Jan_Feb_2017 by Zyaul Designer

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Wish u a Magazine Volume - VII Issue - V Jan-Feb 2017

Latest advancements made in radiology and imaging devices Medical Imaging Market to Grow at 5% CAGR Driven by X-Rays Imaging to 2020 “Digital image acquisition has become the standard for modern equipment used in angiography, ultrasonography, computed tomography, magnetic resonance imaging, and radionuclide radiology, but most radiological images are still recorded, interpreted, and stored on x ray film.With the increasing availability of more efficient and affordable storage phosphor systems, the simple radiograph looks set to become digital and the “filmless” radiology department will be a reality” The medical imaging market has high demand since procedures form the basis of diagnosis and also the treatment of various medical conditions. Market research analysts predict that the global medical imaging market will grow at a CAGR of nearly 5% by 2020. The growing focus on R&D to provide highquality imaging for better diagnosis and treatment of diseases is a critical factor that drives the global demand for medical imaging devices during 2016-2020. Eminent factors such as the advent of 4D medical imaging technology are forecast to spur market growth during the forecast period. Since 4D imaging technology enables doctors to create a 3D picture in real time, its augmented application in ultrasound systems will foster the prospects for growth in this market during the predicted period. Tele imaging enables physicians to perform and interpret medical images in remote areas where the technology is difficult to reach. The technology in tele imaging has become advanced wherein the physicians/centers can share videos and images of ultrasound via the Internet using an IP camera and remote access software. Tele imaging reduces delays in patient care and will be efficient in handling the shortage of the physician's workforce. Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m

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Co nt en ts

6 Hemophliia Federation of India �� 6 Shri Shripad Naik to formally inaugurate the North Eastern Institute of Ayurveda & �� 8 Seminar on Medical Electronics International collaborations & Financing �� 10 Antibiotics should be consumed only when prescribed by the doctor �� 10 Global Public Health institutions collaborate to announce the launch of the first-of-its- �� 12 Prime Minister Shri Narendra Modi unveiled first ever Indian Institute of Skills of India �� 14 With The Somatom Go. Ct Platform, Siemens Healthineers Offers Radiology �� 16 U.S. FDA approves Jardiance® (empagliflozin) tablets to reduce the risk �� 18 IIFL Home Loans to Organize Free Health Check Up Camp in Kolkata �� 20 Fortis Hospital, Anandapur develops ‘Nano Crush’ �� 21 Prolonged Standing Can Trigger Leg And Back Problems �� 22 India in Desperate Need of A Public Cord Blood Bank �� 29 Imaging Modalities In Radiology �� 34 We are totally dedicated & we offer them all pathological, radiological services, �� 36 Physiotherapy Can Help to Treat Shoulder Dislocation �� 42 Devastating Elephantiasis Disease Facing Elimination �� 44 Prevent your eyes from Diabetes �� 49 Let’s speak for Patient Safety in India �� 51 Bd Expands Efforts To Combat Antimicrobial Resistance In India With New Automated ��

CANCER SCREENING Startup offering assistance to patients & TESTS advised surgery

New Trends In Treating Heart Ailments

So you’ve just been diagnosed with diabetes…

Advances in imaging over the last five years have revolutionized almost every aspect of medicine

“CanAssist-Breast”, a Breast cancer recurrence prediction test

Pinless Computer Navigated Total Knee Replacement

Staying Healthy can also be affordable.

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NEWS Update

BD EXPANDS EFFORTS TO COMBAT ANTIMICROBIAL RESISTANCE IN INDIA WITH NEW AUTOMATED ID/AST SYSTEM Launches new BD Phoenix™ M50 System at MicroCon 2016 that delivers modularity, reliability, affordability and high-quality susceptibility results needed by clinical microbiology laboratories BD (Becton, Dickinson and Company), a leading global medical technology company, announced the launch of its next generation diagnostic instrument for the rapid identification of bacteria and detection of antimicrobial resistance (AMR). The new BD Phoenix™ M50 ID/AST system helps deliver the same rapid, accurate and cost-effective testing as the legacy BD Phoenix™ 100, within a smaller footprint. The system is highly reliable and requires no preventative maintenance, thanks to innovative materials and engineering techniques employed during its development.

“The health care community is facing unprecedented challenges with the spread of multidrug resistant organisms, and today’s clinical microbiology laboratories are under increasing pressure to provide fast and accurate bacterial identification and antimicrobial susceptibility testing(ID/ AST) results to influence clinical decision and outcomes.TheBD Phoenix M50 system is an attractive solution for microbiology laboratories in Indiaand intensifies our support to the fight against antimicrobial resistance,” said Noel Wentworth, Business Director of Diagnostics Systems for BD in Central and South Asia.

Neeraj Raghuvanshi, Business Director of Diagnostics Systems for BD in India added, “Over-the-counter access to antibiotics is a problem.Improvements in clinical and laboratory practices, combined with effective deployment and use of medical technology, can help to ensure antimicrobials are utilized appropriately, reducing risk to patients and lowering costs associated with resistance.Antimicrobialresistanceis a threat that can be solved with a collective effort and with the launch of our technology we want to play an active role in this public health challenge.”

Hemophliia Federation of India

battle with Hemophilia. I feel so grateful to Late Ashok Verma for lying down this foundation ages ago when the disease was not that known. He started this movement when there were no funds and optimum resources available to facilitate the actions. People often complained about the expired and tampered medicines or cosmetics from overseas that have adversely affected their health but with time India has shown great improvement in the field of science and medicine. It proved to be catalyst in getting affiliations from UN –WHO. We are proposing for public sector health care units with proper arrangements and better quality medicine chains. To allocate funds, helping the victims cure out in better means all across India. We will make sure that all the grievances of the patients are being taken into account and Anti Hemophilia Factor facilities are provided.” According to Deputy Commissioner National Urban Health Mission Basab Gupta, “We have laid a proposal to FMR to support the fight against Hemophilia and allocation of funds for such specific purposes. We are looking forward to formulate standard protocol and set proper guidelines at National level disseminating the motive of the cause in states and ask for immediate funds for the same."

Hemophilia Federation of India layed a proposal to the Central Government for proper budgeting and provisions to initiate Anti – Hemophilia Factor (HFI) under NACO.

Hemophilia Federation India (HFI), organized an event to commemorate its Founder’s Day on 24 November 2016th at India Habitat Center, New Delhi in the memory of HFI's Founder Late Sh. Ashok. B. Verma (1942 – 2004). The conference was to spread awareness about the disease and its consequences and also measures that have been taken into consideration to extend a helping hand to the patients suffering from this dreadful disease. This year on its founder’s day HFI focused on to lay a proposal to the Central Government for proper budgeting and provisions to initiate Anti – Hemophilia Factor (HFI) under NACO. The federation has also forwarded the desired proposal to National Health Mission of India to help people cure this communicable disease across the country by setting up centres in different cities. Shri Kamlesh Kumar Pandey, Chief Commissioner for Person Disability addressed “Hemophilia is such a disease that can be managed but cannot be removed 6

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from inside. It creates hindrance for the patients to live their lives on their own terms. Hemophilia is such a disease that slowly takes a person towards disability and the ministry is trying to get the bill approved in order set up treatment centres across India in different districts to treat the cause. As per the disability Act, there are 7 diseases categorized under it but soon there be 18 such categories including Hemophilia, cancer and other such related diseases. Administration is taking steps to get this disability recognised in order to the patients on medical terms. The bill has been forwarded to the PMO and will be soon approved by the Rajya Sabha to declare it as a disability in the Disability Act in India.” Dr. G.N. Singh, Drug Controller General of India (DCGI) threw light saying “Health Ministry of India is considering this disease a disability and appreciates the vision of HFI society. We under the plight, consequences and after effects or genetic disorders a patient has to undergo while fighting the

NEWS Update

Shri Shripad Naik to formally inaugurate the North Eastern Institute of Ayurveda & Homoeopathy at Shillong tomorrow NEIAH to provide health care to people of North-Eastern region and Sikkim under Ayurveda/Homoeopathy systems of medicine

The main aims and objectives of NEIAH, Shillong:  To provide under graduate, post graduate, doctoral and post-doctoral teaching, research facilities and quality patient care services under the Ayurvedic and Homoeopathic systems of medicine;  To conduct experiment and develop patterns of teaching in under graduate and post graduate education in all branches of the Ayurvedic and Homoeopathic systems of medicine;  To conduct research on various aspects of Ayurvedic and Homoeopathic systems of medicine; Minister of State for AYUSH (Independent Charge) Shri Shripad Yesso Naik will formally inaugurate the North Eastern Institute of Ayurveda & Homoeopathy (NEIAH) at Shillong in Meghalaya tomorrow. NEIAH is an autonomous institute established by M/o AYUSH, Government of India. The Institute is having College of Ayurveda and College of Homoeopathy with admission capacity of 50 students each along with a 100-beded Ayurvedic Hospital and a 50-beded Homoeopathy Hospital, Documentation-cum-R&D Centre and Pharmacy with Drug Testing Laboratory. The institute will be a unique institution which will be independent and collocated beside NEIGRIHMS with multi-speciality, where education and health care facilities through Ayurveda & Homoeopathy will be provided under one platform. Moreover, it is designed to facilitate the promotion of Ayurveda and Homoeopathy, the expansion of health care facilities, improvement in the doctor-population ratio and Research and Development on bio-resources in the North East. The construction of Ayurveda College & Hospital, Homoeopathy College & Hospital and Library cum Administrative buildings under Phase I of NEIAH project has been completed. Phase II of the Project will include residential quarters, hostels for under graduate boys/ girls, Senior Residents etc. NEIAH has been established at Shillong to provide health care to the people of NE Region and Sikkim under the Ayurveda and Homoeopathy systems of medicine, to promote and popularize Ayurveda and Homoeopathy and to create awareness among the general masses regarding the importance, effectiveness and potentials of Ayurveda and Homoeopathy. 8

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 To provide medical care through Ayurvedic and Homoeopathic systems of medicine to the people;  To conduct refresher courses for Ayurvedic and Homoeopathic systems of medicine;  To develop, promote and propagate the science and art of Ayurveda and Homoeopathy as the case may be.  The Institute has started functioning with one College of Ayurveda and one College of Homoeopathy from the academic session 2016 – 17. The Institute admitted 50 candidates each for BAMS (Bachelor of Ayurvedic Medicine & Surgery) and BHMS (Bachelor of Homoeopathic Medicine & Surgery) courses commencing from 30th November, 2016. The Institute is affiliated to the North Eastern Hills University (NEHU), Shillong for both these courses. The seats are reserved for all seven states of North Eastern Region along with 24 (twenty four) seats under the All India Open Seats Quotas.  The Institute is presently running with OPD and IPD (Ayurvedic & Homoeopathic) with qualified specialist doctors with all diagnostic & laboratory facilities. Free Panchakarma therapies along with free laboratory diagnostic facilities are also available. We also provide free medicines to patients as per availability of medicines in the stock. Presently a 60 beded Ayurveda Hospital and a 20 beded Homoeopathy Hospital are functional.  Shri Naik will be the Chief Guest of the inauguration ceremony which will be presided over by Secretary, Ministry of AYUSH, Shri Ajit M. Sharan. Minister of Health and Family welfare in Meghalaya Government Smt. Roshan Warjri will also be present at the function.

NEWS Update

Seminar on Medical Electronics International collaborations & Financing for Manufacturing' in India on Friday, 16th December at Holiday Inn, Jaipur PHD Chamber in association with AMTZ (Andhra MedTech Zone) organized a Seminar on 'Medical Electronics International collaborations & Financing for Manufacturing' in India on Friday, 16th Dec 2016, 11:00am at Holiday Inn Hotel Jaipur. AMTZ (Andhra MedTech Zone) aims to make India a self-sufficient and in fact an exporter of good quality and costeffective medical technology. The objective of the Seminar was to familiarize the Industry on this opportunity which exists in fulfilling this gap which is likely to only widen as the healthcare services reach out to semi-urban and rural areas. The seminar also threw up opportunities for foreign collaborations for technology transfers and financing for setting up units. Mr. M L Gupta, Co Chairman of Rajasthan Committee, PHD Chamber addressed the delegates and briefly informed them about AMTZ. The Conference was presided over by Mr. Nitin Bharadwaj, Vice-President (HR and Administration) shared that Medical device Industry in India is Rs 30,000 Cr (USD 5.00 Bn) and is fourth largest in Asia. He also shared about the benefits of being the

part of AMTZ project at Vizag, where they are offering Plug-n-Play Infrastructure, Lower cost testing services, Lower Capex for manufacturers, Regulators and Export Facilitation, Promotional activities thru EXPO/ Convention Center, Finance and technology transfer services, Preferential Market Access Circa and all other facilities commonly required in the manufacturing of medical devices etc. Mr Vikas Varma, Financial Advisor & Internal Auditor, AMTZ shared about AMTZ value proposition for investors and he also shared about multiple fiscal incentives provided by AMTZ to the companies participating in the project like 100% reimbursement of Stamp Duty, Transfer Duty and Registration Fee paid on sale / lease deeds on the first transaction and 50% thereof on the second transaction, 50% to micro, 40% to small & 25% to medium & 10% to largescale industry limited to Rs 50 lakh for a period of 5 years from the date of commencement of commercial operations, Exemption of Electricity Duty for new electronic hardware units, after coming into commercial operations entitled for 100% exemption on Electricity duty for a period of 5 years, The cost of filing patents will be reimbursed to the companies having their

headquarters in Andhra Pradesh, subject to a limit of Rs 5 Lakh per domestic patent awarded and Rs 10 Lakh per international patent awarded, 50% subsidy on the expenses incurred for quality certification limited to Rs 4 Lakh (Conformity European (CE),China Compulsory Certificate (CCC), ULCertification, ISO, CMM Certification, SA, RU etc.), 25% subsidy on cleaner / greener production measures limited to Rs 10 Lakh, 100% tax reimbursement on VAT/CST for a period of 10 years subject to a maximum of 100% of fixed capital investment other than land (such as building, plant, machinery, testing equipment, etc).and many more. Mr. Nagaraju Devarajugattu, SM Operations, AMTZ informed the delegates on the plot booking procedure with specifics on Investment in AMTZ. He also gave a live demo on the plot booking procedure for better understanding. Mr Vivek Seigell, Director, PHD Chamber appreciated the efforts being taken by the Andhra Pradesh Govt. and urged the industry members to come up front and be the part of AMTZ project and support the govt. in fulfilling the goal of make in India. He further added to avail the facilities available in manufacturing the medical devices which exists today.

Antibiotics should be consumed only when prescribed by the doctor Dr Ajit Shetty, General Physician, SRV Hospitals.

Antibiotics are usually consumed as per doctor’s prescription incase of any illness. It is meant to kill bacteria but unfortunately patients many a times opt for antibiotics for viral infections as well. This may lead to side effects, hence it is not advisable to consume over the counter antibiotics or exceed the prescribed dosage. These antibiotics can cause side effects like bloating, belching, gas, constipation or diarrhea. As there is hardly any government regulation on antibiotic use in India, chemists conveniently provide medicines over the counter that can have adverse effects on one’s health. Pharmacists are not doctors, it would be harmful to rely on pharmacists or even self medication incase of any illness. It is essential to understand the symptoms and causes of the illness properly before prescribing any medication. It is important to remember that antibiotics only work against infections that are caused by bacteria and certain parasites. Each type of antibiotic only works against certain types of bacteria or 10

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parasites. This is why different antibiotics are used to treat different types of infection. There are various antibiotics available and they come in various different brand names. “There is a lot of difference between bacterial infections and viral infections, antibiotics can be had only incase of bacterial infections. In most incidents fever occurs due to viral infections, which may not need antibiotics but still most patients rely on antibiotics that can have side effects. Occasionally, a viral infection or minor bacterial infection develops into a more serious secondary bacterial infection. With hardly any government regulations on antibiotic use in India, there are not sufficient penalties for irrationally prescribing an antibiotic. There is no role of antibiotics during viral infections; it is essential to understand based on the kind of infection the appropriate medicine that needs to be consumed. Nowadays patients lack the patience needed for an illness to recover, they ask the doctor to help them recover quickly putting them in a fix, this forces many to prescribe antibiotics.

NEWS Update

Global Public Health institutions collaborate to announce the launch of the first-of-its-kind Certificate Course on Cardiovascular Disease and Stroke (CCCS) in India, aiming to expand it globally. Advancing evidence-based learning in CVD & Stroke for primary care physicians, the course is an international partnership between Public Health Foundation of India (PHFI), World Heart Federation (WHF), Population Health Research Institute (PHRI), American College of Cardiology (ACC) and Centre for Chronic Disease Control (CCDC). This unique 12 modular executive on-the-job course will be conducted at 50 different centers in India, aiming to train and build capacity of over 2000 Primary Care Physicians to improve patient outcomes by enabling early diagnosis and evidence based treatment. Recognizing that Cardiovascular disease (CVD), including ischemic heart disease and strokes are an existing public health challenge and a leading cause of death globally which requires an immediate need to build capacity, improve and enhance awareness amongst primary care physicians, the Public Health Foundation of India (PHFI) along with international academic and knowledge partners The World Heart Federation (WHF), Population Health Research Institute (PHRI), The American College of Cardiology (ACC) and Centre for Chronic Disease Control (CCDC), launched first of its kind Pan-India Certificate Course on Cardiovascular Disease and Stroke (CCCS). “The ACC mission is to transform cardiovascular care and This course will be initially launched in India and then extended improve heart health, and programs like this are key to our to other regions of the world with the goal of reaching all ability to work with partner organizations around the world continents within 5 years. When fully operationalized, it is to achieve this mission,” said Dr Daniel José Piñeiro, M.D., expected that this course will train a huge number Primary FACC, Chair of the American College of Cardiology Assembly Care practitioners and measurably increase their capacity and of International Governors. “The ACC is poised to leverage its knowledge to address CVD, ultimately drive the reduction of 52,000 worldwide members to assist in expanding cardiology premature CVD mortality globally. education to primary care doctors where there is a huge Announcing this unique collaborative course Prof. D. opportunity to make an impact.” Prabhakaran, Vice President – Research and Policy, PHFI said, The Certificate Course on Cardiovascular Disease and Stroke “We at the Public Health Foundation of India are committed will be of a duration of twelve months (12 modular course) to improving health and healthcare practices. Through the with once- a- month contact sessions, which will be conducted Certificate Course on Cardiovascular Disease and Stroke, we on designated weekends at regional centers across India with aim to tackle one of the most formidable public health challenges standardized slides, case studies and group work exercises. The of this century—reducing the burden of heart disease and course will comprise of 15 global scientific leaders in the field stroke. Heart disease and stroke are among the nation’s leading of cardiology who shall act as National Experts for this program causes of death and disability, and despite this condition having guiding content, curriculum, delivery methods, conducting a huge individual and societal burden, it is under-addressed faculty briefing sessions and participating in the training within the population level -- both rural and urban and also at sessions in addition to monitoring and evaluating progress. the medical fraternity level, who are poorly trained to diagnose In India, there will be 50 expert faculty members delivering this condition earlier in a patient. As the numbers increase the course. Faculty members will be selected on the basis of for patients diagnosed, the need for an advanced educational criteria which should include a specialized degree in cardiology preparation for physicians needs to be developed. With an aim or equivalent with a preference for DM/DNB/MS Cardiology; to make an impact in CVD and stroke, PHFI along with its major proportion of current practice related to CAD, Stroke and global partners proudly announces this pan-India course. This its complications; and with the required infrastructure to meet course is a well-designed compendium that will help tackle the requirements of this project (out-patient clinic, in-patient the challenges of disease detection, management, and further facility, a training room, computer with internet connectivity familiarizing primary care doctors with advancements in CVD and a patient educator/ counselor/ nutritionist) either in private and Stroke management.” settings or with the associated hospitals. Each center will have Emphasizing the need for improved management and reduced only one faculty and the faculty to participant ratio of 1:20 burden of CVD through strengthened capacity of primary per center. The participant eligibility criteria shall include care physicians to prevent, detect and manage Cardiovascular either post-graduate degree in any medical field, preferably Disease (CVD) and Stroke, Dr. Salim Yusuf, President, World internal medicine or family medicine or medical graduate with Heart Federation in his address said, “Primary care is the at least three years of experience as a primary care physician. cornerstone of prevention of heart diseases and strokes and the A rigorous quality improvement and evaluation system will first step in diagnosis and initial management. This includes be implemented, including pre- and post-testing, observer detecting hypertension and initiating treatments, continuing the evaluation, and mid- and final- assessments. Successful care of patients after they have been stabilized by specialists completion of the programme shall include participation in 10 and promoting smoking cessation .These 3 strategies can of 12 modules, submission of interim assignments and a final make a big impact. That is why the World Heart Federation in exit exam. The entire course content will be developed by the partnership with the PHFI are launching this course in CVD academic partners with inputs and support from PHFI and prevention in primary care. After starting this course in India, National Experts. The secretariat would be set up at PHFI, New we plan to adapt it to other countries and launch the course in Delhi for overall implementation, monitoring and coordination different regions of the world.” of the course  12

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NEWS Update

Prime Minister Shri Narendra Modi unveiled first ever Indian Institute of Skills of India at Kanpur also inaugurated Kaushal Pradarshini to portray major Skill Development Initiatives by the MSDE  L aidfoundation for Indian Institute of Skills in Kanpur-First of its kind Centre of Excellence on the lines of the Institute of Technical Education, Singapore  I naugurated Kaushal Pradarshini (Skill Exhibition) organised by Ministry of Skill Development and Entrepreneurship (MSDE)  L aunched of 31 Pradhan Mantri Kaushal Kendras across the country  I naugurated Drivers’ Training Institutes across the country  S trategic Partnership with industries to train and employ 4 lakh youth under PMKVY In line with the vision of making India the Skill Capital of the World by empowering its youth to be more employable and self-sustainable, the Hon’ble Prime Minister laid the foundation stone of the first ever “Indian Institute of Skills” in the country at CTI Chouraha, Govind Nagar, Kanpur. The Institute has been conceptualized by the Hon’ble Prime Minister during his visit to Singapore’s Institute of Technical Education. Ministry of Skill Development and Entrepreneurship, headed by Shri Rajiv Pratap Rudy, in partnership with the Institute of Technical Education, Singaporedecided to open an institute first ever of its kind in the country, the institute is inspired by the Singapore model of training and would adopt various best practices from the country. The Ministry has decided to have six such institutes all across Hon’ble Prime Minister inaugurated the KaushalPradarshini (Skill Exhibition) for the youth of Uttar Pradesh. The Exhibition would showcase state-ofthe-art vocational training practices across different sectors, and would be open for public view at the Railway Grounds, Kanpur between 19th to 22nd December.

NEWS Update

Shri Modi launched an array of skill development initiatives for the youth of the country, including Pradhan MantriKaushal Kendras (PMKKs) and Drivers’ Training Institutes. There was also strategic partnership with various industries that will train and employ approximate 4 Lakh youth over the next 3 years.

private companies that are engaging in apprenticeship across the country. It is MSDE’s endeavour to encourage State Government support and ensure engagement with more corporates on apprenticeship trainings. This is one direct way of bridging the gap between the potential employee and the employer and has models under Apprenticeship training has benefited economies of many countries. The financial year target for 2016-17 is to ensure enrolment of 5 lakh apprentices at least across the country.

Hon’ble Prime Minister had shown concern about the training of drivers so to achieve his dream Ministry has decided to open up 100 Driver Training Institutes all across India soon. NSDC has signed aMoU with OLA cabs. OLA Ministry of Skill Development and cabs need 1 lakh drivers and we will Entrepreneurship (MSDE) has plans to open one Pradhan Mantri Kaushal ensure we provide trained drivers. The Hon’ble PM announced “National Kendra (PMKK) each, in each district Apprentice Promotion Scheme” in of the country creating opportunities the State where the State Government of growth for the youth locally and has a major role in its successful the launch of some 31 PMKKs will implementation. There are only 23000 be announced by the Shri Modi ji at

the event. Pradhan Mantri Kaushal Kendras are iconic state-of-the-art skill development centres with modern infrastructure to facilitate skill trainings in the country. MSDE also has plans to felicitate skilledcandidates who have been trained under Pradhan Mantri Kaushal Vikas Yojana (RPL) in Kanpurwhere the Hon’ble Prime Minister himself will distribute skill certificates to Street Food Vendors, Leather industry Workers under the recognition of prior learning program of the government. This program helps in assessment of the existing work experience of a person and certifies him on his current skill-set basis the National Skill Qualification Framework approved by both the industry and the government of India 

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NEWS Update

WITH THE SOMATOM GO. CT PLATFORM, SIEMENS HEALTHINEERS OFFERS RADIOLOGY CUSTOMERS AN EXCELLENT RETURN ON INVESTMENT  The Somatom go. Now and Somatom go. Up CT scanners are equally suited to newly established radiology departments and to expanding successful institutions  Standardized workflows and multi-year service packages provide radiology providers high financial reliability and a foundation for successful growth  Unique single-room concept drastically reduces installation costs  Intuitive and simplified control via tablet eases system operation and increases patient comfort At this year’s Annual Meeting of the Radiological Society of North America (RSNA) in Chicago, USA, the separately managed healthcare business of Siemens AG is presenting itself for the first time under its new brand name, Siemens Healthineers. The new name underlines the company’s pioneering spirit and its engineering expertise in the healthcare industry. With a new strategic direction, Siemens Healthineers aims to enable healthcare providers around the world to meet their current challenges and to excel in their respective environments. Through products and solutions designed to increase efficiency and to reduce costs, Siemens Healthineers is setting new trends in healthcare together with its customers – working under the motto “Engineering Success. Pioneering Healthcare. Together.” Based on the key requirements expressed by all its main customer groups in radiology, Siemens Healthineers has developed an entirely new platform for computed tomography. It responds to the needs of diverse users and in doing so improves their competitive position. The Somatom go. platform with the Somatom go.Now and Somatom go.Up scanners offers automated and standardized workflows that help users achieve profound clinical results. In addition, the multi-year service packages and corresponding high financial reliability allow users to run their business successfully. The innovative usage concept facilitates more comprehensive patient care, and 16

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also gives radiology providers the option of using a highly cost-efficient single-room concept for the first time. Based on the Somatom go. Platform Siemens Healthineers offers two scanner variants: the 32-slice Somatom go.Now is particularly suited to radiology providers who want to establish a new CT department. Somatom go. Up is equipped with a wider detector providing up to 64 slices. Among other benefits, it offers faster scanning, which is especially important for lung imaging – e.g., to screen for cancer. This model is therefore suited to radiologists who want to expand an already successful portfolio. Today, rising caseloads and growing patient expectations are putting pressure

on physicians and clinical staff around the world. “Today, we care for twice as many patients as we did a decade ago,” says Professor Michael Uder, MD, Director of the Institute of Radiology at University Hospital Erlangen, Germany, where the first Somatom go. Up scanner was installed. He says that the sharp rise in interventional therapies in particular has led to an enormous increase in workloads. At the same time, shrinking healthcare budgets and declining reimbursements make it hard to invest in the technology needed to give more patients access to state-of-the-art imaging and to keep standards high. “No one is so poor that they should not receive world-class imaging and diagnosis,” says K.G.

NEWS Update

Srinivasan, MD, Managing Director of KGS Scan Center in Madurai, India. In many places, it is also becoming harder and harder to find qualified staff. This is why Dr. Srinivasan and many other physicians around the world are now using teleradiology; it is not uncommon for university hospitals to also provide radiological services for smaller hospitals in their vicinity.

Co-developed with users according to their needs “In view of these challenges, Siemens Healthineers held interviews and workshops with over 500 radiologists, radiology assistants, CFOs, patients, and referring physicians from a variety of countries. Their aim was to collaboratively identify the key characteristics of an ideal CT scanner,” says André Hartung, Head of Computed Tomography at Siemens Healthineers. “The result is a platform that offers high quality standards and responds to the current needs for efficient workflows, and to clinical and financial requirements – whether the users are based in institutes in rural regions of newly industrialized countries, or in radiology centers with a branch network in North America and Europe,” says Hartung. “With the Somatom go. platform, we want to help our customers improve their competitive position and to provide a better CT service to their patients.” The Somatom go. platform has an especially innovative way of fulfilling its customers’ desire for efficient workflows and a high level of flexibility: It can be controlled via a tablet, which paves the way for an entirely new, mobile workflow. Users can control all routine examinations using just the tablet. The standardized work steps are designed so that users can run the scan with just a few inputs. Automated post processing makes it even easier to operate the scanners. This means that even staff with a lower level of training can carry out the examinations, for instance in emergencies during a night shift. The standardization also gives radiologists additional assurance with regard to the diagnostic quality of the images. It helps avoid errors, the need to repeat scans, and thus unnecessary

waiting times – and all irrespective runs for additional two years, covers of whether they are dealing with an many replacement parts, and includes orthopedic or an oncological issue. training for the users. The Siemens Healthineers Connect Plan thus gives At the patient’s side customers a very good overview of The new usage concept at the heart of the overall system costs from the Somatom go. Now and Somatom go. outset. In addition, when developing Up also offers a whole host of other the new Chronon X-ray tube, Siemens advantages. Since the scanners can be Healthineers paid special attention controlled via a tablet, medical staff to achieving a long lifespan for this no longer has to keep moving between key component, so as to also relieve the CT scanner and the control room. the financial burden for customers in Radiographers can thus stay with this area. Innovative remote service patients while preparing the scan, which also significantly reduces system makes the examination experience more downtimes, and many upgrades can pleasant for patients, especially for be installed during normal scanner children. “If a patient feels that someone operation. “If we had a CT system is close by, it is perceived as better care,” with durable components and less says associate professor Matthias May, downtime, we would benefit twofold,” MD, from the Institute of Radiology at says Professor Uder. University Hospital Erlangen. Aside from the many economic The scanners can be controlled on the benefits of the Somatom go. Platform, move while all computer hardware that the developers at Siemens Healthineers was up to now located in the control always kept a close eye on the clinically room have been integrated into the relevant features that are particularly gantry of the scanner. This way, the important for many routine applications institutions can benefit from a flexible – and in this case allow users to expand room concept, a feature that was simply their radiological portfolio. A brand not possible with previous systems. new detector based on the already Instead of requiring two or three proven Stellar technology and spectral rooms for the scanner, the control unit, tin filters, which were previously only and possibly additional technology, available on Siemens Healthineers’ Somatom go. Scanners can – if desired high-end scanners, allow users to – be installed in a single room with perform lung imaging at extremely a minimum size requirement. With low radiation doses. When it comes this setup, a shielded niche is enough to vascular imaging, High Power 80 to protect the radiology staff. This – another feature from the premium room concept drastically reduces the segment – keeps tube voltages installation costs and thus makes the extremely low, which helps to reduce Somatom go. Platform especially dose and minimize iodine contrast. attractive for deployment in emerging markets. However, Professor Uder also sees enormous added value in the flexibility of the new room concept for Germany, as it can cost several hundred thousand euros to convert a single room into a CT room there. “I’d love to be far more flexible with my machines. I want to be able to put them where I need them and not where the building requires me to put them,” says Uder.

An all-in-one package that includes far more than just service Beyond the warranty period, the Somatom go. Platform comes with a service package – called Siemens Healthineers Connect Plan – that

w w w.medegatetoday.com Jan-Feb 2017

NEWS Update

U.S. FDA approves Jardiance® (empagliflozin) tablets to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease The U.S. Food and Drug Administration (FDA) approved a new indication for Jardiance® (empagliflozin) tablets to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease. Jardiance®, marketed by Boehringer Ingelheim is the first type 2 diabetes treatment approved with this additional indication and the only oral type 2 diabetes medicine shown in a clinical trial to provide a lifesaving cardiovascular benefit. “As the only diabetes treatment approved by the FDA to reduce the risk of cardiovascular death, Jardiance® represents a tremendous step forward in our efforts to reduce the impact of heart disease among adults with type 2 diabetes and cardiovascular disease,” said Dr Georg van Husen, Corporate Senior Vice President, Head of the Therapeutic Area CardioMetabolism, Boehringer Ingelheim. “This approval is another example of our commitment to the discovery and development of treatment options for adults with type 2 diabetes. We believe that Jardiance® is an important treatment option for this patient population.” Jardiance® is not for people with type 1 diabetes or people with diabetic ketoacidosis (increased ketones in the blood or urine). “Globally the prevalence of type 2 diabetes is high and is reaching alarming proportions in many countries especially India. With the U.S. FDA approval, Jardiance is a proven option for reducing cardiovascular mortality in adult patients of type-2 diabetes, having cardiovascular disease. This breakthrough approval from the U.S. FDA shows our commitment towards providing novel and innovative treatment options for diabetes management.” said Mr. Sharad Tyagi, Managing Director, Boehringer Ingelheim India. The approval is based on breakthrough evidence from the landmark EMPA-REG OUTCOME® trial, which investigated the effects of Jardiance® compared with placebo when added to standard of care therapies in adult patients of type 2 diabetes and established cardiovascular disease. In the trial, Jardiance® demonstrated a significant 38 percent 18

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reduction in the risk of cardiovascular death (HR 0.62, 95% CI: 0.49-0.77); absolute risk reduction was 2.2 percent for patients taking Jardiance® versus placebo. There was no significant change in the risk of ‘non-fatal’ heart attack or ‘non-fatal’ stroke. The cardiovascular benefits of Jardiance® were consistent among the patient subgroups. Adults with type 2 diabetes should not take Jardiance® if they have severe kidney problems or are on dialysis, or if they are allergic to empagliflozin or any ingredient in Jardiance®. Jardiance® can cause dehydration and low blood pressure. Jardiance® can also cause increased ketones in the blood (ketoacidosis), serious urinary tract infection, acute kidney injury and impairment in renal function, low blood glucose when used with insulin or insulin secretagogues (e.g., sulfonylurea, a medication used to treat type 2 diabetes), vaginal yeast infections and yeast infections of the penis, and increased cholesterol. “People with diabetes are two to four times more likely to develop cardiovascular disease than people without diabetes. The new indication for empagliflozin enables physicians for the first time to provide adults with type 2 diabetes with a diabetes medication that can reduce their risk of dying from cardiovascular disease,” said Professor Christopher P. Cannon, M.D., Cardiovascular Division, Brigham and Women's Hospital and professor of medicine, Harvard Medical School. “It also gives physicians an opportunity to speak with and educate people with type 2 diabetes about their increased risk for cardiovascular disease and to help them understand this serious complication of their condition.” In 2014, Jardiance® was approved by the U.S.FDA as an adjunct to diet and exercise to improve glycemic control, or blood glucose levels, in adults with type 2 diabetes. In India, Jardiance is currently approved for use an adjunct to diet and exercise, to improve glycemic control in adults with type 2 diabetes mellitus.

NEWS Update

IIFL Home Loans to Organize Free Health Check Up Camp in Kolkata In a diligent bid towards improving lives, IIFL Home Loans, one of the leading housing finance companies of India is organizing a free health check up camp on 24th December in Kolkata. The camp will be organized in collaboration with Columbia Asia and is likely to benefit more than 100 attendees at the camp. Tests will be conducted under the aegis of health professional specialists. Wherever required, patients will be referred to hospitals for further care. The free check up and consultation time at the camp has been scheduled from 10 AM to 4 PM. The check up and counseling will foster happiness, health & productivity among people. An official of the IIFL Home Loan says, “Today, people need medical guidance & counseling to lead a better life. Through such

health & eye camps, we want to cater their health needs, create awareness and promote good nutrition in the society.” Each patient will be counseled about Dos and Don’ts to keep himself fit and healthy. The address of the camp is ‘Shukhobrishti by Sapoorji, Amphitheater, New Town Action Area – III, Kolkata, West Bengal’. Mr. Soumabha Sarkar and Mr. Dipankar Ghosh, the volunteers will be available at the venue. Prior to Kolkata, a series of health and eye camps have been already organized across the country. 366 visitors turned up in IIFL Home Loans’ camp in past. After Kolkata, the housing finance company will organize the camp in Patiala (Punjab).

FDA approves first drug for spinal muscular atrophy The U.S. Food and Drug Administration today approved Spinraza (nusinersen), the first drug approved to treat children and adults with spinal muscular atrophy (SMA), a rare and often fatal genetic disease affecting muscle strength and movement. Spinraza is an injection administered into the fluid surrounding the spinal cord. “There has been a long-standing need for a treatment for spinal muscular

atrophy, the most common genetic cause of death in infants, and a disease that can affect people at any stage of life,” said Billy Dunn, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “As shown by our suggestion to the sponsor to analyze the results of the study earlier than planned, the FDA is committed to assisting with the development and

approval of safe and effective drugs for rare diseases and we worked hard to review this application quickly; we could not be more pleased to have the first approved treatment for this debilitating disease.” SMA is a hereditary disease that causes weakness and muscle wasting because of the loss of lower motor neurons controlling movement. There is wide variability in age of onset, symptoms and rate of progression. Spinraza is approved for use across the range of spinal muscular atrophy patients.

Preop Foley Catheter Associated With TURP, TULIP Failure Poor functional status and having a Foley catheter preoperatively are associated with the risk of failure of transurethral resection of the prostate (TURP) or transurethral laser incision of the prostate (TULIP) for treatment of bladder outlet obstruction, according to a study published online in the Journal of the American Geriatrics Society.

The researchers found that 61% of patients had a Foley catheter prior to the procedure. Of those with a Foley catheter at baseline, 64, 4, and 32% had a Foley catheter, had no Foley catheter, and had died by one year after the procedure, respectively. The risk of having a Foley catheter at one year was increased for individuals with a Foley

catheter at baseline (risk ratio, 1.39) and for those with poor functional status (risk ratio, 1.34 for individuals in the worst quartile of function). "Poor baseline functional status and having a Foley catheter preoperatively were associated with greater risk of TURP or TULIP failure, as measured by the presence of a Foley catheter at one year

Urinary Cancer Risk Lower in Spironolactone Users Spironolactone use by hypertensive patients is associated with a lower risk of some urinary cancers, according to a new study. Ya-Wen Chuang, MD, of the Taichung Veterans General Hospital in Taichung, Taiwan, and collaborators analyzed data from 32,167 hypertensive patients with urinary

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cancers enrolled in Taiwan's National Health Insurance Research Database. In adjusted analyses, spironolactone use was associated with 12% decreased odds of prostate cancer in male patients and 19% decreased odds of bladder cancer in female patients, the investigators reported in the Journal of Hypertension

NEWS Update

Fortis Hospital, Anandapur develops ‘Nano Crush’ A new frontier in stenting method

 European Bifurcation Society, Rotterdam accepted this innovative method  Initial results for Major Adverse Cardiac Event (MACE) is recorded at less than 5% ‘Nano Crush’ - a breakthrough technique for stenting of branching arteries – is developed by a team of doctors at Fortis Hospital, Anandapur in Kolkata. The technique has been accepted at the prestigious European Bifurcation Society meet held in Rotterdam recently. The team is led by Dr Shuvanan Ray, Chief of Cardiology and his team, comprising Dr Prithwiraj Bhattacharya, Dr Priyam Mukherjee and Dr Siddhartha Bandhopadhya. The treatment of stenosis (abnormal narrowing) at the branching points of arteries is a major challenge for Interventional Cardiologists. Stents placed at such points often compromise one of the branches. The ‘Nano Crush’ technique is reportedly an easy and effective method of stenting the branching arteries as it does not affect blood flow in any of the branches and offers a long term solution.

Explaining what led to the innovation, Dr Shuvanan Ray said, “The classical stenting technique is time consuming, difficult, technically demanding and at times leads to incomplete revascularization. This triggered the thought of developing a new and effective technique with lesser adverse events.” The Nano Crush technique ensures minimal protrusion of Side Branch Stent as well as complete cover of the SB Ostium which can be performed by an interventional cardiologist with ease. The technique has shown promising results when tested on a sample size of 70 patients. The clinical outcome for MACE (Major Adverse Cardiac Events) was recorded in less than 5%. Speaking further on this technique, Dr Ray added, “Going by the impressive outcome, the Nano Crush method may be applied widely among patients with stenosis at branching points of arteries. This technique ensures minimal metal load with immediate and long term results. It is an improvement over 2 stent technique of bifurcation which is difficult and cannot be performed in all patients.”

Lupin Receives FDA Approval for Generic Norco® Tablets Pharma Major Lupin Limited announced today that Lupin Somerset (also known as Novel Laboratories, Inc.) has received final approval for its Hydrocodone Bitartrate and Acetaminophen Tablets USP, 5 mg/325 mg, 7.5 mg/325 mg and 10 mg/325 mg from the United States Food and Drug Administration (FDA) to market a generic equivalent of Allergan Sales LLC’s Norco® Tablets 5 mg/325 mg, 7.5 mg/325 mg and 10 mg/325 mg. The company shall launch the product shortly. Lupin's Hydrocodone Bitartrate and Acetaminophen Tablets USP, 5 mg/325 mg, 7.5 mg/325 mg and 10 mg/325 mg are the AA rated generic equivalent of Allergan Sales LLC’s Norco® Tablets 5 mg/325 mg, 7.5 mg/325 mg and 10 mg/325 mg. It is indicated for the relief of moderate to moderately severe pain. Hydrocodone Bitartrate and Acetaminophen Tablets USP 5 mg/325 mg, 7.5 mg/325 mg and 10 mg/325 mg had US sales of USD 849.5 million (IMS MAT September 2016). w w w.medegatetoday.com Jan-Feb 2017

DOCTOR SPEAK

PROLONGED STANDING CAN

TRIGGER LEG AND BACK PROBLEMS In the wake of demonetization of high value currencies, thousands of people are being forced to stand for long time outside bank branches for changing their old currency notes or from withdrawing money from banks. However, medical practitioners and specialists have a word of caution: if you stand for long time, there can be problems related to joints, spine and veins of legs. Medical experts have suggested that people should observe certain precautions during long standing and banks should make arrangements so that people are not constrained to stand in queues for an inordinately long time. According to Dr (Prof) Raju Vaishya, Senior Consultant Orthopaedic & Joint Replacement Surgeon at Indraprastha Apollo Hospitals, New Delhi, prolonged standing places significant pressure on the joint of the hips, knees, ankle and feet. This reduces the normal lubrication and cushioning of synovial joints, causing them to tear. The combine effect of pressure and tearing can cause extensive amounts of pain and make it difficult to move or walk. So, if someone has to stand for a long time, they should try to sit down or walk intermittently. Dr. Raju Vaishya said that when during long standing muscles kept in a constant stress position and quickly become exhausted and can result in pain and swelling in the lower back, legs, ankles and feet. Dr Rahul Gupta, Senior Spine and Neuro Surgeon associated with Fortis HealthCare, points out that if people stand for a long time, especially in a particular position, they may face problems of swelling in veins of legs (varicose vein), clotting in leg veins (Deep vein thrombosis -DVT), crams in leg muscles and pain in waist. According to his suggestion, if someone has to stand for a long time, they should try to sit down intermittently and they 22

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should also try to shift their position at short interval and make a small stroll in between. It would be better if people carry small chairs to sit if they have to stand for a long time. In addition, it is absolutely imperative to stand in a correct posture. Also, those who have to stand in queues for a long time must keep with themselves small bottles of water and they should sip water at regular intervals. This is important to hydrate and replenish the water content in the body. If people have to stand on the roadside, it is advisable that they also wear masks as a protection against vehicular pollution. According to Dr. Gupta, Senior Spine and Neuro Surgeon at Fortis Hospital, Noida said that those who have to stand four hours or more of each day, they can suffer from musculoskeletal problems including aching muscles, corns, bunions and excess pressure on hip, knee and ankle joints. Other symptoms include lower limb swelling, varicose veins and back pain. Coronary heart disease and arthritis can also be worsened by standing for long periods. According to experts, during long standing, gravity pulls the blood downwards to the lower part of the body. Body mechanisms, such as vasoconstriction and valves of the veins, assist in pumping blood upwards. As blood is pumped through the body, the valves within the veins prevent the blood from flowing backwards. After extensive, prolonged standing, these valves can become weaken and eventually fail. When this happens, blood is no longer being prevented from flowing backward. Gravity will pull the blood back into an individual’s legs, ankles and feet. This forces the veins to expand or "balloon" to accommodate this extra blood. Standing for prolonged periods can lead to certain cardiovascular disorders.

Standing for long periods can change the distribution of blood in the extremities. This in turn causes the blood to pool and reduces the circulating blood plasma volume leading to hemodynamic changes that impact the body. Men with carotid stenosis or ischemic heart disease were at greater risk for the progression of atherosclerosis. Atherosclerosis can lead to coronary artery disease, carotid artery disease, peripheral artery disease, and aneurysms.

Standing symptoms • Painful Feet And Legs • Swelling in Feet and Legs • Bunions/Corns • Heel Problems • Achilles Tendonitis • Varicose Veins • Low Back Pain • Restricted Blood Flow • Immobilisation/Locking of Joints • Stiffness in Neck And Shoulders • High Blood Pressure

DOCTOR SPEAK

Dr Siddharth Sahni Senior Consultant â&#x20AC;&#x201C; Oncology Indraprastha Apollo Hospitals

CANCER SCREENING & TESTS

revention is one of the most important cancer-fighting tools. Screening your body periodically for cancer symptoms is recommended, especially for some people who are at high risk. Getting these tests done regularly may find breast, cervical, and colorectal (colon) cancers early, when treatment is likely to work best. There are numerous cancer detection and prevention tests that can be used to detect cancer. One should not rely on any one test rather take all clinical factors into consideration to back up a diagnosis. For different types of cancers, there are different types of screening tests.

Breast Cancer

Breast self awareness, i.e. checking yourself once a month to see if there is any change and Mammograms ( a specialized x-ray of the breast) every year after the age of 40, are the best way to find breast cancer early, when it is curable.

Cervical Cancer

The Pap test can find abnormal cells in the cervix which may turn into cancer. Pap tests also can find cervical cancer early, when the chance of being cured is very high.

Colorectal Cancer

Colonoscopy and sigmoidoscopy help prevent colorectal cancer as they can detect abnormal colon growths (polyps) that can be removed before they develop into cancer.

Lung Cancer

Low-dose helical computed tomography is recommended as must test for those who smoke regularly.

Liver Cancer

Alpha-fetoprotein blood test is sometimes used, along with ultrasound of the liver, to try to detect liver cancer early in people at high risk of the disease.

Ovarian Cancer

CA-125 blood test, often done together with a transvaginal ultrasound, may be used to try to detect ovarian cancer early, especially in women with an increased risk of the disease. 24

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Prostate Cancer

Prostate specific antigen (PSA)-based screening for men who have no symptoms.

Listing laboratory tests for cancer detection:

AMAS - Anti-malignin antibody screen test is designed to pick up cancers well in advance of other signs and symptoms, months before conventional medical tests can detect it. Biological Terraine Assessment (BTA) is a computerized device that measures your blood, saliva and urine for: the amount of electrons present, pH balance, and minerals in these fluids. Cancer Marker Tests are immunological methods cancer markers that are produced as cancer grows and are detectable even before it reaches a size big enough for detection by other methods. DR-70 is a highly specific simple blood test that screens for 13 different cancers at the same time. Lymphocyte Size Analysis test measures the diameters of lymphocytes and counts the numbers of swollen versus normal cells in a sample of a patient's blood. If the number of swollen lymphocytes is excessive or when the ratio of swollen to normal lymphocytes is out of balance, then cancer will most likely develop.

EXPERT VIEWS

Startup offering assistance to patients advised surgery Surgivisor: Evolving every stage of a surgery

Mr. Sumeet Khanna

Co-founder & Managing Partner Today, many online platforms are trying to bridge the gap between patients, doctors and hospitals, guiding them to make a sensible choice. SURGIVISOR being prominent among them have helped more than 300 Surgeries in a short span of 4 months, by assisting patients and their family to choose the right hospital and doctor for various medical surgeries through their online platform. 54yr old Suresh Mittal, Businessman by profession was constantly feeling pain in the right abdomen area which was often left neglected due to his hectic work schedule. However, a severe pain in the same area caused him to rush to the nearby hospital where the ultrasound report suggested a 5cm lump inside the kidney. His family was later informed of possible chances of this being a cancer. Suresh’s daughter Sonia “That time we didn’t knew what to do, which hospital to choose, which doctor is best in these cases and many more questions like this… we were in a very confused state”. It was an advertisement in a newspaper that helped Suresh and his family to make an informed choice. She adds, “I read about SURGIVISOR in Newspaper Ad and contacted them. The SURGIVISOR team helped a lot 26

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in my father’s treatment. Their Medical Expert suggested me the best hospital for cancer treatment keeping in mind my locality and budget. From appointment booking to Specialist Doctor meeting, the team at Surgivisor helped me at each step. After CT scan, my father was diagnosed with a stage 2 Renal Cancer. His Radical Nephrectomy went really well at Dharamshila hospital, New Delhi. The cancer is completely eliminated from his body, and he has completed the treatment successfully. He is living a normal active life now, all thanks to Surgivisor and Dharamshila Hospital.” Surgivisor’s customized technology and algorithm based platform serves as one stop solution for each patient to search from a database of 350+ hospitals, 6000+ doctors, 1500+ surgeries and 50+ medical specialties. No matter in which part of the country you are, you have easy access to different healthcare service providers on the basis of procedures, doctors, location, services, insurance, etc under one roof.

Co-founded by Mr. Sumeet Khanna, a healthcare expert with over 20 years of experience, Surgivisor turned out to be a dream come true. It all started when he identified the gap between a patient who has been advised a surgery and health care service provider (hospital or surgeon) who does that surgery. A simple thought which later converted in his vision to provide accessible and affordable services related to surgeries through a single platform and pass on the benefits to the patients. The thought was discussed with two serial entrepreneurs and heads of prominent business conglomerate, Mr. Arvind Bajaj (Managing Director, Amar Shoes) and Mr. Pankaj Bajaj (Managing Director of Eldeco infrastructure and Properties Ltd (EIPL)). The thought was then collectively taken to another level by them and turned into a full-fledged service model. Their entrepreneur experience and guidance has helped shaping the roadmap. The Seed funding was done by both to create this visionary platform. This led to the

EXPERT VIEWS

inception of Surgivisor in January 2016, which now has 20+ team of healthcare professionals, with vast experience of healthcare industry. Sumeet Khanna, Co-Founder & Managing Partner, Surgivisor, “In the primary stage our focus was to add relevant hospitals and other super specialty service providers in Delhi NCR. Currently, we have tied up with 350+ hospitals and Super specialty Clinics in Delhi NCR. So the growth for addition of hospitals have been remarkably great with only 10 hospitals in the first month to 350+ hospitals till October and the number is on the rise continuously. We look forward to extend the facility within 300-400 km radius of Delhi NCR”. The Data displayed on their site is transparent and verified; it’s a 4 stage process where help taken from their partner hospitals. The hospitals mentioned on the website comes under

certain criteria along with an official MOU or agreement, unlike many other players who have no formal engagement. Their forte is dealing with critical medical issues mostly Surgeries, the impact of one unorganized surgery at human life is disastrous from money issues to health concern. The in house Medical Experts and on Board Doctors assist the patients in understanding more about his/her condition and treatment options. They are backed by KPO supervised by Medical professionals which gives counseling sessions and advice to patients & family. For Surgivisor, from query generation to understanding patient’s requirement and fixing an appointment takes not more than 30 min approx. Once a patient or user explains his requirement, their medical advisor assist them in choosing the best Hospital and Doctor, keeping in mind their location, budget, insurance company and various other

parameters suiting their requirement. Accordingly an appointment is fixed and a confirmation mail and message is sent to both patients and hospitals immediately. Additionally, efforts are made to provide smooth, convenient and hassel-free process for the patients by facilitating the end-to-end hospitalization requirements. Their team of experts looks into all aspects of the patient’s travel and facilitates the doctor consultations with the patient much before. Dr. Saurabh Soni (Clinical professional) “To ensure credibility and excellence in our service, we regularly monitor potential service failures or any issue concerning the treatment or procedure of the surgery by the patient and provide the most effective solution without impacting patient in any which way”.

w w w.medegatetoday.com Jan-Feb 2017

DOCTOR SPEAK

NEW TRENDS IN TREATING HEART AILMENTS Dr. Sanjay Cherian

Vice President & Chief Operating Officer & Consultant Cardiac Surgeon Frontier Lifeline Hospitals (Dr. K. M. Cherian Heart Foundation), Chennai

eart disease is the most common cause of death in the world and it is alarming that young Indians are more prone to have heart attacks. There is a myth that heart diseases are usually seen only in the elderly, however the truth is that nowadays, the average age for Indians to have heart attacks is between the age group of 45-50yrs. This increasing risk for heart disease among young Indians is due to the high incidence of diabetes, high blood pressure and high cholesterol, attributed to the change in our life style, especially due to the trend of eating out more often (junk foods that contain high amounts of sugars, saturated fats and salts), increase in stress (work pressure, financial commitments), and lack of physical exercise (inability to find time for sports and other outdoor activities). Several new techniques and technologies have evolved, to improve the efficacy of diagnosis and treatment of heart diseases.

Magnetic Resonance Imaging (MRI)

and 4D echo cardiography have enabled better “realtime” visualization of the cardiac anatomy and assessment of its function.

Bio-degradable stents

In contrast, to conventional metal stents, new bioabsorbable stents, leave behind only the healed natural vessel, allowing restoration of normal structure and blood flow. Late stent blockage is unlikely since the stent is absorbed, and prolonged antiplatelet therapy may not be necessary.

Minimal access surgery

Coronary artery bypass surgery has evolved from stopping the heart during surgery using a heart-lung 28

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machine, to “beating heart” surgery. Technology has enabled these procedures to be under taken using VideoAssisted Thoracoscopic Surgery (VATS) and robotic assistance, through small incisions, permitting quick recovery, less pain and early mobilization.

Transcatheter valve implantation:

Small incisions in the chest or in the groin enable transcathether implantation of artificial valves directly into the heart, without the need for large incisions on the chest. Although this treatment is currently reserved for elderly and very sick patients who may not be fit for conventional surgery, this may expand its applicability in other patients too in the future.

Stem-cell therapy

although in a research status now undergoing trials, this modality may be used as a mainstay in future for the treatment of endstage heart failure. Derived from the bone marrow or directly from the blood, stem cells may help to regenerate new blood vessels (angiogenesis), and heart muscle cells (Cardiomyocytes). With ongoing research and breakthrough revolutions in science and technology, newer treatment methodologies may evolve to combat heart diseases in the future.

DOCTOR SPEAK

India in Desperate Need of A Public Cord Blood Bank

or most of India, the umbilical cord is nothing more than a waste product of the birthing process. Left dangling from the new-born’s navel it disintegrates and falls off on its own within a week. But in the scientific world it is a precious resource with immense regenerative and healing potential. A baby’s umbilical cord is a rich source of stem cells (10 times more than adult bone marrow) which if properly extracted, screened, and stored in a public blood bank could be a saviour in many life threatening conditions including several forms of leukemia, lymphoma and bone marrow disorders not just for the baby or its sibling/ parents, but more so for hundreds of others whose blood make-up matches with his. More than 28 years after the first successful umbilical cord blood stem cell transplant was done in France, India is still to discover its vast potential and make provisions for public banking of this easily available precious resource. What we need is an organised public umbilical cord blood banking system in the country which could treat patients in need and be used for further medical research on the subject. While bone marrow and peripheral blood stem cell transplants have a proven track record of success, the search process can be futile. Therefore, UCB has gained popularity and acceptability as an alternative transplant source for patients lacking appropriate adult donors. UCBT offers several advantages as compared to Bone Marrow (BM) or Peripheral Blood (PB). UCBT requires a 4/6 match as opposed to 6/6 match required for BM or PB. Also, UCB is easily collected and stored without causing any detriment to the quality of cells and is readily available when needed. In India, awareness of benefits of cord blood banking is just dawning, but in the US, reputed medical groups such as the American Medical Association, the American Congress of Obstetricians and Gynecologists, and American Academy of Paediatrics recommend public bank donations over private banking because the cord blood has limited personal applications. The chance of a baby later benefiting from his or her own banked cord blood is currently less than 0.04 percent,

Dr Rahul Bhargava

Director and Head, Hemato-oncology and Stem Cell Transplant, Artemis Hospital, Gurgaon.

according to the ASBMT. Not only is that because the diseases currently treatable with cord blood are fairly rare, but with many, the child's cord blood would be unusable because those stem cells contain the same genetic defects. India has great potential for UCB banking due to a high birth rate and genetic diversity. Nearly 70 per cent of patients of Indian origin who require bone marrow transplantation do not find a match within their own family. Hence, unrelated UCB is a widely accepted source of progenitors for hematopoietic stem cell transplantation. However, to-date the total number of UCB transplants performed in India has been very low mainly due to high cost and limited number of UCB units available against the estimated requirement of 50,000 units annually. With the establishment of public banks utility of UCB is likely to increase in the coming years. For cord blood bank to be effective it should have at least 50,000 units and it shall then be able to provide a matched cord for 98% of its patients. To meet the future transplant needs of India, government support and investment as in the western world is necessary. For the past 30 years the governments in India have ignored the desperate need of providing treatment to their citizens with fatal blood related disorders. It is in the recent past when our honourable Prime Minister Shri Narendra Modi brought to the notice of the parliament the plight of tribal suffering from Sickle cell disease, a condition treatable by UCBT. w w w.medegatetoday.com Jan-Feb 2017

DOCTOR SPEAK

So you’ve just been diagnosed with diabetes…

hen she turned 40, Anjali Wadhwan decided to do her first general preventive health check-up, especially because she was obese (her body mass index was over 30).The examining doctor found that her sugar levels were high. He referred her to me, but asked her to try and lose weight and to exercise. When in a month this didn’t happen, we put her on medication. Unfortunately, these did not have much of an impact either, and in a few months’ time she had to be put on insulin. Anjali was distraught for more reasons that one. “I suddenly felt old—my grandmother had been on insulin, and had been diagnosed in her 50s, and here was I, at 40, with a condition I would live with for the rest of my life,” she said. She was also petrified of injections, recalling her childhood trauma for them. We reassured her that injections had undergone huge changes in the past 30 years, and that they no longer pained. We also reassured her that it didn’t have to be a permanent feature. If she reduced weight, changed her diet, and began to exercise, we could look at oral medication again. Anjali isn’t the only one who is worried at having to live the next 30 or 40 years with diabetes.She’s also not the sole person petrified of injections. Here are a few of the biggest fears that I encounter as an endocrinologist/diabetologist, and what advice I give those who come to me, so they can life their best life possible. Use this article as a guide, not as a prescription—that is something your doctor needs to write out for you.

My doctor doesn’t listen to me.

India has a paucity of doctors, so it’s possible that your doctor is conscious of the mile-long queue outside, to give all patients their due. Having said that, your doctor must be able to clear all your doubts and provide confidence and reassurance. People who are newly diagnosed with diabetes may be acting on several myths. Ask your doctor for a time that is convenient to him when you can clear all your doubts,

note them down on a paper, and convey the message to him. A diabetologist must talk to you about your daily routine, exercise, diet, stress levels and of course medication, and guide you with each aspect.

Injections hurt, and I fear them.

Injections don’t hurt anymore. Most people remember the injections of their childhood which were indeed very painful.Today, there is an array of needles that can be used, which have shorter needle sizes than before, are thinner, and sharper. Insulin pens, for instance, are very easy to operate when you need to inject yourself. Ideally, your doctor should guide your first dose, and also share some literature with you so you know you are injecting correctly. The idea is to inject into the fat, not the muscle.

My stomach will soon look unsightly! The stomach is not the only site you should inject into.The back of the upper arm, the hips, the outer side of the thighs, are all possible sites. Try and use the same area at the same time of the day. For instance, if you inject in the stomach close to breakfast, then use the thigh at bedtime. Insulin is absorbed fastest from the stomach, followed by the arm, the leg, and slowest from the buttocks. So if you are going to eat a meal, you will need to have it covered with insulin in the abdomen. Again, you don’t need to keep injecting in the same spot—change it around. If you do keep injecting at the same spot, little fat globules will form under the skin that appear rubbery outside. These will likely disappear in time, but it’s better to prevent this in the first place.

I am doomed–my whole life will change.

Think of a diabetes diagnosis as a driving lesson. When you are learning to drive, and even in the first year or so of driving, you need to be conscious of the gear, the clutch, the accelerator. But over time, it becomes second nature, and you don’t even notice when you change gears. Your experience with diabetes will be the same. Initially, you will find it a nuisance to check your body insulin levels, to take the injections, to go for the check-ups. With time, all this will just become a part of your routine. If you don’t want it to be routine, change your lifestyle to reverse the disease to some extent.

I can never eat another sweet in my life without feeling guilty.

Factor in the odd sweet when you want to eat one. Ask your doctor how you can do this. When mango season comes up, again consult with him on how to eat a slice and balance it with medication. However, platefuls of sweets are not okay for anyone, no matter how healthy they may be, so if you’re feeling bad that you can’t binge, then reassure yourself that you’re on the road to getting out of a bad habit.

Dr. K M Prasanna Kumar

Senior Endocrinologist and Diabetologist Center for Diabetes & Endocrine Care (CDEC)

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COVER STORY

Advances in imaging over the last five years have revolutionized almost every aspect of medicine Dr. Hemant Patel

President, IRIA Gujarat State Vice President , Indian Radiological & Imaging Association, New Delhi

ore detailed imaging is allowing doctors to see things in new ways. Imaging can provide early and more accurate diagnoses. In some cases, it might even lead to better and more successful treatment. Physicians and surgeons worldwide are realizing how valuable and accurate the diagnosis can be using various radiological imaging techniques.

Four Big Advances in Imaging C omputed Tomography (CT) Angiography : Just a few years ago, an angiography - an examination of the blood vessels could only be done by inserting a catheter into an artery. In the procedure, contrast material is injected through the catheter and X-ray is taken of the area to look for blockages, internal bleeding or other problems. It takes more time, often requires sedatives and sometimes a night in the hospital with added risks, like a small chance of blood clots or bleeding.

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"The newest CT scans allow a completely noninvasive way to get the same information as an invasive catheter angiography." In a CT angiography, the doctor just injects the contrast material into the arm and takes a CT scan. The arteries in the lungs, kidneys, brain and legs can then be examined. The whole process takes just 10-25 minutes. It's safer, faster, and cheaper than the traditional way.  Imaging Tests Instead of Exploratory Surgery One of the biggest changes in the use of imaging, is that it has largely replaced exploratory surgery. "In the past, we had to do surgery just to see what was going on inside the body, but CT scans, MR scans, and ultrasound have become so good that they have largely done away with the need for the surgical approach."  PET/CT Scans for Cancer PET scanning is not new. But it has become increasingly important in recent years, particularly since it was combined with CT scanning in one device. PET scans are a type of "nuclear medicine."Nuclear" refers to the small dose of radioactive material that you are injected with before the test. The amount of radiation exposure is similar to what you would get from a standard X-ray. Unlike many other imaging technologies, PET scans aren't designed to look at organs or tissue, they image biological functions, like blood flow or glucose metabolism. "PET is able to pick up the metabolic changes associated with cancer much earlier than you could see tumors or other physical changes in the organs.” PET/CT scans give a doctor a broader view of a person's condition.  Digital Mammography "Digital mammography for breast cancer screening is a significant leap forward, it gives us a much higher level of detail than older technology."

COVER STORY

The digital approach is easier and faster to perform, it's very easy for a doctor to send the images instantly to other experts or medical centers. Digital mammography was more accurate for some women (were under 50, women with dense breast tissue, premenopausal and perimenopausal women) than conventional mammography.

Easier, Faster Imaging Exams Yield Better Information It's not just the quality and detail of the images that has improved. Some advances have made the actual experience of having an imaging exam easier. For one thing, they are a lot faster. Earlier models of CT scan would take nearly 15-20 minutes for completing whole scan and acquiring the images, while now with multislice scanners, we can now literally get the same amount of information in less than two seconds.

Open MRIs Ease Claustrophobia Other modifications are helping too. For many people, MRIs have traditionally been an unpleasant experience. In standard MRI exams, a person slides into a narrow tube and has to stay there for the length of the exam. People with claustrophobia can find it unbearable. "It can feel like being in a coffin." "In the past, there were trade-offs between the openness of an MRI and the image quality, but we're seeing the gaps being narrowed." New MRI machines are available that are just as accurate as traditional ones, but much shorter, so that they never fully enclose the person. Another problem with some older imaging devices is that they couldn't accommodate heavy people. That has been at least partially resolved. "With new machines, we can give exams to people who are 350-400 pounds, but because of image degradation, imaging tests for the obese are often less accurate in general than for people of average weight.”

Combining the surgeon's eyes with MR improves the operation. Because the human eye, even with a microscope, just can't see what an MR can see. CT scans are starting to be used to create computer-generated models of the heart for use during surgery. The 3D model is shown on a screen, and it moves and rotates to show where the surgeon currently is in the heart, it's a great innovation." In general, imaging technology is becoming faster and more accurate. More fusion imaging like PET-CT, PET-MR are coming up to give doctors a much fuller understanding of a person's condition. CHALLENGES FACED BY RADIOLOGISTS IN INDIA It is a very costly affair to establish a fully equipped radiology centre in India, because all the machines with latest technologies have to be imported from outside, thereby greatly increasing the custom duty and import duty. The PC-PNDT act has been implemented to improve the skewed male : female sex ratio, however, it creates a lot of hassles for radiologists by imposing fine / punishments even for minor clerical errors or technical errors. My final word to all upcoming radiologists would be “radiology is a main stream branch, its highly evolving and no longer a dependent branch, we are clinicians as well, so start looking up and thinking beyond images, keep up the clinical touch with the patients with interpersonal interactions with all your patients. We are privileged that our branch is the topmost branch in the medical fraternity. But its upto you, the younger lot, to keep up its fame, name and popularity by taking it to one level higher.”

Imaging Moved Into the Operating Room Soon, imaging tests may also become a key part of some medical procedures. During minimally invasive surgery, imaging will allow surgeons to see inside the body better, to improve treatment and minimize complications. "Minimally invasive surgery and new imaging technologies are developing hand in hand." "MRI & ultrasound may have the ability to monitor a surgery in real time (already being applied for brain tumors), they could potentially detect when all of a tumor was removed, or when a surgeon was accidentally beginning to harm normal tissue." w w w.medegatetoday.com Jan-Feb 2017

COVER STORY

IMAGING MODALITIES IN RADIOLOGY emitting light that is detected by a photomultiplier tube and this signal is converted to an electronic signal to be displayed on the monitor.Digital Radiography typically captures the image directly onto a flat panel detector without the use of a cassette.

Dr. Suman Salimath

Consultant Radiologist, Indian Spinal Injuries Centre, New Delhi

Radiology is a branch of medicine that uses a variety of imaging techniques such as Plain radiography, ultrasound, computed tomography (CT),magnetic resonance imaging (MRI) , nuclear medicine including positron emission tomography (PET), to diagnose and/or treat diseases.

Plain Radiography: This is the most commonly encountered type of radiological investigation. Radiographs (originally called roentgenographs) are produced by transmitting X-rays through a patient. The X-rays are projected through the body onto a detector; an image is formed based on which rays pass through (and are detected) versus those that are absorbed or scattered in the patient (and thus are not detected).The recording of the pattern may occur on film or through electronic means. Computed radiography uses a cassette that is similar to conventional radiography except that it contains no film and needs no chemicals or dark rooms to develop. Instead, there is a reusable phosphor plate inside the cassette which stores the radiation as a latent image within the phosphor layer as elevated electron energies. When the Image plate is transported through the scanner the scanning laser beam causes the electrons to relax to lower energy levels (photostimulated luminescence),

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COMPUTED RADIOGRAPHY (CT): CT imaging uses X-rays in conjunction with computing algorithms to image the body.In CT, an X-ray tube opposite an X-ray detector in a ring-shaped gantry rotate around a patient producing a fanshaped beam of X-rays . As the scanner rotates, several thousand sectional views of the patientâ&#x20AC;&#x2122;s body are generated in one rotation, which result in reconstructed cross-sectional images of the body. Using on these data, it is possible to create a 3D visualization The multislice CT scanner refers to a CT system equipped with a multiple-row detector array to simultaneously collect data at different slice locations. The multi-slice CT scanner has the capability of rapidly scanning large longitudinal volume with high resolution.

MAGNETIC RESONANCE IMAGING (MRI): This noninvasive technique uses a very powerful magnet ( about 0.2 to 3 Tesla) to align the nuclei of atoms inside the body, and a variable magnetic field that causes the atoms to resonate, a phenomenon called nuclear magnetic resonance.Water molecules within the body (H20) contain hydrogen nuclei (protons), which become aligned in a magnetic field. The scanner also produces a radio frequency current that creates a varying magnetic field. The protons absorb the energy from the variable field. When the field is turned off, the protons gradually return to their normal spin,ant this produces a radio signal that can be measured by receivers in the scanner and made into an image, Protons in different body tissues return to their normal spins at different rates.

Unlike other imaging forms like X-rays or CT scans, MRI doesn't use ionizing radiation. What makes MRI so powerful is,its exquisite soft tissue, and anatomic, detail.

ULTRASOUND: This noninvasive diagnostic modality uses sound waves with frequencies which are higher than those audible to human ears (>20,000 Hz). Ultrasonic images are obtained by sending pulses of ultrasound into tissue using pizo-electric crystals in a transducer. The sound echoes off the tissue; with different tissues reflecting varying degrees of sound. These echoes are recorded and displayed as an image on the monitor.It provides images in realtime and does not use harmful ionizing radiation. Doppler ultrasound can detect and measure blood flow. It depends on the Doppler effect, a change in the frequency of a wave resulting from the motion of a reflector, i.e.the red blood cell.

NUCLEAR IMAGING:

This involves the administration into the patient of radiopharmaceuticals consisting of substances with affinity for certain body tissues labeled with radioactive tracer. The most commonly used tracers are technetium-99m, iodine-123, iodine-131, gallium-67, indium-111, thallium-201 and fludeoxyglucose (18F) (18F-FDG). While anatomical detail is limited in these studies, nuclear medicine is useful in displaying physiological function. The principal imaging devices are the gamma camera which detect the radiation emitted by the tracer in the body and display it as an image. With computer processing, the information can be displayed as axial, coronal and sagittal images (singlephoton emission computed tomography SPECT or Positron-emission tomography - PET). Nuclear medicine images can be fused with a CT scan so the physiological information can be coregistered with the anatomical structures to improve diagnostic accuracy ď ą

COVER STORY

Sapien Biosciences and OncoStem Diagnostics collaborate to launch “CanAssist-Breast”, a Breast cancer recurrence prediction test

apien Biosciences, a niche biotech venture committed to develop novel cutting-edge medical diagnostics backed by Apollo Hospitals Enterprise Limited announces its partnership with OncoStem Diagnostics, to launch “CanAssistBreast”, a robust and cost-effective test to predict the risk of breast cancer recurrence in early stage hormone positive and Her2 negative Breast Cancer patients. Sapien Biosciences is a bio-repository that enables the development of cutting edge diagnostics and therapeutics for personalizing medicine. Patient samples and associated medical data that are systematically collated and ethically banked at Sapien are a necessary resource for rapid validation of novel diagnostic tests. Announcing the partnership with OncoStem Diagnostics Dr. Jugnu Jain, Co-Founder and CEO - Sapien Biosciences said, “We are very excited to be part of this launch of CanAssist–Breast which represents a paradigm shift in customizing Breast cancer treatment. Development of accurate recurrence diagnostics in cancer is particularly dependent on the availability of reliable retrospective information which is acutely lacking in India. To validate CanAssist-Breast, we mobilized five Apollo hospitals data archives to piece together complete 5 years treatment and outcome data for over 6500 Indian breast cancer patients”. In India, about 1,50,000 patients are diagnosed of breast cancer every year and currently there are no affordable tests to predict the risk of cancer recurring. As a result, majority of early stage patients with low risk of recurrence are perhaps over-treated and thus bear toxic effects of chemotherapy treatment (CT) that reduces their ‘quality of life’. Additionally, studies have proven that the benefit of chemotherapy in such patients is known to be 10-15% suggesting many patients can be spared conventional CT. Highlighting the importance of CanAssistBreast, Dr. Manjiri Bakre, Founder and CEO, OncoStem Diagnostics said, “CanAssist-Breast is our flagship product and is a boon for patients as well as doctors. It enables clinicians to assess the aggressiveness of the tumor and personalize and optimize therapy for their patients. The canAssist-Breast test can spare over 60,000 Breast Cancer patients in India and over 660,000 patients worldwide every year from the severe effects and unnecessary costs of chemotherapy-associated toxic”. CanAssist-Breast test uses clinical parameters in combination with novel biomarkers quantified using a standardized

technique which measures protein expression accurately. This information is integrated into a statistical algorithm to stratify patients as “low or high risk” for recurrence. “In India, due to a variety of reasons ranging from awareness to culture, Breast Cancer patients are diagnosed much later, with only 5-8% of patients being Stage 1 at detection. Consequently, the globally available recurrence prediction tests are not very impactful in geographies such as India and SE Asia due to their utility being limited to only Stage 1 patients and the prohibitive cost of the tests. CanAssist-Breast test can be used on a much wider pool of patients up to Stage 2B, and is priced at 1/6th the price of competitor tests and therefore aims to touch the lives of millions of patients worldwide”, added Dr Bakre. CanAssist-Breast is being launched within the Apollo network in India and the worldwide launch is planned in a phased manner. Commenting on the partnership, Ms. Shobana Kamineni, Executive Vice Chairperson, Apollo Hospitals says, "Affordable and broad based tests to estimate the ‘risk of recurrence’ are an absolute necessity for ‘optimal and personalized’ treatment planning. Apollo has been at the forefront of recognizing personalized medicine as the future of healthcare delivery and has been adopting cutting-edge diagnostic tests to deliver better patient care to improve outcomes. Our association with Sapien is one of various initiatives we have undertaken with a vision to enable personalized medicine approach and we are very excited to see this crystallize through partnerships such as this one with OncoStem. Cancer recurrence space is largely unexplored, especially in India and needs immediate attention. I look forward to Apollo & Sapien pioneering the introduction & adoption of this important innovation from OncoStem across our network of oncology centres for the benefit of our patients." CanAssist-Breast is ISO-13485 accredited, and expects to acquire the CE mark by November 2016. These accreditations will enable the launch of the test in global markets later this year. The market for a breast cancer recurrence diagnostic space is currently valued at $ 3 Billion globally and is expected to grow at 18% CAGR. Clinical validation of CanAssistBreast in India and the US demonstrates a high NPV (negative predictive value) of 95%, which is a measure of the accuracy of the test. The results of the global validation study are currently under review for publication.

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INTERVIEW We are totally dedicated & we offer them all pathological, radiological services, known in the medical world. Tell us about SIPL & your motive to establish such a premier institution? We realized this fact much earlier; in near future diagnostics services will be the main probe for any kind of medical treatment. But big questions were that, how will be the quality and technology will ensure for every citizen of India in justified price? How will be the best business practices & business ethics with natural ethics will be served? How will be our clients become well informed about their health issues & its remedies? With keeping these basic questions into our mind we have started our journey way back in 1978 with the name of Janta X-Ray Clinic from Tilak Nagar, Delhi with a great desire to serve the society in best way. From that instant of time, by quality & technology wise we are continuously working on our mission 24 X 7. And after 40 Yrs. from Janta X-Ray Clinic to SIPL , we can say that we are successful in our mission but still many more things we have to do. Today we are proud to say, SIPL has more than 60 branches & 600 plus employees working at deferent levels. We have a huge team of in house doctors & with many hospitals we have tie-ups where we are providing diagnostic service inside their premises. Now we are also cashless, paperless, filmless & moving towards completely Green IT concept.

What services you are offering for patients as well as for pathologist & radiologist? For patients we are totally dedicated & we offer them all pathological, radiological services, known in the medical world. We also believe in full taken care of our employees & colleagues too. So either they our pathologist & radiologist or any other Star family member, we offer them all medical services with proper technical & professional qualifications up-gradation helps. We are promoting cashless & paperless concept between our patients as well as employees from years. Our mobile app & digital document management system is beneficial for pathologists & radiologist more to organized their experience & knowledge in a better way. Similarly same system help our patients to keep their records save & 24 X 7 availability. 36

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Mr. Pawan Gupta

Managing Director Star Imaging & Path Lab

What are the latest investigation done by SIPL?  SIPL done highest number of MR Iron studies in India  3D Imaging, Digital Low Dose X-ray, 5D Ultrasound,  Best collection of 5-CT Scanners which include GE Optima 660 (Lowest Radiation Dose)  CT Coronary Angiography, CT enterography, 5 Beat Cardiac Angiography, Pediatric Coronary Imaging, dedicated VIVID 7 for doing Dynamic Echocardiography by DM Cardiologist.  Whole Body MRI Scans which help to detect Cancer and tumors, Emphysema,  Heart disease, Spinal disease, Aneurysms, Osteoporosis, Ovarian disease, Endocrine tumors etc.  Dental Imaging Revolution Occlusal x-ray  Also upgraded to fully automated lab which is bidirectional, bar coded and runs on DRY platform from Johnson & Johnson for both immuno assays and biochemistry.  Filmless or Green technology implementation  All latest Pathology testing system.

How you are competing with latest technology for premier world class facilities for the patients?  We have a dedicated R&D Team, working over products, services & delivery system  We believe in engaging people in productive works, so time to time we organized many health related camps as well as religious prorammes.  We established a strong relationship with our clients or all stakeholders by providing them online free access to their medical records.  Marching with all Govt. policies & following all standers or norms governed by govt. or any responsible authority.  We are making capable all hospital which is behind purchasing these high ended devices & machines or diagnostic kits by providing them in house services.  We always put forward our patients over ourselves & this is unique quality which make us different form rest of the mob.

INTERVIEW We have started many courses of certification to diploma level here but my personnel & special focus on knowing Diagnostic sector requirements and according of that we trained the people.

Sameer Bhati

Head of Radiology Operations Star Imaging & Path Lab Tell us about your achievement & professional background? I have started my professional journey way back in Yr.2000 & now working with SIPL since Yr. 2002. I grow up professionally as well as technically with SIPL. As we hold 60% market share in West Delhi, 50 % Central, 30% South & East Delhi. In NCR we have 20% market share. More than 60 branches & 600 plus employees we have with most advance machines & fully automated Labs. Every year our productivity & efficiency are increasing by a factor of 0.4.I am not hesitant to say that presently we are one of the three top Diagnostic labs in Delhi NCR region. My professional expertise help our company to achieve this market position. For this hard work my company as well as industry felicitated me many times, AIIMS & CIMS etc. are few of them, those have recognised my work. With having Masters in Radiation Technology & Management degrees, my urge for academics and R&D not stopped yet. I have published many research papers & also presented them in various seminars and conferences like in IITâ&#x20AC;&#x2122;s, AIIMS & XLRI etc. I have successfully implemented many marketing methodologies, which are the now the part of many management courses. Now with our own Para Medical education institute i.e SETI, I am grooming here many new professionals for this industry. 38

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INTERVIEW What are the latest in research & development done by you & your team in SIPL? Our research & development teams work in two research front, one at our products & services and second one on our way of delivering these products & services to its stakeholders. We have done highest number of MR Iron studies in India which help to detect many Iron or blood related problems or deficiencies, in a same way we are focussing onto develop a product to serve Cardio & other disease related patients. Our team has designed many cost effective & highest quality standards based products and we have also getting success in making them famous among the common people. We designed a delivery system which made possible of delivering many highly advanced & sophisticated technologically based products at very reasonable prices. Our service & product feedback system is one of the finest combinations of technology and human acumen. On developing these kinds of system & products, lots of experience & dedication needed & we are fortunate to develop a strong in house R&D team for this purpose. With present days need, we are working to transform us in complete digital & electronic form, so that the concept of Digital India can be realized. We made our labs paper or film less & successfully achieved the concept of “green”. We are succeed to provide or patients an electronic platform through which they can contact us or keep their records safe etc. Due to our R&D we are 24 X 7 X 365 days with our patients for serving them.

What is your strategy to promote medical education specialty in Diagnostic sector? As by my personnel interest in academics, I always have a special focus over developing strong & well trained subordinate work force. So, that we have started our Para Medical Training Institute with the name of SETI (i.e. Star Education & Training Institute), where we trained people in such a way that, they will be fit for the industry from day one. We have started many courses of certification to diploma level here but my personnel & special focus on knowing Diagnostic sector requirements and according of that we trained the people. Here we have all kind of Diagnostic courses & then subsequent industrial training facilities.

What are your future plans?  Make highly advanced Diagnostic services cost effective for everyone  Make our Pan India & world presence physically as well as electronically  Establish Para medical qualifications & courses equivalent to other medical & technical courses with establishing a industrial collaborations with all the technology big brands like, Philips, Siemens etc.  Promote maximum R&D activities in designing new test based kits  Provide maximum & better services to old people, kids & women in routine time as well as by arranging community service camps  Make whole pathology & diagnostic industry more transparent & sensitive towards society & general public.

How you see radiology\imaging & diagnostic industry? These all are the integral part of whole healthcare industry & any medical treatment or preparation of any treatment cannot be started without helping of these above mentioned industrial segments. This industrial part made entire healthcare system more meaningful & accurate. It has provided a more degree of freedom to our doctors to perform their task more accurate & precise. General public also getting more vigilant about their health by getting proper explanations of their medical or physiological conditions through their medical reports on a proper way only because of this part of the industry. But still cost of these services is very high in respect of the purchasing capacity of a common citizen. But by the concept of “Made in India” & other govt.’s new initiatives, in coming time these prices will surely go down & rigorous quality rules will enhance the service quality. Self regulation & govt. regulation will increase the transparency here & more advance and responsive system will be guiding this segment. New updated technologies day by day making this industry more enriched in comparision than others. In a global research, only in health sector new researches are happening & specially in Diagnostic field, this news clearly indicating about a better tomorrow for this industrial part.

Through our educational institutes as well as lab, we organised many educational awareness programs about diagnostic education. We tried and even getting successful to convince people about diagnostic sector’s ample job or business opportunities. A new wave these days blowing in India about Skill development & we are trying to make maximum people skill full. w w w.medegatetoday.com Jan-Feb 2017

PRODUCT LINE

Kick Start your own Medical & Dental 3D Printing unit: The future is here!! This article answers Five Questions that haunt Indian Medical 3D Printing Industry in India: Investment Required, Running Cost, Affordability Of Indian Patients, Keeping up with the Global competition & Marketing??

bout 3 years back, an angel customer of "Acton Engineering" from semi cosmopolitan area of Goa, Dr Mohandas Kamat (Consultant Radiologist - Omkar X-Ray™, Goa), requested us to provide an affordable 3D printer to explore the applications of 3D printing in Medicine and Dentistry. He also wanted a long term technical support from us to convert this idea into a viable project. This request was completely novel to our existing field of expertise, as we had never dealt in 3D printers by then. After thorough research and consultations we acquired a 3D printer that we believed could serve our interests. After getting the 3D printer onboard we understood that it was not a straightforward affair! We struggled our way through for around a year, finding the right hardware-software combinations. The day we found the right recipe, our machine started yielding awesome results that we always dreamt of. We are Sharing our experience with the new age Indian Medico-Entrepreneurs so that they avoid the steep learning curve and to encourage them to start their own medical 3D printing enterprise. This article also summarizes the answers that we discovered & the ideas that have worked for us.

Do I need to invest huge? Which would be the right technology for my Clinic/Hospital? Well, that's a tricky question. Medical 3D printing industry applications can broadly be categorized into 3 segments  Model Making: for Surgical Planning, Mock Surgery, Patient Education, etc.  Surgical Templates/Drill Guides.  Fabrication of patient specific implants/implantable components. Each category requires you to own a machine with different technology & hence it attracts more investment. The investment requirements were never ending! But our strongest support, the senior radiologist from Goa, never went back on his words! Now we proudly hold an exclusive facility at Omkar X-Ray™ Margao - Goa, one in Pune, and 2 new coming up in Mumbai and Jalandhar in 1st quarter of 2017!!

After So much of investment what manpower we would require? Yes you would require somebody who can U nderstand a surgeon’s mind and make anatomically correct model. Yes you heard it right! Anatomically 40

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correct!!! Model making softwares available today do not understand the variations in human anatomy. It's the Model Designer who is needed to be expert in both: understanding surgeons needs & Making correct models from CT/MRI/PET/USG/CBCT data which is acquired at some different facility where you don’t have any command over quality control of acquired data! W e need somebody who will operate & maintain the huge machines, at least 3 of them!

Ok we managed the investment & manpower, now what are the applications? Which specialties can we serve? Ah, this was the most tedious one! Other disciplines of 3D printing; such as automotive, Aerospace etc. have well defined applications & understanding of how it can benefit them. Most of the small Indian/Asian 3D printer manufacturers are really busy making their machine modern & win over the competition. While they continue selling them “easily” & “in more bulk” in automotive & aerospace & other engineering disciplines; nobody apart from 1 or 2 big global players are excited to explore medical field. So its like a “Bonus” sector for small players. Global Brands like Stratasys or 3D Systems are busy exploring this specialized sector of Medicine, but they are making all the technology “closed source” & every component with system “Proprietary”. This results into dollar based royalties that make this branch of patient specific medicine a “Luxury” in India; which is well out of reach of commons! Only institutions that cater to VIP’s & VVIP’s can afford them. At least, in Asian context. So what’s the answer? Well read ahead! At this point only choices in front of us were to close the chase game & regret that this was not a good decision or struggle by ourselves to get hold of knowledge. So our 60-year-old frontier was simply not ready to give up. At the same time it was making my time miserable! Because Acton Engineering was growing leaps & bounds & was asking much dedication & attention as every growing child deserves. So next 18 Months of dual demands from 2 siblings “Acton” & “Dent Med” has subdued our sleeps, messed the life of not only both of us but the whole team. Out of total team 1/3rd was R&D that is unproductive in terms of plain business context!

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Our answer was, Lets take challenges from community & face them head on and do free case studies for them. But these efforts paid back and we developed expertise in the following areas  Dental Drill Guides & Templates  Mock Surgery Guides  Educational models for CME workshops for hands on mock surgery practices.  Craniotomy & other “Patient Specific implants”.  Metallic implants fabrication With all this R&D, did the questions stop? No! Bigger one was waiting ahead.

Who will buy this stuff? If we produce 1 or 2 implants monthly then how much shall we charge? Will it be affordable? How to make this proposition marketable? On this stage everybody in the team said sir, it time for payback, lets sell this at good prices just 5 to 10% less than global players! But our ‘Angel Santa’ as well as myself were not convinced. This was not the way! We have not done all these sacrifices to be just another competitor in the market! Absorbing all peer pressure by myself as I was face of management for the team! So after a month, one day this 60-year-old angel comes with the idea that “We are not going to be close source vendors!" A shock! "Then? Are we going to buy 30+ machines & team of 300+ odd employees & launch company officially? Directly compete with Global giants?" I asked. "No! "He said." We are in fact going to share this knowledge with community freely?" he quipped. "What??" I thought to myself. Goosebumps! Yes he continued, "We are going to share all the knowledge to the young generation enthusiastic entrepreneurs & going to teach all of this to them! We are going to nurture the talents within our society in the McDonalds way! We are going to make doctors partner in our profits rather than customers! " Amazing! But one last question!

 I t could reduce post operative stay & recovery period of patient by couple of days Then Ganesh why couldn’t we sell this? And this was the final blow to the barrage of questions that had haunted us for 3 odd years! Yes, Sharing all this knowledge to the community, the McDonalds way! So new entrepreneurs do not need to invest in buying costly technology. After buying they do not need to reinvent the entire wheel. After re-inventing they shouldn’t struggle to make it affordable to the Indian market. They only should take it ahead from where we have reached. Lets do it the Indian way!!! There is absolutely no need to invest huge, find medical applications of 3D printing by yourself, then market them, then compete with peers for pricing it affordably & employ & nurture team who will run this show and do R&D to keep you updated with marketplace! For further questions you can always reach author on mail id: ganesh@actoneng.com or call helpline 8007-360-033 

Will common people from places like Goa Kolhapur Belgaum (tier 2 cities) going to afford this? Yes! He said: why not? Now we have enough in house market to feed ourselves. It’s proven now. So lets take example of Craniotomy/Cranioplasty & immediate implant placement. '' If ''  We sell it for 1/3rd the market price  It saves time for planning Cranioplasty  It increases the accuracy by planning not on moulds but on actual accurate plastic model printed from CT scan data  It saves surgeons' intra - operative time for plate/Mesh adaptation. In fact it saves so much of time that he or she can accommodate 1 more surgery per day in his/her schedule.  It gives better acceptability & cosmetics to patients  It saves 2-3 pints of blood to the patient

For Any Query Contact ganesh@actoneng.com or Call: 8007 36 00 33 w w w.medegatetoday.com Jan-Feb 2017

DOCTOR SPEAK

Physiotherapy Can Help to Treat Shoulder Dislocation Amit, an IT professional loved going for his evening Tennis practices. One day, while he was playing Tennis, he suddenly felt a sharp pain in his left shoulder and couldn’t move his hand. He was immediately taken to the hospital and investigations revealed that he had a shoulder dislocation. Shoulder dislocation most commonly is a sports injury. A sudden trauma or any form of underlying shoulder joint instability can result in shoulder dislocation or subluxation. Most people regain full shoulder function within a few weeks. However, once you've had a dislocated shoulder, your joint may become unstable and be prone to repeat dislocations. Mostly men involved in physical activities, athletes, etc. are at a high risk of shoulder dislocation. Usually the cases we see mainly belongs to 20-50 years of age. In up to 98% of cases, the shoulder displaces in an anterior direction and in about 2% of cases it displaces in the posterior direction. 42

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While sports injury for people involved in contact sports and in sports involving falls are common, shoulder dislocation can also be caused by trauma that may or may not be related to sports. A hard blow to shoulder during a motor vehicle accident is also a common cause of dislocation. Also, shoulder dislocation can happen due to falls from a ladder or from tripping on a carpet. A person who suffers shoulder dislocation undergoes extreme pain and inability to move arm, even upon the slightest movement. Swelling and significant haemorrhaging occurs around the joint. A visible deformity is present in case of dislocation which may not be the case in subluxation (partial dislocation). A person should make sure to take a professional advice from a physiotherapist and should not return to activity until advised.

DOCTOR SPEAK

Dislocated shoulder signs and symptoms may include:  A visibly deformed or out-of-place shoulder  Swelling or bruising  Intense pain  Inability to move the joint  Numbness  Weakness of the joint

Treatment The treatment of realigning bones after a dislocation includes reducing pain through modal therapies and simple manoeuvres that manipulates the joint to the reposition. This is done involving only specific group of muscles and is followed by exercise routines only after the pain gets reduced. Some positions are advised to the patient to reduce further dislocation.

Dislocated shoulder treatment involves:  Medication. Orthopedic surgeon might prescribe a pain reliever or a muscle relaxant  Immobilization. Special splint or sling for a few days to be worn until three weeks to prevent shoulder from moving and aggravation of pain.  Physiotherapy. After shoulder splint or sling is removed, gradual physiotherapy designed to restore range of motion, strength and stability to shoulder joint is advised along with some pain relief techniques.  Closed reduction. Orthopedic surgeon may try some gentle maneuvers to help shoulder bones back into their proper positions. This might be done under sedation.  Surgery. There may be a need for surgery if the shoulder joint or ligaments are weak and tend to have recurring shoulder dislocations despite proper exercising. After surgery the rehabilitation program starts in phases. This is usually performed along with the consultation of the orthopedic surgeon

The postoperative management of operated shoulder typically requires a minimum of 6 weeks of activity, restriction to minimize stress to healing structures. During this period of limited upper extremity use, active exercise of non-involved joints (elbow, wrist, and hand) is recommended. Isometric shoulder muscle exercises for scapulothoracic and humeral muscles are advised. Also, assisted shoulder exercises initially performed within a limited range of motion are designed to protect the surgical repair and prevent adhesion formation in the early post-operative period. Rotator cuff strengthening is advised with isometric exercises. Light resistance exercises for the rotator cuff and biceps brachii muscles are introduced as early as 4th week after surgery In the later stage of rehabilitation, emphasis is given to functional exercises that prepare the neuromuscular and cardiovascular systems for the return to sports participation. This includes activities that require the coordination of multiple muscles (Eg: catching and throwing activities, racquet and other batting activities, and goal defense activities) to achieve the desired magnitude, duration, and sequence of motor output for a given functional task.

Prevention To help prevent a shoulder dislocation Take care to avoid falls Wear protective gear when you play contact sports Exercise regularly to maintain strength and flexibility in your joints and muscles Once shoulder is dislocated, the joint becomes more susceptible to future shoulder dislocations. To avoid a recurrence, specific strength and stability exercises have to be done regularly.

Post-operative Rehabilitation Rehabilitation for different people takes different time. If there is a need for surgical intervention, various exercises are suggested after the surgery for post-operative recovery. In other cases, shoulder injuries can be treated with physiotherapy alone after ensuring the pain comes down. The basic principles of non-operative rehabilitation for shoulder instability apply equally to post-operative patients. The specific content of post-operative rehabilitation varies according to the operative procedure performed, individual pathology, and the activity level of the individual. Icing/cryotherapy in the post-operative shoulder (applied for 15-minute durations every 1 to 2 waking hours for the first 24 hours, and 4 to 6 times daily for the ensuing 9 days) has been shown to significantly decrease the frequency and intensity of shoulder pain.

Mr Immanuel

Chief of Rehabilitation Services, Columbia Asia Referral Hospital (Bangalore)

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DOCTOR SPEAK

Devastating Elephantiasis Disease Facing Elimination

Dr. Deirdre Hollingsworth UK

E limination of elephantiasis disease lymphatic filariasis assisted by University of Warwick research  About one billion people in 54 countries live with threat of disease, which disables victims M athematical model works out the potential impact of treating and preventing disease with three drugs A disabling parasitic disease which causes elephantiasis, and threatens around one billion people globally – Lymphatic filariasis - could be eliminated more quickly, thanks to research by the University of Warwick. Dr Deirdre Hollingsworth, who leads the Neglected Tropical Diseases (NTD) Modelling Consortium, led an international team that has discovered that if a recently proposed combination of three particular drugs is used together, the disease can be prevented or treated rapidly, in a maximum amount of people, using fewer rounds of drugs. Lymphatic filariasis is a neglected tropical disease, which causes serious damage to the lymphatic system. It is caused by parasitic worms, and is transmitted to humans by mosquitoes. Many people with the disease develop elephantiasis or lymphoedema, causing pain and profound disfigurement - such as large swelling of the arms, legs or genitals - and leading to permanent disability. These patients are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty. A large proportion of the billion people living with the threat of transmission are in India, Indonesia and Myanmar where the triple drug combination could be used. Currently, people with Lymphatic filariasis require multiple rounds of treatment - but if the drugs ivermectin, diethylcarbamazine, and albendazole are used together recent clinical studies have shown that the drugs are more effective at killing the worms. The new modelling work shows that this meant that the number of rounds of mass drug administration needed to treat the disease may fall from many rounds to only two or three.

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The World Health Organisation (WHO) has targeted the disease for elimination as a public health problem by the by the year 2020. The drug companies Merck, GlaxoSmithKline and Eisai have pledged to donate drugs to help eradicate the disease globally. Initial studies show the triple drug regimen is far more effective at clearing the parasite from its human host and that is has a good safety profile. However, experts note that campaigns can run into trouble when they go on for too long because populations can lose interest in taking the drug when the disease is not very common. At this stage the researchers can’t predict how fast this new regimen will speed up elimination, and if so, in which countries. Mathematical models were used simulate a mass drug administration campaign in different settings. As there are many unknowns about the transmission of the disease and how a population responds to intervention, three independentlydeveloped models were used to estimate the impact of the new regimen. The models were developed at the University of Warwick, Erasmus Medical Centre, and Notre Dame Universities. All three models were in agreement in the effectiveness of the regimen in reducing the prevalence of disease. The researchers noted that more effective treatment with fewer drugs rounds is crucial in poorer countries where transmission is high but resources are low. Dr Hollingsworth, who is based at the University of Warwick’s Mathematics Institute and School of Life Sciences, comments: “This more effective treatment has the potential to revolutionise the control of this disease, but it will require that in over a few rounds of treatment the programs are able to treat almost the whole population, even the most inaccessible. Dr Mike Irvine, University of British Columbia in Canada, is the first author of the paper, said: “Our results show that this regimen could potentially overcome important issues plagued by elimination campaigns, by making elimination as a public health problem achievable in a few years.” Dr Wilma Stolk, from Erasmus Medical Centre, added: "We use very different approaches, but our models all have the same message. This new drug regimen can reduce the number of rounds, but it still depends on the programs being well-run. Even with the best possible regimen elimination is difficult to achieve if many people repeatedly don't participate in mass drug administration." Professor Edwin Michael, from Notre Dame University said: “This study demonstrates the power of using multiple models, an important trend in complex systems modelling and use of models for policy making. It allows us to be sure that our insights are robust.” The research, ‘Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis: a modelling study’, is published in The Lancet Infectious Diseases.

PRODUCT LINE

Samsung Premium Ultrasound System Enhances Fetal Heart Imaging and Diagnosis with Advanced 5D Applications WS80A is world’s first and till date only 5DTM Ultrasound System from Samsung. We, in Samsung have been constantly working to bring in more development in 5D Technology to make the system better than the best. The new WS80A is equipped with advanced diagnostic features and superior image performance. This system will help the Ultrasound Specialists to enhance their clinical practice and extract new clinical planes from the volume data set. With advanced 5d technology, exceptional productivity in workflow through highly useful features for Women’s Health and General Imaging will be possible. Now physicians can make a precise diagnosis on patients, even with the most complex women’s health exams. Furthermore, advanced S-Vue transducer technology provides enhanced vision of the scanned areas, ensuring confidence in clinical decisions. 5D Solutions allow utilization of the volume data providing diagnostic planes and measurements automatically. Also, it provides useful information to evaluate various fetal conditions or women’s health issues. Key features of the equipment include

Superb Image Quality  S-Vue Transducer: Delivers broader bandwidth and higher sensitivity in order to obtain more indepth, higher image quality. Even patients with technically challenging cases can easily get scans with superb resolution Provides enhanced color sensitivity in 3D and Doppler images.  S Harmonic: This new harmonic technology improves image clarity, near to far. Reducing signal noise, S-Harmonic provides more uniform ultrasound images. Combined with the S-Vue transducers, S-Harmonic takes WS80A image quality one step further  23” Wide LED Screen: Offers better color representation and enhanced vision of ultrasound images for users.

Intuitive 5D Automated Reproducible Technology  5 D Heart Color (Fetal Heart Examination): 5D Heart Color allows evaluation of fetal cardiac structures for potential blood flow disturbances, an 46

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PRODUCT LINE

operator dependency in MPI measurements. MPI also improves workflow during fetal heart exams with its simple, one-click operation  E Cervix: It is a tool to predict Pre-Term possibility by measuring Elasticity ration between IOS and EOS.

Oncology Support

important component of fetal cardiac examination. Using STIC volume datasets, color Doppler sonography is demonstrated in 9 standard fetal echocardiography views in a single display.  5D CNS+ (Fetal Brain Measurement): 5D CNS+ uses intelligent navigation to provide 6 measurements from 3 transverse views of the fetal brain to enhance measurement reproducibility and streamline workflow. It includes axial, sagital and coronal views with 9 planes following the international guidelines for assessing the fetal brain as set forth by the ISUOG.  5D LB (Fetal Long Bone Detection): 5D LB allows for easy, automatic detection and measurement of fetal long bones from volume data, with intuitive visualization of the fetal structures. Diagnosis of fetal malformation becomes efficient as 5D LB improves measurement accuracy while reducing exam time.  5D NT (Nuchal Translucency Measurement): 5D NT supports intuitive confirmation of the fetal mid-sagittal view, which is first automatically detected and appropriately zoomed from volume data. Then, the fetal nuchal translucency thickness can be measured with simple and efficient semi-automatic operation, reducing

operator dependency.  5D Follicle (Follicle Measurement): 5D Follicle finds follicles automatically and measures size and status of each follicle, leading to improved clinical workflow. This technology is expected to contribute in monitoring ovulation for infertility patients and predicting success of ICF cycles.  5D Limb volume: 5D Limb Vol. is a semi-automated tool to quickly and accurately measure upper arm or thigh volumes from 3 simple seed points on a single volume data set. These measurements can then be used to calculate an accurate estimation of fetal weight as well as provide additional information regarding fetal nutritional status.  Crystal Vue: Crystal Vue is an advanced volume rendering technology that enhances visualization of both internal and external structures in a single rendered image using a unique combination of intensity, gradient and position. The resulting image has the potential to enhance visualization and increase diagnostic confidence. Crystal Vue flow also provided hemodynamic information with Crystal Vue.

Fetal assessment tool  MPI: MPI enables semi-automatic measurement of the fetal myocardial performance index (MPI) to reduce

 E-Breast E-Breast technology calculates the strain ratio between the selected target and surrounding tissues. E-Breast™ is simplified process of selecting one ROI or two ROIs enhance consistency and reduces the chance of error by not manually selecting the surrounding tissue region.  E-Thyroid: E-Thyroid technology provides more objective assessment of thyroid lesions by incorporating a useful index for suspicious area. E-Thyroid™ images are generated using pulsations from the adjacent carotid artery. It thereby eliminates the need for manual transducer compression for greater consistency.  ElastoScan: ElastoScan helps to diagnose benign gynecological disorders and to differentiate fibroids and adenomyosis. Therefore, ElastoScan™ is a promising new technique in the field of gynecology.  S Detect for breast: By simply clicking a suspicious lesion, S-Detect™ draws the lesion borders, suggests the characteristics of the lesion and generates lesion dimensions. S-Detect™ uses the Breast ImagingReporting and Data System (BIRADS®) scores for standardized reporting and classification of lesions.  IOTA ADNEX: IOTA (International Ovarian Tumour Analysis) ADNEX is very useful tool in assessment of different neoplasias in the ADNEX model and is integrated into Ultrasound system. This is a tool for estimating the probability that an Adnexal Tumour is Benign or Malignant. The entire procedure from scanning to report generating can be completed within the Ultrasound Console 

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EXPERT VIEWS

Staying Healthy

can also be affordable. Indians have traditionally always only spent for acute healthcare events. The belief that ‘good health’ is a gift from God and illnesses are destined because of Karma; have long permeated our mindsets. Consequently, despite having some of the best minds working in the healthcare delivery system, the average life expectancy in India is 68.3 years (WHO’s 2015 statistics), ranking India at an unfortunate 125th in global rankings. Consolidated data between urban and rural population, visiting a doctor, average family visit per month exceeds 2.1 times for basic treatment to elective and acute healthcare needs. Simple mathematics can easily determine the healthcare expenditure that most Indian families would incur during their average life span. If we estimate an average spend for a family of four on basic healthcare is in excess of Rs.12 Lakhs and then add invisible, intangible costs of emotional and physical pain, the figures can be rather daunting. Add to this, the illness and recuperation days that are essentially unproductive go completely un-measured. In India, the ‘Out of Pocket’ expenses category for dealing with acute healthcare issues in a family drives at least 2.2% of the population below the poverty line annually. General observation shows that Indians believe that they should visit a doctor only when necessary. Whereas a prudent mindset dictates, spend on doctor when necessary and buy medical insurance that might not be needed for a long time. It would be good to have medical insurance, that is never claimed. Lets think of it like a car worth Rs. 10 lakhs that is insured. We would expect that for the car to run efficiently and gives its best performance, comfort and mileage, the car must undergo regular check ups and preventive care. Using this analogy, we wonder if the Insurance cost for a human life is indeed adequate. Does it provide sufficient protection? At what periodicity does the human need a ‘mileage check’? It is tragic that most people do not spend enough on ‘Preventive Healthcare Management’, which is really what is necessary for their wellbeing and healthy living.

Gagan Kapur

Co-Founder & CEO Affordable Health Services Private Limited

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WHO statistics show us that there are 67 countries within the life expectancy band of 75% to 83.7%. The headroom for India to improve average life expectancy is 12 years at a minimum. Amongst many measures, one critical measure in improving the quality of health is really about understanding the health condition - taking action for early detection and preventive care. India has by far the best medical practitioners, best facilities whether diagnostic centers or hospitals. Many of these facilities work together at a local level, but at a larger level there is not marketplace integrating many fragmented efforts to improve quality of health of the people. Public healthcare funding is focused on selective programs and mainly treatment. At EasyBuyHealth, we see a huge opportunity in changing this mindset of people, creating awareness and driving the expenditure on preventive healthcare. We believe in integrating people, technology and medical industry allowing a self sustained behavior change in supporting the preventive healthcare and improving quality of health. EasyBuyHealth’s technology empowers the medical practitioners to utilize their capacity, enhance their product offering and bring relevant preventive healthcare products to their patients, thereby creating a market that was either not reachable or did not exist. EasyBuyHealth’s analytics engines are designed to enable its affiliates in making smart decisions that are factual and data driven. Our intent is to build partnerships with our affiliates that encourage good behaviours and common goals in raising industry standards. We believe that, EasyBuyHealth will provide the platform for the congregation of value systems encouraging preventive health and improving quality of life health for our people. Our goal really is about improving India’s ranking on life expectancy - from 125th to being amongst the top percentile. This we really believe is achievable.

DOCTOR SPEAK

Prevent your eyes from Diabetes

iabetes is one of the chronic diseases when the body is not able to control sugar properly. Diabetes can affect many parts of the body, but it can make some serious damage to the eyes like it weakens the vision and the overall eye health. This year’s theme focuses on the importance of screening to ensure early diagnosis of type 2 diabetes and treatment to reduce the risk of serious complications. Irrespective of the type, Diabetics are at high risk of developing several eye diseases like retinopathy, glaucoma, and cataracts. Hence, it becomes all the more important for diabetics to take special care of their eyes. The fluctuation in blood sugar levels damages the blood vessels that supply blood to the eyes. The images or the colors seem blurry and it also causes the retina to swell. The condition can worsen and might even lead to blindness if not taken proper preventive steps. Glaucoma also grows with the age. Some of the symptoms of diabetic eye diseases are:  Blurry vision  Dark or blank spots in the vision  Pain in the eyes  Difficulty seeing through corner of the eyes Mr. Amol Naikawadi, Preventive healthcare specialist, Indus Health Plus, “Diabetes is one of the most dreaded ailments in India and affects people at large. We all have heard about amputation of feet due to diabetes, but eye damage is a relatively new and a growing phenomenon in many diabetic patients. Diabetes is not curable but definitely controllable when taken proper care. We are consistently trying to spread the awareness and therefore trying to make it imperative for one and all to invest in healthy living and a preventive health check-up before it’s too late.” It is very necessary to follow strict steps for a Diabetic eye patient to protect himself from further damage. Following are the steps to prevent eye damage from Diabetes:

 Habits: By adopting eye protection habits like wearing sunglasses when in sun, regularly washing eyes, eating fruits that improve the vision will help to lower the diseases  Diet: One should start taking nutrition rich diet like leafy greens vegetables and foods rich in omega-3 fatty acids which helps in protecting overall eye health  Keeping sugar in control: By keeping the sugar in control and by improving blood glucose numbers, will help to lower the risk of retinopathy. Also, one should keep the blood pressure in check because high BP can lead to the damage in blood vessels of retina  Stop Smoking: Smoking affects the tiny blood vessels in the eyes and increases pressure in the eyes that can lead to nerve damage. It also leads to many other risks in the body. Quitting smoking is one of the top priorities to protect eyes  Eye check up: One should go for a regular check up to an ophthalmologist to begin the treatment and for detailed examination. Basis of the test, doctor will suggest the number of times one should see the doctor for an eye check up  Exercising: Regular exercise will help maintain the sugar levels and also helps in maintain the cholesterol in control. Physical activity is also good for vision. It will definitely help in controlling the diabetic eye disease

Mr. Amol Naikawadi

Preventive Healthcare Specialist, Indus Health Plus w w w.medegatetoday.com Jan-Feb 2017

EXPERT VIEWS

As Rheumatoid Arthritis age, it is Double Whammy in Old age

you age, the degeneration in joints of your body is inevitable despite your best efforts to keep them well oiled. You cannot avert it. Sooner or later, you have to confront the age triggered osteoarthritis and the resulting joint pain. But you can stop rheumatic arthritis from aging. And if you do not, it is going to be a double whammy in your old age. In India, according to orthopaedicians, people let rheumatoid arthritis go undiagnosed till it is too late. In old age, the mix of osteoarthritis and rheumatoid arthritis assumes very painful proportions, which is not easy for doctors to tackle at all. Dr. Aashish Chaudhry says, “We can well avoid this terrible prospect of double whammy in old age, provided we avoid letting rheumatoid arthritis fester. People resort to self medication to alleviate the pain, unmindful that the disease remains. It is suggested that one should get themselves checked by a qualified physician. People let it go undiagnosed for years together and consult a doctor only when pain becomes unbearable and fingers of hands and knee get badly deformed. It is a nightmarish prospect really.” Rheumatoid arthritis is a kind of autoimmune disease of joints. It usually affects small joints of hands and feet. But pain in hand and foot joints is not necessarily rheumatoid arthritis. There is an assortment of symptoms that point to the possibility of Rheumatoid arthritis. Dr. Chaudhry says, “If there is pain and inflammation in small joints is persisting for a few weeks and if it is associated with morning stiffness lasting over 45 minutes to 1 hour, there is a high probability that the patient is harbouring rheumatoid arthritis. Though rheumatoid arthritis

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is not curable but it can be effectively controlled and managed like we do with any other chronic disease, diabetes for instance.” He further says, ‘Just do not resort to pain killers for relief. There are specific medicines to manage rheumatoid arthritis. But if this disease is left to worsen for long, treatment gets increasingly difficult, so catching this disease young is the right way to avert this situation. Large numbers of people visit doctors for treatment of this arthritis but what we see is just the tip of the iceberg because this arthritis is highly underreported. Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles.’ For patients of rheumatoid arthritis, temptation of cure is very high and that is where most people err. They turn to alternative systems of medicine and this temptation has been found to be a reason for worsening of the disease in many patients.

Dr. Chaudhry says, “I often meet patients who visited me for treatment a couple of years ago but didn’t follow up for multiple reasons, and when disease worsens, they finally return for treatment. Regular follow up is also a must for limiting dose of medicine.” Dr. Chaudhry further says, “The disease has a genetic predisposition coupled with some extraneous factors.” Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system mistakenly attacks the joints resulting in inflammation that causes the tissue that lines the inside of joints to thicken. As result of this thickening, swelling and pain in and around the joints occur. If inflammation goes unchecked, it can damage cartilage, the elastic tissue that covers the ends of bones in a joint, as well as the bones themselves. Ultimately it leads to even loss of cartilage. In women, it occurs earlier than in men. Having a family member with RA increases the odds of having RA.

Dr. Aashish Chaudhry

Orthopaedic Surgeon and Managing Director, Aakash Healthcare

EXPERT VIEWS

Let’s speak for Patient Safety in India Patient safety is a fundamental element of healthcare and can be defined as freedom for a patient from unnecessary harm or potential harm associated with healthcare.

he statistics are alarming: worldwide, 10% hospital patients see adverse events occur attributed to hospitalrelated mistakes and unsafe care. Individual studies have reported adverse events from 4–17% of hospital admissions. Of these, 5–21% result in death. In low- and middleincome countries, the risk of acquiring Hospital Acquired Infections (HAIs) goes up by 2-20 times. At any given time, the prevalence of HAI varies between 3.5% and 12% in the developed countries, while in the developing countries, the prevalence of HAI varies between 5.7% and 19.1%.

Why this happens:

Medical literature reports the incidence of hospital acquired infections which the patient may not have when s/he walks in the hospital. However evidence also suggests that half of these can be prevented by just investing a minor fraction of the budget while planning the hospital systems, pathways, and processes. This is where public-private partnerships come in, as government set-ups usually have insufficient resources to take care of people. The non-allocation of all types of resources in proportion to the workload has also been documented. Often, it isn’t individuals who inadvertently make mistakes, but systems and processes that may not be efficient enough to prevent infections slipping through.

Why we need to act now:

The issue is coming into the news with the soon-to-be-launched National Health Assurance Mission aimed at universal health coverage for the entire population in India. In August and September this year, there have been two discussions on patient safety at the national stage and at the World Health Organization. The latter has also released a patient safety policy framework for South-East Asian countries, including India. Many countries in the developed world have “Speak Up for Patient Safety” campaigns. Improving patient safety requires a system-wide effort involving a wide range of actions in performance improvement, environmental safety

and risk management, including infection control, safe use of medicines, equipment safety, and safe clinical practice and providing a safe environment of care.

What we need to do:

We must implement the culture of safety such as is observed in the airline industry. Efforts have been made by the National Accreditation Board of Hospitals and Health care providers (NABH) and its different programs, the MoHFW’s National Quality Assurance Mission (NQAS), Joint Commission International (JCI). They have instilled a sense of confidence among patients and service providers alike that a set of minimum standards is maintained in an accredited hospital. The accredited hospitals undertake clinical audits and apply quality assurance processes by design and thus avoid numerous medical errors well in time. The healthcare insurance industry has also played a catalytic role, at least in major cities across India, to indirectly force their clients to improve and standardize the quality of service.

How we can do this:

Like many other issues, the challenge of patient safety also needs to be addressed through a multi-dimensional approach. India has robust mechanisms to roll out blood bank safety, organ transplantation safety and basic maternal and newborn health services across, but needs a booster shot for safe surgical practices, safe medications, stricter control on spurious drugs, safe injections, and safe disposal of bio medical waste. We propose the following 4-point program for all stakeholders to take up patient safety issues on fast track.  Consider a national Patient Safety week. It should be relevant to all public and private sector health sector institutes and standalone clinics.  The MoHFW should continue their efforts to adopt the WHO regional strategy which include nationwide patient safety assessments and capacity development besides behavioral change initiatives.  Bureaucrats and technocrats at state and district level should spend just about 15-20 minutes every week on the issue. A ‘dip stick’ at various health institutes would give them a flavor and they could use their administrative skills to fix the gaps at local level to enhance patient safety.  Professional and Industry bodies should also develop innovative thoughts and supplement government efforts while providing patient care.

Dr. Om Prakash Kansal

Technical Advisor, Injection Safety w w w.medegatetoday.com Jan-Feb 2017

INTERVIEW The increasing consciousness regarding preventative health across India is underpinned by a dependency of critical information.

Michael Koss

CEO & CO-Founder Global Patient Portal, Australia

Tell us about your journey towards digital health since inception? My digital health journey in India began in December, 2013. At the time, I was practicing as commercial lawyer in Australia and I was invited to speak at an International Conference on Hospital Management about health law in India. At the conference, I spent 3 days discussing with doctors various digital health systems. A common complaint they had was that systems designed for other markets such as the USA would not be appropriate for India. However, through their commentary I thought a model emerged about what would be appropriate. I returned to Australia after the conference, left my job, built a prototype and within 3 weeks returned to India to begin a 1.5 year market research project. My goal was to understand the delivery of Indian healthcare as best I could. I spent time in the north, south, east and west. In slums, villages, tier 1, tier 2 and tier 3 cities. I visited various public hospitals, clinics, PHC’s and any other healthcare delivery mechanism I could find. The learnings from this journey underpinned our first Global Patient Portal product which we launched in West Bengal in September 2015. We are now preparing to launch our second digital health solution into India. I am involved at State and Federal levels in India digital health policy. I also provide advice to various stakeholders across the industry about how to bring about digital health adoption. My journey to digital health has taught me the importance of sharing knowledge, there is a huge task ahead to bring quality healthcare to all individuals across India. Collaboration through knowledge and resource sharing will be the key to achieving this goal. How telemedicine & electronic health records can help in diagnostics & Labs? In recent years, the ability to provide accurate, quality and affordable diagnostics has evolved. We are now able to perform tests on the back of a bike that are as accurate as you would find in a University hospital in the USA. However, the collation of these results along with the patient’s broader health record is vital to bring meaning and to give proper effect to the results. In isolation, the ability for a physician to track trends and engage in preventative health is substantially curtailed. 52

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As such, with the proliferation of telemedicine and electronic health records, the labs and diagnostics companies have become integral stakeholders in the health record keeping process. The ability for results to be kept and have meaning brought to them on a long term basis as opposed to being lost, damaged in flooding or other risks to them is a huge advantage. This enhances the value for a patient in investing in diagnostics. Therefore, the safe keeping of the information, as well as being able to use telemedicine to deliver and monitor results can now act as demand creation mechanisms within the lab and diagnostic communities. The ability to provide preventative health across India is underpinned by a dependency of critical information. Electronic Medical Records now protect that information and make it readily accessible, whilst telemedicine has drastically extended the reach of quality care providers to those know need them. In recent months, a number of changes have been occurring at a Federal level in India through new laws and statutory bodies being formed in order to enhance interoperability. This has demonstrated the Government’s commitment to bringing healthcare into Digital India. What is digital health & how it will help patient and healthcare providers? Digital Health at its core is bringing health information online. However, it is complimented and enabled by various other elements of the health and technology sectors including medical devices, security and diagnostics. Patients and healthcare providers alike will be helped by efficient and secure storage of critical information, easily accessible records, and collation of information from various sources in a single record, the ability to integrate with other providers and the option to share information quickly and easily in order to enhance care. How your company helping in Digital India movement? Global Patient Portal is focused on providing digital health solutions into the Indian market that assist the bottom and middle of the pyramid to access quality healthcare. We understand the burdens of cost and time that delay many people seeking treatment. It is our mission to resolve that by increasing access, affordability and availability of healthcare resources. Our business has brought many individuals and healthcare providers online through digital health and we continue to innovate and drive new solutions into the market. The Digital India movement is vital to us. The opportunity to ‘leapfrog’ the mistakes made in other markets has is being seized by India. Consequently, the digitisation of healthcare is enabling us to proliferate the opportunity to engage in preventative healthcare. Our business aims to be at the forefront of bringing about effective uptake of digital health solutions within our target demographics.

INTERNATIONAL CONFERENCE ON

Healthcare IT & Digital Health

Healthcare Infrastructure & Medical Equipment Planning 7th April 2017

6th April 2017

Venue: Medical Fair India 2017 Pragati Maidan, New Delhi

FOR DETAILS CONTACT:

Ms Pinky Chahar Mob: 7840030102 pinky@voiceofhealthcare.org www.voiceofhealthcare.org Knowledge Partner

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INTERVIEW BD has made in untold millions of lives in ways as diverse as helping enable inoculation of children for the final eradication of polio, identifying infectious organisms and providing the research tools to help advance the discovery of a vaccine for AIDS. As you have vast experience in healthcare domain. Please share your journey since inception?

Mr Varun Khanna

Managing Director BD India

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Across the healthcare continuum, BD is known for medical technology, devices and laboratory equipment—from medication management and parenteral drug delivery to diagnostics and solutions for clinical research. What may be less known about us is the difference BD has made in untold millions of lives in ways as diverse as helping enable inoculation of children for the final eradication of polio, identifying infectious organisms and providing the research tools to help advance the discovery of a vaccine for AIDS. Today more than 1000 associates serve every corner of the India, united by one purpose: advancing the world of health. BD started its India operations in 1995 and set up its manufacturing unit in Bawal, Haryana. The plant has aided in designing latest products in hypodermic medical solutions, immunization, diabetes control and peripheral catheter drug delivery systems in India that speed diagnosis, help healthcare professionals and patients use the products correctly, reduce the risk of infection and minimize discomfort to patients. Cognizant of the pressing concerns ailing the healthcare systems in the country, BD stands committed and deeply engaged in bringing its experience, knowledge and collaborative capability to meet challenges and shape the future of healthcare in India by:  Improving standards of Safety and Infection Control amongst patients & healthcare workers  Strengthening clinical laboratory practices  Enabling high-impact public health programs around chronic diseases such as HIV/AIDS, diabetes and cervical cancer  Driving pharma / bio-pharma industry partnerships to harness global and local opportunities BD supports pharmaceutical companies, biotechnology firms and clinical research laboratories in India to help develop leading products for the world. Currently, BD is building relationships with stakeholders from the private sector, the medical community and the nonprofit sector to combat serious health challenges.

INTERVIEW As BD is one of the leading company in Medical technology in diagnostics? How BD is helping patient safety and healthcare worker safety?

Lack of healthcare infrastructure and well-trained healthcare workers are perhaps few of the biggest barriers to access in developing countries. BD’s training and lab strengthening programs create sustainable improvements in healthcare and helps laboratories minimize preanalytical errors by relentlessly educating phlebotomists on best sample collection practices.  We work with NABH on infection control certification program for small and medium hospitals in the areas of injection, infusion, infection control, healthcare worker safety and biomedical waste management.  Leading Indian hospitals have benefitted from BD’s Risk Reduction Program that helps hospitals administer infection control audits, form infusion teams and also set up committees overseeing infection control.  We are closely working with multiple stakeholders to facilitate implementation of WHO guidelines on safety engineered devices that will elevate healthcare worker safety in the country.  We also have an agreement with Healthcare Sector Skill Council to develop co-branded training modules for phlebotomy technician course.  We are working to make Indian nurses and related healthcare professionals better aware and trained to protect patients from medication errors as well as associated infections by following safe infusion practices that are the standard worldwide. BD and The Infusion Nurses Society (India Chapter) launched the first ever guidelines for infusion nursing and online eLearning course for nursing professionals to ensure quality healthcare is guaranteed to patients. Let us know about latest advancement in BD diagnostics? What is the market size of diagnostics industry? BD launched its next generation diagnostic instrument for the rapid identification of bacteria and detection of antimicrobial resistance. The new BD Phoenix™ M50 ID/AST system that delivers rapid, accurate and cost-effective testing, within a modular, scalable and smaller footprint Antibiotic use is a major driver of resistance. A March 2016 paper on ‘Antibiotic Resistance in India: Drivers and Opportunities for Action’ in PLOS Medicinesays “In 2010, India was the world’s largest consumer of antibiotics for human health at 12.9 x 109 units (10.7 units per person)”. Appropriate use of antimicrobials can be life-saving, but inappropriate use needs to be monitored and minimized to prevent and contain antimicrobial resistance (AMR). Examples of inappropriate use include prescribing antimicrobials when they are not necessary, prescribing the wrong type of antimicrobial and prescribing for the incorrect duration.

In this current scenario, tackling AMR is a clarion call for the diagnostic industry, which is growing at 14-16% CAGR. Amidst emerging technologies, core microbiology still remains the gold standard for infectious disease diagnosis. The BD Phoenix™ M50 ID/AST system, as part of BD Microbiology solutions, is an integral component in the fight against the global threat of antimicrobial resistance (AMR). The new system benefits from the demonstrated performance of the legacy BD Phoenix™ 100 system for detecting current and emerging resistances as well as the extended testing capabilities provided by BD Phoenix™ Emerge panels. The new extended panels is easy to implement and will provide many benefits for the rapid detection of Multi Drug Resistant organisms. BD M50 ID/AST system when associated with BD EpiCenter™ data-mining tools, helps generate the most accurate antimicrobial resistance surveillance report for infection control will further help in implementing antimicrobial stewardship program. This system can also be integrated with BD BACTEC™ automated blood culture system and BD Bruker MALDIBiotyper systems, through the EpiCenter middleware connectivity, enabling its broader application in laboratories across the globe.

Tell us about your future plans/ strategy.

The story of BD is one of a high-performing company that is building off its tradition of global innovation and excellence to improve health outcomes in India. BD with CareFusion now has the ability to deliver end-to-end solutions that can increase efficiencies, reduce medication errors, and improve patient safety in all healthcare settings. We will partnerwith organizations to address some of the most challenging public health issues. We will work in close collaboration with customers and partners to help enhance outcomes, lower health care delivery costs, increase efficiencies, improve health care safety and expand access to health.

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