Techagappe 24th Edition (July-September 2020) Ebook by Techagappe

Vol.5 Issue 4

JULY - SEPTEMBER 2020

THE DIAGNOSTICS NEWS JOURNAL

Published at Agappe Diagnostics Limited on July 01, 2020 | 62 Pages | ` 20

IN THE FOREFRONT OF COVID - 19 BATTLE WITH UNIQUE DIAGNOSTIC PRODUCTS Mr. Thomas John

COVID - 19: CLINICAL MANIFESTATIONS AND LABORATORY DIAGNOSIS Prof. Dr. D M Vasudevan

AGAPPE CHITRA MAGNA A PATH BREAKING SOLUTION Dr. Anoop Kumar Thekkuveettil

RT-PCR IN THE DIAGNOSIS OF COVID - 19 Dr. Kannan Vaidyanathan

ROLE OF CBC PARAMETERS DURING COVID - 19 PANDEMIC Dr. Vijay Parekh

MEDIVISION IN TOP GEAR TO FIGHT COVID - 19 Mr. Bibu B Punnooran

COVID - 19 EXPLORING MUST KNOW FACTS ABOUT CORONAVIRUS DISEASE 2019

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CONTENTS ○

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Volume 5 | Issue 4 | July-September 2020 ○

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The Invisible Assassin

12-15 The Covid-19: Clinical Manifestations & Laboratory Diagnosis 16-19 The amazing success of ‘Kerala Model’ in the battle against Covid-19 20-23 Agappe Chitra Magna- A path breaking solution for Covid-19 diagnosis

08-11

AGAPPE IN THE FOREFRONT OF COVID-19 BATTLE WITH UNIQUE DIAGNOSTIC PRODUCTS

40-43 Role of CBC parameters during Covid-19 pandemic 48-50 Some essential health tips 51-51 Brand reach - Customer speaks

30-33

TRAUMATIC DAYS OF A HEALTH WORKER WHO TURNED COVID-19 POSITIVE

26-29 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in the Diagnosis of Covid-19 36-38 Medivision-In top gear to fight Covid-19

52-53

COVID-19: RNA Extraction Protocol

Bravehearts of Agappe

44-47

THE MOVING STORY OF A TRIO WHO FOUGHT COVID-19 IN AN ALIEN LAND

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

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THE DIAGNOSTICS NEWS JOURNAL

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edition of TechAgappe. During the last 6 years of its existence, I am happy to report that this magazine is being regularly published every 3 months. As the whole world is passing through the dreaded pandemic, it is appropriate that this edition projects Covid-19 disease. We have included three medical articles, three live stories, two interviews with eminent personalities, one technical article and a few health tips. th

In the first article the MD explains the new products released from Agappe, aimed to serve the world in managing Covid-19 pandemic.

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

I am proud to bring out this 24

In the medical articles section, we have included three articles on Covid 19. The first one is from my desk, giving an overview on Covid-19 clinical manifestations as well as the characteristics of Corona virus. The second article is from Dr. Kannan regarding the different laboratory tests available to detect the virus infection. The third article is a review by Dr. Vijay Parekh about the importance of CBC testing for the diagnosis of Covid-19. In the life story session, the first one is on the “Kerala Model”, dealing with the successful initiatives of the Govt. of Kerala in managing Covid-19 infections in Kerala. The second story is about a health inspector in Kerala who explains his own experience when he was diagnosed as a Covid-19 patient. The third story is from UAE where Indians are facing many issues during this pandemic. It is a humane story of a group of friends who were affected with Covid-19 and survived after a prolonged battle. In addition, we have included two interviews to share their contributions to the battle against Covid-19. The first interview is with Dr. Anoop from Sri Chitra Thirunal Institute of Medical Sciences, Thiruvananthapuram, who invented the Agappe Chitra Magna RNA isolation kit, in collaboration with Agappe Diagnostics. The Second interview is with Mr. Bibu, the director of Medivision, Kochi who has been serving the society for the past many years. We have included one article, discussing the technical aspects of the RNA Isolation Kit, recently introduced by Agappe.

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MANAGING DIRECTOR Thomas John

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CHAIRMAN Prof. M.Y. Yohannan

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BOARD OF DIRECTORS

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PHOTOGRAPHY Nelson Thomas

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

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PUBLISHING COORDINATOR Jayesh Kumar

EXPLORING THE PANDEMIC COVID-19...

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LEGAL ADVISORY BOARD Adv. Denu Joseph

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EDITORIAL ADVISORY BOARD Dr. C S Satheesh Kumar Abraham K C Varghese George Sanjaymon K R Sankar T S Bintu Lijo

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CONSULTING EDITOR Saj Mathews

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CHIEF EDITOR Prof. Dr. D M Vasudevan

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EDITOR Meena Thomas

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EDITORIAL BOARD

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Volume 5 | Issue 4| July - September 2020 ○

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

Last few months witnessed the lock down of the whole country. During these months of confusion, we could not distribute our last issue on a personal basis. However, I am glad to state that the online readers have increased in number. I am also pleasantly surprised to see that we have received very good feed backs and great appreciation letters for the previous issue, which covered “infertility”. I personally thank all the readers for their continued support. Your constructive criticisms to improve the contents will be greatly appreciated.

Dr. D.M. Vasudevan

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VOICE OF READERS with the laboratory friendly articles as well as helping professional teaching. Very quality content in the session “Good Laboratory Practices”. Do continue same spirit and enthusiasm.

THE TOPICS COVERED ARE CONTEMPORARY The latest issue of Techagappe (January-March 2020) based on Arthritis has given me a lot of insight into osteo and auto immune arthritis. Your way of presentation and especially the discipline in keeping very useful medical articles with substantiable stories are very appreciable. The topics covered are contemporary which helps me to keep updated with latest medical info. Dr. P R Malur, Histopathologist, KLES City Diagnostic Laboratory, Belgavi

EXCELLING IN PUBLISHING VERY HUMANE BASED STORIES With all respect to the magazine, I would like to suggest some content which can be incorporated in the future editions. Since Techagappe magazine is getting published on specific cover stories, when it is comfortable to deal with, please consider the very important topics like virology, infectious diseases and auto immune disorders, the need of those topics are very prevailing in the current scenario. Your team is excelling in publishing very humane based stories and useful medical articles. Dr. M Kavya, Padma Clinic, Hyderabad.

EXCELLENT GOOD LABORATORY PRACTICES Good practice, nice approach

TECHAGAPPE

Bhupesh Rajan, Delta Q Labs, Cuddalore, Puducherry

EIGHT GOLDEN YEARS OF ASSOCIATION WITH AGAPPE We have been associated with Agappe since last 8 years and it had been wonderful journey with Agappe team. They have taken us as family and provided us with immense support and helped us in growing in every possible way. Agappe has an excellent support staff with excellent services with some of the finest instruments to fit in al l types of labs. I wish Agappe team all the best and success for all future endeav ours as their success is our success and vice versa. Dr. Yugam Chopra, Director, Kos Diagnostic Lab, Ambala Cantt.

HELPFUL FOR AYURVEDIC STUDENTS We are very much impressed with your magazine ‘Tech agappe’. Our ayurvedic students are very much eager to read its content. Through magazine is based on Allopathic medicines, the latest updates are clearly communicated in each and every edition which will be useful to approach diseases from Ayurvedic view. Life story sessions are quiet interesting. Great Job Done by Agappe team. Good Luck. Shreya Das,

Lecturer, Maria Ayurveda Medical Col lege, Kanyakumari.

PHYSIOLOGICAL BOOST TO THE DEPRESSED SUFFERERS We are highly thankful for having spread your most precious valuable information through Tech agappe journal. Every issue is placing more valuable details useful not only to the doctors, but also to the patients. Beside clinical advice, your journal is inculcating lot of encouragement and providing morale support to

PROUD TO BE AN ACTIVE READER AND REGULAR SUBSCRIBER Proud to be an active reader and regular subscriber for your esteemed magazine Techagappe. Very good job your team is doing. Nice to hear that Agappe is turned 25 and your history and expertise in the field of IVD would be written in golden letters. Wish all the very best to serve the mankind worldwide. Dr. A Jayarajan, Senior Consultant Physician, Dental Diagnostic Centre, Bangalore

JULY - SEPTEMBER 2020

those suffering from the ailments. The language being lucid and information being comprehensive, even a lay man can easily understand the information you are placing. The life story sessions are very impressive and provide physiological boost to the depressed sufferers. We would like to hear your opinion whether this type of treatment is at the reach of the common man. Ramana, Bless College of Nursing, Tirupati.

USEFUL TO PATHOLOGISTS AND CLINICIANS I am serving as professor of pathology at SCB medical college, Cuttack (Odisha) for last 3 years. I am also practicing at Zenith Life Care, Cuttack. I have been reading your publication which is very informative and useful to pathologists and clinicians. Requesting a copy to my personal address and I shall remain grateful. Prof. Dr. A. K. Das, Professor in Pathology, S.C.B. Medical college, Cuttack.

Cover Story

Poem on COVID-19

Thy appeared in Wuhan out of the blue, Thy pop in this world first time in human’s history, Storming on whole human beings without warnings, Are you just an alien from other worlds, thy name Covid? Are you the gift of cruel world who wants to murder for power? Like growing rodents, insects and all poisonous species ever? Are you genetically engineered by mankind for massacre ? Are you bioweapon developed with mal-intention? Or natural mutations from natural phenomenon? Separating states, countries in death & travel! Is it axiomatic balancing, when Adharma grows? U made reawakening in history with new paradigms. We took this a positive step forging unison & hope across, Medical fraternity as one team, to wipe you out from history. We learnt lessons of oneness with no barriers of religions or nations, Human community the only religion of the universe, the take home lessons. It’s time for introspection and realisation of insignificance of mankind.

Dr. Satheesh Kumar C.S Senior Vice President, Supply Chain Management, AGAPPE

Be with the nature, be with the mother earth, be with the humanity, Our Golden message “Loka Samasta Sukhino Bhavanthu” beware, Respect Nature, embrace gratitude to Almighty, above all.

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Agappe MD’s Desk

AGAPPE IN THE FOREFRONT OF COVID-19 BATTLE WITH UNIQUE DIAGNOSTIC PRODUCTS Thomas John, Managing Director, AGAPPE

The outbreak of the pandemic, Covid-19 has taken the world unawares. It has upset the entire global

healthcare system besides hitting the world economy quite hard. As the world is struggling to combat this dreadful virus, we at Agappe have mobilized all our resources to join the nation’s fight against this pandemic. As part of our endeavor to be the Best Partner in Diagnostics for the Welfare of Mankind, we have come out with a few unique diagnostic solutions in partnership with the prestigious Sree Chitra Tirunal Institute of Medical Science and Technology (SCTIMST), Thiruvananthapuram. These include the recently launched RNA isolation kit ‘Agappe Chitra Magna’, i-CheQ (Infra-Red Thermometer) and i-Clean (IPA based hand Sanitizer). At this critical juncture, we would like to affirm our commitment to be in the forefront of the nation’s battle against Covid-19.

he year 2020 will indeed be marked as a year of gloom in the history of mankind. The world is still grappling with the ongoing COVID-19 situation and we are in fact going through one of the worst times of the current century. The fight against the global pandemic, COVID-19, that has crippled our health care system and inflicted fear across the globe, has certainly added a grey chapter in our history. Most of the mitigation plans have been acted upon keeping the greater good in mind with a view to break the chain and stop the contagious pan India spread of COVID-19. It was imperative that we had to stay focused and doing our part in the fight against the dreadful virus. As aptly said by Martin Luther King, “We must accept finite disappointment but never lose infinite hope”. This has made us scramble in every possible direction to find an effective solution to fight the virus.

Rising up to the occasion Realizing the gravity of the situation, we rose to the occasion focusing on the task at hand and organized all our resources to direct our form of work to help in the nation’s effort to be in the front line of defense. We at Agappe had

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JULY - SEPTEMBER 2020

Thomas John

strictly complied with the decree passed by the Govt. of India for the nation-wide lock-down and the restrictions imposed to contain the spread of the virus. As Agappe Diagnostics Ltd fal ls under the commodities of essential goods and services, we had operated with a skeletal staff to carry out the basic operational functions needed at the hour. All our external operations were put on hold or suspended to safeguard our employees, customers, and distributors. Agappe in its endeavor to be the Best Partner In Diagnostic for The Welfare Of Mankind has been jointly working on a project in the field of Molecular Diagnostics with the Prestigious Sree Chitra Tirunal Institute of Medical Science and Technology (SCTIMST), Thiruvanantha puram, The Department of Science and Technology, Govt. of India, in developing a unique and novel method for virus detection. The Prof. Asha Kishore, Director-Sree Chitra Tirunal Institute for Medical Sciences & recent turn of events across the Technology and Thomas John, Managing Director, Agappe Diagnostics Ltd., globe has made us put this project unveiling AGAPPE CHITRA MAGNA during product commercialisation. on high priority and Agappe and SCTIMST spared no efforts in capitalizing all available resources Magna’ was held the 21st of May and Shri. Dr V.K. Saraswat, the expendable, to expedite this project in the battle against COVID- President of Sree Chitra Tirunal Institute for Medical Sciences 19. Our committed R&D team strived continuously working in and Technology and member of NitiAyog was kind enough to tandem with the teams from SCTIMST to leverage technology and formally launch the product on the occasion. to provide a solution for the grave problems that all of us as a The insightful felicitation address by Prof. Ashuthosh nation is facing. Sharma, the Secretary, DST added value to the function. Even though the whole nation was under lockdown we were Dr. Akhilesh Gupta, DST has also made it to be present on the able to secure the necessary permissions from the authorities to occasion. The event was organized at the SCTIMST campus continue our work in developing the products that was the need of Dr. Asha Kishore, Director SCTIMST, Dr. HK Varma, Head, BMT the hour. We have indigenously developed the RNA isolation kit, Agappe Chitra Magna with the know-how from SCTIMST and this product redefines the RNA extraction process with its innovative edge and ease of use. Apart from the Molecular Diagnostics platThe products developed had a definite form for COVID products, we were simultaneously searching for focus on the concept of “Make in other products to aid in better detection and prevent the spread of virus. The result of all our efforts was the successful launch of India” and we at Agappe were able i-CheQ (Infra-Red Thermometer) and i-Clean (IPA based hand Sanito stretch our legs to achieve this tizer) in the month of May last.

The Launch Ceremony The products developed had a definite focus on the concept of “Make in India” and we at Agappe were able to stretch our legs to achieve this feat. ‘Agappe Chitra Magna’ was the first among the diagnostic products to be conceived keeping in mind the current COVID-19 scenario. The commercial launch of ‘Agappe Chitra

feat. ‘Agappe Chitra Magna’ was the first among the diagnostic products to be conceived keeping in mind the current COVID-19 scenario.

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Agappe MD’s Desk wing SCT, Dr. Anoop kumar, Dr. Maya, Dr. Anugya, Mr. Muraleed haran, Mr. Balaram, Mr. Sandhya, Mr. Sarath, Dr. Nagesh and all other team members were present at the launch. The RNA isolation kit manufactured by Agappe Diagnostics Ltd. is the first indigenous kit based on magnetic nanoparticles- based extraction kit in the market and is different from the imported kits based on magnetic particle basedtechnologies. Internationally, only one or two companies (others merged) manufacture magnetic nanoparticlebased RNA extraction kits. The success of the launch at such short time is attributed to the working of the technical and commercial minds in sync with the needs of the masses. The result of this combined effort was an innovative process to concentrate the RNA at a place by applying a magnetic field creating a high sensitive. This kit has surpassed the existing kit in both efficiency and viability, bringing down the cost substantially. Dr Rajesh Pai, Medical Superintendent of Amrita Institute of Medical Sciences, Cochin and Dr. A. Velumani, the Chairman & Managing Director of Thyrocare Technologies Ltd, Mumbai were gracious enough to be a part of the function and received the first sales kit. The kit was approved by the Indian Council of Medical Research (ICMR), the nodal agency fighting against the pandemic in India, and its mass production was permitted by the Central Drugs Standard Control Organisation. With the advent of the ‘Agappe Chitra Magna’ RNA isolation Kit, Agappe gets a firm footing of national significance in our fight against the COVID 19 pandemic.

i-CheQ and i-Clean Taking into consideration of the requirement of mass screening and the factor of hygiene we have developed two more products that weigh in on these factors. We had planned these products in tune with the ideology of ‘Make in India’ to better serve our customers and make these products accessible by almost everyone. The COVID-19 screening plays a major part in reducing the transmission, and as a first line of screening temperature checks can be first level of diagnosis. However the market was flooded with directly imported units of IR Thermometer which proved to be expensive and not at par with the quality standards. Agappe turned its attention in addressing this problem and at our initiative we explored ways to manufacture this product so that it benefits the market. As a result we were able to manufacture i-CheQ, a truly ‘Made in India’ product that has done away with all the short comings of similar products available in the market. Priced at INR 1999+ taxes, the instrument had broken the affordability barrier that existed earlier and made the instrument available to all the small and medium sized institutions so that they can now check their clients with the first level of symptoms. We have also investigated the hygiene aspect and decided to roll out the IPA based Hand Sanitizer i-Clean 200 mL. Coupled

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I am glad to know that the development of RNA extraction has been done by Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum in association with Agappe Diagnostics Ltd. The strength of Agappe is great enough to reach the product at every nook and corner of the world. I wish Agappe Chitra Magna, the RNA extraction kit be the single largest selling product worldwide for the RNA extractions. Dr. Arokiaswamy Velumani Creator - Thyrocare Technologies Limited. together these products will be front line defense against COVID19 pandemic.

Ongoing Initiatives Agappe is currently engaged in developing and testing a novel method for virus detection in the field of Molecular Diagnostics in association with the renowned Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Department of Science and Technology, Govt. of India. This project is being taken up on a high priority and all available resources are now being leveraged to expedite this project to fight our battle against COVID-19.

The RNA isolation kit manufactured by Agappe Diagnostics Ltd. is the first indigenous kit based on magnetic nanopar ticles- based extraction kit in the market and is different from the impor ted kits based on magnetic particle basedtechnologies.

The product, aptly named ‘Agappe Chitra Gene LAMP-N’ is based on the Reverse Transcription Loop-mediated Isothermal Amplification (RT-LAMP), that allows the detection of Viral RNA. The LAMP technology carries the reaction at constant temperature unlike PCR (Polymerase chain reaction) testing and is a significant improvement from PCR as it is more economical and quicker with 100 percent matching of results as compared to PCR. This instrument holds the accolade of being able to provide confirmatory diagnostic test for N gene of SARS-CoV-2, which makes it, possibly, the first ever instrument to do so. The test kit is also capable to detect two regions of the gene which will ensure 100% accuracy as the test does not fail even if one region of the viral gene undergoes mutation. With 10 minutes for the gene detection and the total test time shortened to less than two hours the ‘Chitra Gene LAMP-N’ provides the quickest test result and further aids mass screening. Upon its completion, the ‘Agappe Chitra Gene LAMP-N’ will be our national pride and will be significantly instrumental in taking forward our nationwide fight against the novel COVID-19 virus. ‘Agappe Chitra Gene LAMP-N’ is undoubtedly a better diagnostic tool which is quicker, affordable and compact, and capable of delivering accurate results and providing much accessible screening for the masses, epitomizing the real meaning of Agappe, “The Divine Love”.

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Cover Story COVID-19 : An Overview

THE COVID-19

CLINICAL MANIFESTATIONS & Prof. Dr. D M Vasudevan,

LABORATORY DIAGNOSIS

MBBS, MD (Biochem), FRCPath, Technical Director, AGAPPE

In December 2019, a new disease, named as Covid-19 (abbreviation of Corona virus Disease 2019) emerged from Wuhan, China. It has been recognized as a pandemic by WHO, affecting almost all the countries of the world. The first case of the disease was reported in India from Kerala on 30 January 2020. This article presents an overview of this pandemic and discusses the various preventive measures and treatment procedures besides providing an update on the hectic efforts to find a vaccine for Covid-19

The Virology

The virus responsible for Covid-19 is named as SARS-CoV2 (Severe Acute Respiratory Syndrome Corona Virus-2). It is related to the severe acute respiratory syndrome (SARS-CoV-1) as well as the Midd le East respiratory syndrome (MERS). SARS-CoV-2 is an enveloped, single-stranded RNA virus. It

belongs to the Orthocoronavirinae subfamily, with the characteristic â&#x20AC;&#x153;crown-likeâ&#x20AC;? spikes on their surfaces. It is a zoonotic infection (transferred from animal to man). The natural reservoir is bat, while palm civet or snakes may be the intermediate host. There are two main strains, S and L types. Inside the envelope, there is the nucleocapsid, which is formed from multiple copies of the nucleocapsid (N) protein, which are bound to the singlestranded RNA genome. The spike glycoprotein (S protein) on the viral envelop binds to its receptor, angiotensin-converting enzyme 2 (ACE2), present on the surface of human cells. When virus enters the human cell, the virus starts to produce the new RNA and proteins, assemble into new virions, and come out of the host cell.

Transmission Method Most of the time, the disease spreads when a sick person coughs or sneezes. Some people having the virus may not have symptoms, but they can still spread the virus. Transmission of the virus can occur from touching a surface or object the virus is on, then touching the mouth or nose. Virus can live for several hours on a surface.

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Currently, there is no evidence of air-borne transmission. Viral RNAs could be found in nasal discharge, sputum, and rarely in blood. Incubation period (time between virus entry and clinical manifestation) is approximately 5–14 days.

Clinical Manifestations

Only about 10% will have severe symptoms which include high fever, cough, myalgia, fatigue,nausea and diarrhoea. In a few number of persons the disease may progress to shortness of breath and later to acute respiratory distress syndrome (ARDS) which may need mechanical ventilation. The mortality rate of hospitalized patients is 2%.

It should be emphasized that 60% of persons infected with the virus may remain without any clinical symptoms. The rest 40% may have some minor symptoms like sore throat, loss of smell, running nose etc. Only about 10% will have severe symptoms which include high fever, cough, myalgia, fatigue,nausea and diarrhoea. In a few number of persons the d isease may progress to shortness of breath and later to acute respiratory distress syndrome (ARDS) which may need mechanical ventilation. The mortality rate of hospitalized patients is 2%.

Immunology In some persons, the virus triggers the immune system to flood the bloodstream with inflammatory proteins cal led cytokines. The overproduction of cytokines is called cytokine storm which leads to eventual death. Such patients have substantially lower lymphocyte counts and higher plasma concentrations of inflammatory cytokines such as IL-6, IL-7, IL-10 and tumor necrosis factor (TNF).

Treatment Currently, there is no validated treatment for COVID-19. The main strategies are symptomatic and supportive care, maintaining oxygen saturation and treating complications, such as sec-

In some persons, the virus triggers the immune system to flood the bloodstream with inflammatory proteins called cytokines. The overproduction of cytokines is called cytokine storm which leads to eventual death.

ondary infections or organs failure. The following drugs are being used experimentally. 1. Remdesivir: The experimental drug is a novel nucleotide analogue. 2. Convalescent plasma(from recovered COVID-19 patients) 3. Antiviral drugs: lopinavir,ritonavir and ribavirin 4. Tocilizumab, a monoclonal antibody against the IL-6 receptor. 5. Baricitinib (Janus kinase inhibitor), 6. Anakinra (IL-1 receptor antagonist) 7. Hydroxychloroquine, which interferes with virus entry into cells. Therefore it is used as a preventive drug. 8. Vaccine: There is currently no vaccine available. The spike protein may serve as a vaccine candidate. More than 100 vaccine candidates are in various stages of development and testing. There are seven candidate vaccines undergoing clinical evaluation against Covid. The vaccine developed by the Oxford University is in the 2nd phase of clinical trial. Oxford University will hand over the technique to the Serum Institute of India, Pune, which has the world’s largest capacity for serum production. This vaccine is supposed to be available by September 2020.

Prevention The most important personal protective measures are 1) Wash hands often with soap and water or clean them with an alcohol-based sanitizer. 2) Practice social distancing. 3) Use masks to cover nose and mouth in public. Disinfectants effective against corona virus include steam, sodium hypochlorite (0.1%–0.5%), 70% ethyl alcohol, 50% isopropanol, 1%

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Cover Story COVID-19 : An Overview iodine, hydrogen peroxide (0.5%–7.0%), or 1:10 dilution of 5.25% household bleach for 10 minutes. For those who had history of travel from epidemic area in recent 14 days, quarantine is advised. The confirmed case should be isolated. For healthcare workers, personal protective equipment should be put on. Dead bodies should be burned or buried deep. The most likely persons who are going for serious illness are people over 65, which other complications such as heart disease, high blood pressure, lung disease, kidney disease, diabetes, liver disease and cancer. Therefore such persons should have “reverse quarantine”.

Laboratory Diagnosis

ryngeal swab, sputum, or lower respiratory tract aspirates. The swab should be placed in the transport medium and kept at 2-8o C. If the first laboratory report is negative but patients’ symptoms persist, a second sample should be examined 24 hours later in case of first negative to rule out initial false-negative result. In RT-PCR, the RNA of the virus is first made into DNA (reverse transcription), which then is amplified millions of times. This is then compared to the genetic sequence of the virus. The PCR test can confirm a diagnosis of Covid.Targets usually include the envelope (E) gene and RNA-dependent RNA polymerase (RdRp) gene of the virus. If the test identifies only one of these genes, then it is taken as an inconclusive result. Such tests should be repeated.

2. Serological Testing

Most RT-PCR tests can take 6-8 hours, are very labour intensive, with several stages at which errors may occur between sampling and analysis. False negatives can occur, meaning they are more useful for confirming the presence of an infection. As such, we now have an 80% specificity – i.e. the chance the test is detecting the virus.

a) Antibody, IgG and IgM b) Antigen testing

Lamp Test

RT-PCR stands for Reverse Transcriptase Polymerase Chain Reaction. For the RT-PCR test the specimen taken are nasopha-

This is a recently introduced test. The Reverse Transcription Loop-mediated Isothermal Amplification (RT-LAMP) carries the

Diagnostic laboratory tests to detect Covid-19 infection are the fol lowing 1. Molecular Testing a) RT-PCR b) LAMP

reaction at a constant temperature. In the PCR technology described above, the reaction is carried out with a series of alternating temperature steps or cycles. Whereas in LAMP, the amplification is carried out at a constant temperature, and does not require a thermal cycler. The RNA from the sample is extracted, which is then converted to DNA (reverse transcription). It is then amplified by LAMP technology. The test targets N gene of the virus (detects two regions of the gene) which will ensure 100% accuracy. The actual test takes only 10 minutes and the total test time shortened to about 1 hour. It is more economical also.

Serological Tests These tests can identify persons who were infected and have recovered. It will take one or two weeks for the antibodies to develop. By this time, the virus should have been cleared from the body. The presence of IgM antibodies indicates recent exposure to virus, while the presence of IgG antibodies indicates later-stage infection. IgG antibodies are against either the

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nucleocapsid or the spike protein or against both. Antibodies against the Receptor Binding Domain (RBD) on the spike protein are considered the main targets of virus neutralizing antibodies. Kits are available to detect both IgM and IgG antibodies against the virus present in human serum, plasma, or whole blood samples. Test will need only 10-15 minutes. Negative results do not rule out the infection, particularly in the early days of the infection. In such cases, repetition with molecular diagnostic test should be considered.

Other Biochemical Tests Biochemical monitoring of COVID-19 patients through in vitro diagnostic testing is critical for assessing disease severity and progression as well as monitoring therapeutic intervention. Routine laboratory data which will carry bad prognosis are lymphopenia, prolonged prothrombin time, elevated D-dimer, increased liver enzymes (alanine aminotransferase, aspartate aminotransferase), raised total bilirubin, high lactate dehydrogenase and increased creatinine. D-Dimer is increased because of the activation of blood coagulation and disseminated coagulopathy. Leukocytosis may occur if complicated with secondary bacterial infection.

C-Reactive Protein (CRP) Estimation of CRP has an important role in the monitoring in COVID-19 Patients. The worsening of the clinical condition is due to the “Cytokine Storm”, otherwise called the overreaction of the immune system. When any cell senses that there is something bad happening, the immediate response of the cell is to kill itself. It is a protective mechanism so virus does not spread to other cells. Cytokines trigger this cell death. This hyper-inflammation is characterized by increase in proinflammatory cytokines such as IL-2, IL-6, tumor necrosis factoralpha, and CRP. In the COVID-19 infection, the CRP levels were positively correlated with lung lesions and could reflect disease

Estimation of CRP has an important role in the monitoring in COVID-19 Patients. The worsening of the clinical condition is due to the “Cytokine Storm”, otherwise called the overreaction of the immune system. When any cell senses that there is something bad happening, the immediate response of the cell is to kill itself.

severity. The increase in CRP level parallels to the severity, and the clinician could predict the worsening 1 or 2 days earlier. The CRP is a pentameric protein, circulating concentrations of which will rise in response to any inflammation. It is an acutephase protein of hepatic origin. It increases fol lowing interleukin-6 secretion by macrophages and T cells. The CRP binds to phosphocholine on the damaged membranes of cells and to extrinsic ligands expressed by many micro organisms. It then activates the classical complement pathway. It is therefore considered as the first line of defense against invading organisms. CRP is a non specific marker of inflammation, but will not indicate the organ or organs affected. More recently, the identification of the importance of small, chronic elevations in CRP as a cardiovascular risk marker in apparently healthy individuals has led to the development of highly sensitive assays, commonly referred to as hsCRP. CRP is usually measured by immuno-turbidimetry assay or by nephelometric methods. Both turbid imetry and nephelometry techniques were developed about 5 decades ago. But nephelometry was not very popular because of the cost of the instrument, whereas turbidimetry was not very popular due to the lack of sensitivity, although having very good specificity. So, turbidimetry was used to determine proteins present in high concentrations in blood, while nephelometry was used to determine proteins present in lower concentrations. This required 2 different instruments, the cost of which could not be affordable by small laboratories. It is in this scenario that Agappe recently introduced the Mispa-i3, which combines both turbidimetry and nephelometry into one instrument. The cost reduction is such that the instrument is now affordable to any small laboratory. It is a cartridge based, automatic, specific protein analyzer which offers detection of 25 protein parameters, including CRP and hsCRP.

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Live Story Kerala Model

THE AMAZING SUCCESS STORY OF ‘KERALA MODEL’ IN THE BATTLE AGAINST COVID-19

The story of how the South Indian state of Kerala emerged as a role model in fighting the Covid-19 epidemic is amazing. It was the success story of a coordinated and determined anti-Corona campaign led by the state government with the unstinted support of the society at large and a committed band of health workers, policemen, media persons and personnel of various other departments of the government. It all started with India’s first Covid-19 case getting reported from Kerala’s Thrissur district in January last. Let’s have a look into the success story in detail.

ollowing a voluntary Janata Curfew on March 22, Prime Minister Narendra Modi announced a nationwide lockdown for 21 days on March 24 in the wake of Covid 19 pandemic. The lockdown was extended through different phases further till June 30 with conditional relaxations for regions where the spread had been contained or was minimal. The nationwide lockdown has helped the country in reducing the spread of the virus and the number of deaths when you consider the situation of America, Spain or Italy, all which boast exceptional healthcare facilities. As of June 08, 2020 the number of deaths in India due to Covid 19 is 7135 whereas America has 110,400 deaths. In Spain and Italy, the number of deaths is around 27,000 and 33,000 respectively.

Kerala’s Resistance Among the Indian states, the southernmost state of Kerala effectively resisted the outbreak of the virus by implementing strict treatment protocols and measures. Even when the neighbouring states recorded more number of infections and deaths due to Covid-19, Kerala had only few deaths until mid May. Times Network on 12 April 2020 predicted that the confirmed cases of Covid 19 in Kerala would peak on May 8 at 72,057 cases with 22,381 severe cases needing intensive care. However, on that day the number of confirmed cases was 503 and active cases only 16. The state’s Health Department earned global praise when they helped recover a Covid 19 patient who was around 93 years old. K K Shailaja, Health Minister, Government of Kerala was hailed as the ‘Corona Virus Slayer’ and ‘Rockstar Health Minister’ by international media houses for effectively reducing the loss of lives and spread of the virus.

The Effectiveness of ‘Kerala Model’ ‘Kerala Model’ first came to attention during the 1970’s when analysts and policy makers wondered how a low-income state with high literacy rates and healthy citizens boasted a standard of living comparable to life in the developed nations. In 2018, WHO praised Kerala which has a population of about 35 million for achieving impressive health outcomes at modest incomes compared to the rest of the states in India. The state often tops in the overall health index of the coun-

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try with low neonatal mortality rates to total fertility rate. In India, Kerala was the first state to report the Covid -19 case. The first case was reported from Thrissur district in Kerala back in January 2020 for a medical student returned from Wuhan, China, the epicentre of the virus outbreak. This was almost an expected scenario for K K Shailaja, Health Minister, Government of Kerala and her team as Kerala has a large number of expats and students either working (especially Hon'ble Chief Minister of Kerala Pinarayi Vijayan and Health Minister Smt. K.K. Shailaja in Gulf countries) or studying abroad. The Health Department of the state issued an tails. Occasionally police officers also visited and ensured that alert by mid January and began to screen passengers arriving from those who are at home quarantine doesnâ&#x20AC;&#x2122;t go out. Keralites abroad especially China. The travel details and health condition of returning from the neighbouring states were allowed through international arrivals were taken. The World Health Organisationâ&#x20AC;&#x2122;s borders after proper documentation and screening. Home protocol of test, trace, isolate and support was adopted to prequarantine was mandatory for all who returned and those who pare for the Covid 19 outbreak in the state. The experience in hadnâ&#x20AC;&#x2122;t the facilities in their home were moved to quarantine handling the deadly Nipah Virus outbreak in Kerala in 2018 also centres setup in each districts. One thing Kerala could be recame handy in dealing with the Covid-19 cases. ally proud of is that the most Covid-19 positive cases came from those who were quarantined. The threat of community Ever since the first case was detected in Kerala, various despread was effectively prevented. partments joined hands to do the contact tracing and to publish As in any situation, there was scarcity for many things. the route map of the patient. Kerala enjoys fairly good socio-ecoMasks and hand sanitizers were out of stock easily and in nomic development, strong public health system, higher literacy other parts sold for higher prices than the MRP. Government rates and community participation which also contributed to the acted quickly announcing a fixed price for both mask and cause. Case isolation, contact-tracing were done with the help of sanitizers. It encouraged local bod ies and groups like several teams. Many were put in home quarantine and each day Kudumbashree to produce face masks and sanitizers and made health officials or volunteers called and enquired their health deit quickly available to the public. The seized spirit by the Excise Department was provided to Kerala State Drugs and Pharmaceuticals (KSDP) and such organisations for producing hand Ever since the first case was detected in sanitizer.

Kerala, various departments joined hands to do the contact tracing and to publish the route map of the patient. Kerala enjoys fairly good socio-economic development, strong public health system, higher literacy rates and community participation which also contributed to the cause.

Hospitals were also prepared. Designated isolation wards were set up in district hospitals. The Health department ensured that gloves, masks and personal protection equipment (PPE) are available to medical officers, nurses and cleaning staff.

Caring the Society Since Anganwadis (child care centres) were closed, the government made arrangements to take their quota of food to their doorstep once a week, covering adolescent girls, pregnant women, lactating mothers, infants up to three years of age, and children from three to five years of age. For the gen-

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Live Story Kerala Model eral public, free rice was provided to every card holder irrespective of the type through public distribution system. It was followed by a kit having essential condiments distributed freely to BPL card holders and at a fair price to other card holders. Taking account of the migrant labourers in Kerala, government made arrangements to provide either food materials or cooked food to them. Nearly 20,000 camps were established with the help of local self government (LSG) bodies and Kudumbashree to ensure food to them. The community kitchen also provided food for destitute and other people who had no shelter during the lockdown associated with Covid19. In some parts, they also provided food to those who were quarantined in government centres. Apart from all these, the government announced Rs.200 billion relief package in early March itself. In order to put cash into the hands of the poor, social security pensions were distributed, assistance from the welfare funds was released and interest free loans to the members of the SHGs were provided. Further, help lines were made available to elderly people to access medicine or food materials through volunteers.

Kerala’s Public Health Profile Kerala’s GDP per capita is $2485.89 whereas GDP per capita of UK and USA is $37,401 and $57,627.38 respectively. Both UK and USA have reported community transmission and the number of death in USA has crossed more than one lakh. The Economist in an article compared Kerala’s success with that of Vietnam which also successfully curbed the pandemic attack. (No

ASHA workers were effectively used to spread awareness programs among the local public. They also provide the bridge between the health department and the civil society organisations such as palliative organisations, voluntar y food programmes and Kudumbashree health volunteers.

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deaths reported until now at Vietnam due to Covid-19.) It notes that like Kerala, Vietnam has also battled deadly epidemics like SARS and Swine flu in the past. It further says: “Vietnam and Kerala both benefit from a long legacy of investment in public health and particularly in primary care, with strong, centralised management, an institutional reach from city wards to remote villages and an abundance of skilled personnel.” A decentralised public health system and investment in public education reflects in the success of Kerala. Every village has a primary health centre and there are hospitals at each level of its administration, as well as medical colleges in most districts. Kerala also enjoys the highest life expectancy and the lowest infant mortality of any state in India; it is also the most literate state. The access to education has helped to foster the understanding that health being important to the well-being of people. A robust health system combined with the active involvement of the community through local governments can be attributed to Kerala’s success in resisting Covid-19 pandemic. Local governments play an important role in running Primary Health Centres (PHC) across the state from the maintenance of the buildings of PHC’s and sub centres, purchase of drugs and medical equipment, employ doctors, nurses and paramedical staff on contract to supplement the honorarium of ASHA (Accredited Social Health Activist) workers. ASHA workers were effectively used to spread awareness programs among the local public. They also provide the bridge between the health department and the civil society organisations such as palliative organisations, voluntary food programmes and Kudumbashree health volunteers. Under the leadership of the elected ward member, squads were formed for outreach and feed back involving ASHA workers. They are also in charge of prevention of vector and waterborne infectious

diseases. Given the high level of involvement of local governments in health and related sectors, it was only natural that they play an important role in the fight against Covid 19. Undoubtedly, the strong health care system of the state has helped Kerala in effectively reducing the deaths related with Covid19. The role of education especially among women also had salutary impact on consumption of health services. It should be noted that Kerala benefitted from the female literacy empowerment of backward classes, high levels of political mobilisation, active involvement of panchayats and municipalities, emergence of civil society groups, and an active media in the long run towards a healthy state.

Commendable Leadership Pinarayi Vijayan, the state Chief Minister was always in the forefront leading the battle against the deadly virus. It was on March 11, 2020 WHO declared corona virus a pandemic. Even before that Kerala government had banned all mass gatherings in the state with an order on March 10th. Classes up to seventh grade were suspended in all schools. The Central government order to shut all institutions, shopping malls, theatres, gyms until March 31 came on March 16. Kerala government announced lockdown on March 23 till March 31 even before PM announced a nationwide lockdown on March 24. To contain fake news, the Chief Minister of Kerala addressed the media daily through a live press conference detailing the number of patients who turned positive, under quarantine, deaths and announcements in relation with the Covid-19. It turned out to be

A decentralised public health system and investment in public education reflects in the success of Kerala. Every village has a primary health centre and there are hospitals at each level of its administration, as well as medical colleges in most districts. Kerala also enjoys the highest life expectancy and the lowest infant mortality of any state in India; it is also the most literate state. The access to education has helped to foster the understanding that health being important to the well-being of people. one of the most watched telecasts in recent days in Kerala. The government has borne the entire cost of testing and treating Covid-19 in the state. The state also extended its helping hand to Maharashtra by sending a team of doctors and nurses. Nearly 50 doctors and 100 nurses from Kerala were deployed to help Mumbai fight Covid 19.

Matterhorn mountain In Switzerland lights up with Indian tricolour to express solidarity to all Indians in the fight against COVID-19 on 19th April 2020

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(As of June 08, 2020 the number of confirmed Covid19 cases in Kerala is 2005 while the number of active cases is 1174. 814 patients recovered from the disease while the deaths recorded are 16. Maharashtra, the Ind ian state with the most number of Covid-19 cases has 85,975 confirmed cases with 43,601 active cases. Although 39,314 recovered in Maharashtra the total deaths due to Covid-19 is an alarming 3060. Keralaâ&#x20AC;&#x2122;s neighbour ing state Tamil Nadu has 31,667 confirmed cases with 14,399 active cases. The recovered cases are 16,999 while 269 deaths have been reported)

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Interview

Dr. Anoop Kumar Thekkuveettil

AGAPPE CHITRA MAGNA A PATH-BREAKING SOLUTION FOR COVID-19 DIAGNOSIS The Molecular Medical Head and senior scientist Dr Anoop of the Biotechnology wing of Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvanathapuram and his teammates had successfully developed a technology which could help diagnosis of the pandemic Covid-19 in a much economical manner. Termed LAMP Technology, it was actually invented to diagnosis Tuberculosis (TB) virus. However upon the instruction of Dr Asha Kishore, Director, SCTIMST, Dr Anoop and his team worked hard and came up with a technology to diagnosis Corona virus in a span of just 16 days. Apart from being cost effective, it has also been certified and validated as 100% accurate and sensitive by the National Institutes of Virology in India. SCTIMST has transferred the technology to the Ernakulam based Agappe Diagnostics Ltd for the commercial manufacturing of the machine and kit. It is now available in the market under the brand name â&#x20AC;&#x2DC;Agappe Chitra Magna RNA Isolation Kitâ&#x20AC;&#x2122;. Recently, Tech Agappe (TA) managed to have an exclusive interview with the master-brain behind the project, Dr Anoop Kumar Thekkuveettil himself. Excerpts from the interview: TA: The world is under the grip of Covid-19 pandemic. As a senior scientist, what are your observations about Covid-19? Dr. Anoop: The first thing we observed about Covid-19 was how the genome was evolving. Quite surprisingly we found that the genome is 93% similar to Bat and 7% coming from some other influenza virus. Another thing we noticed was that it has selected a receptor to enter our body which is very selective and it almost looks like it has made humans as its host. That is very strange. Usually viruses do not make that kind of host selection that fast. It is surprisingly very clear cut human host selection. If you take the Indian scenario, Kerala was the first state where the virus was detected. One of the most appreciable points Kerala did was that it controlled it. That is the way it should be. Now indications are coming that a fusion of viruses can happen very fast and it is an indication that more is to be expected. Three influenza viruses have appeared in the last 30 years and we see that it is repeatedly happening between two animals where influenza viruses are fusing and changing the host. If you ask me whether it is a dangerous sign, I would say that it is. First, we are not prepared and second, viruses are extremely hard to handle. If you look at the history, you will find that we were rarely able to control viral diseases all over the world. The success stories are

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Dr. Anoop Kumar Thekkuveettil

scarce like Polio vaccine. On the other hand look at HIV. We are still not able to find a proper cure to it. Influenza viruses are much more dangerous as it only requires a cell and doesn’t require our genome. It sits like RNA, makes RNA and goes out. It is not even a parasite. It is just using it as a host. HIV is entirely different. It goes into our genome and stays there whereas this influenza virus doesn’t require that process. That’s why influenza virus is spreading so fast. If you look characteristically, you can see that the virus behaves d ifferently in these three months. First, it spreads so fast. Second, the common characteristics of influenza viruses, fever is not found on every patient infected with it. Usually fever is the first symptoms of influenza virus attack. This means, it is in some way invading our system. It is scarier in a sense that the immune system will be under threat. We are still learning new insights about it each day.

AGAPPE CHITRA MAGNA - RNA EXTRACTION KIT

TA: What made you think of developing an economical way for the diagnosis of TB? How did it later pave way to the diagnosis of Covid-19 virus? Dr. Anoop: Molecular basis of diagnosing a disease already exists. But in India very few works have been undertaken in the field. We always depend on imported technology. The classical example is that of TB. The best diagnosis for TB is Real Time PCR (RT-PCR). It is easy and very confirmatory nature. But that test is also an imported technology in our country. Even the kits are imported. India has almost 30% of its population suffering from it. Yet government is struggling to meet the cost of this technology. We were experimenting to bring out much more cheaper technology for diagnosing TB for the last three years. This was where Agappe Diagnostics Ltd also came in. We were very close to finding a solution which could furnish almost 95% similar results in a cheaper and simpler way. Agappe came into the picture there so that they could produce the machine. We were planning to have a national level screening for TB and test whether these machines produced desired result. That was when the Covid-19 hit the nation. So we shifted our attention to it. We now has a platform and as such we thought of using our own technology, similar to the diagnosis of TB, RT-PCR which could considerably reduce the cost of kits imported from abroad to test Covid- 19. Accessing Covid-19 genome is very difficult. So we synthesised two fragments of the Covid genes in the lab and targeted that to develop the technology. That took us about two week’s time. Since

Agappe was always in the TB program as a team, it has helped us a lot be it in the availability of the machines or testing facility. If you developed a technology in a short period of time, you will know how much problems exist. It’s like an overnight technology development. We have passed the alpha version of it and now reached with the beta version of the machine. We are sure that it will be cheaper than the technology from abroad. Also, cheaper alone will not serve the purpose, it should be also accurate. We have also partnered with Agappe and together developed RNA isolation kit. Agappe is already manufacturing it and it can be used for PCR. Our indigenous technologies are on the way, which will help more testing. If you look at the Covid-19 prevention program, testing is the only way ahead. You should

Accessing Covid-19 genome is very difficult. So we synthesised two fragments of the Covid genes in the lab and targeted that to develop the technology. That took us about two week’s time.

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Interview

Dr. Anoop Kumar Thekkuveettil

AGAPPE CHITRA MAGNA-RNA ISOLATION KIT “MUCH SIMPLE, CHEAPER, YET ACCURATE” Dr Asha Kishore, Director, SCTIMST, Thiruvanathapuram ‘Agappe Chitra Magna RNA Isolation Kit’ can detect the “N Gene of SARS COV2 using reverse transcript as loopmediated amplification of viral nucleic acid (RT-LAMP). We are not aware of anybody else in the world doing lamp for N gene for corona virus. It is undoubtedly India’s first and might be world’s second. This is a big achievement Dr Anoop and his team and SCTIMST has accomplished. Although RT-PCR technology is popular and used by all for diagnosing Covid 19 patients, LAMP technology is also recommended by WHO for DNA amplification. PCR DNA amplification takes almost two and half hours for detecting while LAMP takes only 10 minutes. In two hours, we can do 30 samples. Besides, RT-PCR machine is very costly. They cost anywhere between Rs.15 lakhs to Rs.40 lakhs. Moreover it is very complicated to operate that only advanced laboratories and institutes might have the manpower to do tests in it. Our machine is much simple and cheap (Rs.2.5 lakhs), yet accurate. It can be setup in any district hospitals and can be operated by technicians whom the company (Agappe) will train. The kits are also cheap. The imported kit costs around Rs.400/- whereas our single kit will cost only Rs.200/-. The entire kit will cost only Rs.1000/- for the laboratory. Currently the cost alone for Covid 19 tests are Rs.4500/-. There is a huge difference between Rs.15 lakhs and Rs.2.5 lakhs. detect the patients, quarantine them, observe them and reduce the mortality rate. TA: Could you please elaborate on the technology developed for the machine as wel l as reagents? Dr. Anoop: The technology we are tal king about is single temperature based amplification. PCR is a three temperature based reaction. That is why it is called Polymer Chain Reaction. But in an isothermal reaction, you need only a single temperature. It is a simpler technology. We have designed specific primers as we are targeting genes for this. It was a challenge. The detection device was also a proprietary from our side. Agappe is making the machines for that. If you look at this, from RNA isolation to end of detection, our technology is put in use for good. It is almost an indigenous methodology.

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It uses an innovative technology for isolating RNA using magnetic nanoparticles to capture the RNA from the patient sample. The magnetic nanoparticle beads bind to the viral RNA and, when exposed to a magnetic field, give a highly purified and concentrated RNA. As the sensitivity of the detection method is dependent on getting an adequate quantity of viral RNA, this innovation enhances the chances of identifying positive cases. The problem during a pandemic is that all countries will be suffering. If you want to import a kit from another country, they might not sell it. The situation will be like it unless we make it, we don’t have it. Or in other situations, the price goes up as there is huge demand. Agappe getting on board of this program was one of the best things happened in this whole project. Agappe came on board

Dr. Anoop Kumar Thekkuveettil with Agappe’s Reagent and Equipment R&D Team (File picture). not as a business partner. I would rather say that Agappe extended a helping hand to us at a time when we were not quite sure whether it will even work out. But that positive vibe of an industry coming to the aid of R&D unit helping to work it out was a different experience for us. I think it will be remembered for a very long time. We learned a lot together. We are able to make improvements because Agappe is helping us do it even working overtime. TA: How wel l was it received by Indian Council of Medical Research (ICMR)?

the cheaper solution. We are also correcting the data as I had already mentioned that it was like an overnight technology and we need to improve it. We are making it as simple as possible so that the errors will be reduced. Every possible correction is made on a daily basis which is a chance rarely a technology could get. ICMR helps out us in this process. TA: What do you think about the requirement for ind igenous technology is diagnostics?

Dr. Anoop: Unless we develop our own indigenous technology for diagnosis, we will be always in the bottom list or at the mercy of other countries. During pandemics, it could be very bad to us. If you look at the pharmaceutical side, India is on the safer side. But when it comes to diagnosis, we are not up to the mark and we don’t have that kind of technology. There should be a priority on it and it will change the health profile of our country. Import means that it is expensive, the tests are expensive. Ind igenous technology will help us in two ways: one, we will be ready to fight any pandemic and won’t have to rely on other countries. Two, we wil l have a healthy population as the tests become cheaper. The mortality rate wil l Dr. Anoop Kumar Thekkuveettil, Scientist - SCTIMST sharing his experiences with Mr. Jofy Paul, also be reduced. Associate Vice President R&D Reagent, Agappe.

Dr. Anoop: Their response was a pleasant surprise for us. At a time of crisis, everybody looks at solutions. ICMR was also looking at it seriously for its accuracy. I must say that even during the time of crisis, we are looking for the good / accuracy rather than

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“Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India. TEL: + 91 484 2867000 | productcorp@agappe.in | www.agappe.com

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Cover Story RT-PCR

REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION (RT-PCR)IN THE

DIAGNOSIS OF COVID-19 K Vaidyanathan, MBBS, MD (Biochem) , Professor & Head, Molecular Biology, AIMS, Kochi.

COVID-19 is a pandemic which has affected more than 5.5 million people in the world to date and caused close to 350,000 deaths (~6.3% case fatality rate). It has affected almost all countries across the globe. No treatment has been invented for this to date and vaccines are only under development. Early diagnosis is important to isolate the patient, and protect self and the public from getting infected. RT-PCR is the most effective diagnostic tool with close to 100% sensitivity and specificity. This article deals with the utility of RT-PCR in the diagnosis of COVID19. We first describe the basics of PCR and its application, before passing over to RT-PCR and how it is used in the detection of COVID-19. Agappe Diagnostics’ RNA extraction kit and PCR are used as the representative example to explain the procedure.

1. Introduction PCR is an in vitro DNA amplification procedure in which millions of copies of a particular sequence of DNA can be produced within a few hours. It is like xerox machine for gene

copying. Karry Mullis who invented PCR in1989 was awarded Nobel Prize in 1993. The flanking sequences of the gene of interest should be known. Two DNA primers of about 20- 30 nucleotides with complementary sequence of the flanking region can be synthesized. The reaction cycle has the following steps: Step 1: Separation (Denaturation): The DNA strands are separated (melted) by heating at 95°C for 15 seconds to 2 minutes. Step 2: Priming (Annealing): The primers are annealed by cooling to 50°C for 0.5 to 2 minutes. The primers hybrid ize with their complementary single stranded DNA produced in the first step. Step 3: Extension: The new DNA strands are synthesized by Taq polymerase. This enzyme is derived from bacteria Thermusacqua- ticus that are found in hot springs. Therefore the enzyme is not denatured at high temperature. The polymerase reaction is allowed to take place at

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72Â°C for 30 seconds in presence of dNTPs (all four deoxy ribonucleotide triphos- phates). Both strands of DNA are now duplicated (see Fig.1). The steps 1, 2 and 3 are repeated. In each cycle, the DNA strands are doubled. Thus, 20 cycles provide for 1mil lion times amplifications (see Fig.2). These cycles are generally repeated by automated instrument, called Tempcycler. After the amplification procedure, DNA hybridization technique or Southern blot analysis with a suitable probe, shows the presence of the DNA in the sample tissue. 2. Cl inical Appl ications of PCR Diagnosis of bacterial and viral d iseases: In the early phases of tuberculosis, the sputum may contain only very few tubercle bacilli, so that usual acid fast staining may be negative. But PCR can detect even one bacillus (a single copy of the gene) present in the specimen after amplification. Other bacterial and viral infections are also be detected similarly which helps to establish the specific strains involved in each case and each outbreak of a communicable disease. The specific nucleotide sequences of the bacilli are amplified by the PCR and then detected

striction analysis pattern of DNA of one individual will be very specific (DNA fingerprinting); but the pattern will be different from person to person. This is highly useful in forensic medicine to identify the criminal. Diagnosis of genetic disorders: The PCR technology has been widely used to amplify the gene segments that contain known mutations for diagnosis of inherited diseases such as sickle

Fig. 1. Polymerase chain reaction (PCR) by the Southern blot analysis. If reverse PCR is done, living organisms could be detected. This technique is widely used in the diagnosis of viral infections like Hepatitis C, Cytomegalo virus and HIV. Med ico-legal cases: PCR allows the DNA from a hair follicle or a blood cell to be analyzed. The restriction analysis of DNA from the hair follicle from the crime scene is studied after PCR amplification. This pattern is then compared with the restriction analysis of DNA samples obtained from various suspects; the culpritâ&#x20AC;&#x2122;s sample will perfectly match with that of PCR amplified sample. The re-

Fig. 2. Polymerase chain reaction, three cycles are shown.

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Cover Story RT-PCR products due to the amplification of unexpected primer binding sites. Two sets of primers are used in two successive PCR runs, the second set intended to amplify a secondary target within the product of the first round of amplification. This process is very successful, but requires more detailed knowledge of the sequences involved.

Real Time Quantitative PCR (QPCR) By this method, quantitation of the number of virus present in a sample can be calculated, e.g., viral load in HIV or HBV. So, the treatment modalities can be planned and the

cell anemia, beta thalassemia, cystic fibrosis, etc. PCR is especially useful for prenatal diagnosis of inherited diseases, where cells obtained from fetus by amniocentesis are very few. Cancer detection: PCR is widely used to monitor residual abnormal cells present in treated patients. Similarly identification of mutations in onco suppressor genes su cha sp53, or retinoblastoma gene can help to identify individuals at high risk of cancer. Fossil studies: DNA can be isolated and PCR amplified from fossils and is used to study evolution by comparing the sequences in the extinct and living organisms.

response to treatment could be assessed. The Q-PCR is used to rapidly measure the quantity of PCR product (in real time), thus it is an indirect method for quantitatively measuring starting amounts of DNA orRNA. Quantitative Real time PCR uses fluorescent dyes, such as Sybr Green, or fluorophore containing DNA probes, such as Taq Man, to measure the amount of amplified product in real time (see Fig.3). 4. RT-PCR for the diagnosis of COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR)is a laboratory technique combining reverse transcription of RNA into DNA (called complementary DNA or cDNA) and amplification of specific DNA targets using polymerase chain reaction, primarily used to measure the amount of a specific RNA, achieved by monitoring the amplification reaction using fluorescence. RT-

3. Modifications of PCR Reverse Transcriptase PCR (RT-PCR) It is the method used to amplify, isolate or identify a known sequence from a cell or tissue RNA library. Essentially normal PCR is preceded by reverse transcription (to convert the RNA to cDNA). This is widely used in expression mapping, determining when and where certain genes are expressed. Instead of Taq polymerase described above, Tth polymerase from The rmusthermophilus may be used. This enzyme has both DNA polymerase and reverse transcriptase activities at high temperature. This property allows both cDNA synthesis from mRNA followed by PCR amplification. In ordinary PCR, DNA is detected; that DNA could be from a living or non living organism. But in reverse PCR, mRNA is detected; that means, it is derived from a living organism. Presence of HIV RNA in blood can be detected as early as 4 weeks after infection.

Nested PCR Nested PCR is intended to reduce the contamination in

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Fig. 3. Quantitative PCR PCR has risen to become the benchmark technology for the detection and comparison of RNA levels for several reasons: (a)It does not require post PCR processing, (b)A wide range (>107fold) of RNA abundance can be measured, (c)It provides insight into both qualitative and quantitative data, (d)Due to its simplicity, specificity and sensitivity, RT-PCR is used in a wide range of applications from experiments as simple as quantification of yeast cells in wine to more complex uses as diagnostic tools for detecting infectious agents (most recent being SARS-CoV-2 or 2019-nCoV or COVID-19.

Steps in COVID-19 RT-PCR

BRAND REACH

A. Sample Collection B. RNA Extraction or Purification C. Reverse Transcription -Polymerase Chain Reaction D. Analysis and Interpretation

GRATEFUL TO AGAPPE

A. Sample Col lection Sample collection is a crucial step which determines the efficiency of the overall reaction. It is reported that blood or urine samples have only ~1% chance of picking up the virus, whereas nasopharyngeal or oropharyngeal swabs have close to 99% detection rates.

Grateful to Agappe for the superior quality and error-free products““We are using Mispa i2Specific Protein Analyzer for the last two years and we would like to share with great pleasure that our experience has been good and the instrument is giving satisfactory results with highest accuracy and precision. Additionally, as far Agappe reagents are concerned, I have been using it for the last 10 years and experiencing best linearity and accurate test results.

The swab is inserted through the nostrils and gently moved into the nasopharynx and rotated for a specified period to obtain specimen containing the virus. The specimen is then transferred to a Viral Transport Medium (VTM). B. RNA Purification/Extraction

Dr. B.Y Shinagare

RNA extraction can be done by manual methods or automated test kits. Better results are obtained by automated test kits (like Agappe’s Mag-Bind RNA extraction kit) and the experiment in less cumbersome. Principle of Agappe’s Mag-Bind RNA Extraction Kit This kit extract, enrich and purify RNA in specimens using magnetic nano particle technology. The nucleic acids in the specimen and the magnetic nano particles combine in the buffer and are gathered, transferred, dispersed under the external magnetic field to complete the extraction and separation of the nucleic acids. C. RT-PCR This product is designed as a multiplex real-time reverse-transcription PCR system, containing specific primers and fluorescent probes targeting ORF1ab, E and N gene of SARS-CoV-2. Virus nucleic acid is detected by monitoring fluorescence intensity in real-time. Internal control is added to monitor the presence of PCR inhibitor within specimen, thus effectively prevent false negative results. 1. The target genes in the PCR of nCoV2019 are ORF1ab gene, E gene and N gene 2. The choice of target gene depends on the primer and probe sequences The mentioned target genes are used in the RT-PCR kit developed by Agappe Diagnostics. D. Analysis and Interpretation In a real time PCR assay a positive reaction is detected by accumulation of a fluorescent signal. The Ct (cycle threshold) is defined as the number of cycles required for the fluorescent signal to cross the threshold. Ct levels are inversely proportional to the amount of target nucleic acid in the sample (the lower the Ct level the greater the amount of target nucleic acid in the sample).

Shinagare Laboratory, Pune.

Result of judgement

Negative

Positive

ORF1ab gene

> 38

< or = 38

E gene

>37

< or = 37

N gene

>38

Test Result

< or = 38 Result Interpretation

ORF1ab,E and N genes are positive SARS CoV-2 positive ORF1ab and N genes are positive ORF1ab and E genes are positive Only ORF1ab gene is positive Repeat the test. IfORF1ab is still positive, it will be interpreted as SARS CoV-2 positive Only ORF1ab gene is negative Repeat the test. If ORF1aband N gene or E gene are positive,it will be interpreted as SARS CoV-2 positive. Otherwise, interpret the result as a suspect who need to be re-tested ORF1ab(-), E gene (+), N gene (-) ORF1ab (-), E gene (-), N gene (+) ORF1ab, E and N genes are negativeSARS CoV-2negative Conclusions RT-PCR is effectively used in the detection of COVID-19 infection. Agappe’s RNA extraction kit and RT-PCR kit are effective in the early diagnosis of COVID-19. References: 1. D M Vasudevan, Sreekumari, S, K Vaidyanathan “Textbook of Biochemistry (For Medical Students)” Published by Jaypee Brothers (9th Edition, 2019). 2. “Laboratory testing for corona virus disease (COVID-19) in suspected human cases”: World Health Organization Interim Guidance 19 March 2020

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Life Story Aneesh K.K.

TRAUMATIC DAYS OF A HEALTH WORKER

WHO TURNED COVID-19 POSITIVE

The story of Aneesh K. K., one of the first health workers who turned Covid-19 positive in Kerala gives a true picture of the mental trauma such victims undergo during the period. It is also an eye opener to all those who treat such victims as a taboo and underscores the need for a basic change in the attitude of all especially the media towards the hapless victims of the pandemic.

A mob attacked the ambulance carrying the dead body of a doc-

tor who passed away due to Covid- 19. This news came just a few weeks ago from one of our neighbouring state. Even though Kerala didn’t report any such gruesome incidents of that sort, at least in a few places, people gathered raising protest in either burying the body of the Covid-19 victims or objecting to the home quarantine of medical staff and health officials who were on duty at Covid-19 hospital wards. In Thrissur, a doctor lodged a complaint with the police alleging that his front door was vandalised with ‘Corona’ marked on it by the Residents Association. Although all such acts are resorted to because of their fear, it is certainly not the way to approach things. Like our Health Department advises, we must be cautious rather than afraid. The following true story drives this point much better. Aneesh K. K. is a Junior Health Inspector (JHI) at Kodanad Family Health Centre, in Kerala’s Ernakulam district. He was one of the first health officials who became Covid-19 positive while on duty. Aneesh was infected with the disease while on special duty at Cochin International Airport Limited (CIAL). The duty of health workers like him on such special duty at airports is to screen passengers from abroad and collect their details as a part of the Vande Bharat Mission. The two member team of Aneesh has to check each passenger’s temperature using a thermal scanner and to collect the passenger’s complete details including affidavit declaring that they will undergo mandatory home quarantine for 14 days and address of the place where they will undergo home quarantine. Another team will educate them on measures to be taken care during home quarantine. Passengers who were detected with Covid-19 symptoms were separated from the rest and taken directly to the hospital from the airport in an ambulance.

How it Al l Began Aneesh K.K.

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Aneesh took his first duty at CIAL on March 19th. Their duty time was from 5PM to 10AM as there weren’t many day time flights. A set of gloves, N 95 mask and a bottle of sanitizer were their ‘weapons’ to prevent the virus attack. His second duty was

on March 21st. Meanwhile they had their regular duty at Primary Health Centre’s (PHC) as there was no proper order was issued at that time about their home quarantine after airport duty. On March 24th Aneesh’s teammate, a native of Thiruvanathapuram developed a fever and sore throat. He approached doctor and since he had chances for infection was recommended to do a swab test. His test results which came on March 29 th marked him Covid positive. Since Aneesh had close contact with him, he was informed to undergo home quarantine. After consulting doctor, they all took Hydroxy- chloroquine as a precaution against Covid 19. Samples were col lected from them soon. Just before having dinner on March 31st, around 9.30 PM, Aneesh received a call from a doctor in the medical board fighting Covid-19 telling him that they need another sample as something went wrong on the first sample collection. “I was going to have my dinner. Yet the doctor asked me if Ernakulam District Col lector Shri. Suhas S. IAS visiting Aneesh I could come right now. But later he called at his home after quarantine period me again and told me that they will send a one was born on Jan 15, 2020 and his wife was yet to return vehicle to collect me from home tomorrow and asked me to pack home from her ancestral home after the delivery. a small bag with things I might require for a few days. That was when I got the first hint that I might be actually Covid positive. I His main job as JHI is to organise preventive measures informed my elder brother about it and told him that I will have to against various contagious diseases. He explains: “In other leave home tomorrow early morning itself. I instructed him not to words, we start with a child with vaccinations and inform my wife about it,” recalls Aneesh. immunisations, preventing new born babies from invisible

Life as a JHI

Aneesh who joined the Health Department, Government of Kerala in 2009 resides at Punnayam village near to Perumbavoor, Ernakulam district. His elder child is 8 years old while the younger

His main job as JHI is to organise preventive measures against various contagious diseases. He explains: “In other words, we start with a child with vaccinations and immunisations, preventing new born babies from invisible diseases. We need to get to the grassroots of the society with preventive measures.

diseases. We need to get to the grassroots of the society with preventive measures. We have to also conduct inspection at Anganwadis (childcare centres) and take awareness classes for the mothers. In schools, our role is to disseminate health education to the children. We have to also undertake other duties which local self governments ask us to do. We conduct awareness classes before ‘the usual seasons’ of diseaseslike awareness class about Dengue and Chikungunya before every rainy season,”. Aneesh who loves his profession to its core adds: “My job doesn’t have a 9 to 5 structure. You might have to work overtime or in holidays as it is concerned with our foremost wealth which is our own health. Our work structure is in such a way that during morning we will be out in the field and only after noon we will be in the office,”

Being Covid Positive... On the early morning of April 1st, the ambulance took Aneesh to Isolation Ward set up at Government Medical College, Kalamassery, Ernakulam. After taking his sample, they

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Life Story Aneesh K.K. told him that they have been instructed to admit him there. He was led to Room No: 308 in the third floor of the hospital while his colleague who first turned Covid positive was in the adjacent room. By then the news channels had began broadcasting news about his colleague, the first case whereby a health official on duty in Kerala had turned Covid positive. Although Aneesh didn’t inform his wife directly that he had turned Covid positive, she later came to know it through channels which telecasted the news that a second health official had turned Covid positive in the district. Aneesh was very much concerned whether he might have accidentally passed the disease to someone else before he got admitted. The fact that his newborn child was just two months old, also added to his worries. But the staff at the isolation ward extended him the much needed support and strength. The medical board which consists of several doctors oversees the treatment of Covid positive cases at Government Medical Col lege, Kalamassery, Ernakulam. They assumed that Aneesh turned Covid positive not through his colleague but might be through any of the passengers who came from Dubai on March 19th. There were many positive cases on that day. Now, he understood that PPE kit is provided to those health officials working at Airport. Aneesh believes Hydroxychloroquine was effective to him. The doctors informed him that since he didn’t show any symptoms of the diseases, chances are low for him to be a carrier of

the virus to people around him before he was admitted. On alternate days, samples were taken from Aneesh to test. After a few days, one of the samples turned negative and Aneesh was relieved only to know that the next day result was again positive. For the test, they usually took samples from throat and nose. They are either sent to National Virology Institute at Alappuzha or Rajiv Gandhi Centre for Biotechnology at Thiruvanathapuram.

Unfair Conduct by Social Media While Aneesh was admitted in the hospital, things took an ugly turn in the social media. WhatsApp forwards mentioning that Aneesh was high on fever when he got admitted and that he had travelled to many places before being detected made their rounds in the locality. A visible agitated Aneesh asks: “I can understand the fear among the people. But why do people spread such fake messages? People who don’t even know me spread fake Voice Messages saying I had travelled all over the town and the hospital had to be closed as most of the staff was infected due to me. All my travel details were provided to the officials as soon as I got admitted. My contacts during the period were just a few. It included a bank in Perumbavoor town, a med ical shop (to purchase Hydroxychloroquine) and a vegetable shop. Before the CIAL duty, we had to submit our photo for which I had to visit a studio enroute to the airport. A message was circulated mentioning that I had visited the particular studio although it was before I went to Airport duty,”. His family members and office staff were the other people in the list. A total of 14 people including the doctor from whom he took advice in the office had to undergo home quarantine. Samples were taken from all of them and they were all negative.

Aneesh on duty at Kochi International Airport as part of Vande Bharat Mission.

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Another ‘cautious coated’ fake message was that of rival medical shop owner of the locality from where Aneesh purchased the medicine. He left a message in his social media family group saying that a Covid positive patient visited this particular medical shop and all the people who came there on that particular day should be cautious whereas in reality he hadn’t even spent two minutes in the medical store. He had covered his mouth and nose with a mask while he was there and careful not to sneeze or cough. That message was soon forwarded to many other groups. As the fake messages began circulating out of control even involving PHC, the Panchayat lodged a complaint with the police. The Cyber Cell of Kerala Police traced out the

medical shop owner and he later apologised for his action.

Agony and Ecstasy Meanwhile, Aneesh underwent much mental trauma when his elder son developed a throat pain. For the past few years, it was a common disease for him. However this time it was different. As throat pain is a common symptom of Covid-19, an ambulance was sent to collect him from the home. Luckily the result was negative. “Samples were taken from my wife and our newborn baby, her parents and her brother. They were all negative. It was then I felt relieved,” he says. To take Aneesh’s parents and his brother’s family to hospital for taking sample, two ambulances were sent to his house. Aneesh’s house and his ancestral house where his parents and brother’s family stay are in the same compound. This again created much panic among the people who live nearby. People shot all this in their mobile phones and the clips were circulated widely in the social media stating that almost all family members are Covid positive. Eldhose Kunnapilly MLA’s intervention helped Aneesh a lot to regain his confidence. The MLA did a video describing how a health worker in his constituency turned Covid positive while doing his duty. He said it was through people like him that the state was able to contain the spread of the disease. “He requested the public not to isolate family members in the name of disease even when they have no disease and instead should support them in this difficult time. This video garnered much attention in the social media. After this, DHS, DMO, several superiors in the department called

Aneesh with his family and extended their support. Later Health Minister K K Shailaja herself called encouraging me to stay optimistic during this difficult times and extending every help from the department,” says Aneesh.

‘Al l’s Wel l That Ends Wel l’ Aneesh was discharged on April 16th after his successive tests turned negative. All the staff members from his office were present at his house and welcomed him back with a flower bouquet. He underwent 14 days home quarantine and later resumed his work at office. An elated and much relieved Aneesh recalls the personal visit of the District Collector: “Few days later, the Ernakulam District Collector S Suhas IAS, visited my home appreciating our team’s work and expressing support to us. He enquired about my family and kids and provided me a food kit. Later he shared a picture of mine in his Facebook page expressing solidarity with health workers. I can’t express in words how that has restored faith in my job,”

Warm welcome to Aneesh to the Health Centre after successful treatment.

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Interview

Medivision

MEDIVISION-IN TOP GEAR

TO FIGHT COVID-19 E

Bibu B. Punnooran, Director, Medivision Scan & Diagnostic Research Centre (P) Ltd.

Kochi based lab chain Medivision Scan and Diagnostic Research Centre Pvt. Ltd made news few months back after getting approval from Indian Council of Medical Research (ICMR), Govt. of India for conducting Covid 19 RT -PCR tests. With more than 40 networked diagnostic centres, Medivision has more than 2000 collection centres across the state. Led by Bibu B Punnooran and Berly Cyriac, Medivision has the most advanced state of the art technology supported by a highly qualified and skilled staff mainly consisting of a team of very highly qualified doctors and technical head. Apart from the clinical laboratory facilities, Medivision has other facilities for ultrasound scanning, colour doppler, echo cardiogram, digital mammography, digital X-ray, treadmill testing, audiometry, lung function testing, diabetic food checking and computerised ECG (echo cardiogram).

In a talk with Tech Agappe, Bibu B Punnooran recalls how Medivision Scan and Diagnostic Research Centre Pvt. Ltd managed to grow as a reliable health diagnostic lab chain in Kerala. He asserts that Medivision is 100% Kerala born, grown diagnostic chain. “Although there are one or two lab groups born in Kerala, they are now either funded or managed by groups outside Kerala. Medivision is true to its core,” says Bibu. Excerpts from the interview: TA: Tel l us about the beginning of Medivision Scan and Diagnostic Research Centre Pvt. Ltd? Bibu: Medivision began its operation way back in 1993 by a group of 7 technocrats of which I was one. At that time, our focus was on Scan diagnosis. By January 1997, we started the lab thinking that it would be just a support service for our scanning centre. But what happened is that our name was so well established within the industry that the doctors wanted us to explore the laboratory field even more. By 2000, the company’s focus was mainly on the clinical laboratory services and at that same time the company ran into certain financial and other problems. In order to salvage the company, the partners amicably decided one among them will take over the responsibility of the organisation and that’s how I took over the organisation and later I invited my brother-in-law to join it.

Bibu B. Punnooran

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Like I said, from 2000 onwards our focus was on the laboratory services. So we went ahead with automation and now we have almost all the departments. We slowly became a referral laboratory in the state and started labs in different parts of the district and state. We were

one of the first groups to start the idea of franchise within Kerala back in 2002-03 periods. But later we realised that franchise model was not working out well as many private parties were duplicating our name and we had to fight cases. Certain labs we had franchised had to be de-franchised and some we had to take over. This all made us to think about stopping the franchise model. But the good thing about it was that our name spread in the industry. We had maintained the quality despite all the setbacks. That was also one reason why we had to take over some franchise and to de-franchise some of our labs. Now we have almost 50 branches across Kerala and Chennai. We have now 350400 employees across Kerala. Our employees are our strength. The heights Medivision achieved now is not because of an individual but with the teamwork of each and every employee here. Our Mr. Bibu , Director-Medivision receives TechAgappe 23rd edition from central laboratory is situated at Thomas John, Managing Director, Agappe during his visit at Agappe. Medivision House, Sreekandath Road, Ravipuram, Kochi. Our corporate office is also near to it. At MG Road, Ernakulam, we have a ‘Corporate AGAPPE CHITRA MAGNA RNA ISOLATION KIT Branch’ setup only for corporates. Now, we have units at all the WILL REDUCE THE COST FOR TESTING COVID 19 major towns in Kerala. We have also started our operations in Tamil Nadu with the first lab opened at Chennai. We will go agTA: You have a long association with Agappe gressively with the expansion programs at Tamil Nadu after the Diagnostics Ltd. Tel l us more about it? Covid 19 threat subsides. Bibu: At one point of time, Medivision was probably TA: You have a long association with Agappe Diagnostics Ltd. one of Agappe’s biggest customers. At that time Tel l us more about it? Agappe’s biggest product was Semi Automated Mispa and I had ordered almost eight units at a go. Bibu: At one point of time, Medivision was probably one of That was how my association with Agappe started. Agappe’s biggest customers. At that time Agappe’s biggest prodThe relationship is continuing now and I still procure uct was Semi Automated Mispa and I had ordered almost 8 units many products from Agappe, the latest being exat a go. That was how my association with Agappe started. The traction kits. relationship is continuing now and I still procure many products from Agappe, the latest being extraction kits. I’m happy to note

There is no doubt that Agappe Chitra Magna RNA Isolation Kit will reduce the cost for testing Covid-19 and if a mass testing is planned, it will help our country to save a lot from the expensive imported kits. I’m hopeful that the relationship of Medichain with Agappe will continue in the future too.

Also, I think Agappe Chitra Magna RNA Isolation Kit will be received well within the country. We are also proud of the fact that we are the only diagnostic chain Agappe has associated with right from the beginning of its testing procedure at National Institute of Virology, Alappuzha. We have been co-operating with Agappe by giving samples and so. I was really happy to hear that Agappe received ICMR approval for it. There is no doubt that Agappe Chitra Magna RNA Isolation Kit will reduce the cost for testing Covid-19 and if a mass testing is planned, it will help our country to save a lot from the expensive imported kits. I’m hopeful that the relationship of Medichain with Agappe will continue in the future too.

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Interview

Medivision

that both companies have grown rapidly over these years. Also, I think Agappe Chitra Magna RNA Isolation Kit will be received well within the country. We are also proud of the fact that we are the only diagnostic chain Agappe has associated with right from the beginning of its testing procedure at National Institute of Virology, Alappuzha. I was really happy to hear that Agappe received ICMR approval for it. There is no doubt that Agappe Chitra Magna RNA Isolation Kit will reduce the cost for testing Covid 19 and if a mass testing is planned, it will help our country to save a lot from the expensive imported kits. I’m hopeful that the relationship of Medivision with Agappe will continue in the future too. TA: What are the accreditations received by Medivision Scan and Diagnostic Research Centre Pvt. Ltd? Bibu: We are NABL accredited for the last 13 years. Several awards also came our way like the ‘Best Diagnostic Centre in Kerala’, ‘Best Diagnostic Centre in South India’ and so. I was also selected to represent Kerala’s pavilion in the FICCI Business Education Seminar in Maldives on health sector. On a personal level, I also received an award for Outstanding Young Business Person Award by JCI. TA: Which al l are the advanced diagnostic tests performed at Medivision Scan and Diagnostic Research Centre Pvt. Ltd? Bibu: The latest we have introduced is the molecular biology section. Although we have been dealing with molecular biology laboratory for the last one year, with the Covid 19, we had to set up everything perfect in just a month’s time. Moreover our molecular biology lab hadn’t received its NABL accreditation. But with a virtual interview, we were able to do so in just two days time. We also received ICMR certification for the laboratory. We have facilities to do RT-PCR testing in a fully automated environment. We have dedicated one entire floor for this. Now we are one of the few private laboratories in India doing Covid 19 tests. TA: Now that you are one among the few private laboratories in the country approved for doing Covid 19 tests, what are the chal lenges you foresee? Bibu: The foremost challenge is transporting the sample in a safe environment to the lab. You know that everybody can’t take the sample. Proper precautions must be taken before collecting it as well as taking it to the lab to diagnosis. But we make sure that all protocols are followed while doing so. We have also turned one of our outlets exclusively to take Covid 19 samples considering the convenience of our clients. No other facility can be accessed there now. Another challenge will be the turnaround time for the tests. Again, I’m thankful to Agappe which pitched in help when we required a machine urgently. Thomas John, Agappe’s dynamic MD was quick to help and offer us every technical support in no time.

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Our team also deserves a mention in helping us meet the challenges. Dr Tanya Mampilly who handles our Molecular Biology Department, Sajini our Bio Technologist, Anuroop, Microbiologist, Shimi Joseph, Lab-in-Charge and the entire team who worked hard to get us the ICMR approval in record time. TA: What are your expectations or changes you foresee on IVD industry after Covid 19? Bibu: One thing I must note in this situation is that the world has noticed how well Kerala fought Covid 19. I suppose it will be helpful for the state once the Covid 19 threat settles as medical tourism may get a boom. The world has witnessed how efficient our healthcare sector performs. In fact, it is now we are ‘God’s own Country’! A place where people feel safe and a health care sector which waged war with its limited resources and achieved even developed countries like USA & UK couldn’t achieve. Look at how we resisted the virus. State must give an emphasis to this and attract more medical tourists to our state once the threat of pandemic settle down. Regarding IVD industry, people will be more cautious. They will give more priority to quality, accuracy and preventive health care rather than economical factors.

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Cover Story CBC Parameters

ROLE OF CBC PARAMETERS DURING COVID-19 PANDEMIC Alarming rise of Covid-19 cases in India has put the country’s health care system and the authorities under severe pressure. At this critical juncture, detection and prevention holds the key to combat this pandemic. It may be noted that CBC is listed high among the most ordered laboratory tests worldwide. Careful observations published in relation to viral epidemics like SARS, MERS etc. had already shown the utility of CBC parameters. Hence it is imperative that these observations are carefully studied. It is also important to publish India specific data to win the fight against Covid-19 pandemic.

Dr. Vijay Parekh, Ph. D., Scientific Advisor, AGAPPE.

These are unprecedented times in our living history. The

SARS-CoV-2 virus with the sole objective of saving as many lives as possible. Now in the sixth month after the first Covid-19 case was reported, the rate of the pandemic spread appears to be declining. However, restoration of earlier ‘normal’ activities is very difficult, at least in the near future with a bigger In a patient, confirmed as positive for challenge developing now is ‘how to Covid-19 by rRt-PCR test, the marker NLR protect people from the looming repercussions on economic, social and per(neutrophils- lymphocyte ratio) is indicative sonal fronts that are bound to surface’.

Covid-19 pandemic has compelled nations worldwide to strictly restrict people’s movement in order to prevent spread of the

of a high viral load and can be determined by a basic blood test. This might mean that a patient suspected to have Covid-19 infection can be assessed at even primary health centres and other rural setups with a basic blood test (CBC) which is routinely available. This key NLR flag has now been incorporated into the ‘treatment protocol of patients with confirmed Covid-19’ at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad. Reference: Times of India, 17th June 2020

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Healthcare facilities, even in the developed nations, were overwhelmed when what seemed like a stray incident – first observed in end of December 2019 in Wuhan-China and reported to the world only in early January 2020 – has rapidly turned into a global wildfire. As on 29th June 2020, Corona-2 positive cases worldwide are close to 1 crore mark with 500,000 fatalities. As the virus seems unlikely to vanish any time soon, global medical community is unanimous in adopting a strategy of vigorous testing of all suspects,

promptly tracing all contacts of positive cases, diligently treating all who require medical support and continue with sustained tracking of their progress. Testing all persons suspected of contracting the infection Though rRT-PCR technique & Rapid Tests (for IgG & IgM antibodies) were available because of experience from earlier epidemics i.e. SARS (2002), MERS (2012), the overwhelming rise in global demand resulted in severe shortage of testing facilities. In our country, the Indian Council of Medical Research (ICMR) is responsible for formulating and publishing guidelines for testing & treatment. In India, the Indian Council of Medical Research (ICMR) is responsible Notwithstanding the remarkable rise in testing capacity from just around 100 for formulating and publishing guidelines for testing & treatment. rRT-PCR tests per day in March 2020, presently over 150,000 rRT-PCR tests gated by (a) careful inspection of the crime scene, (b) collectare being conducted daily by about 500+ approved test centres in ing every clue / evidence, (c) using all available resources and India. However, because of issues unique to India, these numbers (d) followed-up with logical interpretation, will more often are 50 times fewer when compared with countries like Brazil, Italy, than not help to catch the culprit. Russia, Spain, UK and USA to name a few. It is not surprising that this raises a logical question “Are the low numbers of Corona cases Similarly, as per medical practice evolved over many deseen in India, a result of low testing volmes?”. We will have to wait cades, when a person shows signs & symptoms of an illness till the dust finally settles down. However, let us look at some of the and consults a medical professional, based on patient’s physiissues that complicate the situation in India further. cal examination and medical history, the doctor makes a presumptive diagnosis and may order some common laboratory 1. Which is the right test? In earlier phase of pandemic, there tests such as (1) a CBC (complete blood count) with blood was a delay in deciding whether to use rRT-PCR or Rapid antibody smear review, (2) ESR or CRP, (3) biochemistry tests directed tests to detect SARS-CoV-2 infection before finally settling in to investigate liver, renal, cardiac, metabolic disorders etc. and favour of rRT-PCR. (4) urine, faeces exams etc. often also a Chest X-ray. 2. False Negatives: About 20~30% of rRT-PCR test results can be Because of these well-established medical practices, an false negative mainly attributed to site and timing of swab samestimated 50,000 to nearly one lakh diagnostic laboratories pling and raises the truly dangerous possibility of failure to detect operate across India and a majority of these labs, if not all, a SARS-CoV-2 positive person and consequently increasing the also possess either fully automated or at least semi-autospread among crowded population. mated analyzers to perform those tests. 3. Rigid control of testing facility: As mentioned earlier, due to Role of CBC parameters shortage of testing centres in India, they are unable to meet the need / demand for rRT-PCR tests. This has resulted in rigid control Moving to the topic of ‘Role of CBC parameters during the of “Who gets tested and/or only quarantined?” Covid-19 pandemic’ let us see what advantage can be ex4. Cost of testing: Complicating the issue further is the decision on “Who pays for the rather costly rRT-PCR test?” in view of the modest paying capacity of an average Indian.

What then can be done? In the face of such issues and a tearing need to detect SARSCoV-2 cases, it is important to discuss what can be done. It is said that “no crime is perfect” (i.e. unsolvable) If investi-

tracted from results of a complete blood count.

Because of experience gained over a century, we know the well-established correlations that exist between qualitative & quantitative values of blood components and diseases/ disorders. Changes in them indirectly represent the ‘in-vivo’ changes in the patient. And because of their highly precise, reproducible and reliable output, haematology analyzers provide great help in either arriving at a diagnosis, screen for a

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Cover Story CBC Parameters disease or monitor the efficacy of a given treatment. Because of these advantages, CBC is listed high among the most ordered laboratory test worldwide. Combing the CBC results with other common tests adds to the utility. Careful observations published from earlier viral epidemics like SARS, MERS etc. had already shown the utility of CBC parameters. Therefore, when Covid19 epidemic turned into a pandemic, many of those published their observations. We shal l review some of those papers which could be helpful to (A) suspect SARS-CoV-2 infection while rRT-PCR test is not yet carried out or itâ&#x20AC;&#x2122;s results are awaited, (B) anticipate the course of Covid19 infection in an already hospitalized patient and/or (C) prognosticate the outcome i.e. recovery or disease aggravation.

Reference: Routine blood tests as potential diagnostic tool for Covid-19by Davide Ferrari et al, Clin Chem Lab Med 2020;aop, De Gruyter https://doi.org/10.1515/cclm-2020-0398

1. Multicentre meta-analysis carried at 5 centres

Main features of study:

Reference: Hematologic, biochemical and Immune biomarker abnormalities associated with severe illness and mortality in coronavirus diseases 2019 (COVID-19), a meta-analysisby Brandon MichaelHenry et al, Clin Chem Lab Med 2020, https:// doi.org/10.1515/cclm-2020-0369

z Total patients n=207, (rRT-PCR result Positive=105, Negative=102)

Main features of analysis:

z Increased CRP,ALT, AST& LDH

z 21 studies, total n=3,377 patients from 5 centres in 3 coun tries (i.e. 2 x USA, 2 x Italy & 1 x Brazil)

z Specific cut-off AST > 35 IU/L &LDH>210 IU/L

18 studies (n=2,984) focussed on Severe v/s Non-severe patients 03 studies (n=393) focussed on Survivors v/s Non-Survi vors

Main findings: Patients having Positive rRT-PCR (n=105) showed: z Normal or Low Total WBC# z Decreased Lymphocytes

Conclusions: Using Cut-Offs for basic hematologic & biochemical parameters could help to 1. Identify False Positive & Negative from available rRT-PCR results

z 33 different laboratory parameters were included

2. Optimize scarce resource i.e. rRT-PCR testing or patient facilities

Main findings: Patients in Severe / Fatal groups showed

3. Iranian study

z Increased Total WBC#, Neutrophils, ALT, AST, LDH, CRP, PCT, Ferritin, D-Dimer, Pro.Time, IL-6

Reference: Lab Parameters in detection of COVID-19 patients with positive RT-PCR, a diagnostic accuracy study, by Rajab Mardani et al, Archives of Academic Emergency Medicine, 2020; 8(1):e43

z Decreased Hemoglobin, Lymphocytes, Eosinophils, Platelets and Albumin Conclusions: Findings are helpful in discriminating between 1. Severe v/s Non-severe, 2. Risk stratification and Patient prognosis

2. Italian study

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Main features of study: z Total patients n=200, (rRT-PCR result Positive=70, Negative=130) Main findings: Patients having Positive rRT-PCR (n=105) showed z Low Total WBC#

z Increased Neutrophils,CRP,ALT& LDH Conclusion: findings suggest that considering 1. Levels of LDH, CRP, ALT & Neutrophil# can be used to predict the RT-PCR results and that can help save resources 4. Chinese study Reference: Preliminary study to identify severe from moderate cases of COVID-19 using NLR & RDW-SD combination parameter by Changzeng Wang et al, https://doi.org/10.1101/2020.04.09.20058594 Main features of study: z Total patients (Covid-19 positive) = 45(Tests = 161)

In the current Covid-19 pandemic, detecting persons with SARS-CoV-2 infection is top priority because patient numbers are rising alarmingly and demands use of all available resources at our command.

Clinically moderate = 35 (Tests = 131) Clinically severe = 10 (Tests = 30) Main find ings: Results of Area under Curve (AUC)analysis of hematology parameters alone or in combination showed z Only NLR (Neutro / Lympho Ratio)

= 0.890

z Only PLR (Platelet / Lympho Ratio)

=0.842

z NLR & RDW-SD (> 1.046)

=0.938

(Formula to calculate= 0.078737 × NLR + 0.489253 × RDW-SD e 19.9587) z NLR & RDW-CV (<1.046)= 0.923 (Formula to calculate = 0.1031 × NLR + 1.1137 × RDW-CV e 14.5006) Conclusions: findings of this study suggest that, 1. When only NLR or PLR value is used, it helps in separating patients into Severe and Moderate categories 2. Using RDW-SD values is better than RDW-CV in NLR / RDW calculation 3. When combined NLR/ RDW-SD value is more than 1.046, patient’s condition could be worsening

4. Patient’s condition could be improving when combined NLR/ RDW-SD value is lower than1.046 From the above referred studies, utility of routine haematology parameters (alone or in combination with other common parameters can be summarized as under: 1. Majority of Covid-19 positive patients showed lymphopenia and elevated CRP i.e. infection-related biomarkers 2. NLR, a well-known marker of systemic inflammation and infection as a predictor of bacterial infection, including pneumonia. IncreasedNLR seen in the severely affected Covid-19 positive (as compared to the milder group) 3. Automated Lymphocyte count (ALC) approaching 0.6 x 109/ L or lower could serve as a criterion for early ICU admission and more supportive measures 4. During hospitalization, ICU patients tend to develop neutrophilia with an ANC peak of 11.6 x 109 /L, compared to 3.5 x 109 /L in the non-ICU group 5. Condition of hospitalized patients could be monitored using cut-off value derived from NLR & RDW-SD which seems to slightly better than NLR & RDW-CV.

The Road Ahead

AGAPPE FERRITIN Ferritin estimation made simple and affordable using Nephelometric method in Mispa-12 and Mispa-i3. System reagent packs designed for Mispa-i2 and Mispa-i3 comes with Smart card calibration and patented UCS technology to deliver results within 5 minutes.

In the current Covid-19 pandemic, detecting persons with SARS-CoV-2 infection is top priority because patient numbers are rising alarmingly and demands use of all available resources at our command. In spite of remarkable rise in rRT-PCR testing, healthcare system is unable to meet the huge demand. Hence, though not diagnostic for Covid-19, CBC is performed by 3-PDA haematology analyzers practically by every laboratory round the corner. Hence, when CBC & derived parameters like RDWSD (and easily calculable ratios like NLR. PLR etc.) interpreted along with results of other routine tests like CRP, ALT, LDH, Ferritin etc. are used and correlated with patient’s clinical data optimizes our strained resources. It is also very important that Indian medical professionals not only observe results of routine tests carefully but also publish India specific data to win the fight against Covid-19 pandemic.

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Life Story

Abu Dhabi

THE MOVING STORY OF A TRIO WHO FOUGHT

COVID-19 IN AN ALIEN LAND

How it will be when you are affected by the dreaded Covid-19 in a foreign land? The trauma of such victims who have neither their family nor close ones nearby to support and take care is something very different from that of the Covid victims back at home. Here’s the true story of three such friends who successfully fought Covid-19 with sheer will power and the strength of their friendship in Abu Dhabi.

When the Covid 19 test result of Abhiraj came positive, the

nine expats and friends from different parts of Kerala residing in a rented flat at Tourist Club Area, Abu Dhabi, went into a shock for a split second. Since they shared the same apartment, chances are high for others to be affected too. But all regained their composure. Since one of them is affected, there is every chance that others may also turn positive. However they unanimously resolved on one thing: “we are in this together and we will get out of this together!” Four days later when the Covid 19 test results of eight came, two more –Jinson and Jerin had turned Covid 19 positive. A disease which the WHO has declared a pandemic had made its way

to their small apartment. Away from the caring hands of family members and a familiar health care system, they were now stranded in a foreign country with none other than each of them to take care of themselves. The strange journey which could test their depth of friendship and their ability to look after each other began there....

Far from Home Jinson (25) hailing from Aluva in Kerala was only 19 years old when he packed his bag to Abu Dhabi for a new livelihood, just wthin 10 days of his ITA Refrigerator and Air Condition course results came. Now after completing six years as an expat, he is a Technician at a private organisation in Abu Dhabi which mostly undertakes the electrical, plumbing and maintenance work of apartments. He had gone home at Kerala only once during these six years. “The salary isn’t much. Also, even we wish to join the family during some festival or holidays, the ticket rate of flight will be very high at that time. Moreover, the economic boom of Gulf nations is slowly receding. There is no guarantee of a job when you return,” he says.

Jinson, Jerin & Abhiraj (from the left)

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The cond ition of most expats is almost the same. They very well know the difficulties to find a new job if they return to Kerala. So, most cling on to whatever job they have although the salaries may be low. The plight of their families back at home makes them suffer all the hardships. “When I

“Wash your hands regularly with soap and water, or clean them with alcohol-based hand rub and try to avoid touching your face”.

“Stay home if you feel unwell and practice physical distancing by avoiding unnecessary travel and staying away from large groups of people”.

“Cover your mouth and nose when coughing or sneezing. Refrain from smoking and other activities that weaken the lungs”.

Jinson

Jerin

Abhiraj

came to Abu Dhabi, I shared the room with eight. It was more like a labour camp. Few years ago, my company helped me to move to a new apartment where I share the room with another,” says Jinson. His new apartment is a 3BHK where nine reside. Back home, Jinson’s family consists of father, mother and an elder brother whose marriage will be in next month that probably Jinson might miss. Most of Jinson’s friends at the apartment have similar condition. Abhiraj (26) who hails from Thrissur district, Kerala works as an accountant in a Hospitality Management company in Abu Dhabi. Jerin (30) is an IT Technician and his home is at Chalakudy, Thrissur. Responsibilities on shoulder, they are the only source of income for their family which makes them ‘absent’ in most family functions and festivals back at home.

The Bad News It was Abhiraj who first turned Covid-19 positive among the group of nine friends. Earlier one of his colleagues had turned Covid-19 positive and that’s how he underwent the test. Probably from Abhiraj, Jinson and Jerin got the disease. Now all of them will have to do home quarantine. Since the hospitals were filled with Covid 19 patients, the admission was restricted to only those who are in serious condition. They stayed the same way as they used to stay in the apartment. To rent out a place just for home quarantine with their current salary was almost impossible. Moreover, they figured out

that if the disease was to transmit among them all, it would have happened by now. Among the three, Jinson hadn’t any difficulties associated with Covid-19. “I didn’t have much complication during the period. But Abhiraj and Jerin had many difficulties. The former had breathing difficulties and high fever after he got Covid-19. But he was lucky as his company took good care of him. The positive turned employees of the company were shifted to a separate building with good accommodation facility in an ambulance later. Abhiraj was also shifted to the same place. Jerin also had fever. Abhiraj had been advised by health offi-

They stayed the same way as they used to stay in the apartment. To rent out a place just for home quarantine with their current salary was almost impossible. Moreover, they figured out that if the disease was to transmit among them all, it would have happened by now.

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Life Story

Abu Dhabi

cials to take Hydroxychloro quine after he had breathing difficulties. Jerin and I took usual medicine for fever and it subsided,” says Jinson. Now that three have turned Covid 19 positive, all others in the apartment remained under home quarantine. Although they were negative, they are not allowed to go to work. “To ensure that they remain under home quarantine, there are stringent measures at Abu Dhabi. A mobile app specially designed for this is put in good use here. The public can install this App in their mobile phone. If you are under home quarantine and broke it, the App will alarm the people nearby through the Bluetooth. They can file the complaint to municipality or Covid 19 department of Health Ministry. The fine for breaking home quarantine is 50,000 Dirham. Jinson, Jerin & Abhiraj (from the left) with other friends There wil l be also a case on to be shifted to a hospital or any other quarantine centres as he charges under Prevention of Epidemic,” says Jinson. didn’t want to pass on the disease to his friends. But since he It was in May UAE introduced state-of-the-art corona vihadn’t any symptoms, they told him that he should continue home rus testing and contact-tracing app, Al Hosn. The app is being quarantine and chances for him to pass the disease to someone hailed as more effective than a curfew in curbing the spread of else is less. Jinson is all praise for Abu Dhabi Health Services ComCovid-19 and helps authorities track who potential corona pany “SEHA” which took care of his case in Abu Dhabi. “They are virus patients have come into contact with. The app was very positive and encouraging in their approach,” notes him. In launched by the National Emergency Crisis and Disaster Mancase of an emergency, patients are advised to call 998 for help. agement Authority (NCEMA). Although Jinson’s company enquired about his health status Staffs from hospital daily take follow up of their progress, in every two days, he lost his salary for the one month he retwo times a day. They will move only those who have severe mained under treatment and observation. Others lost salary for difficulties to the hospital. In industrial areas, Abu Dhabi gov14 days as they were in home quarantine. That period is considernment has set up many camp hospitals. Jinson really wanted ered as a leave without pay. Now, the salary has been cut either to half or 30% after the Covid 19 has affected the business. This is the case of most expats.

Staffs from hospital daily take follow up of their progress, two times a day. They will move only those who have severe difficulties to the hospital. In industrial areas, Abu Dhabi government has set up many camp hospitals.

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The Good News After 14 days, Jinson and Jerin had to undergo Covid-19 test again. If it is negative, they should undergo another 14 days home quarantine to make sure that they don’t transmit it to anyone else. A medical certificate will be issued to them upon the successful completion of the home quarantine and to resume office duty. Total 28 days home quarantine. “I underwent those days in my room. During one occasion, I was asked to get to hospital for ECG Test. This was the only occasion when I went out of the apartment in those 28 days. Also, you have to follow the guidelines before going to the hospital. An ambulance will be sent and

you must put your mask, face shield and gloves to the hospital. There was a separate area for Covid-19 positive cases in the hospital,” remembers Jinson. After 14 days of home quarantine, Jinson and Jerin turned negative in their Covid-19 test. Earlier Abhiraj had also turned negative. The trio underwent another 14 days of home quarantine and are now back to their normal lives. No one informed the dreadful news at their home when they turned Covid 19 positive. They didn’t want their family members to unnecessarily worry. After turning negative Abhiraj conveyed the news to home although Jerin’s family still don’t know about it. Jerin’s wife was pregnant and delivery was during those days. So he remained tight lipped. Jinson on the other hand told the news to his elder brother and he informed the parents after his brother turned negative.

Wants to Go Home, But....... Abhiraj had earlier applied in the Vande Bharat Mission to return to Kerala, India when the pandemic was spreading fast. However it was just a week back, he got the call asking if he would like to go home. But he turned down the offer and chose to continue in Abu Dhabi. “We wanted to go home so that we will be safe from Covid-19. Now we have suffered and recovered from it,” says

We wanted to go home so that we will be safe from Covid-19. Now we have suffered and recovered from it,” says Abhiraj. Although there is no proof that people once affected and recovered from Covid-19 will not get affected again, Abhiraj is confident of remaining in Abu Dhabi. “We just passed the hardest par t. Our experience has reinforced the faith in the health care system of Abu Dhabi. Moreover, this country has provided us our bread and butter until now. It is not right to leave the country in a difficult time,” he adds. Abhiraj. Although there is no proof that people once affected and recovered from Covid-19 will not get affected again, Abhiraj is confident of remaining in Abu Dhabi. “We just passed the hardest part. Our experience has reinforced the faith in the health care system of Abu Dhabi. Moreover, this country has provided us our bread and butter until now. It is not right to leave the country in a

After 14 days of home quarantine, Jinson and Jerin turned negative in their Covid-19 test. Earlier Abhiraj had also turned negative. The trio underwent another 14 days of home quarantine and are now back to their normal lives. difficult time,” he adds. Jinson also voices the same concern. “If you ask us whether we wanted really to be back in our country, the answer is yes. We all wanted to return to Kerala. There is an invisible shield of safety you all feel in your home, under the care of your loved ones. We also wanted to undergo treatment at Kerala when we were affected as we were thrilled to learn how Kerala is fighting Covid-19 with its limited resources. At that time, the number of Covid-19 patients was alarming here. However we are happy now with the service and support we received from the Health Department of UAE,” he continued. Jerin wishes to see his wife and new born baby. But since he knows very well the risk associated with a flight journey and possibility of him passing the disease to his wife and kid, he chooses not to go. “Let everything subside. I will go then,” says him.

STAY SAFE WHEREVER YOU ARE

‘That’s what friends are for’

One thing the trio really don’t want to lose is the set of friends they have now in their apartment. They stood with them in their difficult time. “One of my friends in Dubai after turning Covid-19 positive had enquired me, if I could find an accommodation for her, as her roommates refused to accommodate her in the apartment. Her company arranged a facility later. Although she recovered, she doesn’t want to return to her old room now,” says Jinson. “I’m lucky to have such a bunch of friends,” adds him.

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Health Tips

SOME ESSENTIAL

HEALTH TIPS

Dr. C S Satheesh Kumar, Sr. Vice President-Supply Chain Management, AGAPPE., (Retd. Drugs Controller, Kerala) Covid-19 is a viral infection called severe acute respiratory syndrome corona virus 2 (SARS-CoV2), and basic immunity for any viral infections should support the patient from any severe symptoms. That is the reason why many patients have no symptoms as such. There are so many key points for keeping our immunity profile up to combat any viral attack including Covid-19. The general health tips for combating viral attack with higher level of natural immunity are discussed here. Stay Active Working out is a powerful way to boost your immune system. It causes the antibodies and white blood cells in your body to circulate more rapidly, which means they may be able to detect and zero-in on bugs more quickly. Being active this way also lowers stress hormones, which reduces your chances of getting sick. Research suggests that effects of exercise may be directly relevant to virus fighting, too. According to a recent study, those who exercised for at least five days a week had almost half the risk of coming down with a cold when compared to those who were more sedentary. If the former did

catch a cold, they reported less severe symptoms. There is a protective benefit from the sweat generated from your exercise session, as research has shown that simply raising your body temperature may help kill germs in their tracks. The key to exercise, however, is to do it in moderation, say 30 to 60 minutes of work-out (either vigorous or moderate) for 5 to 6 days of the week.

Yoga Practice

Performing proper Yoga practice daily can bring you untold health benefits. Try to perform at least one hour of uninterrupted yoga sessions daily including breath ing exercises (Pranayaama, Sukh aasana), variations of Matsyasana (fish pose), Uttan asana (standing forward bend pose), Ard ha Matsyandrasana (half fish Performing proper Yoga practice daily pose), Shirshasana (head stand pose) Sarvvang can bring you untold health benefits. aasana (shoulder stand Try to perform at least one hour of pose) and Suryanam askkaara. uninterrupted yoga sessions daily

including breathing exercises (Pranayaama, Sukh aasana), variations of Mat- syasana (fish pose), Uttan asana (standing forward bend pose), Ardha Matsyandrasana (half fish pose), Shirshasana (head stand pose) Sarvvang aasana (shoulder stand pose) and Surya namaskkaara.

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The Importance of Diet Cooking with herbs such as garlic, ginger, sweet potatoes, carrots, beets (and donâ&#x20AC;&#x2122;t forget their greens) and many green vegetables, cruciferous veggies, such as cabbage, brussels sprouts, broccoli and turmeric benefits the food to develop

anti-inflammatory properties. You can separately consume two cloves of garlic with warm water every day or make it a part of your daily meal by adding it to soups and hot stews for added flavour. Garlic also appears to enhance the performance of the immune system by energizing certain cell types in the body. Ginger has impressive antiviral, antibacterial and antiinflammatory properties. Studies suggest that this herb is effective in helping prevent avian influenza, RSV, and feline calici virus (FCV). Ginger contains compounds like gingerols and zingerone that helps to prevent the growth of the virus. Also known as Mulethi in Hindi, liquorice root has been used widely in traditional Chinese remedy and other natural practices for centuries. Glycyrrhizin, liquiritigenin, and glabridin are just some of the active substances in liquorice that have powerful antiviral properties. Liquorice root extract is effective against HIV, RSV, herpes viruses, and severe acute respiratory syndrome-related corona virus (SARS-CoV), which causes a serious type of pneumonia. A mint family herb, Sage is an aromatic plant that has long been used in traditional medicine to treat viral infections. The antiviral properties of Sage are mostly attributed to compounds called Safficinolide and Sage one, which are found in the leaves and stem of the plant. Many types of Basil, including the sweet and holy varieties, may fight certain viral infections. Holy basil, also known as Tulsi in South Asia, has been shown to increase immunity, which may help fight viral infections. Fennel is a liquorice-flavored plant that may fight certain viruses. Ginseng extract has exhibited significant effects against RSV, herpes viruses, and hepatitis A. Compounds in ginseng called Ginsenosides have antiviral effects against hepatitis B, norovirus,

A mint family herb, Sage is an aromatic plant that has long been used in traditional medicine to treat viral infections. The antiviral proper ties of Sage are mostly attributed to compounds called Safficinolide and Sage one, which are found in the leaves and stem of the plant.

and coxsackie viruses, which are associated with several serious diseases. Turmeric is known for its anti-inflammatory, antioxidant, anticancer, and antimicrobial effects and has also been shown to help improve the immune system. Green tea findings suggest that drinking 1-5 cups per day of green tea may prevent illness and symptoms of cold and flu. Vegetables: Green leafy vegetables, kale, spinach, arugula, collards, bok choy, cruciferous vegetables (broccoli, cabbage, cauliflower, kale, arugula), onion and garlic family (onions, garlic, leeks, green onions, chives and shallots), starchy vegetables, sweet potatoes (orange and purple), squash, non-starchy vegetables, carrots, red and orange bell peppers, green beans, etc. Fruits like berries (blueberries, raspberries, blackberries, strawberries), cherries, citrus fruits (oranges, tangerines, grapefruit, clementines, lemons, limes), dark coloured fruits like Mangos, papaya, kiwis, red grapes, pomegranates, etc. Beans like black beans, pinto beans, kidney beans, white beans, lentils (green, red, black) or French lentils, black-eyed peas, green peas, chickpeas. Nuts and Seeds like walnuts, almonds, peanuts, cashews, pecans, hazelnuts, seeds like ground flax seed, sesame seeds, pumpkin seeds, chia seeds, hemp seeds, etc. are good.

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Health Tips Omega-3 fatty acids found in some types of fish, such as salmon, sardines, herring, and mackerel, kelp etc. enhance the functioning of immune cells. Plenty of vitamins and minerals play a big role when it comes to immune function, but one particular standout is magnesium. Vitamin C may help protect the body against oxidative stress, and that helps support immune system. Oxidative stress happens when there is an imbalance of healthy antioxidants and harmful substances called free radicals in the body. Vitamin C can be found in oranges, lemons, strawberries, blueberries, tomatoes, broccoli, leafy greens like kale, and bell peppers. Sunflower seeds, almonds, walnuts, sprouting beans and pecans can give you the necessary Vitamin E. Vitamin D has become a hot topic in immunology. Have sufficient sun light daily.

immune system. Get enough sleep: Rest is another natural immune system booster. Our immune system is like your computer. It needs moments of rest so it doesn’t become overheated, sleep reboots the system. When we are sleep-deprived, stress hormones like cortisol are released to keep you awake and alert, suppressing our immune system. Try to get at least seven hours of slumber a night. Forget boozing through the corona virus crisis, because heavy drinking also depletes our immune cells. Some studies have suggested that the first-line-of-defence, the macrophages are not effective in people who have had a lot of alcohol. And there have been suggestions that high alcohol consumption can lead to a reduction of the lymphocytes as well. Avoid heavy drinking habit. Eating proper meals every day while including plenty of fruits and vegetables in the diet is the best way to maintain necessary levels of bodily immunity.

Avoid sugar intake whenever you can. Sugar can trigger Other Ways to Stay Wel l inflammation in the body. In addition, high amounts of saturated fat and trans-fat in the diet can increase inflammation in 1. Wash your hands frequently and thoroughly with warm water the same way, and that and soap, especially after weakens the immune touching common shared response. objects like elevator butThere is a strong link between tons, doorknobs, teleStay hydrated has your immune health and your phone handsets, etc. You become the new manmental health. When you’re can use hand sanitizer if tra for pretty much evunder chronic stress or anxsoap and water are not erything from losing available. iety, your body produces stress weight to boosting en-

hormones that suppress your immune system. Research has found that people who are stressed are more susceptible to developing the common cold. hormones that suppress your immune system.

ergy, and it does provide some magic for improving your health. Proper hydration can help multiple bodily systems, includ ing your immune system.

Minimize intake of alcohol, sugar, animal protein, animal fat and processed food: By eating these food products, we suppress our immune system as well as miss out on eating the healthy food needed to boost our immune system. Focus on eating whole plant products to boost your immune system and lower the risk of illness. Smoking is known to suppress the immune system. Quit smoking to avoid the risk of sickness and disease.

Mental Health: There is a strong link between your immune health and your mental health. When you’re under chronic stress or anxiety, your body produces stress hormones that suppress your immune system. Research has found that people who are stressed are more susceptible to developing the common cold. Those who were stressed were more likely to produce cytokines, molecules that trigger inflammation, and were about twice as likely to get sick. So, practise stress release exercises and meditation. Some stress is good, but know when to relax. Too much stress impairs the

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JULY - SEPTEMBER 2020

2. Try fist bumps instead of handshakes or high fives, when appropriate. Use your knuckles for keypads, doorbells, elevator buttons, etc.

3. Cover your cough or sneeze. Use a tissue, your el bow, or inside your shirt. Throw used tissues away immediately and don’t forget to wash your hands promptly. 4. Avoid touching your face, eyes, or mouth. 5. Limit contact with those infected with the flu or other illnesses whenever possible. If you are sick, stay home to rest and recuperate. Encourage co-workers and employees to stay home if they are sick. 6. It may help to sanitize common home or work surfaces with EPA-approved disinfectants, diluted bleach water, soap etc. These viruses are fragile in the environment but can survive on certain surfaces for a limited time. 7. Keep your immune system working strong by ensuring proper and adequate sleep, nutrition and exercise. 8. In the case of COVID-19, specifically, we also recommend you to avoid unnecessary travel and crowds.

Brand Reach Customer Speaks

Happy with Mispa-i2 Testing We are very happy with Mispa-i2 and its reagent quality. We are using C3, C4, Ferritin, D-Dimer, HbA1c and many other testings. We are happy to serve our patients with Agappe's quality products and timely service.

Dr. Avtar Krishna Ganju American Oncology Institute, Coimbatore.

‘V ery convenient to use and expect mor ‘Very moree innovative pr oducts’ products’ Mr. V. Sivakumar Vijaya Diagnostics Centre, Chennai.

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

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

Dr. Anjali Mahindru, Sigma Diagnostic Lab, Jalandhar

Dr. B.Y Shinagare Shinagare Laboratory, Pune.

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.

TECHAGAPPE

JULY - SEPTEMBER

Cover Story Good Laboratory Practices

CORONAVIRUS DISEASE-2019 RNA EXTRACTION PROTOCOL

The effectiveness of a PCR assay lies in the primary sample process i.e. the extraction method which is used to extract the nucleic acid from the specimen. Many methods are available in the market for extracting the nucleic acid like Chemical based, Column based or magnetic beadbased methods. The Chemical method is based on the ‘phase’ based separation, Colum method is based on the affinity of RNA to silica particle and the magnetic is based on the affinity of RNA to the specifically treated magnetic nano particles. Sanjaymon K R, General Manager, Business Development, AGAPPE

The last decade witnessed an exponential growth in the molecular diagnostic segment. The term molecular diagnosis become popular when the human genome project started worldwide. The highly complex assays which takes time and money

become more popular and less expensive with the introduction new generation compact systems in the market. Today molecular diagnosis was widely used in the field of infectious disease, oncology, genetics, pharmacogenetics and in forensic sciences. Today molecular diagnostics are treated as the golden standard for the detection of infectious diseases. The Molecular diagnosis is based on the replication of the nucleic acid (DNA/RNA) present in the specimen which was first described in the year 1971 by K. Kleppe, E Ohtsuka, R.Kleppe, I.Molineux, H.G Khorana. The process of replicating the nucleic acid is called as Polymerase Chain Reaction (PCR) which was originally developed in the year 1983 by the American biochemist Kary Mullis.With an increase in the infectious diseases like HIV, Hepatitis and now the COVID-19, the importance of Molecular Diagnostics has reached a new level. To detect the Virus, the viral RNA is isolated, converted to cDNA and the DNA is then replicated to millions of copies and detected optically using special instruments. Today many techniques are available in PCR like reverse transcription PCR (RT-PCR), reverse transcription qPCR (RT-qPCR) quantitative real-time PCR (qPCR), and digital PCR (dPCR). The effectiveness of a PCR assay lies in the primary sample process i.e. the extraction method which is used to extract the nucleic acid from the specimen. Many methods are available in the market for extracting the nucleic acid like Chemical based, Column based or magnetic bead-based methods. The Chemical method is based on the ‘phase’ based separation, Colum method is based on the affinity of RNA to silica particle and the magnetic is based on the affinity of RNA to the specifically treated magnetic nano particles. Magnetic bead-based RNA isolation is now widely gaining momentum in the market because of the simplicity of assay and

TECHAGAPPE

JULY - SEPTEMBER 2020

When it comes to Virology testing, the RNA extraction is a crucial step and we need to make sure that the isolation is effective in getting high purity and intact RNA with a very good yield. It is recommended to use an RNA isolation method with more than 95 % yield.

better yield of highly intact RNA from viral transport media samples. Combination methods are also available in the market which uses chemical Lysis ( which is highly effective in lysing more difficult to lyse samples) along with magnetic bead-based isolation to give highly pure RNA and is suitable for multiple sample types. When it comes to Virology testing, the RNA extraction is a crucial step and we need to make sure that the isolation is effective in getting high purity and intact RNA with a very good yield. It is recommended to use an RNA isolation method with more than 95 % yield. The method used should be simple and should be capable of performing as manual assay or automated assay. The efficiency of the isolation also depends on the simple hardware’s used like the microcentrifuges, shaker, heat block and even the pipettes and tips used for transferring the liquids. Points to be noted during extraction of nucleic acids z Make sure that consumables like the pipette tips, tubes, Microcentrifuge tubes and other consumables used are RNase free or use DEPC teared labware’s to avoid contamination of the sample. Always make sure that there are enough consumables

available before starting the extraction process. It is recommended to change the gloves frequently between processes to avoid contamination. Using automated or semiautomated extraction procedure will help in minimizing the RNase contamination. z Methods where “phase” based separation is used, care to be taken while homogenization step and during the transfer of aqueous phase or else there is a chance of having genomic DNA eluting together with the RNA. There may be a chance of getting low RNA yield in case of improper homogenization. Make sure that the vortex mixer or heat block or shaker are tuned properly while performing the extraction protocol. The microcentrifuge needs to be checked and calibrated as per the manufacturer recommendation to assure that the RPM or “g “are proper. This will allow the user to have better separation of the liquids in Chemical based isolation protocols. z Integrity of the sample is one of the major reasons for having low yield in extraction. A fresh sample is always recommended for the RNA isolation or else the sample needs to be frozen immediately or transported and stored in the specific Viral Transport Media. z Effective cleaning of the area is another point to be remembered. Exposure to environment which may have microbes or even traces of hair or skin foliates can contaminate the sample. It is recommended to have proper decontamination procedures in place and is monitored properly to avoid such errors. Even though the protocol of RNA isolation is simple there are some common factors which when overlooked may give a negative response in the PCR based assays. The laboratories should have a logbook for the effective cleaning and calibration of the hardware’s used in the molecular biology to minimize the errors during the RNA isolation.

TECHAGAPPE

JULY - SEPTEMBER

Promotion

New Product

“Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India. TEL: + 91 484 2867000 | productcorp@agappe.in | www.agappe.com

TECHAGAPPE

JULY - SEPTEMBER 2020

Promotion

New Product

“Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India. TEL: + 91 484 2867000 | productcorp@agappe.in | www.agappe.com

TECHAGAPPE

JULY - SEPTEMBER 2020

Engagements Nature Day

Planted seventy trees at Agappe Corporate Office contributed by Agappe employees.

TECHAGAPPE

JULY - SEPTEMBER 2020

Engagements Lockdown Days

BRAVEHEARTS OF AGAPPE “We appreciate your positive and optimistic outlook to fulfill your duty as an Agappean which might have involved risking your own life for the welfare of mankind during this hour of pandemic. ““Thank you all for keeping the fervour of this flame burn bright at this dark hour. Agappe holds your zeal, strive for perfection, sense of urgency and unstinted enthusiasm in high spirits.

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JULY - SEPTEMBER

Toll Free

1800 425 7151

FIRST ‘MADE IN INDIA’

TUBE LABELING SYSTEM 37” TFT Touch Screen display matching the eye contrast ratio 36 tube racks with capacity of 120 tubes 3Per tube labeling time is just 8 sec - Throughput of 450 tubes/hr 3IMD (Intelligent Mechanical Drop) technology 3Faster turnaround time offers operational efﬁciency 3Automatic tube positioning & identiﬁcation 3Customizable category mapping for the tubes 3Thermal printer with 3 modes 3Auxiliary printer for abnormal container label printing 3Flexible design saves valuable space in the lab 3Linux based Operating System | Smart card technology 3HIS/LIS connectivity - Bidirectional | HIS/LIS interface - USB, Ethernet, Wi-Fi

Label Intelligent Tube Labeling System “Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India. TEL: + 91 484 2867000 | productcorp@agappe.in | www.agappe.com

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JULY - SEPTEMBER 2020

Reward Programme

CONSENT

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

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

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

Sign & Seal of the owner / proprietor / director

Scan QR code to download AG Privilege app

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

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

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JULY- SEPTEMBER 2020

Scan QR code and participate in the lucky draw contest. Amazing prizes are waiting for the winners. Conditions apply*

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

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

Postal address:

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

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

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Life Stories Good Laboratory Practices

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Health Tips Interviews

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KNOW THE

‘D’ OF DIAGNOSTICS

MEASURE ACCURATE QUANTITATIVE D-DIMER WITH MISPA-i2 NEPHELOMETRY METHODOLOGY LINEAR UP TO 10 µG /ML READY TO USE REAGENTS NO SAMPLE DILUTION NEEDED NO CALIBRATION REQUIRED

+91 9745794444

1800 425 7151 “Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India. TEL: + 91 484 2867000 | productcorp@agappe.in | www.agappe.com

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www.agappe.com Toll Free

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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. RNI No.: KERENG/2015/62113

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