MT Vol 4 Issue 3 - Jan - Mar - 2020 Eng

ISSN 2582-452X Vol.4 | Issue No.3 | Jan - Mar 2020

COVER STORY

DIAGNOSIS GOES DIGITAL

SPECIAL FEATURE

CORONA VIRUS

THE VIRAL CHALLENGE

asianmeditour.com

HIGH HOPES FOR AI in Cancer detection

Beware of DIABESITY!

STRESSED OUT? Blame social media

FORGET HARVESTING

Let’s make organs!

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Heart Centre Cardiology & Cardiothoracic Surgery

ADVANCED

CARDIAC SURGERY

AT

CARDIO VASCULAR & THORACIC SURGERY The Cardio Thoracic & Vascular Surgery department of BMH Kozhikode, has a fully dedicated team backed by state-of-the-art facilities offering 24 hours service with the competency to handle any major Cardiac and Lung surgeries.

Panel of Doctors Dr. Harilal V. Nambiar, MS, MCh, FIACS Chief Cardiothoracic & Vascular Surgeon Dr. Vineeth Abraham, MS, MCh Cardiothoracic Surgeon Dr. Pramod V, DA Consultant Cardiac Anaesthesiologist Dr. Prajeesh M Nambiar, MD, DNB Consultant Cardiac Anaesthesiologist

Highlights  Adult Cardiac Surgery including Beating Heart CABG (Bypass Surgery)  Single and Double Valve replacement  Redo cardiac operations  Surgery for congenital heart diseases  Endoscopic Vessel Harvesting  Tracheal surgery  Lung & thoracic surgery  VATS  Mediastinal surgery  Mediastinoscopy  Rigid & Flexible Bronchoscopy  Aortic & major vascular surgery  Carotid Endarterectomy

(NABH & NABL Accredited, ISO 9001:2015 & ISO 14001:2015 Certified Hospital)

Kozhikode, Kerala, India | 0495 2777 777 | www.babymhospital.org

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Medical Tourism Jan - Mar 2020

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DIGITAL TECHNOLOGY IN HEALTHCARE

Vol. 4 | Issue No. 3 |Jan - Mar 2020

M RNI No. KERBIL/2016/68979 Editor & Publisher BENNY THOMAS Group Editor C GOURIDASAN NAIR Executive Editor* BYJU ARYAD Editorial Co-ordinator KRISHNA KUMAR K.E.

Mobile health apps have emerged as a crucial tool in day-to-day patient care and healthcare management across numerous facilities all over the globe. And the promise of mobile apps in the healthcare ecosystem is not limited to better treatment.

Digital technology can now bridge the gap in the availability of adequate number of healthcare personnel and infrastructure facilities, particularly in the rural areas.

Telemedicine, which facilitates remote diagnosis and treatment of patients using advanced telecommunication and information technology, and Artificial Intelligence (AI), which enables machines to detect abnormalities in various investigations, are going to be the game changers in the days to come.

Artificial Intelligence can alert the physician to the most effective treatments and also the most common contra indications. Common diseases with uncommon manifestations are another area where Artificial Intelligence can narrow down possibilities and ensure accurate diagnosis. The cover story in this issue is about the role being played by digital technology in diagnosis and treatment of illnesses.

Articles on the role of Artificial Intelligence, Point-of-Care Diagnostic testing, Digital Health Apps, Internet of Things (IoT), Telemedicine, patient data protection protocols, data security regimes and Virtual Reality to diagnose and treat medical conditions from social anxiety to chronic pain to Alzheimer’s disease makes this a wholesome package on the sway that digital technology has begun to have on healthcare at all stages.

Marketing & Promotion TIJO JOHNY (SENIOR EXECUTIVE) Layout & Design LAL JOSEPH Legal Advisor Adv. BIJU HARIHARAN Arabic Translation Dr. A. ABOOBACKER BUSINESS ASSOCIATES Overseas USA : CHICAGO: Vincent Joseph Mob: 847 299 9954 USA : HOUSTON: Shaju Joseph Mob: 847 899 2232 USA : NEW YORK Vincent Sebastian Mob: 917 992 9629 USA : CALIFORNIA: Wilson Nechikat, Ph: 408 903 8997 Canada : Jose Sebastian, Ph: 416 - 509 – 6265 UK : Dileep Mathew, Ph: 044 787 743 2378 Switzerland : Dr. George Sebastian, Ph: 527204780 Ireland : Thomas Mathew Mob: 00353 87 123 6584 Middle East : Anil Nath, Ph: 506854500 Singapore : Mahesh A, Ph: +65 906 22828 Germany : Gayatri Puranik Ph: 0049 179 127 5002 Austria : Monichan Kalapurackal Ph: 0043 6991 9249829 Korea : Dr. A. Thomas, Ph: 0082 10 5822 5820 Australia : S. Mathew, Ph: 61247026086 Oman

odern technologies and innovations are continuing to make era-defining impact on the medical treatment and healthcare industry. The impact of mobility, connected gadgets, wearable healthcare devices and a host of other technologies has become so significant that the healthcare facilities and practices available just a decade ago bear no comparison to the present day scenario.

: Joy Vincent, Ph: 968 9503 5953

BUSINESS ASSOCIATES India Mumbai : Mohan Iyer, Mob: +91 22 6450 5111 Eastern India : Sanjay D. Narwani, Mob: +91 983 120 7202 Hyderabad : Ephram Joseph, Mob: +91 939 131 5072 Tamil Nadu : Gurumurthy, Mob: +91 989 460 4804 Puducherry : K. Ramasubramanian, +91 989 497 7161 Trivandrum : Kuriyan K. Raju, Mob: +91 944 610 6644

3D printing human organs is a relatively new concept. Although it may present certain ethical dilemmas, the use of 3D printing technology to create new organs is likely to be beneficial, by ensuring effective treatment of ailments and increased availability of organs for patients in need. The importance of 3D printing technology for the creation of organs is emphasised in this special issue.

India is seen as one of the preferred medical destinations and, going by the current trends, it will remain so in 2020. Medical tourists have a liking for the country’s health industry, the reasons being many. A key factor is the cheaper treatment and travel costs when compared to western countries like the US and the UK. Those travelling to the country for medical purposes are assured of reasonable savings in terms of treatment expenses. That makes medical tourism potential of the country as a key subject in this issue.

Special Focus: In the light of the massive outbreak of ‘Coronavirus’ (named Covid-19

by WHO), we have included a special focus section in this issue dealing with the specificities of the disease outbreak and its possible causes and the impact that the disease has had on global health concerns. We are particularly gratified that we could also include an exclusive interview with a renowned doctor in Kerala, in south India, who led the team that successfully cured a patient infected with ‘Covid-19’.

Medical Tourism Magazine is one of the official media partners for the ITB Berlin Medical Tourism pavillion. ITB Berlin 2020 is the world’s largest tourism trade fair to be held from March 4 to 8 in Berlin, Germany.

We wish you a happy reading.

C Gouridasan Nair Group Editor

*Responsible for selection of news under the PRB Act CORPORATE OFFICE FM Media Technologies PVT Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India.

Tel: +91 484 403 4055 Email: director@asianmeditour.com www. asianmeditour.com

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Medical Tourism Jan - Mar 2020

Printed, published and owned by Benny Thomas FM Media Technologies Pvt. Ltd, Penta Square, Opp.Kavitha, MG Road, Cochin -682016, Kerala, India.

Editor: Benny Thomas

Printed at Sterling Print House Pvt Ltd, Door No. 49/1849, PonekkaraCheranellur Road,Aims, Ponekkara P.O, Cochin-682041, Ph: 0484 2800406.

Disclaimer: The statements in this magazine have not been evaluated by the Food and Drug Administratin of USA or any other country. Information provided in this magazine are not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, consult your physician. All information is provided for research and education purpose only.

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Contents

24

08 News 16

Special feature: The Viral Challenge

20 Interview: Happy we could rise

to the challenge

22 The rising threat of viral epidemics 24 Cover story:

Diagnosis goes digital

28 Forget harvesting,

let’s make organs!

32

On target

52

Following Buddha to Tranquility

56 Pathya Key to fostering Ojas 58

Interview: Against All Odds

60 Rare Surgeries 42

36 High hopes for AI in

cancer detection

40 Virtual Reality a great promise

in addressing stress

63 Conferences

16

65 Events 67

Equipment World

69 Hospitals 42 Beware of Diabesity!

44 Glory Days Ahead 46 Coffee? Make it right!

48 Stressed out?

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Medical Tourism Jan - Mar 2020

Blame social media

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Rain forest Theme, the entire resort is in midst of lush green plantation and trees

An ideal getaway that offers both luxury and wilderness experience, refreshing and rejuvenating environment would leave you in awe and a retreat like this one, falls short on description. It is an experience that is best felt. Settled on a jungle mountain slope, overlooking thousands of acres of lush green valley , endowed with uninterrupted views, it gets you closer to the vibrant nature.

Facilites:

Ayurvedic SPA, Swimming Pool, Multicuisine Restaurant and rope adventure activities.

Amazing view from almost all the rooms

Rajasthani Architecture The grandeur of Rajasthani architecture on the backwaters of Kerala, It is a beautiful four star resort with all the amenities and comforts of a 5 start resort.

You will feel like a royalty while you stay here. The stunning building will catch your eye from a distance.

Facilites: Swimming Pool, Multi Cuisine Restaurant, Health Club, Conference hall up to 300 pax & Ayurvedic Spa

Call for More

Girish Kumar (Sr. Manager Hotel Sales) 90201 10957 7 A Complete Magazine on Healthcare in Asia AYURVEDA & Health Tourism | Jan - Mar 2020 13

MEDICAL TOURISM NEWS

NEW AI SYSTEM TO DETECT AND GRADE PROSTATE CANCER

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esearchers have developed a method based on Artificial Intelligence (AI) for diagnosis and grading of prostate cancer.

The AI-system has the potential to solve one of the bottlenecks in the modern prostate cancer histopathology by providing more accurate diagnosis and better treatment decisions, they said. The study, published in the journal The Lancet Oncology, shows that the AI-system is as good at identifying and grading prostate cancer as world-leading Uro-pathologists.

"Our results show that it is possible to train an AI-system to detect and grade prostate cancer on the same level as leading experts," said study researcher Martin Eklund, Associate Professor at Karolinska Institute in Sweden.

"This has the potential to significantly reduce the workload of Uro-pathologists and allow them to focus on the most difficult cases," Eklund added.

A problem in modern prostate pathology is that there is a certain degree of subjectivity in the assessments of the biopsies. Different pathologists can reach different conclusions even though they study the same samples.

This leads to a clinical problem where the doctors must pick treatment based on ambiguous information, the 8

Medical Tourism Jan - Mar 2020

study said. In this context, the researchers see significant potential to use the AI-technology to increase the reproducibility of the pathological assessments.

To train and test the AI system, the researchers digitized more than 8,000 biopsies taken from some 1,200 Swedish men in the ages of 50-69 to high-resolution images using digital pathology scanners. About 6,600 of the samples were used to train the AI system to spot the difference between biopsies with or without cancer.

The remaining samples, and additional sets of samples collected from other labs, were used to test the AI system.

Its results were also compared against the assessments of 23 world-leading Uro-pathologists. The findings showed that the AI-system was almost near-perfect in determining whether a sample contained cancer or not, as well as in estimating the length of the cancer tumour in the biopsy.

When it comes to determining severity of the prostate cancer, the so-called Gleason score, the AI system was on par with the international experts. The initial findings are promising but more validation is needed before the AI system may be rolled out broadly in clinical practice, according to the researchers.

MEDICAL TOURISM NEWS

KEEPING LIVER LIVE OUTSIDE BODY This is a major breakthrough in transplantation medicine, which may increase the number of available organs for transplantation and save the lives of patients suffering from severe liver diseases or a variety of cancers. Injured cadaveric livers, initially not suitable for use in transplantation, may regain full function while perfused in the new machine for several days.

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esearchers have developed a machine that repairs injured human liver and keeps them alive outside the body for one week.

According to a study published in the journal Nature Biotechnology, this breakthrough may increase the number of available organs for transplantation, saving many lives of patients with severe liver diseases or cancer.

"The success of this unique perfusion system -- developed over a four-year period by a group of surgeons, biologists and engineers -- paves the way for many new applications in transplantation and cancer medicine, helping patients with no liver grafts available," said study researcher PierreAlain Clavi from the University Hospital Zurich in Switzerland.

Until now, liver could be stored safely outside the body for only a few hours. With the novel perfusion technology, liver—even injured ones—can now be kept alive outside of the body for an entire week.

According to the researchers, the basis for this technology is a complex perfusion system, mimicking most core body functions close to physiology. The Liver4Life project was developed under the umbrella of Wyss Zurich institute, which brought together the highly specialised technical and biomedical knowledge of experts from the University Hospital, Zurich.

"The biggest challenge in the initial phase of our project was to find a common language that would allow communication between the clinicians and engineers," said researcher Philipp Rudolf von Rohr.

The study shows that six of ten perfused poor-quality human livers, declined for transplantation by all centres in Europe, recovered to full function within a week of perfusion on the machine.

The next step will be to use these organs for transplantation. The proposed technology opens a huge avenue for many applications offering new life for many patients with end stage liver disease or cancer.

NEW MODEL TO IDENTIFY PATIENTS WITH COLORECTAL CANCER in at-risk patients. Their technology works by screening for methylation markers, which are DNA modifications that are frequently found in tumours.

A

new machine learning (ML) platform can identify patients with colorectal cancer and help predict their disease severity and survival, finds a new study.

The non-invasive method adds to recent advances in technologies that analyse circulating tumour DNA (ctDNA) and could help spot colorectal cancers in at-risk patients at earlier stages. Like many other malignancies, colorectal cancers are most treatable if they are detected before they have metastasized to other tissues.

Colonoscopies are the 'gold standard' for diagnosis, but they are uncomfortable and invasive and can lead to complications, which leaves patients less willing to undergo screening. For the study, published in the journal Science Translational Medicine, lead researcher Huiyan Luo from University Cancer Center in China and colleagues leveraged machine learning techniques to develop a less invasive diagnostic method that can detect colorectal cancer

The researchers first created a diagnostic model based on nine methylation markers associated with colorectal cancer, which they identified by studying plasma samples from 801 patients with colorectal cancer as well as 1,021 controls. This model accurately distinguished patients from healthy individuals with a sensitivity and specificity of 87.5 per cent and 89.9 per cent, respectively, and outperformed a clinically available blood test named CEA, the study said.

Furthermore, a modified prognostic model helped predict the patients' risk of death over a follow-up period of 26.6 months on average, especially when combined with established clinical characteristics such as tumour location.

One methylation marker was particularly useful, as screening for it alone spotted cases of colorectal cancer and precancerous lesions in a prospective study of 1,493 at-risk individuals, according to the researchers. The researchers concluded that studies with longer follow-up periods will be needed to further assess their model's reliability for clinicians and patients.

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MEDICAL TOURISM NEWS

UTTARAKHAND WOOS INVESTORS TO SPRUCE UP WELLNESS SECTOR

Uttarakhand Minister of AYUSH Harak Singh Rawat speaks during the road-show event at Kochi.

Also seen are Sonika, Additional Secretary (Tourism), L Fanai, Director General (Industries), Manisha Panwar (Principal Secretary, Industries), Dr S Sajikumar (former Chairman, CII, Kerala) and S A Murugesan, Managing Director (SIIDCUL)

U

ttarakhand, the scenic North Indian state nestled in the lap of the Himalayas, is wooing investors big time in its quest to become the global wellness epicenter.

The State government is organising a two-day ‘Wellness Summit’ on April 17-18 at Dehradun, the State capital, to showcase Uttarakhand's investment opportunities in the sector that encompasses AYUSH, eco-tourism and hospitality, nutraceuticals, organic and health food, herbal cosmetics and natural fibers, among others.

“We’re looking to build on strengths endowed on us by nature and our deep rooted traditions in Yoga, Ayurveda, Meditation and Naturopathy. The Uttarakhand government has created a conducive environment for investors,” said Harak Singh Rawat, State Minister for AYUSH and AYUSH Education, while speaking at a roadshow event held at Kochi as a precursor to the summit.

While observing that his State had many similarities with Kerala, another major wellness destination, Rawat said there was need for greater co-operation among the industry players in the two States. “For instance, we’re much ahead when it comes to herbal medicinal production while Kerala has many established industries in the sector. A tie-up will be mutually beneficial,” he noted.

In Uttarakhand, AYUSH and wellness sector has been given the status of industry, which allows investors to enjoy all benefits available to the industrial sector. A single window portal has been set up for investors to reduce paper work and formalities and to make issuance of clearances by various departments easier.

10 Medical Tourism Jan - Mar 2020

“A chunk of the millennials and the elderly now firmly believe in maintaining good health rather than going in for treatment when health complications emerge. Organic food has improved the well-being of the people and India is now the cynosure of everyone concerned about wellness initiatives. The medicinal value of Himalayan herbal products are acknowledged by the world as they are seeking ways to attain a healthy living. They are avoiding modern systems of medicine and embracing Indian lifestyle methods. Uttarakhand is aspiring to become global capital of Yoga,” he said.

Rawat said Uttarakhand will soon have its own ‘Organic Agriculture Act’. It will result in development of nearly 10,000 organic clusters in the State. “Ours is the first State to come up with a policy to allow leasing of agricultural land for 30 years,” he said.

The various areas identified for investment include AYUSH (township, spiritual economic zone, global wellness city, etc), Healthcare, Aroma, Natural Fibre and Tourism.

“In the tourism sector, we are looking to develop 13 new destinations. On a whole, we’ve identified 800 acres of land for infrastructure development. That includes the proposed Aroma park (41 acre) at Kashipur, Madan Negi Estate, Tehri (27.89 acre) and Marchula industrial estate (35.83 acre) in Almora,” said Manisha Panwar, Principal Secretary, Industries.

Contact details IPFC, Directorate of Industries, Industrial Area, Patel Nagar, Dehradun (Phone) 1800-270-1213 (Mail to) ipfc@investuttarakhand.com

MEDICAL TOURISM NEWS

MRI MAY PREDICT INTELLIGENCE LEVEL IN CHILDREN

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esearchers have used ensemble methods based on deep learning 3D analysis networks to answer the global Magnetic Resonance Imaging (MRI) prevision challenge for children.

Importantly, they made predictions for both the fluid intelligence level and the target variable independent from age, gender, brain size or MRI scanner used. MRI is a common technique used to obtain images of human internal organs and tissues.

Scientists wondered whether the intelligence level can be predicted from an MRI brain image.

"Our team develops deep learning methods for computer vision tasks in MRI data analysis, amongst other things," said study researcher Ekaterina Kondratyev from Skolkovo Institute of Science and Technology (Skoltech) in Russia.

"In this study, we applied ensembles of classifiers to 3D of super precision neural networks: with this approach, one can classify an image as it is, without first reducing its dimension and, therefore, without losing valuable information," said Kondratyeva.

The US National Institutes of Health (NIH) database contains a total of over 11,000 structural and functional MRI images of children aged 9-10. In 2013, NIH launched the first grandscale study of its kind in adolescent brain research, Adolescent Brain Cognitive Development, to see if and how

teenagers' hobbies and habits affect their further brain development.

NIH scientists launched an international competition, making the enormous NIH database available to a broad community for the first time ever. The participants were given a task of building a predictive model based on brain images. As part of the competition, the Skoltech team applied neural networks for MRI image processing. To do this, they built a network architecture enabling several mathematical models to be applied to the same data in order to increase the prediction accuracy, and used a novel ensemble method to analyse the MRI data.

In their recent study, Skoltech researchers focused on predicting the intelligence level, or the so called 'fluid intelligence', which characterises the biological abilities of the nervous system and has little to do with acquired knowledge or skills.

Importantly, they made predictions for both the fluid intelligence level and the target variable independent from age, gender, brain size or MRI scanner used.

The results of the study helped find the correlation between the child's "fluid intelligence" and brain anatomy. Although the prediction accuracy is less than perfect, the models produced during this competition will help shed light on various aspects of cognitive, social, emotional and physical development of adolescents.

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MEDICAL TOURISM NEWS

NEW DEVICE TO CAPTURE AND IDENTIFY VIRUSES DEVELOPED

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esearchers have developed a device to quickly capture and identify various strains of virus.

"We have developed a fast and inexpensive handheld device that can capture viruses based on size," said study researcher Mauricio Terrones from Penn State University.

"Our device uses arrays of nanotubes engineered to be comparable in size to a wide range of viruses. We then use Raman spectroscopy to identify the viruses based on their individual vibration," Terrones added.

This device, called a VIRRION, has a wide range of possible uses. For farmers, for example, early detection of a virus in the field can save an entire crop. Early detection of a virus in livestock can save a herd from illness. Humans also will benefit by the detection of viruses in minutes rather than in days with current methods.

According to the study, published in the journal Proceedings of the National Academy of Sciences, because of its size and low cost, such a device would be useful in every doctor's office as well as in remote locations when disease outbreaks occur.

man signal so that we are able to detect the virus molecule in very low concentrations. We then use machine learning techniques to create a library of virus types," Terrones added.

According to the researchers, the VIRRION enables the rapid enrichment of virus particles from any type of sample -- environmental or clinical -- which jump-starts viral characterisation. This has applications in virus emergence, virus discovery and in diagnosis.

"We synthesized a gradient of aligned carbon nanotube forest arrays to capture different viruses according to their size and detect them in-situ using Raman spectroscopy," said study lead author Ying-Ting Yeh. "We designed and assembled a portable platform that enriches virus particles from several millilitres of clinical samples in a couple of minutes," Ting Yeh added.

"We hope to use this device for the capture and sequencing of single virions, giving us a much better handle on the evolution of the virus in real time," said Elodie Ghedin from New York University.

Currently, virologists estimate that 1.67 million unknown viruses are in animals, a number of which can be transmitted to humans.

Known viruses, such as H5N1, Zika and Ebola have caused widespread illness and death.

The World Health Organisation states that early detection can halt virus spread by enabling rapid deployment of countermeasures.

"Most current techniques require large and expensive pieces of equipment," Terrones said.

“The VIRRION is a few centimetres across. We add gold nanoparticles to enhance the Ra-

IFAH ‘TOP 100 HEALTHCARE LEADERS’ AWARD TO APOLLO STAFF Jithu Jose, Vice President, International division, Apollo Hospitals Pvt Ltd, has won the ‘Top 100 Healthcare Leaders’ award, instituted by the IFAH (International Forum on Advancements in Healthcare). The award was bestowed to Jithu during the event held in Dubai on December 16, 2019, after he topped the ‘Advancements and Innovation’ category.

12 Medical Tourism Jan - Mar 2020

Certified as per Indian, US & European Organic Standards

NPOP/NAB/004

MOZA ORGANIC PVT. LTD. Aroma Gardens, 3rd Floor, Near Lissie Metro Station, SRM Road Kochi- 682018, Off: +91 484 4019997, +91 95390 08739 Email: mozaorganic@gmail.com, Web: www.mozaorganic.com

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MEDICAL TOURISM NEWS

‘INDIA HEALS’

EVOKES GOOD RESPONSE;

SEPC PLANS MORE B2B MEETS

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he Services Export Promotion Council (SEPC), set up by the Ministry of Commerce & Industry, aims to leverage two to three new foreign markets by the end of this year for the benefit of Indian healthcare service providers. This in the wake of the success of India 'India Heals 2020', the recently-held international healthcare B2B event at Kochi, which evoked encouraging response. Over 200 foreign delegates had attended the meet and evinced interest in various medical services being provided by Indian entrepreneurs.

“The second edition of ‘India Heals’ was a big success as many MoUs (Memorandum of Understanding) were signed over the three-day event. More than 500 B2B (Business to business) meetings were held between foreign buyers and Indian exhibitors. We’re now planning to hold similar events abroad this year itself, paving the way for presence of Indian healthcare service providers in new foreign markets.

"Similarly, we want to bring more foreign buyers in the next edition, for which we’ve already received invitations from states like Uttar Pradesh, Punjab and Andhra Pradesh,” Sangeeta Godbole, IRS, Director General, SEPC, said.

The Council takes special care to ensure presence of only genuine service providers. “For instance, foreign patients looking to avail treatment from India need only to visit our website ‘Indiahealthcaretourism.com’ to select the healthcare choices that suits them. The site contains only NABH-accredited hospitals. We’re overhauling the site so 14 Medical Tourism Jan - Mar 2020

as to provide all details -- treatment costs, distance, specialties, doctors available and the like,” she said.

Upasana Arora, Director of Yashoda Super Specialty Hospitals and also Member, Governing Council of Healthcare, SEPC, noted that the biggest attraction for foreign clients is the quality healthcare services offered by the country at affordable prices.

“The Ministry of Health has supported us with various measures like relaxation of visa norms. The SEPC is also working hard to enable the Indian healthcare industry to reach out to more international markets. All this will further help in growth of Indian healthcare sector,” she added.

Commander Jelson Kavalakkat, CEO, Aster Medicity, observed that the healthcare sector in the country now require a focused approach to have a sizable share in the global medical travel sector. “India’s healthcare industry has had a late bloom. Previously, tourists used to come only for minor ailments and wellness treatments. The trend has changed and now they are availing treatment here for complex medical conditions. Besides quality service, factors such as quick consultation, shorter treatment duration, trust, integrity and transparency are all helping in the growth of the sector,” he said.

Not just affordable costs, but also the high standards of the Indian medical industry is now recognised by the international community, noted Dr Gayatri Vyaas Mahindroo, Director, National Accreditation Board of Hospitals and Healthcare (NABH) providers. “Currently we’ve over 1000 big and 4000 other hospitals accredited. The aim is to prevent unintentional harm to clients in any way and to help them avail only quality healthcare. The accreditation standard for traditional medicine systems like Ayurveda is also being formulated,” she said.

Overall, 'India Heals 2020' saw over 20 exhibition stalls being put up by major healthcare providers. “We’re happy to attend the B-2-B meet in Kochi, especially at a time when we’re commencing our operations in Kerala. We had fruitful interactions with the visiting delegates. Such initiatives will go a long way to make India a preferred medical tourism destination,” Jithu Jose, Vice President, International division, Apollo Chennai, said.

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MEDICAL TOURISM SPECIAL FEATURE

THE VIRAL CHALLENGE Global tourism market is faced with yet another disease outbreak that threatens to unsettle business plans for the coming few years

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ince its outbreak in China’s Wuhan, the novel Coronavirus has been spreading rapidly, killing hundreds and raising a global health crisis that is much bigger than that caused by the Severe Acute Respiratory Syndrome (SARS).

Named Covid-19 by the World Health Organisation (WHO), the virus has claimed more than 2700 lives and infected over 80,000 people globally during the past two months with a case-fatality ratio of two per cent. The SARS outbreak in 2002 had snuffed out only 774 lives across an eight month period in comparison.

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precautionary measure. Nearly 4,000 people were expected to attend the conference. Similarly, global chip-maker Intel decided to postpone its “Intel Labs Day’ conference scheduled for March 12-13 “due to the coronavirus/COVID-19 impact on the ecosystem".

Hoteliers, tour operators and other tourism players have been plunged into uncertainty. At least over a dozen countries have restricted or banned flights to and fro China. The Indian Ministry of Finance had convened an urgent meeting of all key stakeholders on February 18 to assess the impact of the Coronavirus outbreak on the country’s trade and ponder ways to tide over the crisis.

The virus is substantially a more potent threat to global fortunes this time as China, the epicentre, has leapfrogged to the status of a principal presence in the global economy over the past 18 years. The Asian giant has become the world’s largest market for outbound travel, their number ballooning from 4.5 million travellers in 2000 to 150 million in 2018. As per the figures provided by the UNWTO, the country is also the world’s largest spender, accounting for 16 per cent of USD 1.7 trillion international tourism spend globally.

" Viewed on a national scale, the tourism sector has already suffered a loss of over Rs 500 crore due to cancellation of in-bound packages."

E.M. Najeeb 18 Medical Tourism Jan - Mar 2020

The absence of Chinese travellers in major tourist cities, due to Coronavirus epidemic, is weighing on the global tourism industry like never before and has raised alarm bells ringing in neighbouring countries like India.

“The severity of the crisis is much bigger than what it appears now. The travel and tour industry in a small South Indian State like Kerala had suffered a loss of around Rs 200 to 350 crore following the Nipah outbreak,” says E.M. Najeeb, Vice-President, Indian Association of Tour Operators.

“Many national and international events scheduled for the coming months have been cancelled in the wake of the virus outbreak. Viewed on a national scale, the tourism sector has already suffered a loss of over Rs 500 crore due to cancellation of inbound packages. The outbound business loss (towards South East Asia and the Far East) could be around 30 to 40 per cent, which would translate to over Rs. 1,000 crore,” he says.

Facebook has cancelled its global market conference, which was scheduled to be held in March at San Francisco’s Moscone Center, as a

“On the impact of #CoronavirusOutbreak and any disruptions to #MakeinIndia or to Indian export/ import @FinMinIndia is scheduled to hold a meeting on Tuesday 18 Feb. Stakeholders welcome. If unable to attend please email your inputs at fmo@nic.in,” Union Finance Minister Nirmala Sitharaman had tweeted.

The recurring virus challenge – SARS, H1N1, Ebola, swine flu, is slowly bringing about a change in the medical tourism concepts, especially the preparedness of host nations. Once all major virus-induced and bacterial infections were brought under the control, healthcare within countries

and across borders was all about treating lifestyle ailments.

Medical tourism as a distinct branch of the tourism industry emerged when people began traveling great distances for such treatment. However, today the world is faced with a new ‘viral challenge’. Cross-border travel for treatment purposes can become complicated overnight with a virus outbreak in some corner of the world, many of them causing zoonotic infections.

Patients assess the potential of the healthcare system at a given destination on the basis of its readiness to meet a sudden health emergencies. It is up to governments to overhaul their health protocols to meet the new viral challenges and the resultant emergencies. The South Indian State of Kerala, a major medical tourism destination, had moved with alacrity following the Nipah outbreak in 2018.

If it was panic all around at the time of the Nipah outbreak, there was discernible confidence among the health authorities and the general public when three students who had returned to the State from Wuhan tested positive for Covid-19. The State, known for its robust public healthcare system, had channelized all resources possible and managed to push back the new virus strain without straining too much.

“Just as in the case of Nipah, Kerala has won the battle against Corona virus,” State Finance Minister Dr. T.M. Thomas Isaac tweeted, announcing the achievement to the world. “..All the 3 patients identified have been confirmed by Central authorities to have fully recovered. No case of secondary spread. Number under quarantine observation drastically coming down.

Congrats Health Dept,” Isaac tweeted. That is a feather that nations and provinces across the globe should covet—in the interest of the health of their peoples and the growth of their tourism industries.

VIRUS AND THE FEAR OF FLYING

The number of flyers has dropped drastically since the deadly novel Coronavirus began spreading across borders in December. One of the most frequent queries popping up in the minds of travellers is over the threat of infection once inside an aircraft.

Is wearing a mask enough to protect one from the virus? The question is yet to be answered in full by experts. While COVID-19 can get transmitted from one person to another through air, whether the virus can spread through aerosol (suspension of liquid droplets) is yet to be ascertained by scientists. When an infected person coughs or sneezes and the resultant saliva, mucus or other bodily fluids fall on you, you can become infected as well.

The World Health Organisation (WHO) has advised passengers to avoid close contact with people suffering from fever or cough. However, is it possible to avoid contact with other passengers during air travel? WHO itself defines contact with an infected person as being seated within two rows of one another. If an infected person near you in the aircraft sneezes, there’s nothing much you can do about it.

Further, people fear that the tray tables, foot rests, overhead bins, toilets in aircraft could all be sources of infection as it is not clear how long the virus strain can sustain itself outside the human body.

The ideal thing would be to wear masks and disinfect the aircraft after each trip. But is that enough? “It’s a big question to answer satisfactorily.

It’s true that screenings for COVID-19 are being done at most of the major airports. Also we’re taking care to clean and disinfect aircraft after every service, but whether it would ensure complete prevention of infection in case of people travelling with infected person/ persons is very difficult to answer,” said Aby George, Head of Airport Services, Air India Express.

Airline officials, however, recommend every passenger to follow all possible precautionary measures. That includes washing hands after touching any surface with soap or an alcohol-based hand sanitizer . One shouldn’t touch one's face and should avoid contact with coughing passengers by whatever means possible.

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MEDICAL TOURISM INTERVIEW

HAPPY WE COULD RISE TO THE CHALLENGE The deadly Corona virus (subsequently named ‘Covid 19’ by the World Health Organisation) outbreak in China’s Wuhan city, which claimed over 2700 lives and infected more than 80,000 people globally, had its ripple effect on Kerala too. The State Dr. B. Padmakumar was the only one in the country to report positive cases of the epidemic as three students, who had all returned from China, were detected with the virus infection for which there is no specific treatment.

The State, especially its health machinery, didn’t succumb to panic and defeated ‘Coronavirus’, just as it did with the ‘Nipah’ virus onslaught nearly two years ago. The three patients from Alappuzha, Thrissur and Kasaragod districts have fully recovered from the infection and have been discharged from hospitals.

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‘Medical Tourism’ spoke to Dr. B. Padmakumar, who had treated the patient admitted to the Government Medical College Hospital, Alappuzha, in south Kerala. Excerpts: Can you share the experience, especially the fight against a completely new virus strain?

The youth was detected with the virus strain and admitted to the hospital on January 30. The novel Corona virus infection had by then assumed dimensions of an epidemic. The biggest challenge was to treat a

completely ‘new’ infection and prevent the virus from spreading. In no time, an isolation room with all basic facilities was readied and the patient shifted there.

We don’t have any clearly defined protocol for treating Corona virus infection and we could not wait for that. We followed the general guidelines of the WHO (World Health Organisation) and the Indian Council of Medical Research (ICMR) for handling such situations.

A medical team led by the medical college hospital superintendent was formed with a nodal officer, four medical officers, 12 post graduate Doctors, 9 house surgeons, eight staff nurses, six nursing assistants and nine housekeeping staff.

Since there’s no specific drug to treat the condition, we focused on supportive care (monitoring vitals such as temperature, blood pressure and oxygen, among others, and ensuring that the vital organs functioned normally) for the following two weeks. The symptoms were similar to serious flu infections that affect the lungs. We managed to contain the infection from turning severe and finally cured the patient fully. He was discharged on February 13 after repeated laboratory tests of samples returned negative readings for the presence of the virus.

What were the precautionary measures adopted by the medical team?

We knew the new virus strain is quite dangerous and that it would not be possible to tackle it without adequate precautionary measures. We all used disposable Personal Protective Equipment (PPE), specialised clothing with masks and gloves that cover the whole body.

A high standard of personal hygiene was followed by each one of us once out of the room. Separate vessels were used to serve food for the patient and the same was disposed-off post use every time. The select nursing staff was redeployed every three to four hours and continuous care was ensured for the patient.

People were asked to avoid unnecessary hospital visits, especially to wards. Strict instructions were given against crowding. All were asked to cover mouth and nose with handkerchief, wash their hands frequently and avoid shaking hands. But, when doing so, we were careful not to trigger panic among the general public.

What was the main measure taken to prevent the virus from spreading?

identified the secondary level contacts (family members and other close relatives with whom the patient had interacted) and subjected them to close medical examination. Tertiary level contacts (friends and others who had come into contact with the patient at least once) too were identified and put under home quarantine for 28 days. Their health was also monitored closely.

Did the patient and his relatives face any difficulty, especially social boycott, when information about his having contracted Corona virus spread?

I didn’t feel so during my interactions with them, though some social media posts with his picture were uploaded by someone, and that hurt the family. They filed police complaints on a couple of occasions. Otherwise they did not complain about anything.

Obviously, given this experience, we should have a state-of-the-art virology institute in the State.

Now we are sending the samples, hundreds of them, to the Pune NIV (National Institute of Virology) for testing which results in delay?

The State government is taking all measures necessary for this. A laboratory has been set up at the Alappuzha Medical College itself. After the first two days of the patient admission, we began to test the samples here itself. The government has also started the construction work of Virology Institute at Thiruvananthapuram, the State capital.

No new Corona virus case has been reported and the State government has withdrawn its declaration of the virus outbreak as a ‘State disaster’.

What is your advice to people?

There is no need for panic. However, we should continue to take precautionary measures like covering one’s face while sneezing and washing hands frequently with soap. We should also maintain high standards of personal hygiene. Unnecessary visits to hospitals should be avoided. The virus strain will be active in a carrier for 28 days. Follow directions of the State Directorate of Health and do not trust social media posts about the infection or related topics from unauthorised persons or groups.

Dr. B. Padmakumar Professor of Medicine, Medical College, Alappuzha

The patient was co-operative and courageous. We A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM EXPERT TAKE

THE RISING THREAT OF VIRAL EPIDEMICS Dr Sheeja Srinivas Edamana

V

iral epidemics are occurring quite frequently and spreading faster and further than ever before. The SARS in 2003, Swine Flu in 2009, Ebola in 2014 and the novel Coronavirus (named Covid-19 by WHO) now, the outbreaks have become a fact of life.

The world remains vulnerable to these viral epidemics despite advances made in virus discovery and their control since the turn of 20th century.

The word Virus means ‘poison’ in Latin. They cannot exist by themselves and can replicate and reproduce only in a living organism.

The threat of viral infections turning out to be epidemics is all the more now, thanks to rapid urbanisation and explosive population growth.

The transportation networks, both domestic as well as international, continue to expand in reach, speed of travel and volume of passengers and goods carried, resulting in pathogens and their vectors moving across countries.

Many dangerous viral infections are zoonoses, diseases transmitted from animals to humans. The expansion of human settlements towards forest

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areas provides more opportunities for viruses to have contact with humans.

Growing human population requires increased and more compact livestock production and these domestic livestock may carry viruses that infect humans.

The recent outbreaks of Corona, Nipah had their origin in animals. The population of the best known disease vector, mosquitoes, is on the rise due to improper waste disposal and deforestation. Some viruses like HIV, transmitted via sexual contact, are also on the rise due to unprotected sex and usually there is a long gap between HIV infection and the onset of disease. The infected person may carry the virus for years before finally becoming aware of it.

Most human viruses replicate in huge numbers. Changes in their genetic code leading to mutations are also very high in viruses, which help them to adapt quickly to an adverse environment. This also results in viral epidemics.

There is no specific drug for most of the human viruses partly because the viruses multiply fast and belong to diverse groups with no common drug

targets to exploit. The viruses use the infected person’s cell machinery to reproduce and the drugs that target the growth of viruses may affect the person’s cell, resulting in serious side effects. Further, the capacity of the virus to adapt implies that they have high potential to develop resistance to a drug.

CORONAVIRUS Though the Corona virus outbreak occurred in China, the infection has spread globally in no time. A large number of people with the virus strain travelling out of the country has contributed to this and even a tiny State like Kerala reported three positive cases. The toll, since the disease outbreak in December, has surpassed 2700 deaths across 29 countries.

Coronavirus is one among a number of viruses that cause diseases in mammals and birds. In humans, the virus causes respiratory infections ranging from common cold, typically mild, to pneumonia as well as acute respiratory distress syndrome. The epidemic started in Wuhan, capital of Hubei province in China, and was reported first from a wildlife market in Wuhan.

Rarer forms such as SARS, MERS and Covid-19 are lethal Corona viruses and can also affect intestines besides the respiratory system. There are no vaccines or drugs against Corona viruses yet. Corona viruses are zoonotic infections transmitted from animals to humans and also between humans.

with a tissue or towel and dispose off the same post use. Clean and disinfect frequently touched objects and surfaces using bleaching solution which is prepared by adding three teaspoons of bleaching powder in 1000 ml water or by other disinfectants.

Symptoms of Corona virus are running nose, fever, headache, sore throat, cough and breathing problems. The infection may become more serious in children, elderly, pregnant women, as well as people with other comorbidities.

Face masks should be used by people who show symptoms of 2019 novel coronavirus, in order to protect others from the risk of getting infected. The use of face masks is also crucial for health workers and people who take care of someone in close settings (at home or in a health care facility).

Corona virus is the cause of most of common colds occurring regularly.

Corona virus antibodies won’t persist in human body for longer periods and hence the chance of another infection is greater. The viral spread can be due to contact with infected animals or through the respiratory secretions of infected people. If the infected people sneeze or coughs without covering nose and mouth, the secretions will spread to air and from air, it will be transmitted to other people who are in close contact.

It can also spread through touch, like when one shakes hands with an infected person, or when one touches objects or surfaces with viruses and then touches one's own mouth, nose or eyes before washing hands, and rarely by fecal contamination.

There is no specific treatment for Corona viruses, though physicians provide supportive as well as symptomatic treatment. For severe cases, treatment should include care to support vital organ functions. The patient should take adequate rest and must be well hydrated. The diagnosis is done using secretions from throat, urine, blood, sputum, etc., by real time Polymerase Chain Reaction (PCR) or Nucleic-Acid Amplification Test (NAAT).

Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom, before cooking, before eating and after blowing your nose, coughing or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60 per cent alcohol.

Always wash hands with soap and water if hands are visibly dirty. People with symptoms should avoid going to public places. Avoid travelling to places with diseases and people who came from the infected places should be in home quarantine for 14 days from the last day of contact even though they do not show any symptoms of Corona virus infection.

If the people from infected places develop symptoms of infection, they should be isolated. Avoid unnecessary hospital visits. Meat should be used only after deep cooking.

PREVENTION OF CORONA Avoid close contact with people who are sick. Avoid touching your eyes, nose and mouth with unwashed hands. Stay at home when you are sick. Cover your cough or sneeze

Dr Sheeja Srinivas Edamana, Medical Officer in Kerala Health Services.

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MEDICAL TOURISM COVER STORY

DIAGNOSIS GOES DIGITAL

Digital technology now plays a key role in diagnosis and treatment of illnesses

Byju Aryad

Artificial Intelligence can increase throughput of patients, resulting in early diagnosis and reduction in treatment cost. Telemedicine, which facilitates remote diagnosis and treatment of patients using advanced telecommunication and information technology, and Artificial Intelligence, which enables machines to detect abnormalities in various investigations, are going to be the game changers.

T

echnologies are gradually redefining modern medical treatment. It plays a a vital role in patient safety by identifying risks and reducing harm in the primary care setting. It helps cut down the risks of adverse drug events through electronic prescription which facilitates sharing of information about the prescribed medications for accuracy and efficacy.

Nowadays, researchers are turning to big data and the power of artificial intelligence to support complex clinical decision-making and identification and reporting of adverse events. Point-of-care diagnostic testing devices, such as

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form medical practice and caregiving in a truly never-before way.

India has a huge rural heartland and, despite the advances that nation has made in the science and technology sector, the doctor-patient ratio is much below the recommended WHO standards, says Dr. Amel Antony, senior consultant and head, Lisie Institute of Radiology Research & Imaging Sciences, Lisie Group of Medical Institutions, Kochi. Lack of adequate infrastructure and poor remuneration are often cited as the major causes for reluctance of doctors to take up the rural health challenge.

However, digital technology can bridge the gap of inadequate personnel and infrastructure facilities to a great extent. Telemedicine, which facilitates remote diagnosis and treatment of patients using advanced telecommunication and information technology, and Artificial Intelligence, which enables machines to detect abnormalities in various investigations, are going to be the game changers here, he said.

those for diabetes, HIV and malaria, now plays a big role in rapid analysis as a critical guide for treatment.

Modern technologies and innovations continue to make era-defining impact on the medical treatment and healthcare industry as a whole. The impact of mobility, connected gadgets, wearable healthcare devices and a host of other technologies has become so significant that any of the most advanced medical facilities equipped with latest gadgets and healthcare practices inspire positive awe when compared with those that have facilities available just a decade ago. Digital technology advancements in healthcare are helping people to lead safer, healthier and more productive lives. Increased utilization of digital health apps has particularly

been useful for controlling chronic diseases that have always had a big impact on the health of a population. The treatment, prevention, and management of acute diseases like diabetes, asthma, cardiac disorders, and pulmonary conditions have particularly benefited from the use of these health apps.

Mobile health apps have emerged as crucial tools in the day-to- day patient care and healthcare management across numerous facilities all over the globe. The promise of mobile apps in the healthcare ecosystem is not limited to better treatment. They are also useful in making healthcare more affordable and accessible.The Internet of Things (ioT) also plays a big role here. Healthcare IOT devices and apps have the potential to trans-

According to Dr. Antony, digital technology facilitates online networking of primary health centres, allowing central monitoring of all functions including diagnostic and preventive measures. It also helps in close monitoring of the stock of essential medicines and other requirements for proper maintenance and replenishment. Pooling of skilled personnel would facilitate redeployment wherever there is shortage.

National health programmes are an ongoing effort at prevention, early diagnosis and monitored treatment of various disease conditions and digital technology would make it all possible. Similarly, in cases of outbreak of epidemics, timely diagnosis of the infectious agent, identifying and treating sources, isolating contacts and geographical mapping of the outbreak cane be in an efficient manner with digital technology.

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through mobile apps. Blockchain database can allow unhindered access to personalized patient records and databases while preventing tampering efforts.

With Telemedicine in place, online consultations with health specialists from remote locations are possible, thereby streamlining patient care and management. Timely referral to tertiary care centres is an added advantage. Networking of ambulance services works in tandem with the above facilities. Artificial Intelligence enabled machines like X-ray, Mammography and ECG can differentiate normals from abnormals, further speeding up diagnosis, he added.

“Data collected from patients in different geographical locations can be analyzed for variations in disease pattern and treatment responses. In combination with bioinformatics, big data would finally realize personalized medicine, resulting in optimum treatment and savings on precious resources.

Artificial Intelligence can alert the physician to the most effective treatments and also the most common contra indications. Common diseases with uncommon manifestations is another area where Artificial Intelligence can narrow down the possibilities to arrive at the most appropriate diagnosis,”Dr. Antony said.

One of the biggest concerns for healthcare providers all over the world is preserving and protecting the patient data and preventing all types of threats and vulnerabilities concerning data security. This is 26 Medical Tourism Jan - Mar 2020

particularly true in the context of connected healthcare gadgets that are increasingly posing security threats of all types.

When it comes to data security, there is no better and more equipped technology as the blockchain. Blockchain is a decentralized database that allows open access to information for all stakeholders within an organization, even while controlling access with secure encryption and prevention of data theft or tampering with a ‘write-once, never-delete, never-change’ protocol.

Thanks to blockchain, health apps can ensure far better user experience as they can do away with the socalled protective security protocols like registration and passcodes. Apart from this, blockchain-based processing in case of many healthcare facilities can save a lot of paperwork

Mobile apps can aid in diagnosis of various conditions when symptoms and investigation are keyed in. Apps would also provide the most appropriate treatment and a schedule for follow up. The treating physician and the patient could be alerted regarding follow up visits. Information for the patient could be made available in the app and this could include details regarding disease condition, side effects of treatment, long term complications and warning signals.

However, in order to ensure accuracy, the apps need to be endorsed/ certified by appropriate professional bodies, Dr. Antony said.

Digital healthcare market is growing exponentially, he noted. This is due to advances in computer technology, nanotechnology and the synergy and convergence of various related sciences. From robotic surgery to automated resuscitation machines and personalized medicine, the inventory keeps expanding. At the same time,technology-driven products are inherently prone for obsolescence, leading to a huge drain on precious resources. The dilemma of improving bed strength and preventive health versus investment in digital healthcare does not have any readymade

solutions, but a balanced approach can bring in rich dividends.

Technology can never replace doctors, Dr.Antony says. There are enough examples: robotic surgery requires a trained surgeon to handle the robot, just as autopilot doesn’t mean absence of a pilot. Technology is going to improve patient care and management, by taking care of efficiency and throughput. Doctors have to unlearn and relearn to harness the advances in technology and they will be less burdened by the routine, allowing more time for patient care and management.

Technology also would require redeployment of personnel and defining new roles. However, at the end of the

day, it is going to be technology as a guide and able assistant and not a competing rival. Digital technology entails early diagnosis and non-invasive treatment, leading to reduced hospital stay and substantial savings.

Telemedicine can facilitate diagnosis and medical management of cases in remote areas, which would in turn lead to savings in terms of personnel and better utilization of equipment.

Artificial Intelligence can increase throughput of patients, resulting in early diagnosis and reduction in treatment cost.Personalized medicine means targeted treatment at lower doses, further bringing down the cost. Paperless hospitals and institutions would add on to the advantage, he added.

India is leading in the adoption of digital health technology with 76% of healthcare professionals in the country already using digital health records (DHRs) in their practice, according to a 15-country Future Health Index (FHI) 2019 report by Royal Philips, a global leader in health technology. Interestingly, India meets the 15-country average when it comes to the usage of artificial intelligence (AI) within healthcare at 46%.

Rohit Sathe, President – Philips Healthcare, Indian sub-continent, said, "Philips’ Future Health Index 2019 report confirms that digital health technology is a pivotal pillar in delivering value-based care across the healthcare continuum in India.

Tools including telehealth and adap-

tive intelligence solutions can help lower the barriers between hospitals and patients, thereby improving access to care and enhancing overall patient satisfaction, particularity in tier II & III cities in India. We hope that the insights from this report will assist key stakeholders in designing and implementing robust and sustainable health systems in the country."

According to the findings, 80% of healthcare professionals in India have shared patient information with other professionals inside their health facility, which is equal to the number of healthcare professionals who share patient information electronically across the 15-country average. Individuals in India are also seemingly

not concerned that AI will substitute the human aspects of their healthcare experience, as only one in five (19%) associate AI with less human interaction compared to one-in-three (31%) individuals living within the 15-country average.

The study found that when Indian healthcare professionals are supported by digital technology, their experience improves. For instance, a majority of Indian healthcare professionals who use DHRs in their practice report that the technology-driven system have a positive impact on quality of care (90%), healthcare professional satisfaction (89%), and patient outcomes (70%) when compared to the 15-country average of 69%, 64% and 59% respectively. 64% of Indian healthcare professionals agree that patients having access to their own health data (including test results, prescriptions, scans etc.) has positively impacted their patients’ experience.

The report also found that about twothirds (67%) of Indians feel comfortable or neutral about seeking medical advice from their doctor through a health application on their phone, suggesting a high willingness and openness to further adopt telehealth and unlock its benefits.

Looking at the role and tasks of physicians in general, the era of the e-physicianshas arrived. These empowered physicians will be the ones who use digital technologies in their practice with ease. They are enabled by regulations and guidelines, empowered by technologies and have become experts in hunting down the most reliable and trustworthy digital health resources and innovations. They can also be described as ‘engaged’, when understanding the feelings and points of view of their patients, giving relevant feedback, and involving them throughout the whole healing process.

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MEDICAL TOURISM TECHNOLOGY

FORGET HARVESTING, LET’S MAKE ORGANS! The success of a new medical innovation is determined largely by two factors: the effectiveness of the treatment, and its availability to the masses. Compared to conventional treatment methods where an organ is received from another donor, treatment methods using 3D printing technology are far more effective, says Dr.Santhosh Alex 28 Medical Tourism Jan - Mar 2020

3D printing is not a new technology.

First created in the 1980s, it converts 2D designs into 3D objects by layering multiple sheets on top of one another. This technology has been used before in the medical field to create custom prostheses made of inorganic materials, such as titanium or aluminum.

The idea of 3D printing human organs — a group of tissues that perform a specific function — is a relatively new concept. Although it may present certain ethical dilemmas, the use of 3D printing technology to create new organs will likely be beneficial, providing not only an increased availability of organs for patients in need, but also a more effective treatment than conventional transplants.

The success of a new medical innovation is determined largely by two factors: the effectiveness of the treatment, and its availability to the masses. Compared to conventional treatment methods where an organ is received from another donor, treatment methods using 3D printing technology are far more effective.

Because the transplant is autologous — the cells are from the patients

themselves — the body’s immune system is less likely to attack and destroy the 3D printed transplant. 3D printing also lends customization to the patient’s treatment.

For example, Cornell University biomedical engineers and physicians created an ear by 3D printing personalized casts and filling it with collagen and cartilage to treat children with microtia, or an underdeveloped outer ear. The ordinary treatment is painful and involves harvesting cartilage from the ribs and manually forming an ear.

3D printing for producing artificial organs has been a major topic of study in biological engineering. As the rapid manufacturing techniques entailed by 3D printing became increasingly efficient, their applicability in artificial organ synthesis has gained currency. Some of the primary benefits of 3D printing lie in its efficiency for mass-production of scaffold structures, as well as the high degree of anatomical precision in scaffold products. The constructs thus made effectively resemble the microstructure of a natural organ or tissue structure.

C

urrently in the United States, over 110,000 people require a lifesaving organ transplant, but only around 33,000 patients received one within 2018. In 2016, over 7,000 candidates died waiting for an organ donation.

These statistics highlight the desperate need for readily available organs — a need that can be met through 3D printing.

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Organ printing using 3D printing can be conducted using a variety of techniques, such as Dropbased Bioprinting(Inject) and Extrusion Bioprinting,each of which delivers specific advantages suited to specific types of organ production.

Further, 3D printing leads to increased availability of organs. This increase in organ supply will likely cause a drop in prices. Historically, the first models of a product have always been expensive; however, after a technology is well developed, prices drop significantly. For this reason, transplant treatment will eventually become viable for much of the public and not just the affluent.

Despite these numerous benefits, critics claim that ethical dilemmas make 3D printing methods impractical, alluding to the possibility of artificially enhanced super humans being created, and even cloning. The chances of these outcomes are remote and highly situational. When the 3D printing of organs does emerge, the Food and Drug Administration (FDA) will scrutinize the technology and regulate its use to prevent the aforementioned situations from occurring. More importantly, it is a blatant injustice to prevent access to medical treatment for those in need simply because a few have apprehensions over it.

Evidently, use of 3D printing technology for the creation of organs should be advocated because it will serve as a favourable advanced treatment compared to the ordinary organ transplant methods. It will soon become a viable option for much of the public as well. As long as responsible usage is maintained through government regulations, it behoves the medical community to facilitate the development of 3D printing technology. In the face of change, the human propensity for fear is great — but our propensity for development and progress should beeven greater.

Dr.Santhosh Alex (Consultant Physician, Dept. of Emergency Medicine, Jamaica Hospital Medical Center, Jamaica, New York)

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MEDICAL TOURISM RADIATION THERAPY

ON TARGET Latest advances in radiation therapy has made it possible to target the cancer cells better without affecting the adjacent normal structures

L

ittle did the world realize the enormity of the development when Roentgen discovered X-rays way back in 1895. Initially, people considered it just a toy which would enable them to see the inside of the body and laugh at the sight. Within a year, these invisible rays were used to cure cancer. Such was the pace at which radiation impacted clinical practice.

Radiation therapy is a key component of treatment of cancerous as well as non-cancerous conditions affecting the human body. More than 80% of the cancer patients require radiation as part of their treatment, either as a sole modality or in combination with surgery and chemotherapy. In the 70s, Tele-Cobalt therapy machines were the only ones available for delivering radiation therapy.

The power of the radioactive source of Tele-Cobalt therapy machines comes down by half in 5.2 years and hence it needs to be replaced once every 10 years. The average energy of the gamma rays emitted by Cobalt-60 radioactive isotope is around 1.25 MV (Million Volts). Compare this with the modern medical linear accelerators which have the capability of generating high

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ADVANTAGES WITH MODERN TECHNOLOGY Increasing mortality due to cardiac toxicities has been observed in significant proportions while treating young patients with left-side breast cancer.

As the heart lies on the left side, treatment of left sided breast cancers entails a higher mean dose to the heart.

energy X- rays ranging from 4 MV to 15MV.This translates to better penetration of the radiation to deeply seated tumours within the body achieving better control of the tumour.

TECHNOLOGICAL ADVANCEMENT OVER THE LAST TWO DECADES For a tumour to be controlled, an appropriate dose of radiation needs to be delivered in a stipulated time frame with little dose or damage to the normal tissue surrounding the tumour.

The challenge in radiation therapy practice is delivering a radiation dose that would maximize the tumour control rates and, at the same time, minimize the side-effects of radiation in the adjacent normal structures in the path of the radiation beam.

The tremendous strides we have made in medical imaging (MRI and CT scans) - linear accelerators with small multi-leaf collimators , functional imaging of the tumours with isotope scans like the Positron Emission Tomogram scans (PET scan), integrated to MRI and CT (MRI PET, CT PET) - have enabled us to visualize the tumour as well as the normal structures with more certainty.

The linear accelerators also have evolved in their design to focus the X-rays precisely on the tumour targets. The most important change

that has occurred is the creation of multi-leaf collimators which help us to have irregularly shaped beam to hit complex shapes of the target, without exposing the adjacent normal structures to unnecessary radiation. They also play a crucial role in the intensity modulated radiation treatment planning (IMRT) reducing the radiation dose to the normal structures. This is extensively used in the treatment of cancers of the head and neck region, sparing parotid glands from damage and preventing dryness of the mouth.

IMRT is indeed a boon in the radical treatment of prostate cancer, sparing the adjacent normal tissues like bladder and rectum of the side effects of radiation significantly.

Unlike teletherapy, brachytherapy uses a radioactive isotope source placing it in the close vicinity of the tumour. It could be inside a cavity or a lumen or in an area within the normal tissues bearing the cancer. High therapeutic efficiency can be achieved by brachytherapy treatment by delivering the maximum dose to the tumour while exposing surrounding normal tissues to minimum dose. Modern technology with computer controlled after-loading devices enables the tiny isotope source to access even inaccessible areas of the body through the implanted catheters, tubes and applicators placed in the tumour bearing site.

Modern linear accelerators equipped with active breathing coordinators help to treat the patients in the deep inspiratory phase while the breath is held for a short period in deep inspiration. The heart moves away from the breast tissues thereby resulting in lesser dose to the heart. The risks in cardiac mortality are significantly reduced by this reduction in the mean cardiac dose.

Lung and liver tumours can be treated in their early stages with ablative radiation therapy doses given in extreme hypo fractionated schedules. The treatment will be over in a week’s time with five daily fractions. Active breath coordinators help in minimizing respiratory distortions at the targets in the organs by delivering radiation at the correct phases of the respiratory cycles with great precision.

The volumes of normal tissue getting irradiated are also minimized, thereby reducing the normal tissue toxicities.

Modern radiation therapy thus provides curative strategies for localized tumours in the liver and lung without allowing any major surgery.

To spare the normal tissue while delivering optimum dose to the tumour to destroy it completely has been the focal theme of research over the past two decades. The micro multi-leaf collimators were specifically developed to target the small benign tumours (acoustic chwannoma, pituitary adenomas, AVM’s etc.) in the brain. The Gamma Knife and the X-Knife (Linear accelerator based) stereotactic radiosurgery (SRS) has enabled the radiation oncologist to ablate these lesions in the brain without any surgical A Complete Magazine on Healthcare in Asia

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intervention. Needless to say, these advances in technology that helps to precisely target the small inaccessible lesions in the brain with sub-millimeter accuracy, has turned out to be a marvel of medical science.

CHALLENGES WITH TECHNOLOGY The advances in technology have posed challenges too. From the caregivers’ point of view, the fundamental question of comparative cost-effectiveness in applying these tools in varying clinical conditions needs to be carefully analyzed. It needs to be carefully evaluated how much significant are they in improving the results for a comparative gain in normal tissue side-effects. With very less social support for high end health care for the common man, it remains a huge challenge for the policy makers to create an equitable society.

As the famous physicist educationist, writer C.P. Snow has rightly said, “Technology can offer us lot of gifts but can also stab us behind our backs”. Technology is not just about operating with expensive machines.

The people behind the machines also do matter. Regular quality control 34 Medical Tourism Jan - Mar 2020

(QC) and quality assurance (QA) programmes are mandatory for their safety and accuracy.

Unfortunately, our system of healthcare does not have any mandatory external monitoring policy for medical equipment to ensure their safety and performance. Teaching hospitals have the greatest advantage in this regard. Participation in clinical trials makes it mandatory to participate in external QC & QA programs. The radiation oncology discipline also gets refined with such a supervised approach.

The success behind any enterprising medical technology is the team implementing it. Besides the Radiation Oncologist, high-quality medical physicists and well trained radiation therapy technologists form the backbone in the treatment. Institutions with teaching and training programmes in these disciplines strengthen the quality of the radiation oncology programme.

Besides radiation oncologists, a team of devoted medical and surgical oncologists, palliative care specialists and specialist oncology nurses are required for comprehensive cancer care. Regular interaction between

these specialties, which is a mandatory exercise in teaching hospitals involved in training programmes, leads to a healthy oncology practice.

Last but not the least, the penchant for technology needs to be balanced with a compassionate mind for patient care. We need to strongly factor in the cost-effectiveness of care and the incremental cost-benefit ratio when we think of expensive technology for cancer treatment solutions. ‘Choosing wisely’ should be the guiding principle in our decision-making process.

Cancer sufferers need a comforting care giver. As Albert Camus very eloquently put, “Who taught you all this Doctor, the answer is ‘suffering’.

We need to etch this lesson in our minds when we render our care to the millions suffering from the perils of cancer and care should always be reinforced with compassion and kindness.

Dr. M. Dinesh (Head, Radiation Oncology Division, MVR Cancer Centre & Research Institute, Kozhikode, Kerala)

Stemcell Knee Cartilage Regeneration Revolutionary Technology To Fight Knee Arthritis Arthritis affects millions worldwide and 100 million people in India. Knee arthritis is very common and especially among the elderly. While knee replacement surgery is the gold standard treatment, TOSH Hospital offers an alternative, Stemcell Knee Cartilage Regeneration for knee arthritis.

Knee cartilage regeneration is an emerging technique to treat knee arthritis and help preserve the natural knee joint. The single stage key-hole (Arthroscopy) procedure is done by harvesting stem cells from the patient’s bone marrow in the pelvic bone and injecting it into their knee joint. The worn-out knee cartilage causing discomfort and pain is first removed by a key-hole procedure. The stem cell mixed with clotting gel is injected into the knee joint. These stem cells help in the growth of new cartilage. The surgery takes about an hour and a half and the patient remains in the hospital less than 48 hours totally. Spinal anaesthesia is given to make both legs numb waist down, and the patient remains awake throughout the procedure. In rare cases, general anaesthesia is given.

TOSH is at the forefront of introducing single stage stem cell knee procedures, and the highly proficient team has performed over 350 successful surgeries. As awareness of regenerative therapies increases, the number of patients undergoing knee cartilage regeneration is on the rise. This treatment will substitute at least 50% knee replacement surgeries globally in a decade. It can be performed at any age and a gap of 2-3 months needed between surgeries, for the other knee.

While knee replacement surgeries require a revision surgery after 15-20 years and pose high risk of infection and other complications since a foreign material is implanted into the body, the major advantage of stem cell knee cartilage treatment is that it is a natural way to preserve one’s knee and avoids any artificial implant in the body. The minimally invasive procedure is not painful as there is no cutting of bone or muscle.

The day care procedure ensures the patient moves the joint fully and allowed partial weight bearing walking on the operational leg on the same day. Mild pain relieving tablets are prescribed for 5 days. The sutures can be removed after 12 days. As the new cartilage forms, pain disappears. Post 6 weeks, the patient can get back to a normal lifestyle.

Post-operative physiotherapy is not required and patients can do the advised exercises on their own.

The success rate depends on the patient’s condition, age and level of knee damage. Even advanced cases are handled through this procedure after assessment of X-rays. For curved knees, a small alignment correction procedure is additionally needed.

Dr. S.H. Jaheer Hussain MBBS, M S Orth, M.Ch. Orth (UK) Joint Preservation & Reconstruction Surgeon

ADVANTAGES  Day Care procedure  Retain one’s own natural knee  Safer alternative to total knee replacement  No metal implants  No restrictions of joint movements unlike knee replacement  Squatting, jogging and sports activity allowed gradually

TESTIMONIALS “My wife Mrs. Azza Al Harthi has undergone this procedure for the left knee six months back. I was really apprehensive about the procedure and was wondering if it was actually possible. Now she is happy with the results and planning for other knee. I hope that more people are made aware about knee cartilage regeneration so they can benefit from the minimally invasive procedure that doesn’t use any artificial implants.”

“ Everybody wants to be mobile and enjoy free movement. Dr. Jaheer truly gives a boon for all patients suffering from unbearable knee pain. This revolutionary treatment helps preserve our own knee and offers so much relief. I hope that more people are made aware about Knee Cartilage Regeneration so they can also benefit from the minimally invasive procedure that doesn’t use any artificial implants. “

Mr. Mohammed Naseer Ammar Al Harthi Muscat, Oman

Malathi, Chennai

For more details contact

TOSH (Trauma & Orthopaedic Speciality Hospital) #72, Ormes Road, Kilpauk, Chennai

For Appointments

+91-44 4903 4903 | +91 989 446 7903 | Email : toshenquiry@gmail.com | http://toshhospitals.com A Complete Magazine on Healthcare in Asia

35

MEDICAL TOURISM ONCOLOGY

HIGH HOPES FOR AI IN CANCER DETECTION Artificial Intelligence can help detect one of the most common forms of blood cancer - acute myeloid leukaemia (AML) - with high reliability. AML is a life-threatening disease that should be treated as quickly as possible.

C

ancer is the deadliest of all diseases and the second leading cause of death globally, accounting for an estimated 9.6 million deaths in 2018.

Early detection of cancer boosts survival chances of patients tremendously but, unfortunately, most victims are diagnosed in the final stages of the disease, leaving them with little hope for recovery. By then, the tumor

36 Medical Tourism Jan - Mar 2020

would have spread excessively, leaving no treatment option either for stopping the metastasis or complete removal of the affected cells.

Of late, experts are exploring the scope of Artificial Intelligence (AI) and deep learning in addressing the issue. Both Artificial Intelligence and machine learning have long been there, hugely affecting our everyday lives by bringingmajor changes in

communication, transportation, and media. Researchers are now showing a keen interest in using advances in the field of AI to improve diagnosis, management and better therapeutics to treat chronic diseases, especially cancer.

The application of Artificial Intelligence for betterment of healthcare is booming with each passing day. With advances in algorithms and hard-

According to the researchers, at present ultrasounds can tell if a nodule looks suspicious, and then the decision is made whether to do a needle biopsy, but fine-needle biopsies only act as a peephole, they don't reveal the whole picture. As a result, some biopsies return inconclusive results as to whether the nodule is malignant, or cancerous in other words.

In order to improve the predictive power of the first-line diagnostic, the ultrasound, researchers looked into machine learning or AI models developed by Google. They applied a machine learning algorithm to ultrasound images of patients' thyroid nodules to see if it could pick out distinguishing patterns. ware, machine learning and Artificial Intelligence can learn and analyze an enormous amount of data.

A vast data regarding cancer-diagnosed patients and those who availed treatment is being collected over the years. Experts vouch that early diagnosis of cancer is possible through Artificial Intelligence if the huge database is properly utilised.

Researchers at the University of Texas Southwestern Medical Centre in Dallas have developed a software tool that uses Artificial Intelligence to recognize cancer cells from digital pathology images - giving clinicians a powerful tool to predict patient outcomes. The spatial distribution of different types of cells can reveal cancer’s growth pattern, its relationship with surrounding micro-environment and the body's immune response.

A major technical challenge in systematically studying tumor micro-environment is to automatically classify different types of cells and quantify their spatial distributions, says Dr. Guanghua 'Andy' Xiao, corresponding author of a study published in EbioMedicine. The AI algorithm that Dr Xiao and his team developed,

called 'ConvPath', overcomes these obstacles by using AI to classify cell types from lung cancer pathology images.

The ConvPath algorithm can 'look' at cells and identify their types based on their appearance in the pathology images using an AI algorithm that learns from human pathologists.

The algorithm helps pathologists in making accurate cancer cell analysis in quick time.

"It is time-consuming and difficult for pathologists to locate very small tumour regions in tissue images, so this could greatly reduce the time that pathologists need to spend on each image," says Dr Xiao.

A study, published in the journal PLOS Pathogens, suggests that automated machine learning shows promise as an additional diagnostic tool that could improve efficiency of thyroid cancer diagnosis.

"Machine learning is a low-cost and efficient tool that could help physicians arrive at a quicker decision on how to approach an indeterminate nodule," said the study's lead author John Eisenbrey from Thomas Jefferson University in the US.

The researchers found that their algorithm performed with 97 per cent specificity and 90 per cent predictive positive value, meaning that 97 per cent of patients who truly have benign nodules will have their ultrasound read as 'benign' by the algorithm, and 90 per cent of malignant or 'positive' nodules are truly positive as classified by the algorithm. The overall accuracy of the algorithm was 77.4 per cent.

Thyroid nodules are small lumps that form within the thyroid gland and are quite common in the general population, with a prevalence as high as 67%. The great majority of thyroid nodules are not cancerous and cause no symptoms.

Though preliminary, the study suggests that automated machine learning shows promise as an additional diagnostic tool that could improve efficiency of thyroid cancer diagnoses. Once it becomes more robust, the approach could give doctors and patients more information in order to decide if thyroid lobe removal is necessary.

A team of researchers from Beth Israel Deaconess Medical Center of Harvard Medical School led by Dr. A Complete Magazine on Healthcare in Asia

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Andrew Beck showed that analysis of data through deep-learning had decreased the error rate in breast cancer diagnosis by 85%.

Machine-learning algorithm was also tested for diagnosis of Melanoma, a type of cancer that mostly occur in the skin, by the researchers of Stanford University.

Apart from checking the diagnostic skills of the tool, the researchers also compared these results with certified dermatologists. The study showed that Artificial Intelligence can classify skin cancer as accurately as the dermatologists.

Similarly, researchers tested the commercially available tool for the detection of colorectal cancer, ColonFlag (in Europe) or LGI Flag (in the US), and found that the machine-learning algorithm identified individuals with tenfold higher risk of undiagnosed colorectal cancer at curable stages (0/I/II).

Recently, researchers from the Viterbi School of Engineering at the University of Southern California trained a machine-learning algorithm to differentiate between benign and malignant tumors in breast cancer. They used synthetic data instead of real data to train the algorithm. The results were fascinating, as the lead researcher Prof. Assad Oberai said, "We had about an 80% accuracy rate. Next, we continue to refine the algorithm by using more real-world images as inputs."

Artificial Intelligence can help detect one of the most common forms of blood cancer - acute myeloid leukaemia (AML) - with high reliability, new research has found. The approach, based on the analysis of the gene activity of cells found in the blood, could support conventional diagnostics and possibly accelerate the beginning of therapy, said the study published in the journal iScience. In the early stages, the symptoms of AML can resemble those of a bad cold. However, AML is a life-threatening disease that should be treated as quickly as possible.

"With a blood test, as it seems possible on the basis of our study, it is conceivable that the family doctor would already clarify a suspicion of AML," said Joachim Schultze, a research group leader at the German Center for Neurodegenerative Diseases (DZNE).

"And when the suspicion is confirmed, the patient is referred to a specialist. Possibly, the diagnosis would then happen earlier than it does now and therapy could start earlier," added Schultze, who is also Head of the Department for Genomics and Immunoregulation at the LIMES Institute of the University of Bonn in Germany.

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MEDICAL TOURISM TREATMENT

VIRTUAL REALITY A GREAT PROMISE IN ADDRESSING STRESS

A

nxiety disorders are among the most common form of mental disorders affecting over 18% of adults. The estimated prevalence of anxiety disorders worldwide is 7.3%, and this constitutes a high proportion of the global burden of the disease.

their way into hospitals and therapists’ offices.

to feel as if they are in the traumatic scenario.

Riding a wave of interest in mental health technology, companies creating VR content for therapeutic outcomes are receiving a deluge of attention and funding. And, while VR has been used successfully to treat post-traumatic stress disorder (PTSD) since the 1990s, these new programmes address a much broader range of conditions.

Research has shown how heart rate, facial muscles, electrodermal activity (EDA/GSR), respiration, and other aspects of physiology are reliably impacted by fearful responses. By quantifying these responses in a virtual environment, researchers can get a better idea of what induces fear, and which components are critical for alleviating the fear response.

The role of Virtual Reality (VR) in managing anxiety has been a growing dimension of the healthcare industry as demonstrated by the growing use of technology – along with augmented reality – to create cost-effective and repeatable training courses for surgeons. In physical and cognitive therapy, too, VR shows great promise.

Today’s VR content is primarily designed to aid exposure therapy, a treatment for anxiety disorders in which patients are exposed to anxiety, inducing stimuli in a safe, controlled environment, eventually learning that the ‘threats’ they’re worried about are not actually very dangerous. For example, someone who fears heights might visit progressively taller buildings under the guidance of their therapist (in vivo exposure), while someone with PTSD might revisit traumatic memories in therapy sessions (imaginary exposure).

The use of biosensors has also provided promising results for using VR alongside conventional therapy.

Individuals with general anxiety disorder have been found to exhibit differences in their level of electrodermal activity, which could be used to provide information for judging therapy success.

A new wave of psychological research is pioneering VR to diagnose and treat medical conditions from social anxiety to chronic pain to Alzheimer’s disease. Many of these solutions are still in the laboratory stage, but some are already making

Although medications and talk therapy can help calm the symptoms of PTSD, the most effective therapies often require confronting the trauma, as with virtual-reality-based treatments. These computer programmes, similar to a video game, allow people

Anxiety symptoms can cause significant distress, impair quality of life, and increase stress. Anxiety increases risk for a range of co-occurring physical conditions, including chronic pain. Given the pervasiveness of anxiety and its impact on mental and physical health, effective treatment is clearly needed, yet a majority of affected individuals remain untreated.

40 Medical Tourism Jan - Mar 2020

A new study published in the Journal of Medical Signals and Sensors has added to the research volume in this area showing that virtual reality (VR) can be helpful in treating claustrophobia. The software in this study simulated an elevator moving to the tenth floor and also a magnetic resonance imaging (MRI) device.

Researchers found that it was helpful to reduce anxiety and was accessible and easy for people to use it. The study also examined different dimen-

sions of how playable the game was, including motivation, satisfaction, effectiveness, usability, and learnability.

This study adds to the emerging, promising research using VR technology as a way to address various types of anxiety disorders. Another recent study has examined whether virtual reality could be used to treat social anxiety as well. VR technology is not just limited to the therapists’ office either. One study found that immersive virtual reality could be used as a distraction tool to reduce pain, anxiety, and help with anger management in the emergency room.

Another study found that VR can help successfully reduce anxiety in children undergoing dental procedures. VR can also teach mindfulness skills to help people with generalized anxiety disorders.

VR exposure therapy (VRET) permits individualized, gradual, controlled, immersive exposure that is easy for therapists to implement and often more acceptable to patients than in vivo or imaginary exposure.

VR consists of a fully immersive, 3-D environment that transports people to engaging, interactive environments that can promote new

learning. VR technology also has the potential to assist in training, evaluation, delivery, and supervision of psychotherapy skills, and can provide patients with a physiologically and emotionally evocative experience which can make VR a valuable tool for mental health treatment.

Incorporating VR in therapy can increase the ease, acceptability and effectiveness of treatment for anxiety.

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MEDICAL TOURISM DIABETES

BEWARE OF DIABESITY! With normal Diabetes and obese Diabetes becoming widespread, innovative Diabetes management techniques have become necessary Dr. Joseph Kunnirickal Joseph MD (MED), CCEBDM (Diabetes) Consultant Internal medicine and Diabetology VPS Lakeshore hospital Kochi.

D

iabetes afflicts about 450 million people worldwide. in 2017, it resulted in healthcare expenditure to the tune of USD 727 billion dollars. Obesity is another worrying condition. Over 600 million adults and 100 million children across 195 countries were obese in 2015. What happens if the two occur together? Diabesity! Are the treatment options same for normal Diabetes and obese Diabetes? The answer is no!

A revolutionary change has occurred in the field of Diabetes therapeutics in the past five years. Sodium-glucoseco-transporter-2 (SGLT-2) inhibitors, a new group of oral medications used for treating type 2 Diabetes, like Canagliflozin, Dapagliflozin and Empagliflozin are increasingly used by medical practitioners. They work by preventing kidneys from reabsorbing glucose back into the blood. The SGLT-2 inhibitors block sodium-glucose transport proteins, the protins that reabsorb glucose.

It results in reduced blood sugars, weight loss and helps

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in minimising adverse events (Mace) in Cardiac Diabetes patients. It also exists as a combination with Gliptins (DPP-4 ), most commonly, Empagliflozin with Linagliptin.

Another revolution is the advent of the GLP1 agonist injections (a new group of injectable drugs to treat type 2 Diabetes), namely Dulaglutide (once a week) and Liraglutide (daily injection). The drug reduces appetite by augmenting the action of glucagon receptor. It can reduce both weight and sugars drastically if administered to the right patient.

The new treatment options come as a huge relief for scores of Diabetes patients who, for long, had to depend solely on Insulin. Now if a Diabetes patient is treated by a doctor well-versed in newer therapeutics, it can go a long way in preventing complications like Neuropathy, Nephropathy, Cardiac disease, Retinopathy and Fatty Liver disease.

Presently, medical practitioners are being trained in newer insulin pumps and smart technologies that mimics artificial pancreas and also devices that monitor sugars without repeated pricking. Physicians can monitor patient sugars on his mobile or laptop by getting alerts on a patient dashboard.

As newer molecules like oral GLP 1 agonist are on the anvil, the days of managing Diabetes with vials, syringes, older

regular Insulin and drugs like Glibenclamide are well and truly over. There are some who may argue against costlier newer molecules but the outcomes are too good and potent to be ignored. It is just that the government needs to step in and subsidise the newer game changing molecules and bring relief to millions of diabetes patients.

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MEDICAL TOURISM MEDICAL VALUE TRAVEL

GLORY DAYS AHEAD for India's medical tourism sector India does have an impressive range of medical tourists, with several of them belonging to the South-East Asian countries, the Middle-East, Africa and SAARC countries.

44 Medical Tourism Jan - Mar 2020

W

hen it comes to medical tourism, India oozes confidence like never before.

As per the latest FICCI (Federation of Indian Chambers of Commerce & Industry) report, the country has the capacity to touch the $9 billion markby this year-end in terms of Medical Value Travel (MVT) market earnings.

India is seen as one of the preferred medical destinations and, going by the current trends, it will remain so in 2020. Medical tourists have a liking to the country’s health industry, the reasons being many. A key factor is the cheaper treatment and travel costs when compared to western countries like the US and the UK. Those travelling to the country for medical purposes can effect reasonable savings in terms of treatment expenses. For instance, the daily cost of travel within India at an average is 31 dollars (about Rs 2,232) in contrast to 223 dollars (about Rs 16,056) in the United States.

India has a vast potential with regard to satisfactory healthcare and treatment costs. In 2020, the country’s medical tourism sector is expected to grow even bigger, a key factor being that the country excels in effective medical treatment in areas like spine surgery and infertility treatment.

Metro cities like Delhi, Mumbai, Chennai, Bangalore, Hyderabad and Kolkata remain the most preferred destinations for medical tourists arriving in the country. It is reported that

Chennai draws in around 15 percent of incoming foreign patients while Kerala manages around five to seven per cent.

India does have an impressive range of medical tourists, with several of them belonging to the South-East Asian countries, the Middle-East, Africa and SAARC countries.

India has a global reputation for quality medical care. As per official reports, 38 hospitals have got accredited by the Joint Commission International (JCI). Also, 619 hospitals have been accredited by the National Accreditation Board for Hospitals and Healthcare Providers (NABH).

LESS WAITING TIME Another favourable factor weighing high on the minds of international medical patients is the quick access to service. Surgeries are done with comparatively less waiting period as compared to that in some of the developed countries.

According to the FICCI report, the mortality rate post-surgery is less in India, (1.4 per cent as against 1.9 in the US).

COMMUNICATION BARRIER Also international patients find it much easier to communicate while in India. The country has a sizeable number of fine doctors, guides, medical staff and other required experts who are fluent in English. Hence, the patients won’t find it difficultyto convey their medical condition and

ailment details through the global language.

Another factor going in favour of India’s health sector is that it is powerful ‘bank’ of qualified and skilled doctors. Major hospitals have also quickly integrated latest technologies and know-hows, resulting in accurate and quality healthcare provision.

AYURVEDA The country is popular for its Ayurveda treatments, which has often been proved as an alternative choice of medicine. In fact, many medical tourists are quite happy to try Ayurveda in India!

We have, over time, established connection with leading hospitals and the best doctors in India so that medical travellers are able to get the best experience with minimum difficulty. This year, we are looking forward to treat the medical tourists in a more efficacious manner.

Though there is much scope of improvement in areas like effective regulations, redress mechanism and government initiatives, the country’s medical tourism is expected to peak in 2020. The best is on its way!

Mihir Vora, Founder & CEO Magnus Medi

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MEDICAL TOURISM FOOD

COFFEE? MAKE IT RIGHT! Filter coffee can help fight type 2 Diabetes, studies show

T

here has been extensive research into whether consuming coffee (caffeine) is safe for those with type 2 Diabetes as well as whether or not coffee could help prevent Diabetes.

Coffee contains different chemicals, some of which have beneficial effects whereas others can have an adverse impact, such as caffeine which can impair insulin in a short period.

Researchers have found that coffee can help reduce the risk of developing type 2 Diabetes - but only filtered coffee, and not boiled coffee. The study, published in the Journal of Internal Medicine, shows that the way coffee is prepared influences the health effects of coffee.

46 Medical Tourism Jan - Mar 2020

The findings from Chalmers University of Technology and Umea University in Sweden, offer new insight into this connection, using a novel method to help differentiate between the effects of filtered coffee and boiled coffee.

Coffee contains polyphenols, molecules with anti-oxidant properties widely believed to help prevent inflammatory illnesses such as type 2 Diabetes, and anticarcinogenic (anti-cancer) properties. Besides, coffee contains the minerals magnesium and chromium. Greater magnesium intake has been linked with lower rates of type 2 Diabetes. The blend of these nutrients can be helpful for improving insulin sensitivity, which

may help offset adverse effects of caffeine.

Coffee and its effect on risks of developing type 2 Diabetes have been studied a number of times and the results indicated a notably lower risk of the disease among coffee drinkers.

"We have identified specific molecules – ‘biomarkers’ - in the blood of volunteers in the study, which indicate the intake of different sorts of coffee. These biomarkers are then used for analysis when calculating type 2 Diabetes risk," said study researcher Rikard Landberg, Professor at Umea University.

"Our results now clearly show that filtered coffee has a positive effect in

terms of reducing the risk of developing type 2 Diabetes. But boiled coffee does not have this effect," Landberg added.

With the use of these biomarkers, the researchers were able to show that people who drank two to three cups of filtered coffee a day had a 60 per cent lower risk of developing type 2 Diabetes than people who drank less than one cup of filtered coffee a day.

Consumption of boiled coffee had no effect on the Diabetes risk in the study.

amounts, caffeine also has positive health effects," Landber said.

beans, and the drink in general, are managed.

Many other types of coffee preparation were not specifically investigated in the study, such as instant, espresso, cafetiere, and percolator coffee.

The study stresses that the health impacts of coffee do not depend solely on whether it is filtered or not.

They also vary with how the coffee

Filtered coffee refers to methods in which finely ground coffee beans are placed in a filter, and then water passes through, either in a machine or manually. Boiled coffee is made with coarsely ground coffee beans which are then added directly to the water.

To differentiate the Diabetes risk for boiled and filtered coffee, a new technique called metabolomics was used, in combination with classic dietary questionnaires. Metabolomics makes it possible to identify the blood concentration of specific molecules from a given food or drink and use that as an objective measurement of intake - instead of simply relying on self-reported intakes from the questionnaires, which are prone to large errors.

"Metabolomics is a fantastic tool, not just for capturing the intake of specific foods and drinks, but also for studying the effects that intake has on people's metabolism. We can derive important information on the mechanisms behind how certain foods influence disease risk," said study lead author Lin Shi. According to the researchers, many people wrongly believe that coffee has only negative effects on health.

This could be because previous studies have shown that boiled coffee increases the risk of heart and vascular diseases, due to presence of diterpenes, a type of molecule found in boiled coffee.

"But it has been shown that when you filter coffee, the diterpenes are captured in the filter. As a result, you get the health benefits of the many other molecules present, such as different phenolic substances. In moderate A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM STRESS

48 Medical Tourism Jan - Mar 2020

STRESSED OUT?

BLAME SOCIAL MEDIA Studies show that excessive use of social media raises stress levels

S

ocial network users risk becoming more and more addicted to social media platforms even as they experience stress from their use. Despite the many advantages associated with social media, there are a number of negative effects caused by its excessive usage. Among the common negative effects of social media use are stress, anxiety, depression, addiction, cyberbullying, hacking, scams, cheating and relationship problems, drug abuse and even death.

Research into the habits of 444 Facebook users revealed they would switch between activities such as chatting to friends, scanning news feeds and posting updates as each began to cause stress. This leads to an increased likelihood of technology addiction, as they use the various elements of the platform over a greater timespan.

A study published in the July 2016 issue of the Journal of Computer-Mediated Communication and other research have found that when we receive targeted, personalized communications from people with whom we have strong ties — such as a direct message or comments on a photo we share — well-being tends to improve.

By contrast, social media interactions with someone with whom we have a weaker tie (or an easy-to-produce or one-click interaction, such as “liking” a photo or viewing a friend’s photo or post) don’t tend to help our well-being.

The study further examined two separate ways of coping with the stress.

The first included users creating a diversion by partaking in other activities away from social media, which is the more obvious path. They would switch off, talk to friends or family about issues they were experiencing and spend less time on the platform.

However, the other method consisted of diversion through engaging in different activities within the same Social Network Services (SNS) app itself, and potentially moving on a pathway towards SNS addiction. This method was more prevalent among those social media users who used the sites more regularly.

A study published in the July 2017 issue of the American Journal of Preventive Medicine reported that using platforms such as Instagram, Facebook, and Snapchat for more than two hours a day is associated with feelings of social isolation among individuals between ages 19 and 32. Other data shows that the incidence of depression increases among young adults (also those of ages 19 to 32) who use social media more often than their peers, according to research published in the April 2016 issue of the journal Anxiety and Depression.

“Social media in some cases provides the social support we (as in all human beings) need,” says Christine McCauley Ohannessian, PhD, a professor of pediatrics and psychiatry at the A Complete Magazine on Healthcare in Asia

49

University of Connecticut School of Medicine in Hartford.

Ohannessian’s research, published in January 2017 in the Journal of Affective Disorders, has found that the more time young people spend using social media, the more anxiety symptoms they report experiencing and the more likely they are to experience an anxiety disorder. Other data shows social media use is linked to more alcohol consumption, alcohol abuse, and drug use, according to a study published in January 2017 in the journal Emerging Adulthood.

The use of social media is very addictive. Once you sign up, logging out becomes a problem. Many people have been addicted to social media,

meaning they are always on their phones and computers--liking, commenting and tweeting. It becomes impossible for such people to spend more than an hour without their phones. Now you can imagine a person who has been addicted to using a smartphone, without access to it, he or she is actually stressed. The urge to be updated with new social media posts makes you feel like you're aren't living in the present world.

Social media addiction comes integrated with low quality sleep. The time you're supposed to be sleeping you're checking the viral content on Instagram, Facebook or Twitter, which limits your sleeping hours.

People addicted to social media often chat with their friends till late at night.

Despite your sleeping time, you still have to wake up early to go to school or work.

As you didn't have enough sleep the previous night, your day will likely be filled with anxiety. You'll likely find it hard to concentrate on your day-today activities, which could lower your productivity. If you're a student, your performance starts dropping and in the end you will be stressed by your poor grades. If you're employed, lack of enough sleep denies you the ability to interact with fellow employees, your productivity depreciates and eventually, your employer can add to the stress with an angry fusillade based on your low performance.

TIPS FOR HEALTHY SOCIAL MEDIA USE: *Track your use. You need to know how much time you spend on social media. *Be selective about who and what you follow. Stop following accounts that make you feel insecure or upset. * Browse with more awareness. Don’t browse with the sense that every image serves as evidence that others are happier and living better lives. * Make time to disconnect. Pick a time in your day to actively not check social media. * Use social media with intention. Use it in a way that supports the other parts of your life such as family time, work, exercise, and other interests.

50 Medical Tourism Jan - Mar 2020

Avoid Bypass Surgery Avoid Stents Established in 2003 Leading EECP centre in India Treated hundreds of patients from middle east

What is ECP It is an American machine (USFDA approved) to treat blocked arteries of the heart without Bypass Surgery and without Stents Are you suffering from any of the following?  BLOCKED ARTERIES OF THE HEART  CHEST PAIN  HEART ATTACK  BREATHLESSNESS ON WALKING You can now avoid Bypass Surgery and Stents with this new technique from America called EECP+AMT.  It is totally painless.  Has no side effects.  It is as effective as Bypass surgery and Stents.  It is USFDA approved.  It is very economical

Who can benefit from EECP+AMT? 1.

Those who are unfit for bypass surgery.

2.

Those who have had a failed bypass surgery.

3.

Those whose stents have got blocked

4.

Those who are very sick, very weak or very old.

5.

Those who are afraid of operation.

6.

Patients who’s EF (ejection fraction) is very low and have breathing difficulty during exertion.

12, The Mall, Amritsar – 143001 – Punjab – India Ph: +91 183 222 6660 | +91 981 405 2303 Email: dr.randhawa@gmail.com www.randhawahospital.com A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM YOGA

FOLLOWING BUDDHA TO TRANQUILITY

Muni Yoga is a unique and patented combination of several procedures envisioned to improve the quality of life and enhance spiritual and overall progress of the individual.

Y

oga, one of the conspicuous contributions of ancient India to the world,is anamalgamation of physical, mental and spiritual practices and its origin is speculated to date back to the Vedic era. Yoga started gaining popularity in the west as an exercise during the 1980s and its fame is mounting each day and people are fascinated by its aura. That may be the reason the UN general assembly declared June 21 as the International Yoga day recognizing the fact that “yoga provides a holistic approach to health and well-being”.

A couple of terms that we always hear in relation to Yoga are Ashtamga Yogaand Hata Yoga. The hata yoga is referred to as “six-limbed” yoga while Ashtamga Yoga is known as the “eight-limbed” practice. The practices that the two systems generally share in common with one another as well as with the Buddhist yoga system are posture, breath controland the three levels of meditative concentration leading to Samadhi. In Ashtamga Yoga, these six practices are preceded by behavioral restraints and ritual observances (Yama and Niyama). Hata Yoga considers ex-

52 Medical Tourism Jan - Mar 2020

cess food, excess sleep and excess physical activity as hindrances to attaining the benefits of yoga. So to avoid these factors Hata yoga also recommends the practice of Yama and Niyama even though they are not considered mandatory.

The Yogācāra (“Yoga Practice”) school of Mahayana Buddhism is known to be the earliest Buddhist tradition to employ the term yoga to denote its philosophical system.

Yoga was considered as the “union” or identity with the celestial Buddha named Vajrasattva—the “Diamond essence” (of enlightenment). The behavioral restrictions and ritual observances included in Yama and Niyama is not expalined in Buddhist Yoga practice under the same name.

But the concept and idea behind these are followed in Buddhism too.

The concepts under Yama and Niyama in Ashtamga Yoga are incorporated in Buddhism under the notions of Pancha Sheela (the five rules of good conduct), Arya Ashtamga Marga (the noble eight fold path) and Brahma Vihara (the four qualities).

Muni Yoga is a unique and patented combination of several procedures envisioned to improve the quality of life and enhance spiritual and overall progress of the individual. It comprises three stages- Preparatory Procedures, Main Procedures and Complimentary Steps. The preparatory procedures include practising Panchasheela (rules against stealing, killing, sexual misconduct, untruthfulness and intoxicating agents), Arya Ashtamga Marga (right livelihood, action, speech, effort, mindfulness, concentration, understanding and thought) and to be endowed with the qualities of Brahma Vihara Karuna (to be compassionate to poor, diseased and those in trouble), Maithri (universal love and brotherhood), Mudita (enjoying others success) and Upeksha (equanimity). Buddhist techniques like walking meditation, Anapanasati meditation, Rakshana Mantra (Buddhist way of preventing thoughts that obstruct Meditation) along with Yogasanas, Kapalabhati

and Pranayama constitute the main procedures.The walking meditation and Anapanasathi meditation are two interesting segments of the program.

Lord Buddha proclaimed- “Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment.” Meditation helps to drag the mind, which keeps wandering in the past and future, to the present. The practice of focusing one's attention changes the brain in ways to improve that ability over a period of time. Meditation can be thought of as mental training, similar to learning to ride a bike or play a musical instrument.

THE WALKING MEDITATION In Buddhist monasteries, walking meditation is taught before sitting meditation. On an average, 45 minutes of walking meditation is very beneficial, whereas in routine practice 10 minutes of walking prior to sitting meditation is ideal. This helps

Swami Vivekananda in his famous oration at the Parliament of the World Religions at Chicago has mentioned-“Buddhism was the fulfillment, the logical conclusion, the logical development of the religion of Hinduism (and its Philosophy). The great glory of the Master lay in his wonderful sympathy for everybody, especially for the ignorant and the poor.

Some of Buddha's Brahmin disciples wanted to translate his teachings into Sanskrit, but he distinctly told them, ‘I am for the poor, for the people; let me speak in the tongue of the people.’

And so to this day the great bulk of his teachings are in the vernacular of that day in India”. Buddha always wanted the concepts and practices to be simple, in a way common man could understand. This influence can be observed in Buddhistyoga and Meditation techniques also.

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in quick concentration of mind. It refers to the observation of the phenomena of walking. If walking fast, one should observe alternate movements of the right and left legs, and if slow, should perceive the lifting of foot, moving forward, bringing it down and then firmly placing it on the ground. At every stage one should focus mind without looking at the feet and change direction at 20 steps.

ANAPANASATI MEDITATION Buddha has given forty objects of meditation which are suitable for different types of people and breathing is one among them which is appropriate to all. Anapanasati is to feel the sensations caused by the movements of the breath in the body. The meditator has to sit straight with his spine erect and observe his own normal breathing by concentrating on the tip of the nose or abdomen. It has been scientifically demonstrated that anapanasati slows down the natural aging process of the brain.

Yoga is not just asanas and meditations. Ashtangamarga of yoga talks a lot about self-discipline, love and compassion (Yama & Niyama) and Buddha also talks about the same in a simple way. Concluding with the words of Swami Vivekananda- “The separation between the Buddhists and the Brahmins (refers to ancient Indian philosophy which includes yoga) is the cause of the downfall of India. Let us then join the wonderful intellect of the Brahmins with the heart, the noble soul and the wonderful humanizing power of the Great Master�.

Dr Divya P MD (Ay), PGD HSR Assistant Professor, Muniyal Institute of Ayurveda Medical Sciences, Manipal, Email: drdivyap84@gmail.com

Acknowledgements Dr M VijayabhanuShetty, Chairman, Muniyal Ayurveda Mrs Jyothsna K G MSc (Yoga Therapy), Lecturer Muniyal Institute of Ayurveda Medical Sciences

54 Medical Tourism Jan - Mar 2020

GERMANY CALLING:

SKILLED NURSES, MIDWIVES IN HIGH DEMAND! Indian nurses can now bag lucrative jobs in Germany, thanks to a WHO-compliant project to recruit and train healthcare professionals from developing countries to address the massive nursing shortage in the western European country.

“WE CARE”, an association formed by a group of German healthcare employers to tackle growing challenges in the German healthcare sector, will serve as the nodal body for the project.

The programme will be implemented with the support of the respective governments and their agencies. The same will facilitate effective monitoring of the project implementation by the Ministry of External Affairs.

A Memorandum of Understanding (MoU) will be soon signed with the government agency for recruitment of the nurses. A special consideration will be provided to financially under privileged communities who face social stigma such as orphans, widows, and single women for other reasons, who together form 75 million in India.

Many among such community seldom get foreign job opportunities and this could be a valuable contribution to the society, said a spokesperson for ‘WE CARE’.

India will be a major recruitment destination among other Asian countries, with the association targeting a

“controlled recruitment“ of 20, 000 nurses in the next one decade from Asia out of which 10,000 will be from India.

The project also envisages establishing training centers with international standards in India and Germany which will result in employment generation and help them meet internal healthcare personnel requirement.

“We’ve instructed and authorised our member organisation “Medizin Park Rhein-Ruhr AG” to manage the matters with India,” the spokesperson said.

Statistics show that the demographic change in most countries of the EU is leading to an increasing number of older people, often needing long-term care, and a decreasing number of young people who may choose a nursing and/ or midwifery career.

Between 2005 and 2015, the number of people aged 80 or older in the EU rose from 20 to 27 million, which corresponded to an increase of 36%. In comparison, the overall population grew by only 3% during the same period.

The statistics reveal that approximately 600 million people of the Indian

population are below 25 years of age as against 20 million in Germany. Certain reports indicate that India requires 10 million jobs to be generated per annum up to year 2030 to maintain the unemployment rate.

WHO estimates that 9 million nurses and midwives will be needed worldwide by the year 2030 in addition to the current shortage of health and nursing personnel.

The same has encouraged ‘WE CARE’ to consider a project to start training centres at donor countries.

Taken together, nurses and midwives make up the largest subset of health professionals in all countries and play a key role in delivering safe, effective and efficient, high-quality healthcare. “‘WE CARE’ urge each and every employer, the church and organisations in Europe that there has to be a balance between the donor country and the receiving country and to promote ethical cross border migration to avoid any exploitations,” Prof Dr. Winrich Breipohl, Director, ‘WE CARE’, added.

For further information:

www.nurse4germany.com A Complete Magazine on Healthcare in Asia

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Advertorial

MEDICAL TOURISM WELLNESS

PATHYA KEY TO FOSTERING OJAS

56 Medical Tourism Jan - Mar 2020

The origin of many imbalances in the body and mind can be traced to what we eat and how we eat. One of the primary reasons for the loss of Ojas is the lack of attention to our diet. Attention to our food habits, known as pathya, is central to building Ojas.

Ultimately, the goal of Ayurveda is to increase the Ojas in each being, by understanding and modulating the factors that influence immunity of the body.

T

he ability to attract and inspire is found in people who have an indescribable vitality, sensuality, glow and resilience. Ojas is that state of well-being in which the body-mind reflects true strength through resilience and vitality that keep it healthy and supple.

OJas also prevents decay and degeneration of the body. A true connection between the mind and the body helps develop self-esteem, knowledge of

the self and the inner power. These strengths come out through a glow and lustre that is alluring.

Ayurveda tells us that negative and unattended emotions lurking in the mind are the cause of many diseases.

They prompt us to be less perceptive or misperceive the world around us which is known as asymmetry.

The gut is the central focus of Ayurveda’s interventions. Known as the mahasrotas, the gut and its fires digest all we take in. The origin of many imbalances is in what we eat and how we eat. One of the primary sources of the loss of Ojas is the lack of attention to our diet. Attention to our food habit, known as pathya, is a central tenet to building Ojas.

INCREASING OJAS THROUGH PATHYA Ultimately, the goal of Ayurveda is to increase the Ojas in each being, by understanding and modulating the factors that influence immunity of the body. Ayurveda talks about stress and its impact on our Ojas and prescribes a healthy daily routine called dinacharya to deal with it; modern medicine is now finding that burning midnight oil, too much stress and lack of skills to cope with it and bad food impact our immune system.

To increase Ojas, Ayurveda stipulates daily routine with several dozen instructions on specific tasks. These can be divided into early morning routine, cleaning the senses, under-

standing how to bath the body, living in the world and evening chores.

In addition to lifestyle choices, Ayurveda is clear on what food to consume and what not, depending on our constitution, the season, our gut’s fire, and our pace of running a day. We have three opportunities a day to medicate ourselves with food: breakfast, lunch and dinner. The same are also opportunities to harm ourselves with food. Our choices of what we put into our mouth, who we eat with, whom we allow to prepare our food, and our level of awareness of our food’s origin and its journey from soil to spoon, determine how much we build or decay our Ojas.

The foods recommended for increasing Ojas include milk, ghee, homemade curd/yogurt, honey, many fruits, and in some cases meat soup.

Of the grains, barley is most recommended. An entire list of food is given in the texts to be personalised and prescribed by a vaidya. Also, the modern milk available in the market formed from pooling milk from many cows, homogenization of fat droplets, pasteurization to reduce microbes, artificial addition of Vitamin A & D, addition of sugar as preservative, is without Ojas-building properties. The healthy habit is to drink milk that is from a single cow fed on same grass and is well treated and has its calves nearby. Boil the milk gently and drink warm.

Ojas is not well-understood by most people. It is part of our life’s journey to unravel the sutras and discover their inner meanings to rediscover ourselves. When we start paying attention to ourselves, we can use the restorative scientific practises in Ayurveda to find true medicines for our individual bodies. The use of the right elements in the Universe for bettering our health leads to a net result of glow, lustre, vitality, splendour and strength, known as Ojas, for us.

Ninu Susan Abraham Editorial Co-ordinator Ayurveda & Health Tourism A Complete Magazine on Healthcare in Asia

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MEDICAL TOURISM INTERVIEW

AGAINST ALL ODDS Saga of an aspiring cricketer who mainstreamed Emergency Medicine in India and became one of the best healthcare leaders in the country braving illness, setbacks

F

rom an aspiring cricketer to Anesthesiologist-cum-critical care physician to an Emergency Medicine specialist to finally President of India’s first corporate chain of hospitals, Dr. K Hari Prasad's has been an awe-inspiring journey.

President of the Apollo Group of Hospitals today, Dr. Hari Prasad was instrumental in establishing Emergency Medicine as a specialty in the country. In an exclusive interview granted to Medical Tourism magazine, he opens his mind on a wide variety of topics including the future of Indian medical sector, technological advancements in the field of medicine and the growth plans of the Apollo group.

Q: A lot has been said about the booming healthcare sector in India and how it caters to the needs of the global community. Do you think the Indian market has attained its true potential as a medical tourism destination?

A: Not really… All of us know the medical care facilities in our country are the best in terms of quality and affordability. We have a rich pool of skilled doctors and nurses besides world-class infrastructure facilities. We also have a safe environment and the beautiful landscapes, always an added advantage. However, the medical tourism sector in the country is yet to bloom.

This is because of negative publicity often dished out abroad by the media even as our strengths remain unexplored. I personally feel that there is tremendous potential for hosting a higher foreign client base here.

Q: But is the country's technological infrastructure as advanced as that available in the best medical care centres in the developed world?

A: We’ve come a long way technology-wise in the last two decades and the quality of technological infrastructure is at par with any other developed country.

Despite this, the treatment cost here is much lower.

For instance, we’re now offering world-class proton therapy (used to treat tumors and cancer cells with precision and with very low toxicity). In-fact, the Apollo Proton Cancer Centre is the first such facility in the whole of South Asia. While a similar treatment could cost $ 2 lakh in the US, it costs only one-fourth or less here.

58 Medical Tourism Jan - Mar 2020

Q: There is a huge demand among foreigners for traditional Ayurvedic treatment, especially on the wellness front. How do you view the trend?

A: Ayurvedic treatment is now in high demand and Kerala is among the most preferred destinations. The big hospitals, including us, are attempting to provide holistic treatment to patients that include Ayurvedic practices too. We have found Ayurvedic treatment to be very effective in ensuring shorter recovery period after a major surgery or radiation treatment. However, we’re careful to offer only those Ayurvedic practices that are proven scientifically.

Q: What are your expansion plans?

A: Right now, we’re focused on starting our operations in Kochi, which will be the 73rd hospital of the Apollo Group. The infrastructure is ready and we had a soft launch on January 31. The over 300-bed multi super specialty hospital, coming up at Adlux premises, Angamaly, will cater to international patients, among others.

We’ve deployed best talents in the field to provide top quality service. Nearly 50 specialists are being deployed now and their strength will go up in the

coming days. The hospital will provide every treatment, except radiation oncology, in the first phase. The second phase will be completed in another six months. We expect a lot of foreign clients from destinations like the Middle-East, thanks to the Kochi International Airport located nearby.

Q: You wanted to be a cricketer during your student days, but ended up being an Anesthesiologist and a successful healthcare entrepreneur...

A: Yes.. In-fact, I was the youngest to represent Andhra Pradesh in the Ranji Trophy at the age of 17. However, unlike today, the game was not popular then. I received no encouragement from any quarter and soon ended up studying in a medical school. From then on it was a new innings.

Q: Looking back, what was the most satisfying moment in your profession?

A: I started my career specializing in Anesthesiology and critical care and later specialised in Emergency Medicine in 1996. At that time, Emergency Medicine as a specialty was not recognised by the Government of India. In most of the hospitals, there were just ‘Casualty’ wings to look after accident victims and emergency cases. Often the patients were being treated by ordinary physicians who had little idea about the related complications. An Emergency physician should be able to handle all emergencies belonging to every specialty and should be able to provide optimal care during the Golden hour (the period following a traumatic injury during which there is a good possibility of preventing death by medical intervention).

We approached Emergency Medicine as a separate specialty and held training programmes with the help of faculty and institutions from advanced countries like the US where it was already a focused medical branch. We adapted their protocols to the specific situation in our country.

It gives me immense satisfaction that the initiative prompted the government to look into the issue seriously. The medical council finally recognised the specialty in 2009.

Q: You have faced a lot of challenges in your life and struggled hard to reach where you are...

A: My life was full of ups and downs and, often, it was a roller coaster ride.

Every time I made a major achievement, I had to face some setback or the other, including being afflicted with cancer. But I never remained shy of taking up the challenges that came my way and was determined to work my way up. I penned all these experiences in the form of a biography titled 'I'm possible', which was published just a few days back. I am happy to get good reviews for the book and that the book is inspiring many.

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MEDICAL TOURISM RARE SURGERIES

47-YEAR-OLD SUCCESSFULLY TREATED WITH BONE MARROW TRANSPLANT Dr Rahul Bhargava, Director, Department of Clinical Hematology & Bone Marrow Transplant, Fortis Hospital in Gurugram with his team performed autologous bone marrow transplant where they used Mishra’s stem cells for transplant, thereby reducing the chances of rejection and infections.

I

n a ground-breaking procedure, Haematologists and Bone Marrow Transplant specialists successfully treated Anurag Mishra, a 47-year-old man from New Delhi, suffering from Multiple Sclerosis (MS) for the past seven years.

Multiple sclerosis (MS) is a life-long condition, known to reduce life-expectancy. MS affects the brain and spinal cord that leads to serious disabilities. The most common symptoms of MS include loss of sensation and balance, restricted arm or leg movement and vision loss in one or both the eyes.

Mishra, who was bedridden earlier and is back to his normal routines, was diagnosed with MS -- an autoimmune neuro degenerative disease, where the body’s own defence system starts attacking its nervous system without any specific reason.

Unlike the current line of MS treatment, which mainly includes steroid therapy, physiotherapy and symptom management, doctors used Bone Marrow Transplant (BMT).

“In an autologous BMT procedure, the healthy stem cells from the patient are taken out and preserved. Chemotherapy is then administered to reset the body’s immunity and then the stem cells are injected back to rescue the person from the side effects of chemotherapy,” said Bhargava.

After the surgery, the patient is kept under isolation for a few months to ensure he/she does not contract any infection. “In this case, when Anurag approached us, he was entirely dependent on others for his basic needs. But within six months of the treatment, he is back on his legs and is carrying on with his normal life,” Dr. Bhargava added.

According to the patient, the attacks are sudden and may affect any part of your body, limiting your abilities. “Extreme pain and disabilities this disease gave was scary and left me depressed. I think I am very lucky to get to know about Dr Rahul Bhargava and team, who cured me miraculously,” Mishra said.

“Too much delay in the procedure can considerably affect the clinical outcomes. In the case of Anurag, recovery is 90 per cent, which means he received the treatment within recovery time-frame,” Dr Bhargava said.

ONE-YEAR-OLD UNDERGOES RARE LIVER TRANSPLANT SURGERY

A

14-hour rare liver graft transplant surgery was performed on a one-year-old girl from Saudi Arabia at Artemis Hospital in Sector 51 in Gurugram in Delhi. Baby Fatima (name changed) underwent the living donor liver transplant, where only one out of eight portions of the liver was used to provide a new liver to her.

The surgery called Monosegment (Segment 3) living donor liver transplant is the first such case reported in Delhi-NCR,

in which mono-segmented liver graft has been used, the hospital said.

“Apart from this, the use of bovine jugular vein in liver transplant has been reported for the first time in the world, to provide an inflow of blood to the newly transplanted liver as the baby was born with absence of bile ducts and underdeveloped portal vein,” the hospital said.

Managing the child during such a long surgery was a tedious and tricky task for the doctors.

Born as the third child to her parents, Fatima suffered from unusually prolonged and deep jaundice for months after her birth. Doctors in Saudi Arabia diagnosed her with a rare disease called Biliary Atresia which is found in one in 16,000 live births. The developments of bile ducts in such children are absent.

Fatima underwent biliary bypass surgery at a local hospital in Saudi Arabia before coming to India.

60 Medical Tourism Jan - Mar 2020

MEDICAL TOURISM RARE SURGERIES

HAEMOPHILIA PATIENT'S BLADDER RECONSTRUCTED IN BENGALURU HOSPITAL

A

Haemophilia patient's urinary bladder was reconstructed through surgery at Fortis hospital in Bengaluru.

"The surgery was performed by a team of doctors on a 38-year-old overseas patient, diagnosed with cancer bladder though he was in a Haemophiliac," Fortis Urology Director Mohan Keshavamurthy said.

Touted to be the world's first surgical removal of the urinary bladder on a patient whose ability of the blood to clot is reduced, the doctors replaced his knee and reconstructed his anterior cruciate ligament.

surgery required the bladder affected with Cancer to be removed and a new bladder reconstructed using the small intestine.

"This was our first complex radical cystectomy (surgical removal of bladder) on a Haemophilia patient in two days despite challenges," said Dr. Keshavamurthy.

"The risk of bleeding while reconstructing the bladder is a challenge in such patients and care was taken to maintain absolute hemostasis," said hospital's Urology Consultant Dr. Karthik Rao.

Haemophilia is a bleeding disorder where the patient suffers from defective clotting protein and requires external blood factors to avoid bleeding in case of an injury. The

According to hospital's director Dr. Niti Raizada, the country has an estimated 1 lakh Haemophiliacs although many others remain undiagnosed.

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MEDICAL TOURISM RARE SURGERIES

CARE HOSPITAL PERFORMS RARE BEATING HEART SURGERY

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specialised team of cardiac surgeons at the CARE Hospital, Banjara Hills, Hyderabad, successfully performed a rare beating heart surgery recently. According to the doctors, the 45-year old patient Mohmmed Qutubuddin from Hyderabad, was afflicted with a rare congenital chest deformity. The upper part of his chest (sternum and adjacent costal cartilages) was protruding out (Pectus Carinatum) and the lower part of chest (sternum and costal cartilages) was sunken deep inside (Pectus Excavatum).

According to Dr Prateek Bhatnagar, Director of Cardiac Surgery, CARE Hospitals, Banjara Hills, this was a medically challenging case. “Worldwide, there is limited medical literature available on handling of such patients,” he said, explaining that in the case of this particular patient, he and his team of doctors performed the life-saving procedure through an extremely narrow passage in the chest.

According to him, “The patient was diagnosed with severe mixed chest deformity and had to get a multi-vessel coronary bypass surgery, as he was having angina even at rest and 62 Medical Tourism Jan - Mar 2020

angiography showed left main with multi-vessel disease.

This was a rare situation because in such a chest deformity, there is very little space to conduct the surgery. Beating all odds, we performed the surgery without any blood transfusion.”

After assessing the patient’s condition in detail, Dr Bhatnagar devised the surgical strategy to perform this complex operation. Because of the extreme space reduction in Currarino-Silverman chest deformity, manipulating the heart during the surgery becomes very difficult, he explained, adding that due to the crooked nature of the breast bone (sternum), retraction of this bone to harvest internal mammary arteries (IMAs), using routine techniques during a bypass surgery becomes impossible.

“We are currently verifying from medical literature if this is the first ever such case wherein the patient has been successfully operated upon. Post the surgery, the patient is recovering well. The patient was walking independently within 24 hours of the bypass surgery,” Dr. Bhatnagar said.

MEDICAL TOURISM CONFERENCES

4TH INTERNATIONAL CONFERENCE ON CHRONIC DISEASES (FEBRUARY 17-18, 2020) PARIS FRANCE

The 4th International Conference on Chronic Diseases (Chronic Diseases 2020) scheduled to be held in Paris, France during February 17-18, 2020.

9TH WORLD CONGRESS ON ADDICTIVE DISORDERS & ADDICTION THERAPY (March 09-10, 2020) Rome, Italy

The 9th World Congress on Addictive Disorders and Addiction Therapy 2020 will be held on March 09-10, 2020 in Rome, Italy.

Addiction Therapy 2020 intends to unite researchers, specialists, and leading academic scientists to trade and offer their encounters and research comes about all parts of unsafe impact of Addiction and Treatment and Therapy.

It additionally gives the head interdisciplinary gathering to specialists, experts and instructors to show and talk about the latest advancements, patterns, and concerns, viable difficulties experienced, and the arrangements embraced in the field of dependence treatment and treatment.

Chronic Diseases 2020 is a global event focusing on the immense knowledge and major advances in the rapidly emerging fields of chronic diseases by attracting experts and professionals across the universe. It is the one among the best platform to have the discussion innovative researches and developments in the field of cluster of chronic diseases and so on.

4th International Conference on Chronic Diseases is intended to urge more noteworthy collaboration to offer a forum that will connect people worldwide for the exchange of ideas under the theme “Health Promotion and Diseases Prevention”

22ND WORLD DERMATOLOGY AND AESTHETIC CONGRESS (MARCH 26-27, 2020) ABU DHABI, UAE

Aesthetic Meeting 2020 will be held from March 26-27, 2020 at Abu Dhabi UAE which comprise keynote speakers, oral presentation, poster presentation, and exhibitions.

Conference generally contains lecturers, paper and poster award and panel periods with prominent international professionals and novice. Many also function product exhibitions, tutorials and student research competitions that improve networking prospects for all attendees.

INTERNATIONAL CONFERENCE ON PHYSICIANS AND SURGEONS (April 08-09, 2020) Dubai, UAE

“International Conference on Physicians and surgeons” scheduled during April 08-09, 2020 in Dubai, UAE which will mark the gathering of many renowned Doctors, Professors, Pharmacologists, Healthcare Professionals, Researchers, Academicians, Students, and Business Delegates.

The theme of the conference is ‘’Heal and Repair with Doctors’’. This International event offers numerous opportunities to share your ideas, applications experiences and to establish business or research relations for future collaboration.

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MEDICAL TOURISM CONFERENCES

31ST EUROPEAN HEART AND HEART FAILURE CONGRESS (March 09-10, 2020) Prague, Czech Republic

cardiology professionals and cardiac specialists and for early careers.

The “31st European Heart Diseases & Heart Failure Congress� in Prague, Czech Republic, is scheduled for March 09-10, 2020.

The incorporation of new technologies and research findings will be a special focus of the Congress. It will also bring together expert clinicians, researchers and leaders of cardiac health stakeholder organisations, offering an outstanding set of plenary and state-of - the-art lectures, educational courses, symposia, workshops with experts and sessions designed by

It will provide an excellent platform for the exchange of ideas and authoritative opinions by leading scientists covering the entire spectrum of cardiovascular disease and heart failure research and sharing the cross-cultural experiences of different treatment procedures.

Euro Heart Faliure 2020 is an international conference of cardiologists and heart failure committee to discuss the future of cardiac health and cardiovascular disorders in terms of collaboration, structures and organizational development and advances in cardio-metabolic health and Interventional Cardiology. It is organized around the theme "Mission to fight against Heart Diseases and Heart Failure".

TThe 13th World Congress on Virology and Infectious Diseases will be held on Febraury 24-25, 2020 in Tokyo, Japan. Virology Asia 2020 revolves around the theme Latest and Advanced Therapeutic approaches of Virology.

Virology Asia 2020 will offer a unique experience with the no of Keynote/Plenary Talks, Poster Presentations, and Workshops by eminent personalities.

Tele: +91 471 2722151

Email : gafkerala@gmail.com | gafseminar@gmail.com | gafexhibition@gmail.com www.gaf.co.in 64 Medical Tourism Jan - Mar 2020

MEDICAL TOURISM EVENTS

ITB BERLIN CONVENTION 2020

(March 4 to 8, 2020) Berlin, Germany

Sustainability, digitalisation, shifting customer demands and luxury travel are the key topics at the ITB Berlin Convention 2020 to be held from March 4 to 7, 2020. The slogan of the global travel industry’s largest event this year is 'Smart Tourism for Future'.

Experts, researchers and leading representatives of the industry will present their ideas and offer inspiration to visitors for new approaches, projects and products. These will be substantiated by the latest market analyses, examples of best practices and exclusive surveys by the global tourism industry.

Many tourism companies are focusing more and more on intelligent and sustainable systems for managing tourism flows and including them in their strategies and products in view of the rising CO2 levels and over-consumption of resources and their effects on eco-systems and nature.

The ITB Berlin Convention has comprehensive information on the current situation, the progress being made and the many deficits and mistakes that need to be addressed.

In addition to ecology and sustainability, digitalisation has become one of the factors that will dominate tomor-

row’s tourism industry. Customers want information about their trips everywhere and at all times. Comprehensive digitalisation can make their wishes come true. This topic runs through the entire convention. Every day, event participants will discuss a variety of connected issues and present new ideas.

Development and use of algorithms to create personal travel experiences, opportunities for destinations created by influencers and Instagram users as well as the accompanying challenges, which are often underestimated, will be discussed. The events at the eTravel World will provide a practical context with even more background information on technical innovations and the digital transformation in the industry.

physical exercise, anti-smoking guidance, getting the necessary amount of sleep and exploring the concept of medical communication. The Saudi Healthcare Exhibition 2020 “Healthy Lifestyle” strives to set new and achievable standards by providing the perfect platform with focus on the essentials for a healthy lifestyle.

SAUDI HEALTHCARE EXHIBITION

(March 22 to 24, 2020)Riyadh, Kingdom of Saudi Arabia

Saudi Healthcare Exhibition, which provides a platform for medical professionals, government officials, and providers of healthcare products and services to network and engage in business, will be held at Riyadh International Convention & Exhibition Center, Riyadh, Saudi Arabia from March 22 to 24, 2020.

The event provides attendees with an opportunity to gain benefits from upsurge in the healthcare industry and reap the rewards of unparalleled exposure to key decision makers, government authorities, and high net worth investors from the Kingdom of Saudi Arabia.

Special focus will be given for 'Healthy Lifestyle for Healthy Citizens'. Promoting good health within the Kingdom is important -- ensuring easy access to safe and nutritious food,

The exhibition would help the audience acquire the latest principles of the current ‘Healthy Lifestyle’ related sciences, apply a healthy risk-based model built on scientific evidence to reduce food and smoking hazards and increase physical activities and better sleeping, assess nutritional requirements of hospitalized patients, develop and apply clear health-related regulatory requirements to ensure full compliance of domestic businesses and importers, enhance the safety of imported food and understand the duties of fully qualified clinical dieticians.

It will also provide familiarization with hospital/department policies and procedures related to nutrition, improve health by promoting healthy eating choices and encourage physical activities besides help in quitting smoking.

The event will provide information on how to integrate food and nutrition services in the healthcare delivery systems, learn new concepts of planning and implementation of nutritional care, decrease smoking and improve quality sleeping, explore processes of proposed healthy lifestyle plans and patient/family education programs and liaising and coordinating with other professionals.

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MEDICAL TOURISM EVENTS

ADVANTAGE HEALTHCARE-INDIA 2019 The Advantage Healthcare-India, the 5th International Summit on Medical Value Travel, which showcased India and its immense pool of medical capabilities as well as created opportunities for healthcare collaborations between the participating countries, was held at India Expo Centre and Mart, Great Noida, in November 2019.

The exhibition showcased India's offerings and expense in healthcare, in terms of Hospitals, Healthcare centres, AYUSH Hospitals, Educational institution (Medical colleges, Nursing colleges, Pharma colleges & AYUSH colleges), medical devices and electronics, pharmaceutical companies, pharma machinery and packaging, and associated infrastructure - medical tourism facilitators, hotels, airlines, tour and travel companies and TPAs. The objective of this summit was to promote India as a Premier Global Healthcare Destination and to enable streamlined medical services exports from India. This underlying objective is a unique conglomeration of the ‘5 – Ts’ - talent, tradition, technology, tourism and trade.

The exhibition presented and promoted exclusive medical services and expertise, opportunity for the state governments to showcase their healthcare and wellness industry,

WTM LONDON 2019 SEES INCREASE IN INDUSTRY LEADERS WTM London 2019, the leading international event for the travel industry, saw a 77 per cent increase in ministerial attendance as well as a higher quality of WTM Buyers’ Club Members.

According to Reed Exhibitions, the event’s organizer, almost 50,000 visitors from 182 countries attended the three-day event at ExCeL London, while there were around 1.2 million business meetings conducted and over 110 conference sessions held. This all contributed to a total of £3.75 billion worth of travel industry business deals being signed.

provided excellent brand visibility to the exhibitors, Knowledge Sharing Program where internationally renowned Indian doctors and AYUSH experts delivered lectures on different topics, International Conference on Medical Value Travel, Reverse Buyer Seller Meeting and planned B-2-B sessions with hosted delegates from more than 60 identified countries of Africa, Middle East, CIS and Asia.

Medical Tourism Magazine was the media partner for the event.

we proved that WTM London is not only the event where ideas arrive, but also an event where decisions are made,” he added.

This year, the WTM Buyers’ Club was re-formatted to include a stricter vetting process, which focused on inviting only the top industry buyers with the best reputation and purchasing power. During the event itself, many landmark deals were signed for the travel and tourism industry.

These included a deal between easyJet and Atout France that will see a €1 million advertising campaign launched in the UK to promote French destinations.

“WTM London 2019 was unquestionably a great success,” said WTM London Senior Exhibition Director, Simon Press.

In addition, several large booking deals occurred at the event, which will see clients such as Saudi Arabia, Indonesia and the Seychelles secure increased stand-space heading into the 2020 edition of WTM London.

“We are delighted to have been able to facilitate the business and creative connections of 50,000 attendees, exhibitors, buyers and media in order to form the future of the travel industry. By welcoming almost 80 Tourism Ministers and increasing the quality of Buyers’ Club members,

With high-profile events such as the annual Leaders’ Lunch and the UNWTO & WTM Ministerial Summit, tourism ministers flocked to the event. There was a 77% increase, taking it from 43 ministers in 2018 to 76 this year.

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MEDICAL TOURISM EQUIPMENT WORLD

AMPLIVOX PC850 PC BASED AUTOMATIC AUDIOMETER A portable PC based audiometer that will automatically measure and categorise hearing levels. Results can be used for statistical and trending analysis. Ideal for mass screening programmes. The Amplivox PC850 is a portable automatic audiometer that integrates with a PC to provide a comprehensive and pro-active audiometric facility.

Three extensive tests including the self recording/bekesy type test and an on-screen audiometric questionnaire facilitate a completely paper-less audiometric function. All tests can be reviewed on-screen and subsequently printed or electronically exported if required. The Amplivox PC850 has a user definable recall facility and extensive data analysis features that enable ‘at risk’ individuals and user defined groups to be identified and monitored.

With a unit weight of just 710g and USB connectivity, the Amplivox PC850 can be transferred from location to location with ease. The Amplivox PC850 is a cost effective solution for the provision, storage and management analysis of audiometric test results.

The Amplivox PC850 is compatible with all leading occupational health databases to provide electronic data storage and statistical analysis benefits. The audiometer can interface to OPAS, Cohort and Medgate OH databases.

HYDRAULIC OPERATING TABLE - APPLE SERIES The top segments are translucent for X-rays and enable taking pictures and monitoring a patient with a C-arm. The positions in five section table top are adjusted manually by mechanical drive. It's safe and robust mechanism prevents breakdown during an operation. Specialized for orthopaedic, neurology, ERCP, laparoscopy and urology.

Key Structure : With regular human strength, up-down table position can be fixed by stepping foot pedal downward. The base is eccentric for trouble-free C-ARM movements.

Leg & Head section are interchangeable.

Furnished with hard, robust stainless steel shell which provides the sense of dirt free & sanitized operations. Trendelenburg, lateral tilt, flex-reflex, chair operated manually. Smooth height adjustment of the table can be achieved by using the foot pedal.

www.medisave.co.uk/amplivox-pc850-pc-based-automaticaudiometer-p-99443.html

www.narang.com/operation-theatre-tables/ hydraulic-operating-table-apple-series/index.php

PILLCAM™ CROHN’S CAPSULE

EP RECORDING

The PillCam™ Crohn’s capsule enables direct visualization of the small bowel and colon with innovative imaging technology.

The capsule features allow you to achieve comprehensive coverage for efficient disease management.

The PillCam™ Crohn’s system is the only product that visualizes the small bowel and colonic mucosa directly and noninvasively — with one procedure. The PillCam™ Crohn's capsule gives you a 336-degree view via two camera heads (168° per head), which helps to visualize both the small bowel and colonic mucosa.

The PillCam™ Crohn’s system enables to efficiently assess your patient’s Crohn’s disease and how well it is responding to treatment. The Exclusive Adaptive Frame Rate (AFR) technology adjusts the rate of image capture to 4 or 35 FPS, depending on the movement speed.

Electrophysiology (EP) products of GE Healthcare is designed to empower critical thinking with solutions that helps to focus on the patient, not the process. Get clear data delivered seamlessly. Enhanced signal quality.

Intuitive controls at the fingertips.

And signal-processing algorithms that can help lead to diagnosis and treatment of even the most difficult cardiac conditions.

www.gehealthcare.com/products/ep-recording

www.medtronic.com/covidien/en-us/products/capsule-endoscopy/ pillcam-crohns-system.html#capsule

PHONAK MARVEL Phonak Audéo Marvel focuses on first-class hearing aid – a clear, rich sound experience.

Combined with modern technology it is a multifunctional hearing aid.

Enjoy better speech understanding in noise, less listening effort and be amazed at how well the hearing aids perform from the first fit and every time you wear them.

Phonak Audéo Marvel hearing aids connect directly to either your iOS or Android smartphone or other Bluetooth® enabled devices. Use them for hands-free calls, listening to TV, music, e-books, podcasts and so much more.

Available with powerful rechargeable technology, Marvel hearing aids are easy to use, quick to charge and offer a full day of hearing including streaming.

www.phonak.com/com/en/hearing-aids/phonak-audeomarvel.html

DA VINCI SP® Rediscover the vision, precision and control that you trust in da Vinci® surgery—through a single port. da Vinci SP empowers with narrow, deep access and broad versatility which can create the next era of surgical outcomes.

Through a single 2.5 cm cannula, control three fully-wristed, elbowed instruments, and the first fully-wristed da Vinci® endoscope. Reach up to 24 cm deep and triangulate your instruments at the distal tip.

Reach anatomy anywhere within 360° from one port placement. Rotate the da Vinci SP boom more than 360° around the remote center of the cannula and turn the instrument cluster over 360° within the cannula. www.intuitive.com/en-us/products-and-services/da-vinci/systems/sp

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MEDICAL TOURISM EQUIPMENT WORLD

INSPIRIS RESILIA AORTIC VALVE

ATEC® BREAST BIOPSY SYSTEM FOR MRI

The INSPIRIS RESILIA Aortic Valve, Model 11500A, is intended for use as a heart valve replacement. It is is indicated for patients who require replacement of their native or prosthetic aortic valve.

Materials list Valve leaflets: Bovine pericardium Stent: Cobalt-chromium alloy, polyester Fabric covering stent: Polyester cloth Valve sewing ring: Silicone rubber Tissue platform Model 11500A features RESILIA tissue, bovine pericardial tissue transformed by a novel integrity preservation technology, which incorporates two new proprietary features that, virtually eliminate free aldehydes while protecting and preserving the tissue.

Our flagship ATEC vacuum-assisted breast biopsy system is an all-inone platform designed for use under ultrasound, MRI, stereotactic and 3D™-image guidance. It provides physicians a fast, safe and simple way to perform minimally invasive breast biopsy procedures. The ATEC MRI biopsy device enables physicians to treat patients who are at risk for breast disease under MRI-guidance, while reducing procedure time, minimizing costs and improving patient comfort.

www.edwards.com/gb/devices/heart-valves/resilia

www.hologic.com/hologic-products/breast-skeletal/atec-breast-biopsy-system-mri

With the ATEC MRI biopsy device, physicians can treat a broad spectrum of patients such as women with thin breasts, implants, lesions near the medial wall or multiple lesions. With the ATEC system, physicians can reduce typical procedure time to under 40 minutes, allowing for multiple lesion targeting in one gadolinium session and optimizing costly magnet time.

PROBEAM 360° PROTON THERAPY SYSTEM

100% SILICONE DRAIN BAG FOLEY TRAYS

The ProBeam® 360° Proton Therapy System is designed for next-generation proton therapy, offering uncompromised clinical capabilities with ultra-high dose rates, a 360-degree gantry, and exceptional precision, all within a 30% smaller footprint.

Proton therapy plays an increasingly important role in the fight against cancer, and the new ProBeam 360° System is designed not only for today’s most complex treatment techniques, but also to enable next-generation proton therapy.

The ProBeam 360° System offers uncompromised proton therapy with: 50% smaller volume 30% smaller footprint 25% lower vault construction cost

The 100% silicone drainage bag Foley tray features a 5cc all-silicone BARDEX® Foley catheter pre-connected to a BARD® 2000ml drainage bag and includes the URO-PREP™ Tray. (8972xx, 8974xx, 9072xx) The 100% silicone drainage bag Foley tray is also available with the BARD® SAFTEYFLOW™ outlet device which helps eliminate urine splash when emptying the drainage bag. (9074xx). The URO-PREP™ Tray includes drape, underpad, powder-free exam gloves (not made with natural rubber latex), forceps, rayon balls, pre-filled inflation syringe, lubricant, povidone-iodine solution, specimen container and label.

www.varian.com/oncology/products/treatment-delivery/ probeam-360-proton-therapy-system

ANKYLOS

www.crbard.com/medical/en-US/Products/100-Silicone-Drain-Bag-Foley-Trays

DPTE® ALPHA

The Ankylos implant system is a dependable and well-designed dental implant system providing you with solutions that deliver long-term stability of hard and soft tissues, lasting aesthetics and reliable functionality, which your dental patients will appreciate and Dentsply Sirona Implants as manufacturer backs with a lifetime warranty. Dentsply Sirona Implants backs its implant systems with a lifetime warranty.

The geometry of the Ankylos TissueCare connection moves the transition between implant and abutment to a central position. This integrated horizontal offset design establishes a broad basis for hard and soft tissue stability at the implant shoulder. In combination with the absence of micro-movement and the prevention of bacterial ingrowth, this enables long-term tissue maintenance.

The unique friction-locked and keyed TissueCare connection ensures such a precise fit of the two components that it allows for subcrestal placement of the implant and positive bone response, thus enabling the desired emergence profile, and transgingival healing. Ankylos is therefore able to provide the flexibility of a two-piece system while ensuring hard and soft tissue remain healthy and free of irritation.

The core of the DPTE® transfer system is the Alpha port with its secure interlock enabling totally safe connections and disconnections.

The DPTE® system enables material to be moved from one sterile zone to another through a non-sterile zone, with leak-tight, riskfree reconnection.

www.dentsplysirona.com/en-in/explore/implantology/ankylos.html

www.getinge.com/int/product-catalog/dpte-alpha

/www.angiplast.com/product/gastroenterology/ryles-tube

www.safemorcellation.com/products/versator-tissue-morcellator/

Esteemed manufacturers of medical equipment /devices may forward details of new products for free featuring in Medical Tourism Magazine.

The details can be forwarded to: director@asianmeditour.com For more information call: + 91 98461 21715

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MEDICAL TOURISM HOSPITALS

ADK HOSPITAL

RAK HOSPITAL Sosun Magu Male', 20040 Maldives Phone: (+960) 331 3553 Email: info@adkhospital.com

www.adkhospital.mv

Al Qusaidat Ras Al Kaimah UAE Phone: +971 72074444 Email: mail@rakhospital.com www.rakhospital.com

HOSPITALS IN INDIA

MVR CANCER CENTRE & RESEARCH INSTITUTE

CIMAR COCHIN

Calicut, India Email: info@mvrccri.co

Ernakulam, Kerala India Phone : +91 484 4134444 Email : cimarcochin@gmail. com

www.mvrcancerhospital.com

cimarindia.org

BABY MEMORIAL HOSPITAL

NARAYANA HEALTHCARE Bangalore , Karnataka Ph: +91 99860 13353 Email: international@narayanahealth.org

Kozhikode, Kerala Phone: +91 - 495 – 2723272 Email: info@babymhospital.org

www.babymhospital.org

www.nhinternational.org

SRI RAMACHANDRA MEDICAL COLLEGE

ASTER MEDCITY Kochi Phone: +91 484 66-99999 Email: astermedcity@asterhospital.com www.astermedcity.com

Chennai India Ph: +91 984 096 9698 Email: ipcs@sriramachandra.edu.in

www.sriramachandra.edu.in/medical/

RAJAGIRI HOSPITAL

MANIPAL HOSPITALS Bangalore Ph: +91 80 2222 1111 Email: info@manipalhospitals.com

www.manipalhospitals.com

Cochin, India Ph: +91 484 290 5037 Email: international@rajagirihospital.com

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MEDICAL TOURISM HOSPITALS

ARMC IVF FERTILITY CENTRE

BELIEVERS CHURCH MEDICAL COLLEGE HOSPITAL Thiruvalla India Ph: +91 469 2703100 Email: info@bcmch.org

BMT Annex, Puthiyara, Kozhikode Kerala, India .

Phone:+91 495 272 7376 Email: bdm@armcivf.com www.bcmch.org

www.armcivf.com

CHENNAI FERTILITY CENTER

CONTINENTAL HOSPITALS

Aminjikarai, Chennai India Phone : +91- 44 – 6458 2299 Email: cfcivf@gmail.com www.chennaifertilitycenter.com

APOLLO HOSPITALS CHENNAI

Hyderabad Ph: +91 40 67000000

www.continentalhospitals.com

SIR H.N. RELIANCE FOUNDATION HOSPITAL AND RESEARCH CENTRE

Chennai, India Ph: +91 40 4344 1066 Email: internationalcare@ apollohospitals.com

www.apollohospitals.com

Mumbai Ph: +91 22 6130 5005 Email: rfh.international@rfhospital.org

www.rfhospital.org

KIMS HOSPITAL

ASTER MIMS Kozhikode, India Ph: +918157880111 Email: mvt@asterhospital.com,

Thiruvananthapuram, India Ph: +91 471 294 1888 Email: ipr.tvm@kimsglobal.com

anvarhusain@asterhospital.com

astermims.com

https://trivandrum.kimsglobal.com/

SHARP SIGHT

MEITRA CALICUT Delhi, India Ph: +91 11 401 28881 Email: info@sharpsight.in, ceo@sharpsight.in

www.sharpsight.in

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Kozhikode, India Ph: +91 495 7123456 Email: info@meitra.com

www.meitra.com

MEDICAL TOURISM WELLNESS CENTERS

NIMBA NATURE CURE

KAIRALI AYURVEDIC GROUP Ahmedabad Gujarat India Phone: +91 276 228 3313

New Delhi Phone: +91 11 65028307 Email: info@kairali.com

www.kairali.com

www.nimba.in

SHATHAYU AYURVEDA YOGA RETREAT

KALARI KOVILAKAM

Bangalore Phone: +91 8884133300 Email: info@shathayuretreat. com

www.shathayuretreat.com

SWASWARA

Kollangode, Palakkad, Kerala Phone: +91 4923 305500 Email: admissions@cghearthayurveda.com

www.cghearthayurveda.com/kalari-kovilakom

DHATHRI AYURVEDA HOSPITAL Om Beach, Gokarna Phone: +91 484 4261751 Email: greswaswara@cghearth.co.in

www.cghearth.com/swaswara

SREEDHAREEYAM AYURVEDIC EYE HOSPITAL AND RESEARCH CENTRE

Kayamkulam, Kerala Phone: +91 90200 28888 Email: hospitals@dhathri.in

www.dhathriayurveda.com

PUNARNAVA AYURVEDA HOSPITAL PVT LTD

Koothattukulam, Kerala Phone: + 91 485 2253007 Email: mail@sreedhareeyam.com

www.sreedhareeyam.com

AYURGREEN HOSPITALS

Kochi, Kerala Phone: +91 484 2801415 Email: mail@punarnava.net

www.punarnava.net

SOMATHEERAM RESEARCH INSTITUTE AND AYURVEDA HOSPITAL

Malappuram, Kerala Phone: +91 494 305 5555 Email: info@ayurgreenhospitals.com

www.ayurgreeenhospitals.com

Kovalam, Thiruvananthapuram Phone: +91 471 2268101 Email: mail@somatheeram.in

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MEDICAL TOURISM WELLNESS CENTERS

AYUR BETHANIYA Athani, Thrissur, Kerala Phone: +91 703 40 99 999 Email: info@ayurbethaniya.org

www.ayurbethaniya.org

SHINSHIVA AYURVEDIC RESORT Balaramapuram, Thiruvananthapuram Phone: +91- 471-2266331, Email: ayurveda@shinshivaresort.com www.shinshivaresort.com

AYURVAIDYA Edappally North Kochi, Kerala Phone: +91 4842802383 Email: mail@ayurvaidyahospital. com www.ayurvaidyahospital.com

NIKKI’S NEST Chowara, Thiruvananthapuram, Kerala Phone: 91-471-2267822 Email: info@nikkisnest.in

www.nikkisnest.com

AADISAKTTHI AYURVEDA VILLAGE LLP Kovalam, Thiruvananthapuram, Kerala Phone: +91 963 317 8787 Email: info@aadisaktthiayurveda.com

www.aadisaktthiayurveda.com

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