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Volume V || Issue IV || November-December 2014
The Gateway to Health & Medical World
Sh. J.P. Nadda
(Union Health Minister of India) Scan the QR Code to know more
News Update | Doctor Speak | Expert Views | Product Line | Industry Watch | Healthcare Management
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GASTROENTEROLOGY
• General Medicine • General surgery • Gynecology • Diabetology • Preventive Cardiology • Chest Medicine • Pain Management • ENT (Ear,Nose &Throat) • Opthalmology • Physiotherapy • Nutrition and Dietetics
Upper and Lower GI Endoscopies, ERCP, Capsule Endoscopy, Enteroscopy, all advanced non surgical endoscopic procedures
G.I. SURGERY Surgeries of Liver, Pancreas, Stomach and Cancer Surgeries
NEPHROLOGY Heamodialysis, Peritoneal dialysis and CRRT for multi organ failure World class Kidney Transplant Programme
UROLOGY Laparoscopic Laser surgeries for prostate and kidney stones, management of Congenital kidney disorders and advanced Reconstructive surgeries
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Editor’s note
magazine
Indian Healthcare Architecture Industry on Growth Path India Needs to build 8.9 Lacs more hospital beds to achieve the target of one bed for 500 patients Potential Healthcare industry is the world’s largest industry with total revenues of approx US$ 2.8 Trillion. In India as well, Healthcare has emerged as one of the largest service sectors with estimated revenue of around $ 30 billion constituting 5% of GDP and offering employment to around 4 million people. By 2025, Indian population will reach 1.4 billion with about 45% constituting urban adult (15 years+). To cater to this demographic change, the healthcare sector will have to be about $100 billion in size contributing nearly 8 to 10% of the then GDP. By then, the 10 large national healthcare networks would be able to absorb 30% of the market share. The leaders in the Indian healthcare sector will be benchmarked to international quality and efficiency standards. Where we are talking about GDP and world largest Industry but this is fact that , India faces a huge need gap in terms of availability of number of hospital beds per 1000 population. With a world average of 3.96 hospital beds per 1000 population India stands just a little over 0.7 hospital beds per 1000 population, one of the lowest in the world.
Volume - V Issue - IV Nov-Dec 2014
Editor Chief Editor Editorial Advisor
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Cheif Correspondent Design and Layout Sales and Marketing Subscribtion & Cirrculation
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SA Rizvi, Dr. HN Sharma Mohd. Javed Ahmad Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Deepti Tripathi, Nizamuddin Alam Jagruti Diddi, Saba Khan 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 NEWS World Diabetes Day Siemens Goes Pink India’s premiee hospital New SPECT System HbA1c test listed Intravenous Autologous Control Diabetes
8 10 12 14 16 18 20
EXPERT VIEWS Lifestyle Diseases... A Critical Appraisal... A new way to Treat When and why? Laparoscopy
26 36 50 58
DOCTOR SPEAK Predicting a Heart Attack Timely and Accurate... Infertility Cause...
30 52 56
HEALTHCARE - IT Transforming Healthcare.. IT in Indian Healthcare PALASH Healthcare...
45 60 62
22
24
What do you need to
JP
know about Valve Diseases?
Mr.
Nadda
32
INTER VIEW 46 INDUSTRY WATCH Hospitech Consultancy
64
PRODUCT LINE Eubiq Pioneer in Hospital 66 Medisystems 68
38
SB GROUP
is ready to mark the presence of Welfare Medical in INDIA
54 34
Infection control in Operation room 42 The Most Common Illnesses in
Children during Winter season
8
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Facility Design to Enable NABH Accreditation
EXPERT Update
w w w.medegatetoday.com November-December 2014
9
NEWS Update
World Diabetes Day
Dr. Poonam Khetrapal Singh Regional Director for WHO SouthEast Asia Region
“The number of people in the world suffering from diabetes is increasing. Nearly 87 million people with diabetes live in the WHO South-East Asia Region. India alone accounts for 65 million, the second highest in the world after China, which has 98 million of the total 392 million diabetics in the world. It is projected that the number of diabetics globally will reach 582 million by 2035. It is estimated that 5.1 million deaths occurred globally last year on account of diabetes. Diabetes makes people prone to heart diseases, kidney failure and infectious diseases such as tuberculosis (TB), malaria, and HIV/AIDS, among others, leading to premature deaths. Nearly 80% people with diabetes live in low- and middle-income countries. The magnitude of the problem is huge and is growing rapidly. We must to act quickly to arrest this trend.
such as physical activity and healthy diet. Enabling environments must be created for people to adapt these lifestyle changes, with improved access to areas for walking, bicycling, sports and other physical activities. Healthy food should be made available at affordable rates to make healthy choice an easy choice. This requires a holistic approach and must include the private sector and engagement of sectors beyond health. Another important intervention is creating easy access to early diagnosis and management of diabetes. Approximately half of those with diabetes in the South-East Asia Region are as yet undiagnosed. While governments have a role in prevention and control of diabetes, individuals can also make a difference by taking responsibility for their own health. Eating right and undertaking regular physical activity to maintain a healthy weight can cut the risk of diabetes or delay its onset. Healthy diet, including consumption of Governments need to revisit their health promotion at least five servings of fruits and vegetables, reducing strategies for noncommunicable diseases to increase sugar, salt and fat and sufficient physical activity need to awareness about simple and effective lifestyle changes, be promoted in schools and workplaces.�
Health Ministry will extend all possible help to the state for an impartial inquiry on Chattisgarh deaths duto sterilisation Shri J P Nadda on Chattisgarh deaths due to sterilisation: On the matter of the deaths after ster-
ilisation in Chattisgarh, the Union Minister for Health & Family Welfare, Shri J P Nadda said here today that on the request of the Chief Minister of Chattisgarh, the Center sent a team of doctors from AIIMS which has supervised the medical treatment being given to the affected patients. The Health Minister informed that the team of doctors has provided necessary guidance and support to the team of treating doctors in order to ensure that the best possible care is being provided to the affected. Shri J P Nadda stated that he was in continuous touch with the Chief Minister of Chattisgarh. He informed
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that a judicial inquiry has been ordered by the state government. The center will provide all necessary assistance for the inquiry. The Health Minister stated that it was a misconception that family planning is a target driven programme. On the contrary, he stated that it is a target-free, promotional and a demand driven program. He clearly stated that there are no targets set by the Central government.
EXPERT Update
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NEWS Update
goes pink Across the world, October marks the breast cancer awareness month. Avenues to spread awareness are many: from fundraisers to raise money for researching a cure to fight the life-threatening disease to becoming advocates to spread awareness about the second most common kind of cancer in women. In its bid to sensitize colleagues about the dual importance of awareness and action for early detection/prevention of breast cancer, Siemens organized ‘Pink Day’ at its Worli headquarters on October 30. A multi-pronged strategy was adopted to maximize the impact of the awareness initiative. Sanjeevan Mobile Clinic, parked in the company premises, manned by an all-woman staff, offered mammography screening for employees, staff, press and other stakeholders. Powered by Siemens, the Mobile Clinic is an initiative undertaken in collaboration with Helping Hands, a well-known charitable institute comprising collaborative efforts of eminent oncologists, social workers, patients and their families from all walks of life. Sanjeevan is an indigenously-developed mobile concept from Siemens Ltd., which is designed and equipped to operate as a mobile healthcare clinic and is fully-equipped with the Siemens
Healthcare technology, namely x-rays, mammograms and ultrasound testing devices. The goal of this van is to address the need for accessible and affordable primary health care. As of today, Siemens has rolled out close to 31 Sanjeevan Mobile Clinics for customers, ranging from NGOs, hospitals and other healthcare camps. Said Sunita Jadhav, a house-keeping staff, “I am glad Siemens organized the screening facility. I would otherwise have never gone for one.” Overall, the Pink Day was well received witnessing 100% participation from the employees. Close to 250 women availed the mammography test.
World Polio Day, observed each year on 24 October Dr Poonam Khetrapal Singh
Regional Director of World Health Organization, South-East Asia Region
“The World Polio Day is a reminder of our monumental victory over polio. A victory that came through extraordinary efforts leading to polio-free certification of WHO’s South-East Asia Region in March this year. But as we recall our victory over this crippling virus, we must remain mindful that the risk of polio persists and we need to continue our efforts until polio is eradicated globally. Countries of the Region are maintaining vigilance to rapidly detect any case of importation through sensitive poliovirus surveillance systems. And we are prepared to respond vigorously to any case of importation to ensure that the poliovirus does not make the Region its home again. Polio continues to paralyse children elsewhere in the world. WHO has declared polio as a Public Health Emergency of International Concern. As long as there is polio anywhere, unprotected children in all countries are at risk of getting polio. As the global programme makes effort to stop polio transmission in the remaining endemic 12
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and infected countries, the WHO South-East Asia Region is working towards implementing the Polio End Game Strategy. This involves introducing one dose of injectable polio vaccine into routine immunization schedules, strengthening of routine immunization and withdrawal of the oral polio vaccine in a phased manner beginning with the trivalent oral polio vaccine.”
NEWS Update
Congratulations
Dr. H.K. Chopra
for being elected unanimously as President Cardiological Society of India-2015
India’s premiere hospital infrastructure show is back, and with a bang
A
s the overall investment in the Indian healthcare infrastructure segment continues to grow, the region’s leading event, Hospital Infrastructure and Management (HIM) is all set to provide the perfect platform for companies trying to win tenders, drive sales and increase their market share in infrastructure, construction, fit-out and management. Hospital Infrastructure & Management (HIM) is projected to be the most credible trade fair witnessed by the hospital industry with validated industry buyers including key budget holders, policy makers and investors in healthcare projects visiting the show; they represent the real power behind this thriving industry. Hospital Infrastructure & Management India, will be held in the booming city of Mumbai, and is set to be bigger than ever with over 100 exhibitors covering over 5,000sqm of exhibition floor space, and an estimated 4,000 + trade visitors. The healthcare industry in India has witnessed a massive increase in investment, as is particularly evident by the rising number of public and private hospitals, military hospitals, clinics and specialty centres that have been constructed and developed across the country over the last few years. Hospital Infrastructure & Management (HIM) will raise the benchmark for the hospital industry with leading and relevant names at the show, because it’s here where ‘Decision Makers Get Together; and Business Happens’. “We strive to make Hospital Infrastructure & Management an exceptional experience and platform for the Indian hospital industry for the latest developments, trends, equipmentsand launches. We have attempted to create a knowledge-sharing platform and pave the way to discover the latest trends and techniques which have emerged in current times and we look forward to further supporting India’s healthcare industry to grow further.” said Mr. Vikas Vij, MD, The Ideas Exchange, organisers of HIM.
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Dr. H.K. Chopra
Sr. Consultant Cardiologist, Moolchand Medcity New Delhi
H
e is Sr. Consultant Cardiologist, working at Moolchand Medcity New Delhi for last 35 years. He is also the President of World Heart Academy & World Wellness Foundation. He organized more than 20 world congresses in Cardiology. He is recently nominated by American Heart Association as the first India’s Liaison. He is the editor of text book of Cardiology, Heart Protection Book, CSI Cardiology Update 2014 and the forthcoming Text Book of Hypertension and Obesity Care by Jaypeee Medical Publishers. He authors the Book “Lifestyle and Health: A Mind Body Capsule” published by Sterling Publisher. He was formerly editor in Chief of Indian Heart Journal, Journal of Indian Academy of Echocardiography. He was the Secretary General of IMSA (2006- 2009) and formerly President of Indian Medical Association, New Delhi (1994 & 2005). He is also Chairman of Health Committee of ASSOCHAM and SCOPE. He had contributed more than 548 manuscripts in various national and international journals. He has pioneering contribution in Echocardiography, thrombolysis in STEMI, clinical and preventive cardiology, Mind and Heart Connection, Science and Spirituality is recognized all over the world. He is recipient of national awards and fellowships. Recently he was conferred Icon in Clinical, Preventive Cardiology and Echocardiography by his Excellency Bharat Ratna Dr. A.P.J. Abdul Kalam, Former President of India. He authored the first “Heart Wellness Programme” launched by Health Minister, Govt. of India. He worked as a research fellow in cardiology with Dr. Naivn C. Nanda, University of Alabama at Birmingham, USA and with Dr. Swan and Ganz at University of California, Los Angeles, USA. He is also fellow of CSI, IMSA, ASE, IAE, ACC, AHA, ESC, GSI, ISC. Mandate of Dr. H.K. Chopra for the Medgate today viewers are Heart Wellness Programme, Hypertension care, Obesity care, Diabetes Care, Stress Management, Tips for Attack Heart Attack, lifestyle optimization for healthy heart.
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New SPECT System scans virtually every patient andminimizes costs • Smallest room sizerequirementin its class* • Highthroughput and exceptional detector flexibility • Industry-leading image resolution
S
iemens Healthcare introduces the Symbia EvoExcel SPECT systemat the 27th Congress of the European Association of Nuclear Medicine (EANM).The system is a new version of the successful Symbia E.Symbia Evo Excel combines industryleadingSPECT image resolution and detector sensitivitywith the smallest room sizerequirementin its class*.Designed to fit into almost any existing nuclear medicine exam room, Symbia EvoExcel virtually eliminates costs associated with room renovation and expansion. With a high-capacity patient bed, larger bore sizecompared to previous systems and highly flexible detectors, the system is optimizedfor obese or critically ill patients andincreasesthe variety of applications a healthcare institution can offer. With a room sizerequirement up to 29 percent smaller than for conventional systems in its class*, Symbia Evo Excel fits in a room as small as3.60 m (11 ft 8 in) x 4.57 m (15 ft). The systemimprovespatient comfortwith a 30 percent larger bore [102 cm (40.2 in)],compared to its predecessor, and a highcapacity patient bed thatsupports patients up to 227 kg (500 lbs). The bed also improves accessibility for patients with limited mobility with a convenient minimum access height of 53 cm (21 in). The exceptional detector flexibility allowsimaging of critically ill patients on a gurney or in a hospital bed. Additionally, the short tunnel length and maximum scan length of up to 200 cm (6 ft 7 in) improves patient comfort for claustrophobic and tall patients.
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NEWS Update
HbA1c test listed Medicare overhaul restricts vitamin D as diagnosis of and B12 tests diabetes
G
Ps are now able to diagnose DIABETES in highrisk patients based on raised HbA1c alone with the launch of a new MBS item for the test.
The availability of the new MBS item 66841, which came into effect on November 1, simplifies the diagnostic process for both doctor and patient, clinicians say. Previously, HbA1c testing was subsidised only for monitoring glycaemic control in patients with established DIABETES. The new listing will mean fewer repeat GP visits for patients who will no longer have to undergo fasting BLOOD GLUCOSE and oral glucose tolerance tests. The item will be restricted to once per patient per year, with a HbA1c of ≼6.5% (48mmol/mol) required for a diagnosis.
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T
he MBS items for VITAMINS D and B12 testing have been overhauled to confine their use to high-risk patients in a bid to prevent "screening".
MBS items 66608 and 66609 for VITAMIN D testing were abolished on November 1 and replaced with new items that have specific clinical criteria. The new 66833 item covers 25-hydroxyvitamin D testing for high-risk groups, such as people who have "deeply PIGMENTED SKIN , or chronic and severe lack of sun exposure for cultural, medical, occupational or residential reasons". The item covers testing in 10 other high-risk categories, including patients with osteoporosis and those with malabsorption. The restrictions were introduced after A MEDICARE review in February found there had been an almost 4,000% increase in vitamin D testing.
EXPERT Update
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NEWS Update
Intravenous Autologous Bone Marrow Mononuclear Stem Celltherapy for Ischemic Stroke: A Multicentric, Randomize Trial
Dr. Kameshwar Prasad Professor & Head Dept. of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
U
stroke / paralysis two to four weeks, before inclusion in this study but they had not improved significantly. After measuring their difficulties in using hands and feet and also doing MRI of the brain, 58 patients underwent stem cell aspiration from hip bone and bone marrow stem cells were infused into the veins of their forearm. On an average 28 crore bone marrow cells were injected of which blood forming stem cells were on average 29 lakhs per patient. Thereafter, patients’ difficulties in using upper and lower limbs were measured at 3 months, 6 months and 12 months. To avoid bias, these measurements were done by telephone by a person who did not know who received the stem cells and who did not. The difficulties in their activities of daily livings were measured using two scales. It was found that the stem cell treatment is safe but there is After a preliminary study in 2006, we launched a no added beneficial effect. comparative study in 2008 in which besides AIIMS, New Delhi; SGPGI, Lucknow; PGIMER, Chandigarh; This study has been published in a world renowned AFMC, Pune; R&R Hospital, Delhi participated. Between American journal ‘Stroke’ which has the highest impact November 2008 and January 2010, these five hospitals factor in the field of Stroke. This is the first and largest received consent from 120 patients for participating in this randomized controlled trial of stem cell published in study. For comparison, 60 of these were assigned to receive the field of stroke. Until ongoing or further randomized conventional treatment and another 60 bone marrow trials show efficacy, this treatment should not be used stem cells besides other treatment. All these patients had in clinical practice, and patients should not accept such therapy without question. nder the auspices of All India Institute of Medical Sciences (AIIMS), New Delhi and with the financial grant of Department of Biotechnology, Govt. of India, a study of stem cell treatment in patients with Stroke (Paralysis) is ongoing since 2006. General public, particularly those suffering from disabling and incurable diseases, have limitless hope from stem cell treatment because stem cells have potential to replace the damaged parts of the body. But we should remember that there are different types of stem cells and a scientific study is absolutely essential before using them in clinical practice. Such a scientific study must be a comparative study comparing patients who receive stem cells with those who do not.
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21
NEWS Update
Control Diabetes or be prepared for Heart
Problems Dr. S.A. Merchant
P
eople with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.
Interventional Cardiologist o LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries—the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease. o Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high. o HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.
Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk ÂÂ Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work factor for heart disease and stroke is having a family history harder to pump blood. High blood pressure can strain the of heart disease. If one or more members of your family heart, damage blood vessels, and increase your risk of had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk. heart attack, stroke, eye problems, and kidney problems. You can't change whether heart disease runs in your family, ÂÂ Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for but you can take steps to control the other risk factors for people with diabetes because both smoking and diabetes heart disease listed here: narrow blood vessels. Smoking also increases the risk of ÂÂ Having central obesity. Central obesity means carrying other long-term complications, such as eye problems. In extra weight around the waist, as opposed to the hips. A addition, smoking can damage the blood vessels in your waist measurement of more than 40 inches for men and legs and increase the risk of amputation. more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because Regular checkups to prevent Diabetes and in abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited turn Heart Problems ÂÂ Fasting and Post Meal blood sugar, Hb 1 Ac on the inside of blood vessel walls. ÂÂ Having abnormal blood fat (cholesterol) levels.
ÂÂ Sr Cholestrol, Sr.Triglycerides, Sr Creatinine, T3 TSH ÂÂ Urine for Micro-albumin,Creatinine Clearance Test ÂÂ ECG, 2-D Echo, Stress test ÂÂ Eyes-Fundoscopy, Slit-Lamp, Retinoscopy ÂÂ Carotid Artery Doppler ÂÂ Ultrasound Kidneys ÂÂ Lower Limb Arterial Doppler ÂÂ Ankle –brachial blood pressure, Periscope ÂÂ Sensitometer/ Vibrometer/ Foot Scan
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JP
NEWS Update
Mr.
takes charge as the Union Minister for Health and Family Welfare at Nirman Bhawan in New Delhi
Nadda
24
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NEWS Update
Mr. Afzal Kamal (National Head) Medgate today Magazine Congratulating Sh. J.P. Nadda (Health Minister) and presenting Magazine to him at Nirman Bhawan, New Delhi, INDIA
JP
Nadda's debut straight into the cabinet, as the Health Minister, reflects his importance as a master strategist and trusted lieutenant of Prime Minister Narendra Modi and BJP president Amit Shah.
Nadda is known to be a tough task master. Born on December 2, 1960 in Patna, Mr Nadda has emerged as a very strong political figure from Himachal Pradesh, where he was an MLA before entering the Rajya Sabha.
The 53-year-old, who runs personality development and time management workshops for party workers, prefers Mr Nadda was a member of the BJP's student wing ABVP or Akhil Bharatiya Vidyarthi Parishad and became a to work behind the scenes. Secretary of the student's body in the Patna University in Sources close to the mild-mannered leader say his 1977. His father was a Vice Chancellor in the university. inclusion in the Modi government is a vindication of his efficiency and dependability. He also enjoys the support At 31 in 1991, he became national president of the BJP's of the BJP's ideological mentor Rashtriya Swayamsevak youth wing. His involvement with the party from a young Sangh and has good equations with all prominent leaders age is believed to have instilled in him the importance of of the BJP. training at the grass-roots level. Mr Nadda was a strong contender for the post of BJP President but extended full support to Amit Shah after losing the race earlier this year. Along with PM Modi and Mr Shah, he is known to be a part of all major decisions in the party and is expected to act as a bridge between the party and the government.
He has been the BJP's National General Secretary since May 2010. A three-time legislator, Mr Nadda has been a minister in Himachal Pradesh in the past.
In April 2012, he was elected to the Rajya Sabha and has A prominent student activist in his college days, Mr been a member of various Parliamentary Committees. w w w.medegatetoday.com November-December 2014
25
DOCTOR SPEAK
Dr. Z.S. Meharwal Director-Cardiovascular Surgery Fortis Escort Heart Institute New Delhi
What do you need to
know about Valve Diseases?
T
here are four valves in the heart, 2 on the left side called mitral and aortic valves and 2 on the right side called tricuspid and pulmonary valves. Most of the valvular heart diseases in adult patients arise from left sided valves that are mitral and aortic valves. Tricuspid valve can be involved in many cases mostly in combination with mitral valve though in rare circumstances it can be involved in isolation also. Involvement of pulmonary valve in adults is rare.
What happens in valve disease
The valves in the heart regulate the flow of blood from one chamber of heart to another by regulating the forward and backward flow through them. The valves open up during a specific time during the contraction of the heart to allow forward flow through the valve and remain closed during the rest of the cardiac cycle so that blood does not come back. With disease process, either the valve becomes small so that it obstructs the forward flow. This is called stenosis or it starts leaking during the period when it should be closed. This is called regurgitation. So the valvular diseases can be broadly divided into two groups: either stenosis or regurgitation.
Causes of Valve disease
The most common lesion in mitral valve in young patient is mitral stenosis. In India, the most common cause of mitral stenosis is rheumatic heart disease which occurs 26
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DOCTOR SPEAK
rheumatic heart disease which is the most common cause in our country, most of the valves would need replacement because valve is severely damaged in majority of cases and long term results of repair are not very encouraging. In case of mitral regurgitation due to myxomatous valve In elderly patients, mitral regurgitation is more common and with prolapse or ischemic heart disease, repair can be is due to either prolapse of the valve or due to ischemic heart done and gives good results in experienced hands if the valve anatomy is good disease. due to an infection during childhood with bacteria called group A streptococci. Due to this infection in childhood, the valves of the heart start getting damaged and either stenosis or regurgitation or both may occur though stenosis is the more common.
In aortic valve disease, the most common cause in young patients again is rheumatic heart disease. Aortic stenosis occurs more commonly in older patients after the age of 50 years and is mainly due to either a congenital condition of the valve called bicuspid aortic valve in which the valve is deformed since birth. The other reason for aortic stenosis is degenerative or calcific aortic valve seen mainly in the age group of above 60 years. The tricuspid valve involvement is almost always in conjunction with mitral valve. In majority of cases, it is regurgitation though stenosis is not rare and cause is almost always rheumatic.
Presentation
The most common presenting complaints of the patient with valvular heart disease is breathlessness which is progressive in nature. The person feels breathless on doing regular work and sometimes at rest. Feeling of breathlessness at rest or at night might be a critical point and needs urgent evaluation and treatment. The second most common complaint is palpitation i.e. feeling of one’s own heart beat. The heart beat may become fast and irregular also. The other complaints may include easy fatigability, dizziness or giddiness, syncope i.e. sudden temporary loss of consciousness. In some rare cases, stroke or peripheral limb ischemia may be a presenting complaint. This happens in cases where a blood clot forms in the heart and then that clot detaches and embolizes to any part of the body and causes loss of blood supply to that part of the body.
Treatment
Choice of valve The valves can be divided into two groups i.e. metallic valves and bio prosthetic valves. The valves to be implanted have undergone many changes since they first came to market for replacement in 1960s. Now the majority of metallic valves in the market are bileaflet valves. The other broad category is bio-prosthetic valves. The bio-prosthetic valves are also called tissue valves. These valves are either made of pericardium i.e. outer covering of the heart or they are porcine valves.
The major difference between metallic valve and bio prosthetic valve is in the need for blood thinners (anti coagulation) and re-operation. In case of metallic valve, anti coagulation i.e. drugs to keep blood thin have to be taken life long but need for repeat surgery is less. In case of bio prosthetic valves, chances for need for re-operation are high especially in young people as these valves tend to get damaged over time spontaneously but there is no need for anti coagulation after 3 months of surgery. There are many factors which decide the choice of valve to be used in particular patient. These include the age of the patient, rhythm of the heart, whether patient wants pregnancy in case of female patients and any contraindications for anticoagulation. In patients younger than 60 years or who is in atrial fibrillation and has no contra-indication to anti coagulation like recent stroke or bleeding tendency, mechanical valve is a preferable choice. In patients after the age of 60 years with normal regular rhythm or one who has some contra- indication to long term anti coagulation, bio prosthetic valves would be better. The patient needs to discuss in detail with his doctor in detail before decision is taken about the type of valve.
Presence of any valvular disease demands treatment and surgical treatment is the ultimate treatment though medical treatment may help in initial period if the disease is mild but once the disease becomes severe or the damage to the heart has began or the patient becomes symptomatic; the surgical treatment remains the only option. The two options Post-operative care and follow-ups for surgical treatment are repair or replacement. In aortic valves, majority of the valves need replacement. Repair is The most important thing after mechanical valve replacement is to maintain the desired levels of anti-coagulation, which rarely successful and long term results are not good. is measured as INR. A regular follow-up and regular Echo In case of mitral valve, either repair or replacement can is required after valve repair as well as replacement to make be tried depending on the disease process. In case of sure that the valve is functioning well. w w w.medegatetoday.com November-December 2014
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EXPERT Views
Lifestyle diseases an emerging problem
Dr. Rakesh Tandon Medical Director & Head of Gastroenterology PSRI Hospital, New Delhi
It is estimated that about 166 per 100,000 people in India die due to ischemic heart disease (a condition which is characterized by reduced blood supply of the heart muscle) and around 116 per 100, 000 people in India die due to cerebrovascular diseases. 28
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D
iseases attributed to unhealthy day-to-day living habits are referred to as Lifestyle Diseases. They include obesity, diabetes, hypertension, heart diseases, chronic liver disease/cirrhosis, constipation, gassy abdomen and cancers. They have become a major health hazard in upcoming economies such as India and China. Of them, obesity, diabetes, hypertension and hyperlipidemia are of major concern and cause of death. They are attributed to increased insulin resistance and are grouped as metabolic syndrome. It is the outcome of increasing affluence and adoption of sedentary lifestyle and is being seen increasingly among Indians and other South Asians. Peoples' diet have changed substantially in the second half of the twentieth century with increase in consumption of dairy products, meat, vegetable oils, fruit juice, and alcoholic beverages, and decrease in consumption of starchy staple foods such as bread, potatoes, rice, and maize flour and vegetables, salad and fruits. Other aspects of lifestyle have also changed, notably, large reductions in physical activity and prevalence of obesity. The western lifestyle, characterized by fast food, watching TV and playing video games is taking its toll on children as well as adults, and is producing increased numbers of overweight, passive youngsters with lifestyle diseases.
Obesity on the rise According to the National Family Health Survey (NFHS3) (2005-06), 13 percent of women and nine percent of men in India are overweight or obese. Presence of obesity increases greatly the chance of occurrence of other lifestyle diseases in the same person and they all work together to shorten the lifespan of the affected person. Additionally, obesity itself is associated with a huge number of complications and they could be the cause of early mortality (Figure 1).
EXPERT Update Views
Heart disease – a major killer It is estimated that about 166 per 100,000 people in India die due to ischemic heart disease (a condition which is characterized by reduced blood supply of the heart muscle) and around 116 per 100, 000 people in India die due to cerebrovascular diseases. Around 74 percent of urban Indians face the risk of heart attack, with their heart age greater than biological age. Fifty nine percent of those in the 30-49 age group have high risk levels of cholesterol and 61 percent of them have dangerously low levels of ‘good’ HDL cholesterol. Figure 1. Multiple complications of obesity
results of a recent study, published online in the American Journal of Public Health, indicated that previous research had underestimated the number of deaths caused by obesity in the US each year. This study included men and women between the ages of 40 to 85 over a 20-year period and discovered that obesity was likely responsible for about 18% of deaths during that time, one out of five Americans – an appalling figure.
Uncontrolled hypertension, smoking, excessive drinking and sedentary life styles are other contributing factors for increased number of heart diseases. There is a misconception among young generation that smoking acts as a stress buster. It actually reduces a person’s stamina in the long run leading to the development of multiple diseases, particularly chronic lung disease, heart disease and cancer.
Nonalcoholic liver disease
The liver cells get clogged up with excess fat (triglycerides) as a by product of increased insulin resistance. Over time According to the World Health Statistics report 2012, 11.1 that causes inflammation of the liver cells which leads percent of the adult male population and 10.8 percent of to cirrhosis of the liver and in a small percentage of the female population have raised fasting blood glucose. cases even to liver cancer, analogous to what happens
Diabetes capital of the world
India and other Asian countries predominate among them as shown in the table below. It is estimated that in India 61.3 million people suffer from diabetes. Even its South Asian neighbours like Bangladesh, Nepal, Afghanistan and Sri Lanka have fewer diabetics. That is why India has achieved the dubious distinction of being called the diabetes capital of the world . Globally, diabetes caused 4.6 million deaths in 2011. Diabetics and obese people are more prone to develop chronic liver disease which ultimately results in untimely and early death. w w w.medegatetoday.com November-December 2014
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EXPERT Views
Table 1. Percentage of people with raised fasting blood glucose in South Asian countries (World Health Statistics 2012). India Bangladesh Sri Lanka Nepal Pakistan Men
11.1
9.2
9.3
9.8
11.7
Women
10.8
9.9
8.6
9.3
14.1
in alcohol induced fatty liver disease. This has indeed become the number one cause of chronic liver disease in the industrialised world. In India, the prevalence of NAFLD in the general population varies from 10% to 30%. In people with metabolic syndrome however, the prevalence is much higher; 15-80% among obese people, 25-60% in patients with dyslipidemia and 3355% in pre diabetics and diabetics. The underlying factors are believed to be the same as for other lifestyle diseases ie excess calorie intake and lack of physical exercise and the only effective treatment is reversing these factors. In addition, of course supportive treatment is required for the complications of liver disease.
Other lifestyle diseases
Stress plays a big role in causing acidity. A job that keeps you on tenterhooks or a gnawing problem at home can cause acidity. Children trying to enter into competitive sports may become stressed to perform well constantly. A recurring acidity problem, despite acid suppressants, may lead to vitamin deficiencies and cancer of the esophagus. Spending time excessively in front of computer may lead to neck and back pain. People working in night shifts suffer from a disturbed biological clock leading to insomnia, indigestion, acidity, loss of appetite, headache, irritability, hypertension, mood fluctuations and body pain. Those having late night parties also experience the same with some additional effects of untimely munching, drinking and smoking. Alteration in the circadian rhythm of a person compromises his immunity, further leading to various opportunistic diseases. It is important that parents watch out for signs of psychological strain, as well as physical fatigue from overtraining in their children. Young athletes may also have specific nutritional needs that require extra attention. Often they are misled 30
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by trainers to take excessive amounts of protein that may compromise the functioning of liver and kidneys.
Treatment
The onset of these lifestyle diseases is insidious; they take years to develop and, once established, do not lend themselves easily to cure. Thus they require regimented and individualised treatment comprising a combination of drugs, diet and physiotherapy. Importance of each of these components of treatment differs from disease to disease. For example, in case of diabetes and heart diseases, drug therapy plays a dominant role whereas in that of obesity and fatty liver disease, diet and physical exercise are most important. In addition, a healthy lifestyle must be adopted to combat these diseases with a proper balanced diet, physical activity and by giving due respect to biological clock and body requirements.
Prevention
Most of the lifestyle diseases are preventable and reversible to a large extent with adoption of a healthy lifestyle including a balanced diet, regular physical activity and avoidance of excessive alcohol consumption, smoking and drug addictions. Some sort of physical activity every day for at least 10-15 minutes is extremely necessary to keep healthy. Healthy lifestyle is best inculcated early in childhood at home. Habits formed at that stage stay forever. Parents should be aware and should be responsible to guide their children to eat the right kind of food and engage them in physical activities. In particular, emphasis should be laid on engaging kids in outdoor activities. Fun exercises should be encouraged into family outings. A pizza-and-video evening should be replaced for a hike and picnic.
EXPERT Update
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DOCTOR SPEAK
Dr. Atul Mathur Director Interventional Cardiology Fortis Escorts Heart Institute New Delhi
Predicting a HEART ATTACK What is a Heart Attack
The heart muscle needs oxygen to survive. A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with blood flow can slowly become narrrow from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis . When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow to the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI).
How to Predict and Manage a Heart Attack
Symptoms of heart disease which may lead to a heart attack
Suspect heart disease if you notice that ordinary physical activity causes you to experience : Undue fatigue, Palpitations (the sensation that your heart is skipping a beat or beating too rapidly), Dyspnea (difficult breathing) or Angina (chest pain or discomfort from increased activity)
Non Invasive and Invasive Investigations
Certain tests can be performed to detect presence of atherosclerotic plaques in the coronary arteries. These include non-invasive Stress tests (TMT or Stress Echocardiography or Stress Thallium) or CT Coronary Warning Signs of a Heart Attack Angiography. Gold standard for diagnosis and decision Some heart attacks are sudden and intense where no one on mode of treatment is conventional angiography that doubts what's happening. But most heart attacks start slowly, can now even be performed through the wrist for early with mild pain or discomfort. Often people affected aren't ambulation of patients sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening: Chest discomfort. Most heart attacks involve discomfort How do I confirm if a heart attack has occurred? in the center of the chest that lasts more than a few An electrocardiogram (ECG or EKG) discovers damage minutes, or that goes away and comes back. It can feel to the heart by making a graphical record of the heart's like uncomfortable pressure, squeezing, fullness or pain. electrical activity. Discomfort in other areas of the upper body. Symptoms can Blood testing to detect abnormal levels of certain include pain or discomfort in one or both arms, the back, enzymes in the bloodstream called heart damage markers neck, jaw or stomach. or cardiac markers. Shortness of breath with or without chest discomfort. Other signs may include breaking out in a cold sweat, nausea or Interventions in a Heart Attack: Golden Hour lightheadedness. Even if one is not sure it's a heart attack, Time is muscle and the best time to act is the first hour to have it checked out. Minutes matter! Fast action can save save maximum heart muscle from damage lives. Don't wait more than five minutes to call an emergency Aspirin tablet 325 mg is the first intervention that is even response number. possible at home on suspecting a heat attack Risk Factors and Prevention of Heart Attack Thrombolysis: involves injecting a clot-dissolving drug It is recommended that heart attack prevention begin by age to restore blood flow in the blocked coronary artery. This 20. This means assessing and controlling the risk factors. should be administered within a few (usually three to six) Many first-ever heart attacks or strokes are fatal or disabling, hours of a heart attack. so prevention is critical. There are some controllable factors Coronary Angioplasty: Many patients who reach a that increase the risk of heart disease and stroke. hospital in time can undergo coronary angioplasty to • smoking • high blood pressure • high blood cholesterol restore blood supply to the heart muscle and abort a heart • diabetes • being overweight or obese • physical inactivity attack. 32
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EXPERT Update
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33
EXPERT Update
Sushil Bagga
SB GROUP
is ready to mark the presence of Welfare Medical in INDIA 34
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“ Welfare Medical India�, an associate of Welfare Medical Ltd, United Kingdom. Sushil Bagga has strategically partnered with the global leader in medical industry with the aim to bring the best to India.
INDUSTRY EXPERT Update WATCH
A
first generation entrepreneur with more than 35 years of experience in healthcare industry, Mr. Sushil Bagga was the brain behind the very first medical store opposite to the All India Institute of Medical Sciences in New Delhi. A humble thought of providing the patients their medical needs at their doorsteps, paved the way for one of the world’s largest Healthcare organization, “The Welfare Medical” to India. Born in a Defence family, Sushil Bagga travelled intensively throughout India. A St. Xavier’s Alumni, he was selected for MBBS at the Mahatma Gandhi Institute of Medical Sciences, Seva Gram -Wardha which he had to opt out from due to unavoidable circumstances. A graduate in Science from Delhi University with an advanced Management programme in Marketing, he started his career as a Medical Representative with different global organizations, gaining experience in the healthcare industry. In 1979, Sushil Bagga ventured out as a manufacturing garment exporter. A visionary, with in-depth knowledge of healthcare business, his first successful project was to open a chemist shop in front of All India Institute of Medical Sciences in the year 1988. To strengthen his roots in the healthcare trade he also ventured as an importer for various medical devices and soon established himself as a major hospital supplier. Today he is heading his own Healthcare brand- SB Group, under which he is ready to launch the globally recognized “Welfare Medical” pan India, naming the company-“ Welfare Medical India”, an associate of Welfare Medical Ltd, United Kingdom. Sushil Bagga has strategically partnered with the global leader in medical industry with the aim to bring the best to India. Welfare Medical is an international company which specializes in manufacturing and supply of products created with an innovative technology. Keeping in mind the well-being of the society and the Indian healthcare industry, Sushil Bagga built strategies to keep the products cost effective. The Organization will focus on providing patients and healthcare professionals, state of the art quality products with unparalleled services. Welfare Medical deals in extensive range of products, the primary range of activity and portfolio revolves
around: ÂÂ Surgical stapling line ÂÂ Products for the Operation Rooms ÂÂ Anesthesia. The products are in compliance with CE Marking Regulations and Standards. Further more to achieve excellence in there functioning, Welfare Medical have created a channel system that formally checks their quality management system on a regular basis which satisfies the requirement of ISO 13485:2003-An internationally Recognized Standard. According to Mr. Bagga, “In order to ensure the quality of our innovative devices for the Medical Community we have a formal Quality management system which is certified to the requirements of ISO13485. Every Welfare Medical product is CE marked. We are committed to maintaining a quality system that provides for safe and effective products and services that meet the needs and requirements of our customers” “To reach the right destination, it is important to move in the right direction, we are heading to create pan India operations through various channels and enter the existing healthcare industry with special emphasis on reasonable and affordable pricing”, says the leader Sushil Bagga. “We are a one stop shop for all Medical Device needs; we guarantee high service standards with commitment and professionalism”, says the idealistic entrepreneur. With the core business of the company focusing on medical needs and necessities of the healthcare sector in India and Indian sub-continent, the company has also ventured in insurance, garments exports and construction sector. However health care being their forte, Welfare Medical India, plans to position it self as a cost effective organization with world class products. Regarding their future strategies, the organization is also actively engaged in advanced research and development studies and soon plans to introduce new products under the company banner SB Group.Welfare Medical India aims to become the most admired global medical company through innovation, manufacturing, wide-ranging product solutions and world class customer service support. w w w.medegatetoday.com November-December 2014
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EXPERT VIEWS
Infection control in Operation room
T
Commander Manoj Kumar (Retd) CEO, Hitex Healthcare
The role of drapes, gowns and sets is to improve patient safety and also to minimize the spread of infectious agents such as antibiotic resistant bacterial strains, human immunodeficiency virus (HIV) and others, resulting into decrease of risk of contamination by these infectious agents for staff as well as other patients
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he operating room historically has been one of the departments where the control of infections has been at best a challenge. Despite the fact that this is an aseptic environment, the constant flow of patients and staff doing a wide range of procedures every day where there is continuous exposure to a broad range of pathogens in blood, body fluids and tissues encountered, makes this an ongoing challenge. The selection of medical textiles is an important task for health care sectors in terms of benefits and costs. The basic cost calculation does not always yield to proper results in product selection; it could even mislead. It is usually a complicated task to make a decision whether to work with reusable or single-use products, especially when the patient and surgeons lives are in consideration. This reason lead to a lot of detailed studies to determine the net benefits and costs associated with reusable and single-use products in operating room in different countries. In a 2013 article in the Journal of Hospital Infection, the conclusion was that colony-forming particles from shed lint were significantly lower when single-use clothing was used. In other study reviewing the laundering practices for these products, it was found that the processes used did not sufficiently remove bacterial contaminants. 93% of the towels tested in this study contained E. Coli and Klebsiella. These products, if
EXPERT Update VIEWS
then returned into the hospital laundry, had the potential to contaminate other linens. Based on both studies, it was concluded that, even though the cost is relatively the same or higher, single-use gown and drape sets provide the highest benefit rates. There is no surprise that singleuse sets are more competitive and attractive in the health care sector and more and more institutions are moving towards the use of single-use devices. For production of single use drapes, gowns and sets different kinds of fabrics with different properties are used. There are a lot of options which material can be used for each kind of drape and the end users can often design the final product together with the producer. The role of drapes, gowns and sets is to improve patient safety and also to minimize the spread of infectious agents such as antibiotic resistant bacterial strains, human immunodeficiency virus (HIV) and others, resulting into decrease of risk of contamination by these infectious agents for staff as well as other patients . In connection with the role of drapes there are a lot of factors that can influence the composition of drapes like duration of surgery, volume of liquids which occur during the operation, loading of drapes and gowns. Accordingly the design of the drape is proposed to meet requested performance in the operating room:
tapes, elastic cuff, collection pouches, plastic wire, etc. according to needs which occur during different kinds of surgery. The range of needs for obstetricians/gynecologists in this field is virtually unmatched by any specialty. From pregnancy and delivery to cancer and urinary tract disorders, there is a need for a wide spectrum of procedure specific patient drapes with innovative designs to accommodate unique surgical requirements including the high volumes of fluids that must be controlled to minimize risk. Disposable nonwoven drapes OB/GYN procedures enjoy the benefit of innovations and optimum fluid control combined with unparalleled ease of access. For each kind of surgery special kits or procedural packs are developed which can be possibly modified. These sets offer several advantages especially when they are customized. In that case the surgeons can find in the content of the pack everything what is needed for surgery according to equipment of operating room and way of procedure. Customized sets represent time and cost effective solution with respect to safety.
Reducing the incidence of surgical site infections is a major initiative for all healthcare organizations as this contributes to complications that increase cost to the facility and the patient, increase the length of stay in the hospital and have a negative impact on patient satisfaction ÂÂ drapes can be one or multilayer (to provide comfort for and the reputation of the healthcare facility. And this is the the surgeons, nurses and patients as well) reason why to focus on improving outcomes continues to ÂÂ materials for drapes can be laminated by proper foil be an expectation for healthcare facilities, professionals which ensures the barrier against the penetration of are looking for new ways to make a difference at every level of care. microorganism ÂÂ one or more layers of material can be absorbent to provide better liquid control
ÂÂ linting rate of single use products is minimal which contributes to a reduction in airborne particles ÂÂ some accessories can be implemented on the drapes such as integrated leggins, incision films, adhesive
Author: Surender Singh Bisht Plant Head ( Una ), Hitex Healthcare
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EXPERT VIEWS
A CRITICAL APPRAISAL OF NEUROCRITICAL CARE SERVICES IN TIER II CITIES Dr. V.K. Rajoria Director and Head Deptt. of Neuroscience Cygnus Hospital Dr.V.K.Rajoria has experience of more than 20 years in the field of Neurosciences. He was trained at AIIMS, New Delhi and later received training in Stereotactic and functional neurosurgery at Stockholm, Sweden. He has travelled internationally and has gained rich experience in the field of neurosurgery. He worked as consultant Neurosurgery at Holy Family Hospital, New Delhi for 18 yrs. Later he worked at Indian Spinal Injuries Centre and Primus Superspeciality hospitals. He has presented numerous scientific papers in national and international conferances. He is one of the founder directors of Cygnus Medicare since it was formed in 2011. He is also known for his philanthropic philosophy and is an active member of an NGO which is working for the mentally challenged poor people.
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T
he development of Neurosurgery in India has almost paralleled the achievements of the country and is now at par with the best of such services available in the world. Over the years the number of Neurosurgery centres have increased but these well equipped centres of excellence are mostly based in the major tier I cities. When I started practice 20 yrs. ago, all the patients requiring emergency neurosurgical services like traumatic brain injury were transported to larger cities. One can imagine the transport facilities available at that time (and even today ! ). Many patients used to succumb in transition and many patients used to develop irreversible damage to brain before reaching a proper facility. Another problem faced by the family was to arrange adequate finances on urgent basis before going to big city. Many people were scared to travel to a unknown big city and would prefer to stay back without proper neurosurgical treatment.
EXPERT Update Views
Cygnus Model
Availability of Neurosurgeons In last three decades the number of neurosurgeons in India has increased from mere 200 to 2000. Although from international standards it is much less but still few neurosurgeons are now available for working in tier II cities.Mostly these neurosurgens belong to that area and are willing to settle in their home town. They are given free hand to develop the Department and as the work increases more sophisticated equipment and facilities are created. Assured growth with the organisation and their rapid popularity in the same society to which they belong is the greatest incentive.
Infrastructure In view of these problems few hospitals in tier ii cities started calling superspecialist from the nearby major town to attend the head injury patients. It had the problem about the availability of neurosurgeon at that particular time willing to spare few hours in travelling. Another big problem was operating in an unfamiliar enviornment and then leave the patient in the hands of a rather reluctant clinician. In todays scenario it can have medicolegal implications also.
The most important piece of equipment is the CT Scan. There is no need for any high end CT Scan but a basic machine is all that is needed for diagnosis in emergency situation.
ÂÂ A modest ICU with facility for ventilator and a doctor trained to handle ventilators. ÂÂ Anesthesiologist who has the exposure to deal with neurosurgery cases during his/her residency. ÂÂ A normal operating room used by general surgeons. ÂÂ A basic craniotomy set costing only few thousand rupees to perform a operation to remove brain clots. Â Â A well equipped ambulance with ventilator must also So a need was felt to develop neurocritical services in tier be available to transport patient to higher centre in case ii cities. I will share the experience of Cygnus Medicare in it is required. developing these services in tier ii cities.
Problem of Traumatic Brain Injury in India India has a rather unenviable distinction of having the highest rate of traumatic brain injury in the world.It is estimated that in India nearly 1.5 to 2 million people are injured and 1 million succumb to neurotrauma every year. TBI(traumatic brain injury) leads to severe disability and a major socioeconomic loss to community. Road traffic accident is the leading cause of TBI(60%), other causes are fall, violence and trauma because of animals like cow, bull, buffalo in rural India. In India, 1 out of 6 trauma victim die, while in USA this figure is 1 out of 200. This gap speaks volumes about the absence of proper facilities and lack of procedures in the management of trauma patients. Half of those who die from TBI do so within first two hours of injury. Consequently, the early and appropriate management of TBI is critical to the survival of these patients. Ninety percent of trauma victims in India do not receive optimal care during the golden hour period in which health care administration is essential. Thirty percent of those who currently die from TBI could be saved if quality care were available to them sooner.
Education
Education of both , the local doctors and public at large is very important. Many people still have a mind set to rush a TBI victim to a major town, thereby wasting the golden hour, although facility to deal with the same is available nearby. They are educated through public lectures and other means like leaflets and advertisements in news paper, talking to sarpanchs in nearby villages. Doctors are reached through the educational meetings and the importance of immediate and early intervention is emphasised. This can save the life of a head injury patient and reduce the morbidity significantly.
What are the benefit to people
Availability of a proper facility to deal with head injury and other neurosurgical emergencies in the critical golden hour. This will prevent many deaths which occur during transportation and long term disabilities which can occur due to delay in intervention. Family saves money on travelling and sustaining themselves in an unknown metro city for long duration. Overall treatment costs are less in tier II cities as compared to metro cities. w w w.medegatetoday.com November-December 2014
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EXPERT Update
As the LED revolution impacts India, and also opens up new avenues of application, it is vital to keep in perspective various business dynamics faced by LED lighting suppliers and end users.
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COVER STORY
The market will witness a convergence scenario with other technology areas like wireless sensors and networks, augmented reality, and flexible electronics. This will shift emphasis to the lighting system as a whole. With technological advancements, reliable product performance, increased competition, and reducing LED pricing, increased market adoption is expected across both indoor and outdoor LED lighting markets. Still, the LED market in India has its share of challenges such as relatively higher pricing, reliance on imports, and limited indigenous manufacturing. Hospitality and retail sector, street lighting applications within factories, and information technology parks are key contributors to the commercial and industrial segments.
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he Government sector is the single largest user for LED lights in India today. Apart from the large scale street lighting projects, increasing usage of LED lights for in-cabin lighting as well as the lighting of railway stations have contributed to the Government sector being the single largest adopter and growth trigger. The commercial sector in India is the second largest user of LED lights, then slowly entering into the industrial and automotive segments. Hospitality and retail sector, street lighting applications within factories, and information technology parks are key contributors to the commercial and industrial segments.
According to ,”Frost & Sullivan, “Government initiatives to raise awareness on the benefits of LED as an energy-efficient technology and to promote the domestic manufacturing of LED products have spurred market growth, LED’s promise of quick returns through greater efficiency boosts the technology’s popularity in the Indian B2B and B2C LED segments. Moreover, improvements in technology have led to widening its scope to newer applications in the automotive sector. The energy service company (ESCO) model, which eliminates the need for initial investments by municipalities and corporations, is expected to flourish in and propel growth for the Indian B2G LED segment.
According to,”Frost & Sullivan, “Government initiatives to raise awareness on the benefits of LED as an energy-efficient technology and to promote the domestic manufacturing of LED products have spurred market growth, LED’s promise of quick returns through greater efficiency boosts the technology’s popularity in the Indian B2B and B2C LED segments. Moreover, improvements in technology have led to widening its scope to newer applications in the automotive sector. The energy service company (ESCO) model, which eliminates the need for initial investments by municipalities and corporations, is expected to flourish in and propel growth for the Indian B2G LED segment.
The market will witness a convergence scenario with other technology areas like wireless sensors and networks, augmented reality, and flexible electronics. This will shift emphasis to the lighting system as a whole. With technological advancements, reliable product performance, increased competition, and reducing LED pricing, increased market adoption is expected across both indoor and outdoor LED lighting markets. Still, the LED market in India has its share of challenges such as relatively higher pricing, reliance on imports, and limited indigenous manufacturing.
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COVER STORY
Reza Kabul Architect
Rahul Gore Architect
Dikshu Kukreja Architect
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LED’s infact are the best choice for the future. They are energy savers with a long life that also produce negligible amount of heat which in turn helps control electrical bills especially due to air-conditioning. Aesthetically also the new LED’s are smaller in size and have better light quality. They have varying colour options to cater to all aspects of lighting for mood, task and general lighting purposes.
LED as a technology is fantastic in terms of reducing power consumption. However, as a designer what is fantastic about LED’s is their compact size and various colours of light that they can achieve. These two things have suddenly broadened the use of light in archietcture and interiors and that is the factor that is leading to its widespread use.
LED Lighting is becoming a preferred choice due to various advantages in today’s design scenario.
www.m e d e g a t e t o d a y. c o m November-December 2014
Naresh V Narasimhan Architect
Due to the move towards sustainable architecture, people are opting for LEDs as they are more energy efficient, durable and ecologically friendly when compared to conventional lighting solutions. From an architectural perspective, LEDs can add a new dimension to the concept of smart buildings as there is potential to build smart features directly into the light source. This means that individual fixtures can be controlled through phones and occupant sensors to moderate light intensity according to ambient light levels. Their smaller size and low energy consumption also allows for more versatility in the aesthetic design of fixtures such as the creation of slender and minimalistic forms, floating fixtures etc.
EXPERT Update
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COVER STORY
Facility Design to Enable NABH Accreditation
T Rang Emei Principal Helix Healthcare Architecture New Delhi
Radiology, imaging, radiation therapy and nuclear medicine modalities need to conform to safety regulations laid down by AERB. Planning and design of these departments need to address and conform to all technical and safety requirements of these modalities. Each modality must be planned in the right location based on principles of functional and operational efficiency as well as clinical and physical safety of patients, visitors and care-givers.
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here is a general perception amongst the public that NABH accreditation requirements have little to do with facility design and mostly addresses healthcare service delivery policies and procedures. Yes, the standards do emphasise on healthcare service delivery and SOPs and are mostly not very explicit on the physical infrastructure requirements. However, designers (and operators) need to understand that a well-designed facility enhances functional and operational efficiency and thus supports the process of accreditation. Most of the physical environment requirements are implicit in the guidelines/standards pertaining to standard and quality of care. Generally, the first and foremost prerequisite for accreditation of any healthcare facility is its being a municipal approved building. Secondly, the facility must have a valid NOC issued by the local fire officer. Special focus need to be accorded to fire and life safety aspects of the facility. Conformance to accreditation standards start right at the arrival zone of a facility. For instance, healthcare services being provided by the hospital need to be prominently displayed in the arrival lobby in languages that patients understand. Patients’ rights also must be displayed in a prominent location. This means the architect/ interior designer need to provide appropriate space for such information boards in the design of the interior environment. Since all patients must be registered and provided with unique identification numbers, adequate space with
EXPERT COVER Update STORY
necessary support services (light, power & data supports) must be provided for in the design of the reception/ registration area. Most times, patients have to wait to be admitted till their registration process is complete or till a bed is made available. Facility operators and designers need to recognize this. A dedicated admissions waiting area will ensure a less stressful and anxious wait for patients and their family members. Similarly, a dedicated discharge lounge is extremely beneficial for the hospital, patient, family and the staff. Patient discharge formalities could take many hours depending on the complexity of a patient’s diagnosis, health profile, treatment, therapy, recovery and length of hospital stay. A dedicated discharge lounge outside of the nursing unit is a good strategy from a business perspective as well. Such a facility will free up much needed, revenue-generating inpatient beds (whether critical care, high dependency or acute care). Even though this provision is not so much an accreditation prerequisite, it contributes positively towards enhancing patient & family satisfaction level. Designers need to take cognisance of this aspect of planning and design and ensure that pre-design space program reflects these aspects.
In the event of non-availability of beds in a specific category, the hospital should have adequate provisions for temporary/short-term holding of patients till they are re-directed/transferred to another hospital where appropriate care can be provided to such patients. Such
temporary holding facility should be appropriate in terms of physical space as well as healthcare support services (electrical, data, medical gas, HVAC, etc.) A patient’s initial health assessment includes lab investigations. Lab may be in-house or outsourced. Since lab services must be made available round the clock, even if it is outsourced, there must be appropriate space and supports for sample handling. Radiology, imaging, radiation therapy and nuclear medicine modalities need to conform to safety regulations laid down by AERB. Planning and design of these departments need to address and conform to all technical and safety requirements of these modalities. Each modality must be planned in the right location based on principles of functional and operational efficiency as well as clinical and physical safety of patients, visitors and care-givers. ‘Uniform care’ with a focus on patient safety and wellbeing is a prime criteria impacting the accreditability of a healthcare organization. From a design standpoint it means that uniform level of support facilities (space, light, power, data, medical gas, clean air, sanitation) which are necessary for the treatment and healing of the patient must be planned for every patient in the facility irrespective of the category of ward a patient is being treated in. Physical comfort level may vary w w w.medegatetoday.com November-December 2014
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(multi-bed ward, double room, single room, suite, etc.) depending on a patient’s capability and willingness to pay for a specific level of comfort. Uniform care also encompasses ensuring healthcare services are accessible to every category of patients, including the elderly, children, physically and mentally challenged patients. Healthcare buildings must be ‘accessible’ to all and be environmentally supportive to every category of patients. A supportive environment would be equipped with safety rails, ramps, safety/non-skid flooring, clinically safe finishing materials (low VOC, anti-bacterial, fungicidal), noise-attenuating materials, abundant natural light, view out to natural environment, fresh, clean indoor air and a good way-finding signage system.
concern in every healthcare facility. Designers need to be fully aware of the varying interior environment characteristics requirement of the various departments and zones of the facility. Adequate number of air changes, appropriate filtration level, humidity, temperature, etc., need to be ensured and reflected in the design. Appropriate pressure relationships need to be maintained between various zones in the hospital. When it comes to infection control, the peri-operative zone is of utmost importance. Un-sterile, semi-sterile and sterile zones must be clearly defined in the design. There are specific guidelines issued by NABH for the design of operating rooms. Adequate space also need to be provided for sterilization of surgical and other medical instruments.
Medical errors occur in almost every facility. Design can contribute towards reducing medical error occurrences. Standardization of design is one of the most obvious means. Uniform/standard arrangement of inpatient room layout is one; standardizing the locations of service points/gas outlets on patient bed head walls or service pendants is another. Physical and mental fatigue also do result in medical errors. Design needs to address this and ensure minimum walking distances between staff base / nursing stations and patients. De-centralised nursing stations bring the care-giver physically closer to the patient thus resulting in a higher level of monitoring by nursing staff while reducing staff fatigue.
It is recognised worldwide that touch is the most common mode of transmitting infections from person to person. It is therefore necessary to ensure adequate provisions for hand-washing for care-givers throughout the facility. Location of wet points and routing of plumbing lines need to be carefully planned to ensure that these points and lines do not become sources of infections in the event of any malfunction (or in their normal course of functioning) in the system.
Barrier nursing facilities are necessary to arrest the transmission of infection amongst patients, family and staff. There are specific requirements w.r.t. air temperature, humidity level, number of air changes Another sensitive area is the subject of patients’ rights. and positive/negative pressure relationship to adjoining Patients’ rights include aspects such as dignity and areas. privacy (besides other aspects). Design must ensure adequate and appropriate level of privacy for the patient. Provision of various other appropriate hospital support Patient transfer routes must be appropriately private and services such as bio-medical waste handling system, dignified. Consult, exam and procedure room designs medical gas system conforming to relevant safety need to ensure visual and aural privacy for the patient, standards, water purification system, sewage treatment and disposal system, etc., are necessary to enable the staff and family. delivery of healthcare service that is safe for the patient, NABH guidelines also address the issue of security care-givers and the public. pertaining to neonates in the nursery and NICU. Cases of child abduction do occur. Design must ensure The core objectives of NABH standards being patient adequate visual monitoring and physical security of safety and systems approach to the delivery of healthcare these areas. Physical safety of neonates must top the services, the importance of the necessity to correlate list of design criteria for nursery and neo-natal ICU. healthcare service delivery with facility design needs to Electrical system design must ensure zero occurrence of be unambiguously and firmly defined in the standards. Clear references need to be made to specific clauses of electrical accidents. relevant national and international design standards and Healthcare Associated Infections (HAIs) are a major guidelines. 46
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HEALTHCARE it
Transforming Healthcare with IT-Role of HIS/HMS in Modern Healthcare
Mr. Sarath Anand Jupalli,
Managing Director, Shivam Medisoft Services Pvt Ltd,
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for every solution we have to keep the realities and practices of the hospitals in mind. So we have developed an HMS which sets standards to each process thus ensuring strong management capabilities and control and improve the service quality of each client associated with us. Its a browser based software which is totally open source,platform independent (runs on any OS), multi lingual,multi location,cloud compatible, Bar code enabled software and available with Management dashboard and available with mobile applications for smartphones too which gives freedom to the MD/ Administration of an organization to check real time data even when they are What solution Shivam is providing keeping the traveling. We have a robust marketing team backed up with a strong development, implementation and support present Indian healthcare trend in mind? Indian healthcare systems have unique requirements team to facilitate our clients and ensure best service in the when it comes to billing or patient management. Here industry.
his is the age of informatics and it has been accepted world wide that healthcare today needs to be more IT oriented in terms of functionality, finances,operations and patient care. With the advent of healthcare industry in India,IT has become an integral part of the same. Over the last decade, healthcare division in India has grown over 150% however if we compare the same with HIS enabled healthcare divisions then it's still at its nadir. With the introduction of new govt and pvt hospitals state wise and also considering the bigger brands having their keen interest in healthcare division, there is a huge growing market for HIS/HMS developers. We have made our presence felt across major cities of India and we are ready to emerge as one of the leading HMS company tomorrow.
Punjab:
Delhi:
Kolkata/W.B:
Maharaja Agrasen, Patel Hospital, Tagore Hospital, Sri Action Balaji Sacred Heart Hospital, Medical Inst, Mata Chanan Devi, Prime Liver Inst. Park Hospitals, Shanti Mukundh, Cygnus Medicare Group
Belle Vue, Bhagirathi Neotia, Neotia Gatewell Healthcare, Zenith Hospital, Sanjeevani, HLG Hospital
Hyd: Fernandez Hospitals, Mythri Hospitals, Tulasi Hospitals, Bibi Cancer, Muslim Maternity, Mahaveer Hospital
AP: Nagarjuna Hospital, St.Ann's, Global Hospital, Arvind Kidney Centre
A COMPLETELY WEB BASED,JAVA ORIENTED,CLOUD COMPATIBLE HOSPITAL MANAGEMENT SOFTWARE FOR EVERY HOSPITAL. AVAILABLE WITH DASHBOARD, SMARTPHONE APP AND ON MONTHLY SUBSCRIPTION AS WELL. Starting Range of Monthly Subscription : Location
Neosoft Basic
Neosoft Enterprise
Neosoft Supreme
** Charges mentioned below are Per Month and is variable
Purpose-Income Computerization
Purpose-Income & Expense Computerization
Purpose-Total HMS Solution
OP-IP-LabPharmacy+WMS
Basic+Payroll+Purchase mgmt
As per requirement
Delhi-NCR
9999/-
14999/-
25999/-
Punjab-Chandigarh
9999/-
14999/-
25999/-
Kolkata & Rest of Bengal Cirlce
7999/-
12999/-
20999/-
Hyderabad
6999/-
10999/-
22999/-
Rest of Telangana & Andhra
7999/-
12999/-
23999/-
Call Up: 09248023412/ 040-67333666 Today !! Or Mail: marketing@shivammedisoft.com w w w.medegatetoday.com November-December 2014
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Q
What are some of the consumer trends/demands driving the residential development?
The trends in the residential development cannot be generalized as it differs between cities and even between areas within the same city. For instance, in Mumbai, space is limited and therefore consumers’ primary focus is on the utilization of space which is different from cities like New Delhi & Bangalore. With a huge part of the population being young and having aspirations for a better standard of living, there is a trend of buying homes at a much younger age. The demand for mid-cap housing, especially in the outskirts of bigger cities and tier-II cities are on the rise. There is a trend in buying second homes in the luxury segment as people want to spend their weekends away from the hectic city life without having to compromise on the comforts. Therefore, places like Lonavala and Khandala are coming up as second home options. 48
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Q
Sustainability is the buzzword in building industry today. How can the same be incorporated in real estate construction, development and management?
Sustainable architecture or ecological design is to ensure that our actions and decisions today do not inhibit the opportunities of the coming generations. Sustainable architecture or green design is a philosophy of designing buildings to comply with the principles of social, economic and ecological sustainability. We at S Raheja seek to minimize the negative environmental impact of buildings by using materials, energy and space in a way that is least damaging for the environment. Creating sustainable buildings starts with proper site selection as the location, orientation, and landscaping of a building affect local ecosystems, transportation and optimize energy use .Fresh water is an increasingly scarce resource and as a developer, we try to optimize its use or recycle
INTERVIEW The strategies for each of these segments are different. with In keeping with the changing concepts of luxury, our second-home projects like the Cascades have been designed with keeping privacy and relaxation in mind. Each villa has its own private waterfall and swimming pool besides all other amenities. In our corporate verticals, we do the designing, building and interior work for the client as per their specifications and hand over a complete, ready to use product. Our aim with the midlevel housing is to provide luxury housing at affordable price. In our projects in Palghar and Varanasi, we have provided the best quality materials and all the amenities of a luxury project which are the best in the respective areas. The advantages of being a qualified The redevelopment projects have a few restrictions and architect as well as a builder? stringent regulations to follow and therefore, the planning strategies for such projects are different from the other There are conflicts in the roles of an architect and a builder verticals. However, the primary focus of the company and it can be challenging to try and balance the two. remains providing the finest contemporary designs with However, I feel that I am at an advantage for knowing sustainable practises. both the trades as it lets me experiment with materials and tools to make beautiful projects for others to enjoy and at Are the affordable and middle income the same time be involved with the process of creating housing the way forward for Indian those buildings. real estate? water for on-site use, when feasible. We make sure that the materials used in our constructions minimize environmental impacts such as global warming, resource depletion, and human toxicity. The indoor environmental quality (IEQ) of a building has a significant impact on occupant health, comfort, and productivity and as an architect, I design keeping in mind optimal operations and maintenance of the building. As a real estate firm, we implement all possible methods to simplify and reduce maintenance requirements, reduce usage of water, energy and toxic chemicals to ensure sustainability of all our projects.
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I must add that building brings additional responsibilities too, as an architect’s job may be over upon completion of the project but as both architect and builder one has to resolve any warranty issues even after it is handed over to the client. However, I consider there are greater advantages in combining architecture with building including overall project control, budget and quality control, cash flow, and speed. Sometimes it is considered unusual to do both but I’ve learned a lot about building from designing, and a lot about designing from building. As a builder when you participate in the process, you learn about the innate connection between architecture and its imminent construction, materials, processes, and techniques which helps an architect to look outside the small inner-circle of a just a single project and re-consider the holistic meaning for their practice.
Q
S. Raheja is operating in various segments including residential, commercial and healthcare. Brief on the company’s distinct design & planning strategies for each segment? S Raheja Realty is three generations into designing and developing residential and commercial projects in the country. The company primarily has four verticals; redevelopment, corporate, luxury mid-level housing and second homes.
S Raheja is primarily into luxury housing but having identified the potential of Mid-cap housing in the country, we ventured into this segment with projects on the outskirts of Mumbai and tier-II cities. Higher disposable incomes, increased aspirational values for a better standard of living and also the infrastructural development and general economic growth have given a boost to affordable and mid-level real estate. Considering the pyramid of society, the demand in mid-income housing is bound to be high but in outskirts and tier-II cities, there is a lack in the supply of quality projects. We aim at bridging this gap by providing luxury housing at affordable prices and the success of our projects in Palghar and Varanasi are testimonies to that.
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How do you see demand scenario in luxury residential segments?
The huge population of India ensures that there is always a demand in the real estate market. The economic development and thereby higher purchasing power means that the Indian home buyer is more conscious and demanding about their homes. There is a lot of demand in the luxury home segment with emphasis on the amenities provided. The concept of w w w.medegatetoday.com November-December 2014
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INTERVIEW second or holiday homes are also on the rise where the urban couples want to spend their weekends away from the urban jungle without compromising on their quality of life. Innovative designs, privacy and space are most important to the buyers now. International exposure has brought in its own flavor with buyers requiring private swimming pools, landscaped gardens and technology in their homes to ensure luxury and comfort. Our projects in Mumbai and Lonavala are being designed keeping all these factors in mind.
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Brief on the Hinduja Healthcare project?
While conceptualizing the architecture of Hinduja Healthcare, I tried to balance between the natural aesthetics and technology to bring about a perfect harmony of the two. As an architect, the challenge was to give importance to every detail of design without losing sight of the most important factor of providing comfort and treatment to the patients. For example, the finest organic fibers and plush surfaces combined with soothing shades of beige and white were used to add to the beauty of the building and at the same time to give its patients a restful experience. The elements of light and texture were carefully chosen to transform the place into one of peace and tranquility. It was an enriching experience as designing in healthcare requires a whole new perspective and one can enjoy more freedom in terms of creativity. Technically, it was a challenge as building amidst an urban jungle is never easy. However, the company’s expertise in redevelopment in similar areas over the decades helped me overcome all hurdles and I am very proud of the project as it stands today.
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How do you see the industry evolving in the next five years?
Indian real estate market is going through a very interesting phase with the general economic development. With buyers getting more of international exposure, the nature of the demands are changing as the consumers want quality projects that have all the amenities at par with the rest of the world. This is true not only for the metros but also tier-II cities. The concept of luxury is also evolving with far greater emphasis on personal space and comfort.
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I see a huge growth in the smaller cities with each youth wanting to have his own home at a very early phase of his career. With many big companies coming into the real estate market, only good quality housing will survive as the investors are far more conscious and know exactly what they want. Sustainable architecture and green buildings are also a trend expected to become predominant with concerns about the environment growing. In terms of innovation, I foresee a lot of improvement in terms of technology and demand for smart-homes. The process of construction is also undergoing changes with pre-fabricated materials and alternatives to raw materials like cement, etc. being used by developers to speed up the process. Thus, real estate sector in India will only grow into a larger and better market in the coming years.
Q
While the metro cities continue to remain in demand for commercial & residential development, are Tier II and III cities also fast gaining momentum?
India is a big country with a huge population, large part of which is below the age of 30. The first need for any family with a disposable income is a home and thus, the demand for quality projects are on the rise with the economic growth of the nation. With the overall development of infrastructure and industrialization, this demand is no longer restricted to the metros but has grown considerably in the tier-II and tier-III cities. S Raheja recognized this trend and ventured into Palghar in the outskirts of Mumbai and Varanasi with the aim of providing luxury housing at affordable price. The success of these ventures clearly point to the growing demand in this sector to meet which we plan to launch similar projects all over the country.
Q
Growth plans of the company for the coming years?
S Raheja has always stood for purity; in terms of the quality of projects and consumer satisfaction. Taking forward the legacy of my family, I would like to expand into pan-India. Wherever we build, our buyers will remain the most important to us. We have projects ranging from 20 lakhs to 25 crores to ensure that every segment can own one of our creations. As an architect myself, creativity is of utmost importance and I would like to continue exploring new and innovative designs in all our projects. Primarily, the focus of the company is to continue building quality housing for all.
EXPERT Update
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EXPERT Update VIEWS
A new way to
treat and manage Diabetes
Vedraj Bakshi Data Coach, New Life
through selfhelp printed tool guidekit Your doctor Your doctor plays plays a verya important very important role inrole theintreatment the treatment and management and management of pre-diabetes of pre-diabetes as well as as well diabetes as diabetes type2type2 and type and 1type well1 supported well supported and summarised and summarised by ourbyyearly our yearly package package toolkits toolkits
"MyNewLifeKit" aspires, hopes to empower and engage both the doctors and patients in a new interactive self help but guided protective shield leading to lifestyle change behaviour at home thereby widely enhancing the efficacy of Drugs and insulin intake along with regulated diet and exercise regime .
How MNLk self management data tools at home can help control diabetes
This will assist doctors in treating patients based on their daily recording of Insulin, blood glucose, diet, exercise and medications in formatted structured forms and journals filled up at home to be eventually shared with their doctors who shall evaluate, judge and prescribe treatment and analysis of this valuable primary data collection Mission. Diabetes is a dis- ease in which blood glucose (also referred to as blood sugar ) levels are above normal limits.People with diabetes or even prediabetes have problems converting food to energy because the pancreas does not make enough insulin or cells in the muscles, liver and fat donot use insulin properly. As a result, the amount in the blood is too high which gets detected by regular tracking glucometer readings in our formatted monthly printed trackers and daily 52
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EXPERT Update VIEWS
which Infact will get handsomely fully repaid in terms of discounted prices offered to our valued patrons related to glucometer and strips supply along with insulin and drugs intake by at least 25% lower prices than existing retail market rates that is the hidden power of DATA. Self-management means that you choose to seriously participate by writing down daily your routine as advised and directed by our "MyNewLifeKit" -printed guided toolkit covering all 4 aspects of diabetes treatment methodology used all across the world namely: Insulin, diet, exercise, and medication regimen insulin logsheets supplied under our 3 categories of yearly unique to each body type and genetic code. packages starting from Banana Package suitable for people Your doctor plays a very important role in the treatment and under 200mg of reported blood sugar levels. management of pre-diabetes as well as diabetes type2 and Our Broccoli package is more detailed patient engagement type1 well supported and summarised by our yearly package toolkits. kit suitable for over 200mg but less than 500mg.
Although They might technically guide you in the right direction, but only you have to decide with daily recording of your normal at home activity in easy steps guidebook what is best outcome parameters desired by you. Here are three core areas of diabetes that you'll have to manage yourself depending upon your level of awareness, motivation, and guidance tools like glucometer, blood pressure monitors, diet planners, exercise logsheets, daily insulin recorders, monthly blood sugar trackers and medication journals which if filled up regularly and honestly at home can bring about tangible Diabetes an occur in anyone.However, if you have close and recurring lifestyle change behaviour as envisaged by relatives with the disease you are more likely to develop "MyNewLifeKit"(MNLK) yearly package printed toolkit. it.Other major risk factors caused by undisciplined and mindless lifestyle behaviour include obesity, high ÂÂ You have to decide which foods are the best for your cholesterol, high blood pressure, physical inactivity, stroke, body and blood type, Because people with diabetes have Hypertension, stress and kidney failure. different reactions and tolerance to different foods and even same food category.So you need to be responsible It is however very important for all of you to know diabetes for finding a diet that will not send your blood sugar levels risk factors - many of which are easily preventable once you on a roller coaster ride. become aware, conscious and disciplined in keeping written daily record of all your activities and food intake schedule ÂÂ The emotional side of diabetes is something else that you by filling up our blank formatted forms as truly, frankly and will rarely hear doctors talk about.They can't do much for honestly as possible for better selfhelp management tools as you on that front.Again, only you will be able to know from patients ground angle instead of doctors top view as of your own body language and symptom warning and how now anywhere in the world. to react,mitigate or resolve such emotions and outcomes. The most comprehensive Walnut package will cover more details with deeper insights about each patient engagement behaviour patterns and interaction during our active yearly online and offline knowledge and experience exchange platform offered free to all 1lakh sample study patients as intrinsic and critical component under our " Data Safari" 2014 pilot study project so as to remove any doubts or queries and misconceptions related to food and nutrition or weight loss goals.
Hidden power of DATA
Although you can live a long but under performed life with diabetes, the disease will surely affect the way you live, eat, drink and enjoy life if not self controlled and self managed as directed by our "MyNewLifeKit" simple printed tools and tips with FAQs and shopping guide lists as well. Hence you can control, monitor and regulate diabetes for many years through active daily self-management routine leading to a vastly improved lifestyle behaviour change outcome at lowest possible yearly MNLK package cost
ÂÂ the biggest thing to remember in order to have really good diabetes self management skills is to not live by anyone else's rules, medication of diet plans.Create and monitor your own self help program and daily disciplined routine. Then take it to your doctor so they can assist you wherever you need it on continuos basis along with your family, relatives and Medicare professionals who all can help support you but all decisions and actions towards better health and well-being. For business queries and representation contact:
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DOCTOR SPEAK
Timely and Accurate diagnosis of Dengue is the need of the hour
R
ise of dengue in the city has been a cause for concern for doctors. The number of dengue cases being reported every year has been constantly on the rise. South East Asian regions are one of the most affected regions in the world.
Dr. Sonali Kolte GM - Medico Marketing, Metropolis Healthcare Ltd.
Dengue can only be efficiently tackled if diagnosis is confirmatory and hence no time is lost in treatment and disease management. 54
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Vector borne diseases like dengue have similar symptoms to that of the common flu and hence it is important to undergo testing and confirm infection at the earliest possible. Early diagnosis will help a patient recover completely.
Symptoms Dengue is marked by very high fever, severe body aches, joint pain, pain behind the eyes, severe headache. Rashes develop within 2 days of onset of fever
Diagnosis Dilemma Over the years, Antibody and serology tests have been widely used to detect Dengue. The sensitivity of the IgG and IgM antibody tests is low and many a times result in false negative cases. Dengue is a serious illness and may rapidly develop in a patient and may also lead to Dengue Haemorrhagic fever and Dengue Shock Syndrome depending on the viral load. In these cases, the platelet count drops rapidly, blood pressure drops eventually leading to internal bleeding and organ failure, particularly the liver and kidney. To add to the woes, ready-to-use cheap dengue rapid
DOCTOR EXPERT Update SPEAK
diagnostic test kits that are causing confusion in detection of dengue cases. Last month the Indian Medical Association (Aurangabad Chapter) stressed on formulating precise guidelines of relying on only the tests results of the National Institute of Virology (NIV) kit for detection and confirmation of dengue.
ÂÂ Screen Widows and Doors ÂÂ Use Mosquito netting over beds ÂÂ Apply Mosquito repellent creams on your skin
Dengue can only be efficiently tackled if diagnosis is confirmatory and hence no time is lost in treatment and disease management.
Diagnostic Solutions NS1 Antigen Test: The Ns1 Antigen test is considered conclusive and also allows for rapid detection on the onset of fever. It is a technique based on ELISA and has been widely used. Molecular testing by PCR is the latest and best available for vector borne diseases. A PCR (polymerase chain reaction) test detects the presence of the virus and is the most reliable means of diagnosis. A positive result from a PCR is conclusive. PCR is done in real-time which extract nucleic acid of pathogens from whole blood. With a sensitivity and specificity of a 100%.
The most basic and simple tips to prevent dengue are ÂÂ Do not allow water to stagnate around your house ÂÂ Wear long sleeved clothes ÂÂ Use insecticide sprays in your surroundings
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DOCTOR SPEAK
The Most Common Illnesses in
Children during Winter season
w Dr. Rajiva Kumar Child Specialist Muzaffarpur, Bihar, India
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inter bring a multitude of viral infections. Most of these cause self-limited illnesses and require only symptomatic treatment, but some can lead to more severe infections, especially in children. Two of the most common winter viral illnesses in children are RSV infection and Rotavirus gastroenteritis. Every year around this time I like to give a little insight as to what I’m seeing in the pediatric community these days because, well, frankly, parents always seem to want to know.
DOCTOR EXPERT Update SPEAK
comes the diarrhea. Hydration and supportive measures are ÂÂ Influenza (AKA “the flu”): Despite an unlimited supply of the vaccine this year, it appears it is not preventing the B key and in certain instances, an anti-vomiting medication strain (remember, there are A and B strains of influenza) may be used . circulating this season. So throw in those who declined influenza immunization this year, and well, it makes for ÂÂ Rotavirus: Rotovirus causes an infection in the stomach and intestinal tract, and the main symptoms are vomiting, a pretty busy flu season. As far as treatment measures, diarrhea, and fever. Vomiting is usually most significant in anti-flu medications exist but are only recommended in the first 48 hours of illness, and diarrhea generally starts certain populations (e.g., the younger and elderly, those with underlying medical issues, etc.). on the second day of illness and lasts for six to eight days. The main danger of this infection is dehydration, which ÂÂ Respiratory Syncytial Virus (RSV): This is the virus is more common in infants and toddlers. that can create a bad cold in any aged individual but with the younger ones (infant-aged), it can become quite Again, because this is a viral infection there is no specific problematic. The cough sounds horrible, the airways medication which will kill the virus. Treatment is become clogged with intense nasal secretions and oxygen symptomatic while we wait for the body's immune system to levels can become compromised. Supportive measures are typically all that is needed but absolutely necessary to see fight the infection. Treatment includes modifying the child's your child’s physician if any respiratory compromise exists. diet temporarily so that the stomach can rest. This is done by Many children, particularly those under six months of age, giving clear fluids and bland starchy foods, which are easier require hospitalization for several days if their infections is to digest in smaller amounts frequently. Sometimes despite severe enough to impair feeding or oxygenation. Exposure parents' best efforts, a child will require hospitalization to cigarette smoke makes symptoms significantly worse. to receive IV fluids for several days until they are able to ÂÂ Strep Throat: Yes, strep throat always seems to be tolerate fluids in their gastrointestinal tract. Please call your circulating no matter the time of year. Take home message doctor if your child is not drinking enough to urinate four here is if your child has a sore throat and fever and minimal times each day, if they have more than six to eight episodes cold-like symptoms (runny nose, cough), take him/her in of vomiting in a day, or are acting lethargic. Rotavirus is because this is one illness that has a clear treatment plan. transmitted though saliva and stools. To avoid the spread of Yours truly had it about a month ago but after a day of the this infection do not SHARE food or drink with others, and antibiotics, you really do start feeling better. wash your hands frequently, especially before eating. ÂÂ Viral Gastroenteritis (AKA “stomach bug”): Plenty of this in between all of the other illnesses I mentioned above. So there you have it. These are the illnesses making things a Typically begins with vomiting and when that resolves, here bit tougher for the children I care for these days. w w w.medegatetoday.com November-December 2014
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DOCTOR SPEAK
&
Infertility
Causes Treatment
I
nfertility affects approximately 10-15% couples every year. About 30 % to 40% of all infertility is attributed to the female and 30-40% to the male; in few cases combination of male and female factors may be the cause. Following extensive investigation and treatment, approximately 50% of the infertile couples achieve pregnancy through various technological aids.
Dr. Hrishikesh Pai, Gynecologist & Infertility Expert of Fortis La Femme Hospital, New Delhi & Lilavati Hospital, Mumbai informs, The causes of infertility are many and varied. This includes problems with the production of sperm or eggs, with the Fallopian tubes or the uterus, endometriosis, frequent miscarriage, as well as hormonal and autoimmune (antibody) disorders in both men and women.
Male Infertility
Male Infertility is generally the result of an inability to properly produce healthy sperm or because of a blockage that prevents sperm from joining the semen. The known causes of male infertility can be subdivided into four areas: Dr. Hrishikesh Pai Gynecologist & Infertility Expert of Fortis La Femme Hospital, New Delhi & Lilavati Hospital, Mumbai
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ÂÂ Hormonal problems: The failure of the pituitary gland at the base of the brain to stimulate the testis. Disorders of this group, usually referred to as endocrine causes of male infertility, are relatively rare, affecting approximately 1 in 100 patients. ÂÂ S perm production problems: The disruption of the production of sperm within the testis or the production
DOCTOR EXPERT Update SPEAK
of antibodies against sperm, which block their function. This is the commonest cause affecting about 60 in 100 patients. ÂÂ B lockage of sperm transport: Concerns the obstruction (or blockage) of the tubes leading sperm away from the ovulation or increase the production of certain hormones. testis, namely in the epididymis and vas deferens, into Clomiphene, gonadotropins and bromocriptine are the the ejaculate. This group is the second most common most commonly used infertility drugs. cause affecting about 30 in 100 patients. ÂÂ Erection and ejaculation problems: Relates to problems Sometimes, no matter how many fertility medications of erection and ejaculation that are necessary for normal are prescribed, conception will just not occur. In these sexual intercourse. These problems affect about 5 in instances, using a sperm, egg or embryo donor may be an option. Some couples prefer to use a surrogate. The 100 patients. use of a donor is often recommended for women who are ÂÂ Unknown problems: In 40% of men with male infertility; undergoing cancer treatment. However, advancements the cause of the problem is unknown. This is referred are being made in egg cryopreservation, which may allow to as 'idiopathic infertility' or 'cause unknown'. a woman save her eggs for future use. Similarly, couples may freeze their embryos from a previous IVF cycle for Female Infertility Archana Dhawan Bajaj, Obstetrician & Gynaecologist, future use. Nurture IVF Center informs, There are many different types of infertility experienced by women. However, the sooner you get a diagnosis, the better your prognosis will be. Some of the most common causes of female infertility include retroverted uterus, polycystic ovarian syndrome, fibroids and endometriosis. However, there are several other reasons why a woman may experience fertility problems, such as ovulatory disorders, premature ovarian failure and uterine factors. Egg quality also plays in role in infertility in many women.
One of the oldest methods still used to help women get pregnant is artificial insemination. There are various types of artificial insemination. However, the most common method used is intrauterine insemination or IUI. While this simple reproductive technique has helped many couples conceive, in some cases, more advanced methods of conception are required to help bring about a pregnancy. The term Assisted Reproductive Technologies (ART) encompasses a variety of medical techniques that can be utilized to produce a pregnancy by bringing an egg and sperm together outside of the womb. Treatments that fall under the category of ART include In-vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Gamate Intrafallopian Transfer (GIFT), and Zygote Intrafallopian Transfer (ZIFT).
The female reproductive system is a very delicate structure that is easily affected by even the slightest change. Maintaining good health can help you avoid some infertility risks, like Luteal Phase Defect. Women with eating disorders find it very difficult to conceive. Anorexics often stop menstruating, making pregnancy impossible until the eating disorder is corrected. While most fertility treatments focus on women, there Many women are able to conceive but have difficulties are some available for men as well. Numerous men carrying a pregnancy to term. Women who experience decide to have a vasectomy reversal in order to restore multiple miscarriages should make an appointment with their fertility. Others choose to pursue alternatives to vasectomy reversal. Men with especially low sperm count their doctor to find out what is causing of the miscarriage. or who produce no sperm at all in their ejaculate may require the use of surgical Sperm Retrieval Techniques Treatment while men who cannot ejaculate on their own can decide There are many different avenues infertile couples to use Rectal Electro Ejaculation to help them produce a can take if they decide to use medical solutions for sperm sample. their fertility problems. For certain disorders, like endometriosis, surgery is one option. Women who have Whatever type of fertility treatment you decide to pursue, had their "tubes tied" will also require surgery in order to make sure that you and your partner thoroughly discuss reverse their tubal ligation. However, when surgery can't all the pros and cons of the treatment so that you can be help, then fertility drugs are prescribed to help promote sure this is the right option for you. w w w.medegatetoday.com November-December 2014
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EXPERT VIEWS
? Laparoscopy When and Why
a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.
The advantages of this technique over traditional open surgery include
ÂÂ A shorter hospital stay and faster recovery time ÂÂ Less pain and bleeding after the operation ÂÂ Reduced scarring
How laparoscopy is carried out?
L
aparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery. Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope. This is
Dr. Rajesh C. Shah President: Indian Hernia Society, Indian Society of Wound Management, Gujarat State Hapter ASI (2006), Gujarat Chapter SELSI
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Laparoscopy is carried out under general anesthesia, so you will not feel any pain during the procedure. During laparoscopy, the surgeon makes one or more small incisions in the abdomen. These allow the surgeon to insert the laparoscope, small surgical tools and a tube, which is used to pump gas into the abdomen – this makes it easier for the surgeon to look around and operate. After the procedure, the gas is let out of your abdomen, the incisions are closed using stitches and a dressing is applied. You can often go home on the same day you have laparoscopy, although you may need to stay in hospital overnight.
When laparoscopy is used?
Laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing (biopsy). Laparoscopy is most commonly used in gastroenterology, gynecology and urology.
Some commonly performed operations include:
ÂÂ R emoval of the gallbladder (appx. around 2,00,000 operations per year in India) ÂÂ Removal of the appendix (appx. around 1,50,000 operations per year in India) ÂÂ Female sterilization
EXPERT Update vIEWS
movements.Robotic arm can have 360 degree movement which is not possible by human arm & therefore robotic laparoscopy has changed surgery dramatically & one day impossible task is made possible today!
Conclusion
Safety
Abdomen is still considered Magic Box and many wonders had been noted after Laparoscopic Surgery. It has revolutionized the surgical results & fruits will be tasted by coming generation & open surgery may vanish in years to come!
Laparoscopic surgery is very common and generally regarded as safe. Serious complications are rare, occurring in just one in 1,000 cases, according to estimates.
Possible complications include
ÂÂ Damage to organs, such as the bladder or bowel ÂÂ Injury to a major artery or damage to nerves in the pelvis There are upwards of 7.5 million laparoscopic procedures performed annually worldwide.
SILS
Single incision laparoscopic surgery is modification of Laparoscopic Procedure whereby all the required gadgets are introduced through one port which is usually kept with umbilicus so when removed; it will leave behind scar merged with umbilicus.Long term results are equally same with advantage of minimal scarring.Surgical procedure is tedious and clumsy so that it nedds expertised training and hand-eye co-ordination.
Natural Orifice Trans- Luminal Endoscopy Surgery(NOTES)
This is still method persued for cosmesis and human willingness towards scarless surgery. NATURAL ORIFICES are selected to undertake surgery inside of abdomen and it ultimately result into better cosmesis.
Robotic Laparoscopy
Advent of robot is very useful in Laparoscopic Surgery as it facilitates w w w.medegatetoday.com November-December 2014
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HEALTHCARE it
IT in Indian
Healthcare System
D
espite the strengthening economic prowess of India, it is ranked among the bottom five countries, with the lowest public health spending world over and accounts for nearly 21% of the global disease burden. A World Bank report published in 2010 estimates that India is annually losing over 6% of its GDP due to premature deaths and preventable illnesses. Indian healthcare sector is still suffering on account of underfunding and poor governance which have led to substantial inequities in basic health care provisions. Patient monitoring and tracking is one of the biggest hurdles in our healthcare system due to the lack of
digitization. Moreover, the frugal government spending on healthcare and skewed ratio of doctors & hospital beds to the population has fueled the problem.
Healthcare and IT
Shushmul Maheshwari Chief Excutive, RNCOS
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The Healthcare information Technology (HIT) is termed as the most efficient and promising tool for augmenting the overall quality, safety and efficiency of the healthcare delivery system. Despite India being an IT enabled services’ behemoth, the use of HIT is very limited in the country. The major users of HIT include big pharmaceutical companies, corporate hospitals and other private sector institutions, while the public healthcare sector is lagging way behind in IT utilization.
HEALTHCARE it
The highly pressurized and caving-in public health care system of India is now zealously pursuing the IT route in different states. Currently the healthcare industry is increasingly adopting IT tools in HIMS (Health Information Management System), Telemedicine, Mobile health (Apps, Phones Integrated devices etc), and Disease Surveillance Projects. The National Health Policy endorsed by the Parliament encourages the introduction of electronic communication media in health sector. The Ministry of Health & Family Welfare and the Ministry of Communication and Information Technology (ICT) are jointly creating a national health information infrastructure, for easy capture and dissemination of health information.
ÂÂ R eluctance of Medical Professionals towards Technology Adoption: It’s a commonplace witnessing employees reluctant to adopt any new information technology tool deployed across the workplace.
Overcoming the Challenges & Appeasing the Healthcare Burden Although HIT is tackling the healthcare system challenges, there are above mentioned issues in IT implementation in itself. In order to subdue the impact of above stated predicaments, we believe that mandates for adoption of IT across healthcare institutions must be issued from the government’s end. Moreover, the EMRs/EHRs should be linked with patients’ PAN or UID. Incentive/penalty route for medical professionals could be opted in order to encourage IT adoption. Also, more data repositories like National Health Portal should be created for consolidation and dissemination of knowledge. Government on its own front Is working on various projects like E-Panchayat, VRCs, CSCs, etc. in collaboration with Department of Telecom, ISRO, C-DAC etc. Some of the successful ventures of Indian government include Mother and Chile Tracking System (MCTS), Integrated Disease Surveillance Programme (IDSP), and Nikshay for TB, among others.
In our research, we found that Delhi/NCR has high degree of automation level among private hospitals, while Rajasthan has advanced level ICT implementation across both public and private hospitals. On the other hand, states like Kerala, Odisha, and J&K reported HIMS implementation at a very basic level, although respective governments are making moves to address the issue. The absolute implementation of IT in healthcare is certain to facilitate patient monitoring & tracking through EMR/EHR centralization; curtailing the cost burden Challenges in HIT and improving the health care delivery; and manage the ÂÂ Lack of Government Regulations: Till date there scarcity of doctors & beds through telemedicine. are no regulations for the adoption of IT in the Indian healthcare sector ÂÂ I nteroperability: The patient records are maintained at the department and hospital level but these records are not centralized at the state/national level. ÂÂ S calability: Most of the government initiatives for the establishment of telemedicine platform, CSCs (Central Service Centers), VRCs (Village Resource Centers) etc. are in the pilot mode. Due to lack of resources, scalability of the already existing pilot projects is a huge challenge. ÂÂ Numerous Regional Languages: India is a country of multiple languages. In some of the regions, people cannot even understand Hindi and English, while former being India’s national language. w w w.medegatetoday.com November-December 2014
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HEALTHCARE it
PALASH Healthcare Systems
Leveraging Technology for
Better Healthcare H
ealthcare industry is keeping pace for integrating technology in its working space, but there are several healthcare providers who still lag in adoption of technology especially small and mid-sized hospitals. The reason being ‘unawareness’ about technological advancements. Healthcare industry in India is bereft of a proper guideline for Electronic Medical Record (EMR) and a proper regulation system. These negligence are widening the gap between the requirements of healthcare providers and its deliverables. Several healthcare providers are still maintaining the entire medical records
manually. With a mission to transform this manual work system through its innovative solutions and services, PALASH Healthcare System (PHS) came into existence in 2006 in Pune soon establishing a strong client base mainly in India, UAE, Africa, Caribbean, South East Asia and Europe. PHS has created state-of-the-art comprehensive enterprise-wide Healthcare Information Management System (HIMS), Clinical Information Management System (CIMS), Electronic Healthcare Record (EHR), Electronic Medical Record (EMR) and Analytics software provider. Its faculty focused frameworks and operational components cover all aspects of management and operations of hospitals and clinics. PHS provides solutions for small and medium hospitals & clinics, where they have streamlined the entire processes seamlessly. Under the supervision of Dinesh Samudra, Founder & CEO, the company provides various solutions - Multispeciality, Healthcare platform, Clinical Management, IVF, Ophthalmology, Diabetic and Nephrocare to name a few. PHS has enabled the easiness in the entire workflow mechanism with its single point integrated solutions. Earlier, these hospitals struggled to maintain manual data efficiently. With the implementation of PHS’ solutions, information of patients, labs or others are instantaneously accessible in a single click.
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HEALTHCARE EXPERT Update it
These solutions comprises of various modules as per requirement. For example-Nephrocare, which consists of various modules like patient, billing, laboratory, radiology, nephrology EMR feature, inventory and interfaces to name a few. These modules are streamlined in such a way that the entire medical details about any specific patient are accessible by the physicians or the authorized user. Hence, it eradicates the entire confusion and makes systematic workflow.
Clinical Practice Management tool for the doctors under the
name of PALASH Practice.
PALASH Practice:
This is a scalable ,web-based platform that gives individual and large Consulting and Clinic practices as also small & medium Hospitals and Nursing Homes the ability to function seamlessly across a number of different locations with the same flexibility and interactivity as Adopting latest technology and changing itself as per practices with only one point of operations. the need of the hour is what PHS believes in. Thus, it has equipped itself with cloud-based HIMS solutions. ÂÂ PALASH Practice provides modules for patient management, patient accounting, and advanced Electronic The company merged HIMS and CIMS solutions and Medical Record (EMR) management for patient care developed its version 1.0 that enables centralized data documentation. management. Accessibility of any particular patient portal by concerned physician is also made possible by ÂÂ PALASH Practice seamlessly integrates the administrative, financial, and clinical system needs of single or multiple this cloud-based solution. PHS also provides commercial locations of practice. application delivery and revenue analysis services. The solutions come with remote accessibility that allows the ÂÂ PALASH Practice has ability to integrate with PALASH or any other Hospital Information System along with payer user to easily access through smart phones and tablets. solutions. Patient Information and common data can be The company is attracting VCs’ attention with its easily shared among healthcare providers and facilities successful solutions and are expecting funding amount of and payer institutions. $5million within a year along with a web portal they soon ÂÂ PALASH Practice besides providing a complete system plan to launch. for managing the administrative and financial aspects of Currently serving clients in India including Mewar, a practice which could be standalone or in chain, it also Medipoint Hospital Pvt Ltd, Optis Eye Hospital, Inamdar caters to patient portal, electronic claims processing and Multispecialty hospital to name a few, the company practice financial reporting to track the practice's financial performance. It also provides online, point of service extends its offering to international clients as well. It payment capabilities to speed and increase collections. envisions to soon expanding its offices in UK, Europe and Africa. Over all the years of its operations PALASH has not only been analogous with the domain but has also scrupulously seen the issues associated with it. Our experience says that the major problem of this industry lies in the fact that the health records of the patients are all in silos. This creates duplicated records that are cumbersome to carry and maintain for the individual. PALASH has strongly narrowed down upon creating a common and unique health identification number for everyone in order to overcome the problem of health records in silos. PALASH will present platform through a web based portal that will not only generate a unique health identity for the individual but will also bridge the gap between healthcare providers and individuals.
Mobility of PALASH Practice:
PALASH Practice is available on tablets (iOS and Android) and smart phones (iOS, Android and Windows). PALASH Practice will have a Patient Identification Platform that can be used by multiple healthcare providers to identify every patient, access the EMR and treat the patient comfortably. An individual registered at one provider will get identified across the entire provider and payer network thus facilitating the exchange of information throughout the healthcare ecosystem. For more info: www.palashpractice.com PHS is growing in its own way. It has transformed itself
PALASH will also work towards providing tools for the two main entities of this ecosystem, The individuals and the to become a recognized organization. Recently it has received many awards and appreciations which have healthcare providers.
proven the company’s mettle. PALASH has proven that
Presently PALASH has already launched its EMR and a mission with a vision always carves a niche for itself!! w w w.medegatetoday.com November-December 2014
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INDUSTRY wATCH
Hospitech Consultancy is a team of experts who bring about the project to its logical conclusin at the right cost We are a professionally managed consultancy specialising in hospital & healthcare facility management, back by a team of experts from healthcare, engineering, management & allied professionals providing the target completions of projects with careful attention paid to TIME SCHEDULE, COST, QUALITY & PROFESSIONALISM. With our depth of experience & quality of service, we ensure on-time and efficient results of the highest quality. Headquartered in Bangalore with branch offices in 5 cities including Hyderabad, Jaipur, Ahmedabad, Delhi & Mumbai.
improvement makes transparent what has been achieved so far and what can be done to further improve the services.
Approach Our Team has extensive experience and competence with regard to healthcare processes & delivery. We analyze client’s situation, develop concepts tailored to their needs and support them during execution/implementation. We start by asking the right questions, and then dig deep into the numbers to unearth the right solutions. We help clients decide where they want to go, and how to get there. Our approach and recommendations on every project are highly customized and lead to practically achievable outputs.
Hospitech is an experienced and talented healthcare expertise resource. We offer our clients a cutting edge team of healthcare consultants. We provide innovative solutions to cost, quality, and access challenges for healthcare policy- makers, purchasers and consumers. We have staff with varied expertise and client bases, creating a firm with the talent, people-power and experience in The TEAM a broad range of project types, to set a new standard in Our core group of healthcare industry experts have experience in more than 100+ projects. We work design excellence and commitment to service. as an integrated part of our client’s team, to deliver outstanding results that are sustainable. We make sure our Expertise suggestions/decisions get translated quickly into action We assist leading healthcare promoters/companies work and that the client's team can sustain the momentum into on the full spectrum of strategy, operations, organization the future. Our team is committed to leaving our Client’s and mergers and acquisitions in their new and existing organizations stronger than when we arrive. Our passion business ventures. Our team works alongside client teams about our work results in long term relationship with the at multiple levels of the organization to develop practical client’s and that is possible with the energetic team which solutions that can deliver effective & sustainable results. is always at work & a step ahead in the project deadlines. We work with our clients on all kinds of projects including Hospitals (Multi, Single, Superspecialty), Diagnostic At Hospitech, we work seamlessly together as one team centres, Medical colleges, Nursing homes, Laboratory, to serve our clients wherever they need us. We have 5 Healthcare educational institutions, Day care centres etc. offices in different parts of the country. With offices in major cities, we make our collective knowledge, We assist our clients to gain a clear, demonstrable experience and strong network available to our clients as competitive edge. Continuous monitoring and quick as possible. 66
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INDUSTRY EXPERT Update WATCH
50 beds Belgaum, Promed hospital-50 beds Bangalore, We provide our services which can be either taken Popular hospital-40 beds Bangalore, Krishna hospital-150 together or at different intervals as per requirement. beds Chhattisgarh, Specialty hospital-40 beds Karnataka, Apart from the services mentioned below, Client’s have Multispecialty hospital-100 beds Karnataka. the liberty to appoint us in helping them understand the project, finding the solution to their project issues & even help in implementing the solution to the issues.
Services
Following are the various services offered Market research & Financial Feasibility (Detailed project report) Hospital Planning & Designing Hospital Project management Hospital Biomedical Equipment & Furniture Planning Management Consulting Hospital Business strategy Operational & Marketing Management Hospital Quality management Manpower planning & Recruitment Hospital Information Systems Hospital commissioning assistance Hospital Branding
List of Projects Following are some of the projects completed/under progress in different parts of the country. Multispecialty hospital-150 beds Assam, Ebenezer hospital-150 beds Mizoram, Jaidev hospital-150 beds Tamilnadu, NU life hospital-60 beds Andhra Pradesh, Dr.Sharma multispecialty hospital-100 beds Delhi, Adiva superspeciality hospital-100 beds Jaipur, Optimus Diagnostic centre-Bangalore, Lotus Ayurvedic centreBangalore, Multispecialty hospital-150 beds Tamilnadu, Multispecialty hospital-100 beds Tamilnadu, Suraj hospital-50 beds Mumbai, Naikwadi Medical centrew w w.medegatetoday.com November-December 2014
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PRODUCT LINE
Eubiq Pioneer In
Hospital
BED PANEL
E
ubiq was founded in 2000 with the vision of sectors. Just in last 24 months Eubiq has successfully becoming the world leader in power outlet installed more than 5000 bed head panels across India. systems & Bed Head Panels. The aim of the Eubiq design is to provide a unique The design has taken several years to develop, in hospital bed head panel systems, that supplies allthe course of which a completely new, state-of-the- in-one power, data, lighting, gas outlets & other low art system has emerged that addressees all the needs voltage services that can be mounted in many ways. and demands of the modern hospitals. Moreover, it is The bed head panel can be integrated to looks elegant extremely safe because of the GSS safety feature that and discreet. From an architectural point of view, Eubiq Bed Head Panels are sleek, handsome and is built into the system. beautifully detailed. Eubiq invented and developed the patented GSS power We at eubiq are investing heavily specifically for the outlet system in 2000. This track-based, ultra-flexible indian market, with our design drive philosophy of power outlet system was awarded worldwide patents "taking something ordinary and making it extraordinary"' since 2003 and worldwide sales commenced in the is an inspiring example what a creative economy looks same year. Today, Eubiq products are distributed in like- combing the best practices of vision, innovation, more than 30 countries worldwide through various design and scalable commercialization. channels. Eubiq Bed Head Panels can be 100% customised per Eubiq started its Indian operations in 2012 from users requirements, customization on length , finishing, Gurgaon / NCR Delhi and expanding its presence with options of Light and without light and thanks to the regional offices in Gurgaon, Mumbai & Ahmadabad, to investment on Indian Manufacturing facility, Eubiq meet the increasing demands from the Indian market. Bed Head Panel are now assembled in india as per global standards & the panels will range from Rs 1000/ Eubiq India's network of distributors spreads across ft to Rs 3000 / ft including T5Lightings and Eubiq GSS India and Eubiq's products are widely used in all system.
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PRODUCT LINE
Nurse-Call Systems
Optional features include Nurse Help Request, PatientNurse Intercom, Code-Blue Alert, IV-Drip Alert, Instrument Alarm Relay, Additional Call Signals, Call Transfer Facility, Multifunction Handsets, Corridor Display Modules, Nurse Call Response Monitoring and an SMS Alert facility for selected emergency calls to be forwarded directly to cell phones.
Medisystems Electronic Nurse-Call Systems are modern microcontroller based digital systems. System features have been designed to cater for hospital practices prevailing in India. Hence, the basic audio visual arrangement has been deliberately simplified through an easy to understand red-yellow-green lamp mode with easily recognisable audio chimes. All calls are acknowledgeable, to relieve patient stress, and no call Bed-Head Panels can be cancelled or reset except by visiting the patient Medisystems Bed-Head Panels are specially fabricated bedside. Even trainee nurses placed on ward duty at short for hospital use and designed to converge all the essential notice can adapt to the system in minutes. utilities around a patient’s bed. Standard panels are The system is modular, comprising a Central Display available for ICU, Wards, Private Rooms / Suites. The Console at the nurse-station counter (Optionally, also circuit protected panels carry provision for electrical with Ward Graphic Displays), a Bed Unit module behind power, illumination, communications, Bio-signals, data, each patient's bed and a Handset which reaches out to time and medical gas. A stainless steel universal medical the patient through a length of flexible cable. A Door rail is also provided for holding a range of accessories Display Unit can also be mounted at the room entrance like Utility baskets, Case sheet holders, Blood Pressure – with Nurse-Presence Registration. An Emergency Alert instrument holders, I-V Poles, etc. Patient-Bed Lamps Unit can be mounted within the toilet and / or also within may also accompany the panels. the shower stall.
Figure 1. Nurse-Call Systems
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www.m e d e g a t e t o d a y. c o m November-December 2014
Constructed from light weight extruded aluminium sheets and sections and stainless steel, and surface treated with an epoxy-polyester powder coat ensures a lifetime protection to the metal surface. It facilitates ease of cleaning and
Figure 2. Bed-Head Panels
PRODUCT LINE
ability to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non brick walls made of siporex or gypsum board. All panels have safety metal partitions between high voltage, low voltage and medical gas outlets. Medisystems manufactures a very wide range of such panels to meet practically every kind of need. Such panels are also available in custom configurations which include horizontal, vertical or wall angular orientation, in colours and finish of choice.
OPD Patient-Call Systems Medisystems OPD Patient-Call Systems are the ideal solution for queue management in busy crowded OPDs. Their configuration is based upon the number of consulting rooms and waiting areas of the OPD.
Figure 4. OT/ICU Ceiling Pendants
Figure 3. OPD Patient-Call Systems
The system consists of a Main Display Unit for the waiting area; door display units and desk units for the consulting rooms. The receptionist or cashier can also be connected to this system with additional desk units. The system scrolls all un-answered calls and can also remind for any un-attended calls. A lower programmable display line can carry social or promotional messages for the hospital. Bilingual displays can also be given. The system once installed is user-friendly, cost- effective and needs minimal support.
OT/ICU Ceiling Pendants Medisystems manufactures OT and ICU Pendants in rigid, single arm and double arm configurations. They are
fabricated from Aluminium or pure 304 Grade Stainless Steel sheets and extrusions. The suspension limb is a seamless extruded SS 304 tube of 100 mm dia. mounted with anchor bolts at the true ceiling and a cosmetic flange at the false ceiling. The main pendant body can be made in stainless steel or powder coated aluminium, as desired. The pendants carry provisions for upto six medical gas outlets, eight electrical outlets and data terminals. The pendant can provide entry of medical gas lines, data and electrical terminals on all sides. Electrical outlets can be mounted on a utility backbone which supports upto 4 shelves. These shelves can be employed for placing monitoring, anaesthesiology or other diagnostic/ therapeutic instruments. A utility pole for I-V dispensation can also be provided alongside the shelf array. CR Medisystems Pvt. Ltd.
Mumbai, India, Tel: 91-022-23094416, 23004930 E-Mail : medisystems@gmail.com, Web : www.medisystems.in
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INTERNATIONAL INDIA MEDICAL TOURISM CONGRESS (IIMTC) 13th and 14th December, 2014 Kempinski Hotel, New Delhi
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Dr. Adewale Alabi CEO Global Health Projects and Resources, Nigeria
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Xiao Fang Jia President CIHMTA China
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Dr. Narendra Saini Hony. Secretary General IMA
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Ambulance Equipments Shree Balaji surgical pvt ltd A/002,Ruchi CHS, Grd Flr Devidas Lane Borivali (W) Mumbai - 400103 M: 9820430338, E: sbsjaipur@gmail.com
ANESTHESIA EQUIPMENTS
diabetic care Products
Healthware Pvt. Ltd.
Headlines
Anand Bhuvan Ground Floor 84-A, Princess Street T: 022-66379370
diagnostic & lab products
Afford Medical Technologies pvt ltd
230,2nd Main Road, Sainikpuri Secunderabad - 500094, T: 040-32908880 akhand enterprises
G- 12, Shivlok House 1, Commercial Complex, Karampura, New Delhi- 110015 9350445559, 9717445559 akhandenterprises@gmail.com Medion Health Care Pvt Ltd
201, Shiv Industrial Estate, K.B.B. Marg Marg , Chinchpokli (E),Mumbai-12, M:9987642222 sales@medion.co.in
Autoclave & Sterilizers Jaiveer Surgical emporium
1570, Bhagirath Palace, Delhi-110006 T: 011- 23866065, 2386066, M: 9810880087 jainco.jain@gmail.com Creative Healthtech Pvt. Ltd.
M: 9811339989 Drager Medical Pvt. Ltd.
T: 022-40843826
bDS
biogene Diagnostics & Surgicals Deals in:
Diagnostic Kit, Elisia Range, All Rapid Range, All Surgical Goods, Glass Wear, Plastic Wear, Lab Equipment, Laboratory Chemical Reagents, Dental lab Materials, Medical Equip., Scientific Equipment, Dental products & Medical Disposable Range Flat No. D-337, Ground Floor, Pocket - 11, DDA Janta Flat Jasola, New Delhi - 110025 E-mail: bdsurgicals786@gmail.com
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Disposable
GITA HOSPITAL SUPPLIES
Haribharath Equipments Pvt. Ltd.
T: 022-25666869
Blood Pressure Apparatus Lab Hosp International
M: 9324152433 Remi Sales And Engineering Ltd
T: 022- 40589888 Sanlar Imex Services Pvt. Ltd.
M: 9833192894
Defibrillator Equipments Medical Solution
98873699736 84
serene Tower 8-2- 623/A Rd No. 10, Banjara Hills Hyderabad -500034 T: 040-23318229 Helios Endovision
1/1, Sahkar Niwas , Tekri Bunglow, nr.3 Petrol Pump Old Agra Road, Thane- 400602 M: 9820276976 Om Surgicals
65, Unique. Est., Nr.Jammunadas, Opp jawahar Talkies, Mulund (W)Mumbai-400080 T: 022- 25670626
ENT Equipment Instrument Tufft
Surgical house,44,Mission compound,Ajmer Road,Jaipur T: 141 2373125, 2368568
GLOVES Shree Balaji Surgical Pvt. Ltd. A-002, Ruchi CHSGround Floor, Devidas Lane Borivali (W), Mumbai 400103 Ph.: 022- 28954442 Nulife Global Medical Devices Pvt ltd
B6,Byculla Service Indl. Premices, D.K. Marg, Sussex Road,Byculla, Mumbai-27 T: 2374 8371/2/3
House of Hospital & Disposable Clothings
Surgeon Gown Suits, Caps, Face Mask, Patient Kurta-Pyjama, etc.
Ph.: 011-23860175, M: 9810370662
Sho-47, Naraina Bazar, Near Fountain, Chandni Chk, Delhi-6
Email: manojvtuli@gmail.com
Saras Life Solution
M: 9923455413
Endoscopy Instruments
Hitex healthcare
A-402,Laxmi sadan,Thakur Village, Kandivali Mumbai 22 28860782 Shree Balaji Surgical pvt ltd
1-B-30,Lalita Shashtri Nagar, Behind Kalpatru Shopping Centre, Jaipur-16 T: 0141- 2309675
ECG Equipments Hygeia Incorporation
HEALTHCARE PRODUCTS Shree Balaji Surgical Pvt. Ltd. A/2, Ruchi CHSGround Floor, Devidas Lane Borivali (W), Mumbai 400103 Ph.: 022- 28954442
HOME CARE Easy Care Group
4th Floor Shugar House, 93/95, Kazi Syed Street, Masjid Bunder (W) Mumbai 03 T: 02223450133 E: info@easycareglobal.com Nulife Global Medical Devices Pvt ltd
B6,Byculla Service Indl. Premices, D.K. Marg, Sussex Road,Byculla ,Mumbai-27 T: 022-2374 8371/2/3 Shree Balaji Surgical pvt ltd
S No. 16 , Navghar Bldg 59/ 60, Poonam sagar Complex Mira Road (E) Mumbai 401107 M: 9967064947
1-B-30,Lalita Shashtri Nagar,Behind Kalpatru Shopping Centre, Jaipur-16 T: 0141- 2309675
Nasan Medical Electronics Pvt. Ltd.
Cygnus Hospital
Rangoli Ist floor.,opp Karve Statue Kothrud Pune-411038 M: 8237032389
www.m e d e g a t e t o d a y. c o m November-December 2014
HOSPITALS (Multi Speciality) 1211,Tower-2, Pearls Omaxe,Netaji Subhash Place, New Delhi-110034 T: 011 42488393
CLASSIFIED Update
Fortis Escorts Heart Institute & Research Centre
Okhla Road, New Delhi-25 M: 91 11 4713 5000
Manaipal Hospitals
98, HAL Airport road, Bangalore-560 017 T: 080 - 2502 4444/3344 Pushpawati Singhania Research Institute
Press Enclave Marg, Sheikh Sarai, Phase-II, New Delhi – 110 017 Tel: 011 30611900
HOSPITAL CONSULTANCY Hosconnn
6, Chaithanya Complex Site 1, 17th Cross, Sir MV Nagar T.C. Palya Main Road, Bangalore M: 9845208778, Email: info@hosconnn.com
Red Sun Communication Pvt. Ltd. 304, Shubh House, 77 Swastik Society, B/H. City Centre, Navrangupura, Ahmedabad- 380009 T: 9376121646
Hospitech
Bangalore T: 080 40998807
Health care Institution Global Institutte of Healthcare Management
6 sigma house, 10A, Phase -1, Najafgarh New Delhi-43 T: 011 2532 4000,4001
HOSPITAL FURNITURE Godrej & Boyce Manufacturing company ltd.
Pirojshanagar, Vikhroli, Mumbai- 400079 T: 022- 67965656 Jaiveer Surgical Emporium
1570, Bhagirath Palace, delhi-110006 M: 9810820087 Janak Healthcare Pvt. Ltd.
kalpataru Point, Unit No. -12 1st floor, sion (E) 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
Rehabilitation Product &AIDS
Philips India Ltd.
9th Flr, DLF, 9b , DLF, Cyber city, DLF Phase- 3 sec 25, Gurgaon-122002 T: 0124- 4606000
MOdular- Operation Theatre
Vissco Rehabilitation AIDS Pvt. Ltd.
517, Tulsiani Chambers, Nariman Point Mumbai-400021 T: 022-43330300
Sai Sumeet Appliances
Medical Equipment
Hyderabad M: 08099119595
Technocare Medisystems
Monitoring Equipments & Accesso Afford Medical Technologies Pvt. Ltd.
230, 2nd Main Road, Sainikpuri Secunderabad-94 T: 040-32908880
C/1310-11,New Bombay Market, Umarwada,Surat- 395010 T: 261 2332042,6569308
Shoes Cover Dispenser BIO-X
Drager Medical Pvt. Ltd.
Gold line Business Centre, Link Road Malad (W) Mumbai-400064 T: 022- 40843826 Medion Healthcare Pvt. Ltd.
201, Shiv Industrial Estate, K.B.B. Marg Chinchpokli (E) Mumbai-12 T: 022-23771737
5th floor, Span center, South Avene Santacruz (w) Mumbai-400054 M: 9820355995
Software and IT Solution
Nihon Kohden India Pvt. Ltd.
308, Tower- A, Spaz Edge, Sector- 47, Sohna Road Gurgaon- 122002 T: 0124-4931000
Neonatal Pediatric Intensive c Bird Mediteck
109, 110, NidhiIndl Est, Shankar Industrial Complex No. 2, Waliv, Vasai, Thane-08 T: 0250-3212729
operation theatre equipment
Schrack Seconet AG
Agora Climate Control system
T: 124 414150
Unit No. C-1/2/3/, Sagar Sangam Ind. Est., Sativali Vasai (E) Thane-24 T: 0251-2872193
Kodak Alaris
SURGICAL BLADES
Bird Meditech
109, 110, Nidhi Ind. Est., Nh No. 8, waliv, Vasai (E) Mumbai- 401208 T: 0250-3212729 Magnatek Enterprises
97, SVC Indl Est.Balanagar, Hyderabad-500037 T: 040-65501094
Nurse Calling System
Ribbel International Ltd
20th Mile, Jatheri Road, P.O.RaiNear Rai Industrial Area Sonepat Haryana 131029 M: 8053111016, 8053111011
UROLOGY Ribbel International Ltd
20th Mile, Jatheri Road, P.O.RaiNear Rai Industrial Area Sonepat Haryana 131029 M: 8053111016, 8053111011, sales@ribbel.com
CR Medisystems Pvt. Ltd.
Mumbai, India. Tel : 91-022-23094416, 23004930 E-Mail : medisystems@gmail.com
operation theatre Light Magnatek Enterprises
97, SVC Indl Est., Balanagar, Hyderabad-500037 T: 040-65501094
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www.kodakalaris.com
X- Ray Equipment Allengers
S.C.O 212-213-214, sector 34,Chandigarh - U.T 160 022 (India) T: 172 3012280-84
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uro
UroVysion
innovative . clinical . diagnostics
“An FDA approved, non invasive test for bladder cancer detection & recurrence monitoring. Recommended for patients with haematuria�
belief
UroVysion is a multiprobe flouroscence in situ hybridization (FISH) assay that detects chromosomal abnormalities (3, 7, 17 & 9q21 locus deletion )in bladder cancer. Now included in NCCN Guidelines.
impact
High sensitivity of up to 81% and is a useful adjunct to atypical urine cytology in suspected bladder cancer cases. Significant increase in the sensitivity up to 97% when combined with cystoscopy1,2.
value
The chromosomal aberrations caught on UroVysion might indicate premalignant changes warranting a more aggressive surveillance for such cases. The test is easy to take and requires only 20ml of voided urine or 50 ml of bladder washings.
References: 1. Karnes, Halling, Blute et al., AUA Poster 1005, 2003 2. Halling KC et al., J Urol. 2000;164:1768-1775 3. NCCN guidelines, version 1.0, 2013
406, Udyog Vihar, Phase III, Gurgaon, Haryana: 122016 I T: +91 124 4615 615 or 1800 1032 673 (Toll Free) info@corediagnostics.in I www.corediagnostics.in DMF No. 26710
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Medical Equipment Finance
S
hriram Equipment Finance Company Ltd (SEFC) is a part of the “SHRIRAM” Conglomerate which has significant presence in financial services. SEFC is a fully owned subsidiary of Shriram Transport Finance Company (STFC) which is India’s largest NBFC with assets under management of over INR 520 billion. SEFC is a leading NBFC in infrastructure equipment lending, having started its operations in October 2010, it has already attained a most prominent position in Construction Equipment Finance space in the country. With a customer base of over 20,000, employee base of over 1200 and Assets under Management of over INR 35 billion, SEFC operates through a wide network of over 165+ branches across India while catering to needs of all classes of customers across the geography of the country.
Largest Retail focused company Understanding the distributed customer profile across geography, the risks associated with the profile and segment, Shriram Equipment Finance is focused to empower small and medium enterprises/Individuals with easy and attractive finance option available at their doorstep. Today SEFC is one of the largest retail segment financer in Construction Equipment segment and same would be replicated for Medical Equipment Finance business as well.
PAN India Coverage
Leveraging Shriram Transport’s presence in more than 650 branches, SEFC has manned its operations at 165+ locations thereby covering entire geography of the country. Having started Medical Equipment Financing in 18 branches currently, SEFC has launched Medical Equipment Financing business intends to spread into all 165 locations across the country. primarily focusing on diagnostic and dentistry equipments. Superior Product Offering SEFC intends to aggressively finance equipments like X ray machines, CT scan, MRI machines, Ultrasound, Doppler & Shriram Equipment Finance with its superior industry Monitors, Mammography machines, Dental chairs & lazers, understanding and underwriting skills has evolved product Dental Radiology equipments, cathlabs i.e. to Diagnosis offering in terms of asset selection, Loan-To-Value, tenor and Centres, Nursing Homes, Hospitals as well as individual other finance terms flexible that is by far the best in the industry. Doctors and specialists. Having started its operations at 15 key cities spread across the country, SEFC aims to expand into 60+ centres catering to all customers in this segment in next 3 to 4 months. Eventually this business will be operated out at all 165 branches of the company. Shriram Equipment Finance with its focused approach in industry brings in pronounced advantages for both customers and manufacturers:
Simplified & fastest loan processing Shriram Equipment Finance has simplified and efficient deal processing system aided with cutting edge technology support to provide shortest Turn-Around-Time in the country. SEFC conclude finance and due-diligence aspects of deal within time that is 50% of industry average TAT. 86
www.m e d e g a t e t o d a y. c o m November-December 2014
Covering all & everywhere
Shriram Equipment Finance believes and demonstrates financial inclusion of all asset classes/models and customer grades with best in industry product offering. Complete coverage to the matrix of assets and customer grades make Shriram Equipment Finance a comprehensive solution provider in this segment.
Shriram Equipment Finance – “makes it happen” Contact us: Business Head Shriram Equipment Finance Co. Ltd. 302-306, Shabri Samriddhi Building Sion Trombay Road, Chembur, Mumbai-400071 Tel: +91 22 61146500, Email: enquiry@sefc.in Website: http://sefc.in
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