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Volume VII || Issue II || July-Aug 2016

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A Future as a Home-Care Nurse Most Common Genetic Disorders in India

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The Rise of Dental Tourism in India

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Indian medical tourism industry is Growing It will reach $6 billion by 2018

The current size of the industry is estimated at a little over $3 billion, with tourist arrivals estimated at 230,000 Medical tourism is defined as the travel of patients from their home country to different destinations for the purpose of treatment that may also incorporate an extended holiday. Rise in healthcare costs in developed countries coupled with the availability of high quality medical services at lower prices in developing nations has primarily surged the expansion of the medical tourism industry. Moreover, rise in elderly population along with growing number of uninsured population has further triggered the market growth. Patients are travelling abroad not only for cosmetic surgeries with a quick recovery, but also for sophisticated cardiovascular surgeries. Many countries plan to leverage medical tourism as a strategy to boost their healthcare services and tourism industry. By encouraging its presence in the medical tourism market, a country can stimulate its economic growth and create employment opportunities. Consequently, the medical tourism industry is rapidly expanding and is anticipated to have a significant growth in the near future. Medical tourism is a direct result of globalization of healthcare. According to the Medical Tourism Association, it was estimated that approximately 1.6 million Americans travelled to other destinations last year for medical services and this number is anticipated to grow in the near future. Rising number of uninsured population and rise in demand for cosmetic surgery is further driving market growth. There is an emerging opportunity for Asian and Middle Eastern countries that are catering to the healthcare requirements of developed countries like the U.S, Canada and European countries. Factors such as medical specializations, geographic proximity, portability of health insurance, and reputation of the country are some of the main reasons that compel the patient to move to another destination. However, factors such as problem in follow-up care, medical malpractice and others could restrain the growth of this market. 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 nten ts

Indian Spinal Injuries Centre, New Delhi, Launches Dedicated Cardiac Centre in association with Saroj super specialty Hospital

Safe and effective measles vaccine exists: Can prevent child mortality

Dr. Rajiva Kumar

In a first, 5 year old cured of liver failure and associated lung failure by a rare liver transplant

22 Medela India Hosts the Second Edition of LactoClave 2016

Thyroid Cancer is highly curable

27 WHO felicitates India for yaws maternal and neonatal tetanus elimination

India is on growth path: Scope of Medical tourism Industry is booming

COVER STORY

6 8 Over 200 people attended the TechEmerge Health Innovation Summit �� 8 The Economic Times ‘Best Healthcare Brands 2016’ honours �� 10 Glaxo SmithKline’s MenABCWY Vaccine Set to Revolutionize Meningococcal Disease Prevention �� 12 Leukemia Has Largest Pipeline and Most First-in-Class Innovation in Hematological Cancers Space �� 14 Compounds Hold Promise for New Toxoplasmosis Drug �� 24 Global Type 2 Diabetes Market Set to Almost Double to $58.7 Billion by 2025, says GlobalData �� 24 Dr Lal PathLabs launches state of the art Transmission Electron Microscopy test �� 28 GI Emergencies a diagnostic challenge �� 29 Russian and Australian scientists develop unique heart surgery device �� 32 Men Need Less Sedative Than Women During Oral Surgery �� 34 HMD 1st Indian Manufacturer to get ICMED certification �� 36 Effects of abortion on a woman’s body & Psychology �� 38 The Rise of Dental Tourism in India �� 40 Provider or Facilitator? �� 46 When Presbyopia Strikes: Dealing with Vision after 40 years of age �� 48 Text Neck - A Tech-Induced Ailment �� 50 Diet for a healthy weight loss surgery �� 52 A Future as a Home-Care Nurse �� 54 Most Common Genetic Disorders in India �� 56 Brain Cancer �� 58 Mid Size Hospitals- Small Is The New Big �� 60 Biopsy Reveals Long-Term Changes to Synthetic Jaw Bone �� Voice of Healthcare (VOH) dedicates itself to affordable & accessible public healthcare ��

Indian Spinal Injuries Centre, New Delhi, Launches Dedicated Cardiac Centre in association with Saroj super specialty Hospital

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NEWS Update

ElectroCore’s non-invasive vagus nerve stimulation (nVNS) demonstrates efficacy in preventing cluster headache and menstrual migraine

Biopsy Reveals Long-Term Changes to Synthetic Jaw Bone

The results of two studies, presented at the American Headache Society (AHS) Science Meeting last weekend in San Diego, show that using electroCore’s non-invasive vagus nerve stimulation (nVNS) therapy, gammaCore®, is effective at preventing both cluster headache and menstrual migraine. Cluster headache is considered one of the most painful conditions known to medical science with more than three hundred and fifty thousand patients in the US, and approximately one hundred thousand patients in the UK, suffering from this debilitating condition. Menstrual and menstrually related migraine sufferers form one the largest distinct subgroups of migraine patients, and is generally considered to be one of the most resistant to existing treatments. New results from the PREVA study, a randomized, prospective, controlled study of nVNS for the prevention of chronic cluster headache, was led by Dr. Charly Gaul from the Migraine and Headache Clinic, in Konigstein, Germany. The study found that, “As early as two weeks after adding gammaCore therapy to the standard of care, patients had a significant and sustained reductions in cluster headache attack frequency. This was also associated with significantly greater >25%, >50%, and 75%, response against standard of care.” Researchers from the Headache Center, Carlo Besta Neurological Institute and Foundation, Milan, Italy, the Headache and Pain Unit, Istituti di Ricovero e Cura Carattere Scientifico, San Raffaele Pisana, Rome, Italy, and the Carolina Headache Institute presented the results of their open-label pilot study of nVNS for the prevention of menstrual migraine and menstrually related migraine. The study found that prophylaxis with nVNS was effective in significantly reducing the number of menstrual migraine/menstrually related migraine days per month as well as pain intensity, analgesic use, and migraine disability. These findings demonstrate that nVNS may be an effective and safe preventative measure against menstrual and menstrually related migraine. There are currently no specifically approved therapies for menstrual migraine. “This is a significant result for the many millions of women who suffer from this debilitating condition on a monthly basis,” commented Dr. Grazzi from the Headache centre at the Carlo Besta Neurological Institute in Milan Italy who led the study. “The treatment, which is self-administered by the patient using a gammaCore device, is easy to use and without any significant side effects.”

Journal of Oral Implantology – Synthetic bone, necessary for placement of dental implants, can be made of a range of materials. Unfortunately, some people react poorly to certain synthetic bone grafts that may result in an inadequate attachment of the dental implant to the bone. A case report in the current issue of the Journal of Oral Implantology analyzed the long-term effects of a specific synthetic bone substitute material. A bone sample was removed from the patient three years after a bone graft procedure involving the maxillary sinus. The authors examined the sample to see how well the synthetic material had been accepted. A dental implant surgeon frequently needs to add bone between the jaw and the sinus to support dental implants. Synthetic materials are often used to avoid a second surgical site for retrieving natural bone from the patient. It is well known and accepted that natural (autogenous) bone can replace the substitute over a few months, and studies have examined how well the bone and tissue have formed in four to six months. The authors of this report describe a patient who had undergone a sinus bone graft surgery with the placement of a synthetic bone substitute, but refused the subsequent implant dental placement four to six months later. However, the patient did return to the dental implant surgeon for subsequent implant placement three years later. This extended time lapse provided an opportunity for the surgeon to obtain a bone sample when the dental implant placement surgery was performed. When examining the sample, the authors found a large quantity of connective tissue surrounding the remaining bone substitute. There was nearly as much synthetic material left in the sample, as there was connective tissue. In contrast, a relatively small amount of new bone tissue was discovered with limited blood vessel formation. The authors only found normal bone growth around the crestal aspect of the desired implant site; the remainder of the bone sample showed no signs of ongoing bone growth. The authors speculate that this unexpected result occurred because the graft site had been left dormant and not stimulated by the earlier placement of a dental implant. Additionally, the researchers concluded that once the connective tissue encapsulated the synthetic bone substitute, the anticipated natural bone growth ceased. It appeared that giant inflammatory cells reacted to the foreign synthetic material shortly after it was placed and may have also lead to degradation of the synthetic bone substitute over time. Further study would be needed to discover which characteristics of the bone substitute material influenced the giant cell reaction.

www.m e d e g a t e t o d a y. c o m July-Aug 2016

NEWS Update

Voice of Healthcare (VOH) dedicates itself to affordable & accessible public healthcare

The governing council of voice of healthcare had its organizational annual meeting recently. The meeting was chaired by chairman of VOH Dr. Naveen Nishchal & attended by Mr. Afzal Kamal, General Secretary, Mr. Manish Rastogi Joint Secretary & esteemed Members. The council intensely deliberated for long hours on healthcare issues ranging from falling standard of medical educations to increasing expectation & aspiration of patients. The chairman Mr. Naveen Nischal pointed out glaring contrast between industry efforts for best international quality accreditations on one side & lack of basic healthcare facilities across India for rural & urban poor population on other side.

All the members of the council emphasized over an active role of VOH in improving the rural & urban healthcare standards in association with all the industry bodies, Healthcare NGOs, various govt. health departments. The council was unanimous on plugging the chronicle gaps in healthcare service delivery through all possible resources like technology, media etc.

The council also expressed its willingness to work with international healthcare organizations like UN, WHO etc. to coordinate as well as spearhead their healthcare programs in India. The council concluded its meeting with its earnest request to govt to ensure public & industry friendly healthcare reforms as well as to declare of Right to Healthcare as fundamental right.

Over 200 people attended the TechEmerge Health Innovation Summit Including C-suite executives from Indian healthcare providers, CEOs of health technology companies from around the world and strategic partners in the healthcare ecosystem. The event showcased live demos from innovators featuring a range of technologies from patient engagement tools to point of care diagnostics. Dr. Lal, Chairman and Managing Director of Dr. Lal PathLabs and Senior Vice President of NATHEALTH, presented the opening keynote on the importance of pilot programs in the health technology sector. More than 20 Indian healthcare providers attended the TechEmerge Health Innovation Summit and over one hundred 1-on-1 matchmaking meetings between the healthcare providers and innovators took place. For the pairs that intend to move forward with a formal partnership, the healthcare providers and innovators will engage in a series of discussions to develop the pilot design, timeline, key 8

www.m e d e g a t e t o d a y. c o m July-Aug 2016

milestones and factors that will determine success. With programmatic support and a pool of $1,000,000 in funding, we hope to accelerate the adoption of new technologies in the Indian healthcare market. Thank you to our event partner NATHEALTH, our program partners, the Finnish Ministry of Employment and the Economy and the Israeli Ministry of Economy and Industry, and all of the participating healthcare providers, innovators and other industry experts for your vision, knowledge and support of the TechEmerge program. We look forward to seeing fruitful relationships develop that will contribute to improve healthcare delivery in India and beyond. View the TechEmerge Health Innovation Summit brochure to dive into the eventâ&#x20AC;&#x2122;s featured presentations, leading healthcare providers and health tech startups from around the world [insert link to updated brochure in PAGES version

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NEWS Update

The Economic Times recently felicitated leading Healthcare brands as a part of their ‘Best Healthcare Brands’ Summit held in Delhi. Among the felicitated were Apollo Hospital, Asian Institute of Medical Sciences, Max HealthCare, Abbott India and Johnson & Johnson. Addressing the event, Jagrat Prakash Nadda, Honourable Minister for Health and Family Welfare, Government of India quoted “We are facing dual challenges of communicable and non-communicable diseases; of the gap between urban and rural healthcare; between public and private healthcare. And so we have to see in a holistic manner how to bridge gaps such as these. The government of India is keen to see the industry come forward in PPP mode to do research together, to go forward in this direction to develop healthcare protocols. And so we are looking to fill the gaps to ensure the logistics is provided well. When we talk of universal healthcare, it is not to remain merely a slogan; we are trying to make it a reality.” In recent times, the healthcare sector has grown to become one of the most progressive and promising sector in India. Various factors such as increase in life expectancy, expanding middle class and higher income levels have contributed to this. Additionally, India sees at least 2,30,000 medical tourists in a year making Indian medical tourism a US$ 3 billion industry and this too is expected to go up to US$6 billion by 2018. Also present was Dr. (Prof) Jagdish Prakash, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, who shared his views on healthcare by adding “62% of the Indian population is seen by 2% of the doctors, with 98% of our doctors seeing the other 38%. This is the reality of our country; doctors are concentrated only in cities, not in villages. Our states have to develop their infrastructure. Corporates should come forward and adopt districts and help the government in this way. Corporates can feel great pleasure from doing this and making their districts 100% disease free and with improved infrastructure”. Healthcare in India, comprising hospitals, medical devices, health insurance, medical equipment, clinical trials, 10

www.m e d e g a t e t o d a y. c o m July-Aug 2016

The Economic Times ‘Best Healthcare Brands 2016’ honours

pharmaceuticals and wellness companies, is one of the largest revenue garnering sectors in India. Its increase at a brisk pace is being attributed to both – the services and the increased expenditure by private and public players in the sector. Attending the event was Dr.Sowmya Swaminathan, Secretary-Department of Health & Research, Ministry of Health & Family Welfare, Government of India. She stated “Many come to India not just because of the cost of healthcare, but because of the high quality of healthcare. So there is a lot to be proud about, but we need to be aware of challenges and inequities that could trip us up. There are many social determinants of health, and unless we address this we will not be a healthy nation. Preventive healthcare is important for all sections of society”. The Best Brands Initiative of The Economic Times commenced in the year 2014 and was backed by thorough research and study conducted through a detailed market research. An extensive survey was conducted in association with MRSS and healthcare brands were graded after considering the parameters of innovation, brand value, brand recall, consumer satisfaction, customer service and quality. The result of the research was also collated in a Brand Book which was launched at The ET Best Healthcare Brands Summit.

Following are the brands which were felicitated at the summit:  Apollo Hospitals  Asian institute of medical sciences  Columbia Asia Hospitals  Max Healthcare  Ruby hall clinic  Sir Gangaram Hospital  Asian Heart Institute  Ayurvaid Hospitals  Cloudnine Care  Oasis centre for reproductive  Abbott India Pharmaceuticals  Dr. Reddy  GlaxoSmithKline Pharmaceuticals  Sanofi India Pharmaceuticals  3M India Medical Devices  Becton Dickinson India Medical devices  BPL Medical Technologies  GE Healthcare  Lotus Surgicals  MED-EL India  Sahajanand Medical Technologies  Siemens Healthineers  Sirona Dental Systems  Smith and Nephew Healthcare  Transasia Bio-Medicals  Dabur India  Hamdard Laboratories  Hexagon Nutrition  Himalaya Wellness  Johnson and Johnson  Trophic Wellness - NutriCharge  Medall Diagnostics  Apollo Life  Clove Dental

NEWS Update

Glaxo SmithKline’s MenABCWY Vaccine Set to Revolutionize Meningococcal Disease Prevention Market by 2025, says GlobalData A vaccine protecting against meningococcal serogroups A, B, C, W, and Y (MenABCWY) is set to revolutionize meningococcal disease prevention across the eight major markets (8MM) of the US, France, Germany, Italy, Spain, the UK, Japan, and Brazil, according to research and consulting firm GlobalData. The company’s report* states that of the three major meningococcal vaccines currently being developed in the 8MM, only GlaxoSmithKline’s (GSK) MenABCWY vaccine has the potential to significantly change the approach used by countries to prevent meningococcal disease. Its launch would offer a vaccine that can protect against all common serogroups foun d in the 8MM in a single product and, should it perform well in upcoming Phase III studies, has the potential to become the leader in a market projected to be worth $1.8 billion by 2025. Mirco Junker, Ph.D., GlobalData’s Analyst covering Infectious Diseases, explains: “MenABCWY, effectively a co-formulation of GSK’s Menveo and Bexsero, could reduce the shot burden for patients, and will hold an advantage over other formulations in its combination of conjugated polysaccharides and purified protein-based antigens. “While polysaccharide vaccines can provide excellent protection in individuals against a specific set of serogroups, these vaccines are limited in their protective ability to these serogroups. By contrast, protein-based meningococcal vaccines, which include the MenB vaccine, can also protect against strains from other serogroups. “Combining polysaccharides from a MenACWY vaccine with the protein-based antigens from Bexsero into one vaccine, therefore, might provide effective protective coverage.” Following the expected launch of a MenABCWY vaccine in the US and the five European markets in 2020, national routine immunization schedules are likely to be altered, with the new MenABCWY vaccine potentially replacing a majority of routinely administered meningococcal vaccines. Indeed, MenABCWY is touted as a possible replacement for the MenACWY booster currently recommended to be administered to adolescents in the US. Junker concludes: “Currently, there are no products in the pipeline specifically designed to provide long-term protection against invasive meningococcal disease. However, several clinical trials, including for MenABCWY, are being conducted to further address this important unmet need in meningococcal disease prevention.” GlobalData forecasts that GSK’s MenABCWY vaccine will have sales of just under $437 million in 2025 across the 8MM. 12

www.m e d e g a t e t o d a y. c o m July-Aug 2016

MR Solutions offers choice of two preclinical cryogen-free MRI scanner ranges MR Solutions, which introduced cryogen-free MRI scanners in 2012, is now offering a choice of two cryogen-free preclinical scanner ranges – the Flexiscan and Powerscan. The Flexiscan range is available with multimodality accessories which can be mixed and matched according to research requirements. It is a flexible MRI system as it can incorporate integrated multi-modality options such as PET or SPECT. The Flexiscan system requires no specialist knowledge and can be operated simply by running pre-defined settings. There is no need to materially alter the parameters of the machine. The Powerscan range is available with adjustable magnetic field strengths ranging from 0.1T to 9.4T. The system allows physicists to alter the hardware, software, pulse sequences and algorithms to customise the capabilities of their preclinical imaging research. MR Solutions’ Chief Executive, Dr David Taylor, said: “Our preclinical MRI product ranges now cover the best of both worlds; the Flexiscan, a simple to operate system which is ideally suited to most research laboratories, and a second product family, the Powerscan, for scientists who would like the ability to customise their system’s configuration.” Both the Flexiscan and Powerscan ranges share the many advantages of being cryogen-free. Not the least of which is the lower price, as being cryogen-free eliminates the need for the large and cumbersome helium cooling system, the emergency venting system to cope with the helium turning to gas, or the expensive building alterations needed to accommodate it. Another key advantage is that with a stray field of a few centimetres, the scanner can be placed near other scanners and sensitive equipment and does not require its own room. This speeds up transfer times between different scanning technologies. Both systems can incorporate integrated PET and SPECT imaging solutions, allowing researchers to carry out independent imaging using the PET or SPECT modules, or sequential and simultaneous imaging. Software allows the co-registration of images to maximise the acquisition and quality of imaging data. In 2012, MR Solutions developed the world’s first commercially available high-performance 3T preclinical MRI bench-top scanner using superconducting magnets, which eliminates the need for liquid helium cooling. MR Solutions further enhanced this development with the release of innovative, high-resolution PET and SPECT modules which can be added to create integrated multi-modality systems. A more powerful 7T range followed in 2014 and the company has already announced a 9.4T MRI scanner for delivery at the end of the year. MR Solutions, a winner of the prestigious Queen’s Award for Enterprise 2016 for innovation in the UK, has over 30 years’ experience and in excess of 1000 installations across the world. This includes sales of their MRI spectrometers. Its scanners are renowned for their excellence in terms of superior soft tissue contrast and molecular imaging ability.

NEWS Update

Leukemia Has Largest Pipeline and Most INTERNATIONAL AIDS SOCIETY (IAS) RELEASES NEW First-in-Class Innovation in Hematological STRATEGY TO GUIDE GLOBAL HIV CURE RESEARCH. in Nature Medicine, the IAS Global Scientific Cancers Space,says GBI Research Published Strategy: Towards an HIV Cure 2016 Is a Roadmap for Of the three major indications within hematological cancer, namely leukemia, lymphoma and myeloma, leukemia has the largest pipeline, with 798 products in active development, while lymphoma has 552 and myeloma has 396, according to business intelligence provider GBI Research. The company’s latest report* states that there are currently 1,234 pipeline products in active development in the hematological cancer therapy area, and for each of the three key indications, the composition by stage of development is relatively similar, although leukemia and myeloma have more products in clinical development. Yasser Mushtaq, Senior Analyst for GBI Research, explains: “Leukemia has the most products in the hematological cancers pipeline, with 349 in clinical development and 446 in earlystage development, while three products had an undisclosed stage of development. In terms of individual stages, however, Preclinical is the largest across leukemia and lymphoma, while Phase II is the largest in myeloma. It is notable that Phase II also contains many products for leukemia and lymphoma, which is a promising trend for product development. “The leukemia indication contains the most first-in-class products, with 195, while the lymphoma and myeloma pipelines contain 186 and 82 first-in-class products, respectively.” GBI Research’s report also states that considerable unmet needs remain in hematological cancer, with acute myeloid leukemia (AML) particularly ill-served, as there is a need for more efficacious targeted therapies across all patient subtypes. The treatment of AML is still limited to conventional DNAtargeted chemotherapy regimens, which achieve long-term survival rates of 25-50% in patients below the age of 60, and only 5-15% in older patients, indicating a clear need for more efficacious treatments. Mushtaq continues: “Across other forms of hematological cancer, while some targeted therapies are already present in the market, reducing the rates of relapse and improving survival rates among patients who do relapse are particular areas of need. “For example, across follicular lymphoma (FL), mantle cell lymphoma (MCL) and diffuse large B-cell lymphoma (DLCL), first-line treatment in patients is typically cytarabine-cased chemotherapy in combination with rituximab. Despite largely positive response rates, almost all patients ultimately relapse, with progression-free survival values of one to two years in MCL and above three years in FL and DLCL, presenting a notable need across the non-Hodgkin’s lymphoma pipeline for more effective maintenance therapies to prevent disease relapse.”

www.m e d e g a t e t o d a y. c o m July-Aug 2016

Researchers, Donors, and Stakeholders

Working to Achieve HIV Cure or Remission A comprehensive new strategy, developed by the International AIDS Society (IAS) and published online today in the journal Nature Medicine, presents key priorities for research to develop what experts consider to be one of the most important global health goals of our time – a cure for HIV. The new IAS Global Scientific Strategy: Towards an HIV Cure 2016 was developed over two years by a 59-member IAS International Scientific Working Group and reviewed through an extensive global peer consultation process. The new strategy, which is being published prior to the opening of the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa, analyzes recent research achievements in HIV cure research, obstacles to a cure and the strategies and priorities to advance the field. Advances in HIV cure or remission research will be a major focus of AIDS 2016, which begins with the fifth annual Towards an HIV Cure Symposium, 16-17 July, in Durban. “Not long ago, few considered the possibility that a cure for HIV infection could some day be possible,” said Nobel Laureate Françoise Barré-Sinoussi, co chair of the IAS Towards an HIV Cure Initiative. “Today, thanks in part to advances such as the cure of an HIV-infected individual through a stem cell transplant, the identification of a small cohort of individuals who are able to control infection following treatment, and some noteworthy advances in cell, gene and immune therapy, the search for a cure has become a top priority in HIV research. In 2016, that search is marked by growing scientific interest, an increasing number of novel research strategies in development, and a new optimism that a cure or sustainable remission for HIV is feasible.” While the development of ART regimens that can control HIV have led to dramatic improvements in the health and life expectancy of those with access to the drugs, researchers and policy makers preparing for AIDS 2016 note that treatment is not a cure. Current treatment strategies present serious limitations, including the immense economic, operational and logistical challenges associated with delivering life-long care to the nearly 37 million people now living with HIV. Individuals living with HIV must also manage adherence, drug toxicities, and the persistent immune dysfunction, inflammation and risk of co-morbidities associated with HIV infection. The new IAS Global Scientific Strategy: Towards an HIV Cure 2016 builds on the first IAS cure strategy, published in 2012, which presented the first global roadmap to HIV cure research. This “second chapter” in the search for a cure outlines the past achievements and future priorities in basic, translational, clinical, and social sciences research, along with a new focus on aspects of HIV cure research that have achieved greater significance since 2012, including:

NEWS Update

Medela India Hosts the Second Edition of LactoClave 2016

Human Milk Banks: A Saviour for Infants

 WHO says that 80 per cent of pre-term babies can be saved by breastfeeding  India contributes to one-fourth of the world’s pre-term babies  A human milk bank is the best and only source of human milk next to mother’s milk  Pasteurised human milk is absolutely safe for consumption  Huge demand supply gap due to low awareness  Human Milk Banks is an Unorganised Sector in India Medela India, the world’s leading global producer of breast pumps and nursing accessories today organized the second edition of LactoClave 2016 an initiative to bring together experts and discuss the need and importance of mother’s milk. For its second edition LactoClave was organized in association with Fortis La Femme Hospital and the topic was ‘Human Milk Banks- Banking on Mothers Milk’. India has the highest number of deaths due to premature births and ranks 36th among the number of pre-term births globally. A large number of infants don’t survive due to poor feeding practices in the country. Mother’s milk is the best and first source of nutrition for babies. WHO recommends that pre-term and low birth weight infants should be fed with mother’s milk and when a mother is unable to express milk, then a Human Milk Bank is the only alternative. With an aim to educate new and expecting mothers on the utility and benefits of a human milk bank, this conclave brought together Gynaecologists, Neonatologists and Lactation consultants from Fortis Hospitals in an innovative webinar format. The panel discussion gave mothers from all over the country an opportunity to participate in an event which acted as a great source for facts and insights on human milk banks in India. Present on the occasion was Dr. Raghuram Mallaiah, Director Neonatology, Fortis La Femme who highlighted that human milk banks are not an age old concept. “The first milk bank in India was set up way back in 1989 in Mumbai. However, there has not been enough awareness generated around the necessity 16

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and utility of milk banks. Human milk is a life saviour especially for pre-term and low birth weight babies. Its acts as a stop gap measure for infants who don’t have access to mother’s milk due to various health reasons. Human milk is the best and safest feed for a baby next to mother’s own milk”. Adding further, Dr. Anita Sharma, Lactation Consultant, Fortis La Femme elaborated “A lot of mothers have surplus milk even after establishing lactation with their own babies and identification of such mothers are important so that they can come forward and donate milk for vulnerable babies who really need it. A breast pump is very vital for donor mothers as it helps them express milk in a better and safer way as compared to manual pumping. Mothers can use a variety of breast pumps from manual to electric to help them express excess milk”. Dr. Madhu Goel, Senior Consultant, Obstetrics and Gynaecology, Fortis Hospitals said, “Any lactating mother having excess milk is fit to donate the same after going through mandatory blood tests and basic screening. However, mothers who consume alcohol, caffeinated drinks or other infections cannot donate. Talking about mother’s milk, Dr. Lata Bhat, Head, Department of Neonatology, Fortis Hospitals, Noida said “Mother’s own milk is best suited to a child as it evolves over time and is tailor-made according to the child’s requirements. Mother’s milk is rich in essential nutrients and prevents the child against a host of fatal diseases and infections. It also leads to better brain development of the child. However, in the absence of mother’s milk, any other human milk is the best possible alternative”.

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In a first, 5 year old cured of liver failure and associated lung failure by a rare liver transplant

ould have to be a red-letter day for rare cases of liver failure with associated lung failure. It was on this day that in a first in the country, 5 year old Paridhi underwent a highly complex and treacherous liver transplant to cure her of both, the liver and lung failure. Her mother Mamta, who donated 20% of her liver to save her darling, said, “ my husband Nitin and I had nearly given up all hope of getting Paridhi well as doctors in Mumbai had said that her case was far too advanced for a liver transplant. Then about 3 months ago, we met the Medanta liver team who offered to try and save our child provided we understood that the transplant would be very high risk due to her low oxygen state. We took the chance as a last resort and God heard our prayers.” Dr AS Soin, Medanta’s Chief Liver Transplant Surgeon who led the team said, “we have a long experience of operating milder cases of hepatopulmonary syndrome (HPS - when liver failure affects the lung circulation and in extreme cases, results in respiratory or lung failure), but had never taken on a such an advanced case with nearly 50 % shunt fraction , before”. Explaining the patient’s state prior to transplant, Dr Neelam Mohan, Director of Children’s Liver Diseases and Transplantation, said that Paridhi had been suffering since birth from biliary atresia for which an operation at 2 and a half months did not prove successful. She then deteriorated,had life threatening liver infections with 8 prolonged admissions in hospitals and when she came to us, she was deeply jaundiced, had marked growth failure, had severe HPS with oxygen saturation less than 70 % causing breathlessness,necessiatating continuous oxygen and had blueing and rounding of her nails typical of a low oxygen state.“We took her up as one of the most challenging cases, and carried out an intensive nutritional and medical

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preparation to take her through the transplant successfully, she remarked.” Elaborating on the risks and challenges her operation posed, Dr Soin said, “liver transplant is complex as it is, and therefore, requires perfect function of all other organs. Here, there was a real danger of Paridhi not waking up after surgery due to brain, heart or kidney injury, or, for that matter the new liver not kicking in, if the already low levels of oxygen fell any lower. So we had to do a bloodless, zero error, quick surgery, not allowing any fluctuation in the blood pressure, and with 100% oxygen support.” Dr Vohra, Head of Anesthesia, added that in order to prevent dangerous fall in oxygen levels, they had resort to continuous nitric oxide treatment during surgery, keep a watch on the heart by a special ultrasound probe inserted in the patient’s food pipe, and keep an artificial lung machine on standby. According to Dr Neelam Mohan, Paridhi’s postoperative treatment was also a challenge as the low oxygen state takes several weeks to correct. Nitric oxide, high external oxygen, ventilator support, temporary breathing route (tracheostomy) were necessary

for many days. Infact , she was on ventilatory support for four weeks post operatively followed by oxygen support . Eventually , we discharged Paridhi home after 33 days of surgery. She now breathes normally without extra oxygen, and will grow like a normal child and live a healthy life. Dr Naresh Trehan, CMD and Chief of the Heart Institute, said “Paridhi’s case was easier to handle at Medanta since we use nitric oxide therapy and artificial lung machine quite often on patients with serious heart diseases affecting the lungs”. Medanta’s strong multidisciplinary expertise came to the rescue here, he felt.

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NEWS Update

Indian Spinal Injuries Centre, New Delhi, Launches Dedicated Cardiac Centre in association with Saroj super specialty Hospital  The centre will be functional from August 1, 2016 at the Indian Spinal Injuries Centre facility  The centre will be especially beneficial for those who have a combination of skeletal and cardiac problems With the aim of expanding their services, Indian Spinal Injuries Centre (ISIC), New Delhi, has launched a dedicated cardiac centre in association with Saroj super specialty hospital. The department will provide patients with treatments and surgeries medical and surgical management related to the heart. The new centre, designed with state-of-the-art-facilities, is being has been launched in association with Saroj Super Specialty Hospital, New Delhi, and will be functional from August 1, 2016. The facility will operate under a team of both preventive and interventional cardiologists. Prior to this, ISIC offered non-invasive services for cardiovascular disease (CVD). Spinal-cord injury (SCI) and other trauma-related problems both during acute (short-term) and chronic stages (long-term) of come with the risk of CVD. Heart-related episodes often occur SCI, and are a common cause of morbidity. In addition many of the patients suffering from spinal and orthopeadic diseases are in the geriatric age group and as such require a good cardiological support if they have to undergo a surgery. The cardiac unit will therefore bolster the core strength of the hospital’s spinal and orthopedic specialization. This new dedicated service will ensure 360-degree spinal-cord-injury care. It will also sensitize caregivers to possible risks of CVD. “It is not a well-known fact that cardiovascular diseases occur in spinal cord injury patients. The main reason for the prevalence is that the autonomic nervous system is affected, meaning that involuntary functions of the body may be compromised, including the beating of the heart and related functions. This is most common especially in individuals with high thoracic and cervical SCI. Also, patients’ hampered movements increases risk factors for heart disease: the lack of exercise, resulting in obesity, and in some cases even stress and depression. High cholesterol and insulin resistance are also common in the group. Considering these factors, we took the initiative to launch a dedicated cardiac centre that will offer treatment to support our other specializations,” said Dr. H S Chabbra, Medical Director, Indian Spinal Injuries Centre On the association with Saroj Super Specialty Hospital, Dr. P K Bhardwaj, Medical Director said: “We believe that our two hospitals share a common ethos of patient-centric care. Both are NABHaccredited and believe in the fundamentals of safe tertiary care: of providing patients with the most experienced doctors and support staff, as well as the most advanced equipment and facilities.”

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NEWS Update

WHO felicitates India for yaws maternal and neonatal tetanus elimination

auding India’s most recent public health achievements, World Health Organization today presented certificates declaring elimination of yaws and maternal and neonatal tetanus to the Health and Family Welfare Minister, Mr J P Nadda. “India’s focussed approach on making maternal and newborn care accessible to all and addressing health care equity more generally has made these remarkable successes possible. These victories are not only India’s but all of humanity’s as the country accounts for approximately one-sixth of the world’s population,” Dr Poonam Khetrapal Singh, Regional Director, World Health Organization South-East Asia Region, said after presenting the certificates to the Minister here today. In May this year, WHO certified India yaws-free after a team of experts verified interruption of disease transmission in the country. India is the first country under the 2012 WHO neglected tropical diseases (NTD) roadmap to eliminate yaws, a disease known to affect the most underserved population. It is said ‘where the road ends, yaws begins’. “Highly targeted awareness and early treatment campaigns in vulnerable communities enabled treatment of yaws cases and interruption of disease

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transmission,” Dr Khetrapal Singh said, commending India’s capacity and commitment to eliminating NTDs, which serves as an example to other countries. The Regional Director described India’s achievement of maternal and neonatal tetanus elimination (MNTE) as a momentous public health feat, as until a few decades ago the country reported 150 000 to 200 000 neonatal tetanus cases annually. Reducing maternal and neonatal tetanus to less than one case per 1 000 live births in all 675 districts demonstrates India’s strong commitment and leadership that helped improve access to immunization, antenatal care services and skilled birth attendance in the most vulnerable populations – the poor, the remote and isolated communities. Both yaws and maternal and neonatal tetanus eliminations were achieved using the existing health system and health workforce. Sustained political commitment and clear policies, unified strategies, close supervision and monitoring, tireless efforts of the frontline workers, and invaluable support of partners, particularly for MNTE, were the key factors for these

public health feats, Dr Khetrapal Singh said, adding that the lessons learnt from yaws and MNTE should inform the design and implementation of future disease control programs in the country. Both achievements will not only improve the health of marginalized communities, but will also enhance their socio-economic status and contribute to India’s wider development, the Regional Director said. After India’s success in MNTE, Indonesia was validated for the same on 18 May this year. With this the entire WHO South-East Asia Region has achieved elimination of maternal and neonatal tetanus. WHO SEAR is the second WHO region, after European Region, to achieve MNTE. Indonesia and Timor-Leste are now the only remaining countries with yaws transmission in the WHO South-East Asia Region. WHO’s South-East Asia Region comprises the following 11 Member States: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

NEWS Update

Compounds Hold Promise for New Toxoplasmosis Drug

The Journal of Parasitology – Many people carry a single-celled parasite known as Toxoplasma gondii but never feel its effects. However, when an AIDS patient carries the parasite or a newborn is infected at birth, it can lead to devastating disease. Few drugs currently exist to treat such infections, but new research could soon change that fact. It has been estimated that more than 15 percent of Americans ages 12 to 49 are infected with T. gondii. The T. gondii parasite frequently targets those with compromised or undeveloped immune systems. Newborns infected at birth rarely show symptoms, but toxoplasmosis can develop in later years. There are a few drugs that can treat the infection, but these often have serious side effects and researchers are exploring safer treatment options, particularly for pregnant women. A study in the current issue of The Journal of Parasitology was conducted to determine whether certain compounds can fight the T. gondii parasite. The authors utilized a model in which toxoplasmosis existed at birth to assess the anti-Toxoplasma effects of two different compounds.

Using mice as subjects, the authors studied infections transmitted from mother to fetus during pregnancy. Mice were treated with either estragole or thymol, and then compared against both untreated and uninfected mice. Their study is the first report on how estragole and a particular strain of thymol behave in mice infected with T. gondii. The researchers found that both compounds increased the survival rates of infected mice. It did not appear to matter whether the mice were treated by injection under the skin or orally. In most cases, the treated animals gained more weight as they developed than the untreated mice, an effect that could be significant for people when considering symptoms during childhood. The study also indicated that estragole and thymol can be used safely in animals. More mice with toxoplasmosis survived when treated with these compounds than mice that were not treated. More studies are needed to learn how the compounds change the way the parasite and its host interact, and to move closer to a new drug that can treat the devastating toxoplasmosis disease.

Global Type 2 Diabetes Market Set to Almost Double to $58.7 Billion by 2025, says GlobalData The global type 2 diabetes market is set to almost double from $31.2 billion in 2015 to $58.7 billion by 2025, representing a compound annual growth rate of 6.5%, according to research and consulting firm GlobalData. The company’s latest report* states that this growth, which will occur across the nine major markets of the US, France, Germany, Italy, Spain, the UK, Japan, China, and India, will primarily be attributable to a dramatic increase in the diagnosis and prevalence of the disease, and the fact that the rise in type 2 diabetes-related comorbidities has fueled a more aggressive approach in treatment and the use of multiple-drug therapies. Jesus Cuaron, Ph.D., PPM, GlobalData’s Analyst covering Cardiovascular and Metabolic Disorders, explains: “Increases in disease incidences will result from increased life expectancy and lifestyle changes, such as dietary changes and a reduction in exercise. “Indeed, the US will be impacted the most by such changes, increasing its global market share from 58% to 66% during the forecast period.” Due to the increasing prevalence and progressive nature of type 2 diabetes, there are considerably high unmet needs within the indication. Overall, these unmet needs are interrelated and include improved durability of treatment, a better balance of efficacy of glycemic control with cardiovascular safety, hypoglycemia avoidance, and tolerability and ease of compliance. Cuaron continues: “Currently, all available treatments for type 2 diabetes are initially effective and reduce complication 24

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rates. The need for drugs which are able to maintain glycemic control in the long term, however, represents a significant growth opportunity for new patent-protected products. “Molecules in the earlier stages of development - Phase II or earlier - employ various novel mechanisms of action. Early-stage novel drug classes include those such as 11-beta-hydroxysteroid dehydrogenase type 1 inhibitors and glucokinase activators” GlobalData believes that in order to address the biggest unmet need in type 2 diabetes, new drugs must address the problem of insulin resistance, as this is the root of the disease.

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EXPERT VIEWS

Lower risk of bowel cancer death linked to high omega 3 intake after diagnosis Home cooked meals for infants not always better than shop bought ones Lower risk of bowel cancer death linked to high omega 3 intake after diagnosis People with the disease may benefit from boosting dietary oily fish content, say researchers A high dietary intake of omega 3 fatty acids, derived from oily fish, may help to lower the risk of death from bowel cancer in patients diagnosed with the disease, suggests research published online in the journal Gut. If the findings can be reproduced in other studies, patients with bowel cancer might benefit from boosting their oily fish intake to help prolong their survival, say the researchers. Previous experimental research has shown that omega 3 polyunsaturated fatty acids (PUFAs)—namely, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and docosapentaenoic acid (DPA)—can suppress tumour growth and curb blood supply to malignant cells (angiogenesis). The researchers base their findings on the participants of two large long term studies: the Nurses’ Health Study of 121,700 US registered female nurses, aged between 30 and 55 in 1976; and the Health Professionals Follow Up Study of 51, 529 male health professionals, aged between 40 and 75 in 1986. All participants filled in a detailed questionnaire about their medical history and lifestyle factors when they joined the studies, and this was repeated every two years subsequently. The information requested included any diagnosis of bowel cancer and other potentially influential factors, such as height, weight, smoking status, regular use of aspirin and non-steroidal inflammatory drugs, and exercise taken. Data on what they ate were collected and updated every four years, using Food Frequency Questionnaires, with categories for each nutrient ranging from ‘never or less than once a month,’ to 6 or more times a day.’ The completeness of the data was above 95% for each of the questionnaires in both studies through to 2010. Among 1659 participants who developed bowel cancer, 561 died; 169 of these were classified as deaths from the disease during an average monitoring period of 10.5 years. Other major causes of death included cardiovascular disease (153) and other cancers (113). Participants with a higher dietary intake of omega 3 from oily fish were more likely to be physically active, take multivitamins, drink alcohol and to consume more vitamin D and fibre. They were also less likely to smoke—all factors associated with a lower risk of bowel cancer. But those who had been diagnosed with bowel cancer and whose diets contained higher levels of marine omega 3 had

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a lower risk of dying from the disease. Omega 3 intake, however, was not linked to a lower risk of death, overall. The extent of the reduced risk seemed to be linked to dose, with higher doses associated with lower risk, the findings showed. This held true even after taking account of intake prior to the diagnosis, as well as other potentially influential factors. Compared with patients who consumed less than 0.1 g of omega 3 fatty acids daily, those who consumed at least 0.3 g daily after their dia gnosis, had a 41% lower risk of dying from their disease. This reduced risk applied to food sources and supplements, although few people used omega 3 fish oil supplements, the researchers point out. The association between marine omega 3 intake and lowered risk of death seemed to be particularly evident among those who were tall, had a BMI below 25, or who didn’t take regular aspirin. And increasing intake of marine omega 3 by at least 0.15 g daily after diagnosis was associated with a 70% lower risk of dying from bowel cancer; while a reduction in daily intake was associated with a 10% heightened risk of death from the disease. Similar patterns were evident for death from all causes (13% lower and 21% higher, respectively) in those who either increased or decreased their intake after diagnosis. This is an observational study so no firm conclusions can be drawn about cause and effect, but the researchers say that their findings provide the first line of population based evidence for the potentially positive impact of oily fish omega 3 fatty acids on bowel cancer survival. “If replicated by other studies, our results support the clinical recommendation of increasing marine omega 3 PUFAs among patients with bowel cancer,” they conclude.

EXPERT VIEWS

Thyroid Cancer is highly curable Survival rates in well differentiated thyroid cancer are much better than any other cancer

The word cancer has become associated with death. Today, one hears of many stories of people battling different types of cancers, and while some survive, others don’t. However, one rarely hears of Thyroid cancer, which is now emerging as one of the fastest growing cancers in the world.

Dr. CS Bal, Professor & Head, Department of Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), Delhi who exclusively works in this field for last two-andhalf decades and considered an authority in thyroid cancer treatment says that “Thyroid cancer patients, if treated early and on time, can reach a stage when they are disease free.” There was a case in his department of a patient, who was detected with Thyroid Cancer with lymphnode and lungs metastases when he was 16 years old. He was treated with radioactive iodine and on regular follow- ups, and today, at the age of 48, he is disease free and now may not need any further follow-up. According to the doctor, out of 7500 thyroid cancer patients, there are many such cases like him, where people come for treatment and are able to lead normal disease free lives after the treatment process. Thyroid cancer is the most common cancer of the endocrine system and occurs in all age groups, including children. In India the number of new cases of thyroid cancer is 1-2 per 100,000 men and women per year[1]. According to Dr. Bal, “I am sure that India has one of the highest burdens of thyroid cancer, and, on an average, we see at least 700 cancer cases a year in our hospital alone, it is a cancer with the second burden in the US and there are reports that say that by 2030 it will be the most prominent cancer in the world.”

Amongst men as well as women, the number of new cases of thyroid cancer is increasing at a faster rate than any other type of cancer. Papillary and follicular cancers often referred to as “Well-Differentiated” thyroid cancers (WDTC), and are the most common. Together, they account for about 90% of thyroid cancers. Generally, the prognosis, or long-term outlook, for patients diagnosed with WDTC is very good. “It is important to note that there is no real information on the burden of this disease in India, and this is because we don’t have an official registry of the same.” Dr. Deepak Sarin (Associate Director, Head and Neck Oncology Surgery, Medanta - The Medicity). He further goes on to state that “The reason that there is an increase in the burden is twofold - one is due to an increase of patients with this disease and the otheris the fact that now more people are being tested for the disease. “ Thyroid cancer symptoms may include a lump in the neck, pain in the lower front part of the neck, swollen lymph nodes in the neck, hoarseness of voice, and trouble in breathing and swallowing. Physical examination, blood tests, thyroid and other scans, thyroid ultrasound, fine-needle aspiration biopsy and surgical biopsy can be done to detect thyroid cancer in a patient. “Thyroid cancer is highly curable and not a death sentence, whether detected early or late with the right treatment all patients live a normal healthy life.” Says Dr Sarin. For most thyroid cancer cases, the entire thyroid is removed via surgery followed by radioactive iodine therapy (in a majority of cases). In most of the advanced WDTC surgeries, as part of the post-surgical procedure, patients are required to go for radioactive iodine scans or ablation procedure. To have a successful outcome of this procedure, patients are required to have high levels of thyroid-stimulating hormone (TSH or thyrotropin) in the blood which can be given either by withdrawing thyroid hormone therapy or through the use of recombinant thyroid stimulating hormone injections. A successful treatment plan involves adopting a collaborative approach and combining the expertise of head and neck surgeon, general surgeon and a nuclear physician. According to Dr Sarin,“India has advanced treatment facilities available for patients suffering from thyroid cancer. There are also new innovations to look forward to for the cure of the cancer. Molecular markers will be used to identify and differentiate between each cancer. All cancers will be individually identified and treated individually. This will help in expeditingthe treatment process.” On World Thyroid Day, Dr. Bal says that the one message that he would like people to know is that “Thyroid cancer is a straight forward cancer with a straightforward treatment and excellent outcome.” w w w.medegatetoday.com July-Aug 2016

PRODUCT LINE

Dr Lal PathLabs launches state of the art Transmission Electron Microscopy test Dr. Lal PathLabs is proud to be the first private laboratory in India to set up a Transmission Electron Microscope facility. We have a dedicated TEM lab housing state- of -the -art 120 kV JEOL Transmission Electron Microscope, located at the National Reference Laboratory (NRL), New Delhi. The facility incorporates a dedicated sample processing unit and is backed by a team of highly experienced & renowned pathologists and specially trained technical staff.

Applications of TEM

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TEM finds application in diagnostic pathology, cancer research, virology, materials science as well as pollution, nanotechnology and semiconductor research. The high magnification of the electron microscope enables observations not possible by light microscopy and electron microscopy is considered to be an essential component of human diagnostic renal pathology, Neuromuscular Pathology: neuromuscular pathology and is a useful tool in difficult cases in oncosurgicalpathology. The use of immunoelectron  In muscle fibres, the characteristic diagnostic features of several myopathies, glycogenic storage vacuoles, microscopy enables ultrastructural localization of antigens of nemaline myopathy, actinopathies, and hyaline body interest. Additionally, when samples for electron microscopy myopathy etc. can be seen only with the use of TEM. are inadequate, valuable diagnostic information can be obtained from ultrastructural investigations on reprocessed  Tumours of the CNS for which EM is useful include paraffin- embedded aterial. unusual or atypical variants of meningioma, ependymoma,schwannoma and oligodendroglioma-like Role in Renal Pathology: tumours composed of small “clear” cells and small “blue  In Renal Pathology, ultrastructural features enable cell” tumours of childhood. a diagnosis to be made where the light microscopy  EM is also important in the evaluation of certain is apparently normal. For example: minimal change congenital, inherited and metabolic diseases including disease, thin membrane disease, hereditary Neuronal Ceroid- Lipofuscinoses (NCL), CADASIL nephropathy/ Alport’s disease etc. syndrome, mitochondrial encephalomyopathies and of  Disease with glomerular deposits including fibrillary and certain toxic and drug-induced peripheral neuropathies. immunotactoid glomerulonephritis, collagenofibrotic Oncosurgical and General Surgical Pathology: glomerulopathy, fibronectin glomerulopathy, dense deposit disease etc.  In addition to the CNS tumours as outlined above, an important application of TEM is its utility in initiating a  Ultrastructural features provide information to confirm workup of an atypical tumour or metabolic condition, for the diagnosis, as in immune complex mediated which clinical and histological clues point in no obvious glomerulonephritis, renal amyloidosis, direction. C3 glomerulopathy, diabetic nephropathy etc.  Diagnosis of Primary ciliary dyskinesia and Kartagener’s  Renal allograft Pathology: Early stages of chronic syndrome where ultrastructural alterations in abnormal Antibody Mediated Rejection (AMR) have characteristic ciliary structures form the diagnostic clue. ultrastructural features, which develop much before LM features become evident and are vital clues in deciding For domestic queries therapeutic strategies in post-transplant period. please contact customer care at 011-39885050  TEM also enables structural and morphological diagnosis or write to us at innovativeforum@lalpathlabs.com of viral infections. Negative staining techniques can be For International queries used to identify viral particles and other infectious agents. write to us at raj.sehgal@lalpathlabs.com

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DOCTOR SPEAK

GI Emergencies a diagnostic challenge

GI Emergencies comprise 10-12% of all ER (Emergency Room) visits, yet have not been given adequate attention. The limelight is hogged by cardiovascular and neurological emergencies, as they are more dramatic , carry high mortality and affect the rich class of society. However, GI Emergencies pose a greater diagnostic challenge than the latter because of the long and varied list of conditions causing them which range from acute gastroenteritis to perforation (Table1). They require a multidisciplinary approach for their management and carry a mortality of 10%.

Table 1 Common GI Emergencies.

• Acute Gastroenteritis • Acute intestinal obstruction • Acute GI Bleed – upper and lower • Acute appendicitis / acute cholecystitis/acute diverticulitis • Acute Pancreatitis • Perforation • Abdominal abscess – most commonly liver abscess • Abdominal wall hernia • Inguinal hernia • Ischemic colitis/ mesenteric ischemia Often the first doctor to confront the emergency is a junior doctor in training, the so called RMO (resident medical officer). He may miss out crucial points in the history or physical, resulting into a serious outcome. Thus it is very MD, PhD, FRCP (Hon), FAMS important for him/her to have some guidelines or algorithms Medical Director and head of Dept of Gastroenterology, PSRI Hospital, New Delhi as how to proceed investigating an abdominal emergency. Certain basic features to observe are vital signs, state of hydration, facial color and expression – cyanosis or pallor and pain intensity, abdominal feel –soft/rigid/specific tender point, passage of flatus per anus, increase or decrease of bowel sounds, and plain x-ray films of the abdomen in supine and erect positions. Management algorithms are readily available these days on several mobile apps, such as http://mdapps. emory.edu/surgical-anatomy-of -the -liver/ , www.iliver.eu , http://pgimer.edu.in He/she must also have easy access to his /her senior consultants as well as to colleagues in other specialitiesas the patient may even require an emergent surgrical intervention (Massive GI hemorrhage or ischemic disease of the gut). For a solo practicing family physician, it is all the more important to get help from other institutionally based physicians and share responsibility as also be sure that correct treatment is being given to the patient. Recognition ofthe frequent occurrence and high morbidity and mortality of GI emergencies needs to be promoted urgently by specialists and academic bodies through CMEs and review articles,

Prof Rakesh Tandon

w w w.medegatetoday.com July-Aug 2016

DOCTOR SPEAK

Safe and effective measles vaccine exists:

Can prevent child mortality

Dr. Rajiva Kumar

Child Specialist (Muzaffarpur)

“It is important to receive a measles vaccine because measles can lead to lifethreatening complications, such as pneumonia and encephalitis (inflammation of the brain). In fact, measles is the fifth leading cause of death and sickness in children worldwide”

Most deaths among children aged one to five years are due to diseases that can be prevented, but that can also be easily treated at home or in health facilities. For some of the most deadly childhood diseases, such as measles, vaccines are available and timely completion of immunization protects a child from this illness and death. Measles is a contagious disease that is caused by a virus. Measles starts with a fever, runny nose, cough, red eyes, and sore throat. It’s followed by a rash that spreads over the entire body. Measles virus is a highly contagious virus and spreads through the air through coughing and sneezing. Measles can be prevented with vaccination. The number of measles cases has significantly dropped in recent decades due to immunizations. However, the disease has not been completely eliminated. Measles primarily occurs in unvaccinated children. Some parents choose not to vaccinate their children for fear that vaccines will have adverse effects on their children. Most children and adults who receive a measles vaccine do not experience side effects. But in rare cases, the vaccine has been linked to seizures, deafness, brain damage, and coma. Some parents

believe that the measles vaccine can cause autism in children. However, numerous studies have yet to find a link between autism and immunizations. A vitamin A deficiency is also a risk factor for measles. Children with too little vitamin A in their diets have a higher risk of catching the virus.

Symptoms of Measles?

Symptoms of measles generally appear within 14 days of exposure to the virus. Symptoms include: • Cough • Fever • Red Eyes • Light Sensitivity • Muscle Aches • Runny Nose • Sore Throat • White Spots inside The Mouth A widespread skin rash is a classic sign of measles. This rash can last up to seven days and generally appears within the first three to five days of exposure to the virus. A measles rash commonly develops at the head and slowly spreads to other parts of the body. Signs of a measles rash include

Diagnosing Measles

Doctor can confirm measles by examining a skin rash and checking for symptoms that are characteristic of the disease, such as white spots in the mouth, fever, cough, and sore throat. If unable to confirm a diagnosis based on observation, your doctor may order a blood test to check for the measles virus.

How to Treat Measles

There is no prescription medication to treat measles. The virus and symptoms typically disappear within two to three weeks. acetaminophen to relieve fever and muscle aches • Rest to help boost your immune system • Plenty of fluids (six to eight glasses of water a day) • Humidifier to ease a cough and sore throat • Vitamin A supplements

www.m e d e g a t e t o d a y. c o m July-Aug 2016

PRODUCT LINE

Russian and Australian scientists develop unique

heart surgery device

Scientists from MISiS National University of Science and Technology and their colleagues from Australia’s EndogeneGlobetek medical company have developed a unique device to enhance cardiovascular surgery. From now on, doctors will be able to perform heart bypass surgery without stopping the heart itself.

ardiovascular disorders kill 17 million people annually worldwide or more than any other disease. A stapler like device for mending blood vessels using strong staples makes it possible to quickly and safely restore blood vessels and to considerably reduce the post-operative period. This Russian-Australian invention received an award at the 44th INVENTIONS GENEVA international exhibition. A standard heart bypass surgery lasts four to five hours, with doctors having to stop the heart, and entails lengthy post-operative rehabilitation. Doctors are unable to restart a patient’s heart in 5 percent of all cases. This new stitching instrument allows doctors to operate on the heart while it beats. Instead of sawing the breast bone apart, surgeons can now simply bore two holes through it and put the bypass in place. The entire operation lasts about 60 minutes, and the patient can be discharged on the following day. This innovative stapler uses special resilient nickel titanium (nitinol) reversible shape memory staples. In short, this

www.m e d e g a t e t o d a y. c o m July-Aug 2016

metal can be deformed and then its original shape restored after abnormal deformations. These staples are inserted inside a cartridge which is then placed inside the polymerbody stapler’s distal end. “The world has no other device like it. The main advantage is that it reliably patches up the blood vessels in no time. In addition, it is very easy to quickly learn to use the stapler. It can be used during abdominal surgery to patch up blood vessels and other hollow body organs, including aortic aneurisms or during intestinal surgery,” said Sergei Prokoshkin, a professor at pressure metal treatment department of MISiS National University of Science and Technology. It took experts about nine years to perfect the invention, with Russian scientists continuing to upgrade the staples and their Australian counterparts working on the stapler’s body. Pre-clinical tests have already been completed, and this technology has also been patented in Russia and Australia. Clinical tests are scheduled to commence soon.

EXPERT VIEWS

Men Need Less Sedative Than Women During Oral Surgery Anesthesia Progress â&#x20AC;&#x201C; The stress that oral surgery patients experience during a procedure can cause elevated heart rates and blood pressure during operations. To avoid these side effects, surgeons often request sedation or general anesthesia for their patients. However, finding the right dose of anesthetic can be its own challenge, especially when the dosage needed for each patient can vary greatly.

researchers sought to identify characteristics that affected the average infusion rate of the drug. They found that women generally needed far more propofol to stay adequately sedated for the duration of the surgery. Elderly patients of either sex are also slow to wake from propofol sedation, but the age range in the current study was too small to determine whether patient age was affecting the data.

An article published in the current issue of the journal Anesthesia Progress found that male patients required a lower dosage of a sedative than female patients during oral surgery. This finding is consistent with general anesthesia knowledge, which suggests that females emerge from sedation earlier than males. The researchers were able to establish this finding by using an objective assessment tool known as the bispectral index (or BIS), which allowed them to evaluate sedation levels by a special form of brain wave monitoring beyond merely monitoring the patientâ&#x20AC;&#x2122;s breathing and reactions during surgery.

The authors noted that, on average, the women in the study weighed less than the men. This means that women generally need more propofol per body weight than men to stay at the same level of sedation. The authors concluded that for adequate moderate sedation during implant surgery, women likely need to receive propofol at a high rate.

The authors of the study gathered data from 125 dental patients who were sedated for implant-related surgery. Propofol, a powerful general anesthetic often used during surgery, was given intravenously to each patient. The

www.m e d e g a t e t o d a y. c o m July-Aug 2016

Oral surgeons and dentist anesthesiologists should be able to give lower doses of anesthesia to male patients, making the sedation safer and more effective. The BIS tool used in this study is not routinely used during dental or medical treatment under sedation. Still, the authors noted that even when the tool is unavailable, the studyâ&#x20AC;&#x2122;s results should help in determining the correct anesthesia dosage for patients undergoing minor oral surgery.

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PRODUCT LINE

HMD 1st Indian Manufacturer to get ICMED certification “Indian Certification of Medical Devices Scheme (ICMED)” Country’s first indigenous quality assurance system for medical devices was launched recently on March 15 in the presence of top representatives from government, healthcare industry and quality council fraternity. ICMED - the first home developed international class certification scheme for the medical devices in the country – is a joint initiative of Association of Indian Medical Device Industry (AIMED) and Quality Council of India (QCI) and the National Accreditation Board for Certification Bodies (NABCB). ICMED is aimed at enhancing patient safety, to provide enhanced consumer protection along with much needed product credentials to manufacturers for instilling confidence among buyers and users. This Scheme is intended to significantly eliminate trading of sub-standard products or devices of doubtful origins, a widespread and injurious phenomenon in the Indian market. For manufacturers, it aims to bring down the substantial time and cost-run to obtain globally accepted quality certification for Indian companies and eliminate the malpractices of substandard or fraudulent certification or quality audits, thereby ensuring substantial savings, enhanced credibility and increased competitiveness. As currently, there is no India-specific official quality assurance system, due to which Indian medical device manufacturer’s encountered loss of competitiveness to foreign companies while consumers ended up paying extra premium with no concomitant benefits, ICMED also fills a big regulatory void. “The scheme fills a big regulatory vacuum in quality certification space for medical devices in the country and will enhance the competitiveness and profitability of Indian

www.m e d e g a t e t o d a y. c o m July-Aug 2016

medical device industry, Congratulations to HMD for being the first Indian Company to lead the way " said Shri Anil Jauhri, CEO , NABCB ,QCI . AIMED has termed it a significant milestone due to multiple benefits it would assure to different stakeholders. Great Team Effort and we are proud to lead the way - The ICMED Certification Scheme is a significant milestone for both consumers as well as manufacturers as it brings quality, accountability and competitiveness in the system,” said an excited Mr Rajiv Nath, Jt. Mg. Director, HMD “and in due course will also bring respect to Brand India for those carrying this certificate", The Certification Scheme has presently two options for certification, one being ‘ICMED 9000 Certification (an ISO 9001 plus additional requirements)’ for low risk medical devices and other being ‘ICMED 13485 (An ISO 13485 Plus additional requirements) for medium and higher risk devices. A third level, which would additionally prescribe medical device specifications developed by NHSRC of the Ministry of Health and Family Welfare is still under development and would be launched later this year. According to Dr M K Bhan, former Secretary to the Government of India, Department of Biotechnology, Ministry of Science and Technology,“For a country like India, the twin challenge is to ensure availability of quality healthcare products at reasonable cost so that overall healthcare cost remains reasonable. In this direction, the launch of ICMED

PRODUCT LINE

is a significant collaborative initiative and will go a long way to ensure realization of these objectives.” “QCI is happy to lend a helping hand to the medical device industry in India to showcase its strength in terms of meeting the highest international standards. We have already devised such schemes for ayurvedic products, ready mix concrete plants and yoga professionals and this would be a valuable addition to our portfolio. It would go a long way in contributing to the success of govt’s flagship Make in India programme,” said Mr Adil Zainulbhai, Chairman, QCI. It may be added that NABCB has already secured international equivalence for most of its accreditation programmes and it would facilitate international acceptance of Indian medical devices. “NABCB is accrediting certification and inspection bodies and its accreditation programmes are internationally equivalent placing it on par with European and American accreditation bodies. This equivalence would help facilitate acceptance of ICMED certification in overseas market and respect for Indian manufacturers "pointed out Mr Anil Jauhri, CEO, NABCB. "The manufacturers would need to approach any one of the certification bodies approved by QCI under the Scheme for obtaining certification. The certification bodies shall be under the oversight of NABCB, which as the national accreditation body, would accredit these certifying bodies

as per applicable international standards. The certification scheme is open to both indigenous and foreign manufacturers though Indian manufacturers would be expected to queue up initially. Since it's a voluntary certification scheme its initial success would ride on procurement agencies demanding for this as a qualifying criteria "said Nath ,

ICMED Backgrounder: ICMED is the fructification of a MoU was signed between QCI and AIMED on 30 Oct 2014 to fill the regulatory vacuum in quality certification space for medical devices in the country. The scheme has been developed involving various stakeholders with a Steering Committee chaired by Dr. M.K. Bhan, former Secretary, Biotechnology, at the helm, supported by a Technical Committee and a Certification Committee constituted for this purpose. More than twenty government and nongovernment organizations including Department of Commerce, National Health System Resource Centre (NHSRC), Bureau of Indian Standards (BIS), Central Drug Standard Control Organization (CDSCO), Engineering Export Promotion Council (EEPC), prominent industry bodies like AIMED and Confederation of Indian Industry (CII), Center for Biomedical Engineering, IIT Delhi, Indian Medical Association (IMA), and Association of Healthcare Providers of India (AHPI) and Consumer Organisation etc. participated in various committees.

w w w.medegatetoday.com July-Aug 2016

DOCTOR SPEAK

Effects of abortion on a woman’s body & Psychology A woman may need abortion or termination of pregnancy due to multiple reasons. Sometimes, unwanted pregnancies may force such a step, at other times a couple may decide on termination due to other reasons such as severe congenital defects in the foetus or potentially dangerous health complications of the pregnancy. Whatever the cause, an abortion can affect both woman’s psychology and physiology. To be clear, abortion is not safer than full-term pregnancy and childbirth (when pregnancy is safe). In some studies it is seen that some women report to have a sense of relief after having an abortion and others tend to become depressed due to unwanted abortion or miscarriage. The reasons for relief and depression may also vary from woman to woman. Psychological side effects of having an abortion are as real as physical side effects. Emotional and psychological effects following abortion are more common than physical side effects and can range from mild regret to more serious complications such as depression. Post abortion, it is very much necessary to discuss all the risks in detail with an experienced professional who can address all the queries and related concerns. One of the most important factors related to the negative emotional or psychological effects has to do with your belief about the baby inside of you. Some of the females experience less chance of negative emotional consequences as the have a more detached view of the pregnancy and consider the foetus as an undeveloped life. However, some other women might a more emotional outlook towards the pregnancy and strongly look at the life inside the as a baby. Such women tend to have negative consequences after an abortion or miscarriage. Following are the possible emotional and psychological risks of having an abortion. The intensity or duration of these effects will vary from one person to another. Potential side effects include:  Eating disorders  Anxiety  Regret  Anger  Guilt  Shame  Relationship issues  Sense of loneliness or isolation  Loss of self confidence  Insomnia or nightmares

www.m e d e g a t e t o d a y. c o m July-Aug 2016

 Relationship issues  Suicidal thoughts and feelings  Depression Following abortion it is possible for anyone to experience unexpected emotional or psychological side effects. Women generally report that the abortion procedure affected them more than they expected. However, it is often noticed that some individuals are more prone to experiencing some kind of emotional or psychological struggle. Women with a higher probability of having a negative emotional or psychological side effect include:  Individuals who obtain an abortion in the later stages of pregnancy  Individuals with previous emotional or psychological concerns  Individuals who have been coerced, forced or persuaded to get an abortion  Individuals with religious beliefs that conflict with abortion  Individuals with moral or ethical views that conflict with abortion  Individuals without support from significant others or their partner W omen obtaining an abortion for genetic or fetal abnormalities Recommendations for someone who is considering an abortion G et Help – Probably the most important thing you can do when facing an unplanned pregnancy is to communicate with trained professionals who can answer your questions and discuss your individual circumstances with you. You can even consult a psychologist if you are going through anxiety.  Avoid Isolation – If you are experiencing an unplanned pregnancy, you might have the tendency to withdraw from others to keep the matter a secret and/or to face the issue alone. Although it can be difficult, try to stay connected with family and friends who can support you. Too much isolation under these circumstances can lead to depression. Feel free to discuss your problem with your loved ones and take them into confidence before arriving at a decision. This will reduce your guilt or anxiety.  Evaluate Your Circumstances – See the situations listed previously regarding individuals who are more likely to experience one or more side effects.

Discuss your situation with someone who can help you give your perspective and understanding.  Avoid Pressure – Avoid people who are pressuring you to do what they think is best. Whether you opt to parent, choose adoption, or have an abortion, you are the one who is going to have to live with your choice. So, the decision has to be 100% your own.  Talk to Others – See if you can find someone who has gone through an unplanned pregnancy or had an abortion to find out what it was like for them. Physical side effects after an abortion can vary from woman to woman. It is important to know about the possible detailed side effects of abortion from experienced health professional as well as the doctor. It is mandatory that your period should return about 4- 6 weeks after abortion and you can conceive again after the abortion. It is important to take prescribed antibiotics as directed by your doctor in order to help prevent infection. Following are the physical side effects that are frequently experienced after an abortion. The possible duration to experience these side effects are 2 to 4 weeks following procedure.  Abdominal pain and cramping  Spotting and bleeding  About 5-10% of women suffer from immediate complication. It is important to be aware of the following risks:  Heavy or persistent bleeding  Infection or sepsis/PID/ Endometriosis  Damage to the cervix  Scarring of the uterine lining (Asherman's syndrome)  Damage to other organs  Perforation of the uterus  Endotoxic shock and death  It is necessary to have abortion from a qualified and trained professional. Also, it is recommended if you have an abortion you meet doctor and seek medical attention in order to get healthy and fit as soon as possible.

Dr Shilva Consultant Gynaecology, Paras Bliss Hospital, Panchkula

COVER STORY

The Rise of

Dental Tourism in India

ental tourism (also called dental vacations) is a subset of the sector known as medical tourism, which is a growing sector in India. Indiaâ&#x20AC;&#x2122;s medical tourism sector is expected to experience an annual growth rate of 30%, making it a $2 billion industry by 2015 (making it a 9500 crore industry). Â As medical treatment costs in the developed world balloon, more and more Westerners are finding the prospect of international travel (coupled with a vacation) for dental care increasingly appealing. Â An estimated 150,000 of these travel to India for low-priced healthcare procedures every year. Dental tourism involves individuals seeking dental care outside of their local healthcare systems and may be accompanied by a vacation. Dental tourism is growing worldwide as the world becomes ever more interdependent and competitive, technique, material, and technological advances spread rapidly, enabling providers in "developing countries" to provide dental care at significant cost savings when compared with their peers in the developed world. India is fast emerging as one of the top dental tourism destinations in the world. Every year thousands of people from all parts of the globe including USA, Canada, UK, Europe etc travel to India for low cost but world class dental treatment. Apart from costs of

www.m e d e g a t e t o d a y. c o m July-Aug 2016

dental treatment dental tourists find India very attractive country to travel. India is rich in culture and has some beautiful places to visit including world class beaches, mountains, hill stations, historical monuments, forts, temples and churches. Medical care quality in India has seen a tremendous growth in recent years. Most of the private clinics and hospitals have staff educated, trained and have experience of dental work in countries like US & UK. World class dental treatment with 70% savings and a great holiday, you can get all this in one country - INDIA. Dental and cosmetic surgery costs in India are very economical as compared to US and UK. Dental works in India will cost a fraction of the costs in US and UK. Unlike other medical treatments dental treatments or surgeries take little time and also the recovery time is very less, hence a tourist can also enjoy holidays in India to the fullest. The main reason India has become one of the top choices for dental tourism among dental tourists world-wide is that in India they get same quality treatment at much lower costs. Moreover, in India almost all the doctors and staff at dental clinics are fluent in English and it is widely spoken in the country. To give a comparison, in UK rising cost of dental procedures coupled with long wait at NHS has made it next to

impossible to get world-class treatment at an affordable rate. Correcting dental flaws at some of the much acclaimed dental hospitals abroad have now become a long lost trend. Thanks to the brainwave behind dental tourism, that receiving quality dental treatment at highly slashed prices is very much possible these days in India! Dental Tourism in India comes well within your pocket limits; it's no more a blown out fact that dental treatment procedures here comes out to be 10 times cheaper when compared to the hospitals of the West! Also showcasing the best skilled dentists at service, even the quality is well guaranteed. Clearly, undergoing extensive dental procedures abroad, even when allowing for travel expenses, can be significantly cheaper than the same procedures at home. Pricing and qualifications of the dentists can be easily researched through websites or by contacting the dentists. Through e-mail contact, one can ask for references, ask about payment options, and even obtain information about accommodations. Keep in mind, price is not the only consideration. With high-end and sophisticated facilities available at an affordable rate and with

COVER STORY

also needs to be given the factors such as better infrastructure, roads, connectivity with the state for us to be a patient-friendly nation. The potential for medical tourism will depend upon government policies, faith of the patients and many other external factors. We truly believe that this sector will play a significant role as a contributor towards the overall tourism growth in India. complimenting tourism prospects to benefit from, India tops the chart in arranging for safe, secure and pleasing health vacation to patients from all over the world. A combination of three key factors – quality, availability and cost has been fuelling the phenomenal growth witnessed in the Indian dental tourism industry. An English speaking population, at par technology, competence, attractive tourist destinations and alternative medicine are some factors that are largely responsible for India’s burgeoning dental tourism. The one advantage the country has is that a doctor in India -- especially a surgeon -- would

have acquired in 10 years' time more experience -- both in terms of scale of procedures done and the exposure to varying levels of complexity -- than what a surgeon in the U.S. would get in, say, 30 years of practice. So a doctor with about 15 years experience will probably be unrivalled in the scope and scale of his exposure. Even in my practice, about 40 percent of patients are dental tourists who are either Indians living abroad or local nationals. India is playing host to patients from several countries, even the developed ones, for healthcare services. More people need to be made aware of the capabilities India has and the various services that are available. Attention

By Dr. Kamlesh Kothari

Maxillofacial surgeon and Clinical Director of Aesthetica

PLEASE FIND BELOW A TABLE ELABORATING THE COST EFFECTIVENESS OF VARIOUS DENTAL PROCEDURES IN INDIA IN COMPARISON TO US AND UK.

Dental procedure

Smile designing

Metal Free Bridge Dental Implants

Porcelain Metal Bridge Porcelain Metal Crown Tooth impactions

Root canal Treatment Tooth whitening

Tooth colored composite fillings Tooth cleaning

Cost in USA & UK ($)

Cost in India ($)

General Dentist

Top End Dentist

5,500

500-800

1,800 600

500

600

350

200

100

8,000

3,500 3,000

1,000

2,000 1,000 800

500

300

800-1000

800-1000 300-400 90-130

90-130 80-100

100-130 20-40 60-80

w w w.medegatetoday.com July-Aug 2016

COVER STORY

India is on growth path: Scope of Medical tourism Industry is booming As healthcare turns costlier in developed countries, India's medical tourism market is expected to more than double in size from $3 billion at present to around $8 billion by 2020, a report says. Medical tourism can be broadly defined as provision of 'cost effective' private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry - both private and public. Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. The idea of the health holiday is to offer you an opportunity to get away from your daily routine and come into a different relaxing surrounding. Here you can enjoy being close to the beach and the mountains. At the same time you are able to receive an orientation that will help you improve your life in terms of your health and general well being. It is like rejuvenation and clean up process on all levels physical, mental and emotional. Many people from the developed world come to India for the rejuvenation promised by yoga and Ayurvedic massage,

www.m e d e g a t e t o d a y. c o m July-Aug 2016

but few consider it a destination for hip replacement or brain surgery. However, a nice blend of top-class medical expertise at attractive prices is helping a growing number of Indian corporate hospitals lure foreign patients, including from developed nations such as the UK and the US. As more and more patients from Europe, the US and other affluent nations with high medicare costs look for effective options, India is pitted against Thailand, Singapore and some other Asian countries, which have good hospitals, salubrious climate and tourist destinations. While Thailand and Singapore with their advanced medical facilities and built-in medical tourism options have been drawing foreign patients of the order of a couple of lakhs per annum, the rapidly expanding Indian corporate hospital sector has been able to get a few thousands for treatment. But, things are going to change drastically in favour of India, especially in view of the high quality expertise of medical professionals, backed by the fast improving equipment and nursing facilities, and above all, the cost-effectiveness of the package.

COVER STORY

"India is perceived as one of the fastest growing medical tourism destinations. In recent years, government support, low cost, improved healthcare infrastructure, and its rich cultural heritage, have taken Indian medical tourism to the new heights. Overall, its emergence as one of the world's most cost-efficient medical tourism destinations has helped India to attain a position among the global leaders. Research on Indian medical tourism is an outcome of extensive primary and secondary research, and a thorough analysis of various industry trends. According to the report, India has managed to matchup with the quality of healthcare services that are being provided in developed countries. The qualified medical staff, adoption of advance technology and improving healthcare infrastructure has made India an attractive destination for patients all over the world. Based on the analysis provided in our latest research report â&#x20AC;&#x153;Booming Medical Tourism in Indiaâ&#x20AC;?, we anticipate that the Indian medical tourism industry will register a CAGR of more than 20% during 2013-2015. According to a CII Grant Thornton white paper, cost is a major driver for nearly 80% of medical tourists across the globe. The cost-consciousness factor and availability of accredited facilities have led to emergence of several global medical tourism corridors Singapore, Thailand, India, Malaysia, Taiwan, Mexico and Costa Rica. "Amongst these corridors of health, India has the second largest number of accredited facilities (after Thailand). The Indian Medical Tourism market is expected to grow from its current size of $3 billion to $7-8 billion by 2020," Bangladesh and Afghanistan dominate the Indian Medical Value Travel (MVT) with 34% share. Africa, GCC and CIS regions (whose current share is just 30%), present the maximum possible opportunity for the Indian healthcare sector. Medical tourists from these sectors currently favour the South East Asian medical corridors. Chennai, Mumbai, AP and NCR are the most favoured medical tourism destinations for the floating medical population who avail treatments in India. "While the number of MVTs itself is poised to grow at over 20% CAGR, Kerala needs to focus on its visibility as a healthcare destination amongst other states," said the report. Kerala attracts only 5% of such medical tourists currently and has the potential to increase its share to

a 10-12% with a focused marketing strategy. As per the study, the key factor to drive medical value tourism in Kerala will be availability of national as well as globally accredited facilities across the entire state, an area where Kerala lags behind in comparison to Tamil Nadu, Maharashtra, NCR and Andhra Pradesh. Kerala is already one of the most preferred tourist destination in the country. For medical value tourism,

however, there is a clear need to build and upgrade infrastructure. The white paper suggests tapping a larger share of the health wallet of the African, Asian, Middle East patients as well as welcoming tourists from other regions and countries, as also a marketing campaign with active support of the government and private sector.

w w w.medegatetoday.com July-Aug 2016

COVER STORY

the treatments turn out to be very expensive. The patients can only be relieved if they are covered by insurance. The medical facilities in few countries are not affordable and also few countries have poor healthcare infrastructure , so India has such super specialties facilities that it has become top destination for medical treatment. In India, on the other hand, the international patients find the Dr. Ajit Gupta treatment very cheap. In India , Chairman & Founder provision of cost effective private Park Group of Hospitals medical care in collaboration with "Medical Industry is not doubt the tourism industry for patients increasing at a very fast pace, needing surgical and other forms of but despite the advancements, specialized treatment has reached India is placed among the top three medical tourism destinations in Asia, mainly due to low cost of treatment, quality healthcare infrastructure and availability of highly skilled doctors. The health tourism sector has emerged as one of the largest sectors in India and is poised to grow at an annual rate of 30% to reach about USD 2 billion by 2017. Primary growth levers in this regard include low priced treatment options, availability of variety of treatments, improved infrastructure in terms of healthcare facilities and attractive locations for spending time after treatment. India is known mostly for its cost-effective medical treatments along with high standards in cardiology and other specialities like orthopaedics, nephrology,

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a new dimension. Mostly patients visit India for cardiac procedures, neurosurgeries, joint replacement ,cancer surgeries,kidney treatment , liver transplants etc. Indian Hospitals also take care of the patients and their family, and give them the luxurious facilities. Most of the hospitals provide accommodation as well to the family members of the patient. Each year there is increase of 2230% foreign patients who visit India for medical treatment. but in Delhi /NCR the ratio is 10 - 12 % . Mostly foreign Patients comes from SAARC, CIS , Middle east countries".

surgery. affordable devices like absorbable Medical treatment costs have stents, valve replacement devices to save the patients from traumatic increased in the developed world surgery. manifold with the United States leading the way â&#x20AC;&#x201C; more and more Westerners are finding the prospect of international travel for medical care increasingly appealing. An estimated 150,000 of these travel to India is for low-priced healthcare procedures every year. The correct and imaginative marketing strategies will attract more and more people from all over the world for medical tourism in India in the coming years. As far as advancement of cardiology is concerned, I see a g ood promise in Dr Purushottam LAL the application of stem cells though Chairman lot of research need to be done in this Metro Hospital Hospitals direction. There will be more and more oncology

and

neuro

EXPERT VIEWS

Provider or Facilitator? Does Government Need to Change its Role when it comes to Healthcare Delivery in India For a long time now, there has been intense debate in India about the extent of role the government should play in providing essential services to citizens. The right wing economists have long argued for the government to withdraw from services, and consolidate its position as provider of infrastructure and facilitator. On the other hand, the Left wing economists have maintained that in a country where more than half of the population lives in poverty, government cannot abdicate its role of providing essential services such as healthcare and education. When they set about the task of nation building, our founding fathers led by Prime Minister Jawaharlal Nehru modeled the

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countryâ&#x20AC;&#x2122;s economy on the lines of the then powerful Soviet Union. The model favored greater role of government in all activities of development, envisaging a strong public sector, governmentâ&#x20AC;&#x2122;s active role in industry, education as well as healthcare. However, in 1991, India reset its economic path and turned to greater liberalization of goods and services, paving way for the emergence of a strong private sector that is today at the vanguard of many positive changes sweeping the country. However, the debate on whether the government should continue to expand its role as a healthcare provider is still a hot topic.

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Public Hospitals: Needs & Challenges

To be fair, government hospitals and healthcare centres have been the lifeline of millions of people who live in rural and semi urban areas or cannot afford substantial out of pocket expenses at private hospitals. Institutions such as AIIMS and other government medical colleges have also been at the forefront of producing some of India’s best doctors, leading researches and providing healthcare services to the population. However, such institutions are too far and too few to cater to the needs of all Indians. Moreover, in rural and semi urban areas, healthcare delivery at public hospitals continues to be less than satisfactory with shortage of doctors, supplies, as well as services crippling the system. Deficient infrastructure, shortage of manpower, and unmanageable patient load are some challenges afflicting the public healthcare system in India. Private hospitals, on the other hand, are today an essential cog in India’s healthcare delivery. They not only serve to reduce patient load on public hospitals but also provide faster and more efficient services given their needs for profit and efficiency. However, the availability of private healthcare is not only restricted because of the costs involved, but also because of the fact that their presence is highly skewed in favor of urban areas. This brings us to the essential issue of greater need for the government and private sector to work in tandem through specially formulated policies to ensure healthcare delivery to all.

Government as facilitator

The goal of providing universal healthcare is a noble goal which successive governments have laid down in their agendas year after year. Many policymakers and experts view this as the government’s intention of providing healthcare through public sector services to all 1.2 billion citizens of the country. However, given the limited resources of the government and the sheer enormity of this task, it would logistically not be possible for the government for years to raise the number of doctors, staff, facilities and supplies at government hospitals to this level. The need of the hour is to devise policies that puts the government in the role of a catalyst or a facilitator to enable a large section of our people get access to quality healthcare. Segmenting the population according to financial wherewithal and identifying sub-sets for different policy goals is the first step. While the government needs to maintain, improve and even increase its hospitals and primary health centres to provide free of cost healthcare facilities to people living below the poverty line, a number of other measures can be initiated to allow others get better access at private hands.

Public Private Partnerships:

Private hospitals are often demonized for giving precedence to profits. However, to be fair to them, a private business ceases to be sustainable otherwise. For private healthcare

providers, it is not possible to treat patients without costs even if they have the right intentions. The government can enter into tie ups with private hospitals to facilitate treatment for poorer sections of people. Instead of investing in setting up new hospitals, the government can get into PPPs in every city and help private hospitals subsidize costs for a select group of people, say those with BPL cards. Or the government can subsidize a small section of each private hospital and allow it to work on the lines of government owned hospitals.

Making Insurance affordable and mandatory:

If the government makes medical insurance a mandatory aspect like bank accounts and pan cards, the same shall benefit the common people and not force then into out of pocket spending. With millions coming under coverage, banks can negotiate and get really low premium rates. Moreover this shall give the common man the choice of going to any hospital. This will naturally cover the salaried middle class. Regulatory reform on the lines of Obamacare: The healthcare sector in India also needs major reform and regulation. This is where the Indian government can take a leaf or two out of Obamacare touted as one of the most significant achievements of the outgoing US President. Setting up a health insurance marketplace where Indians can purchase regulated and subsidized healthcare can allow millions have better access to health facilities.

Incentivize private hospitals in rural areas:

According to estimates almost 70% of the doctors in India are concentrated in urban centres, and urban India enjoys access to almost 65% of the country’s hospital beds. The reason is that private hospitals do not find it profitable enough to set shop in rural or semi urban areas. Government can incentivize this by offering benefits such as tax cuts, cost sharing etc to private entities.

Dr. Dharminder Nagar

Managing Director, Paras Healthcare w w w.medegatetoday.com July-Aug 2016

EXPERT VIEWS

When Presbyopia Strikes: Dealing with Vision after 40 years of age “You don’t know what you’ve got till it’s gone,” goes a pertinent saying. This is especially true for your ability to see clearly. As middle age strikes, we observe a number of changes creeping up our bodies. You might not be as agile as you were 10 years back, the knees might just begin to hurt a little. Another noticeable change that strikes around 40 years of age is difficulty in focusing on near objects. You will experience blurred vision in activities focused close to the eye such as reading, working on a computer or sewing. You will suddenly start feeling the need to adjust the position of your newspaper, book or smartphone and hold it at arm’s length to be able to see clearly. A natural occurrence, presbyopia (literally meaning ‘ageing eye’) will eventually happen to everyone typically around age 40, whether you are short-sighted, farsighted or have perfect vision. People with presbyopia will no longer have clear vision at all distances and near vision, blurring occurs even if they are wearing their regular glasses or contact lenses. So, your old spectacles will no longer suffice for all needs. If you are worried, do not be. Presbyopia is not as scary as it sounds and the good news is that it can be easily managed with the right spectacle lenses. A 2008 study published in the Archives of Ophthalmology estimated that over 1 billion people across the world had vision problem due to presbyopia. This number is expected to rise up to 1.4 billion by 2020 and to 1.8 billion by 2050. Unfortunately, more than half of the people currently living with presbyopia have no access to corrective spectacles; a bulk of this population with uncorrected presbyopia living in developing countries like India.

What causes presbyopia? Much like osteoarthritis is caused by age-related depletion of cartilage from the bones, presbyopia is caused by the ageing of eye’s lens. When we are younger, the lenses inside our eyes are more flexible with a greater ability to adjust focus at all distances. However with age, the lens tends to become more rigid and hardened, losing its ability to change its shape and focus easily. This causes progressive worsening of the eye’s ability to focus on near distance objects.

Presbyopia affects productivity While long distance vision impairment is often talked about as a cause of lost productivity, near distance vision impairment due to presbyopia is often not given enough importance. Some people argue that since reading gets affected by presbyopia, people who are illiterate or involved in blue collar jobs may not feel the discomfort. However, this is a myth. Not just for reading or working on computers, near vision quality is also essential in a number of other jobs such as sewing and tailoring, weeding, repairing objects, and performing household chores like sorting grain or cooking. A bulk of the productivity loss happens in low income countries where a majority of presbyopia cases remain uncorrected or 48

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under-corrected. A global correction could potentially lead to a 35% increase in productivity and a 20% increase in monthly income in the developing world, according to the Essilor Vision Impact Institute.

Solutions to Manage Presbyopia Fortunately, there are enough solutions to manage presbyopia. A discussion with your doctor will help you decide on the right solution depending on your lifestyle and severity of the condition, this may be simple reading glasses, mid-distance lenses or progressive lenses for a more optimum solution. Reading Glasses: Reading glasses are often used by presbyopes. An ideal reading glass helps you to focus the vision, usually up to 40 centimeters, where you do not have to stretch your arm to read. However, reading glasses hamper the vision of longer distance, and therefore you have either to peep out of the glass or remove it completely when looking at long distanced objects. Therefore, people using reading glasses have to keep two pair of glasses -- one for reading; the other for distance sight. Bifocal lenses: Each bifocal lens is visibly divided – the top part of the lens provides clear distance vision, while a portion of the lens at the bottom provides clear near vision. Unlike progressive lenses, bifocal lenses do not offer a progression of power between prescriptions so wearers often find the “jump” when changing focus uncomfortable. This is especially pertinent when climbing down stairs. It is also important to note that because bifocal lenses do not provide clear vision for intermediate distances, this option is one to consider . Progressive lenses: Progressive lenses offer a much better option. Progressive lenses such as Essilor’s Varilux are a modern solution for natural correction of Presbyopia. They are easy to manage and enable a smooth and seamless transition between the visions of objects kept at different distances. They remove the ‘image jump’ or jerk factor common with bifocals and offer a clear ability to read a book, view your computer, see clearly across the room without any jump or discomfort. Backed by many years of research, progressive lenses are an established option that is more convenient. Created using new patented technology and the finest craftsmanship the latest generation of Varilux® lenses offer naturally sharper and clearer vision even in low light conditions, in a way that feels natural and effortless, without adding years to your look. While presbyopia cannot be prevented, it does not have to get in the way of living life to the fullest. More importantly, it should not stop you from finding new ways to express your sense of style. With this year’s upcoming beauty trends heading towards big, bright colors and daring new looks, it is the perfect time to rejuvenate your image and stay fashion-forward with Varilux!

Ramachandran P

Group COO, Essilor India

EXPERT VIEWS

w w w.medegatetoday.com July-Aug 2016

Guest

Article

TEXT NECK - A TECH-INDUCED AILMENT

JASRAH JAVED Phsiotherapist

ECHNOLOGY has shown marked progress these days, providing uncountable facilities. One of the very common and useful is the ease of communication. The use of tech-based gadgets is growing every day. Texting is something we all love to do these days, frequently and for long hours. The method of texting is holding the mobile phone in hand and looking downwards to the screen, yes! Not necessarily to be mentioned, but the posture we adapt while doing so is the matter of concern here. Not only texting, surfing internet, playing games, watching videos for hours can also be added to the list of the works we do on our cell phones, tablets and other wireless gadgets. Earlier, when we were not aware of the technology and its benefits, when the technology was not introduced to us, people who used to love reading for hours also adapted some sort of similar posture while reading, holding the book in hand with face downwards and neck somewhat hung forward. But screens has now replaced books, and also influenced the severity of the condition.

A closer look at the condition: L.Fishman, Chiropractic Dean, Florida coined the term text neck and described the condition as “text neck is an overuse syndrome or a repetitive stress injury, where you have your head hung forward and down looking at your mobile device for extended periods of time,” The human head weighs approximately 10lbs, for every inch of forward movement of the head there is an 50

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increase in a 100% weight, again explained by L.Fishman. The neutral position of the head is between both the ears above the shoulder, the condition of the text neck is hence caused due to repetitive stress injury to the neck caused due to repetitive and constant forward movement of the head for long time. A recent study shows that the population between the age of 18-44 have their mobile phones with them almost all the time, this study allows us to determine the number of people prone to ailment. Also, the condition of text neck is observed more in children nowadays. Know that you are suffering from the condition: Following symptoms indicated that you are suffering from the condition  Chronic headache  Shoulder pain  Neck pain  Upper back pain  Muscle spasm  Pain radiating to arm  Increased curvature of the cervical spine

Solving the problem: If the symptoms match your condition and you know that you are now prone to “text neck”, think of the measures that can be taken to avoid further damage to your neck and cervical spine. The measures are immediately to be taken before the condition worsens. The normal curvature of the cervical spine is anteriorly convex and posteriorly concave, the curve increases due to the constant inappropriate posture of the neck. Here are a few exercises which are easy to perform in daily life, at least twice a day to avoid the ailment. Also, there are a few indicators invented for you to determine the correct posture. There are also certain changes in the habits that you need to adapt while correcting the problem.

is indicated by a green or red light, or a vibration or a beep reminder, whenever you attain a wrong posture. This “app” is used for tracking the posture, which gives you a data to analyze whether your condition is improving. Improving the posture Attaining a mountain pose is the best method to be adopted to correct the posture, try to stand erect and avoid craning your neck. The ergonomics Try to avoid the forward flexed posture of your neck and keep the neck in neutral position while using mobile phone, working on computer, reading book, driving. Instead of looking downwards to the screen, try to bring your screen at your eye level. Basic exercises: (repeat each exercise

10 times and hold each pose for 10 seconds)

Chin Tucks: In sitting position, by putting a finger on your chin, try to push your chin backwards. Or in supine lying position (lying straight with head facing the ceiling) on a pillow, try to push the pillow with your head. Shoulder blades squeeze: While standing, bring both the shoulders backwards squeezing the triangular shaped bones (scapula) together towards the mid line. Prone arm abduction:

(strengthening of shoulder)

In prone lying position on the couch (head facing the couch and back facing the ceiling), bring your arm upwards from the side holding a weight of ½ kg in the beginning (increasing the weight gradually). Prone neck extension: (strengthening of neck)

The “application”

In a prone lying position (head facing the couch and back facing the ceiling), try to lift your neck upwards and look up towards the ceiling.

Dr.Fishman created an “app” for the android offering “immediate real time feedback” telling you whether you are standing in a correct posture or not, which

Snow angel: Stand against the wall (back touching the wall), lift both the arms together upwards and then bring them down.

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Diet for a

healthy weight loss surgery

The ideal food chart for a person who undergoes bariatric surgery

Week 1: Liquid diet Immediately after the surgery, patients must consume clear liquids with low sugar content in small portions. The liquids provide nutrition without harming the stomach and intestines. Water, broth, soups, natural juices and tea are considered safe to consume, while heavier liquids such as milk, cream soup and coffee are reserved for later. Once the patient can comfortably digest liquids, they can try solid food.

Week 2-3: Mashed foods

One of the safest ways for people, who want to lose weight, is to undergo bariatric surgery. Those patients who have very high BMI and are unable to shed the pounds through exercise and diet control are recommended to go through this procedure. While the surgery itself is a long-term solution, the months following the surgery are crucial for the patients, as the diet they follow directly affects the results of the procedure. A good rule of thumb is to follow a staged approach to help one ease back into eating solid foods. Dr Jayashree Todkar, Consultant Bariatric & Laparoscopic Surgeon, Apollo Spectra, Pune provides insights on the diet to be followed in the weeks following bariatric surgery. 52

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After a week or so, the patient can start eating soft foods that are mashed or pureed that can be digested easily. It adjusts the stomach and intestines to take in solids towards the end of the recovery period. One can eat ground meats (avoid red meat), beans eggs, cottage cheese, fruits and vegetables. This can be continued with the existing diet of liquids from the first week. Fruits that contain water can be safely consumed to replenish the body. Alcohol and soft drinks must be avoided. Consume enough water half an hour after every meal.

Week 4-8: Soft solids After 2 to 3 weeks, one can start eating soft foods that can be easily swallowed. Since the body absorbs lesser nutrients from the food, it is time to provide the body with healthier alternatives to the liquid diet. Items such as diced meat, fresh fruit and cooked vegetables can be taken at this point. Care should be

taken to cook the food well, so that it can be swallowed easily. Around this time, another important change to be followed is the time taken to eat. Eating lesser portions by chewing slowly aids the digestive system and also gives a sense of feeling full, after the meal. Spicy flavours and high calorie ingredients should not be used while cooking at this point.

Week 9 onwards: Regular food Regular food can be consumed in nine weeks following the surgery. While it is safe to eat normal dishes, it is important to ensure that the food is diced into smaller pieces. One may find it difficult to take in spicy food, so it is necessary to test different flavours to know what can be eaten comfortably and which items to leave out of the menu. Eating restaurant-cooked food must be completely avoided. Post surgery, a diet chart is provided to make it easier for the patient to decipher the new diet they have to follow. Bariatric surgery reduces the amount of food one can consume but the real challenge is to stick to the new diet, which means eating lesser portions at regular intervals and avoiding junk food. While it may be difficult to ditch the old habits, it is in the patient’s best interest to follow this diet to reap maximum benefits of the surgery.

Dr Jayashree Todkar

Consultant Bariatric & Laparoscopic Surgeon, Apollo Spectra, Pune

EXPERT VIEWS

s India evolves as an economy and a market, several new services are being conceived to convenience a modern society. Among them is home-based healthcare, a service that is gaining traction among recipients of medical facilities wishing to recover in the comfort of the home. What used to be an unorganized sector today has the attention of investor brands and follows certain protocols, besides being quite technology intensive. This is why seeking out a career as a homecare nurse is a lucrative alternative to traditional hospital nursing. To qualify, an aspirant must have the following qualifications:  GNM or B.Sc. Nursing  Registered with State Council T raining on life saving technique & Infection Control By and large all home-care nurses in India, and globally, are registered general nurses Their role involves providing care to the patient by working in collaboration with other health-care providers such as the primary doctor, members of staff at the hospital where the patient may have been cared for, as well as members of the patient’s family. Many home carenurses are in fact specialized in providing palliative care or end-of-life care to patients. By providing expert management of pain and other symptoms combined with compassionate listening and counseling skills, home and palliative nurses promote the highest quality of life for the patient and family. Some nurses do like to specialize in areas like oncology-care, pediatrics or geriatrics. Critical-care, diabetes management, cardio specialized nurses, tissue viability, post organ-transplant care, stoma-care and dialysis at home are some of the other health-cases that require specific knowhow and for such cases nurses with both experience and technical training are preferred. There is a distinct body of knowledge with direct application to the practice of home and palliative care nursing. This includes pain and symptom management; end-stage disease

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A Future as a Home-Care Nurse processes; psychosocial, spiritual, and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; outcome evaluation skills; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations and communication skills. Besides being good at decision making and clinical governance, independent nursepractitioners at home are more confident, accountable and updated with thorough knowledge and competent clinical skills. After gaining practical experience a nurse may opt for a bigger role such as nurse counselor, nurse educator, manager, HR recruiter, and clinical quality control manager, industrial or corporate nurse. With palliative care, hospice care and home-based healthcare also being in demand abroad, many can hope to find suitable employment in another country. Since India isa hospital tourism hub, Indian healthcare providers are respected globally, and this includes the nursing community as well. The India International Healthcare Recruiters website, for example, counts countries like Abu Dhabi, Australia, Ireland, New Zealand, South Africa and the UK as the top recruiters for nurses, including home-based healthcare. Nurses, consistent with their individual educational preparation, experience

and roles, also promote the highest standards of end-of-life care through community and professional education, participation in demonstration grants, and in end-of-life research. As society’s needs change and awareness of the issues surrounding the end of life increases, nurses are called to advocate for the terminally ill and their families through public policy forums, including the legislative process. In light of the recent debate on euthanasia, and the Indian medical community’s emphasis that palliative care deserves attention instead, such legislative and policy initiatives by the home-care nursing community takes their role beyond the ambit of caring for a patient by the bedside.

Ms. Usha Prabhakar

Senior Director- Nursing & Clinical quality, HealthCare at Home India Pvt. Ltd

EXPERT VIEWS

Most Common Genetic Disorders in India Family genes are very influential. Various genetic disorders pass on to children through their parents or grandparents and found in the family lineage or ethnicity. While carriers may not suffer from this disorder and live a healthy life, if both partners are carriers the risk of an affected child is as high as 25%. A study by IGENOMIX shows out of 138 Non Consanguineous couple couples 6% had a high-risk of transmission to their offspring. This number is as high as 17% in case of consanguineous couples especially in countries like Dubai. In March 2006, research carried by the March of Dimes Birth Defect Foundation reported the birth defect pervasiveness in India as 64.4 over 1000 live births. Rao and Ghosh (2005) states, 1 out of every 20 newborns admitted to the hospital carries a genetic disease that eventually account for nearly 1 out of 10 infant mortality. In the regions with more congenial marriages, congenital abnormalities and genetic disorders are the third most common cause of mortality in newborns. Nevertheless, it is crucial to prevent the birth of a child with genetic disorder thus reducing the risk Top 5 most Common genetic disorders in Indian ethnicity are Beta- Thalassemia, Cystic Fibrosis, Sickle Cell Anemia, Spinal Muscular Atrophy and Haemophilia A. Beta- Thalassemia: The study shows 1 out of every 300 live births suffers from Beta- Thalassemia. It is a genetic blood disorder carried in which the body makes an abnormal pattern of haemoglobin. Haemoglobin is the protein in red blood cells that carries oxygen. Affected people also have a deficiency of red blood cells (anemia), which results in pale skin, weakness, lethargy, and more severe complications. Individuals with beta thalassemia are at increased risk of growing abnormal blood clots. There is two kind of beta thalassemia: thalassemia minor (known as a carrier of the disease) and thalassemia major (also called Cooley's anemia). 56

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Cystic Fibrosis: Cystic fibrosis (CF) is a transmitted genetic disorder that causes persistent lung infections and limits the ability to breathe over time. A study by Igenomix shows 1 in every 25 live births suffer from Cystic Fibrosis. People with CF have obtained two copies of the defective gene, one copy from each parent, which results in 25% risk of contracting the disease. CF Symptoms include a problem in breathing, chronic lung infections, digestive, and reproductive issues. Sickle Cell Anemia: Sickle Cell Anemia (SCA) is a genetic blood disorder that affects 1 in every 150 live births. It induces red blood cells to grow into a crescent shape, like a sickle. The sickle-shaped red blood cells split easily, inducing anemia. These red blood cells survive for only 10-20 days rather than normal 120 days. This causes severe pain and permanent harm to cerebellum, heart, lungs, kidneys, and other body organs. In the United States, every year about 2,000 live births is born with sickle cell disorder. Spinal Muscular Atrophy: Spinal Muscular Atrophy (SMA) is a genetic disorder that strips an individual of physical strength by influencing the nerve cells in the spinal cord, driving away the energy to walk, eat, or breathe. SMA affects approximately 1 in 10,000 babies, and about 1 in every 50 live births is a genetic carrier. Haemophilia A: Haemophilia A or factor VIII (FVIII) deficiency is a

Rajni Khajuria PhD Laboratory Manager

hereditary disorder affected by the lack of defective factor VIII, a clotting protein. Even though it is carried in genes approximately 1/3 of cases are induced by a spontaneous mutation. According to the US Centres for Disease Control and Prevention, haemophilia occurs in approximately 1 in 5,000 live births. Individuals with haemophilia A usually, bleed longer than other people. Bleeds can happen internally, into joints and muscles, or externally, from minor cuts, dental procedures or trauma. We all have changes in our genes, and the carrier screening test allows us to find out whether they could cause a disease in our children. 20% of infant mortality in developed countries is caused due to genetic disorders. Igenomix would provide a key platform for screening the risk of transmission of genetic disorders to your unborn. Till yet Igenomix has analyzed more than 7,500 samples and screened 6,000 mutation in 600 genetic disorders. It is the only clinically validated genetic screening test based on next generation sequencing, reducing the risk of transmitting genetic disorders to 1:100,000. Genetic diseases cannot be cured but can be prevented with Carrier Genetic Tests (CGT).

EXPERT VIEWS

Research on

Brain Cancer

In India, cancer has some alarming statistics. More than around 40, 000 Indians are diagnosed with cancer of which a whopping 20 percent are children. The most common cancers detected are Lung and oral in men and cervical and breast cancer most commonly effect women. What is alarming though is that two thirds of cancer deaths are preventable with a few alterations in onesâ&#x20AC;&#x2122; lifestyle. Of all the cancer types, the brain tumor, has always been a serious research aspect for the scientist in this field. The complexity of the tumor, makes it difficult to treat. Roughly 2500 to 3000 kids every year are diagnosed with brain tumour in India which sadly spreads through the cerebrospinal fluid to the areas of brain and Spinal Cord. We also have reports suggesting electromagnetic radiations from mobile towers etc being touted as a major cancer causing agent with regards to brain tumour cases . Glioma is said to be the most common form of primary malignant brain tumour in adults, with approximately four cases per 100,000 people each year. Gliomas remain one of the hardest to treat cancers. Scientific experts in Newcastle University have worked upon a pioneering research on the topic of brain tumour where Gliomas require fatty acids to fuel growth and not sugar for energy production as it was hitherto generally believed to be so. This throws light on some fundamental aspects of the biology of cancer cells of the brain and states the fundamental principle that it is the fatty acids which are broken in order to produce energy and sustain growth. Interestingly a drug called Etomoxir is used to slow down the metabolism rate of fatty acids and this shows that it can be included in the treatment of Glioma patients. 58

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This path breaking therapeutic intervention if being implemented after some time in the near future can yield unbelievable life- saving results for Glioma patients which has been discovered by the medical experts of Newcastle university backed up by solid laboratorial research involving cells from human beings being mutated as cancerous cells and thereby being injected into donor mice for obtaining interesting output in this research which has given us a scientific breakthrough. The median life span increases by 17 percent when this injected drug delays the process of cancer cell formation in the brain.

India has documented several cases of brain cancer which have been both a serious killer as well as an early battle won. Only six percent of brain tumour can be treated successfully and the rest are still being worked out with multiple alternatives. Increased use of advance technology in diagnosis process and neurosurgery, we are still battling with this malaise which in some good number of cases leads to death due to its irreversible nature. Cancer research has come a long way in terms of its scientific efforts in promoting world class treatment and care to patients suffering from various stages of cancer.

PRODUCT LINE

MID SIZE HOSPITALS- SMALL IS THE NEW BIG RISE OF MID SIZE HOSPITALS:

Experts say health insurance is one of the reasons for the proliferation of mini- hospitals. The majority of people who have medical insurance have a basic health cover upto 2-3 lakhs. They don't want to go to public hospitals, but cannot Dr. Vinod Singh afford a five-star hospital either. These volumes of patients are Founder & Consultant looking for affordable healthcare. The lower to middle classes Hospitech, Banglore are a big pool and they prefer private healthcare. Nursing homes are no longer sought after due to the popularity of insurance. People want to go to hospitals that are generally better equipped than nursing homes. An ideal business model for a mid size hospital should be This article discusses methods to analyse the benefits, and based on low costs and high volumes, which can help hospitals become profitable within first two years of establishment. If performance related to mid size hospital facilities. you operate at a much higher volume of patients than traditional The results of this article will enable a better understanding of players, you can spread your fixed costs over a larger number the significant performance gains of mid size hospital set ups of customers. vis a vis large size hospitals.

HOSPITAL SIZE & TYPE OF CARE

REDUCE COST & IMPROVE PERFORMANCE

 Leasing the facilities  Mid-size : 70- to 100-bed hospitals  Outsourcing laboratory and canteen services and  Their top USP: Affordable healthcare P artnering with specialty set ups such as: paediatric  Other USP: They are located within neighbourhoods, unlike hospitals for neonatal treatment requiring intensive care bigger hospitals which are concentrated mainly in densely instead of building this infrastructure in-house urbanised areas  Exploit the benefits of a network by setting up multiple  Trend: They seem to be replacing nursing homes that were hospitals in a city, allowing hospitals to share expensive once the mainstay of a city’s health-line resources such as ambulances, administrative staff and other back-end processes CHALLENGES: It is difficult to sustain nursing homes, both in terms of  Performs annual health checks, as a part of preventive infrastructure and staff. healthcare services, to maximize the utilisation of laboratory and diagnostic equipment. Nursing homes are bound to shut down as people with insurance prefer to go to bigger hospitals. This helps you in following ways: Also, doctors running nursing homes no longer want to  Keeping your projects initial capital cost low take any risk and fear they will have to pay a heavy price if  Reducing the operating expenses involved in hiring fullsomething time paediatricians and paediatric nurses.  Low cost of building and maintenance OPPORTUNITIES: The mid-size hospital segment is considered the emerging  This high-volume, focused model allows your hospital to segment in India due to its expected role in expanding health charge lesser which could be half of the cost of the big services to the farther reaches of the country. While 3/4th of private hospitals in the neighbourhood India stays in villages, healthcare services are concentrated  This low cost business model will play a crucial role in mostly in urban areas. To bridge this gap and make quality driving hospitals in Tier 2 & 3 cities towards sustainability healthcare services affordable and accessible in semi-urban through special emphasis on manpower management, asset and rural areas, a chain of mid-size hospitals is a good option. management, marketing and quality assurance. Now, mid-sized entities-or mini-hospitals with 70 to 100 beds When the question arises about the performance of the mideach-are mushrooming across the city's suburbs and satellite size hospitals, a great emphasis has to be placed on the need for towns. From eye care to laparoscopic surgery to orthopaedic introducing professional management systems with focused procedures, these smaller hospitals offer families the option training inputs for ensuring patient safety and quality issues. to seek healthcare right next-door. Given the exorbitant real estate prices, it is easier to set up a 50-70 bed hospital in a CONCLUSION: suburb that is otherwise short on healthcare options. THINK BIG, START SMALL, SCALE FAST 60

www.m e d e g a t e t o d a y. c o m July-Aug 2016

Start-up Profile

Curofy Health tech is blazing hot right now and there's no shortage of companies working on innovative products designed to change the face of healthcare as we know it. That's a good thing, considering Americans are as unfit as ever and bureaucracy continues to muck things up for physicians and patients alike. As technology evolves, it could upend some of these problems. One thing that's certain: Consumer-driven healthcare is coming. And these companies are helping make it happen. Curofy is India’s largest community of verified doctors. Curofy offers doctors a spam-free and secure environment to communicate with each other. Doctors can provide referrals, share cases, call other doctors without saving numbers and have access to most recent, specialty-wise developments taking place in their field. Curofy, through its relevance based algorithm, ensures that doctors get the most relevant case discussions and news updates on their mobile app and ultimately leading to a very high engagement within the community. More than 250 cases across 25 specialties are discussed every day. Curofy is soon moving from 25 specialties to 400 sub specialties to provide even more relevant news updates and cases for discussions to its doctors’ community and thus, ensuring even higher engagement in future. Within eleven months of its launch, more than 50,000 doctors from across 300 cities are using this app. Curofy got funded, in a dramatic, reality televisiontype formatted live event on CNBC called TiE the Knot at TiEcon 2014, a conference organized by The Indus Entrepreneurs in October. Some highly respected angels like Rajul Garg (Sunstone Business School, Global Logic, Pine Labs), Alok Mittal (JobsAhead, Canaan), India Quotient, Spice Labs, Dinesh Agarwal (Indiamart), Dr Shuchin Bajaj (Cygnus Hospitals), and Presha Paragash (Zostel, Sol Primero) have invested in the company. 62

www.m e d e g a t e t o d a y. c o m July-Aug 2016

Mudit Vijayvergiya

Mudit is a dual degree graduate in chemical engineering from IIT Delhi. He worked with Axtira Inc on health informatics and analytics for an year before starting his own venture in healthcare.. He has been an active part of various entrepreneurial avenues like Jagriti Yatra, TIE, youth forums and draper university in silicon valley. He started an international think tank of students at IIT Delhi called ShARE present in prestigious colleges across 4 continents . He is passionate about sports and travelling . While at college, multiple internships with healthcare startups exposed him to the ground realities of the sector in India and that gave birth to Curofy. Nipun Goyal

Nipun is co-founder of Curofy. He is a B.Tech from IIT Delhi with major in Electrical Engineering and minor in Business Management. He worked with Rothschild India for 2 years on Mergers & Acquisitions and Private Equity Funding transactions. He is passionate about making digital health communication easier and more organised and likes to interact with various healthcare stakeholders. Pawan Gupta

Pawan is a B.Tech. in Electrical Engineering from IIT Delhi. He worked with Deutsche Bank for 2 years in Mumbai. He has an interesting mix of interests in technology and finance. He was a part of the Robotics Club and Entrepreneurship Development Cell at IIT Delhi. He represented IIT Delhi at the Stanford University Entrepreneurship Summit and also finished Runners-up in Elevator Pitch Challenge at the Summit. He started Economics Club at IIT Delhi to establish a platform for economics discussions among students and managed to gather support from eminent economists and financial institutions. He is passionate about online knowledge transfer and likes to spend his time on Quora and Coursera. He is also a travel buff and has spent considerable amount of time travelling across continents.

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09/10/11 December 2016 Dr. Prabhakar Kore, Convention Center, Bengaluru

Indiaâ&#x20AC;&#x2122;s definitive exhibition & conference on products & services that aid the inclusion of differently abled

Highlights

Exhibitors from all over India and from abroad.

Many dedicated workshops covering all facets of rehabilitation.

Latest products and services on display.

Eminent speakers at the workshops

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Strong presence of both manufacturers / suppliers and end-users.

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Conference Secretariat: MedOrg Seminars Organizing Tel: +971 4 449 6071, Email: icjr@medorg.ae

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diagnostic & lab products

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Autoclave & Sterilizers Jaiveer Surgical emporium

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HEALTHCARE PRODUCTS Shree Balaji Surgical Pvt. Ltd. A/2, Ruchi CHSGround Floor, Devidas Lane Borivali (W), Mumbai 400103 Ph.: 022- 28954442

HOME CARE Easy Care Group

Hitex healthcare

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ECG Equipments Hygeia Incorporation

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

Endoscopy Instruments

Healthware Pvt. Ltd.

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

HOSPITALS (Multi Speciality) Cygnus Hospital

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

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

Helios Endovision

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

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

Manaipal Hospitals

Pushpawati Singhania Research Institute

Press Enclave Marg, Sheikh Sarai, Phase-II, New Delhi â&#x20AC;&#x201C; 110 017 Tel: 011 30611900

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HOSPITAL CONSULTANCY

Medical Equipment

Nurse Calling System

Hosconnn

Technocare Medisystems

CR Medisystems Pvt. Ltd.

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

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

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

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

Bangalore T: +91-9739708532

Hindustan Syringes & Medical Devices Ltd.,

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

MOdular- Operation Theatre

Six Sigma Star Healthcare Pvt. Ltd.

Sai Sumeet Appliances

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

Hyderabad M: 08099119595

Health care Institution Global Institutte of Healthcare Management

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

HOSPITAL FURNITURE Godrej & Boyce Manufacturing company ltd.

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

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

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

Hospital Garments Kaustubh Hospital Garments

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

ICU Equipments

Monitoring Equipments & Accesso Afford Medical Technologies Pvt. Ltd.

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

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

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

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

Neonatal Pediatric Intensive c Bird Mediteck

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

operation theatre equipment

operation theatre Light Magnatek Enterprises

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

Rehabilitation Product &AIDS Vissco Rehabilitation AIDS Pvt. Ltd.

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

Shoes Cover Dispenser BIO-X

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

Software and IT Solution Schrack Seconet AG

T: 124 414150 Kodak Alaris

www.kodakalaris.com

SURGICAL BLADES Ribbel International Ltd

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

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

Agora Climate Control system

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

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

Philips India Ltd.

Magnatek Enterprises

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

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

X- Ray Equipment Allengers

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

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RNI No. DELENG/2010/33833

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Price : ` 100/-

Medgate today

Volume VII || Issue II || July-Aug 2016

The Gateway to Health & Medical World

MEDICAL

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MED

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TOURISM Healthy Weight Loss Surgery

ISM

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A Future as a Home-Care Nurse Most Common Genetic Disorders in India

Vol. VII Issue II

The Rise of Dental Tourism in India

July - Aug 2016

Medical Tourism Industry in

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