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Volume V || Issue V || Jauary-February 2015

The Gateway to Health & Medical World

Radiology and Medical

Devices Sector

Advances in Renal cell carcinoma

Urology

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News Update | Doctor Speak | Expert Views | Product Line | Interview | Healthcare Management

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Editor’s note

magazine

As part of Prime Minister Narendra Modi’s Make in India push

Volume - V Issue - V January-February 2015

Editor

…Medical Device Market Prime Minister Narendra Modi has made ‘Make in India’ one of the thrust areas of the government, but its own taxation policies seem to push in the opposite direction when it comes to medical devices. While duties on inputs for device manufacture remain very high, making it unviable to manufacture devices in India, duties on finished goods have been steadily reduced and in some cases like cardiac stents even brought to zero. This and some other policies incentivize importing finished goods rather than manufacturing them here.I would like to urge policy makers and govt. official look into matter and do something for medical device industry.

The medical industry is undergoing rapid and pervasive change.New approaches to patient-centered care will address the whole of their lives rather than focusing on specific episodes for treatment. The traditional medical equipment technology (MET) market is therefore likely to lose more and more of the growth potential it has displayed over the past decade. It is therefore crucial for companies in the sector to find new approaches to maintain growth as disruptive innovation in this high-tech area becomes increasingly hard to achieve.

The X-ray detectors market size, in terms of value, is expected to reach $2,552.7 million by 2019 from $2,009.7 million in 2014, at a CAGR of 4.9%. Major factors driving the growth of this market include government support and venture capital investments, declining cost of FPDs, growth in aging population, and rising prevalence of diseases.

Dr Pradeep Bhardwaj

Chief Editor Editorial Advisor

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

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EXPERT Contents Update

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50 NEWS FDA approves Opdivo for for advanced...

8 Symbiosis International University (SIU)...

10 Shri Shripad Yesso Naik at CII...

12 President launches Pulse Polio Programme for 2015... 13 Dr. Mohan’s Diabetes Specialities Centre...

18 Doctor Speak

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Fainting: A benign thing, or a

Advances in

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Radiology and Medical

harbinger of death?

Devices Sector

& Dynamic Entrepreneur Young

32

Understanding

Cardiac Emergencies

56

MYTHS AND REALITIES OF CORONARY HEART DISEASE

Advances in

Renal cell carcinoma

44

34

58

Differential Diagnosis of

Abdominal Distention Revolutionizing Oral Dentistry through Digital Imaging 8

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Hospital Mergers

and Acquisitions

www.m e d e g a t e t o d a y. c o m Januay-February 2015

Oral Health FOR CHILDREN

Doctor SPEAK

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News UPDATE

FDA approves Opdivo for advanced melanoma T he U.S. Food and Drug Administration today granted accelerated approval to Opdivo (nivolumab), a new treatment for patients with unresectable (cannot be removed by surgery) or metastatic (advanced) melanoma who no longer respond to other drugs.

Melanoma is the fifth most common type of cancer in the United States. It forms in the body’s melanocyte cells, which develop the skin’s pigment. The National Cancer Institute estimates that 76,100 Americans will be diagnosed with melanoma and 9,710 will die

from the disease this year.

Opdivo works by inhibiting the PD-1 protein on cells, which blocks the body’s immune system from attacking melanoma tumors. Opdivo is intended for patients who have been previously treated with ipilimumab and, for melanoma patients whose tumors express a gene mutation called BRAF V600, for use after treatment with ipilimumab and a BRAF

FDA clears test that helps predict the risk of coronary heart disease

Study data show test predicts risk better in black women he U.S. Food and Drug Administration today cleared a new screening test that predicts a patient’s risk of future coronary heart disease (CHD) events, such as heart attacks.

FDA cleared the test for use in all adults with no history of heart disease, but studies submitted by the company and reviewed by the FDA show that the test is better at discerning this risk in women, particularly black women.

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“A cardiac test that helps better predict future CHD risk in women, and especially black women, may help health care professionals identify these patients before they experience a serious CHD event, like a heart attack,” said Alberto Gutierrez, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. “We hope the clearance of this test will improve preventative care and reduce CHD-related mortality and morbidity in these patients.”

The PLAC Test for Lp-PLA2 Activitymeasures the activity of lipoprotein-associatedphospholipase A2 (Lp-PLA2) in a patient’s blood. Lp-PLA2is a biological marker for vascular inflammation, a condition associated with the buildup of plaque in the arteries that supply blood to the heart.

Over time, this buildup can result in a narrowing of the arteries and lead to CHD. Patients with test results that show Lp-PLA2activity greater than the level of 225 nanomoles per minute per milliliter (nmol/min/mL) are at increased risk for

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a CHD event. Patients with test results below this level are at decreased risk for a CHD event.

According to the U.S. Centers for Disease Control and Prevention, heart disease is the leading cause of death in the United States for people of most racial/ethnic groups, including blacks, Hispanics, and whites. People of all ages and backgrounds are at risk of heart disease and around the same number of men and women die of the disease each year. The most common type of heart disease is CHD, killing more than 385,000 people annually.

Almost two-thirds of women and half of men who die suddenly of CHD have no previous symptoms.

News UPDATE

Symbiosis International University (SIU) Signs Memorandum of Understanding with National Centre for Cell Science (NCCS), DBT, Ministry of Science and Technology, Government of India Symbiosis International University (SIU) and National Centre for Cell Science (NCCS), an autonomous flagship Institute of Department of Biotechnology, Government of India signed a Memorandum of Understanding on 4th December, 2014 for education, training, and fostering quality research in biotechnology, scientific knowledge sharing and promoting inter-institutional cooperation. The partnership is an important initiative which aims to significantly impact the biotechnology and healthcare landscape.

The MOU was signed in presence of Hon’ble Chancellor, SIU Padma Bhushan Dr. S.B Mujumdar, Principal Director Dr. Vidya Yeravdekar, Vice Chancellor Dr. Rajni Gupte, Dean FOHBS Dr. Rajiv

Yeravdekar, Director SSBS Dr. Vinay Rale and Director, NCCS Dr. Shekhar Mande, Dr. Yogesh Shouche and Dr. Manoj Kumar Bhat of NCCS.

Transfers of technology by the Government Of India to leading medical MSME for Mass Manufacture of World’s First Mobile Microwave based Medical waste disinfection device Ministry of Communications and Technology, DeitY, through National e- Governance Division celebrated “Good governance Day” on the 25th of December, 2014.

This event showcased good governance initiatives and various projects undertaken by DietY and its associated agencies.

As one of the exemplary initiatives of DietY towards good governance in the area of responsible health care systems, the event showcased the invention of an incredible Microwave Medical waste Disinfection System – The OptiMaser TM invented by the Society of Applied Microwave Electronics Engineering & Research (SAMEER), an autonomous body of Ministry of Communications and Technology, DeitY, GoI,.

The event also hosted the official Transfer of Technology (ToT) by SAMEER, DietY to S.S. Medical Systems (I) Pvt. Ltd., (India’s fastest growing Medical MSME) for the mass manufacture of the OptiMaser TM..

The ToT was officially awarded by the Honorable Minister of Communications and Technology, Shri Ravi Shankar Prasad to Mr. Monish Bhandari, the Executive Director of S.S. Medical Systems (I) Pvt. Ltd. being recognized for their wider establishment in Health Care Centers to ensure responsible and sustainable health care system.

Key features of OptiMaser™ (a Microwave Medical Waste Disinfection System) ÂÂ A totally indigenous medical device for the treatment of highly Infectious biomedical waste Onsite, based on contemporary non burn alternate technology. ÂÂ Kills all virulent Microorganisms including (Bacterial

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spores, Viruses of HIV, Hepatitis, AIDS, Vegetative germs, Fungi, Parasites etc., ) within a cycle time of 27 minutes at 90 0 C, with high level of disinfection ranging from 105- 107 log highest known to man (Efficacy test done by Haffkine Institute, Mumbai) ÂÂ It is resource efficient with low carbon footprint as it requires low quantities of water (1 kg/cm2(g)), very little power consumption (1-3 KWH)and can also run on solar power. ÂÂ Eliminates the chances of Secondary Infection, Hospital Acquired Infection (HIV, AIDS, Tuberculosis, Hepatitis….) caused during storage and transport ÂÂ Ensures zero misuse/reuse by safely disinfecting metallic needles, syringes, plastics, blood bags etc. in medical waste ÂÂ Highly automated PLC based, plug and play device, requires zero skilled manpower The device is in line with our Honorable Prime Minister’s initiative for Swachh Evam Swasthya Bharat.

News UPDATE

Shri Shripad Yesso Naik at CII Health Summit: Time to make “Health for All”a reality

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hri Shripad Yesso Naik, MoS, Ministry of Health & Family Welfare said that it is time to make ‘Health for All’ a reality, here today. He stated that people of the country should have access to affordable and quality healthcare. The health strategy of the government needs to take healthcare to the doorstep of the people.The Minister stated that skilled and trained manpower formed a critical component of this strategy. Shri Shripad Yesso Naik was delivering the keynote address at the 11th India Health Summit organized

by CII on the theme “Health for All: Call for Action”.

The Minister highlighted the initiatives of the Ministry of Health & Family Welfare in providing healthcare in the country, including achievements under the National Health Mission, the Universal Immunisation Programme for the children, providing healthcare services for mother and child, and addressing challenges posed by non-communicable diseases such as diabetes, cancer, hypertension etc. Shri Naik stated that significant achievements have been achievements in addressing TB and Malaria, while there are concerted efforts being made to eliminate Filaria and Kala Azar. The Minister said that efforts are being made to reduce the Out of Pocket expenses on healthcare by the common man in the country, which are substantial. The National Health Assurance Mission is a noteworthy step in this direction, he mentioned.Shri Naik stated that technology can be effectively used to bridge the geographical distance. Telemedicine is being used to address the constraints and challenges of the terrain in the country, he informed.

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The Health Summit is a timely opportunity to talk on the topic of “Health for All”, the Minister said. He added that all stakeholders in the healthcare sector need to work towards this aim.

Shri Lov Verma, Secretary, Ministry of Health & Family Welfare, in his address highlighted the primary pillars of the National Health Assurance Mission which include preventive and promotive healthcare; provisioning of free essential drugs, diagnostics and healthcare services; and strengthening the tertiary tier.The key concerns in healthcare in the country are equity, affordability, accessibility and quality, he noted. He stated that while we are ahead on the globalparameters in MMR, we are well on way to achieve the MDG milestone for IMR and below-five mortality rates.

The summit will have panel discussions and presentations on topics such as economics of healthcare deliver; challenges of sustainability in quality healthcare delivery; real solutions in virtual healthcare; preparing workforce for meeting the challenges in healthcare; Make in India: unlocking the potential in healthcare sector; and Swachh and Swastha Bharat: laying the foundation of a healthier India.

Present during the inaugural session of the two-day 11th India Health Summit were Dr Naresh Trehan, Chairman, CII National Committee on Healthcare; Shri Harpal Singh, Chairman Emeritus Fortis Healthcare Ltd., and Shri Rahul Khosla, Co-Chairman, CII National Committee on Healthcare.

News UPDATE

President launches Pulse Polio Programme for 2015

Shri J P Nadda credits sustained hard work and support of volunteers and partners for ‘Polio Free India’ The President of India Shri Pranab Mukherjee launched the Pulse Polio programme for 2015 by administering polio drops to children less than five years old, at the Rahstrapati Bhawan, here today.

Tomorrow is the National Immunization Day. Around 174 million children of less than five years across the country will be given polio drops as part of the drive of Government of India to sustain polio eradication from the country.

Speaking at the function on the eve of the National Immunization Day, the Union Minister for Health & Family Welfare Shri J P Nadda applauded the sustained hard work of nearly 23 lakh volunteers and 1.5 lakh supervisors, along with donor partners for eradicating polio from India. The Health Minister stated that there has been no case of wild polio since 13 January 2011. India was certified Polio Free last year, and is part of the 11 countries of South-East Asia Region of WHO (along with Bangladesh, Bhutan, Democratic People's Republic of Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste) which are polio free.

Affirming that India is looking forward to playing a major role in the implementation of “Polio endgame strategy”, the Minister informed about introduction of inactivated polio vaccine in routine immunization program and a switch from trivalent OPV to has also been issued as per WHO guidelines to bivalent OPV six months later in a synchronized vaccinate all travellers who are travelling between manner globally.

India and eight polio-infected countries comprising The Health Minister stated that efforts to keep the Pakistan, Afghanistan, Nigeria, Cameroon, Syria, country polio free are being sustained. Being mindful Ethiopia, Somalia & Kenya. Moreover, Emergency of the risk of importation from other countries Preparedness and Response Plan (EPRP) has been including the neighbourhood, immunity against polio infection is maintained through National and put in place under which Rapid Response Teams Sub National Polio rounds along with sustained (RRT) have been formed in all States/UTs to high quality polio surveillance. A travel advisory respond urgently to any importations.

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Interview

Akhil Solutions: Simplifying Healthcare with“Miracle” Range of Software Solutions

“MIRACLE” for the Healthcare Sector

Sanjay Jain Managing Director Akhil Systems Pvt. Ltd.

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With continued focus in the healthcare sector, Akhil Systems has been providingsolutions to numerous health institutions a user friendly range of software products over the years. Itis an interactive solution for locating any type of information related to patients and hospital as well. It’s a comprehensive solution comprising of specialfeatures such as electronic charting, electronic prescriptions, document scanning, bar code recognition, strong billing, and Corporate & Insurance management integrated with financial accounting. It also offers an integration facility to manage Q-systems, SMS Gateways, e-mails, lab reports and web portals with dedicated post implementation support services.“This indicates the capability of our solution

Interview SPEAK

to be implemented on a large scale for delivering Radiology Information Systems (RIS) better operational efficiencies,” adds Sanjay. ÂÂ A web based RIS is the platform for a more intelligent Recently Akhil systems have successfully launched approach to imaging, one that takesfull advantage MIRACLE EMR App. On Mobile and coming soon of the information residing in RIS with Patient Portal and New Concept of Akhil Pharmacy Information Systems (PIS) Health World. ÂÂ A web and cloud based solution used to manage warehouse and retails. Also enable users to order, Products and solutions developed by Akhil Systems purchase, distribute and report data. enable healthcare entities to enhance productivity EMR App. On Mobile & Tablets and quality of work.

An array of MIRACLE products range

ÂÂ MIRACLE EMR App. for doctors is an innovative, point of care solution that enhances the healthcare ÂÂ Hospital ERP which Provides automated supplypractice experience. Now, Doctors can have easier, chain with reduced costs that is used for handling secure access to patient data on real time basis bills, administration, clinical and business through their mobiles. intelligence.

Hospital Information System (HIS)

Electronic Medical Records (EMR) ÂÂ Helps in e-prescribing, electronic lab orders and exchange of clinical data for various specializations between doctors & patients. Also, incudes all specialty templates like cardiology, oncology, gynecology etc.

Laboratory Information System (LIS) ÂÂ A web based Laboratory Information System featuring a built in interface engine for seamless integration with HIS, Billing, EMR, and reference labs.

Patient Portal

ÂÂ Through Patient portal, patient can book their appointments online, view investigation reports& clinical details, case records, prescription and many more.

MIRACLE Solutions: Providing Ease of Access in IT for Healthcare Industry Integration of IT infrastructure in the Healthcare Industry possesses various challenges following inadequate sources and complicated delivery networks. In addition to this, other key challenges

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Interview

in deploying IT infrastructure into the health care system constitute lack of standards due to various functionality requirements, lack of in-house IT domain knowledge, reluctant behavior of medical staff to adapt innovative technologies and lack of genuine vendor support. However, New Delhi headquartered Akhil Systems, specialized in catering for Health care sector, offers a comprehensive and cost effective solution suite through its product-Miracle HIS, which is a web and cloud-based automated solution for various healthcare entities such as hospitals, medical colleges, chain of pharmacies, laboratories and multiple dialysis centers. Miracle HIS also provides users easy accessibility and uniformity of stored data with minimal redundancies.

“Although the standardization of Healthcare IT is low, through our 20 years of experience we have included all the technical and functional requirements for the healthcare sector that provides customization as per hospital requirements, “says Sanjay Jain, Director of Akhil Systems. With its corporate office in New Delhi, Akhil Systems has As a pioneer inHIS software in India, Akhil expanded its presence in almost all major Indian Systemshas been continuously striving to offer cities and 7 countries. an advanced range of products for theupcoming A Company you can rely on - Satisfied Clients years. Akhil Systems also aims to connectnumerous in Domestic and International levels clinicians and HIS information portalsin real time AkhilSystems successfully implementing Dubai by implementing BYOD concepts across the vertical based Aster(DM Healthcare) in multiple hospitals & by the end of 2015.Also, coming up with Akhil Health clinics in Middle East & India to set up acomplete World a health portal includes Doctor Profiles from automated workflow starting from patient nearby locations in various cities and search options registration, online billing system, laboratory/ as per specialty, hospitals, clinics etc. for patients radiology,inventory management etc. and an and many more features. integrated centralized database environment that ultimately helped to generate regular efficiency, Additionally, by the end of 2016; Akhil Systems productivity and ROI. Besides catering Aster (DM also targets to offer improved and customized Healthcare), Akhil Systems has also catered to many healthcare pathway solutions for clients. “The major Healthcare centers like Paras Group (Gurgaon main goal of care pathways inclusion in Miracle & other 3 locations in India), Apollo Hospitals is to seek improvement in quality in healthcare, (Bangladesh & other 12 locations in India), Almana coordination among professionals, efficiency and group of Hospitals (Saudi Arabia), Aster Medcity patient satisfaction,” adds Sanjay.

(Cochin), B L Kapur (New Delhi),Moolchand (New With minimized hardware expenses, Akhil Systems Delhi), Lagoon hospitals, Nigeria, Saket city (New aims to host solutionsthat utilize the SaaS delivery Delhi) and many renowned hospitals. model. This conceptwas brought forth to benefit various hospitals while providing a unified data Future ready IT Platform for the Healthcare base instantly. sector

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News UPDATE

Dr. Mohan’s Diabetes Specialities Centre launches its 20th state of the art facility in Kukatpally, Hyderabad

Dr. Mohan’s Diabetes Specialities Centre, a leading Diabetes Specialities Chain in India, inaugurated it’s 20th branch in Kukatpally, Hyderabad on Friday, 12th December 2014.

This most modern Centre for Diabetes was dedicated to the city by its Chairman, Dr. V Mohan, a Padmasri Awardee, in the presence of Ms. Rekha Thankappan, Chief Executive Officer and several other dignitaries.

The centre will be functioning at ‘Sivam Complex, Plot No C/16, Road No 1, K.P.H.B Colony, Beside Sankya Hospital, Kukatpally’, from today.

Dr. Mohan’s Diabetes Specialities Centre in Kukatpally houses state-of-the-art facilities for management of diabetes and its complications. It has a Diabetology unit, ECG facility, blood collection facility, Nutrition and Dietetics unit, pharmacy and specialized diabetic foot wear. Well experienced and seasoned Diabetologists will manage this new centre along with a team of well-trained staff.

but also specialized services for treating common symptoms associated with the condition”, explained Dr. Ranjith Unnikrishnan, Vice Chairman of DMDSC. “Established in 1991, Dr. Mohan’s Diabetes Specialities Centre is recognized by the World Health Organization (WHO) and International Diabetes Federation. With 19 branches in India and one in Muscat and more than 3.2 lakh registered patients, DMDSC is one of the largest diabetes centers in the Dr. Anjana, Joint Managing Director of the hospital country, “ said Mrs. Rekha Thankappan, CEO of said, “A recent survey reveals that Type 2 diabetes DMDSC. and hypertension are fast emerging as twin epidemics In a recent survey by The Week Magazine along with in Telangana and AP as 24% of the population have Nielsen, Dr. Mohan’s Diabetes Specialities Centre been identified with both the problems. We have been (DMDSC) was ranked as the ‘Best Standalone constantly creating awareness among the people Diabetes Hospital in India’. DMDSC has got this about Diabetes and it’s complications as it could cost credit for the 3rd time in a row. them their vital organs like Eyes, Feet, Kidney and For further details: Feet”, “With 66 million people with diabetes and Saravanan, DGM Marketing 77.2 million with pre-diabetes, India is home to the Dr. Mohans, Diabetes Specialities Centre. second largest number of people with diabetes in Mobile: 0 97909 50801 the world. We, at DMDSC, aim to provide quality E-mail: saravanan.as@drmohans.com but affordable treatment not only for diabetes

“This is our 3rd Centre in the city of Hyderabad located ideally in Kukatpally for the benefit of patients living in this part of the city. We practice the treatment protocols matching International standards aiming at providing complete diabetes care with all required specialties under one roof and this facility will be one such place for the patients,” said Dr. Mohan, Chairman of the hospital.

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News UPDATE

Nanavati Super Speciality Hospital Radiology Head, Dr. Deepak Patkar elected as chairman of “Indian College of Radiology and Imaging” Dr. Deepak Patkar, one of the leading consultant radiologists in the country and head of Department of Radiology of Nanavati Super Speciality Hospital, has been elected as the chairman of Indian College of Radiology and Imaging (ICRI), an academic wing of Indian Radiology and Imaging Association.

The appointment is for two years from January 2015 to December 2016. Dr. Patkar has been fellow of Indian college of Radiology and had already been elected as secretary of ICRI in 2008 and 2009.

A globally reputed radiologist, he has been in the profession for 24 years in the UK and in India. He is also Director of Teleradiology Diagnostic Services Pvt. Ltd., dealing in teleradiology with clients in US, Africa and the Middle East. He has been associated with Nanavati Super Speciality Hospital since last 22 years and has been responsible for setting up the new radiology wing there.

Dr. Patkar has been the Organizing Secretary of National Conference of Indian Radiological and Indian Association – 2007, Mumbai. He has delivered more than 1200 lectures and orations at national and international conferences including ‘India meets ESR’ at European congress of Radiology

in, 2008 at Vienna.

He has more than 150 international publications predominantly on Neuro and Musculoskeletal MRI related topics, one of the best being ‘Central Nervous System Tuberculosis: Pathophysiology and imaging findings’ published in Clinical review articles of Neuroimaging Clinics of North America.

Speaking of his selection as chairperson, Dr. Patkar said, “It is a great honour and privilege to be elected as Chairman for the ICRI. During its 36 years of journey ICRI has helped many budding radiologists to quench their thirst for knowledge through its various academic projects and programmes”.

Dr. Deepak has the mastery, commitment, passion and strong sense of giving back and to reach to students of various fields other than Radiology like Biomedical and IIT students. He has successfully organized many national as well as international conferences.

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News UPDATE

WHO urges coordinated action against antibiotic resistance

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eeking accelerated efforts to address the burgeoning problem of antibiotic resistance, the World Health Organization today called upon Member States of the South-East Asia Region to scale up national action plans to combat this daunting public health threat.

“We must act urgently. The world is heading for a postantibiotic era which will be devastating in this age of emerging infectious diseases. If we do not use antibiotics rationally, we will lose the power to fight common infections and minor injuries. We need to step up efforts to prevent antimicrobial resistance and change how we prescribe and use antibiotics,” said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, at the launch of a four-day regional meeting on antimicrobial resistance (AMR) in Jaipur.

The regional meeting focuses on developing and strengthening country-level plans, building national capacities and developing mechanism for generating information on the magnitude, trend, and the burden of AMR in Member States.

WHO has prioritized AMR in view of the serious health, political and economic implication of drug resistance.

A regional strategy on prevention and containment of antimicrobial resistance was developed by WHO in 2010 which was endorsed by all Member States. The strategy focuses on improving intersectoral collaboration, strengthening regulatory mechanism for assuring quality, standardized and rational use of antibiotics, boosting national capacity for laboratory-based surveillance of AMR, reducing burden of infectious diseases, enhancing hospital infection control practices and educating and empowering communities.

In 2011, the health ministers of the Region made a

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commitment to prevent and contain AMR through the ‘Jaipur Declaration’. Since the Declaration, Member States have initiated a comprehensive and integrated national approach to combat antimicrobial resistance.

National focal points have been designated; multisectoral steering committees formed and national antibiotic policies are being developed in most Member States of WHO’s South-East Asia Region. Capacities are being built for undertaking laboratory-based surveillance of AMR to support development of evidence-based treatment guidelines and evaluate the impact of efforts to address AMR. Special attention is being paid to reducing healthcare associated infections by improving infection control practices and building capacity of prescribers for rational and evidence-based use of antimicrobial agents in humans as well as animals.

Earlier this year, a WHO report flagged AMR as a big problem globally and also in WHO’s South-East Asia Region which is home to a quarter of the world’s population. The report, ‘Antimicrobial resistance: global report on surveillance’ noted that globally, resistance is occurring across many different infectious agents, but focused on antibiotic resistance in nine different bacteria responsible for common as well as serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea. The results are cause for high concern, documenting resistance to antibiotics, especially “last resort” antibiotics, in all regions of the world.

The World Health Assembly has now urged WHO to develop a global action plan against AMR by 2015. The plan is being organized around five main areas of concern: awareness; information on the magnitude of the problem; economic impact; rational use of antimicrobials and preventing infection.

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Welfare Medical Limited, Tulip Tree House, Mill Lane, Langstone, Havant, Hampshire, P09 IRX, England Email: info@welfare.com

Welfare Medical Limited, Tulip Tree House, Mill Lane, Langstone, Havant, Hampshire, P09 IRX, England Email: info@welfare.com

Welfare Medical India (P) Ltd. S.B.House, A-257 & A-258, Defence Colony New Delhi- 110024, India.

Telephone: 91-11-41550672, 41551231 Email: welfaremedicalindia@hotmail.com

Welfare Medical Limited, Tulip Tree House, Mill Lane, Langstone, Havant, Hampshire, P09 IRX, England Email: info@welfare.com

Welfare Medical Limited, Tulip Tree House, Mill Lane, Langstone, Havant, Hampshire, P09 IRX, England Email: info@welfare.com

Customer Care:

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Welfare Medical India (P) Ltd. S.B.House, A-257 & A-258, Defence Colony New Delhi- 110024, India.

Telephone: 91-11-41550672, 41551231 Email: welfaremedicalindia@hotmail.com

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Welfare Medical India (P) Ltd. S.B.House, A-257 & A-258, Defence Colony Welfare Medical India (P) Ltd. New Delhi110024, India.

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News UPDATE

More diagnostic confidence in angiography thanks to two new applications from Siemens Syngo Dyna4D premieres time-resolved 3D imaging in the angio suite Syngo DynaCT Smarteliminates metal artifacts

At the 100th Conference of the Radiological Society of North America (RSNA) in Chicago, U.S., Siemens Healthcare will present two new clinical applications for angiography.

Syngo Dyna4D will now, for the first time, enable timeresolved 3D imaging in angiography, making it possible to visualize not only the three-dimensional volume of the vessels but also the flow behavior of blood. Syngo DynaCT Smart removes metal artifacts and allows the physician to e.g. detect bleedings close to metallic objects.

Time-resolved 3D imaging in angiographywith Syngo Dyna4D

In interventional radiology and neuroradiology, getting the best possible diagnosis is central to a therapy’s success – before, during, and on completion of the intervention. This allows the physician to plan and perform the treatment precisely. For such procedures, Siemens Healthcare has developed an innovative angiography software: In contrast to current 3D image acquisition methods, Syngo Dyna4D uses a modified protocol, which makes it possible to combine spatial and temporal resolution (“3D+t”). Siemens is the first and only manufacturer to succeed in making this “fourth dimension” visible: Thus, the physician can track the passage of contrast medium in real time and precisely see how quickly and to what extent the patient’s vessels are filled. This means that the therapy can be more precisely adapted to the individual patient. Prof. Charles M. Strother, MD from the University of Wisconsin School of Medicine and Public Health is already using Syngo Dyna4D in neuroradiology and significantly contributed to its development. „By allowing any view to be seen at any time and any time in vascular filling to be seen in any view there will be a decrease in the need to obtain 2D-DSA studies.

This will reduce both radiation exposure and contrast dose for the patient.” For complex anomalies like arteriovenous malformations (AVM) or arteriovenous fistulas (AVF), Prof. Strother has used Syngo Dyna4D to evaluate the flow of blood or contrast agent three-dimensionally. The results point toward the potential for improved therapeutic planning.“We are now able to evaluate the dynamics of blood flow pattern in a 3D reconstruction of complex abnormalities such as AVMs and AVFs. This capability can contribute to enhanced treatment planning, allow enhanced evaluation of the angioarchitecture of AVMs and AVFs, increase the ability to recognize the presence of intra-nidal aneurysms, direct artery to vein fistula and venous outflow obstructions. This will improve the ability

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to assess the risks of hemorrhage and choose patients best suited for endovascular therapy.”

Removing metal artifacts with Syngo DynaCT Smart

Syngo DynaCT Smart is another new application that Siemens Healthcare introduces for the first time at RSNA. Metal objects in the body, such as surgical clips or coils like those used in aneurysm therapy, cause massive streak metalartifacts to occur in CT or CT-like imaging as delivered with Syngo DynaCT. This makes it impossible to analyze the areas around such metal objects for diagnostic purposes.

Thus, directly after implantation, important information that would help to determine whether complications such as hemorrhages have arisen in the vicinity of the metal object is withheld from the physician. In the worst case, the patient will leave the hospital only to return when complications actually do emerge. Siemens Healthcare has successfully developed a new algorithm called Syngo DynaCT Smart, which removes those streak artifacts caused by metal from the image and visualizes the regions in close vicinity of the metal in a diagnosable manner.

The improved information content of the images helps to reduce the probability of erroneous decisions and therefore the needs for additional post-operative exams and/ orthe hospital readmission rate.

Syngo Dyna4D and Syngo DynaCT Smart will be available from summer 2015 for Artis systems with the new “Pure” platform for Artis zee, Artis Q, and Artis Q.zen by Siemens Healthcare.

News UPDATE

Healthcare Awards H ono u rin g

E x ce l l ence

21st March 2015, Pragati Maidan, New Delhi held alongside

MEDICAL FAIR INDIA 2015

M

MEDICAL FAIR INDIA 2015 TO GIVE A FILLIP TO INDIAN MEDICAL INDUSTRY

21st Edition of Medical Fair India 2015, the much awaited event for the Indian Medical Industry to take place from 21st-23rd March in Pragati Maidan, New Delhi

edical Fair India 2015, the most influential trade fair for medical products, pharmaceutical products, medical technological products and health care service facilities; in its 21st edition will showcase the latest technological advancements in a vastly diversified medical sector. Medical Fair India 2015 the flagship brand of Medica- the world’s largest annual medical event held in Dßsseldorf, Germany. The event will be flagged off from March, the 21st to 23rd, 2015 at Pragati Maidan, New Delhi and would prove to be the bellwether amongst the medical events in the country. The current edition of Medical Fair India comes with a special focus on Hospital Infrastructure and planning, witnessing participation from over 20 countries with dedicated country pavilions from the U.S and the U.K, Germany, Taiwan, Korea, Belgium, China, Italy, Malaysia and Singapore.

The event will have nearly 500 exhibitors from India and abroad showcasing their products and services which will help visitors to identify new providers, new agents and joint venture partners. It is aimed at sourcing out new products and technologies and to find new suppliers for stakeholders in the medical industry. Medical Fair India 2015 will be attended by a wide spectrum of experts in the medical field like doctors, practicing physicians, veterinarian, dentists, physiotherapists, ergo-therapists. The visitor profile will also include professionals like hospital directors/ managers, hospital owners, hospital administration managers and staff, medical specialists and superintendents, service providers. Biologists, microbiologists, biochemists from the research community along with general service providers like process engineers, NGOs for rehabilitation aids, distributors, visitors from academics and universities and visitors from government and international agencies will also be

a part of the event.

Medical Fair India 2015 will have special features like the co-inciding of the 5th edition of Medgate Today Healthcare Awards. The coveted award platform evaluates hospitals, companies and healthcare professionals on their outstanding performance in healthcare and life sciences sector. Also, for the first time in the country, the event will have specific conferences on Hospital Infrastructure and Planning with the theme of Challenges and solutions in hospital planning and the second conference will be on Medical Device & Technology with the theme of Connect, Engage and Explore.

Indian healthcare expenditure is amongst the lowest globally and there are significant challenges to be addressed both in terms of accessibility of healthcare service and quality of patient care.

A significant portion of the Indian population is unable to access healthcare service because of inadequate healthcare infrastructure. Accessibility to healthcare infrastructure on an overall basis is relatively imbalanced and is extremely limited to rural areas of the country. The existing healthcare infrastructure is unplanned and is irregularly distributed. Further, there is a severe lack of trained doctors and nurses to service the needs of the large Indian populous. Healthcare infrastructure (majorly hospitals) requires necessary attention for India to revolutionize its medical and healthcare industry.

The event serves as a perfect platform to network with thousands of healthcare professionals along with generating business and increasing sales. The conference topics and Speaker sessions will provide valuable insights on new trends which could widen the customer base and help companies to stay ahead of competition. With participation from international

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News UPDATE

companies and other countries, building relations to gain access to India and the sub-continent will be facilitated. Some of the key associations supporting the event are Indian Association of Physical Medicine and Rehabilitation, Association of Healthcare Providers (India), ADMI - Association of Diagnostic Manufacturers of India, MSAHITA Medical Surgery and Healthcare Industry Trade Association, Apollo Hospitals Group, Indian Association of Sports Medicine, Fortis Healthcare Limited along with other associations from the U.K, Germany, Korea.

“Medical Fair India would act as an enabler in bringing the entire medical fraternity on one platform where suppliers and buyers from different segments of the industry will congregate and do business. The 2-day technical conference shall bring together eminent speakers from the medical fraternity who shall deliberate on vital issues being faced by healthcare industry professionals.” said Udo Schürtzmann, Managing Director, Messe Düsseldorf India Pvt. Ltd. He further said, “India has embarked on a of healthcare services transformation. The present Indian Government has introduced structural

reforms and has re-emphasized its vision to create the access for improving healthcare services and to provide affordable healthcare for all.”

The private healthcare sector, in particular has witnessed unprecedented growth in the recent years and this holds immense business opportunities for companies interested to explore this huge potential. India’s health challenges, though unique and complex, also offers remarkable opportunities.

The coming years will witness major expansions & progress in the direction to consolidate the India healthcare sector.

About Medical Fair India

The MEDICAL FAIR INDIA, held alternately in Mumbai and New Delhi every year, last time attracted 443 exhibitors and over 8,000 registered trade visitors across 3-day of the show to learn about the entire range of innovations from segments such as medical device technology, hospital, health centres and clinical equipment, rehabilitation, furnishings for pharmacies and care centres/furniture. The 21stMEDICAL FAIR INDIA will be held in Halls 11, 12 and 12A of the Pragati Maidan Exhibition Centre in New Delhi from 21 to 23 March 2015.

Global Health City for the 1st time in India successfully implants an Implantable Artificial Lung In a first-of-its-kind surgery, a 64-years old Bahraini woman with end-stage lung failure receives an implantable artificial lung as a bridge to transplant Hopes of a 64-year old woman from Bahrain were kept alive at Global Health City with an implantable artificial lung, for the first time in India such a device had been used as a bridge to lung transplant.

By introducing this new technology to India, Global Health City offers a glimmer of hope to thousands of patients with end-stage lung failure. With this innovative technology, the waiting time to receive a donor lung is extended.

Mrs. Fatima Mohammed Ahmed, underwent a lung transplant at Global Health City 3-years ago after her lung condition went bad due to Lymphangioleiomyomatosis (LAM) - a rare lung disease that tends to affect women in their childbearing age. Post the transplant, she recovered well and returned to routine life within 2-months.

Things had been looking good and under control

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News UPDATE

since then with regular follow-up and appropriate medication support. Unfortunately a year ago, she developed a fungal infection in her lungs, which led to Bronchiolotis Obliterans Syndrome (BOS) a fibrotic process resulting in progressive narrowing of bronchiolar lumens and airflow obstruction, is a manifestation of chronic allograft rejection.

Having affected by BOS, Mrs. Fatima was prescribed with a series of medication regimes such as Anti BOS drugs, Immuno Suppressive Medications, etc. and the condition of her lung was closely monitored.

Almost 10 months after she developed BOS and with medical management, her lung did not show any sign of improvement.

Dr. Vijil Rahulan – Senior Consultant Pulmonologist said, “Adding to her worries, her lung further deteriorated. She was in ventilator support and was not an eligible candidate for immediate lung transplant. Hence, we decided to postpone the surgery so that sufficient time is given for her to be ready to receive donor organ. Usually, people with end-stage lung failure are supported with a heartlung bypass machine known as Extracorporeal Membrane Oxygenation (ECMO) that uses a pump and oxygenator to deliver oxygen to the vital organs.

While ECMO can be successful for this purpose, it is a temporary solution. Extended use can pose serious health risks, including permanent organ damage and frequent bleeding; moreover it needs a continuous monitoring in ICU.” “In the case of Mrs. Fatima, we had to offer the best possible support that buys her time to revive her condition and to wait for donor lung to become available. Considering the situation, our expert team decided to use Novalung, an Implantable Artificial Lung device. It is a pumpless device that needs minimal monitoring in the ICU and patient can be ambulated easily with the device in place which is not possible with ECMO”, pointed out by Dr. Rahul Chandola – Senior Consultant Heart & Lung Transplant Surgeon.

Commenting on the occasion, Dr. Govini Balasubramani – Senior Consultant Heart & Lung Transplant Surgeon said, “In India alone, about 1 lakh people were diagnosed with chronic endstage lung diseases every year. Most of them succumb to death within 3 to 5 years even with appropriate medical management. Most importantly, 5 – 10% of them require immediate transplant in order to survive.

Unfortunately, only about 17 such lung transplant

surgeries were reported in India till date. The huge gap is primarily due to the non-availability of matching organ at the right time and a very minimal number of centres performing such a high end procedure.

Novalung, as a bridge to transplant, supports the patient’s survival by extending the waiting-period to receive a donor organ up to 6 months.”

“I am very much thankful to the doctors at Global Health City for offering me another chance to live my life and to spend time with my family. When I came here with a failed lung condition, I and my family had a very little hope. Now with the artificial lung device implant, I am waiting to receive a donor lung and I am confident of starting a fresh lease of life again shortly”, said by Mrs. Fatima.

Highlighting the uniqueness of the procedure, Dr. Ashok Vardhan – Group COO of Global Hospitals added “Over the years, Global Health City has become a synonym to the most preferred organ transplant centre and is one of the largest multi-organ transplant centres in India. Adding to many first-ofits-kind transplant surgeries, today with India’s First Artificial Lung Device implant Global Health City has once again demonstrated its constant endeavor to offer the best possible treatment to patients by combining contemporary technology and processes.”

Novalung – An Implantable Artificial Lung Device It is a breathing support system which is designed to support the exchange of gas in the lungs of the patient. The system removes carbon dioxide from incoming blood and Infuses oxygen into the blood thereby increasing oxygen levels. Clinical application of this device is indicated in the situations where strict application of lung-protective is performed and where there is insufficient exchange of gas, in particular insufficient removal of carbon dioxide.

Global Heart & Lung Institute As one of Global Hospital’s cornerstone Centers of Excellence, Heart & Lung Institute is a premium, comprehensive center providing innovative, quality care close to home. Utilizing advanced medical and surgical equipment, the expert team of physicians and nurses practice evidence-based medicine blended with patient-centered care. From intervention to cardiothoracic surgery and rehabilitation, the institute’s approach hinges on personalized care, recognizing that every patient is unique.

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News UPDATE

Health Minister Shri J P Nadda reviews preparedness on H1N1 Influenza

Directs for ensuring adequate stock of medicines and equipment with hospitals In a high powered meeting with senior officers of the Dept. of Health & Family Welfare, Health Research, AIIMS, Safdurjung, Dr. RML Hospital, NCDC and officers from Govt. of Delhi and Ghaziabad, the Union Minister for Health and Family Welfare, Shri J P Nadda reviewed the state of preparedness and action taken to deal with H1N1influenza cases, here today.

The Health Minister stated that the seasonal influenza cases are reported every year between Jan-March and decline immediately after the winter season is over.

The bout of H1N1 during this period is that of seasonal influenza, the Minister stated. The Health Minister has stated that while there is no cause to panic, the central and state governments should be well prepared. He directed the central and states government to stock up on emergency requirements of medicine Oseltamivir, even though the centre and states have procured the same for their respective use. The Health Minister emphasised on the states having adequate quantity of personal protective equipment for healthcare workers, as also diagnostic facilities required for testing H1N1 samples should be ensured.

The Health Minister has advised that the Integrated Disease Surveillance Programme (IDSP) network should continue comprehensive and prompt reporting so that the districts/ states requiring more attention can be identified. The Health Minister has advised that the general public should take the necessary precaution such as covering ones mouth during coughing and sneezing, washing one’s hands and avoid coming in touch with anyone who is exhibiting symptoms of the seasonal flu.

Present during the meeting were Shri Lov Verma, Secretary (H&FW); Dr Jagdish Prasad, DGHS; Dr V M Katoch, Secretary (Health Research);Dr B D Athani, Special DGHS; Dr H K Kar, MS, Dr. RML Hospital;Dr P K Julka, Dean, AIIMS; Shri Sudhansh Pant, Jt. Secretary, Dept. of Pharmaceuticals and senior offices of the Ministry of Health & Family Welfare and NCDC.

Shri J P Nadda launches “Mission Indradhanush” “Will achieve full immunization coverage for all children by 2020 through a Catch-Up campaign” Shri J P Nadda, Health & Family Welfare Minister launched “Mission Indradhanush”, here today. The Mission Indradhanush, depicting seven colours of the rainbow, aims to cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. The Minister launched the Mission on Good Governance Day to mark the birth anniversary of Bharat Ratna Shri Madan Mohan Malaviya and birthday of Bharat Ratna Shri Atal Bihari Vajpayee. Enumerating on the Mission, the Health Minister said, “We have identified 201 high focus districts in the country in the first phase which have nearly 50% of all unvaccinated or partially vaccinated children. These districts will be targeted by intensive efforts to improve the routine immunization coverage.” The Minister stated that of the 201 districts, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan and nearly 25% of the unvaccinated or partially vaccinated children of India are in these 82 districts of 4 states.

Shri J P Nadda informed that between 2009-2013 immunization coverage has increased from 61% to 65%, indicating only 1%

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increase in coverage every year. To accelerate the process of immunization by covering 5% and more children every year, the Mission Mode has been adopted to achieve target of full coverage by 2020, he stated.

The Minister said that the focused and systematic immunization drive will be through a “catch-up” campaign mode where the aim is to cover all the children who have been left out or missed out for immunization. Under Mission Indradhanush, four special vaccination campaigns will be conducted between January and June 2015 with intensive planning and monitoring of these campaigns. The learnings from the successful implementation of the polio programme will be applied in planning and implementation of the mission, he noted. While 201 districts will be covered in the first phase, 297 will be targeted for the second phase in the year 2015.

The Ministry will be technically supported by WHO, UNICEF, Rotary International and other donor partners. Mass media, interpersonal communication, and sturdy mechanisms of monitoring and evaluating the scheme are crucial components of Mission Indradhanush, said the Minister.

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News UPDATE

Zydus launches world’s first biosimilar of Adalimumab

Access to this therapy will impact 12 million people suffering from auto immune disorders like rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, and Ankylosing Spondylitis in India

A

fter more than a decade long wait, the revolutionary therapy that provided a new lease of life to millions of patients suffering from rheumatoid arthritis and other auto immune disorders globally will now be accessible to patients in India. Zydus Cadila becomes the first company anywhere in the world to launch the biosimilar of Adalimumab – the world’s largest selling therapy. Developed by the researchers at the Zydus Research Centre, the biosimilar has been approved by the Drug Controller General of India and will be marketed under the brand name, Exemptia to treat auto immune disorders such as rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, and Ankylosing Spondylitis.

This novel non-infringing process for Adalimumab and a novel non-infringing formulation has been researched, developed and produced by scientists at the Zydus Research Centre. The biosimilar is the first to be launched by any company in the world and

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is a ‘fingerprint match’ with the originator in terms of safety, purity and potency of the product. The biosimilar of Adalimumab is a part of Zydus’ robust biologics programme which has the largest number of monoclonal antibodies under development in India. The group’s R&D pipeline which comprises 24 biologics includes biosimilars and three novel biologics. These biologics are being developed to treat auto immune disorders like arthritis, cancer, infertility and stroke.

Adalimumab, the fully human anti-TNF alpha monoclonal antibody, was first approved globally in 2002 and has since then been the most preferred therapy to treat patients suffering from auto immune disorders. However, the therapy was not available to patients in India. It is estimated that more than 12 million patients in India suffer from these chronic conditions which progressively deteriorate and lead to lifelong pain and in some cases, even disability.

Speaking on the breakthrough, Deputy Managing

News UPDATE

Director of Zydus Cadila, Dr. Sharvil P. Patel said, “At Zydus, we believe that innovations must bridge unmet healthcare needs and provide solutions to patients who are suffering from disease and disability especially in such chronic conditions.

This therapy will offer a new lease of life to millions in India who did not have access to this therapy so far. We are happy to offer them hope, freedom from pain and better quality of life through Exemptia.”

Exemptia is given as a 40 mg subcutaneous injection once every alternate week. Patients normally would have to take the treatment for six months. It has been clinically observed that the therapy is able to arrest the degeneration and the patient goes into remission – which means the auto immune disorder is under control and the patient is able to live a life without pain and can actually lead a fully active life. Zydus will offer a dedicated Exemptia Care support programme to patients and caregivers. The programme shall provide important support and information regarding access, adherence, awareness and thereby help patients to appropriately manage their disease.

The therapy will be marketed by Zydus Biovation a new division launched to exclusively market this ground breaking therapy. The launch of Exemptia begins with a series of CMEs and scientific symposia to highlight the gaps in the current management of auto immune disorders.

Biosimilars are biological products that are ‘similar’ or ‘highly similar’ to the reference medicinal products (originator products) following the EMA (European Medicines Agency), FDA (Food and Drug Administration, USA) and the CDSCO regulatory guidelines. Biosimilars have similar level of efficacy and safety compared to that of the originator products and provide additional advantage to patients in terms of affordability and accessibility. 

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Doctor SPEAK

Tackling Overweight and

Obesity Dr. Vinodh Reddy Consultant in Surgical Gastroenterology and Bariatric Surgery, Manipal International Patient Care Manipal Hospital, Bangalore

I

t doesn't take much more than a casual glance around you to know that overweight and obesity rates have risen during the past half century, specifically skyrocketing over the past five to ten years. Overweight and Obesity is a public health problem that has raised concern worldwide.

According to the World Health Organization (WHO) worldwide obesity has more than doubled since 1980.

In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. 35% of adults aged 20 and over were overweight in 2008, and 11% were obese. 65% of the world's populations live in countries where overweight and obesity kills more people than underweight. More than 40 million children under the age of five were overweight in 2011.

An overabundance of highly processed, fructoseinfused convenience foods and meals eaten at fast food restaurants have been significant contributors to the rapidly growing problem apparent in many with westernization. To put it simply, people today eat differently than their parents and grandparents, and our fast paced lifestyle and lack of physical activity are accumulating pounds around the waists of many children and adults. Health problems related to excess weight impose substantial economic burdens on individuals, families and communities. Most people do not realize that the protruding bellies so commonly

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seen today are a major factor in the development of certain diseases such as type-2 diabetes, hypertension, some types of cancer, excess cholesterol, Stroke, cardiovascular diseases, gallstones, gout, and of course Psychological problems such as stress and low self-esteem. Bariatric surgery is proving to be the most effective form of treatment for morbid obesity, performed as a laparoscopic procedure, with minimal pain, faster recovery, and short hospital. Not only does the surgery help to reduce weight but also to control and treat obesity related diseases like type II diabetes mellitus, hypertension, sleep apnea (interrupted breathing during sleep), poly cystic ovarian disease, arthritis and high blood cholesterol levels. The most commonly performed bariatric surgery are the Gastric bypass, Sleeve Gastrectomy, and Gastric Band.

Cover STORY

Advances in Renal cell carcinoma Multiparametric MRI is showing great potential to improve characterizing solid renal tumor types

R

enal cell carcinoma (RCC) accounts for 2% to 3% of cancers worldwide and the rate has increased 2% per year for the last 6 decades. About 25% to 30% of patients with RCC present with metastatic RCC at diagnosis. Although the 5-year survival rate is 96% for patients with stage I RCC, it is only 23% for those with advanced disease. Since advanced RCC is highly resistant to radiation and chemotherapy, historically the standard of care has been cytokine therapy. However, this treatment provides limited clinical benefit and is associated with significant

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toxicity. Despite the promise of approved targeted therapies a complete response is rare and patients often become resistant/refractory to first line treatment. New agents with improved efficacy and decreased toxicity are needed as treatment options in first line or subsequent settings. Multiple targeted and immunomodulatory agents are in phase II/III development for advanced RCC. The management of renal tumors has progressed considerably over the past few years. Advances in abdominal imaging mean that kidney cancer can be detected at an earlier stage. Laparoscopic

Cover STORY

partial nephrology and other surgical techniques have reduced morbidities and life-threatening complications. New therapeutic drugs, such as molecularly targeted inhibitors of protein kinases, are producing better outcomes for patients.

Thanks to CT, radiologists can identify an increasing number of small renal masses in patients, up to 20% of which are estimated to be benign. Characterizing benign tumors is as important as characterizing malignant ones, as doing so prevents unnecessary surgery.

The characterization of solid renal tumors has improved, but there is a lack of reliable imaging criteria to distinguish benign from malignant tumors, and to separate the different cancer types.

Pre-therapeutic CT image-guided percutaneous biopsy is recommended for histologically verifying if a renal mass is benign.

MR research is showing promise in renal tumor characterization. Combinations of MRI techniques enable radiologists to distinguish most common subtypes of renal tumors and to make accurate diagnoses. In their most recent study, researchers at Bordeaux University found that MR parameters accurately distinguished papillary renal cell carcinomas from other renal tumors with 100% specificity and a high negative predictive value of 86.3%. Identification of oncocytomas from malignant lesions such as chromophobe or clear-cell renal carcinomas had 100% specificity and 94.2% negative predictive value. “Multiparametric MRI is showing great potential to improve characterizing solid renal tumor types. This is very early research, but we are quite excited about the potential it is showing to avoid percutaneous biopsy when unnecessary or at risk. What this means in the context of the study is that imaging follow-up can be used with confidence, keeping the patient safer and reducing treatment costs. Patients who need surgery or ablation could also avoid a biopsy and the related risk of morbidities.

Surgical procedures tend to be less invasive. Partial nephrectomy has become the predominant method of care for all T1 tumors under 4 cm in size, and is increasingly being used for larger tumors under 7 cm that are organ confined. This procedure reduces impairment of renal function and produces good long-term outcomes. Laparoscopic and robotic partial nephrectomy procedures are increasingly being performed, since they have shorter ischaemia

times, a lower complication rate and equivalent renal functional outcomes. But laparoscopic partial nephrectomy is technically demanding so it tends to be only used by experienced surgeons.

Minimally invasive treatments like cryoablation and radiofrequency ablation are being increasingly used to treat patients with small cortical tumors 3 cm in size or less. These are particularly helpful for high surgical risk patients.

Active surveillance is also increasingly being recommended for patients over 75 years of age, who are in poor health with multiple and severe comorbidities and a renal mass less than 4 cm.

Targeted therapies have revolutionized treatment and are increasingly being used. The ability to characterize phenotypes of tumors using multiple parameters offers more detailed diagnostic information and predictive response to therapy.

Targeted therapies directed against vascular endothelial growth factor/receptor (VEGF/VEGFR) or the mammalian target of rapamycin (mTOR) pathways, both major mediators of tumor growth and progression, have significantly improved outcomes in patients with metastatic renal cell carcinoma.

In present era the survival of patients with renal tumors has increased tremendously and future is bright with many newer agents for advanced renal tumors.

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Dental CARE

Revolutionizing Oral Dentistry through Digital Imaging Today conventional radiography comprising traditional oral X Rays is being replaced by digital imaging technology, writes Dr. (Capt) Sandeep Sharma Senior Dental Consultant Axiss Dental, India’s leading multi-specialty chain of dental clinics.

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ver the past 20 years, the world has been swept away by a digital revolution that has in many ways redefined our lives. From communication, to entertainment, to medicine, to books, no field has been left untouched by digitization. Be it the proliferation of mobile phones or the trickling down of Internet, India too has been dramatically affected by what is often described as the Third Industrial revolution.

As the old music records were converted into CDs, books became e books, letters turned into email, film making bid adieu to film reels and computers and smartphones became the central feature of our lives, how could the field of medicine remain untouched by the digital revolution?

In medicine the benefits of digital radiography or tele radiology have been immense. While digital

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X Rays have resulted in better and more accurate diagnosis, their shareability has meant that a doctor sitting in India can share a digital film with a counterpart in the United States and seek his or her opinion on an important case. In the field of medicine, digital radiography is today more a norm than exception. However, in oral dentistry this usage is still relatively new.

Digital Imaging and Dentistry

Much like in the field of medicine, digital imaging is also revolutionizing oral dentistry with far reaching consequences on the way teeth problems are diagnosed, treated and evaluated. The advanced technology provides a valuable tool to medical practitioners in the field to measure cosmetic and health outcomes, such as tooth whitening, plaque, and gingivitis.

Dental CARE

In India, the use of digital imaging in oral dentistry is yet to become a common practice.

However, Axiss Dental clinics are equipped with most advanced digital radiography technology for better diagnosis and treatment.

The physical process for digital radiography is actually similar to traditional dental X-rays that use film. With digital radiography, your dentist inserts a sensor into your mouth to capture images of your teeth – but that’s where the similarities between conventional and digital dental X-rays end. Although it resembles the film used for X-rays, the digital sensor is electronic and connected to a computer. Once the X-ray is taken, the image is projected on a screen for your dentist to view.

Here comes one of the major advantages of digital radiography. Digital radiography not only allows better view and better pictures of the oral site, it also allows the clinician to store images of the teeth and mouth on a computer unlike the traditional X-Ray hard film. The high resolution digital images can be zoomed in to focus more an area, they can be superimposed to get greater clarity of the condition, and can also be transferred easily to another destination through email.

The convenience of storage can also be underlined here, as the films are simply stored in the computer, and need not be carried around. This improves communication between patient and doctor and also eases the process of referrals and insurance claim submissions, as images are stored and transferred electronically.

Apart from medical dentistry, the specialty of orthodontics also stands to gain immensely from digitization. Orthodontics is the field that deals with correction of tooth irregularity, cosmetic improvement in appearance or correction of disproportionate jaws.

Digital radiography gives ability to gain cephalometric analysis for orthodontics, to gauge the size and spacial relationships of the teeth, jaws, and cranium. This analysis assists in better treatment planning.

Here we list some benefits that accrue from using digital radiography as against traditional film X-rays: Less Radiation The equipment used in digital radiography exposes dental patients to much less radiation. In fact, digital X-rays use up to 90 per cent less radiation than film X-rays. While conventional dental X-rays are relatively safe, digital radiography is an excellent option for those who take X-rays on a regular basis or for those

who are concerned about radiation.

Higher Quality Images The standard size of traditional X-rays can make viewing difficult, but digital radiography has done away with the “one size fits all” mentality. Once on the screen, digital X-rays can be enlarged or magnified for a better visual of the tooth’s structure. Brightness, contrast and color can also be adjusted, allowing your dentist to see small cavities easier. If you need a hard copy of your X-ray, digital images can also be printed out.

Transferring Dental Records Digital images can be e-mailed to a dental specialist for immediate review. Digital X-rays are taking away the expense and time needed to copy files and mail them to another dentist, making it easier to transfer dental records or get a second opinion. As more and more clinic turn to electronic patient charts, computers may eliminate the need to mail dental records altogether.

Shorter Dental Appointments Digital radiography can also shorten your dental appointment! With traditional dental X-rays, you’ll have to wait while your dentist develops the film. With digital radiography, the sensor develops the picture almost instantly and projects it onto a computer screen right before your eyes.

Environmentally Friendly Digital dental X-rays are better for the environment!

With digital radiography, no chemicals are used to develop film. There’s also no wasted space of a darkroom and no need to store film, which can pile up in a dentist’s files.

At Axiss Dental clinics, we are equipped with Kodak Digital OPG (Diagnostic Dental X-Ray) for improved diagnosis and treatment. This enables dentists see overall health of teeth and mouth; it helps measure the health of bone and the condition of infection; it assists in planning exact treatment by offering precise and clear images. It is faster than existing equipment and remarkably reduces exposure to radiation by 60 per cent.

In India, the market for dentistry is growing rapidly.

According to global market analysis conducting agency MarketResearch.com, in 2010, the Indian dental imaging market exceeded INR 5 billion. This is growing rapidly year on year. Over the next ten years, a major portion of the dental imaging market is expected to go digital.

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Doctor SPEAK

Kidney Transplant: Blood group matching no more a barriers

Dr. Sanjiv Saxena MBBS, MD (MED), DNB (NEPHROLOGY) SENIOR CONSULTANT & HEAD Department of Nephrology PSRI Hospital, New Delhi

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idney transplant is a life saving treatment for kidney failure patients and now it can be easily done with almost 100% results. But the major problem with kidney transplant is shortage of organ donors. This contributes to growing transplant waiting list. Newer advancement in transplant techniques and medicines allow to do transplant in patients without blood group matched donor (ABO incompatible transplant) to increase the donor pool. This is available at only few centers at present.

Doctor SPEAK

One of our patients, a 32 year old male presented to us with advanced kidney disease and was put on urgent hemodialysis. Need for kidney transplant was explained to patient but only blood group matched donor in the family was his mother. She was investigated and found unfit because of medical reason.

After explaining the cost and long term outcomes of ABOi transplant, patient’s wife (blood group A+) was accepted as donor.

Patient’s blood group was O+ positive.

After achieving minimum target antibody levels in the blood of recipient, kidney transplant was done. Patient started passing good amount of urine post transplant and there was fall in serum creatinine to normal level over next 3 days. Patient was discharged on post operative day 8 with serum creatinine of 1.0 mg/dl.

Now Now he is 6 months after transplant and going for his work everyday.

Other facilities for kidney failure patients at PSRI Hospital:

Patient was admitted about 2 weeks before provisional transplant date and immunosuppressant drugs started. Plasmapheresis was done to remove preformed ÂÂ antibodies against donor blood group antigen on ÂÂ alternate day basis. Plasmapheresis is a procedure in which plasma containing antibodies removed from the blood by a cell separator. Intravenous albumin ÂÂ and normal saline were used as replacement fluid.

Each plasmapheresis was followed by intravenous immunoglobulin. Patient was dialyzed on alternate ÂÂ day basis during hospital stay. We checked routine ÂÂ blood parameters regularly. 

Laparoscopic donor nephrectomy Donor swapping (when a living kidney donor is incompatible with the recipient, exchanges kidneys with another donor/recipient pair).

Kidney transplant in complex cases (marginal donors, difficult vascular anatomy) Pediatric kidney transplant CRRT (slow continuous hemodialysis in hemodynamically unstable patients)

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Industry WATCH

Swati Bagga has taken the control and responsibility to launch the multinational medical giant, Welfare Medical, in India

Swati Bagga & Sushil Bagga

& Dynamic Entrepreneur Young

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Industry WATCH

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n the current business scenario in India, many daughters are seen taking over the reins of family business from their fathers.

This is not because they have inherited the empire by virtue of their birth, but because they have proved that they are competent and capable to take charge of corporate affairs.

Swati Bagga, the only daughter of healthcare maestro, Sushil Bagga, took over as the Executive Director of SB Group Of Companies and DirectorMarketing for Welfare Medical India. This young heiress- a Bachelor in Business Administration (BBA) from IILM, New Delhi and MBA with specialization in Marketing & Information Technology, from University of London (U.K), is a talented young lady who has also mastered several forms of cultural activities. Right now, Swati has her hands full with the responsibility to launch dad Sushil Bagga’s strategically partnered global multinational “Welfare Medical” throughout India.

Swati`s first innovative venture was in the year 2007, when she started Sunrise Afforest & Bio –Fuel Development Industries Ltd (SABDIL), under the Banner of SB Group. She initiated environmental protection steps by introducing Biofuels, also known as green fuel and afforestation in Madhya Pradesh with a huge Land Bank. With a futuristic vision, Swati’s primary aim was to produce Soya and Green Fuel to save the environment from harmful chemicals. Through her company, she was also successful in generating rural employment for the locals.

Swati draws this inspiration from her training as a certified F1/ F3 racer driver. A determined and passionate young lady, she is the only woman owner of the Supercar Prancing Horse “Ferrari” & The British Leopard Jaguar “F - TYPE” in India.

However, Swati Bagga is not only passionate about swanky cars but also knows the technicalities by heart. She has a diploma in advanced motor sports development and racing technology and is also trained by W.R.C racers.

Currently, with a strong marketing team, Swati is ready to drive the launch of the multinational medical giant Welfare Medical in India. “Looking at the current healthcare scenario of India we are resolute on providing the best medical solutions at a very reasonable price. Our company’s aim is

to provide the country with world-class medical products. We believe in high quality products which is cost effective”, says the young leader.”

Welfare Medical will focus on providing patients and healthcare professionals, state of the art quality products with unparalleled services. Welfare Medical deals in extensive range of products, the primary range of activity and portfolio revolves around:

ÂÂ Surgical stapling line

ÂÂ Products for minimum invasive surgery ÂÂ Anesthesia – Critical Care The products are in compliance with CE Marking Regulations and Standards. Furthermore to achieve excellence in there functioning, Welfare Medical has created a channel system that formally checks their quality management system on a regular basis, which satisfies the requirement of ISO 13485, an internationally Recognized Standard.

Confident about his daughter’s inventive marketing tactics, Sushil Bagga feels Swati’s resourceful planning will help project Welfare Medical India as the “One stop shop” for all medical devices.

“The organization’s objective lie in the welfare of the society and because of the same the company is named “Welfare Medical India” We have performed extensive research, with in house testing / quality testing, before we launched our company worldwide. Now we are fully equipped to beat any challenge that comes our way”, says Swati Bagga.

“We pledge to serve the country with full determination, so that people can invest their trust in us without any hesitation and take our name with full confidence. We are also working towards launching more cost effective products under our banner which will be available in the market soon.”

Says the idealistic business -woman.

Swati Bagga has revealed her entrepreneurial skills to her family business and is confident to help the company stay ahead of the curve while taking on ever greater responsibilities on key accounts.

With a health care empire that only seems to be growing, all thanks to his dynamic daughter, Sushil Bagga is one proud father.

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Expert VIEWS

Stitch-less surgical procedure to treat a slip disc offers greater safety, quicker recovery & more convenience Given the dread and anxiety associated with a surgery, specifically a spine surgery, many people feel reluctant to undergo the procedure, living a life of pain and restricted activities. Many people worry about the threat of paralysis/nerve damage if something goes wrong during the surgery, especially when it involves major cuts and stitches. However, advanced technology has enabled us to conduct spine surgery using the endoscopic method that involves a very small incision. The revolutionary procedure usually takes less than an hour and allows the patient to start walking the same day.

And the best part is that there is no risk of paralysis as the operation is done under local anesthesia, with the patient remaining awake, thus ensuring that no harm is done to the patient’s spinal cord or nerves.

But, first let’s understand what exactly a slip disc is…!!

Dr. Arun Bhanot Chief of Spine Services, Paras Hospitals, Gurgaon

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ne of the most common causes of back pain is a herniated disc, known in popular parlance as slip disc. A slip disc not only causes pain in the back but can also cause discomfort and numbness in the legs, making normal life difficult. While most of the cases improve with basic care like physiotherapy, lifestyle management, weight reduction etc along with short course of medicines, still, a number of people may need surgical treatment.

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Our spinal column consists of multiple vertebrae (small blocks of bones stacked one over each other) with small discs acting as cushions between two adjacent bones. These discs act as shock absorbers and protect the bones of the back from injury while performing daily activities ranging from walking to running to lifting.

When a disc between two vertebrae suffers damage (either due to one sudden injury or as a result of cumulative effect of small wear and tear sustained over several months and years) - the soft, gelatinous portion lying at the centre of the disc pierces out through its outer covering to pinch and irritate the spinal nerves, thus becoming a cause of problem.

This is called disc rupture and can lead to a lot of discomfort and pain, either in the back/leg or sometimes both. This may happen in the neck (cervical spine), upper back (thoracic spine) or lower

Expert VIEWS

back (lumbar spine), but is most common in the lower back region. When this ruptured disc pushes or compresses the nerves within the spine, it may cause severe pain in the back alone or also cause what is called “sciatica” – a sharp pain that goes from the buttock towards the leg via the thigh.

As we age, the water content in the disc starts decreasing, making them less flexible and more prone to rupture. A number of factors exacerbate this shrinking of space between the vertebrae including, smoking, sedentary life style of desk workers, sudden pressure on the spine due to improper lifting, repetitive strain on the discs as well as excess body weight apart from some genetic predisposition in certain patients.

Endoscopic Key-Hole Surgery – the New Way Forward

an endoscope which gives a magnified view of the spine to the operating surgeon. The surgery takes 30-60 minutes and the since there are no major cut or stitches involved, the patient can start walking the same day. Some patients are even discharged on the same day.

At Paras Hospitals, Gurgaon, we are currently treating 30-40 per cent of the people with slip disc through endoscopic surgery that allows a faster and safer recovery while reducing the anxiety or fear of surgery dramatically. Since risks and threats are minimized, success rate is very high in these procedures, upwards of 95 percent.

Major Advantages

ÂÂ Fast recovery is a major advantage. The patient starts walking the same day; can step out of the A large number of people suffer from this problem of house in the first week itself and within 2-4 weeks herniated disc and go through a lot of pain. Though he/she can join work. most of them improve with medical treatment and physiotherapy, some patients may need to undergo ÂÂ Since the cut is extremely small, the risk of infection is negligible. This again aids faster recovery and surgery to get rid of the pain and nerve weakness. minimizes risks associated with surgery.

Endoscopic keyhole spine surgery is a boon for many such persons. It is one of the best options for ÂÂ No damage to muscles because of the cutting means spine surgery available today and has tremendous the back remains stronger. This is another reason for faster recovery. There is no damage to other advantages over the traditional open surgery. normal tissues and bones as well.

The aim of a slip-disc surgery is to remove that

part of the disc matter that is causing pressure on ÂÂ It’s a day care procedure and the patient can go home within a few hours, not needing any overnight the nerves of the spinal cord leading to pain. These stay. This also reduces costs of hospital stay and is procdures are often referred to as decompression extremely convenient to patients and their families. surgeries, and may vary according to the need from discectomy or laminectomy to laminotomy. ÂÂ Other benefits are lower risk of blood clots, no major scarring or blood loss, no risk of nerve damage and Traditional surgery to relieve the pressure caused no side effects that are traditionally associated with by a ruptured/slip disc is conducted under general general anesthesia. anesthesia through a big incision in the back to gain access to the damaged disc. This requires cutting Despite major advantages, this procedure of spine through the back muscles as well, with the wound surgery is yet to become a norm in India because needing stitches to be put together. Understandably, not many spine surgeons are equipped to perform it. Keyhole surgery requires specialized training and this is painful and needs greater recovery time to be we need greater training modalities for doctors. followed by extensive physiotherapy.

The field of medicine today needs to move towards All this is eased tremendously when there is no need shorter hospital stays, less medication, less cost & to cut through the back in the case of minimally highly skilled medical professionals. This is what invasive spine surgery. This is the advantage that patients look for as several medical conditions can keyhole endoscopy brings with it. This surgery is done be a drain on resources. We hope by achieving such under local anesthesia and it requires an extremely advances as day care spine surgery, we can help small incision of a few millimeters, not more than reduce the fear of machines, hospitals & doctors a small puncture to introduce the mini camera of among people and impart confidence about the the endoscope. The procedure is performed through safety of these advances.

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Expert VIEWS

Assisted Reproductive Technologies

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ioneered by Robert Edwards & Patrick Stoptoe in the seventies, Assisted Reproductive Technology (ART) is a rapidly evolving subspecialty of medicine dealing with Infertility. Infertility is a significant problem, affecting 10-15% of couples and is the answer to all infertility problems. At the same time, it is a subject of moral controversy and ethical criticism, ever since its conception.

ART involves handling of both human eggs and sperms outside the human body and mainly involves IVF-ET (In Vitro FertilizationEmbryo Transfer) and ICSI (Intra Cytoplasmic Sperm Injection). By definition, IUI (Intra-Uterine insemination is not considered as an ART. Louis Brown, the first miracle baby born through IVF, silenced many a debates and simultaneously gave birth to many worries! It was expected that Louis Brown would be born with multiple defects, as human sperms and eggs were fiddled with, for the very first time. But when Louis Brown was born as a healthy normal baby with no defects, the fears of a “Franken Stein baby” were put to rest! ART has truly paved the path for childless couples to have their own babies!

Dr. Duru Shah Scientific Director Gynaecworld and Gynaecworld Fertility Center

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Invitro fertilization – embryo transfer Invitro fertilization – embryo transfer typically involves stimulating the ovaries with fertility drugs to have large numbers of eggs growing, contrary to a natural cycle, where only one egg grows every month. When these eggs reach a size of 18 – 20 mm, they are retrieved from the woman’s body, using a trans-vaginal approach with the assistance of ultrasound. The retrieved eggs are fertilized in a dish with the sperms,

Expert VIEWS

either naturally through IVF or through ICSI in the embryology laboratory and grown over the next 3-5 days in special culture media which provide nutrition to these multiplying cells. The resulting embryos are transferred back through an ET (Embryo Transfer) into the womb of the mother either on Day 3 or Day 5 after the eggs are retrieved and 2 weeks later a pregnancy test is done to confirm if the embryos have implanted into the uterus. If the embryos implant, the pregnancy test is positive. Various medications are given to assist this implantation.

The complications involve bleeding, infection, ovarian hyperstimulation and multiple pregnancies. However, the complication rate is usually low though multiple pregnancy continues to produce twins and triplets.

Ethical issues, blending with religious fears, are gearing to boil over, more so if third party reproduction is concerned. Third party reproduction involves egg and sperm donation, embryo donation and surrogacy. The legal status of the children born with donated gametes, the rights of the parents, the issue of unclaimed embryos, the surrogate’s rights, to name a few!

Embryo research, sex selection, destruction of unused embryos and stem cell research have

created quite a stir.

ART is the ray of hope for couples who have been without hope for long. However, it is the moral and ethical duty of medical professionals to use this technology to the best of their knowledge, for the good of mankind. From the point of view of childless couples; ART may be the miraculous thread in their lives which binds them to their babies.

After IVF was invented for couples with blocked tubes, the technology has advanced by leaps and bounds to encompass other problem areas.

Currently women with bad tubes have IVF, men who have poor semen quality have ICSI, women do not have any good quality eggs left in their ovaries undergo egg donation, women do not have a uterus, utilize surrogacy and so on so forth.

Everything is possible to day to solve any level of problem which may exist in a couple and which maybe the cause of infertility.

In couples who are diabetic, it is important to have the Blood Sugars under control before planning a pregnancy. This is because high sugar levels during early pregnancy increases the chances of having an abnormal baby 8 times more as compared to having sugar levels under control.

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Healthcare Management

Hospital Mergers

and Acquisitions

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Prof. M. Habeeb Ghatala Dean, Apollo Hospitals Group (Retd.)

Hyderabad

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ergers and Acquisitions (M&As) have become an indispensible part of Indian corporate environment. There have been a total of 480 deals amounting to $27.4 billion during 2013 involving Indian companies. It is predicted that with the improvement in economy and coming in force of the provisions of Companies Act 2013, will pave the way for a number of M&A transactions in all the sectors including healthcare. It will also make corporate restructuring process smooth and efficient. M&As in India are governed by the Companies Act 1956 under Section391 to 394. Although M&As may be instigated through mutual agreements between

Healthcare Management

two firms, the procedure remains chiefly court driven.

Healthcare industry in India is expanding at an unprecedented pace. The active involvement of private and corporate sector to meet the demand for quality healthcare has led to the development of new hospitals and M&As of hospitals as well.

The recent news (Times of India, Nov. 10, 2014) of Mumbai’s well known 1,500-bed Seven Hills Hospital, India’s biggest private hospital in a single location spread over 17 acres and a second 500-bed hospital in Vishakapatnam are up for sale gave further indication of M&A activities. The two hospitals are valued at over Rs. 2,000 crore. Several Indian and overseas corporate hospital systems are reportedly among the potential suitors. The deal is necessitated because of a debt of Rs. 900 crore, primarily because of the Mumbai project.

The transaction will mark the biggest M&A deal in the country’s hospital services space after Fortis bought Wockhardt’s ten hospitals for Rs. 909 crore in 2009. Lazarus Hospital in Hyderabad, a multi super specialty hospital of under 200 beds, and India’s first Green hospital was opened in 2010 and closed its door in 2014. It is up for sale or lease!

With increasing competition among private hospitals for quality, accessibility and cost, the M&A trend will continue. We can foresee the impact on small, medium size and even tertiary care hospitals which are not accredited by NABH, are not managed professionally or are in debt to either close the doors or become candidates for M&A as time passes.

Dr. M. C. Gupta, Medico-legal consultant and former dean at the All India Institute of Medical Sciences (AIIMS) stated in 2012 that clinics and small hospitals with up to 20 beds managed by individual doctors and their immediate family members will have to be closed down in India in the future because of various reasons. According to Dr. Gupta, as what is happening in USA, the number of hospitals will diminish, but the corporate sector will flourish even more. He pointed out the reasons that the cost of medical care including the cost of land, equipment and maintenance of staff will increase so much that will force the small type health care institutions to close down.

Hospital Mergers & Acquisitions Definitions

Merger is a combination of two or more businesses into one business. In India, the term “amalgamation” is used synonymously for merger.

Acquisition may be defined as an act of acquiring effective control by one company over assets or management of another company without any combination of companies. Thus, in an acquisition two or more companies may remain independent, separate legal entities, but there may be a change in control of companies.

Reverse Merger is the merger of a company with a financially weak company in order to get various tax exemptions. The unlisted company also gets listed.

Cross Border Merger as per the 2013 Act is the merger of Indian company with a foreign company or vice versa. It is allowed for only those companies which have been notified by the government.

Why Hospitals Merge?

There is an increasing presence of corporate hospitals in metropolitan areas as well as in Tier II and Tier III cities. Apollo Hospitals Group’s REACH hospitals of 100 to 150 beds with plans for 250 REACH hospitals in rural and semi rural areas could see M&As. Hospital mergers could be advantageous for the following three major reasons: Struggle to survive: Small and not-for-profit and other types of hospitals seek mergers because the atmosphere to stay afloat grows tougher. Mergers are seen as a way to help struggling hospitals through these challenging times. When merging with a larger system, it can help the capital needs as well as the technology and infrastructure upgrades.

New forms of healthcare delivery: The task of providing care to uninsured patients who are also unable to pay, diminishing government reimbursements, and market driven forces impacting rates of payment from insurance companies and TPAs, hospitals everywhere are looking at cost-effective ways of managing healthcare. Merging can play an important role in

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Healthcare Management

allowing hospitals to experiment with innovative new forms of healthcare delivery.

Community matters: A hospital serves its community and in doing so need to keep the community informed and contended on the development of a merger.

Merging can strengthen a facility’s relations with the community, helping with community needs, as well as the possibility with new service lines. Hospital mergers allow for integration models, the ability to take on financial risk tied with overseeing groups of patients and simply, the ability to continue providing care to patients in the community.

Hospital Mergers & Acquisitions Ensuring Successful Merger or Acquisition

If a merger or acquisition is in the best interest of a standalone hospital or a corporate system, thoughtful consideration must be given to the broad and complex topics involved. A sample of topics related to successful merger or acquisition range from vision and culture to physician and clinical impacts, financial benefits, as well as organizational and operational concerns.

There are four strategies for providers considering affiliation or are in early stages of crafting the logistics of a merger or acquisition.

Clarify rationale for affiliation: One of the biggest challenges is to make sure that leaders address the functional ends of the relationship – what they are trying to in terms of potential benefit. Is it enhanced service or clinical capabilities, higher quality care and a better patient care experience, financial benefits in the form of access to capital and economies of scale?

Create value (cost/quality): Historically, quality initiatives have been among the last to be instituted in M&As. Attention should be paid to patient care management protocols, management and staff accountability for quality outcomes and use of IT to support quality improvements. Effective clinical resource utilization is also important to assess as measured by readmission rates, emergency department utilization, length of stay and cost per case. Leaders should calculate these factors’ effects on quality and cost to determine the potential benefit of a partnership. The organizations should be able to deliver care in the most cost-effective manner.

Over communication: The rationale for affiliation should form the basis for initial communication with key constituents. It should be the touch stone throughout the process to minimize uncertainty

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and fear which is generated by merger or affiliation discussions. Leaders should articulate the goals of affiliation and what benefits will be produced.

Blend cultures: Hospitals should evaluate the different cultures which include beliefs and norms of behavior, how the best of each can be leveraged to benefit the combined organization. Specifically, serious attention need to be given using the expertise of sociologists and organizational development specialists top study the values, communication and decision-making styles, risk orientation, and methods for organizational learning and development, and the like. Leaders can also look at existing employee satisfaction surveys, many of which include questions about the hospital’s culture.

Hospital Mergers & Acquisitions Strategies for Due Diligence

Due diligence is an essential element of any transaction. It can be a clinical affiliation or a full sale, due diligence need to be conducted. It will enable both parties to fully understand the other. There should be detailed understanding of the operational performance of each party. If a hospital relies solely on the other party to fully disclose without a robust due diligence process, it will find only positives, which could be misleading.

Following are strategies that could prove useful to executives and board members hoping to ensure a robust due diligence process.

Address due diligence as early as possible, ideally before governance negotiations.

Hold a call or meeting with senior leadership.

Develop a game plan or strategy.

Use a checklist.

Prepare for anything and know the deal breakers.

Encourage full investment from all parties.

Don’t lose sight of the purpose of due diligence.

Hospital executives should not get caught up in closing the deal.

Enlist advisors and legal counsel for assistance throughout the process.

Prepare to navigate politics. Unfortunately, politics can distract and/or delay the due diligence.

Overall, robust due diligence is pivotal because the more one partner knows about another and vice versa, the better – in a transaction or marriage!

HEALTHCARE it

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Dental CARE

Oral Health FOR CHILDREN

O

ral health is a prevalent health issue for children. Pediatricians have an important role in screening, educating, and making referrals during well-child visits. The most prevalent chronic disease among children younger than 6 years is dental caries, known as early childhood caries (ECC). There is no established practice for children to make their first dental visit before they turn one year of age. The predominant cause to make the first visit is caries and its complications, one of them primarily is when the child complains of dental pain. It is recommended that first dental visits should be made when the first tooth erupts that is approximately by 6 months of age. The advantage of doing so is gaining timely information and knowledge about the importance of the primary tooth (milk teeth).

The sad part is majority of the parents often feel that milk teeth is not important as it will be later

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substituted by new permanent teeth. Therefore parents perceptions on primary tooth play a key role on their childrens oral health. It is important that parents should know about the effect of oral health on children’s “Quality of Life� which includes pain, disturbed sleep, growth and development, missed school and physical activities. Ironically it also effects the parents Quality of life for instance missing working time and financial limitations. Therefore to avoid these circumtances it is important that parents take their children for timely dental check ups, get the required treatments and provide good dental practice at home. Maintaining oral hygiene at home requires active participation of parents.

PREVENTIVE MEASURES AT HOME

Starting from scratch is important. Many parents

Dental CARE

will not be aware that its important to keep an infants mouth clean even before the teeth erupts.

Cleaning the gum pad is as essentially important.

What one can do is to take a small gauge between the thumb and forefinger and wipe gently over the baby’s top and bottom jaws. This requires adequate but gentle pressure to remove the film that cover the child’s gum pad. Clean at least twice daily after morning and last feed in the night.

After the teeth erupts

ÂÂ Parental assistance is required. Modelling is helpful one parent can brush along with the child to instill positive attitude towards brushing the teeth, with the other parent supervising the child’s brushing. This can allow to create a fun filled environment. ÂÂ Using a soft toothbrush and pea sized toothpaste is recommended. ÂÂ Brushing twice daily and not allowing the child to take any food item after night brushing.

PREVENTIVE MEASURES FROM THE PROFESSIONALS

IN UNAVOIDABLE CIRCUMSTANCES WHEN EXTRACTION(REMOVAL)OF PRIMARY TOOTH IS DONE “SPACE MAINTAINERS” IS RECOMMENDED.

Space maintainers are appliances used to maintain and regain minor amount of space lost allowing to guide the new permanent teeth into proper position in the mouth.

ORAL HABITS

Did you know oral habits can lead to malpositioning of your child’s tooth?

Oral habits may be a part of normal development, a symptom with a deep rooted psychological basis or maybe a result of abnormal facial growth.

Some common oral habits

ÂÂ Sealants: Professionally applied sealants on ÂÂ Thumb sucking permanent first molars help maintain caries free ÂÂ Digit sucking dentition to adulthood. ÂÂ Lip sucking ÂÂ Topical flourides: This comes in various forms- ÂÂ Mouth breathing gels, varnish. Topical fluoride application can be ÂÂ Tongue thrusting done in a child starting from 3 years. ÂÂ Nail biting

EARLY ORTHODONTICS Recognizing and eliminating the potential irregularities and malpositioneddentofacial structure is as much as important.

Premature loss of milk teeth and its consequences includes the following: ÂÂ Space loss for the new teeth leading to crowding of teeth.

All these mentioned habits if not addressed leads to malpositioning of teeth which requires orthodontic attention.

Hence it is important that a child should visit a dentist so they get the opportunity to get examine before the detrimental effects of the habits manifest as derangement in occlusion and unfavourable esthetics.

In this article we have tried to summarised certain areas which is not clearly known to parents.

ÂÂ Speech : Front milk teeth plays a major role in Conclusion speech articulation. ÂÂ First dental visit with eruption of first milk teeth i.e 6 months. ÂÂ Esthetics: A child may feel shy to smile or laugh. ÂÂ Dental home care under parents supervision. ÂÂ Mastication(chewing): improper assimilation of ÂÂ Dental check-ups annually. food- affected general health. ÂÂ Preserve healthy milk teeth till the time of eruption ÂÂ Impaired growth. of new permanent tooth.

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Market OVERVIEW

Advances in

Radiology and Medical

Devices Sector As the government has allowed 100% foreign investment in the medical devices sector under the automatic route to encourage domestic manufacturing and also potentially opened the existing Indian companies in the sector to foreign acquisition. Please find below views from Trivitron, largest medical technology company of Indian origin.

Dr GSK Velu Founder and Managing Director Trivitron Group of Companies

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hile 100‎% FDI in Medical Devices sector is a welcome in our opinion this was already in existence and many MNCs have 100% subsidiaries in India though predominantly with trading and distribution focus. As a part of this new initiative actions should be taken to control and restrict 100% trading subsidiary operations in India. These trading subsidiaries does not have any manufacturing intent and in fact even distribution margins are being expatriated back to their parent countries by adopting several means. Hence apart from 100% FDI in Medical Devices sector government should create right eco system for manufacturing in the country which presently has " Pro Imports" policies with Inverse Duty structure, lack of control on imports using High Sea Sales route and no coordinated efforts between Academia/ Indian Industry in the R&D initiatives. While MNC s should be encouraged to come and manufacture in India, Indian Domestic companies with majority Indian Ownership should be given special preference in Govt Procurement etc as it is happening in other countries like China, Turkey, Brazil, Russia and many other countries. We sincerely hope a New Medical Devices wing will be created under Department of Pharmaceuticals to promote Indigenous Medical Devices companies by understanding and attending to their needs in this budget.

But overall it is a good news Government is willing to listen to the views of over 750 Indian Manufacturers in this segment and implement changes to the tariff structure and regulatory structure in the upcoming budget. Indian Manufacturers are of the view Government should do away with 100% Customs duty exemption for all product categories as this has not benefited the end patients over the past two decades.

As per the recent reports in the media, a Drug Eluting Stent which is being manufactured for Rs 5000 is being imported to India with around Rs 40,000 with nil

Market OVERVIEW

Customs Duty and the end patient pays around Rs 1.5 lakhs for the same. Hence there is no rationale for Zero Customs duty for any Finished Goods imports and there should be atleast 20% customs duty exemption between Finished Goods imports and Raw Materials/ Components import for ultimate manufacturing in the country. Hence there is an urgent need to boost innovation and manufacturing in this Industry of 35,000 crs with over 80% imports and as a largest

Medical Technology company of Indian Origin with 8 Functional US FDA and/or CE certified facilities and 4 R&D facilities, Trivitron is in the forefront of interacting with government through various industry associations like FICCI, AIMED and Assocham to create the right eco system for the Medical Devices Industry to remove import dependency and make India Outward looking with substantial exports in around 5 to 10 years from now."

Global MRI Market

MRI is undoubtedly one of the most acceptable and advanced imaging modality in Radiology today .Unlike X-ray and X-ray based systems it do not do harmful radiation or make side effects for the patient . Over the last 20 years, MRI has transformed with lot of advancements and became one of the most popular imaging modality. There is great progress in resolution, speed , depth, contrast making the MR equipment more acceptable and affordable. MRI systems are now also available as combination or fusion equipments for PET and Therapy application .

In recent times, CT PET is become very popular and useful and is a critical component for diagnosis , but it has some serious limitations other than radiation . Accuracy of diagnosis is affected by the artifact produced by sequential acquisition instead of simultaneous acquisition. Its image capabilities can be seriously affected by issues of attenuation correction and artifacts.

MRI has many advantages scoring over these critical issues, and also have a large variety of protocols that selectively enhance contrast and thus provide enhanced tissue contrast which can be utilized for dynamic contrast-enhanced imaging, diffusion imaging, functional MRI, and many such

studies . Also MR spectroscopy is become a very good study for detection of organ-specific abnormalities like cancerous tumor . In short , with many recent advances in the Technology, MRI is become more powerful and accurate than ever.

We can list out few key drivers for global MRI Market growth: ÂÂ Rapid growth of new Diseases and rising no of cancer patients ÂÂ Greater demand for cost-effective and healthcare solutions

affordable

ÂÂ Arrival of New technologies driving innovation in Healthcare ÂÂ Increased awareness among patients and doctors about dangers of radiation ÂÂ Open and Hybrid l MRI systems to drive further demand , especially for claustrophobic patients ÂÂ Growing use of MRI techniques by non-radiologists and new Cardiology MR applications ÂÂ Steady reimbursement and other government funding possibility ÂÂ Ever-growing global population and emerging economies

At the same time the challenges for MRI Market are

ÂÂ Import duty for MRI units and spare parts for many countries ÂÂ Limited availability of venture capita ÂÂ Reduced hospital budgets ÂÂ Increasing prevalence of lifestyle-related diseases

Som Panicker Vice President Sanrad Medical Systems

ÂÂ Natural or increased competition from CT systems and CT PET systems ÂÂ

Shortage of dedicated MRI technologists and skilled manpower

ÂÂ High cost of capital equipment and Helium Issues ÂÂ Lack of long-term data on use of MRI in patients

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Market OVERVIEW

and lack of Market study

affordability is growing . With this advantages big Ă‚Ă‚ Unknown biological effects of high Tesla MR usage combined , global MRI market will get opportunities in emerging markets of India , China, Despite these market challenges, Global MRI market is expected a steady growth which is still Russia and Latin America. in its initial growth stage in many countries. Rapid To give some idea of the market size and projections, and Continued growth in this sector will be fueled by new Technology and innovations, cost reductions, Global MRI systems market is expected to grow Insurance reimbursementa, and a special focus on from $3.7 billion in 2012 to over $9.2 billion by 2020, emerging markets. increasing at a Compound Annual Growth Rate One interesting aspect is about emerging Markets, (CAGR) of 11.8% during the forecast period. still permananet type MR can be the best cost The recent economic slowdown made some impact effective solution for small and medium cities and places where uninterrupted power supply is on MRI system sales, especially competitor a problem . Emerging economies such as China technologies are cheaper offering same imaging and India are expected to continue to provide quality and resolution. opportunities for revenue growth for the global MRI market. According to one of the market study US and Europe MRI markets are slowed down , the Indian and Chinese markets accounted for compared to the past , but surely it will regain and 3.6% and 16.5% of global MRI systems revenue in the market will continue growing.

2012, respectively; this share is expected to increase further next few years as physicians tend to prefer New changes in Medical insurance reimbursements, MRI Other aspects are the growth in Medical the increasing aging population, rising occurrence of Insurance coverage and falling prices. disease and the growing demand for advanced MR Emerging Markets like India , China, Russia and systems will act as major drivers for continued growth Latin America , demand for low cost MRI systems in the market. Despite cost- effective measures are growing and no of MRI procedures are also implemented by healthcare authorities, the safety increasing making bright days for MRI market. and efficacy of MRI techniques will continue to drive Also with the increase of average income , the new sales in developed and emerging markets.

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Market OVERVIEW

The market has grown out of mere x-ray diagnosis...

Kalyanraman. S General Manager Marketing and Corp Accounts CURA Healthcare Pvt Ltd

Indian Imaging and Radiology market is pegged at around ` 3500 crore and is growing @ 17-18% p.a.

New advancement in imaging & digital radiology equipments

Indian Radiology and Imaging market has come a long way to become an all important element in the value chain for healthcare provider. The market has grown out of mere x-ray diagnosis to high end imaging diagnostic equipments such as PET CT, Nuclear medicine, CT, MRI of highest orders, digital x-ray, wide applications of color Doppler etc. More than new advancement in equipments, it is more of newer applications of existing modalities which has gained momentum. For example, earlier USG was used only for OBG. Now USG is used by almost across specialties. Moreover, with increased incidences of Non-Communicable Diseases, imaging diagnosis is being used more than ever.

Feature products of cura in imaging devices

CURA has been pioneering in Imaging diagnostics space with digital radiography system, patented design DR solutions, pre-owned CT, MRI, Mammo and BMD. Recently CURA has acquired DE Healthcare which has the ultrasound DNA in it, thus CURA forayed into Ultrasound and Color Doppler segment. CURA has

launched couple of new Dopplers in mid segment with new features. Our new dopplers are: Vinno is an innovative solution catering to imaging diagnostic specialists. Vinno symbolizes image quality and redefined workflow. Its innovative RF platform removes the need for hardware pre-processing and demodulation of traditional ultrasound platform.

This state-of-the-art, first of its kind platform used in an ultrasound/color Doppler system primarily aims at improving the image quality of the system. Vinno allows all RF signals for computing, which is over 40 times of data size than currently used in conventional ultrasound systems. Vinno offers very high quality 3D/4D rendering, Super resolution volume imaging technology and 2D image in any angular slice. Most important is the super high frequency probe ranges (1.0 to 25.0 MHz) for various applications.

S8EXP - S8 exp has new VISTA platform , which can offer you better image ,with technologies like PIH (pulse inversion harmonic). S8 exp has 20 kinds of probes for option, like CWD/ PWD pencil probes, phased array for adult, pediatrics , neonate; Other features include Elastography, Real Panoramic, Color Panoramic imaging, better patient information management etc. eZono 4000: Ultrasound-guided regional anaesthesia is increasingly popular, offering the user a number of advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). eZono4000 is an innovative, first of its kind Ultrasound guided needle visualization in regional anesthesia and nerve block. eZono 4000 offers unique solutions to address the real life challenges facing clinicians every day, when using ultrasound at the point of care.

The product is a robust, portable, very easy to use ultrasound system designed specifically for anesthesia.

It incorporates many special features suggested by practicing anesthesiologists.

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Doctor SPEAK

Understanding

Cardiac Emergencies Cardiac emergency - Signs and Symptoms

Crushing chest pain is the most obvious symptoms, but not all heart attacks begin with it. In fact, some heart attacks cause no symptoms at all. This is more common in people who have diabetes. Sometimes there may be mild chest pain and discomfort.

There are several types of cardiac emergencies where immediate action is required; one has to understand that these can even lead to death. So, symptoms and signs are very important as timely recognition can save life of the person.

Recognizing Cardiac Emergency Symptoms

The symptoms may vary from person to person.

CHEST PAIN

Chest pain can be very deceptive. It is a subjective discomfort experienced by the individual which may be of cardiac or noncardiac in origin. In the short term, the safest course is to always assume it is cardiac.

Crushing chest pain is the most obvious symptoms, but not all heart attacks begin with it. In fact, some heart attacks cause no symptoms at all. This is more common in people who have diabetes. Sometimes there may be mild chest pain and discomfort. That can occur at rest or while one is doing some activity.

Depending on one’s age, gender, and other medical conditions, symptoms may be more or less severe. Chest discomfort that feels like pressure, fullness, or a squeezing pain in the center of your chest; it lasts for more than a few minutes, or goes away and comes back may be due to heart attack.

Pain and discomfort that extend beyond your chest to other parts of your upper body, such as one or both arms, back, neck, stomach, teeth, and jaw.

OTHER SYMPTOMS

Dyspnea (difficulty in breathing) Dyspnea can often be a clue that heart failure is present. Heart failure should be suspected especially if the person has trouble while breathing in lying posture, a condition referred to as orthopnea.

Dr Sameer Shrivastava Director, Non-Invasive Cardiology Fortis Escorts Heart Institute

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Palpitations

They are often described as a pounding in the chest or an awareness of rapid or skipped heartbeats. These sensations can be caused by a wide variety of cardiac arrhythmias (abnormal heart beating). Persistent palpitations should be

Doctor SPEAK

evaluated to rule out life threatening arrhythmias.

Syncope (loss of consciousness) If person has episodes of sudden dizziness, vertigo or brief loss of consciousness accompanied by weakness , it may be due to decrease perfusion to the brain. Also in such people Arrhythmias such as transient asystole( cardiac arrest), ventricular fibrillation or tachycardia(life threatening abnormal heart beating), bradycardia (slow pulse rate) can be the culprits.

Other causes may be pulmonary hypertension (increase in right sided heart pressures).

Coughing

Conditions related to heart that can lead to coughing could be pulmonary hypertension (right sided heart failure) or pulmonary edema (heart failure).

The presence of bloody sputum can be due to heart failure.

Other symptoms, such as sudden onset severe backache (upper part), cold sweats, nausea or vomiting, anxiety, indigestion, and unexplained fatigue One has to remember that chest pain and discomfort are the most common heart attack symptoms for both men and women.

But, women are more likely than men to also experience other symptoms, too. These might include shortness of breath, nausea and vomiting, unexplained extreme fatigue, and neck, shoulder, upper back, or abdominal pain.

Signs of cardiac emergency Once the person has one of the above symptoms than the things one should look for in such persons is ÂÂ Tachycardia(fast heart rate)

ÂÂ Elevated Or Low blood pressure ÂÂ Cyanosis (bluish discolouration seen in extremities) could be due to lack of oxygen supply. ÂÂ Diaphoresis (profuse sweating) could be due to heart attack or heart failure. ÂÂ Anxiety or confusion secondary to oxygen deprivation. ÂÂ Pedal edema(swelling of the feet)- When edema is present, it can indicate heart failure for which the cause has to be evaluated. ÂÂ Engorged( Visible veins), pulsating neck veins (late signs)when present indicates heart failure. ÂÂ Sudden loss of responsiveness. No response to tapping on shoulders. Does nothing when you ask if he is okay.

Could be sign of cardiac arrest or cardiac arrhythmias. ÂÂ No normal breathing. The victim does not take a normal breath when you tilt the head up could be due to heart failure.



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Doctor SPEAK

Fainting: A benign thing, or a

harbinger of death?

Dr Anil Saxena

Director Electrophysiology & Cardiac Pacing Fortis Escorts Heart Institute

W

e have all seen or heard about someone fainting at the sight of blood, a gory incident, or during pain.

Fainting, or syncope as it is medically called, is not a rare occurrence. It is also called ‘passing out’ in common parlance. Nearly everyone faints once in a while during a lifetime. A large number of these episodes are the so-called ‘benign common faints’. However, syncope, in certain situations, can be a harbinger of sudden death: the only difference being that in syncope, one wakes up.

Fainting occurs usually when the blood pressure drops, and blood supply to brain is transiently compromised. Various symptoms may precede fainting, such as feeling of weakness, sweating, pale skin, nausea, loss of body muscle tone etc.

This prodromal phase may last few seconds to a couple of minutes. Once the person faints and falls, blood supply to brain is restored, and the episode of unconsciousness ends.

The majority of fainting episodes are benign, and occur because the nervous system is not able to maintain the appropriate degree of reflex constriction in blood vessels that leads to fall in blood pressure. These episodes usually have no consequences other than the injuries that might occur due to fall. Common situations, which trigger an episode, are sight of blood or injection syringe, painful stimuli, exposure to hot weather, and any acutely distressing event.

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In presence of heart disease, fainting can be due to dangerous rhythm disorders of heart, which may often be fatal if left untreated. This is particularly true if the pumping capacity of heart is reduced due to previous damage. Therefore, if fainting occurs in a patient having heart disease, it should be investigated carefully and appropriate treatment given.

Patients with slow heart rhythm need a pacemaker, which is an implantable electronic device that keeps giving electrical pulses to heart, and maintains heart rate. On the other hand, some patients are vulnerable to sudden death due to extremely high heart rate called ventricular tachycardia and fibrillation. These arrhythmias can be fatal if not treated urgently by an electrical shock. Such patients need implantation of a defibrillator, which keeps monitoring heart rhythm, and delivers a shock promptly on sensing a life threatening heart rhythm.

Undiagnosed and unexplained fainting can be troublesome to treat, and all effort should be made to monitor heart rhythm during an episode. For this, a number of monitoring systems have evolved which monitor heart rhythm for variable length of time. A Holter monitor is most commonly used which records ECG for 24 hours, but is not of much help as fainting is very less likely to occur in such a short duration. An external loop recorder monitors rhythm for one week, and keeps sending ECG to a web based analysis system which alerts physician in case of a significant arrhythmia. An even more advanced system is implantable loop recorder that can record and store ECGs over a period of 2-3 years, and can be very helpful in diagnosing infrequent episodes of fainting.

If you see a person faint, or about to faint, the immediate thing to do is to help the person lie down. If the person regains consciousness quickly, he or she should continue lying for about 10 minutes, and should be given fresh air and water to drink. If one is unconscious, the person should be turned to one side to avoid tongue falling back and obstructing airway. One should check for breathing and pulse, and call an ambulance if the person is unresponsive.

If there is no pulse and breathing, resuscitation should be started by chest compressions while waiting for ambulance to arrive. In many western societies, routine resuscitation training to maximum number of people has brought down mortality due to sudden cardiac death significantly.

Families of patients with significant heart disease should actively seen training in resuscitation. This can make the difference between life and death if the patient gets an episode of cardiac arrest.

Doctor SPEAK

Dr Praveer Agarwal

Director Interventional Cardiology, FEHI

C

oronary Heart Disease (CHD):- Is the commonest verity of heart Disease. It occurs as a result of critical blockages in coronary arteries (arteries supplying blood to the heart), compromising blood supply to the heart muscle and manifesting as angina pectoris, acute myocardial infarction (heart attack), or sudden death.

FAQ Coronary Heart Disease (CHD): Is it curable?

No, it is not curable. The disease course can be modified by proper medical therapy and intervention at appropriate time.

Medication of proven CHD: Is it life long?

Yes, it is life long. Depending upon parameters and symptoms the drugs and doses are modified.

What are the risk factors?

Age, Male gender, family history of premature CHD, high blood pressure, Diabetes Mellitus, smoking, tobacco chewing, high blood cholesterol, obesity, sedentary life style and psychosocial factors.

Can CHD be controlled by modifying risk factors?

Yes, it may reduce the risk or slow down the progression of CHD.

Can I develop CHD without risk factors?

Yes, one can develop CHD but risk of premature CHD is slim provided lifestyle is healthy.

Bypass surgery (CABG): Is it a cure for CHD?

No, it is only palliation. There is about 1-2% mortality and about 2-3% morbidity in bypass surgery. The recovery is about 2-3 months’. About 2/3 of patients usually come back by 10 years with some or other problem.

Angioplasty (stenting): Is it a cure for CHD?

No, it is again palliation. It is a low risk procedure in majority o patients. Done as a percutaneous procedure

MYTHS AND REALITIES OF CORONARY HEART DISEASE (as angiography) without any incision or General Anesthesia (GA). With the newer Drug Eluting Stents, the success is nearly 100% and recovery is quick (within 07 days). The blockages may recur within 6-8 months if at all (in <10% of patients). After that period, the further chances of recurrence are less.

Medication for high cholesterol: Is it life long?

Yes, in majority of patients. But the doses can be adjusted depending upon the levels and side effects.

Can I develop CHD without high cholesterol levels?

Yes, you can develop CHD without high cholesterol levels because cholesterol is not the only risk factor.

Is yoga a substitute for physical exercise for prevention of CHD? No, it is complementary to exercise.

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Doctor SPEAK

Abdominal distension may be generalised or may be localised to a discrete mass or enlargement of an organ. The main causes of generalised abdominal distension are easily remembered by the five Fs:  Fat (obesity)  Faeces (constipation)  Fetus (pregnancy)  Flatus (gastrointestinal)  Fluid (ascites)

Differential Diagnosis of

Abdominal Distention

C Dr. Rajiva Kumar Child Specialist Muzaffarpur, Bihar, India

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onstipation generally is defined as infrequent or painful defecation. It often is due to passing large hard stool infrequently which causes painful defecation and then withholding behaviors. As stool withholding continues, the rectum dilates and gradually accommodates with the normal defecation urge disappearing. Chronic rectal distension results in both loss of rectal sensitivity, and loss of urge to defecate, which can lead to encopresis. Abdominal distention because of stool retention occurs frequently. Treatment includes colonic evacuation, establishing regular bowel habits, eating a balanced diet with dietary

Doctor SPEAK

fiber and laxatives to keep the stool soft and help promote the normal motility patterns

Case Study

A 9 -year-old Patient came to me with a several day history of abdominal distension and generalized abdominal pain. The patient and family could provide few details but the pain was located periumbilically, occurred only during the day and would come and go. He occasionally felt nauseous but had no emesis.

The pertinent physical exam showed a well-appearing male with normal vital signs. His abdomen was moderately distended. He had normal bowel sounds in all quadrants. Palpation found no fluid wave or organomegaly. He had palpable loops of bowel from the left lower quadrant that followed the colon upwards and into the right abdomen. Palpation of the colonic loops reproduced the main. He denied costovertebral angle or suprapubic tenderness.

Abdominal distention is caused by some type of abdominal obstruction or space-occupying lesion that blocks or impinges on the intestinal lumen.

This leads to failure of the intestinal contents to pass through the intestinal tract. Proximal to the obstruction is swallowed air and abdominal contents and secretions. The abdominal contents cannot move distal to the obstruction causing no flatus and bowel movements. If the obstruction is high in the gastrointestinal tract (generally proximal to the jejenum) then emesis is common and there will be Duplications little abdominal distention because there is no air and contents moving further into the distal tract.

Hirschsprung disease If the obstruction is low, then there is more of a Incarcerated inguinal or umbilical hernia reservoir to hold the accumulated material causing Imperforate anus abdominal distention. Emesis is less common with distal obstructions. Fluid loss and electrolyte ÂÂ Neonatal abnormalities secondary to emesis, dehydration, Meconium ileus intestinal stasis, and bowel edema all can lead Meconium plug to bacterial invasion into the bowel wall. This accompanied with increasing intraluminal pressures Necrotizing enterocolitis can cause abnormal intestinal tract vascular flow, ÂÂ Infectious/Inflammatory ischemia, necrosis and perforation of the viscous.

Appendicitis

Differential diagnosis of abdominal distention includes: ÂÂ Anatomical

Ileus Intussception Perforated viscus

Annular pancreas

Organomegaly

Antral web

Sepsis

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Healthcare it

HIS solution and its trend towards adoption of Electronic Medical Records

T

he healthcare information system has been termed as the most promising tool for augmenting the overall quality,safety and efficiency of healthcare delivery systems. Mr. Raji Reddy, CEO, Shivam Medisoft Services Pvt Ltd shares his insights on evolving phase of Indian HIS solution and its trend towards adoption of Electronic Medical Records. Shivam Medisoft is an ISO 9001:2008 certified company based at Hyderabad, dealing into HIS/HMS since a decade and having its presence in most major locations in India like New Delhi-NCR, UP, Punjab, Chandigarh, Kolkata/W. Bengal, Andhra Pradesh, Bengaluru, Nagpur, Kerala etc.

How EMR helps a medical practitioner and the hospital?

clinical documentation facilities gives an improved bottom line of health care practice.

How Shivam EMR is different from others?

The mechanisms of safety for electronic medical records in terms of both patient diagnosis and the security of their health records is one of the main elements that SHIVAM designed into their HIS. An electronic medical health records arena of information sharing within a medical practice naturally reduces unwanted hand transcribed errors. Here there's the facility of auto-prescription where doctor neither needs to write up any physical prescription, nor the patient needs to carry any prescription to the pharmacy. Shivam EMR comes with mobile app where doctors can have it on their tabs, smart phones etc. The same EMR is available on cloud as well where they can access the data from anywhere. Auto prescription facility and dedicated EMR for Gyanae,IVF, Neonatology etc with ICD 10 (WHO approved list)

Electronic medical records systems represent all the various aspects within a medical practice that work as a whole to form a functioning system that more effectively cares for patients and benefits the medical How safe is the Electronic Data? practice. The patients don't needto carry any physical file and thus no issue of missing a patients file as all records are stored in software. EMR facilitates the doctor with fast decisioning and with accurate analysis of all clinical data which can be accessed from anywhere, even sitting at home. Reduction of medical errors give benefit to both the patient and the doctor ensuring proper diagnosis. EMR has the ability to transfer the patient data quickly from one dept to next. Space saving benefit is there of a digital record environment. Improved patient management with reduction of errors in medical practice. e-Prescription and

With the introduction of cloud, the data security of EMR has been restored. There's daily auto back up facility available where clients don't need to worry of any manual back up.

Cloud server is maintained either by Shivam or any other third party, hence there's no worry of server crash. Shivam is built in such a way where application level security of patient health records is an organization commitment.

What are the challenges you do face and how you plan to overcome?

IT being a strategic part of the hospital has its own share of challenges. It takes both strategy and vision along with good salesmanship to make the care giver grasp the IT tool being offered and use it effectively. Partnering with all quarters in the hospital is the key to improved health care delivery and better adoption. This helps in measuring health care standards and improves implementation.

Is it Costly?

Raji Reddy CEO Shivam Medisoft (P) Ltd.

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One can easily afford this and Shivam HIS (along with EMR) comes in monthly subscription as well since we want the mid and small size hospitals also to get benefit from our web based cloud compatible HIS and EMR.

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+91 8373995541, 011-23213039 E-mail: info@kingkesariya.co.in Visit us: www.kingkesariya.co.in

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Diagnostic Kit, Elisia Range, All Rapid Range, All Surgical Goods, Glass Wear, Plastic Wear, Lab Equipment, Laboratory Chemical Reagents, Dental lab Materials, Medical Equip., Scientific Equipment, Dental products & Medical Disposable Range Flat No. D-337, Ground Floor, Pocket - 11, DDA Janta Flat Jasola, New Delhi - 110025 E-mail: bdsurgicals786@gmail.com

Mob.: +91-8826920507, 9717085785

w w w.medegatetoday.com January-February 2015

63

Product LINE

You Visualise we Mould

Sanjay Dedhia Managing Director Mitsu Chem Pvt. Ltd., Mumbai

We have been satisfying the ever increasing demand of quality medical furniture and a clamour for professional services by extending delivery solutions and accessible post sales services.

M

ake in Indiaâ&#x20AC;&#x2122; is the recent buzz wordmaking headlines in the Indian Economy Sector.

The core ideology matches perfectly to the MitsuChemPvt. Ltd. Being a pioneer and sole manufacturer of high-end and innovative products in India, we have set a benchmark in the Plastic Manufaturing Space. We have been satisfying the ever increasing demand of quality medical furniture and a clamour for professional services by extending delivery solutions and accessible post sales services.

64

www.m e d e g a t e t o d a y. c o m January-February 2015

The premium quality and ergonomically designed modules manufactured by us not only serve as a superior import substitute, but also plays significant role in saving valuable foreign exchange. Our modules having strong potential for exports are widely accepted by the Indian Healthcare Industry.

The modest journey initiated with a Conventional Container Manufacturing has seen a major turn around by transforming to world class Furniture Parts Manufacturing Company.

The Mitsu ABS Panels, the flagship product of Mitsu Chem, offered in various combination of material, have secured the market leadership position with a domestic market share of over 70% catering to market leaders Janak Healthcare, Godrej and Boyce, Medimek Industries, Vissco (Steelcraft), Carevel etc. Our extensive range of products are robust, ergonomic, aesthetically pleasing and offers finishing that complies Global Standards. The wellengineered combination of materials makes the products sturdy at the same time easy to assemble and disassemble (Head Bows, Foot Bows, Side Boards, Railing with Brackets). Custom designs and colours further add to the specificity.

Having two units in Tarapur MIDC, 100 KM away from Mumbai and one unit at Rudrapur, Uttarakhand, Mitsu is growing by leaps and bounds by delivering world class Logistic and Inventory Control Support to its esteemed clients.

Kind Attention Stockists & Marketing Professionals Covering

Nursing Homes, Private Hospitals, Big Multi-Specialities Hospitals, Polyclinics, Institutions, Trauma Centers and Doctors.

AGROGEM

AGROGEM A Division of Agron Remidies

(A Division of Agron Remedies Private Limited) Est.1986

Our Products range Includes:-

Provides

Excellent Range, More than 600 Products.

Business opportunity For Dynamic Enthusiastic and Energetic marketing Professionals / Whole sale Chemists

HIGHLIGHTS: -

Manufacturing of all Products in our own state of art Plants Manufacturing of injectables (Beta Lactam and non Beta lactam ) , Tablets , Capsules, Ointments, Lotions, Liquid orals, Eye/Ear Drops etc.

Have revised Schedule M GMP and ISO - 9001:2008 certifications Long experience(30 years) of Manufacturing Very Competitive Price with higher margin of profit Stock Available round the Clock -Timely services & on time supplies Elegant Packing with unmatched Quality Long lasting Relationship, Committed Dealings Road Permit not required for supplies from U.P Depot and Bihar Depot

Inquiries for stockistship and superstockistship are solicited Experienced Pharma Personnels can also contact for excellent opportunity.

Export and 3rd Party inquiries are solicited.

OUR MARKETING DIVISIONS Agron Pharma (PCD Marketing)

Agrovision (PCD Marketing)

AGRON OTC

Agrogem CARDiRON

Agron Vet Care

PSYCHORON

Agron OTC

DERMARON

CONTACT US:

Email:- agronremedies@gmail.com Phone No. : 09358650929, 09359489829,08859001367, 05947275279 FAX:- 05947274929, website: agronremedies.com

Agron Remedies Pvt Ltd. Sarverkhera, Moradabad Road,

Kashipur-244713 (Uttarakhand)

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CLASSIFIED EXPERT Update

Ambulance Equipments Shree Balaji surgical pvt ltd A/002,Ruchi CHS, Grd Flr Devidas Lane Borivali (W) Mumbai - 400103 M: 9820430338, E: sbsjaipur@gmail.com

ANESTHESIA EQUIPMENTS

diabetic care Products

Healthware Pvt. Ltd.

Headlines

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

diagnostic & lab products

Afford Medical Technologies pvt ltd

230,2nd Main Road, Sainikpuri Secunderabad - 500094, T: 040-32908880 akhand enterprises

G- 12, Shivlok House 1, Commercial Complex, Karampura, New Delhi- 110015 9350445559, 9717445559 akhandenterprises@gmail.com Medion Health Care Pvt Ltd

201, Shiv Industrial Estate, K.B.B. Marg Marg , Chinchpokli (E),Mumbai-12, M:9987642222 sales@medion.co.in

Autoclave & Sterilizers Jaiveer Surgical emporium

1570, Bhagirath Palace, Delhi-110006 T: 011- 23866065, 2386066, M: 9810880087 jainco.jain@gmail.com Creative Healthtech Pvt. Ltd.

M: 9811339989 Drager Medical Pvt. Ltd.

T: 022-40843826

bDS

biogene Diagnostics & Surgicals Deals in:

Diagnostic Kit, Elisia Range, All Rapid Range, All Surgical Goods, Glass Wear, Plastic Wear, Lab Equipment, Laboratory Chemical Reagents, Dental lab Materials, Medical Equip., Scientific Equipment, Dental products & Medical Disposable Range Flat No. D-337, Ground Floor, Pocket - 11, DDA Janta Flat Jasola, New Delhi - 110025 E-mail: bdsurgicals786@gmail.com

Mob.: +91-8826920507, 9717085785

Disposable

GITA HOSPITAL SUPPLIES

Haribharath Equipments Pvt. Ltd.

T: 022-25666869

Blood Pressure Apparatus Lab Hosp International

M: 9324152433 Remi Sales And Engineering Ltd

T: 022- 40589888 Sanlar Imex Services Pvt. Ltd.

M: 9833192894

Defibrillator Equipments Medical Solution

98873699736 78

serene Tower 8-2- 623/A Rd No. 10, Banjara Hills Hyderabad -500034 T: 040-23318229 Helios Endovision

1/1, Sahkar Niwas , Tekri Bunglow, nr.3 Petrol Pump Old Agra Road, Thane- 400602 M: 9820276976 Om Surgicals

65, Unique. Est., Nr.Jammunadas, Opp jawahar Talkies, Mulund (W)Mumbai-400080 T: 022- 25670626

ENT Equipment Instrument Tufft

Surgical house,44,Mission compound,Ajmer Road,Jaipur T: 141 2373125, 2368568

GLOVES Shree Balaji Surgical Pvt. Ltd. A-002, Ruchi CHSGround Floor, Devidas Lane Borivali (W), Mumbai 400103 Ph.: 022- 28954442 Nulife Global Medical Devices Pvt ltd

B6,Byculla Service Indl. Premices, D.K. Marg, Sussex Road,Byculla, Mumbai-27 T: 2374 8371/2/3

House of Hospital & Disposable Clothings

Surgeon Gown Suits, Caps, Face Mask, Patient Kurta-Pyjama, etc.

Ph.: 011-23860175, M: 9810370662

Sho-47, Naraina Bazar, Near Fountain, Chandni Chk, Delhi-6

Email: manojvtuli@gmail.com

Saras Life Solution

M: 9923455413

Endoscopy Instruments

Hitex healthcare

A-402,Laxmi sadan,Thakur Village, Kandivali Mumbai 22 28860782 Shree Balaji Surgical pvt ltd

1-B-30,Lalita Shashtri Nagar, Behind Kalpatru Shopping Centre, Jaipur-16 T: 0141- 2309675

ECG Equipments Hygeia Incorporation

HEALTHCARE PRODUCTS Shree Balaji Surgical Pvt. Ltd. A/2, Ruchi CHSGround Floor, Devidas Lane Borivali (W), Mumbai 400103 Ph.: 022- 28954442

HOME CARE Easy Care Group

4th Floor Shugar House, 93/95, Kazi Syed Street, Masjid Bunder (W) Mumbai 03 T: 02223450133 E: info@easycareglobal.com Nulife Global Medical Devices Pvt ltd

B6,Byculla Service Indl. Premices, D.K. Marg, Sussex Road,Byculla ,Mumbai-27 T: 022-2374 8371/2/3 Shree Balaji Surgical pvt ltd

S No. 16 , Navghar Bldg 59/ 60, Poonam sagar Complex Mira Road (E) Mumbai 401107 M: 9967064947

1-B-30,Lalita Shashtri Nagar,Behind Kalpatru Shopping Centre, Jaipur-16 T: 0141- 2309675

Nasan Medical Electronics Pvt. Ltd.

Cygnus Hospital

Rangoli Ist floor.,opp Karve Statue Kothrud Pune-411038 M: 8237032389

www.m e d e g a t e t o d a y. c o m November-December 2014

HOSPITALS (Multi Speciality) 1211,Tower-2, Pearls Omaxe,Netaji Subhash Place, New Delhi-110034 T: 011 42488393

CLASSIFIED Update

Fortis Escorts Heart Institute & Research Centre

Okhla Road, New Delhi-25 M: 91 11 4713 5000

Manaipal Hospitals

98, HAL Airport road, Bangalore-560 017 T: 080 - 2502 4444/3344 Pushpawati Singhania Research Institute

Press Enclave Marg, Sheikh Sarai, Phase-II, New Delhi â&#x20AC;&#x201C; 110 017 Tel: 011 30611900

HOSPITAL CONSULTANCY

Hosconnn

6, Chaithanya Complex Site 1, 17th Cross, Sir MV Nagar T.C. Palya Main Road, Bangalore M: 9845208778, Email: info@hosconnn.com

Red Sun Communication Pvt. Ltd. 304, Shubh House, 77 Swastik Society, B/H. City Centre, Navrangupura, Ahmedabad- 380009 T: 9376121646

ICU Equipments

Rehabilitation Product &AIDS

Philips India Ltd.

9th Flr, DLF, 9b , DLF, Cyber city, DLF Phase- 3 sec 25, Gurgaon-122002 T: 0124- 4606000

MOdular- Operation Theatre

Vissco Rehabilitation AIDS Pvt. Ltd.

517, Tulsiani Chambers, Nariman Point Mumbai-400021 T: 022-43330300

Sai Sumeet Appliances

Medical Equipment

Hyderabad M: 08099119595

Technocare Medisystems

Monitoring Equipments & Accesso Afford Medical Technologies Pvt. Ltd.

230, 2nd Main Road, Sainikpuri Secunderabad-94 T: 040-32908880

C/1310-11,New Bombay Market, Umarwada,Surat- 395010 T: 261 2332042,6569308

Shoes Cover Dispenser BIO-X

Drager Medical Pvt. Ltd.

Gold line Business Centre, Link Road Malad (W) Mumbai-400064 T: 022- 40843826 Medion Healthcare Pvt. Ltd.

201, Shiv Industrial Estate, K.B.B. Marg Chinchpokli (E) Mumbai-12 T: 022-23771737

5th floor, Span center, South Avene Santacruz (w) Mumbai-400054 M: 9820355995

Software and IT Solution

Nihon Kohden India Pvt. Ltd.

308, Tower- A, Spaz Edge, Sector- 47, Sohna Road Gurgaon- 122002 T: 0124-4931000

Six Sigma Star Healthcare Pvt. Ltd.

New Delhi T: 011 25324000 E-mail: sixsigmahealthcare@gmail.com

Health care Institution Global Institutte of Healthcare Management

6 sigma house, 10A, Phase -1, Najafgarh New Delhi-43 T: 011 2532 4000,4001

HOSPITAL FURNITURE Godrej & Boyce Manufacturing company ltd.

Pirojshanagar, Vikhroli, Mumbai- 400079 T: 022- 67965656 Jaiveer Surgical Emporium

1570, Bhagirath Palace, delhi-110006 M: 9810820087

Neonatal Pediatric Intensive c Bird Mediteck

109, 110, NidhiIndl Est, Shankar Industrial Complex No. 2, Waliv, Vasai, Thane-08 T: 0250-3212729

operation theatre equipment

T: 124 414150

Unit No. C-1/2/3/, Sagar Sangam Ind. Est., Sativali Vasai (E) Thane-24 T: 0251-2872193

Kodak Alaris

109, 110, Nidhi Ind. Est., Nh No. 8, waliv, Vasai (E) Mumbai- 401208 T: 0250-3212729 Magnatek Enterprises

97, SVC Indl Est.Balanagar, Hyderabad-500037 T: 040-65501094

Nurse Calling System CR Medisystems Pvt. Ltd.

kalpataru Point, Unit No. -12 1st floor, sion (E) Mumbai-400022 T:022- 49153000

Mumbai, India.

Tel : 91-022-23094416, 23004930 E-Mail : medisystems@gmail.com

Hospital Garments 4- 401, Vanrai Colony , Opp Nirlon, off W.E. Highway Goregaon (E)Mumbai-400065 M: 9869051352

Ribbel International Ltd

20th Mile, Jatheri Road, P.O.RaiNear Rai Industrial Area Sonepat Haryana 131029 M: 8053111016, 8053111011

UROLOGY Ribbel International Ltd

20th Mile, Jatheri Road, P.O.RaiNear Rai Industrial Area Sonepat Haryana 131029 M: 8053111016, 8053111011, sales@ribbel.com

operation theatre Light Magnatek Enterprises

97, SVC Indl Est., Balanagar, Hyderabad-500037 T: 040-65501094

To Advertise in this Section Please Call: + 9 1 - 1 1 - 2 6 9 8 1 3 4 2 , E-mail: info@medgatetoday.com Visit: w w w. m e d g a t e t o d a y. c o m

www.kodakalaris.com

SURGICAL BLADES

Bird Meditech

Janak Healthcare Pvt. Ltd.

Kaustubh Hospital Garments

Schrack Seconet AG

Agora Climate Control system

X- Ray Equipment Allengers

S.C.O 212-213-214, sector 34,Chandigarh - U.T 160 022 (India) T: 172 3012280-84

w w w.medegatetoday.com November-December 2014

79

RNI No. DELENG/2010/33833

Most Prestigious & Recognised Awards in Healthcare Sector Magazine

Presents

Healthcare Awards H ono u rin g

E x ce l l ence

21st March 2015, Pragati Maidan, New Delhi held alongside

MEDICAL FAIR INDIA 2015

For Nomination and Sponsorship Enquiry:

Contact: +91 11-26981342, Mob.: +91 9899037351 E-mail: awards@advancemedia.org For nomination log on to: w w w . m e d g a t e t o d a y . i n Media Partner

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