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Volume III || Issue V || Jan-Feb 2013
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Design and Effect of Ankle-Foot Orthoses Proposed to
Influence Muscle Tone (AFO) Staring Episodes in Childhood are Common and a
Challenging Clinical Problem
Ultrasound Stethoscope from Concept to Reality Obese and Pregnant Women Run a Higher Risk of
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ealthcare organizations have large amounts of data but often do not have the tools to bring the data together for useful business information and planning. Healthcare analytics is the systematic use of data and related business insights developed through applied analytical disciplines such as, statistical, contextual, quantitative, predictive, cognitive, other including emerging model to drive fact-based decision making for planning, management, measurement and learning. Analytics may be descriptive, predictive or prescriptive. Healthcare analytics involves application of statistical tools and techniques to healthcare-related data in order to study past situations such as operational performance or clinical outcomes to improve the quality and efficiency of clinical and business processes and performance. The healthcare analytics market is showing a double-digit growth due to supportive elements such as digitization of world commerce, the emergence of big data and the advance of analytical technologies. Healthcare organizations can differentiate themselves through data analytics. Factors such as, federal healthcare mandates, wide scope of predictive analytics and improvements in the financial and operative function are driving the installation of healthcare data analysis in hospitals. While, the major concerns of this market are the security of data, privacy of individual patients and lack of manpower with cross-functional analytical skills. The healthcare analytics market is estimated to be $3.7 billion in 2012 and is growing at a rate of 23.7% from 2012 to 2017 to reach $ 10.8 billion. Healthcare payers as well as the providers are leading the users of health care analytics for a range of functions from suggesting the most accurate diagnoses, cost reduction, fraud prevention, revenue generation, service improvement to real-time view of the business. The major driver for business analytics is the return on Investments (ROI), with a median of five years, from 10.0% to 1,000.0%.
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Contents 18
Dr. Rajiva Kumar
Vol.3 Issue 5
Jan-Feb 2013
Staring Episodes in Childhood are Commonand...
22 Dr. Suresh Vijan
All you need to know a heartbeat away!
28 Amer Bin Ahmed Interview
Philips releases China’s .............. 6 Health India TPA ....................... 8 Rare abdominal .......................... 10 Forging partnerships .................. 12 3rd International ......................... 14 Asicon 2012 (Kolkata) ................ 17 Inflamatory Bowel Disease .......... 26 Muskotia Retreat ........................ 30 Scientech Technologies ............. 32 Wearable medical......................... 35
34 Manish Malik Spencer
Obese and Pregnant .................... 36 Government Tenders ................... 42 HospiArch 2012 .......................... 46 Meditec Clinika.......................... 48
38 Mohammed Tahir Jamal
Design and Effect of Ankle-Foot Orthoses Proposed to...
44 Gp Capt (Dr) Sanjeev Sood
Ultrasound Stethoscope from Concept ...
6
Jan - Feb 2013
NEWS UPDATE
Philips releases China’s first digital broadband MRI system
Philips has launched Ingenia, the first digital broadband MRI system in China. The system integrates a digital coil design, digital coil interface and digital transferring throughout the whole imaging process. Compared with conventional MRI, the digital broadband MRI provides up to 40 per cent signal-to-noise ratio improvement and is claimed to be the most accurate ultra-high-field MRI. The Ingenia MRI also aims to provide an enhanced patient experience. For patients that suffer from claustrophobia, the 70cm bore of the digital MRI can, to some extent, alleviate their anxiety. Patients can undergo a whole body scan within one minute and the image can be generated with high SNR and resolution and 55cm field of view, raising the throughput by 30 per cent. In addition, its digital coil design makes for flexible combination of all the coils to suit position of patients, which simplifies workflow and increases patient comfort. Expansion of clinical capabilities is essential for advanced clinical and research needs. However, expandability of conventional MRI platform is often limited by the number of radiofrequency (RF) channels.
8
Siemens introduces ACUSON X700 ultrasound system in the mid-range segment
Siemens Healthcare launched ACUSON X700 at IRIA 2013, India’s largest radiology exhibition and conference. Siemens has introduced the ACUSON X700 ultrasound system boasts of advanced features and technologies so that midrange hospitals and diagnostic centres can provide the same facilities like the hi-end healthcare providers. ACUSON X700 claims to be a powerful system that offers exceptional image quality, robust technologies and intelligent workflow solutions at an excellent price/performance ratio. It comes with the tissue contrast enhancement (TCE) technology that improves borders and reduces speckle/ noise, facilitating subtle tissue differentiation, thus allowing faster examination with accurate diagnosis. Another feature is, tissue grayscale optimisation (TGO) technology that provides instantaneous, one-button image optimisation by automatically adjusting the image brightness to the tissue type being imaged. The ACUSON X700 system reportedly also features intelligent workflow solutions that support workflow, ensure exam consistency and enable high patient throughput required by various clinical departments. Jan - Feb 2013
NEWS UPDATE
Health India TPA Selects Adminovate’s forward PAS for Health Claims Administration
Adminovate, Inc., a privately-held solutions and consulting provider for the global life, health and annuity industries, announced today that Health India TPA Services Pvt. Ltd. has selected Adminovate’s forwardPAS to support its healthcare claims administration. Health India is a Third Party Administrator (TPA) focused on offering innovative healthcare services and customer benefit solutions to individuals, corporations and groups. Leveraging forwardPAS will enable Health India to improve its claims adjudication processing, support carriers more efficiently and provide better service to policyholders. Kamaljeet Gupta, Managing Director of Health India, commented, “Health India needs to be a nimble and cost effective provider in our space as we service our current client base and attract new insurance companies to our TPA. In order to do so, we needed a robust system for our comprehensive processing requirements.” Gupta added, “There is no other solution in the world today that compares to forwardPAS. Adminovate is far ahead of the competition and we are committed to be with them on every step of their journey.” Chris Doggett, CEO of Adminovate commented, “We are very pleased to have a client that is an established player and has more than 20 insurance companies under its TPA umbrella. When we developed forwardPAS using the latest available and proven technologies, we knew that we had built something special. Companies like Health India can now leverage the recent advancements in technology in order to react quickly to carriers’ needs and provide superior benefits processing.” 10
Parker Hannifin Corporation opens Rs. 100 Crore green field manufacturing facility at Chennai
Parker Hannifin Corporation (NYSE:PH), the global leader in motion and control technologies, today inaugurated its first green field manufacturing facility at Chennai. The state-of-the-art, world class facility is built on a ten acre plot in Mahindra World City. The new manufacturing site will focus on production for the Filtration, Pneumatics and Drives, Sealing and Shielding businesses. The company has invested Rs. 100 Cr in setting up the facility. The new facility will manufacture broad range of products and systems for segments such as automotive, off highway mobile, telecom, oil and gas, mining, and primary metals. The Chennai facility
targets the employment of 300 people in the next 2 to 3 years. With this facility and acquisitions Parker Hannifin India plans to double their revenues within the next 5 years. Tom Williams, Executive Vice President and Operating Officer, Parker Hannifin Corporation said, “The inauguration of our first green field manufacturing facility at Chennai and localization of our products demonstrate our commitment to India as a key growth market. Our new Chennai facility will enhance our ability to support our customers locally here as we build our presence in new markets in India.”
Jan - Feb 2013
NEWS UPDATE
Rare abdominal tumour removed successfully with laparoscopy at Niramaya Hospitals
Dr. Amit Thadhani, Consulting Laparoscopic Surgeon and Medical Director, Niramaya Hospitals recently performed two laparoscopic surgeries to remove abdominal tumour. These are rare surgeries with very few cases reported in the entire medical literature. 25-year old Hitendra Nikam (name changed to protect privacy) from Mumbai was unable to lie down or sleep since the past two years due to pain in his upper abdomen whenever he slept. On investigation, a 5cm sized cystic tumor was identified located next to the diaphragm, situated directly over the aorta. The patient was posted for laparoscopic treatment of the same under Dr. Amit Thadhani, Consulting Laparoscopic Surgeon and Director, Niramaya Hospitals, a premier 102-bed laparoscopy hospital at Kharghar, Navi Mumbai. He said, “The tumor was identified and a three hour long procedure called marsupialization with omentopexy was done to treat the lesion as it was densely stuck to the aorta. After the surgery, the pain that had been tormenting Hitendra since the past
two years disappeared on the same evening.” The tumor on analysis was found to be a Mesothelial Inclusion Cyst of the Right Crus of Diaphragm, an extremely rare tumor with less than 10 cases reported in the entire medical literature and virtually no cases reported in this location of the body. It also constitutes the first time anywhere in the world that this tumor has been treated with laparoscopy, a minimally invasive approach that enabled this complex procedure to be done with virtually no scars or blood loss. The patient had a completely uneventful recovery and was discharged the next day.
GE Healthcare Announces Acceptance of Applications for Review of Investigational Imaging Agent [18F] Flutemetamol in the United States and Europe GE Healthcare today announced that regulatory bodies in the United States and Europe have accepted its applications for review of the investigational PET amyloid imaging agent [18F] flutemetamol, a positron emission tomography (PET) imaging agent. A New Drug Application (NDA) was submitted to the U.S. Food and Drug Administration (FDA) for [18F]flutemetamol use in the visual detection of beta amyloid in the brains of adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease (AD) or other cognitive disorders. Additionally, a Marketing Authorisation Application (MAA) was submitted to the European 12
Medicines Agency for [18F]flutemetamol use in the visual detection of beta amyloid in the brains of adult patients who are being evaluated for AD. “In clinical trials, [18F]flutemetamol imaging demonstrated consistent performance in the visual detection of beta amyloid in the brain when compared with histopathology data,” said William E. Klunk, MD, PhD, Co-director, Alzheimer Disease Research Center, Distinguished Professor of Psychiatry and Neurology at the University of Pittsburgh. “PET scanning with [18F]flutemetamol has the potential to augment the current methods used in the evaluation of patients with symptoms of Alzheimer’s disease.” Jan - Feb 2013
NEWS NEWS UPDATE
Forging partnerships between the public and private sector is the way forward for the healthcare sector in India: Mr Ghulam Nabi Azad “Though India has earned international accolades for its collective efforts at containing Polio, significant reduction in infant mortality rate (IMR) and maternal mortality rate (MMR), the delivery and outcomes of healthcare facilities need to be improved further”, said Mr Ghulam Nabi Azad, Minister of Health & Family Welfare at the 9th India Health Summit organized by Confederation of Indian Industry (CII) here. He also released the report prepared by McKinsey for CII, titled, “India Healthcare: Inspiring possibilities, challenging journey”, which provides various stakeholders with an integrated view of the healthcare sector in India by 2022. Despite the laudable efforts made by the government in the field of healthcare, significant challenges in the form of inadequate infrastructure, shortage of funds and efficient human resource faculty continue to confront the policymakers, Mr Azad added. The Indian Healthcare is envisaged to grow from the US$65 billion industry currently to US$100 billion by 2015. However, in order to reach this ambitious target, collaboration between public and the private sector in all areas of delivery is crucial, he stressed. Mr Azad applauded the CII’s initiative to create the Healthcare Sector Skill Council (HSSC) to address the skill gap in the area of allied healthcare professionals. Mr P.K Pradhan, Secretary, Ministry of Health & Family Welfare, highlighted that there is an urgent need to strengthen the public healthcare system in such a way that there is a seamless transition between primary and secondary healthcare facilities in the country. The government is working tirelessly towards ensuring that accessible and affordable healthcare services are available to all in the years to come. However, in order to ensure this, it was necessary for the public and private stakeholders to work in tandem with each other, he added. Mr Rahul Khosla, Chairman, 9th India Health 14
Summit, in his welcome remarks said that the healthcare summit in the last few years has become the most definitive platform to discuss and deliberate issues related to healthcare service in India. In his special address, Dr Naresh Trehan, Chairman, CII National Committee on Healthcare, remarked that the quality of medical education needs to be improved in India with special focus on the up hauling of both the quality and quantum of doctors in the country. The skills of the ASHA (Accredited Social Health Activist) workers need to be enhanced, in order to improve the delivery of service in the rural sector. The creation of the HSSC is step in this direction, he further added. Mr Shivinder Mohan Singh, Executive ViceChairman, Fortis Healthcare Limited, in his address remarked that to ensure availability of affordable healthcare services in the country, forging public-private partnerships is the only way forward. Additionally, there is also an urgent need for improving the transparency and accountability on the cost of delivery of healthcare services, he added. Dr Prathap C Reddy, Chairman, Apollo Hospitals Group, added that time has come for the healthcare sector to be accorded infrastructure status in order to improve the sector’s outcomes and platform of delivery access across different sections of the society. Jan - Feb 2013
NEWS UPDATE
3rd International Hospital Build & Infrastructure India 2012 achieves grand success, announces the first ‘Hospital Build & Infrastructure Awards’ The 3rd edition of India’s premier and only dedicated B2B event on Hospital Infrastructure, Planning, Supplies & Healthcare Development had a successful conclusion with packed Conference sessions and a never ending flow of Industry leaders & visitors to see the explicit display of latest Hospital Infrastructure products & technologies at Bombay Exhibition Centre, Mumbai on 14-16 December 2012. The event attracted over 3000 trade visitors comprising of CEOs, Medical Directors, Hospital Administrators, Medical Superintendants, Bio Medical Consultants, Healthcare architects, Project management consultants, Developers, PE firms, and many senior decision makers and healthcare professionals One of the major highlights of this edition was the announcement of the first Hospital Build & Infrastructure Awards to felicitate the best efforts in the Healthcare Facility and to recognize leaders in the Healthcare industry who have devoted their efforts to building hospitals that help improve healthcare services and raise the bar in providing world-class patient care. As this sector is growing, so is the need to reward industry leaders and innovators in a variety of categories. The Awards were introduced to act as a platform to promote the professionals who have worked hard to achieve a hospital environment that enables and promotes a healthy life. The HBI Awards, India, is in line with the International Series of Hospital Build & Infrastructure Awards which is organized by its other portfolio of events like Hospital Build Middle East, Dubai. The Winners of the HBI Awards, India are as follows 1. Kohinoor Hospital – Best Sustainable Hospital Project 2. Hiranandani Hospital – Best Healing Environment 3. Apollo Telemedicine – Best Technology 16
Initiative 4. Fortis Memorial Research Institute – Best Initiative to Improve Design Standard for Healthcare 5. Larsen & Tubro – Builder/Construction Company for a Project 6. Medanta – Best Physical Environment Award 7. Archi Medes-Architect/Designer of the year for a Project The burgeoning opportunities and technological advancements in the Indian hospital infrastructure sector were also highlighted at this three day exhibition & technical conference A strong line up of speakers and industry illuminati shared their expertise and discussed the technological advancements and the way forward in the industry. The 3 day conference was broadly categorized into 3 technical sessions. 1) Leaders in Healthcare - Winning Strategy in the New Regionalised Multi-national Healthcare Market Place. 2) Hospital Build, Design and Upgrade - Designing and building safe, functional, effective architecture & infrastructure. 3) Quality Of Care - Leap over the Quality Chasm through Redesigning Healthcare Quality Model. Attractive panel discussions, from internationally Jan - Feb 2013
NEWS UPDATE
acclaimed companies and influential healthcare personalities from India served as an excellent catalyst to the entire conference programme. Few of the renowned dignitaries who stamped their presence and shared their views at the event were Dr. Chandrasekhar R, Chief Architect – Ministry of Health & Family Welfare, Govt. of India Dr. Sujit Chatterjee, Chief Executive Officer, LH Hiranandani Hospital Dr. Vishal Beri, Chief Operations Officer, Hinduja Healthcare Surgical Mr. Vishal Bali, CEO, Fortis Global Dr. Rajeev Boudhankar, Vice President, Kohinoor Hospital
Director, PWC India Dr. Sameer Mehta, Director-Projects, Hosmac India Ms. Marcelle Mc Phaden, Regional Manager-Asia, Accreditation Canada International Mr. Gaurav Chopra, MD, HKS India Mr. Frederic Nantois, Architectes Ingenieurs Associes-France To further add value to the platform, new initiatives like business match making service was also introduced in addition to the industry specific conference tracks, product demonstrations, seminars and display of leading hospital infrastructure products, technologies and services. The exhibitors included hospital consultants, healthcare architects, planners, developers, medical equipment suppliers, Hospital Furniture & Interiors, flooring, roofing, lighting, clean room partitions, hospital paints, modular OTs, bedhead panels amongst many Mr. VP Kamath, COO, more. Wockhardt Hospitals Around 100 exhibitors from Mr. Gaurav Malhotra, MD & India and abroad, showcased CEO, Patni Healthcare Dr. Ganapathy, President, the entire gamut of hospital infrastructure products, medical Apollo Telemedicine equipments/technology, and Mr. Manpreet Sohal, CEO, SL hospital solutions all under one Raheja Hospital roof. Mr. Abhishek Singh, Associate Jan - Feb 2013
The exhibiting brands were Tata Motors, Godrej Interio, Modular Concepts, Allarch India, TAPHI Pty Ltd, Draeger Medical India, , Mindray, HLL Lifecare, Sio Vassundhara International, Portalp International, Mehta Tubes Limited, Zebra Technologies, Hospaccx India T M, CR Medisysytems, KGD Architecture, Attune Technologies, Hill-Rom, Alvo, RAM Metal Industries, Knauf RAK FZE, Linet, Hospaccx India Systems, Bluestream Manufacturing Services, Agora Climate Control Systems, Aeropure Systems, Light & Magic Automation, Eubiq India, Archetype, American Institute of Architects, STH Architects, Bowman Riley Architects, Bioni Paints India, Helix Corporation, Edifice Medical Systems, Barco, Cosign India, RMG Polvinyl, Tata Consultancy services, Redsun Communication, Pratiba Medinox, Piercing Systems, Studex, CAEM India, Carefusion, Cosign India, Knauf Rak Fze, Everest Industries, Hosmac India, Ziqitza Healthcare to name a few. 17
NEWS UPDATE
Some of the exhibitor feedback included “Hospital Build & Infrastructure India 2012 is a fabulous event which can provide total solutions to the healthcare industry under a single roof. It can play an imperative role in providing innovative solutions. HLL being a total healthcare solution provider got an opportunity to showcase our services through HBII 2012.” HLL LIFECARE “Hospital Build & Infrastructure 2012 has provided a unique platform to the solution providers as well as key decision makers for the Hospital and Medical fraternity. This would go a long way in raising the overall quality of Infrastructure in Healthcare, thus providing medical facilities to the patients at the best of quality and affordable costs.” DRAEGER MEDICAL INDIA “The Hospital Build & Infrastructure is an appropriate exhibition to showcase new concepts in the Hospital industry, i.e., we have the decision makers attending the exhibition. More importantly, no general visitors attend the exhibition.” ZECO ENVIRONMENTAL SOLUTIONS “Hospital Build & Infrastructure is a good show and the right platform for manufacturers/ suppliers of hospital construction/interior/technical products and the right place to showcase the product range to the Hospital owners, decision makers, Architects, Consultants etc. The show was organized well.” RMG POLYVINYL INDIA “We are glad that we took part in this great show. The quality of the visitors and the enquiries we received was really good.” MODULAR CONCEPTS “HBII 2012 has successfully delivered us a unique platform comprising of multidisciplinary Healthcare providers and planners in India. Allarch Healthcare was able to capitalize through our presence and collaborate directly with business decision makers.” ALLARCH HEALTHCARE TECHNOLOGIES “Knauf Middle East experience at HBII 2012 was outstanding, looking at the feedback and the quality of visitors. The exhibition brought together the decision makers and providers for the region. We are looking forward to participate again at HBII 2013.” KNAUF MIDDLE EAST “Hospital Build & Infrastructure India turned out to be a great exhibition with specific clientele. We met a lot of project owners and similar leads.” RAM METAL (PROFEX) “It is all about the three ‘E’s, Excellent Exhibition Experience.” HOSPAXX INDIA The event received unanimous applaud for the elite panel of Speakers, Guests, Exhibitors and Delegates which it brought together for the 3rd edition. Going by the overwhelming response to this event every year and the efforts from the organizers to continuously provide an innovative addition to this series, it is evident that the event is an established platform to meet the key decision makers from major healthcare facilities and showcase the latest technology to the Indian market. This one its kind trade show in India, indeed, did offer everyone in the hospital supply chain an unparalleled opportunity to network, upgrade knowledge, source, sell, partner, share ideas and technology, ALL under one roof. 18
Jan - Feb 2013
NEWS UPDATE
ASICON 2012 (Kolkata) POST EVENT COVERAGE Message from Treasure, ASICON 2012 On behalf of the organizing committee, it gives me immense pleasure to great you all here in the ASICON 2012. I would like to thank all delegates and their associate for their full hearted cooperation and positive intention to make to make this event a remarkable one. This is your inspiration and admiration which help us to undertake this huge responsibility and execute it in a nice way. I admire each and every member present here in this conference for their support and apologize for any inconvenience they faced during their stay. I gave my full effort to make this event a successful mega event. Once again I would like to thank everyone and wish you all very happy & Prosperous New Year 2013. Dr. Somnath Ghosh
Message from Congress President, ASICON 2012
Thank you all for visiting Kolkata at the 72nd Annual Conference of the Association of Surgeons of India. My greetings and heartfelt gratitude to you all coming from different and distant parts of the country and abroad. Please take some time out and visit the places of interest in Kolkata. I expect that you enjoying the academic feast as well as the delicacies of cuisines of Bengal. Apart from academics, there are beautiful places to visit in and around the city. Hope you will enjoy visiting them- Shantiniketan, Digha, Sunder bans, Murshidabad, Darjeeling etc. I hope that your stay and visit here in the conference is proving a memorable experience. Dr. B.P. Chakravarty Jan - Feb 2013
19
DOCTOR SPEAK
Staring Episodes in Childhood are Common and a
Challenging Clinical Problem
S
Dr. Rajiva Kumar Child Specialist Muzaffarpur
20
taring episodes are a frequent reason for referral to paediatrics, as parents and teachers fear the possibility of seizures. Staring episodes in childhood are common and a challenging clinical problem. The difficulty is in differentiating between epileptic and non-epileptic phenomenon at the first assessment. Clear description of the event, preferably by a first-hand eye witness, along with clinicians’ clinical experience will usually lead to a correct categorisation of the episodes. Rarely, a clinician
will be able to actually observe the phenomenon; therefore a video recording of an event is invaluable. The differential diagnosis of staring spells in children can be broadly categorised into absence seizures (‘typical’ in a ‘normal’ child and ‘atypical’ in a child with developmental problems), complex partial seizures (CPS), daydreaming and childhood preoccupation. To achieve an accurate diagnosis a comprehensive approach including a systematic clinical assessment and judicious use of investigations is necessary. However, it should be remembered that as paediatricians we work with children of varying ages and maturity levels, in addition to the underlying neurological impairments that may exist. There is often a lack of information, description and insight into these events. Therefore, the proportion of ‘misdiagnosis’ in epilepsy in this population (infants, young children and neurologically impaired children) is substantial. A simple approach and categorisation of these events is offered here to help the clinician Jan - Feb 2013
DOCTOR SPEAK
in making an accurate diagnosis. Staring episodes in children can be broadly divided into nonepileptic and epileptic events. Non-epileptic staring episodes Daydreaming Daydreaming in children is common. Those children who are referred for evaluation are more likely to have comorbid conditions such as attention deficit hyperactivity disorder (ADHD), learning difficulties and Tourette syndrome. These episodes usually occur during periods of inactivity or when a child finds the activity less interesting. Children during daydreaming tend to ignore verbal stimulation, but usually respond to tactile stimulation. However, in children with learning difficulties and/or developmental delay it may be difficult to interrupt these events. Jan - Feb 2013
The clue to the diagnosis of all these events is that they can be interrupted by touch or tickle and that they do not interrupt otherwise interesting activities. Childhood preoccupation Preoccupation occurs when the child is engrossed in a task. The child appears vacant or glazed (occasionally the eyes may be closed). They could have a glazed expression doing their homework and humming. The length of the episode can be variable depending on the surrounding distraction and they can be stopped by verbal stimulation. Gratification disorder previously referred to as infantile masturbation and benign idiopathic infantile dyskinesia is a well-recognised phenomenon in infants. This behaviour is not akin to the typical manual genital
stimulation behaviour as in older age. Parents report their child staring, grunting and rocking to and fro with crossed legs. This condition is often underrecognised or misdiagnosed as epilepsy. Additional features include (1) onset after the age of 3 months and before 3 years (2) facial flushing with diaphoresis (3) no alteration of consciousness (4) cessation with distraction (5) normal examination and laboratory studies (6) pressure on the perineum with characteristic posturing of lower extremities. Observation of the episode in person or video is sufficient to make a diagnosis. No further investigations or treatment is needed. Parental acknowledgement is at times difficult or delayed. However, clear explanation of the phenomenon with evidence of distractibility should help. Migraine-like events Another entity, which has been described in some children, is the ‘Alice in Wonderland’ phenomenon. These events are thought to be migraine-related. This peculiar syndrome of visual and interpretive distortions of body and environmental surroundings is well recognised in children. This may last for 15–20 min and is then followed by throbbing headaches. During this event, the child may appear to stare, as they are either scared 21
DOCTOR SPEAK
or perplexed by this experience. Children can suffer from headaches (either migraine and/or other type of headache) and epilepsy, either as two different pathologies or having a common underlying pathology. Staring episodes may be a feature of these episodes. In these cases, the headache occurs at a different time to the seizure (interictal headache). However, headaches sometimes occur simultaneously with or very close in time to the seizure. Headaches that occur at the time of epileptic seizure are known as ‘ictal epileptic headaches’ or as ‘hemicrania epileptica’. One that precedes a seizure is known as ‘preictal headache’ and one that follows a seizure is known as ‘postictal headache’. There is a particular type of preictal headache, known as ‘migralepsy’, which occurs during or just after a migraine aura. This entity although described is extremely rare.9 Children during these headache episodes tend to stare and remain unresponsive. Other less common causes Cyclical vomiting, parasomnias and psychogenic seizures could also have staring episodes as one of their features. However, they are usually associated with other more predominant symptoms like vomiting, nocturnal sleep-related events and inconsistency respectively. Epileptic staring episodes For children referred for staring episodes, only absence and complex partial seizures need to be considered in the epileptic category. The differentiation between these two seizure types is detailed in table 1.
Table 1
Differentiation between absence and complex partial seizures Features Absence seizures Complex partial seizures Duration <20 s ≥1 min Aura Absent Present Postictal drowsiness Absent Present Adapted from Current Management in Child Neurology, Absence seizures Absence seizures in childhood are often divided into two major categories: typical and atypical. The international league against epilepsy (ILAE) commission classification and terminology have simplified the classification of absence seizures as follows: 1. Absence seizures: Typical or atypical, each with distinct features (table 2) 2. Absences with special features: myoclonic absences and eyelid myoclonia. 22
Jan - Feb 2013
DOCTOR SPEAK
Table 2 Differences between atypical and typical absence seizures Features Responsiveness Changes in tone
Atypical absences Decreased but not abolished Usually pronounced
Typical absences Varies from mild to severe Usually mild Usually brief; never >30–40 s Immediately
Duration
Usually long sometimes minutes
Postictal recovery
Cognitive impairment may persist
Interictal EEG
Background often Background usually abnormal with frequent normal sometimes with discharges of various types typical IGE discharges
Ictal EEG
Slow (<2.5 Hz) spike and wave
Normal neurological and mental state Other types of seizures
Exceptional
Fast (>2.5 Hz) spike and slow wave As a rule
Atonic and tonic seizures of symptomatic generalised epilepsies
Depend on IGE syndrome (myoclonic jerks, GTCS or both)
Prognosis
Commonly bad
Commonly good
Adapted from Panayiotopoulos CP. A clinical Guide to Epileptic Syndromes and their treatment. 3. Typical absences (previously known as petit mal) are brief (lasting seconds) generalised epileptic seizures of abrupt onset and abrupt termination. They have two essential components: 4. (1) A clinical component manifesting with impairment of consciousness (absence) 5. (2) An EEG component manifesting with generalised spikeslow-wave discharges of 3 or 4 Hz (>2.5 Hz). Atypical absences are generalised epileptic seizures of inconspicuous start and termination with (1). Clinical symptoms of mild-to severe impairment of consciousness (absence), often significant change in tone with hypotonia or atonia, mild tonic or autonomic alterations (2). EEG discharges of slow spike-wave (1–2.5 Hz), which are often irregular and heterogeneous and may be mixed with fast rhythms. 6. Myoclonic absences are rare. The mean age of onset is 7 years. The Jan - Feb 2013
seizures have a sudden onset and ending, and usually occur soon after awakening. Seizure duration ranges from less than 10 s to more than 2 min. The myoclonus is rhythmic and usually involves the shoulders, arms and head. They may have perioral myoclonus, although eyelid myoclonus is rare. The EEG shows a typical bilateral 3Hz spikewave or polyspike activity.3 7. In eyelid myoclonia with absences, absence follows the eyelid myoclonia while the eyelid jerking continues. Consciousness is mildly impaired and automatisms are not observed. Another symptom is the rare occurrence of the ‘pleasurable’ feeling during the absence, which may be related to ‘self-induction’ in some patients.13 8. Frontal onset absences constitute a specific subtype within the childhood absence epilepsies. Children with frontal onset of the EEG abnormalities frequently have complex absences and are more likely to have learning and behavioural problems. They are usually resistant to treatment.14 23
DOCTOR SPEAK
All you need to know
a heartbeat away!
T
Dr. Suresh Vijan
Consultant Cardiologist Lilavati Hospital, Fortis Mulund & Hinduja Khar Hospital
24
he number of elderly people and nowadays young people developing heart failure is increasing. Before we look at what leads to heart failure, it’s necessary for us to understand what exactly heart failure is. The general notion is heart failure means that the heart has stopped working or will eventually stop working. Heart failure is a condition in which a weakened heart is unable to pump the normal amount of blood carrying oisxygen and nutrients throughout the body. Heart failure cannot be termed as a disease but is a chronic syndrome that generally develops slowly. If the heart failure is mild, it may not significantly affect a person’s lifestyle and day-to-day living.
On the other hand, severe heart failure can affect a person’s every move and can be fatal. Thus the severity can range from a very mild heart failure to a severe heart failure. Treatment is essential in all types of heart failure. It can help significantly and, in most nonsevere cases, can allow the person to enjoy a normal and full life. Medication can also significantly help those suffering with severe heart failure to improve their day-to-day living and live longer. Although Heart Failure, like other heart ailments, has been acquiring epidemic proportions in India in the recent past, it has not received adequate public attention. Signs and Symptoms Many people with heart failure Jan - Feb 2013
DOCTOR SPEAK
»» The prevalence of heart failure increases with the age from less than 1 per cent in the 20-39 yr. old age group to over 20 per cent in the people age 80 yr. or older »» The life time risk of developing heart failure is estimated at about 20 per cent both men and women »» The lifetime risk of developing HF at the age of 40 yrs. is 11.4 per cent for men and 15.4 per cent for women »» More than 500,000 new cases are diagnosed each year »» Around 30 to 40 per cent of patients die from heart failure within 1 year after receiving the diagnosis. remain undiagnosed because their symptoms are often overlooked, ignored, or attributed to aging and in today’s times often attributed to excess stress. The symptoms result from the inability of the heart to pump blood around the body efficiently and the result could affect the patient’s left side, right side, or even both sides of the body. Symptoms depend on which side is affected and the severity of the heart failure. In the early stages, Heart Failure may not have any symptoms, however, in later stages it will become severe. It’s important to be aware of the symptoms to take adequate medical treatment at the onset of this condition itself. The most common symptoms are difficulty in breathing, chronic cough, loss of appetite, fatigue, rapid or irregular heartbeat, mental confusion or impaired thinking, cyanosis (blue color of skin), low blood pressure (hypotension), cold sweating and gradual loss of consciousness etc. Jan - Feb 2013
In addition to the above symptoms, a physician may detect signs of Congestive Heart Failure, which may include an abnormal heart murmur caused by valve-related disorder, a crackling sound of fluid in the lungs caused by pulmonary congestion, a rapid heartbeat (tachycardia) or abnormal heart rhythm (arrhythmias), swelling and fluid retention in the liver or the gastrointestinal tract, enlargement of the heart (hypertrophy) and liver malfunction. Seriousness of the condition Seriousness of a heart failure depends on how severe the condition is. When a weakened heart can’t pump enough blood throughout the body, it leads to reduced quality of life, frequent hospitalization and high mortality. Heart failure may occur for a number of different reasons: 1. Chronic high blood pressure- When the blood pressure is very high, the heart
has to work much harder to pump blood through the arteries. This results in enlargement of the heart, especially the left ventricle, which is the heart’s main pumping chamber, making it less efficient. 2. Coronary artery diseaseThe buildup of cholesterol and fatty substances or plaque on the walls of the arteries may decrease the blood supply to the heart muscle to do its work. 3. A previous heart attack- the heart muscle may have lost its strength or weakened because of a previous heart attack. During a heart attack, the heart muscle is deprived of oxygen, resulting in tissue death and scarring. The development of heart failure depends on the extent and location of the scarring. 4. Diseased heart valves- A narrowed or leaking heart valve fails to direct blood flow properly through the heart. The problem may be something you were born with, an inherited condition, or the result of an infection. 5. Irregular heart ratemedically known as cardiac arrhythmia, irregular heart rates can lead to heart failure, but they usually have to be severe and last a long time. They change the pattern of filling and pumping of blood from the heart. 6. Cardiomyopathy- Disease of the heart muscle itself can lead to heart failure. Causes of cardiomyopathy include infection, alcohol abuse, cocaine abuse, and family predisposition. Diagnosis & Treatments 25
DOCTOR UPDATE SPEAK
options for Heart Failure Heart Failure usually can’t be cured, but thanks to advances in technology and drug discovery, it can be effectively managed and patients’ quality of life improved. Coupled with appropriate lifestyle changes, the relentless progression of the disease can even be arrested. Hence the importance of early diagnosis and treatment. The doctor may arrange for tests that include a chest x-ray, blood and urine tests, an electrocardiogram, a painless test where small sticky patches connected with wires to a computer are placed on your chest. The computer records the information from your heart. In addition, the doctor may conduct an echocardiogram, which simply involves moving a probe across the chest. Doctors can see how well the heart is pumping, can assess if the valves are working, the thickness of the wall of the heart, and the size of the chamber. Cardiac resynchronization therapy (CRT) is considered to be one of the effective forms of treatment for heart failure that 26
uses an implantable device to improve the pumping efficiency of the heart. In healthy people, the four chambers of the heart contract in synchrony to move blood through the body (people experience this as their heartbeat). In many patients who have heart failure, the electrical impulses that coordinate the contractions of the heart’s chambers may be impaired. As a result, in up to 30 percent of people who have advanced heart failure – or 10 percent of all people with heart failure – the two lower chambers (ventricles) no longer contract at the same time. This may worsen the symptoms of the disease. In cardiac resynchronization therapy, a stopwatch-sized device is implanted in the upper chest in an attempt to resynchronize the contractions of the ventricles by sending tiny electrical impulses to the heart muscle. For those patients with heart failure who have electrical conduction problems of the heart, resynchronization therapy improves the flow of blood from the heart throughout the body, which may result in reducing symptoms, reduced
hospitalizations and reduced mortality. A treatment plan for a heart failure may vary from person to person. Some of the common plan may include some or all of the following: Medications to strengthen your heart’s pumping action help blood flow better through blood vessels, or regulate your heartbeat • Changes in the amount of your physical activity • Setting limits on the amount of salt and fat in your diet • Increasing the potassium in your diet, if instructed • Losing weight if necessary • Reducing your fluid intake, if necessary While heart failure is a serious condition, it is not necessarily the death sentence that its name suggests. Thousands of heart failure patients live well with this condition. Though it cannot be cured, it can be successfully managed with your doctor’s help and advances in medical technology, the patient can feel better and subsequently see their quality of life improving. Jan - Feb 2013
COVER STORY
INFLAMMATORY
BOWEL DISEASE A LTHOUGH the causes of the common forms of idiopathic inflammatory bowel disease remain unclear, considerable progress has been made in the identification of important pathophysiologic mechanisms since these disorders were last reviewed in the Journal . Newer epidemiologic and clinical surveys have further clarified the clinical features, natural history , and complications of inflammatory bowel disease. In addition, the work of clinical investigators in many centers has enlarged the therapeutic armamentarium used for these diseases. This review will high light these recent developments and provide an overview of the Current understanding of the pathogenesis, diagnosis, and management of inflammatory
28
bowel disease. The reader is referred to several excellent monographs and reviews for a more extended discussion of the foundation for this update. DEFINITIONS AND CLASSIFICATION Inflammatory bowel disease encompasses at least two forms of intestinal inflammation: ulcerative colitis and Crohn ‘s disease, known in its various forms as regional enteritis, Crohn ‘s ileitis and granulomatous colitis. Although many other inflammatory disorders affect the gastrointestinal tract, most can be distinguished by a specific underlying etiologic agent or process or by the character and manifestations of the inflammatory activity. In contrast, the causes of the major forms of inflammatory bowel disease are unknown. In the
absence of identifiable causes, Crohn ‘s disease and ulcerative colitis are defined empirically by their typical clinical, pathologic, radiologic, endoscopic, and laboratory features. Although these features, summarized below, usually permit an operational distinction to be made between Crohn ‘s disease and ulcerative colitis, it should be emphasized that the fundamental validity of this diagnostic classification remains uncertain. Increasing evidence suggests that these two forms of inflammatory bowel disease are partly and possibly wholly distinct in their initial pathogenic events, but it is also likely that they share important common pathophysiologic processes. In some patients, it may not be possible to distinguish with confidence between ulcerative Jan - Feb 2013
COVER STORY
colitis and Crohn â&#x20AC;&#x2DC;s disease affecting the colon with any of the criteria conventionally used to distinguish one from the other. A firm foundation for the classification of inflammatory bowel disease will be achieved only with further understanding of the causes and pathogenesis of these disorders. VARIANT FORMS Although specific inflammatory disorders of the intestinal tract, such as infectious enteritides, can usually be distinguished from
colitis. In fact, these disorders may reflect different manifestations of a single disorder. They are characterized by diarrhea and microscopic endoscopic or radiologic abnormalities. These subtle forms of inflammation
inflammatory bowel disease by a comprehensive evaluation, a number of forms of nonspecific inflammation have been recognized over the past several years whose relation to these disorders remains problematic. They include lymphocytic (also called microscopic minimal change) colitis and collagenous
often respond to treatment with sulfasalazine, an effective treatment of classic forms of inflammatory bowel disease, leading to the suggestion that they are variant forms of ulcerative colitis. Two distinctive disorders of intestinal inflammation may occur after certain surgical
Jan - Feb 2013
procedures: diversion colitis, found in defunctionalized segments of the bowel, and pouchitis, found in the neorectum created from the terminal ileum after an ileoanal pull-through procedure in the management of ulcerative colitis. Although the actual relation of these disorders to inflammatory bowel disease remains uncertain, they may offer in vivo experimental models that could provide insight into the pathophysiologic processes contributing to ulcerative colitis or Crohn â&#x20AC;&#x2DC;s disease. This may be especially true of pouchitis, which is found predominantly in patients with preexisting ulcerative colitis and only infrequently in patients undergoing the same operation for familial polyposis. In contrast, diversion colitis may occur in patients who have undergone surgery for other primary conditions, including noninflammatory disorders, It is nonetheless intriguing that diversion colitis can be ameliorated by the local instillation of short-chain fatty acids, these substances, which serve as primary nutrients for the colonic mucosal cells, can lead to injury and chronic inflammation. 29
INTERVIEW
Premium commanding players in the arena would flutter bringing in interesting times for the healthcare industry. Knauf is a leader in Gypsum based building material products in walls and flooring so, there is room to grow our business in India. Amer Bin Ahmed
Managing Director, GCC, India, East Africa Knauf LLC, Dubai
Shed some light on the companyâ&#x20AC;&#x2122;s journey ? Knauf is 100 years Old company & operated in 60 countries.Here in Knauf we produce products with international standard Knauf is a family name. A multinational producer of building materials and construction systems. A strong characteristic of Knauf is the courage for visions, innovation and investments as well as simple decision-making processes and a wealth of ideas on the part of its personnel. Elaborate on some unique products you have? We have products for dry walls & Floorings.Originally a producer of conventional gypsum, Knauf produces construction materials for drywall construction, Knauf 30
plasterboard, mineral fibre acoustic board, dry mortar with gypsum for internal plaster and cement-based external plaster and insulating materials on the basis of glass wool and mineral wool. What are your future plans for Indian market? India is huge market for construction materials and healthcare products .There is room for growth in India . We will focus on Healthcare Industry. We are looking forward for distribution channel network to grow our business in India. We train people for quality service and product. Rise in demand for Hospitals in India, what are prospects of your products? Rise in demand of Hospital ,India needs 1 lakh beds
each year for next 20 years India presently has a bed deficit of approximately 30 lakh beds as per the WHO recommendation of four beds per 1000 population. Considering even a 250 bedded hospital on an average, the country would need 12000 hospitals in the near future. Premium commanding players in the arena would flutter bringing in interesting times for the healthcare industry. Since Knauf is a leader in Gypsum based building material products in walls and flooring so, there is room to grow our business in India. Good times ahead for construction material companies in every sphere be it new projects or existing.
Jan - Feb 2013
INTERVIEW
what marketing strategy do you manage to edge out competitors in your Industry? Well, Closeness to customers,
appropriate expert service for an ongoing development process. top-grade products and systems: It is the objective of our this has been the Knauf way to company to supply services market. For this purpose it is and products to meet the requirements and expectations of our customers and business partners as well as the statutory requirements, the guidelines of the vocational associations and the applicable standards. Brief about R&D, quality and service of your company? We have Research & Development unit and they are continuously focusing on quality & innovations. Here in Knauf we value our customer and bond to meet or exceed customerâ&#x20AC;&#x2122;s stated & implied needs. the establishment of long-lasting, special customer relationships necessary to have state-of-the-art Interview by offering first class advice and plant technology that is subject to Conducted by Correspondent-Mr.Zoheb Zuber
Jan - Feb 2013
31
HEALTH PROPERTY
Muskotia Retreat,
Nainital- an exclusive residential community for the discerning few!!
V
acation homes is an upcoming concept in India. Owning of Vacation homes is being adopted by people with higher disposable income and it is generally considered for investment post the basic housing and real estate investment needs are met. In India Goa has been one of the most preferred destination for owning Vacation homes amongst high net worth individuals, professionals and Rich and famous. Holidaying in Vacation homes are a great break for the family for rejuvenation and healthy living. Mostly in US, Europe, Canada and also Goa vacation home owner prefer to give their property on rental to ensure best upkeep of the property and get revenue income. Vacation rentals usually occur in privately owned vacation properties (holiday homes), so the variety of accommodation is broad and inconsistent. The property is a fully furnished property, such as a holiday villa, apartment, cottage, 32
condominium, townhome or single-family-style home. Vacation rentals can range from budget studio apartments to lavish, expensive private villas in the worldâ&#x20AC;&#x2122;s most desirable locations. Muskotia Retreat at Nainital is a dream of long years of creating Vacation homes for the discerning few. Plan is to provide Rent-A-Villa proposition to the people who own homes at Muskotia Retreat.These homes are coming up in surroundings of Kilbury forest adjoining Nainital which is an international birding destination and within the touching vicinity of Corbett National Park. Muskotia Retreat homeswould be constructed using unique composite material with standard RCC structure,fully furnished, heated homes,set in a wildscape , whilst using various sustainable methods of living. The attempt at Muskotia retreat is to create a small community of likeminded people who would help build this unique living
complex in an integrated manner, thereby creating a unique asset for their family and friends. The community will have their own homes within Muskotia Retreat. Sustainability is the core to the concept at Muskotia Retreat. The team working on the design is attempting number of initiatives like use of Solar power in passive heating of homes, rain water harvesting and purification, recycling of water, LED lightning, local area plants and flora that has strong survival instincts and consumes less water and some more. Endeavour is to get right balance between environment and those who live, learn, and play here to make sure it lasts long in future. At Muskotia retreat there will be great emphasis for good health. There are planned paved and unpaved trails that will encourage residents to get out and enjoy nature in its most beautiful untouched forest setting. Visit www.muskotiaretreat.com to experience the concept. Jan - Feb 2013
PRODUCT LINE
SCIENTECH TECHNOLOGIES LAUNCHES NEW INFUSION PUMP
SCIENTECH 16B
N
owadays the utilization of infusion pumps is escalating in the community. To make sure that a patient gets the accurate dose, the suitable infusion pump should be prefer for the drug. Scientech 16B Infusion Pump is used to deliver fluids, nutrients or medications such as antibiotics, chemotherapy drugs, and pain relievers, into a patientâ&#x20AC;&#x2122;s body in a controlled manner. It is capable of pumping fluids in large or small amounts. Clinicians and patients rely on Scientech 16B for safe and accurate administration of fluids and medications. Usually, the longer the period of infusion, the more accurate the dose. Scientech 16B, highperformance infusion pump make it trouble-free for hospitals to deliver outstanding patient safety and care. Our comprehensive range includes the most recent and most innovative technology in the market, along with verified, balance systems designed to assist clinical safety and workflow goals. It is compatible with IV sets of any brand with high accuracy and automatic calibration. Having
three different working modes such as; drop counting control, rate control and time control mode. The vital equipment is available in Scientech with unique door free structure and big LCD screen making it easier and more convenient to operate and in the meanwhile avoiding problems of pump stuck and fluid leakage. The advantages of Scientech 16B include unique function of bedside infusion supervision making patient and their relatives more assured while also reducing nurses workload. It gives drug to patient according to time and weight, control the drug delivery rate as well as control drug dose. The other advantage of Scientech 16B is that it having three levels of alarm volume and three levels of occlusion pressure. It consists of KVO function: When finish the infusion, the pump will alarm and enter KVO state also having switch between ml/h and drops/ min freely. Scientech Technologies Pvt. Ltd. is a renowned provider of medical equipments. Our world class products provide user a high degree of quality & reliability.
Scientech offers comprehensive range of medical instruments and technical support. Leveraging the heritage and domain expertise of Scientech, the products encompass a broad technology spectrum and high customer satisfaction across the globe. Our policy is not just offering customers with products but also providing them with prompt technical support. Scientech has 16 branch offices in India & their products are exported to over 52 countries.
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 : csingh@scientech.bz Website : www.ScientechWorld.com 34
Jan - Feb 2013
PRODUCT LINE
S
pencer is a leader in the emergency care equipment field & has a very wide range of products which are available in India. Spencer India is fastest growing company in India in emergency care medical equipments and is known for medical equipments for ambulances, fire & safety, transportation, evacuation & disaster management etc. Spencer is providing more than 1700 products to handle the situations as below:Victim / patient handling/ transportation Evacuation equipments Rescue & protection Immobilization & Pre hospital treatments Resuscitation & suction devices Oxygen therapy & diagnostics Fire & rescue/Burn treatments Training & miscellaneous Our products span from resuscitation and oxygen equipment, suction units, diagnostics, different types of stretchers and chairs, immobilization and extrication devices, triage tools, water and 36
mountain rescue equipment, infusion devices, bags and first aid kits, hypothermia and burn treatment, protection and sterilization, rescue training & all the way to personal accessories and gadgets. The Spencer equipments are used in all types of ambulances, private & government hospitals, large & small nursing homes, military hospitals, research institutes & centers, corporate houses, specialized patient treatment vehicles etc. in India Spencer equipments are already being used in various international and national sports events, emergency situations, and disaster management activities across different states in India Specifically, the Spencer catalogue is also world’s premium catalogue having more than 1700 products for Disaster /emergency care and rescue operations; it is a collector’s edition for the outstanding content. Spencer equipments are supplied in manufacturing and development of hundreds of advanced ambulances in India with advanced medical equipments within a span of few
Manish Malik
(Chief Executive Officer) Spencer India Technologies Pvt. Ltd.
years which are now widely used in India Spencer also provides “Free of Cost” training to ambulance technicians and paramedics all over India for handling patient transports as a CSR activity, Free of Cost” Training to peoples to handle evacuations in case of fire and disaster situations all over India and executing projects on handling any emergency /disaster situation in Schools/ airports/ safety programme etc. Jan - Feb 2013
EXPERT VIEWS
Wearable medical technology set to take off
M
obile health devices that track vital signs are ready to take off. According to a report on wearable technology, which includes devices such as glucose and heart monitors, the market was worth $2 billion in 2011 and will reach $6 billion by 2016. Correspondingly, 14 million wearable devices were shipped in 2011, and that number will likely rise to 171 million in 2016. World market for Wearable technology examines wearable electronic devices used in professional and consumer environments. IMS Research defines these devices as products that are worn on the userâ&#x20AC;&#x2122;s body for an extended period of time and that contain advanced circuitry, wireless connectivity, and can process data. According to the report, several shifts in the market will occur during the next four years that will increase demand for these products among patients as well as healthy individuals. As baby boomers age, theyâ&#x20AC;&#x2122;ll become a primary market for health devices such as blood pressure and glucose monitors that upload up-to-date information to caregivers. Researchers also found that in 2011, glucose monitors accounted for most of the revenue in the health device segment of the market, reflecting Jan - Feb 2013
the need for continuous data on blood glucose levels, particularly in Type I diabetes patients. The dominant wearable products in this category include continuous glucose monitors from Abbott and Medtronic. Wearable technology helps clinicians work more efficiently and extend care outside the hospital environment. When clinicians can collect information on patients anywhere and anytime, the increased knowledge can lead to earlier detection of problems, preventing readmission and resulting in better clinical outcomes. This will decrease the cost of healthcare in the long run. However, these benefits will need to be clearly proven in order for providers to adopt them and for payers to pay for them. Physicians need this data to be integrated into their IT systems, and they will have to change their workflow to accept and use this external data. There will be internal resistance from physicians who are used to standard patient visits. In the long run, once these issues are dealt with, it will lead to greater competition in the hospital and payer markets as patients begin to seek out those health organizations that deploy extended systems of care incorporating wearable technology.
Priyank Kumar Head Bio-Medical Engg. Chandni Hospital Kanpur
Wearable technology helps clinicians work more efficiently and extend care outside the hospital environment.
37
DOCTOR SPEAK
Obese and Pregnant Women Run a Higher Risk of
Developing Rheumatoid Arthritis
A
bout 1% of the world’s population has rheumatoid arthritis, women three times more often than men. Rheumatoid arthritis (RA) usually strikes women in the ages of 25 to 50 who are burdened with heavy work and home responsibilities. However, people of any age can also be affected. One of the main causes of women having a higher risk of rheumatoid arthritis may be obesity or pregnancy. Women who are obese have an 18 to 19 percent higher risk of developing rheumatoid arthritis. Half of the increase in rheumatoid arthritis cases may be linked to rising obesity rates. The impact of obesity on rheumatoid arthritis risk is greater for women which may be due to the fact that women are affected by the disease three times more often than men. Men often develop the condition later in life. “Being overweight has recently been shown by workers at Mayo Clinic in USA to be a risk factor for developing rheumatoid arthritis. Controlling one’s weight not only prevents diabetes and cardiovascular diseases, but it may prevent rheumatoid arthritis as well”, 38
Jan - Feb 2013
DOCTOR SPEAK
says Dr. Anand N. Malaviya, Sr. Consultant Rheumatologist, Indian Spinal injuries Centre. Similarly, smoking has been proven to be a risk factor for rheumatoid arthritis and the development of rheumatoid nodules, a complication of this type of arthritis. Rheumatoid arthritis is an autoimmune disorder that causes inflammation of the joints and also affects other organs in the body. Having excess fat can also contribute to chronic inflammation, a condition that is known to increase the risk of heart ailments and diabetes, and potentially also arthritis. Extra weight around the joints may further accelerate arthritis progression. The effects of pregnancy on systemic rheumatic diseases vary by condition. Thus, pregnancy and rheumatoid arthritis have a complex relationship. In most patients the disease shows improvement with decreasing joint symptoms as the pregnancy progresses resulting in a reduced need for medication. But, the symptoms usually flare up after delivery. In other forms of systemic rheumatic diseases the effect of pregnancy is variable. For example in systemic lupus erythematosus, disease flare, and complications (e.g. kidney involvement) are seen more often during pregnancy. During pregnancy, active systemic rheumatic disease as well as the then necessary medicines to control the rheumatic illness can cause problems. Those diseases Jan - Feb 2013
with the potential to affect the kidney (e.g. systemic lupus erythematosus) are more likely to affect the pregnancy outcome than others. A l t h o u g h rheumatoid arthritis doesn’t seem to harm the developing baby, even if it is active during pregnancy, some women with RA may have a slight risk of miscarriage or lowbirth-weight babies, the vast majority of women have normal pregnancies without complications. There have been reports that rheumatoid arthritis reduces fertility. However, it is not known whether this is a direct result of rheumatoid arthritis. Pregnancy alters the immune state, possibly contributing to a change in the course of rheumatoid arthritis, as mentioned above. Many women, up to 75%, find that the pain and swelling associated with RA is much improved during pregnancy, usually in the second trimester (14-27 weeks) and this is probably due to the normal hormonal changes in pregnancy. This temporary remission normally continues throughout the course of the pregnancy. During the later stages of pregnancy, swelling, backaches and tiredness are common for many women regardless of their RA status. It is important that these normal pregnancy symptoms are not mistaken for
RA problems. “Rheumatoid arthritis itself doesn’t seem to harm the developing baby; however, many drugs for rheumatoid arthritis can cause birth defects. With the right treatment and prenatal care, babies born to moms with rheumatoid arthritis are as healthy and happy as any other baby”, further adds Dr. Anand N. Malaviya, Sr. Consultant Rheumatologist, Indian Spinal injuries Centre. People with RA need a good balance between rest and exercise, with more rest when the disease is active and more exercise when it is not. Patients may get skeptical about few exercises like stretching, which help in keeping the muscle flexible and move joints freely. Low impact aerobic exercises like aerobic dance, water exercises, walking or stationary bicycles help in cardiovascular fitness, controlling weight and improving the overall functionality of the body. 39
EXPERT VIEWS
Design and Effect of Ankle-Foot Orthoses Proposed to
Influence Muscle Tone (AFO) Mohammed Tahir Jamal CEO Edrees Medical Equipments DUBAI
A
Jump start cricket-Most suportive
DAFO-3.5
DAFO-4
DAFO Tami 2-Free Ankle
40
nkle-foot orthoses (AFOs) designed and proposed to influence muscle tone are generally called as “tone-reducing” AFOs, “tone-inhibiting” AFOs, or “dynamic” AFOs. These orthoses were originally evolved from the use of plaster casts to influence the positive support reflex or tonic reflex, which were either triggered by pressing reflexogenous areas on the plantar surface of the foot or suppressed by offloading them. The effects of wearing AFOs to influence muscle tone have mainly been studied in patients with cerebral palsy, stroke, or head injury. Although different AFO designs exist, it seems that there is a lack of evidence to demonstrate that these AFOs can actually reduce or inhibit spastic muscle tone. This article specifically reviews the classification of patient groups recruited in previous studies, the design characteristics of AFOs, and the clinical and biomechanical effects reported. The results of this review suggested that the level of evidence for AFOs being able to influence muscle tone was very low. Therefore, further research with randomized controlled trials is required to investigate their clinical effects. spasticity is one of the most common neurological impairments, which may occur after an upper motor neuron lesion. It is defined as “disordered sensorimotor control, resulting from an upper Jan - Feb 2013
EXPERT VIEWS
motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscle.”This usually involves a lesion of both the pyramidal and parapyramidal systems, which may be caused in association with stroke, spinal cord injury, multiple sclerosis, brain trauma, cerebral palsy, or head injury. Joints that are affected by spastic muscles may develop deformity, pain, weakness, and abnormal movement.Ankle-foot orthoses (AFOs) designed and proposed to influence muscle tone (AFOs with tone-influencing designs) are widely known as “tone-reducing” AFOs, “toneinhibiting” AFOs, or “dynamic” AFOs (DAFOs). These orthoses were evolved from techniques used in the application of plaster casts for patients with spastic muscle tone. These plaster casts were designed to influence the positive support response or tonic reflex, which had been observed in response to cutaneous stimulation of reflexogenous areas on the plantar surface of the feet in patients with cerebral palsy. The theory was then applied to AFO designs. the extent of toe extension induced by the design; • the amount of loading added to areas adjacent to the Achilles tendon insertion point • the effectiveness of the orthokinetic principles applied in the design. Jan - Feb 2013
DESIGN CHARACTERISTICS The design characteristics of the AFOs with tone influencing designs These included nonarticulated AFOs, articulated AFOs, supramalleolar Orthoses and neurophysiological AFOs. However, variations were found in certain pertinent AFO design features within these categories.
41
EXPERT VIEWS
DISCUSSION This article concisely reviewed the current state of knowledge on the effect of the AFOs with tone-influencing designs.The literature search demonstrated that the relevant studies mainly involved patients with cerebral palsy, followed by those with head injury or stroke. Although spasticity is common among these patient groups, it is not clear which of them would benefit the most from these AFOs. Marked variations in AFO design parameters were found, such as 1) The type of AFO (i.e., articulated, nonarticulated, supramalleolar, or neurophysiological) used; 2) The amount of toe extension; 3) The amount of loading on metatarsal heads; 4) The amount of loading at the heel; 5) The amount of loading on the Achilles tendon insertion area; and 6) The alignment of an ankle joint. Although more recent studies adopted DAFOs requires further investigation. The AFOs may have positive effect on gait, posture, and EMG data in patients with spasticity. However, it was not conclusive whether they could actually reduce or inhibit muscle tone. Currently, there is no definitive method to quantify spasticity or muscle tone. This is one of the obstacles in evaluating so-called tone-reducing or tone-inhibiting effects. No significant effect in the median frequency signal26 or 42
Hoffman reflex amplitude of the EMG have been reported with the use of such AFOs. The findings of these studies would question their neurophysiological effect. In addition, some studies showed that AFOs with tone-influencing designs did not have any significant effects in comparison with standard AFO designs.Some studies have also suggested that the AFOs may be recommended for use as an adjunct to appropriate physiotherapy, but they might not be effective if they are used alone. On the basis of the results of this literature review, we conclude that the efficacy of the AFOs with tone-influencing designs (i.e., in reducing or inhibiting muscle tone) has not been sufficiently proven because of the very low level of evidence despite the positive clinical effect reported in previous studies. This is because the study design adopted in precedence studies was not robust enough. The articles reviewed showed an equivalent range of level of evidence of Grade C proposed by Sacket. Indeed, it is difficult to make a strong argument for a particular position on whether AFOs are able to influence muscle tone when the evidence levels are so low. This is in agreement with previous publications. 34,35 Thus, it would not be appropriate to use the term tonereducing or tone-inhibiting for such AFOs until their efficacy is confirmed with grade A evidence level.33 In summary, the following issues need to be further investigated regarding the use of
AFOs with tone-influencing Designs: 1. The classification of patient groups that may benefit from these types of AFOs needs to be more accurately defined. 2. The design parameters used in these types of AFOs need to be more quantitatively defined. 3. The statistical and clinically significant effects of these types of AFOs in comparison with standard AFOs need to be demonstrated with randomized controlled trials. The authors would therefore recommend that future studies should carefully investigate these aspects systematically. CONCLUSION More systematic research with randomized controlled trials is necessary to determine whether AFOs with tone-influencing designs would truly have positive clinical effects. Moreover, it is required to reexamine whether such AFOs do in fact have tonereducing or tone-inhibiting effects while ambulating. If their positive effects are confirmed in future studies, it will be essential to investigate their optimal designs and to demonstrate which group of patients would benefit the most from the AFOs. Jan - Feb 2013
TENDERS
Government Tenders Ref Number: 7132664 Tender Number: W AC/S.3951/2/P4 DATED 21DEC 12 Buyer/Seller: Indian Air Force Requirement: Supply of security equipment lbow & knee pad , light weight portable E stretcher, harness body/seat , gps (with preloaded maps) , light weight 2m tactical tent , poncho, haversack/bagpack , gillie suit, pistol holster , ascenders , m edical kit , field mattress, n avigational compass with map reader m, entrenching tool , stie rope , balaclava , ear plugs , autonomous portable solar generator charger Location: New Delhi - Delhi - India EMD: Rs.366,200 Estimated Cost: R s.18,186,000 Closing Date: 9/01/2013 at 10:00 Hrs. Contact Details: Indian Air Force HQ WAC IAF subroto park, New Delhi India Document Sale To: 9-1-2013 at 10:00 Hrs Ref Number: 7135708 Tender Number: T MC/PRO/412/20012-2013 Buyer/Seller: Municipal Corporation Of Thane Requirement: Supply of operation table equipments 6 nos for various operation theaters of chhatrapati shivaji maharaj hospital Share Like Tender Detail: For further details, contact the undersigned Gaurav Ravrani e-Procurement Technologies Ltd. (abcprocure) A - 201-208, Wall Street - II / Opp. Orient Club, Near Gujarat College, Ellisbridge, Ahmedabad - 380006 Gujarat (India) WLL No. - 079-40005400 / 21 / 22 / 31 / 44 / 66 / 75 / 88, Fax No.-079-40016876 Cellular-09687990222, E-mail : gaurav@ abcprocure.com / rps@abcprocure.com Website : www.DigitalTenders.in / www. abcprocure.com
Neonatal Trolley With Warmer (Bed), ICU Ventilator, Central Oxygen & Suction Air Compressed & Microarray System Location: Jaipur - Rajasthan - India Document Fees: Rs.400
Closing Date: 18/01/2013 at 16:00 Hrs.
Closing Date: 18/01/2013 at 16:00 Hrs.
Document Sale To: 18-1-2013 at 15:00 Hrs
Contact Details: S. M. S. Medical College And Controller Of The Attached Hospitals, Jaipur
Ref Number: 7041965
Rajasthan, India Ref Number: 7006159 Tender Number: NEIGR/SP/OT-48/2012-13 Buyer/Seller: North Eastern Indira Gandhi Regional Institute Of Health & Medical Sciences Requirement: Procurement of Equipments & Instruments - C â&#x20AC;&#x201C;Mac Video Laryngoscope, Anesthesia Cart, Patient Transfer System, Blood Salvage System, Volumetric Infusion Pump, Power Infuser, Emergency and Transport Ventilator for new Operation Theatre Location: Shillong - Meghalaya - India
Tender Number: C/8437/BKP/02/E8 Tender Prod. No: C/8437/BKP/02/E8 Buyer/Seller: Military Engineer Services Requirement: Provision of Furniture of Avionics Lab and I Level repair facility. at AF Station under GE (AF). Location: Medinipur-West Bengal-India Document Fees: Rs.500 EMD: Rs.11,000 Estimated Cost: Rs.5,050,000 Closing Date: 7/01/2013 at 15:00 Hrs.
EMD: Rs.145,000
Contact Details: Under Chief Engineer Military Engineer Service, AF Station Kalaikunda Post
Estimated Cost: Rs.7,250,000
West Midinapore, West Bengal, India
Closing Date: 17/01/2013 at 14:00 Hrs. Contact Details: North Eastern Indira Gandhi Regional Institute Of Health & Medical Sciences
Ref Number: 7140303
Shillong, Meghalaya, ndia
Buyer/Seller: Department Of Higher Education
Document Sale To: 17-1-2013 at 14:00 Hrs
Tender Number: 2012_MHRD_61206_1
Ref Number: 7079330
Requirement: Supply of laboratory fume hood with acid storage cabinet having pvc coated shelf kit and built in blower
Buyer/Seller: Private Company
Location: Jodhpur - Rajasthan - India
Requirement: Providing and installation of Furniture at office of the principal UOTC Surabardi for trainees hostel, administrative building & hospital furniture.
Document Fees: Rs.200
Location: Nagpur - Maharashtra - India Document Fees: Rs.1,000 EMD: Rs.61,740
Document Fees: R s.651
Closing Date: 5/01/2013 at 15:00 Hrs.
EMD: Rs.180,000
Contact Details: Unconventional Operation Training Centre, Surabardi, Nagpur Maharashtra, India
Contact Details: M unicipal Corporation Of Thane, Maharashtra, India
Ref Number: 7116583
Document Sale To: 10-1-2013
Tender Number: 2 012_SMSMC_4373_1 Tender Prod. No: 2012_SMSMC_4373_1
Ref Number: 7157797
Buyer/Seller: S M S Medical College
Buyer/Seller: S. M. S. Medical College And Controller Of The Attached Hospitals
Requirement: Purchase of Neonatal Trolley With Warmer
Requirement: Supply of Multipara Monitor,
Location: Jaipur - Rajasthan - India
44
Estimated Cost: INR5,500,000
Estimated Cost: Rs.13,000,000
Estimated Cost: Rs.6,174,000
Closing Date: 1 1/01/2013 at 16:00 Hrs.
EMD: INR110,000
Contact Details: Principal, S. M. S. Medical College, Jaipur, Principal, S. M. S. Medical College, Jaipur, Rajasthan, India
EMD: Rs.260,000
Location: Thane - Maharashtra - India
Estimated Cost: R s.18,000,000
Document Fees: INR400
EMD: Rs.32,000 Estimated Cost: Rs.1,600,000 Closing Date: 14/01/2013 at 15:00 Hrs. Document Sale To: 14-1-2013 at 9:00 Hrs Ref Number: 7144714 Tender Number: KH/NIT/2012/81 Tender Prod. No: KH/NIT/2012/81 Buyer/Seller: M unicipal Corporation Of Delhi Requirement: Purchase of Crash Cart for HDU in Gynae deptt.- Kasturba Hospital Location: New Delhi - Delhi - India Document Fees: INR150 EMD: INR625 Estimated Cost: INR25,000 Closing Date: 14/01/2013 at 00:00 Hrs. Contact Details: Municipal Corporation of Delhi, New Delhi, India
Jan - Feb 2013
TENDERS
Ref Number: 7052399 Tender Number: 1 2-13/8268-70 Buyer/Seller: District Hospital Requirement: Supply of Miscellaneous Equipments/Tools/Furniture for Various Department of Hospital. Location: Jaunpur - Uttar Pradesh - India Document Fees: R s.1,000 Closing Date: 12/01/2013 at 14:30 Hrs. Contact Details: D istrict Hospital, Jaunpur Uttar Pradesh, India Document Sale To: 3 1-12-2012 Ref Number: 7039007 Tender Number: u m4550-pur-0029-2012-13 Tender Prod. No: u m4550-pur-0029-2012-13 Buyer/Seller: Western Coalfields Limited Requirement: Procurement of Fowler Bed fully automatic, Revolving stool & Bed side trolley for Area Hospital at Area
Anesthesia Machine Ref Number: 7153359 Tender Number: 2012_HFWD_27317_1 Tender Prod. No: 2012_HFWD_27317_1 Buyer/Seller: Department Of Health And Family Welfare Requirement: Supply of Anesthesia Machines (T/E No. 138/1 and Quantity 22 Nos) Location: New Delhi - Delhi - India EMD: INR440,000 Closing Date: 17/01/2013 at 11:00 Hrs. Contact Details: Spl.Secretary (HFWD) Department of Health and Family Welfare Equipment Procurement Cell 9th Level, A Wing, Delhi Secretariat, I.P. Estate Near I.T.O., New Delhi-110002, India Tel.No.s 91 011 23392160 and 23392001 Extn.1901 Document Sale To: 16-1-2013 at 18:00 Hrs
Location: Nagpur - Maharashtra - India
Ref Number: 7159525
EMD: INR4,258
Buyer/Seller: Department Of Health
Estimated Cost: I NR212,890
And Family Welfare
Closing Date: 8/01/2013 at 15:00 Hrs.
Requirement: Supply, Installation & Commissioning of Anesthesia machines, Anesthesia monitors, 3T MNRI Machines (on turnkey basis), Refrigerators, Centrifuges, High Dose Rate Brachytherapy Remote Controlled (on turnkey basis) & Radiotherapy Simulator with cone Beam CT (on turnkey basis) for Various Hospitals under the Government of NCT
Contact Details: D D Rampurkar,07116-247273 Office of the General Manager, WCL, Umrer Area, Umerer (Dist Nagpur) Document Sale To: 7 -1-2013 at 15:00 Hrs Ref Number: 7150778 Tender Number: G H-I-1-2012/33253 Tender Prod. No: G H-I-1-2012/33253 Buyer/Seller: Department Of Health Requirement: Supply of I/v stand . Location: Chandigarh - Punjab - India EMD: INR4,000 Estimated Cost: INR200,000 Closing Date: 8/01/2013 at 11:00 Hrs.
Location: New Delhi - Delhi - India Closing Date: 15/01/2013 at 00:00 Hrs. epartment of health & Family welfare D eqiupment Procurement cell 9th Level A-wing Delhi Secretariat, I.p> Estate Nr. I.T.O. New Delhi 110002 e-mail s pl.secyhealth@gmail.com Tel +91 011 23392160
Contact Details: D r Chander Mohan 01722700255, 01722700255 Director Health Services, General Hospital, Sector 16, Chandigarh Document Sale To: 8 -1-2013 at 11:00 Hrs Jan - Feb 2013
45
EXPERT VIEWS
Ultrasound Stethoscope from Concept to Reality
Gp Capt (Dr) Sanjeev Sood Hospital and Health Systems Administrator Air Force Hospital, Chandigarh
A
cardiologist friend of mine recently remarked that he is quitting his stethoscope for a handheld portable ultrasound unit. “Why listen to ‘lub dub’ when I can see everything?” He quipped. So, does that sound death knell of this ubiquitous device resting atop the white coat, as a symbol of medical profession? Over the past two decades, ultrasound equipment has become more compact, higher quality, and less expensive, which has facilitated the growth of point-of46
care USG. What is PoC Ultrasound? PoC ultrasonography is defined as ultrasonography performed by a provider at a patient bedside by a handheld, pocket-sized tool powered by technology that enables visualization of images in a real time. These real-time dynamic images can be obtained and used immediately, rather than images recorded and interpreted later, allowing findings to be directly correlated with the patient’s condition. It is easily repeatable
if the patient’s condition changes. In a way this versatile device can perform many functions over and above the stethoscope, such as procedural guidance for vascular access. This innovative technology lead to the concept of an ‘ultrasound stethoscope’ that has now become a reality. PoC ultrasonography is optimized for high-quality abdominal, urological, cardiac, obstetric and pediatric imaging—helping one to provide more efficient patient care. With appropriate use, PoC Jan - Feb 2013
EXPERT VIEWS
ultrasonography can decrease medical errors and referrals, provide more efficient real-time diagnosis, and supplement or replace more advanced imaging in appropriate situations allowing less-expensive screening for defined indications. It is used by various specialties in diverse settings that can be broadly divided into procedural, diagnostic, and screening applications, such asa) To visualize an area of pain. b) Thoracic/pleural motion and fluid detection. c) Procedural guidance for vascular access. d) Measurement of the size of the urinary bladder and blood vessels like aorta e) Assessment of left ventricular function. f) Conduct basic prenatal Jan - Feb 2013
evaluation and assessment of fetal position, and the visualization of the uterus and ovaries. g) Scan of the kidneys and urinary bladder. A word of caution However, indiscriminate use of ultrasonography could lead to further unnecessary testing and interventions in the case of false positive findings, or inadequate investigation of false negative findings. Overuse could simply lead to added cost without added benefit, or might even be harmful. As a user-dependent technology, PoC ultrasonography requires consideration of appropriate training and quality assurance. PoC Ultrasound- Supplement not substitute to stethoscope On the other side of the coin, experts have weighed in that
handheld systems are likely to be used in conjunction with stethoscopes, complementing the stethoscope rather than simply replacing it. Stethoscopes still have their use, according to supporters, and costs will prohibit the exclusive use of handheld systems. The use of PoC ultrasonography will continue to diffuse across medical specialties and care situations. Future challenges include gaining a better understanding of when and how to use this effectively, determining the training and assessment that will be required to ensure competent use of the technology. However, its use being regulated under PCPNDT Act, 2003, fulfilling the legal hurdles shall be the biggest impediment to its widespread adoption. 47
SHOW REVIEW
HospiArch 2012 India’s BIGGEST Conference series
on Hospital Planning, Design & Architecture Resounding Success at Chennai, Hyderabad, Mumbai, Bangalore, Kochi and Delhi in 2012
The demand for Hospital beds in India is expected to be around 2.8 million by 2014 to match the global average of 3 beds per 1000 population from the present 0.7 beds. India needs 100,000 beds each year for the next 20 years at over US $ 10 billion per year. Understanding these statistics, 2 young Healthcare entrepreneurs planned to conduct a series of Conferences on Hospital Planning, Design & Architecture across the country and succeeded. HospiArch is the brainchild of Paniel Jayanth & Tarun Katiyar, respective founders of AMEN and HOSPACCX India Systems and was designed to create a platform for Doctors, Entrepreneurs, Consultants and Architects etc. who are aspiring to build new hospitals. The Conference series covered 6 places in 2012 namely Chennai, Hyderabad, Mumbai, Bangalore, Kochi and Delhi. The first HospiArch 48
Conference was conducted at Chennai in January 2012 and continued to Hyderabad in April, Mumbai in June, Bangalore in August, Kochi in September and Delhi in November. Each conference saw a participation of more than 150 delegates comprising of Entrepreneurs, Hospital promoters, CEOs, Administrators, Architects and Students. The topics, strategically designed by Mr. Paniel, were one of the main reasons for the success of the Conference series as they brought about efficient speakers to present on them and prolific discussions within the audience. Some of the Key Topics included: • Architectural challenges involved in Building a New Hospital; • Planning & Designing a New Hospital ; • Re-planning & Redesigning
Tarun Katiyar
Principal Consultant Hospaccx India Systems, Mumbai
an existing Hospital; • Budgeting & Financial Planning for a New Hospital Project; • Quality standards applicable to Hospital Planning; • Planning a GREEN Hospital; • Manpower Planning for a New Hospital; • Planning & Designing Lab and other Diagnostic areas of the Hospital; Some of the Key speakers included : • Dr. Alexander Kuruvilla, CEO, Medica Synergie Pvt. Ltd., Bangalore; • Mr. Anil Maini, Executive Jan - Feb 2013
SHOW REVIEW
• •
• • •
• • • • •
•
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Director, Moolchand Medicity, New Delhi Dr. Anilkumar Mulpur, VP & Clinical Director, Narayana Hrudayalaya, Hyderabad (Hony) Brig. Dr. Arvind Lal, Chairman and Managing Director, Dr. Lal Path Labs, New Delhi; Dr. Arun Sharma, Medical Suptd., Govt. Hospital, Jammu; Mr. Asoka Katakam, Architect, Katakam Associates, Hyderabad Dr. Chandrashekar R, Chief Architect, Central Design Bureau for Medical & Health Bldg., Ministry of Health & FW, Govt.of India. New Delhi; Mr. Gaurav Malhotra, Managing Director and CEO, Patni Healthcare, Mumbai; Ms. Jagruthi Bhatia, Director - Lead Healthcare Advisory Services, KPMG, Mumbai; Mr. Lakshman Gowda T L, CEO, The Cradle, Calicut Dr. S Manivannan, Joint Medical Director, Kauvery Hospital, Chennai; Dr. (Wg Cdr) M.D. Marker, Medical Director, Bhagwan Mahaveer Jain Hospital, Bangalore Ms. Monika Kejriwal, GM, Healthcare Planning, Chaithanya Projects Pvt. Ltd., Bangalore; Mr. Nagappan, GM Materials, Apollo Hospitals, Chennai; Dr. Parvez Ahamad, Group Medical Director, Rainbow
Jan - Feb 2013
• • • •
•
• • • • • • •
Children’s Hospital, Hyderabad; Dr. Pradeep Bhardwaj, CEO, Six Sigma Healthcare, New Delhi Mr. Radhakrishna, CEO, Narayana Hrudayalaya, Hyderabad Dr. Rajeev Boudhankar, Vice President, Kohinoor Hospitals, Mumbai Mr. Ratan Jalan, Founder & Principal Consultant, Medium Healthcare Consulting, Hyderabad; Dr. P S Reddy, G M Hospital Administration, Kamineni Institute of Medical Sciences Hospital, Hyderabad Mr. Sandeep Shikre President + CEO, SSA Architects, Mumbai Dr. Sanjeev Singh, Medical Suptd., Amrita Institute of Medical Sciences, Kochi; Dr. N Sethuraman, Chairman, Meenakshi Mission Hospital, Madurai; Ms. Sujayanti Dasgupta, Associate, HKS, Chennai Ms. Susee Papinazath, Managing Director, Skydome Designs, Chennai; Dr. Varma Vagesna, Vice Chairman & MD, Lazarus Hospitals, Hyderabad; Dr. Vivek Desai, Managing Director, HOSMAC India Pvt. Ltd., Mumbai
“Owing to the success of the series and immense motivation gained from more than 700
Paniel Jayanth
Founder and Chief Strategist AMEN, Bangalore
participants and 25 Sponsors and Partners across the country in 6 cities, we are glad to announce HospiArch 2013, and spread our knowledge platform of perfecting architectural designing and meeting the numbers needed to match the growing need in patient care” announced Mr. Paniel. HospiArch 2013 would be held at 12 different places of the country in 12 months starting from Vijayawada on Jan 24th 2013. The list of places for 2013 include: • Vijayawada • Chandigarh • Pune • Coimbatore • Kolkata • Ahmedabad • Indore • Guwahati • Lucknow • Jammu • Jaipur and • Trivandrum
49
PRE EVENT SHOW
Meditec Clinika - A prescription for growth in the Indian Medical and Healthcare sectors
L
ately, the huge opportunities for growth within the domestic and global medical and healthcare sectors have attracted the attention of Indian industry. Technology in the last two decades has revolutionized the way healthcare is delivered worldwide. It has greatly aided patients and providers alike by enhancing the quality of delivery, reduction in turnaround time of workflows and thus the overall cost. The Indian healthcare market was estimated at US$ ?? billion in 2010, and has registered double digit growth rates in recent years. However, this growth is largely triggered by demand from major cities. India’s healthcare system is paradoxical - on one hand, it boasts of ‘best in class’ healthcare delivery attracting medical tourists from across the world, and on the other, it is characterised by a near absence of accessible, affordable quality health services 50
for a large part of its population. An effective and innovative use of medical technology has the potential of increasing access, significantly reducing the burden of disease and the load on healthcare delivery services through early diagnosis, better clinical outcomes, less invasive procedures and shorter recovery times. Currently, the market for medical technology in India is nascent and highly fragmented with limited indigenous manufacturing and imports constituting over 75% of the estimated US$2.75 billion market. However, the industry has experienced some key impediments to growth. The foremost among these is the lack of - affordability, accessibility, awareness and availability. Increasing penetration of medical technology to improve health standards in India was the key challenge. The solution lies in medical
technology innovation as the tool to make modern care accessible, available and affordable to all by lowering the cost of the product or delivery. Innovation need not only be restricted to products. Business model innovation across the value chain (manufacturing, distribution, marketing etc.) and minimising wastage, can often generate significant benefits to all stakeholders, including patients/ end users. For innovation to make an impact, collaboration between the stakeholders in the medical technology ecosystem is a key success factor. All stakeholders — government, industry, academia, healthcare and insurance providers - need to co-ordinate/ strategise and move in sync for their actions to bring about a lasting change. Existing health care delivery mechanisms are inadequate to meet the ever-growing needs of the Indian population, especially in smaller towns/ rural areas. Jan - Feb 2013
PRE EVENT SHOW
The limited healthcare facilities available in the country are tilted more in favour of the affluent classes. At the high end, India has world-class doctors, clinics and technologies, and attracts international medical tourists in growing numbers. While majority of the population resides in rural areas, doctors and hospitals are largely concentrated in cities. Good quality private healthcare is out of reach for majority of India’s people. Government support/ subsidies alone are not enough to cater to the healthcare needs of this segment. There is a need to use medical technology effectively to address the yawning gap between demand and supply of healthcare services in India. Innovative products and business models are needed to make healthcare affordable and accessible to a larger percentage of the population. At the high end, India has world-class doctors, clinics and technologies, and attracts international medical tourists in growing numbers. However, even today, majority of India’s population cannot afford anything better than basic healthcare. There was thus a need for a platform for manufacturers, distributors and buyers to converge and understand the potential of the Indian Medical and Healthcare sectors while addressing the major issues facing the industry. Meditec Clinika 2013 by Orbitz Exhibition Pvt Ltd to be held from 16-18 March 2013 at KTPO Jan - Feb 2013
Trade Fair Centre, Bengaluru, is the year’s most important event for the Indian medical sector. Now in its 4th edition, it is an indispensable rendezvous for buyers & sellers of medical and hospital equipment and supplies at a global level showcasing emerging medical technologies and top-of-the-line medical and healthcare equipment. It is unique in that it encompasses and focusses on Hospital Infrastructure and Healthcare with two concurrent events namely Meditec HospiInfra and Meditec- Health which broaden its scope and further consolidates it. Meditec HospiInfra is dedicated to Hospital Infrastructure with a special focus on renovation/redevelopment of old and dilapidated hospitals. Meditec Health covers in its ambit the entire spectrum of health, fitness and wellness related products and services. Meditec Clinika consistently attracted many overseas exhibitors and visitors in addition to top Indian manufacturers, suppliers and key decision makers from the medical fraternity. The top draw are the interactive sessions with renowned international speakers at the value-added conferences. Moreover, it is the only Medical & Healthcare Exhibition supported by the Association of Medical Consultants (AMC)- the fastest growing Associations of Specialist Doctors representing more than 7000 key medical Consultants & Hospital owners. Bengaluru is the proven
hub of medical technology and healthcare services in Southern India. It is one of the fastest growing Indian cities and is easily accessible by road, rail and air from anywhere in India. Most international flights land at Bengaluru. Its burgeoning IT sector has set the grounds for innovations and excellence in healthcare. It has created an affluent and health conscious audience with enhanced awareness about health/fitness. This has further fuelled the demand for, and the subsequent growth of, new-age hospitals equipped with path-breaking medical technology. Bengaluru is home to a 7-star hospital besides having numerous multispeciality hospitals. The “reverse brain drain” has brought in highly qualified professionals from overseas to work here. Karnataka Trade Promotion Organization( KTPO) is a premier venue for all trade fairs and expos happening in the city. KPTO was established to meet the growing needs of industrialization and the rapid growth of business. All major domestic and international expos are held here. The state-ofthe-art exhibition centre is spread over 50 acres of land and has an air-conditioned Exhibition Hall of 5,371 square meters. Those who are associated with the Indian Medical and Healthcare industry and keenly tracking its growth potential, would therefore not take a chance to give Meditec Clinika 2013 a miss. 51
BUSINESS SECTIION
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RNI No. DELENG/2010/33833