Medgate march april 2015 by Medgate Today

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Volume V || Issue VI || March-April 2015

The Gateway to Health & Medical World

EDITOR SPEAK

Union Health Care Budget 2015-16 “Finance Minister Arun Jaitley allocated Rs 33,150 crore for the Healthcare Sector”. The Union Budget 2015-16 is a breakthrough budget. The healthcare industry has welcomed Budget proposals to increase tax exemption limits for health insurance cover and set up more AIIMS across India, saying such moves enable people’s access to better facilities. The provision to set up 5 new medical colleges along the lines of the AIIMS will go towards bridging the talent gap for qualified healthcare professionals in the entire country. The above step will be useful in dealing with the shortage of qualified manpower in India. This will also boost patient care in India. Increasing the tax exemption on health insurance cover will increase access to healthcare. Increase in visas on arrival facility to 150 countries will give a boost to medical tourism in the country.

Volume - V Issue - VI Mar.-April 2015

Editor Chief Editor Editorial Advisor

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

National Head

Afzal Kamal

Asst. Manager

Sonia Pandit

Corporate Communication

Cheif Correspondent

Sales and Marketing

SA Rizvi, Dr. HN Sharma

Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Deepti Tripathi, Nizamuddin Alam

Potential Health care industry is the world’s largest industry with total revenues of approx US$ 2.8 Trillion. In India as well, health care has emerged as one of the largest sector with maximum expenditure incurred. An astounding 60% of this is out of pocket expense. India has one of the highest proportions of private health spending, comparable only to a only few countries in the world with a recent history of major internal unrest, such as Cambodia and Myanmar. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners Some unfortunate statistics reflect this state of affairs:

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NEWS Contents Update

Swine Flu can prompt Sudden Heart Attack

NEWS Conference on â&#x20AC;&#x2DC;PHD Manufacturing Signature Series 2015 Doctors at Fortis Escorts Heart Institute bid affectionate send-off to 16 year old Prince, Amitabh Bachchan Inaugurates Latest Technology in Eye Surgery Spinal Cord Injuries (SCI) on the Rise Ministry of Health & Family Welfare, Government of India Launches

33 8 12 14 16

EXPERT VIEWS SMOKING AND CARDIAC SURGERY 44 Health Benefits of Walking 45 Parenting tips for IVF children 48 Sudden Cardiac Arrest: How to prevent it. 50 INTER VIEW Cardiac Arrhythmia, its Sign & Symptom?

Swine Flu Can Attack Children too

DOCTOR SPEAK Liposuction: It a Procedure to Remove Stubborn Fat, Not For Weight Loss 54 Swine Flu Can Attack Children too 56 Glaucoma the silent killer of Sight 58 DENTAL SECTION Smoking & Oral Health

Medical Devices Industry in India : An overview

Healthcare Budget Reaction from Healthcare Experts 43

Kidney Transplant: Blood group matching no more a barriers 62

www.m e d e g a t e t o d a y. c o m March-April 2015

NEWS Update

Conference on ‘PHD Manufacturing Signature Series 2015-Zed Effect’ held on 19th February 2015 at PHD House, New Delhi.

HD Chamber organized a Conference on ‘PHD manufacturing Signature Series 2015- Zed Effect’ on 19th February 2015 at PHD House, New Delhi which was inaugurated by Shri Narendra Singh Tomar, Hon’ble Union Minister of Steel and Mines, Govt. of India. Mr. Alok B Shriram, Senior Vice President, PHD Chamber while welcoming Shri Narendra Singh Tomar Highlighted that India’s manufacturing sector could reach USD 1 trillion by 2025. This could be achieved on the back of the continually growing demand in the country and the inclination of multinational corporations to establish lowcost plants in India. Up to 90 million domestic jobs could be created by 2025, with the manufacturing sector contributing to about 25–30 per cent of India’s gross domestic product (GDP). According to World Bank estimates, simply halving the delays due to road blocks, tolls and other stoppages could cut freight times by some 20-30 percent and logistics costs by an even higher 30-40 percent. This alone can go a long way in boosting the competitiveness of India’s key manufacturing sectors by 3 to 4 percent of net sales, thereby helping India return to a high growth trajectory and enabling large scale job creation, he added. He emphasized that steel is the core sector for development of any economy. Hoping to benefit from the 'Make in India' programme, all steel producers would look to expand their capacity to about 100 - 110 million tonnes per annum. Currently the total output stood at above 83.2 million tonnes in the year 2014, cementing India's position as the fourth-largest steel producer for fifth year now in a row. The sector is also looking to benefit from the fall in iron ore prices to five-year low levels, as also from the declining coking coal prices.

Mr. Anil Khaitan, Chairman, Industry Affairs Committee, PHD Chamber while felicitating the Chief Guest and participants said Studies conducted on the manufacturing industry have concluded that India has a working

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population of 75%. Out of this, only 600 million have acquired education till middle school. Due to this reason, the manufacturing industry in India , which is labor intensive, can provide the requisite number of employment units in the country. Studies have indicated that the productivity of the manufacturing industry in India is approximately 1/5th of the productivity in the manufacturing industry of United States Of America. It is about ½ as compared to the productivity levels in South Korea as well as Taiwan. Sources estimates that the higher input costs for the Indian manufacturing sector as a result of cascading effect of indirect taxes on selling prices of commodities, higher cost of utilities like power, railway transport, water, higher cost of finance and high transactions costs puts the sector at a severe disadvantage as compared to its Asian counterparts, he added. Mr. Naveen Jindal, Chairman, Jindal Steel and Power Ltd demanded transparent policies from the government for all sectors including Steel, Coal and Mines so that no ambiguity prevails and business is conducted with ease and fairly. Mr. Jindal said that the scarcity of Non Cooking coal and Iron ore is the major concern for the steel sector. India has more than 200 coal blocks but only 30 coal blocks has been started so far. At the time of independence, India and China were producing the same volume of steel whereas now China is producing 822 MT and India could be able to touch at appx.85 MT. Government should take imperative steps to

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NEWS Update

encourage manufacturing like expansion of ports, Railway good quality products and become Network etc., he added. competitive like Tata follows the Shri Narendra Singh Tomar, Hon’ble Union Minister of model of TQM( Total Quality Steel and Mines said that the Ministry of Steel is making Management). necessary provisioning in the law to involve private sector participation in exploration of mines and minerals and also empowering them to compensate the cost involved in exploration.

Recent falling IIP figures in manufacturing are a curse for economy. The steel demand is low in the recent past which in turn is creating pressure on steel domestic prices. According to a McKinsey report, lack He said that the auctioning would be only channel available of facilities in Infrastructure and Logistics amounts to INR for obtaining mines and minerals reserves in all categories 45 billion which is equal to 4.3% of India’s GDP. including captive mines and merchant mines and even a India has an advantage of demographic dividend wherein foreign entity such as POSCO would have to be awarded it is easy to find employees for different jobs. India must mining and mineral blocks through auction process even produce good quality products to enable growth in exports though it has been seeking to invest in India in its mines and and to reduce the trade deficit. minerals segment for over a decade. Mr. Easwaran Subramanian, Senior Director - Consulting, By the month of May 2015, the ministry of steel and mines will finalize the new auction rules and regulations for future as for which the mines and minerals resources be awarded and the new rules and regulations finalized by the centre be referred to states such as Odisha, Chhattisgarh, Jharkhand.

Deloitte Touche Tohmatsu India Private Limited said it was the need of hour that private industry players need to invest in Research and development to encourage the innovation and new technologies which will lead to zero effect and zero defect. India has to focus on increasing its productivity He also apprised participants about the initiative taken by the which increased by .4% in comparison to last year whereas government to strengthen the steel sector by increasing the China is more than doubled its productivity. production of iron ore and also restrict unwarranted imports Mr. Rajiv Bajaj, Partner, Nomura Research Institute India to save the interest of domestic manufacturers. (NRI) said that despite tough conditions to do business in Mr D P Deshpande, Managing Director, Tata Sponge India, Automotive industry has marked India’s position in tractor producer, 2nd Iron Ltd said that large unorganized sector serves the steel the world. Today, India is the largest rd largest two wheeler producer and 3 largest Truck and Bus manufacturing industry and the manufacturers must owe the producer in the world. responsibility to organize them, to enable them to produce

SYMBIOSIS INSTITUTE OF HEALTH SCIENCES (SIHS)

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ymbiosis Institute of Health Sciences (SIHS), aconstituent of Symbiosis International University (SIU) is recognized as an International Training Center (ITC) of the American Heart Association (AHA), USA & a “Chapter” of the International Trauma Life Support Organization, (ITLS), USA,SIHS has conducted480 AHA/ITLS / workshops both at the Provider and Instructor level &trained over 20,000 doctors and nurses from all over the country. Last year, AHA has trained over 14 million people in CPR and First Aid programs worldwide & SIHS has contributed immensely towards the same by training 25,000 first responders. We at SIHS are delighted to inform you that out of 1200 International training centers in US and across 98 countries, SIHS is ranked 2nd in AHA training as mentioned in Global recognition awards 2014 and has been recognized as an American Heart Association Silver Recognition Award recipient. This respect &honor was received for delivering high quality lifesaving training to hospitals, pre-hospitals, work places and general public at large.

www.m e d e g a t e t o d a y. c o m March-April 2015

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NEWS Update

Doctors at Fortis Escorts Heart Institute bid affectionate send-off to 16 year old Prince, following successful Heart Transplant Surgery Doctors at Fortis Escorts Heart Institute (FEHI), India’s leading cardiac care facility, said that 16 year old Prince is in good health and ready to go back to his hometown toresume a normal life following the successful Heart Transplant Surgery conducted on January 3, 2015, under the guidance and leadership of Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute. The surgery was conducted by Dr Z S Meharwal, Director of Cardiac Surgery along with Dr Yugal Mishra, Director of Cardiac Surgery, Dr Anil Karlekar, Director of Anesthesia,Dr Sameer Shrivastava, Director of Non-Invasive Cardiology and Dr Vishal Rastogi, Head of Heart Failure Program,who took care of the patient during procedure and his recovery. Prince was suffering from a condition called Idiopathic Dilated Cardio Myopathy, an end stage heart disease with a poor heart function, and an LV ejection fraction of 15%. He had been consulting FEHI for treatment of this disease and was advised heart transplantation when he came two months ago with symptoms of severe breathlessness. The donor of Prince’s heart was a 30 year old IT professional whose family, based in Hyderabad took a noble decision to donate his organs and save six valuable lives, upon being declared brain dead by a team of doctors at FMRI, on January 3, at 8:48 am. Dr. Ashok Seth, Chairman, Fortis Escorts Heart Institute, said,” It is heartening to see Prince’s progress since his surgery a fortnight ago. He has made an uncomplicated recovery. He wants to go cycling throughout the day and is looking forward to playing with his friends. There are approximately 46 lakh patients who suffer from heart failure in India and 10% of these die every year. Seeing Prince’s recovery gives hope to many people in the country whose future can be changed by a meticulous team work of specialists at Institute’s such as ours,who have made this recovery possible in a total sterile environment to avoid infection and organ rejection.We aim to expand this collaboration to airlift donor hearts from other cities for transplantation at FEHI, to bridge the availability factor.” Post-surgery, a rehabilitation team assisted the patient to get back to normalcy. The process includes counseling, education and exercise training to help build muscles that keep the recovery ongoing. The rehabilitation starts from sitting up, graduates to taking a few steps and subsequently slowly increases the activity level of the patient. Dr ZS Meharwal, Director and Coordinator, Cardiovascular Surgery, FEHI and Chief Operating Surgeon for the case,said, “We are delighted to see Prince’s recovery and wish him all the best as he starts a normal lifeincluding going back to his daily routine of resuming school activities and playing. His first endomyocardial biopsy was conducted before discharge and he is absolutely fine with no signs of rejection. He will

www.m e d e g a t e t o d a y. c o m March-April 2015

continue to be on immuno suppressants and would need to be back for regular check-ups.He needs to take adequate precautions to prevent infection.” Added Dr Meharwal, “With recent advances in surgical techniques and improved medical management of organ rejection after transplantation, patients can now hope for an increasingly faster recovery after heart transplantation. The new heart is supported with intravenous medications for about 1-2 days until it recovers from the “shock” of the transplant but the patient immediately feels the difference a healthy heart makes. As the immune system gets activated immediately after the heart is transplanted, the patient is given medications to prevent rejection, both before the transplant, and immediately afterwards.” Dr Yugal Mishra, Director of Cardiovascular Surgery, the second surgeon in the case, “This is a very satisfying and happy moment for the patient and his family and the treating doctors because the Institute has given a successful and uncomplicated recovery to a young patient who got a heart transplant. This is only the first step. Subsequently, the patient has to be maintained with immuno suppressants and monitored for rejection of organs which in itself is a very tedious process. We at the Institute are geared to manage this with extreme care and efficiency. With a growing number of heart failure patients in our country, a heart transplant is an effective and comparatively cheaper mode of treatment as compared to assisted devices. This success has given us tremendous confidence to treat and organize a well structured program in our Institute to take care of these patients. ”Paternal uncle, of the 16 year old boy were also short of words when asked how he felt seeing young Prince all set to take new challenges of life like any other teenager. Tearfully, he thanked the team of doctors saying, “I can never find words to express my gratitude to the team of doctors who gave Prince a new life. More than that, I really have no words to express my intense gratitude to the family who made this possible for him.I salute this God-like gesture of the parents of the donor.”

NEWS Update

Amitabh Bachchan Inaugurates Latest Technology in Eye Surgery • The Vission Eye Center brings the latest ‘FemtoSecond Laser’ to Mumbai • Amitabh Bachchan lauds the efforts by Dr. Himanshu Mehta Mumbai gets its first ‘FemtoSecond Laser’ facility at The Vission Eye Centre, a leading eye care specialty clinic at Juhu, Mumbai. ‘FemtoSecond Laser’ is the latest platform in the world in the field of eye surgery and is a completely bladeless laser assisted eye surgery technology. The first-of-its-kind technology was inaugurated by superstar Amitabh Bachchan. Dr. Himanshu Mehta, a renowned eye surgeon at The Vission Eye Center has been instrumental in bringing this in Mumbai. It is unquestionably the most technologically advanced option for the patients and offers numerous advantages over the previous versions. The technology is capable of supporting Cataract and other procedures in a single platform. It will enable eye surgeons to perform far more accurate, precise and controllable incisions when compared to the current standard procedures. For patients, ‘FemtoSecond Laser’ offers highest safety in procedures of eye surgeries. While appreciating Dr. Mehta for bringing this technology

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to Mumbai, Amitabh Bachchan expressed the need to bring in the latest technologies to India. He commented, “I am sure this technology will take the level of eye care to next level in and all kinds’ of eye surgeries especially cataract surgery can be succufully done in Mumbai. He also added that Dr. Mehta is virtually a part of our family and he has operated Jaya.” Amitabh Bachchan lauded the efforts byTheVission Eye Center and Dr. Himanshu Mehta for bringing the very latest technologies into Mumbai in the last decade.

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High sensitivity of up to 81% and is a useful adjunct to atypical urine cytology in suspected bladder cancer cases. Significant increase in the sensitivity up to 97% when combined with cystoscopy1,2.

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NEWS Update

Spinal Cord Injuries (SCI) on the Rise, Prevention the Only Way Forward Association of Spine Surgeons of India (ASSI) Issues a Position Statement on Prevention of SCI

ith the rising number of accidents in the country, there has been a significant increase in the number of spinal cord injuries in the last two decades. Spinal experts caution that this number is expected to rise sharply if preventive steps are not taken on a priority basis. Although the exact incidence of spinal injuries in India is not known, some pilot studies have estimated the incidence as around 20 per million population.

“Prevention strategies have not been given due emphasis in India and in other developing countries. This has been despite the fact that it has been amply demonstrated in that prevention strategies can be successfully implemented to reduce disability, morbidity and mortality cost effectively. This may partly be due to constraints in availability of resources to organise prevention campaigns especially when faster results can be achieved using the same resources for communicable diseases. However the policy-makers need to be sensitized that in the long run prevention programs prove to be cost effective. Further, the strategies of prevention need to be especially adapted for India since the vast majority of the population (72.2%) lives in rural areas and most of the accidents take place at home or in the unorganized sector,” says Dr. H.S. Chhabra, Secretary, ASSI & Medical Director, Indian Spinal Injuries Centre.

Across the globe, road traffic crashes are generally the most common cause of spinal cord injuries. However, some studies suggest that fall from height may be the most common cause in many parts of India whereas in some other parts it may be road traffic crashes. Domestic falls, fall of load from height, fall while carrying heavy load, diseases (tuberculosis / tumors of spine etc.), violence, sports injuries and water accidents (diving) are “An integrated approach involving all stakeholders is the other causes of spinal cord injuries. essential for success. Active inputs are thus required in “The dictum that Prevention is better than Cure is terms of resources, support and cooperation from policyespecially relevant for spinal injuries as the chances of makers, professionals, the public and the press; and most recovery in complete spinal cord injuries are generally importantly political commitment,” says Dr. Saumyajit slim due to lack of the inherent capacity of the spinal cord Basu, Jt Secretary-ASSI, Consultant Spine Surgeon, Park to undergo neuronal regeneration. Simple measures for Clinic and Kothari Medical Center, Kolkata. prevention can be effective to prevent what otherwise is perhaps the most devastating ailment which can afflict mankind. Hence Association of Spine Surgeons of India (ASSI) decided to come up with a position statement which highlights broad strategies for prevention of SCI”, says Dr. Sajan Hegde, President-ASSI, Consultant Spine Surgeon & Head, Department of Orthopaedics, Apollo Hospitals, Chennai. “Prevention programmes can be translated into action through the 4 E’s of injury prevention and control including Education, Engineering, Enforcement and Emergency Care. Broad approaches for prevention programmes include infrastructure development, environmental modifications, legislation and community education”, says Dr. Ram Chaddha, President Elect ASSI and Prof. & Head, Department of Orthopaedics K.J. Somaiya Medical College, Sion, Mumbai

www.m e d e g a t e t o d a y. c o m March-April 2015

NEWS Update

Ministry of Health & Family Welfare, Government of India Launches

‘National Deworming Day’ to Treat 140 Million Children for Parasitic Worms ÂÂ Shri Jagat Prakash Nadda, Union Health Minister, Smt Vasundhara Raje, Rajasthan Chief Minister, and Shri Rajendra Rathore, Rajasthan Health Minister launch first-ever National Deworming Day. ÂÂ National Deworming Day, the single largest deworming drive in the world, is a groundbreaking school-based initiative focused on reducing the threat of parasitic worm infections, a widespread health issue affecting over 241 million children in India alone. ÂÂ Assam, Bihar, Chhattisgarh, Dadra & Nagar Haveli, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Rajasthan, Tamil Nadu and Tripura to observe National Deworming Day in the first phase of its launch; to treat an initial 140 million children at risk for parasitic worms in schools and anganwadi centres. ÂÂ ALBENDAZOLE tablets and syrup will be administered to pre–school and school-age children ages 1-19 years. The Ministry of Health & Family Welfare today launched the first ‘National Deworming Day’ - a massive school-based deworming effort in twelve states scheduled for February 10, 2015. Shri Jagat Prakash Nadda, Hon’ble Union Minister for Health & Family Welfare, Government of India inaugurated the national program, in Jaipur, Rajasthan, together with Smt. Vasundhara Raje, Hon’ble Chief Minister, Government of Rajasthan and Mr. Rajendra Rathore, Minister for Health & Family Welfare, Government of Rajasthan, in the presence of senior officials from the Central and State Government. National Deworming Day is a groundbreaking initiative focused on reducing the threat of parasitic worm infections, a widespread health issue affecting over 241 million children in India alone. India has the highest burden of soil-transmitted helminths-parasitic worms--in the world. Parasitic worms in children interfere with nutrient uptake, and can contribute to anemia, malnourishment, and impaired mental and physical development. According to the 2012 report ‘Children in India’, published by the Ministry of Statistics and Programme Implementation, Govt. of India, 48% of children under the age of 5 years are stunted and 19.8% are wasted, indicating that half of the country’s children are malnourished. Shri Jagat Prakash Nadda, Minister for Health & Family Welfare, Government of India said, “The early years of a

www.m e d e g a t e t o d a y. c o m March-April 2015

child are the most critical and significant. I am confident that if the comprehensive set of actions identified in National Deworming Day Guidelines is fully implemented, children will have improved health outcomes and be able to achieve their potential to the fullest.” Mass, school-based deworming is safe, cost-effective, and can scale to millions of schools quickly. Deworming has been shown to reduce absenteeism in schools, improve learning outcomes, and increase the likelihood of higher wage jobs later in life. The timely, high quality, mass-based deworming programme for children of pre-school and school age children in India will dramatically reduce the harm caused by parasitic worm infections in millions of children in India. The Government of India is launching a fixed oneday school-based program to ensure intensive deworming coverage and targeted outreach. Community mobilization efforts are also undertaken to engage community-based health workers and other local institutions. Albendazole was orally administered to pre–school and school-going children ages 1-19 years in government schools and anganwadi centres across the states of Assam, Bihar, Chhattisgarh, Dadra & Nagar Haveli, Haryana, Karnataka, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu and Tripura. The National Deworming Day campaign treated an initial 140 million children at risk for parasitic worms in schools and anganwadi centres with schoolteachers and anganwadi workers administering the drugs. In line with any mass-based public health initiative, stringent adverse event protocols are put in place with teachers, anganwadi workers, health officials trained to respond as needed.

NEWS Update

Worldwide Achievers Felicitated the Winners of Healthcare Excellence Awards 2014 Worldwide Achievers recently honoured and awarded icons of the healthcate sector. Worldwide Achievers Healthcare Excellence Awards 2014 to felicitated organizations and individuals for their contributions to the industry by innovating for increased efficiency and improved performance of healthcare delivery at large. The Worldwide Achievers Awards have emerged as the most credible and coveted in the industry within a short span of time. Healthcare Excellence Awards 2014winner’s honoured by Padamshree Dr. Jitendra Kumar Singh, Mr. Ajit Gupta (MDCare world TV)&ShriNavinSinha (Co-convener, Sahyog Cell - BJP). Worldwide Achievers is one of the leading market research company recently organized Healthcare Excellence Awards 2014with Care World TV as Media Partner, Delhi Medical

association as Knowledge Partner, Drug Today Medical Times as Print Media Partner &Medgate Today as Magazine Partner, Ceremony to felicitate India’s top Doctors, Clinics & Hospitals, Healthcare Providers, Nursing Homes, Medical Devices and Hospital Equipment Companies, Diagnostic Laboratories, Health Insurance Companies. The event was held at Habitat World at India Habitat Centre in New Delhi 0n 21 January 2015. The awards were based on a comprehensive market research study and opinion surveys conducted by Worldwide Achievers. Padamshree Dr. Jitendra Kumar Singh, Mr. Ajit Gupta(MD- Care world TV) & Shri Navin Sinha (Co-convener, Sahyog Cell - BJP).were the chief guest & Guest of Honor at the gala ceremony and gave away the award certificates & trophy to the winners which included Individuals/organizations from all across India.

Worldwide Achievers Healthcare Excellence Awards 2014 winners: G Star Health and Allied Insurance Co. Ltd. - “Most Promising Health Insurance Company of The Year” G Medanta – The Medicity - “best Super Speciality Hospital & Research Centre of The Year” G Apollo Hospitals International Ltd, Ahmedabad - “Best Hospital For Wellness & Healthcare In Gujarat” G Saket City Hospital - “Best Hospital For Innovation of The Year” G Civil Hospital, Ahmedabad - “Best Multi Speciality Hospital of the Year (Gujarat)” G J.K.Ansell Ltd. - “Best Healthcare Barrier Protection Company of the Year” G Unihealth Consultancy Private Limited - “Best Medical Tourism Company of the Year” G NowrosjeeWadia Maternity Hospital - “Maternity Hospital of The Year (Western India)” G Billroth Hospitals - “Best Multi Speciality Hospital in Chennai” G Naugra Export - “Best Medical Equipment Company of the Year” G BaiJerbaiWadia Hospital For Children - “Best Paediatrics CareHospital of the Year (Western India) G Dr. VibhaPathalabs Hormone Centre - “Best Pathology Laboratory in Western U.P.” G Dr. Shelly Batra (Operation Asha) - “Innovation & Social Awareness in Healthcare Sector” G Dr. R.K. Tuli - “ Life Time Achievement Award For Healthcare Excellence In Holistic Medicare & Cure” G Dr. Vikram Kumar. V - “ Life Time Achievement Award of the Year (Paediatrics) G Dr. Minnie Bodhanwala -” Healthcare Entrepreneur of The Year” G Dr. Praveen Gupta - “Outstanding Services For Neurology In North India” G Dr. Seema Singh, Fortis Hospital (Vasantkunj) - “Best Dietician of The Year (North India)” G Dr. Ganesh K Mani - “Outstanding Services In Cardiac Surgery Of The Year”

G Dr. S.K Poddar - “Healthcare Personality of the Year (Laparoscopic Surgeon)” G Mrs. Ritu Sharma - “Best Dietician in Mumbai” G Dr. Sanjeev Gulati - “Healthcare Personality of the Year (Nephrology)” G Dr. Viveka Kumar - “Healthcare Personality of the Year (Cardiology)” G Prof .Dr.A. Zameer Pasha - “Healthcare Personality of the Year (South India)” G Dr. PrashantSaxena- “Best Pulmonologist In North India” G Dr. PrabirBhaumik - “Healthcare Professional of the Year (Child Care)” G S.S Medical Systems (India) Pvt. Ltd. - “Best Emerging Medical Equipment Company In North India” G Pediatric Oncall - “Best Child Healthcare Online Service Providers of the Year” G Orthonova Joint & Trauma Hospital (P) Ltd. - “Best Hospital For Innovation-Orthopedic In Punjab” G Dr. K. Rama Devi - “Best Obstetrics &Gyncology Specialist In Andhra Pradesh” G Dr. NeerajSanduja - “Best Ophthalmology Specialist In Delhi/ NCR” G Dr. Rakesh Kumar Gupta - “Best Radiologist In Haryana” G Dr. K K. Kapur - “Best Cardiologist In Delhi/NCR” G Dr. Lalit Mohan Sharma - “Best Cancer Specialist in Rajasthan” G Dr. Bishnu Prasad Panigrahi - “Healthcare Personality of the Year (Delhi-NCR)” G Dr. Ajay Mohan Sahai - “Best Diabetologist in Raipur” G Dr. Srikanth\’S Diabetes Specialities Centre (Vijayawada) “Best Diabetology Centre In Vijayawada (Andhra Pradesh)” G Dr.Saravana - “Best Emerging Pediatrician in Tamil Nadu” G Dr. Shuchin Bajaj - “Healthcare Excellence For Internal Medicine In Delhi-NCR” G Dr. Arvind -“Best DiabetologistIn Gurgaon” G Dr Sunny Malik - “Best Emerging Anaesthesiology Specialist In Delhi” G Dr. Sachin Goyal - “Best Physiotherapist In Delhi”

w w w.medegatetoday.com March-April 2015

NEWS

Worldwide Achievers of Healthcare Excellence

Update

Dr. Minnie Bodhanwala ‐"Healthcare Entrepreneur of The Year"

Medanta – The Medicity "Best Super Speciality Hospital & Research Centre of The Year"

Civil Hospital, Ahmedabad "Best Multi Speciality Hospital of the Year (Gujarat)"

J.K.Ansell Ltd. "Best Healthcare Barrier Protection Company of the Year"

Dr. Viveka Kumar ‐ "Healthcare Personality of the Year (Cardiology)"

Dr. Vikram Kumar.V "Life Time Achievement Award of the Year (Paediatrics)

Dr Sunny Malik - "Best Emerging Anaesthesiology Specialist In Delhi"

Dr. Shelly Batra (Operation Asha) "Innovation & Social Awareness in Healthcare Sector"

Dr. SanjeevGula ‐ “Healthcare Personality of the Year (Nephrology)”

Dr. Prabir Bhaumik - “Healthcare Professional of the Year(Child Care)”

Dr. Bishnu Prasad Panigrahi - "Healthcare Personality of the Year (Delhi-Ncr)"

Dr. Seema Singh, Fortis Hospital (Vasantkunj) “Best Dietician of The Year (North India)”

Dr. Ajay Mohan Sahai "Best Diabetologist in Raipur"

Dr. Sachin Goyal "Best Physiotherapist In Delhi"

Dr. R.K. Tuli - “ Life Time Achievement Award For Healthcare Excellence In Holistic Medicare & Cure”

Dr. Shuchin Bajaj - "Healthcare Excellence Dr. VibhaPathalabs Hormone Centre For Internal Medicine In Delhi-NCR" “Best Pathology Laboratory in Western U.P.”

Dr. S.K Poddar ‐ “Healthcare Personality of the Year (Laparoscopic Surgeon)”

Dr. K. Rama Devi - "Best Obstetrics & Gyncology Specialist In Andhra Pradesh"

Dr. Praveen Gupta ‐ “Outstanding Services For Neurology In North India”

Dr. Prashant Saxena"Best Pulmonologist In North India"

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Dr. Saravana “Best Emerging Pediatrician in Tamil Nadu”

Dr. Rakesh Kumar Gupta "Best Radiologist In Haryana"

Dr. Neeraj Sanduja "Best Ophthalmology Specialist In Delhi/Ncr"

NEWS

Felicitated the Winners Awards 2014

Update

Dr. Srikanth'S Diabetes Specialities Centre (Vijayawada) “Best Diabetology Centre In Vijayawada (Andhra Pradesh)”

Dr. Lalit Mohan Sharma "Best Cancer Specialist in Rajasthan"

Dr. K K. Kapur "Best Cardiologist In Delhi/NCR"

Dr. Ganesh K Mani ‐ “Outstanding Services In Cardiac Surgery Of The Year"

Dr. Arvind -“Best Diabetologist in Gurgaon"

Civil Hospital, Ahmedabad - "Best Multi Speciality Hospital of the Year (Gujarat)"

Billroth Hospitals “Best Multi Speciality Hospital in Chennai”

Bai Jerbai Wadia Hospital For Children "Best Paediatrics Care-Hospital of the Year (Western India)

Apollo Hospitals International Ltd, Ahmedabad “Best Hospital For Wellness & Healthcare In Gujarat”

Unihealth Consultancy Private Limited "Best Medical Tourism Company of the Year"

Star Health and Allied Insurance Co. Ltd. "Most Promising Health Insurance Company of The Year"

Saket City Hospital “Best Hospital For Innovation of The Year”

S.S Medical Systems (India) Pvt. Ltd. “Best Emerging Medical Equipment Company In North India”

Prof .Dr.A. Zameer Pasha "Healthcare Personality of the Year (South India)"

Pediatric Oncall - “Best Child Healthcare Online Service Providers of the Year”

Orthonova Joint & Trauma Hospital (P) Ltd. "Best Hospital For Innovation-Orthopedic In Punjab"

NowrosjeeWadia Maternity Hospital “Maternity Hospital of The Year (Western India)”

Naugra Export “Best Medical Equipment Company of the Year”

Mrs. Ritu Sharma ‐ "Best Die cian in Mumbai"

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NEWS Update

A boon to Insulin dependent Diabetics! Dr. Mohan’s Diabetes Specialities Centre launches Insulin Pump Clinic

nsulin Pump therapy has come as yet another innovation in the field of Diabetes treatments, especially for the patients who are Insulin dependents and who need multiple insulin doses everyday. Dr. Mohan’s Diabetes Specialities Centre (DMDSC) has today added the ‘Insulin Pump Clinic’ facility in it’s Gopalapuram Centre in Chennai. Dedicating the facility, Dr. V. Mohan, Chairman, DMDSC said, “an insulin pump is a small device about the size of a small cell phone that is worn externally and can be discreetly clipped to your belt, slipped into a pocket, or hidden under your clothes. It delivers precise doses of rapid-acting insulin to closely match your body’s needs”. “Small amounts of insulin delivered continuously (24/7) for normal functions of the body (not including food). The programmed rate is determined by our specialists based on the patient’s Diabetes condition. Insulin pumps have bolus calculators that help patients to calculate their bolus amount based on settings that are fixed by our specialists”, he added. During a live interaction with patients on the occasion, Dr. V. Mohan further explained, “since the insulin pump uses only more predictable rapid-acting insulin, patients need not follow a strict schedule for eating, activity, and insulin injections. They have the freedom of eating only when hungry, delaying a meal if required or even broadening the food choices”. “With insulin pump therapy, patients will have to change their infusion set only a few times per month unlike conventional multiple daily injections”, he added. With proper insulin pump use, patients can be four times more likely to achieve their target A1C and potentially reduce their low blood sugar reactions by 84%. Since insulin pump therapy can help achieve better control, it can reduce long-term complications of diabetes such as eye, heart, kidney, and nerve damage.

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Case study suggests thalassemia most prevalent in the South Asia and South East Asia regions Thalassemia one of the hot topics covered at the haematology conference at MEDLAB Asia Pacific 2015 Singapore:Thalassemia is a blood disorder inherited through families in which the body makes an abnormal form of haemoglobin. Haemoglobin is the protein in red blood cells that carries oxygen. The disorder results in large numbers of red blood cells being destroyed, which causes anaemia. According to a recent case study,the highest prevalence of beta thalassemia, which results from one or more genetic defects, is in India, Bangladeshand South East Asia (where the carrier frequency is approximately1–5%). Worldwide, it has 80 to 90million carriers (1.5% of the global population).1 There are two main types of thalassemia; alpha thalassemia occurs when one or more genes related to the alpha globin protein are missing or mutated. Beta thalassemia occurs when similar gene defects affect production of the beta globin protein. Dr VipViprakasit, Department of Paediatrics and ThalassemiaCentre, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, is the co-author of the study. He says, “There are two main types of thalassemia patients; TDT (Transfusion Dependent Thalassemia) and NTDT (Non-Transfusion Dependent Thalassemia). These two conditions will need an extensive clinical and laboratory evaluation including DNA technology for properly diagnosis both. Due to the heterogeneity of mutations underlying thalassemia, DNA testing is the best way to provide the most accurate diagnosis of thalassemia.” Dr Viprakasit will discuss thekey techniques for the management of thalassemia atthehaematology conference atMEDLAB Asia Pacific, organised by Informa Life Sciences Exhibitions, will take placeat the Sands Expo and Convention Centre, Singapore from 18-20 March 2015. In the past, α- and β-thalassaemias were restricted to malariaendemic tropical and subtropical regions. However, in recent years, human global migration from these regions has caused an increase in these conditions in countries previously relatively unaffected by thalassaemias, such as those in North Europe and North America. Therefore, thalassaemia syndromes are no longer ‘rare’ conditions in such regions and warrant awareness from all health care providers involved.2 Patients suffering from thalassemia should be constantly monitored by a specialist in order to manage their condition long-term. They should therefore bereferred to a haematologistas soon as they are diagnosed.

NEWS Update

Prevention of ageing with micro-nutrient beauty supplement ~World 1st Skin trial in France proves that, a micronutrient “Perfectil” tablet can help prevent the ageing effects on skin due to seasonal variation~ A ground breaking clinical trial conducted by University Hospital of St. Jacques, Besançon (France), Europe’s oldest medical institutes dates back to 1182, shows that micronutrient beauty therapy can help prevent ageing effects of harsh climatic variations on the skin. The results of the double blind placebo controlled clinical trial represent the world’s first discovery that oral micronutrient therapy can protect against the negative structural changes in the skin caused by climatic variations. Climatic variations contribute to skin ageing, roughness, reduced skin thickness and elasticity, making the skin ageing visible.Appropriate micronutrient therapy can ensure an adequate supply of nutrients to the body, thereby slowing the aging process, enhancing the appearance of the skin & helping overall wellbeing,” said renowned Prof. Philippe Humbert, Head of the Department of Dermatology at the University Hospital of St. Jacques of Besançon (France). Prof. Philippe Humbert is also the world renowned leading expert on skin analysis. The double blind placebocontrolled studyconducted;involved 80 healthy women aged 35-55 years. Two tablets of Perfectil were given once daily for four months. Clinical trial showed significant increase in skin roughness and micro relief (an indicator of fine lines) in women who did not take the supplement, compared to a consistent protective effect in those taking Perfectil. For all roughness and micro-relief indicators, there was a significant increase from baseline to month 4 in the placebo group (p<0.05) but no change in the supplement group.High-frequency ultrasound on exposed skin revealed that skin thickness was significantly decreased in the placebo group but was stable in the Perfectil group (p<0.01). The researchers found that: •

Women who took the supplement were protected against a marked deterioration in skin micro-relief or volume of fine lines (p<0.01) which was 2.5 times increased in the placebo group compared to Perfectil group.

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•

Increase in skin roughness (Rt) in the placebo group (p<0.01) was found to be double than those in the Perfectil group.

•

Significant adverse changes were also reported in Viscoelasticity (p<0.01) and skin thickness (p<0.01) in the group not taking the supplement.

After few months of Perfectil therapy, women could experience improvement in skin texture, marked deterioration in face wrinkles and a younger look. “The positive results of this trial show that women who wishto protect their skin against seasonal changes should consider Perfectil,” added Prof. Philippe Humbert. Asked about which section of the population is eligible to consume these supplements, Prof. PhilippeHumbert, said, “These supplements are not gender specific. Both men and women are eligible to consume the supplements”. In India, Meyer Organics has been licensed for introducing this micro-nutrient therapy, Perfectil, to combat the negative effects of seasonal variations on Indian population. Prof. Kartar Lalvani, Chairman of Meyer Organics Pvt Ltd, said, “Perfectil is formulated to rejuvenate your body,helping to slow down the aging process and improve your health. In another trial, Perfectilhasproven to have a triple effect on skin, hair and nails.” Talking about the growth of pharmaceutical industry, Prof. Lalvani said, lately “Healthcare through micronutrient support has become one of the key priorities & is fast catching up in the Indian population.

PRODUCT Update LINE

“DuPont™ Corian®, An Innovative Choice for Preventing Hospital acquired infections” Dr. Sukhadiya further says that, DuPont™ Corian® was the only material which gave us smooth, non-porous surface with ease of maintenance. Thanks to the durability of DuPont™ Corian®, it retains its value over years,representing a long-term investment for my institution.For me, installing DuPont™ Corian® in our Operation Theatre is value for money and it also gives me a peace of mind. ”

very year increasing number of patient contract hospital acquired infections during a hospital stay. Despite practicing regular sanitation regime and using some of the best robust materials for surfacing, hospital acquired cross infection is still a major problem. Dr. MehulSukhadiya, Director of Sumiran Women Hospital, Ahmedabad realizes the criticality of the subject. He says, “Selection of the appropriate surfacing material was thecritical decision while building our hospital. The most important aspect of material selection was to have a surface which does not allow microbial growth restricting the spread of cross-infection in a hospital.” The current material options available in the market are epoxy based wall fillers, high pressure laminates, engineering grade prismatic sheets etc. In the process of evaluation, the hospital management realized that thoughthese options are economical but difficult to clean and maintain. The other solution is around steel/MS (epoxy / powder coated with antibacterial coating or stainless steel with antibacterial coating). Though this solves the problem of paint peeling but leaves seams which are either filled with silicon or other fillers which when weatherize create colonies of bacteria thriving in them.

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Mr. NarendraCharan, owner of M/s United Medical Engineers Systems quotes,“DuPont™ Corian® is a nonporous material while material like high pressure laminate needs melamine coating on top surface. This kind of coating is of 40 micron, which can provide protection up to 5 to 6 wash. Most of the HPL suppliers provide only three years warranty while Corian® is designed for life time. Also, this material allows me to design an endless variety of shapes and forms – from single piece basin and vanity units to laboratory countertops and Operation theaters. DuPont Corian can be used for its aesthetic values as well as for hygienic purposes.”

PRODUCT Update LINE

Lybrate: An Easy Way to Connect with More Patients We are entering into an era where the world will soon start traveling using their Password instead of Passport. Technology has transformed the way we cater to our day to day needs. We use social networking sites to connect with friends, e-commerce sites to buy stuff, and rely heavily on sites like Wikipedia and YouTube for knowledge enrichment and entertainment. Evidently, there’s no surprise that people in India are thronging over the web to take care of their health. As a testimony to this fact, a study has estimated that India ranks 3rd amongst the countries where people frequently go to the internet to read about their health issues. Given this massive shift towards the World Wide Web for virtually everything, the moot question for doctors is: “Are you already there where your patients are?” Well, the perceptible answer to this is that doctors are definitely reaching there, but there’s a lot of ambiguity about how to make the most out of this surge. Just like any other basic amenity, healthcare delivery in India is also evolving towards making healthcare easily accessible for patients. Use of the internet for booking appointments with doctors is very much in vogue these days. Doctors have also started connecting with patients on social media platforms. But all these activities still leave a wide gap for doctors where it becomes difficult for them to understand the impact of time they’re spending on the web. In order to bridge this yawning gap, Lybrate has taken a considerable leap to enable doctors make the most out of the time they spend on online platforms. The company has launched India’s first “Mobile-based” platform where doctors and patients can seamlessly connect with each other. While patients get the required consultation right on their smartphone, doctors have the flexibility to decide when they want their consultation fee to be paid. Consultation on smartphone enables doctors to spend more time with patients and save more lives. Let us take a comprehensive view of Lybrate’s intuitive WhatsApp-like platform where proactive doctors like you can enhance your online reputation 30

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as well as income with incredible ease and effectiveness: Lybrate has come up with this easy-touse platform where you can give “Free Opinion” or even “Paid Consultation” to millions of patients. Under the ambit of Free Opinion, also known as “Open Questions”, thousands of patients put forth their health-related doubts on Lybrate every day and you can clear those doubts. You can also agree to other doctor’s response to reinforce the opinion offered to any particular patient. Open questions strengthen your credibility further on the web and let you connect with other good doctors from various cities. Now comes the other significant part of the platform – “Paid Consultation” aka “Private Questions”. We conducted a survey with 1000 doctors to get their views on how technology is changing their practice. Out of 1000, 887 doctors said that patients have been buzzing them every now and then on WhatsApp to show medical reports, or to understand dosages, or just to get the follow-up treatment. Such frequent intervention were disturbing them when they’re busy seeing other patients. Now with Lybrate on your smartphone, you can serve your patients better without compromising on your consultation fee. It works just like WhatsApp where you can ask your patients to share their medical reports, X-ray and MRI scans, pictures, medication history, etc for a better understanding of their issues. You can even have a voice-chat to add more personal touch to your consultation. At

any point of the private conversation you have the privilege to decide what amount you want your patient to pay. In addition, you can also give a try to Lybrate’s Practice Management software to increase your efficiency and cut down your operational cost. You can effectively manage things like patients records, bills, appointments, etc right from your smartphone. We, at Lybrate, are seeing the upcoming future of the healthcare delivery in India. It’s all about empowering patients to get access to better healthcare services irrespective of their geographic location or social standing. And proactive doctors like you will play an instrumental role in helping patients get access to better health.

DOCTOR Update SPEAK

Manipal Hospitals, Goa: Department of Gastrointestinal & Hepatobiliary Surgery

n Manipal Hospital Goa, The Division of Gastrointestinal & Hepatobiliary Surgery is dedicated to providing comprehensive surgical care for patients with basic and complex gastrointestinal, liver, pancreas and biliary diseases. The facility is dedicated to management of a variety of benign and malignant GI disorders via open and laparoscopic approaches with the state-of-the-art technology. Gastrointestinal Diseases include: • • • • • • • •

Repair of primary, recurrent, and complex abdominal wall hernias Gastroesophageal reflux disease, hiatal hernias, and achalasia Cancer of esophagus and stomach Weight-loss surgeries (gastric bypass, vertical sleeve gastrectomy, adjustable gastric banding, and revisions) Colon and rectal cancer Crohn’s disease and ulcerative colitis Enterocutaneous fistula and short bowel syndrome Anorectal disease including rectal prolapse, incontinence

We also have a multidisciplinary Hepatobiliary clinic functioning as a part of the Gastrointestinal division.

Manipal Multidisciplinary Liver, Gall Bladder and Pancreas Clinic A complete team of health care professionals to provide expert, specialised, holistic and all-round care for people with liver, pancreatic, biliary and gall bladder disorders. This includes, as appropriate, diagnostic and interventional radiology, endoscopy, surgery, nuclear medicine, oncology and palliative care. Disciplines involved 1. Hepatobiliary and pancreatic surgery 2. Diagnostic and Interventional Radiology 3. Medical gastroenterology Clinical services •

Use of less invasive diagnostic techniques, including high resolution ultrasonography, magnetic resonance imaging (MRI), endoscopy and endoscopic ultrasound for diagnosis and surveillance.

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New and advanced surgical techniques like CUSA assisted liver resection, laparascopy and intraoperative ultrasound.

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Innovative palliative and curative procedures for primary and secondary liver tumors, including radiofrequency ablation, chemoembolization, bland embolisation and percutaneous biliary drainage.

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Specialist endoscopic procedures.

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Management of acute and chronic pancreatitis (including step up management of acute pancreatitis, Puestow’s and Frey’s procedure for chronic pancreatitis.

Beneficiaries:

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Chronic alcoholics.

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Liver cirrhosis patients.

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Patients with gall bladder stones.

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Short and long duration abdominal pain.

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Viral hepatitis patients.

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Patients with jaundice.

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Diabetics.

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Patients with fatty liver.

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Patients with liver and pancreatic tumours.

DOCTOR Update SPEAK

‘HelpMeSee’ launches Cataract Surgical Simulator to make India free of Cataract Blindness • ‘HelpMeSee’ - the global campaign to end cataract blindness in two decades globally • High-fidelity virtual reality simulator to train surgeons over 249 types of complications related to eye surgeries • Smartphone App to capture location data of each patient for efficient follow-up

elpMeSee is a global campaign to end the public health crisis of cataract blindness in two decades globally. It is introducing the first-of-its-kind surgical training simulator in India to enable and train eye surgeons to handle cases of cataract, the country’s leading cause of preventable blindness. The simulator will train specialists in Manual Small Incision Cataract Surgery (MSICS) to provide a safe, effective, and very low cost procedure to cure cataract blindness. Simulator-based training for over 249 complications The MSICS simulator is a high-fidelity virtual reality simulator that will allow rapid scale-up of high quality training in the MSICS procedure. The highly advanced machine can provide surgical training for over 249 types of errors, complications and challenges that surgeons may face in the operating room during live cataract surgery. The simulator design provides for a virtual limitless number of ‘eyes’ for training with unparalleled visual realism and tactile feel. For the trainee and the instructor, it provides a ‘live’ surgical experience, including pre-existing conditions and all complications. This replaces traditional MSICS training which, up until now, was performed on live patients with associated risks. “HelpMeSee supports highest quality cataract surgery at a cost of no more than US$50 anywhere in the world,” said Mohan Jacob Thazhathu, President & CEO, HelpMeSee. “Access to affordable, high quality surgery restores the life and dignity of every person suffering from cataract blindness,” he added. Reaching out to the community through smartphone apps HelpMeSee recently launched a partnership with HelpAge India to tackle cataract blindness across the country. It aims at providing training to 30,000 MSICS specialists (mostly women) globally to ensure that blindness from cataract is eliminated. The campaign has also set up a communitybased mobilization monitoring system through a GIS-GPS app to empower community health workers to map patient locations and connect them to partner surgeons.

www.m e d e g a t e t o d a y. c o m N Movember arch-April -December 2015 2014

HelpMeSee has formulated a unique and an all-round strategy for its India campaign. Besides training doctors on its MCICS simulator, it has a cloud-based surgical reporting system to support quality assurance of all operations. Once a patient is discharged, it has a comprehensive patient followup and patient care system. To provide safe care, HelpMeSee has also developed a pre-sterilized, single-use surgical kit to minimize the risk of infection and enable surgical specialists to work in the most remote areas. The social-economic burden of blindness According to the World Health Organization (WHO), there are over 20 million people who are blind due to cataract. It is estimated that India accounts for the largest number of blind people in the world with over 20 per cent of the global blind people in India alone. Cataracts are also the leading cause of road accidents in India, according to Union Transport Minister Nitin Gadkari. Blindness from cataract creates an enormous burden on families, care-givers, communities and the world. It results in very poor quality of life, reduces life expectancy, and causes huge losses in economic productivity, estimated to be as much as $1 trillion in lost GDP globally every year. To tackle the problem of blindness in Indian society, the Government of India started the National Programme for Control of Blindness in 1976, with the aim of reducing the prevalence of blindness from 1.4% to 0.3%. Venkat Sambandhamoorthy, Chief of Campaign and Field Operations, says the HelpMeSee mission intends to align itself with the Government of India’s vision to make the country a cataract-backlog free zone and cure cataract blindness in every district of the country. He says, “HelpMeSee will support the Central Government in all possible ways to make the campaign of cataract backlog eradication a success.”

DOCTOR Update SPEAK

Swine Flu can prompt Sudden Heart Attack According to Dr. Lal, who is also Chairman of Metro Group of Hospitals, the condition, known as myocarditis, occurs when a virus penetrates heart muscles and sets off a defensive response from the body. That counter attack can be deadly in people with robust immune systems. Dr. Lal suggested that doctors should also take into account the potential late onset of cardiovascular complications that may occur following the typical flu- like illness. No one knows how many swine-flu patients have suffered from myocarditis, mainly because doctors don’t always recognize the condition. “In flu patients, myocarditis frequently goes undiagnosed until it reaches serious levels, at that point, damage to the heart is often beyond repair”, As swine flu epidemic sweeps across India, cardiologists cautioned heart patients to take proper precautions because it can kill by prompting sudden heart failure. The virus of swine flu can also infect the heart, causing irr-eparable damage to the cardiac muscle and possibly killing those who appear fit, even young adults, said Dr. Purushottam Lal, leading cardiologist and director of Metro hospitals and heart institute.

said Dr. Lal. A few clues, including chest pain and an irregular heartbeat, can suggest that flu viruses have moved into the heart. Patients, who temporarily recover from the flu and then suddenly start feeling sick again also should be screened for the complication, suggest Dr. Lal.

Dr. Puroshottam Lal

Chairman, Metro Group of Hospitals

Dr. Lal suggests that people with heart failure should be alert to changes in their breathing and should promptly report changes to their health care provider. It is especially important to wash your hands often with soap and water and follow other basic hygiene to avoid infection. Do not stop taking your medications without first consulting your health care provider, especially in the event of influenza or a respiratory infection.

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MARKET OVERVIEW Update

Medical Devices Industry in India : An overview

Medical Device Industry hoping for Incorporation of major recommendations • Global harmonisation • Risk-based classification • Separate chapter for clinical trials • Separate regulatory entities for devices • Progressive penalties Swift passage of the Bill in Parliament Dialogue during the creation of Rules • Distinction between devices and drugs should be taken to the last mile during creation of rules Separate Act in the long run • In the long run, this would create an even more conducive environment

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MARKET Update OVERVIEW

Encouraged by the PM’s and his govt’s: • •

Recognition that ‘Make in India’ is the only way to ensure availability, quality and affordability of medical devices in the long run Inclusiveness of all forms of high-quality manufacture irrespective of the origin of the manufacturer

MARKET OVERVIEW Update

What are medical devices? Medical devices are central to medical practice, although they are often lesser known to the public and policymakers than pharmaceuticals. They form an extremely diverse product category with over 14000 different types such as adhesive bandages, drug delivery devices, diagnostics, implanted cardiac, cardiovascular, and neurological devices, stair-walking wheelchairs, robotic surgical systems and magnetic resonance imaging devices. Medical devices and diagnostics allow people to live longer, healthier and more productive lives.

What role do medical devices play in promoting quality healthcare? Medical technology contributes towards the diagnosis and management of complex diseases, thereby alleviating pain, restoring health and extending life. India’s disease burden is gradually transitioning from communicable to non-communicable diseases driven by socio-economic advancements. The World Health Organization, NCD Country Profiles, 2011 states that more than 53% of total deaths every year in India are due to NCDs and by 2020, over 60 million Indians will succumb to them. In this context, medical devices have an increasingly critical role to play in helping diagnose and manage NCDs. Examples: •

The evolution of coronary stents has halved the number of patients dying from heart attacks.

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Implantable cardiac defibrillators have increased the chances of surviving a sudden cardiac arrest from 5% to 98% today.

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Diabetics now have access to accurate glucose monitoring technologies that can prevent hypoglycemia, and help in effective management of diabetes and blindness and peripheral nerve damage triggered by diabetes.

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Minimally invasive technologies and advanced surgical and navigation equipment used to conduct heart, spine and neuro-surgeries have drastically improved the efficacy of procedures and shortened recovery times, thereby reducing hospital stays and loss of productivity at work.

What is the size and potential of the medical device industry in India? Globally, medical devices form a $200-billion industry, but in India it constitutes only a small segment of the healthcare industry. It is currently valued at about US$ 4.0 billion – which is around 7-8% of India’s healthcare sector. With 700 medical device makers, India’s medical device market 38

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is currently the fourth-largest in Asia (after Japan, China and South Korea).1 According to a 2014 CII-BCG report, the industry could grow to US$ 50 billion by 2050 if a conducive environment is created.

What role does the medical devices industry play in helping India address its healthcare challenges? Currently, average expenditure on medical technology in India is low – at US$3.33 per capita. However, as India moves towards universal health coverage, medical technology will become an even more integral part of the country’s public health system. There is an urgent need to provide increased access to quality health technologies. The medical device industry can do a lot in this context by using their expertise to engage in technology transfers, skill development and innovation to address India’s healthcare challenges.

MARKET Update OVERVIEW

The recently introduced Drugs and Cosmetics (Amendment) Bill, 2013 addresses several of the industry’s challenges by ushering in a new regulatory regime. The Drugs & Cosmetics (Amendment) Bill 2015: Summary of Views The Drugs & Cosmetics (Amendment) Bill, is a big leap forward for healthcare delivery and allied sectors in India. This is particularly so in the case of the medical devices industry which for the first time has been accorded a distinct status and definition in the Bill. This will enable the industry to better serve India’s growing healthcare needs in a safe, effective and timely manner. Going forward, as the nation’s non-communicable disease burden rises, health technologies will be as crucial as pharmaceuticals to managing and mitigating public health challenges. However, in its present form, the Bill leaves several important gaps, raising concerns for the industry: -

It does not completely outline an appropriate and robust regulatory framework. For instance, the MDTAB does not ensure representation from both the domestic and international industries

Some provisions (related to penalties and clinical trials) could significantly impede manufacturer’s ability to innovate and operate

It is not fully consistent with international best practices. For instance, while it distinguishes between drugs and devices, the distinction hasn’t been carried to the last letter

In order for India to fully leverage the potential and value However, in the current operating environment, the health technologies hold, the industry is heartened that industry suffers from a variety of perceptional, policy the new Health Ministry has drafted a new Bill: “Drugs and regulatory challenges that prevent the industry from & Cosmetics (Amendment) Bill 2015”. Industry has submitted its recommendations to the Health Ministry and contributing to its full potential. Parliamentary Standing Committee on several occasions Regulatory challenges for medical devices in India and hopes that its key suggestions will be taken into consideration: What are the major regulatory challenges faced by the v Global harmonization: The Ministry should ensure that medical device industry in India? all the regulations for medical devices are harmonized • Currently, 14 categories of medical devices and 8 with international best practices such as the IMDRF and additional products are regulated as “drugs” under the adopt the use of global standards such as ISO. This effort D&C Act, 1940. would help medical device manufacturers achieve the highest standards of safety and efficacy, and also allow • This is problematic because medical devices are very indigenous industry to become globally competitive. different from drugs, and thus need to be regulated as a v Risk-based approach: A risk-based approach to the regulation of medical devices would ensure that There is a lack of predictability in the regulatory Indian patients have timely access to the safest medical system technology. It would be appropriate to notify medical different category altogether.

•

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MARKET OVERVIEW Update

devices in Global Medical Device Nomenclature (GMDN) with four classes of devices – high risk, moderate high risk, low moderate risk and low risk. Higher risk devices should be notified first followed by lower risk medical devices. This would be in line with the classification of the Global Harmonization Task Force (GHTF). We recommend the insertion of riskbased classification in Section 7B. v Separate chapter for clinical trials: Currently, the proposed Bill has a chapter on clinical trials, which is common for drugs, devices and cosmetics. However, for the sake of patient safety, it is critical to understand the differences between drugs and devices: each step in a medical device clinical trial uses different terminology (e.g. pivotal, pilot and feasibility trials); involves physician techniques and device modifications; and involves a different concept of “substantial equivalence”. It is also important to differentiate the clinical trials of medical devices from that of performance evaluation of IVDs. v Implementation of the Bill: The government must ensure that provisions are made for a fair and reasonable transition timeline for the industry to implement new changes. As a practical matter, there are thousands of types of medical devices, and it will take time for the regulatory staff to build resources and expertise to address them all. Phased implementation of the legislation over 5 years should be provided to regulators and industry. v Regulatory bodies:

Regulatory entities should be defined separately for medical devices given that different expertise is required to regulate them. o Medical Device Control Officer o Central Medical Device Laboratory o Medical Device Technical Advisory Board and Consultative Committee o Drugs, Cosmetics and Medical Devices Consultative Committee

v Distinct recognition for In-Vitro Diagnostics: Following adequate stakeholder consultation, the government should cover the IVD industry under a separate chapter in the Bill. IVDs being in-vitro, are very different from most drugs and devices which are in-vivo. Bringing the IVDs under the same stringent regulation as drugs and medical devices, would limit the industry’s potential to grow. v Penal provisions: We recommend that more appropriate penalties commensurate with the violation and in line with global practices, such as a warning letter or fine, be considered. 40

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Appendix I: Why do medical devices need different treatment and separate policies (including regulations) from pharmaceuticals? As the following points2 will demonstrate, medical devices are very different from drugs and thus need to be regulated as a different category altogether. In recognition of these dramatic differences, pharmaceuticals and medical devices are regulated separately in all major markets across the world. v Diversity: Compared to pharmaceuticals, medical devices are an extremely diverse group of products. In contrast to single-molecule drugs, many complex devices involve a number of components that, together, form a system. Given the diversity and complexity of medical devices as compared to pharmaceuticals, outcomes of the use of medical devices often depend directly on the skill or experience of the user (physician, technician, nurse, etc.). v Scientific disciplines involved: The active components of medical devices are generally based on mechanical, electrical, and materials engineering. Many medical devices incorporate and are driven by software. In contrast, pharmaceuticals are based on pharmacology and chemistry, and increasingly encompass biotechnology and genetic engineering. The scientific disciplines involved in assessing new drugs are usually those of pharmacology, toxicology, medicine and biology. In contrast, a complex implantable device can only be assessed by a multi-disciplinary team, since it may involve biomaterial compatibility, electronic circuits with integrated circuits, computer programs,

MARKET Update OVERVIEW

An international guide’ to provide a framework to member states in establishing regulatory programmes for medical v devices. In 2003, it published ‘Medical device regulations. Global overview and guiding principles’ elucidating regulatory challenges. GHTF: The Global Harmonization Task Force (GHTF) was founded in 1992 as a voluntary group of representatives from national medical device regulatory authorities “in an effort to respond to the growing need for international harmonization in the regulation of medical devices”. It v originally comprised the five founding members USA, EU, Japan, Australia and Canada but was later expanded.. IMDRF: The International Medical Device Regulators Forum was conceived in February 2011 to extend the foundational work of the GHTF, as a voluntary group of medical device regulators from around the world to discuss future directions in medical device regulatory harmonization. ISO: Founded in 1947, The International Organization for Standardization is an international standard-setting body comprising representatives from various national standards v organisations spread across 163 countries. ISO standards underscore the procedures and practices of medical device development, manufacture, quality control and conformity assessment requirements. AHWP: The Asian Harmonisation Working Party is a v non-profit organization whose objective is to study and recommend ways to harmonise medical device regulations in the Asian and other regions and to work in coordination with the GHTF, Asia-Pacific Economic Cooperation (APEC) and other related organisations. US FDA: The U.S. FDA regulates medical device products intended for the use in the diagnosis, cure, mitigation, treatment, or prevention of disease. The basic regulatory requirements that manufacturers od medical devices distributed in the US must comply with are establishment registration, medical device listing, premarket notification/approval, investigational device exemption for clinical studies, quality system regulation, labeling requirements, medical device reporting. CE Marking: CE marking is a legal requirement for Appendix II: What are the international medical devices intended for sale in Europe. Consumers best practices for regulation of the medical look for CE marking as an indication of conformance to devices industry? certain minimum standards and a minimum level of quality WHO: In 2001, the World Health Organisation published that other products may lack. ‘A model regulatory programme for medical devices: electro-physiology, haemodynamic effects, toxicology, etc. The sheer complexity of modern devices makes assessment by traditional methods extremely difficult, if not impossible. Differences in product development and improvements: In the pharmaceutical world, it typically takes several years for a new drug to enter the pipeline. Medical devices in contrast are developed through continuous innovation and iterative improvements based on new clinical practices, science, technology and materials. Medical devices typically have a short product life cycle, about 18 to 24 months, and investment recovery period. Market competition from similar devices is often intense, even in the early stages of a new technology. In contrast, pharmaceuticals typically have a long commercial life-cycle (10-20+ years), during which they do not undergo significant changes. Differences in the patent structures: Due to the wide variety of structures and technologies embodied in medical devices, many different patents typically cover a single medical device. By comparison, there are typically very few patents for individual pharmaceutical products. Therefore, unlike pharmaceuticals, the basis for competition in the medical device field is generally not patents and patents generally do not confer market exclusivity as they do for medicines. Mechanisms of action: Drugs generally have a welldefined physiological characteristics, therapeutic effects and side effects. Devices have a great variety of mechanisms of action. They may affect the body and interact with it in many different ways. Drug/device failure: Most drug-related injuries or deaths are caused by overdose, incorrect drug administration or side effects. Devices can fail because of a myriad of mechanical faults, electrical component failure, or biocompatibility problems, degradation or fatigue. User error is more likely to be a cause of device failure than of drug failure. The failure of a drug is usually apparent quite soon after its administration to the patients. By contrast, an implantable device may fail after many years of use and in a manner that was not predictable at the time of implantation. Therefore, clinical trials and pre-market evaluation are not as effective in predicting adverse effects of devices as they are in the case of drugs.

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HEALTH BUDGET Update

Healthcare Budget Reaction from Healthcare Experts Reaction from Malvinder Mohan Singh, Executive Chairman Fortis Group

t is a very good, balanced and forward looking budget that gives you a great sense in terms of directional clarity of what the honorable FM wants to do. He has laid down the intent and the road map for the economy in the years to come and has clearly spelt out the vision of the government. The budget covers a whole spectrum of areas that are directed at giving a boost to the economy, stressing on social inclusivity and channeling funds for public good. The FM has clearly focused on the key elements of infrastructure, including the development of Roads, Housing, Electrification of villages, Skill development and Employment generation. The budget is broad based and provides a thrust to society including the marginalized, the young and the elderly. To move towards the vision of a healthy India, hygiene and cleanliness programs have been accorded priority and contributions towards the Swachh Bharat Fund have been made tax exempt. In tandem, there is a focus on increasing access to healthcare in the cities and villages by widening the health insurance net. There is also a provision to set up 5 new medical colleges along the lines of the AIIMS in J&K, Assam, Punjab, Tamil Nadu and Himachal Pradesh which

Malvinder Mohan Singh Executive Chairman Healthcare Ltd.

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Fortis

will go towards bridging the talent gap for qualified medical professionals in the country. I see the budget as a strong booster for industry. The further opening up of foreign investment, tax-free bonds for infrastructure, simplification and progressive reduction in corporate taxes are welcome steps and will all go towards catalyzing economic growth. I think private investment will certainly increase and there is a dire need for it. Overall a very good budget! I look forward to this getting executed and India crossing an 8 % GDP.

HEALTH Update BUDGET

Quotes from Ameera Shah

he allocated healthcare budget for this year is about 33, 150 crore. Lets compare it with the previous year, in 2014 – 2015, the allocated budget was 39,238 which was slashed by 20% in December. This budget for healthcare is the lowest since 2012 – 2013. This does not send the right message at all, at a time when we are talking about proportionately increasing the budget in terms of GDP. India spends roughly about 2% of its GDP on health, whereas other developing countries like Afghanistan and Brazil spend around 8 % of the GDP, even China spends around 5.4 % of GDP on health.

the health budget and the Finance Minister has failed to address this huge gap. Allocation of funds is an issue but the larger issue is there being no proper system to make sure that the budget is used in the right arena.

The finance minister has rightly linked cleanliness and Swachch Bharat Abhiyan with preventive healthcare. But that is not all that is to it. Preventive Healthcare is a bigger concept and should be Having said that, India has had a history of underutilising taken up in isolation rather than

Ameera Shah

Managing Director Metropolis Healthcare Ltd.

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HEALTH BUDGET Update

combining it with other elements. The right thing to do would be to to link preventive to the increasing burden of non-communicable diseases. Increasing the health insurance premium exemption to 25,000 is a welcome change. But there is a clause of INR 5,000 for Preventive Health Checkup. There is no clarity on the breakup. We had proposed that these two elements be kept separate so that the benefit of preventive healthcare is passed on to the insured as well as the un-insured. The government’s vision of including every citizen in the ambit of health insurance is progressive, but that can only work in tandem with Preventive Healthcare. The proposition of 5 new AIIMS is promising and we are glad that the government is stepping up the healthcare infrastructure in every state. The government has also promised quality medical facility in every city, village and district by 2022. We hope that the government will look at effective public private partnership to achieve this ambitious vision at such a short period of time.

Anjan Bose Commented on Health care Budget “Announcement of new AIIMS for Jammu & Kashmir, Punjab, Himachal Pradesh, Tamil Nadu, Assam and one more for Bihar, as the state needed more augmentation for healthcare, is definitely a good step. Proposal for pharmaceutical institutions in Mr. Anjan Bose, Madhya Pradesh, Rajasthan and Secretary General, Chhattisgarh is a good initiative NATHEALTH for indigenous research”. Increase from 15 to 25 % tax exemption in health insurance premiums for all citizens and 10 to 30% for senior citizens is a most welcome initiative. This will certainly bring more people under the health insurance cover and address the healthcare affordability challenges more effectively. Yoga’s inclusion in list under section 215 of income tax act is a very welcome step because it will support “preventive and wellness based care” as compared to “cure based care”...

In the previous budget, the government had come up with a vision ‘Health for All’. But unfortunately with the proposed budget, it still seems to be just a vision statement. Lastly, I strongly propose that going forward Healthcare Budget should be a separate component like the Railways budget so that Healthcare gets the significance that it deserves. 75-80% of India's population is without insurance. Pradhan Mantri’s Jan Dhan Yojana, will create universal 5 more AIIMS, continuation of 100% automatic social security system for poor and unprivileged…of FDI in MedTech segment, increase in tax exemption course it’s success will depend on a robust implementation limits for health insurance premium – India’s apex process… healthcare body NATHEALTH welcomes new Govt’s NATHEALTH will be happy to work with the Government positive Healthcare Budget for improving access and quality of healthcare in the country…including in areas of technology,innovation and “There was a concern within MedTech sector that any increase skill development.”Magazine in import duty of life-saving products will result in increase in healthcare cost; it is encouraging that the Government has not increased the import duty. 100% automatic FDI route will continue and this is a very positive signal for investment in Medical Device industry. Introduced Making “Buy India” policy mandatory without ensuring voice of adequate preparedness of industry for local innovation and health care manufacturing could have been a serious issue for healthcare sector and group on the patients; we are happy that this has Magazine WhatsApp to not happened... Overall it’s a positive budget yet there are unfinished needs that have to addressed.” Mr. Sushobhan Dasgupta President, NATHEALTH

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HEALTH Budget Reaction from CYGNUS Group of Hospitals

oday as the world stresses on economic growth, globalisation and privatisation; a silent section of the society seems to slip through all safety nets. In India, one is talking about at least 26% of the population who fit into this category. The percentage varies from state to state. In most of the northern states poverty seems to be increasing and if you further disaggregate from urban to rural, you will find that 40% of the rural population in 10 states in India are below the poverty line. If one further disaggregates the figures into schedule caste, schedule tribes, the marginalised etc., the percentages just keep on rising. So we have to accept the fact that there is a segment in our society, and we are talking about 260 million Indians, who are surviving with the burden of disease, estimated of around $ 30 billion constituting 5% of GDP. Potential Health care industry is the world's largest industry with total revenues of approx US$ 2.8 Trillion. In India as well, health care has emerged as one of the largest sector with maximum expenditure incurred. An astounding 60% of this is out of pocket expense. India has one of the highest

“

While I am very happy with the Hon’ble Finance Minister’s proposal to increase the Income Tax Exemption Limit on Health Insurance premiums to Rs 25000 a year, it is slightly disappointing to see that there is no provision for increasing the public health spending and to decrease the out of pocket expenses of those seeking healthcare access.

”

DR.SHUCHIN BAJAJ

Update BUDGET

proportions of private health spending, comparable only to a only few countries in the world with a recent history of major internal unrest, such as Cambodia and Myanmar. Such is the lack of trust in the public health system that not only do 80% of the wealthy seek treatment in the private sector, but a similar percentage of the poor also goes to private practitioners, even though the treatment may be of low quality and provided by untrained practitioners Some unfortunate statistics reflect this state of affairs: One quarter of hospitalised Indians slip below the poverty line because of hospital expenses alone. Hospitalised Indians spend more than half of their annual expenditures on healthcare. ? More than 40% of those hospitalised borrow money or sell assets to cover expenses. The poorest 20% Indians have more than twice the rate of mortality, malnutrition and fertility of the richest 20%. To address these disturbing facts, we have to approach the healthcare system with a fresh new look and fight on all fronts on a war footing. While I appreciate that the government is facing a severe financial crunch and that the hon’ble finance minister may not have had enough cash to spend, it is a matter of concern to me that the healthcare issues of the country are not being given the importance that they deserve. Quotes from Sanjay Murdeshwar : AstraZeneca Pharma India Ltd. “Overall, it’s a positive and balanced Budget. Increase in infrastructure investments, roll out of GST next year, single window in regulatory processes and phased reduction in corporate tax are steps in the right direction. Even though there is no direct impetus to the pharmaceutical industry, plans announced for the healthcare sector are welcome. Setting up of five new AIIMS across the country will help patients and medical education. Three more National Institute of Pharmaceuticals Education and Research will play an important role in bridging the skill gap, the National Skills Mission is an excellent endeavor in this area. Improving accessibility to healthcare has been stimulated through raise in health insurance premium from Rs 15,000 to Rs 25,000. Rs 150 crore announced for scientific research is a positive move, though incentivizing medical/Pharma research would have helped trigger more R&D investments into the sector. This is a positive start with more hits and not many misses, it remains to be seen how effectively it will be implemented.” Sanjay Murdeshwar

Dr. Naveen Nishchal, Dr. Shuchin Bajaj, Dr. Dinesh Batra Directors, CYGNUS Group of Hospital

Managing Director AstraZeneca Pharma India Ltd. (AZPIL)

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SMOKING AND CARDIAC SURGERY

igarette smoking is a powerful risk factor for coronary artery disease, myocardial infarction and cardiac causes of death. Coronary artery bypass is a relatively safe and commonly performed cardiac operation with the mortality of 0.6% to 2.0%. Given the ever increasing cardiac surgical patient population and intractable problem of continued smoking within these patients is a priority to clearly delineate the impact of smoking status. Persistent smoking after cardiac surgery has been consistently identified as a predictor of increased mortality in the followup studies after cardiac surgery, late mortality is significantly worse. Smokers also have a greater incidence of recent myocardial infarction, left main stenosis, urgent operation and chronic obstructive pulmonary disease(COPD). The rationale behind this is poor CABG outcome due to failure of the vein graft patency, greater risk of post operative complications, mortality and earlier need for reoperation. Length of ICU stay is also high in smoker likely due to the fact that smoker most often present with the respiratory disease and have grater ventilator requirement in the post operative period. Patient who continue to smoke or who start smoking again after coronary bypass surgery have an elevated rise not only for myocardial infarction but also for the return of angina pectoris and the need for coronary bypass surgery. Despite the similar rates of early outcome, the continued adverse health effects from smoking on multiple organ systems is well established and should not be ignored. This is reflected in long term follow-up of these patients. The researchers found that heavy smoking noticeably increased matrix metalloproteinase enzyme level in the saphenous vein. These enzymes have been linked to vein graft

Dr. Yugal K. Mishra Director, Department of Cardiovascular Surgery Fortis Escorts Heart Institute

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failure. Deregulation of enzymes may gradually normalize after smoking cessation, a noticeable vein recovery needs at least 6 months, vein enzymes do not completely return to normal levels even after one year. There has been much controversy about whether smokers should receive the same opportunities for CABG as nonsmokers. Discussion on this subject was mainly based on the consistent finding that continued smoking after CABG increased clinical complications, such as myocardial infarction and repeat coronary revascularization. At one year after surgery, smokers had more than twice the risk for myocardial infarction and reoperation as compared with patients who had stopped smoking since surgery. The persistent smokers have a greater risk of death from all causes as compared with patients who stopped smoking after surgery over a long period of follow up. Over a period of time the risk of death from any cause is greater in patients who continued smoking after CABG than it was in those who quit. The benefit of smoking cessation on mortality may be explained largely by the reduction in cardiac death which is higher for the persistent smokers than it is for those who quit. It would be advisable to stop smoking at the 6 weeks prior to surgery but it has been observed that many patients can have adverse cardiac events during this period so smoking status alone should not preclude these patients from receiving these operations. However we emphasize that this should not translate into ignorance of continued smoking in patients undergoing cardiac surgery. Given this adverse effects of smoking on overall cardio vascular morbidity and mortality, patient should be encouraged and even assisted in endeavors to quit smoking.

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Health Benefits of Walking

alking is one of the best and most practical forms of physical exercise. Regular exercise prevents coronary heart disease (CHD) and premature sudden death. Physically fit men and women live longer than unfit people. To prevent CHD, it is not necessary to become an athlete. Brisk walking or any other exercise of equal intensity like swimming, and cycling, or light games like badminton and table tennis for 30 minutes a day, 5-7 times a week is enough. The correct intensity of exercise is one that is somewhat difficult for an individual and is neither too light nor too hard. There is no need to test the limit of endurance, to sweat or to become markedly breathlessness. Excessive effort may be injurious for the muscles and the joints without additional benefits. The level of physical effort can always be increased gradually as one becomes more and more fit. The pace of walking on treadmill may be monitored more objectively by setting a target heart rate. The heart rate tends to increase as the pace of exercise is increased. But there is a limit to which the heart rate can increase in response to exercise. The maximum predicted heart rate (MPHR) is dependent on age and may be calculated as 220 minus age in years. A healthy person may start with a target heart rate to 60% of MPHR and gradually progress to 85% of MPHR. Warm-up - a brief session of slow, gentle, rhythmic and repetitive movements of the major joints of the body before any exercise - is important to improve the flexibility of joints and prevention of injury. It also ensures a smooth and gradual rise in heart rate and blood pressure before exercise. Some cool-down stretching should always be performed after exercise. Cool-downs are vigorous stretches performed after exercise to prevent muscle and joint stiffness, and abrupt fall in blood pressure after cessation of exercise. A few minutes of physical and mental relaxation after cool-down are also rewarding. Exercise either before, or 2 hours after major meals. Avoid exercise when unwell. Avoid a steaming hot shower after

exercise. Donâ&#x20AC;&#x2122;t discontinue exercise for more than 2 weeks at a stretch. Any fresh symptoms should be medically evaluated. Execute all movements gently and rhythmically. Avoid difficult exercises. Avoid breath holding. Avoid early morning walks in winter. Donâ&#x20AC;&#x2122;t walk against cold wind. Avoid heavy woolens, and wear a face scarf in extreme cold. Wear loose and light coloured cotton clothes in summer and exercise under shade. Drink water before, during, and after exercise. Slow down the pace during extremely hot weather. Be alert for signs of heat injury (headache, dizziness, faintness, nausea, cramps and palpitations). Elderly should avoid high impact activities. They should step up the pace of exercise very gradually over a period of time. Obese people should perform low intensity, low impact exercises like brisk walking. They should exercise at least 5 days in a week. Hypertensive patients should avoid vigorous exercise if blood pressure is not well controlled. They should not hold their breath during exercise, and avoid weight training. Benefits of Physical Exercise Lack of regular physical activity has profound effect on physical and psychological well-being. For example, merely 2-3 weeks of bed rest may lead to as much as 20% drop in peak exercise capacity, whether measured in previously active or in sedentary people (Figure 1). The decrease is observed both in the young or middle aged and the elderly. While in the apparently healthy, this is purely due to physical deconditioning, other factors may also play an important role when bed rest is forced by illness. For example, after a heart attack, exercise capacity may Dr. Peeyush Jain Principal Consultant Cardiologist and Head, Dept. of Preventive Cardiology, Fortis Escorts Heart Institute, New Delhi

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decrease as a result of decrease in pumping efficiency of the people accustomed to exercise (Figure 3). This is brought heart (heart failure). upon by specific adaptations in the muscles that favour less production and a more rapid removal of lactate at any The sense of well-being reported by people who exercise particular exercise level. regularly is partially due to psychological boosting. However, exercise also increases the capability to perform the same Exercise training may retard the progression of coronary physical tasks with less fatigue or breathlessness. This is atherosclerosis by its salutary effects on some classical due to an increase in maximal oxygen uptake (VÖ2 max. in coronary risk factors like lipids (cholesterol) and blood scientific literature) after exercise training. As oxygen uptake pressure. For example, physical training for 3 months has required for a given task remains the same, irrespective of been shown to increase HDL (good) cholesterol by 15-23%. whether a person is sedentary or physically active, physically- The reduction in total cholesterol and LDL (bad) cholesterol conditioned people need a smaller percentage of the VÖ2 is a more modest 12% (Figures 4, 5). It is generally agreed max to perform a task (Figure 2). This also explains why that these changes are usually observed when exercise most patients with angina pectoris who exercise regularly is prolonged and high intensity, for example walking report reduction in effort-related angina threshold. approximately 20 miles per week at 60-85% of the peak capacity. The increase in physical capacity with regular exercise is largely explained by an improvement in functioning of the Regular physical activity also leads to weight loss and musculoskeletal system of the body though improvements restores normal body composition. In obese people, there is in circulatory dynamics also contribute. One of the major an increase in deposition of fat in muscles that contributes to factors that limit a person’s exercise capacity is muscle insulin resistance. Insulin is a hormone with multiple actions. fatigue that may progress on to pain if exercise is not It is released by the pancreas into circulation in response interrupted. Muscle fatigue and pain during exercise is due to increase in blood glucose (sugar) levels. Resistance to to accumulation of lactic acid (lactate) in exercising muscles. the actions of insulin sets a chain of chemical reactions in Lactate begins to accumulate at about 55 percent of the peak the body including increased release of fat and cholesterol exercise capacity in the apparently healthy, untrained people. rich particles from the liver, decrease in HDL (good) The threshold for lactate accumulation occurs much later in cholesterol levels, and preponderance of small, sense LDL

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EXPERT VIEWS

(bad) cholesterol, all of which increase the risk of arterial blockages in the heart, brain, and lower limbs. Insulin resistance also contributes to increase in accumulation of fat in abdomen (central obesity), blood pressure (hypertension), and blood glucose (diabetes mellitus). Exercise is a key method of restoring insulin sensitivity.

Majority of the scientific studies report a reduction in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) with regular exercise. With regular exercise, the average decrease in BP in hypertensive patients is estimated to be -11/-6 mmHg. In non-hypertensive people, the average decrease in BP is -4/-4 mm Hg. Besides decrease in resting BP, exercise training also blunts the hypertensive response to physical exercise. High intensity exercise may also reverse exercise-induced drop in systolic BP that is often observed in people with significant heart disease.

Angina pectoris Chest pain or sensation of progressive oppression or tightness in mid-chest or both sides of the chest on physical exertion in presence of critical blockage(s) of one or more major coronary arteries that supply blood to the heart muscle.

Reduces cardiovascular response to stress Retards or reverses atherosclerosis Improves overall quality of life Reduces the risk of sudden death

Glossary

Atherosclerosis At birth, major arteries of the body are smooth, open and elastic conduits, expanding and contracting as blood flows through them. With ageing, arteries lose their flexibility and fatty substance(s) circulating in the blood may clog them up at places. This gradually compromises blood flow through the arteries over a number of decades. These changes constitute, what is known as, atherosclerosis.

Exercise training also reduces spontaneous clotting of blood. Many factors contribute to this effect including decrease in platelet aggregation, efficient clot-lysis, decrease in blood viscosity, and improved red blood cell (RBC) deformability. Hypertensive response to exercise Excessive rise in blood pressure during exercise. In humans, lack of habitual leisure time physical activity predicts progression of coronary heart disease (CHD). Insulin A hormone secreted by pancreas that plays a central Exercise training, on the other hand, appears to retard or role in regulation of blood glucose (sugar) level. Either lack even reverse coronary artery blockages. While the best of insulin secretion or resistance to insulin action (insulin way to achieve retardation of progression or regression of resistance) is thought to cause diabetes mellitus. Insulin CAD is a judicious combination of diet, exercise, and drug resistance may also contribute to occurrence of high blood therapy, yet exercise alone may contribute by enlarging the pressure, lipid (cholesterol) abnormalities, and coronary size of coronary arteries that increases the size of arterial heart disease. lumen. In one study, regression was observed only in those Platelet A blood cell that is crucial in blood clotting. who expended at least 2,200 kcal (kilocalories) per week Overactive platelets contribute to excessive tendency for during exercise training. clotting that may interrupt blood supply to crucial organs The most dramatic benefit of regular physical activity like brain, heart, kidneys, and limbs. is reduction in the risk of sudden death (Figure 6) due to malignant heart rhythm disorders (arrhythmias). Animal experiments have demonstrated that habitual physical activity increases arrhythmia threshold (Figure 7). Summary of Benefits

Improves exercise capacity Increases muscular strength Reduces subjective feeling of fatigue and breathlessness Improves lipid profile, especially HDL (good) cholesterol Improves glucose tolerance Attenuates SBP and SBP rise with physical activity Reduces platelet aggregation Increases intrinsic fibrinolytic activity Decreases blood viscosity and increases RBC deformability w w w.medegatetoday.com March-April 2015

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Parenting tips for IVF children T hey say ‘However motherhood comes to you; it’s a Miracle.’ Oh! The ‘Happy beginning’ of finally holding life in their arms after, sometimes, years of struggling to become adoring mothers and fathers to a little one. To become a parent, to watch a life curl up near you, to see your baby grow into a young child, to be willing to take that fall along and stand right back up, is a dream that one begins to cultivate through the IVF journey. IVF brings hope to the shattered hope to become and experience parenthood. It makes all of the physical, emotional and financial troubles worth it. In vitro fertilization (IVF) is the most common and most effective type of assisted reproductive technology (ART) to help women become pregnant. The procedure involves fertilizing an egg outside the body, in a laboratory dish, and then implanting it in a woman’s uterus.

More than 4.3 million children around the world have been conceived using the technology. Studies have shown that Parenting and the children’s psychosocial development do not differ significantly between IVF families and control families. Most children born through IVF, have grown into healthy young adults, with a quality of life and educational achievements similar to their normally conceived peer. IVF offers another ray on impact of ‘nature and nurture’, on the bringing up of the little one. The Parenting styles adopted to raise IVF children shape on how they turn out. Here are some tips to bring up beautifully, Young Confident Individuals: •

The childhood of your child is the time when you can spend maximum amount of time with your child and grow close to her. Once, they grow into teenagers and adults, they get so busy with their own lives. You should try to have as many as happy memories as possible of each age of your child from toddler to teenager. Let them know how much you love . •

Give Unconditional Love

Do not Be Overprotective

together as a family and will also help siblings become closer. •

Use Genuine Encounter Moments (GEMS)

Your child’s self-esteem is greatly influenced by the quality of time you spend with him or home ; not the amount of time that you spend. With our busy lives, we are often thinking about the next thing that we have to do, instead of prioritizing our children. Focus on their feelings and emotions. Communicate with them for there is nothing more promising and fulfilling than a good conversation. If we don’t give our child GEMS throughout the day, he might start to misbehave or feel isolated.. •

Parent with the End in Mind

Most parents act to bring a certain behavior or situation under control as soon as possible. Don’t look for a expedient solution. This often results in children feeling overpowered. But good parenting requires one to keep in mind how we want our child to be as an adult, thus being more thoughtful in our approach. For example, if we spank our child, he will learn to use acts of aggression to get what he wants when he grows up. •

Be Consistent, Follow Through

If you have made an agreement that your child cannot buy candy when she gets to the store, do not give in to her pleads, tears, demands or pouting. Your child will learn to respect you more if you mean what you say.

This makes the child timid and introvert. Let the child explore things on his own so that he can learn and Lastly, ‘Adopt the pace of nature: her secret is patience. understand it on their own. Just supervise their actions. So, Be patient and nurture your child with love, affection, • Have Family-Time! knowledge because Parenting is one job that never gets a You should try and make it a point to do something vacation. together as a family. This will help all of you bond

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Sudden Cardiac Arrest: How to prevent it.

Dr Aparna Jaswal,

MBBS (Gold Medalist), MD Medicine, DNB Cardiology (Gold Medalist), Certified Cardiac Device Specialist USA, Fellow Heart Rhythm Society USA, Principal Consultant Cardiologist, Fortis Escorts Heart Institute,New Delhi

As per WHO census statistics mortality due to cardiac causes has overtaken mortality due to all cancers put together. In India alone we have about 4280 sudden cardiac deaths per lakh annually. India among highest risk countries by 2030 Source: World Health Statistics Report – 2008 (by WHO)

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study in the popular medical journal Lancet recently revealed that 60% of world’s heart patients will be in India. Today most of the cardiac death is due to Coronary Artery Disease which in turn is usually due to a SCA (Sudden Cardiac Arrest) or Ventricular Fibrillation, a problem of the electrical system of the heart. As a complex and very important organ the heart muscles have the capacity of generating pulses on their own if the sinus node fails to do so. However, the rate of pulse generation is random. Any disturbance in the sinus node or the flow of electrical impulses through the heart results in an abnormal rhythm- ‘arrhythmia’. The rate at which the heart is beating can become abnormally faster or slower than normal. The resultant irregular fast or slow rhythm interferes with efficient pumping action of the heart, compromising blood supply to all parts of the body and at times causing the heart to suddenly stop beating rhythmically. Generally the arrhythmias are momentary and harmless; however some types (Ventricular tachycardia or fibrillation) can be serious or fatal. Sudden cardiac arrest (SCA) is a sudden, unexpected failure of heart function occurring due to fast fluttering action of the ventricles, which does not allow enough blood to be pumped out to the organs which include the brain and the heart itself. SCA is a medical emergency, which can be fatal if not treated immediately. Cardiac arrest is reversible if the victim is administered prompt and appropriate emergency care. This generally involves administration of cardiopulmonary resuscitation (CPR), shock treatment to the chest to reset the heart’s rhythm (defibrillation) and advanced life support. SCA being the result of a disturbed rhythm pattern the only effective treatment is the delivery of an electrical shock.

EXPERT VIEWS

The risk factors for developing heart disease also put one at An Emergency Room inside Your Chest: risk of suffering sudden cardiac arrest. As a treatment option following a sudden cardiac arrest, • Family history of heart disease, smoking, high blood once the patient’s condition stabilizes, Implantable pressure, high blood cholesterol, obesity, diabetes, Cardioverter-Defibrillator (ICD) maybe recommended. a sedentary lifestyle, pre existing cardiac diseases Studies have proved that people who are at high risk of SCA like heart rhythm disorders, congenital heart defects, can be identified using certain routine diagnostic tests. An congestive heart failure and cardiomyopathy. ICD (Implantable Cardioverter Defibrillator) is a device that • Poor heart function, previous episode of cardiac arrest can be implanted into these patients is the only fool proof or heart attack, electrolyte imbalances, hyperthyroidism, solution available today. It is a battery-powered unit that pulmonary hypertension, certain medications that affect is implanted near the collarbone. One or more electrodethe heart function and use of illicit drugs, such as tipped wires run from the ICD through veins to the heart. It cocaine or amphetamines. constantly monitors the heart rhythm. If a rhythm that is too While some drugs are used to try and suppress fast heart slow is detected it paces the heart as a pacemaker would. If rates, none have been able to ward off all episodes of SCD. it detects ventricular tachycardia or ventricular fibrillation, Automated External Defibrillators (AEDs) are devices that low- or high-energy shocks are sent to reset the heart to a are used to deliver the shocks. An AED is extremely easy to use by trained laypersons, with voice-activated instructions normal rhythm. ICDs now also collect information for the and is critical for rapid response to a cardiac arrest. This physician to use by remotely diagnosing and programming device can save lives if made available within 4 to 7 minutes the device to the exact needs of the patient, without the of the onset of Ventricular fibrillation. With the healthcare need for repeat surgery or hospitalization. For patients with infrastructure and system in India being a lot behind that in ICDs, the first-year recurrence rate of sudden cardiac arrest the USA, such devices are not freely available in public or has been reduced to 1 to 2 percent. While ICDs are a recent even most ambulances. It is also not always convenient to invention (10 to 15 years globally) it is necessary to identify carry one around and connect whenever required. Thus more patients at high risk for SCA and get them ICDs to help then than 99% of Indians who experience Sustained Ventricular jump back to life whenever they encounter one. Prevention fibrillation face certain death. is better than Loss.

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INTERVIEW Update

Cardiac Arrhythmia, its Sign & Symptom? •

Electrocardiogram (ECG)- An ECG uses sensors (electrodes) that are attached to your chest and limbs and measures the timing and duration of each electrical phase in your heartbeat and can reveal disturbances in heart rhythm.

•

Exercise ECG or stress test-It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your ECG, heart rate, and blood pressure are monitored.

Arrhythmia can be silent, sometimes harmless and may not cause any symptoms but some can be serious or even life threatening wherein they can cause the heart to stop pumping oxygen rich blood to the body—these arrhythmias cause sudden cardiac arrest (SCA).

•

Holter monitor- Electrode patches are placed under the clothing on the chest to measure and records heart’s electrical activity. The patches have wires attached to them and are connected to a portable monitor and is worn for one to two days.

People who have heart disease are at higher risk for SCA. However, SCA can also happen in people who appear healthy and have no known heart disease or other risk factors for SCA. Some of the common symptoms one is likely to experience are lightheadedness, rapid heartbeat, palpitations, extreme fatigue, shortness of breath, chest pain, inability to exercise or fainting spells. These symptoms could adversely affect the quality of life and prevent one from leading a normal life.

•

Insertable Loop Recorder–It is a small insertable device that continuously monitors heart rhythms and records them either automatically or when you use a hand-held patient assistant. It is inserted just beneath the skin in the upper chest area and can record for a longer duration.

•

External Loop Recorder- Abnormal heart rhythms and cardiac symptoms may come and go. So to record your heart rate and rhythm during a symptom, there is a device called as the External Loop Recorder (ELR). An ELR has the capability to monitor a patient for a long duration (7 to 30 days), and hence has a higher chance of providing a diagnosis to patients with infrequent short-duration transient symptoms, recurring over weeks. The device is placed on the skin in the chest region. This completely wireless system is auto-triggered and also has patient activation capability via a patient trigger magnet (for the patient to activate whenever he/she feels any symptoms of arrhythmia like breathlessness, fainting or palpitations)

What is cardiac arrhythmia, its sign & symptom? An irregular heartbeat is called cardiac arrhythmia.A healthy heart beats 60-100 times per minute, which is necessary to supply oxygen-rich blood to the body. A heartbeat that is too fast, usually more than 100 beats per minute is called tachycardia. A heartbeat that is too slow, usually less than 60 beats per minute is called bradycardia.

Required certain test for this particular disease? A doctor can detect an irregular heartbeat during a physical exam by taking your pulse or through any of the following:

How can we prevent cardiac arrhythmia?

Dr. Ameya Udyavar

Consultant Cardiologist and Ectrophysiologist Hinduja Hospital, (Mumbai)

www.m e d e g a t e t o d a y. c o m March-April 2015

When an arrhythmia is serious, an urgent treatment is required to restore a normal rhythm. This may include electrical “shock” therapy,intravenous medications (given through a vein) or by mouth.

INTERVIEW Update

Implantable Cardioverter DeďŹ brillator (ICD) An implantable cardioverter defibrillator (ICD) is a small device implanted under your skin. It serves the same purpose as an external defibrillator, but ICDs automatically monitor your heart rhythm and deliver therapy as needed to prevent sudden cardiac arrest. It is always there, monitoring your heart rate and administering treatment if needed.

Give your expert advice to doctors as well as to patients? 1. Treatment Options for Bradycardia

The standard treatment for a slow heartbeat is to implant a pacemaker. For people with bradycardia, this small device can help restore a normal heartbeat.

Pacemakers

If you have bradycardia, you may be eligible for an implantable heart device called a pacemaker. Pacemakers are small devices that are implanted under the skin, most often below your collarbone on the left or right side of your chest.

The pacemaker continuously monitors your heart, and if it detects a slow rhythm problem, it sends out small undetectable electrical signals to correct it.

Treatment Options for Tachycardia

Treatments for tachycardia range from medication to surgery. Some of the patients of tachycardia can be cured by a procedure called electrophysiology studywhich assesses the electrical activity and conduction pathways of the heart.The most effective way to treat sudden cardiac arrest is defibrillation. A defibrillator gets your heart back into its normal rhythm. Defibrillators can be external or implanted in your body for long term protection:

Automated External Defibrillator (AED)

An external defibrillator is a portable device which measures the electrical activity of the heart and delivers a therapy shock if a dangerously fast heart rhythm is detected. Most emergency response teams carry and use external defibrillators, and many public places now have external defibrillators. The goal is to provide access to defibrillation when needed as quickly as possible.

My advice to patients is not to ignore symptoms like palpitations, fainting and breathlessness as they may be due to heart beat problems and most of them can be diagnosed by simple tests. My advice to doctors is, if a patientâ&#x20AC;&#x2122;s ejection fraction (blood pumped out of heart during each beat) is less than 30%-35% (even after bypass surgery or angioplasty), then a defibrillator should be implanted to prevent sudden cardiac arrest and every effort should be made to improve functioning of the heart.

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DOCTOR Update SPEAK

Liposuction: It a Procedure to Remove Stubborn Fat, Not For Weight Loss

iposuction or removal of excess fat from the body is a much tal ked about procedure in cosmetic industry today. With greater exposure to the both national and international media, and with the mushrooming of several clinics who offer the procedure, general awareness about the same has grown in India. However, a lack of clear understanding about the procedure and misconceptions about the same are rampant. Since liposuction is a cosmetic procedure aimed at improving appearance, not a surgery required for health reasons, it is pertinent that people should know in detail about it. Proper awareness ensures that they make informed decisions about going for the procedure. Is Liposuction a Weight Loss Procedure? The simple answer is no. Liposuction should not be confused to be a weight loss procedure per se though the patient undergoing it may automatically lose some weight on account of fat loss. Liposuction is aimed at removing excessive fat from any area of the body. For example, the front of the abdomen or the sides of the abdomen, the thighs, the neck, buttocks and even face. Bulges of fat are extremely common in human body. Indians are especially prone to accumulate fat on the tummy. Often, this is a result of our lazy lifestyle, lack of workout as well as fat-rich diet. However, sometimes, despite our best efforts with exercise and diet control, some areas refuse to lose fat. So, while our overall weight would be under control, the stubborn fat on the side of the tummy or on the buttocks would refuse to burn. Liposuction is an ideal procedure to target such stubborn fat. Liposuction as stated above is a procedure to remove small bulges of fat on various parts of the body that diet and exercise could not address. This helps bring the body in better shape which all areas having the right proportion of fat. It should be understood that liposuction does not remove cellulite. How is it done? As the name suggests lipo-suction involve suctioning or pumping out excess fat from a particular area of the body that has pockets of stubborn fat. During the procedure, small and thin tube-like devices are inserted into small incisions made into the skin; and fat is suctioned out through the tubes in a targeted way. The procedure is usually an out-patient procedure but the duration of your stay in the hospital may be determined by the location of the surgery or the amount of fat being removed. This will also determine whether you are administered local

www.m e d e g a t e t o d a y. c o m N Movember arch-April -December 2015 2014

Dr Mandeep Singh, Consultant Cosmetic & Plastic Surgery, Paras Hospitals

anesthesia or general anesthesia during the procedure. Small cuts are made in the target area and fat is pumped out using a suction device or a large syringe. There is a limit to the amount of fat that can be removed at on go, therefore it is suggested that people with average or a little more than average weight are ideal candidates for it. People with excessive weight are not ideal candidates and are not recommended a liposuction. Moreover, liposuction should not be considered a weight loss procedure. It is a targeted fat removal procedure. Its Variants Traditionally the liposuction surgery was done under general anesthesia, using small tubes to pump out fat from the desired area. However, recent advances in the field have put forward better and easier options which are actively being used today. They do away with the need of general anesthesia, hence eliminating the risks associated with it and making the procedure safer. In what is called as tumescent liposuction, a local anesthesia is given to numb the target area and then an anesthetic solution is injected into the fatty tissue that is to be sucked out. The patient can remain awake throughout the solution. Similarly, in Laser Assisted Liposuction, low energy lasers are used to liquefy the fat in a targeted way. The liquefied fat is then easily removed using a small tube. In Ultrasound Assisted liposuction, on the other hand, ultrasound is used to liquefy the fat which makes it easier to remove then. The later day advances have undoubtedly made liposuction a much safer and easier procedure. However, a lot of care should be taken during recovery. While it is an outpatient procedure usually, complete recovery takes time as bandages have to be wrapped around firmly at the target areas. Antibiotics have to be given to prevent infections, and care should be taken to support healing. Strictly a Cosmetic Procedure: It should be remembered, however, that liposuction should not be considered a weight loss procedure. It is aimed to help you get rid of fat bulges that give your body a poor shape. Liposuction is ideal for you if you have achieved a healthy body weight but are disappointed by stubborn fat that continues to cling on to your tummy or thighs. For people with excessive weight or those with morbid obesity, there are other surgical options like bariatric surgery.

DOCTOR Update SPEAK

Pregnancy aspects and being a New Mum

s a new mum, we welcome you to the nine month long roller coaster ride known as pregnancy! Wandering just what you want to expect from the whole thing? The moment a child is born, the mother is also born. She never existed before. The woman existed but the mother never. A mother is something absolutely new. I was recently talking to my client who is also a new mum said, “You know all those things people tell you about being a new mum are actually true; those things that you heard and quickly dismissed as being not applicable to yourself and your unborn child”. While of course individual experiences vary, the common denominator cannot be escaped. Sharing experiences of our clients: In the first month of pregnancy for the first time, you might not even know that you are four weeks pregnant. Since, now you know that you are creating a new life, it is time to clean up dirty and fun habits (smoking, drinking etc). It is good to start making other mommy friends who can guide you and also convince you your pregnancy is normal. At two months of pregnancy, you must have realized that the term “morning sickness” is just bullshit but the sickness is round the clock. In the third month, your partner should know what you expect of him over the next six months. Fourth month is the best part of your pregnancy as you will start to look as if you are expecting: your hair is shining, skin will radiate the pregnancy glow and you have the courage to share this news with your friends and relatives. Fifth month is the halfway point of your pregnancy as it is all downhill from here. During your sixth month, you can feel the baby’s the first kick and also need to change your pre-pregnancy wardrobe with beautiful maternity clothes of great shape. Seventh month brings to you stretch marks, and turning movement of your baby. You can also get crazy dreams. In your eighth month, movements will reduce and you are in the final stretch. Breathing becomes difficult and you don’t have the stamina to take long strides anymore. At full term, you cannot sleep comfortably: so take help of pillows or try different positions.

to be making up for that bliss for the next month or so with something nasty called lochia pouring out of you faster than an extra super maxipad can keep up with. Try to remember that your baby is just a baby, not an alien. You are made to take care of this creature and you can do it really. If breastfeeding comes to you easily, consider yourself lucky and if you are struggling, take help of your lactation consultant or a support group from your hospital. Bonding with your baby is never immediate: it might take time but don’t worry if you don’t feel that maternal ooze of love. You can feel weepy due to change in hormonal levels, anxiety and exhaustion. If this feeling is more than baby blues, talk to your doctor: it can be a form of postpartum depression. The sooner you get the help, better it is. Things are not easy yet but, hopefully, you are finding some semblance of a groove by now. Babies love to be touched, and no matter what your mother-in-law might say, you are not going to spoil your month old infant by holding him/her too much. Better yet, wear your baby in a sling or carrier of some sort, so you can have a round around the house and your baby can feel close to you. Win/win all the way around. Your baby will make love stronger, your nights longer, days shorter, home happier, clothes dirtier, the past forgotten and the future worth living for.

For you, as a new mum is the start of a new adventure: new challenges to face, new memories to make and new obstacles to overcome. Being a mother is learning about the strengths you didn’t know you had, and dealing with fears you didn’t know existed. Just giving birth to a child doesn’t make you a mother! Being a mother means taking care of your kids, cuddling, watching them grow, watching them play and argue, being there for the good and the bad, and Being a mother doesn’t mean that your life is over: in most importantly showing them your unconditional love fact, it is the beginning of a new journey. As a new mum after every second of EVERYDAY. delivery, you still look totally pregnant and will for some I conclude by saying that “Being a new mum is one of time. The uterus starts to contract in the postnatal period the most rewarding blessings in the world”. which leads to discomfort for few weeks. You are going w w w.medegatetoday.com March-April 2015

DOCTOR Update SPEAK

Swine Flu Can Attack Children too Are there signs parents should watch for? “Parents should monitor closely for any signs that children are getting worse, if they have any difficulty breathing, if they are not able to drink, or are not urinating well, if they are very irritable even after their fever goes down, if they have any sort of rash, or if the fever goes down and flu symptoms get better, then get worse again,” Dr. Rajiva says. Call a doctor or seek immediate medical attention if your child: •

Has bluish or gray skin color

•

Is not drinking enough fluids or taking feeding well

•

Has trouble breathing

•

Has severe or persistent vomiting

•

Is not waking up or not interacting

•

Is so irritable that the child does not want to be held

•

Has flu-like symptoms improve but then return with fever and worse cough

Has other conditions such as heart or lung disease, diabetes, or asthma and develops flu symptoms including fever and cough

Causes of Swine Flu Swine flu is contagious, and it spreads in the same way as the seasonal flu. When people who have it cough or sneeze, they spray tiny drops of the virus into the air. If you come in contact with these drops or touch a surface (such as a doorknob or sink) that an infected person has recently touched, you can catch H1N1 swine flu. Despite the name, you can’t catch swine flu from eating bacon, ham, or any other pork product.

Swine Flu Symptoms People who have swine flu can be contagious one day before they have any symptoms, and as many as 7 days after they get sick. Kids can be contagious for as long as 10 days. Most symptoms are the same as seasonal flu. They can include:

If your child is younger than 5, or if your child of any age has a medical condition such as asthma, diabetes, or a neurologic problem, call your doctor or get medical attention. Younger kids and kids with longstanding medical conditions are at

• • • •

cough sore throat body aches chills

• • • •

fever stuffy or runny nose headache fatigue

Like seasonal flu, swine flu can lead to more serious complications, including pneumonia and respiratory failure. And it can make conditions like diabetes or asthma worse. If you have symptoms like shortness of breath, severe vomiting, abdominal pain, dizziness, or confusion.

risk of serious disease if they get either Tests for Swine Flu seasonal or pandemic H1N1 swine flu.

It’s hard to tell whether you have swine flu or seasonal flu, because most symptoms are the same. People with swine flu may be more likely to feel nauseous and throw up than people who have seasonal flu. But a lab test is the only way to know for sure. Vaccine for Swine Flu

Dr. Rajiva Kumar Child Specialist Muzaffarpur, Bihar, India

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The same flu vaccine that protects against seasonal flu also protects against the H1N1 swine flu strain. You can get it as a shot or as a nasal spray. Either way, it “teaches” your immune system to attack the real virus.

DOCTOR Update SPEAK

Glaucoma the silent killer of Sight Glaucoma is silent killer as it steal your vision any warning sign. It is called a silent killer because it has no symptoms like pain for the patient to recognize the disease in time.

careful in cash of eye, it is advisable to visit your eye doctor more frequently.

Diagnosis is an essential part of the treatment process for Glaucoma. At Maxivision, we leverage state of the art technology to understand the nature and extent of a patient’s condition so as to provide the most effective treatment at the earliest.When you arrive at any of our clinics, checking the pressures within your eyes is a part of the simple tests explicitly carried out. Our doctors shall further examine your vision fields to determine any damage to the periphery. Following the test results, the doctor can offer you simple medical treatment in the form of drops, tablets or laser t is caused when there is a disturbance to the constant treatment. ratio of inflow and out flow of a fluid called "Aqueous" inside the eye which ends up building pressure on the Maxivision houses the latest equipment and the most eyeball. The normal pressure is 21mm of Hg and when sophisticated methods like GDX, apart from Visual raised starts pressing the optic nerve. This leads to gradual Fields and NCT machines, to treat Glaucoma. GDx is the loss of peripheral vision to start with and may even lead to most advanced glaucoma detection technology currently total blindness. But if it's detected and treated early, optic available. It has been considered a significant breakthrough nerve damage can be saved remaining vision. Regular examinations are the solution to this problem. This helps the over other existing tests.Humphrey Automated Visual Field doctors to identify such a condition at the right time so you Analyzers, the gold standard in parametric testing, have a proven track record of 25 years in the domain of “visual can avoid any further damage to your eyes. field” development and research. Our field analyzer is the If you are over the age of latest model from Humphrey which has all the latest software 40 and if you have a family and databases. It is one of the fastest and most accurate field history of glaucoma as it is testing tools currently available in the market. hereditary, you should have a complete eye exam with Glaucoma treatment may include prescription eye drops, every six month. Specially laser surgery, or microsurgery.Open-angle glaucoma is most commonly treated with various combinations of eye drops, people with diabetes or laser trabeculoplasty, and microsurgery whereas closehave family histry of eye angle glaucoma first treatment is medication to lower the diseases should be more pressure within your eye and further treatment is needed to prevent AACG from coming back. This involves using laser treatment or surgery to make a small hole in your iris. Dr. Anilkumar Batula The hole allows fluid to flow freely around your iris and can Glaucoma Specialist of stop the iris bulging forwards and blocking the trabecular Maxivision Super Specialty meshwork in the future. Hospital

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DENTAL SECTION Update

SMOKING & ORAL HEALTH Tobacco use has been strongly associated to the development of precancerous and oral cancer lesions. It has been linked to the development of leukoplakia, a white patch that extends from both sides of the angle of the mouth into the cheek mucosa. Other precancerous lesions like erythroplakia are also associated with smoking.

n spite of the growing awareness about the potential ill effects of smoking, it continues to be a major public health challenge world over. Of particular concern to a country like ours is the fact thata greater proportion of tobacco related deaths occur in developing countries rather than developed ones. A huge proportion of these deaths have been related to diseases such as stroke; heart attack; chronic bronchitis; chronic cough; asthma; cold; and cancer of the lungs, throat, mouth, stomach, kidney and bladder.

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In the midst of all this documentation, the effect of smoking on the oral cavity is sometimes overlooked. As the oral cavity is exposed almost instantaneously, it should come as no surprise that smoking causes many deleterious effects, even if these are sometimes not fully appreciated.

At the very least, smoking leads to staining of teeth and halitosis (bad breath), both of which can lead to socially unacceptable consequences. Smoking can lead to coating of the tongue and increased melanin deposition inside the oral cavity. Although these ill effects may not directly lead to dangerous health consequences, they are unpleasant to live with. The effect of smoking on the periodontium has been well documented. The American association of periodontology lists smoking as an important risk factor for the development of gum disease. Some of the ways in which it leads to gum disease is by changing the microflora associated with the gum tissue, decreasing the vascularity to the gum, suppressing the normal immune responses and delaying wound healing. Smoking leads to development of smokerâ&#x20AC;&#x2122;s palate or stomatitis nicotina palatini, a condition in which a number of small spots with red centre project from the surface. The reduction in salivary flow and the change in pH that results from chronic smoking may lead to an increase in the predilection to develop tooth decay.

Smoking has been strongly associated with implant failures, both early as well as late failures. Considering that implants are much in vogue today as a replacement option for missing teeth, this effect of smoking must be clearly understood. Perhaps the most significant effect of smoking on the oral cavity is the risk for development of oral cancer.

DENTAL Update SECTION

Oral cancer is the fifth most prevalent cancer in India and poses a major health hazard because despite improvements in the management of the disease the five year survival rates are not too encouraging.

Tobacco use has been strongly associated to the development of precancerous and oral cancer lesions. It has been linked to the development of leukoplakia, a white patch that extends from both sides of the angle of the mouth into the cheek mucosa.Other precancerous lesions like erythroplakia are also associated with smoking. The transition of precancerous lesions to oral cancer is also associated with tobacco use in all its forms, including smoking.

Other unpleasant truths about smoking include the fact So the next time you smoke, consider that you may not that it seems to affect women to a greater degree. Most only end up spoiling your health but also that of your of all, unlike some other risk factors, smoking affects not loved ones. only oneâ&#x20AC;&#x2122;s own health but also that of people around the smoker. The effects of passive smoking are slightly more Attribute the article to - Dr. KV Arun periodontist difficult to establish, but it is also clearly documented as a health hazard.

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EXPERT VIEWS

Kidney Transplant: Blood group matching no more a barriers

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.

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. alternate day basis during hospital stay. We checked routine After explaining the cost and long term outcomes of ABOi blood parameters regularly. transplant, patientâ&#x20AC;&#x2122;s wife (blood group A+) was accepted as After achieving minimum target antibody levels in the donor. Patientâ&#x20AC;&#x2122;s blood group was O+ positive. blood of recipient, kidney transplant was done. Patient Patient was admitted about 2 weeks before provisional started passing good amount of urine post transplant and transplant date and immunosuppressant drugs started. there was fall in serum creatinine to normal level over Plasmapheresis was done to remove preformed antibodies next 3 days. Patient was discharged on post operative against donor blood group antigen on alternate day basis. day 8 with serum creatinine of 1.0 mg/dl. Plasmapheresis is a procedure in which plasma containing antibodies removed from the blood by a cell separator. Now Now he is 6 months after transplant and going for his Intravenous albumin and normal saline were used as work everyday. replacement fluid. Each plasmapheresis was followed by intravenous immunoglobulin. Patient was dialyzed on Other facilities for kidney failure patients at

PSRI Hospital:

Laparoscopic donor nephrectomy

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

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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EXPERT VIEWS

MEDICAL COMPLICATIONS AS A RESULT OF POOR KIDNEY CARE: A BEGINNER’S GUIDE

he prevalence of Chronic Kidney Disease (CKD), a lifestyle disorder, is increasing rapidly and the cost of treatment is presenting many troubles for healthcare systems across the world. About 1 in 10 people, globally, have some degree of kidney disease. The disease can affect people of all ages and races but it is more common in women and among the older populations. In fact, one in five men and one in four women, between the ages of 65 and 74, have chronic kidney disorderIn India, about 2,20,000–2,75,000 new patients need renal replacement therapy every year and the dialysis population is growing by 10-20% annually. (“Current status of end-stage renal disease care in India and Pakistan”, Vivekanand Jha, 2013). In 2013, 55,000 patients were on dialysis and it is estimated that by the end of 2014, 63,250 patients (approximately) were getting dialyzed in the country.

complications that can arise as a consequence of kidney disease are: •

Hypertension: high prevalence even at early stages of kidney disease. • Electrolyte and volume disturbances: Sodium (Na), Potassium(K), and even acidosis • Bone disease • Anemia (deficiency of red cells or of hemoglobin in the blood), accounting for many symptoms. Also adds to the cardiac risk and is a predictor of cardiovascular With such a staggering increase in the incidence of related events kidney disease worldwide, World Kidney Day was conceived • Dyslipidemia(A disorder of lipoprotein metabolism, almost a decade ago, in the year 2006, by the International including lipoprotein overproduction or deficiency) Society of Nephrology and the International Federation of • Nutritional abnormalities Kidney Foundations, in an attempt to raise awareness of • Growth retardation in children the importance of our kidneys to our overall health and to • Neurological: cognitive decline, dementia, depression, reduce the frequency and impact of kidney disease and its sleep disturbances, peripheral nerve abnormalities associated health problems worldwide. • Cardiovascular abnormalities: higher risk of Heart failure, acute myocardial infarction, angina, arrhythmias, Chronic Kidney Disease is often not accompanied strokes, sudden death. In addition to the traditional with any signs or symptoms especially in the early stages cardiac risk factors in the general population, there of the disease. It is estimated that millions die prematurely are uremia specific risk factors as well. In advanced of complications related to Chronic Kidney Diseases (CKD), stages, uremic pericarditis may present as one of the either without realizing that they have kidney disease or complications with an extremely late diagnosis. When caught early enough, • Sexual abnormalities the progression of kidney disease can be slowed down • Higher chances of bleeding or, in some cases, even prevented with a kidney-friendly • Skin abnormalities diet and help from an integrated care team. If kidney • Hormomal abnormalities disease continues to progress to end stage renal disease, • Lower immunity dialysis or renal transplantation are the only options for Most kidney doctors or nephrologists agree that a kidney survival. screening is a must at regular intervals if you are at high risk People at the greatest risk for kidney disease include for kidney disease. Early detection, prevention and care are those with diabetes and high blood pressure, as well as the only solutions to avoiding medical complications as a older adults. Additional risk factors include people with result of improper kidney care. cardiovascular disease, obesity, high cholesterol, lupus and a family history of the disease. –Dr. Topoti Mukherjee MD Medicine, DNB Nephrology, Fellowship in Transplantation With inadequate renal care measures, some of the many (Canada), Consultant Nephrologist for DaVita India w w w.medegatetoday.com March-April 2015

EXPERT VIEWS

On the ‘World Kidney Day‘, city based Kidney Foundations come together to chronicle the ‘Kidney For Health‘ story

nd-Stage-Kidney Diseases (ESKD) is becoming a dreadful issue in India. The fact that about four lakh people falling prey to this chronic disease every year, is certainly a matter of great concern. Adding to the woes of patients suffering from ESKDs is the deficient treatment facilities available in India. Dialysis is one of the important treatment options; but India is still not well equipped to provide enough number of dialysis centers to patients for their day-to-day care. There are only about 1000 dialysis centers in India. Only 4000 - 5000 (about 1%) patients are fortunate to go for transplants each year in the whole country. Hence, more than 90 % of the patients are left at the mercy of their fates to find remedies for their ailment and cannot access even the basic need of having dialysis. While the risk of carrying ESKD is very high among Indians, unfortunately, in our country, awareness about kidney disease is very low. Said Dr Bharat Shah, Director, Institute of Renal Sciences, Mumbai and Managing Trustee of Narmada Kidney Foundation, “Diabetes and Hypertension account for more than 60 % cases of chronic kidney disease, but the lack of understanding is preventing people from having detection and prevention of kidney diseases at early stages. Hence, for a society where diabetes and hypertension has always been on the rise, the need for spreading awareness of kidney disease becomes very essential.”

Donation. These skits will communicate the importance of Kidney Care and raise awareness about Organ Donation in the society. Other Kidney Foundations which are joining in this endeavor are National Kidney Foundation, Mumbai Kidney Foundation, Mumbai Nephrology Group and Apex Kidney Foundation. The message that will be given out will be ‘Our Kidneys For Our Health’. Added Dr Shah, “On the occasion of World Kidney Day, we want to spread the importance of kidneys for good health. Our initiative is to engage with a large number of people and make them aware about preventing any probable risks of kidney ailments. At our Foundation, we have been continuously working towards educating people about kidney diseases.”

Overall 15 groups from various sectors like Schools, Colleges, Theater Activists, Organizations, Laughter Clubs and even Individuals participated in elimination round of the skit competition. The elimination round of Kidney The need to create a receptive environment to acknowledge Chronicles (Kisse Kidney Ke) was conducted on 8th March this serious disease becomes more visible on the ‘World 2015 at Nair Hospital Auditorium, Bombay Central. Kidney Day’, which is celebrated worldwide on second Thursday of March every year. While world over, the awareness levels to fight out ESKD are growing, India also needs to walk fast to arrest the fallouts of this fatal disease. Narmada Kidney Foundation (NKF), which is India’s one of the largest kidney related NGOs that works for raising awareness about prevention of kidney diseases and the concept of organ donation, has taken up a mass awareness campaign on the sidelines of ‘World Kidney Day’. On the occasion of ‘World Kidney Day’, on the 12th March, Narmada Kidney Foundation, along with other Kidney Foundations in Mumbai, have arranged a Hindi Skit Competition called as ‘Kidney Chronicles (Kisse Kidney Ke). This competition will involve all sections of the community and deliver a unified message about Kidney Health and Organ 66

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