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Volume VI || Issue V || Jan.-Feb. 2016

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News Update | Doctor Speak | Expert Views | Product Line | Industry Watch | Healthcare Management

EDITOR EVENT SPEAK

Glioblastoma Treatment Market Will Expand Fivefold to $3.3 Billion by 2024, says GlobalData  Glioblastoma therapeutics market will grow dramatically from $659 million in 2014 to $3.3 billion by 2024, as promising new therapies are introduced  New drugs will be so lucrative as they are able to overcome problems involved with the blood-brain barrier, and help patients refractory to Avastin, says report The glioblastoma treatment market will increase fivefold from $659 million in 2014 to $3.3 billion by 2024, representing a rapid Compound Annual Growth Rate (CAGR) of 17.4%, according to research and consulting firm GlobalData.

The company’s latest report* states that this meteoric rise, which will occur across the seven Major Markets (7MM) of the US, Spain, France, the UK, Italy, Germany and Japan, will primarily be due to the launch of new therapies for glioblastoma patients with high unmet needs.

Maxime Bourgognon, PharmD, GlobalData’s Analyst covering Oncology and Hematology, says: “Adults with glioblastoma have some of the highest levels of unmet need of any cancer patients. Despite progress having been made in treating the disease, survival rates remain low.

“Although glioblastoma is a rare disease, such high levels of unmet need in the market have created ample opportunities for players with effective therapies. However, developing drugs which effectively treat glioblastoma has proved exceedingly challenging to date, predominantly due to the presence of the blood-brain barrier, which prevents many drugs from entering the brain and attacking the tumor.”

GlobalData believes that current pipeline drugs offer potential solutions to this complex obstacle, and has identified Bristol-Myers Squibb’s immunotherapy Opdivo (nivolumab) as a particular contender to become the primary standard of care by 2024.

Bourgognon explains: “Immunotherapies have shown significant efficacy in other oncology indications, and as they affect the tumor microenvironment rather than directly targeting the tumor, they make attractive candidates for glioblastoma treatments.

“Currently, Avastin dominates the market, working by inhibiting angiogenesis and disrupting the blood-brain barrier, which in turn leads to tumor starvation. Patients refractory to the drug, however, have scant treatment options, and Opdivo addresses this.”

Of the 7MM, Japan will see the most impressive relative growth, with sales expanding from $47 million in 2014 to $268 million in 2024, representing a CAGR of 19.7%.

As with the rest of the 7MM, growth will be driven by the introduction of new drugs such as Opdivo. However, higher pricing of the drug in Japan will result in the country’s even faster growth rate, according to GlobalData.

Have an insightful reading.

Your suggestions are most welcome!

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magazine Volume - VI Issue - V Jan.-Feb. 2016

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NEWS Update

Government is Committed to Extend Immunisation to The Last Child- J.P. Nadda

Indradhanush to Achieve 90% Coverage in Couple of Years

The Government is committed to extend the immunisation programme to the last child of the country said, Shri J.P. Nadda, Union Minister of Health and Family Welfare. He was speaking on the occasion of launching of media campaign on Hepatitis-B in Mumbai today. The Minister said that the humanitarian aspects of Amitabh Bachchan has provided great push to Hepatitis-B awareness programme.

He further said that for health issues, support of the society and very important and Amitabh Bachchan’s contribution has added power to this campaign.

He assured that government will provide all possible support, so that the goal of eradication of Hepatitis-B would be achieved. He further said that Hepatitis-B vaccination would be made part of the ambitious Indradhanush programme and in the couple of years 65 to 90% coverage would be achieved.

The drive will aim to create awareness about Hepatitis-B and its vaccine through

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uninhibited confessions led by UNICEF Goodwill Ambassador, Amitabh Bachchan.

In India, approximately 10 lakh children, on an annual basis, run the lifetime risk of developing chronic Hepatitis infections, leading to life-threatening issues including liver cancer, liver failure and a possibility of premature death. Despite continuous efforts, only 65% children in India had access to all vaccines during the first year of their life. Today, Routine Immunization (RI) in India targets 27 million infants and 30 million expecting mothers, saving 300,000 million lives each year.

Commenting on this association , Amitabh Bachchan said, “Hepatitis B is a very real issue in our country. It can be present in our blood streams for years and go undetected, only to strike with a vengeance when you least expect it. I have battled Hepatitis B following a bad blood transfusion; it has highlighted to me how a small oversight during growing up years can prove to be detrimental to not only one’s own life

but also others. Immunization against Hepatitis B is a very personal issue for me, and I am very happy to be associate with Ministry of Health and Family Welfare and UNICEF India to narrate my story to the Indian population to create awareness about this cause.”

Adding further, Louis Georges Arsenault, UNICEF India Representative said, “Preventing Hepatitis-B through immunisation at birth and the first year of life is critical for the healthy life of a child.

If we could achieve the extraordinary feat of defeating polio, we can surely join hands and also prevent this life threatening disease through timely Routine Immunisation.”

The ‘Confessions from AB’ film is the firstleg of a national awareness drive which aims to highlight the benefits of Routine Immunization led by Ministry of Health and Family Welfare. The joint efforts of Ministry of Health and Family Welfare and UNICEF India attempt to rid the nation of 7 life-threatening diseases (Diphtheria, Whooping Cough, Tetanus, Polio, Tuberculosis, Measles and Hepatitis-B).

Dr. Deepak Sawant, Maharashtra Health Minister, Mr. Louis Georges Arsenault, UNICEF representative of India, Prof.

Ram Shinde, Minister of State for Health (Maharashtra), Mr. C.K. Mishra, Additional Director, Ministry of Health and Family Welfare and Dr. Jayant Barve, Clinical and Interventional Gastroenterologist were also present on this occasion.

The Abraaj Group agrees to acquire a majority stake in CARE Hospitals, a leading healthcare provider in India, from Advent International

quality tertiary care, including cardiac care and neurosciences. To date, CARE has treated more than 6 million outpatients and over 1 million inpatients, a majority of which are from middle and low income groups in underserved second tier cities in India.

The Abraaj Group a leading investor operating in global growth markets, today announced that it has agreed to acquire, through one of its Funds, a majority stake in Quality CARE India Limited one of the largest multi-specialty healthcare providers in India, from global private equity firm Advent International. Headquartered in the city of Hyderabad, CARE is the fifth largest healthcare provider in India, operating 2,600beds across 16 hospitals in nine cities.

Founded in 1997 by Dr. B. Soma Raju and a core group of professionals, CARE is today recognized for its focus on high

Abraaj and CARE’s management team will focus on expanding CARE’s integrated healthcare delivery system, especially in the underpenetrated regions of India. The partnership will also bring CARE’s high quality and proven delivery platform to other markets where Abraaj operates. The CARE Foundation, the Company’s education, training and rural community outreach program, will also be scaled up and expanded to develop and train high calibre nurses, technicians, physiotherapists and community health workers.

www.m e d e g a t e t o d a y. c o m Jan.-Feb. 2016

NEWS Update

Make focused, accelerated efforts to prevent, reduce newborn deaths: WHO Nearly 7400 new-borns die every day in the WHO South-East Asia Region causing untold misery to mothers and families. Two-thirds of these deaths can be prevented by adopting proven and cost-effective measures, World Health Organization said seeking focused efforts by governments and partners to prevent newborn deaths with a sense of urgency.

“Scaling up interventions with good quality care around the time of childbirth and during the first days after birth can substantially prevent complications and infections in new-borns, which are the main causes of newborn deaths,” Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia Region, said here as health partners signed a pledge to reduce newborn deaths.

Led by WHO; UNICEF, UNFPA, World Bank, UNAIDS and UNWOMEN pledged to jointly support the countries in the Region to prioritize accelerated reduction in newborn deaths by ensuring equitable access to essential life-saving interventions for mothers and babies across the Region.

Dr Khetrapal Singh said each preventable death should be accounted for. Countries should review maternal and newborn deaths to improve health services to prevent such deaths in future.

Focused efforts should be made to increase the health workforce - doctors, nurses and specially midwives which remains critically low in many countries of the Region, below the WHO recommended 23 per 10 000 population.

Training midwives, mobilizing sufficient and sustainable funding, and addressing inequities in health care interventions by reaching the unreached populations are among the other key interventions needed to reduce newborn deaths.

The health partners also pledged to address underlying factors like health, nutrition, hygiene and sanitation, and to empower women. They also emphasized the importance of investing more in early childhood development and adolescent health to ensure good quality of life,

Trivitron patents NeoMass AAAC kit for Newborn Screening to detect 50 inborn disorders First kit in the world to offer the broadest panel Trivitron Healthcare, the largest and most trusted company in Medical Technology Space of Indian Origin has launched and patented NeoMass AAAC Kit (CE Approved) for expanded panel of Newborn Screening in India. This is the first kit in the Global market that can detect up to 50 disorders that a newborn baby might be born with or without any immediate symptoms or visible manifestations, making it the broadest available panel of biomarkers. The launch of NeoMass AAAC Kit makes Trivitron a complete solution provider for NBS with Modular Systems, Automated Systems & Kits for core panel screening and Tandem MS/ MS and NeoMass AAAC kit for expanded panel screening.

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health and well-being of newborns through a cross-sector collaboration approach.

Dr Khetrapal Singh said that the Region made significant progress in reducing deaths among children under the age of five years, as part of efforts under the Millennium Development Goals. The under five deaths dropped by 64% from 118/1000 live births in 1990 to 43/1000 live births in 2015. However, the reduction in newborn deaths was slower in comparison, at 55% during the same period - from 53/1000 live births in 1990 to 34/1000 live births in 2015.

Newborn deaths account for more than 50% of under five deaths in the Region, and remain a major factor for SouthEast Asia not achieving the Millennium Development Goal of reducing underfive deaths by two-thirds.

The Region accounts for 30% of global newborn deaths with Bangladesh, India, Indonesia, Myanmar and Nepal as the high-burden countries.

Prioritizing newborn death reduction, WHO has setup a Technical Advisory Group comprising of 12 eminent global and regional experts, to support countries in the Region.

Trivitron aims to create awareness among the target audience about Newborn screening and its alarming need to make it mandatory in India too like other countries. The testing process involves pricking the heel of a newborn baby to collect a few drops of blood on a filter paper within 72 hours of birth and test for detection of life threatening disorders. The launch of NeoMass AAAC kit would lead to screening of inborn metabolic disorders based on a technology called tandem mass spectrometry which allows fast and accurate determination of metabolic disorders.

Dr. GSK Velu, Chairman and Managing Director of Trivitron Group of Companies said, “Trivitron Healthcare is one of the largest provider for Newborn screening solutions in the world and our new patented NeoMass AAAC kit is the first kit in the world to detect up to 50 disorder".

Trivitron Healthcare is always at the forefront of developing affordable technologies for Indian market.

NEWS Update

Symposium on advancements in personalized medicine and technologies in Oncogenomicsat MedGenome MedGenome, the leader in advancing precision medicine in the country,along with Imperial Life Sciences, organised a guest talk on precision medicine and advances in biomarker research in Oncology and prenatal segments.

The symposium hosted talks by Dr. Charles Cantor, Chief Scientific Officer, Sequenom and Dr. Darryl Irwin, Director, Applications, Agena Bioscience. The symposium was attended by researchers and practitioners of next-generation sequencing and proteomics technologies.

The modern genetic labs across the globe use different technologies to determine the genetic basis of a particular disease. Newer technologies and platforms help us to complement the next-generation sequencing technologies to gain a comprehensive and in depth understanding of complex human diseases. The symposium briefly discussed about the MassARRAY system that helps to analyze somatic mutations, gene fusion detections and genotyping of human DNA for various applications in the clinic.

and various sensitive measures under experimentation to continuously monitor cancer patients and decide on drug alternates. Discussions on the benefits of genomics research on large number of patients and large number of time points were highlighted.

MedGenome’s Bangalore sequencing facility has the latest sequencing technology platforms and is the highest throughput facility in Southeast Asia.

MedGenome has diagnostics and research offerings across Oncology, Neurology, Ophthalmology and prenatal disease areas and is the only genetics lab in the country performing a non-invasive prenatal test partnering with their US technology partner, Natera.

“Technologies are available now that helps in designing content for each patient enabling personalized medicine” suggested Dr Darryl Irwin, “ For various diseases with high burden in the country such as thalassemia and congenital hearing loss, we should be able to design ILS has been partners in research to the panels specific to Indian population that scientific fraternity in India providing could have a huge impact” revolutionary solutions in genomics, Dr Cantor discussed about various cell biology, imaging and consumables. advancements in personalized New advanced molecular diagnostics medicine and how liquid biopsies solutions are currently offered by ILS are being researched to replace in the segment of Oncology as well as conventional chemotherapy, biopsies. prenatal and postnatal screening.

Mtda Shaping Indian Medical Tourism in A Such A Way with Transparency and Effectiveness Medical tourism development alliance (MTDA) organized a national Medical Tourism Meet for facilitators and interpreters in collaboration with AlShifa on January 9, 2016 Saturday at Hotel River View, New Delhi under the president ship of Prof. S Inayat Ali Zaidi, Head Tourism Department, Jamia Millia Islamia. Mr. Ahmad Fardin Zalali - Commercial Councillor - Embassy of Afghanistan was Chief Guest.

Dr. B. K. Rana, Joint Director of NABH focused on importance of MTDA draft and further work plan. He has participated the event as guest of honor.

He said that there is huge business scope in the industry of Medical Tourism and this is a right time to pull the socks harder as present government is very supportive and has a special agenda for the medical tourism. NABH is planning to shape up 10

www.m e d e g a t e t o d a y. c o m Jan.-Feb. 2016

the business model of medical tourism with the cooperation of ministry of commerce. He further said currently NABH is working on preparing medical tourism quality care regulation which will be honorary basis.

Mr. Mohammad Afzal Siddiqui, General Secretary of MTDA explained the vision and mission of the MTDA. He said MTDA is single voice of Medical Tourism Industry in India with the aims of empower Indian medical tourism and healthcare providers. He further said that MTDA is playing a vital role to make India one of the most popular destinations for medical tourism in the world. We united the Indian healthcare travel sector to create an effective and sustainable medical tourism with moral and ethical values.

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NEWS Update

ICC Launches Cricket for Good & Team Swachh Campaign in Partnership with UNICEF and BCCI The International Cricket Council (ICC) has reaffirmed its commitment to the Spirit of Cricket and bringing about positive social change through the sport, by launching Cricket for Good, it’s CSR Programme, in association with UNICEF. Team Swachh is the first of a series of collaborations between the ICC and UNICEF under the aegis of Cricket for Good with the aim of leveraging the vast reach and power of cricket. This visionary collaboration aims to build a social movement for sanitation and toilet use, thereby leading to an open defecation-free India.

The five-year global partnership was announced in October 2015 in New York and will be used as the ICC’s platform to advocate for children in India and other countries where cricket is a popular sport.

Speaking at the launch, ICC Chief Executive, David Richardson said. “We are committed to working with UNICEF on initiatives that will improve the health, education, nutrition, protection and sanitation of children, which are causes so critical to us all.

“ICC and UNICEF together will engage the broader cricketing community to empower children and adolescents and will, in particular, during the many ICC events over the next five years, develop and implement various community outreach programs and initiatives in collaboration with coaches, cricketers and cricketing personalities.

“Building up to the ICC World Twenty20 India 2016, there will be an eight host city tour starting next month that will use exciting cricket-based sanitation and hygiene games to engage with school children. During the event itself, there will be coaching clinics with participating teams.”

The initial focus of the collaboration in India will be to improve sanitation. With the largest number of people still defecating in the open – more than 564 million – poor sanitation can cause diarrhoea, which accounts for more than 300 deaths in children under five years every day in India. This partnership will strengthen the

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Team Swachh campaign conceptualised by the UNICEF-WASH United alliance.

And this is where Team Swachh will swiftly move into action, to try and make a difference, and help inspire people to initiate a change at the ground level, to make the journey from apathy to concern and taking action. It will endeavor to cut across urban and rural populations, class, gender, age, region and religion to help make India a clean nation where everyone uses a toilet.

The idea of team and team play is at the core of the Team Swachh initiative. And it starts with the power of cricket teams and the ICC World Twenty20 India 2016.

For the event teams and any other team to be successful, all the different members – different players, coaches, doctors, etc. have to work together to achieve their goal.

Cricket icon Sachin Tendulkar, a UNICEF Goodwill Ambassador, remarked.

“Similarly, ending open defecationachieving sanitation for all in India, takes a genuine team effort in which all relevant actors – from the Government of India to people practicing open defecation, from role models to international development partners - play together as one team.”

The Secretary of the Board of Control for Cricket in India (BCCI), Anurag Thakur, commented: “Team Swachh presents a creative and collaborative platform to make the nationwide movement a resounding

success. The ICC World Twenty20 India 2016 will bring together the collective efforts of the BCCI, ICC and UNICEF towards the mission with the help of awareness programmes.

“I’m sure that the coaching clinics, which will see active participation from the leading cricketers of the world, will inspire and encourage my fellow Indian citizens to contribute to this wonderful initiative.”

UNICEF Regional Director for South Asia, Karin Hulshof, said: “UNICEF hopes to harness the reach and power of cricket, one of the world’s most popular sports, towards the most important cause of all: saving the lives and futures of children.”

A Team Swachh action kit, featuring a unique cricket and game-based tool-kit for WASH (Water Sanitation & Hygiene) in schools was also launched during the event. The kit contains a set of exciting cricket-themed WASH games, along with an implementation handbook and Team Swachh campaign materials featuring the Team Swachh cricket star ambassadors.

And to kick-start the programme, Tendulkar picked up the bat once again and played a game with children of a local nongovernmental organization (NGO), Nine is Mine. The master batsman then took time to discuss sanitation with the kids, and shared ideas and thoughts on how they could spread the message of ending open defecation among their peers.

NEWS Update

CASE STUDY-GLOBAL HOSPITAL Poonam Kapkar – ALF successfully treated with intensive medical management at Global Hospitals, Mumbai A 34-year-old resident of Nashik, Ms. PoonamKapkar was admitted to a reputed hospital in Nashik, as she was suffering from high fever and chills for almost seven days followed by severe vomiting, drowsiness and suddenly became drowsy and unresponsive. The doctors at the hospital diagnosed her with Acute Liver Failure (ALF), post which she was admitted to Global Hospital Mumbai on August 13th, 2014.

The expert team of hepatologists from Global Hospitals, Mumbai, went through her medical history and decided to run a few tests, which confirmed ALF due to Hepatitis E Virus.

A series of several monitoring tests were performed on her liver and it was found that her liver was severely damaged and the first impression of the team was that Poonam may require liver transplant.

After a thorough brainstorming and lot of consultation and deliberations, the team of expert doctors (with the consent

from Poonam’s family) decided to put her on medicine and monitor her condition over the next few days.

Ms. Poonam started responding to medicines and her recovery was on expected lines. The team of expert doctors again did some liver function tests and found it to be satisfactory. The doctors then decided to medically manage her condition, without liver transplant.

Her condition improved steadily and Poonam was discharged from the hospital on August 22nd 2014. She is now leading a normal life with her family and has been advised routine check-ups from time to time.

The best part of medically managing Poonam’s ALF is that, she will not have to be on life-long medications and also was saved from the herculean task of finding a liver donor or wait for a cadaver transplant.

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NEWS Update

Blueair says 2016 Will See Its Disruptive Indoor Air Purification Technologies Making Health Enhancing Breakthroughs Blueair said it will leverage its global consumer insight programs, best practice research, development and production processes and smarter connected indoor air cleaning technologies during 2016 to meet new global demand for safer, healthier environments. Blueair is the world’s leading independent indoor air purification brand with millions of air purifiers being used in homes, workplaces, commercial premises such as hotels, and government institutions in over 60 countries, including India, China, the USA, South Korea, Japan and Europe.

“Blueair intends to usher in a new era of safer indoor air environments at home and work by overcoming the limits of national governments to tackle air pollution in real time, at home or work,” said Blueair founder and CEO Bengt Rittri.

Vijay Kannan, regional Head of Blueair India said, “We are aiming to boost our retail network in 2016 to keep up with the demand for air purifiers in India. Past 9-10 months, there’s been an explosion in demand and we are expecting similar trend next year as well.”

In early January 2016, Blueair will launch the world’s fully connected indoor air monitoring, control and purification system to remove health-sapping airborne pollutants to 1,500 journalists, bloggers and analysts at the annual Showstoppers Media Event at CES, January 6, 2016, in Las Vegas, USA. Mr. Rittri said, “The launch would spearhead a series of blockbusting new Blueair technologies and products planned for release throughout 2016 designed to help people harness intelligent air defense systems to combat allergies and other maladies that threaten health and lower productivity.”

Noting that air pollution is now recognized as a huge environmental disaster behind rising respiratory diseases and millions of deaths worldwide, Mr. Rittri pointed to a new

An Innovation That Gives Throat Cancer Patients Their Lost Voice Back Throat cancer patients who have lost their voice can look forward to speaking again, without having to spend thousands of rupees for an artificial voice box thanks to Dr. Vishal Rao - Head and Neck Surgeon – HCG, who has innovated voice box prosthesis, an artificial device made of silicone, that can help laryngectomized patients to speak again.

One of the major disadvantages for throat cancer patients is the removal of the voice box when they undergo Laryngectomy; they have their larynx removed surgically.

Larynx houses the vocal cords, through which sound is produced. It also lets air travel from the lungs to the mouth. Since speech and communication not only forms a 14

www.m e d e g a t e t o d a y. c o m Jan.-Feb. 2016

basic principle in our society to sustain life force, but also a right for freedom, peace and dignity, it is important for these cancer patients to have their voice box restored.

During laryngectomy when the trachea and esophagus are separated from each other, an opening between the food pipe and the windpipe can be created which is called as a tracheo-esophageal puncture. Even though the patients can eat through their mouths but they cannot speak due to the absence of the voice box. As there was a need for an improved device at this point which would have one way valve that would enable laryngectomy patients to speak, Dr. Vishal Rao started researching further before the discovery was made.

Chinese study by scientists at Shanghai’s Fudan University – published by the Journal of the American College of Cardiology – that found using an air purifier ‘efficiently reduced’ fine particles in indoor air and led to improved heart and lung function.

“We’re going the extra mile to develop air purification solutions that give women and men – as individuals or parents of young children, whether in Beijing, Delhi, London or Los Angeles – the peace of mind they deserve about the air they breathing,” said Mr. Rittri. “With Blueair, people everywhere can feel confident we’re not taking lightly the trust they place in us to protect them and those close to them with superbly performing air purifiers that give compelling wellbeing benefits.”

The Company was founded by Mr. Rittri twenty years ago in Sweden with the ethos that clean air is a basic human right. We are working relentlessly to empower consumers to transform the quality of the air they breathe with smart new technologies that create safer havens at home or work or protect them outdoors from air pollution threats.

NEWS Update

Nayati Multi-Super-Specialty Hospital Mathura Brings The World’s Best in Class Advanced Imaging Equipment for The People in This Region  Installs state-of-art Philips Ingenuity 128 Slice CT Scanner which completes whole body scan in under one minute  Ingenuity 128 slice CT scanner with iDose 4 technique lowers the radiation dose by upto 80 per cent in special procedures In an effort to raise the level of patient care services to world-class standards in the Tier II & Tier III cities, Nayati Healthcare announced the installation of the most advanced CT Scanner- the Ingenuity Elite 128 Slice CT from Philips at Nayati multisuper specialty hospital, Mathura.

Dr. R K Mathur, Sr. Advisor, Radiology & Imaging, Nayati multi super specialty hospital, Mathura from Philips said, “The Philips Ingenuity Elite 128 Slice CT scanner is most advanced diagnostic imaging tool and we are very excited to present this high end technology to the people of Braj.

The installation of this state-of-art CT

scanner further strengthens Nayati’s commitment to provide the highest standards in patient care. The Ingenuity Elite 128 Slice CT is a broad capability scanner that can be applied to trauma, chest, abdomen, and cardiac imaging.

It will enable our doctors to get best quality visual referencing images to base their treatment on.”

This cutting-edge technology offers high resolution imaging with a much lower radiation dose and lower noise, an isotropic resolution.

It produces high definition images which enables doctors to see even the minutest details of any part of the body.

The speed of scanning makes all the differences in critical and emergency situations and enables vascular imaging of the brain, neck vessels, aorta & branches, pulmonary arteries in a matter of seconds.

The Ingenuity 128 slice CT scanner with iDose 4 technique offers upto 80 per cent lower radiation dose as compared to conventional CT scanners.

The scanner uses a smart NanoPanel

Elite detector system that manages the radiation dose optimally by a process called dose modulation.

With the launch of this highly advanced noninvasive digital imaging machine, Nayati multi-super-specialty hospital, Mathura will now have the capacity to offer highly advanced neuro, cardiac, spinal, abdominal and whole body diagnostic service with better clinical outcomes.

Mosquito net safe to use in inguinal hernia repair Sterilised mosquito nets can replace costly surgical meshes in the repair of inguinal (groin) hernias without further risk to the patients.

This makes mosquito nets a good alternative for close to 200 million people in low-income countries suffering from untreated groin hernias. These are the results of a Swedish-Ugandan study presented in the prestigious New England Journal of Medicine (NEJM).

An inguinal hernia is a defect or a hole in the abdominal wall around the groin, through which fat, intestines and sometimes other abdominal organs can be pressed into a sack-like protrusion.

It is a common complaint in both high and low-income countries, and the only effective treatment is surgery. Without surgery, inguinal hernias can cause considerable suffering and lifethreatening complications that cause some 40,000 fatalities a year.

Hernia surgery is also one of the world’s most common surgical procedures, accounting for around 20 million operations every year. However, almost 200 million sufferers do not receive surgery, most of who live in the poorer parts of the world; the operations 16

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that are performed use techniques that are clearly inferior to those used in high-income countries. One of the reasons that too few people in low-income countries are given the chance of effective treatment is that the scientifically tested meshes available on the market are very expensive.

“Commercial hernia meshes cost 100 dollars or more, which is too much for the health services and people living in poor countries,” says Dr Jenny Löfgren, researcher at Umeå University’s Department of Surgical and Perioperative Sciences. “So instead, doctors and surgeons in several countries have been using mosquito nets, but whether they are effective and safe hasn’t been given sufficient study until now.”

Working with colleagues from, amongst other institutions, Karolinska Institutet in Sweden and Uganda’s Makerere University, Dr Löfgren has therefore conducted a large randomised clinical trial to compare mosquito net with the regular commercial mesh used in hernia operations.

NEWS Update

Healthcare IT VC Funding in 2015 Plateaus at $4.6 Billion, Reports Mercom Capital Group Over $13B Raised by Health IT / Digital Health companies since 2010 Mercom Capital Group, llc, a global communications and consulting firm, released its annual report on funding and mergers and acquisition (M&A) activity for the Healthcare Information Technology (IT) / Digital Health sector in 2015. Mercom’s comprehensive report covers deals of all sizes across the globe.

Venture capital (VC) funding, including private equity and corporate venture capital, in the Health IT sector totaled $4.6 billion in 574 deals in 2015, slightly below 2014’s record $4.7 billion in 670 deals – still a big year for the sector. Total corporate funding in Health IT companies including debt and public market financing (including IPOs) came to $7.9 billion this year, up slightly compared to $7.8 billion in 2014.

Since 2010, the sector has received $13.4 billion in VC funding in 2,050 deals and almost $7 billion in debt and public market financing (including IPOs), bringing the total funding for the sector to $20.4 billion.

“After an incredible run from 2010-2014, VC funding into Health IT companies leveled off last year. We are beginning to see a slowdown in early stage deals, a sign the sector is beginning to mature. We are also seeing funding trends shift from practicefocused to consumer-focused technologies and products,” commented Raj Prabhu, CEO and Co-founder of Mercom Capital Group. “Apart from innovative technologies and solutions, business and revenue models are becoming more important.”

VC funding dipped in Q4 2015 with $1.1 billion in 145 deals compared to $1.6 billion in 148 deals in Q3 2015.

Practice-centric companies raised more than $1.5 billion in 171 deals in 2015, down from $2.4 billion in 234 deals last year. Top funded areas included - Data Analytics companies with $294 million, followed by Clinical Decision Support companies with $220 million and Practice Management Solutions companies with $183 million.

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Consumer-centric companies grossed about $3.1 billion in 403 deals, up from $2.3 billion in 436 deals last year. Mobile Health (mHealth) companies raised the most funding with more than $1.1 billion. Most of the funding within the mHealth category went to mHealth Apps with $750 million and Wearables/Sensors with $277 million. Rating and Comparison Shopping companies received more than $1 billion followed by Telehealth companies with $468 million.

The areas with the highest YoY growth in funding were Comparison Shopping with 615 percent, Scheduling and Appointment Booking with 370 percent and Wellness with 126 percent.

Technology Areas with Highest Funding in 2015: Scheduling/Appointment Booking: $790M mHealth apps: $750M Telemedicine: $439M Wellness: $386M Data Analytics: $294M Wearables: $277M Comparison Shopping: $232M

Top funded Health IT Technologies since 2010: mHealth Apps: $1.4B Scheduling/Appointment Booking: $1.1B Wearables: $1B Telemedicine: $929M Clinical Decision Support: $899M Data Analytics: $810M Practice Management Solutions: $691M Wellness: $671M

NEWS Update

The top VC funding rounds in 2015 were Chinese company Guahao’s raise of $394 million, NantHealth’s $200 million round, ZocDoc’s $130 million raise, followed by Virgin Pulse’s $92 million raise. Practo was next with a $90 million round, Collective Health raised $81 million and Health Catalyst brought in $70 million.

A total of 909 investors participated in VC funding rounds for Healthcare IT companies in 2015 compared to 732 in 2014. The top VC investors in 2015 were New Enterprise Associates and Rock Health with nine deals each, followed by Merck Global Health Innovation Fund and Venrock with eight deals each.

There were 55 accelerator and incubator deals in 2015, a steep decline compared to 120 in 2014. Top accelerator/incubator investors were Sprint Accelerator, The Iron Yard, Relevant Health, Bayer Healthcare, DreamIt Health, Blueprint Health and New York eHealth Collaborative.

There were a total of 27 countries with seven. GE Healthcare, McKesson, Health IT VC funding deals in 2015.

Roper Technologies, TELUS HEALTH There were 219 M&A transactions and The Advisory Board Company in the Health IT sector in 2015 each acquired six companies. compared to 220 transactions in 2014, The Top 5 disclosed M&A transactions with 27 companies making multiple included the $1 billion acquisition transactions during the year. of Merge Healthcare by IBM, “M&A deal activity was also flat yearover-year but, unlike funding, most of the companies acquired were practice focused as opposed to consumer focused,” continued Prabhu.

the acquisition of Altegra Health

by Emdeon for $910 million, the $500 million acquisition of Virtual Radiologic Corporation by MEDNAX, the $475 million acquisition of Mobile Health Apps had the most MyFitnessPal by Under Armour and M&A transactions with 22, followed the $400 million acquisition of CECity

by Practice Management Solutions by Premier. with 18 transactions, Data Analytics companies with 17, EHR/EMR There were seven Digital Health companies with 16 and Telehealth IPOs this year, raising $2.2 billion.

Fitbit raised $841.2 million, followed companies with 11.

In the last five years, 166 companies by Inovalon with $600 million, have made multiple acquisitions Press Ganey Associates with $256 including CompuGroup Medical and million, Evolent Health with $225 IMS Health with 10, Quality Systems million, Teladoc with $180 million, with nine, Emdeon and iMedx with MINDBODY with $100.1 million and eight each, and PracticeMax with Adherium with $25.6 million.

Notable Indian Transactions in Q4 2015: VC  Attune Technologies, a developer of cloud-based integrated hospital and lab management software, raised $10 million from Qualcomm Ventures and Norwest Venture Partners.  Welcome Cure, an online homeopathic tele-consultation platform, raised $6 million from two angel investors.  Curofy, a developer of a medical networking app that enables communication between doctors, raised $1.8 million Roundglass Partners.  MeraDoctor, a provider of a health-plus-finance model that offers health insurance, discounts on tests and medicines and 24-hour advice from doctors, received $1.05 millionfrom Unilazer Ventures.  MobieFit, a developer of health and fitness centered mobile applications, received $1 million from Medi Assist.  DocPlexus, a social networking platform for doctors, secured $700,000 from Uniqorn Ventures and ASP Consulting.  Doctor Insta, a provider of healthcare consultation through video conferencing, received $500,000 from angel investor Rishi Parti and BrahmaX Ventures.  Inayo, a mobile app platform that enables customers to order medicines and other healthcare products, raised $300,000 from Amit Ranjan, founder of SlideShare; Kemark Ventures; Zishaan Hayath, cofounder of Toppr.com and other investors.  LiveHealth, a medical records management app, raised an

Funding

initial funding round of $300,000 from angel investors and healthcare veterans Dr. Rajaram Samant, CEO of Akumentis Healthcare, and Dr. Pramod Dhembare, MD and founder of Fidelity Diagnostics. H ealthPlix, developer of a diabetes management app, raised $244,900 in angel funding from undisclosed investors. M edinfi Healthcare, an online platform that helps users find doctors and hospitals for routine appointments, raised $150,000 in a fresh round of angel funding. The investors include XLRI professor Ram Kumar Kakani, Pradeep K. Jaisingh, chairman of Healthstart, Sunil T V, co-founder of IVFA, Vijay Ghadge, COO of Gojavas, Hemant Kaul, MD and former CEO of Bajaj Allianz General Insurance and Gurmeet Chahal, senior vice president and head of healthcare at HCL Technologies Ltd, among others. M edd, a developer of a diagnostic test booking app, raised raised $150,000 in bridge funding from a group of angel investors. M yCOL (my Circle of Life), an online platform that helps to search and book doctors and hospital facilities, raised $150,000 in funding. M edikoe, an online medical platform that lets users search for and book hospitals, diagnostic centers, pharmacy and wellness appointments, raised $100,000 in angel funding from Anil Menon, CEO of CMS Computers. w w w.medegatetoday.com Jan.-Feb. 2016

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NEWS Update

Chronic Obstructive Pulmonary Disease Treatment Pipeline Lacks Robust Innovation, Says GBI Research C hronic Obstructive Pulmonary Disease (COPD) treatment market burdened by unmet need as pipeline lacks substantive innovation

D espite this, advancements in the asthma treatment pipeline could significantly aid that of COPD, as the diseases share mechanisms of pathophysiology, says analyst

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D

espite an influx of new therapies over recent years, the Chronic Obstructive Pulmonary Disease (COPD) treatment market has a number of unmet needs, and the innovation in its product development pipeline is lagging in comparison to other indications, says business intelligence provider GBI Research.

According to the company’s latest report, while currently-available drugs aim to manage the symptoms associated with COPD by reducing the frequency and severity of exacerbations and improving lung function, none have been shown to modify long-term disease progression.

Yasser Mushtaq, Senior Analyst for GBI Research, states that in addition to the need for disease-modifying drugs, much of the unmet need associated with COPD has been linked to poor adherence to medication.

Mushtaq says: “Tedious drug delivery processes and the need for frequent daily doses ultimately lead to poor compliance and management of COPD symptoms. As a consequence, drug development programs are focusing on long-acting medication.

“There is also a need for alternative anti-inflammatory agents. Traditionally reliant on Inhaled Corticosteroids (ICS), analysis of the COPD product development pipeline has confirmed greater interest into novel antiinflammatory agents.”

The analyst adds that beyond ICS therapy, the current market offers very limited anti-inflammatory treatment, which is a notable unmet need in COPD.

GBI Research’s report also states that first-in-class product development in COPD treatment constitutes only 16.5% of the pipeline, which is relatively small compared to other respiratory indications. For example, asthma therapeutics exhibit greater innovation, with first-in-class products making up 23% of the pipeline.

Mushtaq continues: “There are suggestions that such innovation is filtering through into the COPD therapeutics pipeline, as asthma and COPD share mechanisms of pathophysiology, making it likely that products will be applicable to both diseases.

“In this way, innovations in the asthma treatment pipeline will significantly aid that of COPD. However, there is no clear indication that disease-modifying drugs will be released onto the COPD market any time soon, making it an attractive proposition for major pharma players.”

NEWS Update

DAWAILELO SERVICES LAUNCHED IN PANIPAT Dawailelo, DL Lifecare Pvt. Ltd., is a unique venture that is working in the health care vertical in tier 2 cities of India. The company was incepted

by Aditya Agrawal and Arpit Sarin in 2013 in the Heritage City Varanasi.

The middle India, who occupies 60% of the population, is benefitted by the services. Mr. Arpit Sarin, the Chief Operating Officer, said “metros are crowded by facilities where as the actual need is based in the tier 2 and tier 3 cities.”

The idea comes from a need which was realized by the founders at their home.

Aditya Agrawal, Chief Executive Officer says, “When I was in school, whenever my family faced any health problem I was there, but as I moved out of town there was no one to take care”.

So, they conducted the survey of 2000 residents to understand the problem and provide a technological solution for the people who cannot access the right doctor at right time, have to visit medical stores for the medications and go to path labs to get tests done.

Dawailelo is easily accessible. Its mobile app can easily be downloaded through google play store. It can also be availed through website. For all those who are not tech-savvy can simply call Dawailelo to get the services. Their services include Doctors Information, Medicine Delivery at desired time and Path Lab services all at one tap. With this, Founders say: various new features will be added in the near future that will include medicine refill reminders and fixing doctor’s appointment on request.

In the application, people can search the doctors according to their specialization and filter them as per their fees, area, timings, experience etc.

They can also schedule sample pickups of various path lab tests and get the reports delivered at their homes with a discount on original prices.

They also can schedule prescription pickup and delivery date and time for their medications as per their 22

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convenience. The original copy of the prescription is brought to the local pharmacies, verified and then delivered at the doorsteps at discounted price. They also ensure availability of all kinds of medicines provided it is available in the city. For customers, they are offering up to 20 % on the first month of their sale.

Dawailelo is working towards its vision of revolutionizing the healthcare services. The rapid growth rate is a reflection of the company's commitment of penetrating the country with healthcare standards on par with international.

The company has strengthened its working model and built a promising and dedicated team of 10 members and backed up by experts in health and technological fields. The team consists of MBA graduates, Engineers, and Animation and Visual Effects professionals excelling in their respective domains.

Dawailelo is a technological facilitator between health care institutions and their users. Their working model is verified by various legal entities to work in the most compliant manner.

Dawailelo is not an online pharmacy. In their new innovative model they work only on physical copy of prescription once that prescription is verified by the registered pharmacist, medicine is dispensed. Also, at Dawailelo after fulfilment of prescriptions, they put a stamp so that the repurchase can be avoided.

The company has today launched their services in Panipat, Haryana. They have tied up with multiple stores in medicine section, have database of over 200 doctors and have partnered with 3 Labs in the path lab section. They are looking for more doctors/path labs/ medical stores in the near future.

Expansion plans will extend to different cities of Haryana like Karnal, Kurukshetra, Ambala and to other states like Punjab, Rajasthan.

They are also in talks with doctors to provide one hour free consultation every month to the patients who cannot afford to pay the fees and are receiving positive response on the same.

After the launch of services in the city, various dignitaries reviewed the services as: Mr. O.P. Sharma, Managing Director, Urban Corporation Bank said “Dawailelo is fully committed to offer the highest level of services. Hoping to see the busy India with healthier smiles."

Mr. Sujan Singh, Additional Deputy Commissioner, Panipat commented “Nice initiative for the development of society."

Dr. Ankur Gupta, Vice President, Indian Medical Association, Panipat said “The concept is good. It will be beneficial to the patients especially the old patients."

To ensure the execution of all these services successfully to the common people, Dawailelo seeks support and suggestions from all the people and organizations of Panipat. Dawailelo has significantly advanced its position and established itself as the most promising venture coming in healthcare service space. Only with our collaborative efforts, we can make a better India.

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DOCTOR SPEAK

Awareness and timely management key to bring down Acute Liver Failure (ALF) mortality: Experts  50% of ALF cases happen due to Hepatitis A&E, unavailability of clean potable water  ALF mortality has come down to 20 % from 80 % in last 10 years due to advancement in liver intensive care and liver transplantation of ALF patients

Dr. Vaishali Solao

Chief Liver Intensivist Global Hospitals, Mumbai

T

he expert team of Department of Hepatology at Global Hospitals - one of the fastest growing chains of multisuper speciality, multi-organ transplant and quaternary care hospitals in Mumbai, shared their experience in treating and managing Acute Liver Failure patients medically and through transplantation.

Acute liver failure is uncommon, life threatening, catastrophic illness which affects human beings and leads to rapid deterioration of liver function resulting in organ failure and death of a previously healthy individual. The main causes of ALF can be attributed to viral hepatitis, which is caused by contaminated drinking water. It could also be drug induced.

Prof. Mohamed Rela, Director & Group Head, Institute of Liver Diseases and Transplantation, Global Hospitals Group, said, “The major cause of mortality in Acute Liver Failure (ALF) is lack of optimized care and awareness among the care givers and the medical fraternity. The key to success during ALF is timely action, optimal management and access to liver transplantation.”

Prof. Rela further added, “The initial care of patients with ALF depends on prompt recognition of the condition and early detection of etiology. Patients with irreversible ALF need management at an advanced intensive care support unit, treatment of specific etiology and early detection of

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candidates for liver transplantation. The centre should be well equipped to handle all kinds of liver transplantation.”

Speaking about liver diseases and acute liver failure, Dr. Samir Shah, HOD, Hepatology, Liver Intensive Care & Transplant Hepatology, Global Hospitals, Mumbai said, "Liver diseases are amongst top ten killer diseases in India and are increasing because of lifestyle changes. Those suffering from chronic liver problems need recurrent and prolonged medical attention which can be made available at tertiary care centers. ALF, however, requires immediate decision making - referral to the right centre where facilities for optimal liver intensive care to give the best chance to the patient to have a spontaneous recovery is available. Also, in case the patient requires a transplant then the centre should be equipped to do so. Of the ALF cases received at global hospitals, we have been able to save 80%. Of these 50% were managed medically and 50% underwent a transplant.”

Acute liver failure (ALF) can be caused by Viruses (Hep A, Hep E, Hep B, other viruses), Drugs (anti TB drugs, painkillers, alternative medicines) , Toxins (yellow phosphorus, mushrooms), and many times the cause remains unknown. Hepatitis A and Hepatitis E are water borne illness i.e. communicable by drinking contaminated food or water.

Once the liver gets affected not all patients progress to liver failure but if they do then the illness becomes life threatening unless timely action and treatment is given.

Dr. Vaishali Solao, Chief Liver Intensivist, Department of Hepatology, Liver Intensive Care and Transplant Hepatology, Global Hospitals, Mumbai said, “About 10 years ago mortality rate amongst ALF patients was as high as 80% and survival rate was a meager 20%. With advances in treatment and intensive management of ALF patients’ survival has gone up to 80% and mortality has come down to 20%. But only treatment available for ALF patients is liver transplantation and can be treated only at transplant center having specialized intensive care unit and liver surgeons.

However, not all ALF require transplant. 50% survive with medical management in liver care specialized centers.”

Speaking on the occasion, Professor Julia Wendon, Clinical Director, Critical Care Division, Kings College, London, said, “With an incidence of less than 10 cases per million per year in the developed world, acute liver failure is seen most commonly in previously healthy young adults and presents unique challenges in clinical management. The clinical presentation usually includes acute severe hepatic dysfunction with abnormal liver blood tests, and coagulopathy altered conscious level as seen by encephalopathy may develop, with progressive multi-organ failure and death

DOCTOR SPEAK

an important option which can now be safely performed in experienced centers of excellence.  Patient awareness and education along with good medical setup, immediate coordination and judicious transfer of organ should be prioritized so that ALF management could be optimized.  Once recognized it is important to refer the patient to a specialized centre for the only cure is transplantation. Not all patients require transplantation.  About 50 % recover with conservative management, 25% require transplantation and rest 25% die.  Timely referral to a specialized centre, timely transplantation in the severe failure has reduced the mortality in ALF considerably.  It is essential that ALF be managed in specialized ICU who has experience in treating such patients for better outcome.

Global Hospital Mumbai has already established itself in the transplant space and has handled many complex liver surgeries in the past. Global Hospitals has a dedicated Liver Intensive Care Unit. They have experience and expertise in handling serious cases and have sent many patients home without a transplant by curing them with right and timely treatment. The hospital reiterated its commitment to provide world class health care facilities to the patients.

until recently occurring in up to half the cases. However, rates of survival have improved substantially in recent years through advances in critical care management and the use of emergency liver transplantation.”

“Acute liver failure is much less common in the developed world than in the developing world, where viral infections (hepatitis A, B, and E) are the predominant causes. Public health measures (e.g., vaccination and improved sanitation) are among the factors resulting in the reduced incidence of these infections in the United States and much of Western Europe, where drug-induced liver injury is the most common cause of acute liver failure,” added Dr. Wendon.

Talking about ALF statistics, Dr. Ravi Mohanka, Chief Surgeon and HOD, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Global Hospitals, Mumbai, said, “As per studies 160 ALF patients were reported at PGI Chandigarh between January 1996 and June 1998, and 405 patients were reported at AIIMS, Delhi, from January 2004 to June 2011.

At Global Hospitals, Mumbai, we have had 53 ALF patients beginning January 2014 till date. Drawing an inference from western data where ALF is predominantly drug induced, these numbers are not even the tip of the iceberg in Indian scenario, where we have acute viral hepatitis as an important cause for ALF and not every patient lands up in a tertiary care set-up. What further aggravates the problem is the fact that the number of cadaveric liver donation in India is far and in between. Therefore, living donor liver transplant is

DOCTOR SPEAK

Trauma Trauma and Emergency Care

Trauma-care systems in India are at a nascent stage of development. Accelerated urbanization and industrialization of our country has led to an alarming increase in the rate of accidental injuries, crime and violence in India. It is estimated that from its present position of the ninth leading cause of deaths in India, trauma will move up to third position by 2020.

It is also estimated that in the developing countries over 6 million will die and 60 million will be injured, or disabled, in the next 10 years. Looking at this grim scenario of trauma victims and very high rate of morbidity and mortality, we at PARAS HOSPITALS as an organization has taken a lead in establishing international level trauma care system specially to improve the out come of Poly trauma patients which seems on the rise due to unprecedented increase in the number of vehicles that has outpaced the development of adequate roads and highways.

Epidemiology of the injury burden in India

India has 1% of the motor vehicles in the world, but bears the burden of 6% of the global vehicular accidents. Road-traffic accidents are increasing at an alarming annual rate of 3%. In 1997, 10.1% of all deaths in India were due to accidents and injuries. A vehicular accident is reported every 3 minutes and a death every 10 minutes on Indian roads. During 1998, nearly 80,000 lives were lost and 330,000 people were injured. Of these, 78% were men in age group of 20-44 years, causing significant impact on productivity. A trauma-related death occurs in India every 1.9 minutes. The majority of fatal roadtraffic accident victims are pedestrians, two wheeler riders and bicyclists Paras hospitals trauma center is equipped to provide comprehensive emergency medical services to patients suffering 26

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Dr. Ravi Sauhta Chief Consultant & Ex.Prof.In Orthopaedic Surgery PARAS HOSPITALS, GURGAON

traumatic injuries. It provides in-house surgeons, neurosurgeons and other surgical and non-surgical specialists and medical personnel, equipment and facilities for immediate or follow-up treatment for severely injured patients, 24 hours a day, seven-days-a-week.

What is Trauma?  Trauma refers to a bodily injury. It can

be trivial (simple) to serious & life threatening physical injuries which can result in multiple complications such as shock, respiratory failure, neurological complications, organ damage and death.  Road traffic accidents burn injuries, sports injuries, accidental injuries, falls, natural disasters, communal violence injuries, and industrial accidents while working, etc. are classified as trauma injuries.

A person can suffer from Trauma  injuries either at home, on the street or while at work. Any kind of trauma injury requires immediate care in a fully equipped hospital.

Why it occurs?

Trauma could mainly occur due to unpreparedness of human body and mental condition to withstand all of a sudden negative experience resulting from an undesired, unexpected event.

This could significantly impact a person’s balance of physical functionalities as well as mental stability.

Treatment ”At paras h Trauma Centre, our goal is to provide treatment to a child within 30 minutes (Platinum Hour) and Treatment to an adult within 60 minutes (Golden Hour). " Paras Trauma Team follows the worldrenowned ATLS (Advanced Trauma Life Support) protocol as per recommendations from American College of Surgeons for treatment of all types of Trauma cases.

The Trauma Team has a well-defined role in the evaluation of the patient.

Ambulance & Emergency

+91 4585666

DOCTOR SPEAK

 I n trauma cases, it is crucial to reach right hospital at right time.

 T he right hospital is the one, which

could accommodate accidental causalities and could respond faster to trauma injuries with the help of trained trauma care team.

PARAS 

H Trauma care unit has implemented globally recommended “triage” system to prioritize patients according to their risk severities, illnesses, prognoses and resource availability for their access to emergency care.

force to provide seamless access to care in pre-hospital and in-hospital intensive care unit.  PARAS HOSPITALS houses expert team developed under transformational leadership of our qualified trauma surgeon with special training and official certification for compliance with latest versions of Advanced Trauma Life Support (ATLS), Advanced Cardiovascular Life Support (ACLS) and Basic Life Support (BLS) protocols

Our Services and Facilities

 PARAS H Trauma center also provides  Hospital structure with ground level

post-trauma rehabilitation facility for ensuring complete recovery.

Additionally, Glasgow Coma scale is used extensively to identify level of consciousness of the traumatized patients based on responses of eyes, lips and phonations and motor system including upper and lower extremities.

Cardiopulmonary Resuscitation is an immediate care measure for patients with cardiac arrest-a common condition after trauma

PARAS HOPITALS Trauma Center  P ARAS Trauma Center, the only

exclusive Trauma Care Center in Western India, is well equipped with latest technologies and personnel task

Emergency department; exclusive entry for ambulances sheltered from the weather and convenient access for ambulances  Triage area equipped with latest health technologies and well-trained staff for immediate risk prioritization to render best of personalized care  Eleven sophisticated patient beds with state-of-art trauma and life support system Emergency Operation Theater (OT)  exclusively built for trauma patient, who requires urgent surgery in vicinity of Emergency Room 24×7  ICU-on-wheels ambulances with all the latest equipments’ for pre-hospital

care of trauma victims and pick-ups with India’s first PARAS H Urgent Access to Care transport protocol

M obile unit with a defibrillator (to

control heart function/rhythm), and a multi-parameter patient monitor to monitor ECG, noninvasive blood pressure, heart beat, pulse oxygen saturation, respiration and ventilator (appliance for artificial respiration) for real-time vital status with excellent IT setup

State-of-the-art 

Pathology and Radiology Department with 24×7 back-up of all super specialists and full time critical care specialist committed to delivery continuum of evidencebased affordable care.

 Dedicated team for providing expert consultation on medico-legal cases

B est, robust and reliable communication facilities ensuring dynamic trauma care delivery without delay  Special training sessions empowering

staff to perform patient-friendly, efficient and effective CPR

 P ARAS H Trauma Care Center is

equipped with all essential resources for Extracorporeal Membranous Oxygenation (ECMO)” services for better patient outcomes.

w w w.medegatetoday.com Jan.-Feb. 2016

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COVER STORY

Exempt Healthcare Services from GST: NATHEALTH

Anjan Bose Secretary General NATHEALTH • Increase the tax holiday for establishing healthcare facilities from the current period of five to ten years in non-metros • Tax exemption on Preventive Health checkup should be raised • Set up a healthcare infrastructure fund and a medical innovation fund In line with the goal of achieving Universal Healthcare Coverage, NATHEALTH (Healthcare Federation of India), India’s apex Healthcare body, presents pre-budget recommendations to the Govt. to exempt the healthcare services from Goods & Services Tax or GST. Mr. Anjan Bose, Secretary General, NATHEALTH said, GST once implemented, would put various sectors under the purview of service tax.

Healthcare is currently exempted from service tax and this should continue after the GST regime at least for a period of ten years and only thereafter should a decision to levy service tax be considered, after assessing the status of healthcare coverage, costs and performance on key healthcare metrics. Levying service tax on healthcare services and facilities will be a retrograde step which will push back the agenda to provide universal 28

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healthcare. The current stage of development of the healthcare industry cannot afford levy of service tax.

Mr. Bose emphasized, “Given the long payback period, extension of the tax holiday to ten years instead of five will improve the business case for investment.

The lack of skilled healthcare resources in non-metros and tier 2, 3, 4 cities makes the payback period even longer”.

With the huge impact of NCD’S (Noncommunicable diseases) on the Indian population it is absolutely imperative to increase the focus on prevention and preventive healthcare. WHO statistics clearly states that more than 52 lakh lives are lost annually in India alone. The death rate in urban India is expected to rise by 42% by 2021 out of which NCD alone will account for around 62 percent DALY (disability adjusted life year) losses. One person dies of a stroke every minute in India. Every 6th patient below 40 years is a victim of cancer and CVD. The Economic burden of NCDS in India will be 6.2 trillion USD from the period of 2016-2030.

Highlighting the need to focus on preventive healthcare, Mr. Bose stressed that in order to achieve the Government’s stated objective of Universal health coverage, the tax exemption on Preventive Health checkup should be raised from the current Rs. 5000/- to Rs. 20000/- under section 80-D of Income Tax Act 1961.

NATHEALTH recommends the government to withdraw service tax on Health Insurance Premium which acts as a deterrent to consumers. Healthcare is not taxed for services so the same principle should be applied for healthcare financing as well added Mr. Bose.

Mr. Sushobhan Dasgupta, President, NATHEALTH informed, we have urged the government to increase the depreciation rate applicable on medical and pathological equipment and medical devices from 15% to 30%.

At present corporate income tax incentives is given on capital expenditure

for hospitals with 100 beds and above, which needs to be revised for Greenfield Hospitals with 50 beds. This initiative will extend benefits to smaller facilities and will encourage set up of more muchneeded healthcare facilities in tier 2,3 and 4 cities, added Mr. Dasgupta “We appeal to the Govt. to come out with policies that will enable the environment to fund long-term growth and help develop/optimize healthcare infrastructure’,’ said Mr. Sushobhan Dasgupta Govt. should set up a healthcare infrastructure fund and a medical innovation fund which would encourage entrepreneurship and newer business models which are the need of the hour for improving access, availability and quality, especially in tier 2, 3 and rural areas. “Govt. can consider providing seed capital for such fund emphasized Mr Dasgupta.

To bolster skill development in healthcare, Govt. needs to consider introducing special incentives for Health sector skill development and make it easier to collaborate with eminent overseas training partners. This would necessitate increased budgetary provisions for Healthcare sector skill council and relaxation of taxes on training aids and import of training materials said Mr. Bose.

Considering the huge demand and supply gap of doctors, health sector needs strong incentives to set up medical colleges. Free and concessional land in setting up private medical colleges will incentivize more players to get into medical education. To encourage quality and innovation govt. should provide a longer term (10 year window) for 250% deduction of approved expenditure on R&D activities.

Further Mr. Anjan Bose said, “We are hopeful that in the upcoming budget the government will consider the recommendations for the entire healthcare value chain, which will result in progress of Indian healthcare sector.”

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COVER STORY

Voice of Healthcare’s Recommendations for Affordable, Sustainable, and Respectable Healthcare Voice of Healthcare (VOH) is a whatsapp based Platform focused on welfare of healthcare. The VOH would like to spell out actionable policy inputs to accelerate the process of long awaited Indian Healthcare Reforms to meet changed medical needs of the population and Industry’s aspirations

Healthcare Infrastructure: Review and Reform the Concept of PHCs & CHCs. Converge all PHCs & CHCs covering 5,00,000-10,00,000 population into Co-operative Hospitals with all the local stake holders from Panchayat heads to local population .This Government backed co-operative hospitals would usher in “Community driven, Participative & Selfsustainable Healthcare . This would ensure “Affordable Healthcare for All” in sync with WHO’s core objective of “Health for All”. (In 1977 the Government of India launched a Rural Health Scheme, based on the principle of "placing people's health in people's hands")

These cooperative hospitals would also ensure Optimization, Synchronization and Synergization of very scarce healthcare human, technical, financial etc. resources.

Make co-operative hospitals the single window /nodal centres for implementation of all government healthcare programmes and employ all the “existing healthcare workers on government contracts”.

The participation of local population & leadership, and transparent & able financial management, would transform these PHCs & CHCs into a well equipped (with IT technology as well as advanced Medical Gadgets) and sustainable co-operative hospitals in long run.

Incredible Healthcare:

A public relation initiative focused on promotion of Exemplary Indian doctors & hospitals dedicated to medical care of population despite infrastructural, financial, human resources & technical constraints. Govt recognition would motivate others to follow the suit.

This would also enhance the Image of Medical fraternity among public.

International Medical (Treatment) Tourism for International Patients Indian Medical (Treatment) Tourism for Indian Patients

Swachch Healthcare /Healthcare Ombudsman: A single body to look into medico-legal–commercialethical- issues to speed up the process as well as suggest corrective measures.

Value added Medical Curriculum: Basic knowledge must be imparted on Healthcare Entrepreneurship, Business Management, and Healthcare &

Manish Rastogi

S. V. Satyanarayana

Afzal Kamal

Banglore

B an g lo re

Delhi

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COVER STORY

Personal Finance. A commercially educated medical graduate would help in contributing & sustaining the supply-demand aspect of healthcare ecosystem. This initiative would ensure “healthcare entrepreneurship” to be a well thought-off, strategic and futuristic decision not impulsive one.

Govt owned Fair Price “Cash & Carry Co-operative Shops” for Medical Products, Consumables, and Devices & Equipments: A responsible initiative to help small and medium hospitals (having not so effective purchase mechanism and supply chain management in place). This help would translate into affordable healthcare and enhance the profitability of medical services these hospitals committed to govt schemes for poor patients. The healthy small and medium hospitals form the pivot of Accessible & Affordable Indian Healthcare.

Nutrition & Health- India is a country that enjoys demographic dividend. But if we have to reap the benefits of demographic dividend then it is very essential that healthcare needs of people are taken care of .Otherwise it is very likely that the demographic dividend that India enjoys will turn into demographic disaster. We need to look at Health in holistic manner and combine Hunger and Healthcare together and there should be a focus on quality of food which is being distributed by universal public distribution system because according to Hungama report more than 42% Indian Children are anaemic and underweight.

Tax Benefits of Private Healthcare Service Provider- Healthcare services are largely provided by Private sector because Govt. does not have that management bandwidth by which it can cover the entire country but at the same time private sector is being victimised in the name of statutory law and other taxes, so there should be some TAX benefits to private sector so that they can spend more money in expanding their services and make healthcare accessible and affordable to all.

Dr. Naveen Nischal Delh i

These shops would be blessing in disguise for small dealers who could not comply the trade policies & associated targets of medical products companies .These shops would also ensure availability & accessibility to many small & medium hospitals remotely located and poorly served by medical companies Innovate & Make in India: With reference to healthcare industry, set-up a panel of healthcare professionals to make innovation to be driven by product category /need based objectives Make Innovation as Mindset, Aspirational /Me too and Target based approach.

Make it focused process and resource-wise calibrated exercise Innovative products would lead to development of cost effective products and ensure better financial stability of hospitals with cascading impact on affordable healthcare.

PPP in Primary Healthcare- Primary Healthcare system is not being able to meet the expectation of the public at large and needs an overhauling and revamp. It would be really good if we can create special budget for primary healthcare and run it through some private player in PPP model. At the same time we have to spend some money on capacity building so that we can provide essential services at lower level. There should be some extra perks and salary differtitiation for people working at primary centre level.

Insurance of Elderly- Insurance sector is booming and Govt is also doing a lot of things for women and children but we are forgetting elderly population which is growing year on year basis. There should be special provision in budget for the insurance of elderly population.

Preventive and Screening Needs- Special Budget for creating more infrastruture and skilled manpower where we can take care of Hygiene, Preventive and screening needs of the public at large.

Skill Development-Its not only challenge of Healthcare system but of the Nation at large. We need more and more activities in this field. w w w.medegatetoday.com Jan.-Feb. 2016

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AIMED’S PROPOSAL TO ADDRESS “The need of the hour is for India to manufacture Medical Equipments as part of the 'Make in India' programme so that it became available to the poorest of people even in remote corners of India,”– Shri Narendra Modi, Prime Minister of India Affordability The Medical Device Market in India which is over 30,000 Crore Rupees is mainly dominated by

imports.Corporate Hospitals and MNC’s have lobbied for 0% Import Duty in name of affordability and accessibility of Medical Devices over the last 10 years without any proof of passing reduction of Max.Retail Price(M.R.P) to Consumers who have actually suffered by Artificial Inflation. Retailers and Hospitals prefer to use imported devices as imported Unit Packs usually do not carry M.R.P at times but this is labelled only on their Shelf Box which enables them to charge any Price as per their discretion and also for many Medical Devices the importers claiming goods for Institutional sales and not for sales over the Retail Counter so M.R.P not applicable (?)

Domestic Manufacturers need to print M.R.P on unit pack and comply.

Ministry of Consumer Affair (NOT NPPA) & Ministry of Financeneeds to  Ensure Compliance of the recently updated Rules & labelling requirement of mandating Printing of MRP on each Unit Pack of the Consumer good (including Medical Devices) at the time of import, by deputing a Port Officer for checking each shipment of Consumer goods (including Medical Devices) as is the modus operandi being followed by Drug Controller of India for the Pharmaceuticals whereby the Port officer / ADC Port issues the clearance for each shipment of Pharmaceutical Products to the Customs Officer as per the Drugs & Cosmetics Act.  Goods without MRP and claimed by Importer to be for Institutional Sales / Govt. Supplies should be appropriately labelled with “Institutional Supply – Not for Retail Sale” with due justification OR , “Govt Supply - not for Retail Sale” so that these goods are not diverted to Retail Counters.

Packaging Rules may be amended if need be.  It is easier to control the Problem at the originating stage with few teams of officers rather than having a large Army of Inspectors trying to control thousands of Retail Outlets and Hospitals  Initially, discourage Inflationary Max retail Price revisions by an innovative Tax Mechanism 32

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Accessibility Over 70% of Medical Devices are mostly expensive branded imports,therby limiting access.

For ensuring accessibility its recommended by even WHO to have a robust domestic industry.Diverse technologies – plastics, rubber, electronics, engineering, biotechnology &atomic etc,as well as complex multiple issues need inter ministry coordination for enabling indigenous manufacturing.DOP had attempted halfheartedly and was a misfit due to lack of domain knowledge as our industry is not related to Chemicals & Fertilizers. In Japan a 4 person Dept. of Medical Devices is directly housed under their PMO to initiate inter ministry policy reviews and coordination.

MOH – Ministry of Health  As for Ayush, Creation of Dept. of Medical Devices or at least as Coordinator (NHSRC?)  Buy Indian Public Healthcare Policy • 15% benefit for Indigenous products as for World Bank to neutralize Chinese 17% subsidy on their exports of Devices • All public health tenders mandatory IS: 15579/ISO:13485 certification  Regulation of all Medical Devices but not as Pharmaceutical Drugs (Incomplete & Incorrect regulatory framework is confusing and scaring away investors) Enforce 2/3 rd shelf life at time of imports

DIPP:

Develop Manufacturing Infrastructure and be assertive coordinator.  Focus on improving Existing Mfg. Clusters – Delhi NCR, Ahmadabad, Chennai, and Mumbai – Pune.  SEZ – Medical Technology Parks etc.

MOC – Ministry of Commerce  Review Norms of FDI Policy.

Restrict Shareholding of MNC’s

 FDI permitted for putting MFG units not for trading/ warehousing.  MNC 100% owned subsidiary should be permitted to trade if Mfg. Revenue not less than 60%  Restrict Max Shareholding to 40% if Indian subsidiary trading revenue will be over 40%  Minimal 20% Shareholding for Indian Public/F.I’s.  Do not consider 100% Auto Approval Routes for 100% FDI in Brown Field Take over Projects.  It will wipe out the few surviving manufacturers left who will cash and abandon the fight.

MOST & MOIT – Ministry of Science & Technology – Ministry of Information

COVER STORY

HONOURABLE PRIME MINISTER’S VISION  Affordable to Consumers  Accessible to Consumers Acceptability Only 14 devices notified and regulated as drugs.

Indian made devicesface challenge to prove credibility and not easily trusted by usersin absence of regulations &manufacturersneed to ironically rely on 3rd country regulatory approvals to prove quality and safety that delays access as long and expensive learning curve..

Most imports are increasingly from China which does NOT REGULATE EXPORTS or even issues licenses under CFDA for their 100% EOU’s.

In 2005, 10 Medical Devices were incorrectly and incompletely regulated as Pharmaceuticals Drugs. This had sent wrong signals to Investors, especially Foreign Investors, who are standing on the sidelines and are scared to invest in a Country where Medical Devices are being considered as Pharmaceuticals even if they have a huge Market potential.

The Bill by MOH to regulate Medical Devices by amending the D&C Act is being proposed without discussion with Stakeholders and taking due consideration of their proposals, will be an exercise to worsen the situation and discouraging ‘Make in India ’ as it needs conceptual correction.The optimum assurance of medical device safety has several essential elements:  Absolute safety cannot be guaranteed  It is a Risk Management issue  It is closely aligned with device design and performance  It must be considered throughout the life span of the device  It requires shared responsibility amongst the stakeholders – the Users, the Regulated Suppliers and the Regulators By using the distorted definition of LEGAL MANUFACTURER followed in Europe that permits even complete device to be subcontracted to a 3rd party in same or another country the Bill proposes ‘Make in China’ products can be sold as ‘Made in India’!

Solution: Regulatory Framework built around a self Certification forcompliance to systems based on Best International Regulatory Practices& independent of Drugs. Minimum Government, Maximum Governance.

Association of Indian Medical Device Industry (AIMED) and the Quality Council of India (QCI), recently signed an MOU to provide trust in Indian Medical Devices in terms of credibility and reliability as per best International Practices and Standards for Medical Devices.

The Strategic Plan is to have a non-corrupt, professional merit based system, whereby, competent CABs (Conformity Assessment

 Acceptable to Consumers  Viable to Manufacturers Viability Since last 5-7 years investments in medical device projects no longer viable and attractive even with access to 30000+ CroreRs. domestic market with potential for import substitution (with over 70% imports).Against potential of over 7500 manufacturers India has barely 750 and over 100 – 150 units are sick or closed.

Indian and Foreign Investors will only invest if Projects are financially viable. The current Inverted Duty Structure whereby the Import of Medical Devices is at 0% Basic & 0% SAD in most cases and 5% Basic & 0% SAD in some cases whereas the Import of Raw Materials & Components are at Peak Duty Rates – hence the lopsided Tax Regime do not make the Projects viable.

Why will Foreign Companies invest if they can easily access and exploit Asia’s 4th largest Market and build Brand Image without havingthe headaches of putting up a Green Field Projects at considerable, investment costs and efforts and long commercialization and gestation periods?

Ministry of Financeneeds to: Correct/Rationalize Inverted Duty structure of ITC 90.18, 90.21, 90.22, 90.27, 30.06 & 48.18 by  Reverting SAD from 0% back to 4%  Increase Basic Duty on Devices to Min.10%  Reduce Basic duty on Consumables to be 7.5%  Maintain Basic Duty on Parts of Devices 5 %  Keep Max. Basic Duty on Raw Material 2.5% Remove disparity of High Seas Sales circumvention of VAT/ Import duty Address dual interpretation and recovery of additional Excise Duty on Reseller /Associate Co. invoice of JV Co.s

MOH/CDSCO & MOC :  Easy availability of Free Sales Certificate, not only from DGFT - DCGI, EXISTING UNITS ON BASIS OF CE OR Endorsement of DGFT Certificate.  MDA & MAI – 15 Cr Cap to be waived  MEDICA, ARABHEALTH, Africa Health - trade fairs subsidized participation w w w.medegatetoday.com Jan.-Feb. 2016

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Affordability On introduction of GST consider to Regulate the maximum Mark up between Ex Factory (weighted average price) and the Max. Retail Price since Ex Factory price is coming down by competition but Retail price are shooting up to induce Indian Retailer/Corporate hospitals to push their Brand by offering superior trade margins. This is a never ending race and the Consumer is needlessly suffering with this artificial inflation.  Country of Origin should be labelled on the Unit Pack, for the knowledge of the Consumer.

Make in CHINA, being labelled as Made in India.

• Many times Medical Devices are imported from China and they are just being packaged or labelled under the Brand Name of importer and being sold as an Indian Branded Product perceived as Made in India.

Many State Level and World Bank assisted Public Health Tenders have a Price benefit of 10 to 15% for Indian Origin goods to help establish the Domestic Industry of Medical Devices. In the absence of this labelling traders have the same benefit as would be available to an Indian Manufacturer who has spent a considerable amount of money to establish a factory and infrastructure to manufacture these devices. hile Dept. Of Consumer Affairs had kindly considered to W amend the Packaging & Commodities Rules to address some of these issues e.g. (A) above, however implementation needs to be enforced with help of Ministry of Finance ,CUSTOMS and loopholes plugged for (B) + (D), above and Ministry of Finance , Dept. of Revenue needs to work out for (C) a formula to help consumers without harming Industry.

Accessibility Technology Acceleration for R&D, Defining Priorities: Ministry of Health & WHO to map priority disease & Target List of priority Devices  Commercialization not Academic Acclaim  Forum/ Mechanism for close working between USERS, Developers & Manufacturers  Expediting Patent Application processing  Bringing in Utility model  Improved Access to Funding in transparent manner from DST, DBT, and ICMR, BIRAC etc.  Remove Impediments by NABL for research on IVD and giving tested blood samples  Create special purpose vehicles like China for Govt to jointly own patents/IP s shareholdings and infuse 50-100 million$ as equity for R & D projects.  Govt. Colleges and Hospital to allow trial purchases.  Infrastructure / Support system for R&D&Indigenous Development Goals : • Blue Sky innovation • Incremental Innovation • Increase Device/procedure efficacy • Reduce Device/procedure cost

Address Disincentives:

• Tenders stating “Imported / US FDA Approved Only” •A bsence of Regulatory Framework

Incentives:

 Dedicated Med Dev Incubators with appropriate Infrastructure for: • Prototyping • Testing& Evaluation • Mentorship into commercialization • Interaction with Hospitals and Industry.

Information:

 Online database for providing commercial access to the innovations  Online library to access to latest market information  Online access to BIS standards  Auto - Adoption of ISO standards by BIS  Exhibitions/Conferences/Forums created by GOI to bring Medics, Scientists, Developers Manufactures together

Mentorship:

 Free access to inventors to mentorship programmes.  Increased interaction between academia and industry  VC Fund for patentable products  Tax benefits to Incubator Co.

Capability Development:  Up gradation of test Labs  Access to low cost testing  Accreditation of Labs  Training on Regulatory Requirements • Short Term Courses @ NIPMER • Distance e – Learning 34

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Acceptability Bodies) in India (accredited by NABCB under international equivalence of the International Accreditation Forum - IAF) to provide low cost Self Certification access to Indian Manufacturers for ISO13485 (equivalent BIS 15579) Certificates for Medium & High Risk Devices and ISO 9001 for low risk devices.  QMS Audit by only Trained, Certified, Competent Experts Accredited by these CABs.  Compliance to the Essential Principles of Patient Safety (GHTF)  Compliance to Labeling requirements for Consumer Protection.

Europe has a similar System and this was followed in Canada and ASEAN Countries. AIMED & QCI are setting the System in place and the Indian Healthcare Products Regulatory Body, whenever it is set up, can assist in Supervising these Certifying Bodies to ensure Fair and Harmonized Regulatory Controls.

Viability  Africa centric – PEPFAR US AID Fund – Replication INDIA AID with corpus of WHO PQS Indian Pharma & Med Device producers.  China – 17% subsidy on medical devices exports Vs. INDIA 2-3% reduced from 4-5%.Suo Moto CVD against China (?) or increased subsidy  MADE IN INDIA – INDIAN registered BRANDS 3% Additional FMS/DEPB  25 % subsidy on Foreign trademark Registration fees and 50% for Product  Status Holder Privilege – Green Card for NOC Waiver  Accelerated Depreciation at double rate for income tax for ISO 13485 certified co.

Overdue Long Term Measure: Building an Appropriate (non Drug) Regulatory Framework

 Modernization fund – minimal interest loan to upgrade plant facilities – 5 years

Remove Medical Devices from Definition of Drugs through an Ordinance

• Funds/Grants/Soft Loans for R&D (not only commercialization).

Introduce Bill for Patient Safety & regulating Medical Devices through a National Regulatory Authority(NRA) under MOHOr, Rename CDSCO as IHPRA - Indian Healthcare Products Regulatory Authority – Drugs, Cosmetics, Medical Devices & Diagnostics as independent divisions

• Patent filing support and cost reimbursement even for privately funded research

Regulatory controls to be split, shared and delegated between Centre, State , CAB’s Centre for Policy, Licensing, Registration for Mfrs / Exporters/ Importers

• Subsidized access to Testing Labs/IP/Market Data/Standards (to be set up with PPP) • Talent hunt / Innovation development contests - incentives to promote Top 3 ideas adoptable by industry.

• Inculcation of “unmet need identification” strategy even at primary healthcare levels.

Factory Audits for QMS compliance delegated to expert competent NABCB accredited CAB’s State Authorities to Regulate Logistics & Sales Evaluation of Risk & Hazard by CAB for suitable corrective & preventive action (CAPA).Reasonable time for addressing issues and implementing CAPA Move for an Autonomous NRA or IHPRA.NRA to have powers for speedy administrative action & for putting things RIGHT Minimal/No reliance of judiciary and legal criminal action on registered units.Reliance of Judiciary/ Police and criminal action only on non registered units or widespread wilful noncompliance.

Regulatory Controls to be Risk Proportionate & 4 Tiered.

IHPRA annual reporting & accountability to Parliament. Creation of a Tribunal to address disputes/grievances.

Regulations to encourage – MAKE in INDIA & Made in INDIA. Primary Manufacturers, Packers, Re–labellers&Critical Process Subcontractors need to be regulated by NRA.Manufacturing to be at least assembly with substantial Domestic Value Additional.

Importers/Marketing Cos/Distributors not to be permitted to be PseudoManufacturers. Labelling to clearly define above. w w w.medegatetoday.com Jan.-Feb. 2016

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Are Your Bones Ageing Faster Than You? Lack of Physical Activity Reducing Average Age of Osteoporosis Incidence in Urban Young Doctors say the weak bones is now striking relatively younger people compared to 20 years back when physically active lifestyles were common

Dr Rajeev K Sharma Senior Consultant, Orthopedics & Joint Replacement Surgeon

Indraprastha Apollo Hospital, New Delhi

M

ost of us have seen elderly people in the family or neighborhood suffering from debilitating bone fractures of the arm, leg or hip due to osteoporosis.

However, in what is an alarming new trend, cases of such osteoporotic fractures are now being presented in relatively younger people, even those in their 30s.

Doctors say a complete lack of physical activity and a total transformation to sedentary lifestyle is the reason behind the apparent reduction in average age of osteoporosis.

“As a part of the normal ageing process both men and women lose their bone density by 0.3% to 0.5% after the age of 35 years. Known as Osteoporosis, the condition of extremely weak or ‘poross’ bones results from decrease in bone mass due to loss of bone mineral density. While due to anatomy and other physiological factors, the condition is more prevalent in women than in men, due to the change in lifestyle, there is an increase in incidence of osteoporosis in young urban,” he says.

poor habits such as smoking increases the risk of osteoporosis in young urban.

With technology making lives super easy, rising affluence and increasing ownership of vehicles, habits like walking to the neighborhood store everyday or cycling to work are no longer practiced. Elevators have ubiquitously replaced stairs, common instruments like hand-pumps that required hard work are no longer needed with easy availability of water, and the facility of home deliveries has done away with the need to carry groceries home every day. All these conditions have drastically reduced human physical activity levels as compared to 20 years back. This is a major cause of declining strength of bones.

“Besides consumption of a bone-friendly diet, exercising is absolutely crucial to maintain bone health in the long run.

Since bone is a living tissue, it becomes stronger when subjected to exercise.

Loss of bone mineral density that begins during the 30s can be prevented by exercising regularly. People who exercise are found to have greater peak bone mass as compared to people who do not exercise. But, not all kinds of exercises help strengthen the bones.

Weight bearing exercises are ideal for the bones,” says Dr Rajeev K Sharma.

Things are still different in rural India where hard labor is still a part of daily lives. People in rural areas, both men and women, have better bone health as compared to urban areas.

Weight-bearing Exercises

However, the intensity of weight bearing exercises should be decided according to the body’s strength and capability. Also, the intensity should always be gradually increased,” adds Dr. Sharma.  Weight training: This involves lifting heavy weight and should be done by absolutely healthy people. It not only builds muscle but also increases bone health and density. Men and women who start such exercise in their 20s will be fitter and stronger than their counterparts who failed to do so.  Hiking: If you are an adventure lover, go ahead and indulge heavily in hiking, trekking and mountaineering.

This will not only fulfill your penchant for fun but also help build your bones.  Dancing & aerobics: For those who have a dancer’s foot, there is nothing better than dancing out every day.

Pleasurably as it may be, it will also be extremely good for your bones and muscles. You may also take to aerobics.  Running: Running is a good exercise for several reasons. It helps manage weight, it helps keep the heart in good health, and it also strengthens bones and muscles.  Climbing stairs: This is another healthy way to strengthen bones and muscles and build stamina. Shunning elevators and climbing stairs every day is a lifelong healthy exercise.

Causes of Early Osteoporosis in urban “Weight bearing exercises are ideal for the bones. They put extra stress on the  Brisk walking: For those who are young Primarily, deficiency of calcium and vitamin D is the root cause of osteoporosis.

Therefore, the modern lifestyle that includes low intake of calcium, low sun exposure and a resultant deficiency of vitamin D, lack of physical exercise and 36

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bones catalyzing them to respond by building their strength. Any activity that forces your body to work against gravity can be called weight bearing.

These exercises help build bone strength and achieve a higher peak bone density.

not fit enough to perform any of the above due to health or other reasons must certainly do brisk walking for 30 minutes every day. This is a low impact weight bearing exercise but has good effect on bones and muscles.

EXPERT VIEWS

HOSCONNN HEALTHCARE CONSULTANCY MOOTS THE IDEA OF HEALTHCARE COOPERATIVE SOCIETY:

NEW BEGINNING IN HEALTHCARE Win Win Win Scenario: Cooperative Hospital Management:

Manish Rastogi chief strategist Hosconnn Consultancy

What Is Healthcare Cooperative Society?

For Hospital management, with large numbers it would be captive and guaranteed business, so no need to spend on external marketing.

Medical Professionals: General Practioners: A revolution of sorts would be in making, if any collaboration with local general practioners is worked out. The GPs are building blocks of healthcare and first interface of patients in search of medical treatment.

For example clinics maintenance could be the healthcare cooperative society’s responsibility, and all these clinics need to refer patients to healthcare cooperative society. This connect would help cooperative hospital to broaden its base to make more members.

This society aims at providing quality & affordable healthcare to its members. To make this healthcare model operational and efficient, thousands of members would be required.

For example 100000memebers x10000 one time investment=100 cr… an amount more than enough to sustain However …The best solution would be that make GPs 150 beded hospital for “Respected board members”.

Even local general practitioner doctors with sizable patients could also come together to set-up small hospitals & day Independent Consultants: care centers. for them it would be Good opportunity to operate without any constraints of targets, pressure from (Pvt) hospital Why Healthcare Cooperative Society? management rather would enhance their self esteem as part Presently none of the healthcare options available to public of hospital management. meets the twin objectives of quality & affordable healthcare Otherwise, they can also rent the OT for their own patients.

This society would be boon to people of tier 2 and tier 3 urban centers as well as surrounding towns and rural areas that rush Patients to big cities for medical treatment and cough up high price The Patients would not have to pay for hefty (market) for treatment and face a lot of inconvenience. The private treatment charges, being investor-members they would players of tier 2 & 3 cities lack proper infrastructure because be offered least price in sync with cooperative hospital’s of paucity of funds. The healthcare cooperative society with minimum profitability objectives. large numbers of members can raise huge money to set-up Being cooperative hospital, members patients could also and run the hospitals. pay in monthly 6 installments through PDCs (Cooperative Revenue Source hospitals could discount the cheques).Otherwise they would also take advantage of Insurance schemes.

Just an example: 10000x350 =35, 000, 00 from Preventive Healthcare/Month The low cost of treatment would further encourage dormant (Lab test etc.) patients (patients who know their sickness, but due to high cost of treatment do not go for treatment) Home services (Collection of samples) could be offered.

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Respiratory tract infection is common in children during winter -

Respiratory Syncytial virus (RSV) Acute respiratory infections (ARIs) are the most common and prevalent illnesses in children. It comprises 50 per cent of illnesses in children less than 5 years old and 30% in children aged 5 – 12 years. Several factors determine the frequency and nature of these ailments. These include host factors, environmental factors and infecting agents. About 27 million children are born each year in India but nearly 2 million of them do not live to the age of 5. Hence, ARIs are the leading cause of death among children less than 5 years in India.

Dr. Rajiva Kumar

Child Specialist (Muzaffarpur)

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(RSV) is a syncytial virus that causes respiratory tract infections. It is a major cause of lower respiratory tract infections and hospital visits during infancy and childhood. A prophylactic medication (not a vaccine) exists for preterm (under 35 weeks gestation) infants, infants with certain congenital heart defects (CHD) orbronchopulmonary dysplasia (BPD), and infants with congenital malformations of the airway. Treatment is limited to supportive care (e.g. C-PAP), including oxygen therapy.

In temperate climates there is an annual epidemic during the winter months. In tropical climates, infection is most common during the rainy season.

There is no vaccine to prevent RSV infection, but scientists are working hard to develop one. And there is a medicine that can help protect some babies.

Another research team is reporting progress toward developing a vaccine to prevent respiratory syncytial virus (RSV), a common lung infection that can cause deadly complications in infants and the elderly.

Scientists think a proven vaccine could still be years away. But the new findings add to a growing list of recent advances toward routine immunizations against the disease.

RSV causes wintertime epidemics of respiratory illness in children.

According to Peeples, virtually everyone is infected by the age of 2 and is re-infected repeatedly throughout life.

In 2 percent to 5 percent of cases, however, infected infants develop breathing problems that require hospitalization.The infection gets down into the small airways and causes swelling, which shuts off the airways.

DOCTOR SPEAK

Oxygen is a common treatment for kids, but it's not available everywhere. An estimated 200,000 deaths occur worldwide from the disease each year.

Researchers have been trying to develop a vaccine for decades. An early version in the 1950s actually made the disease worse, possibly because it triggered harmful inflammation.

In the new study, the first of three phases of research required before medications can be approved in the United States, scientists tested an experimental nose-drop vaccine in 15 adults, 15 children who'd been infected by the virus and 30 infants and children who had not. Some of the kids got a placebo.

The vaccine was developed by the U.S. National Institutes of Health's Laboratory of Infectious Diseases.

It's a genetically engineered form of the virus that's designed to prime the immune system but not so much that it causes illness. Though this is quite a small study.

Phase 1 studies like this are designed to test safety, determine an effective dosage and pinpoint side effects.

The kids who got the vaccine

developed more runny noses, but it's not clear if the vaccine was the cause.

Earlier last year, researchers in Britain reported success in protecting calves from an illness similar to RSV. And a separate team in England tested that experimental vaccine in healthy adults and reported their immune systems responded to it. Meanwhile, Novavax Co. reported in August that an experimental vaccine reduced RSV cases in seniors by as much as 60 percent.

How to Prevent the Spread of RSV You can help protect yourself, your child, and others from RSV infection by following a few prevention tips:

 Wash your hands often Wash your hands often with

 Avoid close contact with sick people

Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms.

 Cover your coughs and sneezes

Cover your mouth and nose with a tissue when coughing or sneezing. Throw the tissue in the trash afterward.

 Clean and disinfect surfaces

Clean and disinfect surfaces and objects that people frequently touch, such as toys and doorknobs. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects.

soap and water for 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based  Stay home when you are sick hand sanitizer. Washing your If possible, stay home from hands will help protect you from work, school, and public areas germs. when you are sick. This will help  Keep your hands off your face protect others from catching your Avoid touching your eyes, nose, illness. and mouth with unwashed hands.

Germs spread this way.

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REPRODUCTIVE

HEALTH FOR MALE

R

eproductive health is an important component of men's overall health and well-being.

Too often, males have been overlooked in discussions of reproductive health, especially when reproductive issues such as contraception and infertility have been perceived as female-related.

Every day, men, their partners, and health care providers can protect their reproductive health by ensuring effective contraception, avoiding sexually transmitted diseases (STDs), and preserving fertility. For much of their lives, men need a range of medical and, in particular, educational and counselling services to protect their own health and well-being, as well as to equip themselves to be good partners and fathers. There are real barriers, however, toward meeting men's needs, including the lack of awareness that their needs exist.

COMMON ISSUES IN MALE REPRODUCTIVE HEALTH INCLUDE:  Contraception  Avoiding Sexually Transmitted Diseases  Infertility/Fertility

best when they are used correctly and consistently. Using contraception incorrectly or inconsistently increases the risk of pregnancy and in some cases also increases the risk of STDs.  Minimizing the risk of Sexually

Transmitted Diseases It is important to discuss the risk factors for STDs with a health care provider and ask about getting tested. It is possible to have an STD and not know it, because many STDs do not cause symptoms. Men with STDs need to ask a health care provider about treatment to address symptoms, reduce the progression of the STDs, and decrease or eliminate the risk of transmitting an STD to your partner.  Addressing factors that may reduce fertility and seeking treatment when required If you and your partner are interested in having children, but have difficulty conceiving, it is important for both the male and the female partner to consult with a health care provider to assess fertility. Over one-third of infertility cases are caused by male reproductive issues, alone THE WAYS MEN CAN PROTECT THEIR or in combination with female REPRODUCTIVE HEALTH AND THE reproductive issues. However, HEALTH OF THEIR PARTNERS treatments are available to It is important for men to protect their address many of the causes of reproductive health and that of their male infertility. partners by:  Using contraception carefully, consistently, and correctly Men should consult with their health care provider to discuss which contraceptive method is best for the couple, based on overall health, age, frequency of sexual activity, number of partners, desire to have children in the future, and family history of certain diseases. Contraceptive methods work

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HOW EFFECTIVE IS MALE CONTRACEPTION? Not all contraceptive methods are appropriate for all situations, and individuals should consult their health care providers to determine which method of birth control is best for them.

For men, methods of contraception include male condoms and sterilization (vasectomy).

Male Condoms. This condom is a thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Male condoms are generally made of latex or polyurethane, but a natural alternative is lambskin (made from the intestinal membrane of lambs). Latex or polyurethane condoms reduce the risk of spreading sexually transmitted diseases (STDs). Lambskin condoms do not prevent STDs. Male condoms are disposable after a single use.

Vasectomy is a surgical procedure that cuts, closes, or blocks the vas deferens.

This procedure blocks the path between the testes and the urethra. The sperm cannot leave the testes and cannot reach the egg. It can take as long as 3 months for the procedure to be fully effective. A backup method of contraception

EXPERT VIEWS

is used until tests confirm that there is no sperm in the semen. Although vasectomy can sometimes be reversed, it is not always possible. Vasectomy, like other sterilization procedures, is considered a permanent form of birth control.

Different methods of contraception have different rates of effectiveness in preventing pregnancy.

Contraception is most effective when used correctly and consistently. The failure rate increases if a method of contraception is used incorrectly.

CAUSES OF MALE INFERTILITY Infertility is defined clinically in women and men who cannot achieve pregnancy after 1 year of having intercourse without using birth control, and in women who have two or more failed pregnancies.

Many different medical conditions and other factors can contribute to fertility problems, and an individual case may have a single cause, several causes, or—in some cases—no identifiable cause. Overall, one-third of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors.

To conceive a child, a man's sperm must combine with a woman's egg. The testicles make and store sperm, which are ejaculated by the penis to deliver sperm to the female reproductive tract during sexual intercourse. The most common issues that lead to infertility in men are problems that affect how the testicles work. Other problems are hormone imbalances or blockages in the male reproductive organs A complete lack of sperm occurs in about 10% to 15% of men who are infertile. A hormone imbalance or blockage of sperm movement can cause a lack of sperm. In some cases of infertility, a man produces less sperm than normal. The most common cause of this condition is varicocele, an enlarged vein in the testicle. Varicocele is present in about 40% of men with infertility problems.

TREATMENT OPTIONS AVAILABLE FOR MALE INFERTILITY The evaluation of a man's fertility includes looking for signs of hormone deficiency, such as increased body fat, decreased muscle mass, and decreased facial and body hair. The evaluation also includes questions about the man's health history, including past injury to the testicles or penis, recent high fevers, and childhood diseases such as mumps.

A physical examination allows for the identification of problems such as infection, hernia, or varicocele. A health care provider may also ask a man to provide: A semen sample to assess the health and quality of his sperm M easurement of hormones in the blood, A biopsy of the testicle G enetic screening TREATMENTS Treatments for male infertility may be based on the underlying cause of the problem, or in the case of no identified problem, evidence-based treatments that improve fertility may be recommended. Treatments include: M edication can treat some issues that affect male fertility, including hormone imbalances and erectile dysfunction. S urgery can be effective for repairing blockages in the tubes that transport sperm. S urgery can also be used for repair of varicocele. Assistive reproductive technologies, such as in vitro fertilization, can be effective if other treatments do not restore fertility. S urgery can be beneficial to correct or repair anatomic abnormalities or damage to reproductive organs.  Use of medical procedures to deliver sperm to the woman, fertilization of the egg in a laboratory, and using a third party for donating sperm or eggs and/or carrying a pregnancy. w w w.medegatetoday.com Jan.-Feb. 2016

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EXPERT VIEWS

Diagnosed with Diabetes?

Take charge of

your health now consumption of real food, consuming good fats and being physically active . Small basic swaps can yield big impact in the long run-such as: Water-dehydration is one the most important factor leading to many such health issues. Not having enough water also leads to a health issue called diabetic coma. Thus, it is must to be hydrated at all time in order to maintain proper functioning of the body.

Dimple Mirchandani Founder of Holistic Nutrition

D

iabetes is a growing potential epidemic in India with millions of individuals being diagnosed with the disease every day & further expected to double in number in the coming time. The cause is not mainly genetics but is genetics coupled up with various influences like, lifestyle changes, environmental issues, sedentary lifestyle, increased consumption of chemical laden food products, most important cause being obesity. There is a need of urgent intervention in terms of awareness and prevention, in order to mitigate the expected increase of the disease.

Diabetes is a lifelong condition where a person’s blood sugar level becomes too high-Insulin being the governing hormone. There are 2 Kinds-type 1 also called juvenile diabetes and type 2 where a person develops insulin resistance .However, it can be controlled or prevented with healthy lifestyle changes-especially by consuming a good nutritious diet .The best thing you can do for your health is lose excess weight-which not only brings you in a good shape but also has positive impact on energy levels, mood, and overall wellbeing. Physical activity is as vital as eating right in order to control or prevent diabetes.

 High-fiber carbs-carbs have a huge impact on blood sugar levels, hence it is important to chose wisely and swap highly refined carbs like white rice, pasta, white breads with high fiber complex carbs like whole wheat breads, brown rice, wheat pasta, greens.  Low GI ( glycemic index ) food- high GI food spikes blood sugar rapidly, thus it is wise to choose low GI foods over high.  More fruits & vegetables-eating seasonal fruits and vegetables over packaged junk food.  Replace sugary drinks like soda, soft drink and juices with water  Proteins-it is important to have a balanced diet with good amount of proteins-some healthy sources being-low fat dairy, legumes, pulses, eggs, beans, natural yogurt.  Reducing intake of fats-avoid deep fried and processed meat.  Opt for healthy snack and dessert- make smart choices.  Having balanced meals throughout the day.  Maintaining food journal.  Having proper sleep cycle-not sleeping enough causes hormonal disbalance ( ghrelin and leptin- responsible for hunger and feeling of fullness signals ) .  Physical activity-being physically active is a need of our body .Introducing any form of activity is beneficial like walking, cycling, swimming, yoga etc.

A diabetes diet in a nutshell is-simply a healthy eating plan Body is the most important vehicle for our journey of life. It is with high nutrient value, low saturated fat, no chemicals every individual’s responsibility to keep it in good health and take & artificial preservative, less packaged food, increase in charge of their lives.

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DOCTOR SPEAK

Become your own Doctor:

blood in your urine, or you could have a serious liver infection if the color of your urine is brown. If it is red or pink then, it’s sign that there’s fresh blood in your urine, which is a caution of infection or potentially something more serious, like kidney issues or even cancer.

You might be pregnant. Seriously, it's an early sign triggered by hormonal changes that speed up blood flow from the kidneys, says Phillips. If you're positively sure you're not expecting and you also can't blame it on an uptick in your consumption of alcohol or caffeinated drinks (caffeine and alcohol can make you pee more frequently), check in with your M.D. This could also signal diabetes or a tumor.

Foul Smell

Constant Peeing Sensation

10 signs that your urine is trying to tell you something!!

By Dr. Venkatesh Rao Urologist and Andrologist, Apollo Clinic, Bangalore

If your pee smells unpleasant even though you’re staying hydrated and haven’t been consuming things that usually result in an odor like coffee, garlic or asparagus, it could be a sign that you have an infection. It’s also possible that your kidneys are accidentally spilling glucose or protein into your urine which is causing foul smell.

Leaking

Leaking when you laugh, sneeze or exercise can be a sign of stress urinary incontinence, but it can be fixed. Kegel exercises can be performed which basically strengthens the pelvic floor Most of us are aware of the fact that muscles, sometimes you can also require the color of your urine determines how surgeries to deal with the issue depending hydrated you are but it has a lot more to it, on what the doctor suggests it also indicates how healthy you and your Decreased Urination habits are. It’s time to start giving some Not paying regular visits to the restroom attention to your pee, before you flush and also is an alarm that you have something leave the washroom, because the color, wrong medically, it can occur when there odor and consistency of your urine tells is a blockage or infection. If you pee less you what is going on in your body. than 400 milliliters per day, you should up Following are some warning signs to be your water intake and if you still aren’t watchful of every time you go and urinate: peeing more, go visit a doctor and take

Sweet Scent

Sweet-smelling urine is often an important clue in the diagnosis of diabetes, it occurs due to glucose leaking into your urine and for people who know they have diabetes, the sweet smell can indicate that their blood-sugar level is not as under control as it should be. It can also occur because of excess of ketone in your blood which occurs due to excessive dieting or other rare metabolic conditions.

Increased Frequency

medical guidance.

Burning Sensation

Painful urination can be caused by an infection of the kidney, bladder, or urethra, the bacteria in this area cause inflammation. It can also be caused due to Sexually Transmitted Infections.

Untreated bladder infections can lead to kidney infection. Sexually transmitted infections can result in urethritis, which is an inflammation of the tract that carries urine from the bladder out of the body.

Red or Pink Colour Shade of urine can tell you a lot about a This is most often seen with the STIs person’s well being. There might be old gonorrhea and Chlamydia.

This is a classic sign of a UTI, which causes the lining of your bladder and urethra to become inflamed and irritated, leaving you with the feeling of constantly having to urinate, says Phillips. It can also be a symptom of interstitial cystitis, a hard-to-diagnose condition that results in chronic bladder pressure or pain.

Air or Gas Coming Out

Bubbles in urine can result from mixing of urine with cleaning chemicals found in the toilet or it can be something more significant like kidney disease. It may also be a sign of a serious issue like a fistula which starts with some kind of tissue damage, after days to years of tissue breakdown, a fistula opens up. It is always a good idea to discuss this symptom with your physician.

Cloudiness

Cloudy urine is primarily concerning because it can signal infection. It can be caused because of variety of conditions, it can mean diabetes or UTI (Urinary Tract Diseases), and it can be due to vaginal discharge, sexually transmitted diseases, dehydration or certain autoimmune disorder. In some cases, cloudy urine can be due to a life- threatening underlying disease, such as pyelonephritis and urosepsis. Timely diagnosis and treatment of underlying cause, reduces the risk of serious complications, such as kidney failure and shock.

Urine holds significant clues concerning one’s wellbeing and is an excellent predictor of health. So, the next time one can hit the restroom and have a look before flushing, to know what’s exactly going on inside your body. w w w.medegatetoday.com Jan.-Feb. 2016

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DOCTOR SPEAK

Gastrointestal Surgical Suparspeciality Benign Colorectal disorders:

Dr. Rajiv Khanna M.S., DNB, Senior Consultant, Advanced Minimal Access Surgery

PSRI HOSPITAL

We offer Laparoscopic and Traditional Gastrointestinal Operations with an emphasis on Minimal Access to enhance early recovery and good performance out come.

Current Scope of Gastrointestinal Surgery: The G.I Surgery department provides integrated oncological care for G.I Cancer  Gastric Cancer Curative resections for gastric and gastro-esophageal junction cancers are performed, along with extended lymph node dissection  Esophageal Cancer - Transthoracic and trans hiatal Esophageal surgery are also performed, Laparoscopic Esphagectomy is done for Cancer wherever appropriate  Colorectal Cancers (A) Low anterior resections, Sphincter sparing resections,all attempts are made at sphincter preservation. (b)Laparoscopic Right, left, transverse, sigmoid colectomy as appropriate is done for the site of the cancer.

Benign Disorders of UGI Tract  Achalasia Cardia - Laparoscopic Heller`s Myotomy is performed  Gastro Esophageal Reflux Disease Fundoplication for GERD  Ulcer Disease Vagotomy G-J is performed 44

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 Polyposis Syndrome - Patients with polyposis are offered sphincterpreserving procedures like Ileal Pouch Anal Canal Anastomosis (IPAA)  Inflammatory Bowel Diseases Inflammatory bowel disease like ulcerative colitis and Crohn's Disease are handled in consultation with the Medical Gastroenterology department. Advanced procedures like Ileal Pouch Anal Canal Anastomosis are done regularly. Staged procedures for complicated IBD and management of abdominal stomas are also offered.  Rectal Prolapse - Laparoscopic Rectopexy, thus allowing early return to activity for the patients,  Complicated Perianal Conditions - the evaluation and management of complex perianal fistula. Stapler hemorrhoidectomy is offered to patients at their choice, avoiding the painful and prolonged convalescence after piles surgery.

Hepato Biliary Pancreatic Services  Liver surgery - Major liver resections are undertaken routinely for primary cancers of the liver and the biliary tree.  Pancreatic Cancers,chronic pancreatitis- Laparoscopic Surgery is offered in selected Patients  Disorders of the biliary system – Gall bladder and Biliary Stones treated By Minimal Access Surgery.  Bile duct and gall bladder cancer Palliative and curative resections for biliary cancer and palliative drainage procedures are performed.

 Lap cholecystectomy  Lap common bile duct exploration for stone disease  Lap appendectomy  Laparoscopic hernia repair Diagnostic laparoscopy for the  evaluation of obscure abdominal symptoms, pain or ascites  Lap liver surgeries for cystic diseases of the liver  Lap directed small bowel surgeries  Lap Myotomy for Achalasia Cardia  Lap splenectomy

Laparoscopic Surgeries

 Lap cysto-gastrostomy

The unit operates with two fully equipped laparoscopic suites, which are also equipped with advanced equipment like Harmonic Scalpel, ligasure, Argon laser, endoscopic stapling devices and endoscopic suturing devices.

The unit is routinely conducting:

 Lap bariatric surgery  Laproscopic Cancer Surgery Colon Stomach, Esophagus And Pancreas. he list is not exhaustive, please contact T for information on specific Surgical Procedure

DOCTOR SPEAK

Haploidentical Bone Marrow Transplant at FMRI saves infant with congenital Wiskott - Aldrich syndrome

Dr Satya P Yadav Unit Head, Paediatric Haemato-Oncology & BMT Fortis Memorial Research Institute

T

he “sunshine” that arrived on a mid-summer afternoon faded for parents Sarika and Amit (name changed) after a blood test done on their firstborn to study neo-natal jaundice, showed a very low platelet count. A genetic test confirmed their son was born with Wiskott - Aldrich syndrome (WAS) (a congenital disorder which occurs only in boys and is characterized by eczema, low platelet count and immune deficiency rendering a child prone to all kinds of opportunistic infections.

Bone marrow transplant (BMT) has proved to be the new savior in such situations. A successful Haploidentical (Half-matched) Bone Marrow Transplant was performed by the Doctors at Fortis Memorial Research Institute (FMRI) on the five month old child with the mother as donor.

FMRI has established itself amongst the top 10 centers across India where successful haploidentical BMTs are being performed. The unit recently achieved its 100th BMT, a rare feat for a center barely three years into operation.

Of the 50 centers carrying out regular BMTs in India, just about 15 have

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Since 2012, there have been a total of 150 halpoidentical BMTs carried out across India.

Of these, 36 cases have been carried out at FMRI with a high rate of success. crossed the 100 mark. Also, of these, only 5 to 6 centers carry out haploidentical BMTs, a procedure where the bone marrow is taken from one of the parents or a sibling. This provides only a 50% match but has been proven to be effective.

Explaining the procedure Dr Satya P Yadav, Unit Head, Paediatric HaematoOncology & BMT at FMRI said that BMT offers a cure in a wide range of conditions from leukemia, thalassemia, sickle cell anemia, and bone marrow failure to Primary Immuno-deficiencies.

“BMTs are of two types – autologous (use of one’s own bone marrow) and allogenic (use of donor bone marrow).

Most centers in India carry out allogenic transplants from only matched siblings.

Haploidentical transplant becomes an option when there are no matched family donors available. Matched unrelated donors are difficult to find due to lack of donor registries in India and lack of Indian donors on international registries. Haploidentical transplantation is a treatment option gaining global acceptance as it increases the possibility of finding an acceptable donor within the

family. Parents are always a half-match for their children and at times siblings, uncles and aunts can be half-matched donors. Until recently, closely related donor sources such as the patient’s parents, came with a high risk of incompatibility and a high incidence of fatal Graft versus Host Disease GvHD, where donor immune cells attack the recipient’s body but newer transplant techniques have helped us overcome this hurdle,” elaborated Dr Yadav.

Since 2012, there have been a total of 150 halpoidentical BMTs carried out across India. Of these, 36 cases have been carried out at FMRI with a high rate of success.

“Use of haploidentical transplantation has greatly increased the options for patients in need of bone marrow transplant globally and is today a viable option being offered to patients at FMRI. India offers such unmatched BMT programs of global standards at one-tenth the cost of the procedure in the West. We are hence also treating a number of international patients” added Mr. Jasdeep Singh, Zonal Director, FMRI.

DOCTOR SPEAK

Have you crossed 50?

Stay guarded against

Prostate Cancer Prof (Dr) Rajeev Sood Consultant & Head, Department of Urology Dr. Ram Manohar Lohia Hospital, New Delhi

O

f the 7.6 million deaths due to cancer worldwide, one-sixth are caused by prostate cancer which is also today the second most frequently diagnosed cancer after lung cancer.

A disease whose risk increases proportionately with age, prostate cancer is growing in incidence as life expectancy increasing. 70 % of all prostate cancers are diagnosed in men over the age of 65.

It is still unclear why this increase with age occurs for prostate cancer but studies suggest that after 70, most men have some form of prostate cancer, even though there may be no outward symptoms.

The prostate is an exocrine gland of the male reproductive system, and is placed directly below the bladder. Roughly the size of a walnut, it is through the prostate that the urethra (– the tube carrying urine and semen out of the body )- goes through. Besides producing a fluid that forms part of the semen and protects the sperm, the prostate gland also plays a role in urine control.

Traditionally, the incidence of prostate cancer has been the highest in the United States and Europe and lower in countries of South and East Asia. However, with increase in life expectancy, adoption of newer lifestyles and screening using prostate specific antigen (PSA), the incidence of prostate cancer is on the rise in low and middle income countries like India as well.

In India, where life expectancy has increased from 61.97 in 2001 to 65.48 in 2011, prostate cancer incidence is growing by 1% every year. However, not many people are aware of this problem and its treatment options to prevent it from turning fatal. We need to up the ante against the disease by spreading awareness about prostate cancer, its risks and ways to curtail it.

Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause any serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

Before we discuss the prevention and treatment options, here is a quick look at some key facts about Prostate Cancer.

One new case occurs every 2.5 minutes and a man dies from prostate cancer every 17 minutes.

A nonsmoking man is more likely to get prostate cancer than lung, bronchus, colon, rectal, bladder, lymphoma, melanoma, oral and kidney cancers combined.

Because prostate cancer is a relatively slow-growing cancer, the 5-year survival rate for prostate cancer diagnosed at all stages is 98%. The relative 10-year survival rate is 84% and the 15-year survival rate is 56%.

In the West, where a number of celebrities and high profile people have spoken publicly about the disease, awareness has steadily risen. Hollywood stalwarts Robert De Niro and Michael Douglas have undergone treatment for prostate cancer, so has South Africa’s iconic former President Nelson Mandela and former US Secretary of State Colin Powell.

Age, genetic predispositions and diet all seem to have a direct correlation with the risk of prostate cancer. Some studies have also indicated that men with sexually transmitted diseases too have a higher chance of getting afflicted with prostate cancer.

However, in India the awareness about the disease remains low. It is important to note that there are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may appear: A frequent need to urinate, especially at night A weak or interrupted urinary stream Blood in urine or semen Hence, it becomes important to immediately visit a doctor if any of these symptoms are observed. The good part is that prostate cancer is a relatively slowgrowing cancer, and the survival rate is hence high.

The treatment options include surgery (prostatectomy), radiotherapy, hormonal therapy using androgen-depriving drugs, depending upon the stage and level of the cancer.

w w w.medegatetoday.com Jan.-Feb. 2016

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DOCTOR SPEAK

Friendly Fat

Eat Smart for a Healthy Heart

Following a healthy lifestyle can help you prevent overweight and reduce obesity. Limit the use of TV, Computer, and Videogame because they turn for MD Physician, Diabetologist, Apollo Clinic, Pune physical activities. Keep track of your weight, BMI. n the bustle of everyday life, at small meals at regular intervals to Step towards eating smart and your maintaining a good health becomes avoid intake of extra calories. chances of living a hale and hearty life difficult rather ignored by most Reduce on unhealthy fats and cholesterol: gets better. people due to the lifestyle adopted. The best way to reduce saturated The most commonly encountered and Trans fats in the diet is to limit problem while following a cholesterol- the amount of solid fats like butter, lowering diet is not having enough margarine and shortening. One can time to prepare healthy meals. Most reduce the amount of saturated fat in people tend to start buying fast food the diet by trimming fat off the meat or and raiding the junk food aisle of the choosing lean meats with less than 10 grocery stores in search of a quick fix. percent fat These are habits that may gradually Walk off stress: If one is feeling stressed lead to heart concerns. It is essential for and restless, one can simply walk it off. people to make wise choices to ensure It will help put the ideas in order and a healthy heart. reduce tension.

One’s ticket to healthy heart is when Cook Smart and consume the right they include ingredients, that do not food: Legumes such as kidney add up to the fat & vegetables, paying beans, chickpeas and lentils are attention to fiber, eating fish a couple high cholesterol-lowering fiber and of times a week and limiting unhealthy consume fish twice a week as contains fats like saturated and trans fats, as well Omega 3 Fatty acids that help control as salt. Although no single food is cure- cholesterol. It’s important to have milk all, certain foods have been shown to and yogurt in the diet as they help to improve your heart health. Here are reduce blood pressure levels. Also, certain ways for one to ensure a healthy choosing the right cooking methods heart even during a hectic schedule: like steam, bake, broil or grill instead of Drink plenty of water and liquids: Drinking frying will help in reducing the salt and water before meals is very beneficial calorie-laden fat content in the food.

Consume more vegetables and fruits: Vegetables and fruits are low calorie and also contain a lot of vitamins and minerals and fibers. The vegetable should be washed and cut in the refrigerator for quick snacks. One can also keep fruits in a bowl in the kitchen.

Eat 5 times a day in small portions: Overloading the plate and eating until one feels stuffed can lead to consuming more calories, fat and cholesterol. One can

Dr. Mukesh Budhwani

I

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DENTAL SECTION

Say No to braces for a

great smile!

C

lear Path Orthodontics an American company, introduces a breakthrough technology which revolutionizes the way we treat malocclusion (irregular teeth and bite). ClearPath provides new improved quality 3D aligners through its unique proprietary, patented process which provides a hygienic, convenient and a clear solution for the correction of malocclusion without having to wear brackets and wires.

KIMS, Breach Candy hospital among many others. Aligners have been the first choice of many celebrities as well such as Oprah Winfrey, Tom Cruise, Serena Williams, Justin Bieber, Katherine Heigl, Cheryl Cole etc. and quickly this is becoming the first treatment option for correction of malocclusion in many parts ClearPath Aligners are removable, almost invisible, US-FDA of the world including India where people can now avail of this approved medical grade plastic appliances, a custom made revolutionary technology. plastic trays which fit snugly onto patients teeth instead of wires Clear aligners treatment hit the US markets approximately 10 and brackets to correct malocclusion. ClearPath Aligners are a years back; however had negligible presence in the Asian & modern alternative to braces for straightening teeth.

African orthodontic markets primarily due to the cost factor ClearPath Aligners are becoming a popular choice among teens and adults, females and males alike. People aged between 13 years to 60 years are making aligners their first choice of treatment for malocclusion. ClearPath Aligner system is practiced by many leading dentist in the country and are available in hospitals and dental chains like Apollo, Axiss, Vasan Dental Care, Fortis, Dentzz, Beyond Smiles, My Dentist, Dentistree, Dr.Smilez,

and no established manufacturer. With the launch of the first ever 3D aligners in India, Clearpath paves the way for this redefining treatment modality to take these markets by a storm.

This computerized & digital clinical system is used in hundreds of clinics in the USA, India, Jordan, UAE, Lebanon, Oman, Qatar, Kuwait, Syria, Egypt and across the Middle East. The popularity is growing at an incredible rate. w w w.medegatetoday.com Jan.-Feb. 2016

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DOCTOR SPEAK

10 Common Mistakes of Pregnant Working Women Consultant Gynecologist, Apollo Cradle

Pregnancy can cause a lot of stress to a working woman’s life. All pregnant women want safe, healthy pregnancies and happy, perfect babies. A pregnant woman would require the right information and she needs to be sure that she is doing the best things for her baby’s health. Since the pressures at work can't be stalled, a lot of pregnant women continue work through the end of pregnancy. She will have to evaluate her work based on how many hours she works, and whether her job could harm her or her baby. Coupled with the same are unhealthy lifestyle habits that can harm the mother & the baby.

The choice of food, level of daily activity, improper sleep schedule can also harm the mom-to-be.

Most working pregnant women make common mistakes which might have a negative effect on the mom-to-be & her baby.

Long Intervals between Meals: Due to constant focus on work, most pregnant women tend to consume meals at long intervals. A rush in the morning often causes them to miss out on breakfast, the most important meal of the day.

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

During pregnancy, women tend to be unorganized and avoid planning for the day in advance.

The multiple changes in her mind & body often upsets her schedule and she ends up missing out on important details.



Dr. Poornima Ramakrishna

DOCTOR SPEAK

It is important to eat three to five healthy meals a day, as well as nutritious snacks, like sliced raw vegetables, fruits, yogurt, cheese, dals, sprouts, soya, milk and egg products.

These foods are ideal for a pregnant working woman. She should get four servings of calcium spread out over each day.

Folate and Omega 3 supplements in a dosage prescribed by her doctor can help keep her mental health stable as well as her physical health in check.

Unhealthy snacking: Munching a salty chip snack, a fast food burger or a slice of pizza while working can lead to excessive weight gain and water retention during pregnancy.

Keep healthy snacks available at work. She could munch on popcorn, peanut butter and crackers, cheese, hardboiled eggs, and fruit through the day. Hunger or low blood sugar can cause nausea. Medication for morning sickness is available if the problem becomes serious, but there are safer and more natural remedies which may help her. She should keep herself well hydrated by sipping iced water, lemon juice or barley water.

Having an unplanned schedule: During pregnancy, women tend to be unorganized and avoid planning for the day in advance. The multiple changes in her mind & body often upsets her schedule and she ends up missing out on important details. There are high tendencies for her to forget doctor appointments or medications that needs to be taken.

She could keep a notepad handy and write reminders to herself at work and at home. She should list all doctor appointments and responsibilities at work on her calendar, which she should keep with her at home and work. She should stick to her schedule to avoid becoming over worked and excessively tired.

Inadequate Hydration: Not drinking enough water during the day, is a problem that most of us face. During pregnancy improper hydration can lead to multiple issues. Water is very essential for the mother & the baby and if there is less supply, it can lead to pregnancy complications. She needs to hydrate herself and make sure that she gets enough vitamin C from fruits, juices, or supplements.

Inadequate Sleep: Most women fail to realise that during pregnancy they need to clock in extra hours of sleep to ensure proper growth of the fetus. Sleep is very important for pregnant women to gain strength and continue with her day-to-day activities. She needs to get ten or eleven hours of sleep every night. Resting on either side will help good blood flow to her baby and will help prevent swelling.

Cutting down physical activity: A busy professional life coupled with added responsibility of managing a pregnancy leads to women neglecting the benefits of a good workout.

Due to this, there are possibilities of blood clots, varicose veins, and swelling of the feet and legs. She could go for a walk around her work place. Avoid heavy work and lifting, as well as heavy exercise. She should also remember to put her feet up at night.

Smoking or exposure to secondhand smoke: It is very harmful for her and the baby. Exposure to smoke can cause abortion, premature birth, low birth weight, and infant death.

Drinking alcohol: There is no safe amount of alcohol that a woman can consume during pregnancy. It is ideal for a mother-to-be to stay away from it. Fetal Alcohol Syndrome (FAS) causes severe retardation and birth defects for the baby, and it can be caused by even small amounts of alcohol.

Self Medication: She should avoid any self medication even if they are available over the counter or herbal, unless it has been approved by her doctor, especially during the first two months of her pregnancy. The wrong kind of drug exposure may cause low birth weight, nervous system damage, and physical malformations of the baby such as - heart problems and cleft palate. Do not take any medications without the doctor’s approval.

Working continuously without a break: Working continuously can put the women under a lot of stress. She should make sure that she is scheduling a portion of time for relaxation and fun. Take Breaks during work.

Taking care of herself is the most important job as is taking care of her baby! This good practice and will prevent mommy burnout eventually when the baby arrives. w w w.medegatetoday.com Jan.-Feb. 2016

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DOCTOR SPEAK

Adult Hearing Loss is an Underestimated Concern in Our Country

M

ost of us have observed elderly people in our families who are short of hearing, and need communication to be in unusually loud pitch to be able to hear; others use hearing aids to navigate through daily life. Hearing loss often comes on gradually and has been called the “hidden handicap” because unlike other disabilities it can’t be seen and people with hearing loss often are either unaware or deny that they have a problem.

Hearing Loss is more common than you might think. One out of twelve (1/12) persons in India has hearing loss. In fact, over 33% of people in their 60’s suffer from using a hearing instrument.

Usually hearing loss is first noticed by others around you. Detecting and treating hearing loss early is a significant step towards improving the quality of your life. With solutions available to address this problem, hearing loss should not be considered as just another normal part of ageing and timely remedial measures must be initiated to allow a good quality of life.

Hearing helps us get the most from life.

Better physical and emotional health is associated with better hearing. However, in a country with major healthcare concerns like India, the problem of hearing loss is often considered a lesser issue and its impact on the lives of people is often underestimated and understated. However, studies tell us that untreated hearing loss not just handicaps a person’s communication but also causes irritability, negativisim, anger, fatigue, tension, stress and even depression. For a person used to normal living and communication, loss or reduction in capacity of one of the five major senses can be devastating and debilitating. Some people tend to withdraw into a shell, experience social rejection and loneliness and start

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avoiding social situations, leading to diminished psychological and overall health. For those who are still active in work life, loss of hearing can be traumatic and result in impaired memory, reduced ability to learn new tasks, affecting their job performance and earning power.

Communication is the cornerstone of our society and interpersonal relationships. Effective communication is also an essential ingredient in the quality of our lives. We should all aim Another dangerous side-effect of to enjoy the best quality of life. Acting loss of hearing is reduced alertness early to address any hearing difficulties and a resultant increased risk to is paramount to success. personal safety. This often curtails the Lost sounds independence of the affected persons, There are certain areas of the brain that causing increased irritability and low process speech sounds. The ability to self-esteem. understand speech may deteriorate over It is important, therefore, to not ignore time if the brain is not receiving all the any sign of reduced hearing capacity speech sounds. The longer a person and immediately seek medical help. It ignores the problem, the more difficult is important to have a hearing test and the adjustments to hearing aids. Studies have your hearing managed as soon as suggest that we can benefit from using you suspect there may be problem. all sounds that may be available from Early rehabilitation is good rehabilitation amplification.

In most cases the loss of hearing is a very gradual process and takes place over many years. As there is no sudden change, people may not be aware of the problem until it is severe enough to cause many communication difficulties. Many notice the change but ignore it considering it a normal part of ageing. Yes, the hair cells lining our inner ear do suffer damage over time as a part of ageing, but new age technological devices can correct this loss to a substantial degree and allow for a normal life. Unfortunately, many hearing impaired people (and their families) suffer needlessly for years before seeking help. In fact, family and friends often identify a hearing difficulty before the sufferer.

Better health for hearing aid users Hearing well allows us to communicate with our family and friends and keeps us in contact with the sounds of life that surround us 24 hours a day.

When a hearing impaired person only hears part of a conversation and has difficulty understanding speech, this can cause the person to withdraw. So, a hearing impairment can cut down on the richness of experiencing life and restricts social interactions.

Not only improvement in the quality of life comes from better hearing skills, individuals with managed hearing loss also enjoy better physical and psychological health. If you have an elderly family member who experiences difficulty in hearing normal sounds, do not ignore The longer a person ignores the the condition or wait for it to deteriorate. problem, the more difficult the Consult and expert immediately. adjustment will be when hearing aids are eventually worn. Equally, Authored by Neevita Narayan, personal relationships need not suffer Senior Audiologist & Founder, when early intervention is available.

SpHear Speech & Hearing Clinic

INTERVIEW Medgate Today conducted an interview with Dr. Naresh Trehan, who is one of the wellknown cardiovascular and cardiothoracic surgeons in India. Currently, he is the Chairman and Managing Director of Medanta-—the Medicity. Medanta is a multi-super specialty Institute, which is considered to match the highest standards of healthcare delivery globally, at a reasonable cost.

Before establishing Medanta, Dr. Trehan was the Executive Director and Chief Cardiovascular Surgeon of the Escorts Heart Institute and Research Centre for 20 years. He's been honored with Doctor of Science Honoris Causa at the 18th Convocation of the Institute of Medical Sciences, Banaras Hindu University, Varanasi in 1996, for recognition of his contributions ,achievements and reputation in the healthcare industry. He has also received prestigious awards like the Padma Shree and the Padma Bhushan Award, by the Government of India. Here's what Dr. Trehan has to say-

What is your take on the health budget of India?

The health budget in India is very small but we can make it efficient. If we can align the government services, private facilities and NGO resources, then I believe we can deliver 50 per cent better healthcare services today without spending an extra penny.

What are your views on medical tourism in India?

People from all around the world come for treatment in India. We have a fair amount of traffic for quality healthcare.

However, the potential is underpenetrated. I believe we can have a colossal medical tourism if we took care of certain services. Those services include visa issues, the ease of connectivity to India and safety concerns. We need to work on making India better, safer and more attractive for tourists.

What is your message for the youth especially aspiring doctors?

I consider the practice of Medicine, as one of the greatest pleasures in life. To be a doctor is a blessing. It is a wondrous profession. You can help mankind, save people and at the same time make a decent living. Your family can lead a contented life. Not many professions give you this kind of satisfaction. My message for aspiring doctors are, 'The future is bright. You just have to do it right'.

Tell us about your journey so far?

I started my medical schooling in 1963 at King George's Medical College, Lucknow and graduated in 1968. I moved to USA in 1969 and after a few years, I became a heart surgeon.

Shortly after, I decided to serve my nation wholeheartedly and returned to India. That is when my journey really started.

I looked for places in the country that could bring out the finest of heart surgeries, first-class training and research, ultimately culminating into Escort's Heart Institute.

What advancements has India achieved in Cardiology?

In the early 80's, cardiology in India was nil. Today, we have reached such a stage where we not only have native patients but people from all over the world coming to India for cardiac treatments. I have operated on people from New York and other western countries. The list is very long. India indeed has achieved a lot in the Cardiology division.

The need of hour is to bring heart treatments to a level where we can cater services to a larger part of the population. Our heart surgeries are 1/10th the cost of USA, but it is still not affordable by most people. The biggest challenges are insurance, containing costs and economy of scale. But I believe in the next 5 years we can make it happen.

Dr. Naresh Trehan CMD, Medanta Hospital

w w w.medegatetoday.com Jan.-Feb. 2016

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PRODUCT LINE

Shortwave Diathermy is better option to therapeutic ultrasound Deep-heating agent prior to stretching or joint-mobilization techniques In diathermy, a high-frequency electric current is delivered via shortwave, microwave, or ultrasound to generate deep heat in body tissues. The heat can be used to increase blood flow or to relieve pain.

Diathermy means to heat through, and electromagnetic energy can produce thermal and non-thermal physiologic effects. The new generation of SWD devices are better designed and esthetic look. The modality is easy to use and safe.

Decreased muscle flexibility and joint hypo mobility are two common impairments that rehab clinicians treat.

When selecting a deep-heating agent prior to stretching or joint-mobilization techniques, many clinicians turn to therapeutic ultrasound.

However, ultrasound is intended to treat areas that don't exceed two times the size of the sound head, and it doesn't efficiently heat deep muscle. Shortwave diathermy effectively heats large areas, while safely heating deep muscle. It matches the depth of penetration and heating rate of 1 MHz of ultrasound, with the added benefit of heating a larger area. Because

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SWD preferentially heats low impedance tissues (e.g., skeletal muscle, blood, synovial fluid), it can heat deep muscle more efficiently. In addition, soft tissue treated with SWD maintains the tissue temperature increase two to three times longer than an ultrasound treatment. Muscle only maintains its peak temperature for 3.3 minutes post-ultrasound treatment. Tendons and ligaments maintain therapeutic heating levels for up to 5 minutes post-ultrasound treatment. Shortwave diathermy extends these stretching windows, which gives you more time to use passive stretching, joint mobilization and soft tissue mobilization before the tissue temperature retards to a baseline level. You can also perform low-load, prolonged stretching techniques during and immediately after the SWD treatment.

SHORT WAVE DIATHERMY:Â LCS101D SHORT WAVE DIATHERMY UNIT (500W) with disc electrode unique induction field circuitry provides a short wave frequency of 27.12 MHz that penetrates deep into muscle tissues with negligible heating in the fatty layer or bone.

APPLICATION SWD is effective in decreasing joint stiffness, increasing vasodilatation, muscle spasm relief, to reduce pain from ligament sprains and strains to reduce viscosity of joint fluids.

PRODUCT LINE

Shreyans Jain General Manager, Komega Impex Komega Impex is an important name in the medical equipment market, and we provide a variety of new and pre-owned radiology equipment. Our future plans include a proposal to install a fixed cath lab in hospitals for cardiac angiography and angioplasty. We would be investing for the purchase of the machine. We would also be taking care of the maintenance cost of the machine via comprehensive annual maintenance contract (CMC). Where hospitals are running short of funds or scared to put lots of money to buy fixed 100 kW cath lab, we are here to make capital investment and are ready to take care of maintenance of cath labs regularly. The machine will be installed on the site. All running charges of the machine as electricity bill, technicians and doctors salary

will be taken care of by the hospital as we would only be taking table charges for each case done. We must also get an estimate of the average number of patients the hospital caters to in a month, for the first 6 months and then for the next 6 months and so on, so that we can figure it out if it would be viable for taking forward the project and which model can be installed.

By setting up cath labs we aim to improve the quality of medical services in India by ensuring that advanced technology is made available to a larger section of population.

w w w.medegatetoday.com Jan.-Feb. 2016

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EXPERT VIEWS

All You

Want to Know About Surrogacy

The Draft ART Bill which has been in existence since 2008 for Assisted Reproduction has not yet been passed in the Parliament, and as the years have gone by, it has been constantly updated till 2014. Appointing a proper monitoring agency to make sure that legal and ethical practices are followed and putting law in place is important but there should be a proper plan in place.

Authorities should give an opportunity to all to voice their opinion.

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Infertility is not just about the inability to conceive, but also the associated trauma the individual or the couples go through. Women who are childless have to face many social taboos besides being the target of harassment by their families in a country like India, where culturally infertility is looked down upon.

The science of human reproduction has progressed at a pace which is unimaginable! The health sector in India has kept abreast of all these advances and is able to offer the best of health services which are available anywhere in the world!

We have been hearing a lot about surrogacy. Surrogacy is the latest addition to the treatments available for our infertile couples today. Surrogacy is the term used where a woman bears a child for another woman. The usual indications for this are that the woman cannot bear the child because the uterus is absent or malformed or when a medical condition exists making pregnancy a threat to her and/ or her baby's health. So, even though a woman has reached an age of 40 years and is minus a uterus, she can still have her own biological baby made from her own egg and husband’s sperm fertilized in the laboratory, and implanted in a surrogate. A surrogate is a young woman who carries another couple’s baby, within her uterus, delivers the baby, and hands it over to them.

In other words couples who benefit maximum from it are:W omen who are born with an absent uterus.  Women who have lost their uterus due to surgery where the uterus could not be saved.  Women who have repeated miscarriages.  Women who are medically not allowed to get pregnant. e.g. women who have a severe cardiac problem or severe kidney disease.  Women with repeated IVF failures.

Dr. Duru Shah

Scientific Director, Gynaecworld

EXPERT VIEWS

Surrogacy is termed altruistic when a dear friend or relative is willing to carry the pregnancy on behalf of the concerned woman, without any commercial benefits. While where an unrelated woman is willing to carry the patient’s baby and hand over the baby after the delivery for a fee is a commercial surrogacy. Besides earning money, they have a feeling of satisfaction that they have been able to assist another of their fraternity, to become a mother. This very combination of low socio economic status with a value added noble gesture” has made surrogacy very popular in India.

In some countries surrogacy is legal, whilst in some it is banned both for legal and ethical reasons. India has emerged as the main surrogacy destination since it legalized commercial surrogacy in 2002. As IVF centers with excellent medical expertise matching International Standards are available The Draft ART Bill which has been in India, with the entire treatment at a Disadvantages of Surrogacy: lower cost, surrogacy became popular  Surrogacy is a long and tedious in existence since 2008 for Assisted with the international clientele. process and there are a lot of Reproduction has not yet been passed in the Parliament, and as the years processes involved There are two main types of surrogacy: have gone by, it has been constantly T raditional surrogacy: In  T he couple has to ensure that all updated till 2014. Appointing a proper the legal procedures are in place traditional surrogacy, the surrogate is monitoring agency to make sure that before committing themselves to impregnated naturally or artificially, surrogacy or else they may face legal and ethical practices are followed but the resulting child is genetically and putting law in place is important but legal issues later related to the surrogate. This is there should be a proper plan in place. currently not legally recognized.

But whether surrogacy is ethical or Authorities should give an opportunity G estational surrogacy: In gestational unethical is an issue which is debatable. to all to voice their opinion. surrogacy, the pregnancy results With the lure of money, many illegal from the transfer of an embryo and unethical practices came into play, Adoption is no longer the only option. created by In Vitro Fertilization mainly because this medical treatment The infertile couple has the right to (IVF), in a manner so the resulting with so many ramifications does not choose, to have their own biological child is genetically unrelated to the have any monitoring agency to overlook child instead of adopting one which surrogate. Gestational surrogates assisted reproduction, just as it occurs also requires a long wait and legal are also referred to as gestational in other countries. As and when there formalities. Today thanks to celebrities was a regulation brought in. Those who carriers. who openly talk about it. There is a great adhered to legal and ethical practices Advantages of Surrogacy: followed such notifications from the awareness about surrogacy and hence F or couples who are aspiring to regulatory authorities and as occurs in many couples who cannot otherwise have their own child, surrogacy is a every sphere of life, some illegal and bear children are increasingly turning great option as they will have a baby unethical practices continued by the to surrogacy as a possibility to fulfill which will be biologically theirs. others. their parenthood dream. w w w.medegatetoday.com Jan.-Feb. 2016

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HEALTHCARE Technology

Technological advancement in Current Generation of

CT Systems

W

hen 64-slice computed tomography (CT) systems were introduced nearly a decade ago, they were purchased in large numbers to upgrade older 16-slice systems and soon became the new standard of care. Soon after that boom period for CT, sales abated due to the economic slowdown and the uncertainty of future reimbursements due to U.S. healthcare reform. This made many hospitals think hard about replacing CT systems as frequently as they had previously, with many extending the service life from five years to 10 or more. The conversion to a value-based payment healthcare system and concerns over radiation dose also have changed what hospitals look for in return on investment, cost-effectiveness, efficiency and increasing patient safety. This is the setting as many providers now begin thinking about replacements for their older, first generation 64-slice systems.

Higher Slice Systems After the introduction of 64-slice systems, some vendors introduced higher slice systems in an effort to improve image quality, reduce scanning times, eliminate stitching artifacts, and to freeze cardiac and respiratory motion. Today, several vendors offer premium 80-, 128-, 256-, 320and 640-slice systems in addition to their workhorse 64-slice models. Critics of these systems say 64-slice CT can accomplish any scanning tasks without the increased price tag of the larger slice systems.

Supporters of higher slice systems cite their utility in scanning particular types of patients. With children, the speed of these systems can freeze motion,

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increase image area coverage, reduce radiation exposure and reduce the need for repeat scans.

The systems also benefit cardiac scans, where the motion of the heart and breathing is less of a concern because the scans are completed in milliseconds.

The larger imaging area of these systems enable whole organ imaging in a single rotation of the gantry, without the need to stitch multiple images together. New Detector Technology In the past few years, GE Healthcare, Philips, Siemens and Toshiba introduced new detector technology for their CT systems that uses microelectronic circuits. This technology reduces electronic noise and enables sharper images. GE, Philips and Siemens also have introduced new detectors to enable dual-energy spectral imaging on their newest generation CT systems. Iterative Reconstruction Until recently, all CT systems reconstructed images based on filtered back projection because it was fast and could be accomplished in a reasonable amount of time using older computer technology. However, with rapid advances in computing power and the reduction in costs for that power, all the major CT vendors now offer iterative image reconstruction.

This software revises the image over and over with multiple iterations to clean up artifacts and clarify the image pixel by pixel. This enables diagnostic image clarity on low dose scans that was previously not possible. This enables CT scanning at much lower doses than a decade ago. CT Lung Screening In August, GE Healthcare became the first vendor

HEALTHCARE Technology

with a U.S. Food and Drug Administration (FDA)cleared low dose CT lung cancer screening option.

The U.S. Preventive Services Task Force (USPSTF) recommended the use of low dose CT lung cancer screening for high-risk individuals in December 2013. Additionally, Medicare has now approved reimbursement for its beneficiaries who are eligible for the use of low dose CT lung cancer screening in high-risk patients. GE Healthcare’s new lowdose screening reference protocols are tailored to the CT system, patient size and the most current recommendations from a wide range of professional medical and governmental organizations. GE said all new 64-slice and greater CT scanners, and most of the 16-slice CT scanners that it sells, are now qualified CT lung screening systems and will include the new screening option. The solution is also available for some GE scanners currently in use. Spectral CT Imaging Spectral CT (also called dual-source or dual-energy CT) has the potential to become a major trend in the coming years, as all the major CT vendors are now integrating this capability into their scanners. Similar to the way a prism breaks visible light down into its parent chemical elements on the periodic table for analysis, spectral CT can break down X-ray photons by chemical elements. Spectral CT is based on viewing the same anatomy at two different kV energies. This can be accomplished with a dualsource CT scanner, or newer methods that use fast kV switching between different

energies during the scan, or detector elements that record different kV levels during a scan. Different anatomical features are enhanced at different energy levels. Instead of needing to scan a patient multiple times at different energies to achieve various tissue enhancements, spectral CT allows different energy views to be created from a single scan.

Additionally, the spectral software can highlight or eliminate specific chemical compounds based on their atomic number, including iodine, calcium and metals. This allows differentiation between calcified coronary lesions and iodine contrast in the blood vessel. It also enables contrast and non-contrast images to be created from a single contrast scan, since iodine can be removed via spectral filters to create a virtual non-contrast dataset. Applications for the technology include definitive identification of gout, differentiation between different types of kidney stones to better guide treatment, improved metal artifact reduction and clearer identification of pulmonary embolism. The vendors say additional applications are being researched and all of them have made big investments in the technology in anticipation of its use in next-generation CT diagnostics in the coming years

COURTESY itn w w w.medegatetoday.com Jan.-Feb. 2016

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HEALTHCARE HEALTHCARE Technology

Sharper ultrasound images could improve diagnostics New system developed at MIT allows precise measurements and tracking of disease progression

U

ltrasound images, known as sonograms, have become a familiar part of pregnancy, allowing expectant parents a view of their unborn child. But new research at MIT could improve the ability of untrained workers to perform basic ultrasound tests, while allowing trained workers to much more accurately track the development of medical conditions, such as the growth of a tumor or the buildup of plaque in arteries.

The improvements to this widely used technology could provide detailed information far beyond what is possible with existing systems, the researchers say.

The work, led by Brian W. Anthony, co-director of MIT’s Medical Electronic Device Realization Center (MEDRC) and director of the Master of Engineering in Manufacturing Program, was recently presented at the International Symposium on Biomedical Imaging in Barcelona, Spain.

There are two key elements to the improvements engineered by Anthony and his team. First, the researchers devised a way to adjust for variations in the force exerted by a sonographer, producing more consistent images that can compensate for body motions such as breathing and heartbeat. Second, they provided a way to map the exact location on the skin where one reading was taken, so that it can

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HEALTHCARE Technology

be precisely matched with later readings to detect changes in the size or location of a tumor, clot or other structure.

Together, the two improvements could make sonography a much more precise tool for monitoring the progression of disease, Anthony says. The devices are currently undergoing three clinical trials, including one at Boston Children’s Hospital focused on monitoring the progression of patients with Duchenne Muscular Dystrophy (DMD).

In that trial, Anthony says, researchers are trying to determine “how fast the muscle deteriorates, and how effective different medications are.” It’s important to have a reliable way of monitoring changes in muscle, he says. The study is aimed at determining whether ultrasound analysis can serve as a convenient, noninvasive, clinically meaningful way of monitoring disease progression in DMD. The new device maintains constant force through the addition of a force sensor to its probe tip and servomotors that can respond almost instantly to changes in force. That, in turn, makes it possible to analyze how the image varies as the force increases, which can provide important diagnostic information about the elasticity of skin, muscle and other tissues.

Besides the potential for these advanced diagnostic capabilities, enhanced control over testing could make it possible for relatively untrained health care workers to administer basic ultrasound pregnancy tests — especially in remote, underserved areas where trained sonographers may not be available. The various control techniques “take the uncertainty out” of the process, Anthony says.

To provide accurate positioning, a tiny camera and lens mounted on the probe can reveal skin patterns that are distinctive and constant, similar to fingerprints.

“Skin patterns are pretty unique,” Anthony says; his team’s system, using software to compare new images Craig Steiner, an anesthesiologist at Chester County with earlier ones, “can get you back to that same patch Hospital in Pennsylvania, says, “I’m excited about of skin,” something that is impossible to do manually. the prospects” of these improved systems. “The Anthony likens that precise positioning to “an on- reproducibility of the scan with consistent pressure the-patient GPS system” for locating structures in and picture quality would help with remote readings the body. The ability to take images over time from of locally done scans. This could be relevant for exactly the same position makes it possible to monitor teleradiology, which is an area ripe for expansion.” changing tissues quite precisely: The imaging system can determine the volume of a near-surface tumor or other feature to within an accuracy of 1 to 2 percent, he says. There are existing ways to get this kind of accuracy, but these require expensive specialized equipment that few hospitals have.

Steiner adds: “The field of ultrasound is still developing. Ultrasound will partially replace CT scans, reduce radiation exposure to patients and make diagnosing easier when away from the highcost hospitals. It can help our world provide care at a more reasonable cost with a new paradigm of care.” w w w.medegatetoday.com Jan.-Feb. 2016

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1-B-30,Lalita Shashtri Nagar, Behind Kalpatru Shopping Centre, Jaipur-16 T: 0141- 2309675

ECG Equipments Hygeia Incorporation

S No. 16 , Navghar Bldg 59/ 60, Poonam sagar Complex Mira Road (E) Mumbai 401107 M: 9967064947 Nasan Medical Electronics Pvt. Ltd.

Rangoli Ist floor.,opp Karve Statue Kothrud Pune-411038 M: 8237032389

Endoscopy Instruments

Healthware Pvt. Ltd.

B6,Byculla Service Indl. Premices, D.K. Marg, Sussex Road,Byculla ,Mumbai-27 T: 022-2374 8371/2/3 Shree Balaji Surgical pvt ltd

1-B-30,Lalita Shashtri Nagar,Behind Kalpatru Shopping Centre, Jaipur-16 T: 0141- 2309675

HOSPITALS (Multi Speciality) Cygnus Hospital

1211,Tower-2, Pearls Omaxe,Netaji Subhash Place, New Delhi-110034 T: 011 42488393 Fortis Escorts Heart Institute & Research Centre

serene Tower 8-2- 623/A Rd No. 10, Banjara Hills Hyderabad -500034 T: 040-23318229

Okhla Road, New Delhi-25 M: 91 11 4713 5000

Helios Endovision

98, HAL Airport road, Bangalore-560 017 T: 080 - 2502 4444/3344

1/1, Sahkar Niwas , Tekri Bunglow, nr.3 Petrol Pump Old Agra Road, Thane- 400602 M: 9820276976 Om Surgicals

65, Unique. Est., Nr.Jammunadas, Opp jawahar Talkies, Mulund (W)Mumbai-400080 T: 022- 25670626

Manaipal Hospitals

Pushpawati Singhania Research Institute

Press Enclave Marg, Sheikh Sarai, Phase-II, New Delhi – 110 017 Tel: 011 30611900

YELLOW PAGES

HOSPITAL CONSULTANCY

Medical Equipment

Nurse Calling System

Hosconnn

Technocare Medisystems

CR Medisystems Pvt. Ltd.

6, Chaithanya Complex Site 1, 17th Cross, Sir MV Nagar T.C. Palya Main Road, Bangalore M: 9845208778, Email: info@hosconnn.com

C/1310-11,New Bombay Market, Umarwada, Surat- 395010 T: 261 2332042,6569308

Mumbai, India.

Tel : 91-022-23094416, 23004930 E-Mail : medisystems@gmail.com

DDF Consultants 501, B-9, ITL Tower, Netaji Subhash Place, Pitampura, New Delhi-110034 T: 011-47400500 Hospiteck Healthcare Consultancy

Bangalore T: +91-9739708532

Hindustan Syringes & Medical Devices Ltd.,

174, Sector - 25, Ballabgarh - 121 004 (Haryana) Tel : +91 129 4289000, Fax : +91 129 4061164 & 2233242 E-mail: info@hmdhealthcare.com, hmduk@hmdhealthcare.com

MOdular- Operation Theatre

Six Sigma Star Healthcare Pvt. Ltd.

Sai Sumeet Appliances

New Delhi T: 011 25324000 E-mail: sixsigmahealthcare@gmail.com

Hyderabad M: 08099119595

Health care Institution Global Institutte of Healthcare Management

6 sigma house, 10A, Phase -1, Najafgarh New Delhi-43 T: 011 2532 4000,4001

HOSPITAL FURNITURE Godrej & Boyce Manufacturing company ltd.

Pirojshanagar, Vikhroli, Mumbai- 400079 T: 022- 67965656 Jaiveer Surgical Emporium

1570, Bhagirath Palace, delhi-110006 M: 9810820087 Janak Healthcare Pvt. Ltd.

kalpataru Point, Unit No. -12 1st floor, sion (E) Mumbai-400022 T:022- 49153000

Hospital Garments Kaustubh Hospital Garments

4- 401, Vanrai Colony , Opp Nirlon, off W.E. Highway Goregaon (E)Mumbai-400065 M: 9869051352

ICU Equipments

Monitoring Equipments & Accesso Afford Medical Technologies Pvt. Ltd.

230, 2nd Main Road, Sainikpuri Secunderabad-94 T: 040-32908880 Drager Medical Pvt. Ltd.

Gold line Business Centre, Link Road Malad (W) Mumbai-400064 T: 022- 40843826 Medion Healthcare Pvt. Ltd.

201, Shiv Industrial Estate, K.B.B. Marg Chinchpokli (E) Mumbai-12 T: 022-23771737 Nihon Kohden India Pvt. Ltd.

308, Tower- A, Spaz Edge, Sector- 47, Sohna Road Gurgaon- 122002 T: 0124-4931000

Neonatal Pediatric Intensive c Bird Mediteck

109, 110, NidhiIndl Est, Shankar Industrial Complex No. 2, Waliv, Vasai, Thane-08 T: 0250-3212729

operation theatre equipment

operation theatre Light Magnatek Enterprises

97, SVC Indl Est., Balanagar, Hyderabad-500037 T: 040-65501094

Rehabilitation Product &AIDS Vissco Rehabilitation AIDS Pvt. Ltd.

517, Tulsiani Chambers, Nariman Point Mumbai-400021 T: 022-43330300

Shoes Cover Dispenser BIO-X

5th floor, Span center, South Avene Santacruz (w) Mumbai-400054 M: 9820355995

Software and IT Solution Schrack Seconet AG

T: 124 414150 Kodak Alaris

www.kodakalaris.com

SURGICAL BLADES Ribbel International Ltd

20th Mile, Jatheri Road, P. O. Rai Near Rai Industrial Area Sonepat Haryana 131029 M: 8053111016, 8053111011 SURGICAL BLADES

Niraj Industries Pvt. Ltd. 177, Sector - 25, Ballabgarh - 121 004 (Haryana) Tel : +91 129 4289000, Fax : +91 129 4061164 & 2233242 E-mail: info@hmdhealthcare.com, hmduk@hmdhealthcare.com

Agora Climate Control system

Unit No. C-1/2/3/, Sagar Sangam Ind. Est., Sativali Vasai (E) Thane-24 T: 0251-2872193 Bird Meditech

109, 110, Nidhi Ind. Est., Nh No. 8, waliv, Vasai (E) Mumbai- 401208 T: 0250-3212729

Philips India Ltd.

Magnatek Enterprises

9th Flr, DLF, 9b , DLF, Cyber city, DLF Phase- 3 sec 25, Gurgaon-122002 T: 0124- 4606000

97, SVC Indl Est.Balanagar, Hyderabad-500037 T: 040-65501094

UROLOGY Ribbel International Ltd

20th Mile, Jatheri Road, P.O.RaiNear Rai Industrial Area Sonepat Haryana 131029 M: 8053111016, 8053111011, sales@ribbel.com

X- Ray Equipment Allengers

S.C.O 212-213-214, sector 34,Chandigarh - U.T 160 022 (India) T: 172 3012280-84 w w w.medegatetoday.com Jan.-Feb. 2016

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RNI No. DELENG/2010/33833