Page 1

Vol.4 Issue 1

OCTOBER - DECEMBER 2017

THE DIAGNOSTICS NEWS JOURNAL

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

RENDEZVOUS WITH HON'BLE PRIME MINISTER OF INDIA FOR NEW INDIA BY 2022 Mr. Thomas John

COMMON NOSE DISORDERS: AN OVERVIEW Dr. D. M. Vasudevan

APPROACH TO CHILDREN WITH HEARING LOSS Dr. Mary John

“A HEALTHY LIFESTYLE SHELTERS YOU FROM ENT DISEASES” Dr. Milind V. Kirtane

DILEMMA IN THE TREATMENT OF TONSILLITIS Dr. Saikat Samaddar

“MEETING CUSTOMER SATISFACTION IS THE SECRET BEHIND SUCCESS” Mr. Raju Venkatraman

OTORHINOLARYNGOLOGY Unravelling Ear, Nose and Throat Disorders & Its Medical Solutions


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CONTENTS ○

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Volume 4 | Issue 1 | October-December 2017 ○

Ode to Ear, Nose & Throat

12-15 Common Nose Disorders

08-11

16-19 Soaring in the Sky along his Vibrant Dreams

Agappe’s Rendezvous with Hon’ble Prime Minister of India

20-23

‘A Healthy Lifestyle Shelters you from ENT Diseases’ Dr. Milind V. Kirtane

Thomas John, Agappe Diagnostics Ltd.

24-25

Evolution of Pancreatic Profile

Sri. Narendra Modi for New India by 2022

26-29 Dilemma in the Treatment of Tonsillitis

30-33

Abdul Samad

The Iqbal of Bhopal

34-36 “Meeting Customer Satisfaction is the Secret Behind Success”Raju Venkatraman, Medall Healthcare

40-43 Approach to Children with Hearing Loss 44-46 Good ENT Habits 47-49 SOP - Standard Operating Procedure For Biochemistry Testing

50-53 Testimonials 54

Exhibitions & Conferences

55

Engagements - Special Days

58

Moments-Awards

37-39

The ‘Mirakle’ of the Mute

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

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○ ○

From the Chief Editor’s Desk

THE DIAGNOSTICS NEWS JOURNAL

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○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

I

am very pleased to place before you, this 13th issue ofTechAgappe, the quarterly review of health and laboratory medicine. Previous editions were based on Cardiac diseases, Renal illnesses, Hepatic ailments, Pancreatic disorders, Cancer, Neurological disorders, Gastroenterological complaints, Gynecological maladies, Clinical haematology, Lung diseases, Musculoskeletal disorders and Eye diseases 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. This issue focuses on diseases affecting Ear, Nose and Throat (ENT). We have, as usual, included three scientific articles, three life stories, two interviews and one technical article. The first scientific article describes the common causes of nose diseases. The second cover story is from an authority of CMC Vellore, about how to deal and care those children with hearing problems. The third cover story is written by a doctor from Kol kata Medical College about Tonsillitis, a common health problem, especially seen in children.

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As usual, we have added three life stories. The first life story is from Idukki district, Kerala, about how a deaf and dumb person, schooled up to 7th class, could fly an aircraft, manufactured all by himself. Second life story is from Bhopal, about a hockey player who is deaf and dumb. He is the only differently-abled person who plays with other normal players in India nationally. The third life story is about a business establishment of courier services from Mumbai where 90% employees are deaf and dumb. These landmark biographies will tell you how to overcome a deficiency by sheer determination. In this issue, you can see the interview with an eminent ENT surgeon, Dr. Milind V. Kirtane from Mumbai. He received the Padma Shri award as well as the BC Roy award in the field of medical specialties. The second interview is with Mr. Raju Venkatraman, founder director of Medall Healthcare, Chennai. He is a specialist in diagnostic industry.

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

With warm personal regards,

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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

We have also added health tips highlighting requirements for better ENT health and a technical article on the necessity of Standard Operating Procedure (SOP). I am glad to state that we have received very good feedback for the last issue 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. Thus, I am sure, this issue of the TechAgappe will give useful insights to the problems of various ENT 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.

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

MANAGING DIRECTOR Thomas John

CHAIRMAN Prof. M.Y. Yohannan

BOARD OF DIRECTORS

PHOTOGRAPHY Nelson Thomas

WEB MANAGER Sanjaymon K.R

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

PUBLISHING COORDINATOR Jayesh Kumar

Focuses on Ear, Nose & Throat Disorders and Medical Solutions

LEGAL ADVISORY BOARD Adv. Denu Joseph

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

CONSULTING EDITOR Rarima N.S

CHIEF EDITOR Dr. D.M.Vasudevan

EDITOR Meena Thomas

EDITORIAL BOARD

Volume 4 | Issue 1| October-December 2017 ○

Dr. D.M. Vasudevan

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LETTERS TO THE EDITOR

Great Effort towards Excellent Content the Service of the and Up-to-date Public Information

I would like to thank all the people who are working for publishing the diagnostic news journal, TechAgappe. As a regular reader, I could surely say that you all are working very hard until now. I would like to request you people to continue this effort as it helps many people to update their medical knowledge and give a feeling of inspiration through life stories. Your work with such a determination and sincerity towards the service of mankind and humanity is always appreciable. I look forward to seeing what comes in the future editions. The Agappe team who works behind TechAgappe needs special mention.

We greeted the 12th edition (Ophthalmology) with great delight. Thank you for the magazine and we genuinely appreciate your efforts and promptness in sending across the magazine with excellent content. The information provided in Tech Agappe is both up-to-date and specific to our organization’s needs. Keep it up.

Dr. R. T. Vasan,

Ophthalmology edition is ex-

N. S. Clinic, Kollam

Adeline. L, Frontier Life Line Hospital , Chennai

High Quality Articles & Inspiring Life Stories

cel lent with more focus on

Life Stories Kindle Positivity in Readers The story of Dr. Satish Amarnath in the 12th edition

TechAgappe is an eye opener to everybody and very inspiring to us. Knowing stories of such personalities who are passionate about their work and life will be a great surge of energy for us to conquer the life hazards. He had the will power to pursue his career even after such life tragedies. Hats off to him. Thanks TechAgappe for publishing such inspiring stories. Dr. Balakri shnan V R, SAI Sanjeev Clinic, Bangalore

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A Complete Package of Information I think the Tech Agappe edition (vol3 issue3) has come out with good information as wel l as upgradation of medical techniques with a complete package of knowledge. I was happy to read the life story of Maj. D P Singh in your previous issue, the article really instills inspiration, self-motivation and patriotism in life. I would like to read one more of such story from your end. The cover story on knee replacement was very informative which banishes the fear of that procedure for those who plan to undergo such treatment in future. Overall , the edition was quite good. Thank you. Sudhir Purushottam Nayak, Deepak memorial Clinical Laboratory, Karnataka health issues of the eye. Overall look and feel of the magazine is superb. Presentation of articles has been done neatly. Cover story on understanding the quality control chart is wonderful in GLP session. All the life stories would help us to live with a positive vision.

deviation is required from the current way of presentation. Kindly publish latest test and technologies about severe visual diseases also. Thank you.

MS. Suchita Naik,

An All-inclusive Magazine

Awesome in its look &feel and content

Techagappe, as the name says,

VerGo Pharma Research Laboratories Pvt. Ltd. Goa

The 12th edition of TechAgappe

(Ophthalmology) was real ly great and awesome. I am really happy with the look, content and feel of the magazine. Article presentation is fantabulous and the content is clearly comprehensible. I would suggest that no

Dr. Johnny K K,

Reynolds Memorial Hospital, Washim

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 ENT

Ode to Ear, Nose & Throat Dear confrere with the beauteous nose ever seen, Dear companion, with clear throat of expression, Dear compeer with charming earlobes attracting the lot, Dear, Otolaryngology is toto embraces ears, nose and throat. Ears, take me to the limitless enjoyment of this world of sounds First sound you hear from mother is the first lesson in this world, Everlasting, mesmerizing sounds of the cascading creeks at dark, The best music of love & speeches of the noblest souls of the world. The first breath in this universe be the first encounter you face, Nose, you relish the tantalizing memories of bouquets ever exposed, The mystic fragrance of the flowers, a miracle of this universe, The sense that flows and explodes at the peak. First cry from throat be the prelude to the Universe, The unique vocal cords to command the world, The great throat-chakra, power of expression, The seat of the great tonsils, your primary defensive hub.

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

Be aware of the prominence of the healthy ENTs and Envisage that absolute health is so important in daily life, Let us be conscious of the functionalities & peculiarities, How inanimate your life is without healthy ENT.

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Agappe MD’s Desk

Agappe’s Rendezvous with Hon’ble Prime Minister of India

Sri. Narendra Modi

for New India by 2022 Thomas John, Managing Director, Agappe Diagnostics Ltd.

"The overwhelming moment for AGAPPE is that the invitation was limited to a very few selected participants only, I have got this opportunity to participate and contribute for a new India, in this great event".

NITI Aayog, the premier policy ‘Think Tank’ of the

Government of India, providing both directional and policy inputs, recently organized an interactive conference be-

tween the private sector of the country and the Government of India. The Conference was held on 21st to 22nd August, 2017 at New Del hi based on the growth needs to

Address by Hon’ble Prime Minister of India Sri. Narendra Modi during the conference ‘Champions of Change – Transforming India through G2B Partnership’ on 21st to 22nd, August 2017 at New Delhi.

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Mr. Thomas John, Managing Director, Agappe Diagnostics Ltd. (2nd row, 6th from reader's right) with Hon'ble Prime Minister Sri. Narendra Modi and other team members during the conference 'Champions of Change'. be accelerated while realizing the Honourable Prime Minister’s Vision of ‘Sabka Saath Sabka Vikaas’. Termed as ‘Champions of Change – Transforming India through G2B Partnership’, the conference aimed at channelizing private sector’s dynamism and innovative spirit towards the country’s growth and betterment. Finance Minister Arun Jaitley and top secretaries to the government have also attended these sessions. Under the guidance of the Prime Minister Sri. Narendra Modi, for his vision for creating a New India by 2022, Niti Aayog handpicked a few highly motivated, dynamic, young and progressive entrepreneurs from across India. To keep the discussions focused, the participants were divided into six broad categories. The participants in each group were key stakeholders who have made significant contributions in their areas of work. The event was a proud moment for us as I got invited by the NITI Aayog to represent Agappe Diagnostics Limited in this conference and we have got a great opportunity for a remarkable interaction with the Hon’ble Prime Minister of India and other CEOs and

Entrepreneurs from all over the country. The overwhelming moment for AGAPPE is that the invitation was limited to a very few selected participants only, I have got this opportunity to participate and contribute for a new India, in this great event. The young CEOs from different sectors of the industry were categorized in to 6 groups with different themes such as 'A new India by 2022, Make in India, Cities of tomorrow, World class infrastructure, Doubling farmer's income, and fixing finance'. I was representing AGAPPE for the theme, ‘A New India by 2022’ and was a part of a group consisting of 34 members from various business sectors.

In Government, the welfare of the people and the happiness of citizens is supreme and every citizen must have a feeling that this country is mine and I have to work for the country.

TECHAGAPPE

The talk by Hon'ble Prime Minister Sri. Narendra Modi has inspired us to extend our services to the country and our customers with indigenous products, which will meet excellent quality parameters. To fulfill this dream, we have entered into Technology Licensing Agreement with Hitachi Chemicals Co. Ltd., Japan for manufacturing their Fully Automated Specific Protein & Specialized Chemistry Analyzer at Agappe’s Kochi facility on 24th

OCTOBER-DECEMBER 2017

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Agappe MD’s Desk May 2017. Now, we are moving forward with the project to launch it in the world IVD market space under the proud title ‘Made in India’. We wish to dedicate this dream product and its service to the country in the presence of the Hon'ble Prime Minister of India. The NITI Aayog commenced this conference foreseeing the high growth rates which can be achieved and sustained when the private sector’s prowess and innovative spirit is concentrated towards the country’s development and overall growth. The focus of the conference was to attain this progress by a judicious collaboration of both the private sector and the government sector. Prime Minister Narendra Modi has interacted intensively and shared his visionary thoughts with the attended professionals during the event with an eye towards job creation, income enhancement, technology disruption and innovation, ease of doing business, good governance and policy. Prudent entrepreneurs, if they can focus all their brainstormed concepts in the making of novel products, it would surely transform the face of a nation like India. Pinpointing this fact, the Prime Minister expressed his trust in the capability of the handpicked

Hon’ble Prime Minister of India Sri. Narendra Modi with Mr. Thomas John, Managing Director, Agappe. attendees in making India one among the best in the world. The Prime Minister also said that people’s participation is an important element of governance. Similarly, he said, this attempt at CEOs’ partnership with Government is aimed at enhancing their contribution towards the welfare of the people and the nation as a whole. Even a minor step towards progress in the business or technology sector can make a big leap in moulding the future of the Indian masses. Asking young entrepreneurs to be the ‘soldiers of development’, Mr. Modi stressed that the involvement of all the participants in the session would be a building block towards the advancement of India as a global power. During the event, the Prime Minister said that the country’s development too must become a mass move-

Fully Automated Specific Protein and Specialized Chemistry Analyzer Mispa i4 is a fully automated cartridge based specific protein and specialized chemistry analyzer that offers high precision and quick turnaround results. Mispa i4 is well designed to meet increased workflow efficiency, efficient & simple operation, wide protein and specialized chemistry assay panel, and high quality results.

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Address by Hon’ble Prime Minister of India Sri. Narendra Modi during the conference ‘Champions of Change – Transforming India through G2B Partnership’ on 21st to 22nd, August 2017 at New Delhi. ment like our freedom struggle by Mahatma Gand hi. In his motivational address, he said, “A spirit should be created, whereby we all set targets for our contribution to India, by 2022. You are my team, and we need to work together to take India forward”. Calling the young CEOs as his team, the Prime Minister said that the entrepreneurs should think of what more they can contribute to the country’s growth and also for the poor. He urged them to provide policy inputs and be the harbingers for change.

Agappe’s Make in India Initiative 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 cost and outflow of foreign exchange.

"Over the years, Agappe could establish its presence in the full range of Clinical Chemistry, Serology, Immunochemistry, Coagulation, Blood Groupings and Haematology Reagents, out of this, 95%of the reagents are indigenously made in Agappe’s world class manufacturing facility".

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 decade for hospitals, clinics and pathological labs and is already into in-depth research and development activities for reagents and innovative equipment. The team was successful in developing Semi Auto Biochemistry Analyzer viz. Mispa Viva, Semi Auto Protein Estimation System named Mispa-i2 and followed by its upgraded single cartridge based analyzers, Mispa-i3. Over the years, Agappe could establish its presence in the full range of Clinical Chemistry, Serology, Immunochemistry, Coagulation, Blood Groupings and Haematology Reagents, out of this, 95% of the reagents are indigenously made in Agappe’s world class manufacturing facility. Agappe is planning to launch India’s premier and fully indigenous hematology systems in the near future. 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. We earnestly would like to take this opportunity to thank Techagappe readers, our customers and well-wishers for your tremendous support which you have extended towards the growth of Agappe over these years.

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Cover Story Nose Disorders - An Overview

Common Nose Dr. D. M. Vasudevan,

DISORDERS

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

In Greek, Rhis means nose, therefore the medical term of

nose is Rhino. Rhinoplasty is the surgical correction of abnormalities of the nose. Rhinoplasty technique has been well documented by Charaka, the father of Indian Surgery in his treatise in 2nd century before Christ. Before British rule in India, rhinoplasty was very common in India and the British Medical Association sent a deputation of surgeons to India in the 1850s to study the nose repair done by Indian surgeons.

The nose is the first line of defence against sickness. The mucus collects dust and bacteria before they enter the body. Nasal mucus is clear and is made of water, proteins, antibodies and salts. But during an infection, it may be changed to yellow, indicating that body is fighting an infection.

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Normal functions The nose is the first line of defence against sickness. The mucus collects dust and bacteria before they enter the body. Nasal mucus is clear and is made of water, proteins, antibodies and salts. But during an infection, it may be changed to yellow, indicating that body is fighting an infection.


The inner lining of the nose has many blood vessels at the surface. Blood flowing through the nose warms the air as we breathe in. Sneezing is usually caused by foreign particles irritating the nasal mucosa. Sneezing can transmit infections because it creates the droplets that can harbour microbes. It is possible for retrograde infections from nose to the brain. For this reason, the area from the corners of the mouth to the bridge of the nose, including the nose, is known as the danger triangle of the face. Infections may result in the destruction of the nasal bridge or nasal septal perforation; these include tuberculosis, syphilis, leprosy and chronic use of cocaine.

Smell (Olfaction) The nose has an area of specialised cells which are responsible for smel ling. It is technical ly cal led as the Olfactory system. Olfactory neurons have tiny protrusions containing proteins that bind to odour molecules, causing an electrical response that spreads through the receptor cells to the olfactory nerve fibres at the back of the nasal cavity. Olfactory nerves transmit information about odours to the central olfactory system of the brain, which identifies the smell. Smell and taste: Without the nose, the body will not be able to taste food as well. What we call ‘taste’ is actually a mixture of different sensations, including smell. When food is eaten, the nose smells the food and sends information to the mouth. Although taste is a completely separate sense than the smell, the nose plays a role in the way the tongue perceives taste. The aroma of the food plays a role in the taste. Individuals with a congested nose report a decreased sense of taste. The sense of smell is also influenced by the nerve endings, in the eyes, nose, mouth and throat. These nerve endings help to sense irritating substances such as the tear-inducing power of an onion or the refreshing coolness of menthol.

Clinical conditions affecting nose 1. Loss of smel l: It is scientifically known as anosmia. Loss of smell can be total (anosmia), incomplete (partial anosmia or hyposmia), distorted, eg., when something that normally smells pleasant now smells foul (parosmia), or sensation of an odour that is not there (phantosmia). Hyperosmia is a rare condition where the sense of smell is heightened. The common causes of olfactory dysfunction are advanced age, respiratory tract infections, smoking, toxic

chemicals and neurodegenerative diseases. Age: Anosmia is seen in 2% of people under 65 years of age. Around 50% of people of ages between 65 and 80 experience significant problems in smelling. In persons over 80, the number rises to 75%. Infections: The most common cause of anosmia is upper respiratory tract infections. The causative agents include influenza and herpes. Toxins: Chronic exposure to some airborne toxins such as herbicides, pesticides and heavy metals (cadmium, chromium, nickel, and manganese), can alter the ability to smell. Neurodegenerative d iseases: Alzheimer’s d isease, Parkinson’s disease, Huntington’s disease, dementia, hypothyroidism, diabetes and hypertension are important causes for anosmia. In Alzheimer’s disease, the olfactory loss may be associated with decreased intellectual ability.

The sense of smell is also influenced by the nerve endings, in the eyes, nose, mouth and throat. These nerve endings help to sense irritating substances such as the tear-inducing power of an onion or the refreshing coolness of menthol.

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Cover Story Nose Disorders - An Overview 2. Nasal Congestion: The most common medical problem related to the nose is nasal congestion. This can be caused by colds or flu, allergies, or environmental factors, resulting in inflammation of the nasal passages. The body’s response to congestion is to convulsively expel air through the nose by a sneeze. 3. Common Cold and Flu A cold is a common viral infection of the upper respiratory tract–namely, your nose and throat. A runny or stuffy nose, sneezing, coughing, and sore throat are common. As a rule, flu symptoms are more severe than cold symptoms; these include

fever, muscle aches, head ache and fatigue. Most people will recover from the flu in about one week. But it may take several more days to completely recover the tired feeling. Immunization against influenza is recommended for children between 1-5 years and adults over 65 years.

Remedies for flu symptoms Pain relievers: Analgesics like paracetamol will help to reduce muscle aches and pains, headache and fever. Children and teens should never take aspirin for an illness. This is because of the risk of a rare, but fatal, the condition called Reye’s syndrome. Decongestants: They help relieve nasal congestion in sinuses and ears. Expectorants: They help to loosen thick sinus secretions. Cough suppressants: Coughing is a common flu symptom, and some medications can help relieve it. If you don’t want to take medication, some cough drops use honey and lemon to ease a sore throat and cough. Antihistamines: It can relieve watery eyes, stuffy nose and sinus headaches. Honey: It has antibacterial properties. Honey is also an effective cough suppressant. Ginger: Sipping warm water containing a few slices of ginger will ease a sore throat and suppress a cough. 4. Al lergic Rhinitis Symptoms include sneezing, stuffy nose, watery eyes and sore throat. Possible triggers to the disease include pollen, dust mites, dandruff of pets (cats and dogs), cockroaches, cigarette smoke and perfume. Pollen is the most common allergen in seasonal allergic rhinitis. Nearly 8 -20 percent of adults experience allergic rhinitis of some kind. Treatments for allergic rhinitis include Nasal sprays containing antihistamines and steroid nasal sprays. Immunotherapy (desensitization) is also used in conjunction with medications to control symptoms 5. Sinusitis It is another common nose condition. Sinusitis means inflammation of the sinuses, the cavities inside the bones near the nose. The inflammation can come from allergies, viruses and certain diseases. 6. Nose bleeding Nosebleed, known medically as epistaxis, is the second common medical issue of the nose. The highest rates are found in children under 10 and adults over 50.Causes of bleeding of nose are 6A. Broken Nose or injury to nose 6B. Foreign Body in the Nose, especially in children 6C. Low Platelet Count (Thrombocytopenia): One of the com-

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Sinusitis It is another common nose condition. Sinusitis means inflammation of the sinuses, the cavities inside the bones near the nose. The inflammation can come from allergies, viruses and certain diseases.

mon manifestations of thrombocytopenia is severe nasal bleeding. When the skin is injured or broken, platelets clump together and form clots to stop the bleeding. So, when platelets are reduced, bleeding can occur. The symptoms of a low platelet count include Nasal bleeding, Purpura (red or purple bruises), Rashes, Petechiae (pin point sized, red or purple dots on the skin) and bleeding gums. The possible causes of a low platelet count include: vitamin B-12 deficiency, folate deficiency and viral infections. 6D. Idiopathic Thrombocytopenic Purpura (ITP): It is a disorder in which the blood will not clot normally. An unusually low level of platelets or ‘thrombocytes’ in the blood causes ITP. Internal bleeding or bleeding on or under the skin can result. Sometimes the manifestation will be nasal bleeding. It is commonly triggered by an immune disorder or the use of certain drugs. If the platelet count is very few, blood or platelet transfusions may be required. Steroids will be very useful in this condition. 6E. Hemophilia It is a rare genetic disorder in which blood does not clot properly. It is due to the absence of Anti hemophilic factor (Factor 8) or Christmas factor (factor 9) in blood, both of which are necessary for blood clot formation. The absence of the factor leads to prolonged or spontaneous bleeding. The disease is almost exclusively seen in males. Manifestation may be nasal bleeding. Treatment is to inject commercially available factors.

6F. Leukemia Leukemia is a cancer of the blood cells. Easy bleeding or bruising are signs of this disease. Often bleeding of the nose will be the first manifestation. 6G. Cirrhosis Cirrhosis means the scarring of the liver. Liver function tests will be abnormal. The most common causes are alcohol abuse or viral infections (viral hepatitis). About 20 to 30 percent of people infected with hepatitis B and 5 to 20 percent of people infected with hepatitis C will develop cirrhosis. The symptoms of cirrhosis occur because the liver is unable to purify the blood, break down toxins, produce clotting proteins and help with absorption of fats and fatsoluble vitamins. Often there are no symptoms until the disorder has progressed. Important symptoms include nose bleeds, jaundice (yellow discoloration) and small spider-shaped arteries underneath the skin 7. Nasal polyps They are non-cancerous growths within the nose or sinuses. Symptoms of polyps include nasal congestion, sinusitis, loss of smell, and infection. Treatment is nasal sprays containing antihistamines. If this is not effective, surgery may be considered.

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Life Story Saji Thomas (Inventor)

Soaring in the Sky along his

VIBRANT DREAMS... Entrapped by a society that loves to set limits to the differently-abled persons, Saji Thomas a native of Idukki district in Kerala dared to fly above those limits and fences. For him, literally, sky was the limit. To all those people who mocked and ridiculed him for being deaf and dumb, Saji built an aircraft and flew it, up above the limits the society had once put on his dreams.

Saji Thomas

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From childhood itself, aeroplanes up in the sky put him in blissful awe. During those days, he loved building prototypes of small models of aeroplanes, cars and buses carved out of cardboard. Though he was forced to stop his education at Grade VII due to his disability, he loved reading books on different subjects at free time during the job at a local repair shop and rubber tapping. Within a short span of time, Saji rose as an expert in fixing televisions. Saji also began to love his new job and later


began to fix all kinds of electronic items. For a short tenure, he also worked as a vehicle mechanic which later helped him immensely. When Saji was 14, something happened in his village which turn ed out to be a life changing incident in his life. For spraying pesticides in the rubber plantations, two helicopters were used near his village. Fascinated by the sight, Saji spent hours watching them. Later, he made friends with the pilots from Mumbai who offered him a ride in the helicopter. Before parting ways with Saji Thomas, wife and son them, Saji took down their Mumbai address and very much to their surprise, dropped in at their office the very absorbers were those of scooters. The frame contained alunext year. Seeing his genuine enthusiasm in learning about heli- minium pipes and metal sheets. He even fitted it with the encopters, the pilots took him with them for two weeks providing gine of a two-wheeler. It was exhibited in several exhibitions him books and a list of aviation companies which could help him. and later bought by an institute to teach their students about Since most of the books dealing with his favourite subject were in lightweight aircrafts. English, he started to learn English also. The hard work paid off By then, some local newspaper covered Saji’s passion and well. His love for the subject made him learn the language faster. efforts. His next lightweight aircraft was booked by an assoOnce he became acquainted with the language, he collected as ciation for the local fair which former President Dr APJ Abdul many books as he could on the subject to reach his ultimate dream Kalam inaugurated while he was in Kerala. Though Saji wanted of building and flying his aircraft. Years passed by and several things changed but evidently not Saji’s dreams. His life was now shared by Maria, his loving better half. To make a decent living, he also took the role of a wedding photographer and covered local events even though a lion’s share of it went to purchase things wanted for making his aircraft. Initially, Saji’s dream made her angry. “At first I tried to discourage him from pursuing his dreams as it was always very expensive. Though he sourced several things locally, there were still some parts which had to be brought from Bangalore or abroad. But soon, I found out that he was very much obsessed with his idea of building and flying that aircraft. So, I began to support him,” Maria comments. Saji’s first effort was to build a helicopter. In the 90’s, he even successfully built the frame but couldn’t afford to buy an engine for that. So he turned his attention towards a lightweight aircraft. After five years of hard work, he made a small aircraft by using recycled materials and cheaper alternatives. The propellers were of wood instead of metal or expensive fibre glass and the shock

For a brief tenure, Saji also worked with a local engineering college. He assembled and repaired the old aircrafts used for research there. It helped him in knowing more about the technical side of aircrafts. Now, he wanted to venture into the real lightweight aircraft. He travelled several places and met many to clear his doubts. The right help came in 2008 in the form of SKJ Nair, a retired Wing Commander.

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Life Story Saji Thomas (Inventor) to meet Dr. Kalam personally, the tight security didn’t permit it. But Dr. Kalam was kind enough to send him an invitation for an air show at Gujarat as he was impressed with Saji’s aircraft in the exhibition ground. At merely one third of the regular light aircraft price, he made a single seated light aircraft powered with a 26.5 HP Yamaha engine that had 6000 RPM to steer clear in the air. Since he had no means to afford the costly parts of the copter, he used aluminium pipes and metal sheets for the frame. It weighed 200kg and the cost he incurred was Rs.1.75 lakhs. Saji secured the second prize in that air show which fuelled his dreams to soar further up in the sky. Dr. Kalam had also expressed his interest in meeting Saji personally during his next visit to Kerala. However, it didn’t materialise. For a brief tenure, Saji also worked with a local engineering college. He assembled and repaired the old aircrafts used for research there. It helped him in knowing more about the technical side of aircrafts. Now, he wanted to venture into the real lightweight aircraft. He travelled several places and met many to clear his doubts. The right help came in 2008 in the form of SKJ Nair, a retired Wing Commander.

Saji X-Air Within a few months, Saji came up with a two-seater design of a lightweight aircraft. SKJ Nair was impressed with it. As the next stage, he began to assemble things required to make his lightweight aircraft. To procure certain things, he travelled to Bengaluru and other parts of South India. After five long years, he completed the work and named it Saji X-Air. SKJ Nair noted that it was a reverse engineering model of Original Rajahamsa X-Air standard Flapless. He appreciated the innovative modifications which have been incorpo-

Saji Thomas Flying Aircraft

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rated to Saji X-Air like the placement of the instrument panel and its arrangements. He certifies that it is much better than the original model. To take Saji X-Air to the skies, they again took the help of SKJ Nair. Thus, in April 2014, Saji took his lightweight aircraft in a truck to SKJ Nair’s private airline academy of in Ambasamudram near Madurai. Saji, his wife Maria and their son Joshua followed the truck in an auto rickshaw. Al l the way, Maria kept praying so that nothing would go wrong. She remembers that her husband was not seen tensed there but excited as he was about to do what he dreamt all along his life. And with his family, his mentor and the entire crowd watching, Saji successfully flew his aircraft for a few minutes in the air. Since he or his aircraft had no licence, he could fly it only for a few minutes there. Later, SKJ Nair also flew it for a few minutes. The height aircraft reached was limited to 20 ft as there are stringent rules regarding flying aircraft. “Since the keel surface decoration fabric covering has been done away with, the aircraft had a slight adverse effect in flying characteristics, especially in gliding ratio. The wooden propeller used instead of fibre is heavy and requires a reasonable amount of pressure though it can be counteracted with trimmer output.


Saji Thomas in his first hand made helicopter model (file picture)

The engine used is the popular 65 hp Hirth, which helps the aircraft to get off comfortably within about 120 to 150 m of take off roll. Built at a cost of Rs.14 lakhs, Saji X-Air, which weights 265 kg, can fly up to a height of 10,000- 13,000 ft. Saji X-Air is an ideal aircraft for sports aviation, recreation and training purposes. The maximum speed it can attain is 140 km/hr. It consumes 16 litres of petrol for an hour’s flight. The ride is stable and smooth. I would say Saji X-Air is a highly improved version of the original,” said SKJ Nair confidently about Saji’s venture.

had also appreciated Saji’s efforts. Last year, he was also felicitated by an engineering college at Pune by inviting him to inaugurate the tech festival at the college and handed over a cheque for Rs. 1.5 lakhs to propel his dreams forward. There is also news that a Malayalam movie Vimanam, starring Prithvi Raj, is based on the life of Saji Thomas and has begun the production works. Director Pradeep M Nair has already bought copyrights and personality rights for the film from Saji Thomas. Saji is also thankful for the help he received from various people. Appreciating his determination and hard work, an NRI, a few years back, gifted him a laptop. Shortly after his lightweight aircraft made news, an engineering college in Kerala granted him Rs.1 lakh. Saji is also thankful to Basil M G, the System Analyst at Mar Baselios Institute of Technology and Science, Kothamangalam for providing him a website www.sajixair.in and thereby giving an address in the tech world. Shortly after, Saji received a job offer from a private company based in Kochi. But travelling became a problem. Moreover, he feared that it will consume all the time for his further experiments in lightweight aircraft. His next plan is to build a twin-engine aircraft which can take off without having to move on the runway. He requires funds to pursue it. “All Saji wants to do is to fly high. Flying is his biggest passion. He really wants to work with in an aeronautical company as a mechanic,” says Maria about her husband’s ambition. In 2016, a German-based aviation services company appointed Saji as an R&D technician with a good salary. Saji has been appointed at Arrow Aviation Services Company’s office in Kol kata. The appointment was purely on the basis of his performance in the interviews held with him. The company has also offered him family quarters in Kol kata for accommodation.

The way Saji made a lightweight aircraft cost-effectively gives a good lesson to the engineering and aeronautical students. While the material to build a cockpit usually came up to Rs.40, 000, Saji made it with just Rs.5, 000, using his own innovative idea. The shock absorbers are that of a scooter. For the wings, he arranged the cloth from USA. Saji was featured in Discovery Channel’s Heroes with HRX, a documentary series aired during 2015. The series which was anchored by Hrithik Roshan featured true stories of people who had overcome physical handicaps and unfavourable circumstances to achieve extraordinary feats. Former Kerala Chief Minister, Oommen Chandy,

Saji Thomas with film star Hrithik Roshan during TV programme.

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Saji’s wife Maria is all happy now. Now, she believes that they have been rightly rewarded for the efforts and sufferings they had once. “Saji has been humiliated by people several times. People kept saying that he was just wasting money for his crazy ideas. But he was determined to build an aircraft that could fly. Being a sensitive person, Saji was hurt but he did not give up. Now, people tell us that Saji has brought fame to the entire village of Thattakuzha,” says Maria beaming with pride. “What more can I ask for!”

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Interview

Dr. Milind V. Kirtane

"A HEALTHY

YOU FROM

Team Agappe: Could you please share a few things about your journey from school to becoming a doctor and a bit about your family?

Dr. Kirtane: I’m a Mumbaikar - born, brought up, educated and settled in Mumbai. My parents were doctors- my father was a family physician and my mother was a gynaecologist. I had an elder brother who was an engineer. I’m married to Dr. Jyotsna who is a paediatric surgeon. She was the professor and Head of Department of JJ Hospital, which is the largest government hospital in Maharashtra. She headed the department for almost 27 years and is now doing private practice. We have two children, my daughter Gauri is an educationist and is married to Debashish Vanikar. They have 3 sons. My son is an environmentalist and works with an organisation called Bombay First. His wife Shaheeda works with the Observer Research Foundation.

The recipient of Padma Shri and Dr. B C Roy award, Dr. Milind V. Kirtane is one of the prominent ENT specialists in India. Dr. Kirtane has got a special interest in cochlear implants, endoscopic sinus surgery and neurotology. Apar t from being a consulting ENT surgeon at PD Hinduja National Hospital and Medical Research Centre, Breach Candy, Cumballa Hill, Saifee hospital in Mumbai and Professor Emeritus at Seth G S Medical College, he has several publications in indexed journals and has authored books on otology, neurotology and endoscopic sinus surgery.

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I completed my studies at St. Xavier’s High School and College. I joined GS Medical College in 1965 for MBBS, completed my course in 1969, went in for ENT and got my Masters degree in 1973. By 1975, I got staff position at GS Medical College. Till 1985, I worked there as a full time professor. Then an opportunity came as an Honorary Professor and from then on, I have been dividing my time between teaching and private consultation at a few hospitals. It has been 52 years in the same college without a break as I’m an Emeritus Professor there now. In 1985, I joined PD Hinduja National Hospital as a Consultant and am working there for the past 32 years. Subsequently, I became attached to other hospitals also. Besides, I have a passion for teaching and hence I used to conduct workshops on temporal bone hands-on cadaver dissection from 1976 at Seth G S Medical College, Mumbai. In 1991 we began, Endoscopic Sinus Surgery workshops where we would do live surgeries at Hinduja Hospital and hands-on cadaver dissection in the anatomy department of Seth G S Medical College. Now for the last 10 years, I’ve been conducting workshops on cochlear implants. I have fellowships for cochlear implants and we have a special training lasting six months where one fellow comes and stays with me and learns the whole process about cochlear implants, so that he can offer this technology to people wherever he works. Right now, I have the 20th fellow for this training. I also have a fellowship for endoscopic


LIFESTYLE SHELTERS ENT DISEASES"

Dr. Milind V. Kirtane

sinus surgery. For the last three years, we have also been doing hands-on training for ENT surgeons on models at a place called Centre of Excel lence for Minimal Access Surgery Training at Mumbai, a brainchild of Dr. Tehemton Udwadia. There one can get training on all branches like general surgery, gynaecology, urology etc. In ENT, we teach endoscopic sinus surgery and cochlear implants on 3-D printed models. TA: Tell us about your journey of professional life? Why did you select ENT as your specialisation? Dr. Kirtane: I had good marks in surgery. General surgery offered

a variety of specialisations. I had three option to choose from -ENT, Opthalamology and Plastic Surgery. Cosmetic surgery wasn’t a big thing then. From ENT and Ophthalmology, I decided to choose the former and I now enjoy this thoroughly. TA: You are a pioneer in doing cochlear implant surgery and have performed over 2500 cochlear implant surgeries so far! Share your experience with your first cochlear implant surgery in Mumbai? Dr. Kirtane: In 1995, I went to Australia for 5 days training in Cochlear Implants. When we had the first patient, professor

Dr. Milind V. Kirtane sharing his experiences with Mr. Eldhose M. George, General Manager, Agappe.

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Interview

Dr. Milind V. Kirtane

Bill Gibson from Australia came down to Hinduja Hospital and demonstrated the surgery. That was the first surgery I witnessed and assisted. After that I was on my own. For my first surgery, I practiced on several temporal bones before operating. I had a dummy implant which I would put inside and fix it with a wire, then take it to the hospital and have an x-ray taken to see whether the implant was placed correctly. As I had no mentor to turn to for guidance and was using a very expensive device, I practiced till I was confident of doing it correctly. We started slowly. The first implant was in 1996 and we had only one operation that year. The next year, we had just two operations and things didn’t change much until 2000. Later, several hospitals began to call me for guidance and now I go to many hospitals to provide their surgeons assistance and guidance. Now, we do around 200 implants yearly. I believe it is important to share this knowledge because there are almost three million people in India who require an implant. So enabling more doctors to do this is the only way to reach these people. Cochlear implant is not just about surgery. The patient requires post operative training of about three years - AVT (Auditory-Verbal Therapy). For the past 10 years, we train not only the surgeons but also the Auditory Verbal Therapists and audiologists from all over country annually so that the patient can get the same quality of therapy or AVT wherever he may be. TA: Which are the key areas you like most to practice in ENT? Dr. Kirtane: I started my career as a neurotologist. I went to Germany and trained under Professor Claussen, which was a turning point in my life. I learnt about the German methodologies in the field and came back with a lot of enthusiasm for doing neurotology, mainly management of patients with vertigo. We formed an asso-

Frequent Respiratory symptoms such as chronic cough and running noses are probably related to the increased pollution. The number of pollution related disorders is increasing day by day. ciation called- Neurotological and Equilibriometric Society. But being a teacher at KEM Hospital, I had to do all aspects of ENT. So we were doing a lot of otological work. In 1985, we had a visit by Professor Stammberger, an expert on nasal and sinus endocopy. That is how I got into endoscopic sinus surgery. Next year, in 1986 I went to Graz in Austria for further training. I think that I was one of the first people to do endoscopic sinus surgery in India. Neuro otology, otology and sinus surgery remained the main focus. We also practiced all aspects of laryngology and head & neck surgery. TA: Do you see any threatening progress in ENT disease cases in India? Is it a matter of concern? Dr. Kirtane: Because of rampant use of paan and especially gutka, the number of cases of oral submucous fibrosis certainly has increased. At a certain point of time, gutka was banned in Maharashtra and it really was a good move. There is a definite relationship between gutka chewing and the development of oral submucous fibrosis and oral cancer. We have also seen an increase in the number of viral disorders presenting with ENT symptoms. There is a condition called sudden sensorineural hearing loss where a person may go to sleep with normal hearing and wake up with severe to profound deafness in one ear. It is like what you see in facial paralysis (Bells Palsy). We used to see one case in two or three months. But recently, I see at least 5-6 people affected with sudden sensorineural hearing loss per month - may be more. Nobody knows the exact cause. It is believed that a virus infection may be responsible for this disease. There is a higher incidence of noise induced hearing loss as well.

Dr. Milind V. Kirtane receiving Padmasree Award from former President of Ind ia, Sri. Pranab Mukherji.

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Frequent respiratory symptoms such as chronic cough and running noses are probably related to the increased pollution. The number of pollution related disorders is increasing day by day. TA: Prevention is better than cure. What


ENG machine and asked me to do a thesis on ENG (investigations for vertigo patients). I was a Junior Resident then. It opened up an opportunity to learn something quite new. Since there wasn’t anyone I could ask, I refer books on how to do test, how to interpret it. It seemed tedious and boring work but I stuck to it. It helped me immensely. It aroused my interest in neurotology and helped me to gain expertise in it. On the basis of this work, I was awarded Dr. Cooper Award by National ENT association, an event that gave me great confidence and my career in ENT a great boost. TA: You are credited with several articles and books on otology, neurotology and endoscopic sinus surgery. How do you enjoy your life as a professional writer in medical arena?

Dr. Milind V. Kirtane receiving BC Roy Award from former President of India, Dr. APJ Abdul Kalam. are your advices to the TechAgappe readers to prevent ENT dis- Dr. Kirtane: I have been lucky to have studied in a place with eases? excellent resources dedicated and encouraging professors and facilities. Having the benefit of this academic background Dr. Kirtane: Avoid tobacco, smoking, paan and gutka. Avoid exthere was a need a desire to share the same with colleagues all posure to loud and prolonged noise. Have a healthy diet, some over the country. amount of exercise, turn to Yoga. Minimise your exposure to polluted places like wear a mask if so indicated. A healthy lifestyle TA: You are the founder President of the Sinus Endoscopic shelters you from most ENT diseases. Society of India and one of the founders of the Indian Society of Otology and have been the president of the National ENT TA: You are the recipient of Padma Shri award and Dr. B C Roy Association (AOI &HNS), the neurotological and award. You are well-known for your dedicated service in treating Equilibriometric society (NES), and the Cochlear Implant group ENT diseases. Have you accomplished your aim in your medical of India (CIGI). You are reported to be very active in social profession? activities for public welfare. For public awareness, could you Dr. Kirtane: To be honest, I’ve never set goals and aims in my life. please explain your present associations and their functions? I genuinely believe that if you are doing work with sincerity, it is Dr. Kirtane: My current focus is on cochlear implants. I’m bound to pay off. Years back, one of our professors brought an part of a foundation called ‘I Hear Foundation’ backed by three other trustees. We do this to collect funds and help children with profound hearing loss to get a cochlear implant which is a very expensive device. Out of the 2500 implants that I have Avoid tobacco, smoking, paan and done, almost 2000 are by donations. Many corporate compagutka. Avoid exposure to loud and nies help us in this process. The other role of the foundation is prolonged noise. Have a healthy diet, training of doctor and paramedical persons. So far I have trained and mentored over 50 surgeons from all over India and have some amount of exercise, turn to Yoga. gone and stood with them when they perform their first few Minimise your exposure to polluted surgeries (till they are confident of doing them on their own). Twenty of these mentees are from my own city, Mumbai while places like wear a mask if so indicated. others range from Punjab to Kerala and from Tripura and Manipur to Gujarat and Maharastra.

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Promotion Evolution

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

The patient spectrum of chronic pancreatitis in India is changing, with increased occurrence in older patients, incidence of milder disease including milder diabetes, increasing longevity and increasing association with alcoholism and smoking. Globally, in 2015, about 8.9 million cases of pancreatitis occurred. Pancreas is a glandular organ that sits behind the stomach, produces various digestive enzymes and the hormone, insulin. Pancreatic profile is the blood test which can evaluate the function of the pancreas. Inflammation of the pancreas is known as pancreatitis. About 80% of pancreatitis cases are caused by alcohol or gallstones. Acute pancreatitis was first described in an autopsy in 1882. Scientists identified that under extreme disruption of pancreatic function, such as pancreatitis, the pancreas may begin to autolyse and release pancreatic enzymes into blood stream. Thus, through the measurement of serum concentration of pancreatic enzymes, pancreatitis can be diagnosed. According to the American College of Gastroenterology’s guidelines, Pancreatic profile must be checked to diagnose pancreatitis.

1

Routine Pancreatic Test

2

Standard Pancreatic Test

In 1831, Erhard Friedrich Leuchs described the hydrolysis of starch by saliva, due to the presence of the enzyme in saliva, ‘ptyalin’, an amylase. In 1862, Alexander Jakulowitsch Danilewsky separated pancreatic amylase from trypsin. Scientists noted that when cells in the pancreas are injured (as in pancreatitis) or the pancreatic duct is blocked (by a gallstone or rarely by a pancreatic tumour), increased amounts of amylase find their way into the bloodstream, increasing concentrations in the blood and the urine. Amylase Amylase helps to break down starch. An Amylase test measures the amount of Amylase in the blood. In acute pancreatitis, amylase in the blood increases (often to 4-6 times higher than the highest reference value). The increase occurs within 12 hours of injury to the pancreas and generally remains elevated until the cause is successfully treated. The amylase values will return to normal in a few days. In chronic pancreatitis, amylase levels initially will be moderately elevated but often decrease over time with progressive pancreas damage.

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Few years after Amylase identification, scientists noted the presence of another pancreatic enzyme, Lipase, in higher concentration in pancreatitis. In 1848, Claude Bernard discovered that pancreatic secretion could emulsify and saponify fatty substances. He eventually attributed these reactions to an enzyme that was later named as ‘pancreatic lipase’.


Agappe’s Diabetic Profile Amylase (Pack Size: 4 x 5, 4 x 10 mL) 1. CNPG3 Methodology using MES Buffer for optimal reaction - Proven method, Accuracy Guaranteed 2. Wide measuring range of 2 - 2000 U/L Safe reporting 3. Suitable for Serum, Plasma & Urine samples – More convenient 4. Liquid Stable Single Reagent in small

Convenient pack size – More convenient 5. CV less than 3% with-in run – Accuracy Guaranteed 6. Reference Range – Serum/Plasma up to 25 - 86 U/L; Urine up to <470 U/L Lipase (Pack Size: 1 x 25 mL) 1. Synthetic Substrate Methyl Resorufin - Better reagent stability

3 Lipase

2. Wide measuring range of 3 - 300 U/L – Less chance for rerun, Saves Reagent 3. Goods Buffer for optimal reaction – Accuracy Guaranteed 4. 4:1 Reagent format for automation - Saves reagent cost 5. Liquid stable reagents - Ease of use 6. Reference Range – Serum/Plasma up to 60 U/L

Extended Pancreatic Profile

Lipase helps to digest fats in the food. A lipase test measures the amount of lipase in the blood. When levels of lipase and amylase are higher than normal, it may indicate a pancreatic injury or another disease. Most studies show that levels of greater than three to five times the upper limit of normal can usually lead to a diagnosis of pancreatitis, according to guidelines from the American College of Gastroenterology (ACG). Blood amylase levels are sensitive for pancreatic disorders but are not specific. An elevated amylase may indicate a problem but nonpancreatic disorders such as inflammation of salivary glands can cause increased amylase levels. Lipase levels are usually increased in pancreatic disorders and are more specific than amylase for diseases of the pancreas. Evaluating the results of the two tests together help to diagnose or rule out pancreatitis and other conditions.

R esearch studies suggest a few blood tests but these tests are not widely available and are not routinely used. Trypsin Trypsin is the pancreatic enzyme that digests proteins. Measurement of serum trypsin is the most sensitive blood test for pan-

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creatitis, particularly in chronic pancreatitis patients. Fecal Elastase Test Elastase is an enzyme responsible for breaking down protein. In this test, the level of elastase is measured from the stool to evaluate both children and adults for pancreatic insufficiency.

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Cover Story Tonsillitis - An Overview

DILEMMA IN THE

TREATMENT OF TONSILLITIS The Tonsils along with the lingual tonsils, tubal tonsils, adenoid and the lateral pharyngeal band forms the Waldeyer’s Ring. This acts as a barrier to the infective organisms at the point of entry to the aero-digestive tract thus making this lymphoid tissue prone to infection and hypertrophy. Dr. Saikat Samaddar, MBBS, MS (ENT & HNS) (Gold Medalist), Kolkata Medical College, West Bengal.

The term Tonsil usually refers to the palatine ton-

sils located at the posterior part of the oral cavity. These are a pair of lymphoid tissue which helps in the body’s defence mechanism. The Tonsils along with the lingual tonsils, tubal tonsils, adenoid and

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the lateral pharyngeal band forms the Waldeyer’s Ring. This acts as a barrier to the infective organisms at the point of entry to the aero-digestive tract thus making this lymphoid tissue prone to infection and hypertrophy. Acute inflammation of the tonsils may


occur as an isolated event or in conjunction with pharyngitis. It may be a part of systemic infection as in infectious mononucleosis. CLINICAL PRESENTATIONS: The commonest clinical presentation is a sore throat. It constitutes 0.1% of consultation to primary care physician per capita per annum in the UK. Not all sore throats are due to tonsillitis. It commonly affects children during the autumn and winter. Other presentations are fever, painful swallowing and cheesy exudates on the tonsils which look congested. Painful cervical adenopathy is usually associated with it. MICROBIOLOGY Acute infections are generally caused by both viruses and bacteria. Group A Beta Haemolytic Streptococcus (GABHS) is a usual offender. A wide variety of other organisms including anaerobes and viruses may be implicated in a clinically indistinguishable illness although whether they are primarily causative is undetermined. There is a lack of a specific definition of Tonsillitis making the epidemiological data analysis about the true incidence of tonsillitis as opposed to pharyngitis or a sore throat difficult. This makes the assessment of the causative organism and outcomes of management analysis difficult. INVESTIGATIONS Microbiological investigations to diagnose the causative agent includes Throat swab for culture sensitivity and Rapid Antigen Test (RAT). Bacteriological culture of a throat swab may yield a positive culture for GABHS but this does not conclusively prove that the organism is causative. The incidence of a positive culture may be as high as 40 percent in asymptomatic carriers. There is a delay of 24-48 hours before results are available, rendering its value limited in treating a short-lived self-limiting illness. The use of RAT as an office procedure has superficial attractions, mainly the speed in reporting results (ten minutes), but the sensitivity measured against throat swab culture (itself a doubtful gold standard) remains variable across trials at between 61 and 95 percent with specificity from 88 to 100 %. There may be interlaboratory variability. Use of bacteriological criteria for diagnosis and treatment of a sore throat is frequently practiced, but this does not reflect the situation in clinical practice nor is it a reliable â&#x20AC;&#x2DC;gold standard. TREATMENT Management is mainly on the clinical ground. It is constituted by adequate hydration and analgesics. Investigations are reserved

for nonresponsive cases or cases with complications. Microbiological assessment, as mentioned above, in the form of culture of a throat swab or rapid antigen testing is done. Culture specific antibiotic prescription is advocated. RECURRENT AND CHRONIC TONSILLITIS Recurrence of acute attacks of tonsillitis is common in a significant but unknown proportion of patients. There is a recurring infection after an acute attack for a few weeks or months. These episodes may gradually subside but in some individuals, it will last for several years. This is termed as recurrent tonsillitis. A further category of patients presents with chronic lowgrade symptoms in the form of throat discomfort, unpleasant foul breath, persistent low-grade fever and ill health. Obstructive sleep disorder is an important presentation in children as well as adults. This may manifest as long-term pulmonary and cardiac morbidities. These problems never seem to cease. Pa-

Recurrence of acute attacks of tonsillitis is common in a significant but unknown proportion of patients. There is a recurring infection after an acute attack for a few weeks or months. These episodes may gradually subside but in some individuals, it will last for several years. This is termed as recurrent tonsillitis.

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Cover Story Tonsillitis - An Overview tients complain of significant deterioration in the quality of life. A recurrent attack of tonsillitis or chronic tonsillitis is a nagging problem. This is one of the important causes of paediatric ENT referrals. A weak, feverish, inattentive child and the frequent loss of school attendance make the parents more anxious. They resort to hopping from one doctor to another in the hope of gaining a better consultation and complete cure. THE DILEMMA Currently, there are no means of predicting those who would have recurrent attacks. Supportive measures continue to be appropriate. Prescription of a long- term antibiotic course has also been practiced. Several theories can be attributed to the cause of the persistent infection. Resistance to drugs amongst the causative organisms is an important fact. Injudicious use of antibiotics like the poor choice, inadequate duration and inappropriate dosage administration in patients with sore throat has led to such resistance. The rise in the number of uncommon organisms further complicates the situation. Studies have shown the presence of uncommon organisms in the core of the ton-

sillar tissue, which is distinctly different from the tonsillar surface flora. Throat swab for microbiological studies from the surface of the tonsils fails to predict the actual offender. Surrow et al in 1989 published a study defining such a discrepancy. Several other studies have demonstrated the positive predictive value of throat swab to be around 10%. The Penicillin group of antibiotics used to be the drug of choice. Recent studies have demonstrated the need to define the microbiological pattern of a specific area and an antibiotic prescription as per the local need. Numerous studies have shown the efficacy of Cephalosporin over Penicillin. Surgical excision of the tonsils is termed as Tonsillectomy. This is one of the oldest operations described in surgical literature. Celsus in ‘De Medicina’ (14-37 AD) described ‘induration’ of the tonsils, which he advised could be removed by dissection with the finger nail. If this was not possible they could be grasped with a hook and pulled out with a ‘bistoury’. Improved instrumentation, particularly the snares and ‘guillotines’ used by Morrel McKenzie led to popularization of the operation in Victorian England. Sir Felix Semon (1849-1921) removed the tonsils from several of Queen Victoria’s grandchildren and the procedure became fashionable in the drawing rooms of the aristocracy. Its practice has decreased over time because of the use of antimicrobial drugs ensuring adequate relief and documentation of morbidities associated. But Tonsillectomy has stood the test of time. As described, rise of unusual offenders and existence of flora in the tonsillar core distinct from the surface have put the rampant use of antibiotics to question. The magic medication is gradually falling short of its aura. It is not far when the organisms will develop resistance to the prescribed drugs and we shall fall short of our armamentarium. This calls for a more radical approach like Tonsillectomy to handle the issue of chronic and recurrent disease. ‘Paradise Study’ reported in 1984, ‘American Academy Of Otolaryngology Head and Neck Surgery’ (AAOHNS), ‘The British Academy of Otolaryngologists and Head Neck Surgeons’ (BAOHNS), SIGN (Scottish Intercollegiate Guiding Network) Criteria etc have laid down several criteria for taking up patients for tonsillectomy. As per the Paradise Study-‘Partici-

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EFFECTS OF SMOKING WITH TONSILLITIS Home Remedies For You F or a speedier recovery and proper healing, you should avoid smoking and the use of tobacco products. Smoking has a detrimental effect and can worsen the condition significantly. The chemicals and tar present in cigarettes irritate and inflame the tissues of the body and slow down the recovery process. In

fact, doctors suggest that you not only avoid smoking but stay away from second hand smoke as well to prevent the condition from getting worse. Another factor to consider is that tonsillitis is contagious and sharing cigarettes is an easy way to spread the infection. In most cases, tonsillitis is cured with the proper medication and rest. During the period of recovery, it is important that you take the necessary precautions to reduce the risk of the infection spreading. There are also a number of home remedies you can try to lessen the side effects of the disease. These include:

z Drinking a glass of milk with a pinch each of pepper powder and turmeric powder just before sleeping. pation was dependent on children having a history of seven episodes of sore throat in the year prior to the study, five or more in the preceding two years or three or more in each of the preceding three years.’ AAOHNS describes ‘three or more infections of tonsils and/or adenoids per year despite adequate medical therapy’ as the criteria for tonsillectomy. The SIGN criteria include: • Sore throats due to tonsillitis • Five or more episodes of sore throat per year • Symptoms for at least a year • Episodes of disabling sore The most common practices of surgical method include tonsillectomy with cold steel instrument by guillotine method or dissection method. A recent trend has been the use of Coblation tonsillectomy, use of Ultrasound and LASER in tonsillectomy. This advancement has decreased the per-operative bleeding, post operative pain and chances of haemorrhage.

Continue this remedy for three nights or more until the inflammation and pain reduces.

z Fresh fruit and vegetable juices such as carrot, beet and cucumber juice taken separately or mixed together is believed to help treat a tonsillitis infection by improving your immunity. z Mix the juice of one lime in a glass of warm water and sip on this through the day to provide relief from the symptoms of tonsillitis. You can add honey and a pinch of salt to make it more palatable and to increase the antibacterial properties of the drink. z For severe pain and swelling, try gargling with a solution of water boiled with a teaspoon of fenugreek seeds. Strain this and gargle with the solution twice to thrice a day for the best results. z Chronic cases of tonsillitis may require surgery and the removal of the tonsils.

Day-case tonsillectomy is now a reality. Patients undergoing tonsillectomy is kept under observation for a period of only 23 hours post operative. The risk of primary bleeding exponentially decreases after 6 hours post operatively. A strict protocol such as adequate supervision at home, access to telephone and proximity to the hospital is considered before discharging the patient. CONCLUSION The results of evaluation of quality of life before and after the operation suggest that tonsil disease has a markedly adverse effect on quality of life and that there is significant benefit from surgery. The past decade has seen the rise of resistance amongst the common pathogens as well as rise in the number of unusual offenders. Probably this scenario calls for a more judicious use of antibiotics and resorting to the surgical intervention.

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Life Story Abdul Samad (Hockey Player)

ABDUL SAMAD

THE IQBAL OF BHOPAL

When on the playground, Abdul Samad called as the ‘Iqbal of Bhopal’ is full of confidence that he could save his team from the opponents’ goals as a trustworthy goalkeeper. But out of the ground, before life and his dreams, this youth isn’t as confident as we see him on the ground. He is called ‘Iqbal’ because of his life’s similarities with the 2005 Bollywood movie with the same name. The movie tells the dream of a deaf and mute boy Iqbal who makes it into the Indian Cricket team despite his disability. But here ‘Iqbal of Bhopal’ is still struggling and his dream to represent the country in Hockey is far away not because he lacks the talent but just because he is deaf and dumb.

Hockey is literally in the blood Abdul Samad. Samad’s father,

Abdul Wahab, who is his greatest inspiration, had been a national player. Samad’s two younger brothers are also into hockey - the youngest being differently-abled is into ice hockey - and have represented India in the School Olympics. Abdul Suboor, his other brother plays hockey along with supporting the family with a job. Suboor, who speaks for Samad, points out that the appreciation their father received, while playing for Mohun Bagan in the Kolkata Hockey League, kindled the fire to play hockey among them. Samad is equally good in playing cricket and football, adds a proud Suboor. Samad participated in the second National Twenty20 Cricket Championship of the Deaf, held at the Gymkhana Ground in Secunderabad in May

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Abdul Samad playing hockey in a National Tournament. last year and also played in the 2nd State Level T-20 Cricket Championship of the Deaf as the vice-captain and wicketkeeper. Samad also made it into the Mad hya Pradesh football team in the XXI National Games of the deaf held at Chennai earlier this year. Abdul Wahab recalls his child’s love towards the game even though he didn’t play at first. Gradually, he picked up as he always began to assist Wahab to the stadium for practices. Hockey is a team sport and Wahab soon understood that Samad’s communication with his co-players could be a problem. So then, he started training him to be a goal keeper. Dedicated, focused and hard working, Samad very soon rose to the reputation of a good goal keeper in the locality. For a kid who began playing hockey at the age of 10, this reputation was the best achievement. To overcome the communication barrier, Samad learned to read lips. He taught basic sign language signals to his team mates who supported Samad for his skills as a goal keeper. The shelves inside Samad’s house, filled with trophies and medals, tell us a tale about how Samad has overcome his disability through his passion and expertise. Samad’s hockey career began with Bharat Heavy Electrical Limited (BHEL). Since Samad was serious about hockey, his father thought of sending him for training at Sports Authority of India (SAI). The authorities at SAI rejected him with a prompt ‘No.’ Even though Samad felt terribly upset, his persistence once again took him to them asking them to provide him a chance to prove. After watching Samad play, they approved his talent and allowed Samad to undergo training at SAI. The trainee position at the Central Re-

gional Centre of SAI in Bhopal helped Samad to hone his skills. After his five-year stint at SAI, he joined the Madhya Pradesh Hockey Academy and began playing for them. By 2016, Samad had played four junior nationals and six senior nationals alongside regular players. For him, it was a sweet revenge against all those who ridiculed him for his desire to play with regular players. He is also a Limca Book of Records holder recognised as the first deaf and dumb hockey player to have competed in national championships along with normal participants in 10 hockey nationals.

The Big Dream Samad’s ultimate dream is to represent the country. He believes that he has got the potential for it. The only hindrance is his disability for something which he is not responsible. There is also another reason why Samad wants to be in the

Did you Know?

Agappe’s AGHDL is the only HDL with selective inhibition using electrostatic interaction between anionic and cationic compounds.

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Life Story Abdul Samad (Hockey Player)

team of regular players because he believes that it will be the best encouragement and motivation the nation could provide to the differently-abled society. “Imagine the impact it will create among differently-abled persons as there are thousands of normal people dreaming in to get into the jersey of Team India”, Suboor voices forth his brother’s thoughts. Suboor points out the case of a USA Basketball team member, David Smith, who had been included in the team for the last Rio Olympics. He was deaf and the selectors didn’t reject him for that reason. At least, they could provide Samad with a job, states Suboor. The life of David Smith, a two-time Olympian who won a

bronze medal at the 2016 Olympic Games, is something we need to understand on how family and society supports the differentlyabled. David Smith, who hail s from California, USA, was born with mild-to-severe (80 to 90 percent) hearing loss. He wears hearing aids to assist him on and off the court though it seldom helps him in the court as sweat causes his hearing aids to malfunction. He also reads lips and communicates with hand signals. His parents and the society deserve the credit of turning David Smith into an expert basketball player. His parents made sure that he was in a class with the average kids and played sports with every other kid. His coplayers were also very supportive to him in the court. They had even implemented certain rules to assist in Smith’s disability. If Smith calls for the ball, the setter has to give it to him every time as there’s no way to call him off. They even termed it ‘the David Smith rule’ in the court. In a game like basketball where communication between team members is very essential and the call for the ball can change the fate of the game, a team had put a player whom they all believe, irrespective of whether he is deaf or dumb, plays well. When will our authorities wake up to such realisation?

Awards and Recognition Samad’s achievements speak a lot about his talent. He was awarded the Best Goalkeeper’s Award in Obaidullah Khan Hockey Tournament. In 2015, he was awarded the tournament’s Best goalkeeper in Scindia Gold Cup at Gwalior as he did not let in a single goal till the finals. The BHEL Sports Authority awarded him the Certificate of Excellence in Sports in 2007-08. In 2012, he got the Godfrey Philips Bravery Award (Mind of Steel). Last year, Ram Naik, Governor of Uttar Pradesh felicitated Samad for his outstanding achievements in sports. Samad has won three best player awards and five best goal keeper awards at national level tournaments competing with normal players. Despite the fact that Samad is differently-abled, he remains the first choice among goalkeepers for the MP State Hockey Academy for years. His ways of communication with his teammates are well appreciated. Abdul Samad after winning National Tournament .

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For the fulfilment of his dream, time is fast running out. He is now 28 years old and with the passing of each year, he knows that his chance to represent Team India is getting reduced. Authorities can easily reject Samad citing the reason that he is over aged if they


wish so. However Samad’s Chief Coach and former Olympian, Ashok Dhyanchand, who is highly impressed by Samad’s skills and is confident that he will excel in this sport, notes the absence of differently-abled persons in Indian Hockey Team till now. He says that during the national tournaments in 2015, Samad’s name was proposed and it was removed only because he was differently-abled. Ashok Kumar, the Chief Coach and Technical Advisor of the Mad hya Pradesh Hockey Academy, also tried hard to take the issue before Hockey India. Samad grateful ly remembers the help done by Ashok Kumar in helping him out. At several occasions, he expressed his displeasure over the treatment meted out to the extremely talented Samad. “There is nothing that this boy cannot do that a regular goal keeper does on the field. He understands everything from our team meetings and I have never felt the need to repeat something just for him”, certifies Ashok Kumar. He asks the government and authorities to bring out a plan similar to Hockey Victoria, Australia, for the inclusion of differently-abled players. They have envisaged a special programme to include differently-abled children in the hockey which is widely appreciated by the humani-

tarian organisations. However, Hockey India doesn’t seem to have heard this news. Even though Samad’s father, Wahab, being a former national player tried writing a letter to Hockey India, he never got back a reply. Meanwhile Samad is also trying for a job. Even though there are a few government-reserved positions in various state-run departments for disabled candidates, Samad is yet to find a job. Being the elder brother, Samad has to support his family, especially as his father is about to retire. He desperately wants to be self-reliant but finding a suitable job is a challenge. He had completed a diploma from Industrial Training Institute in Fitter trade last year. “We have met Chief Minister Shivraj Singh Chouhan twice. He even promised a job for Samad but nothing has materialised so far,” Suboor lamented. Samad has also applied for several jobs on sports quota basis and has cleared trials too. However, he was rejected at the last stage on medical grounds not just once but four times. The railway officer even told them that he was superb, but they cannot recruit him because he was deaf. “I play alongside able-bodied, normal Abdul Samad with the document of players who get jobs under sports Limca Book of Records. quota, but when my turn comes, I’m always rejected. How will I keep motivating myself if this continues?” Samad has a noteworthy point here. In many developed countries, they do several things to dispel stigma, discrimination and misconceptions about disability. One such thing is wheelchair basketball, which brings people together regardless of their abilities. Here, normal people also sit on a wheelchair and play with others including disabled to understand what is to be in the ‘shoes of the disabled’. It’s time that our authorities also wake up to this issue. Although differently-abled is not the same as disabled, it could still get them the same feel. They will better understand that these disabled and differently-abled require empathy than sympathy. Let our authorities wake up before it’s too late. Let us wish, like in the movie, Abdul Samad, like the Iqbal of Bhopal, also may wear the blue jersey of Indian Hockey Team in the near future.

Abdul Samad with his mentors.

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Interview

Raju Venkatraman

â&#x20AC;&#x153;Meeting Customer Satisfaction is the Secret Behind Successâ&#x20AC;? Chit-chat with Raju Venkatraman-The Man behind MEDALL HEALTHCARE

Medall Healthcare Pvt. Ltd (MEDALL) is South Indiaâ&#x20AC;&#x2122;s largest chain of medical diagnostic service providers . Medall was established by Mr.Raju Venkatraman fondly known as Raju, with a vision to provide diagnostic services, both pathology and radiology imaging to all sections of society. Medall strives to help, serve and solve the health-related challenges of customers; and to provide the highest level of diagnostic confidence to referral physicians. Medall started in 2009 by acquiring a 25 year strong brand called Precision Diagnostics, in Chennai,which was started by 4 eminent radiologists. Precision enjoyed a deep rooted reputation among referral physicians for its clinical excellence. Medall later acquired Clumax Diagnostics in Bengaluru rated as the best diagnostic center in Karnataka and expanded to about 35 centers in Bengaluru .Today Medall has over 5500 + customer touch points and serves thirty thousand customers per day. Team Agappe: Could you please explain the growth path of Medal l Healthcare Pvt. Ltd. which has experienced many success stories over the last 7 years? Raju Venkatraman: Medall was established in 2009 with a vision to serve six million customers per year. We were focused to touch the lives of people and thus we chose rural areas. Initially, our strategy was focused on radiology so that people will accept the brand Medall and it took us about two and half years to build the brand equity of Medall. In that process, we acquired a small set of companies like Precision Diagnostics and Clumax Diagnostics. We expanded those centres with more facilities and introduced new technologies and simultaneously, we entered into laboratory business as we were clear that no company was focusing on integrated diagnostics (both radiology and pathology services under one roof) approach at that time. We launched our own lab and started doing simple biochemistry, Haematology, Clinical Pathology, Serology, Microbiology tests. Later, we have built a lab architecture with the concept of central labs and distributed labs. . This architecture ensures most of the samples are processed in our distributed labs and only high end tests go to centralised lab. To touch the rural side, we are partnering with 4 state Govts currently (Andhra Pradesh, Telangana, Jharkhand and Karnataka) in serving the people from economically weaker sections of the society. We built a strong management team and have now mastered the process of large project execution. Most of us at Medall were from the field of IT/ITeS and we were very confident that we could create a big brand that will serve the customers using technology. In short, Medall has grown to its current size by design. Raju Venkatraman

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TA: Medall Healthcare Pvt. Ltd. is known for providing the very best healthcare facilities to a rural community in a financially responsible manner.


Mr. Raju Ventatraman with his team What is your vision and mission? Raju Venkatraman: Our vision was to reach up to six million people when we established Medall. Today, we touch over 10 million people a year. Now our mission is to bring more and more affordable diagnostic services closer and closer to people in rural areas and provide them with very high technology and high quality test reports. We want to have faster turnaround time in tests and that is why we are now establishing lot of Lab Collection Centers in 63 districts where we are currently present in. Lot of people keep asking us but we clearly don’t want to get into hospital business. Medall is into Care business and not into Cure business. TA: Habitually, organisations run on its core values which might mostly be the strength behind their success. What are Medall Healthcare Pvt. Ltd.’s core values? Raju Venkatraman: First one is integrity and integrity for us, means keeping our commitments. Respect is the next thing. Without team work, this success would not have been possible. Serving customers is another important aspect. Most of our customers come here for diagnostics of a disease, which is not a pleasant thing. Our employees must adjust to understanding their emotional state and behave pleasantly to them. Speed is another important value to us. Last but not least, trust and transparency is mandatory and all pervasive in our organization. TA: How does Medall Healthcare Pvt. Ltd. help public to access your world class diagnostic facilities? Raju Venkatraman: We are opening more outlets to get closer to customers in districts. Today, we have more than 2300+ outlets in across 63 districts in 8 states where customers wal k into these centers. We also have another 3500+ collection points to pick up samples from smaller labs. We believe that they have a prominent

role to play in reaching people. Accessibility is the key. Opening franchises is another way where we want small time entrepreneurs to grow with us. Home collections, senior citizens’ special care and diabetic people’s special care- we are focusing on specific areas so that we can bring in the best in a package that can help them, manage their health. TA: To be one of the best healthcare chains in India, what are the basic goals that a healthcare organisation should have? Raju Venkatraman: No compromise on the quality of reports. It should be systematic and process oriented because we are dealing with the lives of people. We cannot take the tests and results lightly. I believe this is the first thing any healthcare organisation must do. It is easily said but difficult to achieve. The second thing is to assemble a team. This is all about management. Anybody can buy the best of technology in the world today. But what we have seen is that technology alone will not solve the problem. We have to constantly build a management team that brings the service component to the business, which is not easy. It should have consistency. TA: Research and Development in world of IVD industry has

''No compromise on the quality of reports. It should be systematic and process oriented because we are dealing with the lives of people. We cannot take the tests and results lightly. I believe this is the first thing any healthcare organisation must do''.

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Interview

Raju Venkatraman prevalence of mental illness is increasing day by day. The panel of doctors are brought in regularly for talks on different trends in disease management. We also send our pathologists and radiologists abroad for medical conferences and to understand the current trend. We introduce new tests only after our panel of doctors and technical teams approve the process. We also send our team to multiple European countries to learn the technological development and how to implement it successfully here. We also have a separate analyst team that constantly evaluates different trends and presents them before us. To reduce the efforts of customers to get results more easily, we have introduced a mobile appMEDALL, which is available in Play Store. We are clearly seeing more technology adoption now and expect people to check their reports on these mobile apps in the next 2-3 years. Customers can check all the family history in the mobile app. The reports are identical to the hard copy obtained from any Medall centre and customers can download and print it after registering. TA: What accreditations do your lab have now?

resulted in many dynamic changes in various test methods. How does MEDALL Healthcare Pvt. Ltd. adopt and see such changes? Raju Venkatraman: We listen to our vendors. We are a service organisation and not a research organisation. All researchers must eventually come to partner with companies like Medall. We are constantly monitoring technology developments in diagnostic space through an advisory panel of doctors which include card iologists, neurologists, gastroenterologists, pulmonologists, paediatricians, general physicians and so on. Psychotherapy and counselling is another area we focus as the

"AGAPPE is associated with MEDALL since 2012 and they are one of our pioneer customers. We are having supplies to MEDALL for many of our parameters and the main products which we associated with are Glucose, Triglyceride, Cholesterol, Alkaline Phosphates, ASO, CRP, RF and Creatinine". Mr. Sudhir Nair, Vice President – Sales, Agappe Diagnostics Limited.

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Raju Venkatraman: Mainly NABL! We don’t believe CAP (College of American Pathologist certification) is needed as we are not primarily a clinical research organisation. But we follow both the RSNA protocols (Radiological Society of North America) which are globally accepted in radiology reporting. We have a nomenclature that the best of the best radiologists understands. Same way, in clinical pathology, particularly most of our reports will be CAT (Committee for Advanced Therapies) compliant. All our labs follow NABL protocol and we have very strict external quality assessments and every lab must get certified by some external vendor. So those scores are measured. TA: What do you think about the future of the IVD industry in India? Raju Venkatraman: I think it is going to be bigger. The customer expectation will go up and it is our job to ensure that we meet their expectation. I really think that today the quality in this industry is not good. When I combine all the people from the marketplace, the customers don’t even know the difference. There are issues in the IVD industry because of the unawareness of the customer. But I believe that it will decrease as the customer awareness increases over a period of time. Customers are now smart and they will learn it for sure. As an industry, I believe that we need not worry about coming together for anything other than benchmarking on quality and processes. I also believe that we require a national registry of laboratories and technicians because as an industry we must have scores on their integrity. These are all possible because what happens is some lab technicians are cheating, some are misusing reagents and some of them are just absconding. If the industry comes forward and creates a database, we can tackle all this problems. I don’t think it is impossible if we can have a national registry just like one we have in BPO.


Life Story Mirakle Couriers (A Social Initiative)

THE ‘MIRAKLE’ OF THE MUTE... Guess the biggest challenge Dhruv Lakra faced when he established Mirakle Couriers that is almost exclusively run by people with hearing disabilities! Was it funding or infrastructure or getting clients? Not really, but the hardest part for Dhruv Lakra was convincing the parents of his prospective employees.

Dhruv’s idea of establishing some-

thing for the deaf had been published in the newspapers many times. We have read volumes on how Dhruv chanced upon a deaf boy while travel ling in a bus and witnessed his struggle to find his stop to get down. Later, they two communicated using notes. Another time, Dhruv received a courier from a delivery boy without exchanging any conversation. These two incidents triggered the idea of a courier service with the deaf people in Dhruv’s mind. Dhruv always had an inner craving to do something in the social sector. Coming from a business family, he grew up in Jammu. He shifted to Mumbai for graduation and afterwards, worked as an investment banker with DSP Merrill Lynch. After a two year stint, he joined Dasra, an organisation that works with various social impact efforts where his work concentrated on the Tsunami-hit areas of Tamil Nadu, tackling issues like health, education, disaster, women empowerment, child trafficking and helping social welfare groups to raise capital at various places in India. The work experience at Dasra had a deep

Mr. Dhruv Lakra

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Life Story Mirakle Couriers (A Social Initiative) impact on Dhruv. Before leaving to UK on a scholarship for an MBA degree in social entrepreneurship from Said Business School, Oxford University, he had made up his mind to do something for the social sector. In January 2009, Dhruv established Mirakle Couriers in Mumbai. The first operational space for Mirakle Couriers was his friend’s house. As the business grew, he managed to get a working space enough for six to seven people. He is quick to clarify that this is purely a business venture- not charity which requires sympathy. Mirakle Couriers is business where a social element is embedded in the commercial operations. He believes that a ‘for-profit’ model works better than an NGO. The company which employs deaf adults provides them a way for independent source of income. The condition of the deaf people in India is largely ignored. Only a few find a decent job, the rest are bad ly paid, seasonal ly hired and usually treated bad. Dhruv started off with one deaf man and ten shipments.

mon problems encountered by were the educational level of deaf community, their low confidence level as they don’t get to deal much people around, the prevailing poverty in the families of deaf people and the difference of sign languages in different regions. The safety of shipments and getting more clients were other burning issues. The only solution before Dhruv was to prove that they were good at business just like any other company. Luck favours the brave! And to Mirakle Couriers, it came in the form of orders from corporate companies. The clients include Mahindra and Mahindra, The Aditya Birla Group, Victory Art Foundation, JSW Group, Indian Hotels Company, Godrej & Boyce, Essel Propack, Vodafone, Infomedia18, The Business India Group and Tehel ka. By 2011, Mirakle Couriers had employed over 50 members with only five people who aren’t deaf (mostly to deal with clients over phone). The back-end operations are managed by women while the delivery part is done by men. The

The initial response he got in recruiting deaf and mute people wasn’t good. However, he did manage to hire one hearing-impaired boy. For the next appointment, Dhruv needed the help of his first recruitee as it was he who convinced two more to join him. Dhruv points out that the over-protectiveness of the family members usually ends up in deaf people being more dependent on them for everything, even financially. Recruiting the first female employee- Reshma at Mirakle Couriers was the hardest part. It was a hard thing to convince her parents, which he eventually succeeded. Mirakle Couriers was formed as a result of Dhruv’s hard work to understand the difficulties of the deaf, learn sign language and convince companies to give orders. His close association with the deaf made him realise that they were good at remembering roads and buildings as they are so visually inclined or may be because it is their survival instinct. It turned out that they were also good at map-reading, an added advantage to the prompt delivery of couriers. Among the com-

Mr. Dhruv Lakra receiving award from former President of India Smt. Prathibha Patil company also increased its number of offices to two- one in South Mumbai and the other in the western suburbs of Andheri.

Employees at Mirakle Couriers

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Even though the system appears simple, a lot of time and energy has been invested in making it work among the differently-abled employees. Everything, from pick-up to delivery, is carefully planned at the branches of Mirakle Couriers in sign language. The field agents rely on SMS for communications with the branch. The packages at the branch are sorted, processed and prepared for delivery by the female staff. Further sorting is carried out by each field agent who is responsible for a designated area of delivery. Each sorted item is given a tracking code and entered into the system which allows tracking and maintaining transparency of shipments. The digital delivery status report is returned to the clients the day after delivery. For faulty or changed addresses, the phone operator will call the client or the consignee to


confirm a new address. Keeping a low carbon footprint profile, the field agents at Mirakle Couriers travel only via public transport. It is also to avoid the dangers to employees considering the insensitive nature of drivers on Indian roads. By employing differentlyabled people in a highly competitive and professionally demand ing courier business, Mirakle Couriers encourages them to rise up in life. The aim is to give them confidence and eventually financial independence. Mirakle Couriers have stories of employees who stopped using the reserved coaches for disabled persons The team of Mirakle Couriers and began travel ling in the general category. For an outsider, it may look as a minor thing covered a novel aspect of society which was unfamiliar for whereas for the Mirakle employees, this step displays the confi- him before. Apart from this, he is now a volunteer in a rehab dence level that they have gained. In the early stages, it was not centre and to improve the lives of many struggling people. mandatory for the delivery boys to go to an unfamiliar place or Mirakle Couriers now depend on NGOs for its employee locality. But Dhruv changed the scene totally. He thinks that recruitment. It has more than 70 employees now who deliver though they might struggle to find the place at first, it is how they more than 66,000 shipments a month. Currently within India, learn to deal with the society around them. His move proved to Mirakle Couriers offer delivery services to all the major metros be successful. The delivery boys are now ready to take new chalin the country. Mirakle Couriers is also ready to expand to lenges. It has enabled them to learn new things whereas earlier major cities like Delhi, Kolkata, Hyderabad, Chennai and Pune. they were limited to just one role- the mute delivery. Despite Going with the trend, it has started focusing on e-commerce providing the employees a monthly income, Mirakle Couriers and international shipments in a big way. To increase the soalso takes care of their PF and medical insurance. cial impact, they are also working on models like employing Dhruv’s extra-ordinary endeavour has helped to change the people having other disabilities. society’s view about the deaf. Egbert Miranda, who has been Recognising the efforts of Mirakle Couriers and Dhruv in working with Mirakle since 2010, is one such example. Fondly 2009, the venture was awarded the ‘Echoing Green Fellowcal led as ‘Uncle Egbert’ by employees of Mirakle Couriers, he ship’ which helped to expand their operations further. They had 35 years of working experience in different industries in- also received Helen Keller Award in the same year. In 2010, cluding jobs at a bank, a travel agency and being a personal man- they were awarded the National Award for the Empowerment ager at an airline company. It has been an entirely new experi- of People with Disabilities handed by the Ministry of Social ence for Egbert as he did not know sign language. The deaf em- Justice and Empowerment. ployees helped him in teaching sign language and within a short Dhruv believes that every one of us has a significant role in period, he became fully integrated into the company’s commubringing about a social change. “Deafness is an invisible disnity. He now feels more connected to deaf citizens and has disability. Since there are no obvious physical attributes to identify them, it is totally ignored. There is very little public symRecognising the efforts of Mirakle pathy for the deaf and a severe lack of government support for them in India. Particularly when it comes to employment, Couriers and Dhruv in 2009, the there are no opportunities because no one has the patience venture was awarded the ‘Echoing or the foresight to learn deaf language and culture. Perhaps, we can include basic sign language in our school curriculum. Green Fellowship’ which helped to We can also be a little more compassionate towards them. It expand their operations further. is a simple thing but can bring up a huge difference,” Dhruv still has faith in the virtues of humanity.

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Cover Story Hearing Issues in Children - An Overview

APPROACH TO CHILDREN WITH

HEARING LOSS

It is quintessential to create awareness on the importance of identifying children with hearing loss as early as possible and their appropriate intervention. Early identification and rehabilitation of a child with hearing loss is essential for the childâ&#x20AC;&#x2122;s adequate performance in the society. A deaf child can have other disabilities which needs consultation of experts in other fields. The article mainly focuses on hearing loss in newborns.

Dr. Mary John, MBBS, MS, DNB, PhD,

Professor and Ag Head, Department of ENT, Christian Medical College, Vellore, Tamil Nadu.

Prevalence Permanent hearing loss is a disability which is a significant contributor to the global burden of diseases on individuals, families and communities. The most prevalent sensory defect at birth in humans is hearing impairment; with an average of 4-6 in 1000 children being affected across the world. The prevalence of hearing loss in infants is more than twice of that of other screened disorders like congenital hypothyroidism and phenylketonuria.

Impact of hearing loss in children Hearing loss in children causes considerable handicap and can be easily missed because itâ&#x20AC;&#x2122;s an invisible and non-hurting disability. Hearing loss in early childhood has its adverse effect on speech, language, cognitive and psychosocial development threby affecting educational and vocational achievements. Studies have shown that babies with hearing loss with no other disabilities, who were rehabilitated within first six months of life, are likely to have speech and language development, comparable to normal children of similar age, by 2 years of life.

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Aetiology of hearing loss According to the type of hearing loss, it can be grouped as conductive, sensorineural or mixed types, with varying degrees, ranging from mild to profound hearing loss. The likely causes of hearing loss depend on the age of the child. For practical purpose, children with hearing loss can be broadly divided into two groups: newborns mostly with sensorineural hearing loss and older children, mostly with middle ear disease.

Hearing loss in newborns In nearly half of the newborns, (45%) the cause for hearing loss is not clear. In the rest of the babies, it can be either genetic defect or acquired from the environment during pregnancy or soon after. The development of ear during embryonic period is complex and is vulnerable to genetic mishaps. In one third of these children, hearing loss can be part of a syndrome with associated other birth defects. Alports, Pendreds, Cogan, Ushers, Waardenburg etc. are some of the syndromes associated with hearing loss. In others, hearing loss is due to isolated genetic defect termed as nonsyndromic hearing loss. The most common cause is due to recessive mutation at certain gene loci. An example is a plasma membrane protein named connexin-26 that can be affected, which is crucial for function of the inner ear. With advancement in the biotechnology techniques, more of abnormal genes are identified and their inheritance pattern is better known. This helps in genetic counseling of the families with history of hearing loss. The acquired causes can be classified as infections at the time

of pregnancy including cytomegalovirus, rubella and toxoplasmosis or the mother consuming drugs which causes hearing loss and defective development of the foetus.

Risk factors of hearing loss in newborns According to the Joint Committee of Infant Hearing (JCIH), the factors, which increase the risk for hearing loss in children up to one month of age are the following: z Family history of child hood (sensorineural) hearing loss z Infections during pregnancy z Bacterial meningitis z Babies with abnormalities of face and skull z Babies needing ventilation for 5 days or more z Birth weight less than 1500g z Jaundice in babies requiring blood transfusion z Syndrome associated with hearing loss

The acquired causes can be classified as infections at the time of pregnancy including cytomegalovirus, rubella and toxoplasmosis or the mother consuming drugs which causes hearing loss and defective development of the foetus.

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Cover Story Hearing Issues in Children - An Overview z z

Drugs causing hearing loss APGAR score 0-4 at 1 min and 0-6 at 5 min About 30% of the children with severe to profound sensorineural hearing loss presents with other disabilities. The commonest cause for acquired severe to profound hearing loss in children is bacterial meningitis.

present with ear discharge or a hole in the eardrum. In children with otitis media with effusion (OME), the hearing loss is usually mild and can go unnoticed and a high degree of suspicion is needed for identification. Hearing assessment of these children can be done by routine tests as they will be able to follow the instructions given by the test coordinator.

Hearing loss in older children

However, in newborns, identification of hearing loss is more challenging. A good history and detailed examination of the child is necessary as hearing loss can be associated with abnormalities of other organs. A complete ear, nose, throat and head & neck examination with overall assessment of childâ&#x20AC;&#x2122;s general physical and neurological status is needed.

As the babies grow, they get exposed to new environment, food and microbes like bacteria and viruses. They develop immunity by developing repeated infections in throat and upper airway tract. During this time, they are more prone to acute or chronic middle ear infections. Otitis media with effusion (OME), a chronic disease in which fluid collects in middle ear, usually causes mild hearing loss and is the commonest cause of hearing loss in child hood. Repeated acute infection can also lead to chronic middle ear disease with hole in the eardrum and longterm hearing loss.

Identification of hearing loss Hearing loss in older children may be more obvious, if they

Role of universal screening of hearing loss Early detection and rehabilitation provides a hearing impaired child the best possible outcome in terms of speech and language development. A timeline for identification to management of hearing loss is referred as 1-3-6 rule, which means, screening test by 1 month, diagnostic test by 3 months and intervention by 6 months of age. It is advisable to screen all the newborns for hearing loss due to the fact itâ&#x20AC;&#x2122;s a disability with high prevalence and nearly half of the children will not have any risk factors and may be missed if only high-risk babies alone are screened. This practice of universal hearing screening is implemented in most of the developed countries and being widely introduced in developing countries like India. The development and availability of objective hearing tests using otoacoustic emissions (OAE) and /or brain stem evoked response audiometry (BERA) play a significant role in universal screening. These screening tests are usually automated, reliable, fast, noninvasive and can be easily performed by a healthcare worker.

Diagnostic tests Pure tone audiometry identifies the type and severity of hearing loss in children who are five years and above. Behav-

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ioral testing, including distraction testing and visual reinforcement audiometry, tests the hearing pathway from 6 months to 3 years of age. Conditioned and speech audiometry can be used to check children aged 2-3 years. Tympanometry is a reliable objective test to check the middle ear pressure. Otoacoustic Emission (OAE), Brain Stem evoked Response Audiometry (BERA) and Audiometric Steady State Response (ASSR) are the commonly used objective tests for hearing. OAE checks the hair cells in the inner ear whereas BERA checks the hearing pathway from inner ear to brain. Once the hearing loss is confirmed, the child needs to be evaluated for any other associated diseases. High resolution CT scan of the ear and MRI are done to assess the structure of the nerve and the anatomy of the related areas, which is needed for planning the management.

Management of hearing loss Various factors play a role in the management of a child with hearing loss. This includes the age of the child at the time of presentation, the cause and degree of hearing loss and associated disability. A child with hearing loss can have associated disability, which

may require assessment by general and developmental pediatrician, genetic, cardiac, craniofacial, ophthalmologic and orthopedics specialists. The ENT team involved will be ENT doctor, audiologist and speech therapist. The parents or the guardian takes a major role in the management of the child. Caring for a child with severe to profound and permanent hearing loss is a team effort. Hearing aids are electronic or battery operated devices that will amplify sound and will be useful for children with severe hearing loss. However, children with profound hearing loss, will need cochlear implant. Cochlear implant, also called bionic ear, converts sound signal to electrical signal and stimulate the inner ear directly. After amplification using hearing aid or cochlear implant, the child receives speech therapy, which assists the child in speech and language development.

Conclusion Hearing loss is one of the commonest disabilities, affecting newborns. It can go unnoticed, as it is an invisible Various factors play a role in the manadisability. Early detection and gement of a child with hearing loss. This management of hearing loss play a crucial role in the includes the age of the child at the time speech & language developof presentation, the cause and degree of ment and optimal performance of a child in school and hearing loss and associated disability. society.

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Health Tips

GOOD ENT HABITS Dr. C.S. Satheesh Kumar, Sr. Vice President-Supply Chain, Agappe Diagnostics Ltd., (Retd. Drugs Controller, Kerala)

Ear, nose and throat (ENT) are very prominent parts of human body and the medical side of these organs is known under the heading Otolaryngology. Actually, Otolaryngology and Head & Neck Surgery is the full name of the division. ENT surgeons treat the complications of ear, nose and throat. Ear, nose and throat are all interconnected anatomically and any disturbances or imbalance in any one of them lead to the annoying headache and total discomfort that can disturb our normal activities.

There are quite a lot of health tips for the ideal health condition of these parts in toto.

NOSE: Unhealthy practices will have a very heavy impact on your nostrils and subsequently, your sinus. Learning how to take care of your nose can help you enjoy a pain

free, symptom free, lifelong experience of some of the world’s most tantalizing smells. Your nose and sinuses are intimately connected and helping to improve your nose health will help you to improve sinus health. The nose serves two purposes. It provides an avenue for smelling which increases pleasure, warns against danger and helps to improve the quality of life. It also serves as an airway into the lungs. A healthy nose will help filter particles from the airway much better than an unhealthy nose. Fol lowing simple tips can be effective for preventing such disturbances in the nose: 1. Clean your nose regularly Salt water is effective for cleaning and washing your nostrils. There is a unique ‘Nasyam’ procedure in Ayurveda with lukewarm saline water using a special vessel as well as using nasal drops. Nasyam procedure is varying from mild to severe process and accordingly you have relief from the sinus related blocks. 2. Avoid dusty rooms - Dust can trigger allergies and an itchy sensation in the nose. 3. Avoid cigarette smoke Exposure to cigarette may lead

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when it is bleeding. If the bleeding does not stop within twenty minutes or if the nose may have been broken, medical attention is necessary. 11. Sinusitis-An infection in the sinuses is referred to as sinusitis. Usually, sinusitis starts with a cold or allergies, which cause an increase in mucous production. Sometimes, these may also cause the mucous membranes to swell and cause the mucous to build up and get trapped in the sinuses. Many a time, this lets bacteria grow in the sinuses.

to the accumulation of mucus in the respiratory channel. 4. Avoid allergens - Allergies can cause uncomfortable symptoms like a runny nose or nostril congestion and so it is important to know your allergens in order to avoid them. 5. Avoid carpets - While carpets can make a room cosy and comfortable, they often trap dusts or pet hair, which may cause allergies. 6. As much as possible, limit your contact with folks who have been infected with influenza. 7. Wash your hands - Don’t rub your nose with a dirty hand because it may allow germs, bacteria and viruses to be transmitted into your body. 8. Take care of your nose when flying - You can use irrigator or mucus removal tool to protect your nose from being infected with the bacteria contained in the dry air in the aircraft. 9. Sticking objects, including fingers, into your nose is dangerous. While you may have been able to get away with it all of your life, slicing your nasal membranes with an object or a fingernail can lead to infection. Infections in the nasal cavity are hard to treat. It’s just better to prevent anything from traveling up your nostrils that isn’t supposed to be there. 10. Nosebleeds - Most nosebleeds aren’t considered serious and are usually caused by some sort of trauma. They can originate in the front or the back of the nose. A cold compress or ice pack may also be applied but the nose should never be picked or blown

EAR: Hearing is a sense that many of us take for granted. Throughout our lives, we subject our ears to loud speakers, head phones, music, power tools and air travel – without using ear protection. Regrettably, this can cause hearing loss. Also, the natural aging process generally results in hearing loss. Even certain illnesses and medications can adversely affect our hearing. Unfortunately, hearing loss that occurs from such causes is permanent. 1. Limit the use of earphones to prevent hearing problem. 2. When attending a party, don’t stay too close to the speakers. 3. Only clean the outer and inner of your ears very carefully. 4. Doctors advise people not to use earplugs when swimming, because it can lead to problems with ear canals. 5. Take a good care of your earrings - Use a cotton bud soaked in alcohol to clean your earrings to prevent infections. 6. In an airplane - Chew, yawn or swallow when your plane is landing because landing may cause different pressures between the air inside and outside the ears, which may lead to a problem called barotitis.

Take care of your nose when flying You can use irrigator or mucus removal tool to protect your nose from being infected with the bacteria contained in the dry air in the aircraft.

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Health Tips concert at 110 dB is 32 times louder than a normal conversation at 60 dB. THROAT

Know how loud is too loud: Sound is measured in units called decibels. As the decibel level increases, the intensity of the sound increases along with the risk of hearing injury. Here’s a list of sounds with their corresponding decibel levels. Note that any sound above 85 decibels can potentially damage your hearing with prolonged exposure. 7. Use earplugs or earmuffs if you work in a place with loud noises. 8. Keep your ears dry. 9. Wear a helmet when you ride a bike or any similar exercise. The shock on the ear due to falling when riding or exercising can lead to hearing loss. 10. Don’t let any foreign object into your ear canals - Even if your ear is itchy, don’t scratch it with a foreign object because it will risk a rupture to the eardrum. 11. If you experience pain in the ear or hearing problem, consult with your doctor immediately. 12. When you watch a movie or listen to the music, keep the volume down. 13. Seek medical attention if you have pain, difficulty hearing, discharge from the ear, ringing or buzzing sound, loss of balance etc. 14. Otitis Media (middle ear infection is the most common ear problem that affects young children, though adults are not immune to it. This happens when the eustachian tube becomes inflamed from something such as a common cold, sinus infection or allergies and causes an infection by either a virus or bacteria. An infection of this nature can cause the eardrum to become inflamed, which may result in the buildup of pus or fluid behind the eardrum. 15. Know how loud is too loud: Sound is measured in units called decibels. As the decibel level increases, the intensity of the sound increases along with the risk of hearing injury. Here’s a list of sounds with their corresponding decibel levels. Note that any sound above 85 decibels can potentially damage your hearing with prolonged exposure. Normal conversation – 60 dB; City traffic – 85 dB; motorcycle – 100 dB; Music player at maximum volume – 100+ dB;12-Gauge Shotgun Blast – 165 dB; Remember that with the decibel scale, a 10 dB increase is perceived by the human ear as being two times as loud. This means that a rock

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1. Avoid allergens - Dry throat is a symptom of the allergies to dust, pet hair or pollens. 2. Avoid highly polluted areas - Air pollution can lead to cough and sore throat. Use a mask to avoid dusty air and the smog emitted by motor vehicles and factories. 3. According to Healthline, the antibacterial nature of honey can soothe a sore throat. 4. As a rule, gargling saline water can kill the bacteria in the throat. 5. Drink enough water - You can protect your throat from irritation by drinking enough liquid and make sure your body gets eight glasses of water every day. 6. Don’t smoke - Avoid active as well as passive smoking because it is always bad for your health. 7. Keep your mouth clean - Clean teeth and mouth are important for a healthy throat. So, brush your teeth often. 8. Avoid cold water or chilled drinks as far as possible. Have a good woollen covering when you are exposed to chillness. 9. One source of infection that is overlooked by most people is the toothbrush. Left overnight, it can be a potential source of problem for the throat and mouth. Every morning, before brushing the teeth, soak your toothbrush in a glass of hot salt water (a teaspoon will suffice). 10. Gargle every night with a mixture of warm water and salt. Just a pinch of salt will do. During cold and flu season, this is a habit that will help to disinfect the mouth and throat. A sore throat can be eased by drinking a mixture of honey and lemon. Tea with honey and lemon added may also help. 11. One of the very best ways to protect the throat is with ginger juice and honey. After a good brush in the morning, squeeze a little fresh ginger juice (3-4 ml) with 5 ml of honey and have it. 12. Stay Hydrated. 13. Watch your diet. Avoid foods that could contribute to acid reflux such as coffee, spicy foods and citrus fruits. Also very important, don’t eat late at night and limit the amount of alcohol you drink. 14. Garlic contains something called allicin and can be used as a natural antibiotic. It does not kill the helpful bacteria in our bodies that we need to naturally fight infection like prescription antibiotics do. Sucking on a slice of garlic for about 15 minutes will help ease throat infection. Those who care their ENT with proper healthy habits will face rare infections of throat, nose and ear. Prevention is always better than cure.


Cover Story Good Laboratory Practices

Standard Operating Procedure for Biochemistry Testing... Sanjaymon K.R., General Manager - Business Development, Agappe Diagnostics Ltd. With an increase in the awareness of tests and their results, both clinicians and patients are now looking for clinical laboratories having at least one Quality Certification to carry out the tests. This is one of the reasons for an increase in the number of hospitals and laboratories participating in quality audits such as ISO or NABL.

One of the reasons for improper results in the laboratories is

the inconsistency in the procedure. This may be due to improper communication between the workers, improper training or lack of proper documentation.

An SOP is a document which describes the step by step procedure to carry out routine processes by the workers. An SOP is made to assure that the process is uniform at all times to have better work efficiency and quality results.

The best way to reduce such errors is proper documentation of the procedure where comes the importance of Standard Operating Procedure (SOP).

Even though the reagent or equipment manufacturers provide kit inserts or user manual for performing the tests, it is always useful to have an SOP made by the user in simple

The best way to reduce such errors is proper documentation of the procedure where comes the impor tance of Standard Operating Procedure (SOP).

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Cover Story Good Laboratory Practices language to have a better clarity. An SOP can be a flow chart or stepâ&#x20AC;&#x201C;by-step procedure.

Care should be taken while preparing the reference range since the same analyte can be expressed in two different units and can be detected using different methods where there may be a difference in the reference interval. Always refer the kit inserts while making the reference range.

A typical SOP in biochemistry should have the following headers: 1.

Purpose

a.

It describes the parameter to be analysed by the procedure ( Eg. measuring Hba1c)

2.

Scope

a.

Scope descibes who all are covered under these tests ( Eg. All patients who are to undergo HbA1c estimation)

3.

Responsibility

a.

This describes the person responsible for performing and validating the test (Eg: Laboratory technician/Biochemist)

4.

Abrreviations

a.

Any abbreviations used in the SOP ( Eg: IQC â&#x20AC;&#x201C; Internal uality Control )

5.

Principle

a.

This describes the principle of the test which includes the major reactive components in the reagent and their reactions with the analyte in the sample, the end product formed and how the measuremnet of final reaction mixture is made.

6.

Sample type

a.

This descibes the type of samples to be used like serum,

plasma or heparinised blood. In case any special care needs to be taken while collecting/ transporting / storing the sample, it has to be mentioned in detail. This also includes a brief description of the sample collection. 7.

Additives used

a.

If any additive is required to stabilize the analyte, it has to be mentioned in detail.

8.

Equipments & Reagents used

a.

This part describes the instrumnets & reagents to be used for performing the test.

9.

Calibration

a.

This part describes the calibrator to be used, the calibration type, any special precautions and also the calibration frequency . 10. Procedure

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a.

This is the most crucial part of an SOP. This part describes the stepby-step procedure for performing the test.

b.

If any reagent prepa ration is required (working reagent) it has to mentioned in details.

c.

If any sample pretreatment (pre-dilution/additives) is required, it has be mentioned in details.

d.

Reagent to sample ratio, reaction time and reading time.

e.

In case of automa ted instruments, the procedure should include how


to programme/load the new reagent in the system. 11. Quality Control a.

This part defines the approved criteria by the laboratory for performing the IQC or EQAS and the validation process.

12. Interference a.

This part mentions the interfering substances and their concentartion limits in the sample which may lead to inconclusive or false results.

13. Calculation of results a.

In case of manual tests, the entire calculation process needs to be given in detail. 14. Reference Range a.

This refers to the biological reference range.

b.

Care should be taken while preparing the reference range since the same analyte can be expressed in two different units and can be detected using different methods where there may be a difference in the reference interval. Always refer the kit inserts while making the reference range.

15. Linearity Range a.

This is one of the crucial parts where both the lower and upper limit of detection of the analyte with the current procedure needs to be mentioned. In case the results fall either below or above the range , the steps to be taken for assuring the accuracy of the result needs to mentioned in detail.

16. Alert a.

17. Safety Precautions a.

This describes the safety precautions as per the GLP.

b.

In case any additional safety precaution is required other than the routine , it has to be mentioned in detail.

18. Limitations a.

This refers to the limitation of the test mailny due to preanalytical varibles like improper transportaion of sample.

19. Reference a.

The SOP made should be reviewed and discussed between the workers before implementation. This is to make sure that the SOP made is simple, easy to understand and well describes all the points.

If the anlyte comes under critical parameter, laboratory should mention the panic value range.

Laboratory needs to mention the reference of texts, kit inserts or user manual based on which the SOP is made.

The SOP made should be reviewed and discussed between the workers before implementation. This is to make sure that the SOP made is simple, easy to understand and well describes all the points. The approved SOP should be easily available for the workers and the best way is to keep a copy near to the work bench which is easily accessible to the workers, if required. SOPs need to be reviewed periodically to make sure that any change in the system or procedure is incorporated properly. It has been observed that nonconfirmities arise mainly when the procedure deviates from the SOP. Laboratories should make sure that the SOPs are followed properly so that the quality of results can be assured at all times.

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Brand Reach Customer Speaks

1

100% Satisfaction with Agappe Pr oduct Product Ms. Rachana, Lab-in-Charge, Malabar Multispecialty Hospital, Calicut.

2

We are using Mispa i3 of Agappe Diagnostics for the past several years and we are 100% satisfied with the accurate and precise results in protein parameters. Agappe’s service, support and turnaround time are also quite appreciable.

Highly RRecommendable ecommendable Pr oducts Products I have been using Agappe AGA1c for the last one year. I run AGA1c in the semi-automated analyzer and I am 100% happy about the results. The after-sales support we are experiencing from them is also appreciable. I do recommend AGA1c brand to my friends and colleagues in the IVD industry. All the best to the Agappe team.

Dr. Semsing Signar MD, Hills Diagnostic Centre, Karbi Anglong, Assam

Accurate Results, Always Dr. Akbar Lirani MD, Medipath Pathology, Raipur

4

I have been using Agappe AGA1c for the last 3 years and run AGA1c in both the semi-automated & fully- automated analyzers. The results I get are always accurate. I’m also using C3, C4, Ceruloplasmin in the semi automatic. Agappe offers appreciable after-sales support also. I would delightfully recommend Agappe products to my peers in the IVD segment.

Excellent Quality Pr oduct & RReagents eagents Product We are using Agappe’s Mispa Nano – Fully automated Analyzer. We also use Agappe’s reagents, which give accurate & precise results. We are satisfied with the equipment as well as reagents, specially AGA1c. I would say quality is excellent.

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Dr. Anjali Mahindru, Sigma Diagnostic Lab, Jalandhar


Long-term and Cor dial RRelation elation with Agappe Cordial Sr. Jyothsana,

Lourdes Hospital, Ernakulam

6

We are proud to say that we are using Agappe reagents for the last 20 years. We are very much satisfied with the results. Agappeâ&#x20AC;&#x2122;s AGA1c is the best HBA1c available in the market. We are expecting more & more innovative products from Agappe.

Very TTrustwor rustwor thy Pr oduct rustworthy Product Few months back, I have purchased Agappe Mispa Count (Cell Counter) and the equipment is very compact & user-friendly. The results were accurate and I have no complaints till date. I trust Agappe & Mispa Count for the accurate test results.

Dr. Renjith Thomas, Thomas Clinic, Paravur, Ernakulam

7

Perfect and Pr ecise RResults esults Precise Dr. Nayyar Khan MD, Wellcare Diagnostic Clinic, Thane

8

5

We are using Mispa i3 of Agappe, a much needed analyzer for labs and hospitals focusing on result accuracy of proteins at all measuring ranges, especially the parameters like CRP & RF.

Commendable Pr oduct, PPerformance erformance Product, and Pr ompt Service Prompt I am using Mispa Ace, the fully automated biochemistry analyser from Agappe Diagnostics Ltd. since one year. The performance of the machine is excellent for all parameters and also the service is excellent.

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Afsana Hakim, Lab-in-Charge, Glow Vision Diagnostic Center, Pune

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Brand Reach Customer Speaks

9

Highly Satisfactory PPerformance erformance Mrs. Joby Saju, Lab-in-Charge, SUT Royal Preventive Clinic, Thiruvananthapuram

10

Agappe Diagnostics Ltd. supplied us a Fully Automated Biochemistry Analyser, model Mispa Ace. The equipment was installed, commissioned and handed over to us on 15.06.2016 and since then, the equipment has been working at par with our entire satisfaction.

Simple to Use and Pr ecise Precise I’m glad I decided to work with this equipment, Mispa Ace. It’s really great to know this product and the software is easy to manage. The QC results are very accurate and the way QC summary is shown is very clear to understand. It’s so simple. Thanks Agappe.

Mr. Prakash Pinto, HOD-Laboratory, Colaco Hospital, Mangalore

Gr eat Experience and Satisfaction Great Chiranjib Das Gupta, Lab-in-Charge, North Tripura Clinic, Rajbari, Dharmanagar

12

I am delighted to announce that I am using Mispa Ace since last 6 months and it was a great experience with this machine. I am very much satisfied using this machine.

Accurate RResults esults in a Shor urnar ound TTime ime Shortt TTurnar urnaround We have been using Mispa Revo for a little over two years now. It has been a delight to use this analyser as it gives accurate results in a short turnaround time. The service provided by Agappe is also commendable.

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Mr. Jayakrishnan S, QC Head, SK Hospital, Sasthamangalam


Exemplary RResults esults and After -sales After-sales Support Mr. Dayanandan K, Lab-in-charge, Tely Medical Centre Ltd., Thalaserry

14

I have been using Mispa Revo Immunofluorescence analyser for last two years. The equipment is quite user-friendly and compact. I’m more than happy with the results, reagent stability and after-sales support Agappe has provided.

User-friendly and Compact Product Recently we purchased Mispa Count, Hematology analyzer from Agappe. Mispa Count is a very cute userfriendly analyzer. Test results are even comparable with 5 part analyzer. All the best to the Agappe Team.

Dr. Vimohan Kumar, Gayatri X-Ray and Pathology Centre, Muzaffarpur

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‘Wonderful and trustworthy’ Dr. Jagadish Domaria, Pooja Pathology Laboratory, Bhavnagar

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We used HbA1c Pack size 2x15/2x5, 4x.5/2 x 63 ml for the last two years. I am satisfied with all the report that comes with Agappe Brand HbA1c. We found that it is 98% better than any other brands. Thanks to Agappe for bringing such a wonderful products.

‘V ery satisfactory rresults esults fr om Agappe ‘Very from pr oducts’ 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.

TECHAGAPPE

Dr. Vikas K Mand lecha, Chief Pathologist, Shraddha Pathology Laboratory, Ahmedabad

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Engagements Exhibitions & Conferences

Team Agappe in attendance at AMERICAN ASSOCIATION FOR CLINICAL CHEMISTRY (AACC) 2017 on 1st – 3rd August 2017, Stall No. 1105, San Diego Convention Center, San Diego, CA.

Team Agappe in attendance at MEDLAB EUROPE 2017 on 13th – 15th August 2017, Stall No. 2E29, Fira BarcelonaGran Via, Barcelona, Spain, East Entrance - Hall 2.

MORE PLACES TO KNOW ABOUT US MEDICA 2017 13th to 16th November 2017 at Exhibition Centre, Dusseldorf, Germany Agappe’s stal l at Hal l : 18/E17

Medica is the world’s largest medical mar-

ketplace, annually organised in November in Düsseldorf. It attracts more than132,000 trade visitors from 120 countries, and 53% of these visitors are from countries outside of Europe. In all, 4,618 exhibitors from 66 countries make the trade fair more sociable. The total area of exhibition is approximately 116,000 m2. Exhibitors are from diverse arenas like Electromedicine/Medical Technology, Laboratory Equipment, Diagnostics, Physiotherapy/Orthopaedic Technology, Commodities and Consumer Goods, Information and Communication Technology, and Medical Services and Publications.

AMBICON 2017 15th -19th , November 2017, Lalita Mahal Palace Hotel, Mysuru. Agappe’s Stal l Nos. 12, 13 & 27. 25th Annual Conference of the Association of Medical Biochemists of India, this

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year, is being hosted in Mysuru from the 15th to the 19th November. The theme for this conference is up-coming youth brigade. Medical Biochemistry has made tremendous progress over the years and hope that medical professional’s participation would inspire all to update and advance Knowledge. The conference is committed to put up an educational program which would highlight the recent advances in the field of Medical Biochemistry.

APCON 2017 7th -10th December at Gandhi Medical Col lege, Bhopal. Agappe’s Stal l Nos. 37, 38, 59 & 60.

The 66th Annual Conference of the Indian Association of Pathologists and Microbiologists (IAPM) and the Annual Conference of the International Academy of PathologyIndian Division (IAPID) in Bhopal is where the Pathology community of India prepares for the changing times. The plenary sessions by leading national & international faculty will discuss the most recent advances in the field. There will be a special general body meeting of the IAPM

OCTOBER-DECEMBER 2017

to discuss revamping of the organization. There will be discussions on restructuring Pathology education. There will be simultaneous CME programs showcasing what is new and trending in every branch of Pathology.

ACBICON 2017 3rd-6th December at Scientific Convention Centre, King George’s Medical University, Luknow. Agappe’s Stal l Nos. 1, 2 & 3

44th Annual Conference of Association of

Clinical Biochemists of India (ACBICON 2017) to be held in Lucknow from December 3rd to 6th 2017 hosting by King George’s Medical University, Lucknow. ACBICON 2017 presents an amalgam of the latest trends in keeping with the longstanding tradition of presenting science of the highest caliber through a feast of scientific sessions, workshops and symposia. It ensures that the deliberations during the conference will serve all an integrated approach in advanced teaching as well as research and aid a better laboratory practice.


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SPECIAL DAYS 1 : International Day of Elderly 2 : World Cerebral Palsy 3 : World Habitat Day 4 : World animal Welfare Day 9 : World Sight Day 10: World Mental Health Day 12: World Arthritis Day 17: World Trauma Day 20: World Osteoporosis Day 21: World Iodine Day 24: UN Day 24: World Polio Day 26: World Obesity Day 29: World Stroke Day

SPECIAL DAYS 2 : World Pneumonia Day 8 : International Day of Radiololgy 10: World Immunization Day 14: World Diabetes Day 17: World Prematurity Day 17: National Epilepsy Day 18: World Leprosy Day 19: World COPD Day

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* Toll Free No: 1800 425 7151

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.

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MISPA ACE

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Moments

Awards

Managing Director, Mr. Thomas John has been awarded with the “Emerging Entrepreneur of the Year 2016” Award by Dhanam Business Magazine during the “Dhanam Business Summit & Award Nite 2017” held at LeMeridien, Kochi on 28th July 2017. The selection was made by a Judging Committee consisting of eminent personalities like Mr.Venugopal C Govind, eminent financial consultant (Chairman); Mr. C.J. George, Managing Director, Geojit Financial Services; Dr. V.A. Joseph, former MD & CEO, the South Indian Bank; Mr.V.K. Mathews, Founder & Executive Chairman, IBS Group and Mr. M.K. Das, former Editor, Indian Express.

Dhanam business magazine was launched in 1987 and is one of the most circulated business and investment periodical in Malayalam Language. With a circulation of more than 1 lakh copies and a commanding readership of 5 lakhs, Dhanam has established its supremacy among the economic thinkers in Kerala. The function was attended by an invited audience of over 500 consisting of Kerala’s who is who in the business and professional world. Mr. Kochouseph Chittilappilly, Chairman of V-Guard Industries Limited and Vice Chairman for Wonder La Holidays Ltd., presented the Award to Mr. Thomas John during the grand event.

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.

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OCTOBER-DECEMBER 2017


Medical Quiz 1) Ear is the organ for ….. a) Balance b) Hearing c) Converting vibration d) All the above 2) When we breathe air passes through ……. a) Pharynx b) Larynx c) Tracheas

d) All the above

3) Obstructive Sleep Apnea leads to …….. a) Snoring b) Nephritis c) Retinopathy d) All the above 4) Senses of taste and smel l are closely linked to …….. a) Sensory receptors b) Olfactory nerve c) Taste buds d) All the above

Otorhinolaryngology

5) Inventor of first wearable hearing aid ……..

Quiz

a) Hutchison MR b) Wilson J c) Dr. Jaison d) None 6) What is Strep Throat? a) Viral Infection b) Fungus infection c) Bacterial infection d) All the above 7) Streptococcus infection can be quantified by……….. a) CRP test b) ESR c) ASO test d) None of these

8) Uncontrol led Streptococcus infection causes serious complications like …… a) Rheumatic fever b) Glomerular nephritis

c) Sepsis d) All the above

9) Complimentary Parameter Creatinine + Cystatin c is an early indicator of ……… a) Rheumatic fever b) Glomerular nephritis 10)

c) Sepsis d) All the above

Sepsis and the stages of infection can be diagnosed early with ………

a) ESR

b) CRP

c) PCT

d) CBC

Quiz Answers of July-September Edition

Winners will get their prize by post

1-b, 2-c, 3-a, 4-d, 5-b, 6-c, 7-d, 8-a, 9-d, 10-b Quiz Winners of July-September Edition Kanika Shankara Narayanan Iyer, Ahmedabad | MS. Suchita Naik, Goa | Anu Kochumon, Principal, Kayamkulam | Christal Jancy | Mr. Anoop M.A, New Del hi | Ritu Sinhal, Siliguri | Muraleedharan Nair, Trivandrum | Dr. Johnny K K, Washim | Dr.Siva Somana, Thoothukudi | Dr. Sandeep Singh Jadon, Gwalior | Kavita Malhotra, Chandigarh | Dr. Biswajit Batabyal, Kolkata.

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

OCTOBER-DECEMBER 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

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Life Stories Good Laboratory Practices

OCTOBER-DECEMBER 2017

Health Tips Interviews


Healthy Living with AgA1c testing once in a month

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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

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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.

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Techagappe 13th edition (october december 2017) ebook  

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

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