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Advances in Renal cell carcinoma Kidney Disease Symptoms in Adults Time to think about Men’s Health Kidney Diseases

Advances in Urology

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magazine January 2016

Editor

I would like to take this opportunity to wish you all our readers success, peace, joy and prosperity throughout the year. The coming year brings us new hope and expectations and opportunities to grow further.

Feature Editor Editorial Advisor

A new Transparency Market Research report states that the global nephrology and urology devices market was valued at US$13.3 billion in 2011 and is predicted to reach US$20.5 billion by 2018, growing at a CAGR of 6.4% between 2012 and 2018. In addition, the rising awareness on the advantages such as quick recovery time and reduced treatment in patients having renal diseases boosts the demand for nephrology and urology devices. Furthermore, another prime factor stimulating the demand for nephrology and urology devices is the rise in healthcare spending by individuals. However, reduced or nil medical devices reimbursement for purchasing new technologies and devices is the key factor impeding the growth of the market in developing economies.

On the basis of type, the global nephrology and urology devices market is segmented into urinary stone treatment, devices for dialysis, pelvic organ prolapse and urinary incontinence treatment, endoscopy, and benign prostatic hyperplasia (BHP). The segment of dialysis devices held the biggest share in the market. On the other hand, the BHP devices segment is anticipated to experience exponential growth in the forecast horizon.On the basis of geography, the nephrology and urology devices market is segmented into North America, Asia Pacific, Europe, and Rest of the World. Increased healthcare spending has resulted in the redevelopment of the market for lithotripters in Asia Pacific and other emerging economies in the world.

Due to this, many consumers in Europe and North America have refurbished their clinics and hospitals using cuttingedge technologies and innovations.

Have an insightful reading.

Your suggestions are most welcome!

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

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“Nephrology and Urology Devices Market - Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2012 - 2018”

Dr. MA Kamal

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Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Jagruti Diddi, Deepa Sarkar All right Reserved by all everts are made to insure that the information published is correct 'Medgate today’ holds no responsibility any unlikely errors that might occur.

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Contents Health Minister and UNICEF Ambassador Priyanka Chopra Launch WIFS Awareness Campaign

Six Sigma Healthcare Excellence Awards

2015

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Sleep disorder is common among children Dr. Rajiva Kumar Child Specialist

10 Kidney Disease Symptoms in Adults Ms. Kanchan Naikawadi

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Time to think about Men’s Health

22 Men Suffer More Than Women as far as Oncological Disease Burden is Concerned

Dr. Raman Tanwar

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Prof (Dr) Rajeev Sood

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6 Paras Hospitals, Gurgaon Holds Special Christmas Activity for City’s Rag-Pickers ������������������������������������������������������� 6 First Time in Country Transportation of Live Heart by Helicopter ��������������������������������������������������������������������������������� 7 Declare All Out Offensive Against Cancer, Achieve Decisive Victory ���������������������������������������������������������������������������� 9 Dr. Harsh Vardhan Unveils National Biotechnology Development Strategy 2015-2020 ������������������������������������������������ 9 Voice of Healthcare (VOH) steps out of digital closet and takes off for Conference destination �������������������������������� 14 How to fit yourself in Diabetes-Diet Plan ���������������������������������������������������������������������������������������������������������������� 15 JAWA DIET ������������������������������������������������������������������������������������������������������������������������������������������������������������� 20 Advances in Renal cell carcinoma �������������������������������������������������������������������������������������������������������������������������� 21 Kidney Diseases ���������������������������������������������������������������������������������������������������������������������������������������������������� 24 Treating Neurological Disorders: A National Challenge �������������������������������������������������������������������������������������������� 28 WATCH YOUR FAVORITE DOCTORS FEATURE ON CARE WORLD TV THIS MONTH ����������������������������������������������������� 35

FDA approves Zurampic to treat high blood uric acid levels associated with gout �������������������������������������������������������

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NEWS Update

FDA approves Zurampic to treat high blood uric acid levels associated with gout The U.S. Food and Drug Administration today approved Zurampic (lesinurad) to treat high levels of uric acid in the blood (hyperuricemia) associated with gout, when used in combination with a xanthine oxidase inhibitor (XOI), a type of drug approved to reduce the production of uric acid in the body.

Gout is a painful form of arthritis caused by the buildup of too much uric acid in the body, and usually appears first as redness, soreness, and swelling in the big toe. Uric acid in the blood is produced by the breakdown of substances called purines, which are found in all the body’s tissues. Uric acid usually dissolves in the blood then passes through the kidneys and out of the body in urine. Uric acid can build up in the blood, a condition called hyperuricemia. This occurs when the body increases

the amount of uric acid it makes, the kidneys do not get rid of enough uric acid, or a person eats too many foods high in purines. Most people with hyperuricemia do not develop gout, but if uric acid forms crystals in the body, gout can develop.

"Controlling hyperuricemia is critical to the long-term treatment of gout," said Badrul Chowdhury, M.D., director of the Division of Pulmonary, Allergy and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research. "Zurampic provides a new treatment option for the millions of people who may develop gout over their lifetimes."

Zurampic works by helping the kidney excrete uric acid. It does this by inhibiting the function of transporter proteins involved in uric acid reabsorption in the kidney.

Paras Hospitals, Gurgaon Holds Special Christmas Activity for City’s Rag-Pickers; Distributes Lunch Packs and Goodies activity and distributed over 100 lunch packs amongst the rag pickers.

The senior officials who actively participated in the activity include Dr. Neeraj Bishnoi, The Medical Superintendent,Mr. Ratnesh Sinha’s, GM- Sales and Marketing, Mr. Vikas Chawla, AGM, Human Resource.

Even as we gear up to celebrate Christmas with usual aplomb, there is a section of highly visible yet oft ignored populace right among our midst who deal with hunger and destitution on a daily basis.

Paras Hospitals, Gurgaon decided to make the Christmas week a little more memorable for the rag picking children of the city by turning into Santa for them and bringing them lunch packs and gifts.

The idea behind the activity was to spread some smiles to the children in need and share with them the joys of Christmas.

The hospital staff and doctors joined the

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“Christmas is a festival associated with the joy of giving and spreading love and smiles. While we often see Santa visiting the urban towers of the privileged, the underprivileged children of the city are usually left out. Ironically, we often see poor children selling out Christmas decorative items and Santa Claus caps on roads and traffic junctions.

Therefore, this year we decided to give the festival its true meaning and distribute lunch packs amongst the rag pickers, who otherwise keep wandering to people’s homes in search of food or generosity,” said Dr. Neeraj Bishnoi, GM – Operations.

Santa Claus is lovable for with distributing gifts amongst children.

Children are often seen hanging up stockings and socks in the hopes of receiving gifts from Santa on the day.

Taking the same spirit of Christmas forward, Paras Hospitals, Gurgaon also distributed in-house gifts and cards to the children who came to the OPD during the festival.

“On the special occasion of Christmas the AGM – Human Resource of Paras Hospitals, Gurgaon, Mr. Vikas Chawla specially focused the need of the children and emphasized that the legend of Santa Claus is very dear to the children who desire their Santa to come and surprise them with gifts. We wanted to spread the same joy to the children coming to us, especially, on Christmas.

Distributing in-house gifts and cards is a gesture to offer some happiness to the children.

NEWS Update

First Time in Country Transportation of Live Heart by Helicopter

India is rapidly growing on International Standards in Healthcare Sector.

Organs are transferred from one hospital to another in the city and sometimes from One city to another city by Ground Ambulance, Private Jets or Commercial Airlines. But, for the first time in India, a live heart was flown from Vellore to Chennai by Helicopter.

Due to the recent floods, the roads were not in good shape and hospital management decided to fly the live heart by Helicopter. If they would have travelled by road ,it would have taken more than 4 hours. The shelf life of heart is 3 hours . Heart shall be transplanted within that stipulated time only.

The heart of a 45-year-old man, who was declared brain dead at Christian Medical College (CMC), Vellore during the early hours of Monday.

At night 3:30 am, Mr Sathish from Fortis Malar Hospital approached Capt Archit Gupta of Atom Aviation for organizing a helicopter to fly live heart from CMC Hospital,Vellore to Chennai.

Generally obtaining a Helicopter Landing Permission takes 3-4 days as NOC has

to be obtained from five departments i.e. NOC from Helipad Owner, NOC from Fire Department,NOC from Police Department, NOC from PWD Office, NOC from Rdo Office ,than District Collector gives the landing permission.

Atom Aviation, Delhi based aviation service provider company approached the PRO of VIT University & District Collector office at 0815. Initially there was a hitch but after an hour everyone started cooperating and managed to get the permission in just less than three hours thirty minutes (3:30 Mins). Mr Sathish ( Fortis Hospital) was of great help as he utilized all his contacts at

Vellore. The most critical aspect was that all the permission and approvals were done through Whatsapp.

Helicopter flew from Bangalore at 1300 IST and landed Vellore by 1400 IST. Doctors harvested the heart at 1535, within 11 minutes organ reached VIT Helipad by road. Helicopter was kept ready and by 1550 Helicopter was airborne for Chennai. Organ reached Chennai by 1635. Road travelling would have taken more than 4 hours, The entire distance of 140 Kms was covered in just 70 Minutes from body to body.

Atom Aviation is a startup in aviation field,which was founded by Capt Archit Gupta in January 2015.

Company deals into Private Chartered Jets,Helicopters,Air Ambulance and Aviation Softwares. Atom Aviation is currently serving over 100 corporate companies, multiple State Governments and Hospitals across the country. Within just 1 year, Atom Aviation has saved life of more than 50 lives through Air Ambulance Service in a quick notice.

Union Health Minister inaugurates the 38th Annual Meeting of Representatives of National Pharmacovigilance Centres Mr J.P. Nadda, Union Minister for Health & Family Welfare inaugurated the 38th Annual Meeting of Representatives of the National Pharmacovigilance Centres participating in the WHO Programme for International Drug Monitoring.

At the inaugural event it was announced that the Indian Pharmacopoeia Commission is in the process of becoming the first WHO Collaborating Centre for Safety of Medicines and Vaccines in the South-East Asia Region.

Hosted annually by one of the WHO Member States, the meeting acts as a platform for countries to discuss current issues and concerns in pharmacovigilance. This year, the meeting has been hosted by the Indian Pharmacopoeia Commission, the

National Coordinating Centre - Pharmacovigilance Programme of India with active support from WHO from 4-6 November 2015. More than 150 international delegates from over 57 countries are attending the meeting. w w w.medegatetoday.com January 2016

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NEWS Update

Health Minister and UNICEF Ambassador

Priyanka Chopra

Launch WIFS Awareness Campaign “It is our responsibility to ensure that the young energy is channelized in the right direction. This can only be achieved if the adolescents are physically and mentally well-prepared for the future of their country” said, Shri J P Nadda, Union Minister of Health and Family Welfare. He was speaking on the occasion of launching of media campaign for the Weekly Iron and Folic Acid Programme (WIFS) under the Rashtriya Kishor Swasthya Karyakram (RKSK) programme of the Health Ministry. He also said that to provide one IFA tablet each to millions of adolescents every week is in itself a huge achievement.

Nutrition among adolescents is one of the priority areas for concerted action under the Rashtriya Kishor Swasthya Karyakram. The Minister said that the Ministry is working continuously to strengthen the services provided under this programme and the support of the community i.e. parents, teachers and adolescents are critical to defeat anaemia. Also present at the function was Ms. Priyanka Chopra, UNICEF Goodwill Ambassador who is supporting the WIFS campaign by encouraging young adolescents to take one IFA tablet every week.

The Health Minister stated that the association of Ms Priyanka Chopra’s with this programme through the media campaign will help generate awareness on this critical issue.

Sharing her experience, Ms. Priyanka Chopra said that her health improved by taking iron tablet every week to remain healthy. Adding further she said, “I am sure through our concerted efforts we will be able to bring down the prevalence of anaemia amongst the adolescents.”

Highlighting the importance of IFA in one’s diet, Shri BP Sharma, Secretary (Health) said, “Ministry is partnering with other departments to supplement food with Iron.”

He further added that awareness among adolescents about anaemia is low and Media can play a key role in delivering healthy messages across.

Mr. Louis-Georges Arsenault, UNICEF Representative for India commended the WIFS programme and highlighted the importance of “awareness” and “prevention” by simple and profound nutrition. He also laid emphasis on spreading awareness about anaemia among adolescents.

The WIFS programme is implemented in both urban and rural areas among both adolescent boys and 8

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girls in school; and only to out of school adolescent girls (both married and unmarried). The WIFS strategy involves a “fixed day’’ approach for WIFS distribution. It is recommended that Monday be the day on which all schools undertake the programme, with one additional designated day for absentees.

To ensure high compliance in IFA supplementation supervised consumption of the IFA tablets is recommended. The programme also encourages and provides for the consumption of IFA tablets by the frontline workers such as AWW, ASHA, and teachers to enhance the value of WIFS among adolescents and community members.

The Ministry of Health and Family Welfare (MoHFW) is the nodal Ministry for the Weekly Iron FolicAcid Supplementation Programme.

MoHFW is responsible for policy formulation, technical support, yearly planning of the WIFS programme, including the allocation of resources for supply of IFA supplements and deworming tablets, developing resource material for awareness, establishing monitoring systems and reviewing the programme progress.

Under the WIFS programme for adolescents, IFA supplements are distributed free on a weekly basis to the target groups. In addition to IFA supplements, Albendazole tablets for de-worming are administered twice a year, to the same target groups.

Also present on the occasion were, Dr. (Prof) Jagdish Prasad, DGHS, Shri C K Mishra, AS&MD (NHM), KB Aggarwal, Additional Secretary, and Dr. Rakesh Kumar, JS (RCH, IEC),

NEWS Update

DECLARE ALL OUT OFFENSIVE AGAINST CANCER, ACHIEVE DECISIVE VICTORY THROUGH GOVERNMENT-INDUSTRYACADEMIA COLLABORATION, SAYS PRESIDENT The President of India, Shri Pranab Mukherjee laid the Foundation Stone of a State Cancer Institute and inaugurated the Foundation Day celebrations of the Kidwai Memorial Institute of Oncology in Bengaluru today (December 23, 2015).

Speaking on the occasion, the President called for an all out offensive against cancer and achieve a decisive victory through active collaboration and participation of Government, industry and academia. He complimented the Institute for taking a major leap towards extending state of the art cancer care facilities to poor patients.

The President said the unabated spread of cancer continues to be a matter of great concern. The incidence of cancer has been increasing worldwide and India is also showing a steep increase in cases over the years. Systems need to be developed for early detection and proper disease management. It needs to be explored how technology can be best utilised for both prevention of cancer and needed to minimize the suffering of its treatment. An appropriate and well patients and their families. He expressed defined communication strategy will also hope that the Kidwai Memorial Institute be a key factor in the fight against cancer. of Oncology will continue to serve The President said sustained and people and the nation by being a major collaborative multi-agency effort is player in India's war against cancer.

Dr. Harsh Vardhan Unveils National Biotechnology Development Strategy 2015-2020 The Strategy, developed by the Department of Biotechnology, aims to turn India into a world-class manufacturing hub and meet the challenge of turning biotechnology into a US $100bn industry by 2025 The National Biotechnology Development Strategy 2015-20 was unveiled today by the Hon’ble Minister for Science & Technology and Earth Sciences, Dr. Harsh Vardhan, and the Hon’ble Minister of State for Science & Technology and Earth Sciences, Shri.

YS Chowdary, in the presence of the

Secretary, Department of Biotechnology, Dr. VijayRaghavan and other key stakeholders.

The National Biotechnology Development Strategy 2015-20 aims to establish India as a world-class bio-manufacturing hub. It intends to launch a major mission, backed with significant investments, for the creation of new biotech products, create a strong infrastructure for R&D and commercialization, and empower India’s human resources scientifically and technologically.

Said Minister for Science & Technology and Earth Sciences, Dr. Harsh Vardhan: “The Department of Biotechnology is going to soon complete 30 years. It has done commendable work over the years in catalyzing the growth of the biotechnology industry, which has a huge potential to positively impact the lives of Indians in every area, such as research, education, health, technology, and energy. This was sensed a long time ago by the Government. When Shri Atal Bihari Vajpayee was the prime ministry, he used to say that while IT (information technology) stands for ‘India Today,’ BT (biotechnology) stands for ‘Bharat Tomorrow.’ I believe this industry has the potential to grow like the IT industry over the next ten years and beyond. The development of the inexpensive rotavirus vaccine, available for less than a dollar in India when internationally it costs 50 dollars, is an example of what can be achieved by the Indian biotechnology industry. Several other vaccines, such as for dengue and malaria, are already under development. The growth prospects of the Indian biotechnology industry are bright provided it receives the right stimulus and an enabling environment.” w w w.medegatetoday.com January 2016

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NEWS Update

Doctors Professionals were awarded for his hard work at “World Entrepreneurship Summit – and

Six Sigma Healthcare Excellence Awards 2015

SPEAKERS PROF. M.C MISRA, DIRECTOR AIIMS, DELHI (KEY NOTE SPEAKER) SH. RAJESH SRIVASTAVA Chairman, Rockland Hospitals, Delhi Dr. DINESH BATRA CEO, Cygnus Healthcare BRIG. (DR) ARVIND LAL PADMASHRI, CHAIRMAN & MANAGING DIRECTOR DR. LAL PATH LAB, GURGAON

MAJOR HPS AHLUWALIA PADMASHRI –PADAMBHUSHAN, ARJUN AWARDEES, CHAIRMAN – ISIC, NEW DELHI

DR. B.K RANA JOINT DIRECTOR - NABH Dr. Dharmender Nagar MD, Paras Hospital, Gurgaon Dr. D.R Rai Vice President, IMA HQ, New Delhi - Chairperson Prof. Dr. AK Khokhar Director & Dean, IIHMR, Delhi Dr. (Gp. Captain) Sanjeev Sood Gurgaon Dr. Rakesh Gupta Chairman, Sarvodaya Hospitals, Faridaba

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Hospitals & Healthcare

in New Delhi

Dr Pradeep Bhardwaj, Executive Director & CEO – Six Sigma Healthcare (President Organizing Committee) stated that the functions were a grand success and were attended by about 600 delegates. The speakers who constituted the ‘who is who’ of Indian healthcare sector shared their experiences of setting up their businesses and also offered advice to those aspiring to get into the big league of different segments of the expanding healthcare sector.

These events brought together almost all major Healthcare stakeholders - Government Officials, CEOs, VPs and Directors of the Healthcare Sector from leading public/private hospitals, academia, NGOs, industrialists and entrepreneurs of repute during its thought provoking sessions.

The eminent Jury of Six Sigma healthcare has created new paradigm in Indian healthcare, through continuous research, Innovation and Excellence. The primary aim is to recognize the outstanding leaders for their extraordinary contributions in healthcare.

The Director General, MAJ. GEN. SB AKALI intimated that the response to these awards was overwhelming. There were over about 300 applicants for the prestigious awards and it was difficult for the eminent Jury (consisting of experts from Healthcare and Management fields) to select the winners. They therefore decided to honour more than one person in some of the categories.

NEWS Update

The inaugural function started with Saraswati Aradhna in the presence of Dr. Kirit Solanki MP Lok Sabha – Ahmedabad Sh. Parveen Kumar (Bhim), Actor & Arjun Awardees Sh. HPS Ahluwalia Padam Bhushan, Padam Shri, Chairman – Indian Spinal Injuries Centre Delhi

Lt. Gen. B.K Chopra Director General – Armed Forces Medical Services, Ministry of Defence

Dr. Pradeep Bhardwaj Medical Director & CEO, Six Sigma Maj. Gen. KJ Singh Group Vice Chancellor – Amity Universities, Noida Prof. Dr. D.S Rana Padamshri, Chairman, Sir Gangaram Hospital, New Delhi Sh. P.K Dubey IG – Border Security Forces, BSF HQ, New Delhi Sh. Sumer Singh DIG – BSF, Wagha Border, Amritsar Prof. Dr. Balbir Tomer Chancellor – NIMS University, Jaipur Prof. Dr. R.C Deka Former Director – AIIMS, New Delhi Dr. H.S GILL Chancellor Adesh Medical University, Bhatinda

w w w.medegatetoday.com January 2016

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NEWS Update

WINNER OF

SIX SIGMA HEALTHCARE EXCELLENCE AWARDS - 2015

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NEWS Update

SIR GANGA RAM HOSPITAL, NEW DELHI................................................... RURAL HEALTHCARE INITIATIVE OF THE YEAR MEDANTA- THE MEDICITY, GURGAON, HARYANA...................................... BEST SUPER SPECIALITY HOSPITAL OF THE YEAR DR SUNIL KUMAR GUPTA, MEDANTA - THE MEDICITY, GURGAON, HARYANA..................................... BEST DOCTOR OF THE YEAR (ONCOLOGY) DR. GURU N REDDY, Continental Hospital, HYDRABAD................................HEALTHCARE ENTREPRENEUR OF THE YEAR DR. DHARMINDER NAGAR, Paras Healthcare, GURGAON, HARYANA.........DYNAMIC ENTREPRENEUR OF THE YEAR SREEDHAREEYAM AYURVEDIC EYE HOSPITAL & RESEARCH CENTRE

ERNAKUILAM, KERALA....................................................................................BEST AYURVEDIC HOSPITAL OF THE YEAR DR. K H PALIN SHIJA HOSPITAL, IMPHAL.......................................................HEALTHCARE AMBASSADOR OF THE YEAR CYGNUS HOSPITALS......................................................................................BEST HEALTHCARE BRAND OF THE YEAR DR. RAM GOEL, Kamla Nagar Hospital, JODPUR, RAJASTHAN.......................HEALTHCARE AMBASSADOR OF THE YEAR PROF. (DR.) BALVIR S TOMAR, NIMS UNIVERSITY, JAIPUR, RAJASTHAN.......LIFETIME ACHIEVEMENT AWARD ADESH UNIVERSITY, PUNJAB......................................................................... BEST HEALTHCARE ACADEMIC INSTITUTION OF THE YEAR STERLING HOSPITAL, AHMEDABAD................................................................PATIENT SAFETY HOSPITAL OF THE YEAR STERLING HOSPITAL, AHMEDABAD................................................................BEST HOSPITAL OF THE YEAR DR. ANKUR GUPTA, APOLLO HOSPITAL, INDORE, M.P.....................................BEST DOCTOR OF THE YEAR (CRITICAL CARE) DR. N. P. P. NAMBOOTHIRI, SREEDHAREEYAM AYURVEDIC EYE HOSPITAL & RESEARCH CENTRE, KERALA............................................... BEST DOCTOR OF THE YEAR (AYURVEDA) SIDDHANTA REDCROSS SUPERSPECIALITY HOSPITAL, BHOPAL..................BEST HOSPITAL OF THE YEAR (45 BEDS < 50 BEDS) PARAS HOSPITAL, GURGAON.........................................................................HEALTHCARE BRANDING CAMPAIGN OF THE YEAR DR RAJIVA KUMAR, KDKM Hospital, Muzaffarpur, BIHAR..............................BEST DOCTOR OF THE YEAR (PAEDIATRICS) MR. SAMEER BHATI, STAR IMAGING & PATH LAB, NEW DELHI....................... BEST MANAGEMENT PROFESSIONAL OF THE YEAR (DIAGNOSTICS) SIR GANGA RAM HOSPITAL, NEW DELHI.......................................................HEALTHCARE ACADEMIC INSTITUTE OF THE YEAR DR. AASHISH CHOUDHRY, Aakash Healthcare, DELHI....................................BEST DOCTOR OF THE YEAR (ORTHOPAEDICS) APOLLO HOSPITAL, BHUBANESWAR..............................................................BEST HOSPITAL OF THE YEAR CONTINENTAL HOSPITAL, HYDERABAD.......................................................... OPTIMUM GREEN HEALTHCARE INITIATIVE OF THE YEAR SARVODAYA HOSPITAL & RESEARCH CENTRE, FARIDABAD.......................... OPTIMUM GREEN HEALTHCARE INITIATIVE OF THE YEAR FORTIS HOSPITAL, LUDHIANA........................................................................BEST PATIENT CARE PROVIDER OF THE YEAR SURAT RAKTADAN KENDRA & RESEARCH CENTRE, SURAT, GUJRAT............BEST HEALTHCARE NGO OF THE YEAR AGASTYA AEROWORKS PVT LTD, GOA...........................................................BEST LIFE SAVING EQUIPMENT COMPANY OF THE YEAR AIROX TECHNOLOGIES LTD............................................................................ BEST HEALTHCARE ENTERPRISE OF THE YEAR: In Healthcare & Medical equipment category SANJAY JAISWAL ( M.D. Airox Technologies Pvt Ltd.)...................................BEST HEALTHCARE ENTREPRENEUR OF THE YEAR SRL LIMITED, MUMBAI...................................................................................BEST DIAGNOSTIC SERVICE PROVIDER OF THE YEAR AMEN.............................................................................................................. BEST HEALTHCARE Conference Manager OF THE YEAR VASUDEV HOSPITAL, KARNATAKA..................................................................RURAL HEALTHCARE INITIATIVE OF THE YEAR

RESEARCH FOUNDATION OF HOSPITAL

Healthcare Administration, RFHHA, AIIMS...................................................... BEST HOSPITAL MANAGEMENT RESEARCH ORGANIZATION OF THE YEAR STAR IMAGING & PATH LAB (P) LTD. DELHI...................................................BEST IMAGING SERVICE PROVIDER OF THE YEAR MR. RAJIV MISRA, Medanta, GURGAON........................................................ BEST COMMUNITY OUTREACH PROGRAMME OF THE YEAR DR. MAHESH GUPTA, SATYAKIRAN HOSPITAL, SONEPAT, HARYANA...............DYNAMIC ENTREPRENEUR OF THE YEAR DR. RAJESH C SHAH, SCL General Hospital, AHMEDABAD............................BEST HOSPITAL ADMINISTRATOR OF THE YEAR Medgate Today Magazine.........................................................................MOST POPULAR HEALTHCARE MEDIA OF THE YEAR DR KAILASH KABRA, Medihub Hospital, RAJASTHAN.................................... BEST DOCTOR OF THE YEAR (SURGERY)

DR. BISWAROOP ROY CHOWDHURY Dynamic Memory P Ltd, FARIDABAD, HARYANA.........................................BEST WELLNESS SERVICE PROVIDER OF THE YEAR MS. SWETAPADMA DASH, APOLLO HOSPITAL, BHUBANESHWAR..................JURY'S SPECIAL AWARD DR. RAJAT MOHAN, SIR GANGARAM HOSPITAL, DELHI..................................BEST DOCTOR OF THE YEAR (CARDIOLOGY) DR. RAKESH GUPTA, Sarvodaya Hospital & Research Center, HARYANA.......HEALTHCARE ENTREPRENEUR OF THE YEAR DR. RAJESH GULIA, Mayo Hospital, Mohali, PUNJAB.....................................BEST DOCTOR OF THE YEAR (UROLOGY) FORTIS HOSPITAL, LUDHIANA........................................................................BEST HEALTHCARE ENTERPRISE OF THE YEAR FORTIS HOSPITAL, LUDHIANA........................................................................PATIENT SAFETY HOSPITAL OF THE YEAR w w w.medegatetoday.com January 2016

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NEWS Update

Voice of Healthcare (VOH) steps out of digital closet and takes off for Conference destination

T

he Hyderabad conference was the opportunity to share with healthcare industry about the transition of Voice of Healthcare from a humble social media start to more mature platform of healthcare issues based conference.

VOH Conferences Series are backed Medgate Today-Hosconnn Content Research Team

Platform for mature & meaningful Voices medical deptt. Continental hospital hyderabd. He stressed the need for enough of healthcare industry. precaution to develop a sensible,logical, VOH’s content team of Medgate and and need based procurement strategy and Hosconnn healthcare consultancy avoid popular “ ME TOO” Trap. decided to launch new voices of healthcare like Mr Satyanarayana (Senior Finally the conference was summed Advisor, Hosconnn) Mr. Kosalaraman up by a presentation on Marketing & (Director Infra Bee Consultancy ) Branding by Mr Manish who called Dr Vinod Singh (Director- hospitech upon for review of marketing approach. consultancy) Mr Manish (Healthcare He rejected the idea of halthcare Strategist-Hosconnn) and MR Srinivas consumerism because patients come to reddy (head biomedical deppt continental hospital for treatment not for indulgence !!!, marketing & branding needs hospital) customized and innovative approach.

Initiating the discussion Mr. kosalaraman stressed the need to apply Value As a return gift,our delegates suggested Engineering to healthcare projects to some more topics for future conferences shorten the construction process. Mr in sync of our belief “sharing & Manish Rastogi,healthcare strategist learning”.. with Hosconnn healthcare consultancy The Second day of the conference was extended the discussion into Healthcare initiated by Mr Afzal kamal, with a Entreprenureship strategy and strongly comprehensive presentation of VOH recommended a good research led not only as an Idea & Mission but also homework/warm-up phase before getting a movement to meet medical fraternity’s into healthcare projects. The word expectations and aspirations. Mr Afzal “control” is the key word in healthcare also read out the message from VOH projects. Another logical extension of member Dr Naveen Nischal, who could the conference was dr vinod’s hospitech not attend this conference due to some unambiguous assertion that feasibility sudden occurrence. study is gateway to practicality of The VOH agenda for the second day healthcare projects of any sizes. attracted many delegates who shared The first half of conference with three their perspectives on various local issues presentations generated a lot of curiosity of their areas. Many of them thanked VOH for giving them opportunity to as well as questions among delegates. voice their issues. It was really moment Second half opened with an Innovative, of awakening & reckoning to find out probably first time in healthcare industry, the heroic efforts of doctors of tier a presentation on 2 & 3 cities in meeting medical needs Drawing on his rich & long experience of local population despite plentiful of of various aspects of healthcare projects, constraints like abysmal govt support as he called upon stakeholders of new well as lack of staff and facilities. healthcare projects to have strong Finally conference ended on volunteer financial architecture as guidelines for commitments of some of the delegates to building architecture. take the agenda of VOH to their Cities /

VOH Concept is inspired by an unrest desire to find out healthcare issues as well as grass rooted healthcare experts from Medical equipment planning was next Areas and requested VOH to guide them all over Industry, and emerge as common topic by Mr Srinivas Reddy,head,bio in setting up local representative offices.

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NEWS Update

Ribbel Pioneer in surgical blades has launched Foley catheter for Urology sector

Mr. R.K. Kanodia Managing Director Ribbel International Limited

RIBBEL INTERNATIONAL LTD. is established and reputed manufacture of premium quality of Surgical Blades from last 20 years. Recently launched complete range of SILKY GOLD Foley Balloon Catheters.

STATE-OF-THE-ART manufacturing plant setup at Sonepat India as per International Norms and Drug act of India. Manufacturing and packing under Class 10,000 clean room environment.

How to fit yourself in

D

iabetes is a growing potential epidemic in India with millions of individuals being diagnosed with the disease every day & further expected to double in number in the coming time. The cause is not mainly genetics but is genetics coupled up with various influences like, lifestyle changes, environmental issues, sedentary lifestyle, increased consumption of chemical laden food products, most important cause being Obesity. There is a need of urgent intervention in terms of awareness and prevention, in order to mitigate the expected increase of the disease.

Diabetes is a lifelong condition where a person’s blood sugar level becomes too high - Insulin being the governing hormone.

There are 2 types - type 1 also called juvenile diabetes and type 2 where a person develops insulin resistance.However, it can be controlled or prevented with healthy lifestyle changes especially by consuming a good nutritious diet.The best thing you can do for your health is lose excess weight - which not only brings you in a good shape but also has positive impact on energy levels, mood, and overall wellbeing. Physical activity is as vital as eating right in order to control or prevent diabetes.

A diabetes diet in a nutshell is - simply a healthy eating plan with high nutrient value, low saturated fat, no chemicals & artificial preservative, less packaged food, increase in consumption of real food, consuming good fats and being physically active. Small basic swaps can yield big impact in the long run - such as :☻ Water - dehydration is one the most important factor leading to many such health issues. Not having enough water also leads to a health issue called Diabetic coma. Thus, it is must to be hydrated at all time in order to maintain proper functioning of the body.

Ribbel International ltd. is an ISO 9001 & ISO 13485 certified co. and all our products are CE mark, also registered in USA, BIS in India, MOH in Russia and TGA in Australia.

Exporting to 82 countries worldwide.

Ribbel International Ltd, is a growing organisation with a team of highly technical and dedicated workforce and well performing under the supervision of Mr. R.k. Kanodia an Industrialist having a rich experience of more than 40 years.

Diabetes-Diet Plan ☻ High-fiber carbs - Carbs have a huge impact on blood sugar levels, hence it is important to chose wisely and swap highly refined carbs like white rice, pasta, white breads with high fiber complex carbs like whole wheat breads, brown rice, wheat pasta, greens. ☻ Low GI ( glycemic index ) food- high GI food spikes blood sugar rapidly, thus it is wise to choose low GI foods over high. ☻ More fruits & vegetables - eating seasonal fruits and vegetables over packaged junk food. ☻ Replace sugary drinks like soda, soft drink and juices with water ☻ Proteins - it is important to have a balanced diet with good amount of proteins - some healthy sources being - low fat dairy, legumes, pulses, eggs, beans, natural yogurt. ☻ Reducing intake of fats - avoid deep fried and processed meat. ☻ Opt for healthy snack and dessert- make smart choices. ☻ Having balanced meals throughout the day. ☻ Maintaining food journal. ☻ Having proper sleep cycle - not sleeping enough causes hormonal disbalance ( ghrelin and leptin- responsible for hunger and feeling of fullness signals ). ☻ Physical activity - being physically active is a need of our body.

Introducing any form of activity is beneficial like walking, cycling, swimming, yoga etc.

Body is the most important vehicle for our journey of life - it is every individuals responsibility to keep it in good health and take charge of their lives.

By:- Ms. Dimple Mirchandani w w w.medegatetoday.com January 2016

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DOCTOR SPEAK

Dr. Rajiva Kumar

Child Specialist (Muzaffarpur)

Sleep disorder is common

among children O

ver the first year of life, your baby will sleep and nap a lot—from 12 up to 18 hours a day. The amount of sleep an infant gets at any one stretch of time is mostly ruled by hunger. Newborns will wake up and want to be fed about every 3-4 hours at first. Do not let your newborn sleep longer than 5 hours at a time in the first 5-6 weeks.

Thereafter, you can keep the following general milestones in mind:  By 4 months, most babies begin to show some preferences for longer sleep at night.  By 6 months, many babies can go for 5-6 hours or more without the need to feed and will begin to "sleep through the night."  Daytime naps reduce in number as the baby grows. A 2-month-old may nap up to 4 times a day, whereas an older infant may nap only 1-2 times a day.

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Where should our newborn sleep

?

Your newborn can sleep in a bassinet or a crib in a parent's or sibling's bedroom, or with mother bedroom.

Sleep and night time awakening during the first 12 months.

During the first 12 months, babies develop quickly, and their sleep patterns change rapidly as well. It is also important to understand that all babies briefly awaken several times (up to 6) a night. Some babies are able to soothe themselves back to sleep after they wake up. Other babies learn to signal their parents for help (ie, rocking, holding, cuddling) to settle them back to sleep if they wake up in the middle of the night.

However, it is best to let the newborn comfort himself or herself back to sleep rather than develop a need or association with a parent or guardian.

DOCTOR SPEAK

some ways to help newborn sleep well.

There are a number of ways you can help your baby become a better sleeper. These include:  Work on shifting your baby's sleep cycle more toward nighttime by 2-3 months of age. Newborns frequently have their days and nights reversed and often the awake/ sleep cycle is governed by the need to feed. When there is a need to feed during the night, keep lights dim and reserve stimulating interaction for the daytime hours. Eventually, this will help develop a more consistent sleep/wake schedule. Also, try not to cut back on nap time, as this will result in overtiredness and lack of a good night's sleep.

 Establish a bedtime ritual. Your baby can respond well to such near bedtime rituals as bathing, rocking, reading, quiet talking, singing, playing soft music, cuddling, and gentle massage. Even though your baby may not understand these signals yet, setting up these bedtime drills now can help establish a regular bedtime routine that will lead to good sleeping habits in the future. Avoid making bedtime feedings part of the bedtime routine after about 6 months of age. Try to introduce a security object (eg, a stuffed animal or blanket or a knotted T-shirt with your body odor on it) around the age of 1 year. This object, if accepted by the baby, may help the baby soothe itself at night. Make sure the bedroom environment is quiet, cool, dark, and comfortable for sleeping. A nightlight or area light on the very lowest dimmer setting is fine.

 Learn to understand signals that your baby is getting tired.

Signs of being tired differ among babies but can include things like becoming fussy, crying, tugging on body parts,  Do not be surprised to see a lot of body movement as your baby sleeps. Your child may sound like he or she is awake, yawning, and rubbing eyes. Putting your baby to bed when but actually is not. You'll see smiling, sucking, twitching, he or she is showing these signs usually allows them to jerking, and all kinds of motions—these are all normal fall asleep more quickly and begins to establish a bedtime aspects of sleep. However, if he or she continues to cry routine. Most experts recommend putting your baby to bed for several minutes, it is time to check on him or her. Your while he or she is still awake but drowsy. This way the baby may be cold, wet, hungry, or even sick and require baby will learn how to go to sleep on his/her own and learn your care and attention. not to associate your presence with sleep onset.

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INTERVIEW Shamik Dasgupta

is the Vice President of the Cardiac and Vascular Group for Medtronic in South Asia.

Shamik is responsible for managing the business in the geography and his key priorities are to enhance access of Medtronic therapies and building a strong foundation of growth for Medtronic in the region. Prior to this role Shamik was the Global General Manager of Naya Med International SARL based in Lausanne, Switzerland. In this role, Shamik was heading the operation of NayaMed which is a subsidiary of Medtronic Inc. NayaMed offered a new business model to the medical device space with value propositions that help the customers bring efficiency in their purchase and inventory management processes while providing fit for purpose Cardiac Rhythm Disease Management (CRDM) products and instant but remote technical support. This was an effort at business model innovation which has created new trends in the medical device industry and addressed the challenges in the transforming healthcare environment across the world.

Shamik holds a BE Instrumentation Engineering degree from University of Pune and has done management programs at SP Jain Institute of Management in India and Wharton Business School in the US. What is the prevalence of coronary heart disease (CHD) in the country and therapy penetration?

With - 61.5 Mn Coronary Heart Disease (CHD) patients in 2015, India becomes one of the largest contributors of CHD patients in the world. By 2020, India is expected to have the largest disease burden in the world and shall account for 1/3rd of the deaths. Approximately 9-10% of the CHD patients suffer from an acute coronary event, accounting for 4-5 Mn cases of Acute Coronary Syndrome (ACS) every year. Of this only ~ 1.6 Mn patients are treated with cardiac stents over the past 10 years. Cardiac Stent therapy penetration in India is at 2.6% of the diseased population.

Drug-eluting stents (DES) have revolutionized the treatment of coronary diseases. What are your thoughts?

Drug eluting stents (DES) have revolutionized the treatment of patients in the area of Interventional Cardiology, and have significantly improved the patient outcomes and revascularization rates from 40% to <1%. A DES is a metallic coronary artery stent, permanently implanted in an artery, which has been coated with medication to prevent an overgrowth of the artery lining that can occur as a reaction to stent implantation. DES has 4 key components for its design and Integration: 18

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• Stent platform/design – Stent pattern, strut thickness, type of metal (SS or metal alloy) influence how flexible or conformable it is. Stent platform is the core device in case of DES with its mechanical properties to expanding & holding the arterial walls to improve blood flow.

• Stent delivery system (SDS) – An SDS with minimal balloon overhang (balloon outside the stent) contributes to system safety and effectiveness by decreasing the likelihood of vessel injury beyond the stent while maintaining stent retention.

• Drug – Should be proven, long term safety record in systemic use in humans and should have a wide therapeutic range.

• Polymer – This is a coating on the surface of the stent that holds the drug and controls the elution of the drug in the body.

All of these factors together contribute

to form a device which is implanted by an interventional cardiologist (IC) to keep a vessel open and prevent any thrombosis.

Diabetes and Heart Disease is a lethal link- How can a particular treatment meet the special needs of diabetics if they are at a higher risk of coronary heart disease (CHD)?

• Diabetic patients are two to four times more likely to develop cardiovascular disease than people without diabetes and there has been abundant evidence that cardiovascular disease is the leading cause of mortality for people with diabetes.

• Hypertension, abnormal blood lipids and obesity, all risk factors in their own right for cardiovascular disease, occur more frequently in people with diabetes.

• Uncontrolled diabetes damages the body’s blood vessels making them more prone to damage from

INTERVIEW atherosclerosis and hypertension.

People with diabetes develop atherosclerosis at a younger age and more severely than people without diabetes.

• Several studies have shown that people with diabetes tend to have different heart anatomy and comorbidities. They tend to have smaller and often tortuous arteries, longer lesions & diffuse disease with a higher rate of treatment failures when undergoing PCI treatment including relatively high rates of repeat procedures and stent thrombosis. Hence these special people, when they get a heart attack, need a special stent to cure themwhich is Resolute Integrity - The first and only FDA-approved DES for patients with diabetes from Medtronic.

Please elaborate on the technology and USP of Resolute Integrity.

Resolute Integrity is a revolutionary new DES that provides superior deliverability and powerful clinical performance, making it easier to address the needs of complex cases of diabetic patients who require better deliverability and tracking.

The continuous sinusoid technology uses a single continuous wire that is formed into the sinusoid shape.

Continuous sinusoid technology will flex continually thereby ensuring a streamlined delivery in distal tortuous anatomies of diabetic patients. It is then wrapped around a mandrel to give the cylindrical shape of the stent. The stent is then fused in strategic locations to ensure optimum flexibility, conformability and strength (explained in the figure below). This unique manufacturing process pioneered by Medtronic is what makes Resolute Integrity conform to better deliverability and trackability. This technology further reduces the force that is required to navigate the stent into the patient’s anatomy thereby giving enhanced procedural confidence.

The Resolute Integrity DES offers several notable benefits - starting with outstanding deliverability, which means it is exceptionally easy to navigate the stent on the delivery system through the coronary vasculature to the narrowed arterial segment that requires treatment, since the arteries of the diabetics may be more tortuous and smaller and therefore difficult to navigate through.

Secondly its’ biocompatible biolinx polymer, which is used to bind the drug to the stent achieves an extended 180 day drug elution, thereby meeting the longer healing time requirements of the diabetic patients.

Any recent advancement in stent technology from Medtronic?

Built on the proven clinical performance and superior deliverability of the Resolute Integrity drug eluting stent (DES) from Medtronic, the Resolute Onyx DES is the first stent to feature a new advancement called Core Wire Technology. Core Wire Technology combined with continuous sinusoid technology enables thinner struts without compromise in radiopacity or overall structural strength. Resolute Onyx has proven long-term safety and efficacy - no increased risk for stent thrombosis with interruption or discontinuation of DAPT after 1 month. It has thinner struts to help improve deliverability without compromising radial and longitudinal strength of the stent. Wrapped in a Cobalt Alloy shell, the denser, more radiopaque inner core material allows for improved visibility during procedure, referred to as radiopacity.

How critical is innovation and quality when it comes to healthcare?

Meaningful innovation and quality has a significant role in medical technology. Innovation is very critical because patients around the world are looking for 3 distinct things when they are seeking therapy.

• Firstly, they are seeking better patient outcomes, better clinical outcomes.

• Secondly, they are seeking quick recovery time • Thirdly, they are seeking economic value.

At Medtronic, we are committed to accelerating the development of meaningful innovations for patients with chronic diseases — innovations that add real value in better patient outcomes at appropriate costs, lead to enhanced quality of life, and can be validated by clinical and economic evidence. And we’re not just thinking about this at the product level, we’re developing innovations for the therapy, procedure and system levels.

Medtronic’s “Healthy Heart For All” program — which works with local hospitals and physicians to remove barriers to patient access to heart rhythm and vascular treatments — is an early and successful example of our emerging market care pathway approach to help overcome these barriers. The program works to continually evaluate and improve the entire cardiac patient care pathway and it has worked to resolve issues associated with patient awareness and screening, referral connections between general physicians and specialists, and counseling and financing options for patients who need financing assistance to access therapy options. The program works with more than 120 facilities across more than 22 cities in India. To date, more than 1,200 physicians have been trained, 147,000 patients have been screened and more than 14,000 of these patients have received treatment.

With patient lives at stake, we take our responsibility for quality very seriously. Medtronic devices are 100% tested to ensure they meet our quality requirements. Medtronic is looking at how our technology and expertise can be used in new and exciting ways, but we also realize it’s the partnerships we form around the world that can lead to the biggest advances for patients, hospitals, and systems. w w w.medegatetoday.com January 2016

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DOCTOR SPEAK

JAWA DIET We spend a lot of money on good clothes and beautiful accessories to go with our clothes and then we try them on. We look into the mirror and begin to wonder: maybe the arms should be a little thinner; perhaps I need to lose a little more weight around my hips; is that extra fat I see around my midriff? And what does all this do. It adds to our stress levels.

And our rising stress levels are directly related to our eating. We immediately go to get some comfort food. And therein begins our vicious cycle with weight!

We don’t realise it but our weight is directly related to our stress levels and the food we eat. As Jasmin Waldmann,Life Coach, puts it there is always a connection between our emotions and bodily needs.

She found out about this connection when she lost three very close members of her family – her mother, father and grandmother and went through immense emotional upheaval. And her interest in this connection developed.

J. WALDMANN

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recommends a fixed daily routine: time of getting up, eating and sleeping. At the same time she also recommends allowing oneself flexibility on one day such as a Sunday.

She says most of the time why other diets, bariatric surgery or even gymming under personal trainers fail is because once you let go you tend to put back the weight you have lost. After the initial euphoria of losing weight most of us tend to get back to our normal routine and then also back to the old body.

Jasmin has now become an expert in transformation of mind and body and an international life coach. She has also invented the international fitness system Pilardio (pilates with cardio training) and the JaWa Diet.

JaWa Diet is a programme that helps you understand what your body and mind really need. It teaches you to eat what She recommends a targeted approach. you need. It will not only be healthy but  Set a target: That is set your ultimate will also make you feel good once you goal, what you want to achieve and eat your way. then cut that target into a monthly or weekly one to achieve that goal The benefits of a JaWa diet are:  Have a good plan and mobilise the  It helps reduce extra weight right kind of people around you who  It helps reduce cellulite will motivate you to follow the plan  It detoxes the body and mind and be disciplined  It brings the balance back into your body, which is visible through your  Unclutter your mind of unwanted thoughts. regular bowel movements  It gives you the freedom to choose To help you understand your thoughts and emotions you need the right your food as per your liking professional guidance, which is where  It will make you happier  It helps you understand your body Jasmin Waldmann can help. Once you follow this regimen, exercises and the needs better  It also helps you understand your diet that is prescribed to you, your weight loss will be a surety. Also you will feel mental needs better  It will also help you know yourself good in your own skin. (your core) better Some of the JaWa Diet rules are:  It will give you self-confidence  No industrial sugar JaWa Diet is essentially diet management.  Stop drinking any liquid 1 hour The point is not to follow a diet forever before and 1 hour after each meal but to follow your own instincts and eat  Eat slowly and chew at least 30 times what your body needs. And this diet will  Relish your meals last forever.  Eat in variety Jasmin Waldmann has designed a three-  Eat without distraction month programme that everybody can Steps Towards Your Transformation is avail of. They also offer workshops a JaWa diet e-book written by Jasmin but people can do the three-month Waldmann. The e-book is available for programme on their own too. She all who wants to understand about the diet. It is easy to follow too.

The most important rule of the JaWa Diet is that you go one step at a time.

The slower you begin, the faster you will attain your goal. So don’t jump into this diet thinking results will begin to show immediately. Remember slow and steady wins the race!

DOCTOR SPEAK

Advances in Renal cell carcinoma imaging mean that kidney cancer can be detected at an earlier stage. Laparoscopic partial nephrology and other surgical techniques have reduced morbidities and life-threatening complications. New therapeutic drugs, such as molecularly targeted inhibitors of protein kinases, are producing better outcomes for patients.

Dr. Anurag Khaitan SR. Consultant Urology

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

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

Patients who need surgery or ablation could also avoid a biopsy and the related risk of morbidities.

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

Thanks to CT, radiologists can identify an increasing number of small renal masses in patients, up to 20% of which are estimated to be benign. Characterizing benign tumors is as important as Laparoscopic and robotic partial characterizing malignant ones, as doing nephrectomy procedures are increasingly so prevents unnecessary surgery. being performed, since they have shorter The characterization of solid renal tumors ischaemia times, a lower complication rate has improved, but there is a lack of reliable and equivalent renal functional outcomes. imaging criteria to distinguish benign But laparoscopic partial nephrectomy is from malignant tumors, and to separate technically demanding so it tends to be the different cancer types. Pre-therapeutic only used by experienced surgeons.

CT image-guided percutaneous biopsy is Minimally invasive treatments like recommended for histologically verifying cryoablation and radiofrequency ablation if a renal mass is benign. are being increasingly used to treat MR research is showing promise in renal patients with small cortical tumors 3 cm tumor characterization. Combinations in size or less. These are particularly of MRI techniques enable radiologists helpful for high surgical risk patients. to distinguish most common subtypes Active surveillance is also increasingly of renal tumors and to make accurate being recommended for patients over diagnoses. In their most recent study, 75 years of age, who are in poor health researchers at Bordeaux University with multiple and severe comorbidities found that MR parameters accurately and a renal mass less than 4 cm. distinguished papillary renal cell Targeted therapies have revolutionized carcinomas from other renal tumors with treatment and are increasingly being used.

100% specificity and a high negative The ability to characterize phenotypes of predictive value of 86.3%. Identification tumors using multiple parameters offers of oncocytomas from malignant lesions more detailed diagnostic information and such as chromophobe or clear-cell predictive response to therapy. Targeted renal carcinomas had 100% specificity therapies directed against vascular and 94.2% negative predictive value. endothelial growth factor/receptor â&#x20AC;&#x153;Multiparametric MRI is showing great (VEGF/VEGFR) or the mammalian target potential to improve characterizing of rapamycin (mTOR) pathways, both solid renal tumor types. This is very major mediators of tumor growth and early research, but we are quite excited progression, have significantly improved about the potential it is showing to avoid outcomes in patients with metastatic renal percutaneous biopsy when unnecessary cell carcinoma. In present era the survival or at risk. What this means in the context of patients with renal tumors has increased of the study is that imaging follow-up tremendously and future is bright with can be used with confidence, keeping the many newer agents for advanced renal patient safer and reducing treatment costs. tumors. w w w.medegatetoday.com January 2016

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COVER STORY

KidneyAdults Disease Symptoms in

Contributed by Ms. Kanchan Naikawadi, Preventive Healthcare Specialist and Founder Indus Health Plus

• Poor appetite and weight loss This is the most generic symptom commonly disregarded as something serious. Poor appetite is something very easily ignored in fast paced life resulting in weight loss, unfortunately this is treated as a welcome idea! Your body requires nutrition and energy to perform even the most basic tasks on a daily basis which is sourced from the intake of food. It is important to keep a tab on the food we give our body

• Swollen feet, hands or ankles Kidneys are supposed to remove wastes and extra fluid in the body.

When the kidneys fail to perform their functions, the extra fluid in your body will start to build up causing swelling in the face, hands, legs, feet and/or ankles as there is increase water retention Often, the disease is diagnosed as a result of screening of people known • Shortness of breath and fatigue - Apart to be at risk of kidney problems. The from filtering waste from the body, symptoms for kidney diseases are kidneys produce a hormone called usually non-specific and lifestyleerythropoietin. These hormones help related which can lead to down-playing make oxygen-carrying red blood of them. This usually causes delay in cells. When kidneys stop functioning addressing the issue and can cause properly they might not produce loss of precious time in the diagnosis. enough erythropoietin resulting in Hence, it is crucial to get screened Anemia. Berating becomes difficult from time to time as it keeps a person with fluid buildup in lungs informed about their health status giving them sufficient time to deal with • Blood or protein in urine - Blood in the urine is a cause of serious concern the problem and take corrective steps. and must be immediately taken to a Generally the associated symptoms doctor. Protein in the urine is more appear when the disease is already complicated as it can be detected only severe. Many of the symptoms below through a urine test increasing the can be avoided if treatment begins need to get regular check-ups done at an early stage. Even if there are • An increased need to urinate - Kidney no symptoms, people with diabetes, diseases can result in changes in high blood pressure, family history of amount and frequency of urination kidney disease or over the age of 60 pattern. There might be an increase must get screened as they form the in the need to urinate especially at high risk groups. As in case of diabetic night. There are cases of urination in people, statistics show that about 40% smaller amounts with dark urine or in tend to develop chronic kidney disease. larger amounts with pale urine. There Given the subtle nature of the also might be difficulty in urinating symptoms, below is a list to look out or constant experience of building for: pressure without actually passing it Kidney disease is known as a ‘silent disease’ as there are often no warning signs. If undetected, it only worsens over time. A more chronic form of kidney disease leads to progressive loss of renal function in the body over a period of months or years.

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COVER STORY

• Itchy skin - The function of cleansing of the body cannot be under-valued. Building up of wastes in the body have ways of coming out and one of them are through severe skin rashes and itchy skin • Muscle cramps - Some cases of kidney may cause pain. There may be severe cramping pains in different parts of the body depending on the type of kidney disease • High blood pressure - Due to shortage in the capacity of the body to carry oxygen, the heart begins to pump up blood faster in order to carry out the various nervous functions. The over-working of the heart leads to hypertension due to a high blood pressure in the body • Nausea and dizziness - The build-up of waste products in your blood in kidney disease can also cause nausea and vomiting.

Anaemia associated with kidney disease also depletes your brain of oxygen which may cause dizziness and trouble with concentration • Erectile dysfunction in men - An erectile dysfunction is the inability to get or maintain an erection. Severe cases of kidney disease may impair blood flow in the male genitals damaging the nerves, arteries and fibrous tissues in the organ

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COVER

Kidney

STORY

Diseases

W

hen a 49-year-old gentleman was admitted to the hospital with complaints of severeheadache, vomiting and giddiness over 3 daysa routine medical check-up was conducted.

Four years earlier on routine check-up when he had no complaints, his Blood Pressure was 140/90 mm Hg, serum creatinine was 1.2 mg/ dl, and urine examination showed trace of protein and 5-10 red blood cells,the patient did not turn up for follow-up for next four years.

On examination this time his Blood Pressure was 210/130 mm of Hg and grade III retinopathy on fundus examination (Stage 2 Hypertension). His blood urea and creatinine were 80 and 4 mg/dl respectively, suggesting 80% damage to the kidneys (CKD stage 4).

Urine examination showed 3+ protein and some RBCs. He had heart failure on X-ray and Echo examination. Ultrasound showed marginally small kidneys with increased echo-texture.

Why did this patient pick up so many complications?

Despite all the good intentions of many individuals, there is a lack of awareness with reference to kidney diseases in our country. While people may be well aware of the dangers of heart diseases, the majority of people think about kidney disease only when they develop back pain or experience difficulty in passing urine.

Most of the urological diseases leading to kidney failure are silent and do not cause any symptoms. Therefore, there is a persistent need for more screening programs to identify the presence of kidney disease and to lay a greater emphasis on public awareness and education.

This education has to be extended to the general physicians in the community as well as usually the first point of contact for any problem is the general physician in the locality.

There is much ignorance about the implications of an elevated serum creatinine and abnormal urinalysis even among the general physicians.

Despite various guidelines for the management of Diabetes and High BP, a lot of these patients are not screened for kidney involvement till the advanced stages. Furthermore, there is also an awareness deficit of the methods that can be used to treat kidney diseases.

What follows from this is an earlier referral to Kidney Specialists.

Despite a lot of emphasis in the past decades, we all see patients with poor BP control being referred to nephrologists with advanced stage kidney disease for the purpose of dialysis. Obviously there has to be more concerted and aggressive treatment of coexisting hypertension in people with kidney disease to slow the rate of deterioration. Perhaps greater physician education will help to prompt appropriate referrals 24

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Dr. Manoj Singhal MD, DM, DNB, MBA, Director of Nephrology and Kidney Transplantation, Fortis Hospital, NOIDA

COVER STORY

and in that way slow down the rate of kidney deterioration.

This is particularly true in patients with diabetes mellitus, which is the most common cause of kidney failure. This is also applicable to other kidney diseases like chronic glomerulonephritidies (CGN) and familial polycystic kidney disease.

There is a growing awareness of protein malnutrition as a significant risk factor in the long-term outcome including death of dialysis patients. Various studies in the last decade have clearly shown that the dietary protein intake decreases spontaneously with the progressive deterioration of the kidney function, resulting in decreasing muscle mass and malnutrition at the time of starting dialysis. In India, where the dietary protein intake is very low even in normal healthy population because of religious and social reasons (Vegetarian Diet), there is a limited role of protein restriction in ameliorating uremic symptoms and to slow down the rate of kidney function deterioration.

Kidney transplantation is the preferred method of renal replacement therapy in terms of patient survival, costeffectiveness and quality of life. However, there is usually a delay in starting dialysis and kidney transplantation. Studies have shown that these patients already have established anemia, bone disease and are malnourished at the start of dialysis. In fact most of the patients start dialysis only when they have life threatening complications like mental changes, cardiac arrhythmias because of high potassium or swelling and fluid in the membrane around the heart. Inadequate dialysis, frequent blood transfusions and increased risk of hepatitis are other major problems in these dialysis patients.

It all seems to be coming back to physician and patient education to get these patients recognized and started on dialysis relatively early to prevent these life threatening complications.

 There is a pressing need for more screening programs for the early detection of kidney disease and a greater emphasis on public education to reduce the occurrence of advanced kidney failure.

India bears the burden of increasing number of people getting afflicted by kidney diseases to epidemic proportions. There is a huge amount of work that has to be done in bringing up a more viable healthcare infrastructure by the government as there is very little at the moment. Renal replacement is an expensive solution and an important method to be adopted could be to try and reduce the incidence of end-stage renal disease and the renal therapy solutions by preventive measures. Treatment of chronic kidney diseases remains beyond the financial reach of the common, average Indian.

Prevention of chronic kidney disease has to be the goal of medical fraternity, government of India and the general public. Primary, secondary and tertiary preventive measures for prevention of chronic kidney disease can be brought into the forefront as a goal of the nation. There are already many effective and attractive interventions for the treatment and prevention of chronic kidney disease that exist and to develop many more would not be a major challenge.

Points to Remember:  There is a severe lack of awareness with reference to kidney diseases in our country.  Delay in detecting kidney disease leads to failure to institute preventive or controlling measures at the early stages of the disease when it is more amenable to treatment.  There is also a delay in starting dialysis and renal transplantation.  Patients usually start dialysis only when they develop severe life threatening complication like high Potassium, acidosis, encephalopathy, fluid over load, or pericarditis.  Most of these patients already have severe anemia, advanced bone disease, malnutrition, and heart disease at the time of starting dialysis.  This is vitally important, as heart disease is the number one cause of death of patients both on dialysis and after kidney transplantation. w w w.medegatetoday.com January 2016

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COVER STORY

Time to think about

Menâ&#x20AC;&#x2122;s Health When we start to compare a man from a woman, the first picture that strikes us as a male is the image of a tall strong and muscular figure trying to balance his aggression by him mannerism. The knight in shining armor that we imagine ourselves to be as a male is fast losing its valor. Moving from the older times when male sex was a sign of strength, vigor and sexual energy we have entered an era where male is lagging behind the other sex with regards to longevity and quality of life. It is now an old and established fact that Men live less than women and suffer more. The difference in life span of the two sexes ranges from 3-12 years in most regions of the world making it an almost universal phenomenon. The UNICEF data shows that this gap is rapidly increasing. The age gap which in 1990 was just 1 year has increased to 4 years in 2012 in India. The healthy life expectancy which was nearly similar in 2000 now reflects a gap of two years.

most of these are either more common in men or affect men more severely. The top ten killers of men globally are heart disease, cancer, injuries, stroke, lung diseases, diabetes, influenza and pneumonia, suicide, kidney disease and Alzheimerâ&#x20AC;&#x2122;s disease.It has been estimated that most of these chronic health illnesses are preventable (upto 70%) and arise out of lifestyle issues and sociocultural factors. Even though women fall sick more often with minor ailments, they have lower mortality The leading killers in India include cardiovascular disease, resulting from better genomic constitution and care for their chronic obstructive pulmonary disease, tuberculosis, cancer, illnesses. Contrary to this when men turn up in hospitals their digestive diseases and diarrhea etc. If we take a close look disease is more advanced and less amenable to cure.

Right from genetic makeup to the external environment most factors are not conducive for survival of men. The need for health promotion and illness prevention to uplift health care for men is also largely unmet across all age groups and adds to the morbidity. Even adolescent and young adult male health receives very little attention despite being aware of the fact that even little intervention can lead to a huge impact in smoothening the disparities and inequalities between the two sexes.

Dr. Raman Tanwar MBBS, MS, FMAS

MCh Urology Registrar, Post Graduate Institute of Medical Education and Research, New Delhi

Evolutionary process provides evidence of the limited role of male gender in the progress of propagation of species. What is evident is a small speck of the great evolutionary change.X chromosome has been proven to be the superior chromosome when compared to the Y chromosome which is 6-8 times more prone to mutations.

The number of genes on the X chromosome have been estimated to be about 3000 while those on the Y chromosome are only 50. The number of functional genes on Y chromosome are even less. There is also evidence available that telomeres in females are longer and they may be directly responsible for the increased lifespan of women. The speculation is that Y gene may eventually be lost and only male characteristics will be subsequently found in women. It can be supposed that propagation of species will be then be by cloning as was documented in the beginning of time.

In the primitive species we have evidence that males may have a role just for reproduction and their life span may permit only this specific function.

COVER STORY

Current literature suggests that men are a weaker sex from the very beginning. At conception the ratio of males to females has been estimated to be from 107 to 170 males per 100 females.

Even with a boost at conception, male fetus don't make it out of the uterus as often as females. This death differential is estimated to be 111-160 males per hundred females. The male fetus has been found to use two times more energy to grow yet most males are born prematurely and die earlier. Due to the higher weight, sex linked biochemical changes and adverse effects that the male fetus has on the mother, there are high chances of premature birth and subsequently brain damage, cerebral and congenital anomalies of the genitalia and limbs. Physiologically a new born girl is stronger and equivalent to a 3 week new born boy.

Miscarriages are mostly male. A number of factors including prenatal factors, familial conditioning and education influence male health outcomes. Certain influences mediated by epigenetic changes can be transferred genetically and can alter the expression of disease. Male fetus is weaker since inception and more susceptible to maternal stress. Similarly many disabilities also target males more commonly making men fragile as compared to women and males suffer more often from premature death during early adulthood.Due to weaker immunity the male baby is more prone to major infant killers like pneumonia, diarrhea and tetanus.

Reading delays, deafness, autism, Attention Deficit Hyperactivity Disorders, Blindness, seizure disorders, hyperactivity, clumsiness, stammering, and Tourette's syndrome may be three to four times more common and Asperger's syndrome, a mild form of autism is ten times more prevalent.

Growing into adulthood men face unique challenges like being the bread-earner, employment in high risk occupations, exposure to road traffic accidents, exposure to substance abuse and work related stress. They have poor social support and self-reliant behavior leading to poor access to health services. Environmental causes also have led to a decrease in longevity of men apart from social seclusion. The increased prevalence of cardiac disease, metabolic syndrome, cerebrovascular events, and depression and high rates of successful suicides provides the second hit.

Our Herodian image has become so engraved in our minds that we have refused to accept the challenges being faced on a daily basis. Despite of living in a so called male dominant society our health care system has been designed to focus more on maternal and child health. In our millennium development goals, goal 4 and 5 focus on child mortality and maternal health but there is no mention of menâ&#x20AC;&#x2122;s health in the future health goals. There is no doubt that maternal and child health need focus but so do men.

Mere knowledge about these issues can also play a huge role.

We are not far from the time when male sex would be declared endangered as genetic and environmental influences coalesce together and serve as a death blow for the Y chromosome. It is time that we think about menâ&#x20AC;&#x2122;s health more seriously and talk about our health issues in the open rather than being too selfreliant and shy. w w w.medegatetoday.com January 2016

27

EXPERT VIEWS

Treating Neurological Disorders:

A National Challenge The Indian Scenario In 1960s, neuroepidemiological studies were restricted to single disorder such as epilepsy and stroke. It was in late 1980s that neurologists were sensitized to the discipline of neuroepidemiology and the Indian Council of Medical Research (ICMR) identified neuroepidemiology as the thrust area of research and started giving grants.

Prof. M. Habeeb Ghatala Dean and Head Princess DurruShehvar Institute of Medical Technology Princess Durru Shehvar Children's & General Hospital Hyderabad, Telangana State, India

According to World Health Organization (WHO), neurological disorders are diseases of the central and peripheral nervous system. In other words, the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscles. There are more than 600 diseases of the nervous system. The diseases include but are not limited to epilepsy, stroke, cerebrovascular diseases, peripheral neuropathy, migraine, Parkinson’s disease, Alzheimer’s disease, dementia, and multiple sclerosis, to mention a few.

Hundreds of millions of people worldwide are affected by neurological disorders. Approximately 6.2 million people die because of stroke each year. More than 50 million people have epilepsy worldwide. Among the non-communicable diseases, neurological disorders form a significant portion of global burden of disease. Neurological diseases in developing countries with limited resources present public health challenges.

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The crude prevalence rate in India varies from 967 – 4,070 per 100,000 population with an average of 2,394 per 100,000 population. Based on this data, Dr. M. Gouri-Devi, India’s leading researcher on neurological disorders estimates that for the current population of 1.27 billion, approximately 30 million people suffer from neurological disorders in the country! These disorders have been recognized to lead to significant mortality, morbidity, disability and socioeconomic loss.

Neurological disorders affect all age groups and age-specific prevalence rates show increasing prevalence till fourth decade followed by decline to seventh decade. Geriatric population suffers from considerable burden of neurological disorders. It is worth noting that neurological disorders are more common in rural than in urban population with a ration of 1.9: 1. One of the factors responsible for the rural-urban divide is due to the fact that the neurological disorders are diagnosed rather late in rural areas than in urban areas.

Furthermore, the prevalence rate is higher in females than in males.

Among the movement disorders, epidemiology of Parkinson’s disease has been better studied than other disorders in India. The prevalence of Parkinson’s disease in India varies from 6-53 / 100,000 population. It was found that incidence in rural areas was higher than in urban areas.

It is worth noting that 80% of all neurological disorders are due to epilepsy, headaches, febrile conversions, and cerebrovascular disorders. The global burden of disease study of 2000 provides an estimate of 50 million people with epilepsy and more than 80% of them in developing countries. There is a wide variation per 100,000 population in crude prevalence rate of epilepsy in developing countries.

For example, in Pakistan Rural: Urban :: 14.8 : 7.4. In Turkey, Rural : Urban :: 8.8 : 4.5.

PRODUCT LINE

Core Diagnostics on Growth Path CORE Diagnostics began its tryst with Innovation nearly three years ago.

A summary of the time passed by: fascinating journey, reminiscent of the Leonardo da Vinci quote. "When once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, and there you will always long to return."

Having served over 25,000 patients from over a 100 cities across seven countries, it is both exhilarating and humbling to reflect upon the inflection points that led CORE to become synonymous with creativity, quality, and innovation.

Zoya Brar Managing Director Core Diagnostics

inItaisveryfounded logical observation that while diagnostics makes up for only 3% of the Healthcare expense, it impacts 70% of the cost downstream, and 100% of the outcome.

Let’s start with the basics. CORE Diagnostics is a Clinical laboratory focused on Next Generation Diagnostics for disease stratification and therapy selection. Our modus operandi is to bring the most advanced testing techniques and expertise to India, and be the destination for all high-end diagnostic testing.

At a more macro level, we view our charter much broadly: to re-shape the diagnostic industry – in a manner that it becomes the central pillar of healthcare delivery. This is not a hyperbole. It is founded in a very logical observation that while diagnostics makes up for only 3% of the Healthcare expense, it impacts 70% of the cost downstream, and 100% of the outcome. This leverage is even stronger in India because in complex areas like Oncology, Cardiology, Neurology, etc., disease often goes undiagnosed and often underdiagnosed.

This is what makes the diagnostics segment both - important for the patient, and interesting for the entrepreneur.

Hence, setting up a high end testing facility not only bridges this important “white-space”, it also places the apt responsibility and accountability on diagnostics as a segment. As we progress towards fulfilling this, the improvement of clinical outcome, and reduction of the downstream cost is simply a corollary.

Let’s focus next on two specific questions: What are the rate limiting factors in advancement of diagnostics, and how is CORE uniquely positioned to drive this advancement.

There is ONLY one rate limiting factor: talent – in the industry at large. We have interviewed nearly 500 people over the past two years, to hire just over a 100. Our interviewing approach is quite unique. We ask the candidates to interview US, as opposed to the other way around. Their questions tell us a whole lot more about their way of thinking, than their answers to our questions ever well. How well can they engage us…that is the cardinal question in our minds. This is followed by a very extensive induction program, and continues. We ensure a very selfdirected learning by creating a very flat culture – no hierarchy, full transparency, and brutal candor. Net net: CORE is as much a sociological platform as it is a clinical lab.

CORE is uniquely positioned in many ways. First, our panel of experts in the US that provided second opinion on every case is world class and includes some of the top names in Academic Medicine. Second, the work culture… we truly look and feel like a Silicon Valley startup, except that we are located in Gurgaon. Most importantly, it is our DNA of innovation that sets us apart - the most extensive menu of high-end molecular and genomic diagnostics in Cardiology, Oncology, and Reproductive Medicine; one of the most integrated informatics solutions to generate end-to-end efficiency and quality management, and massive reductions in cost of testing. For a market like India, each of these dimensions is critical, and our R&D group is active in all three. w w w.medegatetoday.com January 2016

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

COVER STORY

Causes of Variation The significant variation in incidence in rural and urban areas can be due to a variety of factors including differences in treatment of infections; level of primary care for head injuries; obstetric, perinatal and pediatric services in preventing birth trauma and prompt management of infections in neonates and infancy and treatment gap in epilepsy. All these are higher in rural areas.

There has been a dramatic rise in prevalence of stroke between 2000 and 2015 due to life style risk factors.

Higher stroke rates are due to poor control of diabetes and hypertension, major risk factors. Furthermore, stroke is the second most common cause of mortality and a major cause of disability. It is estimated that the total mortality due to neurological disorders will increase from 11.67% in 2005 to 12.22% in 2030. As per WHO, one billion people worldwide suffer from neurological disorders and 6.8 million die annually from these disorders.

Economic Burden of Neurologic Disorders

Neurological disorders can cause severe economic burden in the fors of direct costs, indirect costs and intangible costs as shown below.

Direct Costs – Outpatient care, drugs, emergency admissions, transportation, etc.

Indirect Costs – Unemployment, under employment, income lost by family members, disability associated issues, excess mortality, etc.

Intangible Costs – Pain, disability, suffering.

The Challenges

India faces a variety of challenges to deal with the task of treating neurological disorders as presented below: 30

www.m e d e g a t e t o d a y. c o m January 2016

 There is an urgent need for more neurologists as the current ratio of one neurologist for 1,250,000 population is very low.  It is crucial to determine the magnitude of pattern of neurological disorders to facilitate planning and prioritizing health needs at all levels of health care delivery system.  Necessary human resources and infrastructure is needed to provide accessible and affordable medical care with allocation of requisite funds to achieve the program objectives.  More surveys of urban population are necessary to confirm the observation that there is higher prevalence in rural population compared to urban population.  There should be strategy for health services with focus on neurology services for disorders like epilepsy, headache, febrile convulsions, and cerebrovascular (CVD) disorders which constitute 86% of all neurological disorders.  In order to minimize CVD, there needs to be national measures to prevent and control risk factors of CVD and adequate services are put in place for the management and rehabilitation of stroke patients.  There is an urgent need to initiate preventive programs to reduce the risk factors of stroke such as cardiovascular diseases, hypertension and diabetes.

 Arrangement of neurological care in remote and rural areas to reduce stroke fatalities and disabilities.  Better control of infectious diseases and improved nutritional status.  Integration of neurological care into the public health system.  Neurological disorders need to be recognized as a public health problem and recognize its magnitude because 30 million people in India suffer from neurologic disorders.  Need for comprehensive rehabilitation program for care of neurologically disabled people.  Need concerted efforts to increase awareness of health in the community and to undertake measures to reduce the prevalence of preventable diseases by controlling the risk factors.  Comprehensive questionnaires should be designed to enable the PHC and CHC nurses to conduct simple clinical examination and look for symptoms of any neurological disorders and as appropriate to refer the patient to the neurologist.

Conclusion The state and central governments need to take public health approach and make sure that customized models of health care delivery system are considered to meet the needs of the patients even in the most underserved remote and rural areas of the country.

COVER STORY

Men Suffer Oncological Disease Burden is Concerned

More Than Women as far as

I

ndia has the second largest population in the world after China with current population in 2013 being 1.24 billion. As per 2011 census the sex ratio is 940 females per 1000 male’s life expectancy at birth for males is 65.77 years and for females is 67.95 years. Men have shorter life span due to their risk taking habits like smoking, chewing tobacco, drinking alcohol, higher suicidal tendency, drugs in take, rash driving, unsafe sex and health hazards at work place. There are a few findings that need to be considered:  On average men live about 3-5 less years than women

Prof (Dr) Rajeev Sood

 1 in 2 men, while 1 in 3 women, will be diagnosed with cancer in their Consultant & Head, Department of Urology lifetime Dr. Ram Manohar Lohia Hospital, New Delhi

Men suffer more than Women as far as Oncological disease burden is concerned. Not only this, the Oncological outcomes in men are worse than women. Men specific Prostate Cancer which was at no. 6 or 7 in India in male populations has already risen to number 2 or 3 position in different cities and can any time become the number 1 Cancer in Indian Male.

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 Men lead in 9 out of the top ten causes of death Urologists / Andrologists along with major specialities of Cardiology, Psychiatry, Endocrinology, Orthopaedics, Reproductive Medicine, and Rehabilitation Medicine are on a mission to improve the health of men and empower them to pursue healthier lives. The reason for this greater interest in men’s health is the overwhelming irrefutable evidence from many scientific studies of the significant disparity in gender health.

All over the world, men live shorter than women and suffer more from heart disease and cancer. This disparity in utilizing preventive healthcare is more pronounced in populations of low socioeconomic status. Moreover, prostatic ailments, andropause, urethral inflictions (urethra being longer

and more vulnerable than female), significant osteoporosis incidence etc. pose more gender specific problems where Urologists and Andrologists have to interact. Realizing this, the urological society of India had also conceptualized PDAP (Prostate Disease Awareness Program), an Indian awareness program for prostate diseases. When the administrators in Govt. of India admit that for decades India has been struggling to achieve National Health Program targets related to women, children and communicable and non-communicable diseases, men’s health has been inadvertently ignored.

As stated Men suffer more than Women as far as Oncological disease burden is concerned. Not only this, the Oncological outcomes in men are worse than women. Men specific Prostate Cancer which was at no. 6 or 7 in India in male populations has already risen to number 2 or 3 position in different cities and can any time become the number 1 Cancer in Indian Male.

Men’s Health is one section of medicine which has often got neglected with no concerted efforts being currently undertaken by the health care system for its promotion on the national front. Urologists along with other specialties can contribute immensely to the endorsement of this cause as we frequently deal with problems of men in the geriatric and adolescent age group.

In the current situation there is a need to find markers to assess men’s health and provide tools which can

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COVER STORY

contribute to promoting male health.

Erectile dysfunction is one such potential marker. Risk of Erectile Dysfunction is higher among men with low socioeconomic status, high body mass index, those who were sedentary, current smokers and those with diseases including diabetes, heart disease, and depression/anxiety. ED is a potent predictor of all-cause death and the composite of cardiovascular death, Myocardial infarction, Stroke and Heart failure. The peripheral cavernosal arteries are end arteries, and thus do not have the ability to form collaterals to compensate for decreased blood flow, as does the heart. This loss of vasodilation may be recognized earlier in the microvascular penile bed than in coronary arteries.

Erectile Dysfunction (ED) thus heralds to the more ominous cardiovascular accidents. In fact ED is now recognized as the Sentinel Marker which precedes Cardiac Event by two years. The endothelial dysfunction is common precursor to both cardiovascular disease and erectile dysfunction.

In a study among newly diagnosed type 2 diabetics, 20% of the patients reported having used ED drugs, but more than 50% had abandoned therapy because of the drug's ineffectiveness or high cost. About 20% of these patients also had depression and many had hypogonadism. It has been suggested that Subclinical endothelial dysfunction and insulin resistance may be the underlying pathogenesis of ED in young patients without well-known etiology. Mean IIEF-5 scores were lower for the men with depression and anxiety indicating a strong relationship between erectile dysfunction and mental state. Patients with ED had significantly lower 5-year stroke-free survival rates and erectile dysfunction has also been referred to as a marker for cerebrovascular accidents. There is an increase in evidence from multiple epidemiological studies that lower urinary tract symptoms (LUTS) and 34

www.m e d e g a t e t o d a y. c o m January 2016

erectile dysfunction (ED) are correlated.

Screening for Erectile dysfunction is thus a powerful tool in the hands of a Men’s Health expert to assess risk of future morbidity from coronary artery disease, diabetes, stroke, depression and metabolic syndrome. It is an integrated marker of overall health.

Men’s health so far has been on the back burner in India. Belatedly though, the concept of Men’s health now seems to be all set to be taken up for inclusion in National Programs. National Health Programs in India are presently concentrating on communicable and non-communicable diseases and also maternity and child health and there is no national health program dedicated to Men’s Health. India is going to host the 10th Men’s Health World Congress (MHWC) in 2016 and the challenge faced is that we lack epidemiological data of male dominated diseases. We have to have our own Men’s Health Country report before planning and targeting Men’s Health related morbidity and mortality issues in the country.

It is our endeavor to convert this thought process into a mission to ensure a Men’s Health Aware India and to lead remedial interventions for reaching the logical end in the pursuit to improve men’s health and empower Indian Man. Our men also suffer from a peculiar premarital anxiety. Many of these young men have been exposed to fallacious ideas and suggestions which are in fact detrimental to their psyche and result in sexual dysfunction.

These men end up feeling guilty about past sexual practices and thus result in psychogenic ED. Another prevalent disorder often neglected is dhat syndrome which destroys the productive years of a number of young men in this country. Awareness is the only hope and answer to the future that is plagued by misconceptions. In infertile couples, the male factors are responsible in about 50% cases. It is important to recognize these factors and educate doctors and public at large to minimize health related problems in males and to improve their quality of life and longevity.

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

Shopping Centre, Jaipur-16 T: 0141- 2309675

Nasan Medical Electronics Pvt. Ltd.

Cygnus Hospital

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

Endoscopy Instruments

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

Healthware Pvt. Ltd.

Fortis Escorts Heart Institute &

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

Research Centre

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

Manaipal Hospitals

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

Pushpawati Singhania Research

Helios Endovision

Om Surgicals

ENT Equipment Instrument

Tufft

Surgical house,44,Mission compound,Ajmer

Okhla Road, New Delhi-25 M: 91 11 4713 5000 98, HAL Airport road, Bangalore-560 017 T: 080 - 2502 4444/3344 Institute

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

YELLOW PAGES

HOSPITAL CONSULTANCY

Medical Equipment

Nurse Calling System

Hosconnn

Technocare Medisystems

CR Medisystems Pvt. Ltd.

6, Chaithanya Complex Site 1, 17th Cross, Sir MV

C/1310-11,New Bombay Market, Umarwada,

Mumbai, India.

Nagar T.C. Palya Main Road, Bangalore

Surat- 395010 T: 261 2332042,6569308

Tel : 91-022-23094416, 23004930

M: 9845208778, Email: info@hosconnn.com

Hindustan Syringes & Medical

E-Mail : medisystems@gmail.com

DDF Consultants 501, B-9, ITL Tower, Netaji Subhash Place, Pitampura, New Delhi-110034

Devices Ltd.,

T: 011-47400500 Hospiteck Healthcare Consultancy

Bangalore T: +91-9739708532 Six Sigma Star Healthcare Pvt. Ltd.

174, Sector - 25, Ballabgarh - 121 004 (Haryana)

Magnatek Enterprises

Tel : +91 129 4289000,

97, SVC Indl Est., Balanagar, Hyderabad-500037

Fax : +91 129 4061164 & 2233242 E-mail: info@hmdhealthcare.com, hmduk@hmdhealthcare.com

MOdular- Operation Theatre

New Delhi

Sai Sumeet Appliances

T: 011 25324000

Hyderabad M: 08099119595

E-mail: sixsigmahealthcare@gmail.com

Health care Institution

operation theatre Light

Monitoring Equipments & Accesso Afford Medical Technologies Pvt. Ltd.

T: 040-65501094

Rehabilitation Product &AIDS Vissco Rehabilitation AIDS Pvt. Ltd.

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

Shoes Cover Dispenser BIO-X

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

Software and IT Solution

Global Institutte of Healthcare

230, 2nd Main Road, Sainikpuri

Management

Secunderabad-94 T: 040-32908880

Schrack Seconet AG

6 sigma house, 10A, Phase -1, Najafgarh

Drager Medical Pvt. Ltd.

T: 124 414150

New Delhi-43 T: 011 2532 4000,4001

Gold line Business Centre, Link Road Malad (W)

Kodak Alaris

Mumbai-400064 T: 022- 40843826

www.kodakalaris.com

HOSPITAL FURNITURE Godrej & Boyce Manufacturing

Medion Healthcare Pvt. Ltd.

201, Shiv Industrial Estate, K.B.B. Marg Chinch-

company ltd.

pokli (E) Mumbai-12 T: 022-23771737

Pirojshanagar, Vikhroli, Mumbai- 400079

Nihon Kohden India Pvt. Ltd.

T: 022- 67965656

308, Tower- A, Spaz Edge, Sector- 47, Sohna Road

Jaiveer Surgical Emporium

Gurgaon- 122002 T: 0124-4931000

1570, Bhagirath Palace, delhi-110006

Neonatal Pediatric Intensive c

SURGICAL BLADES Ribbel International Ltd

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

Niraj Industries Pvt. Ltd.

M: 9810820087

Bird Mediteck

177, Sector - 25, Ballabgarh - 121 004 (Haryana)

Janak Healthcare Pvt. Ltd.

109, 110, NidhiIndl Est, Shankar Industrial Complex

Tel : +91 129 4289000,

kalpataru Point, Unit No. -12 1st floor, sion (E)

No. 2, Waliv, Vasai, Thane-08 T: 0250-3212729

Mumbai-400022 T:022- 49153000

Hospital Garments Kaustubh Hospital Garments

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

ICU Equipments

operation theatre equipment

Fax : +91 129 4061164 & 2233242 E-mail: info@hmdhealthcare.com, hmduk@hmdhealthcare.com

UROLOGY

Agora Climate Control system

Unit No. C-1/2/3/, Sagar Sangam Ind. Est.,

Ribbel International Ltd

Sativali Vasai (E) Thane-24 T: 0251-2872193

20th Mile, Jatheri Road, P.O.RaiNear Rai Industrial

Bird Meditech

Area Sonepat Haryana 131029

109, 110, Nidhi Ind. Est., Nh No. 8, waliv, Vasai (E)

M: 8053111016, 8053111011, sales@ribbel.com

Mumbai- 401208 T: 0250-3212729

X- Ray Equipment

Philips India Ltd.

Magnatek Enterprises

Allengers

9th Flr, DLF, 9b, DLF, Cyber city, DLF Phase- 3 sec

97, SVC Indl Est.Balanagar, Hyderabad-500037

S.C.O 212-213-214, sector 34,Chandigarh - U.T

25, Gurgaon-122002 T: 0124- 4606000

T: 040-65501094

160 022 (India) T: 172 3012280-84 w w w.medegatetoday.com January 2016

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01-03 June 2016

Istanbul Congress Center, ICC