Medgate may- june2015 by Medgate Today

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Volume VI || Issue I || May-June 2015

The Gateway to Health & Medical World

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An Advance Media Group Publication

EDITOR SPEAK

ANNIVERSARY IS THE CELEBRATION OF TRUST, SERVICE AND RELATIONS

You for taking the time to hold Medgate Today magazine for 6 years. Today seems like a good day to express my appreciation to our readers and advertisers at large for the warm welcome and resounding support of all the changes we are implementing.

magazine Volume - VI Issue - I May-June 2015

Thank

I would also like to extend my gratitude to all my professional colleagues from health ministry, Doctors, CEO,consultants & Healthcare Architects for being so kind and giving your utmost cooperation to make Medgate Today a huge Success. Healthcare Sector updates: The Indian healthcare sector, one of the fastest growing industries, is expected to grow at a compound annual growth rate (CAGR) of 17 per cent during 2011-2020 to touch US$ 280 billion. It is expected to rank amongst the top three healthcare markets in terms of incremental growth by 2020. Of total healthcare revenues in the country, hospitals account for 71 per cent, pharmaceuticals for 13 per cent and medical equipment and supplies for 9 per cent. The private sector has emerged as a vibrant force in India's healthcare industry, lending it both national and international repute. It accounts for almost 72 per cent of the country’s total healthcare expenditure. Telemedicine is a fast-emerging sector in India; many major hospitals have adopted telemedicine services and entered into a number of public-private partnerships (PPP). In 2012, the telemedicine market in India was valued at US$ 7.5 million and is expected to grow at a CAGR of 20 per cent to reach US$ 18.7 million by 2017.

Editor Chief Editor Editorial Advisor

Lastly, I would like to THANK to my entire team of Medgate Today, both the editorial and marketing for putting together such a marvelous issue. Have an insightful reading. Your suggestions are most welcome! E-mail: editor@medgatetoday.com Website: w w w . m e d g a t e t o d a y . c o m

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Dr. Pradeep Bhardawaj GP Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia

National Head Business Head

Afzal Kamal

Asst. Manager

Ashi Tiwari

Corporate Communication

Cheif Correspondent

Sales and Marketing Subscribtion & Cirrculation

Adesh Singh Solanki

SA Rizvi, Dr. HN Sharma

Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Deepti Tripathi, Nizamuddin Alam Jagruti Diddi, Saba Khan All right Reserved by all everts are made to insure that the information published is correct ‘Medgate today’ holds no responsibility any unlikely errors that might occur.

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The Government of India aims to develop India as a global healthcare hub. It has created the National Health Mission (NHM) for providing effective healthcare to both the urban and rural population. Investment in healthcare infrastructure is set to rise, benefiting both 'hard' (hospitals) and 'soft' (R&D, education) infrastructure. India is the largest exporter of formulations with 14 per cent market share and ranks 12th in the world in terms of export value. Double-digit growth is expected over the next five years.

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NEWS Contents Update

News Shri Jagat Prakash Nadda, Union Minister for Health and Family Welfare, Dr. Ashok Seth conferred with Padma Bhushan for his contribution in the field of Cardiology GE Healthcare Strengthens “Wake in India” Capability for Accessible, Affordabel Health Care Mylan Launches Gilead Sciences’ Sovaldi® Tablets in India Union Minister for Health urges corporates and different stakeholders to support ‘TB Free India’ “On World Health DayHealth Tests are must” Karnataka government launches much awaited two wheeler ambulance service to speed up medical care Praxis Media Declared the Prestigious National Healthcare Achievers Awards - 2015 Gynaecologists advise influenza vaccinations for pregnant women

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Post Event Excellent Atmosphere at the MEDICAL FAIR INDIA 2015 in New Delhi VII National Seminar on “Hospital & Healthcare Management, Medico Legal Systems & Clinical Research” on 1st and 2nd May, 2015. Health Update Watch out for Food Contamination Healthy Food, Healthy Liver, Healthy Life

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Expert View Quality Health for Tier-II: Emerging Metros of Tomorow

Doctor Speak Liver Surgery-An Update 48Common infections during summer & measures of their prevention 50 Post Event Summit on “India: The Future Global Healthcare Hub” Product Line Role Of Mobile App in Today's HMS technology: Paradigm shift in demand for Anaesthesia Workstations

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Reader's Voice

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Congratulatory Message from Reader's of Medgate Today Magazine on the occasion of Mega Anniversary Issue

Reader's Voice

Medicine is a field of rapid advancements. Healthcare delivery mechanisms are changing rapidly as well. New technology, new drugs, new financing models, new research, new providers-healthcare institutions or healthcare professionals today cannot afford not to be conversant with these latest advances. Medgate Today is leading the way in showing us the path. For six years, Medgate Today has covered diverse fields of healthcare and helped us remain up to date on various sectors of healthcare, be it hospitals and other healthcare providers, pharmaceuticals, healthcare IT, medical education, holistic care or healthcare events. Besides showing the way, Medgate Today has encouraged and recognized outstanding performance in healthcare through the MT India Healthcare Awards spanning across all major healthcare sectors. We congratulate Medgate Today on its sixth anniversary and wish it success for the years to come. True to its logo, it indeed is a gateway to health and medical world.

Prof. Anupam Sibal

MD, FIMSA, FIAP, FRCP (Glasg), FRCP (Lon), FRCPCH, FAAP Group Medical Director, Apollo Hospitals Group

I heartily congratulate the Medgate Today publication on their 6th anniversary issue. The publication has shown commendable achievement in the recent years, with their insight stories, indepth news articles and so on which has been inspiration for the readers of the healthcare industry in India. I wish my best wishes for their continued success and growth. Stephan Kueppers

Messe Dusseldorf GmbH Dusseldorf, Germany

Writing on 6th Anniversary of Medgate Today, is a proud moment for me as I have been a witness to Medgate journey from no where to every where. It was a journey started with steely determination and ingrained conviction of Mr Afzal Kamal that Medgate has to be leading torch bearer in Indian Healthcare. Medgate Today has so far justified it's presence as fourth estate in healthcare. It has been satisfying to notice the transition that Medgate is no more following benchmarks rather has started setting benchmarks. Voice of Healthcare is one of such benchmarks, set up by Medgate Today . It has created an opportunity to discuss many issues plaguing the healthcare. Hope some day it will be prominent think tank, healthcare industry would keep looking forward to. I heartily Congratulate Team Medgate led by Mr Afzal kamal with a wish :Keep enlighting the world like sun in healthcare space.

Manish Rastogi

Director : HOSCONNN

Medgate is refreshingly different. Under one roof, it covers experts views on clinical areas. It provides views from leading doctors on contemporary issues. Above all it keeps us up-dated on what is happening around in the field of healthcare. I would like magazine to provide connect with government and showcase good practices from different state governments. This will in long run help PPP taking active shape, which otherwise has been non-starter. Dr Girdhar J Gyani

Director General Association of Healthcare providers (India)

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I wish all the best to Dr Kamal and rest of editorial team.

Reader's Voice

Guru Prasath K.R

Director- Business Development Messe Dusseldorf India Pvt Ltd Mumbai

I am very pleased to write this congratulatory message on the special occasion of 6th anniversary issue of Medgate Today publication which today increasingly has become synonymous with the Indian medical & healthcare industry. From what I have witnessed the sheer passion and commitment from his leader- Mr. Afzal Kamal, Medgate Today publication has rapidly grown in stature & has truly inspired every reader from the Indian healthcare fraternity. The quality of its news, content & topics covered has immensely benefitted every reader and to be honest- acts as a curator for the next issue to be read. To give more value and opportunity to share ideas and network, Medgate Today has played pivotal role in organizing their highly popular MT Awards. Their recent launch of “Voice of Healthcare” social messaging forum initiative has been truly remarkable one & gives a daily dose of healthcare news /topics which are debated by highly influential healthcare professionals across the industry. On this special occasion, I sincerely congratulate Mr. Afzal Kamal & his team for their excellent contribution to the healthcare industry and to enlighten everyone. I heartily wish Medgate Today a grand success & a greater glory in all their efforts.

It's a delightful feeling to know that Medgate Magazine has completed 6 successful years in the Indian Market. In the increasingly, crowded segment of Pharma & Health Magazines, Medgate has been growing from strength to strength with its inside Research, meaningful information, industry knowledge. Due to its unique approach the Magazine has managed to stand out from the rest of its ilk. With its style of writing and presenting it has managed to rise above the mundane and keep the readers engaged for six years. Heartiest congratulation to Medgate Magazine, may the Magazine go a long way !

Rajiv Nath

Forum Coordinator, Association of Indian Medical Device Industry (AIMED)

Anubhav Guglani

I am very happy to know that Medgate has completed six successful years and has reached to this good position in the healthcare industry. When I was looking for a right platform to promote my product, many healthcare senior professionals recommended me Medgate. I am glad that I listened to them and went ahead with your magazine. Our state-of-the-art technology coupled with your strong circulation has helped us in promoting our Nurse Call System in the healthcare sector. Your magazine is always good in the quality of content and topics. This could be achieved, only, by your hardwork and talent. I hope your magazine performs even well in future. Congratulations to you once again.

Head - India SCHRACK SECONET AG

I congratulate "Medgate today Magazine" on its 6th anniversary. On this occasion, I must appreciate the efforts of Medgate Today in bringing all the stakeholders of healthcare of at a common platform. Reading Medgate Today has always been a pleasure and loads of information. I think everyone in healthcare community knows abut the popularity of Medgate Today. I wish Medgate Today, a great and prosperous future ahead! Keep enlightening! Dr. Naveen Nishchal Director Cygnus Hospitals

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EXPERT NEWS Update VIEWS

Shri Jagat Prakash Nadda, Union Minister for Health and Family Welfare, Government of India releases Textbook of Pediatric Gastroenterology, Hepatology and Nutrition Shri Jagat Prakash Nadda, Honorable Union Minister for Health and Family Welfare, Government of India released a Textbook of Pediatric Gastroenterology, Hepatology and Nutrition on 7th April 2015. This book is the most comprehensive book on the subject in India. The book has been edited by Prof Anupam Sibal, Group Medical Director, Apollo Hospitals Group and Senior Pediatric Gastroenterologist and Hepatologist and Dr Sarath Gopalan, Senior Consultant, Indraprastha Apollo Hospitals. Dr Vidyut Bhatia, Consultant, Indraprastha Apollo Hospitals and Dr Akshay Kapoor, Consultant, Indraprastha Apollo Hospitals are the editors. The Textbook has been written keeping in mind the latest developments in the field of Pediatric Gastroenterology, Hepatology and Nutrition. Utmost importance has been accorded to incorporating case scenarios which every pediatrician faces in daily practice in our part of the world. Almost 30 % of children who see a pediatrician suffer from gastrointestinal and liver disorders. The textbook has to its credit many international and Indian authors who are authorities in their respective fields. It will be useful to all readers in the day to day management of gastrointestinal, nutritional and hepatobiliary disorders in children. It has been published by Jaypee Brothers Medical Publishers. 14

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About Indraprastha Apollo Hospitals Indraprastha Apollo Hospitals, India’s first JCI accredited hospital, is a joint venture between the Government of Delhi and Apollo Hospitals Enterprise Limited. Commissioned in July 1996, it is the third super-specialty tertiary care hospital set up by the Apollo Hospitals Group. Spread over 15 acres, it houses 57 specialties with more than 300 specialists and more than 700 operational beds, 19 operation theatres, 138 ICU beds, round-the-clock pharmacy, NABL accredited laboratories, 24-hour emergency services and an active air ambulance service. Apollo Hospitals Delhi has the leading programme in kidney and liver transplant in the country. The first successful pediatrics and adult liver transplants in India were performed at Indraprastha Apollo Hospitals. The hospital is at the forefront of medical technology and expertise. It provides a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. The Hospital has introduced the most sophisticated imaging technology to India with the introduction of 64 slice CT and 3 Tesla MRI, Novalis Tx and the integrated PET Suite. Indraprastha Apollo has also pioneered the concept of preventive health check programmes and has created a satisfied customer base over decades. The Hospital has been consistently ranked amongst the best 10 hospitals in India by The Week survey for the past few years.

NEWS Update

Dr. Ashok Seth conferred with Padma Bhushan for his contribution in the field of Cardiology Dr. Ashok Seth, Chairman of the Fortis Escorts Heart Institute (FEHI) has been conferred with Padma Bhushan, the prestigious National award and civilian honor for his contribution in the field of Cardiac Care by the Honourable President of India. Dr. Ashok Seth’s contribution to the growth of Cardiology especially Interventional Cardiology has been unparalleled. Over the past 26-years, he has pioneered numerous angioplasty techniques for India and Asia Pacific region like Directional Atherectomy, Angioscopy, Stents, Thrombectomy devices & Drug Eluting Stents, use of Impella heart support device failing heart, Bioabsorbable Stents and TAVI. His other achievements include being a part of the focused Advisory Group and seminal studies for development and clinical applicability of Bioresorbable Scaffold (BRS) Stent, which is recognized internationally. One of the best globally known and respected Indians for his unique achievements & contributions, Dr. Seth, has been honored by the National award of ‘PADMA SHRI’ by the President of India in 2003, the National Award of Republic of Spain “Officer’s Cross Order of Isabella the Catholic” in 2010, ‘Mason Sones Award’ from SCAI (USA) in 2010 among numerous other awards. Dr. Seth has mentored thousands of doctors by spreading

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knowledge through his lectures and demonstration of complex angioplasty techniques and training more than 350 cardiologists from India and abroad in advance techniques of angioplasty. He also has more than 250 publications to his credit in prestigious Indian and International medical journals and has been honored by Honorary Doctorate from four prestigious Universities in India. Congratulating Dr. Seth on the honor of the award, Ashish Bhatia, Chief Operating Officer, Fortis Healthcare Limited said, “The teams at the FEHI and at Fortis Healthcare are extremely proud to have a charismatic, yet humble man who leads by example as their leader. This award, among the numerous awards he has received, is a reflection of his commitment and dedication towards his passion in Cardiac Care. We are proud to be associated with such a luminary and wish him greater success.” On being congratulated for the award, Dr. Ashok Seth, humbly said, “I am thankful for the honor. The award makes my mission to work tirelessly in this field of medical sciences more resolute. As the Chairman of this Institute, my endeavor will always be to lead my colleagues to many more victories and strive towards more solutions to give a ray of hope for numerous patients dying of failing hearts. "

NEWS Update

One-Way Journey To Wellness, From Home – At Home For The 1st Time In Television History, 100 Episodes Dedicated To Diet – Care Word TV The first and largest healthcare satellite channel in Asia, Care World TV that had recently announced its plans to reorient its programmes towards Wellness, has announced its first programme for the season. ‘100 Days Diet Plan’ – the series is not only a first of its kind show but also is a well-researched and planned show on wellness that will be aired beginning the month of May. All episodes of the show have been shot in High-Definition (HD) with International feel and context. The programme aims at breaking certain notions about health diets and amplifying the goodness of a well-balanced diet, factoring in correct calories intake and appropriate nutrient levels. The series is an all encapsulating Wellness diet regime that assures, if followed, will not only address the health quotient of an individual or family but also will make it equally interesting to the palate. “Wellness is an everyday state of being and maintaining a well-balanced diet is the key to healthy living. ‘100 Days Diet Plan’ is designed to educate, clear misconceptions and most importantly bring a disciplined effort towards following a diet to attain wellness,” says Mr. Ajit Gupta, Managing Director, Care World TV. “Today consumption of supplements, promoted by nutraceutical companies, is trending. Many may not even know why they are consuming supplements and are unaware that the same constituents that go into its making can be consumed as simple, home-made food diets. The series is, hypothetically speaking, a hundred page menu card that will help one dish out everyday meals which will eliminate the

Ajit Gupta

Managing Director Care World TV

need for consuming such supplements. Diets beginning with breakfast to addressing even night cravings will be prescribed by our panel of dieticians and nutritionists,” adds Mr. Gupta. The TV channel has also levelled up its production facility to leave no stone unturned in presenting the show with worldclass style. “To match the ideology of the show it is important to deliver it in contemporary style. We’ve taken efforts to build the studio to reflect its objective and audiences can enjoy viewing the same in 4K resolution,” says. Mr. Ashok Singh, Creative Head, Care World TV. In the last 10 – 15 years, sales in the nutraceutical markets have seen an unprecedented spike. A couple years ago, the sale of supplements in this market stood at US $96 billion worldwide and is expected to show a CAGR between 6% - 7%. “The diet industry is nearly a US $60 billion-a-year business globally and the Indian market is becoming a major player in this sector. The need for consumption of such processed, packaged diets stems from the need of wanting a healthy body for many in the urban populaces. Most people are concerned about their weight and may resort to dietary supplements that are available in the market. However, there is no such thing as ‘one size fits all’ in dieting and consuming such foods may prove futile in achieving the end result. Our series aims at completely eliminating the need for supplements intake and instead promotes indulging in a wholesome, nutritious, healthy diet as a habit,” concludes Mr. Gupta.

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NEWS Update

GE HEALTHCARE STRENGTHENS “MAKE IN INDIA” CAPABILITY FOR ACCESSIBLE, AFFORDABLE HEALTHCARE • Manufactures first ever India designed and developed Computed Tomography system – Revolution ACTs • Announces a new venture GenWorks Health Pvt. Ltd to cater to the tier II/III towns GE Healthcare, a unit of General Electric Company (NYSE: GE), reiterated its commitment towards ‘Make in India’ by strengthening its R&D, Manufacturing, Supply Chain, Distribution capabilities and Education initiative. With enhanced capabilities, GE today announced the launch of Revolution™ ACTs*, first Computed Tomography system designed and developed by GE Healthcare in India. The Revolution ACTs is manufactured in India for India and the world. The Revolution ACTs is the result of Rs.120 Crores investment and collaborative efforts of GE and Indian healthcare providers for over 4 years. Speaking at the occasion, John Flannery, President and CEO of GE Healthcare, said, “Make in India means much more than local manufacturing for us at GE Healthcare.

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It is a 360 degree thrust starting with designing and developing relevant solutions in partnership with our users; robust engineering of technologies; developing a world class supply chain, advanced manufacturing, expert user training and developing a network for distribution as well as maintenance of these solutions in the remotest parts of the country and world. It represents our commitment to work towards making quality healthcare truly accessible and affordable for India as well as the world. “ “We are proud that our first ever locally designed CT technology-Revolution ACTs is developed by the people of India, for the people of India. It is a testament to India’s intellectual, design and advanced manufacturing capabilities.” added Terri Bresenham, President& CEO of GE Healthcare South Asia. Healthcare in India is under-served and under-consumed with its skewed imbalance in resources. India faces severe shortfall of both hard infrastructure and skilled talent, especially in Tier II-IV towns. While disruptive technologies have the potential to enhance infrastructure and care delivery, adoption of same has been restricted due to a number of factors like affordability, knowledge about its clinical utility, distribution, service, funding etc. For over 2 decades GE Healthcare has been innovating and making in India to enhance affordability and access of healthcare solutions. GE Healthcare has recently formed a new national network - GenWorks Health Pvt. Ltd and is endeavoring to address these severe challenges faced by healthcare providers in Tier

NEWS Update

II-IV towns. GenWorks has commenced operations with 150 highly experienced team members with each member having an average industry and leadership experience of 17 years. GenWorks is rapidly building presence in 450 tier II-IV towns to take disruptive technologies, training and support closer to healthcare providers in a bid to give these first time users a high quality user experience. “All initiatives to develop relevant technologies would be meaningless if they are not accessible to all and hence we also invested and built a national network. GenWorks Health Pvt Ltd will help us take these technologies to the grass root level and provide world-class training and support for doctors to ensure technology can benefit patient outcomes. Healthier India cannot be built in isolation and hence GE Healthcare is looking at an all-inclusive approach to achieve this. With GenWorks, we are stepping up our efforts to elevate the standard of healthcare services in tier II/III cities and towns through this new venture “said Terri Bresenham. For over 25 years, GE Healthcare has been working extensively towards a healthier India through innovating in India, making in India and now skilling India. GE Healthcare has strengthened R&D facility with the inclusion of a Global Design Studio called eCube. The studio serves the vital role of a stage for immersive research and collaborative co-creation of disruptive technologies with willing healthcare providers as partners. Revolution ACTs is the result of 4 years of research and development by 75 GE scientists and engineers in collaboration with over 500 healthcare providers from both urban and rural settings. The Revolution ACTs also achieved a remarkable feat of 5 global patents for its design and engineering. “Revolution ACTs is a journey into the needs of new

users of CT in smaller towns. It's about innovating for affordability and defining solutions that deliver high quality diagnostic CT solutions in the most challenging healthcare markets. We hope to place one Revolution ACTs per district to improve access to quality diagnosis “said Milan Rao, Chief Operating Officer, GE Healthcare, India & South Asia. Revolution ACTs is 40% more affordable compared to previous generation 4 slice CT systems. The total life cycle cost of Revolution ACTs is further reduced by its 8m2 compact footprint leading to 45% lower siting cost and 47% savings in electricity consumption. Making in India will bring in additional cheer to Indian healthcare providers-faster delivery, faster response and reduced import duties. Revolution ACTs introduces Clarity panel detector, exclusively developed for this product to improve image resolution, along with Smart Dose technologies to lower radiation dose by up to 36% while preserving high image quality. It hosts an efficient digital workflow and an user interface that is easy to learn and use for even a first time user. GE has developed a world class supplier base in India as well as facilities for assembly and testing. Over 30% of the product components and parts are either in-house manufactured or sourced from India and includes the heart of the machine – Generator and Tubes. GE is the first company to manufacture advanced healthcare imaging technologies in India with its first factory set up in Bangalore in 1991. Today, GE Healthcare has three dedicated, world class manufacturing plants in Bangalore with over 400,000 sq. ft of manufacturing space that has produced over 200,000 units of medical technologies for the world. GE has been recognized as the largest medical electronics exporter for 11 consecutive years.

Apollo Hospitals sends team of medical professionals to assist Earthquake victims in Nepal

eading private healthcare provider Indraprastha Apollo Hospitals has pledged support to the victims of the Nepal earthquake. The hospital has deputed a medical team comprising specialists along with medical and paramedical staff, and a consignment of about 800 kg containing implants, medicines, medical consumables, etc. to Kathmandu on 28 April 2015. The teams have been working in coordination with Om Hospitals, Kathmandu providing relief to the patients. The first team comprising of 3 orthopedic surgeons, a neuro specialist and 2 nurses returned yesterday from Nepal. They had carried 50 first aid kits, surgical consumables, instruments, food and utility items. The Apollo team performed about 80 surgeries including spinal fixations and joint repairs, on patients ranging from 6 years to 96 years. The team also coordinated with other local hospitals including the Trauma Centre, Kathmandu to send their patients to Om Hospital, from where the team was operating. 20

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“We have a long standing relationship with Nepal. In this hour of grief after the devastating earthquake, we have tried to extend all possible medical support. A multi-disciplinary medical team was sent to Kathmandu along with 800 kg of medical supplies. The surgeons have performed 80 surgeries over the last 7 days. Our deep sympathies and continuing support lies with the citizens of Nepal.” said Mr. Jaideep Gupta, Managing Director, and Indraprastha Apollo Hospitals.

NEWS Update

Mylan Launches Gilead Sciences’ Sovaldi® Tablets in India POTTERS BAR, England, and HYDERABAD, India – Mylan N.V. (Nasdaq: MYL) announced that its subsidiary, Mylan Pharmaceuticals Private Limited, has launched Gilead Sciences’ Sovaldi (sofosbuvir 400mg tablets) in India. Sovaldi is indicated for the treatment of chronic hepatitis C infection, a blood-borne infectious disease, as a component of a combination antiviral treatment regimen. It is estimated that approximately 12 million people are chronically infected with hepatitis C in India. In February 2015, Gilead appointed Mylan as its exclusive distributor of Sovaldi in India. Mylan President Rajiv Malik commented, “Mylan has a long-standing history of partnering with Gilead to tackle key public health issues in India and around the world, beginning with expanding access to high quality, affordable HIV/AIDS antiretrovirals and now extending our partnership to include hepatitis C treatments. We are proud to continue our work together with the launch of Sovaldi as it supports our joint commitment to meeting the unmet medical needs of patients in India.” “We are pleased to bring this important therapeutic advance to patients living with hepatitis C in India. Today marks an important milestone in Gilead’s ongoing effort to make its hepatitis C medicines accessible to as many patients, in as many places, as quickly as possible,” said Gregg Alton, Executive Vice President, Corporate and Medical Affairs, Gilead Sciences. Sovaldi is sold by Mylan’s dedicated sales force as part of its Hepato Care segment. Additional hepatitis C arrangements with Gilead include: -

A licensing and technology transfer agreement that grants Mylan the non-exclusive rights to manufacture and distribute generic sofosbuvir and generic ledipasvir/sofosbuvir and, upon FDA approval, the investigational NS5A inhibitor GS5816 and single tablet regimen of sofosbuvir/GS5816 in 91 developing countries

An exclusivity for distribution of Gilead’s brand Harvoni® (ledipasvir 90mg/sofosbuvir 400 mg tablets) in India

This press release includes statements that constitute "forward-looking statements," including with regard to sales of products, product approvals and the company's strategy, future growth and performance. These statements are

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made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Because such statements inherently involve risks and uncertainties, actual future results may differ materially from those expressed or implied by such forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to: the impacts of competition; changes in economic and financial conditions of the company's business; strategies by competitors or other third parties to delay or prevent product introductions; risks inherent in legal and regulatory processes; risks associated with international operations; uncertainties and matters beyond the control of management; and the other risks detailed in the company's filings with the Securities and Exchange Commission. The company undertakes no obligation to update these statements for revisions or changes after the date of this release. Mylan is a global pharmaceutical company committed to setting new standards in healthcare. Working together around the world to provide 7 billion people access to high quality medicine, we innovate to satisfy unmet needs; make reliability and service excellence a habit; do what's right, not what's easy; and impact the future through passionate global leadership. We offer a growing portfolio of around 1,400 generic pharmaceuticals and several brand medications. In addition, we offer a wide range of antiretroviral therapies, upon which approximately 40% of HIV/AIDS patients in developing countries depend. We also operate one of the largest active pharmaceutical ingredient manufacturers and currently market products in about 145 countries and territories. Our workforce of approximately 30,000 people is dedicated to creating better health for a better world, one person at a time. Learn more at mylan.com

NEWS Update

RELEASE OF BOOK BY Dr PRADEEP BHARDWAJ & INAUGURATION OF HIGH ALTITUDE MEDICAL SERVICES FOR KAILASH MANSAROVER YATRA – NEW ROUTE AND SHRI AMARNATHJI YATRA- 2015 Dr Pravesh Sahib Singh Verma, MP, Lok Sabha released a book, “LATEST IN HEALTHCARE MANAGEMENT” BY Dr Pradeep Bhardwaj, CEO & Executive Director Six Sigma Star Healthcare (P) Ltd at a grand function attended by more than 500 persons and where dignitaries from healthcare field from across the country were present. Dr Pravesh lauded the efforts of Dr Bhardwaj and congratulated him on his multifarious achievements in the healthcare management field. He appreciated the fact that Dr Bhardwaj had authored the third book at such a young age in his illustrious career. The Saraswati Vandana was followed by lighting the lamp by the Chief Guest and other dignitaries including Shri Praveen Kumar (Bheem), Maj Gen K. Jai Singh (Retd), Group Vice Chancellor, Amity University, Prof. (Dr.) Rajesh Shah, Professor Medical College Ahmedabad. Dr. S.P Bayotra, Senior Consultant & HOD, Sir Gangaram Hospital, Lt. Gen. S.K. Patyal, SM, DGSD, Army HQ, Dr. H. S. Nagpal- Medical Director Hartej Hospital, Amritsar, Dr. Kulraj Kapoor MD. The Director General, Major General S.B Akali (Retd) highlighted the activities of Six Sigma Star Healthcare. He stated that it is India’s 1st and world’s 4th largest healthcare consultancy in its category as per a survey by HBS. Six Sigma Star Healthcare has successfully handled more than 1265 projects in 267+ hospitals pan India, over the past few years. He emphasized the fact that all these achievements are a product of hard work, persistence, intelligence and our faith in our team. Behind this success are great people who do common work uncommonly well and are ably led by the dynamic Dr Pradeep Bhardwaj, their highly acclaimed and awarded live-wire CEO who is recipient of the prestigious Rashtriya Ratan award, listed in Limca Book of Records as the youngest Medical Superintendent and listed among the top ten doctors in India for the years 2012, 2013 and 2014 by surveys conducted by HBS. High Altitude Medical Services along the new route from Nathula to Kailash Mansarovar for the entire duration of the Yatra were also launched on the occasion. The six sigma team will provide free medical services to all yatris at Kailash Mansarover and Shri Amarnath Yatra 2015. The Volunteers of the healthcare Medical Services for the Shri amaranth Ji Yatra 2014 were also felicitated. Dr. Bhardwaj, CEO, Six Sigma Healthcare informed that Hospital and Healthcare Managers are qualified and highly trained professionals, who care deeply about the quality of care their patients receive. They partner with physicians,

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nurses, and other professionals to provide desired medical care. They help in educating community members about important health issues and ensure that hospitals and other healthcare organizations serve as “safety nets” in their communities by providing emergency and ongoing care, as well as accurate, timely information about public threats in times of crisis. For diverse requirements of a manager in hospital or in healthcare sector, no comprehensive reference book was available in the Indian market for one to refer to. Dr Pradeep Bhardwaj’s book, “LATEST TRENDS IN HOSPITAL MANAGEMENT” is likely to fill that gap. It is a wideranging anthology of almost all subjects on Hospital and Healthcare Management – from the traditional topics to the latest like, hospital architecture, green building concept, quality accreditations of Indian and foreign agencies, power of six sigma in healthcare, entrepreneurship in healthcare, laws applicable, IVF Management, TPA management etc. The author has ensured that a healthcare-management practitioner gets not only a comprehensive and reliable book for healthcare related subjects but also the latest authenticated data on such subjects. The book is bound to be accepted by one and all as a good reference book in the Healthcare management arena, stated Maj Gen SB Akali (Retd), Director General. Dr Pradeep Bhardwaj informed that the Governor of J & K has requested that keeping his team’s performance in view, medical services should be provided by Six Sigma’s teams on both the routes of Shri Amarnath Ji Yatra this year. It is a challenge which Six Sigma shall undertake

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NEWS Update

Union Minister for Health urges corporates and different stakeholders to support ‘TB Free India’ National and International experts deliberate issues and way forward •

MoHFW, GoI champions the CALL TO ACTION FOR TB FREE INDIA. TB Free India is an initiative under the global Challenge TB project funded by USAID and led by The Union South East Asia(USEA) office in India sin partnership with WHO.

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Senior officials from WHO , USAID, MoHFW, WB, BMGF among others extend commitement to support TB Free India.

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India continues to be the highest TB burden country in the world with an estimated 2.1million TB cases in 2013 (WHO report 2014)

Honourable Union Minister for Health and Family Welfare , Shri J. P. Nadda today launched a nationwide campaign aimed at TB Free India and urged for support from all stakeholders to this initiative . On this occasion, the minister along with representatives from The Union, World Health Organisation, USAID – US Agency for International Development, Bill and Melinda Gates Foundation, World Bank, The Global Fund, Tuberculosis Association of India, Indian Medical Association, Indian Association of Paediatrics among many others pledged their support to the national campaign. The call to action to end TB in India is a part of the global initiative “Challenge TB” led internationally by USAID and aligns with the Government of India’s vision of a TB free India. The ‘TB Free India’ echoes the sentiments of the WHO’s ‘End TB Strategy’ and the country is now gearing up to intensify its TB control efforts through innovative policies and strategies. Commenting on the campaign, Honourable Union Minister for Health & Family Welfare Shri J. P. Nadda said, The Government of India is committed to end TB from the country and realise the dream of TB free India where all patients will receive accurate diagnosis, appropriate treatment and complete care. He also highlighted the need of innovation which is required for TB care. He also urged all stakeholders to unite in the fight against TB and this Call to Action is such a kind of platform. He also announced the launch of a Missed Call Camapign , massive media campaign and special strategy for addressing key polulations. Commenting on the launch, Mr. Jagdish Prasad,DGHS, MoHFW, said“ I envision a seamless , effective program, that

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works with all of you to address each and every challenge in controlling TB. Our Primary challenge is diagnisos. The Indian patient urgenty needs quick and accurate diagnosis of TB. I also want every single case to be tested for drug resistance at the earliest possible. I believe this is far more cost eefective than testing them later when cases have become extensively drug resisitant Mr. Anshu Prakash, Joint Secretary, MoHFW, activities under this Challenge TB work plan will be designed to develop a Call to Action to End TB as the vehicle for mobilizing all relevant sectors of Indian society, developing new policies and partnerships that support TB control efforts, and increasing domestic resources for TB control activities on a large scale. Dr Sunil D. Khaparde,DDG TB – CTD, Revised National Tuberculosis Control Programme (RNTCP) has made significant achievements since inception. However, there are challenges to reach vulnerable key populations, which can reach through partnerships and community engagement. Commenting on the initiative, Mr. Jose Luis Castro, Executive Director, The Union said This initiatve will contribute to TB Control efforts inIndia thorugh a Call to Action to end TB In India. The goal of thee Call to Action is two-fold: to mobilize a wide range of stakeholders to demand and sustain high-level domestic commitment to end TB in India; and to tap the energy and influence of key stakeholders to drive political, administrative, and technical solutions to specific barriers affecting TB control in India. About International Union Against Tuberculosis and Lung Disease (The Union): For nearly 100 years, The Union has drawn from the best scientific evidence and the skills, expertise and reach of its staff, consultants and membership in order to advance solutions to the most pressing public health challenges affecting people living in poverty around the world. With nearly 17,000 members and subscribers from 156 countries, The Union has its headquarters in Paris and regional offices in Africa, the Asia Pacific, Europe, Latin America, North America and South-East Asia. The Union’s scientific departments focus on tuberculosis and HIV, lung health and non-communicable diseases, tobacco control and operational research.

NEWS Update

“On World Health DayHealth Tests are must” “World Health Day is a global health awareness day celebrated annually. On the occasion of World Health Day, AOH aims to focus on increasing the awareness of essentialand preventive health tests which are often neglected. Because of an increasingly stressful working environment, people have no time for regular health check-ups. These tests should be done only on the advice of a physician. As good health leads to a more fulfilling and happier life. ” Listed below are the tests: In your 20s: Blood Test : At the age of 20, one should undergo the baseline screening for cholesterol and triglyceride and should rescreen in every five years till one turns 40. For the detection of high cholesterol which leads to heart disease and strokes should be tested every year and the risks are at the peaks if stayed unnoticed. Blood Pressure Checks : Hypertension causes elevated blood pressure and these days due to the hectic work environment, increased work stress, which leads you at risk for stroke, heart attack, kidney disease and blindness. At least once in a year blood pressure should be checked and kept in mind or on your check-list. Exam Eye : Get your eye screened every year if you wear contact lens or glasses and the annual screening becomes a must. Aged people and those suffering with hypertension are at a greater risk for dry-eye syndrome. It’s a condition in which the tear glands produce fewer tears. And furthermore, people suffering from diabetes will be at greater risk of eye diseases such as macular degeneration and glaucoma which causes blindness. In your 30s: Depression Screening : A healthy environment with good emotional bonds will have one to be depression and stress free. But there are circumstances wherein depression often goes undiagnosed because many are unwilling or often are unable to talk about emotions. It’s not necessary to undergo the depression screenings every year, but awareness is very important if a person moves beyond the age of 30’s or is in. If you feeling any emotional distress or continuous

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experiencing symptoms of depression, you should finds a mental health professional you trust to disclose the topic and talk about it. Few symptoms of depression are sleeping troubles, irritability and sluggishness. In your 40s: Diabetes Test : Diabetes nowadays, is even detected at a very young age and usually occurs in the mid 30s and in the 40s. It’s better to test for diabetes and get screened for prediabetes. Diabetes is detected in the early age if the person has a family history and even is obese. Thyroid Screening : As the person age, the thyroid gland- a small gland in the neck which regulates our body’s metabolic rate- can begin to slow down. It leads to weight gain, depression, sluggishness and palpitations. With a simple blood test thyroid functioning can be determined and your doctor will check your level of thyroid-stimulating hormone (TSH). T3 and T4 levels can also be checked by the doctor, which helps in getting the complete and overall functionality of thyroid Vitamin D Test : Vitamins are important at adequate levels which helps protect your bones and especially after the age of 40. Vitamin D tests are needed in every two or three years at first, but as the person gets older and the body utilizes more time in synthesizing vitamin D, often more tests are required. The frequency is advised by the doctor. In your 50s: Hearing Test : Variety of pitches and intensity levels will be tested by an audiogram testing your hearing abilities. It is recommended to go through this test once in every three years starting at the age of 50, wherein the hearing capabilities may tend to decrease. Bone Density Scan : As we get older our bones begin losing calcium and other minerals. A bone density scan measures bone mass—the amount of calcium and minerals in bones. This is a key indicator of bone strength relative to other people your age. This can help make a diagnosis of osteopenia or osteoporosis, conditions that can be slowed with medications and other interventions. By Dr. Rajkumar Choudhary, Hon.Secretary, AOH:

NEWS Update

First of its kind Centre for Control of Chronic Conditions (CCCC) launched in India

ith vision is to generate world-class knowledge which can impact policy and practice aimed at reducing the burden of chronic conditions in India and beyond, the Centre for Control of Chronic Conditions(CCCC) was launched today by Hon. Minister of State for Science and Technology Sh. YS Chowdary. The Hon. Minister also released a joint report on “Chronic Conditions in India – Evidence based solutions for a growing health crisis.” The report addresses the rising tide of chronic conditions in India and argues that the cost of inaction towards chronic conditions would be too high for India to bear.

Advancing evidence-based solutions for a growing health crisis, the Centre is an international partnership between All India Institute of Medical Sciences New Delhi, Emory University, the London School of Hygiene & Tropical Medicine and the Public Health Foundation of India The Centre for Control of Chronic Conditions is an international partnership between four leading institutions: the All India Institute of Medical Sciences, New Delhi, Emory University, the London School of Hygiene & Tropical Medicine and the Public Health Foundation of India. The secretariat for this global partnership will be at the Public Health Foundation of India. The Centre is multi-disciplinary group of researchers and health professionals representing a spectrum of clinical, public health, genetics, biochemistry and social science disciplines. The work focuses on the priority chronic conditions of - Cardiovascular Diseases and Stroke, Mental Disorders, Diabetes, Chronic Lung Diseases, Cancers, Injuries and Chronic Kidney Diseases. Lauding this much needed international collaboration, Prof. MC Misra, Director AIIMS said, “India alongside other developing nations has not yet got over infectious disease burden in all age group and child hood in particular. It is also projected that India and China will house largest proportion (>80%) of elderly population with all antecedent health issues, which would include chronic disease burden, which 30

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has not been witnessed earlier. India has already passed the early stages of a chronic disease burden (Diabetes, Stroke, cardiovascular diseases, mental health illness etc.). As if that was not enough we face injury epidemic in the current millennium. If we go by the number today, injury has become a major public health problem in developing countries as also in developed countries. Developed countries have done well by formulating and enforcing injury prevention strategies. Realistic dimension of injury burden has not been well appreciated. Injury epidemic is real in developing countries and 88% of injury burden remains in Asia, which is contributed largely by India and China, two populous nations and developing economies. When we compare death in all age groups, injury is at number 3, but when it comes to years of productive life lost and Disability Adjusted Life Years (DALYs) due to injury, it exceeds both put together cancer and heart disease together. In view of the implications for future disease burden and the demographic transition that is in progress in India and globally the agenda of chronic diseases and injuries should be a priority. This international collaboration between AIIMS, Emory University, LSHTM and PHFI will be the beginning to strengthen institutional framework, national and international capacity building and networks in the regions that will translate evidence into policy and practice.” Chronic conditions are now the leading cause of death in India, accounting for more than 5 million deaths each year – which is over 53% of all deaths. This is projected to rise to almost three quarters of deaths by 2030. They are also a leading cause of disability. In his address Prof. James Curran, Dean, Rollins School of Public Health, Emory University, Atlanta USA, said, “The challenge of chronic conditions confronting India cannot be overstated. It is assumed that chronic conditions are diseases only affecting rich countries or the rich people in poor countries. Evidence now tells us that this is untrue. Chronic conditions are now a global challenge and there is a pressing need for greater understanding on how it affects people, and even threatens to undermine economic development. There is also an urgent need to advocate the integration of best practices for various chronic diseases and injuries with one another as India progresses with its national health agenda, hence this international partnership serves as a platform that

NEWS Update

will try and make a real difference to health outcomes in this enormously important area.” In his address Dr K Srinath Reddy, President, Public Health Foundation of India said, “India currently faces the dual burden of communicable diseases and chronic noncommunicable diseases The Increasing burden of chronic conditions has had not only obvious health implications but also economic and developmental consequences. It is in response to this public health challenge that Centre for Control of Chronic Conditions will generate world-class knowledge which can impact policy and practice, and will work with and educate the wider community about lifestyleassociated diseases to improve quality of life and reduce the burden of chronic conditions.” Prof. Anne Mills, Deputy Director & Provost and Professor of Health Economics and Policy, London School of Hygiene and Tropical Medicine (LSHTM), emphasized that “In India rapid social and economic changes are leaving people at greater risks of developing a range of highly debilitating and life-threatening chronic conditions. Chronic conditions are now responsible for the majority of deaths in India and are the biggest source of disability. The launch of the Centre for Control of Chronic Conditions will further augment targeted health care initiatives, capacitybuilding and policy engagement, to prevent and control chronic diseases in other low and middle income country settings.

Karnataka government launches much awaited two wheeler ambulance service to speed up medical care

n the first-of-its-kind in Asia, the Karnataka government has launched a bike ambulance to speed up the medical care. The First Response mobile first aid unit can rush to an accident spot in 5-10 minutes and provide immediate medical aid. The service is operated by trained paramedics who carry medical equipment and 53 drugs in a kit. The state Health Ministry will place 21 bikes in different accident hotspots in Bengaluru and 10 bikes will be launched in other districts. Even as Karnataka has around 700 conventional ambulances, these units aim to get to those victims whom the ambulances fail to reach in time because of traffic. Each bike ambulance costs Rs. 2 lakhs and is equipped with 40 emergency care medical items such as stethoscope, pulse oxymeter, bandages and IV normal saline apart from 53 basic drugs. The bike ambulance’s driver will be a trained paramedic with a driving license. Each paramedic will reach the site within 10 minutes and provide basic first aid to the victim till the four-wheeler ambulance arrives. Over 40 paramedics have been trained in driving these ambulances. Bike ambulances will provide crucial medical support to the patient in need till the four wheeler ambulance arrives. The service will be very useful in congested areas with heavy traffic, where a four-wheeler is unable to reach on time.

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NEWS Update

Praxis Media Declared the Prestigious National Healthcare Achievers Awards - 2015 To recognize and honor 50 winners at 5 different levels for signifying innovation, dedication, ethics, achievement and excellence in the healthcare sector.

ndia’s leading media and marketing group, Praxis Media Private Limited declared the prestigious National Healthcare Achievers, 2015 to identify and honor leading doctors, surgeons, clinics, hospitals, healthcare companies, researchers, individuals and organizations that have displayed exemplary excellence as healthcare service providers across the country.

Around 50 winners at 5 different levels, 10 major categories and 160 sub-categories, were recognized for signifying their innovation, dedication, ethics, achievement and excellence in the healthcare sector. The awards was the result of determined and assiduous efforts of Praxis Media Private Limited, along with its associates and partners, spread over 2 months, which included nomination process, extensive surveys & research, opinions & feedbacks, categorization and scrutiny of the nominations based on various parameters and finally choosing the awardees though an independent jury panel. The major parameters which were considered for short listing the winners included Qualification, Professional Experience, Infrastructure, Facilities, Innovation, Application of Technology, Career Highlights, Patient’s Opinion, Industry Feedback, Previous Honors and Accolades, Social Initiatives, Annual Turnover etc.

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Winners are as Follows Jury’s Choice Awards: Maharishi Ayurveda Hospital – Jury’s Choice Award for the Best Ayurveda Clinic in India Dr. Vijay Surase – Jury’s Choice Award for the Best Interventional Cardiologist in India Dr. Viral Desai - Jury’s Choice Award for the Best Cosmetic Surgeon, 2015 Dr. Ramesh Kumar Thukral – Jury’s Choice Award for the Best Neuropsychiatrist in India Dr. Sanjat Chiwane – Jury’s Choice Award for the Best Consultant Cardiologist in India Dr. Prakash Nanikram Vaswani – Jury’s Choice Award for the Best Consultant Urologist in India Dr. Ramesh Kumar Thukral – Jury’s Choice Award for the Best Sexologist in India National Level Awards: Dr. Arun Kumar Tyagi – Best Ayurveda and Immunology Consultant in India Dr. Ganapathi Bhat M. - Best Medical Oncologist in India Dr. Viral Desai - Best Cosmetic and Plastic Surgeon in India Alliance Dental Care Limited (Apollo White Dental)- Best Corporate Dental Chain in India KayaKalp Sex Disorder Clinic - Best Ayurvedic Sex Disorder Clinic in India Gaudium Foundation - Most Promising Surrogacy and Maternal Health Organisation in India Dr. Geeta Paul - Best Cosmetic Dental Surgeon in India Dr. Prakruti Dash - Best Clinical and Medical Biochemist in India Dr. A.M. Thirugnanam – Most Promising Interventional Cardiologist in India Dr. Rajiva Kumar - Healthcare Personality of the Year Dr. Dinesh Batra - Healthcare Entrepreneur of the Year Dr. Akta Bajaj - Healthcare Achiever in Gynaecology of the Year

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Zonal & State Level Awards: Gaudium IVF and Gynae Surrogacy Centre - Best IVF and Infertility Hospital in North India Sriram Dental - Best Dental Clinic in Delhi Dr. Jitendra Kumar - Best Consultant Nephrologist in Delhi & NCR Vohra Multispecialty Dental Clinic - Best Multi-speciality Dental Clinic in Delhi & NCR Triveni Dental Clinic and Implant Center - Best Multispeciality Dental Clinic in Haryana Dr. Zoya Zaidi, MD (Honours) Moscow - Best Consultant Rheumatologist in Uttar Pradesh Aster Aadhar Hospital - Best Multi-speciality Medical Care Centre in Maharashtra Dr. Singh's Advanced Homeopathic Clinic - Best Superspeciality Homeopathic Clinic in Maharashtra Teeth Care Centre Dental Hospital - Best Multi-speciality Dental Hospital in Gujarat Dr. Harjot Singh Makkar - Best Consultant Psychiatrist in Punjab Neuro Care Centre - Best Neurological Healthcare Centre in Odisha Dr. Gaurav Gunjan – Most Promising Dentist in Bihar City Level Awards: Dr. Jagruti's Skin and Hair Clinic – Best Skin and Hair Clinic in Ghaziabad Dr. Devesh Clinic – Best Hair Transplantion and Cosmetic Clinic in Faridabad Dr. Garg' Smile Dental Care Centre - Best Dental Clinic in Faridabad Dr. Abhinav Gupta - Best Dental Surgeon in North Delhi Dr. Rajesh Kakkar - Best Consultant Physician in Gurgaon & NCR Vinayak Hospital - Best Multi-speciality Hospital in Jhansi Dt. Nalini - Best Diet and Nutrition Consultant in Chandigarh OraCare Dental Centre - Best Dental Care Centre in Pune LINA Diabetes Care and Mumbai Diabetes Research Centre - Best Diabetes Care Centre in Mumbai Dr. Syed Meeer Madar - Best Ayurveda Consultant in Mumbai Dr. Sonia Tekchandani - Best Consultant Dermatologist in Mumbai Tender Skin International Cosmetology Academy - Best Institute for Aesthetic Medicine and Cosmetology in Mumbai

Shravani Speech & Hearing Centre - Best Speech and Hearing Therapy Centre in Mumbai Dr. M.S. Chandragupta - Best Dental Surgeon in Chennai Artificial Eye Co. – Best Colour Vision Consultants in Kolkata ManipalAnkur Andrology & Reproductive Services – Best IVF and Infertility Clinic in Bangalore

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NEWS Update

Gynaecologists advise influenza vaccinations for pregnant women

here has been a significant rise in influenza (flu) cases over time, resulting in millions being exposed to serious life-threatening health complications. According to data,~5% to 10% of all acute respiratory infections (ALRI)such as pneumonia and bronchiolitis, leading to an upsurge in hospitalizations and even deaths is a resultant of influenza1.

While high risk groups like children have seen a gradual rise in vaccinations, pregnant women are not always advised to take an influenza vaccination. Given the changes in the immune system and heart and lung function during pregnancy, pregnant women face an increased risk of flu complications2. These complications include pneumonia, ear infections, worsening of pre-existing medical conditions such as asthma, diabetes, heart and kidney problems andcan lead to hospitalization1,2,4,. Influenza can also lead to adverse pregnancy outcomes such as low birth weight, premature deliveries, emergency caesarean, still births and neonatal deaths.

- The Federation of Obstetric and Gynaecological Societies of India’s (FOGSI) Committee for Medical Disorders in Pregnancy advise immunization against influenza during pregnancy - Vaccination also defends mothers and their babies from serious health complications Dr. Sheela Mane, Consultant Obstetrics& Gynaecology, Fortis Hospital,says, “It is very important for a pregnant woman to take preventive measures to protect herself and her baby from the complications of flu. Karnataka witnessed an increase in the number of flu cases lately which makes it critical for high risk groups, especially pregnant women

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to take preventive measures to avoid contracting the virus given its contagious nature. The best way to prevent flu and ensure that newborns are immune to the virus is a single shot flu vaccine.The vaccine is safe and effective and will go a long way to protect against severe flu related complications.” Seasonal influenza is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and runny nose. Most people recover from fever and other symptoms within a week without requiring medical attention. But influenza can cause severe illness or death especially in people at high risk3.India has already witnessed a swine flu flare-up that killed a total of 2,167people across different statesand affected 35,077 people as on April 11, 2015. “We decided to include the influenza vaccination in the recommended vaccination list for pregnant women to help increase awareness and diminish the risk of influenza and its severe outcomes. In my practice, I have seen mothers coming forward and getting vaccinated only when there is a scare. This should not be the case as annual flu vaccination is a must and should not be skipped. Influenza can lead to serious health complicationand also cause birth defects and death. Maternal immunization against influenza protects the mother and also safeguards fetal development, ensures maternal health,and reduces illnesses in infants”, says Dr. Leela Bhagwan, Gynaecologist, Cloud Nine, Hospital. According to the World Health Organization (WHO), vaccination against influenza is the most effective way to prevent influenza and its complications. Furthermore, WHO also states that pregnant women constitute the highest priority group for seasonal influenza vaccination.The flu shot has been given to millions of pregnant women over many years and has not been reported to cause any potential harm to either mother or baby. Lack of awareness, overcrowding, poor sanitation and myths about the disease, add to the disease burden. Considering the benefits it has for the mother andinfant, the Association of Physicians of India (API) and the Indian Academy of Pediatrics (IAP) also recommend vaccinating against influenza during pregnancy.

POST EVENT

Excellent Atmosphere at the MEDICAL FAIR INDIA 2015 in New Delhi

Medical Trade Fair registers in excess of 10,400 Trade Visitors

This year the medical trade fair focalised the new segment “Hospital Infrastructure” and kicked off with an accompanying technical conference on the focal themes “Hospital Infrastructure & Planning” and “Medical Device & Technology”. Comprising high-calibre lectures and panel discussions the conference agenda offered decision-makers from clinics, medical professionals, retailers and industry and healthcare agents an ideal platform to learn about trends and network with experts. In addition to the conferences independent workshops allowed the exhibitors to present themselves to the visitors of the MEDICAL FAIR INDIA 2015. The event benefited from the booming Indian health ”Medical Fair India is a one of its kind medical and market which experts expect to grow to US$ 280 billion by healthcare event offering an ideal international platform 2020. Especially in the innovation-driven and export-oriented to the medical and healthcare industry. It is on its way to field of medical device technology India is developing a key becoming the most successful and exceptional exhibition position to which the Government reacted by drafting a new to showcase medical technologies,” summed up Rajiv bill on standards in medical device technology. Nath, Chairman of AIMED, the Dr. Pradeep Bhardwaj, CEO of the Six Sigma Association of Indian Medical Accreditation Board company from Delhi, praised the importance of the event for the Indian health business: “Nice Device Industry. to see the power of the 21st Medical Fair – 2015 in New Delhi, India. Really, this medical fair was an international Guru Prasad platform, which has opened up new opportunities in the Director healthcare industry. The entire medical fair including Business Development & Marketing awards, conferences and exhibitions was highly useful for Messe Dusseldorf India Pvt. Ltd. every hospital, medical device company and diagnostics. I am proud of seeing this event as one of the largest medical fair in healthcare.” n excess of 10,400 international trade visitors, i.e. some 2,400 more than at the previous event, visited the Pragati Maidan exhibition centre to learn about product innovations in the Indian health care sector from 21 to 23 March. However, the MEDICAL FAIR INDIA 2015 not only scored outstanding results in terms of visitor attendance. Exhibitor figures have also been on the constant rise over the past few years. At this event 447 exhibitors from 18 countries presented a comprehensive product portfolio on net exhibition space that has now risen to over 5,250 m². 289 exhibitors from abroad underscored the international importance of the MEDICAL FAIR INDIA, which is held alternately in New Delhi and Mumbai every year.

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POST EVENT

The leading trade magazine for medical professionals in India, Medgate Today, for the first time recognised particularly excellent enterprises, hospitals and physicians as part of the 21st MEDICAL FAIR INDIA. The renowned MT India Healthcare Award was awarded to fourteen Indian companies and individuals. Trade fair visitors included numerous top opinion-leaders from healthcare as well as well-known personalities such as Prof. Dr. Wali, Physician to the President of India, Shailendra Kumar, Director of the Ministry of Health & Family, Government of India, Prashant Kumar, Ministry of Communications & Information Technology, Government of India, Jürgen Maerschand, Government of Flanders, T.S. Srinivasan, Embassy of Belgium and Jan Luykx, Ambassador of the Kingdom of Belgium.

The MEDICAL FAIR INDIA 2015 was supported by national associations such as admi, Association of Diagnostics Manufacturers of India, AHPI, Association of Healthcare Providers India, MSAHITA, Medical Surgical and Healthcare Industry Trade Association, Indian Association of Sports Medicine, Indian Association of Physical Medicine and Rehabilitation and the hospitals Apollo Hospitals Group and Fortis Healthcare Limited.

The international partners attending included abhi, Association of British Healthcare Industries, CCCMHPIE, China Chamber of Commerce for Import 3 port of Medicines & Health Products, Federal Ministry of Economic Affairs and Energy (BMWi), GHE, German Healthcare Export Group, JETRO, Japan External Trade Organization, KMDICA, Korea Medical Devices Industrial Coop. Association, MIRDC, Metal Industrial Research & Development Centre from Taiwan, MREPC, Malaysian Rubber Export Promotion Council, SAMD, Shenzhen Association of Medical Devices, SPECTARIS as well as ZVEI, German Electrical and Electronic Manufacturers’ Association.

The trade fair comes with the MEDICAL FAIR brand that has been synonymous with well-established medical trade fairs organised by Messe Düsseldorf Group abroad. The growing success is also fuelled by the close cooperation with the Düsseldorf-based MEDICA, World Forum for Medicine, which paved the way for dialogue with other important target groups for the Indian market.

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POST EVENT

VII National Seminar on “Hospital & Healthcare Management, Medico Legal Systems & Clinical Research” on 1st and 2nd May, 2015. Symbiosis Institute of Health Sciences (SIHS), a constituent of Symbiosis International University (SIU) organized the XVII National Seminar on “Hospital & Healthcare Management, Medico Legal Systems & Clinical Research” on 1st and 2nd May, 2015. The Seminar was inaugurated byDr. Rajiv Yeravdekar(Dean, Faculty of Health and Biomedical Sciences) Dr. Vidya Yeravdekar, (Principal Director, Symbiosis),Dr. Rajani Gupte (Vice Chancellor SIU),Mr. Anjan Bose(Director General, NATHEALTH), Dr. Santosh Shetty(Executive Director, Kokilaben Dhirubhai Ambani Hospital-KDAH), Mr. Dinesh. Lodha(Country manager& Business head, Samsung)andMr. Anand Deshpande (President, Persistent Ltd.). Dr. Vidya Yeravdekar explainedthe origin of Symbiosis Centre of Healthcare and described the importance of well-being along with education in a student’s life.Dr.RajaniGuptediscussed the changing phase of healthcare economics with a specific impetus on demographics. This was followed by felicitation of the dignitaries and traditional lamp lighting ceremony. Dr. Rajiv Yeravdekarset the Pre Conference Symposium in motion by delivering a key note address on successful Healthcare Models. He shared the plans of future endeavours of Symbiosis in the field of robotic surgery with a special mention on synergy between technology and healthcare. The Pre Conference Symposium continued by way of

www.m e d e g a t e t o d a y. c o m May-June 2015

an entertaining and intellectually stimulating session on “Successful Healthcare Models” which was anchored by Mr. Anjan Bose.Dr. Santosh Shettydescribed the current Indian healthcare scenario and the paramount significance of private healthcare providers in bridging the gap for quality healthcare delivery with reference to KDAH Model.Mr. Dinesh Lodhagave insights into the trends, opportunities and innovations in various verticals of Indian healthcare industry with special reference to medical devices industry which includes Samsung Electronics – 2nd largest MNC in India. Mr. Abdoos Farooqui(Asst. Professor, SIHS)gave an allusive analysis of the growth of Indian pharmaceutical industry, and reiterated is unique advantages over is global counterpart, making it a sunshine industry.Mr. Anand Deshpandetalked about the deluge of advantages that information technology provides healthcare industry in the collection, analysis and interpretation of the medical data.Dr. Adheet S Gogate (Partner and Head, Philips Healthcare, India) spoke about entrepreneurship in healthcare. He described the scenario and opportunities for budding entrepreneurs to enter the healthcare fray. Mr. Dinesh Madhavan (Director, Healthcare Services, and HCG) in the post lunch session gave insights on importance of Branding and Advertising in Health care to survive in the immensely competitive environment. Dr. Sanjay Zodpey (Director, Public Health Foundation of India, PHFI) elucidated the professional and career opportunities in public

POST EVENT

health sectorby drawing contrast between conventional and depletingresources and multiplying needs. modern day public health scenario. Dr. Nimita Limaye (Vice President, Risk Based Monitoring, Dr. Nikhil Datar (Founder President Patient Safety Alliance) CDM, MW and Clinical Operations Services) in her talk briefed about patient safety, medical errors, medical on “Key Trends Transforming the Clinical Trail Industry” negligence and their consequences with respect to both accentuated the approach which involves vertically patient and doctor. Mr. Ajit Golwilkar (Managing Director, integrating Risk Based Analysis internally while outsourcing Golwilkar Metropolis Health Services Pvt. Ltd.)described on-site monitoring via Functional Service Provider Model. the current technological, economical and political scenario She also emphasized on moving beyond transactional of diagnostic care and emphasized upon the challenges cultures to focus on patient centricity and safety. of quality assurance, pricing and local competition. Dr. Dr. Shashikala Gurpur (Dean, Faculty of Law, Symbiosis B.S. Powdwal (VicePresident Operations, Bajaj Alliance International University), Dr. Santosh Kakade(Founder MD Life Insurance) gave a conceptual introduction to Indian and CEO, Core India Institute of Legal Medicine, Pune) healthcare insurance and an insight about various challenges &Adv.Milind Salunke(Legal Consultant, SCHC) talked and opportunities faced by the industry. Dr. Sanjay about transformation of the largely unregulated Indian Gupte(Past President FOGSI & Medical Legal Expert) healthcare sector into a sector which is increasingly coming talked about the special laws related to healthcare such under legal purview and the legal implications of such laws as Medical Termination of Pregnancy act, PCPNDT act, on both the providers and the seekers. Biomedical waste disposal act and various others. The Valedictory ceremony was organized on 2nd May 2015 to Inauguration of XVII National seminar on “Hospital & conclude the two days XVII National Seminar on “Hospital Healthcare Management, Medico Legal Systems & Clinical & Healthcare Management, Medico- Legal Systems & Research” at Symbiosis International University Pune. Clinical Research”. The Valedictory Ceremony was graced (Standing Left to right Dr. Rajiv Yeravdekar, Mr. Dinesh by Chief Guest- Ms. Suneeta Reddy (Managing Director, Lodha, Mr. Anjan Bose, Dr Vidya Yeravdekar, Dr. Rajani Apollo Hospitals Enterprise Limited). The Guest of Honour Gupte, Dr. Santosh Shetty,Mr. Anand Deshpande) for the ceremony was Adv. Ram Jethmalani, (Former Union Day 2 of the National Seminar began with paper Law Minister). The star alumnus award was presented to presentation by delegates. The first session of the day was Dr. Sunil Bandekar (Medical Superintendent, Breach Candy on “Entrepreneurship & Innovations in Healthcare” chaired Hospital Trust Mumbai) &Dr. Mahesh Karajgikar (CEO by Dr. Arvind Chinchure (Chair Professor, SIU). Mr. Sandip Waleed Pharmacy and Stores, Muscat, Sultanate Of Oman), Kapila (Co-Founder, Swasthya India) stressedthe importance for their stellar contributions in healthcare industry. of providing quality healthcare at subsidized and affordable The ISBN numbered “Symbiosis Health Times” was rates thereby mitigating the challenge of rising healthcare released by Ms. Suneeta Reddy who appreciated the efforts costs faced by lower income strata of the Society. of Symbiosis Institute of Health Sciences in organising an The second session on “Healthcare & International relations” by Lt. Gen Dr. M.A Tutakne, (Former VC, SIU)&Mr. Vishal Laroia (Group CEO, Unihealth Global Pvt, Ltd.)outlined the broadening horizons & internationalization of healthcare delivery system. With globalization & the subsequent advent of medical tourism, the requirement of every individual is to seek the best healthcare solutions.

Educative Seminar on a magnanimous level. She talked about India as the centre of healthcare or rest of the world and innovative concept of ancient Ayurveda focusing on skillsets. Adv. Ram Jethmalanimentioned that with better doctors practicing ethically there is no need of law to govern medical practitioners.

Valedictory function was followed by convocation ceremony of PGDHHM, PGDMLS, PGDCR & PGDHIM. The certificates of merit were awarded by Ms. Suneeta Reddy. Around 800 delegates from all over India and some from abroad participated in this seminar. Civil surgeons, district health officers and senior faculty of medical colleges were deputed by the Directorate of Health Services and Concomitantlya session in the convention hall byDr. Directorate of Medical Education & Research, Government Ganesh Divekar (Gm Operations, Bharat Serum) on of Maharashtra. “Quality Systems and SOPs in clinical trials” intensified Valedictory ceremony & release of the Symbiosis Health the importance of adhering to strict, ethical approach in the Times at XVII National seminar on “Hospital & Healthcare conduct of clinical trials and a systematic orientation by way Management, Medico Legal Systems & Clinical Research” of Standard Operating Procedures. at Symbiosis International University Pune.(Standing Left Dr. Vivek Desai (Managing Director, Hosmac India Pvt. to right Dr. Rajiv Yeravdekar, Dr Vidya Yeravdekar, Adv. Ltd.) in his discussion on “Hospitals of tomorrow” divulged Ram Jethmalani, Ms. Suneeta Reddy and Dr. Rajani Gupte) The day continued with a concourse on “Quality comes at a cost!” by Maj. Gen Pawan Kapoor (Chairman , NABH Accreditation Board) who highlighted that though quality comes at a high initial cost, it is the only way to sustain in present and future times as demands of the healthcare seeker is becoming massively quality centric.

the scope of green initiatives and recycling in the era of

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HEALTH UPDATE

Watch out for Food Contamination This year’s World Health Day theme focuses on food safety

Eating out? Getting food in? Beware! Despite necessary quality and hygiene checks you could be the next victim of a stomach infection or worse, a complication which can lead to death. It is for this reason you need to think about food safety at each step – from shopping, to cooking, to cleaning, to storing leftovers to help avoid foodborne illness or food poisoning.

The statistics are enough to make us lose our appetite. As per the World Health Organization, contaminated food can cause more than 200 diseases — and foodborne and waterborne diseases that cause diarrhoea are estimated to kill 2 million people each year worldwide. Food safety, nutrition and food security are inextricably linked. Unsafe food can lead to various health problems like dairrhoeal disease, viral Foodborne diseases encompass a wide spectrum of disease, reproductive and developmental problems and even illnesses and are a growing public health problem worldwide. cancers. They are the result of ingestion of foodstuffs contaminated According to Dr Prof Anil Arora, Director, Institute of with microorganisms or chemicals. Recognizing the urgent Liver, Gastroenterology, and Panceaticobiliary Sciences, need to address this problem, the World Health Organization Sir Ganga Ram Hospital, “Bacteria are the source of much has dedicated this year’s World Health Day on food safety. food borne illness, usually due to improper food handling or cooking procedures. In small amounts, they are not harmful WHO’s five keys to safer food: however the trouble begins when certain bacteria and other harmful pathogens multiply and spread. Contaminated food • Keep clean: may not look, taste or smell any different from foods that are o Thoroughly wash raw fruits and vegetables with safe to eat.” tap water. From production to consumption, there are several

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o Keep clean hands, kitchen and chopping board all potential areas of food contamination. Foods, such as fruits and vegetables, maybe contaminated if washed or irrigated the time. with water that is contaminated with pathogens from animal Separate raw from cooked: or human faeces. Animals naturally harbour many foodborne bacteria in their intestines that can cause illness in o Do not mix raw food and ready-to-eat food. humans, but often do not cause illness in the animals. Most food-borne pathogens are shed in the faeces of infected o Do not mix raw meat, fish and raw vegetables. persons and may transfer to others through food via the Cook thoroughly: faecal-oral route. o Thoroughly cook all meat, poultry and seafood, According to Dr Poonam Khetrapal Singh, Regional especially shellfish. Director, World Health Organization, South-East Asia Region, “Foodborne illnesses are usually either infectious o Reheat all leftovers until they are steaming hot. or toxic in nature. These illnesses may occur through the consumption of food or water contaminated by bacteria, Keep food at safe temperatures: viruses, parasites or chemical substances. Foodborne o Refrigerate cooked food within two hours of pathogens such as Salmonella, Escherichia coli, or preparation Campylobacter can cause severe illnesses or even death. o Never defrost food at room temperature. Defrost Chemical contamination can lead to acute poisoning or frozen food in the refrigerator, cold water or in the long-term diseases such as cancer. Examples of unsafe food include uncooked foods of animal origin, and fruits and microwave. vegetables contaminated with faeces and chemicals.” Use safe water and raw materials: Another route is cross-contamination where pathogens naturally present in one food may be transferred to other o Use safe drinking water for food preparation. foods during food preparation if same cooking equipment o Check use-by dates and labels while buying packed and utensils are used without washing and disinfecting in food. between. Inadequate cooking temperature and improper

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HEALTH UPDATE

storage, that food held or stored at warm (10-50ºC) also important that we ensure the food our plate is safe. Hand allows bacteria to multiply and produce toxins within the hygiene is of utmost importance. Another common habit food. is use of same utensils such as knives and cutting boards The WHO experts have enumerated five key points for for handling both raw and cooked foods. This should be safer food. These include cleanliness, keeping the raw and strictly avoided. Food should be cooked thoroughly and cooked food separate from other foods, cooking thoroughly while re-using cooked food, it should be re-heated properly. especially meat, poultry, eggs and seafood at 70 degrees Moreover, do not leave cooked food at room temperature for Celsius, keeping food at safe temperatures, using safe water more than 2 hours. It should be refrigerated promptly. But prolonged refrigeration is also not advisable. Make it a habit and raw materials. to select fresh and wholesome foods washed well with safe Rekha Sharma, Country Representative and Director, water before use.” International Confederation of Dietetic Associations and former president, Indian Dietetic Association said, “As In most cases of food poisoning, drinking adequate Indians, we cannot resist street food. However, they are fluids, eating small, low-fat meals, and resting is adequate. most prone to contamination. As prevention is better than Antibiotics are not usually recommended but may be used cure, choose street foods sold by clean and tidy vendors and for some cases. In people with persistent diarrhea and/ always insist cooking food in front of you. At home, it is or vomiting, intravenous fluids may be needed to prevent dehydration.

Healthy Food, Healthy Liver, Healthy Life W e know foods like doughnuts and soda can make you fat, but the effects of sugar on liver and brain are far more alarming and most of us are not familiar with. Dietary sugar can damage your liver very much the same way that alcohol can. At its most severe, nonalcoholic fatty liver disease (NAFLD) can progress to dysfunction of liver or liver failure.It is estimated that around 32% of the Indian populace is affected by fatty liver ailment 1.

On the occasion of World Health Day, Global Hospitals Mumbai, India’s fastest growing chain of tertiary care, multisuperspecialty and multi-organ transplant hospitals intensifies the drive on #HealthyFood#HealthyLiver#HealthyLife, backing the WHO theme of ‘Food’. We know that the liver is the engine room of our body, helping us, among many other duties, to digest food and get rid of useless toxins.Excess intake of dietary sugar can create havoc with the liver functioning, and may lead to fat deposits in your liver termed as Non-alcoholic fatty liver disease (NAFLD). Overweight people are likely candidates for NAFLD. Memory loss and diminished cognitive function are often the first symptoms, as the liver loses its ability to filter toxins, which affect brain functioning and can lead to a coma.

Maintaining a healthy weight through eating a well-balanced diet and being active is the best way to prevent NAFLD. The health risks from being overweight or obese can impact on your physical, social and emotional well-being. People with NAFLD who go on to develop cirrhosis are at higher risk of liver failure.

“Although it is not always possible to avoid NAFLD, as some factors such as genetics cannot be changed, you can significantly reduce your risk by exercising as much as you are able to and eating healthy to control your weight,” adds Dr. Samir Shah Head of Department Hepatology, Global Dr. Samir Shah. Hospitals Mumbai says “Non-alcoholic fatty liver disease Better control of existing medical conditions, such as glucose (NAFLD) is a condition causing a variety of liver problems. levels in diabetes, can also help prevent the development While it resembles alcohol-induced liver damage, NAFLD and progression of non-alcoholic fatty liver disease. can affect people who don’t consume alcohol. Obesity, type The best way to avoid NAFLD is to live a regimented life 2 diabetes and metabolic syndrome are major factors leading with regular exercise, watching eating habits and keeping a to the development of NAFLD. Preventing and treating these tab of your health, after all “Health is Wealth”. conditions is the first step in the management of NAFLD.” w w w.medegatetoday.com May-June 2015

AWARD MT INDIA

5th MT India Healthcare Awards 2015 on International Platform

Held at Medical Fair, Pragati Maidan, New Delhi 21st March 2015

edgate today a leading Magazine for medical professionals in India organized “5th MT India Health Care Awards 2015” held alongside Medical Fair India 2015,Pargati Maidan, New Delhi . A galaxy of doctors, healthcare professional, Hospital and companies from all over India participated in the event. Honorable Chief Guest Sri Satish Upadhya (President, BJP Delhi) spoke about the role of doctors in helping the poor section of the society, 14 award winners under various categories received the awards on the occasion. Medgate today focus on every doctor, young entrepreneurs, hospital staff and all people related to the medical fraternity to keep them updated with the rigorous developments of healthcare industry happy to commence this award ceremony. Winners have exemplified excellence amongst their peers in respective Sector and regions. Almost all the winners scored extremely well in our research study due to their dedication towards excellence, dedication, innovation and best ethical practices.

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By competing with the very best from their industry, winners know that their work has been evaluated by the sharpest minds in the industry, and that their services and contribution have truly excelled. These awards intend to inspire others towards big achievements, said Afzal Kamal (Founder & Editor –Medgate Today) Doctors, the second person in the world, who are the first thought of every individual for faith after God, as they are the hands we have to save and treat the best to every person who approaches them. With deep regards from our hearts, we stand here to honor and appreciate their efforts, which is what they deserve. We would like to thank our guest of honor Dr. Girdhar Gyani, Dr. Anupam Sibbal, Dr. Dinesh Batra & Our Juries Dr. M. Wali, Dr. Naveen Nishchal, Dr. Pardeep Bhardwaj, Rajul Garg & Dr. Wale Alabi

AWARD MT INDIA

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VOICE

OF HEALTH CARE

E R A C H T L A E H VOICE OF POLICY THINK TANK

We raise your voice to the concern authority & government Some of Important discussion had in this group are as follows : Shweat PathakMedical is very noble profession but unfortunately now a days it's not. We should fix the MRP for everything in healthcare which will surely reduce maximum number of problems and let's request our health minister to bring ombudsman in healthcare

Manish Rastogi -Dear Mr Sweat, I feel that MRP(maximum reliased price /fee) is going to be next big thing in healthcare. As I said 2/3 days back, MRP would liberate the healthcare and make it affordable for masses. The public at large need "Healthcare Swaraj /Suraaj " Tarun Katiyar More than 60% Hospital and HR Heads feel that the situation will get worse in coming years The‘Via HRx Study on Healthcare Talent Scenario inNorth India,’conducted to map the talent crunch in the healthcare delivery industry and to understand the specifics of the challenges it brings,revealed that Indian healthcare delivery setups are dealing with acute shortage of healthcare professionals and severe challenges in acquiring the right talent.

Manish Rastogi Pl. deliberate : Home Healthcare: is it another version/parallel of e-commerce in Indian Healthcare Industry? Is it value-added geriatrics repackaged as "home healthcare care"? Do Indian healthcare industry bodies have set any Dos and Do nots for "the companies" ushering in this trend ... in already complicated healthcare scenario. Rajiv Nath Home Healthcare is a neglected need and huge scope for medical devices and accessories - India v take care of elderly in joint families as famines become independent and nuclear this need for independent home health care and managing on your own will increase. There is none making even a simple bell calling system or patient night alarm attendant system for example. Dr. Shuchin Bajaj Snapdeal has been issued a notice by FDA for selling drugs online without the prescription of a doctor and without a license pharmacist dispensing it. And guess who is the brand ambassador doing the ad promotion for snapdeal!! Amir Khan!! Should this idiot not be held responsible f0r promotional of a brand involved in dubious activity? Where are the morals of satyamev jayate???

Please evaluate the merits and demerits of this forum. Does this forum offer learning experience or not. What you need to change or suggest about this forum.VoH is positioned as vocal platform on healthcare issues and has a long way to go...Please help VoH to be more objective and effective in its mission. Please offer your feedback, even a “one liner” would be quite insightful info@medgatetoday.com

www.m e d e g a t e t o d a y. c o m May-June 2015

EXPERT VIEWS

QUALITY HEALTH FOR TIER-II: EMERGING METROS OF TOMORROW

“Cygnus Hospitals is a testimony and is now playing an instrumental role in taking healthcare to the next level” Perspective India is at the crossroads of an exciting and challenging period in its history. Making healthcare affordable and accessible for all its citizens is one of the key focus areas of the country today. The challenge is immense, as nearly 73% of the country’s population lives in rural areas and 26.1% is below poverty level. While on one hand, India lacks strong healthcare infrastructure, on the other hand, the country has several inherent weaknesses in its healthcare system. Though the overall level of funding allocated for healthcare nationally is comparatively high (4.1% of GDP), the government’s funding is low (<1% of GDP) compared to other emerging nations. The health care delivery segment is dominated by the private sector in India, with 70% of the total delivery market in India catered to by the private sector. However most of the organized private infrastructure is confined to the state capitals or Tier I cities. Very few have made inroads in Tier II and Tier III cities. This presents the country with both a challenge and opportunity to not only increase the penetration of quality health services but also be the growth driver in these regions. By 2025, India's population will reach 1.4 billion with about 45% constituting urban adult (15 years+). To cater to this demographic change, the healthcare sector will have to be about $100 billion in size contributing nearly 8 to 10% of the then GDP. According to Investment Commission of India, the sector has witnessed a phenomenal expansion in the last 4 years growing at over 12% per annum. As per a recent CII-McKinsey report, the growth of this sector can contribute to 6-7% of GDP. Healthy beginnings! In order to sustain this growth equally in tier-2 cities and district towns of North-India, Cygnus Hospitals in 2011 targeted the untouched and unorganised segment bringing revolution of super-speciality healthcare. The passion to bring accessible and finest quality healthcare at most affordable purchasing parity, led to the foundation of Cygnus Hospitals. Today, the group very proudly Dr. Shuchin Bajaj Director Cygnus Hospitals

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claim of successfully performing over 25,000 life-saving surgeries across 9 hospital locations with 5 in Haryana and 4 in Delhi, since the inception. With this success, the group aim to expand to more geographical locations across northIndia, and bringing positive changes in healthcare to 10 million lives. In order to complement the skills, expertise and resources as well as to alleviate the financing burden for the growth and development of the healthcare sector, the private and public sectors are now working together at a varied pace and working model across the states in India. At Cygnus Hospitals, the team is dedicated to helping experience a lifetime of good health in tertiary healthcare sector. Since their founding, Cygnus Hospitals have remained on the forefront of innovation and evolving to meet the dynamic needs of respective patients, benchmarked to international quality and efficiency standards. Even after 65 years of independence, as a country, majority of the population (residing in tier-II & III towns) are unfortunate and as a result are unable to access quality tertiary healthcare services, especially emergency tertiary care like services for heart attack, or patient suffering from trauma or neurosurgical problems. Citizens in this part of the nation have to travel even from district headquarters to tier-1 cities for treatment of trauma or heart attacks. Team at Cygnus studied this rising demand of healthcare very closely and realized the huge need of emergency services and tertiary care and super-speciality services in district towns of north India and country as a whole. “Demand for adequate as well as quality healthcare facilities was a major stimulus for us to explore these unexplored territories. These cities are underserved as far as medical facilities are concerned. In many cases, people from tier-II cities come all the way to hospitals situated in metros for treatment, which is not always feasible, especially in emergencies.” The group started operations with the intent to serve the people of district towns of North-India and have been successful in these efforts to bring world-class capability, technology and local medical talent in alleviating the burden of diseases. Adding onto this, the management at Cygnus is also delighted to see that the Industry is maturing and that India is well poised to leverage its vast Indian medical talent, technology, infrastructure, systems and processes, to provide world-class medical treatment, with care and compassion, to those 46% patients who have to travel over 100 Kilometres to seek proper primary care; as most diseases have skewed regional/state distribution of prevalence in a country where

EXPERT VIEWS

40% of hospital beds cater to just 10% of population. “Today our hospitals have appropriate infrastructure supporting super speciality services catering to cardiology, neurosciences, joint replacement and intensive and emergency care. In addition to this, we have also set-up Cath-Labs in 3 hospitals with the aim to expand in rest all. The state of Haryana has 21 districts – out of which currently we have presence in 5 and have set-up plans of expanding in others.” We are also poised to expand to Punjab and Rajasthan with plans to venture into many other states and be a 100 hospital group in the near future. Hurdles to leap! Along with the manifold advantages, every investment comes with its package of shortcomings. Experts, though optimistic, are cautious and wary, with the problems of infrastructure and skilled manpower topping the list. As I sum it up, "I would not call them shortcomings, but rather challenges which can be overcome." Challenges for hospitals range from manpower to acceptability and pricing strategies. "Unlike the big metropolitan cities, manpower skill is limited in these cities. Especially in the case of nurses and paramedics where you have to recruit and then train them according to quality standards,". In such a situation, groups usually take in manpower from the larger metropolitan cities to these smaller towns. Here arises another predicament. "Even in such situations, the challenge lies in convincing people to come and work in smaller towns,". Another area of concern is the ability of the masses residing in these towns to shell out the extra penny for the high cost treatments offered. "The ability of these towns to pay is a major area of concern. People here are more used to facilities provided by Government hospitals offering subsidised rates,". "Corporate hospitals will target patients who are covered by medical insurance or who can afford to pay,". It is doubtful whether people are ready to go that extra mile and get quality services at the same time. Ideally in such a situation it is but expected that hospitals should subsidise their rates to suit the needs of the masses. However, hospitals have a different view to offer. "There are a host of factors to be considered when the pricing has to be changed, including the type of investments made like the investment per head, in technology, diagnostics and the level of doctors taken in. So, while changing our pricing structure we have to take all this into consideration. Coupled with this, market forces also play a role,". Despite the obstacles and possible delays in the publicprivate partnership (PPP) models, perhaps it is these private players who can bridge the chasm between the demand and supply in healthcare delivery. Inclusive development! The Team at Cygnus is very passionate about making

quality tertiary health care accessible throughout the district towns of North India. For this the team offer an expansive network of physicians, surgery centres, urgent care centres, and cardiology centres; and also recognize that providing personalized care close to home (especially Tier-II) is an integral part of creating an extraordinary patient experience. When asked that what distinguishes Cygnus, our response is simple. It is the compassion of the highly skilled and devoted caregivers that truly defines brand Cygnus. Their commitment to advancing the state of the art in medicine and approach to care has earned the trust of patients and their loved ones in nine locations across Delhi and Haryana. And the entire team is honoured to be a part of an institution that continues to live its mission every day. As the group is getting prepared for the opportunities and challenges ahead, the team is determined to make decisions based on the needs of our patients and the community. About Dr. Shuchin Bajaj Dr. Shuchin Bajaj deeply believes in the transformative power of healthcare for economic development and has committed his life to bringing a paradigm shift in the quality and accessibility of healthcare delivery system of the country, especially North India. Dr. Bajaj is the founder, promoter and director of Cygnus Hospitals, a group of hospitals that caters to the unanswered tertiary healthcare needs of the communities in the smaller towns and district headquarters of North India. Dr. Bajaj is the recepient of the prestigious Chevening Fellowship at King’s College, London. Recently, he also received the coveted ‘Stars of the Industry Healthcare Leadership’ Award for Excellence in Managing Tertiary Healthcare Centres in Tier-2 & 3 towns. In addition, he has also been honoured and awarded with ‘Healthcare Excellence in Internal Medicine’ Award in Delhi/NCR by World Wide Achievers, a global analytical company and “The Best Consultant in Internal Medicine in Delhi 2012” by the Time Research Media Foundation. On the academic front, Dr. Bajaj graduated from Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak in 1998 and completed his MD in Internal Medicine from Dr. S. N. Medical College, Jodhpur in 2004. Apart from the foregoing, he also did certified professional course on Diabetes Management and Total Control from American Academy of Continuing Medical Education, USA in 2008, Advanced Program in Strategic Management from I.I.M. Calcutta in 2013 and Advanced Program in Cardiac Emergencies from Boston University in 2014. Dr Bajaj is a highly qualified medical scholar and a wellknown name in the medical fraternity. w w w.medegatetoday.com May-June 2015

NEWS UPDATE

Indraprastha Apollo Hospitals assemble Organ recipients at city Press Club to pledge organ donation

To address the important issue of organ donation Indraprastha Apollo Hospitals today organized a press meet which witnessed presence of organ recipients who were given a new lease of life through cadaver organ donations. The event was addressed by Dr Subash Gupta, Chief Liver Transplant Surgeon, Indraprastha Apollo Hospitals who felicitated the organ recipients and highlighted the significance of organ donation. Dr Gupta motivated the patients to pledge organs and spoke about ‘Gift a Life’ initiative of Apollo Hospitals. Organ donation is quickly evolving into a major treatment protocol across all major hospitals. However, it is yet to make a significant dent in India. With each passing year, the gap between the number of organs donated and the people waiting for organ donation is getting larger. Commenting the current status of organ transplantation, Dr Subash Gupta, Chief Liver Transplant Surgeon, Indraprastha Apollo Hospitals, said, “The demand for organ demand outstrips the organ supply. Though we have been slowly picking up, yet despite performing 350 Liver transplants at Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospitals, Delhi this year there have been very few cadaveric organ donations. Apollo Hospitals’ ‘Gift a Life’ initiative beckons needy patients for new lease of life. Organ donation from a single brain stem dead donor can give life to seven patients.”

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Dr Neerav Goyal, Senior Consultant – Liver Transplant, Indraprastha Apollo Hospitals said, “Cadaveric donors largely mean "brain dead" or "heart beating" donors. However in the west about 15% of cadaveric transplants are being performed from organs retrieved from Non-heart beating donors (donation after cardiac death) and recently world’s first transplant of a “dead heart” has taken place in Australia. This surgical technique can significantly increase the number of potential donor organs in near future.” Dr Gupta stressed on creating awareness and motivation amongst masses to make organ donation programme a success. “Though the government has now taken some positive steps regarding organ donation to make it simple for patients, people’s mindset has still not changed. Enhanced awareness among people is needed. Initiatives such as Green Corridor project has helped tremendously in strengthening and empowering organ donation programme. We should build on this initiative and take it up on priority status.” The effective execution of cadaveric organ donation centres on the education of masses and proactive attitude towards cadaveric organ donation. The Government needs to step in with resources to increase awareness and educate the public on importance of organ donation. Apollo Transplant Institutes were created with the aim of providing world class transplant services across the region. Since the first successful liver transplant in India in 1998, the Apollo Transplant Program has performed 21000 kidney transplants & 5600 liver transplants in children and adults till date. Contributing to this milestone, Apollo Delhi has performed 5000 solid organ transplants till date. The high quality - affordable cost value proposition that Apollo Hospitals offer has made them the preferred destination for patients not only from India but more than 30 countries. About Indraprastha Apollo Hospitals Indraprastha Apollo Hospitals, India’s first JCI accredited hospital, is a joint venture between the Government of Delhi and Apollo Hospitals Enterprise Limited. Commissioned in July 1996, it is the third super-specialty tertiary care hospital set up by the Apollo Hospitals Group. Spread over 15 acres, it houses 57 specialties with more than 300 specialists and more than 700 operational beds, 19 operation theatres, 138 ICU beds, round-the-clock pharmacy, NABL accredited laboratories, 24-hour emergency services and an active air ambulance service. Apollo Hospitals Delhi has the leading programme in kidney and liver transplant in the country. The first successful pediatrics and adult liver transplants in India were performed at Indraprastha Apollo Hospitals. The hospital is at the forefront of medical technology and expertise. It provides a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. The Hospital has introduced the most sophisticated imaging technology to India with the introduction of 64 slice CT and 3 Tesla MRI, Novalis Tx and the integrated PET Suite. Indraprastha Apollo has also pioneered the concept of preventive health check programmes and has created a satisfied customer base over decades. The Hospital has been consistently ranked amongst the best 10 hospitals in India by The Week survey for the past few years.

DOCTOR SPEAK

Encephalitis Huge Epidemics can happen during Summer months.. and Northern India Rates of infection in the 3 to 15 year age group are five to ten times higher than in older individuals, because of high background immunity in older individuals. Epidemics in non-endemic regions have affected all age groups, but a bimodal age distribution (young children and elderly) has appeared, indicating an increased risk in elderly people. Encephalitis is inflammation of the brain. Viral infections are the most common cause of the condition. Encephalitis can cause flu-like symptoms, such as a fever or severe headache. It can also cause confused thinking, seizures, or problems with senses or movement. However, many cases of encephalitis result in only mild flu-like symptoms or even no symptoms. Severe cases of encephalitis, while relatively rare, can be life-threatening. Because the course of any single case of encephalitis can be unpredictable, it's important to get a timely diagnosis and treatment. Protection for young children from Encephalitis The best way to prevent viral encephalitis is to take precautions to avoid exposure to viruses that can cause the disease: • Practice good hygiene. Wash hands frequently and thoroughly with soap and water, particularly after using the toilet and before and after meals. • Don't share utensils. Don't share tableware and beverages. • Teach your children good habits. Teach your children to practice good hygiene and to avoid sharing utensils at home and school. • Get vaccinations. Keep your own and your children's vaccinations current. Before traveling, talk to your doctor about recommended vaccinations for different destinations. Protection against mosquitoes and ticks To minimize your exposure to mosquitoes and ticks, follow these tips: • Dress to protect yourself. Wear long-sleeved shirts and long pants if you're outside between dusk and dawn when mosquitoes are most active and when you're in a wooded area with tall grasses and shrubs where ticks are more common. • Apply mosquito repellent. The Environmental Protection Agency (EPA) has registered a number of products containing certain chemicals that repel mosquitoes.

Dr. Rajiva Kumar

Child Specialist, Muzaffarpur

The registered chemicals are DEET, IR3535, lemon eucalyptus and picaridin. Products with higher concentrations of the active ingredient provide longer protection. Lemon eucalyptus isn't recommended for use on children younger than 3 years old. Mosquito repellents can be applied to both the skin and clothes. To apply repellent to your face, spray it on your hands and then wipe it on your face. If you're using both sunscreen and a repellent, apply sunscreen first. • Use EPA-recommended insecticide. The EPA also recommends the use of products containing permethrin. These products, which repel and kill tics and mosquitoes, are sprayed on clothing, tents and other outdoor gear. Permethrin shouldn't be applied to the skin. • Avoid mosquitoes. Refrain from unnecessary activity in places where mosquitoes are most prevalent. If possible, avoid being outdoors from dusk till dawn, when mosquitoes are most active. • Keep mosquitoes out of your home. Repair holes in window and door screens. • Get rid of water sources outside your home. Where possible, eliminate standing water in your yard, where mosquitoes can lay their eggs. Common problems include flowerpots or other gardening containers, flat roofs, old tires and clogged gutters. • Control mosquitoes in standing water. Fill ornamental pools with mosquito-eating fish. Use mosquito dunks — products that are toxic to mosquito larvae — in birdbaths, ponds and garden water barrels. • Look for outdoor signs of viral disease. If you notice sick or dying birds or animals, report your observations to your local health department. Protection for young children Insect repellents aren't recommended for use on infants younger than 2 months of age. Instead, cover an infant carrier or stroller with mosquito netting. Tips for using mosquito repellent with children include the following: • Always assist children with the use of mosquito repellent. • Spray on clothing and exposed skin. • Apply the repellent when outdoors to lessen the risk of inhaling the repellent. • Spray repellent on your hands and then apply it to your child's face. Take care around the eyes and ears. • Don't use repellent on the hands of young children who may put their hands in their mouths. • Wash treated skin with soap and water when you come indoors. w w w.medegatetoday.com May-June 2015

DOCTOR SPEAK

LIVER SURGERY- AN UPDATE The last three decades have witnessed a quantum leap in the field of hepatic surgery. From a surgery which was performed occasionally and at a few centres with high rates of complications and mortality, it has transformed into a routine procedure done at many specialized centres with complication rates similar to most other major surgeries. The two major types of liver surgeries are liver resections and liver transplantation. Liver resections A liver resection is the surgical removal of all or a portion of the liver. It is also referred to as a hepatectomy,. The procedure may be performed through a traditional open procedure or using minimally invasive techniques.liver resectios are usually performed for tumors in the liver which could be benign or malignant. Some of the common indications of liver resections are as follows: Malignant: •

Hepatocellular carcinoma- caused due to hepatitis B, hepatitis C, cirrhosis, non -alcoholic steato hepatitis (NASH). Only about 15-20% patients are candidates for a liver resection.

•

Liver metastatic disease- over the last 10 years, due to advances in chemotherapy and surgical techniques, a lot of patients with liver metastases have been resected successfully. This is especially in cases of liver metastases from colon and rectal cancers and neuroendocrine tumors . some of the other cases where liver resections for metastases are performed are renal cell carcinoma, ovarian cancer and breast cancer but the scientific evidence is still not as clear as the colorectal or neuroendocrine.

•

hilar cholangiocarcinomas- most of these tumors at the bile duct confluence are trrated with a liver resection since the tumor spreads along one of the ducts.

Dr. Ganesh Nagarajan,

Consultant - Gastroenterology Surgery, P.D. Hinduja Hospital & MRC

www.m e d e g a t e t o d a y. c o m May-June 2015

•

gall bladder cancer- a commonly found cancer in India especially in the northern parts which needs liver resection around the area where the gall bladder lies . in some cases, a formal hepatectomy is required if the major blood vessels or bile ducts on one side are involved by the tumor.

Benign : Most benign conditions like cysts and hemangiomas do not need surgery and can be observed. Some of the indications of liver surgery for benign conditions are if hemangiomas or cysts are symptomatic, adenomas of liver since they are premalignant conditions. Some parasitic cysts also need surgery. Investigations prior to liver surgery A complete work up is necessary since a liver resection is a major surgery lasting for a few hours. The most important investigations are a liver function test, coagulation profile and a CT scan or MRI to map out the liver anatomy. For most resections, it is essential that the coagulation and liver profile are normal. The CT scan/MRI tell us about the anatomy of the liver and the involvement of the blood vessels and bile ducts along the liver. The basic principle is to leave behind adequate functioning liver tissue while removing all the tumorous liver. Technical aspects All liver resections require general anaesthesia. Incisions are on the upper right abdomen and can vary from a bi-subcostal to an L-shaped incision. Special retractors are used for adequate exposure. Specific instruments like the harmonic scalpel , CUSA, waterjet are used for the resections. Results are best in centres which perform these surgeries routinely since all the necessary equipment is usually available and the anaesthetist and nursing staff are used to the finer nuances of these surgeries. Complications Bleeding is the most feared technical complication and may be grounds for urgent reoperation. Biliary fistula is also a possible complication, albeit one more amenable to nonsurgical management. At times, an endoscopic biliary stent may be required. Pulmonary complications such as atelectasis and pleural effusion are commonplace, and dangerous in patients with underlying lung disease. Liver failure poses a significant hazard to patients with underlying hepatic disease; this is a major deterrent in the surgical resection of hepatocellular carcinoma in patients with cirrhosis.

DOCTOR SPEAK

Liver transplantation This is one of the most complex abdominal surgeries performed. Liver transplant involves removal of a diseased cirrhotic liver and replacing it with a new liver or part of a liver. The donor liver can be procured either from a cadaveric donor who is brain dead and whose family opts to donate his/ her organs. The other option is a living donor who is a close relative who opts to donate part of his/ her liver for the patient. In India presently, living donor liver transplant is much more common. Most commonly, liver transplant is performed for patients with advanced cirrhosis due to various causes like hepatitisB, hepatitis C , alcoholic liver disease, NASH, etc. it could also be for certain liver cancers like Hepatocellular carcinoma which fall within the stipulated criteria for transplant. Patients who are not eligible for a liver transplant are those with a severe active infection, poor general condition, ongoing substance abuse, poor cardiac or pulmonary risk status. As far as the living donor is concerned, an entire range of tests are needed . first and foremost, the blood group has to be compatible. The donor is assessed medically to ascertain complete fitness. Then , the CT scan and MRI are performed to have an in depth assessment of the liver anatomy of the donor . only if all the parameters are normal and the anatomy is favourable , the donor is considered for donation. All the pros and cons are explained and only after ascertaining that the donor is donation of his own free will without any pressure or coercion is he cleared for donation. Liver transplant is a surgery which is a team effort and involves 2-4 surgeons, a liver transplant hepatology physician, intensivist, specialist liver transplant anaesthetists, interventional radiologist and ancillary staff like phisiotherapists, dieticians, nurses etc. After the transplant, the patients are monitored in the ICU for 2-3 days and then kept in a separate ward since they are on immunosuppression. These patients are on medications to keep the immune reaction of the body in check so as to prevent a rejection of the graft. This in turn, predisposes these patients to certain infections especially in the early post operative period. Success rates of liver transplant are fairly good with more than 90% patients going home after the surgery and long term 5 year survivals of above 80%.

w w w.medegatetoday.com May-June 2015

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Common infections during summer & measures of their prevention Hyperthermia a group of heat-related illnesses ranging from heat exhaustion to heat stroke happens when the body overheats. Older adults and very young children are more susceptible to hyperthermia; because of lose of their ability to dissipate heat. Chronic medical conditions, such as heart disease, poor circulation and obesity, medications, such as those for high blood pressure, heart disease and depression can diminish an older person's ability to respond to heat. Any older adult suffering from cramps or early signs of heat exhaustion, such as heavy sweating, weakness, dizziness or nausea should also seek medical treatment. To prevent heatrelated illnesses, avoid exerting yourself outdoors during the hottest hours of the day, and seek air conditioning on hot days and drink eight to nine glasses of water a day. However, consult with your physician on how much water you should drink if you were told to limit fluid intake for a condition such as congestive heart failure, kidney or liver disease. Boils- Increased sweating during summer months with tight clothing for prolonged periods predispose to this condition & also the increased risk of fungal infections. Daily bath at least twice daily with loose fitting clothes may reduce the risk. Appropriate antibiotics/ Antifungal may be required in consultation with doctor. Allergy- Summer can be a dangerous time for kids and adults with asthma. More smog and air pollution, high pollen levels causes a spike in asthma attacks. Sun allergy and heat allergy there are many other types of allergies are seen. Timely & appropriate institution of anti asthmatic drugs can control the symptoms well. Food &Water Borne Diseases-Water borne diseases like Cholera, Typhoid, Jaundice, Dysentery, Amoebiosis, Diarrhea and many more are commonly seen especially among those who are used to eating outdoors. Bacteria thrive in warm and moist environment and so food poisoning and occurrence of diseases due to food infection is more during summer days. Older adults, young children and anyone with a weakened immune system may be more susceptible to food poisoning. It can be devastating for those with one or more chronic conditions e.g. Hypertension, Renal failure, Diabetes etc .Loss of water volume and electrolytes due to a diarrheal illness can cause dehydration, as well as kidney, heart and muscle problems for older adults. Prevent food poisoning by frequently washing your hands and cooking surfaces, not allowing foods and utensils to become cross

www.m e d e g a t e t o d a y. c o m May-June 2015

contaminated, cooking foods to their proper temperature, keeping perishable foods refrigerated or in a cooler with ice. Food left out of refrigeration for more than two hours may not be safe to eat. In temperatures higher than 90 degrees Fahrenheit, food should not be left out for more than one hour. Tips for Preventing Summer Illnesses are 1. Avoid giving cut fruits and food items from roadside vendors. Also avoid cooking spicy and fried food items. Stick to fresh fruits, green vegetables and fresh fruit juices. 2. Encourage to increase intake of water. Make sure that the water is properly purified. Lemon juice, coconut water and other natural fluids are always good. 3. Take food rich in fiber. Pay attention to their diet and right nutrition. 4. Wear light weighted and loose fitting clothes preferably made of natural fibers. 5. Exercise early in the morning or late evening to avoid over exhaustion. 6. Make sure you take care of sun safety, water safety and insect safety measures during summer season. Mosquito Borne Diseases-Accumulation of water here and there generates the number of mosquitoes and hence dengue, malaria and other diseases caused by mosquito bite are commonly seen. An insect repellent, soybean oil can help to prevent mosquito bites. Wear light-colored clothing and avoid using any scented soaps or other products on your body, since the fragrances can attract insects. Avoid areas with insect nests. Keeping doors & windows closed in evenings, using mosquito nets in night are some other measures. Last but not the least, Naegleria fowleri- free-living, thermophilic, can cause amebic meningoencephalitis, a rapid and usually fatal infection. It affects children who swim in warm, polluted and stagnant water, such as a lake or poorly chlorinated swimming pool. By - Dr. Rajesh Kumar Consultant Internal Medicine Paras Hospitals, Gurgaon

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Metropolis Healthcare reports Ovarian Cancer Data O arian cancer has emerged as one of the most common cancer affecting women in India. An analysis of samples collected over the past two years (2013-2014) by Metropolis Healthcare Ltd reveals that a total of 7945 tested positive for high CA125 levelsout of the 36,515samples processed at Metropolis Healthcare in Mumbai.

According to Indian Journal of Cancer, 1 out of 5 women are prone to ovarian cancer.The majority of ovarian cancers arise from the epithelium (outer lining) of the ovary.9 out of 10 ovarian cancers are epithelial ovarian cancers.A host of factors affects female ovaries such as family history, age, obesity, fertility drugs, personal history and hormone replacement therapy (HRT). Ovarian cancer is a highly aggressive cancer and is one of the leading causes of women's death. It is an important cause of morbidity and mortality, especially in the middle aged women. Development of cancer cells in ovary accounts for about 4% per cent of all cancers in women.Certain inherited gene changes (mutations) can increase the risk of ovarian cancer. These include changes in the BRCA1 and BRCA2 genes. If you have inherited a mutation of one of these genes from either parent, your chances of getting breast and/or ovarian cancer increases. Ovarian cancer is difficult to pick up as symptoms likeabdominal pain, persistent bloating and difficulty while eating are extremely common conditions in the disease. Accurate ways to detect ovarian cancer early could have a great impact on the cure rate. If a woman has these symptoms more than 12 times a month, she should see her doctor, preferably a gynecologist. Cancer Antigen – 125 test or popularly known as CA-125, assesses the concentration of this protein in the blood. Doctors may suggest a CA-125 test if they suspect ovarian cancer, endometrial, peritoneal or fallopian tube cancer. CA – 125 is a screening and monitoring test marker.However CA-125 has a low specificity & positive predictive value as it can be elevated in other cancers involving pancreas, breast, bladder, lung, and liver & in benign conditions like diverticulitis, endometriosis, pelvic tuberculosis, pleural effusion. Combining other detection methods like transvaginalsonography and rectovaginal pelvic examination increases the accuracy of detecting ovarian cancer. A CA125 test result of greater than 35 U/ml is generally accepted 54

www.m e d e g a t e t o d a y. c o m M November ay-June -D 2015 ecember 2014

as being elevated.CA125 test is one of the first tests doctor orders if he suspects early symptoms of Ovarian Cancer. Commenting on the study, Dr.Deepak Sanghavi, Deputy Chief of Lab Services, Metropolis Healthcare said “In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer isn't identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system.Women who have their first full-term pregnancy after age 35 or who never carried a pregnancy to term have a higher risk of ovarian cancer.Breastfeeding may lower the risk even further. Fertility drugs with no outcome or hormone therapy after menopause is also linked to the disease. Mutations in BRCA1 and BRCA2 are also responsible for most inherited ovarian cancers.” Several advances in biomarker discovery and development have now led to additional tools that may be useful in the clinical management of women with adnexal masses, with recent FDA approval of Risk of Ovarian Malignancy Algorithm index popularly known as ROMA index gives a fair indication for the risk of ovarian cancer in pre- and postmenopausal women with a pelvic mass.The ROMA test is intended for use in women who meet the following criteria such as over 18 years of age, have an ovarian mass,surgery is planned or not yet referred to an oncologist (Source: Indian Journal of Cancer, American Cancer Society) *CA-125 (Reference range: All values between 0-35 U/ml is considered normal and values above 35 are out of the normal range. Clinical correlation is suggested

DOCTOR SPEAK

Mumbai is a hotspot of vectorborne diseases With the peak season for Malaria fast approaching it is essential that Mumbaikars, arm themselves with information to help combat the deadly disease “A continuing theme from last year is Invest in the Future, defeat malaria a part of the WHO initiative, holds the limelight for this year’s World Malaria day. They aim is to completely irradiate the ailment even if the number of cases is reducing year by year, a lack of awareness and preventive measures is still a major cause for concern. Improved awareness initiative programmes, will help to control this fatal disease. The nature of the disease is as such that is difficult to detect, and is not picked up in the first two blood samples. Due to this, there are several cases of patients landing in hospitals with lung, heart, liver problems.

tests. Transmission of malaria can be prevented with the use of mosquito nets and insect repellents. Although no vaccine exists yet, development is in progress. Severe malaria is treated with quinine or artesunate and mefloquine. By - Dr. Rajkumar Chaudhary Hon.Secretary, Association of Hospitals Preventive measures •

Mumbai is a hotspot of vector-borne diseases owing to its unique environment and demographics. Mumbai is densely packed slums and these areas are always disproportionally impacted. Although the infection rates are high, many peoplecannot afford anti-malarial drugs, repellent or use mosquito nets. A major chunk of these individuals live below the poverty line and are unable to procure sufficient amenities to protect themselves and their families against Malaria”

Use of mosquito net over beds at night. An Insecticide net, which is a specially medicated preventive barrier that has been treated with chemicals to kill mosquitoes. It does not have any ill effects on humans. It has to be in a good condition with no holes and is properly tucked in to be effective.

•

Sprayingthe room often with an insecticide before sleeping.

•

April 25, World Malaria Day demarcates an effort towards spreading awareness about malaria and its prevention. Following arepreventive measures, and common symptoms of this deadly disease

Wearing loose-fitting tops with long sleeves, trousers and socks when out at dusk or at night. Light color clothing is better because the mosquitoes are attracted to darker areas.

•

Apply a reliable insect repellent containing diethyltoluamide (DEET) to skin and clothes. Local pharmacy can advise on a good one. If you are using sunscreen, it should be applied first and the insect repellent second. The repellent will not work if you cover it with a thick layer of sunscreen. Alternatively, use a sunscreen that contains a repellent.

•

Cover bedroom doors and windows with finemesh netting. Use air-conditioning or a fan in the room, as mosquitoes are less active in cooler temperatures.

•

Mosquitoes thrive very well in humid, hot corners. This means an environment with constantly wet grass, stagnated water in cans (rubbish), puddles and stagnant water, etc will provide fertile grounds for mosquitoes to breed and multiply. Keep doors and windows clear of things that mosquitoes can hide in. This will prevent them from breeding

Symptoms The symptoms start around 7-10 days after being bitten by a carrier mosquito. The patient feels fatigued, has bouts of fever every few hours, shivers even when the outside temperature is normal, and suffers from headache, diarrhea, nausea, and vomiting. If immune system is weak, the symptoms may get triggered sooner than usual. On severe signs of thesesymptoms it is pertinent to undergo tests and get a proper diagnosis as soon as possible. Malaria can be cured easily if diagnosed at an early stage. It is exceedingly difficult to treat malaria if it is in an advanced stage because the parasites keep on reproducing, leaving the body prone to further infections. The disease is normally diagnosed by the examination of blood using blood films or with antigen-based diagnostic

w w w.medegatetoday.com May-June 2015

DOCTOR SPEAK

Fatty Liver Disease to surpass Hepatitis B & C as a cause for Liver Transplant & Liver Cancer • To emerge as major cause of liver failure • 2 Lakh people die annually in India due to end stage liver disease • Launch of Fatty Liver Clinic to generate awareness about liver diseases

he Hepatology team at Global Hospitals - one of the fastest growing chains of multi-super specialty, multiorgan transplant and quaternary care Hospital in India has found in their day to day practice that the incidence of liver failure has increased in patients suffering from Fatty Liver Disease (FLD) as opposed to patients with Hepatitis B & C. Liver diseases are the 9th leading cause of death in India next only to diabetes. Experts in Global Hospitals have discovered that more and more cases of liver failure are happening due to FLD; and the incidence of liver failure due to Hepatitis B & C is declining gradually. Another interesting fact is that the number of patients with Non- Alcoholic Fatty Liver Disease (NAFLD) are increasing compared to alcoholic fatty liver disease. There are over 100 types of liver diseases and most of these diseases are called silent killers as they have a long gestation period.

Speaking about Liver Diseases, Dr. Samir Shah - HOD, Hepatology, Liver Intensive Care & Transplant Hepatology, Global Hospitals, Mumbai said, “Liver is the most important part of the human body which plays an important role in many bodily functions from protein production and blood clotting to cholesterol, glucose and iron metabolism. Almost 50% of the liver problem cases seen by us for evaluation of liver transplant had fatty liver disease. Out of these around 60% had NAFLD and 40% had Alcoholic Liver Disease. NAFLD could be caused by obesity, eating junk food, lack of exercise, Diabetes, high cholesterol, metabolic syndrome etc. About 3 to 4 out of 10 Indians have fatty liver which is often ignored or people are not even aware that they have it. Spotting the trend, we realized that FLD will be a major cause for liver failure very soon. WHO on the occasion of World Health Day has adopted the theme of Food Safety – From Farm to your Table. Improper and untimely snacking, bingeing and sedentary lifestyle, with little or no exercise are causing lot of liver diseases.” 56

www.m e d e g a t e t o d a y. c o m May-June 2015

Dr. Ravi Mohanka - Chief Surgeon and HOD, HepatoPancreato-Biliary Surgery and Liver Transplantation said, “Due to vaccination for Hepatitis B and effective medications now available for both Hepatitis B and C, the incidence of liver failure due to them has been on decline. Alcoholic and non-alcoholic Fatty Liver Disease could also lead to cancer and liver cancer is the 3rd leading cause of cancer related deaths in the world. If this damage is not controlled at this stage by lifestyle changes, it may progressively lead to liver cirrhosis, requiring a liver transplant. The problem becomes more complex due to the fact that the numbers of organ donors are very less compared to people in need of a transplant. On an average, it may take few months to a year to get a liver for cadaveric transplant. It is also common to find family members of patients to have fatty liver and therefore not suitable for living donor transplant.” Taking cognizance, Global Hospital Mumbai will be opening a Fatty Liver Clinic. It will offer comprehensive and holistic liver care at one place. Consultations with experts in hepatology, endocrinology, dietetics, physical trainers, liver and bariatric surgeons will be followed by a patient specific plan. They will be given nutritional goals, exercise goals and monitored closely, evaluated periodically to check the health of their liver. Dr. Shah said that experts will also deliver talks and conduct camps to create awareness about the menace of liver disease in the general public as well as in the corporate sector through various initiatives. We would be visiting the societies in the vicinity and educating the residents of causes of liver disease and preventive measures to be taken. We will also be targeting schools during their Parents Teachers Association gatherings and create awareness among parents as well children. We would be encouraging more and more people to come forward for organ donation.

EXPERT VIEWS

The role of EMS is Vital - Acute Medical Care is need of hour in Earth Quake During the time of major disasters like earthquake, building collapse, fire etc., the role of emergency medical services is vital. By the time the emergency response teams equipped with search and rescue personnel reach the place, the first hour i.e., the golden hour is critical wherein a lot of lives can be saved if immediate first aid and medical care is available. The role of emergency medical services thus becomes important from the view point of disaster management.

erms Such as the Golden Hour and the Platinum the minutes typify the importance of emergency medical services (EMS) all over the worlds.

In India, Many Private Hospitals and Public Partnership Ambulances Are Using Medical Equipment And Devices in Ambulances Compliant With international Standards as ISO It is well-accepted fact that a patient who receives Emergency 9001, ISO 13485, CE Markings with Respect to European Medical care from trained Professionals and transported to Directives 93/42/EEC And Also EN1789 standards. Various National and International Games, Sports, and the nearest healthcare Facility immediately in an emergency other Events in India Were Seen Having Latest and Advanced has the Greatest Chance of Survival. Emergency Medical Services in Terms of advanced Life Emergency Medical Service is an essential Part of Support Ambulances. the overall Indian healthcare System as it saves lives by Today in India the Focus of Emergency Medical Services Providing Immediate care. is not Only Limited to transportation Patients, victims it is this Recognition that has led to research and to Nearest Hospitals but also to Provide Immobilization, Development in EMS and Special Ambulance for Special Resuscitation Suction, Oxygen Therapy, and onsite Needs is the New Concept in the Indian Healthcare industry. Diagnostics Either Through Ambulances, Responder Cars, Installation of Emergency call boxes on national or Trained Para Medics . Highways, Provision of by-lanes, ambulances available on The Focus Should Also Be on What An Ambulance Highways, Toll Numbers, and Emergency Call Numbers on Should be like- a Chassis Cab or a Monocoque, size of the Sign boards Along Various Roads to Handle the Emergencies Vehicle, its Fabrication, Panels applications, Norms, and and accident victim in the Golden hour are the Recent Standards for Medical Devices and its Exteteriors. Developments in Indian EMS. Moreover, Improved EMS system and ambulance also the Formulation of National Emergency Medical services to Provide Responsive Emergency care to Patients Services Network and National Ambulance code is being and victims can Ensure Saving Lives But this must Be Pursued in India, as Currently in its Absence the Focus is Affordable, Easy to Use, and Effective and consider the Missing on the Quality of Ambulances and ambulance Socio- Cultural Realities of the Country. Equipments. Recently a Indian state has just launched bike International Congress And Exhibitions on EMS ambulances which will provide crucial medical support to Products And Service Have Also Provided the way for the patient in need till the four wheeler ambulance arrives. Evolving Better Emergency Medical care Systems in India. The service will be very useful in congested areas with heavy With The Medical Council The specialty, There are traffic, where a four-wheeler is unable to reach on time. Huge Opportunities for Personnel in this area, Especially Nurses, Para Medicine Specialized Doctors. Pre-Hospital Emergency care in the Form of Ambulances is one of the Key Factors in Improving the Quality-of Healthcare as Emergency Cases Rise Due to Accidents and Terrorist Activities. In Indian Ambulance Services Healthcare Providers Incorporate Efficiency and Enhance Services to Increase the Number of Vehicles, Impart Proper Training And Incorporate Technologically Advanced Devices in Ambulances.

Manish Malik

CEO, Spencer India Technologies Pvt. Ltd.

w w w.medegatetoday.com May-June 2015

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How organised & indigenised is Indian hospital planning & designing

is not about the wrong choice, but there is lack of better specialists & also affordability from the client’s point of view. It’s also true that not every promoter could afford the services of a Hospital architect/consultant but rest assured that hiring a consultant does not have to be an expensive proposition. There were times when the doctor used to complete the project on his own by making handmade drawings & passing it on to the contractor who would then execute the whole project. But with times, there was introduction of a designer who would assist the doctor in giving a better shape to the building & improve the efficiency by giving a better design. At a larger level, there are companies providing Hospital planning & designing services at the same time taking up turnkey projects too. This way, there would be better coordination among the designing & executing teams for the smoother completion of the project.

he Indian market of Planning & designing a hospital hasn’t seen a larger growth in the olden days. It is only in the last one decade that the some of the promoters of the hospital have started approaching the specialist designers who are specifically designing hospital projects/buildings. Traditionally, Contractors & doctors use to complete almost everything related to the planning & designing of the hospital and there was no scope of a hospital project consultant or a specialised hospital architect. But with time, a need was felt for the availability of a specialist due to the growing competition to make the hospital building look bigger, better & more cost-efficient from the operations point of view. This resulted in the doctors turning towards hospital architecture specialists & hiring their services. Even then, the Planning & designing of the hospitals still remains stagnated at the urban level & hasn’t penetrated at the semi urban & lower levels. People still prefer their local designers of commercial & residential buildings to design their hospitals. The question

Dr. Vinod Singh

Founder & Consultant, Hospitech Health Care Consultancy

www.m e d e g a t e t o d a y. c o m May-June 2015

Typically, a project needs not just an architect but also a business consultant. Alternatively if the consultant is experienced in Architecture too, then this is best option to hire his team for all the services. A consultant actually acts as a catalyst for change because he brings about new perspective in the project. Many a times, people do not understand the requirements & limitations involved in designing a healthcare facility. There are also times when hospital promoters understand planning & designing as a very complex & confusing issue to be hiring a consultant or hospital designing specialist. Hospital facilities aren’t built for today but for the next 10 years time. Hospital promoters need to understand whether they want to hire a specialist for their dream project or go with their own designs & with lesser expertise involved. In order to stay in the competition, one needs to understand the need for a better infrastructure which is crucial to the project’s survival in the future. With this, the hospital has a bright future to handle any kind of competition in the business. In addition to spotting key changes and trends in the external environment, there are multiple internal benefits a hospital can realize from a strategic planning process of the hospital. A well-crafted, properly executed strategic plan can provide numerous intangible internal benefits for an organization's culture, working environment and employees. In the dynamic healthcare operating environment of today, with expectations of hospital operating performance growing, the benefits create a compelling case for hospital strategic planning. In short, Promoters should hire a consultant/Hospital designing expert if they want to move from a mere “Survival strategy” to “Growth strategy” for their hospital business.

DOCTOR SPEAK

CABG IN CARDIAC PATIENTS N

on-communicable diseases are a major barrier to economic growth and social development of any country.Out of all non-communicable diseases, Coronary artery disease (CAD) and Diabetes mellitus (DM) tops the list. Cardiovascular disease is the leading global cause of death, accounting for 17.3 million deaths per year, a number that is expected to grow to more than 23.6 million by 2030. With Improvement in medical facilities , there is increase in life expectancy , which resulted in increase of disease prevalence, and improved technology resulted in decreased physical activity , which eventually is the root cause of CAD and DM. Recent data clearly suggests that overall Incidence of CAD and DM is increasing also,Its an well established fact that Diabetic patients are more prone to develop CAD (risk of CAD is 2 to 4 times higher in diabetic patients).In Indian Population, CAD now occurs prematurely i.e, 10 to 20 years early than west. Out of all Deaths occurring due to CAD in all developing countries, 25% belong to India only and prime cause of deaths in diabetic patients is CAD. Diabetic patients are more prone to develop complex coronary artery lesions(triple vessel disease, left main disease). So, diabetic patients require more focus, not only to early detect CAD but treat it as well (if intervention is required). G we found metals, we made machines. G we found love, we made humanity. G we found sickness, we made medicine. G we have been chasing dreams and turning them into reality!

G ever since we learnt to question! Numerous studies show that CABG is gold standard in diabetic patients who got CAD. •

CABG, compared to Percutaneous Intervention (PCI).

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Syntax Trial : Supplements Freedom Study, That CABG Is The Treatment Of Choice In Complex CAD Disease Patients.

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Freedom trial:(2005-2010) showed that M.I ,Death, Revascularization and Stroke rates All Are Less In Patients Undergoing CABG Compared To PCI.

Economically if we see results in freedom trial no doubt, total cost for hospitalization of CABG was higher per patient compared to PCI but Over next 5 years, follow-up and cumulative costs were higher for PCI mostly due to repeat revascularization. CABG being complex surgery, is an extremely safe procedure in expert hands .At present era medical science advanced to such a level that beating heart CABG are conducted routinely, preventing all the complications of Heart Lung Bypass machine. After a short recovery period patients improve significantly in terms of cardiac complaints. In gist prevention of diabetes mellitus and coronary artery disease is very much possible, with life style and diet modification, however in Diabetic patients having complex coronary lesions, CABG is the treatment of choice.

Dr. Y.K. Mishra

Director Department of Cardiovascular Surgery Fortis Escorts Heart Institute

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Summit on “India: The Future Global Healthcare Hub”

1st May 2015 at PHD House, New Delhi

oreign Trade & Investment Committee and Health Committee of PHD Chamber of Commerce and Industry jointly organised the Summit on “India: The Future Global Healthcare Hub”, with the support of the Ministry of External Affairs, Government of India, on 1st May 2015 at PHD House, New Delhi. H.E. Mrs. Gennet Zewide, Ambassador of Ethiopia to India was the Chief Guest in the Inaugural Session. H.E. Prof. Sudharshan Seneviratne, High Commissioner of Sri Lanka to India was the Chief Guest at the Valedictory Session. Around 150 representatives from the industry, including 20 diplomats, participated in the event. Mr. Saurabh Sanyal, Secretary General, PHD Chamber welcomed guests and stated the increasing consciousness about healthcare amongst Indians pertaining to factors like increase in population and phenomenal increase in per capita income. He requested the guests to observe a two minutes silence for the victims in the Nepal earthquake and requested the participants to come forward and contribute generously. The Inaugural Session was presided over by Mr. Sanjeev Sardana, Chairman, International Affairs Committee for Africa, PHD Chamber. Mr. Sardana mentioned about the

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increasing role of the healthcare sector in the Indian economy generating both revenue and employment. He said that India is now becoming a preferred medical destination for patients from Africa and Asia, prime reasons being the availability of well trained medical professionals and cost effectiveness. He also mentioned that to maintain the current position the sector needs to cater to problems like visa issues, lack of proper SOPs for patient care, quality and hygiene concerns, lack of post treatment care to the patients. Mr. Nishant V. Berlia, Chairman, Health Committee, PHD Chamber in his theme presentation highlighted that due to certain advantages of highly skilled doctors, reduced costs, low waiting periods, better services and increased compliance to international quality standards, India is moving to become one of the most preferred destinations for healthcare services and medical wellness. He talked about the initiatives taken by the Government as well as the private sector in promoting this sector. While addressing the Inaugural Session, H.E. Mrs. Gennet Zewide complimented the Indian Healthcare sector on their becoming one of the preferred medical destination for patients around the world. She mentioned that patients from Ethiopia have now shifted to India from countries like South Africa and Thailand, the reasons being well trained medical

POST EVENT

professionals, updated technology and cost attractiveness. She discussed that although India is the preferred destination for patients from Ethiopia, the major concern is the lack of a formally organised body that can eliminate the hassles linked with intermediaries and medical brokers. Other issues included inflated billing mechanism, charging heavy facilitation costs, trust issues, information mismatch and absence of a proper follow up mechanism.

develop the Healthcare facilities public private partnerships are very important. He mentioned about the MoU signed between India and Rwanda in the healthcare sector which has provisions for technology transfer, exchange programmes, training, etc. He spoke about the successful Indian investments in Rwanda like Dr. Aggarwal Eye Hospital. He stated that for secondary healthcare service Rwanda public systems are not fully equipped and in this area a lot can be learnt from India whose regulations are well in place. He mentioned that apart from cost effectiveness, less waiting periods and ease of contact with doctors make India a preferred medical destination. He said that the ease of contact has a positive effect on the patient’s emotional condition. He concluded by saying that for long term relations elimination of brokers is a must and both the countries should work towards building a strategic partnership.

She suggested setting up a legal body that would take care of the patients needs upon arrival in a transparent manner. She said that many patients travel from Ethiopia and other African countries for super critical care facilities. She indicated that Ethiopia would offer 100% FDI benefits for Indian professionals that intend to explore the country for setting up of hospitals and other healthcare facilities with concessional land and incentives including tax schemes to suitably protect the Indian investments in the health sector. H.E. Mr. El Hadj Ibou Boye gave a brief overview of the Mr. Vivek Seigell, Senior Secretary, PHD Chamber thanked healthcare sector in Senegal. He mentioned about the new Her Excellency Mrs. Gennet Zewide, Ambassador, Embassy economic and social strategy plan of Senegal gives utmost of Federal Democratic Republic of Ethiopia for bringing out importance to healthcare development. He said that the critical points which can serve as direction for the conference new plan aims at holistic development of the healthcare in next technical sessions and can also act as future action scenario. He invited Indian investments to Senegal and points for the chamber and the Government. He emphasized mentioned the benefits available to them. Benefits include on India – the Future Global Healthcare Club, should not same treatment to foreigners and nationals, no employment be confused with Medical Tourism as when a patient comes issues for expatriates, guarantee of transfer of profits and for a surgery it is anything but tourism. He also talked about capital and also ensuring complete property rights. He the importance of leap of faith the patient takes when he/ spoke about the need of developing healthcare industry in she comes to a foreign country for treatment and it is the Senegal and asked for partnership from India in upgrading medical technology, providing training, creating centres of country’s responsibility to fulfil their expectations. excellence, telemedicine, amongst others. Mr. Himanshu Baid, Co-Chairman, Health Committee, PHD Chamber delivered a vote of thanks to the guests and H.E. Mr. Mawxell Ranga spoke about the cordial assured the house that the Chamber will work towards the relationship Zimbabwe shares with India. He mentioned objective of creating India and a reliable global healthcare about the presence of a huge Indian community there with Indian doctors manning hospitals and also running hub. their private clinics. Zimbabwe also imports drugs and Technical Session-I was on Care and Concern Areas pharmaceuticals from India. He said that although a large for Foreign Patients where several Ambassadors and amount of patients come from Zimbabwe to India for other diplomats - H.E. Mr. Ernest Rwamucyo, High treatment, the aim is to improve the healthcare delivery Commissioner of Rwanda to India; H.E. Mr. El Hadj Ibou system in Zimbabwe. The major challenges as mentioned by Boye, Ambassador of Senegal to India; H.E. Mr. Mawxell him are dubious agencies imparting incorrect information to Ranga, Ambassador of Zimbabwe to India; Mr. Mongy the patients and diagnostic issues. He suggested setting up of Aly Mohamed Badr, Minister, Economic & Commercial a medical tourism council that can have registered agencies Bureau, Embassy of Egypt; and Mr. Syed Zirgham Raza, in different countries that will ensure smooth monitoring First Secretary (Trade), High Commission of Pakistan - by the embassies. He also invited Indian investors to set up elaborated on the areas of cooperation between India and diagnostic centres in Zimbabwe and to develop strategic their respective country in the healthcare sector and on the partnership with their hospitals and various departments concerns and issues being faced by them, with regard to The Summit was concluded with a vote of thanks by Mr. quality, costs and post treatment care. Sastry, Co Chairman, Committee on AYUSH, PHD Ms Shabnam Pareek, Secretary, International Affairs, PHD Chamber to the Chief Guest, Ambassadors, speakers and Chamber moderated the Technical Session - I delegates. H.E. Mr. Ernest Rwamucyo stated that for every nation its The event was followed by a Networking Cocktail Reception. healthcare is one of the most important areas. He said that to w w w.medegatetoday.com May-June 2015

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HOW CAN YOU PREVENT MODERN LIFE STYLE DISEASES?

(Obesity, Hypertension, Diabetes, Heart Disease, Non Alcoholic Liver Disease)

etabolic syndrome is not a disease but a group of conditions that place you at risk of developing heart disease, diabetes and other serious ailments including fatty liver disease. Those conditions are high blood pressure, high blood sugar, high triglyceride and cholesterol levels, and increased abdominal fat. Having any of them is bad but two or more become alarming.

and other Asian countries predominate among them. It is estimated that in Indian approx 61.3 million people are suffering from diabetes. Even its South Asian neighbours like Bangladesh, Nepal, Afghanistan and Sri Lanka have fewer diabetics. That is why India has achieved the dubious distinction of being called the world diabetes centre. Globally, diabetes caused 4.6 million deaths in 2011. Diabetics and These risk factors double your risk of blood vessel and heart obese people are more prone to develop chronic liver disease disease, which can lead to heart attacks and strokes. They which ultimately result in untimely and early death. increase your risk of diabetes five times. HEART DISEASE – A MAJOR KILLER Fatty liver disease is another menace arising from metabolic syndrome which can become fatal in some patients. Today being the World Liver Day, we wish to highlight the high morbidity and mortality associated with fatty liver disease and focus on ways to prevent it as well as other components of metabolic syndrome. Fatty liver appears in a number of people because of a variety of conditions. Most of them are benign and harmless. However, when fatty liver is associated with metabolic syndrome and is accompanied by inflammatory reaction in the liver (raised blood levels of liver enzymes) the setting is made for progression into chronic liver disease. This sequence of events is covered in an all encompassing term – NAFLD (nonalcoholic liver disease). That is briefly discussed in this communication as also seperately in an accompanying write up.

It is estimated that about 166 per 100,000 people in India die due to ischemic heart disease (a condition which is characterized by reduced blood supply of the heart muscle) and around 116 per 100,000 people in India die due to cerebrovascular diseases.

OBESITY

NON ALCOHOLIC LIVER DISASE

Around, 74 percent of urban Indians face the risk of heart attack, with their heart age greater than biological age. Fifty nine percent of those in the 30-49 age group have high risk levels of cholesterol and 61 percent of them have dangerously low levels of ‘good’ HDL cholesterol. Uncontrolled hypertension, smoking, excessive drinking and sedentary life styles are other contributing factors for increased number of heart diseases. There is a misconception among young generation that smoking acts as a stress buster. It actually reduces a person’s stamina in the long run leading To begin with however, I give below the alarming statistics to the development of multiple diseases, particularly chronic related to prevalence of metabolic syndrome in India. lung disease, heart disease and cancer. Thirteen percent of women and 9% of men in urban India are overweight or obese. They face increased morbidity and mortality because of a number of complications including obstructive sleep apnoea, diabetes, hypertension, coronary artery disease, cerebrovascular disease and nonalcoholic steatohepatitis.

The liver cells get clogged up with excess fat (triglycerides) as a by product of increased insulin resistance. Over time that causes inflammation of the liver cells which leads to cirrhosis of the liver and in a A small fraction of them may be related to genetic factors small percentage of case even or hormonal disorders but the majority are because of bad to liver cancer, analogous eating habits (high calorie fast food and lack of exercise). to what happens in alcohol induced fatty liver disease. Thus, obesity should be preventable in the majority. DIABETIC CAPITAL OF THE WORLD According to the World Health Statistics report 2012, 11.1 percent of the adult male population and 10.8 percent of the female population have raised fasting blood glucose. India

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DR. RAKESH TANDON Medical Director & Senior Gastroenterologist PSRI Hospital, New Delhi

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This has indeed become the number one cause of chronic liver disease in the industrialised world. In India, the prevalence of NAFLD in the general population varies from 10% to 30%. In people with metabolic syndrome however, the prevalence is much higher; 15-80% among obese people, 25-60% in patients with dyslipidemia and 33-55% in pre diabetics and diabetics. The underlying factors are believed to be the same as for other lifestyle disease ie excess calorie intake and lack of physical exercise and the only effective treatment is reversing these factors. In addition, supportive treatment is required for the complications of liver disease. What causes metabolic syndrome ? •

Inherited genetic tendency towards insulin resistance

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Being overweight

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Being physically inactive

Note: While you cannot change the genetic inheritance, the other two are preventable. What can you do to prevent or reverse metabolic syndrome? •

Looseweight

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Become physically active

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Eat healthily to keep blood pressure, cholesterol and blood sugar levels under control

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Stop smoking

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Cut down on alcohol

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If your blood sugar or cholesterol levels are high, consult your doctor to start treatment to control them.

OTHER LIFESTYLE DISEASES Stress plays a big role in causing acidity. A job that keeps you on tenterhooks or a gnawing problem at home can cause acidity. Children trying to enter into competitive sports may become stressed to perform well constantly. A recurring acidity problem, despite acid suppressants, may lead to vitamin deficiencies and cancer of the esophagus. Spending time excessively in front of computer may lead to neck and back pain. People working in night shifts suffer from a disturbed biological clock leading to insomnia, indigestion, acidity, loss of appetite, headache, irritability, hypertension, mood fluctuations and body pain. Those having late night parties also experience the same with some additional effects of untimely munching, drinking and

smoking. Alternation in the circadian rhythm of a person compromises his immunity, further leading to various opportunistic diseases. It is important that parents watch out for signs of psychological strain, as well as physical fatigue from overtraining in their children. Young athletes may also have specific nutritional needs that requires extra attention. Often they are misled by trainers to take excessive amounts of protein that may compromise the functioning of liver and kidneys. TREATMENT The onset of these lifestyle diseases is insidious; they take years to develop and, once established, do not lend themselves easily to cure. Thus they require regimented and individualised treatment comprising a combination of drugs, diet and physiotherapy. Importance of each of these components of treatment differs from disease to disease. For example, in case of diabetes and heart diseases, drug therapy plays a dominant role whereas in that of obesity and fatty liver disease, diet and physical exercise are most important. In addition, a healthy lifestyle must be adopted to combat these diseases with a proper balanced diet, physical activity and by giving due respect to biological clock and body requirements. PREVENTION Most of the lifestyle diseases are preventable and reversible to a large extent with adoption of a healthy lifestyle including a balanced diet, regular physical activity and avoidance of excessive alcohol consumption, smoking and drug addictions. Some sort of physical activity every day for at least 10-15 minutes is extremely necessary to keep healthy. Healthy lifestyle is best incultated in childhood at home, Habits formed at that stage stay for ever. Emphasis should be laid on engaging kids in outdoor activities and games. Watching movies on television while munching potato chips should be replaced by outdoor picnics and games.

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INTERVIEW

India should adopt universal access to essential healthcare for all We are always talking about to make healthcare Accessible, affordable to all. Health is an important component of human development. Access to affordable healthcare is critical for the empowerment of people. Today we find that healthcare is neither accessible nor affordable. How will this be ensured?

Progress over the last few decades. However challenges are still many and the work has to go on. One of the important enabler of accessibility, affordability and availability is information technology….IT has transformational potential in healthcare. Therefore, NATHEALTH and NASSCOM are working together for progress of healthcare of the Nation.

Healthcare in India currently faces the unique challenges of poor access, low affordability and high variation in quality.

The Medical Devices Industry in India is unregulated. There is no regulatory body or institution to regulate it? Please give your opinion.

It’s time to review the current health system; India must take lessons from systems (multiple archetypes exist, each with varying degrees of effectiveness) and adopt an India –centric health system that is capable of powering economic development in India. India should adopt universal access to essential healthcare for all, with provision being led by the private sector, and the government shifting towards a payer and regulator role, with provision support focused on under-served areas/segments. As access expands, India should proactively manage the risk of healthcare cost inflation and ensure affordability for a defined basket of essential services. Minimum assured quality standards need to be defined and institutionalized, with ensuring regular data capture at points of care, and tracking and measurement of outcomes, moving towards protocol-based care. In conclusion I would like to say that Indian healthcare, both in Government and in private sectors, have made impressive

The Medical devices Industry is definitely not unregulated and there are various Government departments and agencies that oversee and administer the regulatory processes. Some examples are in the areas of X-Ray (BARC), PNDT Act, various regulations and controls exercised by DOP, DCGI and others. How do you see India moving ahead in the healthcare sector front in the next five years or a decade? My aspiration is that, India in the next 5 years will be a healthy India, where citizens will be health aware and engaged, and will have equitable access to affordable health coverage with a focus on prevention, early diagnosis and assured minimum quality care, offered by a vibrant and sustainable ecosystem of public and private players. I also foresee that, with encouragement and support from the Government, there should be the possibility of many ‘Make in India’ MedTech projects coming up… this should have a positive impact on availability and affordability of healthcare with acceptable quality. Medgate Today magazine , India’s foremost healthcare magazine is celebrating its 6th Anniversary .On this occasion say few words .

Anjan Bose

Secretary General Health Care Federation of India (NAT HEALTH)

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What is your personnel experience share it readers ?

to our

I wish Medgate all the very best to be a ‘healthy’ stakeholder in India’s progress in healthcare. As part of India’s Media fraternity, Medgate will need to be aware of and true to its role of being responsible, constructive and positive.

INTERVIEW “We have to create proper infrastructure for doctors in the rural areas and security is also to be provided. Doctors should be paid adequately at par compared to their counterparts practicing in the cities if they have to retain in rural areas.”

Dr. Jagdish Prasad Director General Health Services Government of India

Now coming to the basics of medical and healthcare sector in India, how do you see the present status of healthcare in the country? Are you satisfied with the initiatives taken by the past and present governments to improve the healthcare of the citizens?

country and there is a special Ministry under the Government of India which is taking proper care of the problem of STs and in the same way all the State Governments are trying to improve their health status and health care system. It definitely requires strict monitoring to implement the health The present status of the health care in the country varies. In delivery system. some parts of the country it is very good i.e. Southern States Health is an important component of human development. (Tamilnadu, Kerala, Karnataka etc.) and in other parts of the Access to affordable healthcare is critical for the country it is not good (especially in North–Eastern states). empowerment of people. Today we find that healthcare is We are satisfied with the initiative taken by the past and neither accessible nor affordable. How will this be ensured? present Govt. to improve the health care of the citizens. It is not true. Health care is an accessible and affordable in As I see today there is a great rural-urban divide in healthcare the public sector. Lots of initiatives have been taken by the sector in the country. The condition of primary healthcare Central Government under NRHM to make the health care in rural areas is deplorable. According to a PWC report in accessible and affordable for example different facilities 2013, nearly 70 percent of India’s healthcare infrastructure have been provided in the rural areas. Pregnant women is concentrated in the top 20 cities or what we call Tier 1 are given incentive to give the delivery in hospitals. Total cities. How can this ever widening urban-rural divide be expenditure from delivery to child care is taken 100% by the tackled? Government. There are central health programmes which There is a definite wide gap of health care facilities between screen the children for 32 diseases and for their problems. urban and rural areas. It is also true that health care Government of India provide the funds. We have also taken infrastructure is concentrating in few cities of the country. initiative by opening 6 AIIMS like institutions in different However, to tackle this problem first of all we have to stop the parts of the states like Patna, Jodhpur, Raipur, Bhopal, expenditure in becoming a doctor from private sector. We Bhubaneshwar and Rishikesh. It has been planned to open have to create proper infrastructure for doctors in the rural more AIIMS like institutions so that tertiary care facility can areas and security is also to be provided. Doctors should be made available at affordable cost to the majority of the be paid adequately at par compared to their counterparts citizens. practicing in the cities if they have to retain in rural areas. Public spending on medical, public health, and family According to National Rural Health Mission there are welfare in our country is much below than what is being presently 84.33 million Scheduled Tribes in the country. provided in other countries less developed than ours. On the The health status and healthcare systems in states having contrary private health sector spending is rather increasing. significant tribal concentration such as Bihar, Jharkhand, The low levels of spending are adversely impacting the Orissa, Andhra Pradesh, Maharasthra and others is a matter of creation of preventative health infrastructure. In your views great concern. What are your views? Is anything substantial how can this be overcome. being done by the Centre and respective state governments? Preventing health infrastructure does not require money. It The health status and health care system in states having requires awareness by educating people. Many diseases may significant tribal population such as Bihar, Jharkhand, be prevented by educating and imparting awareness about Orissa, Andhra Pradesh, Maharashtra etc. is definitely a tobacco, alcohol, junk food, physical exercise, meditation matter of great concern. Both Central and State Govts.want and yoga etc. This does not require money. These can be to improve the health status of the population. There is a practiced at home. Central and State Governments have to separate budget provision for the development of tribals in the create awareness for these things for better implementation.

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CONCEPT OF OPTIMUM SPACE FOR INPATIENT WARDS IN INDIAN HOSPITALS The term “Healing environment” implies creating an environment, physically healthy and psychologically appropriate which would indirectly contribute to patient’s well being. Indoor environment of the inpatient wards play a critical role in recovery of the patients, where in light has the most significant role in modeling this indoor environment. The achievement of certain standards of comfort is often considered a vital ingredient for the maintenance of human health (defined as a total sense of physical, mental and social well-being). (Chappell’s, 2004). Heather Chappells and Elizabeth Shove in their research paper on ‘Comfort – A review of philosophies and paradigms’ have stated that although ‘comfort’ is a controversial (people’s perspective from varied climatic backgrounds) and contested issue because of many theories and researches, yet this issue is of much importance to the construction of sustainable buildings, cities, lifestyles and societies.

In the era where technology is working at par to deliver healthcare successfully, with advancement in clinical procedures, pre and post-operative care and more sophisticated equipment, it seems uncertain whether the Riggs model would be able to accommodate the clinical needs in terms of space planning and functionality. It should also be noted that most of the patients that require treatment in wards need to be assisted to the treatment rooms, but limited workforce and large wards make the situation difficult, hence most of the clinical procedures are performed on the bedside.

There is also variation in standards for inpatient facilities at national (India) and international level. Internationally, where wards are deigned as a 24-bed unit with 50% of single bed accommodation and 50% multi bed (4 beds in a room) occupancy wards. Nationally (in India)the requirements are fulfilled by more number of multi bed (6, 8, 10 or 12 beds In India, the space and functional planning of Inpatient in a room) occupancy wards than single beds. Although the wards lays back to the Nightingale and Riggs model. The scenario is population based yet we must not forget that reason being a population of 1.2 billion people where comfort and need of the patients remain the same. primary healthcare is unavailable to all. A Nightingale The Indian guidelines mention on a broader perspective model with around 15-20 beds in a bay(room) and a Riggs the minimum standard of bed space per patient as 7sqmt per model with 4 to 6 beds in a bay(room) seems to be a more bed in general ward and 10.5 sqmt per bed in an ICU. There economical and easy to deliver care option. The literature is barely any evidence how Indian standards detailed the bed reveals that since 1966 the Riggs model by Macaulay has space allocated as 7 sqmt per bed in purview of care provided been adapted and is in use till date. A lot has been done to by the clinicians and healthcare workforce. Secondly, all improve the overall delivery of healthcare but nothing so departments do not have surgical procedures; hence some of far has been explored to detail the Riggs model in terms of them require daily monitoring at regular intervals only while space and functional planning. The only other model used others undergo pre-operative and post-operative procedures is the single room accommodation ward, but it would be or clinical care. uneconomical in terms of project costs, construction, land requirement, and functional issues keeping in mind that the It is to be understood that when all departments have different type of carerespectively, then the allocation of a workforce availability is limited in the Indian context.

Ms. Preeti Chauhan, is a leading healthcare architect and planner with more than 15 years of experience in handling major projects in the healthcare sector, ranging from teaching hospitals to full-service medical centres with almost 1000 beds experience. Ms. Chauhan is Associate Director "DDF Healthcare Consultants-Redefining Healthcare" based in New Delhi, India. She has a background of architecture with masters in twon planning. She is also a masters degree holder from London South Bank University,UK in planning building for health. She runs the Research and Development department in DDF Healtchare. Preeti Chauhan Associate Director DDF Consultants

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generic 7sqmt of space for all bed wards seems impractical. For example a gynecology and obstetric ward might suggest a cradle next to the mothers bed while an orthopedic surgical patient might require regular dressing or some physiotherapy treatment in ward. On the contrary, a skin or ENT patient (comparatively mobile and needs no assistance most of the time) would require lesser space than the former departments. This is to suggest that all ward units cannot be designed with a single universal standard. Each department would depend on its clinical procedures (both medical procedures and nursing procedures) to derive the right standard for a bed space.

advancements in surgical techniques. This means new and more sophisticated equipment would be required, not only for operating procedures but as well as for post-operative care. It is to find what types of surgical procedures are more prominent in Indian Public hospitals? What kind of equipment is being used presently and in line for future? What type of space is required for permanent bedside equipment and mobile equipment for medical clinical procedures along with the workforce required in performing these inpatient procedures? As we know that mostly the post-operative surgical patient is immobile and would require clinical support from the day of the admission, hence the space standard around the bed would not only cater to the maintenance and housekeeping and transfer or personal care but primarily clinical procedure space(both medical and nursing), equipment planning (both stationary and mobile) and workforce management (both regular and specialized).

A discussion document â&#x20AC;&#x2DC; ward layouts with single rooms and space for flexibilityâ&#x20AC;&#x2122; by efm-evidence is a well detailed document on the bed unit space standards that define a bed space and its ergonomics (dimensional study) regarding general procedures in a bed space like changing of bed linen, general monitoring of blood pressure and temperature, meals for the patient, assisting to toilets etc. then there are transfer With a 7sqmt per bed space in India and around 15.25 procedures from the hoist, trolley or a wheel chair. sqmt per bed space in UK, Indian standards need revision To further compact the design and lower the space to raise the bar of minimum space standards. The standards of the ward unit the internal circulation space has been must consider that all departments require separate space squeezed together to bring the ward unit area down to 73.5 standards based on the kind of clinical care required. sqmt, which in an alternate layout has been further reduced DDF Healthcare has been researching on this topic for to 61.0sqmt of space.Per bed space would be 15.25 sqmt. the past few years with specific focus on the orthopedic The document further details the bed unit space as below. and gynecology and obstetrics ward. Eminent hospitals This detailing explains the area as defined in initial picture. from northern India were researched and surveyed with Although the detailing is based on practical approach, questionnaire and observation study. The analysis revealed yet it can be noted that the space standards derived are with that for the Orthopedic, gynecology and obstetrics or respect to patient assistance, housekeeping, and dietary other departments requiring more clinical care bedside and transportation requirements only. This document does and for patients who require assistance both pre and post not mention specifically in its derivation and analysis of operative, the space per bed should be 11.0 sqmt. rather optimum space standards, the requirement of space for all than the standard 7 sqmt., as per Indian standards. DDF is clinical procedures, whether medical or nursing.With the still continuing their research in this prospect to conclude extensive types of surgical procedures being done in India a document that devises a concept optimum space for each as of now, future technology holds good for new technical healthcare department separately. The quest is onâ&#x20AC;Ś

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“

Unfortunately, medical treatment is ineffective in majority of patients. Aspirin is usually prescribed for most patients. It is also important to keep the patient well hydrated, and not do any activity, which causes hyperventilation.

’’

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Brain bypass procedures: a cure for patients with moyamoya disease

ypass surgeries are usually associated with heart; however, there are conditions when the brain does not get adequate blood supply, causing strokes. One of these conditions is called Moyamoya disease, which is a rare disease affecting both children and adults. Overview Moyamoya disease is characterized by idiopathic occlusion of both internal carotid arteries (ICAs) in the brain, along with formation of multiple small collateral circulations at the base of the brain. These small collateral vessels appear as a puff of smoke on angiography, and hence the name, moyamoya (puff of smoke in Japanese) disease. The disease was initially described in Japan, and was thought to be limited to the Oriental population. But recently it has been reported from all over the world, including the USA, Europe and India. Moyamoya disease is common in both children and adults. In children, it presents with strokes, or transient ischemic attacks. Typically it is precipitated by hyperventilation, crying or doing any activity in which brain requires extra blood flow. On rare occasions, there are children who have complained of having transient neurological symptoms after having spicy food! In adults, this disease manifests both as stroke or transient ischemic attack, and hemorrhage. The hemorrhage is usually due to rupture of the fragile small perforators at the base of the brain.

EXPERT VIEWS

There are two kinds of surgical revascularization, Indirect and direct. Indirect revascularization involves placement of al the tissues which are supplied by the external carotid artery (ECA), including the superficial temporal artery (STA), dura, muscle over the surface of the brain. The most common procedure that is performed is called EDAMS (encephalo-duromyo-synangiosis), which involves placement of the STA, muscle and dura over the brain, in order to promote new vessel formation in the brain, and prevent future strokes. It is a simple surgery, however, the revascularization is delayed, unpredictable and sometimes inadequate. It is mostly efficacious in children, however its efficacy in adults has not been established yet.

The gold standard of treatment of this disease is STA-MCA bypass, along with indirect bypass. Basically, the attempt is to increase the blood flow to the brain by diverting the blood vessel supplying the scalp, and attaching it to the artery supplying the brain. In this surgery, the superficial temporal artery is harvested, and cut distally. Following this, a suitable recipient artery in the brain is isolated. This artery Other than that, patients can have headache, seizures or is the cortical branch of the middle cerebral artery. The cognitive decline as their symptoms. superficial temporal artery is then anastomosed to the middle cerebral artery branch under high magnification and using Natural history very fine (10â&#x20AC;&#x2122;O) sutures. This is a very specialized surgery, Left untreated, majority of patients are at risk of repeated involving multiple important steps, designed to improve the strokes, or hemorrhages, or both. The annual risk of stroke circulation of a chronically ischemic brain. in a patient who has had an ischemic symptom is as high as 10-15%. It is estimated that 65% of patients will have a The surgery, as stated above, is fairly safe and effective, the stroke within 5 years of the first symptom. There is high risk morbidity and mortality from the procedure is less that 2%. of repeat hemorrhage in patients who have bleed as their first More than 95% of patients are free from their symptoms following the surgery. presentation. We at Manipal Hospitals have the largest experience of doing bypass surgeries of the brain. The team of neurosurgeons, stroke neurologists, neuroradiologists, specialized stroke nurses and neurorahabilitation experts work as a team to provide excellent care to these patients. We have operated Treatment more than 75 patients with moyamoya disease, performing The mainstay of treatment, in absence of any effective over 125 revascularization procedures with excellent medical treatment, is surgical revascularization. Data has outcomes. shown that surgical revascularization reduces the stroke risk Apart from moyamoya disease, bypass surgeries can be used from 10-15% per year to 1% per year. The surgery is quite for complex intracranial aneurysms, stroke patients and safe as well, with less that 2% risk or perioperative stroke, patients with chronic ICA occlusion. and less that 1% mortality. Unfortunately, medical treatment is ineffective in majority of patients. Aspirin is usually prescribed for most patients. It is also important to keep the patient well hydrated, and not do any activity, which causes hyperventilation.

w w w.medegatetoday.com May-June 2015

DOCTOR SPEAK

Role of Beta-Blockers in Heart Failure

eart Failure (HF) is a clinical condition where the heart is unable to meet the body's metabolic demands as a result of impaired cardiac pump function, which can either be due to systolic dysfunction (HFrEF – Heart Failure with Reduced Ejection Fraction) or diastolic dysfunction (HFpEF – Heart Failure with Preserved Ejection Fraction). Heart failure is considered a major economic burden worldwide with significant morbidity and mortality, despite advancements in treatment modalities in the recent years. The hospitalization rates and the morbidity associated with the disease are on the rise. The cost involved in the treatment is also enormous compared to the treatment of other chronic diseases. Due to these challenges, despite the guidelines laid out, treatment for most of the patients remains inadequate.

The aim of heart failure treatment must be targeted to relieve signs and symptoms, thereby prevent recurrent hospitalization and improve survival. Three major neurohormonal regulators - ACE inhibitor [or angiotensin receptor blocker (ARB)], a beta-blocker, and MRA (mineralocorticoid receptor antagonists) that play a significant role to slow or prevent progressive worsening of HF, must be considered in every patient in combination with a diuretic (to relieve congestion).

that can trigger apoptosis, worsening of ventricular function and increased susceptibility for life-threatening arrhythmias. The ACE inhibitors, angiotensin receptor blockers and aldosterone antagonists target the RAAS while β blockers mainly aim at the SNS. It is possible to reduce the sympathetic influences that stimulate chronotropy (heart rate), inotropy (contractility), dromotropy (electrical conduction) and lusitropy (relaxation) by blocking the beta receptors. β blockers or beta-adrenergic blocking agents act on the beta-adrenergic receptors and inhibit adverse effects caused by the adrenergic drive on the myocardium. Mechanism of β blocker effects: There are 3 beta receptors: β1 receptors are predominant in the heart (and kidney) while β2 receptors are found in vascular and bronchial smooth muscle and β3 receptors are located in the adipocytes and heart.

This review aims at projecting the beneficial effects of beta blockers (β blockers) as these agents still remain underused despite overwhelming evidence in their favour. Gaffney and Braunwald had initially cited reasons that anti-adrenergic effects on the failing heart would further worsen the disease. However, Waagstein and colleagues were the first to report improved survival rates with β blockade therapy. Neuro-endocrine activation: Increased activity of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) has been observed after a myocardial insult, which supports a damaged heart. However, prolonged activation of these compensatory mechanisms leads to ventricular remodeling

Blocking β1-receptors in the sino-atrial node and the myocardium reduces heart rate and contractility respectively. In the kidney, it inhibits the release of renin from juxtaglomerular cells and thereby reduces the activity of the reninangiotensin-aldosterone system. Blockade of beta-receptors in the brainstem inhibits the release of neurotransmitters and decreases sympathetic nervous system activity. Possible beneficial actions of beta-blockers in CHF

Dr. Vishal Rastogi

Head & In-charge Advanced Heart Failure Program Centre for Advanced Heart Failure - Fortis Escorts Heart Institute, New Delhi

www.m e d e g a t e t o d a y. c o m May-June 2015

DOCTOR SPEAK

• • • • • • • • • •

Reduce sympathetic tone Increase vagal tone (↑ coronary blood flow and decreased myocardial oxygen demand) Normalize high phosphorus energetic imbalance Reduce subendocardial ischemia Reduce renin release (When combined with ACEI/ ARB, β-blockers augments RAAS inhibitors) Improve myocardial work/oxygen consumption ratio Reduce endothelin production and release Reduce inflammatory cytokines Suppresses ventricular arrhythmias Antioxidant effect

Evidence supporting use of β blockers in patients with HF: β-blockers continue to be underutilized in spite of compelling evidence supporting the safety and efficacy of the agent. The reason behind this underutilization could be the transient negative inotopic effect of beta blockade that could lead to decompensation in patients with acute decompensated heart failure.11 Evidence based β-blockers (carvedilol, metoprolol succinate XL, bisoprolol and nebivolol) are the cornerstone in the treatment of heart failure. Several randomized trials have showed beneficial effects of β-blockers and few even demonstrated significant reductions in mortality, far exceeding that of even ACE-inhibitors. In 1998 there was a meta-analysis of 18 double-blind placebo-controlled trials including the MDC, CIBIS and carvedilol trials that had 3,023 patients. The overall reduction of total mortality from chronic beta blockade was 32%, with a 41% reduction in sudden deaths and a 37% reduction in hospitalisation. Myocardial function and remodeling: Studies have shown improvement in ejection fraction with long time use of β-blockers and the results are much more impressive than with ACE inhibitors. Improvement in contractile function, diastolic function, reduction in mitral regurgitation and reversal of remodeling was noted, all with long time use. The MERIT-HF study also showed

significant reduction in SCD attributable to the combined effects of central and peripheral systems by reduction in ventricular wall stress, reduction in ischemia and decreased sympathetic activity with an increase in vagal tone, all that would otherwise provoke arrhythmias. Waagstein et al., in their study found an improvement in ventricular filling after initiation of β blockade with disappearance of third heart sound corresponding to decrease in size of early filling e-wave. However, upon withdrawal of β blocker, there was deterioration of diastolic function. Recommended β blocker and initiating therapy: Results of several trials have shown Carvedilol, Metoprolol XL and bisoprolol to be more effective than the standard β1 blockers. It is advisable to start the agent at a low dose (Carvedilol at 3.125mg twice daily or Metorolol XR 12.5mg once or twice a day as there can be worsening of symptoms initially) and then gradually up-titrate over a period of 2-4 weeks till maximum tolerated dose, provided the patient remains to be stable. If there are any signs of worsening, the dose of ACE inhibitors, diuretics and digoxin have to be adjusted before decreasing or discontinuing β blockers as abrupt discontinuation leads to rebound effects with higher mortality and morbidity. β blockers should not be initiated in patients who are fluid overloaded. However, in patients already on β blockers, who present with hypotension and signs of hypoperfusion, the dose has to be reduced or discontinued and supportive therapy with inotropes considered. Once heart failure is completely under control, β blockers should be cautiously reintroduced well before discharge. Conclusion: Several trials have challenged the conventional belief that beta blockers are contraindicated in heart failure wrong. The long-term benefits of β blockade therapy far outweigh the shorts term risks involved. Every patient should be entitled to the benefits of β blockade therapy, unless contraindicated and this can be achieved with proper dosage and monitoring of side effects at regular intervals. w w w.medegatetoday.com May-June 2015

PRODUCT LINE

Role Of Mobile App in Today's HMS technology: Mr. Pradeep Jupalli, Vice President Shivam Medisoft shares his insight on HMS Technology Mr. Pradeep Jupalli

Vice President Shivam Medisoft

Its the era of Mobile App. From Shopping to Social Networking, from Hangout to Healthcare all have become “App Centric”. Then why not HMS?

www.m e d e g a t e t o d a y. c o m May-June 2015

PRODUCT LINE

The healthcare industry is undergoing unprecedented change and obstacles to be able to provide best-inclass customer care. Driven by new regulations and reimbursement models as well as increasing customer demands, it’s clear that your organization needs to readjust to stay at the forefront of healthcare in the years to come.

How Shivam Mob App is different & How it helps Hospital Owners: Shivam Dashboard mobile app is available for Android and iPhones. For androids the application is readily available in google playstore. •

Gives the owner/Mgmt freedom to access from anywhere.

Bringing mobile technologies to healthcare • Shows locationwise, department wise performances especially to clinical care operations can be an along with revenue generated. innovative way to improve patient care, reduce • Analyze the finance. complexity, improve efficiency, and empower • Analyze the doctor performance. healthcare decision makers with actionable in sight at • Analyze the service quality with patient waiting the point of care. But deploying mobile technologies time. to healthcare providers cannot be done without careful planning and consideration. To effectively secure, • Online and Onsite appointment statistics. manage, and control mobile devices and access data, • Real time visibility of data in owners' phone/tab. you must deploy appropriate enabling technologies beyond the network infrastructure. This is how we In Shivam development is a continuous process and everyday introcduced Mobile app for our Hospital Management we come up with something new and that's why our product and our service makes us one of the leading HMS providers Software in Shivam. in the country.

w w w.medegatetoday.com May-June 2015

PRODUCT LINE

Paradigm shift in demand for Anaesthesia Workstations

he last decade has witnessed a paradigm shift in the demand for Anaesthesia Workstations. Having a good reliable Anaesthesia Workstation with Temperature compensated Anaesthesia Vaporisers and in-built ventilation has now become the new norm. We are witnessing increased number of customers upgrading from existing boyles type basic anaesthesia machines to quality Anaesthesia Workstations packed with safety features. Our Range of workstations is designed in such a manner to offer a range of customizable features to suit varied budget requirements depending on the customer needs without compromising on the safety standards of the equipment. Every hospital is now focused on improving its patient safety and comfort standards and upgrading conventional Anaesthesia Machine to Anaesthesia workstation is the first step towards achieving that goal.

The safety features offered by Anaesthesia Workstations are at a huge advantage and substantially minimize chances of any accidental incidents during Anaesthesia. All our workstations are equipped with a twin station manifold for mounting two selectatec type temperature compensated anaesthesia vaporisers with interlocking safety, an anti hypoxic system, an inbuilt integrated ventilator with direct switching controls from the circle absorber system and integrated patient alarms.

modes comprising of CMV – Continuous Mandatory Ventilation, PCV - Pressure Controlled Ventilation, SIMV – Synchronized Intermittent mechanical ventilation and Manual ventilation modes. The advanced versions offer an addition of PSV – Pressure Support Ventilation, SIMV – Synchronized Intermittent mechanical ventilation with Pressure / Flow triggers, Spontaneous mode of ventilation.

The display screens are offered in a series of sizes and The workstations are offered with our Meditec Pisces touch / non- touch variants to meet varied customer vaporisers, which are suitable for delivering Halothane, requirements. The ventilators offers a choice of Ventilation Isoflourane, Enflurane and Sevoflouraneanaesthetic drugs. The vaporisers offer a drug delivery range starting from 5% to 8% and come with a choice of drug filling options. The vaporisers are accurate and precise and are designed to compensate for variance in temperatures and flow.

Aditya Kohli

Director – Marketing & Sales, Allied Medical Limited

www.m e d e g a t e t o d a y. c o m May-June 2015

The workstations are offered with a choice of monitoring options starting from basic monitoring of ECG, NIBP, SP02, RESP and Dual Temperatures. The monitors offer a number of upgradeable features such as EtC02 monitoring, Anaesthetic Gas Monitoring, Invasive blood pressures, Cardiac Output, Depth of Anaesthesia Monitoring and many others used for advanced anaesthesia monitoring.

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diabetic care Products Anand Bhuvan Ground Floor 84-A, Princess Street T: 022-66379370

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NEWS Update

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