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Volume III || Issue II || July-Aug 2012

The Gateway to Health & Medical World

Interview

Dr. B. Ramana Laproscopic & Bariatric Surgeon Ideal Immunization Schedule For The Infants Efforts to lose weight

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World Hepatitis Day

News Update | Expert Views | Dental Hygiene | Health & Fitness | Product Line

UPDATE Editor speak

Volume-III

World Hepatitis Day 2012

aving considered the report on viral hepatitis. Taking into account the fact that some 2000 million people have been infected by hepatitis B virus and that about 350 million people live with a chronic form of the disease; Considering that hepatitis C is still not preventable by vaccination and around 80% of hepatitis C virus infections become a chronic infection; Considering the seriousness of viral hepatitis as a global public health problem and the need for advocacy to governments, all parties and populations for action on health promotion, disease prevention, diagnosis and treatment; Expressing concern at the lack of progress in the prevention and control of viral hepatitis in developing countries, in particular in subSaharan Africa, due to the lack of access to affordable, appropriate treatment and care as well as an integrated approach to the prevention and control measures of the disease; Considering the need for a global approach to all forms of viral hepatitis â&#x20AC;&#x201C; with a special focus on viral hepatitis B and C, which have the higher rates of morbidity; Recalling that one route of transmission of hepatitis B and C viruses is parenteral and that the Health Assembly in resolution WHA28.72 on utilization and supply of human blood and blood products recommended the development of national public services for blood donation and in resolution WHA58.13 agreed to the establishment of an annual World Blood Donor Day, and that in both resolutions the Health Assembly recognized the need for safe blood to be available to blood recipients; Reaffirming resolution WHA45.17 on immunization and vaccine quality which urged Member States to include hepatitis B vaccines in national immunization programmes; Considering the need to reduce liver cancer mortality rates and that viral hepatitides are responsible for 78% of cases of primary liver cancer; Considering the collaborative linkages between prevention and control measures for viral hepatitis and those for infectious diseases like HIV and other related sexually transmitted and bloodborne infections; Recognizing the need to reduce incidence to prevent and control viral hepatitis, to increase access to correct diagnosis and to provide appropriate treatment programmes in all regions; Further recognizing the need for universal coverage for safe injection practices as promoted through the WHO Safe Injection Global Network,

Have an insightful reading. Your suggestions are most welcome! e-Mail: editor@medgatetoday.com

Issue-II

July-Aug 2012

Editor Dr. M.a Kamal Chief Editorial Adviser Dr. Pradeep Bhardwaj National Head Afzal Kamal Sr. Manager I.A Khurshid Cheif Correspondent SA Rizvi l Dr HN Sharma Design and Layout Zyaul Haque Ansari Sales and Marketing Amjad Kamal Rahul Ranjan Neetu Sinha S.Y Ahmed Khan Subscribtion & Cirrculation Pallavi Gupta All right Reserved by all everts are made to insure that the information published is correct, Medgate today holds no responsibility any unlikely errors that might occur.

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July - Aug 2012

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Contents UPDATE

Volume-III

News Update ADDING MULTIMEDIA GE & Partners Launch ‘WY Women First’ to Increase Access to Breast Cancer Screening in Wyoming 3M and NABH Launch Program in India for Preventing Healthcare associated Infections and Promoting Quality of Patient Care

July-Aug 2012

Ask a Question

Dr. Pradeep Bhardwaj 06

Product Line

scientech technologies launches new fetal maternal monitor – scientech 17B

Siemens introduces Acuson P300 compact portable ultrasound system

Beauty Tips from

Shahnaz Husain

Cole-Parmer Presents Fluid 08 Handling and Lab Equipment at ACHEMA 2012 .A full range of Masterflex® pump systems and related accessories were on display Philips commences operations at greenfield healthcare manufacturing facility in India New biomarker for liver cancer diagnosis

Health & Fitness

Efforts to lose weight

Doctor Speak

Dr.Sharad Lakhotia,

Update on Femtosecond Laser Refractive Surgery.

Dental Hygiene

Get Rid of from Plaque Attack

Interview

Dr. B. Ramana

Dental Cancer connections with Gum Diseases

Bariatric Surgeon

Ideal Immunization 20 Schedule for the Infants Dr. Rajiva Kumar Child Specialist

Cover Story World Hepatitis Day 4

Issue-II

Expert Views

Mohd. Ameel OCT: The Optical Ultrasound 22

July - Aug 2012

NEWS UPDATE

ADDING MULTIMEDIA GE & Partners Launch ‘WY Women First’ to Increase Access to Breast Cancer Screening in Wyoming

• Aims to screen 15,000 women in Wyoming through a new mobile mammogram van with GE technology and a nonprofit grant program to support expenses for uninsured women • One third of Wyoming women never get screened mostly due to long travel distances to screening facility – on average about 70 miles • Part of GE’s $1 billion global cancer commitment that works to accelerate cancer innovation

and improve care for 10 million patients by 2020 GE deployed a new mobile mammography van to travel across the state of Wyoming to increase access to breast cancer screenings. The van is part of the WY Women First Program, a collaboration among GE, the State of Wyoming and Susan G. Komen for the Cure®, which works to increase access to mammography screenings in one of the most rural states in the United States. The mobile mammography van will be equipped with GE Healthcare’s Senographe Essential technology, a full-field digital mammography system designed to be a flexible screening unit.

3M and NABH Launch Program in India for Preventing Healthcare associated Infections and Promoting Quality of Patient Care 3M India and NABH have launched ‘Sterilization Assurance and Surgical Safety’ program in hospitals to promote best practices & standards for preventing healthcare associated infections & promote quality of care for patients in India. This is the next step post the collaboration finalised between 3M India Ltd and NABH. The first workshop in the series of 3M-NABH knowledge program was conducted on March 31, 2012 in Bangalore at M.S. Ramaiah Hospital. The workshop was conducted by leading experts on infection control area from various Bangalore hospitals. Under this program, 3M and NABH are planning to conduct a series of workshops related to prevention of healthcare associated infections like Surgical Site Infection (SSI) prevention, Sterilization Assurance, Care of IV Lines & Wound Management across major Indian cities in the next few months. 3M and NABH are planning to conduct 40 such workshops which will reach more than 1500 healthcare professionals from more than 100 hospitals across India. Speaking on the occasion, Dr. Girdhar J. Gyani, 6

Secretary General, Quality Council of India, and CEO, NABH said: “NABH accreditation is beginning to have desireda impact in healthcare in terms of improving patient safety. There is need for Capacity building and hospitals are looking forward for facilitation so as to comply with 636-objective elements, provided in the NABH standards. These knowledge workshops by 3M & NABH are aimed at assisting the healthcare facilities in capacity building and will help in preventing & controlling infection related morbidity & mortality. In a way it will reduce the cost of care linked to healthcare– associated infections”. July - Aug 2012

NEWS UPDATE

Siemens introduces Acuson P300 compact portable ultrasound system

New offering provides high performance and reliability in the compact portable ultrasound market Siemens Healthcare expands its ultrasound portfolio with the introduction of the Acuson P300 ultrasound system, a compact portable device for a wide variety of clinical settings. The new system integrates high-performance hardware and software and offers 13 multifrequency transducers for high clinical versatility. The system also features advanced image optimization technologies to support both routine and specialty application needs. The Acuson P300 system is characterized by its comprehensive capabilities, compact and elegant design and demonstrates Siemens’ competitiveness, a goal of the Healthcare Sector’s Agenda 2013 two-year global initiative. It is ready for shipment in July 2012. 8

Cole-Parmer Presents Fluid Handling and Lab Equipment at ACHEMA 2012 .A full range of Masterflex® pump systems and related accessories were on display Cole-Parmer, a global leader with more than 50 years of experience in fluid handling, life science, general laboratory products, instrumentation, and equipment, presented a wide range of Fluid Handling and Lab Equipment at Achema 2012, held during 18-22 June in Frankfurt am Main. Attendees of ACHEMA had the opportunity to see a variety of Masterflex® pump systems live at the Cole-Parmer stand (Hall 4.2, N53). This selection of high-performance peristaltic pumps serves the biotechnology, chemical, industrial, research and development, manufacturing, and pharmaceutical industries, among others. In addition to the Masterflex® C/L® (Compact/ Low Flow), L/S® (Laboratory/ Standard), and I/P® (Industrial/ Process) pumps, various tubing styles and pump heads were operating to demonstrate application-based pumping systems.

Lab equipment featured at the stand included the ColeParmer® Rotational Viscometer, which offers greater chemical resistance and the ability to withstand chemically corrosive materials. The StableTemp® Modular Block Heaters provide the flexibility to heat different sizes of microtubes, centrifuge tubes, vials, microplates, and PCR strips or tubes. Each digital or analog heater accepts more than 40 interchangeable heating blocks which accommodate sample enclosures. The StirPak® High-Speed, Low-Torque Overhead Stirrer System is a heavy-duty modular system that allows users to customize components to suit their mixing application. Several high-quality Oakton® thermometers were also available, including the Oakton® TempTestr® Infrared Thermometer with laser vision to pinpoint the center of the measurement area. July - Aug 2012

USAIM’s The M. Ch. ( Ophthal ) Certification Programme Admission Announcement ( Batch no. 7 ) September’12 - February’ 13 Don’t Miss this time…!

Programme Highlights • • • • • • • •

6 months ONLINE programme 24 X 7 Advanced Contents ( Study anytime ) Theory designed toward Clinical Exposure 6 Specialties covered ONLINE Post Assessment Thesis Submission & presentation at KXP 3 days KXP after 6 months Final MCQ based Exam at KXP

Programme Takeaway

• The M. Ch. Certification in Ophthalmology • CME Credit hours awarded by AACME • Letter confirming attendance at the Lecture program • Knowledge sharing with the experts and fellow professionals during the KXP • Letter of acceptance of thesis which is subject to publication in the Journal of M.Ch.

Who Should Enroll? “Ophthalmologist with minimum 8 posts of surgical experience” To Avail Early bird offer & EMI scheme submit Enquiry Form here: http://www.booleaneducation.com/mch-ophthal/enquiry.aspx OR send email to registrar@mch-ophthal.com

CALL +91 9225545711 +91 2066858107

www.mch-ophthal.com

*** M. Ch. Ophthal is not a registerable certification with MCI

NEWS UPDATE

hakan, India - In line with its strategy to expand the company’s industrial footprint in India, Royal Philips Electronics (NYSE:PHG, AEX:PHI) today announced commencement of operations at its first greenfield manufacturing facility for imaging systems in the country. Located in Chakan, near Pune, 200 kilometers east of Mumbai, the Philips Development and Manufacturing Center will play an essential role in Philips’ commitment to locally develop and produce meaningful products and solutions that help improve access to healthcare for people in India and other growth geographies. With this multimillion euro investment, Philips has reinforced and optimized its production capacity in India. The facility will focus on diagnostic and interventional imaging solutions, initially developed for the Indian market and then for global markets. These solutions will primarily target cardiology (catheterization lab) and radiology (general X-ray) applications. The first products to be manufactured in the facility will be diagnostic X-Ray systems and the Allura FC – Philips’ first India developed catheterization lab. The Allura FC is used in the diagnosis and minimally-invasive treatment of cardiovascular disease, one of the leading causes of death in India. Both products are aimed at the value segment in India and abroad. “This plant is an example of how Philips can combine its technology strengths and market knowledge to manufacture prod10

Philips commences operations at greenfield healthcare manufacturing facility in India

ucts for a healthier India,” said Rajeev Chopra, Managing Director & Vice Chairman, Philips India. “The Pune facility is producing X-ray and cath-lab equipment backed by Philips quality that is affordable for

tier-two and tier-three towns and rural markets.” The Pune facility was specifically designed with manufacturing flexibility in mind so that it can quickly adapt to changing market and product needs. Many of the products and components developed in Pune can also serve the needs of mature markets looking to replace or upgrade entry-level diagnostic devices. “The opening of the Pune manufacturing facility is further proof of Philips’ commitment to innovation in India,” commented Gene Saragnese, CEO Imaging Systems at Philips Healthcare. “In order to make a difference in this market, we need local expertise, low-cost manufacturing capacity and close relationships with our customers. Equally exciting, several demand-

ing customers in global markets are already using our ‘Designed and Made in India’ products, and the feedback is very positive.” Philips conducted in-depth research to understand the on-theground requirements in India and worked closely with healthcare partners to gain better insight into their ‘Made in India’ needs. This research indicated that several factors, including low operating costs, energy-efficiency, easy serviceability and support for high patient volumes, are critical to increasing healthcare access in India and thereby improving patient outcomes. In 2008, Philips initiated the expansion of its industrial and commercial footprint in India with the acquisition of Alpha X-ray Technologies and Meditronics, leading manufacturers of cardiovascular X-ray solutions and general X-ray systems, respectively. This enabled Philips to expand its portfolio and deliver lower cost products that meet the growing needs of customers in India and other global markets. July - Aug 2012

NEWS UPDATE

MEDICALL 2012

Chennai: Beyond Hospital & Medical Equipment The hospital industry is an important component of the value chain in Indian Healthcare industry rendering services and recognized as healthcare delivery segment of the healthcare industry, which is growing at an annual rate of 15%. The size of the Indian healthcare industry is US$ 36 billion today and is estimated to be a whopping US$ 280 billion by 2022. Rising incomes and a growing elderly population are all factors that have triggered the demand for highquality medical care, transforming the healthcare delivery sector into a profitable industry. With the Integration of World Economies, high quality treatment at a fraction of the cost, in comparison to western countries, makes India an ideal healthcare destination for highly specialized medical care. A recent MEDICALL gets top of the mind recall. It is India’s premier Medical Equipment Expo and the first real “supermarket” for hospital equipment and supplies. Its awesome and comprehensive range of exhibits includes Hospital Information System, solutions, surgical and examination furniture, rescue and emergency equipment, diagnostic / laboratory, O.T. equipment dental / ophthalmology equipment, medical disposables and cleaning equipment. MEDICALL is a result of the acute vision and acumen of its organizers. Started 6 years ago with the idea of bringing all the requirements of a hospital under one roof, its debut hosting in 2006 had 90 exhibitors and 2750 visitors. Over the years these figures have recorded impressive growth to stand at 430 exhibitors and 8,250 quality visitors in 2011. MEDICALL Expo is organized by Medexpert Business Consultants, a company promoted by Dr. S.Manivannan. An anesthesiologist by profession, he is one of the founder directors of Kavery Group of Hospitals, Trichy, Tamil Nadu, India. Another factor that contributes to the growing popularity of MEDICALL is the regular introduction of novel 12

concepts and value additions in each successive edition that keeps the medical fraternity enthused and impressed. As a brand MEDICALL continues to draw the highest percentage of hospital owners, doctors, medical directors and purchase heads in addition to being a proven and highly successful platform for attracting affluent producers, dealers and suppliers. The international appeal too is further enhanced by exhibitors from USA, Germany, Japan, China, S. Korea, Taiwan, UAE & Iran in addition to visitors from Europe Kenya, Nigeria, Sri Lanka & Bangladesh.

Attractions At Medicall 2012, Chennai

The organisers of MEDICALL have invited the top 100 Hospitals of India to visit the expo. MEDICALL 2012 will have South Africa along with Sri Lanka as visitor countries, the latter having been one at last year’s hosting too. Hence exhibitors at MEDICALL 2012 can look forward to confirmed buyer delegations from both these countries. This lends an international character to the event • B2B Buyers and Sellers meet • Fashion Show on Hospital Garments —. • The MEDICALL Innovation in Healthcare Awards • The concurrent conferences July - Aug 2012

NEWS UPDATE

Third hip implant banned + cemented implant: higher death rate

A third hip replacement component has been banned from further use due to high failure rates. Patients with a metal liner component of the R3 acetabular system, sponsored by Smith & Nephew Surgical, are advised to visit their surgeons for assessment, the Therapeutic Goods Administration announced In Australia, 47 of the 602 patients with the implant have had to undergo revision surgery. This equates to 2.48 revisions per 100 observation years - compared with a revision rate of 0.79 revisions per 100 observation years for all primary total hip replacements in Australia. The TGA stressed that revision rates were normal for the ceramic or polyethylene liner components of the R3 acetabular system, and were not affected by the ban and Smith & Nephew advised that there is no single and dominant reason why the metal liner is not performing to the required standard. This latest announcement follows earlier bans of the metal-on-metal hip replacement system Stryker MITCH TRH in April this year, and the DePuy metalon-metal ASR hip replacement system in 2010. Meanwhile, a UK study has found that cemented total hip replacements carry a small but significant risk of death compared to uncemented hip replacements,

leading the authors to recommend the latter. But uncemented hip replacements carry a small but significant increased risk of revision compared to cemented replacements, the researchers reported in the BMJ. Pooling data from the national joint registry, the study involving over 150,000 cemented hip replacement patients found 7.6% died and 1% had a revision compared to 3.1% and 1.6% in the uncemented replacement group of over 120,000

Meta-analysis questions EULAR fibromyalgia advice The effectiveness of drug treatments for the management of fibromyalgia is questionable but non-pharmacological options may be the most promising, a new meta-analysis concludes. Swiss researchers concluded drugs were “of questionable linical relevance”, while there was “limited” evidence for non-pharmacological treatments. Reporting in the Annals

July - Aug 2012

of the Rheumatic Diseases, the researchers found most trials were “very small” and “hampered by low methodological quality”. Metaanalyses restricted to trials with 50 or more patients found some drugs had advantages over placebo on pain and quality of life, but in the case of SSRIs and tricyclic antidepressants (TCAs), these advantages were statistically non-significant.

NEWS UPDATE

New biomarker for liver cancer diagnosis A newly tested serum protein marker for hepatocellular carcinoma (HCC) could improve early diagnosis and better distinguish HCC from nonmalignant chronic liver diseases, say Chinese researchers. Dickkopf-1 (DKK1) â&#x20AC;&#x201C; a secretory antagonist of the WNT pathwayâ&#x20AC;&#x201C;was more diagnostically accurate across a range of scenarios than the most widely tested biomarker for HCC, alpha-Fetoprotein (AFP), a retrospective study involving nearly 1,300 articipants

found. DKK1 maintained diagnostic accuracy for patients with early-stage HCC as well as for AFP-negative disease, which was important since 30-40% of all HCC patients were AFP-negative, the investigators said. Reporting in

The Lancet Oncology, the authors wrote that raised concentrations of DKK1 in serum could differentiate HCC from both chronic hepatitis B virus (HBV) infection and liver cirrhosis, which AFP was unable to do. In all scenarios, DKK1 alone or together with AFP was better than AFP alone. â&#x20AC;&#x153;Our results indicate that serum DKK1 could potentially be used to diagnose HCC, especially early-stage disease, and will help to resolve the deficiencies of AFPnegative patients, and can be used to make differential diagnoses.

Pharmacists to Early surgery backed use iPhone ECGs for endocarditis

Pharmacists are to screen customers for undiagnosed atrial fibrillation using an iPhone ECG app and refer them on to their GPs for stroke thromboprophylaxis. A feasibility study is being launched in which 10 community pharmacists will be trained to perform a pulse palpation on customers and record the result, then assess cardiac rhythm using an iPhonebased single-lead ECG device. 14

Early surgery can be life saving in patients with infective endocarditis and large valvular vegetations, a randomised trial has shown. The trial found that patients who underwent valve repair or replacement within 48 hours of diagnosis were significantly less likely to die in hospital or develop embolic events than those treated conservatively with antibiotics. weighs into longstanding controversy over the timing of surgery in infective endocarditis uncomplicated by heart failure. Operating during active infection can be risky and technically challenging but delaying, on the other hand, can lead to systemic emboli, atrioventricular block and heart failure, the researchers said. Guidelines vary, some recommend surgery only in those with recurrent emboli and persistent. July - Aug 2012

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Interview

Dr. Ramana is a renowned laparoscopic and bariatric surgeon with extensive experience. He has performed over 25,000 laparoscopic surgeries, which includes many complex procedures.His surgical experience includes the laparoscopic and open approaches to all varieties of GI and abdominal surgery, including complex ones like removal of the pancreatic head (Whipple’s operation), the entire colon (proctocolectomy a procedure done for diseases like ulcerative colitis). “Medgate Today Spoke to Dr. B. Ramana about latest advancement in Bariatric Surgery” or over). According to a report in the August 2006 New England Journal of Medicine, excess body weight during midlife is associated with an increased risk of death. On the other hand, being too thin and having a BMI that’s below the healthy range (18.5 to 24.9) can also be a health concern. According to the USNIH definitions, a healthy weight is a BMI of 18.5-24.9; overweight is 25-29.9; and obese is 30 or higher.

How can we maintain our BMI?

Dr. B. Ramana

MS, DNB, FRCS Advanced Laparoscopic & Bariatric Surgeon Belle Vue Clinic, Kolkata

What is BMI and how important is it for our body? Well I could say that BMI means us (Bariatrics & Metabolism Initiative), a premier institution for weight loss & metabolic solutions, but universally it stands for Body Mass Index. Essentially, BMI is a simple mathematical formula, based on height and weight, which is used to measure fatness. You should be aware of your BMI because of the health risks of being overweight (that is, having a BMI of 25 16

Now that is a question on which one can write an entire book, but still be inadequate to be able to completely & truly answer it. As every person is unique so is his body & thus calling for their own unique requirements. The shortest & simplest way to explain how maintain your BMI would be to ask you to follow a sensible diet plan. Stay away from high amounts of processed food, deep fried foods, fast food, candy, pies, cookies, cakes and frozen dinners. Avoid carbs as much as possible. Eat mainly nutrient-dense foods like lean meats, fruits, vegetables, seeds, nuts, whole grains and beans. Maintain a high protein diet & regulate or adjust as per individual needs while exercising to stay fit & in shape. However all this only works well till about a certain BMI (30 arguably) after which none of it works in a longer time frame. Any amount July - Aug 2012

Interview

of exercising & diet fails to give you sustained long lasting results. While a few people are able to bring down their BMI this way, even fewer people are able to maintain it for a long period of time. The best example of this is the TV show ‘The Biggest Loser’ most of the contestants have put back most of the weight lost during the show. At this stage the above method is futile & the only scientifically proven method is Bariatric Surgery, which provides long term, quantifiable & sustainable weight loss.

What is a Bariatric Surgery , advancement in Bariatric surgery and when should go for this type of surgery? Bariatric surgery is a class of surgery includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve July - Aug 2012

gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). While Gastric Banding is losing its erstwhile p o p u l a r i t y, advancements in bariatric procedures continue. The latest addition to the list of procedures would be Gastric Plication although still termed experimental it is promising with good results shown over a short period of time in which it has been performed & observed. Long-term studies show the procedures cause significant longterm loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%. The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes. However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no comorbidities or a BMI of 30 to 35 with significant comorbidities.

Dr. B.Ramana Re-do surgeries by the minimal access method are Dr. Ramana’s forté. He has a series of more than 120 revision gall bladder and bile duct surgeries, most of which were initially done by open methods in peripheral/rural centers. He set up the bariatric department at Kolkata’s Apollo Gleneagles Hospital, following which he performed Eastern India’s first laparoscopic sleeve gastrectomy in 2006. Since then, he has been known to be sought after by patients all over the world. 17

Interview

What is the effect of bariatric surgery on and history of prior pulmonary embolism. Specific obesity-related health problems? to Bariatric Surgery the biggest side effect would Morbid obesity has been found to affect the quality of your health and the length of your life. Morbid obesity has been linked to several serious and life-threatening diseases. These comorbid conditions include type 2 diabetes, heart disease, high Cholesterol and high blood pressure, acid reflux/GERD, obstructive sleep apnea, infertility, depression, osteoarthritis, stress urinary incontinence and cancer. Most of these conditions do not develop for years. So many people living with morbid obesity may have one or more of these health issues without even realizing it. One study found that gastric bypass surgery reduced the total number of co-morbid conditions of participating patients by 96%. Many surgeons recommended bariatric surgery as a treatment option for type II diabetes. In some cases, resolution of type II diabetes occurred within days of the surgery. A meta-analysis stated that several studies found that bariatric surgery patients felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.

Brief about the merits & Side effects of Bariatric Surgery? With Bariatric surgery morbidly obese patients with several weight-related risk factors (like heart disease, high blood pressure, and type 2 diabetes) can greatly reduce their chances of premature death—by as much as 89 percent. Any major surgery involves the potential for complications—adverse events that increase risk, hospital stay, and mortality. Some complications are common to all abdominal operations, while some are specific to bariatric surgery. The overall rate of complications during & post surgery is over 20% (all complications included) & a mortality rate of 0.2%. Mortality and complications are affected by preexisting risk factors such as degree of obesity, heart disease, obstructive sleep apnea, diabetes mellitus, 18

be a leak from the newly created stomach, deep vein thormbosis, and more easily manageable ones like temporary hair fall & malnourishment. It is also perhaps affected by the experience & ability of the operating surgeon: the learning curve for laparoscopic bariatric surgery is estimated to be about 100 cases. On a lighter note spending a lot on new dresses could also be counted as a side effect.

Brief your research/testimonial/experiences? There is a very old & well somewhat clichéd story of a boy throwing dying starfishes back into the ocean one at a time from a beach washed up with several hundreds of them from a storm. And if you have read or heard of the story you would know that all though others felt that he didn’t really make a difference by saving just a few he believed that he did make a difference for that one starfish which did survive. Yes!!! It truly was & is an all-inspiring story & certainly did inspire me. While Bariatric Surgery isn’t changing the world for us all as we know it, but it certainly is changing the worlds of all who undergo it. It is quite a remarkable experience to listen to patients, on the verge of divorce, knee replacement, patients unable to conceive, unable to find a partner for marriage, or being socially rejected & made fun off due to obesity & its related problem, coming back after surgery sharing their sheer joy & elatedness for planning their second honeymoon, going for trekking, having to do family planning, or being able to have made it as an anchor & a model or being one of the coolest dudes in the campus. I am not exaggerating at all, these have really been some of the experiences shared by patients, & I rest my case along with my pen & scalpel going to bed with a sense of minor achievement, having made a difference to a few people. As for research, we are now testing different operative techniques in sleeve gastrectomy and comparing the outcomes in leaks, etc. MT July - Aug 2012

Interview

What is immunization and how does it work ? Dr. Rajiva Kumar

Child Specialist, Muzaffarpur

The schedule recommends that that the vaccinations should start when the baby is 1 1/2 months old. But what should be done if the baby is brought late for vaccinations? Should vaccination still be started? Yes, definitely. Even if the baby is brought late for vaccinations, she should still receive all the vaccinations. While it is the best to follow the ideal immunization schedule, on no account should the baby be denied vaccinations, even if she is brought late for them. But every attempt must be made to complete full immunization, before the age of 1 year.

My friendâ&#x20AC;&#x2122;s baby, who was given the B.C.G. injection about two months ago, has developed a small blister at the site of injection. Is this a cause for worry?

Please reassure your friend that there is no cause for worry. This is a normal reaction after the B.C.G. injection. About 4 to 6 weeks after B.C.G. injection a small lump called a papule appears at a of the injection which may later break, giving out a whitish discharge. This will heal in about 10 to 12 weeks after the injection has been given and will leave a scar. Only if the discharge continues without the wound drying up, should the doctor be consulted.

mmunization is a way of protecting the human body against infectious diseases through vaccination. Immunisation prepares our bodies to fight against diseases in case we come into contact with them in the future. Babies are born with some natural immunity which they get from their mother and through breast-feeding. This gradually wears off as the What are the side effects of babyâ&#x20AC;&#x2122;s own immune system starts to develop. vaccinations? Only very few infants and children develop Having your child immunized gives extra side effects after a vaccination. We have protection against illnesses which can kill.

July - Aug 2012

Interview

already discussed the side effects of the B.C.G. After the D.P.T. injection, the infant may have pain at the site of the injection and may even develop fever. In that case the baby may be given 1/2 a table or 1/2 a tsp. of paracetamol. After the measles injection, measles like rashes may appear. These are normal. Very rarely, children can have allergic reactions straight after immunization. Also if the baby develops high fever or loses consciousness, a doctor should be consulted immediately. People giving immunizations are trained to deal with allergic reactions and if the child is treated quickly, he or she will recover fully.

Sometimes it is not possible to take the baby for the second and third vaccinations after precisely a month. If so, should the whole course be repeated? No, a slight delay does not matter. Continue the vaccinations as per the schedule and complete the course as soon as possible. The child will be fully protected only after she has received 1 B.C.G. injection. 3 D.P.T. injections, 3 O.P.V. doses and 1

measles injection. Hence it is very important to take the baby for the vaccination at the correct time and to make sure that all the vaccinations are given.

How do we know that vaccines are safe? Vaccines like all other medicines under go extensive and rigorous tests regarding their safety. Only after the have been found to be safe that they are introduced for general vaccination programs. Each vaccine is continually checked even after it has been introduced and action is taken if it is needed. If a vaccine is not safe it is not used. IDEAL IMMUNIZATION SCHEDULE FOR THE INFANTS If the infant has been delivered in a hospital/clinic, she should be given the B.C.G. injection at birth. Even if you are late for an injection/dose, you must still get it. Consult your health worker regarding this. AGE

Birth 6 weeks 10 weeks 14 weeks 9 months 1 year 15 months 16 months 18 months 2 years 2 years 1 month 2 years 7 months 5 years 10 years VACCINE

Birth BCG OPV Hepatitis B DTP Hib Measles MMR Typhoid Td PCV Varicella Hepatitis A HPV Rotavirus July - Aug 2012

VACCINES

BCG, OPV, Hepatitis B DTP, OPV+IPV, Hepatitis B, Hib, PCV DTP, OPV+IPV, Hib, PCV DTP, OPV+IPV, Hepatitis B, Hib, PCV Measles Varicella (Chicken pox) MMR, PCV Booster Hib Booster DTP Booster, OPV+IPV Booster Typhoid (Repeat after 3 years) Hepatitis A Hepatitis A DTP Booster, OPV Booster, Typhoid Tdap, HPV

DISEASE(S)

BCG, OPV, Hepatitis B Tuberculosis (Bacillus Calmette Guerin) Oral Polio Vaccine Hepatitis B Diphtheria, Tetanus, Pertussis Pneumonia, Meningitis, Bacteremia (Haemophilus Influenzae Type B) Measles Measles, Mumps, Rubella (May be Rgpeated after two month of the first does) Typhoid Tetanus Bacterial diseases causing pneumonia, meningitis etc., (Pneumococcal Conjugate Vaccine) Chicken Pox Hepatitis A Human Papilloma Virus causing cervical cancer Rotavirus 21

COVER STORY

World Hepatitis Day, 28 July Since 1986, a hepatitis B vaccine has been available and should be given to newborns and children in the United States. The vaccine, however, is unavailableâ&#x20AC;&#x201D;or has only recently become availableâ&#x20AC;&#x201D;in many parts of the world. You are at higher risk for hepatitis B if you or your mother was born in a region of the world where hepatitis B is common, meaning 2 percent or more of the population is chronically infected with the hepatitis B virus. In most Asian and Pacific Island nations, 8 to 16 percent of the population is chronically infected 22

July - Aug 2012

COVER STORY

epatitis B is a liver disease spread through contact with blood, semen, or other body fluids from a person infected with the hepatitis B virus. The disease is most commonly spread from an infected mother to her infant at birth. Hepatitis B is also spread through sex, woundto-wound contact, and contact with items that may have blood on them, such as shaving razors, toothbrushes, syringes, and tattoo and body piercing needles. Hepatitis B is not spread through casual contact such as shaking hands or hugging; nor is it spread by sharing food or beverages, by sneezing and coughing, or through breastfeeding. Hepatitis B may start as a brief, flulike illness. Most healthy adults and children older than 5 completely recover after the body’s immune system get rid of the virus. Hepatitis B becomes chronic when the body’s immune system can’t get rid of the virus. Over time, having the virus can lead to inflammation of the liver; scar tissue in the liver, called cirrhosis; or liver cancer. Inflammation is the painful red swelling that result when tissues of the body become

Hepatitis A

Hepatitis B is called a “silent killer” because many people have no symptoms, so the disease often progresses unnoticed for years. Unfortunately, many people first learn they have chronic hepatitis B when they develop symptoms of severe liver damage, which include zzyellowish eyes and skin, called jaundice

swollen stomach or ankles zztiredness zznausea zzweakness zzloss of appetite zzweight loss zzspiderlike blood vessels, called spider angiomas, that develop on the skin A health care provider can test your blood to see if you are currently infected or were infected in the past. If you test positive, your doctor may measure virus and liver enzyme levels in your blood to determine if the virus is active or causing liver injury. The doctor may use ultrasound—a procedure that

Hepatitis B

Hepatitis C

infected. Young children and people with weakened immune systems are especially at risk. People who were infected as infants have a 90 percent chance of developing chronic hepatitis B.

Symptoms:

1.4 million estimated 2 billion people

cases of hepatitis A occur annually. July - Aug 2012

(estimated) worldwide have been infected with the virus.

zz a

130 million people

at least are chronically infected with hepatitis C virus. 23

COVER STORY

uses sound waves to create images of the body’s internal tissues and organs—to screen for liver cancer, also called hepatocellular carcinoma. You may not need treatment right away, but you will need periodic tests to monitor the health of your liver. Encourage your family members and other close personal contacts to get tested. Hepatitis B is preventable. Get vaccinated if you have not been infected. The hepatitis B vaccine is given in three shots over 6 months. You must get all three shots to be fully protected. The vaccine is safe for people of all ages, including pregnant women and infants. If you think you have been recently exposed to the hepatitis B virus, see your doctor right away. The first dose of hepatitis B vaccine combined with hepatitis B immune globulin—an injection of antibodies that temporarily protects against hepatitis B infection—may prevent infection.

No cure exists for hepatitis B, but several medicines are approved for treating chronic hepatitis B. The goal of treatment is to reduce the risk of liver damage, liver cirrhosis, and liver cancer by decreasing liver inflammation and the amount of virus in the body. Current medicines do not completely get rid of the virus, so treatment is often lifelong. People with chronic hepatitis B should avoid alcohol, drugs, supplements, and herbal medicines that may harm the liver.

Prevention All infants should receive the hepatitis B vaccine: this is the mainstay of hepatitis B prevention. The vaccine can be given as either three or four separate doses, as part of existing routine immunization schedules. In areas where mother-to-infant spread of HBV is common, the first dose of vaccine should be given as soon as possible after birth (i.e. within 24 hours).

The first official WHO World Hepatitis Day is marked to increase the awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as: strengthening prevention, screening and control of viral hepatitis and its related diseases; increasing hepatitis B vaccine coverage and integration into national immunization programmes; and coordinating a global response to hepatitis. 24

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. After age 40, protection following the primary vaccination series drops below 90%. At 60 years old, protective antibody levels are achieved in only 65 to 75% of those vaccinated. Protection lasts at least 20 years and should be lifelong. All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including: zzpersons with high-risk sexual behaviour; zzpartners and household contacts of HBV infected persons; zzinjecting drug users; zzpersons who frequently require blood or blood products; zzrecipients of solid organ transplantation; zzthose at occupational risk of HBV infection, including health care workers; and zzinternational travellers to countries with high rates of HBV. The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children. July - Aug 2012

EXPERT VIEWS

Ask a Question from Healthcare Industry Expert “Medgate Today, introduce a Special Section: Ask a Question from industry expert in Hospital & Healthcare Planning, Operations, Management, Quality, Medical Education, Medico Legal & Materials Management”.

UR EXPERT : DR. PRADEEP BHARDWAJ, CEO & Executive Director, Six Sigma Healthcare Limited, Delhi will answer your questions through his expertise knowledge & experience in Hospital & Healthcare Management. He is an expertise Healthcare Planning, Management, Medico Legal Consultant, Author’s and Visiting Professor & Faculty in leading Healthcare Management Colleges / Universities like Harvard, IIM – Lucknow, IIM-A, ISB – Hyderabad, Amity University, Symbiosis International University, AIIMS, National Board of Examinations etc. He is also Board of Advisory in many healthcare organizations / management institutes / universities. . Dr. Bhardwaj is renowned hospital and healthcare management expert, recipient of many prestigious awards like Rajiv Gandhi Award -2010, Best Medico Legal Expert – IBN 7 26

Dr. Pradeep Bhardwaj CEO, Six Sigma Health Care

Q. I’m a Neuro Sureon from Rajasthan. I want to change my field from Neuro Surgery to Hospital Administration. I have taken admission in MHA and doing project on Hospital Administration. What is the scope of this course and how I can add value in my profession of hospital administration? Is there is any book on this topic ?

Dr. Gupta, Neuro Surgeon, Rajasthan

ospital administration is one of the most competitive and challenging career you can embark on and one of the most rewarding . The hospital administrator plays a vital a role in saving lives, without having to take scalpel in hand. Hospital administrator are in great demand, In fact, they are the most sought professionals in healthcare sector today. Hospitals are becoming a highly scientific and complex medical center and are becoming hub of whole system of healthcare. Medical sector becoming increasingly competitive and capital intensive the need for managing hospitals has become even more acute. In today’s, world of advancing technology healthcare delivery represents an extremely complex collection of diagnostic, operational and administrative processes. Management skills in Planning, Operation, Marketing, Materials, Telemedicine, HIS and Human Resource Management are the need of the hour. Today, we have about 3.5 lakh health institution in India (Large, medium, small). Our health system is unique as compared to other countries - there July - Aug 2012

EXPERT NEWS VIEWS UPDATE are Government, Private, Religious, Industrials, MNC’s, Allopathic, Ayurveda, Homeopathy, Para medicals & Nature cure hospitals and institutions. There are newer diseases, newer diagnostic technology etc. All these factors will required trained hospital administrators. So , we are on the road to professionalise health care services. Therefore, this is the right and exciting time to ensure an international future in the world’s largest and fastest growing hospital & healthcare industry. Be a healthcare professional with a sharp Managerial & Administrative prospective. You are advised to obtain some more qualifications in Medico Legal Management or Materials Management. The combination of this qualification with MHA will add value to your career in hospital Administration. You can also read a book : Opportunities in Hospital Administration, Published by Jaypee Brother Medical Publisher, Delhi.

Q. What Are New Obligations In Medical Practices ?

Dr. V.P Singh, Ahmedabad, Gujrat

Expert View : The Following New Obligation is applicable in medicine practices • Maintaining records as per format for three years. • Giving copy of records within 72 hours if demanded by patient or their agent. • Format of certificate states that it shall bear signature/thumb impression and two identification marks of patient. • Write generic name of a drug. • CME for 30 hours per 5 years. • Display charges in waiting room. • Display registration no. On letter heads/sign boards/waiting room. • Signs board not to be very large. • Sign Board Not to display away from clinic and residence.

You can mail your query at editor@medgatetoday.com

July - Aug 2012

PRODUCT LINE

SCIENTECH TECHNOLOGIES LAUNCHES NEW FETAL

MATERNAL MONITOR â&#x20AC;&#x201C; SCIENTECH 17B

Contact:

Mr. Chaitanya Dev Singh Sisodiya Scientech Technologies Pvt. Ltd., 94, Electronic Complex, Pardesipura, Indore â&#x20AC;&#x201C; 452010, INDIA Cell No. : +91-7389910103 Tel : 0731-4211100 Fax : 0731 2555643 Email : info@scientech.bz Website : www.ScientechWorld.com

Doctors do not use their hands alone in order to save lives. They need the help and assistance of medical equipment in order to cure an ailment and to put a person back to his or her healthy state. Scientech 17B Fetal Maternal Monitor is used by doctors for tracking how well the growing fetus is within the contracting uterus and for detecting signs of fetal heart distress. Scientech 17B is equipped with ultrasound and TOCO transducers, pregnant woman event marker, SPO2 Sensor and a cuff for NonInvasive Blood Pressure (NIBP). The increasing number of high-risk pregnancies is placing greater demands on hospitals and obstetrical clinicians worldwide and it is of interest and importance to those who deliver obstetrical care to know how the latest technologies are helping to address these new challenges and demands. Fetal monitoring is the standard of care in most modern labor and delivery care settings. Scientech 17 B is a new generation of fetal monitors can provide noninvasive monitoring in one device and offer July - Aug 2012

PRODUCT LINE solutions for patients’ desire for ambulation as well as caregivers’ needs to be away from the bedside during labor. Waterproof cordless transducers that allow the use of a Jacuzzi or bathtub or shower for relaxation and also pain relief during labor or for the option of a water birth. An advanced DSP technology assures fast, accurate reading and reliability. There is no cable inter twisting as 3 in 1 transducers. Fetal monitoring is performed by attaching external transducers to the mother’s abdomen with elastic straps. A high sensitive multi crystals ultrasound transducer uses 1 MHz Doppler pulsed wave to detect fetal heart motions and the information is sent to the fetal monitor that calculates and records the fetal heart rate on a continuous strip of paper. Scientech 17 B comes with 7” LCD screen with 90 degree folding which is also capable of monitoring the twins (optional). Inbuilt high resolution long

July - Aug 2012

life thermal printer prints all the parameters and graph readings. It is easy to use, space saving and light weight. It also has in build lithium ion battery. One can also connect it to the central monitoring system which is an optional feature. Scientech Medicare, a Scientech Group Company is a renowned provider of medical equipments. Our world class products provide user a high degree of quality & reliability. Scientech Medicare offer comprehensive range of medical instruments and technical support. Leveraging the heritage and domain expertise of Scientech, the products encompass a board technology spectrum and high customer satisfaction across the globe. Scientech Medicare policy is not just offering customers with products but also in providing them with prompt technical support. Scientech has 16 branch offices in India & their products are exported to over 52 countries.

BEAUTY & COSMETICS

Beauty Tips from

Shahnaz Husain

in the sun, apply a sunscreen lotion sparingly under the eyes. Add a drop of water to it before applying, to give a lighter coverage.

Shahnaz Husain (Beauty Expert)

I have dry skin. Tell me about sunscreen and moisturiser. I am tall and thin, with short hair and oval face. What kind of hairstyle and dress will suit me?

I have dark skin on face and neck, but body is fair. Suggest easy home remedies. I have oily skin.

Use a facial scrub twice a week. Buy a facial scrub, or you can mix rice powder with curd and use as a facial scrub. Apply on the face and rub gently on the skin using small circular movements. Leave on for 5 minutes and then wash off with water. Do not apply on pimples, acne or rash. Mix one teaspoon each of rose water and lemon juice and apply daily on the face, at any time. Wash off after 20 minutes. Twice a week, mix 3 teaspoons oats with egg white and one teaspoon each of curd and lemon juice. Apply on the face, avoiding the lips and area around eyes. Wash it off after half an hour.

I have dark circles around my eyes. Please suggest me home treatments.

Dark circles under eyes can occur due to hereditary factors, nutritional deficiencies, stress, inadequate sleep, sun-sensitivity, etc. So, check these aspects. Daily apply pure almond oil sparingly under eyes and massage it lightly on the skin, using only the ring finger, for one minute under each eye. Massage in one direction only. Leave on for 15 minutes and wipe off gently with moist cotton wool. You can also mix cucumber juice and potato juice in equal quantities. Apply under eyes daily for 20 minutes. Wash off with water. Before going out

Most sunscreen lotions are also moisturises. Some natural ingredients help to moisturize the skin, like honey and aloe vera juice or gel. You can apply one of these daily and leave on for 15 minutes. Wash off with plain water. Most hair styles suit oval faces. Short hair can have width at the sides. Try a side swept fringe. Those who are slim and tall can carry off most styles and clothes. You can wear bold prints, striking contrasts and heavy jewelry. Thin people look nice in crisp cottons, high necklines, collars and even frills. Avoid tight clothes and limp fabrics. Clothes with detail, like a touch of lace, gathers, pleats and so on will suit.

I want to grow my nails, but they break easily. Please advise. A4. Diet is very important for strong nails. Include adequate protein and calcium in your diet. Take skimmed milk, yogurt, cottage cheese, leafy green vegetables, fish and sprouts. Follow a ten-day programme of taking gelatin. Dissolve one teaspoon gelatin in a little boiling water. Cool the water and add it to fruit juice. Have this daily for ten days. While filing nails, file in one direction only, not back and forth. Apply warm almond oil daily on the nails and massage it on nails with your thumb, using a circular movement. Any question you may have mail us:

editor@medgatetoday.com July - Aug 2012

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HEALTH & FITNESS

Efforts

The food you eat reflects your beliefs about yourself, your spiritual being, the people important to you, and the world. You can change your diet to communicate your wish for a healthier self and society. 36

July - Aug 2012

HEALTH & FITNESS

to to lose lose weight weight N

owadays there are plenty of quick fix solutions available in the form of pills, diets, and equipment that claim to show you how to lose weight fast and easy, without much effort. However, many of these so called miracle weight loss plans are not really a viable option as they have not been scientifically proven. One of the first steps in trying to figure out how to lose weight and keep it off as well is to calculate oneâ&#x20AC;&#x2122;s BMR or basal metabolic rate which is the number of calories an individual requires to maintain basic bodily functions such as digestion and breathing. The BMR of an individual is the minimum number of calories that the individual requires for their body to function on a daily basis. Therefore in order to know how to lose weight naturally one should also factor in daily physical activity levels as exercises causes a rise in BMR. Once you have gone through the basics of how to lose weight, you should try to maintain a log of your daily food intake. You can use a food diary to record your meals along with their calorific values as this will help to ensure that your calorie intake does not exceed your requirements. Sometimes people want to known how to lose weight in a week because they may have a beach vacation or a high school reunion coming up and they want to look their best. It is important to understand that losing resources of fat from your body may take longer depending on your weight loss goals and your physical fitness levels. In order to lose weight quickly, one can go on a low calorie but nutritious diet plan along with a revised exercise schedule. Drinking plenty of water will also aid weight loss as it helps to prevent water retention in the body. If you have just one July - Aug 2012

week to lose weight, make sure that you have realistic expectations. If you want to learn how to lose weight in 2 weeks, keep in mind that you cannot follow a very restrictive diet plan or you may start to experience nausea, giddiness, and fatigue. Also, if your goal is too ambitious and is not practical then you may get disheartened and give up quickly. Additionally the target should also have a time limit which should be ideally decided beforehand. One of the simplest tips on how to lose weight is to reduce snacking. This means that you should try to eat only the three main meals of the day which are breakfast, lunch and dinner and try and avoid snacking in between. Since it may not be very easy to follow this type of a diet plan, you can have a fresh unsweetened fruit juice or a small fruit platter instead of your usual snacks. However before going on any such diet which will help one in reducing weight at a quick rate one should always consult

HEALTH & FITNESS

their doctor or medical practitioner as everyone has different metabolic rates and the calorie requirement of every individual will also be different. On an average it has been observed that reducing 500 calories on a daily basis from one’s diet will help the individual to lose almost a pound of fat per week. As part of knowing how to lose weight fast, one should also try to seek alternatives for the foods that have a high fat content and instead choose foods such as lean meats like fish and chicken which are both known to be low in fat. Additionally certain fish like tuna, sardines, and salmon are also know to be highly rich in omega 3 fatty acids and antioxidants that help in the smooth functioning of the body. It order to lose weight fast and naturally one should also try and have several small meals during the day rather than just three large meals as this tends to help in steadying the metabolism of the individual . However the frequent meals should not include snacking on calorie rich foods and should instead include plenty of fresh fruits and vegetable which are rich in vitamins and fiber. Fiber is an essential part of any weight loss diet as it tends to keep a person feeling satiated for longer periods of time. Another important tip as to how to lose weight fast naturally is to increase one’s consumption of water. This is because if the person is dehydrated the body tends to retain water. In fact, one should also have a glass of water before their meal as it is known to aid digestion. Along with a diet there are also several exercises to lose weight that one may also take up such as low impact aerobic activities like cycling, brisk walking, and swimming which

are known to not only help in burning c a l o r i e s but also keep the heart healthy. Swimming is also a great exercise for those individuals who are severely overweight or suffer from joint problems. One should develop and follow an exercise regimen that will allow them to at least get 30 – 40 minutes of aerobic exercise for a minimum of four days in a week. Similarly in addition to aerobic training one should also take up weight training or resistance training as this helps in building of muscles and also in raising one’s metabolism. In order to lose weigh fast and naturally one should also allow the body to get an adequate amount of rest and one should not work the same group of muscles everyday. Similarly one should get an adequate amount of sleep as well as it has been observed that insufficient sleep is known to adversely affect one’s ability to lose fat. One of the key elements of knowing how to lose weight fast is to be disciplined and consistent. Once the individual has reached their target weight they should also form and follow a way of life that is healthy for them so as to ensure that they don’t regain weight by reverting to their old unhealthy eating habits and lifestyle. July - Aug 2012

“MEDTEX1”

EYE CARE

Update on Femtosecond Laser Refractive Surgery.

T Dr.Sharad Lakhotia, M.S.(OPHTH) Lakhotia Eye Centre and Laser Institute

However all femtosecond refractive procedure are also available. Femtosecond laser has been used successfully in intrastormal astigmatic incision and presbyopia correction. Newer role of femtosecond cataract surgery is the most recent advancement in technology. More & more usage of femtosecond laser are expected in glaucoma, retina & cornea surgery. 40

he growing role of femtosecond laser in refractive surgery is undisputable. The most common and important role of Femtosecond laser in corneal refractive surgery is in making corneal flaps. Femtosecond is an ultrafast laser generating pulses as short as one quadrillionth of a second (10-15). The world Femto came from Danish word for number 15.

Introduction:- Femtosecond laser were first

in limelight when bladeless flap creation in lasik was achieved by Intralase Femtosecond laser in USA. Why Bladeless Flap is Better:-Corneal flap created by femtosecond laser is better than microkerotome for the following reasons as seen in literature----

It shows better contrast sensitivity. zzThere

is increased safety in comparison to flap related complication of microkerotome. zzFaster unaided visual acuity post operatively. zzThere is less induced aberration because of smooth flap. zz There is less IOP variation during making of flap. zzThere is lesser incidence of dry eyes following lasik. This is probably because femtosecond laser makes a thin flap with uniform geometry with greater predictability. This is clearly evident in optical coherence tomography, which reveals a very uniform flap.

Technology:- All femtosecond lasers use

a wave length of approximately 1053nm. The main technical specifications are (i)Laser pulse repetition rate (ii) Spot size (iii)Pulse pattern. July - Aug 2012

EYE CARE

Femtosecond laser produce photo disruption & optical break down. This creates plasma and a cavitation bubble is formed, which produces tissue cleavage. A shorter pulse (200-500fs) requires lower energy than longer pulse (500-1300fs) to reach threshold of photo disruption. The diameter & volume of laser spot is guided by numerical aperture of the lens. Higher numerical aperture use lower energy and increase depth & accuracy of lamellar cut. If high energy photo disruption is used, the pulse need not be placed closed together as the bubble is large to produce tissue cleavage. However if Low energy disruption is used than a greater number of pulse are placed in an overlapping pattern as the very small bubble does not induce tissue cleaving. Thus an ideal device should have small spot size, a high repetition rate and low energy per pulse. July - Aug 2012

Two main patterns are raster and spiral. In raster pattern pulse are applied in a liner pattern starting from the hinge & ending to the opposite edge. In spiral pattern, pulse begin centrally & proceed centrifugally . A centripetal approach is also available. Most devices use a raster pattern which ensures smooth stromal bed eg. intralase machine (AMO). However Visumax (Carlzeiss, Meditec AG, Jena Germany) relies on spiral pattern. There is a difference in suction ring & docking system amongst different machines. The devices which applanate the cornea induce higher pressure as is seen in intralase (AMO), Wavelight Ultraflap and LDV (Zeiss Ophthalmic systems, Switzerland). Curved applanation docking surface induce lower pressure as seen in visumax & femtec (Technolas perfect vision,Germany) lasers. The Visumax & Technolas laser used curved docking system, thus inducing lower pressure.Visumax, in addition, uses limbal suction mechanism instead of conjunctival suction mechanism.It has 500- kHz pulse and lower energy profile. It can thus also be used in femtosecond only refractive procedures like FLEx ( femtosecond lenticular extraction) and SMILE (small incision lenticular extraction). Because the patient retain vision during the procedure, they actively co-operate throughout the procedure. 41

EYE CARE

pressure, lower energy & faster repetition rate of pulses.Prior to Excimer laser treatment, density of OBL can be lessened by gently scraping the surface with a spatula. Interface haze:- When very thin flaps of less than 100 microns are made, there can be interface haze as a possible complication. Dense Interface haze:- Photophobia and mild pain can appear days after surgery & may persists for weeks. This is transient light sensitivity syndrome which was common in earlier versions because of high raster energy & lower numerical aperture optics . Another problem of earlier versions is rainbow glare.It is because of light scattering from perfect array of laser spots on the back surface of corneal flap. Itâ&#x20AC;&#x2122;s visual impact is not seen much in most cases.

Astigmatism Correction :The LDV from Ziemer is small & portable femtosecond laser. It has very high pulse rate and low energy , causes very less bubble formation and ensures a smooth corneal bed. It has no vertical side cuts, so the flap making is similar to microkeratome with tapered flap edge. Because of tapered edge, the flap can be irregular if air is present. During application of pulse,the procedure is not visible and also an interface fluid is needed, which are some of its limitations. It can also perform intrastormal ring channels & lamellar keratoplasty. Femtec laser works similar to intralase in terms of pulse & energy. However it has a curve applanation docking system which induces less pressure. Correction of Presbyopia by Intracor is studied on this machine.

Complication:Opaque Bubble layer:- During cutting by femtosecond laser some bubble escape into deeper stroma forming opaque bubble layer. They may take few hours to disappear and may also impair Eye â&#x20AC;&#x201C;tracking . It is less common in softer applanation devices which induces less 42

In high degree of astigmatism as in post keretoplasty and also in high naturally occurring astigmatism, femtosecond laser astigmatic keretotomy is effective . In post keretoplasty astigmatism ,its safe and more accurate than manual technique .Femtosecond laser can also create intrastromal- only astigmatic incisions which are safe and stable but may not be very effective. The technology for astigmatism is still evolving.

Presbyopia Correction:Intracor procedure increases depth of focus to combat presbyopia. Non invasive intralenticular femtosecond laser pulse can restore some accommodation in crystalline lens by increasing flexibility and sliding of lens fibres. The main fear to this approach is formaton of cataract and reduction in best corrected visual acuity. Studies shows development of pin point opacities at the site of laser interaction but there is no progressive cataract formation. The main positive feature of this technique is minimal invasiveness, negligible infection rate & possibility of performing a refractive lens exchange surgery, if it fails. July - Aug 2012

Covidien Healthcare India Pvt Ltd 10Th Floor. Building No.9B Dlf Cyber City Phase Iii, Gurgaon, Haryana 122002

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DENTAL HYGIENE

Get Rid of from

Plaque Attack

Plaque is the major culprit for gum disease, which later on can lead to a severe phase when permanent tooth loss might set it, and then even heart compilations can occur. Dental plaque is extremely dangerous and no one wants it on their teeth. You are going to the dentist once or twice per year for professional cleaning, but there are people who develop plaque extremely quickly. 46

July - Aug 2012

DENTAL HYGIENE

laque is the major culprit for gum disease, which later on can lead to a severe phase when permanent tooth loss might set it, and then even heart compilations can occur. Just follow the list below in order to find out which are the strongest plaque destroyers out there:

Use a good toothpaste – and make sure

to use it every day, twice! Certain toothpastes contain abrasive ingredients which can help scrubbing away plaque deposits from the teeth.

Use the dental floss –

plaque is not sticking only on the back or front side of your teeth, but plaque forms easily in between the teeth. Make sure to use the floss after brushing your teeth, in order to eliminate the harmful formations.

Plaque fighting with Xylitol – this is a

natural, antibacterial sugar – alcohol sweetener, and it is a common ingredient in chewing gum or sometimes in oral mouthwash. Xylitol helps fighting fiercely against plaque, so do not underestimate the power of the ingredient.

Your saliva –

your teeth are extremely protected by saliva. People with bad breath complications for instance, are most probably struggling with a dry mouth. Therefore, you need to produce the right amount of saliva to protect your teeth and mouth tissue. Drink plenty of water, chew on a sugarless gum, or try a slice of lemon now and then.

Innovations: plaque disclosing products. These are some special tablets, which will basically color that part of your teeth where the plaque is. This way, you can always check out which are the problematic areas in your mouth, and you will be able to insist on removing harmful plaque from there. Using a toothbrush with sonic vibrations – you can dispose of your old

manual toothbrush, if you want to be able to remove plaque in the most efficient manner. These sonic toothbrushes or plaque sonic cleaners are products that can be procured easily and they are very efficient.

MEDGATE TODAY JOINED HANDS WITH

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July - Aug 2012

DENTAL HYGIENE

Dental Cancer

connections with Gum Diseases

cientists have recently discovered that gum disease can increase the risk for certain cancers such as head and neck cancers, where the main culprit is the HPV (Human Papilloma Virus). This is why the British Dental Health Foundation is now trying to raise the awareness of the general public upon the importance of good oral health and hygiene.

According to the study, the patients who struggle with HPV do present a much lower bone density than healthy patients. Bone los is one of the leading causes of severe gum disease. Currently, about 6,000 patients in the UK are struggling with oral cancer, and abut 2,000 of patients lose the battle with the disease on an annual basis. In the last ten years, studies showed that

the leading cause of oral cancer is smoking. However, now scientists can say that the HPV can actually become the no.1 culprit in oral cancer development. Researchers still need to do more in depth studies in order to be able to pinpoint the exact link between the increased risk of HPV related oral cancers and severe gum disease. Cancer and very poor oral health have been linked in the past too, but now it seems there is even more evidence popping out to sustain the matter. Good oral health is of primordial importance, and according to another recent Swedish study people who fail to brush properly their teeth might increase their chance of death from cancers. The researchers have brought to light that there is a clear link between the high level of plaque on the teeth and cancer deaths. A patient can reduce his life expectancy even by 12 to 13 years, which is a huge gap. Therefore, paying a lot of attention to oral health habits is the most important.

Gum disease is an entirely preventable condition. If your gums are bleeding, if your gums get easily inflamed, these can be clear signs of periodontal disease. Talk to your dentist about all these premature signs, and get the treatment that you need in time, before gum bleeding turns into serious gum disease.

July - Aug 2012

Expert Views

Hospital facilities are improving with Hygienic privacy care. Mr. Vishal Saraf (Technical Director)

Window Techs India Pvt. Ltd.

ospital infections are one of the leading causes of death, in today’s world healthcare facilities are awaking with different kinds of infections carried in infected textile. Hospital Administrator and MS are aware for the hygienic care in the hospitals. Patient privacy curtains take an important role to prevent infection in healthcare facilities. There is a necessity and expectation for a wide range of textile products finished with Antimicrobial /Anti-fungal and flame retardant properties, says Mr. Vishal Saraf (Technical Director) Window Techs India Pvt. Ltd. What are the most important features of hospital privacy curtains? The most important feature of good hospital privacy curtains is that they are well constructed and the fabric used is effective as a privacy barrier. Ideally a hospital privacy curtain should be 8 or 12 ounce fabric that is also inherently fire retardant.

range of solid and subtly patterned colors and they are ideal for any type of medical facility. The antibacterial component is applied to the curtains to help to minimize and reduce the growth of fungi, molds and mildew that can develop in any type of an indoor environment. In addition antibacterial treatment of hospital privacy curtains can help control the growth of MRSA, which is a very virulent and treatment resistant form of staph infection. Since this is a huge concern in medical settings, antimicrobial curtains are strongly recommended. Antimicrobial fabrics offer many of the same benefits as the antibacterial fabrics. This fabric, when used as hospital privacy curtains, resists mold, mildew and bacteria growth but it also has stain and odor release properties that make them durable and long lasting. Generally the antimicrobial fabrics tend to be 8 ounce fabric, which is highly practical for larger cubicle areas.

What are bioactive hospital privacy curtains? Bioactive hospital privacy curtains are made from a fabric containing Trevira CS Bioactive What are antibacterial and fibers. These fibers are naturally antimicrobial fabrics? flame retardant, which makes Antibacterial fabrics are them ideally suited for most typically the heavier, 12 ounce fire safety regulations and fabrics. They come in a wide protocols. In addition the fibers 50

make the curtains antibacterial as well, keeping mold, mildew and bacterial growth problems in check. Perhaps the biggest advantage to Bioactive hospital privacy curtains is that the features of the curtains, the flame retardant and antibacterial properties, are right in the fabric itself meaning that they will last the entire life of the curtain. These fabrics are also remarkable in that they have been certified to be non-allergenic and to not cause any skin reaction to contact with the fabric. Since many people are highly sensitive to fabrics and fabric treatments, this is a very important consideration for doctors and medical facility managers. Like all hospital privacy curtains the Bioactive line comes in over 40 different colors and patterns, all designed to provide a restful and attractive privacy curtain in any medical facility or patient examination room. Properties of Trevira CS Bio Active: • Permanent antimicrobial and flame retardant effects • Contributes to the reduction of transferring bacteria • Increasing/improvement of hygienic standards • Effectiveness even after 100 washes • Oekotex 100 certified July - Aug 2012

EXPERT VIEWS

OCT: The Optical Ultrasound… A

Mohd. Ameel

(Head, Biomedical Engineer)

Era’s Lucknow Medical College & Hospital

lthough, ‘Optical Coherence Tomography’ does not employs any sort of sound energy, rather it uses a near infrared light, but still it is referred to as ‘optical ultrasound’ or ‘intravascular ultrasound’ or even sometimes as ‘ultrasound biomicroscopy of the eye’. Optical coherence tomography (OCT), is a rapidly emerging technology for high-resolution medical imaging. OCT is analogous to ultrasound, measuring the back-reflection of infrared light rather than sound. Optical Coherence Tomography is a technological advancement used for assessment and evaluation of integrity of anterior segment of eye, layers of retina and optic nerve, with precision. It helps in early diagnosis of the diseases with accuracy and so in management and follow up evaluation. As of today, this is the most important and desired tool for research work in the field of retinal and optic nerve diseases. July - Aug 2012

EXPERT VIEWS

Understanding the literal meaning of ‘Optical Coherence Tomography’, the word optical refers to eye and coherence is the property of light of being in logical, orderly, and aesthetically consistent relationship. Whereas, the term tomography has been derived from the Greek word ‘tomos’, meaning ‘slice’. Hence, tomography is the process of viewing an image in form slices or cross sectional view. Constructing a tomographic image initiates by measurement of distance within the material or tissue. It is done so by measuring the echo time delay and intensity of backscattered or back reflected light. It can be a double dimensional or triple dimensional data set that represent differences in optical backscattering or back reflection in a cross sectional or volume (for two dimensional and three dimensional, respectively) in the form of an image. The main reason for high resolution is the use of light rather than sound or radio frequency. When light is directed on the tissue, a small portion of it is reflected from the sub-surface and is collected. The remaining scattered light which has lost its original direction does not contribute in forming the image, rather it glares. The scattered light is filtered using

July - Aug 2012

the ‘OCT’ technique and the glare is removed resulting in a high resolution image. Optical Coherence Tomography, forms sub-surface images of translucent and opaque materials at almost the resolution of a lowpower microscope. However, OCT stands out in the medical community as it provides tissue morphology at much higher resolution than Magnetic Resonance Imaging (MRI) or ultrasound. Moreover, it gives direct imaging of tissue morphology with no ionizing radiations and any preparation time. While buying an Optical Coherence Tomography system a few features should definitely be incorporated, that include ‘Retinal Nerve Fiber Layer (RNFL) analyses, detailed study of deeper layer of retina, corneal thickness measurement and optic nerve head evaluation. Although, an Optical Coherence Tomography system is a hefty investment for a small organization of about Indian National Rupees Thirty Lakhs, but it proves to be a useful tool for optical diagnostics and research purposes. Since Optical Coherence Tomography has better resolution and penetration than the conventional ultrasound and is safer as compared to ‘Magnetic Resonance Imaging (MRI)’, ‘Computed Tomography (CT Scan)’ and ‘Positron Emission Tomography (PET)’, it is likely to replace these techniques in other fields of biomedical and non-medical. As per now, it is the most desired research and diagnostic tool in the field of Ophthalmology. Although, Ultrasound has its flag high in its forte, comparing ultrasound to OCT in its own field also has some advantages. Like, OCT does performs for transparent images as it works on light and ultrasound can work with its sound echo technique. Moreover, OCT gives diminished images for retinal and subretinal hemorrhages. Above that, OCT has not shown good results for pupil diameter below 4 millimeter. Hence, conventional ultrasound is in vogue yet. 53

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July - Aug 2012

“SOUTH-EAST ASIA’S LARGEST MEDICAL SHOWCASE!”

The international exhibition on Thailand’s healthcare services and public healthcare.

The International Exhibition on Medical, Hospital, Diagnostic, Pharmaceutical & Rehabilitation Technology and Equipment.

Hosted by:

The Medical Council of Thailand

Endorsed & Supported by:

The Ministry of Public & Health

The Society of Plastic & Reconstructive Surgeons of Thailand

Organized By:

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Singapore Industrial Automation Association

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Fireworks Media (Thailand) Co., Ltd.

Contact Us : Fireworks Media (Thailand) Co., Ltd. | tel: (+66) 2513-1418 | fax: (+66) 2513-1419 | e-mail: thai@asiafireworks.com | website: www.asiafireworks.com

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EXHIBITOR PROFILE

27 February – 1 March 2013 • Singapore EXPO Convention & Exhibition Centre

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SUPPORTING ORGANISATIONS All India Occupational Therapists Association • Asia-Pacific Development Center on Disability • Hong Kong College of Physiotherapy • Hong Kong Physiotherapy Association • Indonesian Occupational Therapy Association • Macau Occupational Therapists Association • Macau Physical Therapists Association • Malaysian Confederation of the Disabled • Malaysian Physiotherapy Association • National Federation of Associations of Physical Therapists, Taiwan (ROC) • New Zealand Association of Occupational Therapists • Occupational Therapist Association of Thailand • Physical Therapy Association of ROC (Taiwan) • Physical Therapy Research Foundation, Pakistan • Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) • Rehabilitation International (International Commission on Technology and Accessibility) • Singapore Association of Occupational Therapists • Singapore Physiotherapy Association

HIMSS AsiaPac12 will link people

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lINKING PeoPle, Potential and Progress

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Opening address by Guest-of-Honour Mr GAN Kim Yong Minister for Health, Republic of Singapore

Opening Keynote by Dr Blackford MIDDletON Corporate Director, Clinical Informatics Research & Development, Partners HealthCare System, Harvard Medical School, Brigham & Women’s Hospital

closing Keynote by Dr charles sAWYer MD, FACP Associate Chief Health Information Officer Geisinger Health System

transforming healthcare through IT ™

RNI No. DELENG/2010/33833