March 2019

www.MedgateToday.com

Volume X | Issue III | March 2019

Your Gateway to Health & Medical World

DNA–Based Testing: A powerful tool for disease management

Latest Advancements Promise better Cancer treatment

T op 5 innovations

by Leaders of Home Healthcare in India

Basic Concept Of Laboratory Diagnostics

An Advance Media Publication

Advance Media Group A Healthy Journalism

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

EDITOR SPEAK

VOICE

OF

HEALTHCARE

th 4 VOH International Conference on Viable Healthcare & 25th addition of Medical Fair India Exhibition

On the behalf of Advance Media Group would like to THANK YOU for your overwhelming support for making the VOH a grand success, held on 21st - 23rd February 2019.

VOH is fresh initiative to create a platform to honour the best Indian professionals for delivering the quality work comparable to the International standards using the best practices in the field of Healthcare sector, with the aim of achieving inclusive growth, recent policy initiatives for improving healthcare delivery across all sectors in Healthcare industry in India. The mission aims to provide universal access to equitable, affordable, and quality healthcare that is accountable and at the same time responsive to the needs of the people.

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Mohd. Afzal Kamal

Feature Editor

Razi Ahsan, Neeraj Vats

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Dr. Sarika Gupta

Manager Business Development

Rushda Parveen

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Aiswarya Tapaswini Mishra

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Faiyaz Ali, Hina Kausar, Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath,

Subscription & Circulation

I am sure that without your overwhelming support, time and participation, it would have been difficult for us to achieve this task. We look forward to your continued support and invite you to take part in the next year.

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Have an insightful reading.

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2019

Volume - X Issue - III March 2019

VOH holds the view that in the current business scenario where the cooperation and collaboration between economies of various countries is the key towards mutual growth and development, the publication and media plays a significant role in creating the awareness and opportunities existing in both the economies. These conference cum summit are thus a channel for the introduction and recognition of the contribution to the sector, which can be utilized and leverage at a global spectrum.

Lastly, I would like to extend a heartfelt congratulations to the team of Medical Fair India especially to Mr. Thomas Schlitt and wish him all the very best for his future endeavor.

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Inside Volume-X Issue - III

NEWS UPDATE

March 2019

EXPERT VIEWS

POST EVENT

06 Dr. Lal PathLabs Ltd. collaborates

24 Relevance of Absolute Values In

54 9th MT India Healthcare Award

06 New strategy to tackle “don’t eat me”

28 Leveraging Technology in the

08 Actor Atul Kulkarni Inaugurates

30 Leveraging Artificial Intelligence to

with ORDI to sensitize India on Rare diseases signal on cancer cells

Robotic Assisted Joint Replacement Centre at Upasani Super Specialty

08 28 year old man from Tumkur

donates his heart and saves the life of a 42 year old from Uttar Pradesh

10 Medica Hospital organises 9th

Masterclass LIVE Neurosurgery Workshop

10 150 days of Ayushman Bharat PMJAY more than 12 lakh Patients

12 PM interacts with beneficiaries of Pradhan Mantri Bhartiya Janaushadhi Pariyojana

12 Wellthy Therapeutics presents Real

World Evidence of effective disease management...

14 Geetanjali Hospital Conducts its First Successful Kidney Transplant

Cbc Test– (Basic Concept Of Laboratory Diagnostics) Medical Devices Sector

Transform Healthcare Delivery in India

32 Promising new drug shows potential to stop progression of sepsis

34 Future Trends In Customer

Experience For Healthcare

COVER STORY

Medgate Today continues its glorious traditions of honoring Healthcare Leaders

58 4th International Voice of

Healthcare Conference held at New Delhi

62 M edical Fair India 2019 64 Recipients of HCL Grant 2019 66 Oblique Lateral Interbody Fusion (OLIF) technique emerging as a treatment of choice...

DOCTOR SPEAK

36 Treating blood cancer

44 Viral hepatitis B is responsible for

38 DNA–Based Testing: A powerful tool

46 I s it time to “Check your Hearing” 47 THDC boosts health services in

The Targeted way

for disease management

40 Latest Advancements Promise better Cancer treatment

42 Lesser known Molecular

Diagnostics today expands to every section of clinical laboratory

about 80% of liver cancer cases

remote areas of Tehri

48 Satnam device for endoscopic

surgeries to treat spinal problems

50 Precision & Efficiency What Tomotherapy is all About

16 Online Consultation for Paediatric

52 Practo releases India’s most

16 Noise pollution can lead to

53 Driver’s foot can be caused due

Care grows at 250% year on year: Practo progressive hearing loss over time

18 GOI did not succumb to US MNC

lobby pressure of rolling back Price Caps on Stents

20 National Health Authority-

Ayushman Bharat (PMJAY)...

22 Top 5 innovations by Leaders of Home Healthcare in India

23 Carestream Health To Sell its

Healthcare IT Business To Philips

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March 2019 w w w. m e d g a te to d a y.co m

comprehensive healthcare map on women to long hours of continuous driving

NEWS Update

Dr. Lal PathLabs Ltd. collaborates with ORDI to sensitize India on Rare diseases Observing Rare Disease Awareness day on 28th February 2019, Dr. Lal PathLabs Ltd. has associated with Organization of Rare Disease India (ORDI) for a campaign “RARE NEEDS CARE”. A leading diagnostic and related healthcare service provider, Dr. Lal PathLabs Ltd. has been proactively working towards the cause and combating rare diseases of neurology through its NeuroPro division.

This association is in alignment to what the brand stands for.

In India, 70 million people suffer from rare diseases which means 1 out of 20 children is diagnosed with rare disease. Racefor7 is an event organised by Organization of Rare Disease India (ORDI) to empower patients and their families with access to

national and international resources. To raise awareness for the 7,000 documented rare diseases, the event consists of a 7,000 m walk. This year the event is speard across 9 cities viz Mumbai Bengaluru, Kolkata, Chennai Mysuru, Coimbatore, Kochi, New Delhi and Thiruvananthapuram.

Commenting on the association, (Hony) Brig Dr Arvind Lal, Chairman & Managing Director, Dr. Lal PathLabs Ltd. said, “We are honoured to collaborate with ORDI. Through this event we aim to make people aware about the challenges patients face due to rare diseases. We are participating in the event as associate sponsors to spread awareness about these rare diseases and help these patients get a correct & timely diagnosis.”

New strategy to tackle “don’t eat me” signal on cancer cells Myeloid immune cells kill cancer cells by eating them but cancer cells prevent this from happening by giving out a 'do not eat me' signal. Led by immunologists Ton Schumacher (Netherlands Cancer Institute and Oncode) and Ferenc Scheeren (Leiden University Medical Center), researchers from various research institutes have discovered a new method to inhibit the 'don’t eat me' signal, and have therefore found a new target for immunotherapy.

The “don’t eat me” signal

Different types of immune cells have different strategies to fight cancer cells.

For example, some immune cells-myeloid cells-kill cancer cells by eating them.

Cancer cells can prevent this by expressing proteins on their surfaces which give out inhibiting signals to the immune cells.

One example is the 'don’t eat me' signal, officially called CD47, which ensures that the cancer cell stays alive.

Researchers around the world are now looking for medicines to block this “don’t eat me” signal. One method for doing so is to intervene on the surface of the cell, by covering the CD47 molecules on cancer cells with a specific antibody.

This method of blocking the CD47 signal from cancer cells is currently being clinically developed and is promising, but 6

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there are side effects, such as a decrease in red blood cells. On top of that, patients require a weekly IV to block the CD47 molecules on cancer cells adequately.

Are there any other ways to counteract the “don’t eat me” signal CD47? To investigate this, PhD student Meike Logtenberg, lead author of the article, set up a collaboration with experimental geneticist Thijn Brummelkamp, who uses a unique method to map the genetic regulation of any desired protein in a cell.

"With this screening method you can potentially find new targets," says Meike Logtenberg.

of this enzyme, we instantly blocked the “don’t eat me” signal on tumor cells.

Identifying this new target is especially relevant because the substances we can use to inhibit the QPCTL enzyme are likely to have some advantages over the strategies currently being clinically developed to inhibit the CD47 signal route."

Screening the CD47 molecule

Blocking the signal

Together with the immunologists, Brummelkamp screened CD47, which also plays a role in healthy cells as an immune system check, and found that the QPCTL enzyme is a crucial protein in forming the “don’t eat me” signal. QPCTL changes the structure of the CD47 protein and without any QPCTL activity, the CD47 molecules are no longer able to give off an inhibiting signal to myeloid cells.

Research leader Ton Schumacher: "In collaboration with the groups of Jeanette Leusen (UMC Utrecht) and Timo van den Berg (Sanquin Research), we then showed that as soon as we inhibited the activity

With a QPCTL inhibitor, for example, it becomes easier to control how long you want to block the signal, and so-called small molecule inhibitors are easier to administer than antibodies. Moreover, the substance does not inhibit the CD47 molecules on the healthy red blood cells that a patient receives during a blood transfusion to fight anaemia.

Clinical studies

The researchers expect that QPCTL inhibitors will be available for testing in clinical studies in the coming years. First clinical trials are expected to take place in patients with blood cancer.

NEWS Update

Actor Atul Kulkarni Inaugurates Robotic Assisted Joint Replacement Centre at Upasani Super Specialty Hospital Doctors at the Upasani Super Speciality Hospital in Mumbai this week performed two back-to-back successful Robotics-assisted total knee replacement surgeries, for the first time in Mumbai on a 65 years old Kanchan Patil both with severe knee pain since over 5 years.

These surgeries were done using the NAVIO PFS Robotics surgical system, the latest advanced generation Robotic intervention in joint replacement (developed in the USA) and to the delight of the families, enabled these patients to walk without significant pain within 4 hours of the surgery itself.

Robotics-assisted joint replacement surgery has many definitive benefits over traditional joint replacement surgery: It enables the surgeon to operate with enhanced precision even during the most complex procedures and difficult cases. Enhanced precision and lesser bone removal leads to less blood loss, painless, faster and better post-operative outcomes for the patient.

“Robotics assisted joint replacement is

at a much higher pedestal than traditional joint replacement surgery”, says Dr. Tejas Upasani, renowned Orthopaedic Surgeon and Head of Orthopaedics at Upasani Super Speciality Hospital.

“The NAVIO Robotics-assisted system reduces the possibilities of human error and ensures perfect alignment, leading to the longevity of the joint implant. Though this is a very high end technology in our hospital, we have chosen to not make it expensive - so that more patients will be able to benefit from this”, confirms Dr. Tejas Upasani, who operated upon the 2 patients.

Robotic Assisted Joint Replacement Centre at Upasani Super Specialty Hospital was inaugurated at the hands of Chief Guest Actor Atul Kulkarni.

Atul Kulkarni said, “This significant change in the medical sector has enhanced the lives people, it is the science to prove that the progress made in medical science and new facilities and equipment helps in diagnosing bigger diseases.”

The two patients and their families are extremely happy with the outcomes from such world-class cutting edge technology, now available to them in Mumbai. They were both discharged to get back home within 2-3 days of the joint replacement surgery and are now undergoing physical rehabilitation to return to an active lifestyle soon.

Using Robot-assisted surgery helps to prevent human error as well as gives best results to the patient, after the surgery same day the patient can walk more confidently, also gets the discharge within three days which results in minimum hospital stay, reduces the use of painkiller medicines, no need of physiotherapy. Overall, the robotics has become a boon for the patients.

28 year old man from Tumkur donates his heart and saves the life of a 42 year old from Uttar Pradesh The heart was transported from Fortis Hospital, Bannerghatta Road to M S Ramaiah Narayana Heart Centre with the help of a green corridor 42 year old from Uttar Pradesh gets a new lease of life as he undergoes heart transplant at M S Ramaiah Narayana Heart Centre- a unit managed by Narayana Health. The donor is a 28 year old youth from Tumkur.

He had met with a road accident on 03 March 2019. Though he was immediately taken to a local hospital in Vellore, owing to his condition he was referred to Fortis Hospital, Bannerghatta Road for further treatment. He was declared brain dead at 9:30 AM on 05 March 2019 and his wife consented for organ donation.

The heart was retrieved at Fortis Hospital, Bannerghatta Road and was transported to M S Ramaiah Narayana Heart Centre, Mattikere with the help of a green corridor.

The distance of 18.6 kms was covered in a span of 23 minutes.

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March 2019 w w w. m e d g a te to d a y.co m

The recipient is a businessman from Uttar Pradesh and he was suffering from Dilated Cardiomyopathy Severe Left Ventricular Dysfunction on Biventricular Assist Device. He was on medical management at M S Ramaiah Narayana Heart Centre.

After a thorough evaluation by the team of cardiologists and cardiac surgeons, the patient was advised a heart transplant and had registered with Jeevasarthakate (ZCCK) on 14th February 2019. The patient was lucky to get the matching heart within 20 days of his registration.

The heart retrieval and transplant was performed by Dr. Nagamalesh. U.M, Senior Consultant Heart Failure & Transplant, M S Ramaiah Narayana Heart Centre, Dr. Ravi Shankar Shetty, Senior Consultant Cardiothoracic &

Heart Transplant Surgeon, M S Ramaiah Narayana Heart Centre, Dr. Julius Punnen, Senior Consultant Cardiac Surgeon, Narayana Health City, Dr. Shilpa Rudradevaru Consultant Cardiac Surgeon, M S Ramaiah Narayana Heart Centre, Dr. Prashanth Ramamurthy, Consultant Cardiac Anaesthetist, M S Ramaiah Narayana Heart Centre, Dr. Guru Police Patil Anaesthetist, M S Ramaiah Narayana Heart Centre and team.

NEWS Update

Medica Hospital organises 9th Masterclass LIVE Neurosurgery Workshop Young neurosurgeons witnessed master-class live neurosurgical operations Deliberations on advanced skull-base, vascular, tumours and complex spine With an aim to impart knowledge and help the practitioners in staying updated with the latest trends in Neurosurgery, Kolkata-based Medica Superspecialty Hospital organised the 9th Masterclass Neurosurgery Workshop and Live Surgery on February 23 and February 24.

Senior Neurosurgeons from across the country took part in the conference for the benefit of junior doctors and medical students. The event was attended by over 250 doctors from all over the country.

The choice of operations, videos, lectures were in the field of skull base, vascular, CV Junction, spine and tumours.

The live procedures as well as videolecture sessions were conducted by guest faculties like Prof. Atul Goel (Mumbai), Dr. Suresh Sankhla (Mumbai), Dr. Paritosh Pandey (Bengaluru), and Dr. Lokendra Singh (Nagpur) among others.

Consultants from Kolkata including

Dr. L. N. Tripathy, Director, Medica Institute of Neurological Diseases & course convener, Dr. Harsh Jain and Dr. Sunandan Basu (host-faculty), Dr Sandeep Chatterjee, Dr P.R. Datta, Dr D. K. Pradhan and many more participated in the interactions.

Elaborating on the Masterclass Workshop, Dr. L. N. Tripathy, Sr. ViceChairman and Director, Medica Institute of Neurological Diseases (M.I.N.D) & course convener, said, “Neurosurgery is an evolving and dynamic area of expertise which demands doctors to stay updated with the advancements in order to provide the best quality care for all patients. These workshops are essential for the training of the next generation aspiring neurosurgeons who will carry the mantle forward.”

Dr. Alok Roy, Chairman, Medica Group of Hospitals, while inaugurating the

Seminar, said: “I would like to congratulate MIND team lead by our dynamic Senior Vice-Chairman, Dr. Tripathy, the team of masterclass neurosurgeons from all over India who came and offered a unique learning experience for the aspiring neurosurgeons. I am sure the live surgery and discourses on advanced neurosurgery will definitely benefit the trainees.”

“The live surgeries provided a real-time experience to us. The two-day workshop allowed us to exchange the thoughts and intuitive learning which will be beneficial for us in the coming years,” said a trainee, who witnessed the masters operating live.

150 days of Ayushman Bharat PM-JAY more than 12 lakh Patients provided free of cost healthcare In less than 150 days since the launch, more than 12 lakh people have received treatment under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY). Launched on 23rd September by the Hon’ble Prime Minister from Ranchi, the scheme has provided secondary and tertiary care benefits worth over INR 1,600 crores to beneficiaries across the country. PM-JAY aims to provide a health cover of Rs 5 lakh per family annually to more than 10.74 crore poor families or 50 crore people for secondary and tertiary care hospitalisation through a network of empaneled health care providers.

In addition, more than 1.7 crore beneficiary e-cards have been generated facilitating access to quality healthcare under the scheme to 12 lakh poor across the country. Currently 14,856 hospitals have been empaneled under PM-JAY. Out of these, around 7244 or 49 per cent are private hospitals.

Shri Jagat Prakash Nadda, Hon’ble Union Minister of Health and Family Welfare, said, “With its focus on providing best-inclass impatient care to the poorest 40 per cent in the country, 10 March 2019 w w w. m e d g a te to d a y.co m

PM-JAY is, two-thirds of the total hospital admission amount of more than Rs. 1,600 crores has been utilized towards tertiary care procedures or treatment for serious illnesses.”

“Cardiology and cardio-thoracic and vascular procedures such as CAG (Coronary Angiography), PTCA – double and single stent (medicated, inclusive of diagnostic angiogram), Coronary Ballon Angioplasty and Orthopedics procedure such as External fixation - Long bone are the top five packages of PM-JAY worth more than Rs. 592 crores and account for 37 per cent of the total admission amount,” he added.

1.3 lakh village level entrepreneurs across more than 65,500 Common Service Centres (CSCs), a network of single-window service providers, run by village level entrepreneurs (VLEs), that are a part of the government's rural outreach programme for delivery of digital services, have been engaged for verification of Ayushman Bharat beneficiaries through generation of PM-JAY e-cards across 13 states.

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NEWS Update

PM interacts with beneficiaries of Pradhan Mantri Bhartiya Janaushadhi Pariyojana The Prime Minister, Shri Narendra Modi, today, interacted with the beneficiaries of Pradhan Mantri Bhartiya Janaushadhi Pariyojana and store owners of Jan Aushadi Kendras, through video conference. The Union Government had decided to celebrate 7th March 2019 as ‘Jan Aushadhi Diwas’ across India, for creating awareness and providing impetus onthe use of generic medicines.

Interacting with beneficiaries and store owners from over 5000 locations, the Prime Minister said that in order to ensure the availability of high quality medicines at lower prices, Government had taken two major steps. First, the cost of 850 essential medicines were regulated and the prices of heart stent and equipment

for knee surgery were reduced. Second, a series of Jan Aushadi Kendras were started throughout the country. These steps have greatly benefitted not only the poor, but also the middle class, PM said.

The Prime Minister said that medicines are available at fifty to ninety percent lower price than the market rates at Jan Aushadi Kendras. He added that more than five thousand Jan Aushadi Kendras have been opened in the past four and half years. The Kendras provide not only good quality medicines but also provide selfemployment and create new employment opportunities, PM said.

Speaking about the vision of holistic transformation of health sector, Prime Minister said that the approach of the

Government is ‘No Silos- Only Solutions’. All the stake holders related to health sector are working together to transform the sector, PM said. He said that in the past four and half years, 15 new AIIMs have been either built or are being built and 31,000 MBBS and postgraduation seats in medical sector have been increased.

Interacting with the Prime Minister, the beneficiaries expressed happiness with the good quality of medicines available at Jan Aushadi Kendras. The beneficiaries mentioned that the low cost of the medicines have enabled them to save money while getting proper medication.

Wellthy Therapeutics presents Real World Evidence of effective disease management at the 12th Advanced Technologies & Treatment for Diabetes Conference in Berlin The study shows Wellthy Therapeutics’ digital diabetes DTx increases patient engagement and as a direct consequence, health outcomes in patients with type 2 diabetes A new study published by Wellthy Therapeutics, reveals an improvement in blood glucose levels and an increase in physical activity, aside from better insights into a patient lifestyle journey between two doctor appointments with Wellthy’s digital therapeutic (DTx) platform. Wellthy Therapeutics presented these findings at the 12th annual conference of the ATTD in Berlin.

The study demonstrated a positive correlation between engagement with Wellthy’s DTx and decrease in blood sugar and increase in self-reported physical activity. The most engaged patients reduced their fasting blood sugar readings by 21.4 mg/dL and cumulatively increased their activity by 133 minutes during the study. Both observations were several times greater than the results for the least engaged cohort of patients. These results are clinically significant and show that improved glycemic control and better patient self-management is possible by patients who engage with a digital therapeutic.

Dr. Vinod Mattoo, Wellthy's Chief Scientific Officer, said, “The data gathered from these studies further supports our hypothesis that digital therapeutics can provide effective strategies in diabetes management that are incremental to 12 March 2019 w w w. m e d g a te to d a y.co m

the current standard of care. The results from this study will be used to further develop and deploy high quality, evidence-based, customised therapies to transform the manner in which patients manage their medical condition and engage in their day-to-day care.”

According to the Diabetes Atlas published by the International Diabetes Federation (IDF), India[1]accounts for 49 percent of the global diabetes burden, with an estimated 72 million cases in 2017. This figure is expected to double by 2025.

Dr. Rajeev Chawla, president of the Research Society for Diabetes in India (RSSDI) said, “Traditional methods of improving patient outcomes are not adequate to address the growing burden of diabetes in India. There is a desperate need for innovative solutions capable of delivering personalized health interventions at scale. Wellthy Therapeutics’ Digital therapeutics suite, designed in collaboration with RSSDI, has the potential to drastically transform the way patientcentric health interventions are delivered across millions of Indians to prevent or delay life-threatening health complications arising from mismanagement of diabetes.”

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NEWS Update

Geetanjali Hospital Conducts its First Successful Kidney Transplant Geetanjali Medical College & Hospital (GMCH), Udaipur conducts its first kidney transplant on a 33 years old man.

His mother Basanti Bai donated one of her kidney to his son. The operating team comprised of Nephrologist & Transplant Physician Dr. Gulshan Kumar Mukhiya and Urologist & Transplant Surgeon Dr. Pankaj Trivedi. They were adequately supported

by Nephrologist Dr. Chetan Mahajan, Urologist Dr. Vishwas Baheti, Anesthetist Dr. S.S. Jaittawat, Dr. Uday Pratap & Dr. Anil, Cardiologist Dr. Ramesh Patel, Neuro Vascular Interventional Radiologist Dr. Sitaram Barath, Radiologist Dr. Ravindra Kundu and Infection Controller Dr. Upasna Bhumbhla. It is claimed as the first successful kidney transplant of South Rajasthan.

“The kidneys of the man had failed in the year 2003 as he was diagnosed with high BP & swelling in his body. He was on medications for the same. On investigations of kidney biopsy he was diagnosed with "Glomerulonephritis".

This disease occurs due to auto immune disorders. He discontinued the medication after two years. Recently, in December 2018 he suffered the same problem of high blood pressure which resulted in complete renal failure. He was admitted in Geetanjali Hospital where he underwent hemodialysis twice in a week. He was then counseled for kidney transplant to which her mother agreed and donated one of her kidney to him. The duo were admitted in hospital and were on close monitoring for a successful transplant. Dr. Patel helped monitor their health and on investigations the mother was diagnosed with thyroid and slight blood pressure which was managed by Endocrinologist Dr. Onkar Wagh. The complete and normal recovery led them shifted in Kidney Transplant Unit (KTU) for operation,” said Dr. Mukhiya, the Nephrologist.

“At times kidney transplant patients are at a risk of kidney rejection by the body which was controlled by medicines. Also to reduce the risk of infection Dr. Upasna Bhumbhla (Microbiologist) helped to maintain an infection free environment for the patient. Kidney transplant patients are more prone to infections which need to be

14 March 2019 w w w. m e d g a te to d a y.co m

cared and prevented. To control this in our hospital we have constructed our Kidney Transplant Unit (KTU) with an isolation room which doesn’t have direct entry. The patient and her mother are being educated on daily basis. The patient has also been asked to drink 8-10 liters of water per day for better recovery. The dedicated and compassionate care here at GMCH have resulted in better outcomes and marks a good recovery of the duo,” said Dr. G K Mukhiya.

"The patients who had undergone kidney transplant are more likely (around 70%) to live more than 10 years than being on dialysis."

Transplant Surgery:

“The transplantation of human organ is elaborate & protocol oriented surgery.

Primarily, it is pertinent to identify the kidney of donor which shall be transplanted. To conform the standards of same investigations like renal scan, CT angiography and renal angiography were performed by Dr. Sitaram Barath and Dr. Ravindra Kundu. To remove the kidney Laparoscopic Nephrectomy was performed in compare to open nephrectomy which is a better option available for transplant. It helps the donor to recover well, reduces hospitalization, small scar and incision which reduces the chances of infection. With the help of small incision the main artery, aorta and vena cave were clipped and the kidney was removed. The kidney was kept in an ice tray and was cleaned through kidney perfusion fluid. Now, the kidney needs to be placed in the recipient’s body. To place the same, a graft bed is being created.

The kidney was then placed in pelvic cavity, below the lower abdomen,” said the treating transplant surgeon Dr. Pankaj Trivedi.

He also said that, “to plant the kidney an external ileac artery and external ileac vein were created which were then connected to the artery and veins of that respective kidney. The ureter was attached with the bladder and the normal flow of urine started. This was performed with the help of magnification loop as these tubes were thin and the kidney was transplanted.

During the procedure the kidney was continuously washed with ice water so that it can be kept cool. This procedure had to be completed in a time span of not more than 30-40 minutes otherwise it affects the functionality of the transplanted kidney.”

The surgical process of transplant, at times may lead to excessive bleeding, thrombolysis, urine leak, infections which may affect the working of the kidney and also to maintain electrolyte and fluid balance in recipient.

CEO Geetanjali Hospital Mr. Prateem Tamboli presented the history of the journey of Kidney Transplant Unit being installed in GMCH. He said that, "Geetanjali Medical College & Hospital is a quarternary care multi super-specialty hospital where the complete experienced and skilled team of renal as well as other organ transplant is present. At GMCH, the pre, peri & post procedures are provided to patients, as per the international standards of medical treatment. There are more patients registered with us for kidney transplant and soon will be operated for the same.

Geetanjali Group’s Executive Director Mr. Ankit Agarwal said that, “South Rajasthan's first successful kidney transplant here at Geetanjali Hospital is a matter of pride for all Mewar region. I bow my head and give my deep respect to the mother (donor) for giving new life to his son. Soon, heart and liver transplant surgeries will be started in GMCH. I am thankful to all our team of doctors and Government of Rajasthan for giving the sanction of kidney transplant so that the services could be availed by people of not only Udaipur but also from the surrounding regions. We've also established a trust named "Lt. Narmada Devi Agarwal Trust" where the needy patients can avail the medical benefits."

NEWS Update

Online Consultation for Paediatric Care grows at 250% year on year: Practo ✓ Practo partnered for a joint conference of PediSTARS, IPSS and INSPIRE, organised by AIIMS ✓ Attended by experts in Paediatrics such as Vinay NadkarniChildren's Hospital of Philadelphia, Peter Weinstock-Harvard Medical School, Kimberley P Stone, Seattle Children's Hospital, among others ✓ The group collaborated on the importance of quality healthcare delivery in a digital world Practo, India’s leading digital healthcare platform, focussed on improving the access, affordability and quality of healthcare in India, partnered with the 4th Annual National ConferenceSIMULUS 4, held from 27th February to 3rd March 2019 at the All India Institute of Medical Sciences (AIIMS), New Delhi. The event was aimed at raising awareness of the need for high quality healthcare and use of technology in Paediatric Care. Along with other esteemed speakers from International and National Paediatrician society, Dr. Ajay Alexander, Head - Medical, from Practo took the floor.

Dr. Ajay spoke about Practo’s passion for building quality healthcare ecosystem in India and how it’s integrated in everything Practo does. Country’s geographical and infrastructural challenges, allow for digital healthcare to play a pivotal role in bridging gaps and providing access to quality healthcare 24/7, even in remotest corners of the country.

Practo recognises the need for building a one-stop shop for all healthcare needs and all its offerings viz. searching and booking an appointment with a doctor at his/her clinic or

hospital, 24/7 Online Consult with 60 seconds TurnaroundTime (TAT), Diagnostics and Medicine Delivery, sometimes within two hours, are tailored to that effect.

Speaking at the event, Dr Ajay Alexander, Head - Medical, Practo said “Digital healthcare holds possibilities for transformative outcomes unimagined before. With the help of technology, we’re enabling access to quality healthcare to all.

It complements the existing healthcare options, by ensuring patients do not self-diagnose, or get worked up worrying about their illness till they see a doctor physically. Paediatric care is a prime example of how online consult offers a peace of mind to parents by helping with a trusted, verified doctor’s advice at odd hours, during the time of an emergency, or even for any follow-up questions that the parents may have post a doctor visit. It’s one of the fastest growing speciality in online consultation at 250% y-o-y growth, and goes a long way in furthering our vision to help Indians live longer, healthier lives.”

Noise pollution can lead to progressive hearing loss over time About 900 million people are likely to suffer hearing loss by 2050

Statistics by the WHO indicate that there are about 466 million people across the world with disabling hearing loss. This number is likely to increase to 900 million by 2050 if no action is taken. The need of the hour is to lay emphasis on early identification and intervention for hearing loss. More than one billion young adults aged between 12 and 35 years are at risk of hearing loss due to exposure to higher recreational noise levels. Around one-third of people over 65 years of age are affected by disabling hearing loss.

The primary causes of hearing loss have been identified as inherited diseases, infections, continued exposure to loud noise, drugs and aging. Many of these causes leading to hearing loss could be prevented by approaches like immunization and restricted exposure to loud noise. Adopting strategies like immunization would help in effective prevention of hearing loss in children that occur as a result of infections 16 March 2019 w w w. m e d g a te to d a y.co m

like rubella, meningitis and mumps.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Everyday noise exposure over time has an impact upon our ability to hear and on the degree of hearing loss that develops.

Constant exposure to loud noise can cause high frequency sensory neural hearing loss. An exposure of 90 dB (which is equivalent to the noise made by a power lawn mower or passing motorcycle) is allowed for 8 hours, 95 dB for 4 hours, 100 dB only for 2 hours, 105 dB (power mower) for one hour and 130 dB for (live rock music) 20 minutes. Listening to music at 110-120 dB damages the hearing in less than an hour and a half. A short blast of loud noise – greater than 120 to 155 dB – such as from fire crackers can cause severe to profound sensorineural hearing loss, pain, or hyperacusis (pain associated with loud noise). Most unregulated large bombs can produce a noise of more than 125 dB.”

It is recommended that people who are continuously exposed to a noise level of greater than 85 dB should be provided hearing protection in the form of muffs or plugs.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Vedic literature has described four gradations or levels of sound: Para (background noise of nature, no spoken sound), pashyanti (observed sound or perceived in mind), madhyama (audible sound), and vaikhari (articulated sound or spoken words). We should speak in pashyanti and madhyama.

Noise shifts the body to sympathetic mode and takes us away from conscious-based decisions. Hence, we should make an effort to speak softly to minimize the ambient noise levels. All of us are now used to mikes in class rooms or lecture halls or DJ music. Instead, ask the audience ‘Am I audible?’ If you are audible without mike, then don’t use a mike.”

NEWS Update

GOI did not succumb to US MNC lobby pressure of rolling back Price Caps on Stents GOI Safeguards healthcare interest of masses at large and Ayushman Bharat Modicare Programme We are pleased that Govt. of India did not relent to 3 MNC lobbying pressure to protect their profiteering & decided to protect healthcare interest of common masses & safeguard our Ayushman Bharat Modicare programme by not rolling back Price Caps on Stents.” said Mr. Rajiv Nath, Forum Coordinator, AIMED. Contrary to the news that has been circulating on Govt’s offer to US to replace price cap for coronary stents, we are grateful that GoI listened to the request of The Indian Medical Devices Industry to not to remove price caps on Stents for at least 2 more years to ensure continued affordable access to Indian consumers and allow Indian manufacturers to continue to further gain credibility that their lower price is NOT lower quality or less safer and less innovative, as some lobbyists would like us to believe.

“Importers lobby is least concerned about making healthcare affordable for Indian consumers & Indian Medical Device Industry but thinks only for protecting their own profits” said Mr. Rajiv Nath, Forum Coordinator, AIMED. Voicing the concerns of Domestic Medical Devices Industry, Mr. Rajiv Nath, Forum Coordinator AIMED said “At AiMeD we have been specifically seeking Trade Margin Caps on Devices notified as Drugs but from 1st point of sale in Supply Chain, which as per us is when 1st sale takes place and GST is applied 1st time e.g. when goods enter country (on the CIF import landed price for imported and Exfactory price for Indian) “This will maintain parity between Indian & overseas manufacturers.” He further added.

For some devices like Stents where there is excessive price disparity between Indian manufacturers low price and imported device very high price, there may be a need to consider for such exceptional cases, Price Caps e.g. Stents and IV Cannulas.

18 March 2019 w w w. m e d g a te to d a y.co m

On other Devices notified as Drugs we recommend NPPA to consider to apply AiMeD’s proposed formula to cap trade margins over import landed / ex-factory price e.g. Syringes and Spinal implants on experimental basis and study impact on MRP reduction and as a Make in India and ethical marketing enabler for ensuring affordable access .

On other hand,considering Trade Margin Caps on stockists & Hospitals & Retailers without capping Trade Margins of Importers/ marketing organizations / Distributors may not lead to reduced MRP , ethical marketing or put an end to high Trade Margin induced sales. You can’t have an importer making 200% mark up and rest of whole of supply chain sharing only 30% margin ( 43% mark up) .

“Any attempt to pacify the 3 powerful US MNCs who are using their deep pockets clout to lobby for a favourable Policy to keep themselves out of trade Margins and price controls needs to be reviewed with caution by Government on on the impact it would have on affordable access or competitive growth of Indian made products” cautioned Mr. Rajiv Nath.

Consider the following example if Cancer Drug formula is applied on price to Stockist and AiMeD formula on whole supply chain post manufacturing, assuming US MNCs will be permitted to sell at any price to stockist and MRP will be 30% over price to stockist as done for Cancer Drugs.

Question to consider is if the import landed price of any Stent is Rs. 20000 and they sell at Rs. 60000 to stockist then MRP will be Rs. 90000 as per cancer drug formula & if domestic manufacturers price to stockist is Rs. 20000 then his MRP will be Rs. 30000.

Hospitals & stockiest earn Rs. 60,000 extra on imported device and will go back to pushing more profitable imported

stents to patients and question quality competitiveness of Indian products !

However, if AiMeD formula is applied on Stents (which we asked specifically not to, and retain Price Caps for now) then the applicable cap would be, 66% trade margin on landed CIF / Ex Factory Action Price. If import landed is Rs. 20,000, then maximum MRP is Rs. 80,000.

If Indian made product has ex factory at Rs. 20,000 (possibly lower) then its MRP would be maximum Rs. 80,000 This would reduce the inducement motivation to push products on basis of higher margins and encourage procurement by hospitals on lower cost of their procurement, after evaluating quality.

The question to be asked the Overseas Medical Devices Mfrs / Indian Importers lobbyists - CII, FICCI, MTAI, ADVAMED, AMCHAM, USIBC etc isWhat’s rational profit for a ImportersMarketer- Distributor? You say 30-50% margin is adequate for rest of Trade ie for Stockist & Retailer / Hospital and Govt should implement this as done for Cancer Drugs .

AiMeD the voice of Indian Medtech Mfrs recommends to cap Trade Margin from import landed price to MRP to be 50-85%!

So if 30-50% is deducted for rest of Trade other than Importer, then there’s provision for 20% to 35% gross margin for Importer. Is that not enough? How much more do you need as margin over the Import landed price post duty & initial GST that would be considered reasonable for you and not profiteering by consumers?

Remember when manufacturers sell / export they already included in their selling price R&D costs and marketing costs.

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NEWS Update

National Health Authority- Ayushman Bharat (PMJAY) & Healthcare Federation of India (NATHEALTH)

A New Momentum to Ayushman Bharat-PMJAY  National Health Authority (NHA) and NATHEALTH announced collaboration to scale up Ayushman Bharat-PMJAY NATHEALTH encouraged all its members to take advantage of the program and consider empanelment of their hospitals under PM-JAY in order to ensure quality care is within reach for all Indians.  NHA and NATHEALTH have decided to setup a mechanism to provide technical experts and inputs, as and when sought by NHA. This will be particularly important, as NHA intends to start soon with the exercise of calibrating package rates and the development of standard treatment protocols/guidelines. NATHEALTH resolved to ensure that its members will actively participate in costing exercises and technical support requests from the NHA and the State Governments.

H

ighlighting the critical role of both public and private sector providers for Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna (PMJAY), its implementing agency National Health Authority (NHA) is set to collaborate with NATHEALTHHealthcare Federation of India.

NATHEALTH & NHA officials met in New Delhi today to discuss collaboration on a comprehensive range of ideas to scale up the impact of the scheme.

During the meeting, it was decided that NATHEALTH will extend full support and set up a mechanism to provide technical experts and inputs, as and when sought

by NHA and the State Governments.The development of quality and accessible health service packages is an important step towards the goal of PM-JAY. The collaboration comes at a critical time as NHA will be undertakingthe exercise of calibrating package rates and development of standard treatment protocols to ensure quality healthcare across India.The NHA,which has the

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mandate to undertake costing exercise and revision of package rates, has committed to establish a transparent process based on established methodology and global best practices and is seeking inputs and full involvement of private sector in the costing process.

“This collaboration is part of our practice of mutual learningfrom the industry to improve design and implementation of PMJAY. With the well-being of the last mile beneficiary as our focus, we look forward to active and sustained contributions of NATHEALTH towards improvement of quality of health care and increasing private investment in health infrastructure in the country.” said Dr. Indu Bhushan, CEO, NHA. “We are happy to collaborate with NATHEALTH and welcome active participation from its members in our costing exercises and technical support requests. I also encourage all its members to take advantage of this collaboration and consider contributing to Ayushman Bharat PM-JAY by empaneling their hospitals and hence expanding the provider network and quality of care.” said Dr. Dinesh Arora, Deputy CEO, NHA. "We had a very meaningful meeting with NHA. NATHEALTH, in its endeavor to increase access and quality of healthcare across India, will extend full support to the NHA. We will provide technical experts and inputs, whenever required by the Authority. The exercise of calibrating package rates and the development of standard treatment protocols is expected to begin soon and is a very important step towards a meaningful and sustainable collaboration ,” said Mr. Daljit Singh, President, NATHEALTH.

“Government officials and industry leaders are of the common view that to achieve set goals under the Ayushman Bharat, all stakeholders need to move forward in a collaborative spirit. Building a strong delivery network, with wide participation by the private sector, is very critical for successful implementation of the scheme and NATHEALTH will work in this spirit with NHA towards fulfillment of Ayushman Bharat goals, added Mr. Daljit Singh Siddhartha Bhattacharya, Secretary General, NATHEALTH said, “For a larger and meaningful impactof Ayushman Bharat, it is critical to adopt a partnership approach between Ayushman Bharat and the private sector. Focus needs to be on the point that health services delivered to the beneficiaries are safe, sustainable and of appropriate quality to ensure peoplecentric care. All efforts should be made to strengthen and reinforce the primacy of an effective and viable delivery ecosystem.

This collaboration is an important step to work out a robust mechanism that draws upon expertise available across the healthcare sector to achieve universal health coverage in India.”

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna (PMJAY) (AB PM-JAY) is the world’s largest government-supported healthcare scheme that aims to provide more than 10 crore poor and vulnerable families (or 50 crore individuals) with a health cover of Rs. 5 lakh per family per year for secondary and tertiary care for a range of serious illnesses. AB PM-JAY was launched by the Honorable Prime Minister last year on September 23 from Ranchi, Jharkhand. So far, more than 10 lakh people have availed free treatment under the scheme and this has resulted in savings of approximately Rs. 3,000 crores to the nation.

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NEWS Update

Top 5 innovations

by Leaders of Home Healthcare in India Despite many advancements in the past decade, healthcare is still a huge concern for India. India has approximately 1 million allopathic doctors for a population of 1.3 billion.

Further challenges of acute shortage of healthcare infrastructure as well as regional imbalances in healthcare delivery worsen the situation. Increasing number of healthcare professional as well as healthcare infrastructure is a long term and high investment proposition. In such a situation, home healthcare is an immediate and cost effective solution to improve availability, accessibility and affordability of healthcare solutions to the masses. Home healthcare is in a very nascent stage in India. As per Cyber Media Research’s analysis, in 2016, home healthcare industry stood at $3.20 billion and is expected to grow to $6.21 billion by 2020. For a country of our size, the numbers still have a huge potential to increase much further.

While home healthcare industry faces major challenges from the unorganised players, innovations by leaders are ensuring that awareness and acceptance of home healthcare is on a steady rise.

cities with a population of more than 2 lakhs in the next few years. Moreover, their focus on quality led them to support Quality and Accreditation Institute (QAI)’s standardization drive for home healthcare. HCAH’s Co-Founder and CEO Vivek Srivastava says, “I strongly believe that home healthcare is an extended arm for hospitals. At HCAH we have always invested in maintaining high quality standards to ensure that we match flow of care from hospitals to home smoothly, comfortably and at a better price point for patients. Along with continued training for HCPs and advanced equipment, our most recent step towards quality maintenance is supporting QAI in designing home healthcare standardization norms.’

Promoted by the Burman family, HCAH has received investment from Quadria Capital to further support their growth path.

Innovation: Low price point

Innovation: Standardisation One of the pioneers of home healthcare in India, HCAH continues to set standards for home healthcare. They were the first to introduce ICU at home solutions in the country. They recognised the need to take their solutions to tier II and III regions and hence, have targets to expand to all 22 March 2019 w w w. m e d g a te to d a y.co m

Apollo Hospitals have extended their reach to their patient community by offering home care solutions. Coming from a hospital background, they understand the key concerns of patient as well patients’ family. Hence, Apollo focuses on cost benefit as well comfort to the patient and patient’s family.

Mahesh Joshi, CEO, Apollo Homecare says, “Homecare as a concept is gaining ground in India and the reasons are clinical and societal. Iit definitely works out cheaper to the extent of 30 per cent as compared to the hospital cost as there is no infrastructure and other overheads.

This apart, the cost of a family member needing to stay off from work is an additional saving.”

Innovation: Comprehensive solutions at one platform Portea is counted amongst the leaders in home healthcare industry in India. They constantly adapt themselves as per needs of the patient community. Portea is also fast establishing itself as the one-stopsolution for all clinical needs of patients at the comfort of patient’s home. Portea currently offers lab test solutions, pharma delivery, medical equipment rentals and sales, medical manpower deployment along with basic to advanced home healthcare solutions.

Innovation: Focus on critical care CCU’s differentiator is providing home healthcare solutions to critical care patients through extensive use of technology. Rajiv Mathur, founder of the organisation says, “ While metropolitan cities have world-class facilities, the situation in tier II and III cities is not adequate to meet the healthcare demand.

More importantly, for chronic ailments, there is no necessity to continue with long stays and go through the stress of re-admissions. With appropriate use of technology, high-quality home healthcare services can be implemented and expanded to cover a wide base of population in India.”

NEWS Update

Carestream Health To Sell its Healthcare IT Business To Philips Companies Share Commitment to Continuous Innovation and Enhancing Patient Care

Carestream Health has signed an agreement with Royal Philips (NYSE: PHG, AEX: PHIA), a global leader in health technology, to sell its healthcare information systems (HCIS) business to Philips.

Carestream’s HCIS business unit provides imaging IT solutions to multi-site hospitals, radiology services providers, imaging centers and specialty medical clinics around the world. The business has developed strong customer relationships in attractive, highgrowth healthcare segments and is positioned for continued growth and success.

Innovation: Holistic care model Complete healthcare for patients requires support of multiple entities. In many cases, these entities work in silos, delivering their specialty of care separately. To add value to home healthcare solutions to the patient, Care24 looks at care from a holistic perspective by supporting flow of communication across different disciplines of care teams. “Providers are focusing on improving care quality and outcomes not only from a clinical perspective, but also from an emotional, spiritual, social and financial perspective. The goal is to improve the experience for the individual and leverage the potential for improved resource allocation and reduced costs.” Says Vipin Pathak, Co-Founder and CEO at Care24.

Continued innovation will lead to home healthcare extending the reach of quality healthcare solutions to all regions of the country. With industry leaders paving the way, home healthcare can revolutionise India’s healthcare industry.

As a result of this acquisition, Philips’ expanded healthcare IT business will feature Carestream’s enterprise imaging platform—including best in class VNA, diagnostic and enterprise viewers, multimedia reporting, workflow orchestrator and clinical, operational and business analytics tools—as part of its broad portfolio.

“We have had global success in providing radiology and enterprise imaging IT systems to help medical professionals provide quality care and enhance their operations,” said Ludovic D’Aprea, Carestream’s General Manager for Healthcare Information Solutions. “By becoming part of Philips, the HCIS business will have a greater opportunity to thrive and grow. Both organizations share a commitment to meaningful innovation which is deeply embedded in each company’s culture. Customers will have access to a broader portfolio of healthcare IT solutions to simplify medical image management, enable effective collaboration and enhance patient care.”

Like Carestream, Philips has built a strong, global business based on customer focus, world-class technical excellence and continuous innovation.

“Philips partners with global healthcare providers to connect people, information and technology with the commitment to deliver on the Quadruple Aim of improved patient experiences, better health outcomes, improved staff experiences, and lower costs of care,” said Robert Cascella, Chief Business Leader Precision Diagnosis at Royal Philips.

“This acquisition will enhance our ability to provide flexible solutions to hospitals and health systems. The combination of our successful innovations in imaging system platforms, workflow optimization and artificial intelligenceenabled informatics, combined with Carestream’s cloud-based enterprise imaging informatics platform and complementary geographic footprint will provide a solid foundation to deliver on the promise of precision diagnosis.”

Carestream will retain its medical imaging, dental and industrial films, non-destructive testing, and precision coating businesses which are not impacted by the sale. “These established businesses have solid financial foundations, innovative technology platforms and have earned the trust of loyal customers around the world,” said David C. Westgate, Chairman, President and CEO of Carestream. “Our focus will be on delivering innovation that is life changing—for patients, customers, channel partners, communities and other stakeholders—and we will grow the company for long-term success.” w w w.medgatetoday.com March 2019

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EXPERT VIEWS

RELEVANCE OF ABSOLUTE VALUES IN CBC (COMPLETE BLOOD COUNT) TEST– (Basic Concept of Laboratory Diagnostics)

NITIN NAYYAR

Scientific Communications Coordinator HORIBA Medical (India) Pvt. Ltd. New Delhi

I

n the niche of haematology, the cellular components of the blood are regularly measured. However, the use of absolute or relative values of number of blood cells remains questionable controversial and has received clashing opinions from many medical experts from various medical specialities. Many internists progressively pay attention to the absolute values in the complete cell count. Although, representatives of other specialties, such as paediatrics, do appreciate the relative values due to the larger persistence related to age dependency.

One of the most frequently applied laboratory methods is the differentiation of cellular components of white blood cells. However, since its introduction, manual differentiation has been subject to relatively little changes over the last many years. A differential blood count has to be performed to precisely assess an increased or reduced white blood cell (WBC) count.

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A complete blood count (CBC) is a panel test that gives information about the cells in a patient's blood.It is generally requested by a doctor or another medical practitioner to diagnose specific diseases and to confirm the health status of the patient.A study reveals that a great number of clinical decisions and diagnoses are supported by laboratory medicine and clinical information obtained from laboratory tests, which plays a vital role in the diagnosis of various pathologies.

Some studies have shown that although physicians usually request laboratory tests, they tend to misinterpret or ignore the results; such unacceptable interpretations have obvious impact on the treatment and quality of patient care.

Illustrations: To highlight intrinsic role of absolute Values: ✓ In a patient with chronic myeloid leukemia, the increase in basophil concentration is a vital diagnostic criterion. A relative value of 1% basophils with an aggregate WBC count of 100,000 cells/μL may give off an impression of being normal, but when considering the absolute value, this shows pathological basophilia with a high count of 1,000 cells/μL. ✓N ormal values for total WBC and differential in adult males and females are: •T otal WBC: 4,500 - 10,000 •B ands or stabs: 3 - 5 %

• Agranulocytes ❱ Lymphocytes: 25 -35% relative value (1700-3500 absolute value) ❱ Moncytes: 4-6% relative value (200-600 absolute value) • Granulocytes ❱ Basophils: 0.4% - 1.1% relative value (40-110 absolute value) ❱ Eosinophils: 1 – 3.1% relative value (100-310 absolute value) ❱ N eutrophils : 50 - 70% relative value (2500-7000 absolute value) To make a precise assessment, one should keep in account, both relative and absolute values. For example a relative value of 70% neutrophils may seem very normal; however, if the total WBC is 20,000, the absolute value (70% x 20,000) would be an abnormally high count of 14,000,which is alarming. ✓L ymphocytes are the only exception as it can be divided into relative lymphocytes and absolute lymphocytes. Normally 20%–40% of human WBC are lymphocytes. When the percentage exceeds 40%, it is known as relative lymphocytes. When the total lymphocyte count in blood is more than 4000/μL in adults, 7000/μL in adolescents, and 9000/μL in infants, the patient is identified with absolute lymphocytosis.

EXPERT VIEWS

How difficult it becomes to decide on the Relative Case Study: High lighting Relevance of Absolute numbers value: Evidence through numbers Cell Type

Value (%)

Relative Value(cells)

Neutrophils Eosinophils Basophils Lymphocytes Monocytes

60-70 1-4 0.5-1.0 20-30 26

3,000-7,000 50-400 25-100 1,500-4000 100-500

ANC=

1,500-2,000

Not Significant

ANC= ANC= ANC=

1000-1,500 500-1000 <500

Minimal Risk Moderate Risk Severe Risk

Why do you need to consider absolute counts?

The reason to consider absolute counts is very vital because if you just have a look at percentages, you could not have a clear idea. Let’s say, there are 61% neutrophils in a particular patient. You might take a glimpse at that and think, okay, that lookspretty fine. But if you don’t take the time to know the absolute neutrophil number, you could be missing a very crucial thing. If the WBC count in a particular patient is very low than the demanded, say 1.5 (normal being 4-11), then the patient would certainly have a low number of neutrophils, nonetheless, the percentage of neutrophils lies in the normal category.

Contrarily, if the same patient has a very high WBC (assume 110), then 62% of the total WBC would be a very high number!

So, by just looking at the percentage of neutrophils, you might go okay, that looks fine .But, if one consider closely, the number of neutrophils would be very high. So that’s the theory that goes in favor of the absolute numbers. In reality, most of the time you can just have a glimpse at the WBC, then further figure out the absolute numbers of the individual white cells.

A 57-year-old man with a fever and some other problems like fatigue. The CBC shows a WBC of 2.0 × 109/L with the following differential: ✓ Basophils 0% (0–2%) ✓ Eosinophils 0% (0–7%) ✓ Monocytes 10% (0–12%) ✓ Lymphocytes 50% (15–45%) ✓ Neutrophils 40% (40–70%) Based on the results and its connected reference range, one might conclude the patient has lymphocytosis (albeit relative) and continue diagnostic considerations based on these findings.

But, if these differential results are converted into absolute values, the following data can be more appropriately assessed: ✓ Basophils 0.00 × 109/L (0.0–0.1 × 109/L) ✓ Eosinophils 0.00 × 109/L (0.0–0.4 × 109/L) ✓ Monocytes 0.20 × 109/L (0.2–0.8 × 109/L) ✓ Lymphocytes 1.00 × 109/L (1.0–3.4 × 109/L) ✓ Neutrophils 0.80 × 109/L (1.8–6.8 × 109/L) Now we can easily conclude that the patient has moderate neutropenia and may be at risk of some infection. Besides, we now focus our diagnostic points on the causes of neutropenia. We also realize that the patient does not have a true lymphocytosis, as the absolute lymphocyte count is at the lower range.

Understanding Intrinsic nature of Absolute Values: Learning through Example

A progressive decline of T helper (CD4+) lymphocytes T shows the identification of the infection with the human immunodeficiency virus (HIV) . The main reason for this depletion occurs because the virus infects and kills CD4+ T lymphocytes, the main mechanism for programmed cell death apoptosis . These cells mainly act as regulators and amplifiers of the immune response and are related with the immunopathogenesis of HIV infection.

Thus, the decline of CD4+ T cells results in a weakened immune system which results in the progression of infection to AIDS(human immunodeficiency syndrome) and death due to conditions associated with the same infection.

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25

EXPERT VIEWS

The level of CD4+ T cells is consideredto be one of the most vital immunological parameters in HIV-infected individuals to evaluate their prognosis and precise results of immune deficiency, to decide the inception of antiretroviral therapy, to monitor the effectiveness of this treatment, to assess the need to start or discontinue prophylaxis, and to establish the diagnosis of AIDS. Thus, quantification of CD4+ lymphocytes is a crucial procedure in the assessment of patients with HIV. Immunophenotyping provides significant information about the leukocytes of the whole immune system, differentiating the total lymphocytes (CD45+), T lymphocytes (CD3+), and subtypes of T lymphocytes which comprise two subsets: cytotoxic T cells (T lymphocytes CD3+/CD8+) and helper T cells (T lymphocytes CD3+/CD4+). Thus, the total lymphocyte count and percentage values of lymphocyte subsets may be calculated by using CD45+ monoclonal antibody, using flow cytometry, in association with CD3+, CD4+, and CD8+ antibodies.

The absolute count of lymphocytes may be greatly influenced by biological factors that impact the total count of lymphocytes and leukocytes, such as the use of drugs that suppresses the bone marrow, acute infections (e.g., malaria, sepsis, and tuberculosis), and pregnancy, which may lead to hemodilution. Other than these biological factors, there could also be a variation because of the methodological factors such as differences in the methods.

Several studies have reported that variations in the percentage count of CD4+ T lymphocytes are not so stable parameters than variations in the absolute count to assess the progression of the disease.

The main concern regarding the use of counting the percentage of CD4+ T cells is how the variation of results could have a great impact on big decisions related to the care of people infected with HIV and the clinical treatment.

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Understand in a simpler language, let’s go through the below explanation: Complete blood count (CBC) Blood is made up of nutrients, water, proteins and living cells. A CBC tells about cancer care team about the cells in the blood. It quantifies3 basic types of blood cells: ✓ Red blood cells ✓ Platelets ✓ White blood cells Each of these cells has a unique and important purpose.

Red blood cells (RBCs)

RBCs carry oxygen to the cells and carbon dioxide away from the blood cellsin one’s body. The CBC measures red blood cells in many ways, but the simplest measure is either

Hemoglobin (Hgb) or Hematocrit (Hct)

When the Hct values and Hgbfall too low, it’s called anemia.

Platelets (Plts)

Platelets help control bleeding. One may bleed easily when one’s platelet levels are low. The risk of bleeding goes up very high when platelet levels go below 20,000.

But, knowing the absolute values help doctors to a great extent to work in the right direction.So, the disease can be cured easily and promptly.

White blood cells (WBCs)

The most significant infection-fighting WBC is the neutrophil.

The number of doctors look for the absolute neutrophil count .

A healthy person has an ANC between 2,500 and 6,000.

But,let’s assume that a person is having ANC of 5900. That doesn’t imply that person is completely healthy as it gives an indication to keep a check on the health of the person. So, it’s very much necessary to get the precise results, which one can get by knowing the absolute values.

The ANC is calculated by multiplying the WBC count with the percent of neutrophils in the blood. For instance, if the WBC count is 9,000 and 50% of the WBCs are neutrophils, the ANC is 4,500 (9,000 × 0.50 = 4,500).

When the ANC falls below 1,000 it is called neutropenia.

Doctor will have to watch one’s ANC closely because the risk of infection is much higher when the ANC is below 500.But, the absolute values can vanish this drawback as it can be easily concluded from the reports that what actions have to be taken for the care of the patient.

Therefore, it may be concluded that absolute numbers are better indicators to diagnose, understand and treat precise disease and relative numbers do not give a clear idea about the patient’s actual pathology.

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EXPERT COVER STORY VIEWS

Leveraging Technology

in the Medical Devices Sector

Innovation is pivotal for the healthcare segment

JATIN MAHAJAN

Managing Director J Mitra & Co. Pvt Ltd Diseases are ever transforming in keeping with the changing lifestyles and mutation of the viruses, and it is critical that innovation in healthcare remains the only constant, in keeping with the age-old adage change is the only constant. Technology has been driving the innovations in the healthcare segment as a whole, and more so in the medical devices segment, where the focus is more towards detection and management.

History is witness to innumerable innovations that have transformed lives. Some of them are: Innovation in Devices– Artificial heart, robotic catheter, hand held medical scanner, bone injection drill, spectacles, hypodermic needles, thermometers, dialysis machine, lens implant, prosthetics & implants …

Technological Innovations – ECG, X-ray, Nano healing, MRI, ultrasound, mammography …

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Innovation forms the backbone of the healthcare segment.

Constant technological innovations drive newer trends in the healthcare segment, and this by far is the segment that has the maximum number of patents registration apart from the information technology segment. The technological innovations in the medical devices segment have very significant milestones, and each innovation has helped in increasing longevity and quality of life. Artificial Heart and pacemakers helped all heart patients lead a more fulfilling life.

Dialysis technology ensured that oncology patients could lead a closer-to-normal life The diagnostic market is the fastest growing segment globally, as well as in India. According to Pricewaterhouse Coopers (PwC), it is forecasted to grow to USD 17 billion by 2021. A phenomenal increase in the number of hospitals has created a need for sophisticated devices and equipment, which can provide accurate treatment to individuals.

As per an ASSOCHAM study, the Medical Devices and Equipment industry is valued at around USD 2.5 billion contributes 6% of India’s USD 40 billion healthcare sector.

Indian medical devices sector is Asia’s fourth largest market.

Incidences of chronic diseases have surpassed infectious diseases in India. To combat the rise of chronic diseases, an efficient and effective healthcare delivery mechanism is the key. Technology will play a pivotal role in enabling the delivery of affordable healthcare. Indian healthcare industry is rapidly adopting advanced medical technologies and devices to strengthen and deliver high-level performance with the right solutions.

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New medical advancements such as state-of-the-art live image guidance technology have created new possibilities in interventional procedures. In addition, it has enabled interventional cardiologists and vascular specialists to decide, guide and confirm the right treatment for their patients in real-time. The medical device industry has brought low-cost innovations and technology for chronic care management. Medical technology has opened new doors for the connected care propositions wherein the patients can access doctors from home for medical consultation and diagnosis. The segment of wireless portable medical device is gaining popularity and market share, for e.g., Glucometer, Portable ECG, Cardiac monitors etc.

The major developments in the field of digital x-ray are helping radiologists with reliable diagnostic image quality along with mobility – a boon for restricted places like ICUs and operation theatres. With advancements in medical electronics, the healthcare industry is capable of manufacturing small-footprint medical devices ideal for small procedure rooms.

All these innovations are making healthcare affordable, accessible and available to a larger population and simultaneously, benefiting the entire ecosystem of doctors, patients, government, employers, family, resulting in a healthier nation. The increased demand for better medical facilities has catalysed the need for advancement in medical equipment, devices, and services

that can be handled easily, increasing efficacy and helping in accurately identifying the problems and providing treatment to patients.

At J Mitra, we too have been singularly focusing on technological innovations to create path-breaking solutions to make healthcare affordable and accessible to all. In August 2018, we launched iQuant, a unique product based on Fluorescence Immunoassay technology, that will transform disease detection in the rural and semi-rural areas.

Designed& developed in collaboration with IIT Madras’ HTIC (Healthcare Technology Innovation Centre), this portable equipment with 8 diagnostic parametersis a state-of-theart analyser for quantitative and qualitative determination of blood test parameter – that includes TSH (Thyroid Stimulating Hormone), T3 (Tri-iodothyronine), T4 (Thyroxin), Vitamin D, Dengue NS1 Antigen, Dengue IgM, Dengue IgG and HbA1c test. With this launch, various highly-active and sought-after diagnostic solutions will be available across the country and in the remotest of locations at a minimalcost.

The two key important thoughts that drive innovation are – quality, accessibility & affordability. Technological innovationsare helping mankind in early and potent diagnostic of ailments, leading to effective treatment and recovery. This not only reduces treatment cost and discomfort, but also goes towards creating a healthier society. Early and effective diagnostics will ensure that the overall productivity of the civilization increases and there is higher quality of life index ❑ w w w.medgatetoday.com March 2019

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EXPERT VIEWS

Leveraging Artificial Intelligence to Transform Healthcare Delivery in India In Healthcare, AI tools can assist us with quicker services, diagnose problems and analyze data to identify trends, writes Vivek Kanade

W

Mr. Vivek Kanade Executive Director, Siemens Healthcare Private Ltd.

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hile the buzz around artificial intelligence has gained momentum in the last couple of years, technology giants decided to utilize Machine Learningbased-algorithms not just to assist organizations in driving growth but also improve Healthcare globally. Amidst such advancements, India has emerged as one of the early adaptors which have integrated Artificial intelligence across various growth pillars of the nation’s economy.

This adoption of artificial intelligence categorically in healthcare is growing while radically changing the face of care delivery.

Union Government in its Interim Budget 2019-20 has stressed on top 10 areas for the tech-enabled development with ‘Healthy India’ as one of the main agenda in its ‘Vision 2030’. Such progressive efforts reflect how the government understands the potential of digital technologies like Artificial Intelligence. To actualize this ambition, the government is developing a National Artificial Intelligence Portal along with

a national Programme on AI; thereby, creating an ecosystem for adoption of technologies which would support the continuum of care in a holistic manner.

Today, AI has opened up opportunities which were previously unavailable or unrecognized. These mechanisms are equipped to sense and comprehend data with human-like efficiency or even better, using big data and algorithms.

Datasets with the help of algorithm intelligence help in corroborating the patient’s diagnosis with other similar cases on the basis of signs, symptoms and other reports. Some applications include using AI to analyze unstructured data & predictive modelling to manage patient flow, and hospital capacity allocation.

Although an intriguing field of study when it comes to life and death, in its early stages, Artificial Intelligence is bridging the gap between healthcare service delivery and patient recovery.

Diagnosing a patient for critical diseases, virtual nursing assistance, management of workflow and administrative tasks are some spokes of the healthcare wheel

EXPERT VIEWS

which ultimately help in seamless delivery of care to the patient. At Siemens Healthineers, we create AI algorithms to help speed up clinical workflows, prevent diagnostic errors, reduce missed billing opportunities; there by enabling sustained productivity increase. With an investment in dedicated reading and annotation teams, Siemens is equipped with a database containing over 300 million curated images, reports, data (clinical and operational) which are used to train the algorithms.

As a case in point, the pattern recognition algorithm automatically detects anatomical structures, independently numbers vertebrae and ribs, and aids in precisely overlaying different examination dates along with different modalities, thereby integrating diagnostic radiology even more strongly into outcome-oriented clinical decision-making process.

AI applications like Hybrid Artificial Intelligent Systems (HAIS), can address complex sets of data by using combination of techniques like artificial neural networks, optimization models etc. With their superior computing ability, such applications are unlocking limitations and assisting clinicians in a big way. Besides, it also allows for system adjustments for common sense, creating knowledge bank by mining of raw data and adapting to changing environments.

Primarily, the application of AI focusses on all three medical tasks: Diagnosis, Prognosis, and therapy but mostly in the area of medical diagnosis. There are several techniques through which the medical diagnosis cycle can be replicated and the role of intelligent data system (i.e. the physician), input (patient data) and output (patient diagnosis) can be simultaneously played by a capable AI infrastructure.

Diagnostic imaging with new methods of machine learning and deep learning is emerging as a powerful tool for translating large datasets into coherent knowledge for better care. This form of robotic learning would enable us to automate complex diagnostics and support optimal treatment. For instance diagnostic AI applications gather and synthesize clinical data and compare information with predefined categories such as diseases to help with diagnosis and treatment. Raising analysis and interpretation of digital medical images to a whole new level, it paves the way for quantitative, standardized yet also personalized diagnostics, while helping prevent errors in diagnosis.

Personalization of care Another field of healthcare which will be closely impacted by Artificial intelligence is Personalization of care. Fundamentally it aims at establishing a new form of relationship between people, professionals and system. Thus, leveraging the most out of the expertise, potential of people, families and communities.

Going forward, in areas like cardiac imaging AI-based image would be analyzed along with lab results and aid in identifying high-risk patients, delivering personalized diagnostics and treatment, help prevent unnecessary treatments. Thus, involving diagnostic radiology more closely to not only being outcome oriented but also reducing the healthcare costs.

Way forward Moving firmly yet cautiously, AI research and development will guide us towards a healthcare system which is more trained and consequently intelligent. While leaving complicated matters and final call to human clinicians, AI systems can perform routine, less risky diagnostic and treatment processes.

AI strongly promises higher automation, productivity and standardization, along with unprecedented use of quantitative data; beyond the limits of human cognition in medical imaging.

Here on, it is clear that the implementation of AI in practice will require interdisciplinary collaboration in which radiology experts have a significant role to play.

One of the primary drivers of AI solutions is data, and thus appropriate handling of data, ensuring privacy and security is of prime importance. Its challenges include data usage without consent, data selection bias and the resulting discrimination of AI models, risk of identification of individuals through data and asymmetry in data aggregation.

In this interconnected world of Healthcare, AI tools can assist us with quicker services, diagnose problems and analyze data to identify trends that would predispose someone to a particular disease. When saving up on time can be matter of life and death, AI and machine learning can be groundbreaking not only for care delivery but for healthcare as a whole.

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EXPERT VIEWS

Professor Steve Kerrigan

Royal College of Surgeons in Ireland, Dublin

R

esearch into a new breakthrough therapy in the fight against sepsis has shown that the drug has potential to stop all sepsis-causing bacteria from triggering organ damage in the early stages of the condition.

The pre-clinical trial of InnovoSep, carried out by researchers at RCSI (Royal College of Surgeons in Ireland), has demonstrated that the drug also has the potential to stop progression of sepsis to multiple organ failure in the later stages.

The study is being presented today at RCSI Research Day 2019 by Dr Sinéad Hurley, a Postdoctoral Fellow at the School of Pharmacy and Irish Centre for Vascular Biology, RCSI. Principal Investigator on the research, Professor Steve Kerrigan, Associate Professor in Pharmacology at RCSI and inventor of InnovoSep said: “Sepsis occurs when an infection gets into the bloodstream and our own body’s defence system spins out of control trying to fight the infection, which results in multiple organ failure if untreated.

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Promising new drug shows potential to stop progression of sepsis “There is only a short window of opportunity for treatment of sepsis with the early administration of antibiotics and fluid. However, in many cases antibiotics are not effective due to drug resistance or delays in identifying the type of bacteria that has caused the infection. Therefore, there is a need for a non-antibiotic therapy that can be used at all stages of infection against all bacterial causes of sepsis”.

Identification of a new therapy such as the InnovoSep drug candidate is critical as current research from the World Sepsis Alliance suggests that the incidence of sepsis is growing annually by 8%.

Professor Kerrigan continued “Our research has shown the InnovoSep candidate drug can prevent sepsis progression early or indeed treat advanced sepsis. The drug appears to act by preventing the bacteria from getting into the bloodstream from the site of infection by stabilising the blood vessels so that they cannot leak bacteria and infect the major organs.”

“The promising results of the InnovoSep pre-clinical trial gives hope for a new non-antibiotic treatment of this condition that could be effective in both the early and more advanced stages of sepsis which results in almost 3000 deaths in Ireland each year,” Professor Kerrigan said.

Sepsis, otherwise known as blood poisoning, is a silent killer because

it is unpredictable, rapid and can go undiagnosed due to its non-specific signs and symptoms. It is critical that the public are empowered with the knowledge of spotting signs and symptoms of sepsis so that rapid treatment can be initiated.

The signs and symptoms of sepsis mimic those of the flu - high temperature, rapid heart rate, rapid breathing, pain, pale or mottled skin, and feeling generally very sick. The main difference between sepsis symptoms and flu is that sepsis will come on very quickly whereas flu comes on over days.

Any type of infection can cause sepsis ranging from seemingly minor infections on the skin, urinary tract infections, pneumonia or appendicitis - even a simple cut, scrape, or break in the skin can allow bacteria to enter the body and potentially lead to sepsis.

Currently there are almost 15,000 cases of sepsis each year in Ireland with almost 3000 deaths. In Ireland sepsis kills more people than either heart attack, lung cancer, colon cancer or breast cancer. A staggering 60% of all hospital deaths has a sepsis or infection diagnosis.

The Innovosep pre-clinical trial is supported by the Enterprise Ireland Commercialisation Fund. The intention is to form a spin out company for the further clinical development of this technology.

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Future Trends In Customer Experience For Healthcare Leveraging Data For Healthcare

Dr. Rajeev Boudhankar CEO-Bhatia Hospital, Mumbai

H

ealthcare is an industry that affects everyone, but one that has historically had a reputation for less-than-positive customer experiences.

However, customer experience is now becoming a focus of many healthcare companies, hospitals and clinics. This is aided by new approaches and technology that have the power to transform healthcare.

Here are some trends for healthcare customer experience for the near future and beyond.

Augmented Reality Training For Healthcare Augmented reality is a trend across all industries, but it is especially powerful in the healthcare field. One of the strongest applications is in medical training.

Using AR, healthcare providers can see diagnoses and procedures right in front of them to learn new skills and expand their knowledge. Augmented reality also makes it possible to train more providers at once, which could fight the shortage of trained professionals around the world. Imagine a doctor being able to have treatment options pop up on a screen as he looks at different conditions or have growth charts appear around a child during a checkup. Instead of doctors having to spend more time reading studies to refine their skills, the information they need can simply appear in front of them as they seamlessly treat patients.

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Healthcare has always used data, but new types of data and ways of collecting it will impact customer experience. Automated systems can comb through huge amounts of data in real time to provide the best patient experience. Healthcare data comes in many forms, from post-visit feedback surveys to numbers of what days and times are the busiest so OPDs and clinics can properly staff their offices. Data can predict when a patient will get sick so that preventive action can be taken, create personalized healthcare plans, and potentially limit the spread of diseases before they grow out of control. It also allows providers to have a more complete view of each patient, which can potentially remove the pre-visit intake/admission questionnaires, which customers say is the most frustrating aspect of healthcare.

Patient Personalization

Customers today don’t have time to be sick, and they don’t want to wait around for services they don’t need. With the growth of data comes the ability to personalize the healthcare experience. Starting today and growing in the future, healthcare offices/ OPDs/clinics will be able to create a completely personalized experience for each customer. Instead of everyone being treated the same, clinics will be able to use data to see what doctors a patient prefers, if they like being seen in person or remotely, their health history, and any potential health issues. That means that instead of having to navigate through a complicated web of healthcare representatives, a patient's information will be easily accessible so the right treatment options, preventive care, and recommendations can be made.

Using Wearable Devices In Healthcare Wearable devices are powerful tools to keep patients involved and invested in their personal health. The most frequent users of wearable devices are people who are less healthy than average and more likely to need to be hospitalized. Devices like activity trackers help customers stay more active and healthier on their own, which can decrease their need to see a doctor, while more advanced devices can monitor patient health metrics such as blood pressure, heart rate, and diet on the go. Instead of having to go to a clinic for monitoring, patients can do it at home and always be connected to a doctor. If a monitored patient’s blood pressure spikes, the doctor can receive a notification and take action. Wearable devices are a less invasive way to still get great care.

Hospitals Using Smart Technology Advances in technology have created a new wave of products to improve patient comfort and care. Using connectivity and automation, these tools alleviate some of the pressure on healthcare providers and put customers in control. Smart technology comes in a variety of forms to increase comfort and efficiency and decrease risks.

Modern Hospitals around the world have started using smart beds that self-adjust to the correct pressure and support for each patient’s preferences and condition. Other clinics in the western world are using robots that can monitor a patient without a human provider being in the room. Smart devices and applications will continue to grow and spread throughout the healthcare field.

Industry updates

COVER STORY

Treating blood cancer The Targeted way

Dr. N Aditya Murali

Consultant, Medical & Hemato Oncology, Aster CMI Hospital

M

ultiple myeloma is a type of blood cancer that develops in the bone marrow. The bone marrow is home to various type of cells like red blood cells, neutrophils, lymphocytes, plasma cells and platelets. Plasma cells are a type of white blood cells that make antibodies to fight infections. When this circuit goes haywire, there will be an unregulated production of plasma cells.

A cancerous or malignant plasma cell is called a myeloma cell. Myeloma is called “multiple” because there are frequently multiple patches or areas in bone where it grows.

There are about 2, 30,000 people living with myeloma worldwide, and 1, 14,250 new cases are diagnosed yearly. It is the 2nd most common blood cancer in the world. The age standardized rate for myeloma incidence in India is 0.7/1, 00,000 population amounting to about 6,800 new cases a year. Men are 1.5 times more likely than women to develop multiple myeloma. The disease is most frequently diagnosed in 65-74-year-olds, and it is twice as common in people of African descent. In India, the median age of onset of myeloma is 1-2 decades lower at 52-61 years.

Many factors have been implicated in the development of multiple myeloma Exposure to toxic chemicals, atomic radiation, anything that interferes with the immune system, or infection with

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cancer-causing viruses have all been implicated as causes or triggers of myeloma. Toxic chemicals that have been identified include: benzene, dioxins (such as those found in Agent Orange), agricultural chemicals (such as defoliants and pesticides), solvents, fuels, engine exhausts and cleansing materials.

Myeloma can also be hereditary. Firstdegree relatives of people with myeloma have a higher risk of developing myeloma or its benign (non-cancerous) precursor, monoclonal gammopathy of undetermined significance (MGUS).

In 70% of patients, the most common symptoms of myeloma are back or bone pain. Patients with myeloma may also have low haemoglobin levels leading to excessive fatigue and difficulty in performing strenuous tasks. An often missed presenting feature of multiple myeloma is kidney dysfunction. Patients with unexplained kidney failure are often tested and found to have multiple myeloma. For an accurate diagnosis of myeloma, the patient may need to undergo a variety of tests, including blood tests, urine tests, imaging studies, bone marrow aspiration, or a core biopsy. With advances in diagnostics, genetic studies to detect chromosomal alterations are being done to determine the prognosis as well as guide the treatment of multiple myeloma. Newer imaging modalities like whole body PET-CT are being employed to exactly determine the sites of bone involvement.

When myeloma is diagnosed, the stage of the disease varies from patient to patient.

The most commonly used clinical staging system, the Durie-Salmon Staging System, demonstrates the correlation between the amount of myeloma and the damage it has caused, such as bone disease or anemia.

Innovations like targeted therapy and immunotherapy have revolutionised the treatment of multiple myeloma.

Most patients these days, undergoing first line treatment for myeloma receive chemotherapy free regimens. In the past 15 years, nearly 10 new therapies

have been approved in management of multiple myeloma. Most treatment protocols nowadays include 4 to 6 cycles of induction treatment followed by consolidation therapy with Autologous Bone Marrow Transplantation.

Radiation therapy also has an important role to play in the management of multiple myeloma. If the disease is confined to a single location, then radiation can be used as a primary treatment modality. Another commonly used indication for radiation therapy is treatment of painful bone lesions.

Autologous bone marrow transplant is a procedure in which, stem cells are removed from a person before the patient receives high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer. After high-dose chemotherapy or radiation treatments, the patient’s stems cells are put back into the body to make normal blood cells. This process is also called as stem cell rescue. With advances in supportive care and stream lining of treatment protocols, the mortality rates associated with this intensive procedure has been brought down to 1-2%.

Patients with multiple myeloma who experience disease relapse, also have multiple options with regards to salvage treatment. Monoclonal antibody therapy has improved the salvage rates in multiple myeloma to nearly 65%. CAR-T cell therapy is being tried out in clinical trials in patients with multiple myeloma who have become refractory to all lines of therapy.

Advances in therapeutics have transformed the management of multiple myeloma, turning this once deadly blood cancer into a chronic condition where multiple treatment options are available. Awareness, early diagnosis and appropriate treatment can help patients with multiple myeloma achieve nearly a 50 % long term survival.

COVER STORY

DNA–Based Testing:

A powerful tool for disease management Today, we know much more about our DNA or genetic code, as compared to what we understood a decade ago, primarily due to diligent research undertaken for decades to understand the DNA structure better. The niche technology called NextGeneration Sequencing (NGS) has been a significant contribution to this expansion of knowledge. NGS technology has helped experts dive deep into the complex genetic codes, unraveling hidden mysteries unknown so far and are now able to sequence the entire human genome in a matter of days. This phenomenal discovery is a paradigm shift and has enabled doctors to understand the disease origins and its patterns with higher accuracy. The impact is big, and the future is promising for the emerging molecular science.

Genetic testing offers distinct advantages because of its ability to facilitate early disease detection with simpler and costeffective investigations, stratification of patients into groups allowing selection of optimal therapy, reduction of adverse drug reactions, improvement in the selection of new biochemical targets for drug discovery, and minimization of time, cost and failure rate of clinical trials for new therapies.

A genetic test involves analysis of human DNA, RNA, chromosomes, proteins or certain metabolites in order to detect alterations related to a heritable disorder.

Thalassemia and sickle cell disorders are considered a major health burden in India. As many as 35 to 45 million people in India are found to be carriers of Betathalassemia gene, that causes severe anemia which makes the affected person transfusion dependent. Thalassemia is caused by a genetic mutation in a gene called HBB and this genetic disorder is found to be running generation after generation in families.

The applications of DNA based testing has a wider scope and can reveal details about our health at various stages of life which can help in prognosis and management of the disease.

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Pre-natal and Newborn Screening Tests Congenital and hereditary genetic diseases form a significant health burden in India merely on the basis of a larger population, high birth rate and also prevalence of consanguinity in many communities in India. Hence there is a strong felt need for an adequate and effective genetic testing and counselling. Newborn screening is the norm and mandated in many western countries, but shockingly, its implementation is less than 1% in India. This means that most of the diagnosable genetic conditions remain undiagnosed at birth.

In urban areas, congenital malformations and genetic disorders are known to be the third most common cause of mortality in newborns. Factors contributing to this high dominance include consanguineous marriages, high birth rate and a lack of appropriate understanding of genetic disorders. For example, the non-invasive pre-natal screening test (NIPT) which involves a simple screening of mother’s blood and analyzes cell free fetal DNA to predict the baby’s risk for several genetic disorders from as early as 10 weeks of pregnancy can be offered to pregnant women. The information that can be got from this noninvasive test would enable a couple and the family to feel reassured about the health of the baby and also empower them to take informed decisions especially when there is a family history of a genetic disorder. There are more than fifty disorders that can be detected through the simple New Born Screening Test, including Phenylketonuria and Congenital Hypothyroidism, and many of them can be treated and managed well by simple diets and also help in preventing severe morbidity and mortality

Cancer and Genetics

The incidence of cancer is increasing at an alarming rate in the country and is estimated to record over 1.75 million cases by 2020. Among top two forms of cancer found in the Indian population are lung cancer and breast cancer.

It is also a fact that, approximately 70% of the cancers prevailing in India are preventable if identified in the earlier stages Research conducted on lung cancer has so far identified mutations in genes such as EGFR, KRAS and ALK as the biggest genetic risk factor. Predictive genetic testing is a useful tool in assessing such risk factors where early detection of gene mutations can help in initiating early therapy and thus improve the survival rates. Targeted therapies tailor based on such information can be very useful during treatment of cancers if the precise mutation is known.

Another important area of concern is the rising burden of breast and ovarian cancer in India. A recent multi-city study has identified 14 genes including the BRCA1 and BRCA2 genes being responsible for breast cancer in Indian women. A costeffective genetic screening test can help in early detection and preventive therapy as well as promote extended family screening

Personalized medicine

Personalized genomics is the new area in human healthcare where genetic information of an individual’s genome is interpreted to predict predisposition to complex diseases. Based on predictive markers, early and accurate diagnosis of complex diseases can be offered with provisions for better treatment and aggressive disease management, a muchneeded solution, especially when the country is reeling under the pressure of non-communicable diseases.

DNA-based genetic tests indeed offer a wider scope in terms of medical research and disease prevention. Adoption of DNA-based testing as part of routine clinical practice can help the clinicians in understanding and managing the diseases that were previously difficult to even diagnose. A wider adoption of genetic testing will not only bring down the burden of diseases but also enable people to understand and manage their health better and eventually leading to a better quality of life.

Dr. Sheetal Sharda Consultant Clinical Geneticist, MedGenome Labs, Bangalore

COVER STORY

Latest Advancements Promise better Cancer treatment

Dr Arun Kumar Lingutla Consultant Medical Oncologist CARE Hospitals

E

xtraordinary progress has been made over the last 70 years to understand, prevent, diagnose, and treat cancer—progress that gives hope to many people facing a cancer diagnosis.

Diagnostic advances Molecular diagnostics

Landmark advances in molecular diagnostics continue, with the most significant achievement made with the TAILORx breast cancer study. This study demonstrated that as many as 70% of women with hormone receptor-positive, node-negative breast cancer could safely forgo adjuvant chemotherapy, based on results from a 21 gene assay. New successes are being achieved with targeted therapies, including the introduction of medicines that delay the progression of breast and lung cancers. Growing microbiome research field identifies specific bacteria possibly associated with risk for certain head and neck cancers.

Liquid biopsy

Analysis of ctDNA allows clinicians to assess the characteristics of a patient’s tumor through a simple blood test, what is referred to as the “liquid biopsy.” The term “liquid biopsy” may refer to assays that analyze proteins, DNA, or cancer cells that circulate in the blood. Recently, it has been used in reference to mutations found in circulating, cell-free DNA that is released by tumors, also called “circulating tumor DNA” or “ctDNA.” Compared to traditional biopsy, which involves removing a piece of tumor tissue from the body, a liquid biopsy is less invasive and is associated with less potential complications.

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Despite growing excitement around the use of liquid biopsies in oncology, with possible applications ranging from cancer screening to informing treatment decisions and monitoring response to treatment, there are a number of questions with this strategy: ✓ There is not enough evidence, at this time, to know whether use of the majority of ctDNA tests in advanced cancer is justified, outside of screening for participation in, or during, a clinical trial. ✓ There is not enough evidence, at this time, to support the routine use of ctDNA tests for early-stage cancer, making treatment decisions, monitoring how well a treatment is working, finding remaining cancer cells, or for cancer screening, except screening for participation in, or during, a clinical trial. ✓ There are inconsistent findings when testing with liquid biopsies versus testing with tumor tissue, so negative liquid biopsy results should be confirmed with tumor tissue genotyping.

To date, only a single liquid biopsy test has shown what is considered sufficient clinical utility to be approved by the U.S. Food and Drug Administration (FDA) – the COBAS assay for mutations in EGFR, to be used in non-small-cell lung cancer. Nonetheless, a variety of liquid biopsy tests have been made available for use in clinical practice.

“Liquid biopsy has shown considerable promise toward improvements in the management of NSCLC patients, offering an alternative to standard procedures when tissue biopsies are insufficient or unfeasible, and providing a rapid and dynamic assessment of emergent resistance mechanisms that can be used to guide treatment decision-making,” the researchers wrote.

Future:

Investigational Blood Test Detects Common Cancers

Early detection of cancers by a simple blood test, often called a liquid biopsy, is another facet of diagnostics that has been gaining traction. Some recent studies have shown that a blood test that assesses multiple potential markers, including both genes and proteins, may be sensitive enough to potentially diagnose cancer. One such test, Cancer SEEK, was able to detect eight common types of cancer by assessing eight protein biomarkers and tumor-specific mutations in circulating DNA found in blood samples.

COVER STORY

Treatment Advances

Treatment advances across the spectrum of cancers have continued at a rapid pace. Lung cancer experienced significant treatment breakthroughs this year, primarily in immunotherapy, as it has in the past several years. Other immunotherapy trials brought new treatment options to patients with a range of solid tumor and blood cancers.

In addition, in 2018, a Nobel Prize was awarded to the researchers who found that the immune system could be harnessed to attack cancer, highlighting the significance of research advances seen in this area. Progress in treatment was also seen in systemic chemotherapy, targeted chemotherapy, surgery, and radiotherapy.

Immunotherapy

In advanced non–small-cell lung cancer (NSCLC), two trials demonstrated that immunotherapies have a role in firstline treatment r and proved superior to conventional chemotherapy only arm. Advanced melanoma is one of the few cancers that often metastasizes to the brain. These metastases can cause severe neurologic symptoms and lead to death within a year. Combination immunotherapy can reduce brain metastases in people with melanoma. Combination immunotherapy boosts renal cell cancer survival, established as new standard. The combination of two immunotherapy agents, nivolumab and ipilimumab, is used routinely in melanoma and is now being explored in other types of cancer. Pembrolizumab provides greatest benefit in head and neck cancers with high PD-L1 expression.

Chimeric antigen receptor T-cell (CAR-T) therapy trials show longer term benefits. In 2018, CAR-T therapy, also known as adoptive cell immunotherapy, was named the Advance of the Year by ASCO. Unlike checkpoint inhibitors, this form of immunotherapy boosts the ability of the body’s immune system to fight cancer using a patient’s own genetically re-engineered T cells. An early-phase clinical trial formed the basis of the 2017 FDA approval35 of the anti-CD19 CAR-T therapy tisagenlecleucel (Kymriah) for acute lymphoblastic leukemia, the most common cancer in children.

Targeted Therapy Advances

Targeting medicines to specific gene mutations in a cancer cell, as opposed to administering systemic chemotherapy that can affect every cell in the body, is still an exciting and productive frontier in oncology.

New EGFR inhibitor delays lung cancer progression. One of the more frequently mutated genes in lung cancer is EGFR, and it can mutate in different ways and at different locations along its stretch of DNA. Some of the mutations that occur are responsive to first-generation targeted therapies, such as gefitinib (Iressa) and erlotinib (Tarceva). However, resistance mutations commonly emerge during treatment with these agents. Two recent trials tested a new, secondgeneration drug, osimertinib (Tagrisso), that was developed to treat NSCLC with resistant or less common EGFR mutations. The oral medicine was approved by the FDA in 2018 based on a phase III international trial.

New protein-targeted therapy delays cancer progression and gains approval for certain advanced breast cancers. HER2/neu was the first gene mutation in breast cancer for which a targeted therapy, trastuzumab, was developed.

Since trastuzumab’s approval by the FDA in 1998,42 a handful of other targeted drugs for breast cancer have been developed. Abemaciclib (Verzenio), a newer drug, inhibits activity of the CDK4/6 proteins that regulate the rate of cell division as opposed to targeting a specific gene mutation. In two phase III trials, abemaciclib showed activity against previously treated metastatic hormone receptor–positive, HER2negative breast cancer.

Novel combination treatment shows promise for elderly patients with acute myeloid leukemia (AML). In AML, this approach is being pursued to improve care for older patients who are generally not healthy enough to tolerate conventional therapies. Medicines such as azacytidine (Vidaza) and decitabine (Dacogen), which affect the DNA methylation process, have shown some short-lived benefit in these patients. To further boost their therapeutic impact, researchers turned to an oral medicine called venetoclax (Venclexta), which provokes cancer cell death by targeting the BCL2 protein.

Other Therapeutic Approaches

New modified chemotherapy regimen proves more potent in pancreatic cancer. For patients with pancreatic cancer who have had surgery, the standard postsurgery treatment until now has been gemcitabine, a chemotherapy drug that blocks tumor cells from multiplying. Despite this treatment, more than 70% of patients typically experience cancer recurrence within 2 years of surgery. This year, a trial identified a new, more effective approach using a combination of chemotherapy drugs (FOLFIRINOX) ❑

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COVER STORY

Lesser known Molecular Diagnostics today expands to every section of clinical laboratory Dr. BR Das

Advisor and Mentor R&D and Molecular Pathology SRL Diagnostics

Not much was known about Molecular Diagnostics before year 2000. Gradually it has made inroads in the medical world and clinical laboratory, largely virtually indispensable today.

Known by different names Molecular Diagnostics (MDx), genome medicine or Molecular Pathology, its applications today expand to almost every section of the clinical laboratory. Such is the need and the advantages that molecular diagnostics offers that it stems from its extreme specificity and sensitivity providing rapid results with accuracy.

All these were largely unknown in the medical world till year 2000 but with continued innovations and newly developed applications of MDx technologies there is a tandem shift from reactive to proactive and to predictive care.

Molecular Diagnostics involves laboratory tests which are meant to diagnose and screen a disease or an infection. It may also relate to cases of predisposition to an ailment and involves analyses of Nucleic Acids, like DNA or RNA. Today’s clinical practices around Molecular Diagnostics are widely used in healthcare for ailments related to neurology, cardiology, infectious diseases, oncology, and metabolic disorders amongst others. All these were largely unknown in the medical world till year 2000 Advancement of technology in Molecular Diagnostics (MDx) has gone through drastic changes in the course of time, especially in past two decades. This would have not been possible without the 42 March 2019 w w w. m e d g a te to d a y.co m

technological innovations and continued focus on applied research relevant for clinical medicine. As a consequence of explosion in molecular tests in terms of volume and range besides growing awareness of its existence among both physicians and amongst people, it is expected to further progress and make deep into further innovation for the benefit of people and for the medical fraternity. MDx today is empowered and fuelled by continual advancements in technology. Experts say, there has been over 400 % growth in molecular diagnostics research, which has actually translated to over 750 % of growth in patent applications in past 25 years.

An MDx technology has undergone dramatic changes since its debut in the late twentieth century. Initially, it was largely restricted to simple traditional PCR assays interrogating single to a few genomic targets; advancements such as real-time PCR (RT-PCR), quantitative PCR (qPCR). However, as technology took over in applied research, automation in the form of sample-to-result instrumentation have now expanded diagnostic horizons for infectious diseases and oncology. Multiplexing technologies have enhanced our capability to interrogate single specimen for the presence of multiple pathogens or gene targets associated with various clinical syndromes.

MDx- Evolving influence on the healthcare spectrum

With advancement in genomics has not only transformed and catalysed clinical practices, especially in last 4-5 years, but has been disruptive to bring in more refined and innovative Next Generation Sequencing (NGS) technology.

Today, globally, Molecular Diagnostics market is estimated to be around USD 7000 million in 2017 and is expected to register a CAGR of around 9% during the forecast period, between 2018 to

2023. Of this Asia-Pacific is estimated to register around 15% CAGR during this period. India ranks third after Japan and China.

Molecular oncology has emerged as significant and rapidly growing market segment, while infectious diseases segment continues to account for the largest share of the global molecular diagnostic market.

Globally with clinical implementation of NGS in genetic disorders and preventive disease segment more than 26,000 genetic tests are available for over 3600 genes. Personalized genomic medicine undoubtedly has become one of the hottest areas in the global healthcare sector. Once esoteric, these tests have earned their place in routine medical practice and expanded to all spheres of healthcare—from the pathology lab to the doctor’s office and clinics of developing countries including India.

MDx- Future prospects

MDx is positioned to directly benefit from the explosion in genomics knowledge.

MDx is expected to expand its critical role in identifying disease risk, diagnosing complex disorders and selecting appropriate treatment. The future is likely to witness the establishment of new disease or gene associations with widespread use of personalised therapy with the introduction of predictive tests. Looking at the clinical realm of infectious diseases, antibiotic resistance is a major aspect that will have a longterm impact in the molecular diagnostics space. In context to India, flexibility and smart testing will play a major role in the coming years. There is an enduring need to push the frontiers of Molecular Diagnostics with development of microfluidics, in cloud-connected Point of Care devices which are user-friendly and cost-effective.

DOCTOR SPEAK

Viral hepatitis B is responsible for about 80% of liver cancer cases

Hygiene, immunization, safe sex, and safe blood transfusion are all harm reduction efforts

I

ndia rolled out the National Viral Hepatitis Control Program (NVHCP) last week with the aim of eliminating viral hepatitis. The disease infects and kills more than HIV, malaria and tuberculosis combined. The National Action Plan – Viral Hepatitis was launched in Mumbai by the Union Minister of State for Health and Family Welfare. Viral hepatitis is recognized as an important public health problem across the world.

According to estimates by the WHO, viral hepatitis caused 1.34 million deaths globally in 2015, a number comparable to deaths due to tuberculosis, worldwide. There are about 4 crore people suffering from Hepatitis B in India, and another 0.6 to 1.2 crore people suffering from Hepatitis C. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “It is imperative to not underestimate the threat of hepatitis. More than 80% cases of liver cancer are due to viral hepatitis. Many people are not aware even when they are infected as majority of people doesn’t even know they are infected because symptoms of jaundice such as yellowing of skin, whites of the eye, and urine happen in the later stages of the disease. Both the fatal infections (Hepatitis B and C) spread through contaminated blood and other fluids, with unsafe blood transfusion, tattoos or dental procedures using unsterilized tools, unprotected sex, sharing razor, etc. This further leads to the infection spreading from an infected person to a healthy person.

Progression of liver disease is faster in individuals with HIV and viral hepatitis coinfection; also, they may not respond as well to treatment.”

Apart from other measures, the programme will also focus on screening of pregnant women for hepatitis B, in places where institutional delivery is less than 80%, to ensure provision of birth dose hepatitis B vaccination and Hepatitis B immunoglobulin, if required.

44 March 2019 w w w. m e d g a te to d a y.co m

Adding further, Dr Aggarwal, who is also the Group Editorin-Chief of IJCP, said, “Acute hepatitis due to any virus is usually self-limiting and requires a good diet, bed rest and only symptomatic treatment. Urgent hospitalization may be required only in cases of acute liver failure in acute viral hepatitis. One may also need intensive treatment and liver transplant. Chronic hepatitis B and C can be treated with antiviral drugs both oral and injectable. Hepatitis C virus (HCV) is curable now and HBV can be controlled with medication. The vaccine is available for hepatitis A virus and HBV only.”

Some harm reduction tips from HCFI

✓ Maintain quality standards for public water supplies ✓ Establish proper disposal systems for human feces ✓ Maintain hygienic practices such as handwashing with safe water, particularly before handling food ✓ Avoid consumption of water and/or ice of unknown purity ✓ Get immunized at regular intervals as advised ✓ Safe blood transfusion ✓ Safe injection ✓ Test any donated blood for hepatitis B and C ✓ Indulge in safe sex and promote correct and consistent use of condoms

DOCTOR SPEAK

Is it time to”

Check your Hearing

“

Dr. Arjun Dasgupta, Dr. N.V.K. Mohan & Dr. Chirajit Dutta, ENT Consultant; Dr. Anupama S Satpathy, Junior Consultant, ENT- Medica Superspecialty Hospital

On this World Hearing Day on 3rd March, World Health Organisation (WHO) has rightly suggested to “Check your hearing”! It notifies those who are living unknowingly affected by hearing loss, to get themselves checked before the world around them turns deaf.

According to a report by WHO, “by 2030 there will be nearly 630 million people with disabling hearing loss; by 2050 the number could rise to over 900 million.” This is indeed alarming considering India is a densely populated country the number of people with hearing loss has risen from 76.5 million in 2008 to 100 million in 2018. Currently, the number of people suffering from disabled hearing loss is 466 million, worldwide. In which, 34 million are children. This scenario will significantly impact our healthcare sector and also pose threat to the Country’s economic growth.

It is an unhealthy trend in today’s generation who cannot give up the use of earphones and personal audio devices. Most of them “Blindness separates us from things but deafness separates us from people as per Helen Keller,” said Dr. Arjun Dasgupta Quoting Nietzche, Dr. Chirajit Dutta said: “We hear only those questions for which we are in a position to find answers.”

“The thing about hearing loss is that no one can see it.

Most people are so impatient; they just assume that the person with hearing loss is being rude, or slow-witted,” said Dr. N.V.K. Mohan.

46 March 2019 w w w. m e d g a te to d a y.co m

listening continuously for hours end up harming themselves. We do hear the axiom, ‘Technology is a boon till it is our slave and as we let it become the master, it becomes a bane.’ With unlimited data plans provided by telecom operators it has become a fad to binge watch shows and live TV on one’s smartphone. The damage which is happening today will not be evident for years.

It is not just the loud volume but the electromagnetic waves emitted from the smartphones can also damage our hearing in the long run. A report from the World Health Organization estimates more than one billion young people are at risk of permanent hearing loss, simply from listening to music that is too loud.

Approximately 50% of all cases of congenital hearing loss are attributable to environmental factors, such as congenital hyperbilirubinemia, ototoxic medication exposure, neonatal hypoxia, viral infections, and meningitis. Rest of the population inherits it genetically. With increasing noise pollution, ototoxic drugs, ototoxic chemicals the incidence of old age deafness is on increase. It has been noted by the WHO that half the causes of deafness are preventable and about 30%, though not preventable, are treatable or can be managed with assistive devices. Thus, about 80% of all deafness can be said to be avoidable.

The most important thing in communication is hearing even what isn't said. So, it is advisable to protect one of your most valuable natural assets. Hearing loss can affect the quality of our life and relationships. Certain conditions such as age, genetics, illness and modern life factors such as earphones, plenty of sources of loud noise by vehicles may play a role in hearing loss. Advanced age is the most common cause of hearing loss.

Noise wears down hearing if it's loud or continuous so, few professions such as factory workers, traffic policemen, soldiers, construction workers, even musicians are at risk of noise induced hearing loss. A cochlear implant is still a distant dream for many in this Country. The Central and State Governments have extended financial support to the low income sections of the society but lot more awareness is required to ensure early detection and its treatment.

Every child born with hearing loss must be identified and treated early to ensure a better healthy upbringing. Unfortunately, in India with the rarity of an ENT specialist or surgeon at a primary healthcare centre in villages aggravates the problem. So it is time to consult the ENT specialists, get the hearing tests done, detect the problem and get cured before it's too late for recovery.

DOCTOR SPEAK

THDC boosts health

services in remote areas of Tehri

T

he hill state of Uttarakhand has a population of 1.01 crore, with a majority of people residing in rural areas. Due to the mountainous terrain and remote location, rural people have to travel long distances to access health facilities.

Tehri district of Uttarakhand, with a total area of 4,421 sq. kms, shares its borders with Dehradun, Uttarkashi, Pauri, Chamoli, Rudraprayag and Bageshwar. Health centres in the district do not have adequate number of health professionals to cater to the people; most centres have only pharmacists to tend to patients. Due to unavailability of other pathological and radiological facilities, people are forced to travel to distant cities to avail medical treatment.

To answer this urgent need of the district THDCIL been providing health services facilities in the area through various health camps and awareness drives in association

Sh. H.L. Bharaj Executive Director (S&E/Services) with reputed hospitals and institutions.

Through SEWA-THDC, a company sponsored NGO, a full-fledged hospital with a MBBS doctor, nurse, pharmacist with an ambulance and diagnostic facilities has been set up at Deengaon, in Pratapnagar. It serves the health needs of nearly 40 nearby villages.

Since June 2014, it has registered approximately 67,000 patients up to December 2018. Every year SEWA THDC also conducts 10-15 multispecialty medical camps, including eye camps, in Tehri district led by THDC doctors posted at Tehri, Koteshwar projects, Rishikesh and Nirmal Eye Institute, Rishikesh. After signing a MoU with AIIMS, Rishikesh, last year, special medical camps were held at Tehri, Koteshwar and Rishikesh to scale up health services in partnership with the District CMO. Rotary International, another reputed NGO, has also being roped in to further enhance health services in Tehri district.

So far, SEWA- THDC has organized 131 medical health camps since 2011-12, treated 30,867 patients and undertaken 2,021 cataract eye operations, spending around Rs. 190 lakhs so far. w w w.medgatetoday.com â&#x20AC;&#x201A; March 2019

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DOCTOR SPEAK

Satnam device for endoscopic surgeries to treat spinal problems Dr Satnam Singh Chhabbra

S

Head Neuro & Spine Surgeon, Sir Gangaram Hospital, New Delhi

lipped disc is a common problem, which affects approximately 1% of the population at any given time. It usually affects people between the ages of 30 to 50 years. But these days, it is not bound to any age group or gender.

The device is now being used by numerous hospitals in India, providing a sigh of relief to patients suffering from the agonizing pain.

It is profound in people involved in occupations with frequent bending and lifting heavy objects. However slipped disc is not the only cause of backache/leg pain. These aches can often result from diseases like spinal tumor, infection, T.B., cancer spreading to spine, osteoporosis, arthritis, spinal stenosis, fractures, congenital diseases etc.

But thanks to the latest advancements in medical technologies, serious health diseases have now become curable.

Determined for the same, Dr Satnam Singh Chhabra Director of Neuro and Spine Department at New Delhi based Sir Gangaram Hospital has successfully taken spinal surgeries to an altogether new level.

Dr Chhabra explains; Nowadays, surgery for slipped disc is performed through a tiny (about 1.5 cms) incision in the back with the help of an endoscope.

The surgery grants patients the relief to go back home within 12-24 hrs of getting operated. Additionally, such patients can also easily walk and use the toilet the very same day, besides getting fit to resume office in a few days time. Generally the idea of undergoing a spinal surgery often puts people on tenterhooks given the risk of paralysis or fear of getting bedridden and depending on others. Such is the mindset of patients that theyâ&#x20AC;&#x2122;d rather suffer the pain than get operated. However with modern surgical techniques on the go, such complications are extremely rare.

Dr Satnam Singh Chhabra has recently introduced a new device to provide relief to patients suffering from savior slipped disc and compressed nerves. Gaining popularity under the same banner, Satnam Device has been submitted for patent rights by the name of Satnam Device for Endoscopic Surgery.

Satnam Device for Endoscopic Surgery is a special tube which is placed into the back of patient through a minor cut in the skin.

Surgery is performed through this tube under endoscopic view on LED monitor.

The device gives enormous magnification and clarity of vision which in turn minimizes the risk to normal nerves.

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DOCTOR SPEAK

Precision & Efficiency

What Tomotherapy is all About Dr. S. Hukku

Senior, Consultant & Chairman, Radiation Oncology, BLK Super Speciality Hospital With Tomotherapy, specialists can adjust the size, shape and intensity of the radiation beam to accurately target the size, shape and location of the patient's tumor Advancement in radiation therapy has transformed the entire procedures which are deployed to treat patient suffering from critical life threatening diseases such as cancer. Oncologists, surgeons and Radiation experts, after first-hand experience with Tomotherapy, have been convinced with its efficacy and outcomes.

Precision and speed are two key features which make tomotherapy, the most sought-after advanced radiation machine.

Patients reeling from diagnoses need precise and effective treatment to get their lives back. Treatment teams need next-level precision, speed and efficiency to improve patient outcomes. Clinical practices need to treat a broad range of indications with superior outcomes. Tomotherapyâ&#x20AC;&#x2122;s latest version -The Radixact Treatment Delivery System- enables all of this with a fully integrated platform for intelligent treatment planning, data management and treatment delivery.

Using a refined x-ray beamline and nextgeneration imaging technology, the system delivers scalable and highly reliable treatments for patients with a variety of individual treatment needs. Tomotherapy has come as a boon to cancer patients. It is now used as a curative treatment for cancer, the second leading cause of death across the world. With the most recent introduction of Tomotherapy, the radiation oncology has touched an all new high in the race of effective curative treatment for serious illnesses. In India, a very few health institutions are equipped with 50 March 2019â&#x20AC;&#x201A; w w w. m e d g a te to d a y.co m

tomotherapy. BLK Super Specialty Hospital has now acquired the latest version of the machine for tomotherapyRadixact.

Cancer patients require radiation therapy as part of their treatment plan. Tomotherapy is marked as the latest and the smartest radiation therapy to trick and treat the most complicated of cancers. What makes doctors so confident in this technology is the fact that unlike the former techniques of radiation for cancer, Tomotherapy works in a much unique way. This system combines imaging and radiation delivery to target cancer more precisely.

Efficiency of the Tomotherapy can be gauged with the fact that is a systematic process that combines treatment planning, CT image-guided patient positioning and treatment delivery into one integrated system. It helps in calculating the shrinkage of the cancer caused after each cycle, allowing the doctors to plan the next steps as per requirements.

Although it has been in use since the beginning of this century, but the introduction of this treatment process in India is regarded as a ground-breaking development in the healthcare space of the country. The procedure begins with treatment planning. With the use of 3D images and special software, the precise contour for each tumor is defined. How much radiation the tumor should receive, as well as acceptable radiation levels for surrounding tissue and organs are also some of the matters that get decided in the stage of planning. From there, the technology calculates the appropriate

pattern, position and intensity of the radiation to be delivered.

Next in line is the CT Image-Guided Patient Positioning. Precision in patient positioning is crucial for effective radiation treatment. With Radixact 9, a special CT scan is taken just before each treatment to verify the tumor's location and adjust the positioning, if necessary.

This is extremely useful since with every session the position may change slightly and certain types of tumors, such as prostate cancers, can change shape or shift from day-to-day.

With this technology, physicians can make sure that the radiation is directed precisely from one session to the next.

With Tomotherapy, physicians can adjust the size, shape and intensity of the radiation beam to accurately target the size, shape and location of the patient's tumor.The equipment used for Tomotherapy looks much like a computed tomography (CT) system. During treatment, the patient lies on a couch that moves continuously through a rotating ring. Radiation is delivered from all angles as the ring turns and the couch moves through the gantry.

Overall, Tomo Therapy is an all- in- one advanced form of treatment that combines Intensity Modulated Radiation Therapy (IMRT) with the accuracy of Computed Tomography (CT) scanning technology (IGRT- Image Guided Radiotherapy).

The procedure in its final stage combines IMRT with a spiral delivery pattern which means radiation can be delivered from all around the body, which helps ensure the treatment is confined to the tumor.

DOCTOR SPEAK

Practo releases India’s most

comprehensive healthcare map on women

Practo’s healthcare map finds online consultation empowers women to be more proactive about their health Data across 6 crore women patients finds women over 50 years of age as one of the fastest growing user base of online consultation for their healthcare needs

Report findings:

✓ Dermatology issues, stomach pain, kidney stone, chest pain and breast cancer are the most commonly searched terms by women > 50 years ✓ Women increasingly prefer consulting online: growth of 176% amongst women users using online consult, while 31% growth of women users for physical appointments ✓ Gynecologist and dermatologist are the top most searched specialties among all Indian women, both for physical and online appointments Practo’s first-ever healthcare map on Indian women is based on transactions by 6 crore women users in the period of Jan 2018 - December 2018.

That’s nearly 10% of all women in India and 45% of all women Internet users in India. Overall, Practo helps over 2 crore patients each month.

Enclosed below are some key insights:

✓ Growth in online consultation primarily reflects two trends: • Women find online consultation an easily accessible, private and trustworthy option, especially during working hours and late in the night. While women residing in smaller towns and cities find online consult really helpful as it provides them access to top doctors otherwise inaccessible for them • Online consultation is becoming a great replacement for self-diagnosis and medication as it is more reliable and takes much less time (60 seconds to chat with a doctor, instead of hours online searching) ✓ Increased focus on mental health and wellbeing: • Psychiatrist emerges as one of the top specialties in online consult. Experts point that women prefer discussing stigma-related or private matters with doctors online • Depression emerges as one of the top areas in online consult for women in the age group of 21-30. Experts suggest that this often has symptoms such as loss of interest and enjoyment in practically every aspect of life, in addition to various physical symptoms such as heavy headache, backache, insomnia, restlessness, blurred vision, amongst other such symptoms. It also indicates a growing trend of people seeking help • Relationship counselling is one of the two fastest growing issues amongst women booking for physical appointments with 257% growth 52 March 2019 w w w. m e d g a te to d a y.co m

✓ Women use online consultation to discuss issues concerning their children as well. Pediatrics registers a 144% growth in searches. Experts suggest women reach out to Pediatricians esp. at odd hours when there’s an emergency and for second opinions, mostly for their peace of mind ✓ PCOD/PCOS is on a rise too, with a 135% year on year growth in searches for physical appointments ✓ Diet and Nutrition has emerged as the fastest growing healthcare concerns for online consultation, with a 321% growth year on year. It shows awareness and efforts taken

by Indian women to maintain a healthy lifestyle ✓ Experts see the next phase of online consult growth, esp. among women, coming from Tier 2 and Tier 3 cities, where getting a trusted doctor and specialist may be a challenge.

Jaipur has registered the highest growth in this regard with 666% growth, closely followed by Visakhapatnam at 569% and Guwahati at 375% ✓ Indian women find Monday 6pm-8pm & Saturday 10am12pm as the best suited time to see doctors physically, while Monday - Friday - 10am-12pm & 6pm-8pm as the best time to consult doctors online Access to healthcare for women is not limited to that one individual's health, but has a wider impact on the community's health and wellbeing.

It's important for women in all strata of the society, across urban, rural or remote villages to get access to doctors in a timely manner; not just for themselves but for their family which includes the elderly and children. Telehealth is the answer to this, where are the click of a button, women can connect with doctors anytime and for any issues - a routine or minor ailment or in emergency situations. Technology has contributed to reducing infant mortality, maternal mortality, ensuring timely vaccinations for mothers to be and infants significantly. It’s heartening to see this technology reaching out to elderly, esp. women, who have taken very little initiative in the past to take care of their health proactively.

It truly has empowered all sections of our society by simplifying the process significantly.

Dr. Sanjay Sharma Jt. Secretary cum Treasurer, Telemedicine Society of India

DOCTOR SPEAK

Driver’s foot can be caused due to long hours of continuous driving Dr Alok Kalyani

Associate Consultant – Rheumatologist Max Super Speciality Hospital, Shalimar Bagh, New Delhi

Akshay, a 32 years man who is a startup entrepreneur had to commute daily from Delhi to Gurgaon to reach out to his office. With daily driving of over 5-6 hours, he started facing problems in his right foot from the big toe, arch, heel and ball of the foot. The pain worsened even after resting and taking medical treatment for long, and even he had stopped driving but the pain did not vanish.

The pain was at its peak usually if he sat for a long time or got down from the car after long hours of drive.

This agony kept him away from doing daily activities and had to consult doctors on a regular basis. He was initially kept on medications, though painkillers gave him temporary relief but the pain would peep in again soon as he thought of stopping them. On complete investigation, the condition was diagnosed as Driver’s foot, which was creating problems with his plantar fascia.

Driver’s foot is a common foot pain condition, most often felt by long driving. Waiting in traffic and continuous driving for 2-3 hours at a stretch not only generates heel pain, but also he started feeling numbness in the right leg with pain propagating to his lower back. If left untreated for a long time this pain aggravates to have problem known as plantar fasciitis along with pain in the heel and the ball of the foot.

What is Driver’s foot?

A very common foot pain condition, usually found among drivers. This condition leads to other complications if the cause of the abnormality is undiagnosed. A person driving for a long time consistently is highly prone to such condition.

Usually the pain is felt in the heel of the foot, across the big toe, inflammation in the arch of the foot, and pain in the ball of the big toe where the foot is kept on the accelerator. Traffic can make this pain even worse due to the fact that the foot has to be kept in a same position for a longer period of time.

What are the symptoms?

Pain in the ball of the foot- the area of the foot which meets the pedal has the maximum pain. Constant pushing of the pedal

can also worsen the pain leading to bursitis (bruising of toe bones.

Pain in the heels – Heels being rested on the floor in the complete course of driving, it can be bruised and become painful. The rocking motion of applying brakes and again keeping it on the accelerator pedal enhances the chances of pain.

Pain on the top of the feet – tension caused in the foot due to the long holding of the pedal in crucial traffic areas or having to push down on pedals which are too hard can also aggravate pain in the top of the foot. Though this pain vanishes quickly but daily commuters and continuous drivers should not ignore it as complications can be serious if untreated on time.

Inflammation in the arch of the foot – usually people with this condition feel a hot sharp sensation in the heel and arch of the foot. The pain elevates soon after getting down after a long drive.

How to treat it?

✓ Exercise and stretching – It is first necessary to sketch out the painful areas for precise stretching and exercises, to treat the condition. Stretching is the best treatment as it releases the tension from the heels, arch and the ball socket. Avoid long drives and heavy weight lifting can provide relief quickly. Application of ice to the affected area for 20-30 minutes several times a day along with exercises to stretch the Achilles tendon and plantar fascia can be the main stay of the treatment and reduces the chances of recurrence. ✓ Medications - In the initial stages, anti-inflammatory or analgesic medicines along with heel pads may be sufficient enough to relieve pain and inflammation. ✓ Surgical intervention – surgery may be very rarely required. If the complications worsen over time and is not treated even with medications, the surgeon may suggest for surgical interventions.

How to deal with Driver’s foot?

✓ Immediately stop driving to prevent further cramps if you are driving for a long time. ✓ Improve your blood circulation of the foot by massaging and rubbing them. This relaxes the muscles and the cramps dissipate. ✓ Always wear comfortable shoes that fit the best. ✓ Persistent cramps are also a symptom of Vitamin and electrolyte deficiency in the body. Drink plenty of fluids with potassium and magnesium. w w w.medgatetoday.com March 2019

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POST 9th MT India Healthcare Award Medgate Today continues its glorious traditions of honoring Healthcare Leaders EVENT

Medgate Today world’s foremost and India’s leading healthcare and medical magazine organized the “9th MT India Health Care Awards 2019”. These awards aim to recognize and honour the doers and pioneers of healthcare sector.

The Awards were distributed based on the profile, assessment of achievements and visions, comprehensive online research, customer reviews and patient satisfaction. Last but not the least, the recommendation from the eminent panel of jury was the deciding factor for the winning ticket.

The Honourable Minister of State for Health and Family Welfare Shri Ashwini Kumar Choubey could not attend the award function but sent his best wishes to the team of Medgate Today.

Sh. Ashwini Kumar Chaubey said, “I whole heartedly congratulate Medgate Today for successfully organizing the 9th MT India Healthcare Awards for recognizing and encouraging the best talent in the Healthcare Industry. These professionals adhere to high standards of work and deliver the best equipments, techniques, medicines etc. They create new standards every day with their diligence and strive to keep the Indian healthcare Industry way ahead of others”.

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Leaders in healthcare, these experts have shown excellence in understanding the nitti-gritties of medical science and utilizing their skills to produce latest developments in Healthcare sector.

Undoubtedly these experts are playing an important role in growth of India’s Healthcare Industry. They are assets for our country and I firmly believe they will reach new milestones and take India ahead on the path towards progress.

These awards aim to encourage these professionals to continue pursuing greater success with time”, said Mr. Afzal Kamal, Editor-in-chief of Medgate Today.

Dr. Anil Kohli, Padmabhushan, Padamshree and Dr. B C Roy Awardee, Dr. Naveen Nishchal,Chairman,VOH. Dr.M.Wali, Dr.Rajesh Shah Mr. Horst Giesen, Global Portfolio Director, Healthcare and Medical Technologies, Messe Düsseldorf GmbH and Mr. Thomas Schllit, Managing Director, Messe Düsseldorf India Pvt. Ltd. Were also present at the occasion along with other dignitaries.

The 9th MT India Healthcare Awards 2019 is being held on22nd February 2019 at Pragati Maidan, New Delhi.

Candidates were recognized under different categories. The winners are:

Dr. Naveen Nishchal Special Award For Contribution in Healthcare Sector

Dr. M Wali Special Award For Contribution in Healthcare Sector

Dr. D R Rai Special Award For Contribution in Healthcare Sector

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9th MT India Health Care Awards 2019

WINNER LIST

EVENT

Geetanjali Medical college & Hospita

Best Medical College & Hospital of the year

Nowrose jee Wadia Maternity

Best Single speciality Hospital of the Year (Not For Profit)

PSRI Hospital

Most Ethical Hospital of the Year

Indraprastha Apollo Hospitals

Best Hospital in Facility Management & Hospitality

Dr.Arora’s Clinic

India’s Biggest Sexual Health Clinic

Dr. Raajiv Singhal

Healthcare Business Leader of the year

Fortis OP Jindal Hospital & Research

Most Promising Hospital for Tier2/3 Cities

Dr. Minnie Bodhanwala

Healthcare Personality of the Year (Editor’s Choice)

Dr.D. S Rana

Healthcare Personality of the Year (Nephrology )

Gaurav Malhotra

Healthcare CEO of The Year

Dr.Dharminder Nagar

Healthcare Personality (Editor’s Choice)

Dr.Ashish Singh

Most Emerging Orthopedic surgeon of the year

Dr.Anuvijayant Goel

Best Anesthesiologist of the year

Dr Vidushi Agrawal

Best Doctor in Nutrition & Dietetics

Dr Saktimaya Mohapatra

Best in Healthcare Analytics

Dr.Shourya Poswal

Best Endodontist of the Year

Tejas Patel

Young Healthcare Entrepreneur of the year

Anamika Sinha

Women Business Leader In Healthcare

of

the

Dr. Rajesh C. Shah Special Award For Contribution in Healthcare Sector

Year

Dr. Amna Mirza Special Award For Contribution in Social welfare

Akums Drugs & Pharmaceuticals Ltd. Best Pharma manufacturing Company of the Year Medikabazaar

Most Emerging Company in Healthcare

Sai Sumeet Appliances

Most Innovative company in MOT

BPSD Education Pvt Ltd

Most Promosing Paramedical College

Technomed India

Best Company in OT Light & Table

Transasia Bio-Medicals Limited

Best Company in Medical Devices (IVD)

Fujifilm India Private Limited

Best Company in Radiology & Imaging Devices

Akhil Systems Pvt. Ltd

Most Admired Company Healthcare IT

Asti Infotech.

Best IOT Company of the year”.

Mrs. Jasmin Majethia

Iconic personality of the year

Meddo

Healthcare Startup of the year

Dr. Barnali Das

Healthcare Leader in Quality & Management

Sai Ganga Panakeia Pvt Ltd

Most Innovative Medical Product Of the Year

Dr. Harsha Vardhan

Eminent personality of Healthcare

Jury Member Dr. Naveen Nishchal

Special Award For Contribution in Healthcare Sector

Dr. M Wali

Special Award For Contribution in Healthcare Sector

Dr. D R Rai

Special Award For Contribution in Healthcare Sector

Dr. Rajesh Shah

Special Award For Contribution in Healthcare Sector

Dr. Amna Mirza

Special Award For Contribution in Social welfare

Dr. Sarika Gupta

Special Award For Contribution in Healthcare Sector

Dr. Sharad Lakhotia

Special Award For Contribution in Healthcare Sector

Dr. Anil Bhola

Special Award For Contribution in Healthcare Sector

Dr. Sarika Gupta Special Award For Contribution in Healthcare Sector

Dr. Sharad Lakhotia Special Award For Contribution in Healthcare Sector

Dr. Anil Bhola Special Award For Contribution in Healthcare Sector w w w.medgatetoday.com March 2019

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Geetanjali Medical college & Hospital Best Medical College & Hospital of the year

Dr. Raajiv Singhal Healthcare Business Leader of the year

Dr. Dharminder Nagar Healthcare Personality of the Year (Editor’s Choice)

Nowrose jee Wadia Maternity Best Single Speciality Hospital of the Year (Not For Profit)

Fortis OP Jindal Hospital & Research Most Promising Hospital for Tier2/3 Cities

Dr. Ashish Singh Most Emerging Orthopedic Surgeon of the year

PSRI Hospital Most Ethical Hospital of the Year

Dr. Minnie Bodhanwala Healthcare Personality of the Year (Editor’s Choice)

Dr. Anuvijayant Goel Best Anesthesiologist of the Year

Indraprastha Apollo Hospitals Best Hospital in Facility Management & Hospitality

Dr. D. S Rana Healthcare Personality of the Year (Nephrology )

Dr Vidushi Agrawal Best Doctor in Nutrition & Dietetics

Dr. Arora’s Clinic India’s Biggest Sexual Health Clinic

Gaurav Malhotra Healthcare CEO of The Year

Dr Saktimaya Mohapatra Best in Healthcare Analytics

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Tejas Patel Young Healthcare Entrepreneur of the year

Sai Sumeet Appliances Most Innovative Company in MOT

Akhil Systems Pvt. Ltd Most Admired Company Healthcare IT

Anamika Sinha Women Business Leader In Healthcare

BPSD Education Pvt Ltd Most Promosing Paramedical College

Asti Infotech Best IOT Company of the year

Akums Drugs & Pharmaceuticals Ltd Best Pharma Manufacturing Company of the Year

Technomed India Best Company in OT Light & Table

Mrs. Jasmin Majethia Iconic personality of the year

Transasia Bio-Medicals Limited Best Company in Medical Devices (IVD)

Meddo Healthcare Startup of the year

Sai Ganga Panakeia Pvt Ltd Most Innovative Medical Product Of the Year

Dr. Harsha Vardhan Eminent personality of Healthcare

Medikabazaar Most Emerging Company in Healthcare

Fujifilm India Private Limited Best Company in Radiology & Imaging Devices

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4th International Voice of Healthcare Conference held at New Delhi

On the occasion of Inauguration of Medical Fair India exhibition and Voice of Healthcare On behalf of Health Minsiter (MOS) Shri Ashwini Chubey Mr. DEVENDER SINGH, ADVISOR TO MINISTER OF STATE FOR MINISTRY OF HEALTH AND FAMILY WELFARE & FORMER ADDITIONAL SECETARY TO LOK SABHA, Said, I deem it a great honor and privilege to be here this morning at this inaugural ceremony.

I just wish to say a few words about the National Health Policy 2017. The NHP 2017 aims to make healthcare in India affordable, accessible and qualitative. It also takes into its ambit Allopathy, Ayurveda, Yoga, Unani, Siddha, Homeopathy and Naturopathy to make the healthcare basket wider and make it easier for people to choose from which system of medicine they consider helpful.

As you all know that the Ayushman Bharat was launched by the Honorable Prime Minister on 23rd September, last year. It aims to revamp and upgrade our Primary Healthcare Centers into 1,50,000 health and wellness centers across the country. They will be upgraded and duly equipped with all the medical devices, diagnostic facilities, doctors and healthcare practitioners by the end of 2022.

And the Ayushman Bharat brings into its ambit about 10 crore families which means almost 50 crore people will be covered. And they will have a health cover of Rs. 5 Lakh per annum per family. The government is committed to give healthcare to our people, to make it accessible, affordable to all the people, particularly the weaker section and the vulnerable sections.

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conference and certainly they will be submitted to the government for their consideration.

Mr. SURAJIT BIT, DIRECTOR, PROJECTS, MESSE DUSSELDORF INDIA PVT. LTD. I consider it as a great privilege to propose a Vote of Thanks to all the dignitaries who have gathered here to begin and witness the 25th Edition of Medical Fair India. On behalf of Messe Dusseldorf India, I would like to express our gratitude and want to thank our Chief Guest Shri Devender Singh on behalf of Shri Ashwini Kumar Choubey who has graced this occasion with his thought provoking address to set a perfect tune for the fair. A hearty thanks goes out to all our exhibitors, sponsors, partners, all our stakeholders and colleagues of Messe Dusseldorf Group who always stand by us, guide us, lead us and motivate us to make this edition a big success. Special thanks to Mr. Rajiv Nath for having a belief that E-Med is right platform to have at Medical Fair India. I would like to thank Ms. Veena Kohli to graciously agree to chair the CLIN LAB CONFERENCE. I would also like to thank the Voice of Healthcare team led by Mr. Afzal Kamal and Dr. Naveen Nischal.

POST EVENT

Span Policy. So we would like to have more and more cooperation with the countries in the South-Asia and SouthEast Asia. We always can learn from each other to improve the healthcare of our people. So I and my colleagues were very happy to participate in this wonderful international conference and we hope that we can learn from you and we can share our experience with you. So lastly I would like to express my best wishes for the success of this international conference.

CHUNG YI LEE, DEPARTMENT OF PUBLIC HEALTH NATIONAL CHEN KUNG UNIVERSITY OF TAIWAN! I would like to express my appreciation to the organizing committee, specially Dr. Naveen Nishchal to invite us to participate in this big event. The NCKU provides a platform for the university researchers and people from the industry to improve the quality of healthcare. 25 years ago, the Government of Taiwan launched the national health insurance program. Before that it was difficult for the poor people to get health insurance. Since 1994, all the people DR. HSU L LIN, DIRECTOR, INTERNATIONAL MEDICAL CENTRE, NATIONAL CHENG KUNG UNIVERSITY HOSPITAL TAIWAN I am Dr. Hsu l Lin. I am a chest surgeon and trauma surgeon. I have come to India more than ten times since 2008 mostly to the rural areas for public health for the promotion and education. This time I have come here to represent the Government, Ministry of Health to promote partnership between India and Taiwan and today I will

Launch of India's Top Orthopedics Coffee Table Book

were covered by Universal Health Program. So over the last two decades of efforts the health condition of the people of Taiwan improved quite a lot under the Policy of Taiwanese Government. There is a new policy called the South-

Unveiling of Medical Fair India 2019 Show Directory

share with you about Taiwan Healthcare. In Taiwan our population is 23 million and our life expectancy in 80 which is the same as in the OECD countries. Our infant mortality rates is 4. The top 10 causes of mortality are cancer, heart diseases, pneumonia, stroke, diabetes, etc. If we talk about cancer, there is lung cancer, liver cancer, oral cancer, breast w w w.medgatetoday.com â&#x20AC;&#x201A; March 2019

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cancer, cervical cancer which can decrease because since 2010 we have free cancer screening. And we also have latest techniques for organ transplantation and for plutaneous intervention. We have a comfortable transplantation and the best survival rate of heart transplantation and spring liver transplantation and other organ transplantations. In our future plans, we will build up psychology health center and woman and children center. We have only 2% of hospitals in Taiwan. Most of the doctors in Taiwan serve in the clinics. But for the 2% hospitals we need accreditation

by JCT. We have only 19 Medical Centers and 83 regional centers and 400 district hospitals. In Taiwan the available beds for the medium hospitals is 162which is same as the beds with OECD countries. The expenditure for healthcare is 6% of the GDP. We have unique single pay National Health Insurance. We cover 99.6% of Taiwanese population and 93% hospitals and clinics have contracts with the Government of Taiwan. Our health insurance covers everything in-patient, out-patient, dental, even a traditional Chinese Medicine Therapy. And because National Health Insurance is controlled by the Government of Taiwan, we can provide the best quality. But I know that the number is much lesser than it is in India. But besides the medical service, we also have the new growing medical industry.

The growth in contact lens is almost the half of the

medical industry. We also have medical service, device and equipments and medical chemistries. We have very good dentist grafts and other medical equipments. Our exports and imports are in The US, Japan and China. I think in future India will be our main partner. With this I end my speech. Thank you very much.

Launch of VOH Academy by Dr. Naveen Nishchal, D C Jain, Dr. V G Somani, Gaurav Malhotra, Dr. Indu Bhushan, Afzal Kamal, Prof. Rajesh C. Shah 60 March 2019â&#x20AC;&#x201A; w w w. m e d g a te to d a y.co m

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FIRST TIME IN HISTORY AFTER INDEPENDENT OF INDIA,

F

HEALTHCARE HAS RECEIVED HIGH LEVEL OF POLITICAL COMMITMENT FOR HEALTHCARE SECTOR.

irst time in History after independent of India, Healthcare has received high level of political commitment for healthcare sector.

Ayushman Bharat CEO,Dr. Indubhushan said at 4th VOH International conference that Ayushman Bharat scheme is the world’s largest healthcare scheme of the country.

In span of 5 months since Ayushman Bharat scheme has launched, • 2crore card has been issued in 150 days.

• 4-5 lac card is issuing per day • 15000 Hospital joined this scheme and giving treatment to patients. (Where 50% Hospital are Private ) He urged private sector to help poor people and ready for collaboration.

And Health For All what WHO said by 2020 should be the motive and our Honourable Prime Minister had come up with a very noble scheme which is Ayushman Bharat. And let me go a little bit in detail of that why we need this Ayushman Bharat.

Now when we talk about Health For All, in our country we do not have the system like Europe or The USA where people, each countryman is covered by Health Insurance because we don’t have insurance very common but it’s coming up very fast.

So when we talk about providing Health For All, a question arises that how can it reach, now already I think many lakhs of people have been issued the cards and Rs. 5 Lakh for a family, said Dr. Naveen Nishchal,Chairman, VOH

we have 300 Medical Colleges and now The Central Government is thinking about opening a medical college in each district. We have only 10 Lakh doctors which is just 0.

63 per thousand people. Also we have the problem of quacks which are not qualified that’s another big area because of that the load of the medical system increases. Today if you ask me we get more of retreatment cases than the treatment cases which are being spoiled by the less knowledge of less education of the people of the rural area. So there is a lot we can do and now we have Dr. Indu Bhushan, we will share with him about what best we can do to contribute to the betterment of Medical System of this country.

Everybody was talking about Ayushman Bharat and we were again and again going back to Ayushman Bharat because I think this is a phenomenal thing that has happened in the recent past. So today I think we have a golden opportunity and Dr. InduBhushan is with us. ’’ said Mr. GauravMalhotra,VOHConference,Co-Chairman

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Glimpse of

Medical Fair India 2019

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Recipients of

HCL Grant 2019 Felicitated by

Mr. Amitabh Kant & Mr. Sourav Ganguly

✓ Three NGOs across categories of Environment, Health & Education received a grant of Rs.15 crore (US$ 2.1Mn) ✓ Two finalists in each category also received a grant of Rs.25 lakhs (US $0.035Mn) each, taking the overall HCL Grant 2019 purse to Rs.16.5 crore (US$ 2.3Mn) ✓ HCL Grant has already disbursed Rs.35 crore (US$5.38 Mn) till date (excluding current commitment) to strengthen and support the NGO community

The recipients of HCL Grant 2019 are: ✓H ealth – The 2019 HCL Grant winner

in this category is She Hope Society for Women Entrepreneurs. Established in 2001, the organization is working in remote, border and isolated areas of Jammu and Kashmir on Physical Rehabilitation.

✦ Project Title: Humanitarian assistance

to strengthen inclusion and safety of vulnerable persons especially women and children in conflict affected areas of Jammu and Kashmir.

✦ Project Location: 4 Districts of Jammu & Kashmir (Kupwara, Baramulla, Rajouri and Poonch)

✓E nvironment – Wildlife Trust of India

HCL Foundation, the CSR arm of HCL Technologies, today announced the recipients of HCL Grant 2019 in the presence of Mr. Amitabh Kant, CEO, NITI Aayog and Mr. Sourav Ganguly, Former captain of the Indian National Cricket Team. One of the biggest and most coveted institutionalized CSR grants of India, HCL Grant recognizes the rise of community-led ecosystems of NGOs. Three NGOs across the categories of Education, Healthcare and Environment received a grant of Rs.5 crore each. This year, HCL Grant also introduced an additional grant of Rs.25 lakhs each for the six finalists across the three categories, taking the overall Grant purse to Rs.16.5 crore.

The HCL Grant award ceremony, held at the HCL Technologies campus in Noida, was also graced by Mr. Shiv Nadar, Founder & Chairman, HCL, Ms. Roshni Nadar Malhotra, Vice Chairperson, HCL Technologies and Chairperson, CSR Committee, HCL Technologies, along with senior dignitaries, bureaucrats, NGO-partners and the HCL leadership.

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is the winner of HCL Grant 2019 in the Environment category. WTI has been working towards wildlife and biodiversity conservation issues across the country since 1999.

✦ Project Title: Connecting Landscapes, Empowering

People and Protecting Elephants- An initiative to secure the Baghmara - Balpakram Elephant corridor and protect the wildlife habitats of Garo Hills, Meghalaya.

✦ Project Location: Garo Hills, Meghalaya.

Education – The winner for HCL Grant 2019 in the Education category is Srijan Foundation. Established in 2001, the Srijan Foundation aims to work for the welfare of the underprivileged by building capacity of the community as well as grass root organizations.

✦ Project Title: Educating the Women Farmers for better Livelihood Opportunities and better Income Generation.

✦ Project Location: Hazaribagh and West Singhbhum in Jharkhand.

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Till date, HCL Grant has committed Rs.35 crore (US$5.4 million) towards rural development with an ambition to reach over 900,000 people. Today, the seven HCL Grant recipients are addressing some of the most pressing issues in the remotest corners of the country with innovative solutions – creating the last mile support framework. Since 2015, HCL Grant projects have already significantly altered over 3,70,000 lives in 3500 villages across 26 districts in 12 states of India.

Mr. Amitabh Kant, CEO, NITI Aayog said, “HCL has put together a great model to support the country’s development agenda.

Health, Environment and Education constitute core components of any country’s development program. It is also imperative that all the stakeholders government, corporates, NGOs and civil society work together to make a greater impact. I congratulate the winners and the finalists for their sincere work and wish them all the best.”

Mr. Sourav Ganguly, Former Captain of Indian National Cricket Team said, “I feel privileged to be a part of this event. It is inspiring to see the work of the NGOs and I congratulate the winners of HCL Grant and HCL for the outstanding work they are doing to make a difference in the lives of the communities they serve. I believe working for causes and charitable purposes is like a habit and we should all strive to do our bit because development is not a one-person job – but requires a team effort to drive meaningful impact.”

During the event, the third edition of the “The Fifth Estate - NGOs transforming Rural India in Environment, Health and Education”, was also released. This is a comprehensive compendium detailing out the work of India’s top NGOs who are making credible efforts towards empowering rural India.

This Compendium is put together basis the research that HCL conducts during the evaluation process of HCL Grant and serves as a point of reference for other organizations or individuals looking to support NGOs in a particular field.

Speaking on the occasion Ms. Nidhi Pundhir, Director HCL Foundation, said

“HCL Grant is a unique initiative in the CSR space where we make an attempt to not only recognize the heroes contributing to growth and development of India but also engage with them over years to achieve the desired impact. Over the course of four years, HCL Grant has enabled the emergence of a cadre of remarkable community-based, participatory NGOs that are strengthening grassroots development by driving deeper and wider impact.”

The eminent Jury for this year’s Grant was chaired by Ms. Robin Abrams and comprised Dr. Isher Judge Ahluwalia Leading Economist and Chairperson, Board of Governors, Indian Council for Research on International Economic Relations, Ms. Pallavi Shroff - Eminent Legal Counsel, Shardul Amarchand Mangaldas & Co., Mr. B.S. Baswan - Former Director, Indian Institute of Public Administration and former HRD secretary, Mr. Richard Lariviere - President, Field Museum, Chicago and Former President of the University of Oregon, James Syring, Senior Vice President, Enterprise Operations Support, USAA. and Mr. Shiv Nadar – Founder & Chairman, HCL. “HCL Grant is a path-breaking initiative towards recognizing and supporting the inspiring work done by NGOs in three key development categories in India. It has been an interesting journey to shortlist the finalists and winners as all the entries had a significant story to tell with a visible impact on ground” said Ms. Robin Abrams, former president of Palm Computing and longest-serving Board member of HCL Technologies.

The fourth edition of HCL Grant witnessed an overwhelming response from NGOs from across the country, with over 4,000 applicants. The applications were carefully scrutinized through a robust 8-month long process, monitored and audited by Governance Partner, Grant Thornton. Built into the Grant’s structure, beyond identifying the project that needs support, there is a system to fortify the organization itself, provide a methodology for implementation, and monitor the impact, sustainable in time and complexity. w w w.medgatetoday.com March 2019

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Oblique Lateral Interbody Fusion (OLIF) technique emerging as a treatment of choice for minimally invasive spine surgeries Spinal disorders are on a rise in India and OLIF can help reduce treatment duration and hospital stays Statistics indicate that lumbar spine disorders are on a rise in India with people as young as 16 to 34 years of age suffering from some form of a spinal problem. Over time, this can lead to numerous complications. While there are several options available to treat such degenerative spine disorders, the oblique lateral interbody fusion technique (OLIF) is gaining popularity as the preferred mode. Some reasons for this include lower rate of morbidity, decreased postoperative pain, and reduced operating time and hospital stay.

A majority of back and leg pain originates from the lumbar spine which also bears the most stress. The OLIF procedure allows surgeons to treat lumbar spine conditions from an oblique lateral position. This spinal fusion procedure helps them in achieving the same outcomes as in a traditional spine surgery albeit in a minimally invasive manner. It is also safer when compared to the conventional open spine procedures as the latter requires larger incision, leads to more blood loss, increased duration of hospital stay and recovery, and more analgesics post operation. It also leads to muscle stripping and cutting and poses a higher risk of nerve injury.

Speaking about this, Dr. Manas Kumar Panigrahi, Senior Consultant Neurosurgeon at KIMS Hospital, Secunderabad, said, “Given the rise in the number of degenerative spinal disorders, the need of the hour is to raise awareness about the availability of minimally invasive techniques like OLIF. It has better health outcomes than others. The technique avoids the Psoas muscle surrounding the spine on both sides in the lower levels. By 66 March 2019 w w w. m e d g a te to d a y.co m

doing so, it limits the chance of damage to those nerves thereby reducing the risk of leg pain, thigh weakness, and numbness. A majority of patients in the country tend to ignore spinal ailments and OLIF can prove to be a boon in addressing these. I am thankful to Dr John K Schuster for being with us today and sharing his experience and global best practices in the treatment of spinal disorders".

Dr John K Schuster (MD), Orthopedic Spine Surgeon at the Northwest Orthopedics, Washington, USA said, “Minimally invasive surgery is an evolving trend in addressing spinal disorders and makes use of smaller incisions to do traditional surgeries through new approaches. OLIF is one such type of surgery which is beneficial in more ways than one. It avoids harming major blood vessels by going behind intestines (peritoneum); reduces the potential risk to the nerves located in Psoas muscle surrounding the spine; and the interbody footprint allows for more degree correction options and larger surface area to promote spinal fusion. “ Performed under general anesthesia, in OLIF the patient is positioned with their right side down and left side up for surgery. Once the skin is cleaned and sterile drapes are placed, a small incision is made over the appropriate spinal level. For multiple levels, a longer skin incision is made. After moving the abdominal contents to the side, blood vessels are safely protected, and spinal discs exposed. The psoas muscle is then gently moved out of the way and a minimally invasive spinal retractor is placed. The disc is then removed and the ends of the spinal bones (vertebrae) are prepared for the spinal fusion.

OLIF treatment plans and outcomes are specific to the individual patient and can produce varying results. However, its advantages include the fact that a larger size of interbody can be placed which helps in giving the human spine natural lordosis and increased surface area for early fusion. Patients can go back to their normal life early, there is less post-operative pain, no long-term muscle scarring or neural damage, and overall pain free outcomes.

So far, over 40 spine surgeons have used OLIF and passed on the benefits to over 250 Indian patients. It is imperative to consult the physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

With the growth in population, there will be a commensurate increase in the demand for safe spine surgery to ensure better quality of life – and OLIF can help achieve this.

Dr. Manas, Sr. Consultant Neurosurgeon, KIMS Hospitals, said, “The live workshop was designed to expand and share global knowledge in the field of OLIF25, granting event attendees access to valuable content they may not otherwise have available to them. We are proud to conduct workshops like these.”

More than 50 Neurosurgeons from various hospitals and medical colleges from India have attended this workshop.

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