eHEALTH October 2014

ASIA’S FIRST MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE

VOLUME 9 / ISSUE 10 / OCTOBER 2014 / ` 75 / US $10 / ISSN 0973-8959 Hubert Aroule VP Business Operations & Finance, Septodont India

eHEALTH Magazine

Michael Kelley Senior Principal Scientist, Scientific and Regulatory Affairs at Wrigley

Amarinder Singh Founder & CEO, Clove Dental

Smile Doctors Indian Oral Health Industry Nears Boom Nitin Bindlish President of Corona Dental Labs

Dinesh Lodha Vice President & Business Head, HME Division, Samsung

V S Venkatesh CEO, Apollo HospitalsWhite Dental Prof Nigel Pitts Dental Innovation & Translation Centre, King’s College London Dental Institute

Dr Neetu Kamra Head, Department of Dentistry, BLK Super Speciality Hospital

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ASIA’S FIRST MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE VOLUME

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ISSUE

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OCTOBER 2014

PRESIDENT: Dr M P Narayanan

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NEWS

Major breakthrough in Type 1 diabetes cure

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s per the medical experts and researchers, the hunt for a cure for Type 1 diabetes has now taken a giant step now with treatment and medicines of the disease.

Basically, the disease is caused by the immune system destroying the cells that regulate and monitor the blood sugar levels. A team at Harvard University utilised stem cells to generate hundreds of millions of the cells in the experimental laboratory.

Tests on mice showed the cells could treat the disease, which experts described as “potentially a major medical breakthrough”. Beta cells in the pancreas pump out insulin to bring down blood sugar levels. But the body’s own immune system can turn against the beta cells, destroying them and leaving people with a potentially fatal disease because they cannot regulate their blood sugar levels. But the body’s own immune system can turn against the beta cells, destroying them and leaving people with a potentially fatal disease because they cannot regulate their blood sugar levels.

It is different to the far more common Type 2 diabetes which is largely due to poor lifestyle. The team at Harvard was led by Professor Doug Melton who began the search for a cure when his son was diagnosed 23 years ago. He then had a daughter who also developed Type 1 and were much higher in mice resistant to diabetes.

Scientists find ‘good’ fat to cure diabetes

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edical experts at the Salk Institute and Beth Israel Deaconess Medical Center (BIDMC) in Boston have discovered a new class of molecules—produced in human and mouse fat—that helps cure diabetes.

The researchers found that giving this new fat, or lipid, to mice with the equivalent of type 2 diabetes lowered their elevated blood sugar, as detailed October 9 in Cell. The team also found that levels of the new lipids are low in humans with a high risk for diabetes, suggesting that the lipids could potentially be utilized as a therapy for metabolic disorders. Lipids, like cholesterol, are typically associated with poor health. But in recent years, researchers have discovered that not all lipids are bad for you, such as the much touted omega-3 fatty acids that are found in fish oils. The newly discovered lipids, called fatty acid hydroxy fatty acids, or FAHFAs, were lower in humans with early stages of diabetes and were much higher in mice resistant to diabetes.

NPPA caps prices of 43 more medicines

India has capped the prices of 36 drugs, including those used to treat infections and diabetes, in its latest move to make essential medicines more affordable, a senior official of the country’s drug pricing authority said on Friday. The medicines join the 348 drugs deemed essential and that are therefore subject to price caps, covering up to 30 per cent of the total drugs sold in the country where less than 20 per cent of its people are covered by health insurance.

Global and Indian drugmakers have been hit by wide-ranging governmentimposed price reductions in the last one year in India. Industry officials say prices in the country are already among the lowest in the world.

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Prolonged work hours put people at higher risk of Type 2 diabetes

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s per t h e study conducted and stated in The Lancet Diabetes & Endocrinology, employees working for more than 55 hours per week and especially those doing manual work or other low socioeconomic status jobs easily have a 30 percent higher risk of developing Type 2 diabetes as compared to other working people in the future.

Mika Kivimäki, Professor of Epidemiology at University College London, UK, and colleagues conducted a systematic review and meta-analysis of published studies and unpublished individual-level data examining the effects of long working hours on Type 2 diabetes up to 30 April 2014.

Nominate

Nominate 14 -16 November 2014 The Leela, Kovalam, Kerala

Chief Guest

Guest of Honour

Programme Chair

Shri Oommen Chandy Hon’ble Chief Minister, Kerala

Shri P K Kunhalikutty Minister for Industries & IT, Kerala

Shri P H Kurian Principal Secretary, Industries & IT, Kerala

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BANKING

Department of Information Technology, Government of Kerala

eHealth, broadly defined as the use of Information and Communication Technology in health sector, can make a world of difference in delivery India of healthcare services. In a country, where a major chunk of the population lives in Banking for merging areas that are difficult to access and availability of health services negligible, technology alone can help spread health awareness, provide medical facilities and thus save lives.

In this backdrop, eIndia Health Awards will reward the initiatives aimed at boosting use of ICT in healthcare, better spreading health awareness, delivery of healthcare services in far-flung areas and much more.

Key Speakers @ eIndia 2014

Anil Swarup Additional Secretary, Cabinet Secretariat, Government of India

>> >> >> >> >> >>

Dr (Prof) Jagdish Prasad Director General, Health Services, Ministry of Health & Family Welfare, Government of India

Sujata Saunik Principal Secretary Public Health Deapartment, Government of Maharashtra

Deepak Upreti Principal Secretary (Health) Health Department, Government of Rajasthan

Dr K Ellangovan Secretary Department of Health & Family Welfare, Kerala and many more

ICT initiatives in Health segment HIS & HMIS Provider of the Year mHealth Project of the Year PPP Initiative of the Year in Healthcare Innovative Use of Technology by a Hospital Health Insurance Initiative of the Year

>> Innovative Use of Technology by a

Diagnostic Service Provider >> Innovative use of ICT in health by

government department >> Preventive Healthcare Initiative

Contact: Sunil Kumar, awards@eindia.net.in, +91-8860635837 eIndia.eletsonline.com

NEWS

New tool assesses skill development in robotic microsurgery

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new standardised assessment provides a useful tool for following up on the updates and progress of surgeons as they develop the skills needed to perform robot-assisted microsurgery, says a study of the Plastic and Reconstructive Surgery.

“The Structured Assessment of Robotic Microsurgical Skills (SARMS) is the first validated instrument for assessing robotic microsurgical skills,” according to the report by ASPS Member Surgeon Dr Jesse C Selber of the University of Texas MD Anderson Cancer Center, Houston. Initial assessments using the SARMS show that, after a steep initial learning curve, surgical trainees display steady improvement in their ability to perform robot-assisted microsurgery tasks.

SARMS Tracks Development of Robotic Microsurgery Skills; The researchers describe the development and testing of the SARMS as a standard technique for evaluating technical skills for robot-assisted microsurgery. The SARMS consisted of 11 items—six evaluating microsurgery skills and five evaluating robotic skills.

Randox India receives ISO accreditation

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lobal medical diagnostics firm Randox’s operations in India have recently achieved registration to both ISO 13485: 2003 and ISO 13485:2012 for the manufacture of medical devices. The registrations were awarded by BSI Group India and covers the filing, packaging, labelling and distribution of In Vitro diagnostic test kits, reagents and analysers.

Speaking after the achievement, head of Randox India Brian Walsh said, “Randox has had a significant presence in India for over a decade and, since the opening of our manufacturing facility in Bangalore in 2012, we now employ almost 100 people across the country and have a very loyal customer base.

“Our achievement of these registrations is further evidence that Indian confidence and loyalty in the Randox brand continues to grow. We are very excited for our future here, and for how we can contribute to healthcare in India.

“Ensuring high quality standards in the healthcare and diagnostics industry is of vital importance to Randox wherever we have a manufacturing facility across the globe.

“Randox are renowned for manufacturing products of exceptional quality and we aim to ensure that our standards are consistent throughout the world. We are therefore delighted to have been recognised for our standards in India.

“Manufacturing to quality management standards such as ISO 13485: 2003 and ISO 13485:2012 also reinforces the confidence that our customers across India have in Randox and our products. As one of the world’s major growth economies, the scale of the market means there is always room for new business opportunities and we hope that these opportunities continue to grow.”

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Mobile Health Unit launched to tackle women’s health

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n an effort to bridge the widening gap between rural and urban health needs of women, a free Mobile Healthcare Unit (MHU) was launched in Delhi. Shikhar Dhawan, opener of the Indian International Cricket Team, lighted the torch at Triveni Kala Sangam in the presence of a large gathering of dignitaries.

The Naari Jeevan Srot Express (MHU), as it is called, is a unique initiative that will connect 15 cities through a bus cruise for the cause of women and girl child health was flagged off by Dr Sushma Dureja. Deputy Commissioner (AH), Ministry of Health & Family Welfare under the Naari Jeevan Srot program.

Scanning babies’ fingerprints might save lives through vaccination tracking

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very year around 2.5 million children die across the globe because they do not receive several life-saving vaccinations at the right time and right place.

Mr Anil Jain, a Michigan State University professor, is developing a fingerprintbased recognition approach to check vaccination schedules for infants and toddlers. This would automatically enhance immunisation coverage and ultimately save precious lives.

To increase coverage, the vaccines must be recorded and tracked.

The traditional tracking method is for parents to keep a paper document. But in developing countries, keeping track of a baby’s vaccine schedule on paper is largely ineffective, Jain said.

“Paper documents are easily lost or destroyed,” he said. “Our initial study has shown that fingerprints of infants and toddlers have great potential to accurately record immunisations. You can lose a paper document, but not your fingerprints.”

Jain and his team traveled to rural health facilities in Benin, West Africa, to test the new fingerprint recognition system. They used an optical fingerprint reader to scan the thumbs and index fingers of babies and toddlers. From this scanned data, a schedule will be created and become a part of the vaccine registry system.

Once the electronic registry is in place, health care workers simply re-scan the child’s fingers to view the vaccination schedule. They know who has been vaccinated, for what diseases and when additional booster shots are needed.

FMRI transplants North India’s first Mechanical Heart

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mild respiratory infection which would have taken a usual course for recovery took a fatal turn in the case of 29-year-old Rabeea Majhool, barely weeks before his nikah, back in Iraq. The infection spread from his lungs to his heart and within a fortnight of contracting the disease, Majhool was diagnosed with severe left ventricular dysfunction and doctors back home told him that without a heart transplant there was no hope.

With an extremely poor rate of cadaver donations internationally, Majhool would have never made it to the list of awaiting recipients despite having the best technology available in healthcare. The Human Organ Transplant Law in India allows a foreign patient to receive a cadaveric organ only once the national list is exhausted.

Setting a landmark in cardiac surgery, for the first time in North India, Doctors at Fortis Memorial Research Institute (FMRI), Gurgaon successfully implanted a FDA approved ‘Mechanical Heart’ (a type of Left Ventricular Assist Device – LVAD) in 29-year-old Majhool, giving him a new lease of life. The patient required multiple hospital admissions during this period.

Sun Pharma, Merck & Co enter agreement for Tildrakizumab

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he US-based Merck & Co Inc and Sun Pharmaceuticals have entered into an exclusive worldwide licensing agreement for Merck’s dermatology molecule – tildrakizumab (MK-3222), which is currently under phase 3 registration trials.

Tildrakizumab is developed for the treatment of chronic plaque psoriasis, a skin ailment.

Under terms of the agreement, Sun Pharma will acquire worldwide rights to tildrakizumab for use in all human indications from Merck in exchange for an upfront payment of USD 80 million. Merck will continue all clinical development and regulatory activities, which will be funded

by Sun Pharma.

Upon product approval, Sun Pharma will be responsible for regulatory activities, including subsequent submissions, pharmacovigilance, post approval studies, manufacturing and commercialisation of the approved product while Merck will receive undisclosed payments as well as tiered royalties, stated a Sun Pharma release.

“Consistent with our previously announced global initiative to sharpen our commercial and R&D focus, including prioritising our late stage pipeline candidates, we are pleased to enter into this agreement with Sun Pharma to help realise the potential of tildrakizumab for patients with chronic plaque psoriasis,” said Iain D. Dukes, senior vice president, Business Development and Licensing, Merck Research Laboratories.

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NEWS

Health insurance minimises mortality in Indian poor

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ndian government scheme to offer health insurance for catastrophic illness to households below the poverty line (BPL) has minimised mortality rates and out-of-pocket expenses for people staying in Karnataka, as per the World Bank-funded research.

The programm called the Vajpayee Arogyashree Scheme (VAS) – funded by the World Bank Group and implemented by the Karnataka government – was evaluated led by Neeraj Sood, professor and director of research at the University of South Carolina’s Schaeffer Center for Health Policy and Economics.

Govt and pharma industry form the India Responsible Healthcare Trust

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n a major development in Indian healthcare sector, the Government of India and the major pharmaceutical industry companies have collectively come forward to build a nation that has responsible Healthcare Trust to support the Brand India Pharma campaign. A unique public-private collaboration, the creation of the Trust showcases the dedication to secure the motives and

goals of the pharma sector.

The Trust chaired by the Commerce Secretary comprises key stakeholders, namely, the Indian Pharmaceutical Alliance (IPA), Indian Drug Manufacturers Association (IDMA), Bulk Drug Manufacturers Association (BDMA), Association of Biotechnology Led Enterprises (ABLE), Pharmaceutical Export Promotion Council of India (Pharmexcil) and India Brand Equity Foundation (IBEF). The Trust aims to combine both financial and non-financial resources towards a common agenda.

The Trust aims to create better awareness and develop an informed perspective about Brand India Pharma in both the domestic and global markets.

Health Assurance Plan being worked out, says Health Minister

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peaking on the Health Assurance Plan Health Minister Dr Harsh Vardhan said that India would have to develop its own plan, rather then copying the American of British models. Dr Vardhan said the Indian Health Assurance Plan would have to be suitable for India. He the idea that everyone gets medical insurance was a good, but details needed to be worked out. He pointed out that the National Health Assurance plan that was a part of the President’s speech was also suported by the Prime Minister.

New rules for anticancer vaccines

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India Home Healthcare partners with Nationwide

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ndia Home Healthcare, one of the leading home health care providers in India announced their strategic partnership with NationWide Primary Healthcare Services Pvt Ltd for specialised home healthcare services.

This partnership provides holistic care to patients at home through Nationwide Primary Healthcare Services’s doctor network and India Home Healthcare’s nursing expertise.

The partnership includes doctor at Home services apart from the long duration nursing services, Pharmacy at Home – wherein medicines are delivered at home, Physiotherapy at Home by which physiotherapists come at home for treatment.

As customisation is the key to innovation they have post hospitalisation and rehabilitation services for the elderly, cost effective packages across services for Individuals, apartment complex residents and corporate employees.

cientists have found a way to find the proverbial needle in the cancer antigen haystack, according to a report published in The Journal of Experimental Medicine. As cancer cells divide, they accumulate random mistakes (mutations). This process creates new versions of proteins, some of which are recognised as foreign invaders by immune cells called T cells, prompting the cells to attack and eliminate the cancer cells.

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IN PERSON

Dinesh Lodha, Vice President & Business Head, HME (Health and Medical Equipment) Division, Samsung, in conversation with Shahid Akhter of ENN, talks about the new wave of innovations in healthcare being rolled out by the company

India is a Priority Market Since the launch of HME Business in India in 2013, Samsung has strengthened its presence in the Indian healthcare market. Please elaborate.

HME division of Samsung was set up globally in 2009 but the Indian chapter was initiated more recently in 2013.

Presently, our product line can be divided into categories of ultrasound, in-vitro diagnostics, digital radiography and mobile CT. In the near future you can expect the launch of several new products in other categories as well.

We have merged and absorbed competencies from various healthcare companies like Medison, Nexus, Prosonic, etc. Moreover, we have initiated digital radiography, in-vitro diagnostics, 5D technology in ultrasound from our own R&D labs.

Your overview of the Indian healthcare market ?

Today innovation is the buzzword and the healthcare industry reflects it. Healthcare is among the fastest growing industries with tremendous

scope for innovation and quality delivery with greater reach to the rural areas.

Samsung endeavors to make it more patient centric and thereby infusing greater trust between care givers and patients. We can assure better quality treatment and thus saving money.

In India, the key lies in the understanding of the principle of ‘affordable and quality delivery with a strong reach.’

India is the second most populous country in the world, healthcare services falls significantly short of the demand and the solution lies in innovative medical technology that can bridge the demand supply gap. More precisely, in rural areas, healthcare delivery is far from adequate.

We also need to be more flexible in order to adapt to the changing health needs and be prepared for the risks that may arise in future.

The Public Private Partnerships in health care is laudable. The steps initiated by the government need to be carried forward to achieve ‘health for all’ goal.

In India, the key lies in the understanding of the principle of affordable and quality delivery with a strong reach

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Indian healthcare is urban centric.

We do have world class doctors and top notch hospitals with best of facilities but they cater to a small fraction of the population. It is high time to focus on providing good medical facilities in urban areas. Regulations are needed to provide impetus to life the population that lies at the bottom of the pyramid.

How would you profile your healthcare products and what makes them different? How does it impact the end user?

Samsung endeavors to develop products with certain cherished values like accuracy (in diagnostics) which matters most in healthcare, next comes the ease of use or user friendly products that are fast (time engineering is vital) and equally acceptable by way of design and style.

Our approach is patient driven and we focus on health management rather than disease management. We always aim at total customer satisfaction through high quality of products, professional and customised approach to each customer, prompt after-sale services and unmatchable application support. Our relationship with customers will grow stronger with the wide basket of products on which we are working right now.

Our focus is to offer quick, easy and accurate diagnosis Some of our existing products include: ULTRASOUND 5D: Samsung has introduced the world’s first 5D technology enabled ultrasound equipment UGEO WS80 A. While 5D NT enables realistic visualization and automated measurement of NT images that helps to detect Down Syndrome; 5D LB allows for easy, automatic detection and measurement of fetal bones.

Volume NT/IT technology reduces the average scan time by 50 percent, OVIX Mirror View and Volume Slice technologies further provide faster diagnosis, while the HD led monitor provides flawless image even with minutest details.

IN-VITRO DIAGNOSTICS: Immediate results (shortest TAT between 7-20 minutes depending on the model and the test conducted), accuracy (clinically proven) and prompt services (RMS), space saving compact designs.

DIGITAL RADIOGRAPHY: Our equipments offer the best quality output with very low dose radiation, fastest patient throughput, ease in user operation and patient positioning, integrated automatic exposure control to reduce patient dose and dose area product for reporting and monitoring the same.

It also offers advanced applications like smart dual (dual energy studies) for chest studies and smart stitching for full spine and long bone changing.

How well is Samsung’s after sales service addressed?

Our service network is quite strong.

It covers 97 percent of the geographical area of our country. Our infrastructure is quite capable of addressing the problems that may crop up. For instance, we are well equipped with back end support by way of spare parts and the network of distribution system. Our service professionals are well equipped and trained in this direction. Moreover, our training is so diverse that trouble shooting becomes easier. Our academy is

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IN PERSON

recognised as India’s most extensive training facility.

Your approach to telemedicine or mHealth ?

Given the diverse topography of India ,telemedicine is an ideal solution and mHealth is of great importance. We are levering on mobile technology to focus on mHealth. All our healthcare products have digital capabilities and this translates into immediate tele transmission anywhere in India. This aspect comes handy and useful to the population in remote areas who are being served through telemedicine.

We have also introduced advanced solutions to help in improving the efficiency in OPD & IPD. Patient Companion™ is a Wi-Fi based bedside nurse call system with a motivational dashboard for patients. The other one CARE Q™ has been positioned as a low cost mobile station to utilize time of patients, while waiting in the OPD.

How have you addressed the safety features and low dose radiation in your products?

Patient safety is our prime concern. Samsung DR systems ensure the best image quality at the lowest radiation dose due to Samsung’s most advanced detectors and unique post processing algorithms.

Its ‘Soft handling’

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We would rather focus on opportunities than challenges and focus on improving the quality of treatment function revolutionises the way users operate X-ray devices as they need only a little amount of energy to move around the THU (Tube Head Unit).

What challenges you face in Indian healthcare?

Challenges are all about seeking solutions and we are working in this direction. It is important to see the right har-

mony and relationship between doctor and patients. There is need to bring transparency in medical treatment so that the patients have clarity about their course of medical diagnosis and treatment. Transparency ensures better flow of information, efficiency, productivity and it also helps clinicians to get on with caring of patients.

Why should one prefer Samsung products over others ?

Samsung offers an integrated solution in the field of healthcare. We have an entire range of products and solutions spanning from air conditioners, mobile devices and solutions, display and IT solutions, which along with our healthcare products and solutions can provide onestop solution for hospitals, nursing homes, diagnostics chains, and such.

Where do you see Samsung HME five years from now?

In pursuit of excellence and with the vision to establish ourselves as world’s leading medical device company, we are already on the right path. We continue to give shape to innovative technologies in healthcare with the mission to promote smarter, patient centric healthcare solutions.

We believe that in near future we can emerge as market leader by the year.

We look forward to becoming one of the top tier medical equipment manufacturing companies within the next eight to nine years.

GASTROENTEROLOGY MENTAL HEALTH

Mental Health in India

A WAKE-UP CALL Dr Samir Parikh, Director, Department of Mental Health & Behavioural Science, Fortis healthcare

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he World Health Organisation has estimated that by the year 2025, mental illness will catch up with or overtake heart disease as the biggest global health concern. Already, Suicide is the depression alone affects 8th leading 121 million people worldwide. Suicide accounts for cause of death one death every 40 seconds worldwide, we on an average. Mental illness still haven’t is a leveller, and can affect any of us at any time. Even in India, come up with studies have shown that up to a suicide 12 percent of children between prevention the ages 4 to 16 have a diagnosable psychiatric disorder. policy

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Despite the prevalence of mental illness having mental healthcare is restricted to large cities with fewer and fewer mental health professionals in the peripheries.

Mental health has never really become a priority in our country, be it in terms of funding or policy. Barely 1-2 percent of the health budget is dedicated to mental health, in comparison to 10 to 12 percent in other countries. At the same time, for suicide, which is the 8th leading cause of death worldwide, we still haven’t come up with a suicide prevention policy.

However, despite our limitations, there is a still a great deal that can be done. Keeping in mind the paucity of trained mental health professionals, the need of the hour is for all our resources to come together - be it the government, the NGO sector, public and private healthcare facilities, media, schools and the community at large. Besides spreading the right kind of awareness and reducing stigma associated with mental illness, we also need to focus on expanding the reach of mental health services to those who need them. General medical practitioners can be trained to identify and treat symptoms of mental illness. School teachers and social workers can be

taught to recognise signs of distress and provide preliminary psychosocial support to those in need.

But if we’re to deal with the epidemic of mental illness, we need to take a dual approach, which encompasses not just the curative, but the preventive as well. Preventive healthcare just hasn’t got the attention it deserves in our society.

From the very start, children need to be given adequate lifeskills training to cope with the conflicts and challenges of everyday life.

People need to learn more adaptive ways of dealing with stress. Myths and misconceptions regarding life choices need to be addressed head on. Emotional well-being needs to become a priority.

Mental health has never really become a priority in our country, be it in terms of funding or policy. Barely 1-2 percent of the health budget is dedicated to mental health, in comparison to 10 to 12 percent in other countries

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MENTAL HEALTH

We deal with 75-80 patients suffering from mental illness and our OPD witnesses 750 patients every day, says JN Chaudhary, Chairman, Vidyasagar Institute of Mental Health, Neuro & Allied Sciences (VIMHANS) in conversation with Neha Thakur of ENN

Brain Disorders on the Rise

Tell us about VIMHANS, its focus areas and specialities.

At VIMHANS we have many focus areas, such as in Mental Health we have psychiatry, psychology,in Neurosciences - Neurosurgery, Neurology, Interventional Neuro Radiology.

The hospital also runs mental health and Neuro rehab centers for patients. These centres function on highly subsidised basis.

In the Mind Body Centre we provide services in specialties like health psychology, Ayurveda and Panchkarma hypnotherapy, yoga, NLP, energy medicine.

Allied specialties include cardiology, internal medicine, general and minimal invasive surgery, etc. Special emphasis is laid on the care of the elderly, ranging from acute to chronic and home care as well.

Since 2000 we have many training programmes like, internship programmes for undergraduates and post graduates. Train the Trainer programmes include regular workshops with school counsellors. Home Care Workers Training programme has its 21st Batch in progress.

The services at VIMHANS are complemented with infrastructure, facilities, backup support system and medical equipments. VIMHANS, as part of its social responsibility runs a rural health care centre in village Saidul Ajaib, in Mehrauli which is in Delhi.

The hospital conducts free medi-

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cal camps in various disciplines every month at the centre and in various slums and villages in the district.

How healthy are people in terms of mental health in India?

Although we do not have the exact figures, but people are actually not mentally healthy, the reason for not having proper statistics is the taboo associated with mental illness. In India one percent of people have psychosis and remaining 4-5 percent are variable.

In the last two decades medicines have definitely helped overcome mental illness. However with increasing pace of life, mental illness is a common scenario in kids and adults today. When compared to Western countries Indians are more prone to mental and brain disorders due to lack of awareness.

How many patients does VIMHANS cater to everyday and how well equipped is it to deal with rising number of patients?

1 percent of the world population suffers from psychosis and 3-4 percent of people undergo neurosis in their lifetime

We have several patients on daily basis. Our OPD has almost 750 patients a day, out of which 75/80 are mentally ill patients. Therefore, you can say that almost 300 patients visit VIMHANS everyday for various brain and neurological disorders.

What are your expectations from the new government?

My expectations are very nominal from

the new government. I want them to eradicate poverty which is the root cause of several health problems. Putting the available resources into insurance should also be implemented.

The government must allocate adequate funds towards health sector which is missing at the moment.

At the legislative level and bill also, I feel the government can do much better than what it is doing right now. No doubt, the government is giving good remuneration to the doctors as well as the hospitals, but a lot more has to be done for the welfare of hospitals.

What are the latest technology and developments initiated at the VIMHANS? Holistic aspect of mental health treatment is to be focussed. Repetitive Transcranial Magnetic Stimulation has been partly useful in treating chronic depression. Earlier patients dealing with MRIs felt relieved so, now MRI is being used as a therapy.

Today, mental illness symptoms got better with magnetic treatments.

Also procedures for major mental health issues like OCD (Obsessive compulsive Disorders) are treated with gamma knives. Certain parts of brain are targeted and burnt through radiation. Although laws of such procedures are not clean and efficient but hopefully they will become fruitful soon. Basically, modern medical instruments can control 90 percent of the illness in patients.

What are the challenges faced

by VIMHANS and how do you plan to resolve it?

There are many challenges in terms of infrastructure. We wish to expand the campus and surroundings. We want adequate funds to be allocated to the hospital and also in general health care, although transition is there with private sectors providing better care and facility but it will take long time before it establishes itself well. We are finishing two buildings in the campus.

We are better off as compared to the West in terms of value and family support system, which is why the number of mental cases are less than abroad

1200 bed facility and is much better equipped to handle numerous cases.

And we are less than 100 beds and a non profit NGO organisation, but we do help in clinical work and offer internships including practical training. We basically send our professionals to NIMHANS.

One allocated for the cancer ward and the other for the multi-speciality.

What are the various types of neurological and mental disorders that you come across daily?

What kind of specialised Psychiatry treatments are given to mentally ill patients?

All sorts of counselling and treatments are offered to the patients depending upon the intensity and severity. For example people with mild depression are given prolonged counselling and those with chronic or genetic depression are given anti-depressants for a longer period of time. In severe cases they are admitted for a longer treatment through counselling, medications and psychotherapies.

Tell us why you think there are raising cases of people suffering from depression among kids and adults?

These days our society has become individualistic and highly impatient.

And nuclear families are also fast coming up. Given the rising competition, diminishing family support system and career pressures people are getting self obsessed and highly engaged in their own lives. With negligible social life and fast lifestyle in cities, most people are becoming prone to depression. It is more prevalent among kids because of working parents and no siblings to share their thoughts to. While adults can still learn ways to cope with stress and brain disorders, it is actually the kids who are absolutely helpless.

How different is VIMHANS from NIMHANS Bangalore?

NIMHANS Bangalore is centrally funded hospital. It has more than

There are two main mental health categories Psychosis and Neurosis.

Then there is Schizophrenia, bipolar (Mood disorders). Neurosis comprises of Anxiety and panic attacks, alcohol and substance abuse. Most of the Neurosis mental cases are life-long which require proper dosage of medications.

These medicines are reversible one that overcomes the issues that eradicate depression from its roots.

One percent of the entire world has psychosis and 3-4 percent of people have neurosis in their entire lifetime.

Overall mental health covers 20 percent of illness in Britain that is close to 16 percent of cancer.

Where do you see VIMHANS by way of IT five years from now?

Five years from now, I wish to see VIMHANS expanding in areas like IT and medical facilities. I feel slum and poor areas must have better access to basic health care system. We wish to improve our rehabilitation area in terms of infrastructure and availability of medical staffs. The government must also become pro active in terms of improving health sector by taking various new initiatives for enhancement of health sector.

IT in medicine field has enough potential to transform the health image in India and can really be the game changer. We have several machines, where image capturing facility is available during surgeries. These images help a doctor review his performance post surgeries.

OCTOBER / 2014 ehealth.eletsonline.com

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MENTAL HEALTH

The disease is not curable, but certain lifestyle modifications like engaging in physical activities and cognitive tasks, eating right and stress management delays the disease’s onset, says Dr Manjari Tripathi, Professor Neurology and President, Alzheimer’s & Related Disorders Society of India (ARDSI), Delhi Chapter as she gets candid with Neha Thakur of ENN

Alzheimer Patients Need Utmost Care How early as in at what age does Alzheimer affects a person?

It mainly affects older people and chances of people being affected at a young age are rare and uncommon. The increasing age is a major risk factor and the standard age when Alzheimer begins to affect a person is from 55-60 years onwards.​

How is Alzheimer’s disease diagnosed?

Following an introduction the patient’s medical history is taken down. Whether the body is able to carry out different functions and the mental and cognitive faculties of patient are tested. Brain imaging tests such as computerised tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) may be performed to rule out other illnesses with similar symptoms.

Laboratory tests such as complete blood count (CBC) that shows nutritional deficiencies such as those of folate or vitamin B12, liver function test, thyroid test, as well as checking the levels of certain minerals or chemicals in the blood are also done. These tests are required to understand if other illnesses are causing the symptoms.

A lumbar puncture is sometimes done to test for the presence of some proteins in the spinal fluid. Electroencephalogram, a test to measure electrical activity in the brain, may also be performed.

What are the various stages of Alzheimer’s disease?

There are total of seven stages of Alzheimer’s.

In stage one there is normal memory and no signs of dementia. In stage two very mild cognitive decline, forgetting familiar words or the location of everyday objects. But still no symptoms of dementia can be detected. In stage three mild cognitive decline is seen in some patients. Early-stage Alzheimer’s where one can notice difficulties. A detailed medical interview can detect problems in memory or concentration. In

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stage four moderate cognitive decline or mild or early-stage Alzheimer’s disease. Forgetfulness, inability to do arithmetic, loss of planning and managing abilities are diagnosed.

In stage five moderately severe cognitive decline, moderate or mid-

stage Alzheimer’s disease. Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities.

In stage six severe cognitive decline, mid-stage Alzheimer’s disease, memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. Unable to recognise own family, changes in sleep pattern, loss of bladder and bowel control.

At stage seven a very severe cognitive decline (Severe or late-stage Alzheimer’s disease) is seen. There is a severe loss of the ability to respond to their environment, to carry on a conversation and even body movement.

Is it more common among males or females?

It is generally more common among females as compared to males esin fepecially after postmenopausal​ males.

Is there a permanent cure for Alzheimer’s? ​ ell, there is actually no permanent W cure for Alzheimer’s as of now. Therefore it would not be wrong to state that there is no permanent cure and only prescribed medicines made to prevent very rapid progression of the disease and preserve activities of daily living can safeguard a person from Alzheimer’s and its repercussions.​

Has the percentage of people affected with this disease increased over the years? ​ s of now there is no well studied and A researched data to establish the fact but risk factors of the disease have increased rapidly as increased longevity is a risk factor plus genetics, hereditary and lifestyle factors that has tremendously improved over the years. These factors can easily be attributed to the increased number of Alzheimer’s, so yes it is projected to have increased over the years without doubt.​

Dementia and its forms Dementia is the progressive loss of the powers of the brain. The most common kinds are Alzheimer’s disease and vascular dementia. These disease damage and kill brain cells, so that the brain cannot work as well as it should. This causes problems with memory, communication and thinking and also with day to day activities such as handling money and dressing.

For individuals, dementia can be devastating. Bit by bit it takes away people’s ability to do everyday things. They lose the ability to make decisions about their lives. They become reliant on others. Families have to provide more and more support and care. There is no cure for dementia, and treatment is limited.

Dementia is also a major public health issue in India. It is the fourth biggest killer after heart disease, strokes and cancer. It is most common among older people, and as life expectancy increases, there will be older people and so more people with dementia. By 2030 there will be about eight million people with dementia in India, up from four million today.

Research shows that many factors affect the risk of developing dementia. Some factors you can’t do anything about. For example, the biggest risk is getting older – dementia is more common in older people. But there is a lot you can do which may reduce your risk. Though not curable as yet, involving in activities that keep the brain active is the best way to mitigate risks associated with Alzheimer’s disease.

Eat healthy, socialise, adopt healthy lifestyle and keep the brain utterly active to reduce risks of Alzheimer’s disease How can family members and relatives help a person suffering from Alzheimer’s?

By reading the careg​iver manual and contacting the locals Alzheimer’s and related disorders society of India (ARDSI)- Chapter for understanding the disease and the person affected.

What are main causes and symptoms of Alzheimer’s?

Gradual and relentless slow progression of diff​ iculty in remembering recent things, calculation mistakes, reading and writing and understanding difficulties, getting lost in familiar places, not being attentive, loss of analytical and deduction skills, not being able to do usual learned tasks, change

in personality and behavior etc. Any two or more of these have to be present.

What steps are being taken to spread awareness about Alzheimer?

Most people find the suggestions unglamorous and restrictive so don’t follow doctor’s advice. There should be exclusive cycle track, walking track with safety for free physical exercise, palm and cheap oils which are polyunsaturated should be banned in the country. Smoking and alcohol should have very heavy price, there should be free measure of BP and sugar in all shopping malls/ community places etc, good food should be inexpensive harmful food and packaged food be very expensive etc. Day care centers for the person with dementia should be made in every few km of the city each area having its own, a family with a person with dementia should get full social security and empathy.

OCTOBER / 2014 ehealth.eletsonline.com

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MENTAL HEALTH

Do not hesitate in consulting a psychiatrist and once diagnosed ensure regular and proper treatment inclusive of medications and psychotherapy, says Dr Manu Tiwari, Consultant Psychiatrist Mental Health & Behavioural Science, Fortis Noida in conversation with Neha Thakur of ENN

Mental Issues are Treatable What is the current scenario of mental disorders in India?

According to a community based study under the WHO Mental Health GAP Action Program, in India, the life time prevalence of mental disorders range from 12.2 percent to 48.6 percent. The Ministry of Health and Family Welfare suggests that 6-7 percent of India’s population suffers from mental disorders with about one percent suffering from severe mental disorders.

An increase in population has definitely increased the number of mentally ill patients in India. Lack of manpower is a major threat in developing comprehensive psychiatric services in the community. In spite of best efforts, the ratio between psychiatrist and population is worsening day-by-day, reason being the rapid growth of the Indian population, while no development of manpower.

What are the main causes and types of mental illness?

The main causes of mental illness can be understood as being genetic wherein mental illness tends to run in families and hence a vulnerability to develop mental illness is inherited. Thus, if a person has a mental illness, their close relatives like children or siblings run a higher risk of developing mental illness.

Secondly, chemical imbalance wherein increase or decrease in the amount of neurotransmitters (chemicals secreted in the brain) exists can cause mental illness. Third

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factor being psychological that covers maladaptive behavioural, emotional and thought processes contributing to development of mental illness. In addition, interpersonal factors which showcase conflicting relationships, unhealthy communicational patterns, and relationship discords contribute to mental illness. Lastly, environmental factors involving daily stressors, significant negative life events, trauma, and loss can also contribute to mental illness.

Few of the common mental illnesses are; Anxiety disorders which includes Obsessive-compulsive disorder, panic disorder, phobia, and generalised anxiety disorders. Then there are mood disorders which includes heavy depression, Bipolar Disorders.

Other illness includes Schizophrenia and delusional disorders. Thereafter are alcohol, and drug use and lastly personality disorders.

How serious is the problem of mental illness across the globe?

Mental and behavioural disorders account for 12 percent of the global burden of diseases. The WHO, in its World Health Report 2001 has drawn attention to the fact that of the nearly 45 crore estimated to be suffering from mental disorders globally, ‘only a small minority’ are adequately cared for.

How common is the problem of mental illness among men and women?

Depression is rising with erratic lifestyles and rise of nuclear families and therefore it affects men and women equally. While mental illness affects both men and women equally, certain illnesses more prevalent in men for e.g. alcohol and drug use disorders while in women depression is the most common form of mental illness.

What are the main causes of Schizophrenia?

Basically there are three main causes of mental illness which includes genetic, biochemical and drug usage. While in genetic; mental illness tends to run in families and hence a vulnerability to develop mental illness is inherited.

Thus, if a person has a mental illness, their close relatives (children, siblings) run a higher risk of developing

and always consult a psychiatrist without fail.

What are the most common types of mental disorders that you come across every day?

There are around five types of common mental disorders that I come across every day, they include anxiety disorders which comprise of Obsessive-compulsive disorder, panic disorder, phobia, and generalised anxiety disorder. Then mood disorders which consists of depression and bipolar disorders. Schizophrenia, delusion, alcohol, drug and personality disorders are also some of the disorders we come across.

How effective are the antidepressants for treating mental illness?

Anti-depressants restore neurotransmitter levels in the brain and are required in the treatment of depressive Mental and behavioural disorders disorders. Medicines, account for 12 percent of the global when taken together with psychotherapy burden of diseases. 6-7 percent of India’s population suffers from mental yield the best treatment response. disorders They are medicines that regulate mood mental illness. In Biochemical chang- swings and maintain hormonal imbales there is increase or decrease in the ance in the body. amount of neurotransmitters (existing chemicals in the brain) which can Why is mental illness a stigma in cause mental illness and last but not society? the least is regular consumption of al- It is really sad that a problem as comcohol or Drugs/Substance usage. mon as mental illness is avoided by all and nobody wants to talk about openly.

Lack of awareness about the causes How soon can mental illness be and outcome of mental illnesses rediagnosed?

As soon as family members, caregiv- sults in labelling people who suffer and ers, and peers, observe significant socially isolate and stigmatise them changes in a person’s mood and behaviour, along with impairment in Has the issue of mental illness daily, social, and occupational func- increased over the years, if yes tioning, they should seek immediate why so? professional help. Diagnostic criteria Yes, an increase in population has defvary across disorders. However what- initely increased the number of menever be the situation and severity tally ill patients in India. The prevadon’t ignore the behavioural changes lence of mental illness has been stable

over the years. The risk factors at society level such as increased stress and problems in carrying out daily life activities decreased social support and interaction has resulted in more vulnerable population that is prone to depression.

Is there a permanent cure for all types of mental illness and how long does it take to get fully cured?

Yes, there is cure and hope for all affected with mental illness. Therefore, depending on the severity of the illness, medical treatment can take a few months or substantially longer in few cases, but no matter what the duration is mental illness is definitely curable.

What are the risk factors and preventive measures for mental illness?

Risk factors are genetic factors, alcohol and drug use over a prolonged period of time, poor coping abilities, poor social support, inability to concentrate, chronic stress, impaired relationships and poor physical health increase the risk of developing mental illness. Preventive measures - maintain a balanced lifestyle and seek help as soon as you see significant changes in personal, social and professional life.

Your message to all suffering from mental illness and families dealing with such patients.

Do not hesitate in seeking professional help, and once diagnosed ensure regular and proper treatment inclusive of medications (taken under expert psychiatric supervision) and psychotherapy. Both medical and psychotherapeutic treatments, when used together, ensure faster recovery and relapse prevention. Families and caregivers should seek psycho-education and supportive counselling along with illness management of their loved one.

Caregivers’ stress and fatigue should also be not ignored.

OCTOBER / 2014 ehealth.eletsonline.com

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MENTAL HEALTH

Dr Saumya Jamuar, co-founder of Global Gene Corp and Chief of Genetics and Genomics at Boston Children’s Hospital, has developed a new technique known as “targeted high-coverage sequencing”.

In conversation with Shahid Akhter, ENN, he explains the contours of his technique and the basic issues involved

Deep Sequencing to Decode Genetic Brain Disorders What is somatic mutation and how is it different from germline mutation?

When cells divide and grow, the DNA sequences are supposed to be copied and duplicated but sometimes the copy is not an exact replica of the earlier version. This is because of mutations or changes in the DNA sequence, which constitutes the genes.

If the mutations take place in the post-zygotic phase, that is, after the male and female reproductive cells (sperm and ‘egg’) have come together, then these mutations are called “somatic mutations.” These are neither inherited from an earlier generation (of the organism: plant or animal) nor are they passed on to the offspring.

On the other hand, a germ-

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line mutation is a genetic change in the reproductive cells (also called germ cells) and these mutations are inherited and transmitted from one generation to another. This is also hereditary mutation.

What is the significance of these mutations?

As can be imagined, the growth and functioning of various organs of the body are controlled through the genes, and mutations can have an impact on them. The impact of germline mutations is greater and more widespread than somatic mutations, mainly because the latter happens very early in the development of an organism. The somatic mutations often have rather harmless effects, such as the reddish colour of an apple.The germ-line mutations can be much more impactful, and in rare cases, a single mutation if untreated

can lead to conditions that ultimately cause death

What are the causes of genetic mutation?

One of the common sources of genetic mutation is inheritance; a mutation that is passed on from one generation to another. This type of mutation is present throughout a person’s life in virtually every cell in the body.

Sometimes mutations can occur just after fertilisation has occurred, and these may explain genetic disorders in which an affected child has a mutation in every cell, but has no family history of the disorder. Somatic mutations are also caused by environmental factors such as exposure to ultraviolet radiation, etc.

How are genetic mutations detected?

There are different methods that labs use for genetic testing. Some lab methods look for large deletions and/or duplications, and others look for point mutations. If the mutation in the family is already known, use a

Genes undergo mutation, cause Genetic Disorders Almost 15 years have passed since the human genome was mapped in its entirety, and genes responsible for various diseases were identified. But it is also true that the genetic pattern undergoes changes later during life, and there may be differences in the genes present in different organs of the body. They undergo mutations, or spontaneous changes, which may result in genetic disorders and in some cases malformation of body organs. breast and ovarian cancer), according to findings published in a recent issue of the American Journal of Human Genetics. Researchers uncovered genetic mutations, previously missed by standard gene tests, in the breast cancer gene BRCA1, adding to a growing body of evidence that says current screening methods are not enough.

Could you explain how your study helps to solve this problem?

In our study, which was published in the August 21 issue of The New England Journal of Medicine, we studied

This new approach enhances whole-genome and whole-exome sequencing and changes the way we think about genetic diseases and translates into clinically relevant diagnostic tool that can help conduct a patient’s diagnosis method that finds that type of mutation. If the mutation in the family is not already known, start with testing for large deletions and duplications as the first step. These together are the most common causes of the condition like DMD/BMD. If the lab does not find a deletion or duplication, move on to a method that finds point mutations.

How can it be said that present detection techniques are not enough?

Sometimes one test isn’t enough (eg: when it comes to detecting hereditary

158 patients with brain malformations of unknown genetic cause, who had symptoms such as seizures, intellectual disability and speech and language impairment.

Rather than analyzing the whole genome or exome (protein-coding regions of genes), we focused on a panel of known or suspected genes, but drilled deeper than the traditional genomic sequencing technique.

Whole genome or exome sequencing typically breaks the DNA into little fragments, each of which is read multiple times—typically 30—to find

the disease-causing mutation. But 30 reads aren’t statistically enough to catch mutations that only occur in 15 to 20 percent of our cells—especially given that mutations may affect just one of our two copies of a gene.

Hence my colleagues and I scaled up the number of reads, sequencing each candidate gene not 30 but greater than 200 times. This enabled them to find mutations in 27 of the 158 patients (17 percent). Of these, 8 mutations (30 percent) occurred in only a proportion of the blood cells (so-called mosaic mutations)— five of these eight were missed by traditional gene sequencing, and one was missed on previous whole-exome sequencing.

What is the significance of the latest study?

This new approach enhances wholegenome and whole-exome sequencing. We found that approximately 30 percent of patients with an identified mutation had a somatic mutation, 63 percent of which would have been missed on traditional testing. This has huge implications for researchers studying similar disease conditions such as autism, schizophrenia, etc. It changes the way we think about genetic diseases and lastly, translates into clinically relevant diagnostic tool that can help reach a patient’s diagnosis. With increasing diagnosis and awareness of these mutations, the hope is that it would lead to identification of a potential target for medication and cure.

OCTOBER / 2014 ehealth.eletsonline.com

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MEDICAL EQUIPMENT

Medical Equipment Industry Brighter Days Ahead Dr Shashi Kant Baliyan, Managing Director, Clearmedi Healthcare Pvt Ltd

T

he diagnostic landscape in our country is highly fragmented. Still largely populated by unorganised players, approximately 10 percent is constituted by organised entities. The Indian medical device market is among the world’s top 20, valued at USD 3,226 mn in 2013, according to a recent report published

by Business Monitor International.

Moreover, it is growing at a faster annual rate of 15 percent than 10-12 percent growth seen in the Healthcare sector in its entirety. Advancement in medical technology, substantial demand, coupled with ongoing standardisation of regulation and accreditation, has made India an attractive destination for foreign companies to invest here.

Establishing facilities for assisted technologies for treatment is expensive.

Most of the services at present are being provided by the private sector and the benefits of these scientific advances are limited to the wealthier sections of the population. The question that arises is whether in a country of

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The Indian medical device market is among the world’s top 20, valued at USD 3,226 mn in 2013

approx one billion people, of which a third lives on or below the poverty line shouldn’t better diagnostic services be available for all? Or is it that until the technologies become affordable only the rich should benefit from the scientific advances? In India where a large number of people die each year primarily due to the non availability of proper healthcare centers for treatment, affordable diagnostic services are a must.

In rural India, where the number of Primary healthcare centres (PHCs) is limited, 8 percent of the centres do not have doctors or medical staff, 39 percent do not have lab technicians and 18 percent PHCs do not even have a pharmacist.

The quality of infrastructure is usually poor and people end up having to go to nearby large cities if they need high-quality care.

D u e to non

accessibility to public health care and low quality of services, a majority of people in India turn to the local private health sector as their first choice of care. If we look at the health landscape of India 92 percent of health care visits are to private providers of which 70 percent is urban population. However, private health care is expensive, often unregulated and variable in quality. Besides being unreliable for the illiterate, it is also unaffordable by low income rural folks.

Studies suggest that resolving the health problems of rural communities will require more than simply increasing the quality and accessibility of health services. Health and well-being in such communities relates as much to the sense of community cohesion as it does to the direct provision of medical services.

Underutilisation of existing rural hospitals and health care facilities is also a common phenomenon. Many a time rural patients bypass local rural hospitals despite the availability of comparable medical services. The general conditional analysis of data on patients and hospitals suggests that hospital characteristics (size, ownership, and distance) and patient characteristics (payment source, medical condition, age, and race) influence rural patients’ decisions to bypass local rural hospitals.

Rural India is looking for “high-quality” healthcare provided in a cost efficient manner.

The difference between rural and urban indicators of health status and the wide interstate disparity in health status are well known. Clearly the urban rural differentials are substantial and range from childhood and go on increasing the gap as one grows up to 5 years. For the children growing up in rural areas the disparities naturally tend to get even worse.

With increasing urbanisation and the problems associated with modern-day living in urban settings, the disease profiles are shifting from infectious to lifestyle-related.

Around 80 percent of the graduate doctors in India work in urban settlements which account for only approximately one-fourth of the population. Urban population has much improved financial access and better hospital infrastructure then rural areas. The spending capacity is also higher in such areas.

But there is still a huge gap and opportunity for highquality and specialty healthcare services in tier-II and tierIII cities.

Presently Tier II and III cities represent an area of underserved need, with a growing need for improved health infrastructure. These cities usually have difficulties in recruiting and retaining medical and paramedical talent.

Another challenge is profitability of centers in Tier II- III cities which restrains large players from entering them i.e., challenges exist around scale and price points. In such areas difficulty also runs in patient recruitment and

retention as business is based on credibility in local communities. Such areas also lack in Quality Benchmark at par with the Global Standards.

The sector can move forward with government’s intervention into the industry. By public private partnership, the diagnostic centers can reach every area of the country.

It is important to detect the necessity for resources, funds allocation for training and skill upgradation in the rural areas. Involvement of medical technology clusters with common facilities for development, calibration, testing, quality control, waste manIn rural India, agement etc. hence, can also where the number help in creating an ecosystem for the benefit of SME’s focusof Primary ing on medical technology.

Healthcare Government should also encourage greater collaboraCentres (PHCs) is tion between medical centers limited, 8 percent and technology universities. of the centres do Medical technology education not have doctors should be within the medical curriculum. The training for or medical staff, regulatory staff especially at 39 percent do the state level to ensure consistent interpretation of regunot have lab latory approval processes technicians and should also be considered.

18 percent PHCs Developing a regulatory structure is important as the do not even have companies in the market are a pharmacist on the increase. Moreover, significant efforts have been made in the medical technology ecosystem to stimulate innovation in this space so that the opportunities provided in the Indian market can be capitalised by the companies working in this domain and the Indian consumer of healthcare services stands to benefit.

An optimistic forecast would be based on the fact that the full potential of the vast public health infrastructure would be fully realised soon. Its extension to urban areas would be moderated to the extent substantial private provision of health care is available in urban areas, concentrating on its sensible and effective regulation.

A market-centred approach and more effective government intervention for horizontal and vertical hospital integration may lead to better utilisation of rural health care institutions. A sensible mixture of external regulation and professional self-regulation can be devised in the consultation with the profession to ensure competence, quality and accountability.

Clearmedi Healthcare is a specialist provider of advanced medical equipment solutions. It works and supports hospitals to provide great patient care.

OCTOBER / 2014 ehealth.eletsonline.com

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Oral Healthcare

Creating Smiles

Teeth are not only about chewing the eatables; they are also about the overall beauty of a face that impacts the very persona of an individual. So, no wonder, there is an evergrowing consciousness about oral health. This has created a huge dental care products market, running into billions.

Taking forward the message of oral health from the 102nd Annual World Dental Congress, held last month, we produce here a section on dentistry. It is intended to give you an overview of the related issues, opportunities, latest trends and advancements in oral healthcare. Read on...

ORAL HEALTHCARE

Michael Kelley, Senior Principal Scientist, Scientific and Regulatory Affairs at Wrigley, in conversation with Shahid Akhter, ENN, talks about the advent of new-era chewing gums that impact oral healthcare

Chewing for Health Are there dental health benefits accruing from chewing sugar free gum?

Scientific studies suggest that chewing sugar-free gum is good for oral health, particularly the teeth. It increases saliva, which helps to keep the mouth moist and is the most powerful protector of the oral cavity. Saliva is, in fact, a key element in reducing harmful plaque acids.It is the mouth’s natural defence against acid.

Your teeth is most vulnerable to acid attack, following your breakfast or lunch or whenever you eat. The acid is accelerated by the plaque bacteria and the presence of sugar in food, gradually attacks the enamel and dentine of the tooth by dissolving them and this leads to the creation of a cavity.

Chewing gum stimulates the flow of saliva which neutralises acids from foods eaten and also remineralizes tooth enamel to help strengthen teeth. This can be countered by chewing sugar free gums that stimulate the flow of saliva which neutralises acids from foods eaten.

Moreover, chewing gum refreshes breath and prevents stains from accumulating and reduces plaque. Chewing sugar free gum has also been shown to be one of the most preferred treatments for dry mouth.

Finally, when it is not possible to brush your teeth every now and then, chewing sugar free gum ensures that the teeth remain clean and healthy after eating or drinking. So the oral care mantra is to eat, drink and chew.

What exactly is sugar free gum?

Sugar-free gum is free from any sugar in it. The taste is added using sweeteners, and therefore the gum does not lead to tooth decay. The gum releases its flavours over a period of time, just like ordinary gum.

What can be the best time for chewing sugar free gum and for how long?

Chewing sugar-free gum for 20 minutes, following meals and snacks has been proven to help protect your teeth. In studies on the effect of sugar-free gum on the development of cavities, those who chewed sugar free gum after eating had fewer cavities than those who did not. Chewing stimulates the salivary glands resulting in the flow rate by up to 10 times the resting state during the first few minutes of chewing and keeps it signifi-

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cantly elevated throughout prolonged chewing. Stimulated saliva also has a high bicarbonate concentration that enhances the capacity to neutralise acid.

proved additional claims which noted a relationship between two of the oral care benefits of chewing sugarfree gum - the neutralisation of plaque acids and the reduced demineralisation of tooth enamel - as being risk factors in the development of caries.

What have been your advances in scientific research?

Wrigley Science Institute was constituted in 2013 and restructured to form the Wrigley Science Advisory Council (WSAC) to promote and share Wrigley’s scientific research by estabDoes chewing of sugar free gum lishing advisory boards and impact stomach peer reviews as needed. acidity?

Chewing sugarfree gum has also been The WSAC operates in Chewing of sugar free shown to be one of the most preferred conjunction with the Mars gum leads to sharp rise Science Advisory Council in saliva volume which treatments for dry mouth (MSAC), providing guidance contains bicarbonate on research and quality issues, as well and when swallowed, it affects acid Wrigley’s contribution in the as access to a vast external network neutralising properties in the stom- understanding and creation of that keeps the company abreast of adach. Research on this issue reveals chewing gums that impact oral vances, opportunities and challenges. that patients who have a duodenal healthcare?

Wrigley is a founding partner of ulcer, or X-ray negative dyspepsia, According to the FDI World Dental benefit from chewing sugar free gum.

Federation, tooth decay is one of the the Platform for Better Oral Health most common non-communicable dis- in Europe - a joint initiative of acaeases on the planet. It is largely pre- demics, chief dental officers, public Has the sugar free gum been ventable but instances of tooth decay health associations and the industry endorsed by any dental remain unaddressed due to unavail- to advocate for a common European association or body?

The FDI World Dental Federation and able or insufficient oral care services. approach toward better prevention, Wrigley recognises the severity of education and access to oral care. The more than 25 national dental associations have recognised and acknowl- this issue, and we are committed to initiative is promoted and supported edged the strength of the scientific collaborating with oral health experts by Wrigley’s Oral Healthcare Program evidence which supports chewing sug- to better understand and advance sci- and GSK Consumer Healthcare. arfree gum. The FDI has even granted ence in this area, for the mutual benethe use of its logo on Wrigley sugar fit of consumers and the scientific and Tell us about Wrigley’s oral free gum packs. Additionally, the Eu- public health communities. health care programme?

Since the 1930s, Wrigley has been Wrigley’s commitment to oral care ropean Commission has approved oral health claims for sugar-free chewing researching the oral health benefits around the world is evident through gum, one of the few food categories to of chewing gum. We have carried out the Wrigley Oral Healthcare Program gain such recognition. In 2009, the Eu- internal research and partnered with (WOHP), which was initially launched ropean Food Safety Authority (EFSA) leading independent researchers and in Germany in 1989 and now operates approved claims that sugarfree chew- academic institutions. in more than 40 countries. Through We’re reaching consumers around this initiative, Wrigley partners with ing gum can help neutralise plaque acids, remineralise tooth enamel and the world through our Oral Care dentists and hygienists to help them reduce oral dryness.In 2011, EFSA ap- brands – Extra, Freedent and Orbit improve patients’ oral healthcare rou– and a united call to action: tine through one extra, simple and enEat Drink Chew. It was First joyable step: chewing sugar-free gum launched in Australia in 2006 after eating and drinking. We equip and now active in more than dentists and hygienists with knowl40 markets, our Eat Drink edge, resources and educational maChew platform and accompa- terials to help them integrate sugarnying “Break Up with Linger- free gum into the preventative oral ing Food” campaign show con- health routines of their patients. In sumers that when brushing fact, the WOHP was a founding corpoisn’t possible, chewing sugar- rate partner of the FDI Global Caries free gum is a great way to help Initiative, a dental profession-led “call keep teeth clean and healthy to action” to eliminate caries, and imafter eating or drinking. prove oral and general health.

OCTOBER / 2014 ehealth.eletsonline.com

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ORAL HEALTHCARE

Amarinder Singh, Founder & CEO, Clove Dental, in conversation with Shahid Akhter, ENN, discusses the fragmented dental industry in India and his approach to offer the best of services and to build a pan-India network of multi-specialty clinics

Clove Sets the Benchmark for Dental Services Please throw some light on the origin of Clove Dental and the idea behind it?

We have learned that 90 percent of the entire Indian population of 1.2 billion has some dental issue or the other that needs attention. However, only 10 percent of this group actively seeks dental care. The importance of oral healthcare for all age groups, including very young children, is critical.

Consumers tend to visit the dentist only when they experience pain, and even then, they do so reluctantly. We are here to introduce pain-managed, standardised, high quality dental care and to stress the importance of preventive care for all age groups.

Clove is setting the benchmark for dental services by offering services across all dental specialties in convenient locations and at a competitive cost.

Branded healthcare is a new idea in India. How is it being accepted by the end users and customers?

India faces a growing need to fix its basic health concerns. The private

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sector has emerged as a vibrant force in India’s healthcare industry, lending it both national and international repute. The sector’s share in healthcare delivery is expected to increase from 66 per cent in 2005 to 81 per cent by 2015.

Dental care is one segment that has gained traction with the entry of a number of new players and a fresh injection of private capital. Dental care in India has typically been dispensed by conventional, stand-alone clinics, but now firms are trying to achieve economies of scale by establishing networks. The market opportunity in India is huge and incubating a fledgling dental chain that offers an attractive opportunity for early-stage investors.

How are you going to ensure quality in branded healthcare?

We offer affordable, convenient care in an ethical and transparent manner. We have over 145 dentists in our 40+ clinics, and nearly 60 percent of them have advanced degrees from the best dental colleges in the country.

Our membership in the Royal Society

Dental technology is applied to save the teeth and hence our approach has become preventive rather than curative of Medicine, UK, is another indicator of our emphasis on quality, ethics and transparency. We are the only Indian healthcare organisation to have been given a membership by this prestigious body.

Clove clinics adhere to the highest international standards for hygiene, as set by the Indian Dental Association and its American and European counterparts. Advanced dental equipment and state-of-the-art dental technology ensure that the well-being of our patients is never compromised.

Quality audits are conducted on a regular basis to ensure that our standards are upheld every single day in every single clinic. Our clinics follow a strict protocol for the sterilisation of dental equipment.

Which are the cities you are in?What are the expansion plans

for Clove Dental?

Clove has over 40 clinics in the Delhi NCR region and the Chandigarh TriCity area. Clove Dental is building an infrastructure for dental care and raising awareness on the need for dental care and the services available. We aim to build a pan-India network of multi-specialty clinics and plan to have around 90 clinics in Delhi NCR and Punjab by the end of this fiscal year.

We are also very passionate about our community outreach initiatives, wherein we provide free dental checkups in schools, communities and underprivileged localities. We have two fully equipped mobile dental clinics that enable us to provide the same high standard of care that we offer in our bricks-and-mortar clinics.

What kind of specialised services can one expect at Clove Dental?

Aside from general services such as scaling, polishing, fillings and root canals, Clove Dental offers a wide range of specialised services for every member of the family. We can provide space maintainers for a child who has lost a tooth prematurely due to decay. (The space maintainer will hold the space until the permanent tooth comes in.) We can provide colored braces for a fashion-conscious teen.

We can provide smile redesign and whitening treatments for the professional who is concerned about his or her appearance. And we can provide implants – one of the latest and most promising innovations – to replace the tooth of a senior who has lost one due to the aging process. Every dental specialty is well represented in our network: periodontists (for gum disease), endodontists (for root canals), prosthodontists (for tooth restoration and replacement), orthodontists (for braces and aligners), pediatric dentists (for children). We can also provide cosmetic

dental treatments and even oral cancer detection.

Why should one choose Clove Dental?

Clove Dental offers the largest pool of trained oral care professionals in North India -150 well-qualified doctors on board. Our pain management is by way of The Wand – Single Tooth Anesthesia system from the U.S. It offers computer-guided technology that delivers anesthesia exactly where it’s needed, for a significant reduction in treatment-related pain.

We consistently provide high quality treatment in every single clinic by ensuring that we are using the latest technology and equipment. We keep our dentists trained in the latest advancements and the very highest standards for clinical hygiene. We offer convenience by keeping our clinics open from 9:00 am to 9:00 pm, even on Saturdays and Sundays.

We follow a strict sterilisation protocol that ensures that our patients are never exposed to harmful germs or bacteria. Our tools are cleansed, packaged and sterilised and then

We are the only Indian healthcare organisation to have been given a membership by Royal Society of Medicine, UK stored according to the highest standards.

Finally, we are affordable. Our pricing is competitive and transparent. There are never any hidden costs in the services we provide, and we always involve patients in decisions regarding their care so that they can choose the treatments that suit them and their wallets.

OCTOBER / 2014 ehealth.eletsonline.com

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ORAL HEALTHCARE

Hubert Aroule, VP Business Operations and Finance, Septodont India, in conversation with Shahid Akhter, ENN, talks about the latest developments with applications in restorative and endodontic segments

The ‘Local’ POWERHOUSE Please tell us about Septodont products available in India. Also elaborate upon your latest and the most innovative products in India.

at injection. We also showcased our new launch RTR (Reabsorbable Tissue Replacement) solution which is the apt brand name for a very unique formulation. It is a very simple and easy to use solution for even complex Septodont is a dental pharmaceutical bone augmentation therapies. RTR company with the products categoreleases Calcium and phosphate ions rised into drugs and medical devices to promote strong new bone formafor treatment in almost every dental tion and regenerates new bone in 3 to specialty. The product range includes 6 months. topical as well as injectable local anAt Septodont’s booth, visitors esthetics, needles and syringes, prod- Did Septodont participate in the were introduced to Septodont’s latucts for endodontics, periodontics and FDI World Dental Congress held est developments with applications in dental surgical procedures. last month?

Cross contamination is the biggest Yes, we were present and it was an restorative and endodontic segments.

The company thus patentthreat in dental practice ed in these segments two and Septodont has prodSeptodont was the first MNC to start its breakthrough technology ucts also for disinfection platforms called Nano-Dimand hygiene for the safety manufacturing plant in India for dental er Conversion Technology – of both dentist as well as materials way back in 2001 N’Durance Range and ‘Actipatients. vate Biosilicate Technology.’

Bio-active dentine substitute BioTell us about the Septodont ideal time for the company to showdentine received a tremendous remanufacturing plant in India? case its latest products in pain consponse all over the world due to its trol, pulp vitality preservation and Septodont has world class manufacturing facility at Taloja MIDC in New bone grafting. Septodont presented versatile usage in restorative proceMumbai. In fact, Septodont was the the Ultra Safety Plus – a single-use dures. It is the only one material for first MNC to start its manufacturing sterile device with protective sheath Dentin bulk replacement and has very plant in India for dental materials and handle and Septoject Evolution – unique bio-compatible properties. way back in 2001. We became the first a dental needle designed with a larger Biodentine keeps the pulp vital and company in India which indigenously interior diameter to reduce pressure virtually eliminates post-operative

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manufactured its Plastalgin alginates brand – a flagship product. We are also manufacturing Dental Impression material, mouth-wash, disinfectants and other hygiene-related Products. Our facility is ISO 9001 & 13485 Certified. The facility is also certified

by FDA Maharashtra for GMP (Good Manufacturing Practices) Certification.

pain. Biodentine saves patients from dentists in India. Some of the prod- time is money, this will offer more ROI undergoing unnecessary endo treat- ucts are so unique in their features to dentists and lesser treatment cost ment and saves at least 45 minutes for that they can’t be replaced with any to patients due to reduced number of visits to clinic. At the same time we Dentist. All in all, Biodentine is pulp competitive products. are trying to provide dental friendly, time saving, cost treatment in the most reeffective and safe.

Some of the products are so unique in mote areas in the world by Unique curved syproviding free products in ringe of RTR Bone graft their features that they can’t be replaced the camps run by social ormaterial has now become with any competitive products ganisations. Similarly, our the preferred choice for management always deImplant Specialists, Oral cides the prices to different countries Surgeons and Periodontists around You have to face increased depending on the socio-economic conthe world due to its ease of placement. competition from local dition, dental awareness and affordRTR is also available as RTR gran- providers offering similar ability in general. Therefore, prices of ules and RTR cone to offer different products at lower costs. How our products in India are much lesser choices to dentists depending on their do you see the oral healthcare compared to developed countries in needs. infrastructure and the emerging Europe and America. market in India?

What in your opinion makes When it comes to quality, there is no competition for Septodont at least What general prospects do you your product particularly from locally-manufactured products. see for your company in India suitable for the Indian market?

Consistency in quality and range of However, our goal is not to cater only for the years to come? What products for all dental specialties with to niche customer segment but also to further plans do you have for the a very competitive price, make our make the same quality more afford- region? products suitable for Indian market. able even for dentists in small towns Our strategy is to manufacture more Septodont’s efforts to manufacture and interiors. and more products in India and sell some of these products in local plants them in India as well as neighbouring to make them cost effective -- without Technology comes countries. We also intend to compromising its high quality stand- at a price. How penetrate even the smallards -- has been appreciated by the do you intend est towns across the dental world in India. country. If we increase to introduce our market share to the latest the expected level, we technologies Compared to other markets may invest in one at a you operate in, what particular more plant in the competitive challenges does the Indian country. price? market pose?

India is a very price-sensitive market Of course, techand to offer the same quality as in oth- nology comes with er strict quality conscious markets in price but our motto the world is a big challenge. However, is service to the it is a conscious decision taken by our mankind. Septodont parent company to operate in India has been doing a lot with “No profit – no loss” equation or of work in research and minimum profit margin. development of new technologies to make dental How do you visualise the treatment opportunity for Septodont to s i m p l e r, cater to the Indian market?

Septodont has been always present time saving cost in Indian market and is now having a and strong foothold due to its commitment e f f e c t i v e . to dentistry and the trust shown by As we say,

OCTOBER / 2014 ehealth.eletsonline.com

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ORAL HEALTHCARE

Nitin Bindlish, President of Corona Dental Labs, in conversation with Shahid Akhter, ENN, talks about his latest venture in oral healthcare in the form of Corona Dental Labs that is poised to stand out among dental care providers

Smile with CORONA How do you view the oral care infrastructure in India?

Please tell us about the emerging trends in oral care market.

India’s infrastructure for oral healthcare is constantly improving, thanks to the introduction of new technoloThe last decade has seen significant gies and a greater awareness among consumers, not change in the way that oral healthcare to mention the expanding market potential that has resulted from these deWe will establish Corona Dental Labs velopments. as a serious competitor through In 2012, more than 1,80,000 dentists were practicing in 1,25,000 registered quality, attractive pricing, warranties, clinics. Each year, roughly 25,000 graduates loyalty programs and the efficient and emerge from India’s 297 dental schools (140 timely delivery of our products. of which offer post-grad courses in dentistry) to enter the job market. Over 90 percent of India’s dental services are provided in India. Subprofessionals work in and around Instantial improvements have occurred dia’s major cities. in education, infrastructure and cliniAs India’s middle class expands, cal standards, and in service delivery. consumers are becoming more The changes have been driven in part knowledgeable about dental servicby rapidly changing demographics, es and solutions. This is reflected particularly the growth of the middle in the acquisition and use of highclass and the general rise in incomes. er-end dental technologies, equipThese changes are behind the emergment and consumables to meet ing trends we are seeing now. the demands of India’s consumKnowledge Enhancement: Geners. The trend is also driving erally, healthcare providers are gaindomestic R&D programs to deing a greater awareness about the velop world-class solutions that importance of clinical hygiene and can compete on a global stage. sterilisation. Additionally, the DenIndia’s healthcare infratal Council of India (DCI), which sets structure offers huge investguidelines for Indian dental clinics ment opportunities in both and dentists, has suggested changes urban and rural localities. An to India’s Clinical Establishment Act. indication of the opportunities Once approved, the new guidelines that exist is visible in the need will also help to improve the minimum for roughly 1.8 million hospistandards required for dental clinics. tal beds, 1.54 million doctors These changes are leading dental proand 2.4 million nurses by end of fessionals to invest more in clinical 2025. hygiene and sterilisation equipment.

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India’s healthcare sector is expected to grow at a compound annual growth rate of 15 percent to USD 158.2 billion in 2017 from USD 78.6 billion in 2012 Health / Dental Insurance: After the liberalisation of economic policies, a number of private entities began to offer health insurance plans, which sometimes include dental benefits.

However, less than 10 percent of the population is currently covered by health insurance. We expect to see growth in the insurance market in the coming years.

India as manufacturing hub: India’s dental equipment and appliances market is currently worth nearly USD 90 million and registers an annual growth rate of 10 percent. Some believe that the growth rate for dental technology will double in the coming years. Foreign companies are starting to invest in India by establishing production units here. And India is now supplying dental equipment and material to countries such as Sri Lanka, Pakistan, and a number of countries in Africa and the Middle East.

How do you visualise the opportunity for Corona Dental Labs to cater to the Indian market?

Corona Dental Labs is very enthusiastic about opportunities in the dental market, as we are aware of the growing demand for more sophisticated solutions at a competitive cost, especially in the area of cosmetic dentistry.

There are several differentiators that will ultimately allow dental care providers to distinguish us from our competitors. For example, our lab is supervised by a senior prosthodontist who carefully and consistently monitors the work of our technicians to ensure that it meets the expectations of our customers and their patients.

We adhere to a very strict protocol for sterilisation. We allow only authorised personnel to enter the lab and

when they do so, they must be fully attired in sterile shoe covers, lab coats, mouth masks and head covers. A special entrance is designated for their entry to further reinforce our sterilisation protocol.

We are offering products developed from the most advanced CAD/ CAM technology that are both aesthetically pleasing and technologically superior. We have a varied product range in materials that include acrylic, zirconia and maxillofacial silicon.

Finally, we will establish Corona Dental Labs as a serious competitor through quality, attractive pricing, warranties, loyalty programs and the efficient and timely delivery of our products. We understand that constant communication with our customers is critical for the success of our relationships, and we are putting special emphasis on this.

How would you refer to the demographic trends increasing demand within India and globally?

In India, rising incomes have translated into a greater awareness regarding health care, dental care and the elective options now available. Pair this awareness with a greater purchasing power, and you see an increased demand for longer-lasting, more sophisticated solutions. Dental professionals are aware of this and they take patient concerns and demands into consideration when administering treatments. For example, dentists now take greater care to preserve the site of an extraction so it can serve as host for an implant. Patients know about implants and they can afford them, so this factors very much into the way we go about our business. They must be satisfied with the products and the care they receive, and we make every

attempt to ensure their satisfaction.

Demonstrated in numbers, India’s healthcare sector is expected to grow at a compound annual growth rate of 15 percent to USD 158.2 billion in 2017 from USD 78.6 billion in 2012.

That represents an opportunity of enormous proportions, and we are positioning Corona Dental Labs to take advantage of this opportunity.

A rise in the global demand for cosmetic dentistry and a growing interest in dental tourism will definitely have an impact on the Indian dental market. The global dental industry is looking to Asian markets as a source of growth and we’re sure to see this play out in the years to come.

Please share some details on the range of high quality prosthetic and orthodontic products that you intend to deliver?

We use the finest materials and the most advanced technology to produce beautiful, durable prosthodontic and orthodontic solutions. We provide the best quality products and our range is very exhaustive, covering nearly all the products required by dentists for their patients.

In prosthodontics, our products include CAD/CAM fabricated metal-free crowns and bridges, implant custom abutments, implant-supported hybrid dentures, cast partial dentures, flexible dentures, precision attachmentbased prostheses and silicone-based maxillofacial appliances. In orthodontics we cater to both active and passive appliances – namely, retainers, bite planes, myofunctional appliances like bionators and Frankel’s appliance.Our high-quality maxillofacial products use medical-grade silicone from international manufacturers such as Dow Corning. Our maxillofacial products are stained intrinsically and extrinsically for the best possible match with the patient’s own skin.

We count world-class suppliers such as 3M, DENTSPLY, Bego and Ivoclar Vivadent among our partners.

OCTOBER / 2014 ehealth.eletsonline.com

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ORAL HEALTHCARE

V S Venkatesh, CEO, Apollo Hospitals-White Dental in conversation with ENN, talks about the twist in dentistry amidst the range of relaxation therapies that the new spa has to offer

Redefining the TREATMENT TRAIL understanding of dentistry with a significant increase in awareness level. Does this translate into reduction of dental treatment?

Please tell us about the origin of Apollo White dental?

Dentistry is in the midst of illness and wellness. Our aim is to deliver personalised and superior dental care along with the expertise offered by the best dental practitioners and Apollo White Dental is a pioneering step in this direction.

Established in the year 2004, Apollo Dental Center is the dental vertical of multi-disciplinary healthcare giant Apollo Hospitals. With 14 dental clinics and one dental spa in India, Apollo Dental Centers is the one-stop destination of quality dental care needs.

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Envisioned to take Indian dental care to the next level, Alliance Dental Care Ltd was incorporated in the year 2011 as a Joint Venture between Apollo Hospitals and Trivitron Healthcare. Alliance Dental Care Ltd delivers dental care in two formats: Apollo White Dental Clinic and Apollo White Dental Spa. Spread across length and breadth of the nation with a presence in 15 cities, we have now 69 dental clinics and six dental spas.

The oral health of Indian population is influenced by age, diet, stress, genetics and life style patterns. The advance in dental technology only alleviates the fear of dentists amongst people and encourages them to take up dental treatment. A significant increase in dental awareness only makes more people visit their dentist on a regular basis. With changing lifestyle, dental problems are always going to be there. The awareness levels will only motivate people to take up their treatment. Even if there is not going to be a dental problem, people should visit a dentist because studies have shown that many life threatening diseases such as cardiac, diabetes, cancers, migraine and pain of unknown origin have been diagnosed with a good dental check up.

Cosmetic dentistry is the new face of dentistry. The trend has been changing. More people look up to having that perfect smile and feeling good and dentistry sure will stay to cater the same!

Impressive advances have been made in dental technology and scientific

Please share your thoughts of emerging oral diseases. Total oral healthcare for all by 2020 is the

goal of IDA. How realistic is it?

Total oral health care for all by 2020 is a fantastic goal set up by the IDA. But to achieve the goal is going to be a tedious path; though not impossible. Dental awareness will for sure help achieve the same in a big way.

Treating oral diseases alone does not enable us achieve total oral health care for all. We have to take preventive measures to control further occurrence of any oral diseases. That alone will make the goal attainable.

For example, oral cancer is one of the most widely-occurring dental diseases and curbing it would be impossible without putting a stop to the factors which cause the disease. As long as the risk factors are going to be there, the disease too will be around. So, to attain the goal, a holistic approach is required.

Creative awareness on the use of tobacco, chewing and/or smoking, is an ongoing effort to avoid that.

What are the most popular cosmetic dentistry treatments?

How important is whitening today?

Nothing is better at boosting one’s confidence and self-esteem than a bright, healthy smile. Teeth whitening, tooth veneering, smile correction, jaw bone deformity correction, cleft lip surgery, tooth crystals, tooth tattoo, ornamentalisation of tooth, orthodontic treatment, etc, are the most popular dental procedures done for cosmetic reasons.

Life style and current food habits make discolorisation difficult to avoid.

Brightening or whitening will give a clean and healthy smile.

What are the new developments and trends that have shaped the field of cosmetic dentistry?

Silver amalgam, commonly known as silver fillings, was the material of choice for more than several decades and is still widely used. Despite the material being effective, long lasting

and durable, it is aesthetically unappealing. Porcelain ceramic is just one of the many new material types that offer same benefits in addition to matching the appearance of the natural tooth.

Introduction of CAD/CAM dentistry has revolutionised dental prostheses delivering more accurate and faster zirconia crowns. 3D Digital imaging systems such as CBCT are used during cosmetic recontouring and orthodontic treatment for better treatment planning and precise treatment outcomes.

What do you think the future holds?

Durable restorations such as dental implants when combined with technology and precision will be the

Apollo White Dental Spa caters to a premium clientele which is used to a certain standard. We have patients from different parts of the globe. So the idea is to provide best dental care in a patient friendly luxurious environment with an avant-garde atmosphere.

The idea behind conceiving the new age dental spa was to design a dynamic space that does not resemble a typical clinic. The new age dental spa offers a wide variety of luxurious services which includes special lounge with Wi-Fi, Zero Gravity Electronic Body Massage and manicure or pedicure – spa facility and gaming room for kids. The purpose behind these facilities is to minimise patient discomfort and alleviate the fear associated with dental treatment.

The spa aims to provide best dental care in a patient friendly luxurious environment with an avant-garde atmosphere treatment option for most edentulous patients. Though technique and/ or technology are important, it’s the clinician’s skill which plays a major role. However, with computer aided or guided software for implants, the outcomes are better with precision.

Newer methods of implantation are also reducing the number of implants at the same time providing for the teeth is distinctly on the horizon.

Internationally trained doctors, high-end technology and equipment, strict quality protocol, mandatory Blood tests (to prevent unknown complications), trained dental hygienist and assistants, efficient guest relation executives to guide you from hassle free registration to final bye are also a few reasons for one to choose Apollo White Dental for dental treatment.

Why should Apollo White dental be my choice for oral healthcare?

What are the expansion plans for Apollo White dental?

Fear of going to dentist affects over 90 percent Indians. The noise of drill, the fear of pain, the dental phobia and the inhibition due to privacy contribute to dental stress and anxiety. In contrast to the highly clinical set up where the patient is sitting in a wooden bench and hearing noise of drill inside the chamber, Apollo White Dental Clinic is outfitted with ambient luxury lounge and personalised treatment rooms.

Currently, the chain operates 70 clinics across 15 cities. To increase the accessibility, AWD is looking to be a 250-clinic chain over the next two years. Also, we are planning to have 15 dental spas across the country. Our vision is to be the largest and the most preferred dental care service provider in Asia and the Middle East region and we aim to achieve a 10 percent share of the dental care service market in India.

OCTOBER / 2014 ehealth.eletsonline.com

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ORAL HEALTHCARE

Dr Neetu Kamra, Head, Department of Dentistry, BLK Super Speciality Hospital in conversation with ENN, shares her philosophy of smile amidst total oral care

Restoring SMILES How much of work that you do would you consider as cosmetic?

It has gone mainstream and now millions can smile the way they want.

Thanks to the techniques and technologies that have revolutionised cosmetic dentistry.

Broadly, cosmetic dentistry offers teeth whitening (bleaching), bonding, veneers, reshaping, lengthening of the crown, smile makeovers, tooth jewellery, dental implants, invisible braces, etc.

of tooth discoloration is excessive ingestion of fluoride during the development of teeth that gives a whitish pattern on the surface of tooth.

Gone are the days when dentistry used to be simply a case of filling or extracting teeth. These days more How long does the whitening and more people are turning to aeslast? thetic dentistry as a way to enhance Regardless of whitening procedure, their image and appearance. Besides, the tooth stays white, it depends we offer an extensive range of restormainly on the eating habits and lifeative dental procedures and services style. Certain food, habits (smoking) that are based on individual needs. and medication that you take after Almost all the work that we do What are the causes of tooth whitening can lead to staining on related to denture correction, I con- discoloration? the whitened tooth. In order to mainsider them as cosmetic in nature from There are many causes of tooth dis- tain your whitening for longer period crown, bridge, veneer, tooth colour- coloration. External factors include of time, one needs to avoid these as ing to fillings and whitening. All this smoking or drinking dark colored much as possible. Good habits and adds beauty oral hygiene are the best and enhances ways to keep your tooth European Union applies stricter laws when overall physihealthy and white. On an it comes to teeth whitening. They have laws cal appearance average if whitening is of the person. maintained it may last upgoverning the teeth whitening products and the Beyond the to one and a half years. level of use of hydrogen peroxide in accordance gateway of with advice from the European Scientific smile lies the What is the efficacy of multi-faceted in-office (same day) Committee on Consumer Safety approach to whitening? oral healthcare which also needs to beverages such as tea, coffee, which Demand for aesthetic dental treatlook at the disease process in addi- leads to a yellow tint on the tooth as ment is increasing day by day as peotion to the improved functionality of the colour gets adsorbed on to the ple are more concerned about their the denture. tooth surface causing discoloration. looks with many people seeking the Too much consumption of tea, coffee, so called “Hollywood smile� or bright carbonated drinks impacts the colour white teeth. In-office bleaching techWhat are the most popular of the tooth. nique uses light/laser in conjugation cosmetic dentistry treatments Internal factors may affect discolwith bleaching agent. It is a fast techtoday? oration due to use of tetracycline or nique and gives favourable bleaching Cosmetic dentistry is an elective consideration with a wide variety of op- similar antibiotic drugs during the de- results.

EU (European Union) applies tions and price tags. The floor is open velopment of tooth. Trauma can also and the choice is yours. You can walk lead to tooth discoloration as it caus- stricter laws when it comes to teeth in for simple smile makeover or think es nercosis of pulp and the tooth looks whitening. They have laws governing of redefining the colour of your teeth. bluish grey in colour. Another reason the teeth whitening products and the

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level of use of hydrogen peroxide in accordance with advice from the European Scientific Committee on Consumer Safety.

The most popular oral fashion statement today?

A healthy pearly white smile is the most stylish oral fashion statement where you can never go wrong with beautiful smile. On our part, we offer a number of ways to improve your smile. We endeavour to give you the smile that you want.

What are the new developments and trends that have shaped the field of cosmetic dentistry?

There has been a remarkable improvement in new technique and trend in cosmetic dentistry. Now the procedure dentists do not only aim on functioning well but look good too.

New advancement in material and technique has made it possible to have pearly white smile. We now use CAD/ CAM technique for aesthetic crown fabrication and through the advent of material dentistry has become almost painless. There are invisible braces or clear aligner for the correction for malaligned teeth. Dental lasers are there for bleaching and other bloodless surgeries. Dental implants with tooth colour crowns. Now these materials more closely resemble the look and feel of natural teeth. Cosmetic surgery is a part of plastic surgery.

Please tell us about the services and facilities offered at BLK dental?

BLK Super Speciality Hospital has a state of the art dental department with ultra modern equipment and an experienced staff to take care of any and every dental problem. We have pool of expert professionals to take care of the complex needs of dentistry.

With help of Digital RVG X rays, Patient database management system, latest equipment, experienced and trained Paramedical staff, dedicated appointments and patient centric approach is the hallmark of the center.

The team is continuously rendering services for all routine and specialised dental procedures for the past decade. The team prides itself in retaining the best talent available

in any field of dentistry to deliver an effective, functional and lasting treatment performed in a pleasing and caring environment. The paramedical staff is particularly trained to guide and assist the patients in a manner to ensure complete satisfaction.

Why should BLK be my choice?

BLK stands for state of art techniques, strict adherence to sterilisation protocol and an experienced faculty who are up to date with latest advances in cosmetics as well as general dentistry that treat a broad range of people from young to old.

We are also treating a wide array of international patients so we are better equipped to handle and make up to the mark with international standards and certification.

What are the most meaningful technological advancements in cosmetic surgery?

Everyday something new is emerging and technological advancement is redefining things by way of braces, crowns, bridges, dentures, root canal, dental implants, paediatric dentistry, bone and gum surgery, cosmetic dentistry, smile makeovers, single sitting root canal treatment, metal free crowns, instant tooth whitening, invisible braces, immediate implants, instant digital x rays.

OCTOBER / 2014 ehealth.eletsonline.com

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ORAL HEALTHCARE

Prof Nigel Pitts, Dental Innovation and Translation Centre, King’s College London Dental Institute in conversation with ENN, discusses the issue of caries – the biggest dental problem, and his innovative remineralization technology

A Cavity-Free Future Do you consider caries to be the greatest dental concern ?

Dental caries in children (according to Lancer Series on global burden of diseases) was ranked at number 10 in the list; severe periodontal disease stood at number 6, while tooth loss rated at number 23. Dental caries is certainly the biggest burden for the global population today. It is a preventable disease (caries) that is still causing an unacceptable burden.

What causes caries, and what can be done to prevent it ?

Caries is a multi-factorial issue. Sugar is certainly one of the key causes behind caries. It begins with a tooth surface which is susceptible to caries, and a biofilm which is ending up with low pH. Earlier, we used to have a focus on individual microorganisms, but today the focus is very much on the whole ecology of the biofilm. There are certain types of biofilm where when it meets sugar, it gets unacceptably low pH, which demineralizes the tooth. Yet, there are other biofilms which are much more compatible with health and they could be made up in many different ways, and they’re very much health promoting. So, it’s a chain of interactions combined with biofilm, combined with tooth and combined with sugar. It’s a combo interaction of these three agents over time to do damage.

People should be advised to try to maintain a high level of oral hygiene. The focus should be on cleaner mouths, if not plaque-free. It varies from patient to patient. What matters is clean mouth, limited or controlled sugar and carbohydrates in your diet and using pre-

ventive products where you need to.

Again, the level of oral care varies from individual to individual. The key agent that we can consider is fluoride and its different forms. It can be fluoride in toothpaste or fluoride in mouth rinse. There are even efforts to supplement the use of fluoride and build on the additional benefits. Fluoride continues to be the global standard in oral hygiene.

What is the role and relation of sugar in promoting caries ?

Sugar come in a variety of forms and they are all key agents in promoting caries. Sugar, like salt, is hidden in a wide variety of food products. Besides, we need to look at tooth susceptibility and biofilm as well. Impact of sugar on health and more precisely oral health has been a debate since long. There are only rejoinders to this debate. This will allow caries prevention to get into wider places of debate and policies about prevention that will help address the problem of obesity and general healthcare as well.. The latest reports and the WHO papers on sugar have given a new twist and stimulus to new groups to appear and the old groups to renew their efforts.

It’s a very important area and the lobby has been there for long.

You are the Chairman of the global ACFF (Alliance for CavityFree Future), what is this alliance about and how important is it ?

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The Alliance for a Cavity-Free Future, a non-profitable charitable organization, is a worldwide group of experts who have joined hands together to promote integrated clinical and public health action in order to stop caries initiation and progression, and to move towards a Cavity-Free Future for all age groups.

Worldwide, 60-90 percent of school children and nearly 100 percent adults have dental cavities. In fact, dental caries ( which includes all stages of tooth decay) is the most common, yet preventable chronic disease on the planet. When dental caries occurs, hard tissue in the tooth is damaged by acids that naturally exist in our mouth and help break down foods, which results in tooth decay. Early dental caries can be prevented and controlled if the multiple causative factors, namely a susceptible tooth surface, the presence of cariogenic and acid producing bacteria in dental plaque biofilm, and the exposure to ingested carbo-hydrated and sugars are reduced.

When was ACFF initiated and its global strength ?

Since it establishment in 2010, the Alliance has increased its global presence to 15 chapters around the world, including Australia, Brazil, Central America, Central Eastern Europe, China, Colombia, India, Malaysia, Mexico, Pan-Europe, Philippines, Russia, South Africa, Turkey and Venezuela, with additional chapters to follow. A sampling of acativities include providing tools via a local ACFF website, securing commitment from dental school deans to integrate caries prevention and management into school curriculum and promoting community based education and prevention programs to families and communities.

What does the future hold for fillings for minor cavities ?

Researchers at King’s College London are developing a procedure that uses

Alliance for a Cavity-Free Future Declaration Global collaborative action is needed to challenge global leaders and other stakeholders – including country and community leaders, health and dental health professionals, public policy and education communities and the public – to learn the importance of caries as a disease continuum and to participate in action toward the delivery of comprehensive caries prevention and management that can positively influence the continuing problem of caries. This action should: • Ensure that primary prevention with appropriate fluoride strategies are in place.

• Promote the preventive control of initial caries lesions through education to change human behavior and the use of appropriate, evidencebased technologies.We call upon interested organizations and individuals to join the Alliance for a Cavity-Free Future and make a collective commitment to take action and elevate the importance of caries prevention and management as a global health issue.

low frequency electrical currents to help teeth “self heal” cavities without drilling. Drillings may become a thing of the past. Precisely called “electrically accelerated and enhanced remineralization,” will put an end to fillings for early-stage lesions and moderate tooth decay. Possibly, it could lead to more treatments for more advanced decay.

When to expect this technology to reach the dental clinic ?

This technology is expected to make

it to the dentists’ offices within three years. By the time a dentist examines a cavity- chances are high that he is seeing a tooth that has already lost minerals in the enamel and is on the way to decay.

There is a possibility of replacing these minerals with ones found in saliva or fluoride through a natural “remineralization” process. Researchers have been trying to figure out and fix how to enhance that process by making it faster and allowing it to work more deeply in the tooth.

Remineralizationhas been talked about since 1980s ?

Yes, we in the dental research field have known about remineralization for some time but it’s been hard to achieve a viable way that will remineralize established, large lesions in depth. The eureka moment came dentists started focusing on preparing the tooth by removing barriers to the remineralization process, including saliva and tissue. The next step involves the use of electrical currents to help drive minerals into the tooth.

We place a “healing hand piece” on the surface of the tooth for the duration of the relatively quick procedure. It emits an imperceptible electric current that drives minerals back into the tooth. It will be a a painless process and cost as much as traditional filling.

Will it lead to a greater turnover of patients ?

Yes, the technology might be close to meeting the growing demand for a popular, pain-free, effective solutions to cavities that will encourage people from coming back to the dentist’s office for other serious problems such as gum disease.

The procedure that’s involved in cutting a cavity and giving an injection is in some ways really uncomfortable. For some patients it’s a real phobia. When patients are more relaxed, they’ll come for monitoring.

OCTOBER / 2014 ehealth.eletsonline.com

45

HEALTHCARE IT

PALASH Healthcare Systems

LEVERAGING TECHNOLOGY for BETTER HEALTHCARE

H

ealthcare industry is keeping pace for integrating technology in its working space, but there are several healthcare providers who still lag in adoption of technology especially small and mid-sized hospitals. The reason being ‘unawareness’ about technological advancements. Healthcare industry in India is bereft of a proper guideline for Electronic Medical Record (EMR) and a proper regulation system. These negligence are widening the gap between the requirements of healthcare providers and its deliverables. Several healthcare providers are still maintaining the entire medical records manually. With a mission to transform this manual work system through its innovative solutions and services, PALASH Healthcare System (PHS) came into existence in 2006 in Pune, soon establishing a strong client base mainly in India, UAE, Africa, Caribbean, South East Asia and Europe.

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Archana Samudra Vice President Branding & Promotions Palash Healthcare Systems Pvt Ltd

PHS has created state-of-the-art comprehensive enterprise-wide Healthcare Information Management System (HIMS), Clinical Information Management System (CIMS), Electronic Healthcare Record (EHR), Electronic Medical Record (EMR) and Analytics software provider. Its faculty focused frameworks and operational components cover all aspects of management and operations of hospitals and clinics. PHS provides solutions for small and medium hospitals & clinics, where they have streamlined the entire processes seamlessly. Under the supervision of Dinesh Samudra, Founder & CEO, the company provides various solutions - Multispeciality, Healthcare platform, Clinical Management, IVF, Ophthalmology, Diabetic and Nephrocare to name a few.

PHS has enabled the easiness in the entire workflow mechanism with its single point integrated solutions. Ear-

lier, these hospitals struggled to maintain manual data efficiently. With the implementation of PHS’ solutions, information of patients, labs or others are instantaneously accessible in a single click. These solutions comprises of various modules as per requirement. For example - Nephrocare, which consists of various modules like patient, billing, laboratory, radiology, nephrology EMR feature, inventory and interfaces to name a few. These modules are streamlined in such a way that the entire medical details about any specific patient are accessible by the physicians or the authorized user. Hence, it eradicates the entire confusion and makes systematic workflow.

Adopting latest technology and changing itself as per the need of the hour is what PHS believes in. Thus, it has equipped itself with cloud-based HIMS solutions. The company merged HIMS and CIMS solutions and developed its version 1.0 that enables centralised data management. Accessibility of any particular patient portal by concerned physician is also made possible by this cloud-based solution. PHS also provides commercial application delivery and revenue analysis services. The solutions come with remote accessibility that allows the user to easily access through smart phones and tablets. The company is attracting VCs’ attention with its successful solutions and are expecting funding amount of USD 5million within a year along with a web portal they soon plan to launch.

Currently serving clients in India, including Sunshine Hospital, Alchemist, Kamalnayan Bajaj Hospital, Mewar Hospital, Inamdar Multispeciality Hospital to name a few, the company extends its offering to international clients as well. It envisions to expand its offices in UK, Europe and Africa soon.

Over all the years of its operations PALASH has not only been analogous with the domain but has also scrupulously seen the issues associated with it. Our experience says that the major problem of this industry lies in the fact that the health records of the patients are all in silos. This

creates duplicated records that are cumbersome to carry and maintain for the individual. PALASH has strongly narrowed down upon creating a common and unique health identification number for everyone in order to overcome the problem of health records in silos. PALASH will present this platform SWARM. Earlier, these HIE (Health Information Exchange) through a web based hospitals portal Consulting Connect struggled to that will not only generate a maintain manual unique health identity for the individual but will also bridge data efficiently. the gap between healthcare With the providers and individuals. implementation Consulting Connect will have of PHS solutions, two main tools that will efficiently manage the major eninformation of tities of this ecosystem – the patients, labs practitioners and the individuals. The doctors will be assistor others are ed by ‘PALASH Practice and instantaneously the individuals have PALASH accessible in a Fingertips at their disposal for maintaining their health inforsingle click mation.

PALASH Practice: This is a scalable ,web-based platform that gives individual and large Consulting and Clinic practices as also small & medium Hospitals and Nursing Homes the ability to function seamlessly across a number of different locations with the same flexibility and interactivity as practices with only one point of operations. Along with this doctors using PALASH Practice are connected to the Consulting Connect portal PALASH Fingertips: PALASH Healthcare Systems has developed an Individual Health Platform that is hosted through a web based portal. It stores the entire health information of an individual after registering on it. This digitized health record is available to the person at fingertips – it is actually your health record on the move. It can be accessed 24x7, 365 days a year on any hand held gadget (fablets or tablets), laptops or PCs. Apart from this PALASH Fingertips provides access to Consulting Connect for doctor search apart from other high end utilities offered there. An informative dashboard with all health updates along with selective trends is available. Health education and evaluation and direct communications with the doctors as and when required are the other services offered on the PALASH Fingertips portal.

PHS is growing in its own way. It has transformed itself to become a recognized organization. Recently it has received many awards and appreciations which have proven the company’s mettle. PALASH has proven that a mission with a vision always carves a niche for itself!!

OCTOBER / 2014 ehealth.eletsonline.com

47

GASTROENTEROLOGY

Prof Anupam Sibal, Group Medical Director, Apollo Hospitals Group, New Delhi, in conversation with ENN, talks about the advancements in paediatric gastroenterology and hepatology at Apollo Centre of Advanced Paediatrics

‘We Have Come a Long Way Since the First

Paediatric Liver Transplant’ You have dedicated much of your career to the study and treatment of pediatric GI disorders. Please elaborate on the history of the field of functional GI and its transition over the years.

In the early part of life of an individual, genetic and environmental factors (family attitudes toward bowel training or illness in general, major loss or abuse history or exposure to infection) may affect one’s psychosocial development (susceptibility to life stress, psychological state, coping skills, social support) or the development of gut dysfunction (abnormal motility or visceral hypersensitivity).

In the later part of the life, the presence and nature of a functional GI disorder is determined by the interaction of psychosocial factors and altered physiology via the braingut axis. In other words, one individual afflicted with a bowel disorder but with no psychosocial disturbances, good

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coping skills and adequate social support may have less severe symptoms and not seek medical care.

Another having similar symptoms but with coexistent psychosocial disturbance, high life stress, or poor coping skills may frequent his physician’s office and have generally poor outcome.

The expansion and refinement of investigative methods have helped in understanding the pathophysiology of functional GI disorders in terms of biological, cultural, and psychosocial (i.e. brain) spheres. These developments include the improvement of motility assessment, the standardisation of the barostat to measure visceral sensitivity, the enhancement of psychometric instruments to determine psychosocial influences, the introduction of brain imaging (PET, fMRI) to determine CNS contribution to symptoms, and the molecular investigation of brain-gut peptides, which provide insight into how these symptoms become manifest.

The Rome Criteria is an international effort to characterise and classify the functional GI disorders using a symptom-based classification system. The rationale for such a system is based on the premise that patients with functional GI complaints consist-

ently report symptoms that breed true in their clinical features, yet cannot be classified by any existing structural, physiological or biochemical substrate. The Rome Criteria was built upon the Manning Criteria, which was developed from discriminate function analysis of GI patients.

The decision to develop diagnostic criteria by international consensus was introduced as part of a larger effort to address issues within gastroenterology that are not easily resolved by usual scientific inquiry or literary review. By 1992, several committees had met to discuss the criteria, which ultimately resulted in the publishing of many articles in Gastroenterology International and a book detailing the criteria titled “The Functional Gastrointestinal Disorders.

The criteria have been revised subsequently and currently Rome III criteria are being followed which were last revised in 2006”.

What is the progress specifically in the area of pediatric liver transplant and surgical gastroenterology?

Pediatric liver transplant is an area which has progressed leaps and bounds in the last three decades.

Especially in India, we have come a long way from the first pediatric liver transplant at our centre in 1998. With better training and skill refinement our surgeons are at par with the best in the world. Better intensive care, anesthetic care and potent immune suppressants have contributed in no small measure to the success of pediatric liver transplantation in India.

The numbers have grown exponentially and we would have performed close to 150 pediatric transplants by the end of 2014.

Surgical gastroenterology, similar to transplant surgery, has benefitted from advent of new technology.

Your overview of liver failure issues among children in India?

The commonest cause of pediatric

Patients with more painful and severe symptoms may prove to have ‘abnormal perception of normal gut function’ rather than abnormal function acute liver failure in the country unfortunately continues to be infectious causes like viral hepatitis which can be easily prevented by proper sanitation and hand hygiene. As regards chronic liver failure, biliary atresia continues to be the leading cause in India as elsewhere in the world.

The ability to identify patients who should be referred to a tertiary centre for further management of the disease state is limited. Facilities for intensive care monitoring of children with acute liver failure are scarce in the country.

Financial issues and gender bias are other issues which affect ultimate outcomes in children with liver failure.

Please tell us about the advancements in paediatric gastroenterology and hepatology at ACAP (Apollo Centre of Advanced Pediatrics)?

ACAP has a state of the art facility for the advancement of Pediatric gastroenterology and Hepatology services in the country and subcontinent. All diagnostic and therapeutic modalities related to endoscopy, colonoscopy and ERCP are available. There is also provision for capsule endoscopy, endoscopic ultrasound and fibroscan.

Simulators for UGI endoscopy, colonoscopy and enteroscopy are available for teaching our fellows the nuances of such techniques. They have also been used in international endoscopy and colonoscopy courses to teach delegates.

ACAP has conducted the Kunwar Virendra Oswal International course on Pediatric gastroenterology Hepatology and Nutrition for the past two years where international faculty

and delegates have participated extensively to further the cause of the subject. For the first time a hands-on training endoscopy workshop was conducted in the country on porcine models by national and international faculty, where delegates mastered both diagnostic and therapeutic skills.

In addition, a gastroenterology CME is conducted annually in December wherein general pediatricians are encouraged to participate and bring forth their problems in pediatric gastroenterologies which are addressed by the experts.

What do you see as you look to the future of functional GI disorder treatment?

Future studies will identify pathophysiological subgroups each having their own determinants and treatments.

Some patients will develop their disorders or exacerbate symptoms via sensitisation of afferent transmission from infection, enhanced motility, or trauma to the gut. They may respond to the newly-developing neurotransmitter blocking agents.

Patients with more painful and severe symptoms may prove to have ‘abnormal perception of normal gut function’ rather than abnormal function.

This dysfunction in the central regulation of incoming visceral signs may be remedied with a psychopharmacological treatment approach. The symptoms of some patients could be attributed to genetic factors, which result in abnormalities in central reactivity to stress, in which case genetic manipulation strategies would prove beneficial.

Early learning within the familial structure and socio-cultural influences has been demonstrated to affect symptom perception and illness behavior. Future studies are also likely to identify psychological and behavioral interventions that are targeted for this subgroup.

(With inputs from Dr Akshay Kapoor)

OCTOBER / 2014 ehealth.eletsonline.com

49

OPTHALMOLOGY

T

Retinopathy of Prematurity

THIRTY DAYS TO LIGHT!

Babies born prematurely with or without infertility treatments need early eye examination, writes Dr Subhadra Jalali, Associate Director, Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad 50

OCTOBER / 2014 ehealth.eletsonline.com

oday, more couples are turning to assisted fertilisation to help build families due to numerous advances and improved successes of these techniques. Now, women have great opportunities and they are choosing to develop their education/careers instead of becoming housewives. However, by the time, they focus on having a family, age becomes the major deterrent. There are also couples who stay far away from each other, but still want to have babies. Assisted fertilisation techniques have come as a boon for such people.

Babies born after any type of assisted conception are more likely to be born pre-term, more likely to be of multiple births (twins/triplets/quadruplets) and of low-birth weight. Pre-mature babies including those after ‘’Assisted Conception’’ are vulnerable to a serious eye disease called, ‘Retinopathy of Prematurity (ROP)’. Awareness about this risk is low even amongst those doctors that deliver, or those that take care of these babies after birth, resulting in needless and irreversible blindness.

Retinopathy of Prematurity (ROP) is abnormal blood vessel development in the retina of the eye in a premature infant. The blood vessels of the retina begin to develop three months after conception, and complete their development at the time of normal birth. If an infant is born prematurely, that is anytime less than a month before the expected date of delivery (EDD), this eye development can be disrupted. The vessels may stop growing, or grow abnormally from the retina into the normally clear gel that fills the back of the eye. The vessels are fragile and can leak, causing bleeding inside the eye not visible from outside. This dynamic disease is not present at birth. Although, the retinal vasculature is immature at birth, there is an attached macula that has a potential for good vision. ROP starts only two-three weeks after birth, providing a window period for screening and offering treatment at the right time. All pre-term babies are at risk of ROP and should have one compulsory retinal examination before 30 days of life. Smaller babies should be screened earlier by 20 days of life. Further, close follow-up examinations are needed till the child reaches the EDD, and then once or twice a year at least till the child is five years old.

Scar tissue may develop and pull the retina loose from the inner surface of the eye (retinal detachment) causing irreparable vision loss. Routine use of excess oxygen to treat premature babies is an additional risk factor. If oxygen is accurately monitored, and given in a controlled way, the problem is less likely but not absent, and can occur even when no oxygen was given. The risk of developing ROP also depends on the degree of prematurity and the sickness after birth. Generally, the smallest, low-weight and most sick premature babies have the highest risk, but

no premature baby is ‘without risk’ of ROP, and ROP blindness.

There are five stages of ROP • • • •

•

Stage I: There is mildly abnormal blood vessel growth.

Stage II: Blood vessel growth is moderately abnormal, and in some cases may need early treatment.

Stage III: Blood vessel growth is severely abnormal, and requires early treatment within 72 hours.

Stage IV: Blood vessel growth is severely abnormal, and there is a partially detached retina and some eyes may improve with urgent surgery.

Stage V: There is a total retinal detachment, and only very few eyes get minimal vision even after advanced treatment.

The blood vessel changes cannot be seen with the naked eye. A detailed retinal examination by a well-trained person is needed to reveal such problems.

Symptoms of severe ROP usually in its incurable advanced stage include • • • •

Abnormal eye movements Crossed eyes Severe nearsightedness White-looking pupils (leukocoria) Early stages of ROP where treatment is effective have no symptoms, and cannot be detected by routine eye examination. Hence, a routine dilated retinal examination within 20 to 30 days of birth is the only way to detect ROP, and prevent this blindness.

results are universally poor and hence the importance of early screening by 20 to 30 days of life. Success in ROP is directly linked to the time and rapidity of treatment. It is a medical emergency, and should be treated as such.

Complications The severe case of ROP can occur due to extreme prematurity, fluctuating or unmonitored oxygen, sepsis and delayed presentation to the ophthalmologists beyond 25 to 30 days of life. A few cases fail due to inadequately done laser.

If there is a poor response to treatment, the child should be referred within 48 hours to an expert who can do more aggressive laser, early surgery, or in selected cases inject an anti-VEGF drug to halt the progression of the disease.

Babies with ROP can have sequelae such as low vision, myopia, anisometropia and squint. Advanced cases can also develop complications like glaucoma and late-onset retinal detachments besides cataract.

Expectations If managed appropriately, most premature infants with ROP recover with no lasting visual problems, but many of them would need spectacles. Many premature infants with slight problems in retinal blood vessel growth have the vessels return to normal without treatment and can recover completely.

Prevention

Treatment In ROP, time means vision. The first 20 to 30 days of life are the most critical for ROP management. Early ablation of the avascular retina produces improved visual outcomes. Laser ablation is the standard of care, and is highly successful in more than 85 percent cases. It is safe, if performed properly at the correct stage of disease, usually within three to five weeks of birth. Failed laser cases can be offered immediate use of newer emerging therapies like Avastin (Bevacizumab) injection, or immediate surgery under expert guidance.

Late cases can be offered surgery, but

ROP starts only twothree weeks after birth, providing a window period for screening and offering treatment at the right time.

All pre-term babies are at risk of ROP, and should have one compulsory retinal examination before day 30 of life

The most effective prevention of Retinopathy of Prematurity is prevention of premature birth which currently is not possible, and in fact is on the rise partially due to assisted fertilisation techniques that often result in premature and multiple births. Preventing other complications of prematurity (such as neo-natal respiratory distress syndrome) may also help prevent ROP. ROP is an increasing concern among young parents who are caught unawares with blindness in their premature baby due to poor ROP management. The science and art of preserving vision in these fragile newborns has to be taken out of journals where the scientific information lies in the form of complicated medical studies and has to be placed in the cribs (baby beds) amongst the caregivers. The slogan for all those who handle pre-term babies should be “Tees Din Roshni Ke: Thirty Days to Light!”

OCTOBER / 2014 ehealth.eletsonline.com

51

HEALTHCARE IT

Intel-owned Wind River has been the go-to solutions provider for healthcare OEMs. Gaurav Sareen, its Head of Sales, explains to ENN’s Rajesh K Sharma how Wind River plans to market its virtualisation solutions in the Indian healthcare space

Wind River Enters

Indian Healthcare OEM Space

M

edical devices are the backbone of healthcare industry. From the neighbourhood doctor to the multispecialty hospitals, everyone relies on medical devices that aid the doctors in their functioning. Machines like MRI and CT scan have helped doctors identify the ailments of patients better, thus being able to save more lives.

But medical devices, like any other technology, need to be updated on a regular basis, to incorporate the latest medical advances in medical science. But designing a newer version of a machine with added functionality is an expensive and time-consuming business, a problem that is addressed by virtualisation.

Wind River Technologies, a subsidiary of Intel Corporation, offers virtualisation solutions that help medical device makers like MRI machine bring down their manufacturing costs. They help in consolidating the complex machines, thereby reducing their costs. It focuses on all parts of medical landscape, whether it is in the service delivery side or the devices themselves, or driving down

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the cost of innovation for emerging markets, and markets where conventional market technologies cannot be retrofitted, and provide benefits to a large percentage of the populations.

Starting out as a company that developed a real-time operating system to communicate between the hardware and the software running on it faster, Wind River later went downstream and developed applications for the devices as well. With a strong presence in aerospace and defence, it is not getting into industrial design and networking too.

Speaking on Wind River’s foray in healthcare, Wind River’s Head of Sales, Gaurav Sareen outlines the plan.

Healthcare, he says, can be split up into three different areas – medical devices, service delivery, which covers hospitals and diagnostics centres and the professionals in the industry itself. According to him, the biggest driver for companies that build medical products is to bring about consolidation among the various medical branches. With newer and faster capabilities available, medical device designers should reduce the form factor of the medical devices, thereby bringing down the prices of the devices. Giv-

ing the example of an MRI machine, Gaurav Sareen says that it has a life cycle of 10-12 years. But to incorporate the latest advances in medicine, these machines need to be redesigned to reflect the changes, both, from the hardware as well as the software side. The product design cycle in this case is huge, he says, because of all the regulatory requirements. “If a company is manufacturing or designing MRI machines has to move to a new hardware, their regulatory requirements and their testing requirements are prohibitive and have an expanded design cycle,” he says, adding, “With the technology that we provide at Wind River, this movement gets accelerated almost by a factor of Wind River’s real three to five times depending time operating on the product, and significantly accelerates the entire system’s impact redesign process by being able in medical to do more with the existing technology has application, as they are, on the new hardware. It makes the been immense new hardware almost opaque given its real-time or virtualized to the existing nature. In fact, application, and helps provide a path to that application.” most medical The medical devices mardevices using a ket, he says, is cluttered by dereal time OS use vice makers that can be classified under people who build Wind River’s OS. bio-medical devices, early detection devices, imaging devices such as MRCT, X-ray, diagnostic devices like DHR, PACS. Wind River is present in all of these markets. In medical devices, each device is classified as class 1, class 2 or class 3 depending on the safety level and security that it expected from the devices.

In fact, class 2 devices are further divided into class 2A and 2B. Each of these classes has their own regulatory requirements in terms of how these devices are expected to behave, and what is the criticality of these devices. Sareen says when Wind River offers a solution it keeps the regulatory requirement of the solution in mind.

Wind River’s real time operating system’s impact in medical technology has been immense given its real-time nature. In fact, most medical devices using a real time OS use Wind River’s OS. It is Wind River’s first flagship product that gets adopted by medical device manufacturers. Winder River’s embedded goods migration technology, called Hyper Visor, provides a proven path to visualise a design environment that enables a migration from an old legacy hardware to a new one quickly, with all the regulatory and compliance requirements already considered and factored.

Wind River has put special emphasis on security on its products. Security plays an important when moving from

medical devices to deliver, says Gaurav Sareen. He says nowadays, medical devices are interconnected to each other, and exchanging information with each other or with the cloud. With internet becoming pervasive, the robustness of delivery has undergone a change and new technologies that are driving innovation in the field of remote patient monitoring, remote patient diagnostics. Wind River provides the entire infrastructure which enables the devices to aggregate a connectivity and aggregator to cloud connectivity. It provides the basic building blocks of hardware as well as pre-integrated software as a complete platform to enable companies looking to connect medical devices either in a hospital environment or for service providers to leverage all of these devices to deliver medical care to patients and provide for patients in their homes to subscribe to. This entire platform is provided with Intel. Intel is driving the initiative where Intel and Wind River combined will provide a complete readymade platform for the internet of things market, specifically targeted towards medical technology and healthcare.

The solutions provided by Wind River also take care of device security. It makes sure that any embedded device is secure from multiple aspects - from ensuring communication, from making sure that the underlying hardware is driving the device that it is meant to be driving.

Wind River’s India plans are aimed at helping the indigenisation movement, says Gaurav Sareen. So far, Wind River has provided its solutions to the top medical device makers like GE, Phillips and Siemens. But now, it wants to move downstream, and target Indian manufacturers that are working towards indigenising medical devices to Indian conditions. Gaurav Sareen feels that Wind River’s solutions can integrated virtualisation solutions can provide a cost effective solution to Indian manufacturers. He is confident about the impact of Wind River’s presence in the Indian healthcare market. “It will make sure that technology becomes available to a broader set of people,” he says. He feels that device level consolidation and indigenisation will held drive down the prices of medical devices, thus making healthcare more affordable to everyone.

As Wind River makes its presence felt in the Indian market place, it is betting on a segment that does not exist yet in India. Indian medical device is almost negligible to be of any consequence. But Wind River, with its proven technology, may just ignite the sector towards a bright future.

OCTOBER / 2014 ehealth.eletsonline.com

53

IN VITRO DIAGNOSTICS

Operating under the umbrella of Beacon Group of Companies, Beacon diagnostics manufactures and distributes reagents for biochemistry and serology testing. Chirag Joshi, CEO, Beacon Group of Companies, tells ENN’s Rajesh K Sharma of the sector’s phenomenal growth and where the IVD industry is headed

Growing to Serve the IVD SECTOR Please tell us about Beacon Diagnostics’ presence in the IVD segment.

The Beacon group of companies consists of three companies – Beacon Diagnostics Pvt Ltd, Vector Biotek Pvt

Ltd and Biogeny Diagnostics Pvt Ltd. All three companies make reagents for the various IVD branches.

Beacon Diagnostics is into manufacturing and marketing of IVD reagents used for Biochemistry tests and serology testing. It also markets Turbidimetry tests and rapid tests manufactured and imported from different high quality sources.

Vector Biotek markets equipments imported from various sources which includes Biochemistry- semi and fully automated systems, hematology- includes 3 part and 5 part differential analysers and electrolyte. It also markets Hematology reagents.

Biogeny Diagnostics markets generic hematology reagents and urine chemistry products. All the 3 companies have pan India operations with more than 300 distributors and customers including private labs, corporate hospitals, government and semi government institutions.

What is the IVD sector’s worth right now, and in your opinion, are its future prospects?

The IVD sector is currently estimated to be around `4000 crores.

The future prospects are very bright as the market is growing at estimated 17-20 percent per annum.

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What is the current state of innovation in the IVD industry?

Do you see a trend emerging about which way the industry is headed? Please tell us about the R&D happening at Beacon.

IVD market is witnessing in tests moving from lab to near patients (NPT) and rapid testing. The expansion of immunochemistry and application of Molecular biology are the emerging trends in IVD markets. The industry is moving towards more and more products beings manufactured in India.

The R&D activities are focusing on future trends of testing including molecular and Rapid testing.

What are the practices that you follow at Beacon Diagnostics to ensure the quality of your products? Is the Indian market quality conscious when it comes to diagnostics?

We are ISO 9000-13485 certified company and have FDA approved manufacturing facility. Hence, we are compliant to very high and rigorous manufacturing quality procedures.

Indian market are definitely quality conscious. However, pricing also plays a major role and hence we see Chinese companies dominating the market in middle and lower market segments.

4

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HOSPITALS

I wish to create an environment where doctors, researchers and interns feel like a family and they get every opportunity to learn in an atmosphere that’s peaceful and friendly, says Dr MC Mishra, Director, AIIMS in an interview with Neha Thakur of ENN

The Banyan Continues to Grow Being a mammoth organisation, what is the capacity of AIIMS to cater to numerous patients who arrive every day?

AIIMS has several comprehensive facilities for teaching, research and patientcare too. It conducts teaching programmes in medical and paramedical courses both at undergraduate and postgraduate level and awards its own degrees.

Teaching and research are conducted in 42 disciplines here. Under the Pradhan Mantri Swasthya Suraksha Yojana six new All India Institutes of Medical Sciences have been established. The full academic session for the six new AIIMS at Bhopal, Patna, Jodhpur, Rishikesh, Raipur and Bhubaneswar has started in August 2014.

AIIMS has state-of-the-art infrastructure and is well-equipped with all resources. Its modern labs have all the facilities that make it possible to carry all kinds of researches. The institute has hitech labs, library, central animal facility, computer facility, central workshop, electron microscope facility, medical, social and welfare services.

Dr Rajendra Prasad Centre for Ophthalmic Sciences is a 300 bed ophthalmic (eyes) speciality centre designated as the apex eye referral centre for India, and is the WHO collaborating centre for ophthalmic programs.

Recently Dr BR Ambedkar Institute Rotary Cancer Hospital’s construction has been completed. It specialises in medical, radiation and surgical oncology.

Jai Prakash Narayan Apex Trauma Centre is the first fullfledged centre to treat victims

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of trauma in the country. It is located about a kilometer west from the main campus.

The Government of India, Ministry of Health and Family Welfare has designated this centre as National Centre for Excellence for implementation of National Oral Health Programme in the country. This centre provides technical support on Oral Health to the Government and WHO. Despite having very few faculty members, this centre has been giving best research output per person in the whole country.

AIIMS also runs the National Drug Dependence Treatment Centre at Ghaziabad, one of Delhi’s suburbs.

The Centre for Community Medicine at AIIMS maintains a teaching and treatment facility at Ballabhgarh, a suburb outside Delhi, it also provides comprehensive services to a population of 84000. Faculty members from AIIMS are posted there by rotation.

What are your expectations from the new government?

The new government has been very supportive, understanding and helpful so far, they are willing to lend their financial support to all our noble causes. Even in the parliament various discussions and bills related to health care have been discussed. Government has already set up four new

AIIMS in the country that have several technical advancements in surgeries and areas like organ transplantation including heart, kidney and lungs, Neurology, Gynaecology, ENT and orthopaedics have taken place. Government has supported our plan of new diagnostic centre and OPD complex.

Elaborate on the impact of technology on medicine and science at AIIMS. Science and Technology has really grown well at AIIMS in the past years.

Actually, we want to make hospital completely patient and environment friendly. We have revolutionised brain

plan to resolve them?

The biggest challenge is the huge influx of patients everyday that adds to the work load of doctors as the infrastructure is limited. So, in order to ensure better services to patients improvement in infrastructure is the need of the hour. AIIMS is a world renowned institution and has established itself as a brand since it was set up in 1956.

For 800 beds to 2500 beds today along with 52 special departments under one roof, we’ve come a long way.

We want to make a robust information system, build new surgical centres, build a new OPD complex and have

The biggest challenge is the huge influx of patients everyday that adds to the work load of doctors as the infrastructure is limited. So, in order to ensure better services to patients improvement in infrastructure is the need of the hour surgeries and others like Laparoscopic surgery, organ and heart transplantation. There is also image guided therapy which has reduced the risk of surgeries. Basically, health is actually state subject in India and therefore state government must also be friendly.

Globally, where do you see Indian medical education and doctors?

Indian medical education has undergone several transformation and developments in the past 10 years. Technically speaking, Indian doctors and surgeons are class apart and we are very strong and self reliant in terms of having highly qualified and experienced doctors along with innovative medical instruments like Gamma knife as well. All techniques used in foreign countries are very conveniently used in India.

What are the challenges faced

by AIIMS today and how do you

bigger plans of hospital expansion; for example, trauma centre.

We receive almost 10,000 patients and 50,000 footfalls every day. We perform 1.5 lakh special operative procedures every year. So, with this kind of workload and ever increasing number of patients maintaining our image as patient-friendly and offering low cost treatments continues to be a challenge and a priority.

Managing a huge crowd is a challenge and we are devising some effective mechanisms to treat maximum number of patients and to continue welcoming those who look up to AIIMS as a facility for their treatment.

What new developments have been initiated across various departments of AIIMS? I intend to improve patient care services to ensure maximum customer satisfaction. Also, I am planning to set up some surgical centres maternity centres and new blocks but the plan needs approval recommendations and

hence it is yet to be formulated. Then, I also aim to expand the AIIMS campus and add extra hostel facilities. In addition, computerisation of hospital services through intranet is also the topmost priority. An efficient online system is also to be introduced to computerise the appointment system with doctors.

How well equipped is AIIMS to deal with any crisis like Dengue or Ebola?

AIIMS is very well equipped technically and manually to deal with any kind of medical emergencies and it has best of the doctors who are world renowned. Every season, we witness a number of medical urgencies and since there is no dearth of doctors, all the cases are well taken care of. We will be soon having 1000 doctors in the coming year.

Where do you see AIIMS five years from now?

I see AIIMS well-developed and fullyequipped in all the aspects of medical care and facility. It already has begun its journey towards achievement of various technological advancements and in the next five years it would definitely become class apart and ready to compete globally too. We seek to develop strong work force with 3500 nurses and 9000 technicians and assistants in the coming years. Besides, we would have diagnostic centre with 630 full time faculties.

What new plans have been introduced to change the medical education at AIIMS? Most importantly, I wish to create an environment where doctors, researchers and interns feel like a family and that they get an opportunity to learn every moment and also there remains a peaceful, friendly and caring atmosphere. Besides, there will be an introduction of new evaluation system including OSCII and new assessment and examining status in PG status.

OCTOBER / 2014 ehealth.eletsonline.com

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LAUNCHPAD

Samsung launches premium Ultrasound system - RS80A

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amsung Electronics Co. Ltd., announced the launch of ‘RS80A’, a premium ultrasound system designed for exceptional image quality and functions for increased diagnostic performance. The RS80A is Samsung Medison’s first product to target the Radiology segment which is the largest portion in diagnostic imaging market.

Samsung RS80A provides clinicians with superior ultrasound performance and features ideal solutions for General Imaging.

The new machine is equipped with a 23” HD LED Screen, 13.3” full function touch screen with tilt facility, 5 probe port and electronic console movement (up-down and sidewise).

It also supports 10 ports Digital TGC which provides easy control with the help of reference image on the touch panel.

The RS80A’s S-Vision Architecture provides outstanding images through newly developed S-Vision Beamformer and Imaging Engine while the 23 inch LED monitor provides clearer and brighter display. These state-ofthe-art technologies ensure detailed resolution and tissue uniformity for all types of applications in Radiology and general imaging. S-Vue Transducer gives broader bandwidth and higher sensitivity to enable exquisite image quality at depth.

A

s the first all-in-one biocompatible and bioactive dentin substitute, Biodentine fully replaces dentin wherever it’s damaged.

Biodentine helps the remineralisation of dentin, preserves the pulp vitality and promotes pulp healing. It replaces dentin with similar biological and mechanical properties.

Improving on Biodentine clinical implementation, you can now bond the composite onto Biodentine in the same visit and perform the full restoration in a single session.

To enjoy the clinical benefits of the first and only dentin in a capsule, ask your dental distributor for Biodentine .

Biodentine The first and only dentin in a capsule

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OCTOBER / 2014 ehealth.eletsonline.com

Inviting participation for School Ranking 2014

Top Schools of India In a world living to the Darwinian maxim of survival of the fittest, school education is not limited to the realm of academics alone. Are you a school that believes in keeping the child at the centre of it all? Do you believe you have it in you to prepare children for success not just in terms of education, but also in their well-being, skills and social integration? If so, nominate your institute for the prestigious digitalLEARNING School Ranking that seeks to recognise and honour the best from across the country.

 Academic Excellence  Start-up  Infrastructure  Minority Education  ICT Implementation  International Curriculum  Boarding To fill ranking questionnaire, pls visit http://digitallearning.eletsonline.com/school_ranking/

Highlights The ranking will cover schools from the metros, as well as the Tier II and Tier III cities across 29 states and 7 union territories of the country.

Felicitation for top-ranked schools at the School Leadership Summit in January 2015 The best ranked schools will be felicitated at the School Leadership Summit in January, 2015. This summit will host top Indian schools and educators, educationists, providing an excellent platform to network and collaborate with each other, helping achieve the next level of growth.

To see school ranking 2013, Pls Visit http://digitallearning.eletsonline.com/2014/01/presenting-top-schools-of-india-december-2013/

For queries and participation, please contact Seema Gupta, mobile - +91 8860651643, mail - seema@elets.in Nidhi Sharma, mobile - +91 8860651631, mail - nidhi@elets.in

Last date for submission of forms 15-November-2014

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