he is going to have a second hip replacement.

“Each day is a gift from God and I should fill it with as much joy as I can. I will die with a smile on my face remembering the entire row of good things God did for me”.

discovered that I can cook well. I can draw, sketch and paint,” His hip replacement surgery was done by a Singapore doctor reveals Risabh. Despite the attack of a brigade of diseases, he says who is rated as one of the top ten surgeons of the world. His right that no disease is deadly. “Our mindset makes a disease deadly hip was done first followed by the second in 2016. by thinking and acting like it. If you happen to have any disEarlier, he had asked the doctor about how he ease, don’t take it as the end of your life. Think of it as a could know if the two hip replacements were blessing from God. If He has taken something from you, He successful. The doctor informed him, “After definitely will replace it with something better. You just have the surgery if you have a catheter on you, then to find it,” he points out a wonderful truth here. consider it successful. If no catheter is atMeanwhile, he is also busy as an author publishing tached to you, it means only one replacement two books – in the first one, ‘Inside the Heart of Hope’, is successful. After waking up from the aneswhere he has described in detail the story of his heart. thesia effect, the first thing he did was to check The second book, ‘Flying without Wings’, is about his for the catheter. When he found out that he had two hip replacements represented as truthful as one in place, he felt relieved. he could do. Risabh finds writing as a healing Before the second surgery, doctor informed him treatment. Already, he is working on his about the three possible outcomes of the surgery. third (which will be released soon) and The first could be death due to surgery. In fact, fourth book. The profit from the any surgery could kill him as his blood had book sales is directed to people anticoagulants. The second thing could be that who can’t find fund for surgeries. he will be paralysed for the rest of his life. One thing which saddens The third could be that he could walk again. Risabh is the outlook of society Risabh’s mind was engaged in serious thinktowards people like him. “When ing and he responded, “Death isn’t an opit comes to relationships, people tion for me. That is your problem and you don’t really like my scars on sort it out. If I walk again, it’s most the body. They think I’m a welcome! If I become paralysocial defect. I’ve observed sed, how fast could I move on this in our society that peop to a joystick controlled wheelle want their son or daughchair?” The doctor was astonished ter to get married to a healthy and probably might have thought that guy. Think of something bad I was high on some kind of drugs,” he happening after that and recalls smiling broadly. then they will blame desThe hip replacement is complete only when tiny,” he rightly points out the the patient starts walking again. Risabh tried his double face of the society. walking abilities after the two hip replacements. As a man who has saw death “Each step was horrific but glorified for befrom close quarters, Risabh is now cause I knew that I will definitely wal k from grateful to God. “Each day is a gift the next day onwards.” Like a toddler starting from God and I should fill it with as to wal k, Risabh once again enjoyed the joy of much joy as I can. I will die with a walking again. Risabh’s quality to take is health smile on my face remembering the condition very positively needs to be apprecientire row of good things God did for ated. “Looking at the brighter side of all these, me,” he signs off with a gesture of imit helped me to unearth the other side of me. I mense gratitude.

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Cover Story Interventional Cardiology - An Overview

RECENT ADVANCES AND TRENDS IN

INTERVENTIONAL CARDIOLOGY The field of cardiac sciences has seen a lot of new developments in the last few years. We have better drugs to treat life threatening diseases. Non-invasive cardiology has benefitted from the ever improving technology. Invasive cardiology has not lagged behind with the most exciting developments occurring in the field of percutaneous valve therapies, which continue to evolve. Gene and stem cell therapy have also shown progress. These trends give us a glimpse into the future, which appears very promising.

Dr. Mathews Paul, MD, DM. Consultant-Interventional Cardiologist, Moulana Hospital, Perintalmanna, Kerala.

G one

are the days where people say, “He is gone…alledged to have some heart attack…. his fate….Couldn’t help!” There has been tremendous effort from preventive cardiology to find out and manage the risk factors leading to heart disease and thereby preventing a heart attack and praiseworthy milestones in inter ventional cardiology to manage heart attack in a safer way on the top of conventional medicines. People have started demanding for interventions when they come to a cardiologist unlike few years ago in many of the cases. I would like to mention here that medicines form the back bone of management of heart d iseases and interventions are ba-

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sically meant to understand the disease in a practically better way and managing it with clarity. It is never a replacement to medical management, but an add-on to it.

PACE MAKER

Interventional Cardiologists can be broadly divided into two groups –‘Plumbers’ and ‘Electricians’. Those who deal with coronary interventions - like angiograms and angioplasty belong to the first group. The second group deal with electrophysiology - like pacemakers and radiofrequency ablation for tachyarrhythmias - (abnormally fast heart beats). Recent advances in interventional Cardiology Before I go to the recent advances, I would like to start from the basics. For a common man, interventional cardiology is all about angiogram and angioplasty. It has many developments which have increased the success rate and perfection of the treatment. Coronary Angiogram is the procedure done through your hand or through your groin, where a catheter (tube) is passed in to the origin of your heart blood vessels (coronary arteries) and a dye is injected. It is done in a cath lab under X-ray fluoroscopy. The injection video gives us the anatomy of the blood vessel and let us knows if there is a block, its severity and thereby facilitates the decision making- whether to go ahead with medications alone or with angioplasty or with bypass surgery. Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. It is either balloon angioplasty or angioplasty with a stent - a metal mesh tube that expands inside a coronary artery. Primary Angioplasty – Heart attacks occur due to sudden occlusion of a preexisting partial block, thereby completely cutting of the blood supply to a portion of a heart muscle. These 100% blockages need to be removed within 3-6 hours from the onset of heart attack or else the muscle of the heart gets damaged permanently. So, this is the angioplasty done in such acute settings. Fractional flow reserve - FFR I have quite often seen people carrying the angiogram CD and doing ‘doctor shopping’ for buying opinions, whether to take only medicines or to go ahead with angioplasty in borderline blocks— (50-70 stenosis)% and they often do not reach any conclusion.

TAVR FFR is a technique where a pressure sensor wire is passed across the block which compares the blood flow before and after the block and thereby determining the likelihood that the block impedes oxygen delivery to the heart muscle. Intravascular Ultrasound-IVUS After performing an angiogram, the operator may sometimes need more clarity regarding the type of the block to decide the best treatment strategy. IVUS is an imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter and the proximal end attached to the ultrasound equipment. It helps to see from inside of blood vessels through the surrounding blood column, visualizing the endothelium (inner wall) of blood vessels. It helps us to determine

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. It is either balloon angioplasty or angioplasty with a stent - a metal mesh tube that expands inside a coronary artery.

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Cover Story Interventional Cardiology - An Overview

the content of the block, severity of the block, size of the vessel and thereby deciding the treatment strategy. It is also used to assess the effects of treatment with or without stents and to ensure perfect stenting. Optical coherence tomography - OCT OCT is an optical analog of IVUS, used to examine the coronary arteries. Ultrasound employed for IVUS examination is replaced by near infrared light with a wavelength of about 1300nm, which is absorbed by red blood cells, water, lipids and protein at relatively low levels. OCT produces high resolution in vivo images of coronary arteries and deployed stents. This has 1-3mm tissue penetration as compared with 48mm of IVUS, with the exception of calcified lesions in which sound has limited penetration. Rotablation Now by these imaging modalities, if you have found that the content of the block has extensive calcium deposition, you may need to prepare the vessel well before putting a stent. Just balloon dilatation may not open the block well. It is a catheter based procedure that includes a high speed rotating metallic burr that abrades calcified plaque rotating at speeds of around 2 lakh RPM and thereby breaking the hard calcific block before deploying the stent. Pacemakers A pacemaker is a medical device which generates electrical impulses delivered by electrodes to contract the heart muscles and regulate the electrical conduction system of the heart. It is placed in the upper chest and connected to the heart through

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wires which prompt the heart to beat at a normal rate. Pacemakers are used to treat arrhythmias. (Arrhythmias are problems with the rate or rhythm of the heart beat.) Artificial Implantable Cardiac Defibril lator - AICD AICD is a battery powered device placed under the skin that keeps track of your heart rate. Thin wires then connect the ICD to your heart. If an abnormal heart rhythm is detected, the device will deliver an electric shock to restore a normal heart beat if your heart is beating chaotically and too fast. It has been very useful in preventing sudden death in patients who are at risk for life threatening ventricular arrhythmias. Cardiac resynchronisation therapy - CRT Some people with advanced heart failure, experience a delay between the contraction of their right and left ventricles (lower chambers of heart) or between different walls of left ventricle. This is called dysynchrony.CRT is a device aimed at bringing back synchrony , improves heart function, quality of life, ability to exercise and survival.CRT is made up of 3 leads which are attached to the heart muscle at one end (right atrium, right and left ventricles)

AICD is a battery powered device placed under the skin that keeps track of your heart rate. Thin wires then connect the ICD to your heart. If an abnormal heart rhythm is detected, the device will deliver an electric shock to restore a normal heart beat if your heart is beating chaotically and too fast.


and to a pulse generator (battery) at the other. The pulse generator is placed under the skin like a pacemaker. Lead less pacemakers Unlike most of the pacemakers that are placed in the patient’s chest with leads running to the heart, leadless pacemaker is implanted directly into the patient’s heart. A few advantages are: z Less invasive - It is placed in the heart via a vein in the leg, thus no chest incision, scar or bump that results from conventional pacemakers. z Self-contained - It eliminates potential medical complications arising from a chest incision and from wires running from a conventional pacemaker into the heart.

The TAVI procedure is generally done by puncturing the femoral artery in the groin. A patient’s experience with TAVI may be comparable to an angiogram in terms of down time and recovery and it will just require a shorter hospital stay.

z Small – It is around 90% smaller than conventional pacemakers, about the size of a large vitamin capsule.

delivers a fully collapsible replacement valve to the degenerated valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

TAVI- Transcatheter Aortic valve implantation

Conclusion

As age progresses, the aortic valve of the heart (the opening through which blood comes out of heart) may have degenerative

Though I have made a small effort in enlisting a few of the newer advances in cardiology, I would like to emphasise that the basic compassionate clinical examination of the patient doesn’t have a substitute. The ever emerging field of medicine has no limits. All these new investigatory tools and technologies are meaningful only after a proper clinical diagnosis.

URIC ACID

I would like to echo certain great words of my teachers here. “The greatest diagnostic tool lies between the ears. Diseases do not read the text book which I read”. Every patient has to be considered unique and cannot be generalized on the basis of what I have read. The ideal patient experience merges excellent medical care, high quality outcomes, compassion and empathy that address the emotional needs of patients. The field of Cardiology has undergone rapid changes in the last few years. We have more potent drugs, development of new diagnostic techniques, and evolution of stent technology with more complex coronary anatomy being treated percutaneously. New valve therapies for high risk patients have emerged and likely to evolve further. It can be said that the future looks bright and there is so much too look forward to.

Agappe’s unique Uricase-TOPS method of Uric Acid ensures reproducible result with high linearity of 25 mg/dL & long shelf life of 20 months makes it the preferred brand. changes resulting in shrinkage of its opening (Aortic stenosis).Conventionally, it was treated only by surgical replacement of the diseased valve with an artificial valve by surgically opening the chest. The TAVI procedure is generally done by puncturing the femoral artery in the groin. A patient’s experience with TAVI may be comparable to an angiogram in terms of down time and recovery and it will require a shorter hospital stay (average 3-5 days). It

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Health Tips

Cor is Your Core Organ, Pay attention to it... Dr. C.S. Satheesh Kumar, Vice President-Operations, AGAPPE., (Retd. Drugs Controller, Kerala) Your heart is the centre of your cardiovascular system (CVD) and it is vitally responsible for just about everything that gives your body life, ranging from the transportation of oxygen to the success of your immune system.

the many other tissues that make up your cardiovascular system. CVD is a term used to describe all diseases of the heart and blood vessels. Coronary heart disease (which includes hear t attacks and angina) and stroke are However, the food you eat, stress level and common forms of CVD. the amount of activity you A healthy lifestyle plays choose to take part in, can an important role in the dramatically affect the prevention and manaoverall health of gement of CVD. your heart and

Today, the uncomfort-

able truth is that there is no age factor that determines heart ailments. People in their 20s are fal ling prey to heart attacks. Now we skip our meals and substitute it with convenient food with zero nutrition. Probably we follow a mix of these and several other factors of modern living. The problem is that it is telling on our health a few decades earlier than expected.

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Stress & Sleep - Stress level is the major contributory factor to the health of CVD at large. In a study, young and middle-aged adults who slept 7 hours a night had less calcium in their arteries than those who slept 5 hours or less or those who slept 9 hours or more (an early sign of heart disease). There are many examples of senior executives with high stress level and less sleep succumbing to death much early. Stress multiplies the blood pressure, the extra force can damage artery walls and create scar tissues, and consequently, the heart has to pump harder and gets worn out faster. If you do not get enough oxygen, its parts will start to die. Cut back on salt, limit alcohol to no more than one to two drinks a day, favour healthy eating habits (think fruits, vegetables, whole grains, and lean protein), manage your stress through meditation and work out. These changes are often enough to bring your blood pressure back down into the normal range. If not, your doctor might recommend you to take medication. Make it a point too to spend time with people you’re close to. Tal k, laugh and confide in them. Yoga - One option is to include a generous slice of nature in our daily lives. Yoga and meditation can be healthy and natural alternatives for heart patients. Yogic exercises are essential, as a preventive measure and can be very beneficial as a curative one too. Tadasana, Vrikshasana, Thrikonasana, Veerabhadrasana, Marjasana, Bhujangasana, Dhanurasana, SethuBandhasana, Sarvangasana, Pachimottasana, Savasana are some important Yoga poses. Give up smoking: If you’re a smoker, quit. It’s the single best thing you can do for your heart health. It is one of the main causes of coronary heart disease. A year after giving up, your risk of a heart attack falls to about half that of a smoker. Get active: Getting and staying active can reduce your risk of developing heart disease to great extent. It can also be a great mood booster and stress buster. Do 150 minutes of aerobic activity every week. One way to achieve this target is by doing 30 minutes of activity on five days a week. Fit it in where you can such as by cycling to work. Manage your weight: Being overweight can increase your risk of heart disease. Stick to a healthy, balanced diet low in fat and sugar, with plenty of fruit and vegetables, combined with regular physical activity. Find out if you are a healthy weight with the BMI calculator. If you’re overweight, do try proper weight loss plan. Eat more fibre: Eat plenty of fibre to help lower your risk of heart disease – aim for at least 30g a day. Eat fibre from a variety of sources, such as wholemeal bread, bran, oats and wholegrain cereals, potatoes with their skins on, and plenty of fruit and vegetables. Research from the University of Oxford shows vegetarian diets reduce our risk of hospitalization or death from heart disease by nearly one-third. Non-meat eaters are not only significantly less likely to develop heart disease, but they’re also less likely to get cancer and foodborne illness, the research shows. A

handful of healthy nuts such as almonds or walnuts will satisfy your hunger and help your heart. Berries are full of heart-healthy phytonutrients and soluble fibres and Flaxseeds contain omega-3 fatty acids, fibres and phytoestogens to boost heart health. Dark beans such as kidney or black beans are high in fibres, B-vitamins, minerals and other good stuff. Red wine can help improve good (HDL) cholesterol levels; Red, yel low and orange veggies such as carrots, sweet potatoes, red peppers and acorn squash are packed with carotenoids, fibre and vitamins to help your heart; Fruits such as oranges, cantaloupes and papaya are rich in beta-carotene, potassium, magnesium and fibre; Tomatoes provide lycopene, vitamin C and alphaand beta-carotene; Dark chocolate is good for your heart health, but just be sure that it’s at least 70 percent cocoa; Co-enzyme Q10- has precious fat-soluble vitamin giving energy directly into your heart. Together with Vitamin E and selenium, CoQ10 presents good antioxidant, protecting against hardening of the arteries and inflammation and the richest sources of CoQ10 are eggs and fish. Beetroot is a natural source of nitric oxide which causes blood vessels to widen, helping to restore a healthy blood flow and may even lower blood pressure.

Being overweight can increase your risk of heart disease. Stick to a healthy, balanced diet low in fat and sugar, with plenty of fruit and vegetables, combined with regular physical activity.

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Health Tips Pomegranate is often labelled as the anti-ageing fruit with more antioxidants than blueberries and more flavonoids than red wine. Now the ‘cholesterol’ myth has been dispelled, eggs provide perfect nourishment; vitamins, minerals, good fats and masses of protein. Crisp,fresh broccoli florets dipped in hummus are a terrific heart-healthy snack with a whopping list of nutrients, including vitamins C and E, potassium, folate, calcium and fibre. To the great delight of every vegetarian, beans are a fantastic addition to a heart-friendly diet with soluble fibre which can bind cholesterol and prevent its absorption. When this specific fibre is fermented in the gut, changes to short-chain fatty acids are initiated which can inhibit cholesterol formation in the first place. Eat fish at least twice a week, including a portion of oily fish. Fish such as mackerel, sardines, fresh tuna and salmon are a source of omega-3 fats, which can help protect against heart disease. Pregnant or breastfeeding women shouldn’t have more than two portions of oily fish a week. Cut down on saturated fat and Salt - Eating too many foods that are high in saturated fat can raise the level of cholesterol in your blood. This increases your risk of heart disease. Food is high in salt if it has more than 1.5g salt (or 0.6g sodium) per 100g. Adults should eat less than 6g of salt a day in total – that’s about one teaspoon. Obesity also leads to heart failure, a very serious condition in which the heart is incapable of pumping enough blood to meet the body’s needs. Numerous studies have found that belly fat is particularly dangerous. In fact, in one recent study, a pot belly even in people who were otherwise nor mal weight dramatically increased the risk of dying. Fat in the belly doesn’t just sit there, taking up space. It pumps out chemicals like cytokines that trigger chronic inflammation throughout the body. That’s a big problem because chronic

Regular exercise like walking and swimming can help prevent heart disease, lower blood pressure and improve your cholesterol levels. Break up long periods of sitting and stand or walk while doing things like talking on the phone or watching TV.

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inflammation is thought to be one of the major factors linking obesity to various life-crippling diseases, including heart disease. Drink less alcohol - Alcohol contains calories. Regularly drinking more than recommended dosage can have a noticeable impact on general health. Exercise - Regular exercise like walking and swimming can help prevent heart disease, lower blood pressure and improve your cholesterol levels. Break up long periods of sitting and stand or walk while doing things like talking on the phone or watching TV. Aerobic (cardiorespiratory) is useful with a daily minimum of 30 minutes and optimally 60 to 90 minutes, alternating moderate-intensity days with vigorous-intensity days. Regular flexibility (stretching) postures are helpful to enhance overall flexibility and ability to exercise more freely. Be social - Stay in touch with your friends and family. Research shows that people with more social support are less prone to heart trouble. After all, friends are good medicine, as per study it is found women with bigger, more supportive social networks are less likely to be overweight, smoke or have high blood sugar or high blood pressure. It’s good for your emotional health and your heart. Diabetes- High blood sugar damages arteries and makes heart disease more likely. If you have borderline high blood sugar, also called pre-diabetes, take action now to turn things around. Reduce processed carbohydrates (like white rice) and consume more fiber-rich whole grains (like brown rice). Every positive change you make in what you eat and how active you are will help. In nutshell, a balanced diet with adequate exercise, rest and stress-free life style can contribute a lot in maintaining the cardiac health to a greater extent.


Cover Story Good Laboratory Practices

Importance of

HARDWARE CALIBRATION IN

CLINICAL LABORATORY Sanjaymon K.R., General Manager, AGAPPE.

Even though the laboratories are doing their best to assure the quality, there are some hardware variables which are sometimes overlooked and become one of the reasons for inaccuracy.

In this highly competitive world, each laboratory is

doing their best to make sure that the results are of supreme quality. Assuring quality of test results depend up on many factors, starting from pre-analytical, analytical and post analytical variables. In analytical segment, there are multiple ways to validate the quality of the tests performed. Two major quality assurance methods are either by means of running an internal quality control (IQC) or by means of a peer group comparison. There are laboratories doing inter-lab and intra lab comparisons as a criterion for quality assurance. Even though the laboratories are doing their best to assure the quality, there are some hardware variables which are sometimes overlooked and become one of the reasons for inaccuracy.

Centrifuge Centrifuge is the most common hardware found in the laboratory irrespective of their size. This is one of the essential hardware in diagnostics. In general, each parameter is having its own standard operating procedure, which usually starts from clear plasma/ serum after centrifugation. In many text books, the speed and time of centrifugation is also mentioned. Now, let us take the case of HDL cholesterol estimation by means of the precipitation method. This

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Cover Story Good Laboratory Practices

Agappe’s AGA1c reagent is the unique double reagent system which is reliable, convenient, accurate and ensures value for money. It has regular and system packs and can be performed in most of the fullyautomated or semiautomated system. method for HDL estimation is the cheapest method available, which has multiple steps in the procedure. In this method, one of the steps is centrifuging the serum-reagent mixture at 4000 RPM for a minimum of 10 minutes. Here, the timing and speed is clearly specified to make sure of getting a clear supernatant which can be used for next step. The accuracy of estimation depends on the clear supernatant and any minute particle can lead to variation in result. There are two types of common centrifuges available - one having a dial with pre-fixed speeds and the other having a variable dial. There are systems with timer for auto cut-off and display to show the speed.

Have you ever thought of the reason for variation in manual testing? One of the reasons for high CV% in manual testing is the Micropipette. Micropipettes are mechanical devices and hence are prone to wear and tear. When you closely look into the pipette manufacturers booklet, we can see that each pipette is having a tolerance range.

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Now, the question is how do we validate the speed of centrifuge? Do we depend on the display value? Or the pre-fixed speed in dial? If the answer is yes, then this may lead to random errors in testing. Because of the nature of working at high speed, the wear and tear of the hardware is high and the centrifuges are vulnerable to variation in the speed upon continuous usage. It is recommended that the laboratory should perform a hardware calibration of the centrifuge periodically. For centrifuge calibration, noncontact tachometers are available in the market, which can be used for onsite calibration of the centrifuge. Make sure that the tachometer is pre-calibrated from an accredited agency for assuring traceability of onsite calibration. The laboratories can also consider opting for an accredited calibration agency, which is the easiest way.

Micropipettes Have you ever thought of the reason for variation in manual testing? One of the reasons for high CV% in manual testing is the Micropipette. Micropipettes are mechanical devices and hence are prone to wear and tear. When you closely look into the pipette manufacturers booklet, we can see that each pipette is having a tolerance range. We calibrate the Semi-automated system using a calibrator and the calibrator is taken using the micropipette. The question is: “Is the micropipette calibrated?” In majority of cases, the answer will be NO. This is one of the major factors for accuracy. The micropipette manufacturer itself


recommends periodical maintenance and calibration of the pipette and in most cases, the maintenance kit is also provided along with the pipette box. But unfortunately, 90% of the cases, the pipette remains in the same way without any maintenance. Today, most of the common clinical chemistry parameters are calibrated using a multi calibrator, which is usually presented in lyophil ised form. The calibrator needs to be diluted with specific volume of distilled water and in case the same is diluted using an old non-calibrated pipette, it can make serious error in the entire parameter calibration. The condition will be even worse when we use serial dilution in calibration. Since the fluid calibration is highly technical and requires dedicated costly instrument and special environment. It is always recommended to calibrate the pipette from an accredited agency. It is recommended to have two sets of calibrated pipettes with different calibration expiry. This will make sure that the laboratory is having calibrated pipettes in all time.

Temperature Monitor The reagent kits are highly sensitive and needs to be kept at 28 degrees to retain the stability and sensitivity as claimed in the

The reagent kits are highly sensitive and needs to be kept at 2-8 degrees to retain the stability and sensitivity as claimed in the manufacturer kit inserts. Certain specific reagents are highly temperature sensitive and a few hours in temperature below zero degrees can create reagent instability.

manufacturer kit inserts. Certain specific reagents are highly temperature sensitive and a few hours in temperature below zero degrees can create reagent instability. Monitoring of the cold room temperature is essential for assuring the reagent stability which is one of the major factor defining the accuracy of results. How do we confirm that the temperature in the cold room is accurate? Majority of the laboratories depend on the builtin temperature monitor of the cold room/Fridge or incubator. There may be a chance of error and it is advisable to use an electronic calibrated temperature monitor to read the temperature of the cold rooms, incubators etc in the laboratory. For laboratories having 24 hours operation, a room temperature monitor having maximum-minimum reading is ideal to monitor the environmental condition. It is recommended that a chart is pasted on the doors of the cold room or Fridge and the temperature is monitored at least twice in a day. For incubators and dry bath, makes sure that the temperature is checked each time a test is performed. Laboratory manager should check the chart at least on a weekly basis and make sure that there are no recurring issues happening. Laboratory should maintain a calibration record file for all the critical hardware systems and should make sure that the calibration is renewed properly to assure the quality of the tests performed.

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FOR ACCURATE AND PRECISE BLOOD GLUCOSE MEASUREMENT Accurate precise blood glucose measurement is necessary in the management & prevention of the major complications in diabetes.


India's Largest IVD REAGENTS MANUFACTURER launches GLUCOSE HEXOKINASE

The Gold Standard In Glucose Estimation With

HEXOKINASE METHOD 7 Excellent Linearity of 900 mg/dL 7 Fast Reaction, 5 Min incubation 7 One month on board stability 7 High accuracy, CV <2% 7 Provided 2mL Calibrator for along with kit The hexokinase method developed by the American Association of Clinical Chemistry has been accepted as the reference method for glucose determination. The Hexokinase method is a two-step reaction. This method has advantages over glucose oxidase method, primarily because fewer substances interference and it uses safer reagents. In the first step, hexokinase in the presence of ATP, adds a phosphate to glucose to form Glucose – 6 – Phosphate (G6P). In the second step, G6P in the presence of NAD and the enzyme Glucose – 6 - phosphate-dehydrogenase is converted to D-Gluconate-6-phosphate with the production of reduced nicotinamide adenine dinucleotide (NADH).

EXCELLENT SENSITIVITY & SPECIFICITY HIGH LINEARITY Packs LiquiCHEK - 4 x 125 mL | Mispa Nano/ Mispa Ace - 4 x 35/2 x 18 mL Mispa Clinia - 4 x 50/2 x 30 mL | TBA-25FR - 4 x 35/2 x 19 mL TBA-120FR/ 2000FR - 4 x 100/4 x 28 mL

*

For more details, contact our

Toll Free No: 1800 425 7151


Brand Reach Customer Speaks

Rachana Chandran,

Lab-in-charge, Malabar Multispeciality Centre, Calicut

2

Quality RRepor epor ts and PPerformance erformance eports We are using Mispa i3- cartridge based specific protein analyser in our laboratory department for one year. The test report obtaining from this equipment is meeting the quality requirements. The performance of Mispa i3 is satisfactory.

Satisfactory Pr oducts and Products Customer Car Caree We are using TBA 25FR fully automatic biochemistry analyzer for the past three years and we are very much satisfied with your products and customer care.

Umashankar, Best Diagno Lab, Chennai

Reliable and Affor dable Pr oducts Affordable Products Dr. Atul Kapila Diagnostic Point Sarvodaya Hospital, Ghaziabad

4

It is to state that I have been using Mispa Nano fully automatic biochemistry analyzer of Agappe for more than 5 years. I find it to be a reliable sturdy machine with low breakdown. Maintenance of this instrument is not expensive and service back up is also good.

Trustwor ty Pr oducts with Shor rustworty Products Shortt TAT I am using Mispa i2, Mispa Clog and Mispa Revo for the last two years and I am fully satisfied with the results derived. It is especially helpful in managing patients of DM & Allergic disorders as HbA1c & IgE are available in a short span.

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Dr. Atulya Atreja Consultant Chest Physician, Aarogyam, Karnal

3


Privileged to Use Agappe Products Dr. Nilesh V Thorat.

Dr.Thorat’s Pathology Laboratory, Satara

6

We are using Mispa i2 - specific protein analyzer equipment of Agappe since last two years and are happy with the results. Also, we are using biochemistry kit-Triglycerides, cholesterol, creatinine, SGOT, SGPT etc. Sales staff does visits frequently and are updating us the information about the launches. We are enrolled in AG Privilege also.

Stable, Compact & User - Friendly Product We are using Agappe nephelometry equipment Mispa i2 specific protein analyzer for more than one year. We run HbA1c, CRP, RF, D-dimer etc. and very much happy with the results. The machine is very stable, compact & user friendly.

Ravi Jain

Mahavir Medical Research Centre, Mumbai

Excellent Results, After Sales Support and Very Affor dable Affordable Dr.Raja, Bio Diagnostika, Heart Hospital Patna

8

We are using Agappe’s HbA1c, Enzymatic creatinine, HDL D, LDL. Result of these parameters are excellent and comparable to big names in the diagnostic world. Mispa Revo is also placed in this hospital. We are using few parameters including NT-proBNP. The results are good and service is excellent. Agappe is known for its quality reagents & equipment at best price. Best wishes to Agappe Team.

Top-notch Quality and Unerring rresults esults I am glad to share that I am using Agappe’s Mispa Count, Mispa Viva & Mispa i2. All these machines are reliable in terms of result & quality. Post sales & service is also very good.

5

7

R. Kumar,

Alpha Medical Services, Howrah

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Engagements Exhibitions & Conferences

AGAPPE at â&#x20AC;&#x153;MEDLAB (Middle East) 2017, Dubai.

MORE PLACES TO KNOW ABOUT US MEDLAB ASIA PACIFIC 2018

MEDICONEX 2018

AACC 2018

Date:- 2 - 4 April 2018 Venue:- Suntec Singapore International Convention and Exhibition Centre, Singapore

Date:- 14 -16 April 2018 Venue: Cairo International Convention Centre, Cairo, Egypt

Date:- 31 July - 2 August 2018 Venue:- McCormick Place, Chicago, IL, USA.

AGAPPE Booth No:- M 31

AGAPPE Booth No:- J 30A

AGAPPE Booth No:- 653

T

he inaugural MEDLAB Asia Pacific Exhibition & Congress was launched in February 2014 as part of the MEDLAB series. Now in its fifth year the exhibition will provide a platform for leading companies to showcase current technologies and clever innovations in the field of laboratory and diagnostics. Following the huge success of 2017, the event is always expanding with more than 4,000 visitors from around the world, MEDLAB Asia Pacific will bring together key companies to showcase the latest products and innovations. Held alongside the exhibition, MEDLAB Asia Pacific will feature a multi-track, fully accredited, conference programme providing unparalleled education and management solutions to help labs excel.

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Mediconex Exhibition and

Congress is North Africa's largest healthcare exhibition and is a leading platform for the industry to meet, learn and do business. The exhibition takes place from 14-16 April 2018 at the Egypt International Exhibition Center (EIEC), Cairo, and will attract more than 4,000 healthcare professionals and host 155 of the worldâ&#x20AC;&#x2122;s leading healthcare suppliers, manufacturers and service providers.

APRIL-JUNE 2018

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he 70th AACC Annual Scientific Meeting & Clinical Lab Expo is the largest global scientific conference and tradeshow in the field of laboratory medicine. At this dynamic meeting, the participant will have the opportunity to connect with global leaders in clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of breaking science in laboratory medicine and to learn about cutting edge technology. The AACC Clinical Lab Expo has more than 200 new product introductions each year. The participant can also hear vital research and learn about important changes in the field. With more than 200 educational and scientific sessions, they can design an educational experience that meets their need to stay ahead of changes in the field.


Engagements Special Days

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Promotion

New Product

SEMI-AUTOMATED URINE CHEMISTRY ANALYZER

MISPA URISKAN 100 PLUS IS AN INNOVATIVE URINE ANALYZER WITH OUTSTANDING FEATURES WHICH OFFERS SIMPLE AND QUICK SOLUTION FOR URINE ANALYSIS.

Ÿ Ÿ Ÿ

Principle –Reflectance Photometry using cold light source 11 assay parameters with Microalbumin Large capacity of 1000 Patient memory Through put is 120 strips/hour Connectivity option to Urine sediment analyser

Kid SCREEN

Ÿ Ÿ

Product

Purpose

ULTRA STIK

11 Parameters with Microalbumin

MRP

Visual Strips for Glucose

PRODUAL

Visual Strips for Glucose, Protein

KETODUAL

Visual Strips for Glucose, Ketone

ECOSTIK

Visual Strips for Glucose, Protein, Ketone

*

For more details, contact our

Toll Free No: 1800 425 7151

SIMPLE & QUICK SOLUTION FOR URINALYSIS


Promotion

New Product

5 PART DIFFERENTIAL HEMATOLOGY ANALYZER

MISPA COUNT PLUS IS A COMPACT 5 PART DIFFERENTIAL HEMATOLOGY ANALYZER WHICH OFFERS CUTTING-EDGE TECHNOLOGY SOLUTIONS TO PERFECTLY SATISFY THE QUALITY NEEDS OF THE LABORATORY.

Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ Ÿ

Compact design Single button startup and shutdown Minimal maintenance Color Touch screen with high contrast ratio Alphanumeric patient ID Positive sample identification using barcode reader USB connectivity

GERMAN TECHNOLOGY

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For more details, contact our

5 PART ANALYSIS REDEFINED Ÿ

28 Parameters

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Triple count technology

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LED based flow cytometry

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Optimal workflow management

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Open vial sampling

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60 Samples / hour

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Sturdy hardware

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Dual counting modes

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35000 result memory with Scatter plot

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Whole blood 15.6 µL & pre-diluted 20 µL

Toll Free No: 1800 425 7151

RIGHT FIT FOR YOUR LABORATORY


Moments

Awards

ASSOCHAM MEDICAL TECHNOLOGY EXCELLENCE AWARDS 2018 Agappe has participated in the Associated Chambers of Commerce and Industry of India’s (ASSOCHAM) Medical Technology Excellence Awards 2018 and awarded as the winner of “Best Technology Solution – Diagnostic” for our R&D developed product “Mispa Label” – The Tube Labeling System. Mr. Thomas John has received the award from Shri Y. S. Chowdhary, Hon’ble Minister of State for Science & Technology and Earth Sciences, Government of India during the ASSOCHAM Conference on ‘Future of Medical Technology in India’ held on January 24, 2018 at New Delhi. Mr. Thomas also received a special invite to address the session on “The Future for Technology Enabled Healthcare: How the Industry Realizes the Opportunities?” as panellist. It is really a proud moment for us that our Company is creating landmarks in the history of diagnostic industry and bringing the brand AGAPPE to the heights of the IVD Segment.

CII INDUSTRIAL INNOVATION AWARDS 2017 “Mispa-i3” the cartridge based specific protein analyzer, has created another history. For the innovation of this Product, AGAPPE has been selected and awarded with “CII Industrial Innovation Awards 2017one of the Top 26 Innovative Organisation”.

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Reward Programme

CONSENT

By signing this form, I confirm that the information provided above is true and that I am fully familiar with and accept the General Business Terms for Privilege Account. I agree that the authorized personnel of Agappe Company may col lect and process my personal information, the information about received privileges, collected points, information regarding the privileges used and other Information acquired during my visit to AG privilge website and ACEP mobile application. Also in absence of me, I authorize my staff Mr / Mrs. / Miss / ………………………….........to avail benefits of AG Privilege and redeem Reward point's benefits using the registered mobile……………………………..... Number, through AG Privilege Website / AG Privilege mobile application. Also Agappe Diagnostics Ltd undertakes to handle the information in line with the requirements of the Personal Data Protection Act and that it will use them only for marketing reasons.

Proprietor Name:..................................................................................................................................................... Address..................................................................................................................................................................... .................................................................................................................................................................................... Date:

Disclaimer • AG Privilege points are subjected to offer made to Agappe Loyal customers who are either purchasing or using existing Agappe reagent as products.AG Privilege offers are not valid on instrument purchase. • Lab must claim points accrued through the program through the redemption process to exchange the points for reagents. • Lab must claim points or rewards only after reaching the redemption level. • Points can be claimed and used for rewards available in the then current program only and by authorized personnel of Laboratory. • Point requirements assigned to any reward are subject to change from time to time without notice, and rewards may be substituted at any time. • The loyalty points can be claimed by the Legal owner of the program and will be done only after

Sign / Seal of the Owner / Proprietor / Director

Scan QR code to download App

submitting the signed copy of the disclaimer. • Agappe diagnostics/Agappe employee will not be in any manner responsible for any claim on account of claim/Point redeemed or point burnt by lab technicians/distributors, distributor staff or any other personnel who is not a part of lab or hold any organizational position. Any such act, if it comes to the notice, will be considered as malpractice and the concern laboratory owner/director or any other official wil l be informed. • Delivery of reagents will be done after conducting and possible due diligence. • Agappe require verification of lab identity and account prior to processing your order. • Government/Semi Government undertakings wil l not be covered under this program. • The Privilege program is not meant for any Agappe staff. • Jurisdiction: Any dispute arising out of this program shall be subject to the exclusive jurisdiction of the Courts at Ernakulam, Kerala, India.

Kindly fill the form carefully and hand over to Agappe’s staff or post to The Manager-Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562. For more details, contact +91 9349011309.

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Editorial Quiz & Feedback Quiz Answers of JanuaryMarch 2018 Edition.

1. The Heart is a double-pump which supplies blood throughout the entire body initially via the aorta! True or False? A. True B. False 2. After birth, which anatomical hole closes as to al low proper functioning of the lungs? A. Foramen ovale B. Oblique ovale C. Circumflex ovale D. Mitral ovale E. Atrial ovale

1-B, 2-C, 3-C, 4-A, 5-D, 6-B, 7-A 8-C, 9-A, 10-C Quiz Winners of JanuaryMarch 2018 Edition.

HEART QUIZ

3. Blood pressure measurement is expressed as A. Diastolic pressure over systolic pressure B. Sacral pressure over diagonal pressure C. Systemic pressure over diaphragm pressure D. Systolic pressure over diastolic pressure 4. How many leads are there in a standard electrocardiogram? A. 12 B. 14 C. 15 D. 10 5. The heart pumps... A. More quickly when at rest C. Irregularly when in a-flutter

B. At a usual rate of 60-100 beats per minute D. Very slowly when dead

Dr. Apurva Arora, Taran Taran | Arun.R, Kozhikode | Poornima, Santhekatte | Parul Salunke, Mumbai | N. K. Bansal, Ahmedabad | Jaineel K Shah, Ahmedabad | Dr. Biswajit Batabyal, Kol kata | Prasanth A. S, Trivandrum | Sr. Sudhanya , Calicut | Davis K. J., Palakkad | Dr. Munjal Shah, Mumbai | Rejish V., Palakkad | Ambujam M. B., Kottayam | Sreenish V. P., Calicut.

Answers of this quiz contest will be published in the next edition along with details of the winner. Participants can either hand over the answers to Agappeâ&#x20AC;&#x2122;s staff or send in their responses directly to Techagappe at techagappe@ agappe.in or post a mail to The Manager-Corporate Communication, Agappe Diagnostics Limited,Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562.

What do you think of this edition of Techagappe? Are you happy with the overall look and feel of the magazine? Do you recommend any change of style with regard to presentation of articles? You can share your views with us in the space given below. All you have to do is to post this sheet of paper to the address given below. The best letter shall be featured in the next editionâ&#x20AC;&#x2122;s 'letters to the editor' section. ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ............................................................................................................................................................................... Name..................................................Address..................................................................................................... PIN....................................Mob.............................................Mail ID..................................................................

Postal address:

The Manager - Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562. Email: techagappe@agappe.in | Mob: +91 9349011309

Kind ly let us know which section of the magazine you like more... Poem Cover Stories

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Life Stories Good Laboratory Practices

Health Tips Interviews


PT APTT FIB Mispa Clog + is an innovative hemostasis analyser with smart card calibration technology which offers simple and quick solution for the coagulation analysis. Ÿ

Principle: Photometry.

Ÿ

Parameters available - PT, APTT, Fibrinogen.

Ÿ

Smart Card Calibration.

Ÿ

User friendly, easy to operate software.

Ÿ

Control & sample mode are available.

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Display of number of test done, remaining tests & stability of the reagent.

Ÿ

Quick start menu.

Ÿ

One reading chamber & four reagent, sample incubation positions.

Ÿ

Special magnetic stir bar for homogenizing of the

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Test results are displayed as – Sec, INR,% for PT;

Ÿ

Low CPT - Minimum volume required for any test is

test suspension which increases the sensitivity. gm/L, mg/dl, ratio for others parameters.

Smart Hemostasis Analyzer

FIB

200 µL only.

*

For more details, contact our

PT

Toll Free No: 1800 425 7151 APTT

Reset Button Incubation chamber Reaction chamber Display Screen

CORPORATE OFFICE Agappe Hills, Pattimattom P.O, Dist. Ernakulam, Kerala - 683 562, India. Tel: +91 484 2867000. Fax: +91 484 2867222; agappe@agappe.in Branches: Delhi | Bangalore | Kolkatta

Power ON/OFF Smart Card Slot

REGISTERED OFFICE Office No : 401 & 402, 4th Floor, Jaisingh Business Centre, 119, Sahar Road, Parsiwada, Andheri (East), Mumbai - 400099, India. Tel : 022-4300 8000, Fax no: 022 - 4300 8050 | mumbaioffice@agappe.in

GLOBAL ACCESS POINT AGAPPE DIAGNOSTICS SWITZERLAND GmbH, Knonauerstrasse 54 - 6330, Cham - Switzerland Tel: +41 41 780 60 10 | Fax: +41 41 780 60 11, info@agappeswiss.com


RNI No.: KERENG/2015/62113

www.agappe.com Toll Free

1800 425 7151

Printed and Published by Ms. Meena Thomas on behalf of Agappe Diagnostics Limited and Printed at Five Star Offset Printers, Nettoor, Cochin-40 and published from Agappe Diagnostics Limited, â&#x20AC;&#x153;Agappe Hillsâ&#x20AC;?, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas.

Sharp for accuracy and smooth in procedure open to all and no closed loops bright as future and simple as present

Techagappe 15th edition (April - June 2018) E-book  

Agappe Diagnostics Limited is the first Indian IVD company publishing an International Diagnostic News Journal “Techagappe” for the public t...

Techagappe 15th edition (April - June 2018) E-book  

Agappe Diagnostics Limited is the first Indian IVD company publishing an International Diagnostic News Journal “Techagappe” for the public t...

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