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Volume VI || Issue VI || Mar-Apr 2016

The Gateway to Health & Medical World

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MR solutIoNs BRINgs PREClINICAl MRI IMAgINg solutIoNs BRAIN CANCER A CANCER thAt lAsts loNgER IN lIfE

Medical Technology Industry in India An Advance Media Publication

Advance Media Group A Health Journalism

EDITOR EVENT SPEAK

Health is a major indicator of economic development. Finance Minister Arun Jaitley presented India's national budget for 2016-17 in the LokSabha recently, which is a sigh of relief for the farmers while causing the affluent to raise an eyebrow. The budget mostly focuses on the rural economy. The budget for the fiscal year begins on April 1, 2016. Speaking of the longstanding growth and the sustainability of the nation, the Finance Minister fixated on the chief aspects – farmer rights, agriculture, manufacturing, employment opportunities, social welfare, infrastructure and investment, banking and policy reforms, education and health amendments, fiscal control and tax reforms. I believe there’s been a vast comfort in the healthcare domain for few factions. For instance, the charges on dialysis procedures for patients with kidney disorderswill be reduced and dialysis facilities will be available at all district hospitals. This will serve as a huge relief for renal patients, because every 17 out of every 100 people suffer from kidney diseases. Of this, 6% have stage III kidney disease which necessitates medical attention and, in some cases, costly treatment like dialysis or transplant.It is also heartening to know that the government will also provide health insurance of up to Rs 1 lakh for the underprivileged families whereas senior citizens will get additional healthcare cover of Rs 30,000 under the new scheme. Likewise, the PM Jan AushadhiYojana will be strengthened and 300 generic drug store to be opened.To sum it up I think, health sector has got a fair share which was needed in terms of the people who were in dire need of proper healthcare.This will certainly act as animpetus for investment in healthcare segment and assist in enhancing affordability and accessibility of quality healthcare. However, a question will still remain that how Government will run dialysis centres, when we are battling for skilled work force like dialysis technicians? Similarly, there are very fewer facilities in tier 2 and tier 3 cities which can provide a holistic care to the needy and an insurance holder.Furthermore, encouragingdoctors to serve in the semi urban and rural areas have not been highlighted. There has likewise not been any emphasis on sorting the manpower issues in healthcare with great scarcity of doctors and medical caretakers hampering our endeavors in supplying health coverage. Healthcare sector was also hoping to get a positive response from the government to its approvals of exempting of healthcare services from GST, increment of tax holiday for instituting healthcare facilities for a long duration in non-metro areas, increase in tax exclusion on preventive health checkups and establishing regulated funds for health and healthcare. I also feel that the government has not addressed the issue of recent increase in import duty on medical equipment and devices. The medical technology division is still at its nascent stage with manufacturing limited to less complex devices. 75% of medical gizmos are still being imported and therefore the duty increase will result in increase in healthcare cost. It is time that the government understands that health is a critical marker of economic improvement and work towards an all-encompassing vision for healthcare." 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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Contents 32 Is your Child a Victim of Attention Deficit Hyperactivity Disorder (ADHD)? Dr. Rajiva Kumar

36 Commemorating Triumphs and Transforming Futures Mr. Sushil Bagga

48 In an exclusive interview, Dr. Ashok Seth talks about his typical work day, his hobbies and inspirations.

6 By 2025 India will Procure 10 percent of the Bio-medical Market, says Union Minister �� 6 New Drug Delivery System that Targets Inflammation Points in Body �� 8 Earlier Diagnosis of Fungal Lung Infection can now be Possible �� 8 MR Solutions brings preclinical MRI imaging solutions to the Netherlands �� 10 Amniotic Membrane can be the New Wound Healing Technique �� 12 Frost & Sullivan Spotlights Carestream’s Innovation and Continued Success in North �� 12 Alzheimer’s Disease Market Will More than Double to $10.4 Billion by 2021, says GBI Research �� 14 24MRC Network Declared the Winners of 2015 Leaders Awards (Healthcare) �� 16 Xviii National Seminar on Hospital & Healthcare Management, Medico Legal Systems �� 18 Comment on Budget 2016-17 �� 20 6 Things You Should Know About Zika Virus �� 22 Post budget reaction from healthcare industry �� 24 BRAIN CANCER A cancer that lasts Longer in life �� 26 Prevalence of Gestational Diabetes is High but Can be Controlled with Right Medical Intervention �� 28 Is Preventive Operation catching up in India? �� 30 Genomics Driving Personalization of Healthcare �� 34 GI Emergencies A Diagnostic Challenge �� 38 Electrosurgery �� 40 Pros And Cons Of Bariatric Surgeries. �� 44 In Rendezvous with Ramakanth Desai �� 46 Interview with Shashank ND �� 54 Combating Diabetes: The not so sweet Indian Scenario. �� 56 Amulet Innovality The New Leader in Digital Mammography �� 58 HealthNet Global Limited Advances �� 60 Lowering the burden of disease and overall healthcare cost through safe injection practice regime �� 61 Family Matters Heart Disease Lurking in Your Family Tree �� 62 Does my heart pump enough? The EF number reveals it all �� 63

The Next level Healing with the New Medical Technology ��

52 Emphasis on Health Programmes Dr. Jitendar Kumar Sharma

68 ZIKA Virus Public health emergency of International Concern Dr. M. Wali 4

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NEWS Update

By 2025 India will Procure 10 percent of the Bio-medical Market, says Union Minister The Next level Healing with the New Medical Technology A team of researchers at the Massachusetts Institute of Technology (MIT) are in the process of developing a novel wearable device that will change the way how doctors diagnose and treat patients. It is a polymer network that is synonymous to the human tissue. It is a hydrogel, consisting mostly of water and 5-10 per cent of polymer. It is extremely elastic and can stick easily to surfaces. This gizmo is exclusively designed to be compatible with the human body – both inside and out. Because of this compatibility principle, a new class of biomedical devices can emerge. Xuanhe Zhao, an associate professor of mechanical engineering, MIT said that electronic tools such as sensors and drug delivery devices can be embedded into this matrix to achieve smart applications. These types of applications can turn a usual band-aid into a gadget that can autonomously monitor and heal wounds. For instance, if a sensor detects an abnormal increase in temperature it will send out a command that can deliver a specific drug to that specific location. The researchers are now calibrating the properties and functionality of their hydrogels. They believe that soon healing everything from a cut to an ulcer will be as easy as putting on a band-aid.

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Department of Biotechnology, Ministry of Science and Technology, Government of India organized a conference at the CSIR Science Centre, New Delhi on 'MedTech Innovation for Make-in-India'. Hon'ble Union Minister for Science and Technology and Earth Sciences, Dr. Harsh Vardhan was present at the conference and shared insights on the current and future endeavors and possible scenario of medical market in India. Dr. Harsh Vardhan informed that Indian medical technology market was valued at US$6.3 billion in 2013 and is the fourth largest in Asia. He also stated that the current penetration levels of 8% implies a domestic market of $20-25 billion. Dr Vardhan said addressing the conference, ''Globally the medical technology market is expected to be $600 billion by 2025 implying a manufacturing base of $200 billion by then". He also confirmed that India will capture 10% of that share by 2025 in line with China's share today. This will lead to an opportunity of at least $20 billion by 2025. Dr.Vijay Raghavan, Secretary, DBT, and other senior DBT officials were present at the event. Realizing the demand for medical technology innovation, the Department of Biotechnology is promoting this sector by supporting a range of programmes pan India ,which have fruitfully resulted in affordable products of societal and public health relevance.

Report by U.S Scientists Confirms Three Parent IVF is Safe and Ethical. A U.S committee of researchers and ethicists are given a green signal by the U.S government to create “three-parent babies” in clinical IVF experiments, as long as certain guidelines are followed. These babies can be conceived by a procedure known as mitochondrial replacement therapy or three-person IVF. The target is to prevent rare genetic disorders that impairs energy-producing mitochondria from being passed from a mother to her child. The methodology involves the scientists to extract and discard the nucleus of a donor egg containing healthy mitochondria and then infuse the nucleus from a mother's egg. Sperm from the father fertilizes the egg, resulting in an embryo. Thus, the principle is that the majority of the genetic information should come from the mother and father, and only a trifle amount of DNA should come from the donor’s mitochondria. In the United Kingdom, three-person IVF is already legal but the US FDA has requested that a jury convened by the Institute of Medicine to inspect whether ethical considerations should prevent clinical studies in the United States. This panel concludes in a report published in the journal Science, that it is ethical to conduct the experiments, but the technique should be limited to making baby boys. The reason is to avoid 'germline modification' of future generations because mitochondria are usually inherited from the mother. The team also advises that 3 way IVF should be restricted to women with serious mitochondrial diseases. Likewise, an expecting mother’s health and the skills of the scientists should be taken into account before approving studies. The FDA carefully reviewed IOM committee recommendations and stated that the latest federal budget prohibits the agency from reviewing applications 'in which a human embryo is intentionally created or modified to include a heritable genetic modification. Consequently, the mitochondrial replacement therapy or three-person IVF for the prevention of transmission of mitochondrial disease is not approved and cannot be practiced in the United States at this time.

NEWS Update

New Drug Earlier Diagnosis of Fungal Lung Delivery System Infection can now be Possible that Targets Medical engineers at the University of Hospitals, UniversitĂ¤tsklinikum Essen, Exeter have devised a new diagnostic Paul Scherrer Institute, to design a novel Inflammation technique that can help doctors detect diagnostic process. They've tested spores of the fungus, Aspergillus their new diagnostic methodology in a Points in Body the fumigatus, sooner and help decrease the disease model. A researcher at the University of California has developed a new device that can carry drugs to points of inflammation in the body. Dr. Ghada Mutlaq Al-Mutairi holds a doctorate in chemical engineering and has received a global innovation award from HIN, the largest organization endorsing scientific research in the United States. Her technique was recognized as one of the four most phenomenal inventions by the United States Congress in 2012. Her device provides a way to penetrate the body, detect inflammation, and provide treatment using nano-capsules containing the drug. She confirmed that the technology has been successful in treating eye and rheumatoid patients in the United States, with possible applications in other fields including agriculture, engineering and manufacturing. Al-Mutairi said the development took 10 years, and by 2011 they were able to produce a substance that interacts with the inflammation and by 2013, they we were able to develop the nano-capsule technology that does not dissolve in water and only opens on contact with inflammation in the human body. Dr. Ghada's invention has caught the interest of many pharmaceutical, chemical, engineering, and solar companies around the world. A Japanese agricultural company and Pfizer has also purchased a license for its use Currently, she is working with her brother Dr. Khaled Al-Mutairi, a well-known plastic surgeon in the United States, to support research in plastic surgery, specifically developing a new chemical to rid the body of excess fat. 8

risk of death in patients with weakened immune systems. Aspergillus fumigatus are miniscule ubiquitous spores that are present in the air and breathed in by humans on a daily basis. People that have healthy immune systems are not adversely affected by the spores as they get destroyed before they can grow and infect the body. But in patients with a weak immune system, the fungus faces little resistance. Once it enters the body, the fungus settles into the lungs and spreads from there, causing invasive pulmonary Aspergillosis and sometimes even death. Currently, this infection causes an estimated 200,000 deaths globally, each year. The best way to prevent death is to detect the spores early and subject them to specific and targeted treatment, but till recently this was not possible as there were no quick and reliable method of diagnosis. A team of medical engineers led by Professor Christopher Thornton, Associate Professor of Fungal Immunology at the University of Exeter, and Director of ISCA Diagnostics, have collaborated with scientists from the TĂźbingen University and University

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The procedure involves tagging radioactively labeled antibodies to the infecting structures formed by the growing fungus. This makes fungus visible to physicians. The researchers used a combination of MRI and PET imaging to identify the spores and to rule out other bacterial and viral lung infections. This an easier and faster way of detecting the spores than the existing method which involves taking tissue or fluid samples from the lungs of immuno-compromised patients with abnormal symptoms. Professor Thornton confirms that in the future patients can avoid the tedious, time-consuming, and sometimes dangerous procedures, currently in practice. And doctors can detect the spores early on and gain valuable time for successful treatment. This innovative technology has the scope to bring about a paradigm shift in medical and healthcare practice globally and will help pave the way for better diagnosis of other potentially fatal diseases.

NEWS Update

Teknimed to Launch New Biomaterials & Surgical Solutions in Orthopaedics and Spine Surgery in India TEKNIMED, designer, developer and manufacturer of innovative surgical products, will showcase its latest innovations for the Indian market at Medical Fair India 2016. The company recently registered a list of products 100% made in France which are now or will be available soon in India. TEKNIMED will first present its OPACITY+ product, low viscosity bone cement dedicated to vertebroplasty and kyphoplasty surgeries for spine application. The product has already been certified for the Indian market and is available. Three other products (CEMFIX 1/3, GENTAFIX 1/3/3MV and EUROSCREW PLA and PLA/TCP) are being tested to receive certifications as per Indian regulations and will be available in India in April this year.CEMFIX and GENTAFIX are PMMA cement (respectively with and without antibiotics) with low, medium and standard viscosity dedicated to any knee, shoulder or hip prosthesis surgeries. EUROSCREW PLA and PLA/TCP resorbable interference screws are dedicated to ligamentoplasty surgeries. TEKNIMED has strong expectations from the Indian market, as said by Ms. Isabelle Iversenc, APAC and MEA Export Manager: “India is a highly dynamic market. Key words to enter this market: Innovation, quality and well-priced products. With our arthroplasty and vertebroplasty range of products, we have the solutions to meet the requirements of Indian healthcare sector for innovative surgical and biomaterial products”.

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MR Solutions brings preclinical MRI imaging solutions to the Netherlands

MR Solutions will be displaying its latest cryogen free 3T and 7T preclinical, multimodality MRI models to the imaging science community at the 11th European Molecular Imaging Meeting on March 8 – 10, 2016 in Utrecht, in the Netherlands. This is an annual event organized by the European Society for Molecular Imaging, of which MR Solutions is a member. Dr David Taylor, CEO of MR Solutions commented: “We will be showing off our latest scanners which offer multimodality scanning (including PET or SPECT) and better performance, all at a very competitive cost.” MR Solutions, which is based in Guildford, UK, is the world’s largest independent developer and manufacturer of preclinical MRI technology and remains the only company to deliver a commercial cryogen free 3T and 7T range of preclinical bench top MRI scanners. To provide the SPECT images, MR Solutions has devised a system where the four gamma camera heads and focusing collimator can be easily clipped on to the front of the bore of the MRI scanner to provide state of the art 3D SPECT images. The SPECT images can be registered with the MRI images providing anatomical-functional

combined capability. The SPECT gamma camera can also be used independently. The PET capability is provided by solid state detectors which are incorporated in the bore of the MRI scanner. The scanner combines the exquisite structural and functional characterization of tissue provided by MRI with the extreme sensitivity of PET imaging for metabolism and tracking of uniquely labelled cell types or cell receptors. This is particularly useful in oncology, cardiology, and neurology research. MR Solutions’ range of cryogen free, Benchtop, 3T to 7T MRI scanners with 16, 31 and 72 cm bores has become a complete game changer in the field of preclinical scanning. The technology not only provides superior soft tissue contrast and high spatial resolution, a vastly reduced stray magnetic field and all the benefits that brings but also allows the magnetic field strength to be easily varied. MR Solutions 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.

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NEWS Update

Amniotic Membrane can be the New Wound Healing Technique The rate of diabetes continues to rise and foot ulcers and chronic wounds are its by-product, leading to amputations in severe cases. To combat it, medical experts are now turning to wound dressings, derived from human amniotic membrane, a tissue found in the human placenta. This innovative approach gives another option to patients whose wounds do not heal using existing treatments. The technique uses a material that would otherwise end up discarded as medical waste after child birth. Amniotic membrane is the innermost layer of the placenta consisting of a thick basement membrane and an avascular stromal matrix that covers the placenta as a fetus develops. 'Water breaking' is when this protective layer ruptures. During parturition, the membrane comes out of the woman's body along with the rest of the placenta. When this membrane is put on the wound, the wound starts to heal faster. The amniotic membrane resembles a piece of standard cling wrap, but it is a haven of various proteins, growth factors and stem cells. The stem cells are scraped away when the membrane is prepared for use as a wound covering, leaving behind the intricate network of the proteins. This scaffold is rich in a certain protein called collagen whose functions are replacement of dead skin cells. According to a report by the Centers for Disease Control and Prevention, diabetic ulcers affect 15 percent of people with diabetes during their lifetimes, and these wounds lead to more than 70,000 amputations annually. The wounds develop due to high levels of blood sugar which damages the nerves over time. This nerve damage, called neuropathy, interferes with the body's normal protective mechanisms. People with diabetes may not sense that they're putting too much pressure on one part of a foot for long periods of time, producing painful sores. The disease can also dry out skin, leading to cuts on the foot a person with diabetes may not even feel. Poor blood circulation means broken skin takes longer to heal, increasing the risk of infection. The products are available in the market and could potentially be employed by any physician and specialized wound care centers. Amniotic membrane is relatively free of any side effects when used in the sheet form and tissue rejection or allergic reactions have not been reported. The natural antigens that detect a foreign entity are not present in this exclusive environment. The only backdrop of using amniotic membrane products is that the cost to cover one wound can be incredibly high. They come in different sizes and the price can range from $400 to $4,000 easily. However, its applications extend beyond aiding people with diabetes. It can help those with burns or diseases such as Epidermolysis Bullosa, a painful genetic disorder in which the skin surface peels away. 12

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Frost & Sullivan Spotlights Carestream’s Innovation and Continued Success in North American Medical Imaging Market Company focuses on innovation to elevate value of diagnostic imaging that helps facilities enhance patient care and clinical collaboration Frost & Sullivan has awarded Carestream Health its 2016 North America Frost & Sullivan Award for New Product Innovation Leadership for innovation focused on value-based imaging that solves real-life problems and addresses unmet customer needs. By empowering numerous new points-of-care and specialties with advanced, easy-to-use and cost effective imaging modalities, Carestream is expanding its value proposition well beyond the centralized imaging departments, through its best-of-breed imaging and informatics solutions, to areas such as orthopedics, intensive care, emergency department, intra-operative and bedside imaging. The award focuses on all aspects of the company’s digital medical imaging portfolio which includes new fluoroscopy and ultrasound systems; new cone-beam CT technology; and a vendor neutral enterprise imaging Clinical Collaboration Platform. “A result of Carestream’s commitment to innovation is its latest flagship digital radiography (DR) product, developed using proven, in-house detector technology,” said Frost & Sullivan Industry Principal Nadim Michel Daher. “This nextgeneration product builds off of its predecessor, the first-ofits-kind ‘DR retrofit’ offerings. It supports a higher level of workflow productivity, dose efficiency and image quality, without requiring heavy investments.” Carestream is set to replicate the success of its DR systems in the fluoroscopy department with the launch of the DRX-Excel Plus, its multi-purpose fluoroscopy/radiography equipment. This device was developed in response to the relative lack of product and technology innovation in this specialty area. It presents healthcare providers with considerable savings by enabling them to share flat-panel detectors among multiple radiography and fluoroscopy rooms and systems. Similarly, Carestream’s recent entry into ultrasound modality is a perfect example of the design philosophy at the company. The Touch Prime and Touch Prime XE premium ultrasound imaging systems underline Carestream’s focus on performance and usability across its product lines. Carestream was able to optimize features based on the actual needs of ultrasound professionals. The all-touch control panel, which is extremely easy to clean and offers tactile feedback on home keys so that operators can stay focused on the patient, is garnering praise from the marketplace. The user interface also can be customized to the preferences of the sonographer.

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NEWS Update

Speedy Diagnosis of Multiple Sclerosis by New MRI Technique A group of researchers at the University of Nottingham and Nottingham University Hospitals NHS Trust have devised a new way of utilizing MRI scanners to look for signs of multiple sclerosis in the brain. Multiple sclerosis (MS) is a chronic, potentially debilitating disease that affects the central nervous system, which is made up of your brain and spinal cord. Multiple sclerosis is widely believed to be an autoimmune disease, a condition in which your immune system attacks components of your body as if they're foreign. It affects around 100,000 people in the UK. It is scandalously hard to diagnose, as it has several symptoms but not all victims experience all of them and the disease can develop at different rates. For this purpose, MRI scans have been used as a diagnostic device to identify white matter wounds in the brain, however these are not always a marker of the disorder. The scientists at Nottingham have discovered a way to utilize clinical MRI to differentiate between MS lesions and other brain white spots which are found in MS. They have used a clinical MRI scanner called a T2-weighted imaging process which can detect lesions in the brain's white matter that are centered on a vein—a known indicator of MS. Dr Nikos Evangelou who is leading the research work quoted, "Huge research MRI scanners could detect the part of lesions with a vein in the brain's white matter, although these scanners are not clinically accessible. We wanted to analyze whether a single brain scan in an NHS hospital scanner could also be valuable in differentiating between patients who have MS and patients known to have non-MS brain lesions. We are happy to say that our results show that clinical application of

this technique could be a wonderful add-on to the prevalent diagnostic procedures for MS." For the blinded trials, 40 patients participated from the neurology outpatients' department of Nottingham University Hospitals NHS Trust. Firstly, a group of 10 patients with MS and 10 patients with non-MS white brain matter lesions were scanned. Scans were analyzed anonymously, blinded to clinical data and simple diagnostic rules were devised. The remaining 20 patients were subjected to same rules (13 with MS and 7 with other lesions) by a blinded observer. As a result, all patients with MS had central veins in more than 45 per cent of brain lesions, while the rest had central veins visible in less than 45 per cent of lesions. Then, by applying the same diagnostic rules to the second cohort, all the remaining patients were correctly categorized into MS or non-MS, by the blinded observer, taking less than two minutes per scan. This novel study is significant because presently, among patients referred to MS treatment centers with suspected MS, fewer than 50 per cent are revealed to have it. This portrays that diagnosing MS in a considerable minority of cases can be tricky. The Nottingham University team has now started a new study examining patients with real uncertainty about the diagnosis and aim to extend the study in other UK towns so more patients can participate in this important research. It is possible that in less than two years we will know if this new test is accurate as it appears to be. In that case, the way we will be diagnosing MS will probably be quicker and more reliable. The Nottingham team has already presented their data in the US and a similar US based study is planned based on the Nottingham results.

Alzheimer’s Disease Market Will More than Double to $10.4 Billion by 2021, says GBI Research The Alzheimer’s disease market will more than double from just under $5 billion in 2014 to an estimated $10.4 billion in 2021, at a Compound Annual Growth Rate (CAGR) of 11%, according to business intelligence provider GBI Research.The company’s latest report states that such impressive growth, which will occur across the eight major markets (8MM) of the US, Canada, France, Germany, Italy, Spain, the UK, and Japan, will be primarily driven by increased disease prevalence during the forecast period. Yasser Mushtaq, Senior Analyst for GBI Research, says Alzheimer’s disease is significantly more common in the older population and incidence rates increase

rapidly after the age of 65. Mushtaq comments: “The fact that people are living longer across the globe means more cases of the disease are developing, and this has posed a growing public health crisis, which represents a very serious disease burden for patients and careers alike. “Despite the urgent need to develop more effective treatments for Alzheimer’s disease, thorough research is being carried out into understanding the disease, as its underlying pathology remains unknown. “However, these extensive studies have helped to develop the research and development process within this indication, providing hope for the future of Alzheimer’s disease therapeutics.”

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GBI Research also states that although disease prevalence will be the strongest driver of market growth, innovation in the pipeline will also be a factor. Mushtaq explains: “While many of the later-stage therapies focus on common targets, the earlier stages of the pipeline do not appear to follow this trend, as they contain many first-in-class molecules with novel molecular targets within the context of Alzheimer’s disease therapeutics. “The primary new approvals for drugs that will drive growth during the forecast period will supplement current market leaders and offer greater therapeutic options. Promising examples include verubecestat, aducanumab and azeliragon, all of which have demonstrated clinical benefit and will be approved during the forecast period.”

NEWS Update

24MRC Network Declared the

Winners of 2015

Leaders Awards (Healthcare)

Awards Winners:

Dr. Anup Kumar Excellence in Urology of the Year Dr. Ankur Barua Excellence in Public Health of the Year Excellence in Otorhinolaryngology (E.N.T.) of the Year Dr. Kumaresh Krishnamoorthy Dr. (Prof.) Jayakar Thomas Excellence in Dermatology of the Year Dr. Pradip Kumar Bhattacharya Excellence in Diabetology of the Year Dr. (Prof.) Nekib UA Yamaneh Excellence in Yoga & Naturopathy of the Year Dr. Prasant Kumar Sahoo Excellence In Interventional Cardiology of the Year Surya Children's Medicare Private Limited Best Single Specialty Hospital of the Year Dhiraj Hospital, Vadodara Best District Hospital of the Year Kids Clinic India Private Limited (Cloudnine Hospitals) Best Hospital for Wellness & Healthcare of the Year Cygnus Medicare Private Limited Best Multi Specialty Hospital Of The Year Dr. Rakesh Garg Excellence in Pain Management of the Year Dr. (Prof) Subroto Mandal Excellence in Cardiology of the Year Excellence in Obstetrics and Gynecology of the Year Dr. Shagufta Dr. Syed Sirajuddin Excellence in Hijama (Cupping) Therapy of the Year Dr. Rizwan Haider Healthcare Innovator of The Year (Pediatrics)

About 24MRC Network 2015 Leaders Awards (Healthcare): The 2015 Leaders Awards (Healthcare) “The Most Authoritative Awards for the Healthcare Industry”

Winning an award and receiving the recognition of your peers in your sector or industry is the ultimate accolade, 24MRC Network has initiated the 2015 Leaders Awards (Healthcare) - The most authoritative awards for the healthcare industry to encourage the best healthcare providers in India. The awards will be a witness for the coming together of the entire healthcare community. 2015 Leaders Awards (Healthcare) aims at felicitating organizations and individuals for their efforts towards operational excellence, innovatively adopting and inventing technologies and processes for India, and improved healthcare delivery. With leaders from private and government organizations, policy makers, representatives from the government and key people from sector affiliates, all assemble to recognize and applaud the achievements of the best healthcare providers. Each Award recognizes excellence in healthcare as manifested in the varied ways that may significantly impact the health and well-being of our citizens. These awards aim to set a new benchmark for the healthcare industry. The awards are determined by means of a comprehensive selection process which is based on robust and dynamic framework.

The 13th International Congress of the Middle East Africa Council of Ophthalmology will be held from 4-8 May in Bahrain The Middle East Africa Council of Ophthalmology (MEACO) will hold its 13th international congress from 4 - 8 May 2016 at the Bahrain International Exhibition & Convention Centre. The congress is under the patronage of His Royal Highness Prince Khalifa bin Salman Al Khalifa the Prime Minister of Kingdom of Bahrain. It is supported by the Ministry of Health in collaboration with the University of Maryland School of Medicine – 16

Department of Ophthalmology and Visual Sciences, International Council of Ophthalmology and the Bahrain Ophthalmological Association. The MEACO Congress is the largest ophthalmic meeting in the Middle East and Africa regions that attracts ophthalmologists, eye care professionals, and exhibiting companies from the region, as well as from Europe, America, Asia and Australia. The MEACO Scientific

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India and United States Partner on Cancer and Traditional Medicine Research Efforts Collaborative research on cancer and traditional medicine may pave the way for potential breakthroughs The first U.S.-India Workshop on Traditional Medicine (March 3-4, 2016) began in New Delhi today. The Workshop was jointly inaugurated by the Minister of State for AYUSH (Independent Charge) and Health & Family Welfare, Shri Shripad Yesso Naik and U.S. Ambassador to India, Mr. Richard Verma and Assistant Secretary of Global Affairs at HHS, Ambassador Jimmy Kolker. Representatives from the U.S. Department of Health and Human Services (HHS) Office of Global Affairs (OGA), the National Institutes of Health (NIH) National Cancer Institute (NCI), and U.S. academic institutions will interact with their counterparts from the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), and Indian research institutes and universities, in New Delhi during the workshop. The Workshop is being organized under the auspices of the first U.S.-India Health Dialogue held in September, 2015 in Washington, D.C. This effort underscores the discussions between the U.S. President and the Indian Prime Minister to encourage bilateral dialogue on traditional medicine. Over the course of the two-day workshop, participants will share current traditional medicine therapies and practices for cancer in U.S. and India. They will review available evidence for AYUSH products and interventions, which could reduce pain/morbidity from cancer treatments and improve the quality of life.

Program Committee has put together a state-of-the-art program that will make MEACO 2016 Congress a memorable educational as well as social experience for everyone. Some of the congress topics include Cornea, Glaucoma, Cataract, VitreoRetina, Paediatric Ophthalmology and Strabismus, Refractive Surgery and Eye Research. Special sessions will be conducted for Young Ophthalmologists and Women in Ophthalmology. For more information on the congress, please visit www.meaco2016.com.

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NEWS Update

XVIII NATIONAL SEMINAR ON HOSPITAL & HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS AND CLINICAL RESEARCH Indian healthcare is exhibiting an inclusive & remarkable growth trend along with global recognition. It maintains its status of a sunshine industry and all the verticals in healthcare are contributing towards a new era with patients at the centre. New startups are rising, veteran organizations are upgrading to global standards, healthcare IT has revolutionized automation, Government’s regulatory framework is supportive, foreign investments are on rise and customers are more aware than ever. All in all, the healthcare eco-system is better than ever and has a promising CAGR of 22.9 per cent to reach US$ 280 billion by 2020. Seminars, forums and workshops have contributed immensely towards understanding the current scenario, roadblocks and future bringing together the luminaries, entrepreneurs, industry experts, government bodies and other stakeholders. It has always been a platform for leaders to inspire and aspirants to learn and lead. Symbiosis, being a premium educational institute has always taken a lead to be an effective catalyst towards constructing initiatives to fill the gap in industry and academia, initiating ideas, inspiring people and igniting minds to do more and to achieve more. Based on the above doctrine, Symbiosis Institute of Health Sciences (SIHS), a constituent of Symbiosis International University (SIU) is proud to announce the eighteenth version, ‘XVIII National Seminar in Hospital & Healthcare Management, Medico Legal Systems & Clinical Research’ on 6th & 7th May 2016 at Symbiosis International University (SIU), Lavale, Pune. This has been accredited by Maharashtra Medical Council (MMC) as well. This National Seminar has been planned to be a consummate platform to new ideas, uprising segments/ verticals, global standards and would prove to be an imperative platform for industry and academia nationally and globally. 18

Symbiosis International University (SIU), Lavale, Pune Highlights this year will be CONNEXIONS, National Seminar main event, Master Classes, Star Alumnus Awards and Healer of Mankind Award. CONNEXIONS – A workshop and a placement drive is open to all on 5th May 2016. An informative and innovative sessions on “Role of Six Sigma in Healthcare” by Dr. Pradeep Bhardwaj, CEO, Six Sigma Star Healthcare, followed by an insight on “Game Changers : Telemedicine in Health care” by Mr. Sanket Arora, GM, International Business, Columbia Asia, Bengaluru and later a session on Entrepreneurship by Mr. Velumani, Founder & CEO, Thyrocare Pvt Ltd. are planned. CONNEXIONS workshop will be followed by a placement initiative which will feature hospitals, TPA, IT & Clinical Research companies to name a few. The main event of National Seminar starts on 6th & 7th May 2016 and will be inaugurated by Mr. Thumbay Moideen, Founder President, Thumbay Group, UAE. Dr. Rajani Gupte, Vice Chancellor, Symbiosis International University (SIU) and Dr. Vidya Yeravdekar, Principal Director, Symbiosis will grace the occasion. The sustenance of a successful business model is equally important, if not more important than creation of one. To elaborate on how to create and sustain an effective, efficient & successful business model, a pre-conference symposium on ‘Sustainable Healthcare Models' has been structured. The session

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will be anchored by Ms. Shobha Mishra, Senior Director, FICCI. The session will be crowned by a cohort of stalwarts Dr. Ravindra Karanjekar, Group CEO, Jupiter Hospital, Mr. Shushobhan Dasgupta, MD, Johnson & Johnson, India, Mr. Aniruddha Rajurkar, Head India Business, Dr. Reddy’s Laboratories Ltd., Mr. Kaushik Sen, Co-founder & CEO, Healthspring. The second half of the day will feature a session on Healthcare Communications by Dr. Nagesh Rao, President, MICA, Ahmedabad. This will be followed by a session on Enterprise Performance Management by Dr. Rana Mehta, Director, PWC. Driving on the immense success of the XVIIth edition of National Seminar, this year’s edition too will feature four intensive, domain specific master class sessions. The first of the master class will be on Changing Paradigm in HR by Dr. H. Sudarshan Ballal Chairman, Manipal Health Enterprises. The second master class will deal with the Emerging trends in Diagnostic Care by Dr. Arvind Lal, Chairman, Lal Path Lab. The third session in the series will look into the Opportunities and challenges in Health Insurance by Dr. Geeta Bharadwaj, Managing Director, MD India. The final master class will have Dr. Sanjay Gupte, Past President, Federation of Obstetric and Gynaecological Societies of India & Medical Legal Expert on Special laws related to Healthcare.

NEWS Update

Day 2 of the XVIIIth National Seminar is equally diverse and teeming with a horde of industry experts talking on a multitude of industry relevant subjects and starts with paper presentation by delegates followed by a session on Medical Tourism and Care beyond boundaries by Mr. Abhay Soi, CMD, Radiant Life Care Pvt. Ltd. Later a session on Business Analytics & financial modeling will be delivered by Mr. Murlidharan Nair Partner, Consulting Practices of E & Y. Dr. Prabhu Vinayagam, Managing Director, Asia Pacific, JCI will conduct session on Quality & AccreditationNational & International. Home Health Care a rising concept will be explained by Mr. Vishal Bali, Co-founder and Chairman, Medwell Ventures. For students of Clinical Research, a session on Quality systems in Clinical Trials will be taken by Dr. Suneela Thatte, Vice President, Quantiles, India Pvt. Ltd. Followed by a session on Pharmacovigilance by Dr. Chandrasekhar Potkar, Medical Advisor, Pfizer.

Healthcare sector is witnessing increasing trend in cases related to consumer and medico legal issues primarily due to increasing consumer awareness and expectations in past decade. Because law is in a constant state of flux, healthcare management personnel must stay updated on the knowledge of the medico legal law. A topic on Legal Aspects of Healthcare (Landmark Judgements) shall be discussed by Dr. Gopinath N. Shenoy, Medico Legal Consultant. This year the Valedictory Ceremony will see the introduction of two stellar awards to be conferred upon individuals acknowledging their commendable efforts in the healthcare field and contributions thereof to the Society. They are namely 'Healer of mankind' award, which is on similar lines to a lifetime achievement award! The second award will be given to our Star Alumni who has contributed significantly to the Society. The valedictory ceremony will be graced by the Guest of Honour Adv. Ram Jethmalani, Former Union Law Minister

and presided over by Padma Bhushan Dr. S. B. Mujumdar, Founder & President, Symbiosis and Chancellor, SIU. XVIII National Seminar has reached its acme and promises to be a must attend event for professionals from all verticals of healthcare. For Registration and further queries Please Contact: Phone: 91-020-25655023, 20255051, 08888892258, 09552588162/ 92 Email: info@schcpune.org, dep@schcpune.org, ic.symbiosis@schcpune.org, hod_academics@schcpune.org Website:Â www.schcpune.org We hope to see you there!!! Dr. Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Day & Date: Friday 6th & Saturday 7th May 2016 Venue: Symbiosis International University- Lavale, Pune

NEWS Update

Two KIMS Medical Centers receive ACHSI Accreditation KIMS Medical Center in Doha and KIMS Oman Hospital in Muscat recently achieved ACHSI Accreditation. KIMS Oman Hospital is the first organisation in Oman to achieve this milestone. The official certificate presentation ceremony for KIMS Oman Hospital (KOH) was held at the Grand Hyatt Hotel Muscat on 31st January, followed by the ceremony for KIMS Qatar Medical Center (KQMC), on 1st February 2016. Dr Desmond Yen, ACHSI Executive Director attended the ceremonies with dignitaries including Dr Mazin Bin Jawad Al Khabouri, Director General of Private Healthcare Establishments in Oman, Engineer Saeed Bin Nasser Al Saadi from the Ministry of Manpower, Dr Mohammed Sahadulla, the Chairman of KIMS Group, Dr Sheriff Sahadulla, the Executive Director-Medical & Group Chief Medical Officer and Mr Jacob Thomas, Director Operations KIMS. Commenting on ACHSI Accreditation, Dr Mohammed Sahadulla, Chairman of KIMS Group, said, Since its inception, KIMS Oman Hospital has strived to serve the Omani community with the highest standards of medical care and health services. Today, with the joint efforts of our medical and administrative teams, we have proudly achieved this milsetone."

Guests attending the Qatar celebrations included Dr Samar Aboulsoud, AICE0 of the Supreme Council of Health, Mr R K Singh, Deputy Chief of Mission, Indian Embassy to Qatar and Dr Mohammed Sahadulla, Chairman of KIMS Group. KIMS now employs more than 5,000 staff including over 750 doctors in 17 healthcare facilities throughout India, Bahrain, Oman, Saudi Arabia, Qatar and UAE, and has its flagship hospital Trivandrum, India.

Comment on Budget 2016-17 From Shri Rajiv Pratap Rudy, MoS for Skill Development and Entrepreneurship (Independent Charge) and Parliamentary Affairs

“The budget for skill development is highly encouraging for us. As announced, we will be creating 1500 Multi Skill Training Institutes (MSTIs) which will basically be the new generation ITIs set up in PPP mode. So far we have just had standalone government or private ITIs. These will be set up in those blocks and districts of the country which are yet to focus on skill development. We are also certain and committed to achieve our target of skilling 1 crore youth over the next 3 years under the Pradhan Mantri Kaushal Vikas Yojana (PMKVY). 20

In line with this, we are already setting up model skill centres across more than 500 districts in the country. The formation of the National Skill Certification Board is another big step in further strengthening the skill ecosystem. It will see representation from both government and industry, which will collectively enable a joint framework for quality skill assessment. The focus of the budget on creation of jobs and entrepreneurship opportunities through initiatives like Start-Up India and others, spells out the clear vision of government, to link the skilled workforce with employment opportunities.” We will work to deliver entrepreneurship, education and training in 2200 colleges, 300 schools, 500 government ITIs and 50 Vocational Training Centres. Aspiring entrepreneurs will be connected to mentors and credit markets.”

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Extracorporeal Life Support rescues 53 year old from reversible cardiac failure M S Ramaiah Narayana Heart Centre attends many cardiac emergency cases daily. However, the case of this 53 year old man was different. He was rushed to the hospital in a very critical condition. Heart function was drastically reduced due to lack of blood supply to the heart. Various organs of the body did not receive sufficient nutrition and oxygen due to the inability of the heart to pump adequately. The patient was in ‘Cardiogenic Shock’. He also developed severe breathlessness due to excess fluid in his lungs. This was a challenging case for the team specializing in Cardiac Emergency at M S Ramaiah Narayana Heart Centre as the patient’s condition was deteriorating. His breathing was supported with mechanical ventilation; however both his blood pressure and oxygenation continued to be low.

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NEWS Update

6 THINGS YOU SHOULD KNOW

ABOUT ZIKA VIRUS

ika virus is an emerging epidemic disease which was first discovered inside a Rhesus monkey in Zika Forest, Uganda in 1947. It was later isolated from a human being in Nigeria in 1954. It is caused by a virus transmitted by the bite of the mosquito species Aedes aegypti. The virus is prevalent in South America, Central America and the Caribbean, but is likely reach all countries and other tropical and subtropical regions. The WHO has predicted that the virus could infect up to 4 million people this year. It is rather spreading at a explosive rate. The previous world health crisis to escalate to that level was the Ebola epidemic, which spanned 2014 and 2015. However, few people had ever heard of Zika virus before last month, unlike Ebola, which made news headlines for decades. The latter too, was a mosquito-borne virus was known to cause mild symptoms like rashes and fevers, in four out of five infected people, on the other hand Zika doesn't produce any symptoms at all.

SYMPTOMS OF A TYPICAL ZIKA INFECTION

TRANSMISSION OF ZIKA VIRUS IN HUMANS

Vaccine development may take months or even years, so one should keep in mind to not to get bitten in the first place. If someone is living or travelling to a Zika infested country, they should follow certain guidelines to be on a safer side. The safety measures are:  Avoid travelling to countries manifested with Zika mosquitoes  Use insect repellent outdoors  Wearing long-sleeved shirts and long pants, especially during day times  Wearing permethrin-treated clothing and gear  Applying insect repellents containing DEET, Picaridin, and IR3535(safe for pregnant women)

The virus is transmitted to people through the bite of infected female Aedes mosquitoes, the same kind of mosquito responsible for the terror of dengue, chikungunya and yellow fever. They breed in stagnant waters, water filled areas and ponds, and are chiefly active during dawn and dusk. The female mosquitoes bite because they need blood in order to lay eggs. The virus present in their gut travels through their circulatory system to their salivary glands and is injected into the victim. Their saliva contains proteins that prevent blood clotting. The reason is that when they bite, they do not want the prey’s blood to clog their pipe-like proboscis. 22

A Zika infection is diagnosed by blood test and the virus remains in the blood for approximately 7-10 days. The manifestations typically last two to seven days. The symptoms include:  Rashes  Mild fever  Headache  Conjunctivitis (sore red eyes)  Joint and muscle pain

TREATMENT

Currently, there aren't any Zika specific medications and no vaccine has been developed so far. The WHO and CDC have warned people to travel to areas with an active infestation. However, doctors are advising to take plenty of rest and drink lots of fluids to prevent dehydration.

PREVENTION

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ADVICE TO PREGNANT MOTHERS

Studies have proved that Zika virus can spread from pregnant woman to her foetus. Several reports confirm that the infected mothers have given birth to babies with an acute head deformity called microcephaly. It is characterized with unusually small heads and damaged cerebral functioning. However, some cases have exhibited just tiny heads and no apparent damage to brain. Some children, in their later years of life, may experience intellectual shortfall, developmental setback or hearing loss. The consequences vary from child to child. Health organizations have advised pregnant women to not to travel to Zika virus infested regions or countries. But if they are travelling and have developed symptoms of rashes, fever and joint pains, they should immediately consult a physician and get their blood tested. Women who are wishing to conceive are also advised to get themselves thoroughly tested, before getting pregnant.

CONTROLLING MOSQUITO POPULATION

Following measures can control the spread of Aedes mosquitoes. G et rid of any sources of standing water like rain barrels, bird baths, tires etc E mpty any water that accumulates in collecting vessel or tins. C hange water in flower vases, coolers and dump out excess water from any pot or plates. S taying in screened-in windows and air conditioning W hile napping at daytime use an insecticide-treated mosquito net

EXPERT VIEWS

The much needed ACCHE DIN effect is beginning to show "The budget in my view was very thought through and well pointed towards the social sector. It brings great relief to farmers and people who are marginalised. The social scheme & the infrastructure movement forward to create jobs, so I think from that point of view at the base level it has done a lot, for the real ground realty people. As far as health is concerned, it's a great move forward to insure every family for one lakh, which imminently gives them the security that they can access healthcare that was the idea how to create universal access. For elderly, its 1.30 lakh which is even better. Also along with that, the announcement of PPP board there will be many dialysis centres established closer to the villages, that will help a lot because that has been a big problem for people to travel across to require dialysis twice or thrice a week and to travel long distance is devastating for family and the patient, so that's a good sensitive move and the third thing is providing 3000 fare price to medical shops also very good thing.

Dr. Naresh Trehan

Overall I think, health sector has got what was much needed in terms of the people who were under the burden of healthcare will get relief which was surely needed and what we were pushing for the last couple of years. So overall, its real thumbs up to the budget and I am happy and proud that they have done this way. The much needed ACCHE DIN effect is beginning to show."

Higher Govt. Spending & New Health Protection Scheme should Boost Universal Healthcare,

Mr.Anjan Bose

"Higher Govt. Spending & New Health Protection Scheme should Boost Universal Healthcare: NATHEALTH NATHEALTH Welcomes announcement of New Health Insurance Scheme" Union Budget 2016-17 has given due attention to the social sectors including health. Higher allocation & spending should boost universal healthcare. Speaking on the Union Budget announcements, Mr. Anjan Bose, Secretary General, NATHEALTH said, 15% increase in government spending on the social sectors with focus on healthcare should go a long way in ensuring universal health coverage. It is promising to note that the Government intends to provide health insurance coverage to under privileged class through the new Health Protection Scheme of Rs. One Lakh to cover unforeseen illness in poor families. This should also act as a catalyst for investment in healthcare sector and help in improving affordability and accessibility of quality healthcare. This is all the more important considering that nearly 75% of India population is currently without any health insurance. However Mr Bose also added that the implementation process for such a large project has to be very efficient and he sees potential opportunity for PPP in this area. Mr Bose felt that government's announcement of opening 3000 stores under Prime Minister's Jan Aushadhi Scheme is also good news towards affordable healthcare for the masses. Further, announcement of National Dialysis Service programme is yet another welcome measure for the health sector. The industry could have a major role to play in this as the programme would be carried out in PPP mode in district hospitals. Exemption of custom duty on dialysis equipment would further support this commendable programme. However, the health care industry is concerned since the Government has not addressed the issue of recent increase in import duty on medical equipment and devices. The medical technology sector is in an infancy stage with manufacturing limited to less complex devices. More than 75% of medical equipment / devices is still imported and hence the duty increase will result in increase in healthcare cost. Healthcare sector was also looking forward to positive response from the government to its recommendations of Exempting of Healthcare Services from GST, Increase of tax holiday for establishing healthcare facilities from the current period of five to ten years in non-metros, Increase in Tax Exemption on Preventive Health checkup and setting up of a healthcare infrastructure fund as well as a medical innovation fund. NATHEALTH requests the Government to consider these recommendations for the benefit of the healthcare sector and the citizens of the country.

A good budget with a flip side

Dr. Naveen Nishchal 24

I am really happy with the budget because its really good for healthcare sector, few points are worth mentioning here. 1. Insurance Scheme of Poor people covering expanses upto 1.3 lacs will not only benefit the needy but also boost the business of healthcare providers working in tier two cities. 2. Opening Dialysis centres is also a welcome sign 3. Generic medicines stores will also cater the needs of poor and help in reducing the burden of a common man. This Budget has a flip side also, that is, how Govt. will run dialysis centres when we are struggling for skilled manpower like dialysis technicians, also there are very less facilities in tier 2 and tier 3 cities which can provide a holistic care to the needy and an insurance holder.

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EXPERT VIEWS

A promising budget but no healthcare reform addressed "Overall a promising budget. Its heartening to see the fiscal discipline and a slew of initiatives for the under privileged. A lot of emphasis on infrastructure has set the right tone for overall economic reform. When it comes to healthcare, the union budget has rightly addressed the issue of unexpected healthcare expenses being a burden and pushing families in to poverty. The Health Protection Scheme and the Rs. 1 Lakh cover will surely help the families in need. However the budget has once again failed to address any kind of healthcare reform. It is important that the leaders from this industry are heard in the policy process where they can join hands with the Government to spearhead more planned and regulated funds for health and healthcare. This by far has been the most disappointing budget for health. It is time that the government realizes that Health is an important indicator of economic development and work towards an overarching vision for healthcare."

Ms. Ameera Shah

Free preventive & primary care–backbone of universal health coverage model “I welcome the Union Budget, which has announced the provision of health insurance of up to Indian Rupees One Hundred Thousand (INR 100,000) per family, with an additional top up of Indian Rupees thirty thousand (INR 30,000) applicable for senior citizens. While it is heartening to know that the Government will focus on reducing both out of pocket and catastrophic medical expenditure, we hope similar attention will be paid to primary dare and preventive packages under this announcement. These are also a source of out of pocket expenditure.

Siddhartha Bhattacharya

Provision of free preventive and primary care forms the backbone of a successful universal health coverage model. Health insurance coverage that goes beyond a pure hospitalization program and takes into account investment in essential and cost effective interventions, such as preventive and primary care activities, demonstrates value for money of scarce financial and human resources. Additionally, the announcement of a National Dialysis Service to address the high costs involved in renal dialysis and the opening of three thousand Jan Aushadhi stores across the country are a step forward toward providing improved health benefits to all, especially the economically weak strata of the population.”

Budget 2016-17 seems promising for India's youth whether it is about quality of education, focus on skill development, improving teaching and research outcomes, emphasis on job creation or creating an ease of business to promote entrepreneurship. It is good that the Public Private Partnership model has worked reasonably well for the skills ecosystem which needs to be given more encouragement. The setting up of 1500 Multi Skill Training Institutes (MSTIs) is a great PPP initiative that will give major boost to skill development while the National Skill Assessment & Certification Board with both government and industry representation, will be instrumental in ensuring quality assessment of the skilled workforce that gets trained.

Shri S Ramadorai

The continuity in tax benefits available under section 35CCD to training institutes till 2020 is also encouraging to the skill ecosystem."

The budget looks fairly positive for the healthcare sector The union budget exudes optimism and provides some encouraging measures to help India towards rural development, infrastructure, tax reforms, and structural transformation. The 9-pillar agenda was fairly strategic and is reflective of the Government’s intent of a long term programmatic approach. Inclusion of health insurance for elderly indicates the progressive nature of the budget. It will be good to see larger ambit of population benefiting from such steps that will ultimately bring down costs of healthcare in the country. The budget looks fairly positive for the healthcare sector. An impetus to higher public healthcare spending would have made it more favorable.

Varun Khanna

It is encouraging to see the reduction in import duty on certain dialysis equipment but the budget could have been broad based by extending import duty exemption on devices across a broader spectrum. This calls for greater representation of the medical devices sector and benefits extended to diseases with high burden in India such as hepatitis, cervical cancer, diabetes, tuberculosis and cardiac problems.

w w w.medegatetoday.com March-April 2016

DOCTOR SPEAK

BRAIN CANCER A cancer that lasts Longer in life

 Grade I Tumor: Benign, slow growing, long term survival.  Grade II Tumor: relatively slow growing, cells look abnormal in microscope.  Grade III Tumor : Malignant = cancerous, tumor spreads into nearby normal parts of the brain  Grade IV Tumor: Most malignant, grows fast, spreads into nearby normal brain.

SIGNS AND SYMPTOMS of Brain cancer:P ersistent Headaches V omiting, especially in the morning  W eakness in Hand & Leg Dr. Krishna K Choudhary  S eizures Sr. Consultant & H.O.D Neurosurgery S peech problem Primus Super Specialty Hospital C hange in Behaviors, personality etc. G radual changes in intellectual or Brain Cancer is the disease of brain in which emotional capacity cancer cells arises in the brain tissue. Cancer A bnormalities in vision (for example, cells grows to form a mass of cancer tissue double vision, loss of peripheral vision) that interferes with brain functions such as muscle control, sensation, memory and RISK FACTORS OF BRAIN CANCER:other body functions. Tumors composed of The cause of brain cancer is still largely cancer cells are called malignant tumors. unknown. Although there are some genetic Mainly it is of two types - Primary Brain conditions and environmental factors Tumors while tumors that spread from other which may contribute to the development body parts to the brain are called Secondary of brain cancer, the risk factors are much less defined for brain cancer than for other Brain Tumors or Metastatic. Primary Brain Cancer rarely spreads beyond cancers in the body. the central nervous system and deaths result Risk factors are as follows:from uncontrolled tumor growth within the  G ender – certain tumors are more likely limited space of skull. to develop in females like Meningiomas. ge Secondary Brain Cancer indicates advanced  A G enetic disease and has a poor prognosis.  W eak immune System Both types take up the space in the brain  M ultiple endocrine neoplasia type 1 and causes serious symptoms like hearing eurofibromatosis type 2 loss, vision loss etc and complications like  N T uberous sclerosis paralysis of vital body functions. O ne environmental factor i.e., ionizing All cancerous brain tumors are life radiation. threatening because they have an aggressive and invasion nature. A non-cancerous brain TREATMENT FOR BRAIN CANCER tumor is life threatening when it compress A treatment plan is individualized for each brain cancer patient. The treatment plan is vital structure like an artery or brain stem. constructed by the doctors who specialize TYPES OF BRAIN CANCER:in brain cancer, and treatments vary According to WHO (World Health widely depending on the cancer type, brain Organization) brain tumor is divided into 4 location, tumor size, patient age, and the Grades which are as under:patient's general health status. 26

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Surgery, radiation therapy, and chemotherapy are the major treatment categories for most brain cancers. Individual treatment plans often include a combination of these treatments. Surgical therapy attempts to remove all of the tumor cells by cutting the tumor away from normal brain tissue. Radiation therapy attempts to destroy tumor cells by using high-energy radiation focused onto the tumor to destroy the tumor cells' ability to function and replicate. Radio-surgery is a nonsurgical procedure that delivers a single high dose of precisely targeted radiation using highly focused gamma-ray or X-ray beams that converge on the specific area or areas of the brain where the tumor or other abnormality is located, minimizing the amount of radiation to healthy brain tissue. Equipment used to do radio-surgery varies in its radiation source; a gamma knife uses focused gamma rays, and a linear accelerator uses photons, while heavy-charged particle radio-surgery uses a proton beam. Chemotherapy attempts to destroy tumor cells using drugs that are designed to destroy specific types of cancer cells. There are many chemical agents used; specific drug therapies are numerous, and each regimen is usually designed for the specific type of brain cancer and individualized for each patient. Other treatment options may include hyperthermia, immunotherapy, or steroids to reduce inflammation and brain swelling. These may be added on to other treatment plans.

LIFE EXPECTANCY AFTER SURGERY:Normally a patient can survive 1-2 years after the surgery in case of high grade malignant tumors (Glioblastoma multiforme) low grade tumors have longer life expectancy.

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DOCTOR SPEAK

Prevalence of Gestational Diabetes is High but Can be Controlled with Right Medical Intervention

Dr. Shilva

Consultant PGI

Paras Bliss Hospital Panchkula.

regnancy-related complications are common and need to be handled very cautiously lest they harm the mother or the child. Even after treading cautiously and following right advice, many expectant mothers face unforeseen complications that make their pregnancy very difficult and stressful. One of such complications is what is called gestational diabetes in medical parlance. Gestational diabetes is defined as blood sugar imbalance in a pregnant woman who did not have diabetes earlier. As the name suggests gestational diabetes is intrinsic to pregnancy; it usually arises after the 24th week of pregnancy and in most cases goes away after the birth of the child. Although, the condition is temporary, it can cause much difficulty and associated complications during pregnancy, if not treated properly. According to the American agency Centers of Disease Control & Prevention, gestational diabetes occurs in over 9% pregnancies in the US. While we do not

have consolidated figures for the same in India, clinical evidence suggests the incidence is high and has been increasing with time. During pregnancy, a woman’s body undergoes many alterations primarily due to changes in the hormones. Accordingly, the body also develops some degree of insulin resistance in a bid to provide the unborn with glucose and nutrients. The change is beneficial as it allows a baby to survive even if the mother experiences famine or short periods of starvation. However, the condition turns into a case of gestational diabetes when the insulin resistance shoots up exceptionally high. It is highly important to raise awareness among women about this condition and the need for being extra cautious against it during pregnancy. Untreated gestational diabetes can hurt your baby. Untreated gestational diabetes can lead to fetal macrosomia (large babies) and concomitant birth trauma. If women with Gestational Diabetes Mellitus (GDM) has fasting hyperglycemia (FBS >105mg%), it is associated with an increased risk of fetal death during last 4-8 weeks of gestation. A recent study has highlighted that gestational diabetes may affect the fetal brain development. About 4% of infants of women with GDM required intravenous glucose therapy for hypoglycemia. There is also a link between gestational diabetes and increased future risk of acquiring type 2 diabetes. More than half of women with gestational diabetes ultimately develop overt diabetes in the ensuring 20 years, and there is mounting evidence for long range complications that include obesity and diabetes in their offspring. Women with GDM are also at risk for cardiovascular complications associated with abnormal serum lipids, hypertension and abdominal obesity. 50% of women with GDM develop GDM in subsequent pregnancies. So, lifestyle changes including weight control and exercise between pregnancies likely would prevent recurrence of GDM. So, if you are pregnant, it is recommended that screening for GDM should be

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performed between 24-28 weeks in those women not known to have glucose intolerance earlier. It is very important to maintain a close check on your blood glucose levels and take the right precautions to control them. Right diet, regular exercise and if needed medication are crucial to controlling gestational diabetes and ensuring that you deliver a healthy baby.

How to control blood sugar levels during pregnancy? Limit consumption of saturated fats: Reduce your intake of saturated fats like ghee and butter. Limit intake of fried food and turn to unsaturated fats like olive oil and nuts. Break you meal over the day: Since it is important to stay full and yet eat healthy throughout the day during pregnancy, breaking the meal into smaller meals comes as good idea. Breaking the meal ensures that a continuous supply of food is provided to the unborn for its complete development. In addition, this would enable you to have all the requirement food products, minerals and components daily. The patient should stay in regular touch with her dietician. This would also help you keep your blood sugar levels under control. Reduce intake of sugary foods and desserts: Even if you are craving daily for an ice cream, avoid the temptation in the interest of your own and your baby’s health. Limit the intake of sugary foods that immediately shoot up the sugar levels in the blood. Exercise daily: Make sure you walk and indulge in other moderate exercises of up to 40 minutes daily. This is most crucial in controlling blood sugar levels. Follow doctor’s advice: Due to lack of awareness, we often come across women who do not take this condition as seriously as it should be taken. Remember, loss of control of blood sugar levels can harm your baby. Make sure you follow your doctor’s advice religiously and take medication if needed.

DOCTOR SPEAK

Is Preventive Operation

catching up in India?

T DR. GANAPATHI. BHAT. M

MEDICAL ONCOLOGIST & STEM CELL TRANSPLANT PHYSICIAN, JASLOK HOSPITAL & RESEARCH CENTRE.

Prevent a disease from happening by operating and removing the source of the disease

he healthcare scenario in India differs from that of developed nations, where people are more aware of what causes cancer and what measures can help prevent the disease. Preventive steps like prophylactic mastectomy still a breaking news in reality. It's not just about the tests and surgery; there is a need for genetics and counselling as well a will to have a long way to go." Preventive operation is a surgical intervention where, the tissue that does not yet contain cancer cells will be removed, which has the probability of becoming cancerous in the future. This may also be referred to as prophylactic surgery. Preventive mastectomy is an example of a surgery with a preventive purpose. Main examples of surgical management of cancer risk include prophylactic mastectomy in BRCA mutation carriers, prophylactic salpingo-oophorectomy in BRCA carriers and mismatch repair gene mutation carriers, and prophylactic colectomy in individuals with familial adenomatous polyposis (FAP).

Does it ensure 100% recovery from the cancer? At first reflection, it would appear that "prophylactic surgery" would have a place in many hereditary malignancies; however, the procedure has applicability only if certain criteria are met: (1) the genetic mutation causing the hereditary malignancy must have a very high penetrance and be expressed regardless of environmental factors; (2) there must be a highly reliable test to identify patients who have inherited the mutated gene; (3) the organ must be removed

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with minimal morbidity and virtually no mortality; (4) there must be a suitable replacement for the function of the removed organ; and (5) there must be a reliable method of determining over time that the patient has been cured by "prophylactic surgery." Prophylactic mastectomy has been a mainstay of management of BRCA mutation carriers because of their markedly increased risk of breast cancer. The breast cancer risk reduction associated with bilateral prophylactic mastectomy is approximately 90%. Prophylactic salpingo-oophorectomy has primarily been studied in women with BRCA1 or BRCA2 germline mutations, provides premenopausal BRCA mutation carriers with protection from both ovarian cancer 90-95% risk reduction and breast cancer 50% risk reduction.

How acceptable is the surgery among Indian women? Sounds like a breakthrough idea because breast cancer is the most prevalent in urban India and accounts for about 25 to 35 percent of the country’s cancer burden in cities. In addition, the average age of breast cancer patients is also coming down from 50-70 years to 30-40 years. If there is a possibility of getting tested and acting early, it is certainly empowering and life-affirming. Till 2003 there were no reports of Indian families with such mutations when the first study detected nine cases in a controlled sample of 90 women which included ten breast cancer patients. In 2009, a study in south Indian patients showed a BRCA mutation of 28 per cent, indicating that this test is indeed

DOCTOR SPEAK

How expensive is the surgery?

valuable for early prevention. For the majority of patients not only in India, but also universally preventive mastectomy or oophorectomy, is a matter of concern because various factors ranging from lack of awareness, social ,cultural factors,cost,concerns about with sexual and reproductive function and self-image, even if the procedure may add years to their life expectancy. Possible reasons for the discrepancy for the acceptance of these prophylactic surgeries also include lack of data proving survival benefit, concerns about appearance and sexuality following mastectomy.

It worth to know about the cost of mutations tests, which determines the need of the preventive surgery. The test for both BRCA1 and BRCA2 mutations will roughly about 60,000-plus for both and about 30, 000-plus for one. Compared to the prices in the US (US $3,000), itâ&#x20AC;&#x2122;s much cheaper - roughly one-sixth; The catch in India is that the cost of testing will be more than the prophylactic surgical procedures, especially govt; supported centers. Pros and cons exist for preventive surgeries. Due to unique risk factors for cancer of each individual patient, a preventive surgery does not guarantee the patient will never develop cancer. Therefore, the decision of a preventive surgery should only be considered after a careful discussion between the surgeon and the patient. Although the burden of cancer is daunting, primary and secondary prevention of this disease is possible in many instances. Recent trends for decreased cancer incidence and mortality in the US are

largely due to improvements in risk reduction measures and early detection of cancer through screening. Since the human genome has been sequenced many mysteries of cell biology have been unravelled, thereby clarifying the pathogenesis of several diseases, particularly cancer. By Analysing the of the Human Genome Project, it is possible to invent novel pharmacologic and biologic compounds that block the metabolic pathway(s) activated by specific genetic mutations which may prove beneficial in preventing the outgrowth of malignant cells in patients destined to develop a hereditary cancer.

Conclusion It is not too late for us inÂ supporting such innovation in life sciences and biotechnology which can save many of human lives, and to be on a more certain wicket. Moreover, medical experts are assigned to take stock of cancer risks among people in a particular community, depending on which longterm medical policies are implemented.

w w w.medegatetoday.com March-April 2016

DOCTOR SPEAK

Is your Child

a Victim of Attention Deficit Hyperactivity Disorder (ADHD)?

ttention-deficit hyperactivity disorder (ADHD) is a childhood hyperactivity and is a severe behavioral disorder. It is one of the most prevalent childhood disorders, and affects 5-12% of the school-age population. Studies have documented that ADHD is more widespread among boys than girls. Most of the times, the symptoms of inattention goes unnoticed.

Dr. Rajiva Kumar

Child Specialist (Muzaffarpur)

Studies have documented that ADHD is more widespread among boys than girls. Most of the times, the symptoms of inattention goes unnoticed. The characteristic attributes of children with ADHD are extreme motor activity, lack of concentration, and impetuosity. 32

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The characteristic attributes of children with ADHD are extreme motor activity, lack of concentration, and impetuosity. The American Psychiatric Association says that the concept of ADHD is relatively new. Though, history records cases of children portraying signs of distraction, hyperactivity, and impulsivity since the last 200 years. The clinical categorization, elementary concepts, and nomenclature of this disorder have evolved over the time. Most of the historical accounts are, however, in accordance with the modern diagnostic benchmark for ADHD.

Causes It is not certain what factors are responsible for ADHD, however certain things do play a pivotal role in its cause.

Lifestyle Scientists believe that mothers who have a habit of smoking tobacco products or consuming alcohol during their gestation period, lead to the development of behavioral and learning problems in their children. Similarly, inhaling lead dust from the air, or during home renovations(repair and painting) or drinking lead infested water leads to hyperactivity in children. Therefore, nicotine, lead, and alcohol can be detrimental to developing brain tissue and may have long-term effects on the behavior of the children exposed to these materials at early ages. Though, it is unlikely that such exposure accounts for differences in brain development in the vast majority of children and adolescents with ADHD.

DOCTOR SPEAK

Pregnancy Issues

Mothers who have had difficult pregnancies, premature children or children with low birth weight tend to develop a a higher risk of having ADHD.

Injury or Trauma ADHD can also occur in children who have encountered head injuries to the frontal lobe of the brain, the region that controls emotions and desires. They experience distraction and poor impulses. While such circumstances can result in a diagnosis of ADHD, the occurrence of such is uncommon.

Heredity

ADHD is an inherited disorder. A child has more than 50% chance of having ADHD if a parent suffers from it. Most of the information about the heritability of ADHD comes from family studies, adoption studies, twin studies and molecular genetics research. Genetic characteristics seem to be passed down.

Symptoms

 Has difficulty playing or engaging in leisurely activities quietly  Interrupts or intrudes on others  Talks excessively  Blurts out answers before questions have been completed  Cannot remain seated for small to moderate periods of time  Fidgets or squirms  Runs or climbs about at times  Has difficulty awaiting turn  Hyperactive

How to treat your child?

 Counseling, psychotherapy and play therapy can help ADHD stricken handle their feelings and frustration. This also boosts their self-esteem. Therapy sessions creates awareness of the disorder and help cope with the challenges of living with such children.

 At times, medication is important, but should be given under stringent medical supervision. Stimulants like amphetamine and methylphenidate can reduce hyperactivity and impetuosity and improve concentration. Non stimulant drugs like clonidine, atomexitine and guanfacine are approved medicines for treatment of ADHD syndrome.  Influence positive behaviour with specific praise or rewards.  Watch for warning signs. If your child looks like he/she is about to lose self-control, intervene. Divert if possible.  Invite your child's friends for playing, but keep the time short, so that he/ she does not lose self-control. It will also help your child improve his/her sleep quality. Ensure that they not doing anything too exhausting or exciting close to naptime.  Watch out for what your child eats. Some foods trigger hyperactivity, keep an eye on that.

w w w.medegatetoday.com March-April 2016

INTERVIEW

Genomics Driving

Personalization of Healthcare

few years ago, nobody would have guessed that sequencing your dog’s genome and tracing its ancestry would become a trend. We can now retrieve limitless information from our genes and this can help us understand how our body functions uniquely. With this information, we can make small tweaks to our daily habits to live a healthier and better life. We are able to understand that each person has a different genetic makeup and this means that different people respond differently to the same conditions. This also means that each of us is at different risks to different health conditions. The knowledge of this risk can help us make healthier lifestyle choices. Salt Sensitivity is a measure of how your body responds to salt intake. Not everyone experiences an increase in blood pressure on following a high-salt diet. This is because the effect of sodium on blood pressure differs for individuals depending on their salt sensitivity. Salt sensitivity can cause the development of high blood pressure and increase the risk for Cardio Vascular Diseases. These individuals will need to monitor and control their daily salt intake. Salt sensitivity has been positively correlated with body weight. It also depends on numerous factors such as gender, demographic and familial history.

“Salt consumption in developing countries is increasing in parallel with increasing urbanization” said a study conducted by researchers at the University of Rajasthan in 2015. Salt sensitivity is also linked to insulin resistance. This can cause the Type II Diabetes, Obesity and Hypertension. Extreme cases can develop increased risk of stroke, heart failure, osteoporosis, stomach cancer, kidney disease, liver cirrhosis and water retention.

The recommended amount has been 6g of salt per day. 31% of Asians carry an ACE Gene variant that is known to be associated with increased salt sensitivity. Around 87% of Indians were seen to be salt sensitive and 60% of the world’s Cardio Vascular Diseases occur in India. The salt consumption in the Indian population is the highest in the world with the average Indian consuming 9-12g of salt daily. The average salt intake in South India is seen to be higher with the average Tamil Nadu resident consuming12g/day.

What can you do?  Consuming just half a teaspoon lesser salt can drastically impact your health.  Eat lesser of processed pickles, churan, curry pastes, papads and chutneys. Make them at home- they will need lesser salt.  Avoid baked goods – baking soda has high amounts of sodium.  Use lesser salt while cooking. Avoid canned foods.

We can reduce the incidence of strokes by 25% and of heart attacks by 10% by reducing our salt intake. We should also be able to prevent salt sensitive forms of hypertension by keeping a check on our daily salt intake. Another condition dictated by a person’s genetic disposition is Lactose intolerance. Lactose intolerance is the inability of a person to digest the milk sugar lactose. This is due to the deficiency of an enzyme called lactase that is responsible for breaking down lactose. This is primarily because most mammals reduce the production of lactase after weaning. Lactose Intolerance is a medical condition known to affect three quarters of the world population and is seen to run in families. Symptoms can be observed around 30 minutes to an hour after consuming milk/ milk products. People suffering from this condition experience flatulence, bloating, rumbling sounds in the belly, Irritable Bowel Syndrome, Gastro-Esophageal Reflux, abdominal pain, and vomiting. Around 10,000 years ago, humans learnt to domesticate ruminant animals and use them as a source of milk and other dairy products. Europeans are the least lactose intolerant population while Asians and Africans are the most intolerant. Lactose intolerance has been observed in 88% of South Indians and 66% of North Indians. Researchers speculate that this could be due to North Indians being of Aryan descent and being habituated to dairying.

What can you do?  Avoid milk, butter, cream, sour cream, cheeses, yogurt, ice cream and other fermented foods.  Find substitutes like soymilk or almond milk. Recently the brand Ben and Jerry’s came up with Non-Diary flavors of ice cream!  Some prescription medications also contain lactose; learn to read labels everywhere!

What should you watch out for? What should you watch out for? Don’t overdo it: low sodium too can be a problem, leading to confusion, depression, hallucinations, headaches, fatigue, irritability, muscle weakness, cramps, nausea, restlessness, vomiting and in severe cases even death.

Dr. Saleem Mohammed Director XCode Life Sciences

www.medegatetoday.com ww w. m e d e g a t e t o d a y.co Mm arch March -April -A2016 pril 2016

The biggest challenge is to find alternative sources of Calcium and Vitamin D to compromise for the lack from milk. Calcium deficiency can lead to osteoporosis These are just few examples of how genomic information can be used to personalize nutrition. The next wave of revolution in Biotechnology belongs to genomics and gene therapy. Both of these technologies are going to help in identifying causes of diseases as well as curing them.

PRODUCT LINE

Potential of Telemedicine in Improving Healthcare Delivery

Mr. Hisao Masuda Managing Director Omron Health Care Services, India

Hisao Masuda is Managing Director, Omron Health Care Services, India- the leading innovative medical technologies and products for monitoring and therapy in India.

ealthcare is one of the last industries to be completely disrupted by technology. When we look at the healthcare delivery system in our country, it is slowly adopting technology. Be it medical devices, e-health, m-health or telemedicine, all these innovations are helping in giving a new dimension to the way quality healthcare is provided to millions of people. Even technology companies are evolving and working towards innovative products and services that help healthcare practitioners to reach out to patients within minimum possible time. This has only been possible with the development of telemedicinewhich allows access to remote clinical services, via real-time two-way communication between the patient and the healthcare provider, using

electronic audio and visual means. Telemedicine is a rapidly developing application of healthcare where medical information is transferred through the internet and other networks for the purpose of consulting and remote medical examination. As consumers move towards an internet driven economy, majority of the work today is being done with a few clickslike weight watching, diet mapping or booking an appointment with a doctor. Even the ‘Digital India programs’ key focus area is to make healthcare available to every Indian with the help of technology. However, as there is a growing need for healthcare options, the consumer’s requirement has to be kept in mind. Thanks to the world of apps, smartphones are proving to be an effective preventive healthcare and telemedicine tool, instantly connecting consumers and healthcare providers. Technology innovators are now thinking out of the box to create innovative applications that have medical implications, to simplify treatment procedures and fulfill healthcare requirements. Further, there are also various public private partnership that are fueling the growth of telehealth in India Today apps are being created to serve as reference material record database or even ECG guides, eliminating the need to carry around ECG cards. Geo positioning applications can further assist in keeping a track of people with disabilities or chronic conditions. Additionally, smartphone applications can also function as clinical examination

tools or technique guides. Patients can now take the doctor’s appointment with the help of smartphone applications that have been developed for their comfort. This further diminishes the time spent in waiting areas. At the same time, mobile applications have made real time face to face messaging a reality, getting live feeds from a location is so much easier. By doing so, addressing critical situations like medical emergencies will become swifter. For instance there are applications for mobile devices which enables the staff to provide clinical health care at remote locations and also helps to eliminate distance barriers which further improve access to medical specialists that would often not be consistently be available in distant rural communities. For physicians recommending genetic tests, there are apps that help them connect with patients, with access to health history, reports and genetic counselors' recommendations. The potential of telemedicine is tremendous. As per an IBEF report, The telemedicine market in India is valued at US$ 7.5 million in 2016 and is expected to grow at a CAGR of 20 per cent to reach US$ 18.7 million by 2017. As innovation in the segment continues, telemedicine will prove to be a boon for healthcare providers and patients alike. From a patient’s perspective, they will have access to the best medical facility without time lag and infrastructural hurdles. The government aims to develop India as a global healthcare hub and telemedicine will push this vision further. w w w.medegatetoday.com March-April 2016

PRODUCT LINE

Commemorating Triumphs and Transforming Futures

Mr. Sushil Bagga MD, Welfare Medical

The most powerful leadership tool is your own personal example. A combination of great team with dedication and hard work is essential to make a company progressive and successful. There is no elevator to success; you have to take the stairs step by step to build a firm foundation. The father daughter dynamic duo have achieved great milestones in the past two years, ever since they launched Welfare Medical in India under the banner of “SB Group”. The multinational medical giant, Welfare Medical UK was strategically partnered by healthcare genius Mr. Sushil Bagga, who bought the primary range of activity and portfolio with bringing surgical stapling line, products for the operation rooms, anesthesia, minimum invasive surgery and gave the responsibility of its marketing and brand building to his versatile daughter— Ms. Swati Bagga, Marketing and Operations Director of SB Group. With her expertise, the company has been able to achieve unprecedented heights and major success in a short span of time.

Welfare Medical has built its brand image to a level of high trust amongst the healthcare market and medical professionals. They have been successful in launching more products in their portfolio at a very reasonable and cost effective price with international standards. All products are CE/ISO marked that is of internationally recognized standard. The company has been awarded with several certificates of excellence for its spectacular services in the healthcare industry, the latest being “Healthcare Personality of the Year 2015” won by Mr.Sushil Bagga, for his unparalleled work towards the healthcare domain and strong determination towards his promised goals. Welfare Medical has increased its sales force extensively to cater every possible city, state and even small towns, to reach even the most remote areas, so that everyone is benefited with these world class products. Likewise, they are resolute in providing 24x7 services, keeping their corporate office operational at all times with a special helpline number to deal with emergency cases that require urgent supplies. Furthermore, throwing light on their humanitarian endeavors, the company has also been a regular helping hand to the people in need by providing them products on free-of-cost basis. This also includes donations made to numerous institutions and hospitals. “The most powerful leadership tool is your own personal example”, says Mr. Sushil Bagga. He started from scratch as a medical representative in the beginning of his career and now he owns one of the most reputed and successful organizations in the healthcare industry. He believes that a combination of great

team with dedication and hard work is essential to make a company progressive and successful. “There is no elevator to success; you have to take the stairs step by step to build a firm foundation.”, adds the founder of this corporation. In a very competitive environment, where there is always a struggle for existence, Welfare Medical has managed to maintain its quality assurances and promises, which has been appreciated in the global market. It is also regarded as one of the most admired brands. “Marketing is telling a story about your value that resonates enough with people that they want to invest not only their money but their faith and trust in you. You cannot sell anything if you cannot tell anything. A goal without a plan is just a wish. Novelty and innovative techniques also play a major role in brand management and brand building. Welfare medical was like a new born baby given to me at the time of its inception, I feel building a brand for a company is like building your own reputation and we have been successful in doing that so far. Business also works when you don’t give up on your aspirations, your thoughts of being successful, combined with passion, sincerity and humility.”, says the young entrepreneur Ms. Swati Bagga.

Ms. Swati Bagga 36

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Director, Welfare Medical

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DOCTOR SPEAK

GI Emergencies

A Diagnostic Challenge

Prof Rakesh Tandon MD, PhD, FRCP (Hon), FAMS Medical Director and head of Dept of Gastroenterology, PSRI Hospital, New Delhii

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 important for him/her to have some guidelines or algorithms 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

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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 specialties as the patient may even require an emergent surgical 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 of the 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,

EXPERT VIEWS

Electrosurgery Electrosurgery is the application of high-frequency electric current to biological tissues as a means to cut, coagulate, desiccate or fulgurate tissue.

History of Electrosurgery

First reference to the use of heat as a healing medium was in 2800 BC in the earliest known book of surgery, the Edwin Smith Popyrus, an ancient Egyptian medical text. It is oldest known surgical treatise on trauma. The first application of electric current in surgical techniques was in the middle of the 19th century when the heating instruments were externally superseded by the discovery of the ability of electric current to heat a metallic conductor, when lowing through it. It was the first application of electric current in surgical techniques. More recently, electrosurgery was developed in 1926 by Dr. William Bovie in direct response to an unsuccessful attempt by his colleague, Dr. Harvey Cushing of Brigham and Women’s Hospital, a teaching hospital of Harvard University. Dr. Cushing had attempted to remove a mass from the patient’s head. The resultant bleeding was so heavy that Dr. Cushing could not complete the procedure. A few days later, Dr. William Bovie proposed the use of an electrosurgery unit to control the heavy bleeding by cauterization of wounded blood vessels. The result was a successful removal of the mass for the patient and for the world at large, the birth of electrosurgery. Electrosurgery can be used to cut, coagulate, desiccate or fulgurate Bovie is synonymous with electrosurgery. Bovie is the device tissue. The use of electrosurgery is pervasive is gynecologic that cuts, cauterizes, and seals tissues and blood vessels. abdominal procedures. The technology is also common in many vaginal and operative hysteroscopic procedures. Electrosurgery is also commonly used in dermatological, gynecological, cardiac, plastic, ocular, spine, ENT, maxillofacial, orthopedic, urological, neurological and general surgical procedures as well as certain dental procedures.

Uses of Electrosurgery

Electrosurgery is performed using an electrosurgical generator which is also referred to as power supply or waveform generator. and a hand piece including one or several electrodes, sometimes referred to as RF Knife. The apparatus when used for cutting is called a “Bovie”, after the inventor.

Prof. M. Habeeb Ghatala Dean and Head

Princess DurruShehvar Institute of Medical Technology Princess Durru Shehvar Children's & General Hospital Hyderabad, Telangana State, India

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Electrosurgery has been used in dentistry for more than 75 years. It was first used in 1847 by Russian scientist Cusen to destroy a neoplasm. Both opponents and advocates of electrosurgery have presented a variety of clinical studies in favor of their respective opinions. In the area of dentistry, a critical evaluation of controlled clinical studies proved that adverse responses of epithelium, connective tissue, bone, and cementum are related to an excessive lateral heat production during the procedure.

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Improving Competency of Surgeons

On the basis of the research reports, clinical guidelines have to be developed to give practical advice to the clinicians using electrosurgery. Provided that these safeguards are adhered to, There is still a need for formalized training in the safe and effective scientific evidence supports the biological compatibility of use of electrosurgery. With the exception of the use of laser surgery, there is no uniform credentialing process to allow surgeons to electrosurgery for intraoral surgical procedures. operate with devices that supply electrical energy to tissues. Industry – sponsored events and sales representatives provide The benefits include the ability to make precise cuts with limited much of the training in the use of new surgical devices. In blood loss in operating rooms or in outpatient procedures. postgraduate studies/residency, most education is limited to Today’s surgeons have the ability to perform more procedures on observing a senior resident or attending surgeon. a outpatient basis. Outpatient procedures means reduced risk and Safe application of energy-based surgical devices lies in the less downtime for the patient, lower cost and increased revenue hand of surgeons. A sound understanding of the fundamentals potential. of surgical practice is still of prime importance. Adherence to Surgeons can have precise control over bleeding during standards for careful surgical dissection, appropriate exposure of complicated surgeries that are highly vascular in nature. Heavy the surgical field, and a thorough knowledge of anatomy are still bleeding makes it difficult, if not impossible, to locate and necessary regardless of all of the advances in modern technology. extract tumors and masses in the brain and the chest cavity. In 2010, the Society of American Gastrointestinal and Endoscopic Bovie electrosurgery units cause almost instant cauterization Surgeons (SAGES) developed the “Fundamental Use of Surgical when using a blended cut mode, improving the surgeon’s field of Energy” (FUSE) program to address the knowledge gap and vision, and requiring less if any transfusion to the patient. contribute to a safer operating room environment. The curriculum includes 10 sections: The use of electrosurgery equipment is associated with increased  Fundamentals of electrography risks. Hence, HF (High Frequency) generators and accessories  Mechanism and prevention of adverse events with electrosurgery are listed under the “Critical Equipment Technology” group in  Monopolar devices the relevant statutory regulations.  Bipolar devices. Risks to patients, operators and third parties can arise from a  Radiofrequency for soft tissue ablation  Endoscopic devices number of possible causes like:  Ultrasonic energy systems  Technical deficiency  Microwave energy systems  Unwanted high frequency burning  Energy-based devices in pediatric surgery  Incorrect operation  Integration of energy system with other medical devices.  Defective accessories Future development of the FUSE program will include specific  Ignition of flammable liquids and gases modules tailored to individual energy devices.  Risks from improper combination with other equipment. When used properly and competently, electrosurgeries have proved to be reliable and safe medical system. This is absolutely In order to facilitate the safe use of electrosurgery, it is essential conditional upon the operating instructions supplied with each that the surgeons participate regularly in CME programs. Several unit being understood. avoidable deaths have been reported because of such simple

Benefits of Electrosurgery in Surgery

Risks of Electrosurgery

Conclusion

Special Risks of Electrosurgery

matters like faulty electrical switches, injuries from electrical devices and the like. Awareness need to be created which would The use f electrosurgical equipment is associated with special lead to safer standards and technologies for the typical electrical risks. Risks to patients, operators and third parties can arise systems used in the operating rooms, including EKG machines, from a number of possible causes. Relevant literature, accessible anesthesia monitors, cables, switches and operating room tables. statistics and experience gained by companies show these to be:  Technical deficiency  Unwanted high frequency Incorrect operation  Defective accessible  Ignition of flammable fluids  Risks from improper combination with other equipment It can be stated that, when used properly and competently, electrosurgical systems have proved to be reliable, safe medical systems. This is absolutely conditional upon the operating instructions supplied with each unit being thoroughly understood. 42

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DOCTOR SPEAK

PROS AND CONS OF BARIATRIC SURGERIES.

Dr. Sanjay Borude

GI Surgeon since past 30 years, practicing Obesity Surgery exclusively since past 15 years. One of the Pioneering Obesity Surgeon to Bariatric surgery in India.

Bariatric surgery is the only available treatment for morbid obesity that consistently achieves and maintains substantial weight loss, decreases the incidence and severity of obesity-related medical diseases and improves overall quality of life and survival. 44

besity is a great epidemic & health problem in many developed countries and is becoming an increasing concern in developing countries. Presently, Bariatric surgery is the only available treatment for morbid obesity that consistently achieves and maintains substantial weight loss, decreases the incidence and severity of obesity-related medical diseases and improves overall quality of life and survival. The first bariatric surgery performed in humans was reported in 1954. Due to the continued demand for weight loss operations, subsequent procedures were developed that focused more on gastric restriction and limited mal-absorption. The most commonly performed Bariatric operations at present are the Roux-en-Y gastric bypass and the adjustable gastric band and vertical sleeve gastrectomy, affecting on hormonal, inflammatory, central nervous system and gut microbial flora factors. Laparoscopy allows surgery to be performed through small incisions, minimizing pain and wound complications. Comparing the success and complications of the contemporary bariatric operations has been difficult but it surely outweighs on cons.

deflated by injecting water into the port as an outpatient. Hospital stay is one day.

LAPAROSCOPIC SLEEVE GASTRECTOMY In this, approximately 80-90% of the stomach is excised and removed as per the patient’s need. Stomach takes the shape of a small tube. It also removes the part of the Ghrelin Hormone thus by reducing the apetite. This complements the restriction of the intake. Hospital stay is two days.

LAPAROSCOPIC GASTRIC BYPASS A small stomach pouch is created by dividing the stomach. This causes restriction of the food intake. Next y-shaped section of the small intestine is attached to the pouch to allow food to bypass the first part of the small intestine for mal-absorption. This rearrangement allows good gut hormones to be secreted and which in turn helps control adverse metabolic diseases like diabetes, high blood pressure etc. Hospital stay is three days.

PROS  Assured weight loss.  Easy to maintain lost weight.  Resolution of Obesity related diseases  Improved quality of life. OBESITY IS THE MOTHER OF MOST  Improved self esteem. OF THE DISEASES !!!  Improved social image.  Short hospital stay. MANAGEMENT: Bariatric surgeries are considered only in  Almost painless procedures. patients who have failed on expertly guided CONS life style modification programme.  Potential peri-operative or post-operative Various weight loss surgeries have been developed and refined over the years. Today there is a wide variety to choose from. The top three types of weight loss surgery are Roux-en-Y Gastric Bypass, gastric banding, and gastric sleeves. Each has its pros and cons.

LAPAROSCOPIC GASTRIC BANDING This entails a laparoscopic implantation of a Silastic Band around the upper part of the stomach. This creats an Hour-Glass effect. Since the outlet is small, food stays in the pouch longerand one feels satiated for a longer time. Band can be inflated or

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complications.

 They are rare about 1%-5% depending on the quality of a surgeon, hospital and the equipments.  Cost. This is mainly because of the equipments used in the surgery. Overall cost cutting may lead to deaths and sufferings.  Nutritional complications.  Regular follow up visits with the primary doctor minimises the chances. BARIATRIC SURGERY IS NOT A CURE, IT’S A BEGINNING.

INTERVIEW  Preventive care is enabled especially around cardiac and cancerrelated diseases.  Hospitals and healthcare delivery systems will find ways to treat patient at their homes & places of residence

Ramakanth Desai CEO, ttatva innovation labs

 Care can become patient centered & EHR/EMR for outpatients will be enabled  Remote patients will now get the required care and interventions from Specialists without having the need to travel. Our platform will help patient receive care through moving patient clinical and diagnosis information and not moving people

In Rendezvous with Ramakanth Desai

What are the unique products and solutions offered by Curespring for medical and healthcare industry?

When was Curespring established? What has been has your customer adoption? We started Curespring in 2014 and launched our tele-care as a service platform in mid 2015. We acquired another company ( Avanttec ) in 2015 which has been in healthcare solutions delivery for the approximately 8 years. With this acquisition, We got HIS platform, PACS software in addition to diagnostics information system for diagnostic labs. Now, we have all the 4 key IS/IT solutions required for quality healthcare delivery. We have 40+ hospitals and 10+ diagnostic labs for various solutions. We have collaboration with many leading medical device manufacturers for enabling our Tele-care service.

Curespring offers a cost effective Telecare service platform to enable remote patient care transformation and reduce overall cost of care for patient. The platform enables  Establishing doctors network  Sharing of patient data and secure video chat  Remote diagnostic review through Tele-Imaging (Web based PACS)  Next generation HIS for patient care coordination Our Vision is to help Hospitals extend Specialist care to remote areas by connecting remote physicians & What is the vision of your company? hospitals

What are the various services Curespring offers for cost effective healthcare service Our visions are to enable 5000 remote tele-clinics with access to specialist care delivery with the ICT intervention? in the next 4 years Since logistics costs in healthcare is Deploy our HIS for hospitals with becoming very high, using our secured extensions of doctor to doctor cloud based tele-care and tele-imaging collaboration, doctor to patient solution interaction platform, hospital  Number of visits to a doctor for chronic performance enhancement around disease management can be reduced care parameters and third party apps  Second opinions, point of care for diagnostics diagnostics and clinical workflow Deploy our PACS system to launch automation are enabled image enabled EMR/EHR

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INTERVIEW In an exclusive interview, Dr. Ashok Seth talks about his typical work day, his hobbies and inspirations. We all know that a doctor's job is very exhausting and challenging. So, how do you describe a typical work day at the hospital?

Dr. Ashok Seth

Chairman, Fortis Escorts Heart Institute New Delhi

I believe that unless I take care of myself, I may not be able to give the best. I exercise 6 days a week and make sure that I can spend more time with my family because once I come to work, I know that I would be able to leave by midnight. I do not take a break for lunch, tea, dinner, and continue working till midnight or past midnight. However, I will not say that I am overburden by work. My job provides me satisfaction of serving people. The ethos of this profession is to never be irritated with your work or patients, irrespective of whatever time of the day it is. As doctors, we shouldn't just be giving treatment, but also confidence to the patient. Confidence comes from the fact even at 12 am at night, you would be able to do a complicated procedure at that time and come out with the best results. On the flip side of the coin, my work demands an administrative role. My profession requires me to deliver the best of healthcare. I should not be saying that I only treat, I should also be creating an example for the country and the rest of the world. A few days ago, I was transmitting a complicated angioplasty procedure from Delhi to a meeting at Singapore .Around 2000 angioplasty doctors were present, there were two patients, it was a very complex operation and took 4 hours to perform and was successful. Similarly, I have trained many professionals in Asia Pacific region on interventional cardiology. Hence, these are leadership matters. So to sum it up, my typical work day is pretty involves multitasking. It starts at 9:30 am and ends at midnight.

What do you do when you are not in the hospital, what do you do in your leisure time? (Laughs) I enjoy singing and scuba-diving. However, the last two years have been very hectic and unfortunately I've given up these habits. This is bothering me a lot because I've been trained rigorously in scuba-diving and singing. In fact, in 2009, I had held my own singing concert consisting of 200 people, where I had even invited the chief minister of Delhi. Nonetheless, this year, I definitely plan to get back to my hobbies. This has been my new year agenda. 48

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INTERVIEW I also believe, that one should always have the time to spend with the family. I have made it a hard and fast rule, to go on 2 holidays with my family every year. My life goes around the hospital so much that I start thinking that spending time with family is like a hobby. And I regard this as one of my important past time.

You have definitely achieved a great deal in life. So, to whom do you attribute that success? I have been thinking about this lately. In the drift of all things, I continue to rise, achieve and deliver the best of my services. All I do is hard work and passion to give my best. But you can ask me, that a lot of people work hard, why are they not successful? I believe it is the blessings of the elders, prayers of the parents. I guess I did something good in life which has made me successful today. I stayed in UK for 10 years and came back only because my mother was not keeping good health. Now I look back and say what a great move it was to come to India and achieve so much from my country that I could never had achieved if I stayed abroad. I also accept that the sacrifices of the family, has made me what I am today. My wife and children gave up a lot of their efficiencies, so that I could achieve. I would also like to mention the love from my patients. Their blessings, their prayers, keep adding on and this helps me to do more good to others and achieve better. But the gift of my expertise is all God's will. I treat people and help them get better. If they thank me, I am only thanking God because at the end of the day, I believe that God gifted me the skills to give the best to my patients. This is him, who is healing, not me. The journey of my life has all been God's plan. He paved this path for me. I was always making different choices and those decisions were being reversed by the almighty. When I look back upon my life and say that I was not the mastermind who created this 30 year track of greatness. It was a default, not my planning at all. The plan was being woven, things were happening to me, despite of me going against it. Therefore, without all of these, there is no Ashok Seth.

What are your expectations from the government of India in regards to the healthcare budget 2016?

understand that health of a nation is actually a gain. If we are to move forward, the government must look at what it spends, concentrate on how to utilize the budget judiciously, so that the people at the grassroots, get the benefits of that spending. On the other hand, the public and private healthcare deliverers in our country are operating in their own independent manner. This may result in a big doom of our country, if these two silos do not meet each other at some point. My advice is to make a common health sector. The scenario in our country is such that the primary healthcare system is not manned, the secondary system consisting of the district general hospital which should be taking care of 80 per cent of disease process, is filtering out the patients to tertiary healthcare systems. I recount the poisoning cases that happened in Bihar. All the patients from district general hospitals were taken to the medical colleges. A district general hospital cannot even take care of a simple poisoning case. That is the reason why AIIMS is exploded with people suffering from mild ailments like diarrhea, vomiting, abdominal pain etc. These things should be taken care by the secondary healthcare system of our country. Then there's the private healthcare system, which is a default sector for the rich, because they cannot go to an unmanaged, less infrastructure and poorly staffed secondary healthcare sector. The private healthcare domain is catering to people who can afford it. They have efficiency, the best technology, doctors and expertise, that is why they exist. As a result one silos is getting worse and the other is getting richer. Both healthcare delivery systems have the same aim, so why does the government blind itself? We should come up with a strong strategy, a plan to work together. We must also play our parts too. We must realize that 80 percent of the diseases can be treated at the primary level with good sanitation, nutrition and hygiene. For more advanced treatment, we can go to the tertiary level, consisting of less crowd. We must move from free healthcare to a subsidized one. We do not need free healthcare. Keeping all these things in mind, a national agenda should be devised, not a personal one. The budget is just a paper issue.

What legacy do you want to leave behind?

Increased spending is a very important aspect of any healthcare delivery and we as a nation are doing very little and are too late. We knew 30 years ago that an 'Australia' I want to be remembered as an ethical person and good was being added to India every year, and health never doctor. That is all I want. became a primary issue. The principal issue is how to get votes. Health has always been considered as spends and not gains. But as we are progressing further, we have to

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INTERVIEW What is antibiotic resistance?

 Antimicrobial resistance kills Antibiotics are crucial to the health of  Antimicrobial resistance hampers the control of infectious diseases people everywhere. They are used in the medical world for treating various diseases  Antimicrobial resistance increases the and also for surgeries. costs of health care Antimicrobial resistance (AMR), also How does this phenomenon happen? called Antibiotic Resistance is resistance of a microorganism to an antimicrobial drug Producing antibiotics creates loads of that was originally effective for treatment waste in the form of water, air and solids. of infections caused by it. Resistant If these waste streams are not managed microorganisms (including bacteria, responsibly, the pollutants they contain fungi, viruses and parasites) are able to end up in our environment; creating an withstand attack by antimicrobial drugs, increasingly growing breeding ground for such as antibacterial drugs (e.g. antibiotics), bacteria to develop resistance. Thousands antifungals, antivirals, and antimalarials, so of tons of antibiotics are produced that standard treatments become ineffective every year, and there are also numerous and infections persist, increasing the risk of examples of factories that use insufficient waste management and treatment spread to others. In short: systems, dumping untreated waste water and antibiotics into the environment. In addition, Poor infection control practices, inadequate sanitary conditions and inappropriate food-handling encourage the further spread of antimicrobial resistance.

To what extent is antibiotic resistance a global threat today and for our future?

Vineet Singhal Chief Executive Officer/Business Unit Director, Asia Pacific, Middle East & Africa (AMEA) DSM Sinochem Pharmaceuticals

New resistance mechanisms emerge and spread globally threatening our ability to treat common infectious diseases, resulting in death and disability of individuals who until recently could continue a normal course of life. Without effective anti-infective treatment, many standard medical treatments will fail or turn into very high risk procedures. Every year, AMR is responsible for nearly 50,000 deaths in the US and EU alone[i]. In India, annually nearly 60,000 babies die from sepsis caused by bacteria resistant to antibiotics. In 2012, there were about 450 000 new cases of multidrug-resistant tuberculosis (MDR-TB) worldwide. If not addressed – by 2050, Antibiotic Resistance will be the leading cause of health-related deaths, even surpassing cancer, with more than 10 million lives lost every year.

How can we tackle the issue? Today, most raw materials and intermediated for antibiotics are manufactured in China and India (80-90%). Therefore these countries carry a huge responsibility to contribute to the solution. While there are outstanding examples of compliant manufacturers in both India and China, unfortunately, there are also production plants which have serious compliance and quality problems. 50

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As a country, we can tackle this issue by the following ways:

High quality and responsible production processes need to be followed. Manufacturers can introduce new production techniques and strict quality controls along the production and supply chain. It is essential to treat wastewater from the antibiotic industry in dedicated Waste Water Treatment Plants (WWTP) before it leaves the production site to municipal plants. Manufacturers should limit discharges and emissions of active pharmaceutical ingredients into the rivers, local lakes and drainage systems.

How can the public and other stakeholders such as doctors, health workers, pharmacists and policymakers help on this issue? In addition, People can help tackle resistance by: hand washing, and avoiding close contact with sick people to prevent transmission of bacterial infections and viral infections such as influenza or rotavirus, and using condoms to prevent the transmission of sexually-transmitted infections; getting vaccinated, and keeping vaccinations up to date; using antimicrobial drugs only when they are prescribed by a certified health professional; completing the full treatment course (which in the case of antiviral drugs may require life-long treatment), even if they feel better; Health workers and pharmacists can help tackle resistance by:

 Enhancing infection prevention and control in hospitals and clinics;  Prescribing and dispensing the right antimicrobial drugs to treat the illness. Policymakers can help tackle resistance by:

 Improving monitoring around the extent and causes of resistance;  Strengthening infection control and prevention;  Regulating and promoting appropriate use of medicines  Fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools.

INTERVIEW Emphasis on Health Programmes & Correction in Inverted Duty Structure Promises Bright Future for Medical Devices Sector in India.  Identification, Assessment and uptake of innovations for health

Dr. Jitendar Kumar Sharma, Sr. Consultant & Director WHO Collaborating Centre for Priority Medical Devices & Health Technology Policy

Dr. Jitendar Kumar Sharma is Head of Healthcare Technology Division and Founder Director of WHO Collaborating Centre for Priority Medical Devices & Health Technology Policy, at National Health Systems Resource Center, the technical support institution under Ministry of Health & Family Welfare, Government of India. He is also Adviser (Health & Medical Technology) to the Hon’ble Chief Minister, Govt. of Andhra Pradesh. He has contributed through several research papers, seven books on health technologies & assessments, six compendiums on technical specifications for medical technologies and has been contributor to several reports on health technologies by International agencies including WHO. He is a key designer and coordinator of several health technology programs in India and a faculty for courses on health technology policy & assessment in several countries. He referred as the “Med Tech Man of India” for his contributions to the field of medical technology policy & programs. What initiatives are taken by the WHO collaborating centre for Priority of Medical Devices and Health technology Policy at NHSRC for the medical devices industry? Health Technology division of NHSRC works in the area of technologies and its policy interface. It is South East Asia’s only WHO Collaborating Centre for Priority Medical Devices & Health Technology Policy. Primarily the division of Healthcare Technology is supporting Ministry of Health & Family Welfare, Govt. of India in following technical areas:  Formulation of technical specifications for devices procured under National Health Mission. Until now technical specifications of 180 medical devices have been prepared which has lead to appropriate and cost effective procurement. 52

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programs. The process of innovation uptake is facilitated through ‘National Healthcare Innovation Portal’ which can be accessed at www.nhinp.org. . The assessment of technologies includes assessment of efficacy, risk, cost effectiveness, legal and social aspects concerned with the technologies. HCT Division, NHSRC is a pioneering centre which has introduced Health Technology Assessment in India. Assessments of over 80 technologies have been completed, and compendium of HTA has been jointly published by NHSRC and WHO Country office for India. In addition, HCT Division NHSRC has been jointly conducting Health Technology Assessment Fellowships once every six months and over 300 professionals have been trained so far across scientific and public health institutions in the country. This has provided for the critical mass of technology assessors and largely contributed to use of critical knowledge amongst public health partners in the domain of Health Technology Assessment & Health Technology Policy.  The division of Healthcare Technology also formulates guidelines on Technology intensive programs such as that for free diagnostic services; Medical Technology life cycle management and maintenance; Ambulances and Mobile Medical Units. These guidelines provide details for essential services tailored to various levels of care, equipment and model tender documents for appropriate public private partnership (PPP) models wherever required. The guidelines are intended to provide states with a broad framework on implementation of key health services that are technology intensive.  The division support technology policy and systems strengthening initiatives. It has led to commencement of Materiovigilance program of India which is meant to improve safety of medical devices in a systematic manner.  The division also gives technical advice on technology policy and trade impacts particularly in the domain of costs, customs duty and imports/exports.  Enabling and providing technical support on creation of Medical Devices manufacturing parks and medical devices testing laboratories are some of the system building initiatives.

What was the idea behind India's first ever medical technology park, which is to be established in Andhra Pradesh? Lack of domestic manufacturing of medical devices is the main reasons for import dependency and high cost of medical products in the country. To address this situation, Govt. of Andhra Pradesh has decided to establish

INTERVIEW country’s first Medical Technology Manufacturing Park at Vishakhapatnam. The goal of this progressive initiative would be to make Andhra Pradesh an internationally recognized manufacturing hub for medical devices, help in national agenda of import substitution and export promotion, make Andhra Pradesh a leader in medical technology exports, generate employment, and contribute to volume generated cost reduction of medical devices for patients. In a meeting organized on 6th Nov, 2015, Hon’ble Chief Minister of Andhra Pradesh shared his vision on this important project with Medical Devices Manufacturing Association, Central Govt. officials and State Health Authorities. The creation of such as park is based on the fact that medical devices manufacturing requires certain high investment facilities which are too capital intensive for individual manufactures to invest upon. A park with in-house high investment scientific facilities would help manufacturers reduce the cost of manufacturing by more than 40%-50%. Currently, due to lack of such centrally located sharable facilities, either manufacturers do not undertake production of technologies requiring them or send their products abroad for process up-gradation and value addition. While the park would have all such facilities in-house to reduce manufacturing process costs, it would be located in an area which is well connected with Railways, Roadways, Waterways and Airways with near presence of Industrial Corridors, Port and Harbor to reduce logistical costs. The park will provide for all capital intensive common manufacturing facilities required by medical device manufacturers and modern state of art 100-150 independent manufacturing units, each of a built-in ready to use area of 1 to 2 acres.

of employment opportunities for skilled and semi-skilled professionals besides leading to a surge in Medical Devices industry including spare parts, components and ancillary sectors. Recent notification of correction in inverted duty structure for medical devices segments and creation of low cost intensive models of med tech manufacturing, coupled with increased emphasis on health programs would lead to demand-supply match and a progressively bright future for medical devices sector in India is certainly on the cards.

How do you perceive Medgate today as a healthcare media? Medgate today is one of the few journals dedicated to medical devices, not only in India but also globally. Its coverage of emerging technologies, opportunities in Med Tech Sector and bandwidth is much appreciated. While it would be wonderful to have more coverage on low cost models of care, use of medical technology to reach the un-reached, the focus of Medgate Today has been truly scientific. It has remained the trend setter in med tech publishing world and is sure to keep sharing the light with readers, innovators, patients and users of medical technology. The views expressed in this article are individual views of Dr. Jitendar Sharma and does not reflect views of any of the organizations/institutions to which he bears an affiliation.

What according to you, is the future of medical devices industry in India? Future of medical devices in India is progressive especially with the impetus of Make in India, Digital India and Start up India that has been provided by the Hon’ble Prime Minister. Under National Health Mission, substantial investment is being made for procurement, management and life cycle maintenance of medical equipment and technologies. While chronic problems such as high rate of dysfunctional equipment have been addressed through the launch of Biomedical Equipment Maintenance Program; effort has been made for progressive uptake of innovations through the National Health Innovations Portal. Support has also been extended for establishment of SNCUs, MMUs and upgradation of X-ray facilities, Labor rooms and Operation Theaters. Several key initiatives including Laboratory, Tele-Radiology, CT Scan, Biomedical Equipment Maintenance Program, Mobile Medical Units, and Dialysis care – all under Public Private Partnerships are in advance stages of launch across several states in the country. While such technology intensive initiatives have provided greater access to healthcare to patients, it has also created an array w w w.medegatetoday.com March-April 2016

INTERVIEW

Shashank ND Founder & CEO, Practo What was the idea behind launching Practo? We started Practo when we discovered that there was a profound need to transform the healthcare industry and make it easier and simpler for consumers and healthcare providers (HCP) alike. In 2009, I asked my doctor to email me a copy of my medical report, the doctor said he couldn’t do it because his software didn’t have an email button. The first thing that occurred to me was why people weren't storing their own medical records in the digital format. You didn't have any digital data about your health and it's funny because that is the one thing that you should have all in one place. People had all kinds of data with them but health was not one of them. I saw that this was a global problem. The reason was that the doctors were not able to generate digital data. Email was not new in 2009, it was widespread and yet no one had thought of putting an email button in his software! Traditionally, doctors are not considered to be tech-savvy and it is felt that they have tremendous resistance towards adopting technology. We believe the exact opposite. We believe that the reason doctors haven’t really taken to software is because up until we came along, software wasn’t really designed specifically for them. We decided to change this and build a product that was designed from the ground up for doctors and in 2009, we launched Practo Ray - a cloud based clinic management software. We kept it cloud based so doctors didn’t have to worry software updates, hardware requirements, data security and data backups. This allowed them to focus on what is important – their patients. From the start we received tremendous response from doctors. They were and still are passionately involved with us in co-creating the product. We receive tons of ideas and feedback daily. We go through them and build out the features that everyone wants. For example, one of the first unique features we built way back 54

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in 2009 was SMS reminders. Through our interactions we learnt that patient no-shows were a big issue for doctors so we built a reminder service that automatically sends SMS reminders to patients who have an appointment with the doctor today. This simple reminder reduced no-show rates by upto 70%! We recently added our speciality specific EMR modules which provide specialty specific features to doctors. For example, we know that paediatricians require growth charts – so pediatiricians using ray can get the module custom designed for them and their work flow to make their consultation process better and even more efficient. Another feature we’ve recently built is prescription reminders. We realise that non-adherence to prescribed medicine/dosage is a big reason why patients don’t get better soon so now when a doctor creates an e-prescription using Practo Ray, he can setup so that Ray will automatically send reminders on behalf of the doctor. This also has shown considerable improvement in compliance ensuring doctors can treat patients better. We’re really humbled by the love and support we’ve received from the doctors over the last 7+ years and its because of our co-creation that Practo Ray today has over 90% market-share in India and doctors use Practo Ray to manage healthcare for millions of patients every month. But we didn’t stop there and have launched Ray in several international markets and have found amazing acceptance and adoption from doctors there as well and we will continue to take Practo Ray to many more countries in the future to enable healthcare provider to use the best technology advancements and software and help billions of people across the globe. In 2013, we launched Practo.com – our doctor discovery platform which allows consumers to find the right doctors and book instant appointments with them. We list doctors for free (post verification) and make it super easy for consumers to search for and find great doctors near them. In this digital era, more and more consumers are looking for their doctors online and Practo Search makes it easy for the millions of patients searching online to find and connect with the right doctor. We are ofcourse continuing to expand our product offering and now cover over 200,000 doctors, 10,000 hospitals, 8,000 diagnostic centers and more.

How has Practo Ray played a pivotal role in digitizing medical practice management? Earlier, most of practice management software’s were not built to fulfill the need of the doctor. We wanted to change that and build a product that was specifically designed for them. Practo Ray is one of the first SaaS based products that was conceptualized, designed and built in India to address the need of the Indian healthcare provider. It has helped in simplifying practice management and streamlined the way a clinic functions. Practo Ray is also available for specialties, which provides better tools to healthcare providers and significantly improves patient care for some of the biggest healthcare issues plaguing our country, including controlling lifestyle diseases and ensuring immunizations for infants and children. Practo Ray is now being used by thousands of healthcare providers, globally, in five countries - India, Singapore,

INTERVIEW Malaysia, Indonesia and Philippines. We have been successful in playing a vital role in bringing that shift by building world class products like Practo Ray and have proved that doctors can manage millions of patients and healthcare records every month digitally. Today, we are the world’s largest appointment booking platform with nearly 40 million appointments managed every year and connecting millions of patients to over 200,000 healthcare providers 10,000 hospitals, 8000 diagnostic centers and 4,000 witness and wellness centers listed on the platform across 50+ cities and 15 countries across the world.

What are the benefits of Practo Ray?

Key Benefits of Practo Ray include:  Practice Management with Analytics  Enables superior clinic management with unified interface to manage appointments bookings, billing, inventory and more. Practo Ray will also provide advanced analytics and automatic reporting to help you stay on top of your clinic’s operations.  Doctor’s can schedule appointments in their Practo Ray Calendar and Practo Ray will automatically send reminders to patients so that no-shows can be reduced. Practo Ray can also be used to send alerts reminding patients to stick to their periodic checkup schedules thus ensuring consumers get timely care.  Practo Ray helps doctors generate digital health records for patients. This is an easy way for doctors to manage their own patient files including clinic notes, medical imaging files, prescriptions and invoices while at the same time providing convenience to their patients. EHR also enhances protection against medico-legal cases as well as reduces denial rate of insurance claims. P racto Ray enables doctors to present a highly professional appearance to patients by enabling doctors with digital records, as well as neat printouts for bills, prescriptions and reports. Further, we’ve recently launched Practo Consult, an online platform where patients can easily ask questions online and verified doctors can respond to their medical queries within a span of 24 hours. This helps the consumers as they can get qualified medical advice while also becoming a very effective channel for doctors to connect with and help out more and more patients. Signing up for Practo consult is ofcourse free for both doctors and patients.

How did Practo Ray (SaaS solution for Doctors / Healthcare Providers) build up a business case for Practo.com? Actually, we never look at products from a business case perspective. I firmly believe that first you must solve a meaningful problem. The monetization can always be figured out. Our mission is to help mankind live healthier, longer lives and we want to build products that help us achieve that. Going further, having both Practo Ray and Practo.com enables us to build a set of products that no one else can offer. For example, a consumer could go to a doctor using Practo Ray and when he creates a digital prescription, we can send the consumer automated alerts reminding him at the time he has to take his

medication! Another service we could offer is that when you get a diagnostic test done, the report from the lab automatically flows into your health account and you could share it with your doctor with one click and just get his opinion on the phone. These are all game changing services that we could offer since we have Practo Ray and Practo.com. We believe the interplay of the two is where the magic will happen to truly transform digital health as we know it.

How do you compete with other similar start-ups who offer cloud based solutions? How do you keep ahead of the competition? Well, firstly, healthcare is a large problem and we believe that more people joining in to solve this problem is great. Specifically for Practo, we’re in the unique position of having a globally respected business-to-business (B2B) software product, Practo Ray, that is tightly integrated with its consumer offering, Practo Search. Practo Ray and Practo Search come together to create the world’s first healthcare hyperloop, connecting the entire healthcare ecosystem and helping consumers make better healthcare decisions. Our goal is to provide a platform where our offerings work seamlessly together to deliver the best experience for all users – the doctors as well as the patients. We belive that only with this seamless integration can we help great doctors get discovered by more and more patients, while simultaneously enabling the doctors to treat their patients better. This is visible in the rapid expansion and adoption of our products - Practo is the world’s largest appointment booking platform with nearly 40 million appointments managed every year and every month connects millions of patients to over 200,000 healthcare providers 10,000 hospitals, 8000 diagnostic centers and 4,000 witness and wellness centers listed on the platform across 50+ cities and 15 countries across the world

What is the revenue generation model? While we do not charge doctors or patients to list or book appointments on Practo, we have several strong revenue models:  Practo Ray, - a cloud based clinic management software which doctors can subscribe to. The doctors can schedule patients SMS reminders, stores the patient’s digital records and also allows the doctors to send e-prescriptions to the patient. It has over 90% market share and today helps doctors manage millions of patients and their healthcare records every month.  The other source of revenue is Practo Reach - which allows clinics to showcase hyper contextual and factual information cards about the clinic based on the user search query on Practo. It shows the user factual information on the clinic on the basis of the users search, specialty and proximity.  With our acquisition of Qikwell, and Insta, we have great revenue streams from the enterprise segments as well. Additionally, basis Qikwell an Insta acquisitions we have been able to penetrate deeper into the enterprise segment, especially hospitals and diagnostic centres and are bringing incredible systemic w w w.medegatetoday.com March-April 2016

EXPERT VIEWS

Combating Diabetes: The not so sweet Indian Scenario.

Dr. Shuchin Bajaj Founder Director, Cygnus Hospitals

Dr. Shuchin Bajaj, Founder Director of Cygnus Hospitals was recently in London on the Chevening Gurukul Fellowship by the Foreign and Commonwealth Office (FCO), UK Government and has come back with a deep insight on NHS.

istorically, non communicable diseases (NCDs) or diseases related to metabolism and lifestyle, such as Diabetes and Hypertension, have been more prevalent in the developed parts of the world. Whereas in India, the high prevalence of communicable diseases (CDs) has been more of a concern. With the demographic changes around the world, and economic development, these realities are steadily changing. NCDs such as diabetes and hypertension, hence, are no longer only a problem of the affluent and developed nations. These are now the leading causes of death in all the worldâ&#x20AC;&#x2122;s regions except sub-Saharan Africa. The toll NCDs are taking (measured by years of life lost or Disability Adjusted Life YearsDALYs) on people ages 60 and older in low- and middle-income countries is much greater than for people in high-income countries. India, for example, is witnessing an alarming rise in the prevalence rates of Diabetes and Hypertension, as well as of other NCDs. It is estimated that currently, India has some 62 million people living with Diabetes and prevalence rates close to 13%. Hypertension is another significantly serious health issue with 33% of the urban and 25% of the rural population being hypertensive. Emerging economic changes leading to changed dietary patterns and habits are one of many reasons behind the epidemiological shift. The other major contributor certainly is population ageing, with people living longer and as a result, being more vulnerable to these diseases. From about 100 million older people in India currently, the country is projected to have about 323 million older people by 2050.

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The developed parts of the world, such as the United Kingdom, have had their own Diabetes and Hypertension epidemics over a long period of time with Hypertension prevalence rate in the country being 31.5% and 29% respectively in adult males and adult females. Diabetes, the other seriously challenging public health issue in the UK, has about 3.2 million people impacted and by 2025, over 5 million in the UK will be living with Diabetes. UK is certainly a country with advances medical facilities, higher literacy rates and adequate technical capacities to address Diabetes and Hypertension effectively. India, on the other hand, has very limited infrastructure, facilities and capabilities to deal with the rapidly growing Diabetes and Hypertension crisis. It is also noteworthy that both Diabetes and Hypertension are diseases with relatively good prognosis. What this means is that with proper and timely diagnosis, with good understanding of the diseases, with access to treatment regimens, and with well directed self care, people living with these disease can live very healthy lives and could ensure what is called secondary prevention. Therefore, the need of making our populations understand Diabetes and Hypertension better, and making them important contributors in battling with the epidemic, is a much needed priority. In India, it is clearly evident that the focus on preventive measures is very weak. Due to lack of capacity and resources, very few organizations have been involved in the process of educating the masses on prevention methods, thus leaving large numbers of people unaware about diabetes and hypertension. These challenges in India are clearly more severe in rural settings. During my time in London, I observed a few things which made me understand why the NHS is so effective in treating these NCDs and I feel if we can implement a few easily achievable recommendations we can very quickly catch up:

EXPERT VIEWS

Patients' education/secondary prevention

building would be critical aspects of ensuring healthy ageing. Recently launched First WHO World Report on Healthy Ageing People living with these diseases can still live a healthy life shares about various possibilities in the context of action against for a long period of time and can avoid serious complications. NCDs among elderly. Accordingly, patient education, or secondary, prevention education in medical terms, plays a critical role in ensuring Financial aspects and partnerships a healthy life and in avoiding life threatening complications. India needs to prioritize the allocation of its funds aimed Health practitioners and health authorities have been giving towards prevention and control of NCDs, which continue to a lot of emphasis to secondary prevention in the UK. These be very poorly resourced, resulting into inadequate capacities efforts result in reduced prevalence of cardio-vascular diseases and infrastructure. However developed countries have more and other internal organs complications due to diabetes and financial resources to fund health programmes in comparison hypertension. In India too, secondary prevention is getting to India. Partnerships at various levels will be of crucial increasing importance in medical and public health programmes. importance. Multi-layered partnerships must be developed that However, those efforts remain to be concentrated in selected connect Government, healthcare providers NGOs, patients and parts of the country. Learning from other experiences such as communities in general. from the UK may further strengthen this critical component of diabetes and hypertension management, and in expanding the A national level position paper same to the remote parts of the country. Latest technologies It would be worthwhile to think of producing a national level provide excellent expansion opportunities of trainings and position paper focusing on diabetes and hypertension with a those must be fully utilized in this context. defined vision and clear action plan. Aspects related to training, research and partnership building must be discussed in detail Workforce development in the position paper. The resource scenario and funding In India, this is one of the most neglected parts of battling with commitments should also be clearly indicated within the paper. diabetes and hypertension epidemics. This results in limited A participatory process must be taken up to develop this paper awareness about diseases among caregivers and health workers. that includes all opinions and voices. There is a need for strengthening the training component of the physicians and nurses, focusing on diabetes and hypertension at a regular basis. Curriculum need to be revised and latest technologies must be used effectively such a s e-learning and mobile-health.

Community education Village Health Workers working in rural areas with the Government and NGOs can be effective community educators. A cadre of VHWs at the national level must be created and trained for the rural parts of the country.

Research aspects Population size in India will always make data collection a mammoth task. We need to employ both quantitative as well as qualitative research tools effectively for there to be any change. In India, the research on diabetes and hypertension is by and large confined to the management aspects and has remained within the functions of selected national level medical research bodies. Quantitative research tools must be given attention and strong efforts need to be made to explore data collection tools with varying metrics levels.

Addressing healthy ageing and self care Promoting self-care among older people is a very critical part of ensuring healthy ageing, which is relatively well practiced in the UK. India has to address its ageing challenges in a more coordinated way with a rapid demographic transition at large in the country. Training, capacity building and partnership w w w.medegatetoday.com March-April 2016

PRODUCT LINE

Amulet Innovality The New Leader in Digital Mammography I

t’s interesting to know that Fujifilm’s Amulet Innovality has made a roaring success within short span of its introduction, both in India and Globally. So, what made the Fujifilm’s Amulet Innovality – the new leader in Full Field Digital Mammography (FFDM) segment? Let’s look at the key reasons for its phenomenal success. Amulet Innovality, Fujifilm’s newest Digital Mammography system, combines state-of-the-art, Hexagonal Close Pattern (HCP) image capture technology and intelligent image processing, optimizing contrast and dose based on breast density. This resulted in exceptional imaging, optimized contrast, low dose and fast acquisition time. The motivation for Fujifilm’s Imaging Technology Center (R&D) team is to meet the challenges and requirements of Radiologists, Mammography technologists, Administrators, and Patients alike.

Phanesh Atmuri National Sales Manager DR FUJIFILM INDIA PRIVATE LIMITED

Unique and Disruptive design of Detector The detector is the heart of any Digital Mammography system which has direct impact on the Image Quality obtained and on X-Ray dose. It is very important to detect even a small sign of calcification during breast cancer screening. Two types of flat panel detectors (FPD) are used for mammography: a direct conversion-type detector and an indirect conversion-type Detector. The resolution of the direct conversion-type

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detector is generally higher than that of the indirect conversion-type detector. Therefore, Fujifilm preferred direct conversion-type A-Se detector because of its high spatial resolution. In the conventional detector design, the TFTs (Thin Film Transistors) incorporate the spaces between neighboring pixels for the laying of signal wires. Owing to these gaps, the electrical field intensity is naturally weak and thus reduces the collection efficiency of the signal charge generated from X-Rays. And the design of square shaped pixels constituting the TFTs will further decrease the signal charge. In order to overcome these detector inefficiencies, Fujifilm’s design team has introduced the unique disruptive technology of Hexagonal Close Pattern (HCP) structure into TFTs as Hexagonal pixels can be arranged to reduce the spaces that suppress the disturbances of electrical field intensity. Also, a hexagonal pixel is preferable to a square pixel because of its higher sampling efficiency, consistent connectivity and angular resolution. As a result of this radical new HCP design, Fujifilm is able to increase sensitivity by about 20% compared with conventional TFTs that used square pixels. The detected data by the hexagonal pixels were converted into a 50 µm square image matrix by the imaging processing unit for a 50 micron image display. The HCP design also increased DQE and MTF and reduced the exposure dose while maintaining a high Image Quality.

PRODUCT LINE

Optimized X-ray dose and contrast for each breast type In general, images taken with the Molybdenum (Mo) anode represent stronger contrast than with the Tungsten (W) anode, which allows physicians to make diagnoses more easily. X-rays generated from the Mo anode have a low energy distribution; therefore, they are easily absorbed in the breast. That enables high-contrast imaging. However, with the Mo anode, the radiation dose is definitely larger than with the W anode. Fujifilm addressed this challenge and developed a radiation qualitycorrecting technology, to create the same high quality of images with the low-radiation W anode as is possible with the Mo anode and the technology is known as Image-based Spectrum Conversion (ISC). In a nutshell, ISC technology optimizes contrast in an image, offering the dose advantages of a tungsten target for all exposures and breast types. The conventional AEC uses multiple sensors to detect X-rays that passes through the subject. It calculates the required dose, based on the sensor that received the smallest quantity of X-rays through the subject during preirradiation, that is, the sensor for the region where the glandular density is considered to be the highest. Fujifilm has developed i-AEC technology that detects the mammary gland region based on the morphological characteristics recognized within the images taken during pre-irradiation. iAEC has realized radiation dose control that optimizes the quality of images of the mammary gland region, regardless of the state of the breast, such as being fatty, with the scattered mammary gland and having implants.

angles via reconstruction so that the information can be utilized in diagnosis. In addition to images at a high resolution, Tomosynthesis required imaging at a lower radiation dose, as the examinees need to undergo Mammography several times. During the Tomosynthesis process, the wider the imaging angle, the higher the depth resolution of the image obtained. In view of this, Fujifilm has incorporated two different tomosynthesis mammography modes, i.e., ST mode and HR mode. ST mode achieves imaging as quickly as just four seconds by narrowing the imaging angle. Quick and lowradiation tomosynthesis mammography is possible in this mode. HR mode provides high depth resolution by widening the imaging angle. That

enables observation focusing on the region of interest. Providing those two distinctive modes allows users to make purpose-specific selection.

Patient Comfort Most of the cases, the patients are not comfortable during a Mammo examination as the compression of the breast causes pain / discomfort. Keeping the patient comfort as pivotal to its design, Fujifilm has developed a unique patented comfort paddle that allows pressure to be more evenly and gently distributed across the breast compared to conventional, flexible paddles. This design improves the patient comfort during mammograms significantly.

Digital Breast Tomosynthesis (DBS) Tomosynthesis is a technology to generate a tomographic image from multiple images taken from different w w w.medegatetoday.com March-April 2016

PRODUCT LINE

HealthNet Global Limited Advances Its Remote Healthcare Initiative with Control-H Health Monitoring Device from American Megatrends

merican Megatrends, Inc. (AMI), a global leader in BIOS, remote management tools, network data storage products and unique solutions based on the Linux® and Android™ operating systems, is pleased to announce that it has entered into a strategic partnership with HealthNet Global Limited (HNG), an affiliate of Apollo Hospitals, aimed at delivering global digital health solutions for Rural Health Connect, Home Health Monitoring and Tele-health Services. Through this partnership HNG will launch a new set of digital health care solutions under the “Control-H” brand. AMI is pleased to announce that the Control-H will be packaged as an integrated medical device technology kit developed by AMI with the total remote healthcare solution technology developed by HealthNet Global. Control-H provides the user with essential health information at any time and place by collecting key vital data such as non-invasive blood pressure (NiBP), pulse, blood oxygen level, body temperature, blood glucose, hemoglobin and cholesterol levels via a compact and portable device and sending the data to the HNG Health Cloud. The HNG Health Cloud then connects to the Apollo network of doctors, physicians, consultants and specialists to provide quality healthcare to individual patients - anytime, anywhere. Through this strategic partnership HNG is augmenting its digital healthcare platform with healthcare monitoring technology from AMI to deliver innovative digital healthcare solutions to the masses. This partnership is the first of its kind to bring self-health monitoring to the doorstep of every individual by way of a digital health platform. Now, consumers using Control-H can observe and track vital health information in the comfort of their homes and then share it with the Apollo network of hospitals, specialty clinics, pharmacies and 24x7 emergency care facilities to receive top quality health advice and recommendations. Ms. Sangita Reddy, Joint Managing Director of Apollo Hospitals Group, expressed her

strong belief in remote healthcare and the convergence of healthcare, IT and handheld devices by saying, “In order to address predominant healthcare issues such as lack of infrastructure and access to it, we are constantly striving to develop new models and innovative solutions. One of these models – which we strongly feel will go a long way to address these issues - is a device capable of putting healthcare directly into the hands of an individual, like Control-H.” Highlighting the need for such devices as an integral part of one’s daily wellness routine, Mr. Anindith Reddy, Director of HealthNet Global, said that “Statistics show that more than 40% of hospital walk-in patients can be treated at home. Through the integrated use of various technologies, we are building a remote health platform that can treat all of these cases and non-communicative diseases from home - and the Control-H devices announced today play an integral role in this platform.” "American Megatrends shares a common belief with the Apollo Group that devices such as Control-H will soon become readily accessible to the general public. Both companies are hard at work perfecting a health monitoring solution that is accessible, easy-to-use and affordable, yet powerful enough to make important health information readily available at one’s fingertips. Ideally, wide adoption of these products would enable physicians to reach out to patients before health issues become serious problems and also empower patients to take a more involved and proactive approach to their own healthcare. It is our firm conviction that our partnership will help make this vision of the healthy future a reality," said Subramonian Shankar, President and CEO of American Megatrends and Chairman of American Megatrends India Pvt., Ltd. Mr. Vikram Thaploo, CEO of Apollo TeleHealth Services and HealthNet Global, believes that the point of care is shifting from hospitals to homes and from curative to preventive modalities. “In a country like India, where the doctor to patient ratio is 1:1700, we have a strong need for

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technology which will aid in monitoring and managing patient health around the clock. This is the essence of our collaboration with AMI, to make remote healthcare delivery fully comprehensive through devices such as Control-H,” he noted. “American Megatrends is extremely proud to partner with HealthNet Group, an affiliate of Apollo Hospitals, to advance its remote healthcare initiative,” commented Mr. Sridharan Mani, Director and CEO of American Megatrends India Pvt., Ltd. “Through this initiative, we firmly believe that quality healthcare will become more accessible to citizens across the nation. This initiative also reaffirms our commitment to providing quality solutions in support of the Prime Minister’s vision of ‘Digital India’ and ‘Healthcare for All’.” About Apollo Hospitals With more than 15 years of experience delivering tele-health services and solutions, Apollo Hospitals is a pioneer of telemedicine in India and is committed to augmenting its Health & Diagnostic Services platform as a complete “Digital Health Platform”. About AMI Founded in 1985 and known worldwide for AMIBIOS®, American Megatrends Inc. (AMI) supplies state-of-the-art hardware, software and utilities to top-tier manufacturers of desktop, server, mobile and embedded systems. AMI's industry leading Aptio® V UEFI BIOS firmware, innovative StorTrends® Network Storage hardware and software products, MegaRAC® remote server management tools and solutions based on the popular Android™ and Linux® operating systems continue to garner industry acclaim and awards around the world. In line with the diversity of its technology and product line, AMI is a member of a number of industry associations and standards groups, such as the Unified EFI Forum (UEFI), the Intel® Internet of Things Solutions Alliance and the Trusted Computing Group (TCG). Headquartered in Norcross, Georgia, AMI has locations in the U.S., China, Germany, India, Japan, Korea and Taiwan to better serve its customers.

EXPERT VIEWS

Rajiv Nath Joint Managing Director, HMD

Safe injection practice lowers the burden of disease and overall healthcare cost. HMD has been an active partner in global initiatives for moving towards a safer injection practice regime and has inculcated this as part of its CSR program. Syringes should be life giver, not life taker. But sadly this has not really been the case as unsafe injections continue to be a major problem threatening patient’s life, casting shadows over immunization programs and raising overall healthcare cost for both individuals as well as countries. According to WHO, every year at least 16 billion injections are administered worldwide.1 The vast majority – around 90% – are given in curative care. Immunization accounts for around 5% of all injections while the remaining indications include transfusion of blood and blood products, intravenous administration of drugs and fluids and administration of injectable contraceptives. Unsafe injections can result in the transmission of blood-borne pathogens from patient to patient (through reuse of syringes), patient to healthcare worker (through needle-stick injuries) and more rarely, health worker to patient. The community at large is also at risk when used injection equipment is not safely disposed of. Unsafe injection practices have also been the cause of outbreaks of viral hepatitis B and C and HIV in healthcare settings including in high income countries.2 A 2007 hepatitis C outbreak in the state of Nevada, United States of America, was eventually traced to the practices of a single physician who injected an anaesthetic to a patient who had hepatitis C. The doctor

Lowering the burden of disease and overall healthcare cost through safe injection practice regime then used the same syringe to withdraw additional doses of the anaesthetic from the same vial – which had become contaminated with hepatitis C virus –and gave injections to a number of other patients. In Cambodia, a group of more than 200 children and adults living near the country’s second largest city, Battambang, tested positive for HIV in December 2014. The outbreak has been attributed to unsafe injection practices. In 2007 and 2008, in Kyrgyzstan, dozens of children became infected with HIV because of unsafe injections and other medical procedures. In Egypt, the rate of hepatitis C infection – which is the highest in the world – has been tied to re-use of needles and administration of unnecessary injections. Society thus has to pay a heavy price for the practice of unsafe injections. Unsafe injection practices are also associated with substantial morbidity and mortality. Before safe injection campaign first began in year 2000, it was estimated that up to 1,60,000 human immunodeficiency virus (HIV), 4.7 million hepatitis C and 16 million hepatitis B infections each year are attributable to unsafe injection practices. The problem was complex and fuelled by a mixture of socio-cultural, economic and structural factors. India Specific Problems: Practice of unsafe injections has been quite prevalent in the rural areas, which is home to over 65% of our population. One of the largest epidemics of acute hepatitis occurred in February-March 2009 in the Sabarkantha district of Gujarat in India, with 456 cases and 89 deaths.3 The center of the outbreak was Modasa taluka. All the victims gave history of receiving injections about 2-3 months prior to the development of clinical signs and symptoms from one particular doctor. Gross and continued use of contaminated injection devices led to this explosive outbreak with such high mortality. The particular doctor was caught and found guilty of such practices.

A study conducted by CLEN Program Evaluation Network on behalf of Ministry of Health, Government of India and the World Bank (2002-2004), revealed that around 65% of syringes used in the country were not disposed or sterilized, and often reused. Still, the true extent of the practice of unsafe injections has neither been fully documented nor studied across states, mainly due to resource constraints and lesser appreciation of the problem by various governments. Nonetheless, it is safe to conclude that the practice of unsafe injections was widely prevalent in India and continues to be practiced widely in some pockets. Government of India has been aware of the problem but has also been slow to mandate the use of safe injection practice, which in practice means compulsory use of AD syringes for all kinds of injections. It was only in July 2014 that the Union Ministry of Health launched a ‘Handbook of Guidelines for Safe Injection Practices’ to promote awareness about the benefits and use of AD syringes. Subsequently, the National Health Resource Centre of Ministry of Health conducted an HTA (Health Technology Assessment) which substantiated the need to use Auto Disable Syringes for curative and immunization injections as appropriate technology to prevent noscomial infections. However, the implementation of government’s advisory for use of AD syringes for therapeutic injections has been half hearted in India despite periodic reminders. It is hoped that with new advocacy campaign, there will be increased awareness for more responsible health practices which also brings down overall health spending and average days of stay at health centers. This fact has already been substantiated in countries like Uganda, Tanzania, and Nigeria which saw sharp drops after large scale adoption of AD syringes and mandating it for over 90% of injections. w w w.medegatetoday.com March-April 2016

DOCTOR SPEAK

Family Matters Heart Disease Lurking in Your Family Tree “But I’m too young to have a heart disease”, said a young Payal to her doctor, with a bead of sweat trickling down her forehead. At 35, life was rolling as planned and she loved every minute spent at work or with her husband and son at home. While she denies experiencing any cardiac symptoms earlier, her mother had succumbed to a heart attack while only in her 40s, her grandmother had survived a heart attack at 60 but not the second episode at 68 and her elder brother had developed hypertension over the last couple of years. Also her mother weighed over 90kgs and her brother had been a heavy smoker for over a decade. This young woman, however, shared none of those risk factors. So why was Payal sitting in her doctor’s clinic complaining of chest pain?

Dr. Sibananda

HOD & Director ICVS SSKM Hospital and IPGME & RI. Kolkata

How much do you really know do not control diabetes then you are Coronary Artery Disease about your heart’s health? It is easy to more likely to develop cardiovascular Coronary artery disease (CAD) also be fooled by misconceptions and turn a disease at an earlier age than other people and it will be more devastating. blind eye to reality and facts. A family history of heart disease boosts If you are a pre-menopausal woman, your diabetes cancels out the protective your risk of having a heart disease. If a first-degree male relative (e.g. effect of estrogen and your risk of heart father, brother) has suffered a heart disease rises significantly. attack before the age of 55, or if a firstdegree female relative has suffered one before the age of 65, you are at greater risk of developing heart disease.

If both parents have suffered from heart disease before the age of 55, your risk of developing heart disease can rise to 50% compared to the general population.

Risk factors to be aware of  High blood cholesterol  High blood pressure  Physical inactivity  Obesity & overweight  Smoking  Diabetes  Poor diet Lifestyle habits, such as smoking or poor diet passed on from one generation to the next can also increase the risk of heart disease. Diabetes can also add to these risk factors and increase the chance of heart attack. Type2 diabetes is a major risk factor for coronary artery disease (CAD) and stroke.If you 62

known as coronary heart disease (CHD) is a potentially damaging condition which results due to buildup of fatty, waxy deposits that are made up of cholesterol, calcium, and other substances in the blood inside your arteries. These deposits slowly narrow  Age the coronary arteries, causing your  Gender heart to receive less blood and oxygen.  Family History This decrease in blood flow may cause Having a family history of heart chest pain (angina), shortness of breath disease is sometimes called a 'non- or other symptoms. A blocked coronary modifiable' risk factor - this means artery can result in a heart attack. it's a risk factor that you can't Some of the typical symptoms change. Genes can pass on the risk include of cardiovascular disease, and they can also be responsible for passing on  Chest discomfort or pain (angina) other conditions such as high blood  Shortness of breath pressure or high cholesterol levels.  Extreme fatigue with exertion One of the commonly inherited factors is high cholesterol level, known as familial hypercholesterolemia. If you have inherited this condition then you will experience a build-up of lowdensity lipoprotein (LDL) cholesterol in the blood, commonly known as “bad cholesterol”. LDL collects in the walls of arteries, causing the blockages. This can lead to coronary artery disease (CAD). Higher LDL levels put you at greater risk for a heart attack from a sudden blood clot in an artery.

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 Swelling in your feet  Pain in your shoulder or arm Medical care is essential once heart disease is diagnosed, with the goals of stabilizing the condition immediately, controlling symptoms over the long term, and providing a cure. Stenting is a minimally invasive treatment of treating a coronary artery disease. Stenting uses a device called a stent (tiny, expandable, mesh like tube) to restore blood flow in the coronary artery.

DOCTOR SPEAK

Does my heart pump enough? The EF number reveals it all Stages of HF

Dr. Amit Vora MD (Internal Medicine); DM & DNB (Cardiology)

During each heartbeat your heart contracts and pushes blood out of the main pumping chamber of your heart called the left ventricle. Heart’s ejection fraction (EF) is a measurement of how healthy your heart’s pumping function is. It can be calculated with an echocardiogram or more directly during an angiogram of the heart. Ejection fraction is used to evaluate the heart’s primary function as a pump. A normal EF is 50-65 percent. If your heart muscle has been damaged by a heart attack, heart failure, or heart valve problem, your EF may be low. The easiest way to determine your EF is a painless ultrasound called an echocardiogram that uses sound waves to produce images of your heart. A low EF number is an early sign of heart failure. This is a condition where the heart does not pump enough blood to the rest of the body. If you have a low EF number (less than 35%), it is important that you recognize the signs of heart failure, which may include:

Signs and Symptoms Many people with heart failure remain undiagnosed because their symptoms are often overlooked, ignored, or attributed to aging and in today’s times often attributed to excess stress. Symptoms depend on the severity of the heart failure. In the early stages, Heart Failure may not have any symptoms, however, in later stages it becomes severe. It’s important to be aware of the symptoms to take adequate medical treatment at the onset of this condition itself. The most common symptoms are difficulty in breathing, chronic cough, loss of appetite, fatigue, rapid or irregular heartbeat, low blood pressure (hypotension), cold sweating and transient loss of consciousness etc. In addition to the above symptoms, a physician may detect signs of Congestive Heart Failure, which may include an abnormal heart murmur caused by valve-related disorder, a crackling sound of fluid in the lungs caused by pulmonary congestion, a rapid heartbeat (tachycardia) or abnormal heart rhythm (arrhythmias), swelling and fluid retention in the liver or the gastrointestinal tract, enlargement of the heart (hypertrophy and dilatation) and liver congestion.

Class Class I (Mild)

Patient Symptoms No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath). Class II Slight limitation of physical activity. Comfortable (Mild) at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea. Class III Marked limitation of physical activity. (Moderate) Comfortable at rest, but any ordinary activity causes fatigue, palpitation, or dyspnea. Class IV Unable to carry out any physical activity without (Severe) discomfort. Difficulty in breathing, inability to lie down flat because of breathlessness even at rest. If any physical activity is undertaken, discomfort is increased.

Diagnosis & Treatments options for Heart Failure Heart Failure usually can’t be cured, but thanks to advances in drugs and device technology, it can be effectively managed and patients’ quality of life improved. Coupled with appropriate lifestyle changes, control of hypertension, diabetes and correction of any blockage of the coronary arteries or valve disease, the relentless progression of heart failure can even be arrested. Hence, the importance of early diagnosis and treatment. The doctor may arrange for tests that include a chest x-ray, blood and urine tests, an electrocardiogram, an echocardiogram and specialized tests like angiography and MRI of the heart. Cardiac resynchronization therapy (CRT) is one of the effective forms of treatment for heart failure in select patients. An implantable device similar to a pacemaker is inserted in the body to improve the pumping efficiency of the heart.. A CRT pacemaker is , a stopwatch-sized device, implanted in the upper chest to resynchronize the contractions of the heart chambers by sending tiny electrical impulses to the heart muscle. For some patients with heart failure and those who have electrical conduction problems of the heart (left bundle branch block), resynchronization therapy improves the flow of blood from the heart throughout the body, which results in reducing symptoms, hospitalizations and mortality. The quality of the life of the patient improves significantly and the patient is able to lead a near normal healthy life. A cardiac check-up as recommended by the family doctor with an ECG and echo testing will help to determine if you are prone to heart failure and guide steps for prevention and management. w w w.medegatetoday.com March-April 2016

COVER STORY

Medical Technology

Industry in India

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COVER STORY

echnology is the purposeful application of information in the design, production, and application of goods and services, and in the coordination of human activities. We use technology in our day to day lives, we all depend on technology and we use them to achieve particular tasks in our lives. Today, we have countless emerging technologies which influence our lives in various ways. Doesn’t matter which industry you’re dealing in, technology will be utilized in a certain manner. Technology can be a matter of life and death in the medical professions. It has saved multitudinous lives. It is simply the use of our knowledge to build objects to protect living organisms from disease or death. Medical technology, which is a proper subset of health technology, encompasses a wide range of healthcare products and is used to diagnose, screen or treat diseases or medical conditions affecting humans. In India, there’s been a rapid evolution in the physical and technological attributes of medical devices in hospitals. Medical technology is gradually becoming complicated and futuristic. The advent of nanotechnology, biologics and combination devices, among other novelties, is changing the shape and size and in addition the business and clinical potential - of the medical devices industry. The Indian medical devices sector has entered a phase of rapid growth. It is estimated that the market will outperform within the Asia Pacific region. Statistics reveal that the worth of Indian medical technology is approximately USD 3 Billion and is expanding at a CAGR of15%. Approximately, 75% of the medical devices used in India are imported. The local firms are mainly involved in manufacturing reasonable budget-friendly products for local and international consumption. Several multinational companies are dominating their local presence in India. The medical technology market in India is greatly controlled by factors like net healthcare expenditure, GDP, treatment options for population’s disease pattern linked demand, population’s perception of treatment choices and their response to certain device-based therapy, healthcare deliverers, regulatory atmosphere, taxation and reimbursement options. Medical technologies are changing the healthcare scenario in India. They are paving the way for a new generation of gadgets that have become tools to improve health care delivery and aftermaths. The scope of these emerging technologies is spectacular. Straight out of science fiction, new contraptions have developed that can scan a body of the patient without poking or probing and, in seconds, diagnosis is made. This may sound futuristic but many devices already exist. For instance, let’s talk about on-call doctors via telehealth services. This technology offers new ways for doctors to check-in on patients outside of an office visit. Telehealth is on the rise, and more payers are reimbursing providers and hospitals for treating patients distantly. w w w.medegatetoday.com March-April 2016

COVER STORY

Talking about medical records on the go, EHR or Electronic Health Records have taken the country by a storm. It is an electronic version of a patient’s medical history, which is handled by the provider over time, includes all of the key administrative clinical data relevant to that patient’s care under a specific provider, including demographics, progress notes, problems, medications, vital signs, prior medical history, immunizations, laboratory data and radiology reports. In some cases, telehealth and EHR may have even replace visits to the clinics for certain urgent, but not life-threatening, illnesses. After 4 decades of service, the X-ray computed tomography (popularly known as CT scans) can still be a challenge to capture. The slightest movement by the patient can result in a blurry image. But with GE's new Revolution CT, doctors will be able to image the entirety of the innards in the span of a single heartbeat. The Revolution CT uses a high resolution camera combined with a motion correcting system which can effortlessly capture formerly-unamenable organs like a beating human heart. It can scan even the most challenging patients, without stopping for even a minute, with amazingly clear pictures. News confirmed that this hi-tech gizmo will hopefully be rolling out to hospitals across the world in short order.

uses including the spine, which proves to be a unique additional diagnostic element for the doctors. G Scan enables true weight-bearing investigation which impossible before and was one of the greatest challenges to MRI. By permitting scanning in upright standing position, this MRI also helps doctors diagnose functional alignments of patients' joints and whether the disorder will get worse. Additionally, the contraption is open and friendlier for claustrophobic patients. In context to connected medical devices, biomedical engineers from Philips Innovation Labs and GE Healthcare in Bangalore are investigating and experimenting with mobility platforms and healthcare, which will be born in India soon in the form of a linked medical world. Both companies are spending close to $70100 million each a year on R&D, to make connected health and home modules a reality. Philips Innovation Labs are working on home devices that can communicate with each other. These instruments have the ability to send messages about a person’s health when he/she is driving or when at work or say when he/she comes back home. When linked to a smartphone via Bluetooth or Wi-Fi, they can outline the house profile of the customer. For instance, these apps can tell the Philips air purifier at home to cleanse the room to remove bad particles and make breathing easy. GE is developing a robot system that can sort and sterilise surgical tools. All data coming from machines will be collected and analysed for prognostic maintenance on behalf of hospitals and care centres. Likewise, Philips and GE are developing ECG machines that are getting smaller every year. The reports then, will be instantly emailed to the patient’s tablet in PDF format

Gone are the days when the patients used to feel uncomfortable and sometimes frightened during an MRI Scan are due to the ominous noise it produces. At Mahajan Imaging, India’s first ‘Silent MRI’ has been developed, where the only racket the patient hears is the noise experienced at room-level. This means, undeniably no noise during scanning of certain anomalies and maximum patient comfort and a relaxed experience. On the flip side, Apollo Hospitals has installed a first-of-its-kind cutting edge technology G (Gravity) Scan - an standing open MRI After GE and Philips, Siemens is not far behind. It is banking on scanner. This is a ground-breaking platform for musculoskeletal a new medical technology which can detect liver abnormalities in

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COVER STORY

early stages. Liver elastography is a technology when connected to the ultrasound imaging machine and can detect liver disorders like liver tumours, that cause cirrhosis, and also in knowing the stage at which hepatitis is widespread. This technology has huge potential in India where liver diseases are highly widespread. The ultrasound market in India is is worth approximately $100 million, of which 25% constitutes the high-end market which consists of advanced techniques used for spotting vascular diseases and musculoskeletal disorders, and liver elastography falls in the highend type. The machine price and installation charges range from Rs75lakh to Rs1.5crore, depending on the machine configuration. Medical Technology will definitely be a game changer in the manner in which healthcare services will be delivered in India. The private sector will be the major driving force behind technology adoption in the Indian healthcare segment. To optimize costs and effectively manage operations, IT solutions will become an integral part of process management, patient care and the management information system (MIS) in hospitals. With the health insurance sector poised for major growth in the coming decade, increasing demand from this sector for more efficient systems for storage and retrieval of information will put pressure on hospitals and other healthcare providers to imbibe technology to modernize existing infrastructure. There can be no better example than India to display the requirement for medical technology for refined healthcare delivery. It is the second most populated nation in the world and the dispense of healthcare services falls significantly short of the demand. With the convergence of many scientific and technology discoveries, the pace of medical invention is accelerating, inspiring hope for improved clinical outcomes with less invasive procedures and shorter recovery times, all in lower cost settings thereby creating immense value. These changes can drive demand for new lower cost diagnosis, monitoring and treatment procedures.

mHealth-Delivering Healthcare in Patients Hand

Ravi Ramaswamy Senior Director Healthcare at Philips Innovation Campus (PIC)

If we look at dispersion of medical services in India, we find that there is a disproportionate concentration of medical practitioners and paramedics in the metros and cities as compared to the Tier2/3 regions.Â There are 400,000 doctors to support 85 million people in urban areas as against 50,000 to support 740 million people in Semi urban / rural areas of India. On the other hand, we find there is a tremendous growth in telecom and In Infrastructure. There are 700+ Million Mobile phone users.Â The internet connectivity stands at close to 150 Million. This growth has permeated into the Urban/semi urban/rural environment with equal flair. The buzz word in healthcare these days is "convergence." It will be the defining characteristic of the industry moving forward. Convergence is being powered by mainly broader acceptance and adoption of digital technology both by doctors and patients. Information and communication technologies (ICTs) have great potential to address some of the challenges faced by us in providing accessible, cost effective, high-quality health care services. Telemedicine helps overcome geographical barriers and increase access to health care services. This is particularly beneficial for semi urban, rural and underserved communities â&#x20AC;&#x201C; groups that traditionally suffer from lack of access to health care. IT will be the force multiplier in the decentralisation process of Healthcare. w w w.medegatetoday.com March-April 2016

DOCTOR SPEAK

ZIKA Virus

Dr. M. Wali Padma Awardee

Consultant Physician to Hon’ble President of India North Avenue, New Delhi

Introduction Zika virus is an emerging mosquito born virus that was named from Zika forest of Uganda, where the virus was first isolated in the year of 1947. It is customary to name such uncommon virus along the area where they are found such as Ebola was identified in a village near river Ebola. World Health Organisation (WHO) has taken notice of Zika virus because cases were reported outside African continent through travelers for the first time in Switzerland, Sweden, USSR, possibly in United States of America. Brazil was worst hit as around four thousand children who were born with microcephaly out of mothers who suffered from Zika virus during pregnancy. Since this virus otherwise do not produce fatal illness like Swine flu, Bird Flu, Ebola and other virus illnesses so scare of this viral disease is not much as it is self-limiting and till date no treatment is available but what is important to note is if the pregnant lady specially till fourth month of pregnancy catch this infection is result in disabling conditions which effects the new born there bran and their head size named accordingly as Microcephaly which is a 68

Public health emergency of International Concern

rare neurological condition in which an infant's head is significantly smaller than the heads of other children of the same age and sex. It is a life crippling state of child. So it signifies that it should be dealt with very stringent manner so that new born do not suffer and therefore WHO rightly raised an alarm. There was another reason like Ebola why WHO declared it as public health emergency of International concern (PHEIC) on 1st February, 2016. because countries affected by the virus do not have sufficient resources to combat it hence resource mobilization and contribution towards research and to fight this menace needs finances. Hon’ble Union Health minister Shri J P Nadda, Secretary Department of Health and Family Welfare Shri B P Sharma and Dr Jagdish Prasad, Director General of Health Services Union Health Ministry have taken adequate measures and issued guidelines on the Zika virus disease in the light of the current disease trend, and its possible association with adverse pregnancy outcomes to prevent a public outbreak and for the thorough preparedness. A review of vaccine and trials are underway. Brazil which was affected by the Zika virus tried to dodge the virus fear with the celebrations for Rio-de-Janeiro carnival as the annual mega-bash famed for lavish and traditional samba parades and all night dancing could not come at a better time for enhancing the morale of citizens of this country but with full awareness and vigil. Symptoms: The most common symptoms of Zika are fever, maculopapular rash, joint pain, malaise or conjunctivitis .Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. The illness is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.

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Diagnosis: Physician may order specialized blood tests to look for Zika or other similar viruses like dengue or chikungunya. If you have recently traveled, tell your physician when and where you travelled so that he is aware of your travel history completely. Treatment: Treat the patient symptomatically :  Drink plenty of fluids to prevent dehydration of the patient.  Be particularly vigilant for the 2 hours after sunrise and the 2 hours before sunset.  Take adequate rest.  Can take medicine such as acetaminophen to relieve fever and pain.  Do not take aspirin and other non-steroidal anti-inflammatory drugs until Dengue can be ruled out.  Consult and report to the physician as and when required. Prevention: We can prevent Zika by avoiding mosquito bites because Mosquitoes that spread Zika virus bite mostly during the daytime. Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites  Wear long-sleeved shirts and long pants.  Use Environmental Protection Agency (EPA)-registered insect repellents only.  Do not use insect repellent on babies younger than 2 months of age.  Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin. You can rather apply on the margins of cot, Dr M. Wali suggests.  If you use both sunscreen and insect repellent, apply the sunscreen first and then the repellent. Currently in our country National center for Disease Control (NCDC), Delhi and National Institute of Virology (NIV), Pune have the capacity to provide live diagnosis on Zika in acute feverish stage as these institution have been marked as the apex laboratories to support the outbreak investigations and confirmation of lab diagnosis

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