Page 1

Vol.3 Issue 4

JULY - SEPTEMBER 2017

THE DIAGNOSTICS NEWS JOURNAL

Published at Agappe Diagnostics Limited on July 01, 2017 | 62 Pages | ` 20

“ AGAPPE JOINING HANDS WITH HITACHI CHEMICAL-JAPAN ” Mr. Thomas John

CATARACT: CAUSES AND TREATMENTS Dr. D. M. Vasudevan

RETINOBLASTOMA: A COMPREHENSIVE REVIEW Dr. Parag K. Shah

“DONATE AND ENTRUST YOUR VISION TO THE NEXT GENERATION" Dr. Tony Fernandez

EYE DONATION & TRANSPLANT: A NOBLE CAUSE Dr. Thomas Cherian

DDC: DEDICATED TO DIAGNOSIS & RESEARCH Dr. P. K. Rath

OPHTHALMOLOGY Discussion on Specic Eye Ailments, Eye Donation and Transplant Procedures


Privilege

®

It’s not about how much you give But how much we admire!

Scan our Reagent Kits to Earn Your Privilege Points & Get Exciting Gifts*

AGAPPE CUSTOMER ENGAGEMENT PROGRAM Review Product Catalogues | Check System Reagents | Reference Range At A Glance Know Our Products | Enquire About Parameters | Win Exciting Gifts & Rewards

Don’t forget to scan the BARCODE !


Earning & Redeeming Points in 5 steps, It is Easy & Secure...

1

2

3

Purchase Our QUALITY & INNOVATIVE Products

Scan the product Barcode Using AG PRIVILEGE’S SCANNER

Earn 1 Point for Every 100 RUPEES Purchase

4 Redeem Points through ONLINE REWARD STORE

5 Enjoy EXCITING

GIFTS

*conditions apply

+91 - 484 - 2867078 | Mob: +91 9387028253

Contact: agprivilege@agappe.in


CONTENTS ○

7

Volume 3 | Issue 4 | July-September 2017 ○

My Embrasure to the World

Agappe joining hands with Hitachi Chemical-Japan

24-25 Evolution of Diabetic Profile

30-33

08-10

12-15 Cause and Treatment of Cataract 26-29

Eye Donation & Transplant A Noble Cause

Thomas John, Agappe Diagnostics Ltd.

Dr. Gayathri Sankaran A Rare Musical Gem

34-36 DDC-Dedicated to Diagnosis and Research

16-19

Shekhar Naik :

Unveiling a Passionate Blind Cricketer 37-39 Dr. Satish Amarnath: A man who has Proven His Mettle 40-43 A Comprehensive Review on Retinoblastoma 44-46 How Healthy & Strong are Your Eyes ?

Mr. Thomas John

47-49 Understanding Quality Control Charts 50-53 Testimonials 54

Exhibitions & Conferences

55

Engagements - Special Days

58

Moments-Awards

20-23

"Donate and entrust your vision to the next generation..." Dr. Tony Fernandez

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.

4

TECHAGAPPE

JULY-SEPTEMBER 2017


○ ○ ○ ○

From the Editor’s Desk

THE DIAGNOSTICS NEWS JOURNAL

○ ○

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

I am very pleased to place before you, this 12

issue of TechAgappe, the quarterly review of health and laboratory medicine. Previous editions were based on Cardiac disease, Renal illnesses, Hepatic ailments, Pancreatic disorders, Cancer, Neurological disorders, Gastroenterological complaints, Gynecological maladies, Clinical Haematology, Lung diseases and Musculoskeletal disorders respectively. 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. th

This issue focuses on eye diseases. The first scientific article highlights the most common cause of blindness, that is, Cataract, where the lens becomes opaque. The second cover story deals with the often-asked questions on eye donation and eye transplant. The third cover story is about Retinoblastoma, a cancer arising from retinal cells.

Focuses on Eye Diseases & Treatment ...

○ ○ ○ ○ ○

As usual, we have added three life stories. The first life story is about a female musician from Chennai, who is blind from birth, but now is a recipient of the Padmashree award. The second life story revolves around the former Blind Indian cricket team captain from Shimoga. He is also awarded Padmashree this year. The third life story deals with the Microbiologist from Bangalore Manipal Hospital. He became blind due to an acid attack, 20 years back. These landmark biographies will tell you how to overcome a shortcoming by sheer determination.

○ ○

We have also included two interviews. One is with Dr. Tony Fernandez, the doyen of ophthalmic surgery. The second one is from the eminent Dr. P.K.Rath from DDC Laboratory, Trichy on the diagnostic speciality.

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Thus, I am sure, this issue of the TechAgappe will give useful insights to the problems of various eye 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,

I am glad to state that we have received very good feed back through ‘letters to editor’, where most of the readers stated that they are happy to read TechAgappe and are eagerly waiting for the next issue. The responses to the ‘quiz’ were also very encouraging.

○ ○ ○

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

We have also added health tips highlighting Yoga exercises for longlasting eye health. This time, the technical article is on interpreting the quality control charts.

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 Dr. C.S. Satheesh Kumar Sudhir K. Nair Jofy Paul Gopalakrishnan R. Suresh Babu Sanjaymon K.R Vijith Kumar V. Mallya

CONSULTING EDITOR Rarima N.S

CHIEF EDITOR Dr. D.M.Vasudevan

EDITOR Meena Thomas

EDITORIAL BOARD

Volume 3 | Issue 4 | July-September 2017 ○

Dr. D.M. Vasudevan

TECHAGAPPE

JULY-SEPTEMBER 2017

5


LETTERS TO THE EDITOR

A gr eat RRefer efer ence Keen to showcase great eference Book and a latest Updates Motivation to always Healthcare industry is going Healthy Life I am happily saying that your diagnostic news journal, ‘Techagappe’, is very useful for improving my medical knowledge and updating latest medical news. It is so wonderful to use as a reference point and I used to recommend this wellwritten journal to my well-wishers. Thanking Agappe for serving public with such a great publication. It is not only supporting public but making people more vigil to their health condition and motivating them to have a victory in their life.

Dr. R. T. Vasan,

N. S. Clinic, Kollam

through a huge makeover in the new century. These changes are known to the world through health magazines like Agappe’s Techagappe. Experts’ advice and their experiences contribute to excellence in quality of messages of Techagappe magazine. Each session on Orthopedic aspects reflects great knowledge in the field. Interview and life story of Aditya Mehta is heart touching. We expect the new edition with enriched knowledge. All the best for the bright future of Agappe.

Prof. Urmila D. S.,

Vice Principal, Ananthapuri College of Nursing, Trivandrum.

Wonderful Health TTips ips that Incorporates Indian Heritage This orthopedic edition of Techagappe was very useful for all types of persons and institutions. We are very happy with its overall look and felt very comfortable with each and every chapter of the edition. Each and every topic is excellent to learn new things especial ly health tips, which are very useful for all. How beautifully the author has written it and big thanks to them for incorporating Indian heritage too while writing healthy tips. It is very rarely seen in any type of medical journals. We are very eager to study all the articles of the present edition and the presentation of which has been done very beautifully. Thanks to Agappe for Techagappe.

Mr. A. Ayyappan, Sri Sai Laboratory, Tirupur

6

TECHAGAPPE

JULY-SEPTEMBER 2017

Very Useful to Resear ch esearch Pr ofessionals Professionals The 11th edition, consisting of orthopedic issues, was wonderful and excel lent with good knowledge and information on Knee replacement. Overall look and feel of the magazine was attractive and presentation of articles was excellent. Technical article is very useful for research professionals like us and we used to read it as a reference note. Thanks to Techagappe.

Ms. Suchita Naik,

Vergo Pharma Research, Goa.

An Excellent Pr ofessional Professional Journal Techagappe is an excellent journal to the professionals. It provides enjoyable reading experience and makes the reader continue the process of reading. Its layout is appreciable and articles are educative and informative. I believe that the upcoming issues wil l be much more enriching with informative articles.

Prof. Suvarnalethadevi K., Principal, College of Nursing, Ananthapuri Hospitals, Trivandrum

Very Useful and Motivating Journal The 11th issue of Techagappe has really given a useful over-

view of musculoskeletal disorders. The life stories in the magazine are very unique and motivating. The overall quality of the magazine is very appreciable. I wish team Techagappe the very best to continue this good work.

Dol ly Kuruvil la, Trivandrum

An All-inclusive Magazine Techagappe, as the name says,

is a hitch journal. It is inclusive of all the recent developments occurring in the field of medicine and lab diagnostics. The look and the paper quality are excellent. I appreciate its team for parenting such a beautiful magazine. Ms. Prathibha, Principal, Udupi Dhanwanthari College of Nursing, Kallianpur.


Cover Story

Poem on God’s gift - Eye

My Embrasure to the World

Oh, my fountainhead of vision and vista,

The unique windows to this beautiful world, The panes to the realm of knowledge and beauty, My favourite fount of perceptive globe, my dear EYES. You are my gateway to: The wondrous earth of colours and shades, Marvellous heaven of rainbows and stars, Flowery plants in spring, the queen of the seasons The dazzling colours of flowers and petals, Amazing gardens of indescribable butterflies. You are my vestibule to: Mysterious horizons of thunders and lightning, Thundering water falls roaring down the rocks heavy,

Babbling brooks with music of melody, Snaky routes of the mountains so devious, The heavy downpours in cats and dogs.

You are my door to: World of deserts and sandunes, hilarious, Elegant fruits and gorgeous greeneries of the nature, Dew drops dripping down the leaves at dawn. White and shady waves of the beach ashore, Dark blue facade of the deep sea, far and wide, Oh my embouchure of wonderworld, My own EYES that witness thee, I will take care of my eyes so prudent, Lest I lose the beauties of this universe.

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

TECHAGAPPE

JULY-SEPTEMBER 2017

7


Agappe MD’s Desk

"Agappe joining hands with

HITACHI CHEMICAL-JAPAN" Thomas John, Managing Director, Agappe Diagnostics Ltd.

We are proud to announce our new initiative of joining hands with the Japanese multinational conglomerate, Hitachi Chemical Company Ltd., through technology licensing for manufacturing their most advanced Fully Automatic Specific Protein and Clinical Chemistry Analysers in India.

W

e are proud to announce our new initiative of joining hands with the Japanese multinational conglomerate, Hitachi Chemical Company Ltd., through technology licensing for manufacturing their most advanced Fully Automatic Spe-

cific Protein and Clinical Chemistry Analysers in India. The manufacturing of the equipment, through Hitachi Chemical technology licensing agreement, would commence at Agappe’s world class manufacturing facility at Cochin, Kerala. This Project will also cre-

Signing ceremony of the technology license agreement for Fully Auto Cartridge Based Protein Analyser between Agappe Diagnostics Ltd., Ind ia and Hitachi Chemicals Co. Ltd., Japan on Wednesday, 24th May 2017.

8

TECHAGAPPE

JULY-SEPTEMBER 2017


Presence of esteemed dignitaries and officials at the signing ceremony event. ate better employment opportunities as well as great breakthrough in research and development.

The Press Meet and Signing Ceremony were conducted on 24th May 2017 at Cochin. The ceremony was attended by repThe initiative, once it becomes functional, would also mark the resentatives from Hitachi Chemical Co. Ltd. - Mr. Jackie Chuah, Director / General Manager Sales & beginning of clinical laboratories all over InMarketing, Hitachi Chemical Asia-Pacific dia embracing the automation mode thereby Pte. Ltd. and Mr. Mitsutaka Shimabe, enhancing the quality of tests and accuracy Deputy Director, Medical Business Unit, Mr. Tsuyoshi Uchida, of results. Affordable pricing would help Hitachi Chemical Co. Ltd., Japan. rural penetration with medium and smaller labs also entering the platform of advanced testing. The instrument provides ease of operation, fast and highly specific results at a reduced cost estimated at roughly one-third of the cost per test compared to the conventional method analyzers. The aim is to provide everyone across the nation the right result at the right time for proper diagnosis and avail treatment on time. The instrument enables early detection of kidney malfunctioning, cardiac problems and osteoporosis. It can also support detection of prostate cancer through PSA testing and TB detection through ADA testing. The unit is expected to start production within a year.

President / CEO, Hitachi Chemical Diagnostics Inc., USA, explained the technological advancements offered by the new equipment. "The machine enables us to measure the Protein levels along with substr ates and enzymes present in the blood ".

Mr. Tsuyoshi Uchida, President / CEO, Hitachi Chemical Diagnostics Inc., USA, explained the technological advancements offered by the new equipment. ‘The machine enables us to measure the Protein levels along with substrates and enzymes present in the blood. The normal protein estimation is very complex where the calibration is very critical for the end user. With this instrument, there is a special advantage of automatic retrieval of calibration due to pre-calibration, where the chances of errors are almost zero.� Mr. Tsuyoshi Uchida also reiterated that Agappe has a long-standing asso-

TECHAGAPPE

JULY-SEPTEMBER 2017

9


Agappe MD’s Desk

Agappe is proud to announce about

the technology association with Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala through Technology Transfer for developing Rapid Diagnostic Kit with Antibiogram for Urinary Tract Infections.

Ms. Shalini Warrier,

Chief Operating Officer, Federal Bank Ltd., Aluva.

Mr. T.P. Imbichammad,

Vice President, Indo Japan Chamber of Commerce & Industry, Chennai.

Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) is an Institute of National Importance under the Department of Science and Technology, Govt. of India. The joint culture of medicine and technology pioneered by its founders more than three decades ago, has come of age and gained unprecedented acceptance in India. The institute has the status of a university and offers excellent research and training facilities. The Institute is a Technical Research Centre for Biomedical devices and has a medical devices incubator (TIMed). Infections are very common in clinical practice, in lungs, urinary tract, or any organ in the body. But, the identification of the causative agent or organism is not very easy. Laboratory methods now available are very cumbersome and take 3-5 days to get the results. The clinician cannot wait that much time for starting the antibiotics for such acute emergencies. There are

The Make in India Initiative

Dr. Georgy K. Nainan

Sr. Consultant Nephrologist & Eminent Personality among Medical Fraternity

Mr. Jacob Kovoor

CA. Executive Committee, Indo Japan Chamber of Commerce, Kerala.

ciation with many Japanese reagent giants which itself was a positive note for Hitachi Chemical to select Agappe for this association. We are confident that this association will take both Agappe and Hitachi Chemical to new heights and also enable us to deliver the best in class diagnostic solution to the common man at an affordable price.

10

TECHAGAPPE

JULY-SEPTEMBER 2017

Currently, except for a handful of domestic manufacturers, the lab reagents and equipment meant for conducting various diagnostic tests are currently imported from USA, Europe, Japan and China at huge import costs and outflow of foreign

exchange. These reagents and equipment include Fully Automated Protein Analyzers, Semi Auto Clinical Chemistry Analyzers, Electrolytic Analyzers, Coagulation Analyzers, ESR Analyzers, Urine Analyzers and Immuno Assay Analyzers (Chemiluminescence Analyzers) and their reagents. Agappe has also been manufacturing and marketing a range of these analyzers for more than a


Technology Transfer from Sree Chitra Tirunal Institute of Medical Sciences and Technology.

The Memento towards Technology Transfer was handed over by Shri. Jagat Prakash Nadda, Honorable Union Minister for Health and Family Welfare at the 2nd Technology Conclave & Industry Meet held at Thiruvananthapuram to Dr. D.M. Vasudevan, Director – Technical (R&D), Agappe Diagnostics Ltd. costly equipments now available to detect the organism within about 6 hours, but the cost is prohibitive and only A class laboratories can afford for that. Thus, common man could not get a diagnosis of infection within a reasonable time or within a reasonable budget. This makes the large majority of infections in India treated unsatisfactorily.

nario. By this new technique, the infective agent could be identified within 6 hours.

The new method developed by the Sree Chitra Tirunal Institute for Medical Sciences and Technology, manufactured and marketed by Agappe Diagnostics Ltd, is a blessing to the Indian sce-

Moreover, the cost is affordable, the technique is very simple, while no costly equipment is required. So, this test could be done in any small or medium laboratories. Thus, the identification of the infective organism could be done very rapidly at a very cheap rate. So the correct antibiotic could be administered at the appropriate time, and patients could be saved.

decade for hospitals, clinics and pathological labs and is already into research and development activities for reagents and equipment. The team was successful in developing Semi Auto Biochem-

istry Analyzer viz. Mispa Viva, Semi Auto protein Estimation System named Mispa-i2 and followed with its upgraded single cartridge based analyzers, Mispa-i3.

Over the years, Agappe could establish its presence in the full range of Clinical Chemistry, Serology, Immuno Chemistry, Coagulation, Blood Groupings and Haematology Reagents.

Over the years, Agappe could establish its presence in the full range of Clinical Chemistry, Serology, Immuno Chemistry, Coagulation, Blood Groupings and Haematology Reagents. Agappe is planning to launch India’s premier and fully indigenous hematology systems in the coming days. In addition to the world-class reagent manufacturing facility in Cochin, Agappe has full-fledged manufacturing facility of sophisticated lab equipment at KINFRA, Nellad, Kerala, which is mainly concentrating on equipment manufacturing, in-house research and development of products and related activities.

TECHAGAPPE

JULY-SEPTEMBER 2017

11


Cover Story Cataract - An Overview

Cause and Treatment of Dr. D. M. Vasudevan,

CATARACT

MBBS, MD, (Biochem), FRCPath, Technical Director, Agappe Diagnostics Ltd.

In a normal person, the lens inside the eye focuses light so that external objects are seen very clearly. This lens normally contains proteins that are specially organized to focus light on the retina to have a clear vision.

What is Cataract? Cataract is the opacity of the lens of the eye, which leads to decrease in vision. According to the World Health Organization, cataracts are the leading cause of blindness in the world. More than half of all people aged 65 or above have cataract. Cataracts cause half of all blindness and one-third of visual

impairment throughout the world. Vision might appear a little hazy at first and artificial lights might give off a halo or glare. The cataract begins as a small opacity within the lens and grows until it interferes with vision. Many people have small cataracts and do not even notice until the defect grows large. Symptoms start with a blurry vision, halos around light and progress to trouble in reading or recognizing faces and lead to increased risk of falling.

History Cataract surgery was described by the Indian physician, Susrutha, about 100 BC. Cataracts and their treatment in ancient Rome are described in 29 AD in a work of the Latin encyclopedia. The word ‘Cataract’ is derived from Latin ‘cataracta’ meaning ’waterfall’, believing that blindness is caused by an outpouring of diseased humour (water) into the eye.

Normal Physiology The lens is bathed in its anterior side by the aqueous humor and in its posterior side by the vitreous humor. Lens has no blood supply, so the aqueous humor is responsible for the nutrition of the lens and the disposal of metabolic products of the lens. The majority of the proteins in the lens are alpha, beta and gamma crystallins. In normal persons, these protein molecules are arranged side by side and they are in a non-aggre-

12

TECHAGAPPE

JULY-SEPTEMBER 2017


gate state so that light can pass through the lens. Changes in the redox states or changes in osmolarity in the lens can produce an aggregation of these proteins and consequent blindness.

Pathology The lens is primarily composed of long-lived, highly stable proteins called crystallins. The normally transparent lens gradually becomes cloudy with aging, leading to cataract formation. Cataract primarily develops as a result of the extensive modification, aggregation and precipitation of the lens crystallins. The cataract lens shows degradation of crystallin proteins by enzymes.

slow its development. Microwave radiation can also cause cataracts. Cataracts have been associated with ionizing radiation such as X-rays. Blunt trauma causes swelling, thickening and whitening of the lens fibers. Cataracts may develop in 0.7 to 8.0% of cases following electrical injuries. Electric and heat injuries denature and whiten the lens. Cataracts of this type are often seen in furnace workers. Low vitamin C intake is associated with greater cataract rates. However, use of supplements of vitamin C has not shown any real beneficial effect. Adequate intake of antioxidants (such as vitamins A, C, and E) may protect against the risk of cataracts. Eye

An immature cataract has some transparent protein but within a mature cataract, all the lens protein is opaque. In a hypermature cataract, the lens proteins would have become liquid. Cataracts are classified based on type as nuclear, cortical or posterior. The cataracts are further classified based on severity on a scale from 1 to 5.

Causes of Cataract Age is the most common cause. Lens proteins degrade over time and this process is accelerated by diabetes mellitus and hypertension and also by smoking tobacco or prolonged exposure to sunlight and alcohol. Radiation and ultraviolet light have cumulative effects. Ultraviolet light may also cause cataracts. Wearing sunglasses can

TECHAGAPPE

JULY-SEPTEMBER 2017

13


Cover Story Cataract - An Overview drops containing acetyl-carnosine has been shown to reduce the oxidation damage in the lens by reducing the cristallin crosslinking and could also help prevent cataracts. Furthermore, diets rich in the antioxidants lutein and zeaxanthin have been shown to reduce the risk of developing nuclear cataracts in some studies.

Diabetes Mellitus and Galactosemia In normal conditions, some of the glucose molecules that enter the lens are converted to fructose. This quantity is usually very low. In Diabetes Mellitus, the concentration of glucose is high and so, a high quantity of sorbitol is formed. This sorbitol accumulates in the lens, which increases the osmotic effects producing cell swelling and structural damage. As a result, crystallin proteins aggregate and form structures that scatter the light, resulting in cataract. Galactosemia is a congenital disease. In that condition, the patient cannot metabolize galactose and this sugar accumulates, leading to cataract. Bilateral cataracts in an infant may also be due to Congenital Rubella Syndrome. In this condition, the foetus gets infected with the virus, rubella, usually during the first trimester of pregnancy.

Treatment of Cataract In the early cases of the disease, the symptoms may be improved by correcting the vision with glasses. In later cases, removal of the cloudy lens by surgery and replacement by the artificial lens is the only effective treatment. Cataract surgery involves replacement of the eye’s natural lens with an artificial intraocular lens (IOL). Cataract removal can be performed at any stage of the disease.

Bilateral cataracts in an infant may also be due to Congenital Rubella Syndrome. In this condition, the foetus gets infected with the virus, rubella, usually during the first trimester of pregnancy.

Phaco-emulsification This is the most widely used cataract surgery. This procedure uses ultrasonic energy to emulsify the cataract lens. The eye is numbed with proper anesthetic. Then two cuts are made at the margin of the cornea to allow insertion of instruments into the eye. Then a needle is used to create a circular hole in the capsule of the lens. After that, an ultrasonic probe is used to break up and emulsify the lens into liquid using the energy of ultrasound waves. The resulting emulsion is sucked away. Finally, a plastic, foldable lens is inserted replacing the natural lens, which remains in the eye permanently.

Extracapsular Cataract Extraction (ECCE) It consists of removing the lens manually. The lens is expressed through a 10 to 12 mm incision which is closed with sutures at the end of surgery. This procedure may lead to certain complications and therefore, is less frequently performed nowadays. Manual Small Incision Cataract Surgery (MSICS) has evolved from ECCE. In MSICS, the lens is removed through a self-sealing scleral tunnel wound in the sclera which does not require suturing.

Post-operative recovery The recovery period is usually short. The patient is usually ambulatory on the day of surgery. The eye is

14

TECHAGAPPE

JULY-SEPTEMBER 2017


usually patched on the day of surgery and use of an eye shield at night is often suggested for several days after surgery. Antibiotics are usually administered for a few more days. In all types of surgery, the lens is removed and replaced with an artificial lens, known as intraocular lens, which stays in the eye permanently.

Complications The risk of retinal detachment is about 0.4% within 5 years, with older studies reporting a substantially higher risk. The incidence is increasing over time and the risk increase lasts for at least 20 years after the procedure. Corneal edema and macular edema are less serious but more common and occur because of persistent swelling at the front of the eye in corneal edema or back of the eye in macular edema. They are normally the result of inflammation following surgery, and in both cases, patients may notice blurred, foggy vision. They normally improve with time and with the application of anti-inflammatory drops. The risk of either occurring is around one in 100. Posterior capsular opacification, also known as after-cataract, is a condition in which months or years after successful cataract surgery, vision deteriorates. This is usually due to thickening of the back or posterior capsule surrounding the implanted lens, so-called

‘posterior lens capsule opacification’. Management involves cutting a small, circular area in the posterior capsule with targeted beams of energy from a laser. The laser can be aimed very accurately. This procedure leaves sufficient capsule to hold the lens in place but removes enough to allow light to pass directly through to the retina. Serious side effects are rare.

How Long Is the Recovery Time After Cataract Surgery? Some patients see very well the day after cataract surgery. Other patients see well a few days after surgery, and still others may need a full month to reach their maximum vision improvement. The First Week after Surgery: During the first week after surgery, it generally is recommended that the patient keep his or her eye covered at all times, either with eyeglasses or an eye shield, to protect it from being bumped or rubbed. A small amount of pressure can easily open the incision, and protecting the eye prevents this. Also, it is recommended that the patient refrain from (a) bending with

the head below the waist, (b) lifting more than 10 pounds, and (c) straining (on the toilet, for example) to the point of holding

one's breath. All of these activities increase the pressure inside the eye and can open the incision. A Few Weeks after Surgery: A few weeks after the surgery, the patient is checked for eyeglasses and given a final prescription. Artificial lenses last for a lifetime, and with newer types of lenses, it is very rare to experience a lens-associated complication. Occasionally, an artificial lens can dislocate (move out of its intended position) and result in blurred vision. This usually occurs as a result of trauma to the eye and the doctor should be contacted immediately.

TECHAGAPPE

JULY-SEPTEMBER 2017

15


Life Story Shekhar Naik (Cricketer)

Shekhar Naik

Unveiling a Passionate Blind Cricketer

Padma Shri recipient, Star player and the Captain of visually challenged Indian Cricket Team - the list of achievements in Shekhar Naik’s credit is numerous. But little do people know about the hardships Shekhar Naik from Karnataka has passed to reach this position.

B

orn in 1986 in a farmer family at Shimoga, Shekhar Naik was completely blind till he was eight years. A hereditary disease, it had consumed the eyesight of his mother and 9 others of his extended family. Luck came in the guise of an accident to Shekhar who had fallen into a canal when he was eight years old. An Eye Camp was going on in the village that time and the next day, Shekhar and his mother were examined by them. After examining their eyes, the doctors informed that they both could regain their eyesight partially. They were taken to Bangalore for the operation and it gave them a ray of hope- at least they could see a little. A distance of two meters was visible for them after the surgery. After this, Shekhar was sent to a special school for studies. The luck bells didn’t chime long. Shekhar’s father passed away the same year. After his demise, the blind school Sri. Sarad ha Devi And hara Vikas Kendra in Shimoga, became home to Shekar and his mother. Thus, in 1995 when Shekhar was nine years old, he joined the first standard. There he saw his high school friends playing cricket for the first time about which he had no prior knowledge. Initially, Shekhar wasn’t interested. Later when the team fell short of a player, he was pulled in. He was given the opportunity to bat in the fifth position and he played well. Hearing about his playing skills from other students, though the Physical Training in charge, Mr. Suresh, invited him to play for the school team, he politely refused the offer. But gradually, he fell in love with cricket and started playing cricket seriously with Suresh as his mentor. “I told about the game to my mother who never knew what cricket was. But she said something which I remember still in my heart. She told that I had to achieve something for my parents. She didn’t want the visual imparity to

16

TECHAGAPPE

JULY-SEPTEMBER 2017

Shekhar Naik with 20-20 World Cup


stand as an obstacle before me. She wanted me to show the world what I was capable of. She was constantly inspiring me. Earlier my blindness had prevented me from leading a normal life. Other boys never allowed me to join their group as I couldn’t climb a tree or jump into the river,” recol lects Shekhar. Slowly, he started practicing cricket and it turned into a growing passion. In 1997, at Bangalore, a State level Cricket Tournament was conducted. Shekhar remembers that it was the second time he went out of town in his life as the first one was for his eye operation at Bangalore. He says, “I was introduced as a Wicket Keeper in the first match. Later in a match conducted at Mandya district, Karnataka, I scored 133 runs from 52-53 bal ls. That was a fatechanging game for me and I was selected into the state team.”

Shekhar Naik receiving Padmasree Award from Hon’ble President of India, Sri. Pranab Mukherjee

In 1998, his mother also passed away leaving Shekhar alone in this world as he didn’t have any siblings. But by then, he had set his goals high – to become an Indian player of the visually challenged cricket team and after that to become the Captain of the team. His first tournament after getting into state team was at Belgaum. He was out of form in all the matches. But in the final match against Kerala, he rose to the occasion and scored a brilliant 249 runs in a one day match. That game turned out to be the turning point in Shekhar’s life. It helped him to secure a position in the national team and thereby represent India in the second World Cup for the visually challenged in Chennai in 2002. Shekhar got promoted in his batting position and was given the position of the opening batsman. But there was no proper coordination between the team members. Since most players were state players representing different states, the language also become a barrier to communication. The team didn’t even make it to the Semi-Finals. But Shekhar bagged two ‘Man of the Matches’ awards- one against Sri Lanka and other against Australia. In 2004, the visually challenged Indian team visited Pakistan for a tournament. India lost the series by 2-3 against Pakistan. Shekhar scored an unbeatable 198 against Pakistan in one of the matches, which is his highest score in the International matches. In 2005, when Pakistan came to India to play in the visually challenged tournament, India defeated them in all the matches and took the tournament by (5-0).

stacle. So, he made it to a point to learn different languages. In 2006, he learned a little bit of Hindi and English. He now understands a bit of almost every language. “In 2010, my mother’s dream was fulfil led”, beams Shekhar. He became the Captain of the Indian team. “We had

Shekhar got promoted in his batting position and was given the position of the opening batsman. But there was no proper coordination between the team members. Since most players were state players representing different states, the language also become a barrier to communication. The team didn’t even make it to the SemiFinals. But Shekhar bagged two ‘Man of the Matches’ awards- one against Sri Lanka and other against Australia.

When representing India for the first time, Shekhar knew only Kannada. But he soon understood that it might be his major ob-

TECHAGAPPE

JULY-SEPTEMBER 2017

17


Life Story Shekhar Naik (Cricketer) an England tour - T20 and One-day tournaments of three matches under my captaincy. We won the series by 3-0 in both T20 and Oneday matches”. T20 World Cup Tournament for visually challenged was introduced in 2012. Ten countries took part in the first ever World Cup. Indian team coach was Patrick Rajkumar, who was a Politics Professor at a Government College in Karnataka. It was he who instilled hope to win the tournament among the players. Since it was the first T20 World Cup, he mentioned that the champion’s name would be etched in history and be heard as long as the game exists. It was an opportunity not to be missed for Sekhar and his teammates. The visually challenged cricket match between India and Pakistan bore the same fiery spirit as in any match between India and Pakistan. India won all the matches against other teams except a match against Pakistan in the league. In the Finals between India and Pakistan, they won the toss and decided to bowl first. India scored 258 runs in 20 overs and Pakistan’s desire to win the World Cup ended at 229 runs. “We won the first ever T20 World Cup for visually

Shekhar Naik with Hon’ble Prime Minister of India, Sri. Narendra Modi challenged and it was only after that people came to know that such a team for visually challenged existed. It was only then we got a little bit of recognition,” comments Shekhar with a mixed feeling of pride and joy. Shekhar meanwhile has set his next goal- to win the One Day World Cup. “Life is a huge journey. Once you reach your goal or destination, set another goal and extend your travel so that you can achieve more in your life,” Shekhar says with sheer confidence. India won the One Day World Cup for visually challenged in 2014 after defeating Pakistan once again. The players were surprised when they returned home from South Africa as the Indian Prime Minister Narendra Modi congratulated them telling that they made the country proud and invited them to his residence. It was a huge recognition for the visually challenged team. Shekhar remembers a particular incident happened when PM hosted them. One of the players who was from Gujarat state asked an autograph from the PM. Modi’s reply surprised them and made them all proud. He told, “I’ve given enough autographs. Now, I will take autographs from these 17 players who made our country proud and will exhibit it in PM’s Museum”. So PM took the autograph of the players on a cricket ball and it is now exhibited in PM’s Museum. Subsequently, they also received some cash awards both from the Central as well as State Governments for the first time. Shekhar remembers all the people who helped him.

18

TECHAGAPPE

JULY-SEPTEMBER 2017


“After my mother’s death, nobody helped me. I was staying in a hostel and found no means to have funds for even my basic necessities like the dress. Only our School warden Ambika helped me considerably. She used to get me most of the things I needed. I consider her as my mother. Whenever I visit Shimoga, I pay her a visit. She has filled the gap of my mother. She dreams that I would get a government job. But in Karnataka it isn’t that easy”, he states. In Kerala, he believes that the government pays attention to people like them. He knows two visually challenged players from Kerala who represented Indian team- Manish and Vishnu. Both were offered government jobs by the Chief Minister. “I believe Kerala Government provides good support for such disabled players. No other states extend such support. Even after being a Padma Shri recipient, I approached the state government in search of a government job and nothing has materialised yet,” Shekhar comments with disappointment. Shekhar got married in 2009. His wife is also a visually challenged woman. They are blessed with two daughters- Poorvika and Sanghvika. “My elder daughter had visual impairment so we did an operation when she was one year old whereby they removed her cataract and fixed a lens. She can see now like a normal person. The second daughter is now just one and half years old and next month we will go for the check up. Since this condition is hereditary, we don’t want to take a risk,” Shekhar comments with the tenderest fatherly love. He expresses his gratitude towards the Indian government for bestowing him with Padma Shri in 2017. “I believe it will inspire every visually impaired cricketer to go that extra mile and to achieve

“After my mother’s death, nobody helped me. I was staying in a hostel and found no means to have funds for even my basic necessities like the dress. Only our School warden Ambika helped me considerably. She used to get me most of the things I needed. I consider her as my mother. Whenever I visit Shimoga, I pay her a visit. She has filled the gap of my mother. She dreams that I would get a government job. But in Karnataka it isn’t that easy”, he states. something,” he says. Even so, he is unhappy about BCCI’s ignorance towards them. “If BCCI, one of the richest cricket bodies in the world, could give a small percentage to us, say 3 or 4 crores to us, we can conduct a World Cup. For BCCI, it is a negligible amount as what they offer to a single normal player is often beyond that. Even if the normal players win a cup, what you see is Indian flag above all others. That is the same even if we win. We are also playing the same sport. I will say that they must give us recognition. In India, we have more than 14,000 visually challenged cricketers. Yet, it is hard to get any sponsors for the visually challenged Indian cricket team,” he points out. Shekhar wishes to be in the team as long as he could play the game. He also finds time to work for an NGO called Samarthanam. It works for the education, mobilisation, skill development and placements of challenged people. They have more than 1500 beneficiaries.

Shekhar Naik performing in an international tournament

When asked about his message to the society, he said, “My message to the society is that our disability is not our weakness. It is our strength. My disability is God gifted. It is my weapon. Only because I’m disabled I was able to be a part of the Indian team even though for the visually challenged. Don’t you know how many wish to be in that Jersey at least for once?”. Shekhar is a larger than life figure who will surely chase and catch all his dreams with his self-confidence and selfesteem.

TECHAGAPPE

JULY-SEPTEMBER 2017

19


Interview Dr. Tony Fernandez Dr. S Tony Fernandez is one of the senior most ophthalmic surgeons and a doyen in the profession in Kerala. He has become a household name in Kerala with his 50 years of professional excellence and humanitarian services among the people. From the very beginning to this point of time, professional service along with social commitment has been one of the key aspects of his Philosophy. Thousands of people have experienced the healing touch from his magical hands in the last five decades.He shares his experiences with Agappe.

‘ Donate and

to the next

Agappe: Tel l us about your child hood days. What sparked the interest in you to become a doctor?

Dr. Tony: I was born and brought up in Malaysia. My father was working in the medical field there. It was a time when South Indians, especially Tamilians and Keralites, who were in seek of a job used to migrate to Malaysia. At that time, there weren’t many doctors in Malaysia. The few doctors who practiced there were mostly foreigners. Rubber estates were abundant in Malaysia and associated with these rubber estates, there used to be Estate Hospitals, which had pharmacies along with it. In the olden times, the pharmacies supplied what they called mixtures instead of tablets. According to the doctor’s prescription, the pharmacist will get you required mixture quantity which is kept in large bottles. As a child, I remember playing around this pharmacy a lot which I believe had influenced me in the future. Later, I returned to Kerala as a small boy to pursue my studies with my mother and younger sisters. After completing my school and college at Trivandrum I was trying to get admission in a medical College. In 1953, Dr. T.M.A. Pai, established Kasturba Medical College (KMC) at Manipal, Karnataka, the first self-financing medical college in India. Today, hailed as one of the most prestigious and premier medical colleges in India, KMC Manipal wasn’t in its glory when I joined there for the first batch. It was a risky move. Some political parties and ministers opposed the idea of self-financing medical colleges. Apart from that, the place where the medical college situated wasn’t quite developed. The facilities also were limited. However, I stood rooted in my decision facing all the tough situations. For clinical training after the completion of our MBBS course, we were sent to Government Hospital, at Mangalore (Which was a part of Madras Presidency then) as KMC Manipal didn’t have a hospital. Agappe: What made you to choose ophthalmology? Dr. Tony: The joy of eyesight is inexplicable. Only those were born without vision and those who lose eyesight in some accident only know the real value of this gift called vision. A small surgery will do the magic in many cases. Cataract is the cause of half the blindness and 33% of visual impairment worldwide. Cataract is the clouding of the lens in the eye, which leads to a decrease in vision. Cataracts often develop and slowly lead to blindness, and can affect one or both eyes. Symptoms may include faded

20

TECHAGAPPE

JULY-SEPTEMBER 2017


entrust your vision generation...‘

Dr. Tony Fernandez

Dr. Tony Fernandez sharing his experiences with Mr. Biju Philip, General Manager, Agappe. colours, blurry vision, haloes around the light, trouble with bright lights and trouble seeing in the night. It was during my training that I understood the real value of eyesight. During that time, I saw many villagers who were totally blind undergoing cataract surgery. After the operation, it took them seven days to open the eyes. I had witnessed many people seeing the world after many years of wait. As there were no qualified eye doctors in the villages, they remained blind. It influenced me a lot. I also felt the need for more ophthalmologists in the country. Moreover, then the operation didn’t take a long time. Within few minutes, you could complete one operation if everything else is ready. There was also another incident which made me choose Ophthalmology. I had tried to take Malaysian citizenship since my father was already there. For the same purpose, we had met a Min-

ister at Malaysia who happened to be from Tamil Nadu. The minister enquired me about my specialization. At that time, I hadn’t gone for my specialization. So, the Minister asked me to complete my specialization in Ophthalmology and to return to Malaysia. He promised to grant me Malaysian citizenship since Malaysia had a lack of qualified ophthalmologists. Agappe: You had been lucky to work under world renowned professor Late Dr. G. Venketasamy? Tel l us more about it? Dr. Tony: For specialization, I went to London and spent four years there undergoing my training. I completed the Diploma in Ophthalmology from the Royal college of Surgeons and Physicians London. During that time, almost all educated Indians went abroad in search of better job and salary. The trend was so high that the government had to introduce project

TECHAGAPPE

JULY-SEPTEMBER 2017

21


Interview Dr. Tony Fernandez India. Looking back, what do you feel after serving long 40 years there? Dr. Tony: In 1969, I joined Little Flower Mission Hospital, Angamaly. From a 5-bedded eye wing, we developed it to a 200bedded Ophthalmic Institute, which has become famous all over India. I was influenced by the number of patients who came there for treatment. Since majority were poor and from rural areas, they couldn’t afford to go for higher treatment anywhere outside Kerala. It prompted me to establish a wellequipped Centre. To garner public involvement and support, we also set up an Eye Bank Association in 1970. It was the first eye bank in the private sector in India. We started conducting free eye camps in 1971 with the help of corporates and clubs like Lions Club and Rotary Club. The school screening programs, to eradicate preventable blindness in Kerala was also initiated by us. Making use of the trained teachers in the schools, it benefitted thousands of school children saving them from becoming blind. Through the Eye Bank Association, we could collect thousands of eyeballs that have provided sight to thousands of blind people by corneal transplantations. Today, it is still one of the major Eye Banks in India and has collected more than 10,000 eyes and nearly 2800 transplantation surgeries are done successfully. The Eye Bank has nearly 175 Donor forums working in the villages and 12 collection centers. To increase the facility of eye donation, a new Eye Bank at Aluva under the name ‘Darsana Eye Bank’, with the help of the Indian Medical Association, Aluva Municipal Council, the Kerala Action Force, Residents’ Associations and others service organizations was started at Aluva. This Eye Bank is attached to the Dr. Tony Fernandez Eye Hospital. I would like to strongly point out that people should be ready to donate eyes and entrust their vision to the next generation.

Dr. Tony Fernandez receiving Padmasree Award from Former President of India, Smt. Pratibha Patil called “Pool Officers” where Indians who have left the country will be given a good job for a maximum period of two years, to help them find a permanent job. Through this Pool officer recruitment, I was posted of Madurai Medical College. Renowned Professor, Late Dr. G. Venketasamy happened to see my bio-data sent by the Central Government and requested for my appointment. That was how I joined the Madurai Medical College as an Assistant Professor. The rules were relaxed so that I could do my M.S studies without resigning from the Assistant Professor position and this made me eligible for salary. In short, I donned two roles at Madurai Medical College - one of a student and another of an assistant professor. As I had special training in the treatment of Squint diseases we started the Orthoptic and Pleoptic Department and a training school for the treatment these cases, the first of its kind in South India at that time. Agappe: You had played a major role in making Little Flower Hospital, Angamaly into a major hub for Ophthalmology in

22

TECHAGAPPE

JULY-SEPTEMBER 2017

Slowly, Little Flower Mission Hospital was raised into a position where eye transplants can be done reliably. We pioneered the starting of several new types of surgeries in Kerala like intraocular implantation, refractive surgery, squint and corneal transplantation, which attracted patients not only from different parts of Kerala and India but also from abroad. Little Flower Hospital, Angamaly shot up to national and interna-

"Limited funds were another problem we encountered during those days. An international fellowship enabled me to travel abroad without much hassles and to learn new things. It was an opportunity to meet world renowned doctors and to learn from them. I also invited a few to our hospital and some used to come."


Dr. Tony Fernandez with his eye hospital staff tional fame as a Mecca for Ophthalmic care in no time. Agappe: What were the d ifficulties you faced during that period? Dr. Tony: Earlier, the entire eye had to be taken out and now it is just the cornea. At that time, India depended mainly on Sri Lanka for eyes. Various religious beliefs and unawareness prevented people from donating their eyes. I’m happy that today more and more people are coming forward to donate eyes in India. Limited funds were another problem we encountered during those days. An international fellowship enabled me to travel abroad without much hassles and to learn new things. It was an opportunity to meet world renowned doctors and to learn from them. I also invited a few to our hospital and some used to come. Agappe: How do you feel to be recognized by awards and recognitions? Dr. Tony: I accept them with due humility and consider them as the recognition of people of the state. Apart from surgeries and conducting eye camps, I had also served as the Editor of the Indian Journal of Ophthalmology (IJO) from 1987 to1992. I was elected unanimously as the president of the Indian Ophthalmological Society in 1994. I had been the executive member of the Indian Medical Council and the member of the Medical Faculty of the M.G. University. I was honored with the Padma Shri Award by the President of India in 2008 and B.C. Roy Award by the Medical Council of India in 1997. I had the rare privilege to be honored by the order Chevalier by H.H. The Pope Benedict XVI, in 2009. Agappe: Your family? Dr. Tony: I married Dr. Yvonne Fernandez, M.B.B.S, D.A.(Vellore) in 1966. She had been working as the Head of the Anesthesia Department at Little Flower Mission Hospital, Angamaly. Currently, she is the Visiting Consultant at Dr. Tony Fernandez Eye Hospital and Executive Director of STF Charities. I have 2 sons Dr Freddy is the M.D. of my Hospital, Mr. Tony is a soft wear engineer at London. My eldest daughter Sylvia is professor at Ramaiah Dental College, my second daughter, Sonia, is Architect at AECOM, Abu

Dhabi and my youngest daughter, Sabeena is an M.B.A settled down at Canada. Agappe: Your future plans? Dr. Tony: I started the new hospital, in my name at the late age of 74 years when people prefer to remain retired and relax. The main reason was that I had my son Dr. Freddy T Simon an outstanding surgeon to run the hospital. He was a brilliant student all along, who studied at Trivandrum for M.B.B.S and took his M.D in ophthalmology from AIIMS Delhi. He completed his D N B from their as well. He secured F. R. C. S. from both Edinburgh and Glasgow and worked in U K for 3 yrs and later joined as consultant at L F hospital . He is an excellent corneal, refractive surgeon and runs to hospital efficiently. Our aim is to establish a hospital of high repute equipped with advanced machinery and provides service to all especially for the poor and needy. The latest diagnostic equipment’s like Femto second Laser (for bladeless Lasik) was used for the first time in Kerala by Dr. Tony’s Super Specialty Eye Institute. We also have other diagnostic equipment’s like OCT (Ocular coherent tomography), ORA (Ocular Response Analyzer), HFA (Humphry Field Analyzer), Topography, Autorefractometer, A-Scan, B-Scan, Fundus Photography, Slit Lamps, Non-Contact Tonometer, Ophthalmoscopes, indirect ophthalmoscopes, Pediatric vision kits etc. My son, Dr. Freddy, is the Managing Director of the hospital. We are also associated with Film Actor Mammootty for a comprehensive eye care program- ‘Kazhcha’. In association with Yeshua Charitable Trust. Kazhcha aims to create a cataract-free Kerala and eliminate curable blindness by the year 2020. This program will help the financially backward people get proper eye care. More than 25,00,000 people wil l be screened and 50,000 cataract surgeries will be conducted through this project. Kazhcha also includes School Screening Program for the children, Tribal village camps and promote eye donation. Dr.Tony Fernandez Eye hospital at Palarivattom ,Ernakulam is a franchise of our hospital. We undertake similar operations there as well.

TECHAGAPPE

JULY-SEPTEMBER 2017

23


Promotion Evolution

Evolution of Diabetic Profile Ms. Bintu Lijo, Product Manager, Marketing, Agappe Diagnostics Ltd.

Diabetes mellitus is one of the world’s major diseases and India ranks among the top three countries with a diabetic population of more than 62 million. Diabetes describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate or because the body’s cells do not respond properly to insulin or both. Medical health experts assert that regular check-ups and timely detection play a vital role in controlling and managing diabetic problems. The first mention of diabetes was made by the Egyptians around 1500 BC. Indian physicians, around the same time, identified the disease and classified it as ‘madhumeha’ or ‘honey urine’ noting that the urine would attract ants. The term ‘Diabetes’ or ‘to pass through’ was first used in 250 BC by the Greek Apollonius of Memphis and the term ‘Mellitus’ or ‘from honey’ was added by Thomas Willis in the late 1600s.

1

For thousands of years, no one knew how to live with diabetes, let alone treat or cure it. An effective treatment was developed only after the Canadians, Frederick Banting and Charles Best, first used insulin in 1921 and 1922. Here, we try to provide a comprehensive history of Diabetic profile tests in two stages.

Stage 1 Routine diabetic tests In the early 1800’s, Researchers developed the first chemical tests to indicate and measure the presence of sugar in the urine. In 1911, Benedict devised a new method to measure urine sugar (Benedict’s Solution). During the last century, the d iagnosis of d iabetes was based on the urine test. However, since around the 1970s, blood glucose testing has become the standard tool for diagnosis.

24

TECHAGAPPE

JULY-SEPTEMBER 2017

Glucose A blood glucose test measures the amount glucose in the blood. Fasting blood glucose test, glucose tolerance test and random blood sugar test help to diagnose diabetes, prediabetes and gestational diabetes.

Microalbumin This test determines the presence of small quantities of al bumin in urine. By this method, we can find out whether diabetes has damaged the kidneys as diabetes is a leading cause of kidney failure.

Dipstick test This test is to evaluate severe hyperglycemia (severe high blood sugar) by looking for ketones and microal bumin in the urine. Ketones increase when there is insufficient insulin to use glucose for energy.


Agappe’s Diabetic Profile Glucose

Microalbumin

Ultrastik

1.Time tested GOD – PAP Methodology Proven method, Accuracy guaranteed

1.Turbidimetric Immuno Assay method - Highly sensitive, Accuracy guaranteed

1.11 parameters including Microalbumin – Wide test menu

2.High Concentration of Glucose Oxidase enzyme - 15000 U/L, which offers stable calibration - Accurate results

2.Calibrator provided -Multipoint calibration – Takes out extra cost & matrix problems

2.30 seconds to 2 minutes- Rapid test results

3.Tris Buffer offers optimal reaction - Accurate results even in high concentration

3.Wide measuring range of 4-395 mg/L Safe reporting of lower & higher side values

4.High Linearity of 550 mg/dL – Reduce rerun of the high sample, saves time & cost

4.No Prozone effect up to 6000 mg/L & no false negative - Safe reporting

3.Designed specifically considering Indian conditions like humidity & temperature – High accuracy 4.High shelf life of 2 years – Ensure complete usage of strips

AGA1c 1.Latex-enhanced Immunoturbid imetry Method - Uses ultra micron latex particle, High Specificity, Sensitivity & Reproducibility 2.Direct Method – directly measures A1c in % - Highly Precise & Accurate result 3.Two Reagent system with 4 level calibrators – No stability problems 4.NGSP Standardize DCCT Reference material & correlated with HPLC – Ensured Accuracy

2 Stage 2 Standard diabetic tests In the 1970s, scientists identified two particles HbA1c & CPeptide, which play a major role in the diagnosis of diabetes. Samuel Rahbar is the person who discovered that HbA1c is elevated in people with diabetes. This breakthrough came in 1968. In 1998, UKPDS established HbA1c as a valuable clinical marker in people with type 2 diabetes and in 2010, ADA recommended the HbA1c test as a means to diagnose diabetes and pre-diabetes.

cose) is stuck to red blood cells. It also shows how well your diabetes has been controlled in the past 2 to 3 months and whether your medicine needs to be changed.

C-Peptide The C-peptide test measures the level of this peptide in the blood. It is generally found in amounts equal to insulin because insulin and C-Peptide are linked when first made by the pancreas. This test is used to differentiate between type I (low level of insulin and C-peptide) and type II (normal or high level of C-Peptide) diabetes. It is a better indicator of B-cell function than peripheral insulin.

C-Peptide was first described in 1967 and the first documented use of the C-peptide test was in 1972.

C-Peptide levels are measured instead of insulin levels because C-Peptide can assess a person’s own insulin secretion even if they receive insulin injections.

HbA1c HbA1c is glucose bound to hemoglobin. This test measures how much sugar (glu-

TECHAGAPPE

JULY-SEPTEMBER 2017

25


Cover Story Eye Donation - An Overview

EYE DONATION & TRANSPLANT A Noble Cause

Dr. Thomas Cherian , MS.

Deputy Medical Superintendent of Little Flower Hospital, Angamaly

There are 12 million blind people in India. Out of these, about more than 1 lakh people have corneal blindness. It is estimated that 25,000 to 30,000 new cases of corneal blindness are added on to this, every year. Only less than 25,000 surgeries are performed all over the country in a year due to the scarcity of eyes/corneas.

There are 12 million blind people in India. Out of these, about more than 1 lakh people have corneal blindness. It is estimated that 25,000 to 30,000 new cases of corneal blindness are added on to this, every year. Only less than 25,000 surgeries are performed all over the country in a year due to the scarcity of eyes/corneas. Corneal blindness can be tackled only by a surgical procedure called Keratoplasty, wherein a donor cornea is transplanted to the affected eye.

Corneal diseases which can be treated by Keratoplasty include:1. Corneal infections like bacterial or fungal keratitis 2. Vitamin A deficiency diseases like Xerophthalmia 3. Scarring due to injury 4. Corneal dystrophies 5. Complication of Cataract surgery like Pseudophakic Bullous Keratopathy 6. Keratoconus-thinning and protrusion of the cornea. 7. Certain corneal opacities caused due to traditional eye medicines and home remedies To reduce the burden of corneal blindness, there should be a multipronged strategy which includes procuring of corneal tissue, equitable distribution and a good network of skilled surgeons to perform the procedure.

Eye Bank Association, Kerala 1970 was a landmark year as far

26

TECHAGAPPE

JULY-SEPTEMBER 2017


as eye donation is concerned. The Eye Bank Association, Kerala, was registered as a charitable society on the 5th of October, 1970. Dr. J.P. Grifith, the Managing Director of J. P Coats (Madura Coats ) was elected as President and Mr. Mathukutty as Secretary. The brain behind the initiative was Dr. Tony Fernandez. He could bring together Fr. Panikulam, the then Director of Little Flower Hospital, Angamaly and his colleagues, Dr. K. L. Jacob and Dr. C.K. Eapen. Dr. Fernandez could also enlist the support of the clergy and the social leaders and opinion makers of the time. Misinterpreted regional beliefs, wrong concepts and lack of awareness about eye donation were the stumbling blocks in the early years. Those days, eyes used to come from Srilanka, thanks to the help of Air Lanka and Indian Airlines. Formation of ‘Eye Donation forums’ in different parishes

Dr. Thomas Cherian, MS.

gradually turned the tables. Fr. Rocky Vazhapally, Mr. E.V.Philip and Mr. Augustine Master are some names worth mentioning in this regard. The Eye Bank Association, Kerala, now has a tieup with ‘Sightlife’, an international NGO working in the field of Eye Banking. This relationship has provided our own Eye Bank with modern technical support and training for the staff. The Cornea Department at Little Flower Hospital has been instrumental in performing the transplants.

Dr. Thomas Cherian is presently the Deputy Medical Superintendent of Little Flower Hospital, Angamaly and Treasurer, Eye Bank Association-Kerala. He adorns the positions of Consultant, Kochi Eye Care Center, Aluva; Honorary General Secretary, Kerala Society of Ophthalmic Surgeons (KSOS); Convener, Committee for Prevention of Diabetic Blindness, Indian Medical Association (IMA), Kerala State Branch; Governing Council Member, Vitreo Retinal Society, India (VRSI).

Eye Donation

This article is a tribute to the legend, Dr. Tony Fernandez, the pioneer in eye banking in southern India.

HCRP (Hospital Cornea Retrieval Programme)

Eye donation is an act of donating one’s eyes after his or her death. It is an act of charity and is totally voluntary. Eye donation is possible only with the consent of the next of kin. Motivation is carried out at various levels like self-motivated eye donation, motivation through volunteers and hospitalbased programmes. In the early days of eye donation, the whole eye used to be removed from the dead body and replaced with a plastic shell. This eye used to be transported to the transplant centre in a moist chamber. Nowadays, only the cornea is removed from the donor’s eye. It is transported in various media which can store cornea for up to 2 weeks. In any case, retrieval of the cornea from the donor has to be made within 6 hours of death. This technique of removing only the cornea leaves the body much more aesthetically acceptable.

This is the programme which links eye banks to hospitals. An eye donation counsellor is permanently stationed at the

TECHAGAPPE

JULY-SEPTEMBER 2017

27


Cover Story Eye Donation - An Overview

QUESTIONS ON EYE DONATION & TRANSPLANT What is corneal blindness?

cannot donate eyes.

What is cornea?

Cornea, the main focusing part , is the clear front surface of the eye. Like a window, it allows light to enter the eye. Vision could be markedly reduced or lost if the cornea becomes cloudy or scarred. This condition is known as corneal blindness.

What is an Eye Donation?

The cornea is the clear surface at the front of the eye and is the main focusing element. When the cornea becomes cloudy from disease, injury, infection or any other cause, vision will be drastically reduced.

What are the causes of corneal blindness? Injuries to the eye, birth defects, malnutrition, infections, chemical burns, congenital disorders and complications of eye surgery. Who can donate eyes? ·Eye donors could be of any age group or sex. ·People who use spectacles, diabetics, patients with high blood pressure, asthma patients and those without communicable diseases can donate eyes. Persons with AIDS, Hepatitis B and C, Rabies, Septicaemia, Acute leukemia (Blood cancer), Tetanus, Cholera, and infectious diseases like Meningitis and Encephalitis

Donating eyes after death. What is an eye bank? The eye bank is a nonprofit organization and obtains, medically evaluates and distributes eyes which are donated by humanitarian citizens for use in cornea transplants, scleral reconstruction, research and education. To ensure patient safety the donated eyes and the donor’s medical history are evaluated by the eye bank staff in accordance with the Eye Bank association of America’s (EBAA) strict medical standards. Who can be an eye donor? Anyone. Cataract, poor eye sight and age do not prohibit you from becoming a donor. Prospective donors should indicate their intention on donor cards and driver’s licenses. Perhaps the most important single thing you can do is make your next of kin aware of your wishes to make sure they are carried out. Why should eyes be donated? Donated human eyes and corneal tissue are necessary for the preservation and restoration of sight and are used for transplantation, research and education. Over 90 percent of the more than 41,300 cornea transplant operations performed each year successful ly restore vision to persons suffering from corneal blindness.

major hospitals, and once a death occurs, the counsellor approaches the relatives and motivates them for eye donation. A blood sample is also collected along with the donated eye. Once the cornea is procured, it is transferred to the eye bank. The blood sample is used for serological tests to rule out

28

TECHAGAPPE

JULY-SEPTEMBER 2017

What is a cornea transplant? Cornea transplant is the surgical procedure which replaces a disc-shaped segment of an impaired cornea with a similarly shaped piece of a healthy donor cornea. More than 90 of cornea transplant operations successfully restore the recipient’s vision. How prevalent is cornea transplantation? Cornea transplants are the most frequently performed human transplant procedure. In 1991 there were more cornea transplants than all other organ transplants combined. In the last 30 years, more than 500,000 cornea transplants have been performed, restoring sight to men, women, and children ranging in age from nine days to 103 years. How soon after donation must a cornea be transplanted? Cornea transplant is usual ly performed within 4 days after donation, depending upon the method of cornea preservation. When does the donation take place? The surgical removal of the eye tissue is performed soon after death, ensuring the tissue is in the best possible condition for transplant. This also makes sure that the funeral arrangements are not delayed in any way. Because the removal causes no disfiguration, an open casket is still an option for the donor family. Can the whole eye be transplanted? No. Only the cornea and the sclera (white part of the eye) can be transplanted. The whole eye can be used for valuable research on eye diseases and treatments and education.

infectious diseases. The quality of the cornea retrieved is assessed by Specular Microscopy and Slit-Lamp Examination. The cornea is graded into various categories like Optical quality, Therapeutic quality etc. and used for the treatment of different eye diseases. In addition to Little Flower Hospital, the eyes are


Wil l t he donor’s family pay or receive any fees?

in any way involved with eye procurement or with the transplant.

No. It is illegal to buy and sell human eyes, organs and tissues. Any cost associated with eye procurement are absorbed by the eye bank.

In addition to fulfilling your loved one’s wishes, donation can offer comfort to a grieving family. Just knowing that a small part of our loved one is going in life, helping someone see this world is a consolation, something to hold on to in times of sorrow.

Wil l the recipients be told the identity of the donor? No. Donor anonymity is strictly preserved

How is the donor suitability determined?

by law.

Potential donors are carefully screened for medical suitability and high risk factors. HIV, Hepatitis B and syphilis tests are done before any tissue is released for surgery. If any tissue is deemed unsuitable for transplant, the information is then scrutinized for the possibility of use of research. Our primary concern is the safety of the potential recipients, eye bank staff and researchers.

Wil l the quality of medical care be affected if one is known to be a Donor?

How do research and education benefit from eye donation? The addition to corneas used for surgical procedures, more than 35,000 eyes are used annually for research and education. Research on glaucoma, retinal disease, complications of diabetes and other sight disorders benefit from eye donations because many eye problems cannot be simulated only human eyes can be used. These studies help us find out the causes and effects of specific eye conditions and lead to new treatments and cures. Wil l eye donation affect the appearance of the donor? No. Great care is taken to preserve the appearance of the donor. No one will be able to notice that eyes have been donated. Families may even hold a viewing and have an open casket ceremony.

Absolutely not. Strict laws protect the potential donor. Legal guidelines must be followed before death can be certified. A Physician certifying a patient’s death cannot be

What are the benefits to a donor family?

How can I become a donor? The most important action you can take is to tell your family and legal representative. Most states now require that families be offered the option of donation when a loved one dies. Families may give consent for donation. It is most helpful if they know how you feel in advance. A donor card can serve as an indication to your family, your legal representative and hospitals of your intention to be an eye donor.

After eye donation...

The donor’s family receives a certificate of appreciation from the eye bank The eyes are taken to the eye bank and evaluated by a trained eye bank staff Tests are carried out and the tissue is sent to the corneal surgeon The waiting list is referred and the recipient is called for corneal transplant Corneal transplant is performed Periodic follow-up of the recipient is done over time to ensure that the graft is successful

Services of the eye bank

Availability of trained staff round the clock to attend the calls Evaluate and provide quality corneas to corneal surgeons Enable corneal research using eyes unsuitable for grafts, to find newer techniques, improve preservation methods and train corneal surgeons Increase public awareness on eye donation and eye banking Train doctors in eye removal procedures Develop and establish a network of eye donation centres

supplied to various eye hospitals all over India. The Eye Bank Association, Kerala, with its headquarters at Little Flower Hospital, Angamaly, has procured about 19,000 eyes till date. Around 11,500 transplants were performed and the rest were used for research and training purpose. Fr. Sebastian Kalapurackal

Courtesy to http://www.aravind.org

is the current President of the Association who is also the Director of Little Flower Hospital, Angamaly. The message of eye donation has now reached the households in and around Angamaly, but as a nation, India’s demand far exceeds the supply.

TECHAGAPPE

JULY-SEPTEMBER 2017

29


Life Story

Dr. Gayathri Sankaran (Musician)

Dr. Gayathri Sankaran

A RARE MUSICAL GEM... Undoubtedly, music is a fiery spirit that unites hearts beyond all barriers. When she sings, even the crudest and rudest of hearts will melt in extreme joy. It is a voice that is heavenly and a rendition, so pure and mellifluously flowing. She is Dr. Gayatri Sankaran, a well-known Carnatic vocalist who hails from Andra Pradesh and migrated to Chennai to pursue her all time passion - music.

W

hat distinguishes Gayatri from others? Ironically, it is a shortcoming that makes her perfect and a larger than life figure! She is visually impaired from birth and is the first visually challenged person to be conferred with Padma Shri. Apart from being a renowned vocalist, she is an accomplished violinist, a Ph.D. in Music from the Madras University and an A Grade artist with the AIR, Chennai for more than two and a half decades. She is a person who has been moulded to her enviable present status through her infallible willpower, staunch passion for music, tutelage under the maestros of art and the dedicated support of those who love her beyond words. She began her tutelage at the tender age of 3 years under her mother, Smt. Subbulakshmi Gurunathan, who was herself a B Grade vocalist of the AIR. Reminiscing about her fond mother, Gayatri recalls how her mother used to sing repeatedly to her and how she developed an acute sense of ‘Kezhvi Jnanam’ that has helped her all through her life. Unfortunately, her mother passed away when she was six years of age but Gayatri continued learning music. She kindled the flame which her mother had ignited in her until age 12 at her hometown in Samalkot, And hra Pradesh under Allamaraju Someswara Rao. He was a famous vocalist in AIR

30

TECHAGAPPE

JULY-SEPTEMBER 2017

Dr. Gayathri Sankaran


at Vizag. She gave her first concert at the age of 11 marking her arrival into the scintillating and challenging arena of Carnatic Music. The second phase of her musical learning was between ages 13 and 19 and happened at Kalakshetra in Chennai. She was instantly admitted into Kalakshetra after Rukmani Devi Arundale heard her sing and recognized the immense talent in this young artist. During her six years at Kalakshetra, she learned vocal music under Pudukkodu Krishnamurthy and Vairamangalam S Lakshminarayanan (both “A” grade artists of AIR Chennai). She learned violin under Pakkala Ramdas, (an accomplished “A” grade artist of AIR Chennai and a disciple of Shri Lalagudi G Jayaraman). During this time, Gayatri completed her Diploma and Post Graduate Diploma in Music at Kalakshetra and also learned Braille.

Dr. Gayathri Sankaran receiving Padmasree Award from The third phase was a turning point former President of India, Dr. APJ Abdul Kalam. when she was accepted by the legendary Padma Bhushan Shri sad hana when she would practice 4-5 hours a day and also Lalgudi G. Jayaraman as a student in 1998. She nostalgically re- attend 3-4 classes a week. From 2008 onwards, she enriched members that day of 25th January 1998. She says that here is her knowledge of music under the guidance of Padma Bhushan where her musical understanding and performance truly blos- Dr. K.J. Yesudas. somed as she learned swara jnanam, manod harma sangeetham, She also completed her Ph.D. in Music in 2011, at Madras the depths of our limitless musical tradition and also the nuances of being a performing artist. “He helped me understand music in University, under the supervision of Dr. M. Pramila, who its entirety by looking beyond the ragas and compositions to in- guided her thesis on the ‘Stylistic Analysis of Kalidaikurichi still emotion into my singing “, recollects Gayatri. Understand- Vedanta Bhagavatar’. ably, Gayatri’s music today carries the rich flavour and uniqueIt is while pursuing her Ph.D. that Gayatri realised how ness of Lalgudi. She recalls the intensity of those four years of difficult it is for the visually challenged to have access to kritis with notations. “It’s impossible to memorise all the notations. So the visually challenged are always dependent on someone else to read them out. Hence I decided to start notating them in Braille. A few basic segments of the Carnatic repertoire are available but I wanted to take it further by including geethams, varnams and a few kritis,” points out the vocalist, who has been carrying out these exercises in association with the National Institute for the Visually Handicapped. “In fact, we are looking at coming up with notations for almost all popular Carnatic kritis in Braille”, says a determined Gayatri.

Dr. Gayathri Sankaran in recognition by Former Tamil Nadu Governor, Sri. Surjit Singh Barnala

She is the first person to have created Carnatic Music notations in Braille. She undertook this project under the guidance of the Ministry of Social Justice and her work will serve as a permanent reference for the visually-challenged who wish to learn music.

TECHAGAPPE

JULY-SEPTEMBER 2017

31


Life Story

Dr. Gayathri Sankaran (Musician)

Gayatri is a commendable social contributor. She also trains and counsels visually-challenged students in schools. “I want to raise more awareness, particularly in rural areas, about the benefits the Government offers to the visually challenged. It’s very important for them to know the opportunities available to them in various fields or even the support they can get if they want to be self-employed,” says Gayatri, who has been making efforts to reach out particularly to visually challenged women. “Safety is a big issue. Sometimes when they trust the wrong person it could put them in a dangerous situation. I also guide them on how to be more independent and go about their chores by themselves. The ability to handle things on your own is the first step to gain self-confidence.” The immensely gifted Gayatri sings in three and a half octaves, her voice reaching the highest notes effortlessly and smoothly. The notes are clear, resonant and have a haunting quality. She has a deep, inborn, intuitive understanding of her art. An amazing and balanced blend of musical acumen and melody - this is how we can define Gayatri in simple words. One incident which she recollects with immense pride and joy is when she gave a unique music performance at Music Academy, Chennai, for the dance programme of the Clarke School for Deaf and Dumb School. The performing children could not hear her music but followed her lip movement and she could not see them but had to follow them by the sound of their footsteps. But the coordination was so good that everyone applauded, including the then Governor of TamilNadu.

Never tired of learning new things, Gayatri has also explored the Harikatha trad ition as part of the Senior Fel lowship programme through the Ministry of Culture. “I also want to become a Harikatha performer. Listening to discourses is my favourite pastime. I find the epics, mythology and historical anecdotes quite fascinating”, she smiles. Her listening and memorizing capability come really handy in this particular area of the art form. Gayatri has students who are passionate about music all over the world. She takes classes online through Skype and many great future musicians are in the making under her guidance. Gayatri takes dedicated hard work before she ventures out for a concert or talk. She gets her students to read out the relevant books, records the main points for revision, downloads information from the Internet using the ReadPlease software. She memorises the information she needs. She wakes up early and practices till it is time to leave for work. She listens to news channels to know what’s happening in the world around her. She gives music lessons during weekends. Once she took a student along on a musical tour to get a running commentary of places they visited. She noticed two things during one such tour to London. “Audiences abroad are curious. They asked knowledgeable questions after my lecture on the musical forms in Thol kappiam. Secondly, life is a lot easier for challenged people there. Everything is accessible. The London tube has special turnstiles and a guard guides you to the train. The train repeatedly tells you to ‘mind the gap’

32

TECHAGAPPE

JULY-SEPTEMBER 2017


between the step and the platform. Tourist spots offer concessions. I was even allowed to touch the wax models at Madame Tussaud’s. I took a ride in London Eye that gives you an idea of the city. I visited the gardens to feel the flowers. I can imagine the colours”, she again gives out that winsome smile that literally wins our hearts. She has made overseas performances in Canada, USA and in several other countries other than London. When asked about how she judged the reaction of her audience, she replied, “I usually judge the audience from the response I get to the first couple of songs.

She has won the prestigious Kalaimamani award which is given by the Government of Tamil Nadu for her excellence in the field of music. Of all the accolades she has won, one thing that is more dear to her heart is the National Eminent Scholar award from the Sankaracharya of Kanchi HH Shri. Jayendra Saraswati. Before every concert, I make it a point to discuss my audience with the organisers. I am always prepared to change my list of songs. I switch the tempo, ragas and songs to suit my audience. The idea is to provide an enjoyable experience. I prefer to sing familiar songs though I do introduce new ones.” Then she smiles. “So far I have not forgotten my lines.” She usually gives cues to her talented accompanists by her nods who understand every cue from her side and support her wholeheartedly. She has won the prestigious Kalaimamani award which is given by the Government of Tamil Nadu for her excellence in the field of music. Of all the accolades she has won, one thing that is more dear to her heart is the National Eminent Scholar award from the Sankaracharya of Kanchi HH Shri. Jayendra Saraswati.

Dr. Gayathri Sankaran in a musical performance

Dr. Gayathri Sankaran with former Prime Minister of India, Dr. Manmohan Singh

Gayatri expresses her sincere gratitude to her husband Sankaran, who had quit his salesman’s job to manage her schedules, organise her travel and run the household. “I don’t know anything about the house,” she confesses shyly. “His coopera-tion is crucial to my work.” She is grateful to her Guru Lalgudi who taught her more than lyrics and laya and who still is a guiding star in her in living and working efficiently. She remembers all those who have been supporting her effort with an equal sense of thankfulness. Continuing her career as a performing Carnatic Vocalist, she has travelled extensively to give concerts. She continues to train students in this form of art irrespective of age, caste and creed. She just sets aside questions on how she manages everything despite her visual impairment with a very cool and confident reply saying, “God is always by my side”. We truly feel the presence of a divine spirit beside her when she wears a disarming smile on her face telling that nothing can come between her and her music-which is God Himself for her.

TECHAGAPPE

JULY-SEPTEMBER 2017

33


Interview Dr. P. K. Rath

DDC-Dedicated to Diagnosis and Research Face to face with Dr. P. K. Rath, Director, Doctors Diagnostics Centre

Diagnosis is the basis of treatment and cure. Realising the importance of diagnosis and the lack of modern facility to diagnose different types of diseases, doctors of Trichy, Tamil Nadu and surrounding areas under the leadership of Dr. P. K. Rath established ‘Doctors Diagnostics Centre’ (DDC) in 2004 at Trichy. Today, it has all the state-of-the-art machinery and excels in the field of pathology, advanced biochemistry, hematology, microbiology, immunology, molecular biology and cytogenetics. DDC has brought in quality diagnostic services at affordable cost, thereby saving lives. DDC was also the first private Medical Laboratory in India to start detection of Dengue & Chikungunya virus in the blood.

Team Agappe: Tell us about yourself. How did you come on board of DDC? Dr. P. K. Rath: Actually, I hail from Odisha (Orissa). After finishing my MBBS from VSS Medical College, Burla, Odisha, I did my senior House Surgency from CMC Vellore in 1986 and joined the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry as an MD student of Pathology. After completing three years, I worked there for one year as a Senior Resident Doctor. Later I moved to Trichy. In 1991 December, I joined a corporate hospital called Seahorse Hospital at Trichy. I was the Chief of the Lab Services. I started Immunohistochemistry (IHC) for the first time in a corporate set up there. During that time, only CMC Vellore and Medical Colleges had that facility. In my opinion, it was the best available technology with high-quality lab reports. I was also quite interested in Oncopathology. When you give a diagnosis of cancer, it should be 100% sure and you need to identify subdivisions of various types of cancers coming up. The

Dr. P. K. Rath

34

TECHAGAPPE

JULY-SEPTEMBER 2017


diagnosis needs to be in accordance with WHO classification. Suppose in Lymphoma, if you don’t give a phenotype d iagnosis like T-Cel l lymphoma or V Cel l lymphoma or a grading of lymphoma, it wouldn’t be possible to have a treatment for lymphoma. In my opinion, WHO Classification is necessary. So IHC was the need of the hour which nobody was practicing. Coming from JIPMER, I was well versed with the technology and we initiated it.

Dr. P. K. Rath with his team at DDC Laboratory, Trichy Similarly, on transmission sector, I started doing component trans- the investigation reports. Our motto is -Dedicated to diagnomission- the first time in this part of Tamil Nadu in 1992. sis and research. We want it to be affordable to people and have kept the rates as low as possible. Q: We are curious to know why you chose Tamil Nadu despite Od isha, being your native place. Q: In a short span of time, DDC has branched out to various parts of Tamil Nadu. Tel l us about the growth path A: As you know, our organisation, Doctors Diagnostics Centre of DDC? (DDC), was established in 2004. The organisation comes under the A: We are now into the 14th year of existence. In these 14 company Multi Speciality Lab Services Pvt. Ltd. The parent comyears, we had probably added 800 more tests in our labs. We pany has got many other concerns like Doctors Institute of Lab have opened up 15 branches all over Tamil Nadu. Out of these Sciences and Doctors Blood Bank and Research Centre. I was work15, 10 are tertiary branches, which mean they can have all ing in the corporate sector from 1992-2004 in Trichy, Tamil Nadu. kinds of investigations like biochemistry, immunology, microAll the doctors around there liked my quality of work and reports. biology etc.We have increased our turnover from 7 lakhs per So they requested me to start this organisation. I started this month to 18 crores now. We plan to reach 20 crores by this organisation with the support of the entire doctor community year. Now, we have taken further expansion into molecular here. A private limited company, DDC has got 50 doctors as sharegenetics. We will be starting our gene sequencing and molecuholders and I’m just the Managing Director. Our sole aim was to lar genetics lab next month. That will help a lot of gynaecologist have a place where you could conduct all kinds of investigation. At friends for IVF, pre-implantation for embryo workup and those times, all kinds of investigations, including those of thyOncopathology like oncogenetic work, which will be helpful roids, were going to major corporate companies. It took a long for all cancer patients. Another expansion is radiology. We time to get all the results. So that’s how we thought of a place will be having diagnostics modules to help the doctors to treat where you could conduct all kinds of investigations under one the patients. We will have the PET scan inaugurated in June. We roof. Also, we didn’t take any loan for our organisation. All funds will also have Nuclear Scanning and afterward will have other were raised from share capital. All the doctors paid the money and we bought the instruments. Returning to the question, since I did my studies here, I had a special connection with Tamil Nadu. By the time I completed my studies, I was well acquainted with the language and people here. So I thought of settling down here. Q: What is DDC’s mission and vision? A: Our mission was to make the reports available for patients as soon as possible so as to save their lives. Our vision is to make this service available at the nook and corner of Tamil Nadu and the entire country so that people wouldn’t have the difficulty to get

"Our quality is our strength. Our technical superiority enables us to stay stronger along with our supporting doctors. We get around 25,000 biopsies a year which tells about the confidence that doctors have on us. We get biopsies from the nook and corner of the state. Sometimes, even from Medical Colleges". Dr. P. K. Rath states.

TECHAGAPPE

JULY-SEPTEMBER 2017

35


Interview

Dr. P. K. Rath

Q: How is your overall experience with Agappe so far? A: Good thing about Agappe is that Agappe is a company that follows Make in India. This is something you have really stuck on to from a long time. Even before our PM has come up with Make in India, Agappe has been following it. I have seen Agappe growing and think that it has improvised and brought in new technologies. I will always recommend Agappe and believe that Agappe will continue its good work. Agappe’s instrumentation is really big and it now contributes to bigger hospitals and laboratories. The foothold has increased considerably. radiology parameters like Mammogram, MRI, CT scan and the like. We believe it will add on to our values. Q: What accord ing to you are the qualities of DDC which distinguishes it from other labs? A: At our main lab branch, we have medical faculties in each branch. We have four MD pathologists, MD biochemistry, MD microbiology, and cytogenetics. We have three biotechnology people for molecular biology. So each division has its own faculty so that quality of individual tests is supervised by top most people in the clinical field. We have to keep the faith of doctors on us. Q: DDC has opened up many branches in rural areas. Tel l us more about it. A: We aren’t scared to invest even in small cities. As I mentioned earlier, we had already opened 10 branches in tertiary areas. Stand alone laboratories, which has got facilities for molecular genetics or molecular pathology, is unthinkable. In opening up of branches in the rural areas, we are much ahead of our competitors and have enabled the people to have these facilities. We have also introduced a modular system which enables a sample to undergo different tests. You don’t have to take a sample from biochemistry machine to put it in immunology machine. It will reduce the turnaround time. Also, we are using updated software so that the integration is done along with it. Q: How does DDC spread in facilitating health services to the public? How do you offer 100% patient satisfaction service? A: We are an NABL accredited laboratory. Starting from receiving patients to giving reports, there are a set of NABL requirements including software integration to which we adhere completely. Now for the next step, we are planning to provide online results to patients. The process is in the pipeline and we will introduce it soon. We also have CAP (Council of American Pathologists) accreditation. We have 25 centres, out of which 15 are branches and 10 are collection centres employing 210 staff including doctors and administrative staff. Two more branches are

36

TECHAGAPPE

JULY-SEPTEMBER 2017

Q: Today Agappe, with its new expansion of production facilities, is having the largest and most modern plant in the Indian subcontinent. Agappe is privileged in claiming that we are “the best partner in diagnostics”. What would be your advice to Agappe for strengthening its tag line your best partner in Diagnostics? A: We are now moving towards molecular pathology and molecular genetics. I believe that the future is molecular. Every disease is related to a gene. My advice to Agappe is that it should move on to molecular pathology and genetics where there are only a few players. You also have next generation sequencing which has come out in India. also coming up. We also have six hospitals where we run the laboratory as part of the hospital laboratory management program. Apart from this, Government of Tamil Nadu has recognised DDC as Centre of Excellence for doing any kind of investigation related to infection, which is important for public health. Every day, we directly report on the status and number of swine flu, dengue, malaria and tuberculosis cases after confirming it. We have R&D facility in tie-up with certain universities in fields like genetics, molecular biology and biochemistry. TA: What are your core values which provide mileage for your growth? In other words, what is your strength? A: Our quality is our strength. Our technical superiority enables us to stay stronger along with our supporting doctors. We get around 25,000 biopsies a year which tells about the confidence that doctors have on us. We get biopsies from the nook and corner of the state. Sometimes, even from Medical Colleges. Q: What are the future plans for DDC. A: As I told you, our intention is to expand further and provide the same care. We would also like to do further research and see that we go to the rural corners of the country. Q: Tel l us about your family. A: My wife is a dentist. She has got her own clinic. My daughter is currently doing her MS at the University of Southern California. My son is doing his MBBS at Amrita Institute of Medical Sciences, Kochi. Q: What is your take home message to the medical profession and to the diagnostic industry? A: I believe we all have to give back to the society what society has given us. The god has given us the wisdom to make the society healthy. I believe that we doctors must use this to keep people healthy and they should continue to do so.


Life Story Dr. Satish Amarnath (Microbiologist)

Dr. Satish Amarnath

A Man who has Proven HIS METTLE

Acid attacks! The name itself insinuates a pre-planned and heinous crime. Acid attacks are not new to India. Several episodes in which the desperate and rejected boyfriends throwing acid onto their lovers’ face have made states to prohibit the sale of concentrated acid to public. Though North India tops the list of acid attacks, some cases from South India also made the human conscience to shudder at the cruelty. A particular case from Bangalore, where the prey of acid attack was a doctor, is slightly different from this rejected love story. The attacker is still unknown and if his aim was to frighten the victim, he was utterly wrong. The doctor bounced back to life within a couple of months even though the acid attack had disfigured his face and destroyed his eyesight permanently.

Born and brought up at Bangalore, Karnataka, Satish Amarnath

completed his MBBS in Karnataka Medical College, Hubli in 1983. Belonging to a middle-class family, his father Amarnath was a branch manager with a transport company. After a while, he started his own transport company cal led Sri Chamundeswari Transports. His mother was a homemaker and Satish had no siblings. He remembers that he was passionate about Microbiology right from graduation. He did his Diploma in Industrial Microbiology along with his B.Sc. He attributes his keen interest in the subject to the inspiring teachers he had like Dr. Ramanananda Rao from Indian Institute of Science and Dr. Veerabhadrappa from Dept. of Organic Chemistry, Bangalore University. Even so, he wasn’t able to pursue microbiology at first since his parents felt that being a doctor is better. Apart from that, they dreamt their son could be the first doctor from the family. So, after fulfilling his parents’ dream, he pursued microbiology and did his MD in it. Meanwhile, in 1984, he married Jyotsna. In 1986, he completed his Post Graduation studies at the same institute where he did his MBBS. While appearing for the final exams, he was offered a job by one of the examiners who happened to be the Head of Microbiology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). So, he took up the offer and worked there for almost 8 years and if had continued, he would have become a Professor. But, he resigned as an Associate Professor from JIPMER. After his father passed away, his mother and grandmother refused to come to Pondicherry where Dr.

Dr. Satish Amarnath

TECHAGAPPE

JULY-SEPTEMBER 2017

37


Life Story Dr. Satish Amarnath (Microbiologist) Satish had been working and staying with his family. Dr. Satish felt it wasn’t worth staying somewhere clinging on to a central government job. So after discussing it with his wife, they decided to move back to Bangalore. He says he has got no regrets at all about that decision. He joined the Manipal Hospitals in 1996 as a Consultant Microbiologist and now has gone through different positions. Life had been smooth until this particular incident happened on September 5th, 1998. Dr. Satish remembers that he was supposed to take his family for a dinner outside. On that day, he reached back home a little early from work. Since his mother had asked him to get her new clothes stitched, he took a halt at the tailoring shop on his way back. After giving the dress to the tailor, he tal ked with him for a few minutes and on his return, this unfortunate and shocking incident happened. “Since I was wal king back from a very brightly lit area, I couldn’t see those people standing in the dark. Usually, when you come from a very brightly lit area your eyes will take some time to adjust to the darkness. Only when the acid fell on my face, I could understand that they threw acid upon me. Immediately I shouted and got some people to help me. I washed it with some water and then was immediately taken to the hospital. But then it was too late. The fellow threw concentrated sulphuric acid and it fell directly on my eyeball,” recollects Dr. Satish.

Dr. Satish Amarnath at his work place

38

TECHAGAPPE

JULY-SEPTEMBER 2017

“I underwent four eye surgeries and several plastic surgeries. Nearly one month, I was hospitalized. I began to get back to the hospital and concentrate on my job after the 40th day, initially for a few hours and subsequently for full time,” Dr. Satish comments with undefeatable will power. The acid attack has disfigured his face and he lost his eyesight. Police could never find out the culprits behind the incident. They believe it to be a case of mistaken identity. “I underwent four eye surgeries and several plastic surgeries. Nearly one month, I was hospitalized. I began to get back to the hospital and concentrate on my job after the 40th day, initially for a few hours and subsequently for full time,” Dr. Satish comments with undefeatable will power. Dr. Satish was pretty popular when he joined Manipal Hospitals since he used to write articles in newspapers, give lectures in various scientific forums and so. When this particular incident happened, the organisation decided to help him to come back to life. By then, Dr. Satish had made his decision to fight for a normal life. Once he felt the tears of his daughter in his hands, he decided not to fail before the attackers. He returned to his original position after that. Dr. Satish remembers the support extended by his colleagues. From his experience of working as a Consultant Microbiologist, he could interpret many things even though he can’t look through a microscope or see a result. The authorities found his work to be very helpful and decided to give him more responsibilities. The hospital was running a course in Distance Education for


Dr. Satish Amarnath with his family members three different specialities. Dr. Satish was given the charge of the Bangalore centre. He had a lot of students. He is also known to keep very good contact with them. Many of his students settled around the world pay him a visit if they happen to visit Bangalore. Dr. Satish was also given the additional responsibility of the Chairman of the hospital for Infection Control. The hospital group wanted to introduce the industrial best practices which all major hospitals were trying to introduce. Under Dr. Satish’s guidance, the hospital smoothly achieved it. The standards are now par with international standards and Dr. Satish attributes it to the unfailing teamwork. He was also given the responsibility of pushing the overall quality of the hospital. The management wanted it to be the first group securing that title. Dr. Satish was made the quality management representative. “It is a credit that we are one of the first few hospitals to secure an ISO- 9001-2000 certificate for quality. We also won a national award- the Golden Peacock National Quality Award in the hospital sector,” he comments beaming with pride. As a part of management’s strategy to start preventive health wellness and beauty clinics across the country, Dr. Satish was given new responsibility- to re-engineer health care delivery in 2007. He was asked to be the Medical Director and under his guidance, the team went on to create a unique service initiative on which even today people tal k about. “We integrated all the good points of health care and tried to address the bad points. We rolled out this model clinic in Ahmedabad, Pune, Mumbai and Bangalore. We tried to make it a little more fun by adding retail space into it where the customer can come and purchase any health care products. For a quality benchmark, we went for Australian Council of Health Care Standards International Certificate,” he adds on.

So, how does he do all these? “It’s been tough. But I’m thankful that I have wonderful colleagues. I also use special software which helps me with the work, presentation, browsing the web and reading or typing a document or mail. It reads out the text on the screen which enables me to read emails or browse the net. I’m also a programmer and makes use of such skills to ease my work. I know six languages reasonably good,” says Dr. Satish with a winsome smile. When asked about his message to the people, he said, “Many of us believe that we can’t do something even before trying it. I will advise them to try it. Do it again if you weren’t able to succeed in the first attempt. I can do many things which many people think a blind person is incapable of. Never get worried about other people judging you. Believe in yourself.”He says that he has never compared his life before the incident with his current life. “I only look into what I have got to do. I’ve never tried it to question why it happened to me. I only concentrate on the problem and the solution to overcome it. That has been my approach to everything I do.” His wife Jyotsna is currently working with Defence BioEngineering and Electro Medical Laboratory (DEBEL), a DRDO Organisation under Central Government in Bangalore. They have got two children. His daughter has joined Manipal Hospitals as a Consultant after completing her MS in Gynaecology with a state rank. She also completed a fellowship in Reproductive Medicine. His son has just completed his MS from the University of Arizona. The family moves on with their life happily banking on the infallible courage and will power of Dr. Satish, the man whom they adore and cherish.

TECHAGAPPE

JULY-SEPTEMBER 2017

39


Cover Story Retinoblastoma - An Overview

A Comprehensive Review on

RETINOBLASTOMA Prof. Dr. Parag K. Shah, DNB

Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore.

Retinoblastoma is the most common intraocular malignancy in childhood. It usually presents before 3 years of age and can be germinal or nongerminal. There has been a paradigm shift in the classification and management of retinoblastoma. This review provides the international retinoblastoma classification, latest classification of vitreous seeds, and current and newer treatment modalities such as intra arterial and intravitreal chemotherapy.

R

etinoblastoma is the most common intraocular malignancy in children, with a reported incidence ranging from 1 in 15000 to 1 in 18000 live births. There is no racial or gender predisposition in the incidence of retinoblastoma. It is bilateral in approximately 25– 35% of the cases. The average age at diagnosis is 18 months, unilateral cases being diagnosed at approximately 24 months and bilateral cases before 12 months. Pawius described retinoblastoma as early as in 1597. In 1809, Wardrop referred to the tumor as fungus hematodes and suggested enucleation as the primary mode of management. The discovery of ophthalmoloscope in 1851 facilitated recognition of specific clinical features of retinoblastoma. Initially thought to be derived from the glial cells, it was called a glioma of the retina by Virchow. Flexner (1891) and Wintersteiner (1897) believed it to be a neuroepithelioma because of the presence of rosettes. Later, there was a consensus that the tumor originated from the retinoblasts, and the American Ophthalmological Society officially accepted the term retinoblastoma in 1926. There has been a paradigm shift in the management of retinoblastoma since then. It is now known as a curable cancer. Among the most important objectives in the management of a child with retinoblastoma is survival followed by preservation of the globe, and focus on visual acuity comes last. Therapy is customized to each individual case and is based on the overall anatomical situation, including threat of metastatic disease, laterality, the number, size and

40

TECHAGAPPE

JULY-SEPTEMBER 2017


location of the tumor(s), evidence of subretinal fluid, localized or diffuse vitreous seeding, risks for secondary tumors, systemic status, and estimated visual prognosis. GENETICS OF RETINOBLASTOMA It is caused by a mutation long arm of chromosome 13, band 14 (13q14). RB1 gene is a tumor suppressor gene, and both the genes have to be mutated to cause this disease. When both the mutations involve only the retinal cells (somatic cells), the child develops a nongerminal type of disease, which is non heritable. However, when one mutation involves the germinal cell, the child develops the germinal type of disease, which is transmittable to the next generation. Out of the newly diagnosed cases of retinoblastoma, only 6% are familial whereas 94% are sporadic. Bilateral retinoblastomas involve germinal mutations in all cases. Approximately 15% of unilateral sporadic retinoblastoma is caused by germinal mutations affecting only one eye whereas 85% are sporadic. In 1971, Knudson proposed the two hit hypothesis. He stated that, for retinoblastoma to develop, two chromosomal mutations are needed. In hereditary retinoblastoma, the initial hit is a germinal mutation, which is inherited and is found in all the cells. The second hit develops in the somatic retinal cells leading to the development of retinoblastoma. Therefore, hereditary cases are predisposed to the development of nonocular tumors such as osteosarcoma. In unilateral sporadic retinoblastoma, both the hits occur during the development of the retina and are somatic mutations. Therefore there is no risk of second nonocular tumors. Genetic counseling is an important aspect in the management of retinoblastoma. In patients with a positive family history, 40% of the siblings would be at risk of developing retinoblastoma and 40% of the offspring of the affected patient may develop retinoblastoma. In patients with no family history of retinoblastoma, if the affected child has unilateral retinoblastoma, 1% of the siblings are at risk and 8% of the offspring may develop retinoblastoma. In cases of bilateral retinoblastoma with no positive family history, 6% of the siblings and 40% of the offspring have a chance of developing retinoblastoma. Apart from empiric genetic counseling, as described above, the current trend is to identify the mutation and compute specific antenatal risk. Knowledge of the full range of mutations can aid in the design of screening tests for individuals at risk.

CLASSIFICATION The classification currently used for staging and grouping retinoblastoma is “The International Classification of Retinoblastoma.� It has replaced the older Reese Ellsworth classification, as it could not be applied to current treatment modalities. This classification consists of two parts: 1. Staging for the patient 2. Grouping for each eye.

Staging for patient as a whole : There are five stages Stage 0: When the child presents with intraocular retinoblastoma with no regional or systemic metastasis, and no enucleation has been performed. Stage 1: When enucleation has been done in one eye. High risk pathology features may be present in the enucleated specimen. It may be present in the other eye. Stage 2: When residual orbital tumor is seen at the cut end of the optic nerve during enucleation. Stage 3: When there is an overt orbital extension with involvement of preauricular or cervical lymph nodes. Stage 4: Distant metastasis. It is subdivided into: (a) Stage 4a: Non central nervous system (CNS) spread (b) Stage 4b: CNS spread. Grouping for each eye This also has five groups: 1. Group A: Small tumors which are <3 mm in size and should be located at least 3 mm from the fovea and 1.5 mm from the optic disc.

TECHAGAPPE

JULY-SEPTEMBER 2017

41


Cover Story Retinoblastoma - An Overview 2. Group B: Any tumor >3 mm in size (except smaller tumors which are very close to fovea and optic disc as specified in group A). Cuff of exudative retinal detachment <5 mm from the tumor base or <1 quadrant is allowed 3. Group C: Any tumor with localized tumor dissemination, i.e., vitreous seeds or subretinal seeds, which are <3 mm from the tumor surface 4. Group D: Any tumor with diffuse vitreous or subretinal seeds 5. Group E: End stage disease. DIAGNOSIS A thorough clinical evaluation with careful attention to details, aided by ultrasonography B scan helps in the diagnosis. Computed tomography is usually avoided to reduce radiation exposure, which can trigger second cancers in children with germinal mutation. Magnetic resonance imaging (MRI) is the preferred modality for diagnosis and to rule out extraocular or intracranial “trilateral” retinoblastoma. A child with suspected retinoblastoma necessarily needs complete ophthalmic evaluation including a dilated fundus examination under anesthesia. The intraocular pressure is measured and the anterior segment is examined for neovascularization, pseudohypopyon, hyphema, and signs of inflammation. Bilateral fundus examination with 360 degree scleral depression is mandatory. Direct visualization of the tumor by an indirect ophthalmoscope is diagnostic of retinoblastoma in over 90% of the cases. RetCam is a wideangle fundus camera useful in accurately documenting retinoblastoma and monitoring response to therapy. Ultrasonography B scan shows a rounded or irregular intraocular mass with high internal reflectivity representing typical intralesional calcification. On fluorescein angiography, smaller retinoblastoma shows minimally dilated feeding vessels in the arterial phase, blotchy hyperfluorescence in the venous phase, and late staining. Hand held spectral domain optical coherence Tomography (HH SD OCT) imaging has dramatically improved the sensitivity to detect early tumors, recurrences, and complications in focal therapy management of

retinoblastoma patients. Overall, indirect ophthalmoscopy remains the gold standard for the diagnosis and treatment of active retinoblastoma. Lumbar puncture and bone marrow aspiration for distant staging is done only when there are features of extraocular spread. MANAGEMENT OF RETINOBLASTOMA The primary goal of management of retinoblastoma is to save life. Salvage of the organ (eye) and function (vision) are the secondary and tertiary goals, respectively. The management of retinoblastoma needs a multidisciplinary team approach including an ocular oncologist, pediatric oncologist, radiation oncologist, radiation physicist, genetist and an ophthalmic oncopathologist. The management strategy depends on the stage of the disease – intraocular retinoblastoma, retinoblastoma with high risk characteristics, orbital retinoblastoma, and metastatic retinoblastoma. Management of retinoblastoma is highly individualized and is based on several considerations including age at presentation, laterality, tumor location, tumor staging, visual prognosis, systemic condition, and family and societal perception, and, to a certain extent, the overall prognosis and cost effectiveness of the treatment in a given economic situation. TREATMENT OF INTRAOCULAR RETINOBLASTOMA A majority of children with retinoblastoma manifest at the stage when the tumor is confined to the eye. Approximately 90– 95% of the children in developed countries present with intraocular retinoblastoma, whereas 60–70% present at this stage in the developing world. Diagnosis of retinoblastoma at this stage and appropriate management are crucial for life, eye, and possible vision salvage. There are several options for the treatment of retinoblastoma, and the ocular oncologist should be thoroughly familiar with the indications, technique, and expected results of all treatment methods as well as the expected systemic and visual problems. Various methods to manage intraocular retinoblastoma are focal (cryotherapy, laser photocoagulation, transpupillary thermotherapy, transscleral thermotherapy, plaque brachytherapy), local (external beam radiotherapy, enucleation), and systemic (che-

PROGRESSION OF RETINOBLASTOMA

42

TECHAGAPPE

JULY-SEPTEMBER 2017


motherapy). While primary focal measures are mainly reserved for small tumors, local and systemic modalities are used to treat advanced retinoblastoma. Group A Only focal treatment in the form of cryotherapy, laser photocoagulation, or thermotherapy. 1. Cryotherapy involves freezing the tumor till its apex with a cryoprobe and thawing it for 1 min. This is done thrice and is called triple freeze thaw cryotherapy. This treatment is preferred for anterior tumors. The disadvantage is that the scar formed is much bigger than the tumor size 2. Laser photocoagulation involves surrounding the tumor with two to three rows of green laser (532 nm). This cuts off the blood supply and leads to regression of the tumor. This is preferred for posterior tumors. However, here also the scar formed is much bigger than the initial tumor and high power if used on tumor surface can cause iatrogenic vitreous seeding. 3. Transpupillary thermotherapy (TTT) is a method of applying localized heat to tissue that is below the coagulative threshold, and thus sparing the retinal vessels from photocoagulation. The goal is to deliver a temperature of 42â&#x20AC;&#x201C;60°C using a diode infrared (810 nm) laser system and induce tumor necrosis. The advantage of TTT is that the scar formed is not bigger than the tumor size. Group B

inoblastoma who are at greatest risk for this brain tumor. Group D In addition to the treatment described above for group C, a reduced dose of 36 Gy of whole globe EBRT (standard dose is 46 Gy) would be required if reactivation of tumor is seen. EBRT may induce a second cancer among patients with familial disease. Babies who are younger than 12 months of age have a greater risk for second cancers than patients over 12 months of age in the field of irradiation.

Here, in addition to local therapy, the tumor needs to be reduced in size with the help of chemotherapy. Here, at least three cycles of chemotherapy (carboplatin, vincristine with or without etoposide) are needed along with local therapy before every cycle. Primary episcleral brachytherapy using either Ru 106 or I 125 seeds is also an option.

The 30 year cumulative incidence for second cancers in bilateral retinoblastoma (germinal mutation) has been reported at 35% for patients who received radiation therapy compared with 6% for those who did not receive radiation. This was found to be dependent on patient age at the time of irradiation as well as other factors. Primary enucleation is still an option in unilateral group D cases.

Group C

Group E

Most retinoblastoma centers now adopt a protocol of three agent chemotherapy using vincristine (0.05 mg/kg), etoposide (5 mg/kg), and carboplatin (18.6 mg/kg) (VEC) delivered 3 weekly over 6 cycles to allow for adequate tumor reduction along with local therapy before each cycle. In addition to this, 2 ml of sub tenon carboplatin (STC) can be given to tackle the avascular vitreous or subretinal seeds on the day of chemocycles 2, 3, and 4.

The ideal treatment option for this group is enucleation. The idea is to gently remove the intact eye without seeding the malignancy into the orbit. Orbital implants are routinely placed in children at the time of initial surgery and give excellent cosmetic results with improved prosthesis motility. After enucleation, on histopathology, if high risk pathology features are present, the child will require six cycles of adjuvant chemotherapy to prevent distant metastasis.

However, it causes lot of periocular inflammation and might cause a frozen orbit. STC should be avoided along with cryotherapy as this combination can lead to rhegmatogenous retinal detachment. A strikingly fewer numbers of trilateral retinoblastoma were noted in children who were treated with chemotherapy, and hence, Shields concluded that chemotherapy might be protecting against the highly fatal intracranial neuroblastic tumors. This observation is particularly important in children with bilateral or familial ret-

In rare cases of bilateral group E, treatment as specified in group D should be attempted. Based on the International Classification of Retinoblastoma, treatment success was found in 100% of group A eyes, 93% of group B eyes, and 90% of group C eyes. Group D eyes showed 48% success, however, more recently, these eyes have been managed with additional focal chemotherapy (intra arterial and intravitreal) to improve control. Courtesy to Kerala Journal of Ophthalmology and Wolters Kluwer - Medknow

TECHAGAPPE

JULY-SEPTEMBER 2017

43


Health Tips

HOW HEALTHY & STRONG ARE

YOUR EYES..?

Dr. C.S. Satheesh Kumar, Vice President-Operations, Agappe Diagnostics Ltd., (Retd. Drugs Controller, Kerala) Eyes are our windows to the whole world.The eyes might be the proverbial window to the soul, but they are also a clear window to your health and the amount of information they can reveal is astounding. Eye exam was the first indicator of 34% of diabetes cases, 39% of high blood pressure cases and a shocking 62% of high cholesterol cases.

L

ike any other part of our body, eyes too demand conscious efforts to protect them, which also help in improving your vision. Almost a third of people are unaware that Glaucoma runs in their family in general. Knowing if you have genetic conditions such as Type 2 Diabetes, Astigmatism or Myopia can protect the future health of your eye health. Taking proactive and conscious efforts to take care of your eyes surely benefits you in the long run. Here are some simple tips which you can follow, ensuring maximum protection and care for your eyes. Nutrition: Healthy eating is essential for healthy eyes. Foods rich in lutein, vitamin-A found in leafy greens such as kale, delays the onset of as Age-Related Macular Degeneration (AMD) and Cataract. Omega-3 is believed to help reduce your tendency of getting dry eyes and maintain healthier eyes into old age. Fish like tuna and salmon are the best food sources for high levels of Omega-3. Zinc can help promote better vision and can be found in foods such as cheese, mil k and poultry. Include more green veggies and fruits in diet. Following a healthy diet, rich with fresh fruits and raw green vegetables, will benefit your body to be fit as well as your eyes to be strong and sharp. Dietary Supplements recommended for better functioning of eyes are Vitamin C, Vitamin E, Zinc, Selenium,

44

TECHAGAPPE

JULY-SEPTEMBER 2017


Lutein, Calcium, Thiamin, Folic Acid, Omega 3 Essential Fatty Acids, Nacetyl Cysteine, Alpha Lipoic Acid etc. Drinking in moderation is strongly advised to maintain good overall health. The three factors of poor diet, smoking and alcohol abuse can lead to a toxic, progressive optic neuropathy (optic atrophy) which can cause visual impairment and damage to the optic nerve cells. Ultraviolet (UV) light exposure for prolonged periods can seriously damage your eyes and in some cases is responsible for causing retinal burning and even blindness. UV light is known to increase the risk of AMD and Cataracts. It is imperative that on bright days sunglasses are worn. If you are feeling discomfort from sun’s rays this may be a sign that your eyes are being damaged. UV levels are at their highest between 10am-2pm and so plan accordingly. Snow reflects up to 80% of the sun’s natural UV light, which can cause snow blindness. Therefore, remember your sunglasses in hot and cold weather. Adequate sleep: Like your body, eyes too require adequate sleep and rest at night, so that it can function properly without being puffy, red and tired. Clean your hands and your contact lenses properly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate. Wash your hands properly before rubbing your eyes or even touching your eyes. Rest your eyes while at work: Majority of office jobs require constant and direct glaring at the computer screen, making it difficult for your eyes. Make sure to take a break, every twenty minutes. Just close your eyes or get some fresh air. Keep a safe distance from electronic screens: Adults are exposed to computer screens at workplace while kids are glued to TV screen at home, leading to eye problems. Make sure that your TV is kept at a maximum distance while viewing Avoid self-medication for any eye diseases. Check your eyes if they are itchy or red and soothe them with cold compresses. If you feel grittiness, like there’s sand in your eye, rinse with clean water or saline. See a doctor if symptoms continue, or if you have eye pain, secretions, swelling, or sensitivity to light. Have regular eye check. Nandiyarvattom Flowers& Breast Mil k – From ancient times, these are very good remedies for eye diseases. The juice of the flowers can be applied over eyes as eye drops for eye diseases.

The flower juice can be mixed with oil and used as eye drops. If you tend to have allergic reactions, avoid eye makeup, especially old stock after 3 months and try only one new product at a time. Never share cosmetics and don’t use store samples. Clean your face thoroughly before and after using makeup, and don’t apply cosmetics inside lash lines. Control your blood sugar, blood pressure. Keeping your blood glucose, blood pressure and cholesterol levels low help to keep your eyes and the rest of your body healthy. Give your eyes a rest -Take regular breaks when working in front of your computer. Staring at the computer causes eyestrain and tired eyes and can cause long-term damage to your vision. Incorporate regular breaks and try some eye exercises to relax your eye muscles. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain. Also, place your screen so it’s about 25 inches away and slightly below eye level. Make sure you have proper lighting. Position your lights correctly when reading or working at the computer. Low light or bright lights can cause eyestrain. Practice workplace eye safety - Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times and encourage your co-workers to do the same. Yoga - Other than a few diseases such as cataract and glaucoma which occur due to bacterial infections, many eye disorders are related to the malfunctioning of the ocular muscles caused by chronic mental and emotional tensions. Studies have shown a link between a sedentary lifestyle and an increased risk of Glaucoma. Research at the University of Wisconsin revealed people who exercise regularly are 70%

TECHAGAPPE

JULY-SEPTEMBER 2017

45


Health Tips one after the other, by shifting your vision to the space between the eyebrows-left thumb; the space between the eyebrows-right thumb; again the space between the eyebrows-left thumb. Repeat this exercise 10 to 20 times. After completing this exercise close your eyes and rest. Clasp the two palms interlocked, with thumbs upward, make extreme top and bottom movements with thumbs up, keeping the el bow straight, eyes following the thumbs. Repeat 5 times. Now have the movement to right and left extremes, keeping clasped fists with thumbs up, eyes following the thumbs, 5 times. Make diagonally opposite directions and focus your eyes on thumps.

less likely to develop a degenerative eye disease such as AMD. Yoga techniques help to alleviate various disorders related to defects in the eye muscles such as myopia and hypermetropia. Practicing these exercises regularly for a few months can go a long way in facilitating the normal functioning of our eyes. Below mentioned Yogic exercises are useful in maintaining proper Eye health. 1.Palming. 2.Blinking. 3. Changing focus of eyes on clasped fists up & down, side to side, diagonal and Rotational viewing 4. Preliminary nose tip gazing. 5. Near and distant viewing.

Palming Relax, rub the palms of your hands vigorously, until warm and place the palms gently over your eyelids. Stay in this position until the heat from the hands has been completely absorbed by the eyes. Repeat 3 times.

Blinking Relax, blink around 10 times very quickly. Close your eyes and relax for 20 seconds. Repeat this exercise about 5 times.

Changing focus of eyes on clasped fists up & down, side to side, d iagonal and Rotational viewing Sit with legs straight in front of the body. Now lift the arms keeping your fist closed and your thumbs pointing upward. Look at a point straight in front of you in level with your eyes. Keep the head in this fixed position, focus on the following

46

TECHAGAPPE

JULY-SEPTEMBER 2017

Now draw a circle with the clasped thumbs with maximum radius, 5 times each in clockwise and anticlockwise direction, your eyes following the thumbs. The head and the spine should be kept straight throughout. Close the eyes and relax.

Preliminary nose tip gazing Sit in a cross-legged pose. Lift the right arm straight directly in front of the nose. Making a fist with the right hand, keep your thumb pointing upward. Focus both eyes on the tip of the thumb. Now bend the arm and gradually bring the thumb to the tip of the nose, all the while having the eyes focused on the tip of the thumb. Remain in this position for a while with the thumb held at the tip of the nose with the eyes focused there. Continuing to gaze at the tip of the thumb, gradually straighten the arm. Perform at least five such rounds. Near and distant viewing Stand or sit by an open window with a clear view of the horizon. Keep the arms by your side. Focus on the tip of the nose for 5-10 seconds. Repeat this for about 10 to 20 times. Close and relax the eyes. After completing all the above exercises, lie in shavasan (corpse pose) for a few minutes and relax completely. Breathe gently and normally, and do not resist any thoughts or sensations during the exercise.


Cover Story Good Laboratory Practices

Understanding Quality Control Charts Sanjaymon K.R., G.M. - Business Development, Agappe Diagnostics Ltd.

Assuring quality is one of the major challenges in the laboratories of the modern world. Quality depends on many variables like apparatus or instrument used, the process followed and the person responsible for performing the process.

Assuring quality is one of the major challenges in the laboratories of the modern world. Quality depends on many variables like apparatus or instrument used, the process followed and the person responsible for performing the process. To assure the quality of tests, most of the laboratories depend on the statistical methods. Graphical representation of the control values in the form of a chart was introduced by Walter Andrew Shewhart in 1930 which made it easy to understand and to interpret the process controls. Levey -Jennings Chart, commonly called as LJ Chart, was introduced in the year 1950 by two pathologists, Levey and Jennings, in the medical laboratories. The chart is simple and plots the value floating between the 3SD from the mean to understand the trends and shifts in estimation. In late 1970â&#x20AC;&#x2122;s, Dr. James O. Westgard coined the multirule control procedure, internationally known as â&#x20AC;&#x2DC;Westgard rulesâ&#x20AC;&#x2122;, which is widely used as the Statistical Quality Control tool worldwide till today. Implementation of the Westgard Rules made it easy to understand and correct the systematic error and random errors that can happen in the clinical laboratory.

Ideal Control Chart In an ideal control chart, the value floats in between the process average and may or may not have an outlier. It is always recommended to establish the instrumentspecific, laboratory-specific mean by the laboratory to have a better QC chart. The

TECHAGAPPE

JULY-SEPTEMBER 2017

47


Cover Story Good Laboratory Practices range also should be defined by the laboratory based on the laboratory quality system protocols and also based on the Westgard Rules. Upper Control Limit (UCL)

Measurement

Due to normal variation (Common Cause)

Process Average

Out-of-control Point (Special Cause)

Time

Lower Control Limit (UCL)

Trends and Shifts in QC Charts To assure the quality of tests, the laboratory should perform the Internal Quality Control on a regular basis and should plot the QC values in the L-J chart to understand the performance and also to look for the ‘Trends and Shifts’, and thus to identify the Random and Systamatic errors in estimation. Trend: A trend is defined as the gradual change in one direction on repeated analysis of the QC material. The trend may be due to: Deterioration/Aging of the reagents Aging of the instrument Reagent Carryover Sample Carryover Control deterioration Calibration issues Accumulation of dirt in the fluidic path Reaction temperature issues

DID YOU KNOW? Look at the graph below:

ALKALINE PHOSPHATASE “ Agappe Alkaline phosphatase uses DEA buffer with a working reagent stability of 1 month”

This clearly shows an increasing trend where the QC values start moving upwards from the 15th day onwards. Laboratories should take steps immediately when the last 3 consecutive estimations show an upward or downward Trend. Shift: This is the change in the analytical system that happens abruptly and continues at a new level. Ideally, the control should float between the upper and lower side of the mean, without any outliers. Change is the reagent lot Change in the calibration/Calibrator

48

TECHAGAPPE

JULY-SEPTEMBER 2017


Due to system change ( instrument maintenance) Replacement of the optical system Error in the fluidic dispensing system Environmental changes like temperature

The above graph shows a shift towards the upper side and then remains there for further estimations. Please note that the values are moving around the new average giving a new running mean for the parameter. This can be maily due to the change in reagent or control lot or due to some other system errors. In some cases, the controls will behave abnormally high or low and then returns to the normal upon repeating the tests (random error). This mainly happens due to the deterioration of the control material used. Please refer below graph.

In some cases, the controls will behave abnormally high or low and then returns to the normal upon repeating the tests (random error). This mainly happens due to the deterioration of the control material used. It is recommended that the laboratory should use two levels of controls regularly to have confidence in normal as well as pathological levels of testing. Twin plot analysis is another way of representing the QC data graphically where two levels of controls data are plotted together in the same graph to have a better understanding.

Ideally, the values should be close to the 45-degree line and should lie within the blue area. Any points outside the square are considered as the total error and values that are far from the 45-degree line are indicative of a random error. Points that lie near the 45-degree reference line, but far from the median, indicate large systematic error. It should be noted that laboratories not implementing the quality assurance systems are bound to have serious errors. The best way to assure the quality is by performing Internal Quality Control regularly, plotting the L-J graph or Twin plot and analysing the graphical data systematically. Laboratories should find out the root cause for the inaccuracy and should take necessary corrective and preventive actions to prevent such causes.

TECHAGAPPE

JULY-SEPTEMBER 2017

49


Brand Reach Customer Speaks

1

‘Gr eat quality pr oducts and service’ ‘Great products We are using Agappe reagents and equipment in our different counters. We are suppliers to many hospitals in Karnataka like SDM hospital, Udupi and Hassan. Our customers are satisfied with the quality and service of Agappe.

2

Proprietor

Keyur Enterprises Lab & Surgical Supplies Ujire

‘Expecting mor oducts’ moree high quality Agappe pr products’

Chief Pathologist Sodani Hospital & Diagnostics Pvt. Ltd., Indore

We are pleased to say that we are the users of Agappe products for the past few years in our main laboratory at Indore and other branches in Indore periphery areas. Presently using Mispa – i2 and Mispa Viva. We are highly convinced and satisfied with services and the results of instruments, looking for many more quality products from Agappe in coming years too.

3

‘Convenient to use and pr ompt service’ prompt We have been using Agappe routine biochemistry reagents and nephelometry analyzer Mispa – i2 for the last 3 years and recently we have upgraded Mispa – i2 to Mispa – i3 (Cartridge based specific protein analayzer), here. It is very convenient to use these products and we are enjoying satisfactory results and prompt service.

4

Lakshmi Hospital Bangalore

‘V ery convenient to use and expect mor ‘Very moree innovative pr oducts’ products’

Mr. V. Sivakumar Director Vijaya Diagnostics Centre, Chennai

50

Chief Pathologist

TECHAGAPPE

JULY-SEPTEMBER 2017

I am using Mispa – i2 Nephelometry analyzer for the past one and half years. I am very much satisfied with the results. now I am using small pack size like 15 tests, for parameters like HbA1c, ASO, CRP, RH factor and micro albumin. I am sure this kind of small pack size is useful to all kind of Medium sized laboratories. We are waiting for ELISA and CLIA testing instruments from Agappe in the coming years.


5 Mr. R. Rajagopal Manager-Lab Services, Maruti Hospital, Trichy

‘Affor dable pr oducts with exceptional quality ‘Affordable products and accurate rresults’ esults’ We are using Agappe reagents for the past few years. We found the exceptional quality and accurate, reliable reports all the time. We are experiencing such an exceptional quality results after a long gap at affordable price.

6

‘Superior quality of pr oducts and pr ecise products precise results’ We are using Mispa Nano – Fully Automatic Biochemistry Analyzer. We are also using Agappe reagents which gives us accurate and precise results. We are satisfied with the equipment as well as reagents. I would say, the quality is excellent.

7

Dr. Vikas K Mand lecha,

Chief Pathologist, Shradd ha Pathology Laboratory, Ahmedabad

Chief Pathologist

PXL Laboratory Kukreja Hospital Del hi

‘V ery satisfactory rresults esults fr om Agappe pr oducts’ ‘Very from products’ Our laboratory is equipped with BC 3000 + and Mispa – i2. We are happy with the excellent performance of these instruments and we are also using Agappe reagents which give us accurate results. We are very much satisfied with the performance.

8

‘Grateful to Agappe for the superior quality and err or -fr ee pr oducts’ error or-fr -free products’ We are using Mispa – i2-Specific Protein analyzer for the last two years and we would like to share our experience in such a way that the instrument is giving satisfactory results with highest accuracy and precision at its best. Additionally, as far Agappe reagents are concerned, I have been using it for the last 10 years and experiencing best linearity and accurate test results. Thank you Agappe for serving us with quality products.

TECHAGAPPE

Dr. B.Y Shinagare

Chief Patholgist, Shinagare Laboratory, Pune

JULY-SEPTEMBER 2017

51


Brand Reach Customer Speaks

9

‘Extr emely happy with Agappe Pr oducts’ ‘Extremely Products’ As an in-charge of our laboratory, I am impressed and highly satisfied with the timely customer service of Agappe Diagnostics. We have been using Mispa –i2 for last two years. We are also using the parameters like HbA1c, CRP, ASO, RF, C3, microalbumin, IgE. All these parameters are helping us to produce excellent, accurate results. We are happy with the performance of Mispa - i2.

Mr. Sajeesh P.P

Chief Lab Technician, Advanced Cl inical & Research Laboratory, Kottayam

10 ‘Mispa i2 is highly rrecommendable’ ecommendable’ Dr. Subhash Patel Chief Pathologist, Amins Pathology Referral Laboratory, Vadodara

We, Amins Pathology Referral Laboratory, have installed Mispa –i2Semi Automated Specific Protein Analyzer from Agappe Diagnostics Limited. We are using it for more than two years of time. We are happy with its performance and results produced by system. It is accurate and precise for measurement of specific proteins in small segments. Smart card calibration system employed in Mispa – i2 eliminated change of calibration error and reagent wastage. Mispa – i2 have wide range of menu of almost around 22 parameters. It is very easy to operate and versatile machine for specific protein measurement. We would like to recommend the Mispa - i2.

‘Mispa RRevo evo – A compact, user -friendly user-friendly pr oduct with accurate rresults’ esults’ product The gap in laboratory diagnostic menu for cardiac and septicemic patients has been bridged by Mispa Revo of Agappe Diagnostics. Results by immunofluorescence Technology is very accurate. Machine is compact, operator friendly and concept of QC smart card with each lot nullifies the error. Furthermore, due to speedy results, patients can be managed in “The Golden Hour” following heart attack, to prevent damage to cardiac muscles and impact patient’s survival in a positive way.

52

TECHAGAPPE

JULY-SEPTEMBER 2017

11 Dr. Jigar R Mehta, Chief Pathologist, Asutosh Multi Specialty Hospital, Surat


12 Dr. Kopparthi

Balaiah, Chief Laboratory Med icine, Bhagawan Mahaveer Jain Hospital, Bangalore

‘Excellent pr oduct with commendable service’ product This is to inform that I, Dr. K Balaiah, Chief Pathologist, Bhagawan Mahaveer Jain Hospital, Bangalore, am using Mispa – i2. The performance of the instrument is excellent and the service and supply of reagent is very good.

13

‘Agappe – a fantabulous and rreliable eliable company with excellent service’ We happily announce that, we are the user of Agappe Diagnostics Limited products and feel proud in dealing with this fantabulous and reliable company. I am using Agappe’s biochemistry instrument “Mispa Viva” and reagents and I am fully satisfied with its quality and reliability. I am also very much fascinated with the service and support they provide to the customers.

14 Dr. Minal D. Kulkarni Chief Pathologist, Dr. Minal’s Pathology Laboratory, Mumbai

Mr. Ashok Massey

Lab in charge, Deol Hospital, Ludhiana

‘Appr eciable quality of pr oducts’ ‘Appreciable products’ I am, Dr. Minal D Kul karni, using HbA1c, HDL direct and SGPT from Agappe Diagnostics and quite satisfied with the quality of reagents using since the past two years.

15 ‘High pr ecision and economical pr oducts’ precision products’ We have been using your reagents like HbA1c, TGL and cholesterol since last few years. Reagents are having high precision and are economical. We are highly satisfied with Agappe products.

TECHAGAPPE

Dr. Ram Mohan,

Chief Pathologist, ITMR Specialty Diagnostics, Hyderabad

JULY-SEPTEMBER 2017

53


Engagements Exhibitions & Conferences

MORE PLACES TO KNOW ABOUT US

AMERICAN ASSOCIATION FOR CLINICAL CHEMISTRY (AACC) 2017 August 1st to 3rd, Agappe’s Stal l No: 1105. Venue: San Diego Convention Center, San Diego, CA.

Team Agappe in attendance at HOSPITALAR 2017-THE LEADING HEALTHCARE EVENT IN THE AMERICAS on 16 - 19 May 2017, Stal l No. RUA2-11 AZUL, Expo Center, Norte, Sao Paulo, Brazil.

Team Agappe in attendance at MEDLAB ASIA PACIFIC 2017-THE LEADING HEALTHCARE EVENT IN ASIA on 03 - 05 April 2017, Stall No. 401-402, Suntec Convention & Exhibition, Singapore.

54

TECHAGAPPE

JULY-SEPTEMBER 2017

BETTER HEALTH THROUGH LABORATORY MEDICINE AACC is a global scientific

and medical professional organization dedicated to clinical laboratory science and its application to healthcare. Their leadership in education, advocacy and collaboration helps lab professionals adapt to change and do what they do best: provide vital insight and guidance so patients get the care they need. AACC’s strategic plan set goals for innovation, growth, and influence in five areas: value of membership; best practices; science and innovation; financial resources; and global influence. As the leading event for laboratory medicine worldwide, the 2015 AACC Annual Meeting & Clinical Lab Expo is the place where breakthrough innovations in clinical testing and patient care are introduced to the healthcare world.


Engagements Special Days JULY

S 30

M 31

2017

T

W

T

F 1

S ----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

2 9 16

3 10 17

4 11 18

5 12 19

6 13 20

7 14 21

8 15 22

SPECIAL DAYS Jul 01 : Doctor's Day Jul 05 : World Environment Day Jul 06 : World Zoonoses Day Jul 11 : World Population Day Jul 15 : Plastic Surgery Day Jul 28 : World Hepatitis Day Jul 29 : International Tiger Day

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

23

24

25

26

27

AUGUST

S

M

28

29

2017

T 1

W 2

T 3

F 4

S 5

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

6 13 20

7 14 21

8 15 22

9 16 23

10 17 24

11 18 25

12 19 26

----------------------------------------------------

2017 SPECIAL DAYS Aug 03 : World Friendship Day Aug 06 : Hiroshima Day Aug 09 : Nagasaki Day Aug 10 : Organ Donation Day Aug 12 : World Youth Day Aug 13 : World Lefthanders Day Aug 19 : World Humanitarian Day Aug 29 : National Sports Day

----------------------------------------------------

----------------------------------------------------

27

28

29

30

31

SEPTEMBER

S

M

T

2017

W

T

F 1

S 2

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

3 10 17

4 11 18

5 12 19

6 13 20

7 14 21

8 15 22

9 16 23

----------------------------------------------------

----------------------------------------------------

----------------------------------------------------

24

25

26

27

28

29

30

2017 SPECIAL DAYS Sept 02 : World Coconut Day Sept 08 : World Literacy Day Sept 10 : Suicide Prevention Day Sept 12 : World First Aid Day Sept 16 : World Ozone Day Sept 18 : World Bamboo Day Sept 21 : World Alzheimer's Day Sept 25 : World Maritime Day Sept 27 : World Tourism Day Sept 28 : World Rabies Day Sept 29 : World Heart Day

2017


Promotion

Focus Product

MISPA CLOG+ Smart Hemostasis Analyser

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

Ÿ

Principle: Photometry.

Ÿ

Parameters available - PT, APTT, Fibrinogen.

Ÿ

Quick start menu, Smart Card Calibration & User friendly, easy to operate software.

Ÿ

Control & sample mode are available.

Ÿ

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

Ÿ

One reading chamber & four reagent, sample incubation positions.

Ÿ

Special magnetic stir bar for homogenizing of the test suspension.

Ÿ

Test results are displayed as – Sec, INR,% for PT; gm/L, mg/dl, ratio for others parameters.

Ÿ

Low CPT - Minimum volume required for any test is 200 µL only.

SIMPLE & QUICK SOLUTION FOR HEMOSTASIS


Promotion

Focus Product

* Toll Free No: 1800 425 7151

MISPA ACE

Fully Auto Clinical Chemistry Analyser

Mispa Ace is the first step to Automation for Semi Automated customers which is capable of performing all biochemistry panels like Lipid, Diabetic, Liver, Kidney and Immuno-Turbidimetry Tests.

Ÿ

Can perform up to 100 tests/hour

Ÿ

Double switch operation for power saving

Ÿ

Fiber optic transmission

Ÿ

Clean and safe operation

Ÿ

Preheating of reagents

Ÿ

Minimum optical length

Ÿ

Flexible reagent / sample tray

Ÿ

Multi-function sample/reagent probe

Ÿ

High performance independent mixer

Ÿ

Reaction tray with disposable cuvettes

YOUR FIRST STEP TO AUTOMATION


Moments

Awards

IVD GROWTH BREAK THROUGH AWARD Mr. Sudhir K Nair, Vice President, Agappe Diagnostics Ltd. receiving Mindray’s IVD Growth Break Through Award for the excellency in sales and service support in India, from Mr. Feng Zhang, Channel Line Manager (IVD), Mindray Medical International Limited, China.

Agappe has received Appreciation Award for Environmental Protection from Kerala Government Capacity of Agappe's Effluent Treatment Plant (ETP):

60,000 Liters / Day

Receiving award by Mr. Babu Daniel, Vice President – System Automation, Agappe Diagnostics Ltd. and Mr. K.P Eldhose, Dy. Manager-Maintenance, Agappe Diagnostics Ltd. from Shri. A. C. Moideean ( Minister for Industries and Commerce), Kerala Government, in the presence of Shri K. Sajeevan (Chairman- Kerala Pollution Control Board). Happy to inform to you that we have won the APPRECIATION AWARD for Environmental Protection from the Kerala State Pollution Control Board. This appreciation is for efforts in pollution control and initiatives in Environment Protection. A solid testament to our ever strong commitment to preserving nature and the goodness of life itself.

Capacity of Agappe’s Rain Water Reservoir is 35 Lakh Liters and Water Treatment Plant is 96,000 Liters / Day

58

TECHAGAPPE

JULY-SEPTEMBER 2017


Medical Quiz 1) a)

Who is the father of Indian Ophthalmology? Charaka b) Sushruta c) Dhanvantri d) All the above

2) a)

Who holds the Guinness Book of World Record for highest ophthalmic surgery in a day? Dr.George Bartisch b) Dr.Leven Hook c) Dr.M.C.Modi d) None

3) a) c)

What is the function of Retina? Connect light to Neural Signal b) Provide nourishment to Eye Protective Layer d) All the above

4) a)

What is the function of Iris? Connective tissue b) provides nutrient to eye c) Neural signal d) Control the light

5) a)

Hyperopia occurs due to……. Light falls in front of Retina b) Light falls behind Retina c) Light falls side d) Light gets blocked in Lens

6) a)

Myopia occurs due to …… Light falls behind Retina b) Light falls straight c) Light falls front of Retina d) No light

7) a)

Uncontrolled Diabetes & Hypertension cause….. MI b) Nephropathy c) Retinopathy d) All the above

8) a)

According to DCCT intensive control of Diabetes reduce ……% of Ocular disease 76% b) 20% c) 50% d) 30%

9) a)

Which are the parameters that offer early indication of micro angiopathic complication…. Cystatin C b) Microal bumin c) Corneal sensitivity test d) All the above

10) a)

Eye donation is giving Light to another life. The donor eye should be removed within……. after death. I day 2) 4 – 6 hours 3) no time limit 4) All the above

Quiz Answers of April-June 2017 edition

Winners will get their prize by post

1-a, 2-b, 3-a, 4-d, 5-b, 6-d, 7-d, 8-d, 9-b, 10-d Quiz Winners of April-June 2017 edition

Dr. S. C Jainwal, Jabalpur; Dr. Biswajit Batabyal, Kolkata; Mr. Kamla Kant Mohanandia, Rayagada; Dr. Chima Ranjan P., Sambalpur; Mr. A. Ayyappan, Tirupur; Prof. Suvarnalethadevi K., Trivandrum; Dr. A. Balasubramanian, Chennai; Sr. Bincy Xavier, Chhattisgarh; Prof. Urmila D. S., Trivandrum; Ms. Suchita Naik, Goa; Mr. Anoop.M.A. , New Delhi; Dolly Kuruvilla, Trivandrum.

Answers of this quiz contest wil l be published in the next ed ition along with details of the winner and the prize. Participants can either hand over the answers to Agappe’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 Hil ls, Pattimattom PO, Ernakulam district, Kerala-683562.

TECHAGAPPE

JULY-SEPTEMBER 2017

59


Editorial Submissions What do you think of this edition of

Techagappe? Are you happy with the overal l 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.

Pull your thoughts together and get started right here... ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ ................................................................................................................................................................................ 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

60

TECHAGAPPE

JULY-SEPTEMBER 2017

Life Stories Good Laboratory Practices

Health Tips Interviews


The Synergy of Superior Technology & Quality Semi-automated Clinical Chemistry Analyser

1

Embedded system with 5.7” TFT LCD color display with popup keypad

2

ALD Function

3

Direct Access Key

4

Accuracy Enhancing Features

5

Calculated Tests

6

5000 Test Results memory

7

18000 QC result memory Operational Flow Select Test

Select the test using the stylus as per required test parameters.

Aspirate Sample & Reagent

Get the Results

e ch t a

r ilte F d

(EMF)

Ener gy

Aspirate reagent and sample using aspiration switch.

EMF ensures long filter life and offers equal & stable intensity at all wavelengths for accurate estimation of test parameters.

M

EMF

After the measurement results are printed on the internal printer.

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

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 12th Edition (July - September 2017) Ebook.  

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

Read more
Read more
Similar to
Popular now
Just for you