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Editor’s Note magazine

World Heart Day takes place on

Volume - IV Issue - III Sep - Oct 2013 Editor

29th September each year The World Heart Day is organized by World Heart Federation, a non-governmental organization with its headquaters in Geneva, Switzerland, endorsed by World Health Organization and other organizations.

It identifies the numerous factors responsible for the cardiovascular diseases and premature deaths. World Heart Federation also spreads the news on how stroke and heart diseases could be avoided if physical activities and unhealthy diets are controlled.

World Heart Federation also imparts important information related to signs and symptoms of a heart attack or stroke. It tries to connect with policy makers, corporates and general public and spread the importance of a heart-healthy lifestyles.

Since its formation it has opted for many captivating themes to celebrate the event and create awareness among the people about the risk of heart diseases. The theme of World Heart Day 2013 is the importance of a life-course approach to the prevention and control of cardiovascular disease (CVD) with a focus on women and children. This campaign will highlight what actions can be taken through a person’s life to reduce their risk of CVD.

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Sep - Oct 2013 Contents

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18

Welness Expo 20013

3rd Rahul Gandhi

world Heart Day 19

20

Dr. JAGDISH PRASAD DIRECTOR

Dr. Rajiv Singhal Vice President

24

Dr. K.SRINATH REDDY PRESIDENT

6

Wockhardt Hospitals

8

Inmarsat and Cisco

26

Dr. PURSHOTAM LAL CHAIRMAN

Wockhardt Hospitals Ltd. today, announced that the W

Inmarsat (LSE:ISAT.L), the leading

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28

Healthcare Franchise

Dr. AJAY KAUL DIRECTOR

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Dr. RAJIVA KUMAR Child Specialist

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Dr. AARTI SHARMA, CONSULTANT

20 WORLD HEART DAY

22 BEST LONG TERM RESULTS FOR MULTIVESSEL

The Healthcare Franchise Knowledge Series, organized by

11 Tobacco Industry

Tobacco industry whistle-blower, DrJeffrey Wigand - whose personal and public

14

Bisphosphonates may

15

Somatropin injector

Wockhardt Hospitals Ltd. today

The Easypod auto injector used with Saizen (somatropin,

18 BM BIRLA becomes the Heart

Some bisphosphonates may offer an additional treatment option for

19 World Heart Day

Cardio-Vascular diseases CVDs) are the number one cause of death globally.

32

Woman’s Heart

Women are so busy taking care of everyone else that they their own health and

38 Diabetese and Oral Heart

Too much glucose also called “sugar”, in your blood from diabetes can be the

40 Patients who have

A few decades ago, Physiotherapy was limited only to Orthopaedic

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34

Protect your HEART from CVD

Highlighting the Need for Early

38

42

Rheumatic Heart Disease in Children

Electronic Wellness Record System by

NEWS UPDATE

Wockhardt Hospitals, Goa Becomes the First NABH Accredited Hospital in the State Wockhardt Hospitals, Goa receives prestigious NABH accreditation

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ockhardt Hospitals Ltd. today, announced that the Wockhardt Hospital, Goa has received accreditation from National Accreditation Board for Hospitals and Healthcare Providers (NABH), the highest national recognition and a mark of quality patient care and safety.

This makes Wockhardt Hospitals, Goa the First to be accredited in the state. With this recognition, Wockhardt Hospitals Ltd. has received their 5th NABH accreditation, making them the only Hospital group with the highest accreditations in the west zone.

The NABH accreditation is basis an evaluation of hospitals against 100 standards and 503 objective elements. NABH is an institutional member of International Society for Quality in Health Care (ISQua) as well as member of ISQua Accreditation Council. NABH standards for hospitals have been accredited by ISQua, thus hospitals accredited

by NABH will have international recognition. Wockhardt Hospitals, Goa, is a dedicated Super Specialty Hospital offering comprehensive, end to end care in Cardiology, Cardiac Surgery, Neurology, Neurosurgery, Orthopaedics and Joint Replacement Surgery.

Speaking on the occasion, Ms. Zahabiya Khorakiwala, MD, Wockhardt Hospitals said, “We at Wockhardt Hospitals are proud that our Goa hospital has been accredited by NABH. We are constantly working towards providing the best of services to our patients, enabling the benefits of the latest technological developments in the field of medicine.

Patients are the highest beneficiaries of the accreditation as it assures high quality of patient care and safety. This achievement strengthens our commitment to fulfil the needs of the community and provide patients care essential for their well being.�

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With this accreditation, The Wockhardt Institute of Aesthetics at Goa also became the First Institute of its kind in the country to be certified by NABH. The institute is known for its range of aesthetic surgeries and also for the fact that it is one of the first institutes that carries out such surgeries within a superspecialty hospital in a dedicated facility. It also has a substantial number of reconstructive surgeries that are carried out on patients with birth defects or trauma cases. The hospital offers the confidentiality and facilities required for carrying out aesthetic surgeries.

NABH is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for hospitals and healthcare organizations. NABH board is structured to cater to the desired needs of the consumers and to set benchmarks for the progress of the health industry.

The board while being supported by all stakeholders including industry, consumers and government; has full functional autonomy in its operation. ttt

Sep - Oct 2013

NEWS UPDATE

Inmarsat and Cisco team-Up to extend availability of eHealth Services Inmarsat’s satellite network fills connectivity gap for the world’s most isolated communities

Inmarsat (LSE:ISAT.L), the leading provider of global mobile satellite communications services, announced a new collaboration with Cisco to provide the satellite connectivity needed to make Cisco’s mobile telemedicine system, the Cisco TelePresence® VX Clinical Assistant, available in the world’s most remote and underserved communities. The strategic collaboration will enable Cisco to leverage Inmarsat’s global 3G satellite network, enabling medical teams to provide quality healthcare to communities that are located in areas with little or no terrestrial telecommunications infrastructure.

The VX Clinical Assistant gives healthcare facilities, including hospitals and clinics, the ability to interface

and collaborate with medical professionals anywhere in the world using Cisco TelePresence to share content and ultimately deliver medical care. The unit enables the delivery of virtual medical care through high definition videoconferencing and real-time transmission of key diagnostics ranging from ultrasounds to blood pressure readings.“The VX Clinical Assistant is a marvel of medical technology but its ability to help doctors in remote areas to diagnose, treat and monitor patients can be compromised by the absence of reliable terrestrial connectivity,” said Drew Brandy, Inmarsat’s Vice President, Industry. “Inmarsat’s award-winning, global satellite network offers ubiquitous IP broadband and unmatched reliability, empowering medical teams in the world’s most remote regions through access to high quality, reliable data and voice services.

Through Inmarsat’s network, healthcare professionals can communicate and share essential health statistics, in real time, with doctors located all over the world.” ttt

World Physical Therapy Day Celebrated in the Capital ISIC Celebrates World Physical Therapy Day

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n order to raise awareness on the crucial role of a physical therapist in keeping people healthy, mobile and independent, Indian Spinal Injuries Centre 9th September, celebrated World Physical Therapy Day. The day was celebrated with events such as debates, quizzes, extempore, poster presentations and sporting activities.

As World Physical Therapy Day is being celebrated all over the world, ISIC, already a big name in the field of rehabilitation has gone a step further in recognizing the importance and role of a physical therapist in a patient’s rehabilitation.

“At ISIC we encourage several educational competitions and promote budding physical therapists to bring forward their skills and knowledge on a common platform which in turn has helped several people lead healthy & independent lives,” says Dr. Chitra Kataria, Principal and HOD, Rehabilitation at ISIC. Physical therapists have different titles in different countries and are also called physiotherapists in some countries. Some countries even have their own versions of the word physical therapist, such as kinesiologist but 10

they are all part of the same profession.

Physical therapists provide services that develop, maintain and restore people’s movement and functional ability as much as possible and help people be fit for life. They can be of immense help to people at any stage of life, when physical movement and other functions are threatened by ageing, injury, diseases, disorders or environmental factors.

“Physical therapists also help millions of people avoid non-communicable diseases (NCDs) such as heart disease, stroke, diabetes, chronic respiratory disease and cancer through recommending safe and appropriate physical exercise programmes,” further adds Dr.Kataria.

Physical therapists help people maximise their quality of life by looking after their physical, psychological, emotional and social well being. They work in the spheres of promotion, prevention, treatment/intervention, habilitation and rehabilitation. ttt Sep - Oct 2013

NEWS UPDATE

Healthcare Franchise Knowledge Series concludes with unique perspectives on the Industry

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he Healthcare Franchise Knowledge Series, organized by Indian franchise association , was a successful congregation of Healthcare experts ,doctors and entrepreneurs seeking new business models in the world of Healthcare. Held at Le Meridian hotel, New Delhi, on 30th and 31st August, the event focussed on the best practices for integrating business interests with the highest degree of quality and sincere service that the industry commands.

Some of the prominent speakers at the conference were Sanjeev K Chaudhry, Managing Director, SRL Limited; Om Manchanda, CEO, Dr Lalpath Labs; Sandeep Ahuja, MD, VLCC Healthcare Ltd; Narendra Saini, Secy General, Indian Medical Association; Visham Sikand, Founder & CEO, Indian Health Organisation; Dr Girdhar Gyani, DG, Association of Healthcare Providers among others.

The Franchise Knowledge Series is especially designed for people looking at exploring growth opportunities for businesses in healthcare, wellness or alternative therapies.

It was formulated keeping in mind current and prospective franchisors and suppliers to the franchise and health care industries, prospective investors and entrepreneurs, and health care and medical professionals interested

in learning more about the opportunities presented by franchising.

Eminent speakers who threw light on the various fine points of being in the Healthcare industry were Dr. Sandeep Sharma, Promoter & Director of Axiss Dental; Shakun Rai, Chief Executive Officer Peridot Life Sciences; Ravi Gupta, Editor- in- Chief eHealth magazine amongst others. Some of the critical areas discussed were refranchising, PPP in healthcare, the correct organisational moment to enter into a franchising model, building the retail franchise brand, executing corporate aspirations at the franchisee level etc. ttt

DPP-4 inhibitors show no cardiovascular benefits

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wo major studies involving DPP-4 inhibitors have shown they have neutral overall effects on cardiovascular outcomes.

When used in patients with type 2 diabetes at risk of cardiovascular disease, saxagliptin did not increase or decrease the rate of ischaemic events, but did increase and the risk of hypoglycaemic events and hospitalisation for heart failure, according to a study

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in the New England journal of Medicine this week.

A separate study found that alogliptin had no effect on rates of major adverse cardiovascular events among patients with type 2 diabetes who had had a recent acute coronary syndrome. ttt

Sep - Oct 2013

NEWS UPDATE

Tobacco industry T

obacco industry whistle-blower, DrJeffrey Wigand - whose personal and public struggle against Big Tobacco was immortalised in the Hollywood blockbuster “The Insider” - arrives in New Delhi this week to speak to policy makers, civil society and journalists about public health and the tobacco industry.

He is the key speaker at a seminar (September 9, 2013) on public health and journalism jointly organised by Newslaundry in collaboration with Who’s There? Yes (WTY), a global journalism and public health mentoring initiative launched by Chitra Subramaniam Duella (Switzerland) and Dr Franklin Apfel (United Kingdom).

Called Media’s pH Value, this is a media-led public health discussion and the event marks the end of a three-week web-based conversation on aspects of tobacco control ranging from the disease burden to deceitful marketing tactics. The organisers believe that both public health and news media are public goods and a public service that should be publicly debated and accounted for.

“Tobacco kills and the tobacco industry is a very finelytuned machine that manufactures nicotine delivery devices that kill thousands every day. This man-made death machine is ruthless and it will stop at nothing – large developing countries like India are hunting grounds for these merchants of death”, Dr Wigand told Newslaundry.

Tobacco kills six million people in the world today, one million in India alone. “We cannot stand by and watch this public health disaster – strokes, cancers, heart-attacks, the list is long. And sadly there’s very little space in news for

Sep - Oct 2013

public health issues”, said Madhu Trehan.

A cigarette is the only freely available consumer product that kills one in two regular users. “Every tobacco-related death is preventable. Tobacco addiction is a communicated disease – communicated through advertising, marketing and deceitful tactics”, say Subramaniam and Apfel who led the World Health Organisation’s (WHO) flagship campaign “Tobacco Kills – Don’t be Duped” at the turn of the century. That WHO campaign which underpinned the development of the Framework Convention on Tobacco Control (FCTC) – the world’s first treaty entirely devoted to public health – was launched by Dr Wigand in 1999 on the sidelines of the release of the film, The Insider.

In 1989, Dr Wigand was brought on board as Vice President of R&D at Brown and Williamson to make safe cigarettes. In 1996, he appeared on the CBS news programme, 60 Minutes and stated that Brown and Williamson had intentionally manipulated its tobacco blend to increase the amount of nicotine in cigarette smoke. He was harassed, received death threats and his story was portrayed by Russel Crowe in the 1999 film “The Insider” directed by Michael Mann also starring Al Pacino and Christopher Plummer. The Academy Award nominatedfilm is also a commentary on journalism and media organisations. ttt www.newslaundry.com

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NEWS UPDATE

Welness Expo 2013

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are world Tv, Asia’s only health care satellite tv channel, invited the city of Mumbai to be present at the The Wellness Expo 2013- Complete Wellness Under One Roof. Over 5000+ people stepped away from their daily chores to visit the mega event which made all the health & wellness products & services easily accessible at the same time & the same place.

The event was organized on August 24 & 25, 2013 at Tulip Star, Juhu. Honored guests & participants included big brands such as GRD, Mind Spa, Shreeji Biotech, Cmax, Health Total & so on and Celebrities like Smita Jaykar, Prem Chopra, Gufi Paintal, Pooja Mishra, Sudeep Pandey, Sahila Chadha and many more. The main objective of the expo was to inform, advise and spread awareness related to health issues and the cons of self-medication. Speaking about this, Ajit Gupta, Managing Director, Care World TV, said: “This expo has been organized by Care World TV as a part of a campaign against self-medication. It is a part of the strategy of informing and educating everyone about the developments and nuances within the Wellness Sector. It is open for anyone and everyone.”

70+ established brands of various wellness genres were present to make people aware of the options available to 14

enhance beauty, fitness or tranquility. Free cancer check up, aura scanning, different ways to heal & take care of the mind, body, beauty and soul present under the same roof were the highlights of the grand event. The Expo introduced Wellness Mall, India’s first consumer-friendly online e-wellness mall that offers a wide spectrum of products hand-picked by expert panels consisting of doctors and health experts.The event made a lasting impression on the celebrities and here is what they had to say Prem Chopra commented “It’s a great initiative to have a wellness expo. Wish u a very best of luck and hope to see many such events in future.” Gufi Paintal said “Wellness Expo is a very nice concept and a great start.

People will get to know what is good for them physically and mentally.” Pooja Sharma, Big Boss 5 fame, said “Wellness, fitness & health has become an integral part of our life. I happen to go through the stalls and they have everything from fairness cream to vastu shastra to fengshui. I think that is a lot under one roof.” Sahila Chadha remarked “The event is very amazing. Health is wealth and this Expo is great to keep us informed & keep healthy.” ttt

Sep - Oct 2013

NEWS UPDATE

Bisphosphonates may be effective in osteoarthritis

Study points to high cost of prosthetic joint infection

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he cost of treating a prosthetic joint infection can be as much as $66,000, Australian research suggests.The study of 140 patients across 10 hospitals identified a number factors linked to increased hospital, surgery and antibiotic costs of treating prosthetic joint infections.

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ome bisphosphonates may offer an additional treatment option for osteoarthritis, UK researchers have suggested.The drugs that have traditionally been used to prevent osteoporosis are currently being investigated for their analgesic and disease modifying effects on OA, according to clinicians at the University of London.In a systematic review of the literature on bisphosphonates and arthritis they found limited evidence of benefit for bisphosphonates, and concluded that more targeted studies were needed to look at the timing, site of action and effect of the drugs on bone structure.

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Septic revision arthroplasty upped costs by around 70%, as did hypotension on presentation, said the authors from Melbourne’s St Vincent’s and Alfred Hospitals.

Polymicrobial infections were associated with a 41% increase while culture-negative infections decreased costs by 29%, they found.Surgery with either onestage exchange or resection arthroplasty increased costs while treatment failure – which occurred in nearly a third of patients – raised costs by over 150%.The median cost per patient of a successful treatment of a prosthetic joint infection was $25,300 but this rose to $66,400 when the initial treatment was unsuccessful, the authors calculated.

Golden Staph accounted for just over half the infections while around a third were polymicrobial and involved enteric bacteria such as E. coli, the study found. ttt

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Metformin linked to cognitive decline

he widely-used diabetes drug metformin is associated with cognitive impairment but this may be reversed with vitamin B12, Melbourne research has suggested.A study of more than 1300 patients found that those with diabetes (126) had lower cognitive performance than patients who did not have diabetes. People with diabetes, worse cognitive performance was associated with metformin use (odds ratio 2.23).The association was 16

weakened after taking into account vitamin B12 levels, suggesting that the effect metformin has on cognitive function may be mediated by vitamin B12, said the study authors from the University of Melbourne.They noted that calcium supplements had previously been shown to alleviate vitamin B12 deficiency and in their study better cognitive performance was seen among patients taking calcium supplements.According to the researchers, metformin is widely

used by patients with diabetes and its use is associated with vitamin B12 deficiency due to a drug interaction inhibiting uptake of the vitamin in the distal ileum. Calcium had been shown to reverse this interaction and alleviate metformin-induced vitamin B12 deficiency, they added.However, while calcium supplements might have benefits on cognitive function, caution was needed as they had also been linked to an increased risk of myocardial infarction. ttt Sep - Oct 2013

NEWS UPDATE

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Somatropin injector recalled over dosing issue

he Easypod auto injector used with Saizen (somatropin, growth hormone) is being recalled and will be replaced with newer model.

The Therapeutic Goods Administration in conjunction with manufacturer Merck Serono Australia has announced that the 5.1 model of Easypod auto injectors is subject to a recall notice due to the potential for dosing confusion.

The injectors are used to administer Saizen (somatropin), a human growth hormone used to treat growth failure in children and growth hormone deficiency in adults.

According to the recall notice, the Easypod auto injectors are preprogrammed to deliver the correct dose of Saizen to the user. However, not every patient being treated with Saizen uses an Easypod auto injector.“It has been identified that there is potential for patients using the current 5.1 model to inject too much or too little Saizen if they override a safety mechanism that warns if the Saizen cartridge does not match the device’s programmed settings,� the notice

says.Merck Serono Australia says it is arranging to replace all of these devices (and any earlier models) with the new 5.2 model free of charge. The new model will not give an injection if the information programmed into the device does not match the information about the Saizen loaded into it.Doctors who have prescribed Saizen to patients have been requested in a letter to contact patients to verify if they use Easypod auto injector and, if so, to provide them a patient information leaflet.

Affected patients should be advised to continue using Saizen while waiting for their replacement device.

The potential for incorrect dosing was identified after investigation of overseas reports, in which inadequate reprogramming of Easypod auto injectors had been undertaken when patients switched from Saizen solution to Saizen powder. Saizen solution is available in either 5.83 mg/mL or 8 mg/mL concentration.

Fish oil may prevent methotrexate bone loss

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upplements of fish oil and genistein may prevent the deleterious effects of the chemotherapeutic agent methotrexate on bone density, animal studies have suggested.Researchers at the Sansom Institute for Health Research in Adelaide have shown that fish oil and/or genistein given concomitantly with methotrexate

enabled preservation of osteogenic differentiation, osteoblast numbers and bone volume.The supplements also prevented methotrexate-induced increases in bone marrow adiposity, osteoclastogenic cytokine expression and osteoclast formation when used in a rat model for five days. ttt

Sep - Oct 2013

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NEWS UPDATE

3rd Rahul Gandhi National Awards For Excellence 2013 In Media, Health, Education and NGO/CSR (Nominations Open)

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LL award ceremonies have their own stars and moments of pride. Rahul Gandhi National Awards For Excellence 2013, is a platform that will recognize purposeful contributions made by individuals and organizations, in the field of Media, Education, Healthcare and NGO / CSR. It is a dais to share best practices in these fields for a larger community benefit.

Rahul Gandhi National Awards For Excellence 2013 will be held at ‘The Ashok’, New Delhi. This grand occasion will be a host to some of the biggest names in the industry. ‘rahulgandhikabharat.com’, a dedicated portal for Shri Rahul Gandhi which is run by an NGO gandhikabharat. com, is honored to invite you to offer your candidature or your organization for these National awards under the categories of Media, Health, Education and NGO/CSR. ‘gandhikabharat.com (NGO)’ believes in the power of innovation and unity to transform the country into a developed Nation. We believe that an innovative approach has the ability to move boundaries beyond imaginations and it is our endeavor to bring success in leaps and bounds to our country.

RAHUL GANDHI VICE PRESIDENT - AICC

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Each year the honorable jury chooses the most deserving candidates, organizations and institutions from the nominations filed. The winners are the ones who have the broadest and most profound knowledge of their respective fields in the country and their respective regions.

After the grand success of these National awards last year, we are here again, recognizing professionals and individuals from different fields and genres who have made extraordinary contributions in their field of work.

It is the third consecutive year for awards and your nomination plays a significant part in the accumulation of a bank of knowledge. It forms the basis for the eminent Sep - Oct 2013

NEWS UPDATE

After the grand success of these National awards last year, we are here again, recognizing professionals and individuals from different fields and genres who have made extraordinary contributions in their field of work. It is the third consecutive year for awards and your nomination plays a significant part in the accumulation of a bank of knowledge. It forms the basis for the eminent jury, in finding the winner who, in the spirit of Rahul Gandhi, best promotes and works in the uplifting of the respective fields. jury, in finding the winner who, in the spirit of Rahul Gandhi, best promotes and works in the uplifting of the respective fields.

We warmly invite you to take part in the nomination process for 3rd Rahul Gandhi National Awards For Excellence 2013 in Media, Health, Education and NGO/CSR Media

We are here to award the finest media professionals and organizations that have contributed to the society and the growth of the country. The efforts of these individuals and organizations will be judged by our esteemed jury for their overall contributions in their respective fields and area of work.

Sep - Oct 2013

Health

We are here to recognize the most innovative and creative growth strategies and medical solutions adopted by individuals and the organizations in healthcare industry.

These awards will be presented to the organizations in the healthcare or medical sector that have demonstrated the best practices in several regional and global markets.

Education

We are identifying revolutionary, transformative and innovative projects. These awards will distinguish individuals, institutions and organizations that promote and showcase innovative and revolutionary educational projects that have a transformative impact on societies, communities and education sector at large.

NGO / CSR

We aim to press forward India’s non-profit field by promoting and strengthening community support of civil society. We aspire to promote ethical standards and practices with overall transparency, resource mobilization and accountability. In order to achieve so, we are celebrating the excellence and distinction in this sector for long term protraction.

To file the nominations:

Option1: Log on to the website http://www.rahulgandhikabharat.com and submit the form Option 2: Download the form from the website http://www.rahulgandhikabharat.com and mail it to rg.nomination@gmail.com.

Any information that relates to new works or contain any other relevant new information along with the USP’s should be submitted along with the form. It is to be noted that the distinguished jury maintains the right to reject nominations; if made after the above mentioned date, if the form submitted is incomplete or contains false information or otherwise invalid in any sense.

Any queries can be addressed to: Phone No: +91 8588871446

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NEWS UPDATE

BM Birla becomes the Heart of Healthcare with ‘Shishu Sathi’ A Noble initiative in aid with the Government of West Bengal

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M Birla Heart Research Centre in association with The Government of West Bengal announced the success of ‘Sishu Sathi’, a noble initiative of West Bengal Health and Family Welfare Department. The occasion was graced by the revered Dr. Biswaranjan Sathpathi, Director of Health Services, Government of West Bengal, Mr. Rupak Barua, the CEO of B M Birla Heart Research Centre along with Dr. Sushan Mukhopadhyaya and Dr. Lalit Kapoor. B.M. Birla Heart Research Centre is intrinsic in taking this initiative to provide optimum healthcare for children who are suffering from cardiac ailments.

Two children, Sandipa Biswas (4yrs.) and Kaushik Hazra (8yrs) were admitted to the hospital with holes in their heart. The surgical team of 20

B.M. Birla Heart Research Centre has successfully performed life saving surgeries on them under the leadership of Dr. Sushan Mukhopadhyaya and Dr. Lalit Kapoor. Under this scheme quality cardiac care has been provided without charging a penny from the family. Purnima, one of the parents of a patient said “It seems like a dream, I never thought that we could do the surgery in a private hospital without spending a dime. I am thankful to the surgeons who monitored my child with care and everyone else for their support in saving my daughter” This surgery Hazra, according Mukhopadhayay, complicated, as he

of Kaushik to Dr. Sushan was a little had a congenital

Ventricular Septal Defect. Dr. Mukhopadhyay said “ It’s great to see the child doing well , in fact in India with this initiative we can actually bring quality change in the lives of many with advanced paediatric correction at the right time, thousands of children having congenital cardiac problems can lead a quality life” Talking about the initiative Mr.Rupak Barua said, “It is indeed our privilege to be a part of ‘Sishu Sathi’ and we are extremely happy and welcome this intiative. We look forward in collaborating with the government with further such cases in future. It is a pleasure to see the smile of the children. In fact their smile is our reward.” ttt Sep - Oct 2013

WORLD HEART DAY

NEWS UPDATE

WORLD HEART DAY Dr. jAGDISH PRASAD

Director, GENERAL OF HEALTH SERVICES, GOVT OF INDIA MINISTRY OF HEALTH & FAMILY WALFARE

I am happy to know that world heart day would be observed on 29th September 2013, with the focus on women and children

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ardio-Vascular diseases CVDs) are the number one cause of death globally. More people die from CVDs than from any other cause. More than 80% deaths from CVD occur in low and middle-income countries. The number of people, who die from CVDs, mainly from heart disease and stroke, will increase to reach likely 23.3 million by 2030. CVDs are projected to remain the single leading cause of death. Most CVD diseases can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, high blood pressure, diabetes and raised lipids.

Cardiovascular diseases affect all of us sometime early and sometime late in our life. The technical ability to diagnose and treat as well as affordability has increased tremendously. Preventive measures should be inculcated Sep - Oct 2013

in our daily habits like doing exercise and physical activity, eating lot of fibers in our diet through increased intake of fruits and vegetables, refraining from use of tobacco and alcohol and managing stress.

To address the increasing burden of Chronic NonCommunicable Diseases, ‘National Programmes for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)’ has been initiated since 2010. High priority is being given to prevention & Control of NCDs including heart diseases in the national health policies and programmes. ttt

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WORLD HEART DAY

INTERVIEW

Dr. Rajiv Singhal Vice President Fortis Escorts Heart Institute, New Delhi

In his capacity as Vice President, apart from looking after the operations of FEHI he is also responsible for overseeing & managing the functioning of 4 Independent Hospitals Fortis Escorts Hospital Raipur, Fortis OP Jindal Hospital & Research Centre (Raigarh), Fortis Escorts Hospital, Dehradun & Fortis Escorts Hospital, Agra. Over 24 Fortis Cardiac Centers all over India & abroad.

What is the vision and mission of the hospital?

“To create a world-class integrated healthcare delivery system in India, entailing the finest medical skills combined with compassionate patient care� based on foundations of efficient systems and trust When was the hospital established, what was the bed strength, what departments and facilities did you start out with?

Fortis Escorts Heart Institute (FEHI) was incorporated in 1998and today is recognized as the ultimate cardiac care destination in the Asia Pacific region. The institute has been setting benchmarks in cardiac care with its pathbreaking work for over two decades. FEHI boasts of a vast pool of renowned doctors who are acknowledged leaders in their respective areas within the discipline of cardiology.

How has the hospital grown over the years, in terms of increase in profit, specialties and super-specialties and footfalls in the OPD?

22

Year on year, FEHI has continuously shown improvement in all areas of operations - financial growth, expansion, upgradation, new medical programs & quality patient care.

What is the current status of beds, departments, facilities?

The hospital today is 310 beded and offers a spectrum of offerings including Cardiac Bypass Surgery, Minimally InvasiveSurgery, Interventional Cardiology, Non-invasive Cardiology, PediatricCardiology and Pediatric Cardiac Surgery.

Tell us about the equipment and technology incorporated at the hospital?

There are 5 Cath Labs equipped with OCT & FFR technology, 9 OTs. FEHI is equipped with the best infrastructure and the latest technology required for cardiac bypass surgery, minimally invasive surgery (robotics), interventional cardiology, non-invasive cardiology, paediatric Sep - Oct 2013

INTERVIEW

cardiology and paediatric cardiac surgery. The hospital is backed by the most advanced laboratories performing complete range of investigative tests in the field of nuclear medicine, radiology, biochemistry, haematology, transfusion medicine and microbiology. It has a state of the art Nuclear Medicine Department, Cardiac MRI & besides a host of other world-class facilities.

What is the USP of the hospital/what makes the hospital stand out from others?

FEHI offers several firsts in areas of clinician engagement, specialty clinics, Medical Programs and the latest Technology Engagement is one of Fortis Escorts Heart Institute’s core values and EngagingClinicians is a critical element to building a quality and safety culture in the organization.Clinical Engagement empowers clinicians to improve collaboration toimprove patient outcomes.

In addition, the hospital runs several medical programs and new clinical technologies. In FY2012-13, the following new programs were instutionalised: TAVI – first time in India under LA A remote patient monitoring system aided by real time two way audio-visuals. It is an ideal blend of medicine with technology to improve critical care delivery. It is also a clinically proven programme that has resulted in delivering quality patient care with reduced the mortality & infection rates along with decrease in ALOS. On February 21st& 22nd 2012, Fortis Escorts Heart Institute performed India’s first TAVI procedure. The catheter procedure was developed in Europe, initially performed in 2002.

Electronic Anesthesia Charting A device that device which captures anesthesia records electronically.

Massimo – Intra - operative Fluid Management Technologies adopted in OR Intraoperative Fluid Management Technologies are adopted (IOFMT) in OR. It enables monitoring & management of patients’s Hydration status during major and high-risk surgeryFacilitated improved outcomes for patients.

Chest Pain Pathway Chest Pain Pathway (CPP) initiative was developed in collaboration with “The Medicines Company”, one of the Sep - Oct 2013

global leaders in Acute and Intensive care in the world.

Clinical pathways have been shown to have significant impact on quality andeconomics of healthcare worldwide.

The Chest Pain Pathway enableevidence based medicine at the point where it matters the most: at the patientbedside.

It works as guidance for clinical care of patients presenting with acute chest pain right from admission till discharge and follow up. It helps standardize clinical care based on international consensusguidelines customized by the Fortis Escorts It also augments efforts toestablish benchmarks in cardiac care by enabling measurement of qualityparameters in real time and take necessary actions.

Critinext – electronic ICU A remote patient monitoring system, aided by real time two way audio-visuals. It is an ideal blend of medicine with technology to improve critical care delivery. It is also a clinically proven programme and results in delivering quality patient care with reduced the mortality & infection rates along with decrease in ALOS. Fortis Escorts Heart Institute (FEHI) currently supports several CritiNext sites and 25 HCCs across 10 states and four countries.

Additional achievements include FEHI performed the first Cardiac patient in Asia with Coronary Artery Disease, successfully treated by using a Bioresorable Vascular Scaffold (BVS).FEHI is the first hospital in Asia, to enroll a patient into the ABSORB EXTEND trial, a worldwide trial of up to 1,000 patients at 100 centers in Europe, Asia Pacific, Canada and Latin America.

In a first-of-its-kind procedure conducted in India in FY13, two patients successfully underwent heart valve replacement without anaesthesia. Further, the drug-eluting bioreabsorbable vascular scaffold (BVS) was launched.

FEHI also created Fortis’s first team of Infusion Nurses to build capacity in this specialised area, and disseminate knowledge and best practices to other group hospitals.

The Fortis Acute Stroke Treatment (FAST) was launched in May 2012. On the preventive side, considering that diabetes puts individuals to greater heart-related risks, an exclusive helpline for diabetics and their caregivers commenced operations in September 2012. The helpline provides access to information on diabetes, its treatment and containment protocols. Fortis Organ Retrieval &

23

INTERVIEW

Transportation (FORT), an initiative aimed at helping save lives, was also launched in FY13.

During the year FY13, FEHI set a “Guinness World Record” for conducting 14,161 preventive cholesterol tests in a single day – the highest number achieved by any hospital in the world.

Please elaborate on the quality measures taken by the hospital?

The hospital’s quality Standards are at par with Best in the World. Its hospital, CABG and pediatric Congenital Cardiac Surgery Mortality rates lower than International standards..

Tell us about the future plans for the hospital

Some of the new Programs to be introduced include: yy Heart Transplantation

Program

-Establishing Heart Failure Clinic -LVAD: yy EP Program yy Hybrid Cath Lab – Launching Vascular Program : yy Strengthening TAVI yy E-ICU beyond borders with new locations in India and Overseas yy Strengthening Clinical Research

Firm-up Skin Relax Muscles and Nerves Safely, Fast with 1 mhz Ultrasonic Massagers

MuscleMate 38L

Additional Information: award and Accolades, FYI yy NABH Accredited 2008

1mhz Ultrasonic

yy Fortis Escorts has been awarded as Super Brand- 2008

yy Best Hospital in Delhi- Fortis Escorts, Mail Today- Feb, 2008 yy India’s most caring hospital, Ministry of Consumer Affairs, 2009

yy Best Cardiology Centre in India (Fortis Escorts Heart

Institute)- Declared in a survey yy conducted by Consumer Department (Government of India) -2009 yy JCI Accredited 2010 yy NABH Re-accreditation 2011 yy Blood Bank – NABH Accreditation, 2011 yy Asian Hospital Management Awards Excellence Award 2011 yy Most preferred Cardiac Hospital in North India- The Week’12 yy Best Single Specialty Hospital – Cardiology - ICICI Lombard & CNBC TV18 India yy Healthcare Awards 2012 yy Most Preferred Hospital for Cardiology in India– The Week’12 ttt

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WORLD HEART DAY

COVER STORY

Highlighting the Need for Early Diagnosis and Treatment of RHD

R

heumatic heart disease (RHD) is the most-common cardiovascular disease in young people less than 25 years of age and affects the most-vulnerable communities. RHD is caused by rheumatic fever (RF), which in turn isan abnormal autoimmune reaction to a throat infection with Group A Streptococcus (strep throat).

Although RF is a reaction to a communicable disease, RHD is a chronic, non-communicable condition that,if left untreated, can cause severe heart valve damage and lead to stroke, congestive heart failure and death

RHD makes pregnancy unsafe and kills or debilitates young people in their most productive years. Those with advanced RHD depend on costly and complicated medical care for survival that is unavailable and unaffordable for most of those who have the disease.

Dr.K.Srinath reddy President world heart federation 26

As in other developing countries, RHD is a major problem in India. Early prevalence studies, based on clinical examination, suggested that prevalence ranged between 1.0/1,000 and 5.4/1,000 children in India. However, a Sep - Oct 2013

COVER STORY more recent study based on echocardiographic screening of 6,270 children in northern India found prevalence of 26.5 per 1,000 children (aged 11-15 years) and 12.6/1,000 in children aged 5-10 years. And while it has been suggested that there may have been a decline in RHD prevalence in some parts of the country, this should not prevent a focus on this devastating disease.

Indeed, RHD can be prevented and controlled. Treating strep throat with antibiotics can prevent RF. Moreover, regular antibiotics (usually by injections every three to four weeks) can prevent patients with RF from contracting further strep infections and causing progression of valve damage. But a number of barriers exist in ensuring effective control of RHD. Since RHD and RF were virtually eliminated in highresource settings they have been neglected at the global level. The dissolution of the WHO Global Programme on RF and RHD in 2001 has been accompanied by a sharp decrease in funding for research from all sectors of society. Consequently, identified research priorities aimed at preventing and controlling this disease are not being progressed as quickly as they need to be.

According to the recently published “Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease” successful prevention of RF and control of RHD requires education, treatment of streptococcal infection (primary prevention), registerbased secondary prevention and the medical treatment of patients with complications of RHD.

recurrence of RF and development for progression of RHDwithbenzathine penicillin G (BPG) intramuscular injections has been proven effective. But implementing a secondary prevention plan also has challenges – the inconsistent quality and supply of BPG and low patient compliance with three to four weekly BPG injections – that limit the efficacy of secondary prophylaxis.

The cost-effectiveness of primary prevention through sore throat screening programmes is still being debated.

But, comprehensive register-based control programmes (secondary prevention) are widely accepted as the most cost-effective method for controlling RF and RHD.

“There are many challenges associated with preventing and controlling RF and RHD,” said Dr K. Srinath Reddy, President of the World Heart Federation. “Without a doubt RF and RHD control programmes play a key role in eradicating this disease. But providing doctors with access to the equipment they need,ensuring the supply of high quality BPG, and educating parents will greatly help to drive early diagnosis and aid effective prevention.”

Coordinated screening and control programmes can help to identify patients before they progress to severe RHD for a fraction of the cost associated with treating these patients;and studies have proven that even in low-resource setting it is possible to implement these programmes.

Moreover the introduction of portable echocardiography machines has further increased the number of patients being identified in the early stages of the disease.

The Public Health Foundation of India is leading countrylevel efforts to control RHD. Globally, the World Heart Federation has identified the objective of reducing premature deaths from RF and RHD by 25 percentamong individuals aged <25 years by the year 2025 and is currently engaging with governments, civil society, patient advocates, clinicians, researchers and funding agencies to unify global efforts in pursing this goal.

Once identified, treating patients to prevent the

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Sep - Oct 2013

27

WORLD HEART DAY

COVER STORY

Protect Your Heart from CVD W

orld Heart Day is globally held on the last Sunday of September each year to inform people about cardiovascular diseases, which are the biggest cause of death worldwide. The event also aims to promote preventative measures that reduce the risk of cardiovascular diseases. This year world heart day is emphasized on prevention and control of cardiovascular disease (CVD) with a focus on women and children. As we know cardiovascular disease known as heart disease includes numerous problems. These problems are related to a process called atherosclerosis. Atherosclerosis is the build-up of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries becomes blocked, a heart attack can occur.

It is important to get help right away if any of these symptoms occur.

Dr. Purshotam Lal Padam vibhushan & Dr. BC Roy awardee, Chairman, Metro Group of Hospitals and heart institute

The most common symptom of cardiovascular disease is called angina.

Angina is often referred to as chest pain. It is described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw.

There are four main types of CVD

Coronary heart disease Coronary heart disease is the blockage of the coronary arteries, usually 28

Sep - Oct 2013

COVER STORY

caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaques) on the inner walls of the arteries. These plaques can restrict blood flow to the heart muscle by physically clogging the artery or by causing abnormal artery function.

Stroke A stroke, sometimes referred to by the older term cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.

Aortic valve steno sis (AS)

Aortic valve steno sis (AS) is a disease of the heart valves in which the opening of the aortic valve is narrowed. The aortic valve is the valve between the left ventricle of the heart and the aorta, which is the largest artery in the body and carries the entire output of blood.

Peripheral arterial disease

Peripheral arterial disease (P.A.D.) is a disease in which plaque (plak) builds up‑ in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.

When plaque builds up in the body's arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on P.A.D. that affects blood flow to the legs.

In case of any cardiovascular diseases, the doctor will advise you of medications and lifestyle changes according to how badly the heart was damaged and what degree of heart disease caused the heart attack. The major causes of cardiovascular disease are tobacco use, physical Sep - Oct 2013

inactivity, an unhealthy diet and harmful use of alcohol.

Smoking yy The carcinogens found in cigarettes are part of the

relationship between smoking and heart disease. These substances that are in the cigarette are absorbed into the blood stream. As a result, the blood becomes contaminated.

Diabetes yy Some people believe that they need to have been born

with diabetes for it to be a factor; but in fact, a person can get type two diabetes. Type two diabetes usually comes about when a person is very much overweight, particularly because of their diet. Too many people have a fondness for junk food, and junk food has a hefty amount of sugar in it.

Eating too much sugar not only makes considerable weight increase, it also increases the level of sugar in the blood.

Hypertension or high blood pressure yy Hypertensive heart disease is on the whole a more serious

and dangerous form of heart disease and it is normally caused by uncontrolled and extended elevation of blood pressure, as this can lead to various changes in the myocardial structure, coronary vasculature, and conduction system of the heart.

Stress

yy There are two types of stress: physical stress and emotional

stress. The physical stress places quantifiable and reproducible demands on the heart, and this physical stress which is usually accredited as being good and in fact, the lack of physical stress is what considered as being a major risk factor for heart disease. yy You may have family history of heart disease yy Kidney disease can be one of the regions of heart disease. yy Your risk of CVD also increases as you get older. yy You can help to prevent CVD by living a healthy lifestyle, for example eat a healthy, balanced diet that is low in salt and saturated fat. yy Take regular exercise yy Keep your weight the healthy range (use the BMI tool to check whether you are a healthy weight) yy If you smoke, give up yy Don’t drink too much alcohol If you have diabetes, controlling your blood glucose level will also help to reduce your risk of CVD. ttt

29

WORLD HEART DAY

COVER STORY

BEST LONG TERM RESULTS FOR MULTIVESSEL CORONARY ARTERY DISEASE IN DIABETIC PATIENTS Dr.Ajay Kaul

Director, Department of Cardiovascular surgery, Fortis Escorts heart institute Delhi

C

urrent evidence supports a policy of increasing use of arterial grafts during CABG, bilateral internal mammary arteries in particular.

It has been proved beyond doubt that the arterial graft not only stays patent for a long time but also reduce the incidence of Re-operations after CABG Unfortunately almost 90% of patients who undergo coronary artery bypass grafting have leg veins used at Escorts Heart Institute.

Most CABG patients require grafting of the three main native coronary arteries; for the last 15 years the â&#x20AC;&#x153;standardâ&#x20AC;? operation has achieved this using a single internal mammary artery (SIMA) and supplemental vein grafts Although this procedure achieves excellent short and medium term outcome, the long term results are limited by progressive vein graft failure, almost 50% of the vein grafts are blocked by 10 years .this is the reason for high incidence of redo procedures after vein grafts.

EVIDENCE FOR BILATERAL INTERNAL MAMMARY ARTERY GRAFT

Three recent studies tilt the balance in favour of BILATERAL INTERNAL MAMMARY ARTERY GRAFT(BIMA). In one large observational study the 30

Our patients ranged from 80 years old patient to Insulin dependent diabetes.

We have also used it in most of our reoperations.

Cleveland Clinic compared survival in over 8000 patients with a SIMA and 2000 patients with BIMA grafts.2 Significant survival advantages occurred in BIMA patients irrespective of age, ventricular function, and diabetes.

Furthermore, the benefits of BIMA grafts increased with duration of follow up and with particular reference to the need for redo surgery, being approximately 40% in SIMA and 8% in BIMA ANGIOGRAPHIC PATENCY OF BIMA GRAFTS

The survival benefit of the IMA graft is almost certainly due to its inherent resistance to the development of atherosclerosis, the IMA appears to remain patent indefinitely. Ten years after CABG up to 95% of IMA grafts remain in pristine condition whereas around three quarters of vein grafts are blocked or severely diseased.13 RISKS OF BIMA GRAFTS

Diabetic patients are those with potentially most to gain from BIMA grafts as they often have more severe, diffuse, and distal disease. Appropriate patient selection and modification of the IMA harvesting technique can significantly reduce the risk of impaired wound healing in these patients.

Almost 85% of over patients received bilateral internal memory arteries (BIMA). There are no cuts on hands or

Sep - Oct 2013

COVER STORY

legs. You will be glad to know that in last 400 consecutive patients operated using BIMA we had no mortality.

The morbidity was comparable with patients who had undergone routine CABG i.e. one IMA and vein grafts.

Our patients ranged from 80 years old patient to Insulin dependent diabetes. We have also used it in most of our reoperations.

You may find it interesting to go through the CT-angio of some of our post operative patients who had undergone total arterial CABG at Escorts Heart Institute CASE 1: A patient with diffused disease and multiple blocks of LAD was considered inoperable. However a technique of using IMA as â&#x20AC;&#x2DC;on lay patchâ&#x20AC;&#x2122; with jump graft to reconstruct LAD back to normal was performed. A perfusion scan showed no defect.

CASE 2: A 28 year old patient with LAD and LCx disease with a non dominant RCA, underwent CABG. Since his Sep - Oct 2013

radial artery and RIMA were not suitable for grafting, a single LIMA was used as a sequential graft to perfuse both the arteries. This operation requires highest degree of surgical skill. A small kink or stretch in the artery can lead to intractable arrhythmias.

CASE 3: A patient requiring revascularization to six vessels with diffused disease underwent total arterial CABG using BIMA to all six vessels. No vein grafts were used.

CONCLUSION

Though there is strong evidence that using bilateral IMA for CABG gives best long term results but less than 10% patients get these grafts , because this operation has a long learning curve and require high degree of surgical skill. The use of BIMA grafts improves survival and significantly reduces the need for redo surgery, without increasing perioperative mortality or morbidity. ttt 31

COVER STORY

Woman’s

heart!

The increased risk for heart disease often begins years before diabetes is diagnosed. If you are a person suffering from diabetes or a pre-diabetic, it’s better to take proper precautions in controlling your blood sugar levels and not let heart diseases hamper your normal life.

34

W

omen are so busy taking care of everyone else that they their own health and well-being tends to fall last.

According to the American Diabetes Association, one in three women will die of heart disease compared to one in nine women dying of breast cancer. Forty percent of heart attacks result in death.

Furthermore diabetes is a powerful risk factor for heart disease in women and such a condition is termed as Diabetic Heart disease (DHD). Women with diabetes are 2 times as likely to have a second heart attack and 4 times more likely to have heart failure than women without diabetes.

Sep - Oct 2013

COVER STORY Good news – preventive measures can save!

The good news is that if women start looking out for symptoms, seek help and get the right treatment, this can save lives and prevent permanent damage to the heart.

For some reason, heart disease and heart attacks are only associated with men. While it’s true that estrogen protects women’s heart for a majority of their lives, post menopause, women are as susceptible to heart disease as men. But the notion that heart disease doesn’t touch women is so strong that very often women even ignore symptoms of a heart attack. Ignoring heart health is a big mistake and women as well as men should take all the necessary measures to ensure a healthy heart.

The increased risk for heart disease often begins years before diabetes is diagnosed. If you are a person suffering from diabetes or a pre-diabetic, it’s better to take proper precautions in controlling your blood sugar levels and not let heart diseases hamper your normal life. With CGMS (for those who are insulin dependent) coupled with strict dietary regimen and regular exercise routine, sugar levels can be kept well within the normal range and people with diabetes can see their quality of life improving.

Continuous Glucose Monitoring System (CGMS) have made it possible to monitor and record blood glucose levels 288 times in a day for 3 continuous days.

Optional info

The CGMS can be easily inserted in the abdominal area and worn by the patient as they go about their normal activities like walking, exercise & swimming. The device gives useful information about what effect different activities have on the patient’s blood glucose levels and this data is uploaded on a computer in a graphical form.

It gives the person a clear idea as to how much the blood sugar has risen after a particular meal and can thereby take corrective measures.

develop. Once diagnosed with diabetes, a treatment plan with diet, exercise, medication, monitoring and control of blood glucose levels will prevent the long term complications of diabetes like heart attack.

New treatment for complicated hearts

For those who are already diagnosed with complications like diabetes and heart diseases, there is new hope. New technologies like Resolute Integrity, which is the first and the only stent approved by the US FDA for diabetic patients, provide superior deliverability and powerful clinical performance, making it easier to address the needs of complex cases especially occurring in Diabetic patients.

The complications with diabetic patients increase as they tend to have narrower, more tortuous arteries with more diffuse disease and persistently elevated bloodsugar levels. All of these factors can increase the rate of procedural complications and long-term safety risks.

Additionally, these patients are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization.

The vessel failure rate (TVF) with Resolute Integrity DES is less than 8% (with 1st generation stents it was 14 %) thus challenging to be equal to or even better than surgery (with vain grafts).

Optional info

Resolute Integrity DES, the innovative technology used, combines the powerful clinical advantages of Resolute DES with the groundbreaking continuous sinusoid technology (CST) that encompasses one continuous, single strand of wire, making each stent comparable to a flexible spring.)

Looking ahead!

This combined with insulin pump therapy are recommended for effective control. This therapy is today being more commonly used in India and all over the world because of their unique ability to continuously infuse insulin, closely mimicking the behavior of physiological secretion from a normal pancreas.

Diabetic Heart disease is a serious condition but not necessarily the death sentence that its name suggests.

Making informed decisions and opting for the right treatment can help save lives. If you are a woman, spread the word this ‘International Woman’s Day’ and help save more families.

It is important to detect diabetes early before complications

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Sep - Oct 2013

35

WORLD HEART DAY

DOCTOR SPEAK

Rheumatic

Heart Disease

in Children

Dr. Rajiva Kumar Child Specialist Muzaffarpur Bihar, INDIA

39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death. With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction.

36

O

ver the years, the medical management of RF has not changed. Paediatric and juvenile mitral stenosis (MS),

upto the age of 12 and 20 yr respectively, severe enough to require operative treatement was documented. These negate the belief that patients of RHD become symptomatic â&#x2030;Ľ20 years after RF as well as the fact that congestive cardiac failure in childhood indicates active carditis and RF. Nonsurgical balloon mitral valvotomy for MS has been initiated. Mitral and/ or aortic valve replacement during active RF in patients not responding to medical treatment has been found to be life saving as well as confizrming that congestive heart failure in acute RF is due to an acute haemodynamic overload.

Pathogenesis as well as susceptibility to RF continue to be elusive. Prevention of RF morbidity depends on secondary prophylaxis which cannot reduce the burden of diseases.

Primary prophylaxis is not feasible in the Sep - Oct 2013

DOCTOR SPEAK

absence of a suitable vaccine. Attempts to design an antistreptococcal vaccine utilizing the M-protein has not succeeded in the last 40 years. Besides pathogenesis many other questions remain unanswered. Rheumatic heart disease is the most serious complication of rheumatic fever. Acute rheumatic fever follows 0.3% of cases of group A beta-hemolytic streptococcal pharyngitis in children. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death. With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in the United States. Acute rheumatic fever and rheumatic heart disease are thought to result from an autoimmune response, but the exact pathogenesis remains unclear.

Incidence of this disease has decreased in developed countries, and the mortality rate has dropped to just above 0% since the 1960s. Worldwide, rheumatic heart disease remains a major health problem. Chronic rheumatic heart disease is estimated to occur in 5-30 Sep - Oct 2013

million children and young adults. The mortality rate from this disease remains 1-10%. A comprehensive resource provided by the World Health Organization (WHO) addresses the diagnosis and treatment Rheumatic fever develops in some children and adolescents following pharyngitis with group A betahemolytic Streptococcus (ie, Streptococcus pyogenes).

The organisms attach to the epithelial cells of the upper respiratory tract and produce a battery of enzymes allowing them to damage and invade human tissues.

After an incubation period of 2-4 days, the invading organisms elicit an acute inflammatory response with 3-5 days of sore throat, fever, malaise, headache, and an elevated leukocyte count.

In 0.3-3% of cases, infection leads to rheumatic fever several weeks after the sore throat has resolved. Only infections of the pharynx initiate or reactivate rheumatic fever. The organism spreads by direct contact with oral or respiratory secretions, and spread is enhanced by crowded living conditions. Patients remain infected for weeks after symptomatic resolution of pharyngitis and may serve as a reservoir for infecting others. Penicillin treatment shortens the clinical course of streptococcal pharyngitis and, more importantly, is effective in decreasing the incidence of major sequelae.

Group A Streptococcus is a gram-positive coccus that frequently colonizes the skin and oropharynx. This organism may cause suppurative disease, such as pharyngitis, impetigo, cellulitis, myositis, pneumonia, and puerperal sepsis. It also may be associated with nonsuppurative disease, such as rheumatic fever and acute poststreptococcal glomerulonephritis. Group A streptococci elaborate the cytolytic toxins streptolysins S and O. Of these, streptolysin O induces persistently high antibody titers that provide a useful marker of group A streptococcal infection and its nonsuppurative complications.

Group A Streptococcus, as identified using the Lancefield classification, has a group A carbohydrate antigen in the cell wall that is composed of a branched polymer of Lrhamnose and N- acetyl-D-glucosamine in a 2:1 ratio.

Group A streptococci may be subserotyped by surface proteins on the cell wall of the organism. The presence of the M protein is the most important virulence factor for group A streptococcal infection in humans.

37

DOCTOR SPEKA

More than 120 M protein serotypes or M protein genotypes have been identified[2] , some of which have a long terminal antigenic domain (ie, epitopes) similar to antigens in various components of the human heart.

Rheumatogenic strains are often encapsulated mucoid strains, rich in M proteins, and resistant to phagocytosis.

These strains are strongly immunogenic, and anti-M antibodies against the streptococcal infection may crossreact with components of heart tissue (ie, sarcolemmal membranes, valve glycoproteins). Currently, emm typing

is felt to be more discriminating than M typing.

Acute rheumatic heart disease often produces a pancarditis characterized by endocarditis, myocarditis, and pericarditis. Endocarditis is manifested as valve insufficiency. The mitral valve is most commonly and severely affected (65-70% of patients), and the aortic valve is second in frequency (25%). The tricuspid valve is deformed in only 10% of patients and is almost always associated with mitral and aortic lesions. The pulmonary valve is rarely affected. Severe valve insufficiency during the acute phase may result in congestive heart failure and even death (1% of patients). Whether myocardial dysfunction during acute rheumatic fever is primarily related to myocarditis or is secondary to congestive heart failure from severe valve insufficiency is not known.

Pericarditis, when present, rarely affects cardiac function or results in constrictive pericarditis.

Chronic manifestations due to residual and progressive valve deformity occur in 9-39% of adults with previous rheumatic heart disease. Fusion of the valve apparatus resulting in stenosis or a combination of stenosis and insufficiency develops 2-10 years after an episode of acute rheumatic fever, and recurrent episodes may cause progressive damage to the valves. Fusion occurs at the level of the valve commissures, cusps, chordal attachments, or any combination of these. Rheumatic heart disease is responsible for 99% of mitral valve stenosis in adults in the United States. Associated atrial fibrillation or left atrial thrombus formation from chronic mitral valve involvement and atrial enlargement may be observed.

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Sep - Oct 2013

WORLD HEART DAY

DENTAL HYGIENE

DIABETES AND ORAL HEALTH

This can create conditions that show the way to infection in the mouth.

Since diabetes decreases the bodyâ&#x20AC;&#x2122;s resistance to infection, the gums are among the first of the tissues likely to be effected. Periodontal (gum) diseases are infections of the gum and one that hold your teeth in place. It can lead to c difficulty in chewing and loss of teeth.

Dr. Aarti Sharma, Consultant-Dental Operations, Clove Dental

40

Sep - Oct 2013

DENTAL HYGIENE

Introduction

Too much glucose also called “sugar”, in your blood from diabetes can be the reason of pain and infection, in your mouth. People who have diabetes know the disease can impairment of the eyes, nerves, kidneys and heart.

Did you know diabetes can also be the cause of various problems in your mouth?

Diabetes if not controlled appropriately, the elevated glucose levels in saliva may help the bacteria to flourish.

Plaque that is not removed can eventually harden into tartar. When tartar collects above the gum line, it becomes more difficult to thoroughly brush and clean between teeth. This can create conditions that show the way to infection in the mouth. Since diabetes decreases the body’s resistance to infection, the gums are among the first of the tissues likely to be effected. Periodontal (gum) diseases are infections of the gum and one that hold your teeth in place. It can lead to c difficulty in chewing and loss of teeth. Dry mouth is very often a symptom of undetected diabetes. This can also cause soreness, ulcers, infections, and tooth decay. Smoking causes these problems to get worse.

The other common oral health problems associated with diabetes are tooth decay; salivary gland dysfunction; fungal infections; lichen planus and lichenoid reactions (inflammatory skin disease); infection and delayed healing; taste impairment.

the oral complications of diabetes. The dentist may also suggest the use of antimicrobial mouth washes to control the gum disease.

Watch for signs and symptoms of oral disease and contact the dental office immediately when a problem arises. Observe good oral hygiene at home; follow your physician’s instructions regarding diet and medicines, plan regular 6 month dental checkups to maintain a healthy and beautiful smile.

How can you prepare for a visit to your dentist?

Plan ahead. Talk with your doctor and dentist before the visit about the best way to take care of your blood glucose during dental work.

How will you know if you have mouth problems from diabetes?

If you take insulin or other diabetes medicines, take them and eat normally before the dental visit.

Check your mouth for signs of problems from diabetes.

One of the first indications of gum disease is swollen, tender, or bleeding gums. Sometimes there are no signs of gum disease. You may not know you suffer from this until the damage is serious. Hence best defense is to see your dentist twice a year for a regular cleaning and checkup.

Carry your diabetes medicines and food with you to the dentist’s office.

You may have to postpone any non-emergency dental treatment if your blood glucose is uncontrolled.

If you get nervous about visiting the dentist, talk to your dentist and the staff about your fears and apprehensions. Your dentist can adjust the treatment plan to suit your needs. Don’t let your anxiety stop you from having regular checkups.

How can you keep your mouth healthy?

Good blood glucose control is the key to controlling and preventing mouth problems. People with uncontrolled blood glucose levels get severe gum disease more often than people who have the diabetes well controlled. Twice a day brushing and flossing, regular dental check-ups and controlled blood glucose is the best defense against Sep - Oct 2013

Delay in taking care of your mouth could make things worse. ttt

41

DOCTOR SPEAK

Patients who have cardiology ailments, a well chalked out Physiotherapy Programme can always help such individuals live a healthier life.

As a Physiotherapist I always believe that merely adding years to life doesnâ&#x20AC;&#x2122;t necessarily mean a healthy life style. For e.g. Post a cardiac event if a patient wishes to return to his activities, he wishes to do so with optimal quality; wherein he is able to enjoy them.

A

few decades ago, Physiotherapy was limited only to Orthopaedic problems. Now, as times have changed, Physiotherapy has a vital role to perform and deliver in the healthcare industry ranging from its role in Cardiology, Respiratory, Neurology, Sports, Gynaecology, Geriatrics, Paediatrics to name a few.

Physiotherapy has become an integral part of rehabilitation and has an intensive role to play in medicine and surgical cases, for example in cardiovascular (heart) diseases.

Typically when a person is diagnosed with a heart disease, besides following a drug intake regimen, he or she is also prescribed a life-style modification. Cardiac Rehabilitation also is a pre-requisite for the individual to be able to regain, enjoy and persevere his or her QoL (Quality of Life).

Cardiac rehabilitation is a branch of Physiotherapy which essentially deals in optimizing the physical functions of patients with cardiac disease or recent cardiac surgeries.

Patient can avail this service either on an out-patient (OPD) basis, or while he is hospitalized.

As a Physiotherapist I always believe that merely adding years to life doesnâ&#x20AC;&#x2122;t necessarily mean a healthy life style.

For e.g. Post a cardiac event if a patient wishes to return to his activities, he wishes to do so with optimal quality; wherein he is able to enjoy them.

Dr. SadiyA VANJARA Consultant-PHYSIOTHERAPIST SAIFEE HOSPITAL, MUMBAI 42

Not to miss that professional guidance and advised precautions are always followed. Therefore a wellplanned tailor exercise programme is made keeping their subjective ailments, demands & supply of the Sep - Oct 2013

DOCTOR SPEAK

cardiovascular system and his or her present lifestyle in mind. Exercise therapy is the key element of Cardiac Rehabilitation.

members. They are also explained what is the importance of Physiotherapy and how the patient will benefit from it before and after the surgery.

Physiotherapy for Cardiology patients can be divided into two major parts: Surgical & Non-surgical.

According to the Chartered Society of Physiotherapy, physiotherapy-led CR (Cardiac Rehabilitation) programmes are clinically effective in reducing mortality, improving health & quality of life, reducing length of hospital stay and reducing the number of hospital admissions. The programmes also support early return to work and self-management of the condition.

In both instances, a thorough evaluation of the individual (physical, lifestyle & behaviour) remains the first part of the Physiotherapy Program. A person with cardiovascular disease such as angina may also have Osteoarthritis, or a Lumbar surgery done or Joint replacement done. It is imperative for a Physiotherapist to consider these factors before outlining a Physiotherapy Cardiac Rehabilitation Programme.

For surgical patients, i.e. patients who have undergone or who are on schedule for a surgery soon, the protocol differs a bit. In the surgical cases, things like pre-operative lung clearance, preparing the patient for a post-operative rehabilitation, pain management and such things are discussed as team with the patient and his family Sep - Oct 2013

Physiotherapist are the key members and often the clinical leads of the multi-professional team, supporting patients to learn how to be physically active and embrace activity as part of a range of lifestyle improvement measures, says the Canadian Physiotherapy Association.

Physiotherapy Cardiac Rehabilitation is an inexpensive treatment and it helps patients get back on their feet, physically and emotionally through exercise, education and support."

43

PRODUCT LINE

THE

HEALTHIER THE

HAPPIER

TRACK NOW

SECURED

BETTER TOMORROW

RIGHT HANDS

FOR A

IN THE

Electronic Wellness Record System by

swasthe change What is a wellness record system?

A system which is continuously screening various health related variables for an enrolled individual against benchmarked risk factors of diseases and conditions.

The system also tracks compliance to treatment plan of existing ailments requiring both short term and long term care and screens ailment related variables against benchmarks to assure proper treatment and continuity of care. It allows for medical care givers and care facilitators to anaylse and reviews a patient’s progress and easily detects any deviance from the suggested treatment plan.

How does it benefit the enrolled individual?

EWR based on the demographic (age/ gender), social and medical profile will draft a preventive care plan comprising of physician screening,

44

lab & medical tests screening. EWR will automatically re-compile the findings and assess any risk alerts as per pre-defined benchmarks.

For individuals requiring Long Term Care with existing ailments, in consultation with the care giver, the EWR will check compliance and deviance from the recommended treatment plan to assure the ailment is always controlled and/or cured.

How does it benefit individuals requiring Long Term Care for chronic ailments?

Long term care for ailments like Asthma, Arthritis, Hypertension, Cardio Vascular Ailments, Diabetes, Elderly care (Geriatrics) require strict monitoring to control the ailment and/ or condition. EWR’s allows a care giver to device and deploy the most recommended treatment and screening plan based on all the health related variables available. EWR’s then

continuously screen the individual’s record for any deviation from the suggested treatment benchmarks and alert both the individual and the care giver to provide/organize an effective corrective action plan.

How does it benefit the care giver?

EWR’s allow care givers to do accurate and scientific assessment of individuals or a population using pre-defined benchmarks. It allows a care giver to look across various contribution variables while assessing or recommending treatment for an individual.

EWR’s are a great tool to analyze the overall health of a population of subset of it by analyzing health variables and indicators. EWR’s allow for an early disease detection process which can be useful in assigning a correct diagnosis and treatment plan. w w w. s w a s t h e x c h a n g e . c o m ttt

Sep - Oct 2013

PRODUCT LINE

SCIENTECH TECHNOLOGIES, DIGITAL 12 CHANNEL ECG MACHINE - SCIENTECH 13B

T

he heart is a two juncture electrical pump and the heart’s electrical activity can be measured by “Scientech 13B, Digital 12 Channel ECG Machine” by placing electrodes on the skin.

Thousands of people gone through the electrocardiogram and the scientech 13B has saved lives of inestimable patients by showing a serious circumstance like heart attack with an excellent degree of accuracy.

Digital 12 Channels Electrocardiograph (ECG) Machine, scientech 13B is used to measure the electrical activity, rate and rhythm of the heart. It is use to analyze the signal from patient heart and produce the result in graphical output. It is capable of printing all lead waveforms

Mr. Chaitanya Dev Singh

Scientech Technologies Pvt. Ltd., 94, Electronic Complex, Pardesipura, Indore – 452010, INDIA Cell No. : +91-7389910103 Tel : 0731-4211100 Fax : 0731 2555643 Email : csingh@scientech.bz Website : www.ScientechWorld.com

46

simultaneously with interpretation as well as provide indirect evidence of blood flow to the heart muscle.

This is the most important device which can help the doctor to identify the problems in certain heart failure.

Ten electrodes are needed to produce 12 electrical views of the heart. An electrode lead, or patch, is placed on each arm and leg and six are placed across the chest wall.

The signals received from each electrode are recorded. The printed view of these recordings is the electrocardiogram. The advantages of scientech 13B also use to solve the underlying rate and rhythm mechanism of the heart. The others advantages of scientech 13B are noninvasive, safe, inexpensive, and easy to perform, the necessary equipment is available in scientech.

Scientech 13B is very light, compact, easy to use and space saving machine, comes with 7 inch screen to view ECG waveforms simultaneously. There are standard 12 leads with alarm for lead-off and low battery. Digital 12 Channels Electrocardiograph (ECG) Machine have auto-save function also printed ECG files can be saved

automatically. Thousands of ECG files can be saved to the scientech 13B and also having option to save 2000 files to SD card. Built-in ECG simulator for demo purpose along with soft, silicon gel keyboard and automatic adjustment of baseline for optimal printing. One can also connect with the computer which is an optional feature. It also has built -in rechargeable lithium battery, over 2 hour working.

Scientech Technologies Pvt. Ltd. is a renowned provider of medical equipments. Our world class products provide user a high degree of quality & reliability.

Scientech offers comprehensive range of medical instruments and technical support. Leveraging the heritage and domain expertise of Scientech, the products encompass a broad technology spectrum and high customer satisfaction across the globe. Our policy is not just offering customers with products but also providing them with prompt technical support.

Scientech has 12 branch offices in India & its products are exported to over 52 countries. ttt Sep - Oct 2013

Doctors on Care World TV

TV C H A N N E L www.careworldtv.com

September - October 2013

Dr Ganapthi Ramanan Oncologist Kumaran Hospital Chennai

Dr Jhoomer Kulshreshta Homeopath, Cosmetologist Trichologist &

Dr Mukesh Gupta Obstetrics & Gyneacologist Laparoscopic Surgeon Infertility Specialist Psychological Counseling

Dr Nandita Palshetkar Obstetrician,Gynecologist & IVF GIFT & ICSI Specialist

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Dr Sujay Prabhugaonkar

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Dr Vivek Chaudhary Oncologist Director Regional Cancer Center Raipur

MD,DPM

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To feature in this Section please Call:

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EXPERT VIEWS

Current Trends in Cost Analysis for Drug Pricing Mahendra Rai Sr. Consultant Health Outcomes Reasearch

P

harmacoeconomics comprises of evaluation of behavior or welfare of individuals, firms, and markets relevant to the use of pharmaceutical products, services, and programs. Pharmacoeconomics can be also referred to as “health economics” or “health outcomes research” especially when it includes comparison with non-pharmaceutical therapy or preventive strategies such as surgical interventions, medical devices, or screening techniques. Further, it is a collection of descriptive and analytic techniques for evaluating pharmaceutical interventions, spanning individual patients to the health care system as a whole. The techniques include costminimization, cost effectiveness, cost-utility, cost-benefit, cost of illness, cost-consequence, and any other economic analytic technique that provides valuable information to health care decision makers for the allocation of scarce resources.

The free drug policy launched by the Government of India aims to provide medical benefit to the 121 crore population. According to this policy, every citizen of the country will be entitled to free medicines in all public health centres spread across the country. Only generic drugs will be provided. The policy will be effective over the next 5 years and will support around 40% of the population.

48

Richa Goyal

Consultant Health Outcomes Research

Cost-minimization is used in pharmacoeconomics and is applied when comparing multiple drugs of equal efficacy and equal tolerability.

In light of the above scenario, various cost analysis have been described below: Cost effectiveness analysis (CEA):

Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes/ effects of two or more courses of action. CEA is often used in the field of health services, where it may be inappropriate to monetize health effect. The CEA is expressed in terms of a ratio where the denominator is a gain in health from a measure (years of life, premature births averted, and sight-years gained) and the numerator is the cost associated with the health gain. The most commonly used outcome measure is quality-adjusted life years (QALY). This analysis is often visualized on a cost-effectiveness plane consisting of four-quadrants.

Outcomes plotted in Quadrant I are more effective and more expensive, those in Quadrant II are more effective and less expensive, those in Quadrant III are less effective and less expensive, and those in Quadrant IV are less effective and more expensive.

Cost-minimization analysis (CMA):

Cost-minimization is used in pharmacoeconomics and

Sep - Oct 2013

EXPERT VIEWS

is applied when comparing multiple drugs of equal efficacy and equal tolerability. Therapeutic equivalence must be referenced by the author conducting the study and should have been done prior to the cost-minimization work. When conducting a cost-minimization study, it is required to measure all costs (resource expenditures) inherent to the delivery of the therapeutic intervention and that are relevant to the pharmacoeconomic perspective.

It is used to compare costs of alternative therapies that have: identical clinical effectiveness (including adverse reactions, complications and duration of therapy), but different costs choose the least cost alternative among equivalent or equally efficacious alternatives Cost-utility analysis (CUA):

Cost–utility analysis (CUA) is generally used to guide procurement decisions. The most common and well-known application of this analysis is in pharmacoeconomics, especially health technology assessment (HTA). In health economics, the purpose of CUA is to estimate the ratio between the cost of a health-related intervention and the benefit it produces in terms of the number of years lived in full health by the beneficiaries. Hence, it can be considered a special case of cost-effectiveness analysis, and the two terms are often used interchangeably. Cost is measured in monetary units. Benefit needs to be expressed in a way that allows health states that are considered less preferable to full health to be given quantitative values. However, unlike cost–benefit analysis, the benefits do not have to be expressed in monetary terms. In HTAs it is usually expressed in quality-adjusted life years (QALYs). The CUA allows comparison across different health programs and policies by using a common unit of measure (money/ QALYs gained). CUA provides a more complete analysis of total benefits than simple cost–benefit analysis does.

Cost-benefit analysis (CBA):

Cost-benefit analysis (CBA), sometimes called benefit– cost analysis (BCA), is a systematic process for calculating and comparing benefits and costs of a project, decision or government policy (hereafter, “project”). It is generally done to determine if it is a sound investment/ decision (justification/feasibility) or to provide a basis for comparing projects. It involves comparing the total expected cost of each option against the total expected benefits, to see whether the benefits outweigh the costs, and by how much.

Sep - Oct 2013

Cost of illness (COI):

Cost-of-illness (COI) was the first economic evaluation technique used in the health field. The aim was to measure the economic burden of illness to society. It has been suggested that COI can be a good economic tool to inform decision makers if it is considered from another perspective. COI can provide information to support the political process as well as the management functions at different levels of the healthcare organisations. To achieve the same, the design of the study must be innovative, capable of measuring the true cost to society; to estimate the main cost components and their incidence over total costs; to envisage the different subjects who bear the costs; to identify the actual clinical management of illness; and to explain cost variability. In order to reach these goals, COI need to be designed as observational bottom-up studies.

Cost-consequence analysis (CCA):

A cost-consequence analysis (CCA) concerns with an estimation of the costs as well as the health consequences and other consequences associated with one intervention compared with an alternative intervention for a health condition. These estimates then are presented in a disaggregated tabular or graphical format. When a CCA is performed as a variant of a CEA, it takes an incidence-based perspective and estimates the costs and consequences for an individual or disease cohort for as long as the health condition lasts. However, a CCA also can be performed from a prevalence-based perspective, where the costs and consequences of alternative mixes of interventions can be compared over a 1-year time frame for a population with the condition of interest.

Pharmacoeconomic tools are essentially important in analyzing the potential value for individual patients and the public. These methods supplement the traditional market place value as measured by the prices that the patient is willing to pay. With government agencies and third parties continuing concern about the higher expenditures for prescriptions, pharmaceutical manufacturers and pharmacy managers are highly focussed that pharmaceutical interventions and services require comparative cost-justification and continual surveillance to assure cost effective outcomes. ttt

49

TENDERS

Hospital Ref Number: 8721286 Tender Number: Buyer/Seller: Department Of Atomic Energy Requirement: Design, Fabrication, Supply, Installation & Commissioning Of Fumehood With Ventilation System Location: Mumbai, Maharashtra, India Document Fees: Rs.300 EMD: Rs.60,000 Closing Date: 30/09/2013 at 16:30 Hrs __________________________________________ Ref Number: 8907309 Tender Number: Buyer/Seller: National Institute Of Mental Health And Neuro Sciences Requirement: Supply of Hospital furnitures â&#x20AC;&#x201C; ICU cots, patient metal cots basic back adjustable & basic back adjustable with SS head, bed side diwans, bed side lockers, emergency & recovery trolley.

Location: Bangalore, Karnataka, India Document Fees: Rs.2,000 EMD: Rs.11,000 Closing Date: 30/09/2013 at 16:30 Hrs __________________________________________ Ref Number: 8911439 Tender Number: Tender Prod. No: STR-4/FUR/GTN-01/2013-14 Buyer/Seller: National Institute Of Mental Health And Neuro Sciences Requirement: Supply of Hospital Furniture Location: Bangalore, Karnataka, India Document Fees: INR2,000 EMD: INR110,000 Closing Date: 30/09/2013 at 16:30 Hrs. Contact Details: NIMHANS PO NO 2900 Hosur Road Karnataka India __________________________________________ Ref Number: 9005388 Tender Number: Buyer/Seller:National Institute Of Technology Requirement: Supply of intermittent Cervical and Lumbar Traction, Treatment Table for Traction, Dual Head - 1 MHZ and 3 MHZ Ultrasound therapy, Computerized Interferential Therapy with MST and TENS (3 in 1) Location: Tiruchy ( Tiruchirapalli ) - Tamil Nadu - India Document Fees: Rs.150 EMD: Rs.2,500 Closing Date: 30/09/2013 at 16:00 Hrs __________________________________________ Ref Number:9018116 Tender Number: Buyer/Seller: Indian Council Of Agricultural 50

Research Requirement: Award the contract for supply and fixing of modular laboratory furniture â&#x20AC;&#x201C; reg Location: New Delhi - Delhi - India Closing Date: 30/09/2013 at 16:00 Hrs __________________________________________ Ref Number: 8885786 Tender Number: Buyer/Seller: Government Medical College Requirement: Supply of Trinocular research microscope with camera with LCD projector, Strechure trolley, Laminar flow.

Location: Nagpur - Maharashtra - India Document Fees: Rs.250 Closing Date: 19/09/2013 at 15:00 Hrs. Contact Details: Government Medical College Nagpur Maharashtra India Document Sale To: 19-9-2013 at 12:00 Hrs __________________________________________ Ref Number:8907006 Tender Number: Buyer/Seller: Department Of Police Requirement: Supply of Riot Control Vajra Vehicle, Riot Control Jeep Mini Vajra, Body Protector Cane, Helmet, Lathi, Water Canon, Pillet Gun, Pepper Gun, Dragon Light, Stretcher, Polycarbonate Shield, Fire Extinguisher Fome 9 kg & Video Camera Location: Patna - Bihar - India Closing Date: 19/09/2013 at 14:00 Hrs. Contact Details: Department Of Police Patna Bihar India __________________________________________ Ref Number: 8949795 Tender Number: Buyer/Seller: Rajasthan Medicare Relief Society Requirement: Supply of machine & equipments - cardiac monitor, defibrillator, tube sealer, table, patient trolley, central oxygen & section system, oxygen cylinder, regulator, BP instrument, patient bed, bad side locker, IV stand etc Location: Chittorgarh - Rajasthan - India Document Fees: Rs.400 EMD: Rs.40,000 Estimated Cost: Rs.2,000,000 Closing Date: 19/09/2013 at 12:00 Hrs. Contact Details: Rajasthan Medicare Relief Society Chittorgarh Rajasthan India Document Sale To: 18-9-2013 __________________________________________ Ref Number: 8888702 Tender Number: Buyer/Seller: Indian Institute Of Integrative Medicines Requirement: Supply and installation of fume Sep - Oct 2013

TENDERS

Furniture Tender hoods and lab furniture (for Cancer Pharmacology Lab & Plant Physiology Lab), Lab Work station Location: Jammu - Jammu-kashmir - India EMD: Rs.180,000 Closing Date: 17/09/2013 at 15:00 Hrs. __________________________________________ Ref Number: 8999428 Tender Number: Buyer/Seller: Employees State Insurance Corporation Requirement: Supply Of Operation Theatre Tables And Infant Resuscitation Warmers To ESIC Hospital.

Location: Bangalore - Karnataka - India Document Fees: Rs.1,000 EMD: Rs.40,000 Closing Date: 17/09/2013 at 14:30 Hrs. __________________________________________ Ref Number: 8762879 Tender Number: Buyer/Seller: Department Of Technical Education Requirement: Supply of laboratory & other wooden furniture Location: Jodhpur - Rajasthan - India Document Fees: Rs.425 EMD: Rs.30,000 Estimated Cost: Rs.1,500,000 Closing Date: 17/09/2013 at 10:30 Hrs. Contact Details: Department Of Technical Education Jodhpur Rajasthan India Document Sale To: 16-9-2013 at 18:00 Hrs __________________________________________ Ref Number: 8934987 Tender Number: Tender Prod. No: NGP/H/448/S/Amb.AQ dated 02/09/13 Buyer/Seller: Central Railway Requirement: Contract Hiring of private ambulance (Omini Van) for Ajni Health Unit on 24x7 bases. All expenses including petrol, Driver, Oxygen cylinder, Stretcher, First aid Box further arrangement for I/V Fluids maintenance charge will be borne by supplier Location: Nagpur - Maharashtra - India Document Fees: INR1,000 EMD: INR12,912 Estimated Cost: INR645,600 Closing Date: 9/10/2013 at 15:00 Hrs. Contact Details: Dr C N PIPRIKAR 07122565047, 07122565047 near DRM Office Central Railway Sitabuildi Nagpur Maharashtra India Document Sale To: 9-10-2013 at 15:00 Hrs __________________________________________ Ref Number: 8991012 Tender Number: Buyer/Seller: Government Higher Secondary School Sep - Oct 2013

Requirement: Supply of Lab Furniture Location: Pauri - Uttaranchal - India Document Fees: Rs.200 EMD: Rs.6,000 Estimated Cost: Rs.150,000 Closing Date: 10/10/2013 at 12:00 Hrs. Contact Details: Government Higher Secondary School Pauri Uttaranchal India Document Sale To: 10-10-2013 __________________________________________ Ref Number: 8985154 Tender Number: Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply & installation Of laboratory benches furniture & fixturess & fixture - Laboratory Fittings â&#x20AC;&#x201C; Water Taps, Laboratory Electrical Socket/ Switches-Ip 55 Grade Weather Proof, Hinges, Locks, Slide, Galvanized (Zinc Coated) Steel Or Stainless Steel 304 Grade, Electrical Cabling..

Location: Bhopal - Madhya Pradesh - India Document Fees: Rs.5,250 Closing Date: 10/10/2013 at 14:00 Hrs. Document Sale From: 6-9-2013 Document Sale To: 9-10-2013 __________________________________________ Ref Number:8995354 Tender Number: Tender Prod. No: T.No.34/H/ME/13-14 Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply of Patient Trolley Cum Bed. Location: New Delhi - Delhi - India Document Fees: INR2,000 EMD: INR150,000 Closing Date: 11/10/2013 at 00:30 Hrs. Document Sale To: 7-10-2013 at 0:30 Hrs __________________________________________ Ref Number: 9003861 Tender Number: Tender Prod. No: T.No.36/H/ME/13-14 Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply of ICU Bed at AIIMS Location: New Delhi - Delhi - India Document Fees: INR2,000 EMD: INR300,000 Closing Date: 11/10/2013 at 00:30 Hrs. Document Sale To: 7-10-2013 __________________________________________ Ref Number: 9007270 Tender Number:

Tender Prod. No: T.No.39/H/ME/13-14 Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply of Dental Chair & Unit.

Location: New Delhi - Delhi - India Document Fees: INR100 EMD: INR6,000 Closing Date: 11/10/2013 at 00:30 Hrs. Document Sale To: 7-10-2013 __________________________________________ Ref Number: 9007918 Tender Number: Tender Prod. No: T.No.45/H/ME/13-14 Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply of Resuscitation Cart / Crash Cart Location: New Delhi - Delhi - India Document Fees: INR1,000 EMD: INR100,000 Closing Date: 11/10/2013 at 00:30 Hrs. Document Sale To: 7-10-2013 __________________________________________ Ref Number: 8945946 Tender Number: Buyer/Seller: Gujarat Ayurved University Requirement: Supply of furniture & equipment for hospital.

Location: Jamnagar - Gujarat - India Document Fees: Rs.500 Closing Date: 14/10/2013 at 15:30 Hrs Contact Details: Gujarat Ayurved University Jamnagar, Gujarat, India Document Sale To: 26-9-2013 at 16:00 Hrs __________________________________________ Ref Number: 9014992 Tender Number: Buyer/Seller: E S I C Hospital Requirement: Supply of Crash Cart Location: New Delhi - Delhi - India Document Fees: Rs.500 EMD: Rs.4,000 Closing Date: 29/10/2013 at 14:00 Hrs

51

POST EVENT

Seminar on Big Data to Predictive Analytics Future of Healthcare

T

he PHD Chamber of Commerce and Industry organized a Seminar on Big data to Predictive Analytics – Future of Healthcare on 5th September 2013 at PHD House.

In a statement issued here today, Dr. (Ms.) Syeda Hameed, Member, Planning commission said that “ We will have the Big Data in Quintillion bytes created in the Healthcare sector but the question which arises here is “How do we put it to use”? It is important that we are able to reach out to the remote locations like Nicobar and tribal areas with the Healthcare services through the optimum use of technology.”

Dr Syeda Hameed also stressed on the relevance of Interoperability and Health Information Exchanges (HIE) which could connect number of hospitals and may have records for millions of patients, which could be used by physicians for treatment.

Further in the Seminar (Brig.) Dr. Arvind Lal, Chairman, 52

Leverage Technology – Interportability and Helath Information Exchanges (HIE) - for inclusive healthcare services and reach out to the tirbals and the needy at remote locations” said Dr ( Ms) Syeeda Hameed, Member Planning Commission, Govt Of india at a National Seminar on ‘Big data to Predictive Analytics – Future of Healthcare’ conducted by PHD Chamber on September 5th, 2013 at PHD House, New Delhi.

Health Committee, PHD Chamber said that Predictive analytics requires analysis / real-time analysis of the structured big data which could make healthcare proactive and not reactive. Predictive analytics can improve results for both the patient and businesses participating in the complex healthcare market. It simulates PRO (Patient Reported Outcomes) for care quality improvement / outcomes and could predict high risk patients for ACO (Accountable Care Organization) and hospitals along with simulating connected health consumer and recommend technology interventions that drive healthy behavior change.

Today, healthcare executives are under tremendous pressure to address a host of different challenges: medical errors, rising costs, inconsistent quality, inefficiency, declining doctor satisfaction, and mounting staff shortages. Dealing with these issues will ultimately lead to better healthcare, but the process appears as complex and overwhelming as the challenges themselves. Information – or lack of it – is a big part of today’s healthcare problems. Accordingly, Information based on Technology should be a big part of the solution. Healthcare stakeholders can now have access to promising new threads of knowledge. This information is in the form of ‘’Big Data’’, so called not only for its sheer volume but for its complexity, diversity and timeliness. Getting access to this valuable data and factoring it into clinical and advanced analytics is critical to improving care and outcomes, incentivizing the right behavior and driving efficiencies.

Sep - Oct 2013

T|R|A|D|E & T|R|E|N|D|S

Therapeutic Ultrasound A brief overview on therapeutic ultrasound, its applications and myriad benefits

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herapeutic ultrasound is a method of stimulating tissues beneath the skin's surface using high freqquency sound waves that can penetrate up to 5 â&#x20AC;&#x153; below the surface of your skin without heating the skin. The technology is the same as that used to inspect foetus in mother's womb.

Benefits of ultrasound are well established. Therapeutic ultra-sound is typically between 800,000 and 3,000,000Hz. This sound can not be heard by humans. The higher the frequency lesser the depth of penetration.

At 3MHz, penetration can be just 1 or 2 mm, perfect for skin care and treatment.

The ultrasound waves vibrate, or move body cells and thus massage and relax them. The massaging effects of therapeutic ultrasound have three primary benefits: Ultrasound therapy increases bloodl flow in the treated area which speeds the healing process. Very little heat is generated.

Ultrasound therapy reduces swelling l and edema which are the main sources of pain.

Ultrasound waves gently massage the l muscles, tendons and/or ligaments in the treated area and enable medicines to reach deep inside. This enhances the recovery rate of damaged tissue

without adding strain, and softens any scar tissue that is usually present in an injured area.

What can be treated with ultrasound?

An incredibly wide variety of ailments are treated using ultrasound.

Essentially, anywhere there is a desire to promote blood circulation and reduce swelling and Injuries, on the skin or deep inside.

Always consult your doctor before administering ultrasound therapy, as it can harm also, if misused.

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Cover Story : Healthcare Management, Infrastructure & Consultancy

Rise in demand of Hospital & Healthcare consultants India needs 1 lakh beds each year for next 20 years: India presently has a bed deficit of approximately 30 lakh beds as per the WHO recommendation of four beds per 1000 population.

Considering even a 250 bedded hospital on an average, the country would need 12000 hospitals in the near future. As almost 80 per cent of this would be fulfilled by the private players, a huge rise in IPO’s and premium commanding players in the arena would flutter bringing in interesting times for the healthcare industry.

Recent spurt in Public Private Partnership(PPP) projects, and thrust on quality by the government sector and its demand (& mandate in some areas) on NABH and ISO, a lot of consultancy business is abuzz with the projects galore in the accreditation and QMS field. India to its credit already has one government hospital NABH accredited and many are in the pipeline. With CGHS making NABH mandatory for care and hospitalisation cost reimbursements, there is hectic activity seen in hundreds of hospitals waking up to the long due need for quality healthcare and applying for the coveted quality mark.

The trend is on a steep rise, and it is just a matter of time when the government launches patient awareness on NABH quality in full swing. This would make the patient demand at least an ISO QMS certified hospital if not NABH. Good times ahead for healthcare consultants in every sphere be it new projects or existing.

Medgate Today coming up with special focus on Healthcare Consultants, Construction & Architecture Complete coverage: • • • •

Builders & Architects Management, Equipment Planning Hospital Doors Hospital properties

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Interiors & Exterior of Hospitals Hospital Doors & Windows Healthcare Infrastructure & Planners Flooring ,Tiles,walls,privacy system,curtains

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Project Conceptualisation Green Hospital Healthcare consultants Lighting

Special Feature: Healthcare IT: IT Solutions & Consulting: Healthcare extends beyond one person, in one department, in one building. It is an active process that requires communication, collaboration, and decision-making-across care providers and care settings. IT solutions help you eliminate silos, so patient information flows to the authorized care team-enabling better collaboration, and more informed and efficient decision-making. We offer solutions that break down barriers to help you solve business problems, improve patient safety, strengthen the revenue cycle, and enable technology to improve patient care. Learn howcIT helps you achieve better patient outcomes with innovative information technology (IT) solutions today.

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WORLD HEART DAY

EXPERT VIEWS

Dr. Praveer Agarwal

â&#x20AC;&#x153;Back to future Technology with a differenceâ&#x20AC;?

Fortis Escorts Hospital

D

id you know that, the size of your heart is that of your fist? Heart is a vital organ; it supplies blood to the entire body, in turn heart gets the blood from the coronary arteries.

Who is at Risk?

People with a history of high cholesterol, diabetes, smoking, high blood pressure, being overweight and a family history of CAD (Coronary Artery Disease) have an increased risk of developing atherosclerosis in the coronary arteries.

Increasing age adds to the risk of CAD. In addition, menopausal status may play a role in women.

Risk factors Can be Classified into Controllable and uncontrollable risk factors (that you can influence): Controllable

yy Smoking

Coronary artery disease (CAD; also called coronary heart disease, CHD) is the most common form of heart disease worldwide. The incidence of CAD is lower in patients who are on diets, low in saturated fat and cholesterol. CAD usually results from atherosclerosis, a condition that occurs when arteries become narrow and hardened due to cholesterol plaque build-up. Myocardial infarction (heart attack) can be a serious result of CAD, occurring when a blocked coronary artery causes death to a portion of the myocardium (heart muscle).

Figure1 Sep - Oct 2013

yy High cholesterol level yy Hypertension yy Lack of physical activity yy Obesity and excess of weight yy Diabetes mellitus yy Stress

Uncontrollable

yy Age yy Gender yy Family History yy Genetics

Causes of Coronary Artery Disease As mentioned above, due to lack of oxygen to the surrounding area which the coronary artery supplies blood too, the area becomes dead.

The exact cause, as in, how does this damage occur is still unknown. However there are a few theories about how these coronary arteries become damaged.

Theory One:

High LDL ( low density lipoprotein) levels and low HDL ( high density lipoprotein) level leads to excessive cholestrol being taken up creating vessel trauma.Patients with CAD must have their HDL ( high density lipoprotein ie good cholestrol) and LDL ( low density lipoproteins ie Bad cholestrol) and triglycerides under check or to be followed.

Theory Two:

The second causative theory for CAD is smoking.It is believed that smoking creates excess of carbon monoxide in the Table: 1 blood stream leading to Hypoxia ( less According to WHO (World Health of oxygen) resulting in the damage to the Organization) Indians are at a much walls of coronary artery. higher risk of contracting heart disease Theory Three: than other nationalities due eating habits, The third causative theory of CAD is diabetes, stress and less exercise. India is hypertension. It is believed that constant considered to be diabetic capital of the high pressure due to hypertension (high world with prevalence of diabetes in 5.08 blood pressure or blood pressure greater crore patient out of 28.5 crore patients than 140/90) leads to the damage of the diabetic across the globe. It is a matter coronary arteries. of concern.

Once the patient has a heart attack with PROCEDURES ECG changes, he or she needs immediate Coronary angioplasty or ballooning is a minimally-invasive procedure used to medical attention.

EXPERT VIEWS

of Balloons or stents. I remember having performed my 1st successful angioplasty in the year 1993 says Dr. Praveer Agarwal (Fortis Hospital, New Delhi) and the patient is still doing fine.

After having performed more than 20,000 complex angioplasty procedures and still learning, I feel every patient is different and needs different techniques and devices. The procedures and devices have undergone a sea change.

Previously, I mean in the year 1977, to open a blocked artery, uncoated balloons were used to expand and restore blood flow to the clogged artery, through this procedure the plaque or the blockage gets compressed against the artery, so that blood may flow more freely through the vessel.

Restenosis (picture below) literally means the reoccurrence of stenosis. This is usually restenosis of an artery, or other blood vessel, that has been “unblocked”.

This term is common in all branches of medicine that frequently treat stenotic lesions (e. g. interventional cardiology following angioplasty).

Pantera Lux™ drug eluting balloon catheter is with a difference i.e. coated BTHC (butyryl tri hexyl citrate) with Paclitaxel, has undergone successful clinical evaluations across Europe & is To overcome this, Drug-coated stents recommended in NICE (National institute of Health and Clinical Excellence, United were developed in the year 2000.

Kingdom) & ESC (European Society of Cardiology) guidelines.

Drug-eluting stents (DES) are small wire meshes which are coated with a drug. This drug is slowly released into the wall of the blood vessel or artery and potentially reduces the chance that the artery becomes re-narrowed.

The implantation procedure of a DES is similar to the one of a bare metal stent (BMS = stent without drug coating).

Though DES have been effective in reducing restenosis, there are concerns PTCA with a normal uncoated balloon associated about the polymer coating Coronary angioplasty - also called PTCA like inducing inflammation and increased (percutaneous transluminal coronary incidence of late thrombotic or blood clotting complications or death. angioplasty) – is a procedure in which The drug distribution from a DES to the a tiny balloon is expanded that presses the arterial wall is inhomogenous (i.e. not plaque blockage against the artery so that blood may flow more freely through the uniform), since about 85% of the stented vessel. Normal hospital stay is overnight. vessel wall is not covered by the stent struts.

In addition to regular angioplasty a stent is inserted into an artery after angioplasty to The drawback of the drug eluting stent is delayed healing due to prolonged drug help ensure that blood continues release, which means that patients have to flow freely through the vessel and to to take drugs to prevent blood clots for a reduce the chance that plaque will block long-term period. Otherwise, they would the artery again. be at increased risk of blood clotting and heart attacks.

It is true that life is a big circle i.e. after 3 decades we are again using the balloon coated with a drug. Restenosis prevention continues to be a challenge in interventional cardiology.

PTCA with a Stent

One such promising & smarter technology is perhaps here to stay adding confidence to lead a better life.

In this world of equal innovative opportunities, it’s the sheer experience which defines revolution. Sincere planning turns mere product into creation.

Pantera Lux

Pantera Lux

The world of interventional cardiology is fast changing from polymer eluting devices to polymer less devices for good.

It brings me back to those old POBA (Plain Old Balloon Angioplasty) days but with a difference of a contact with a vessel wall leaving the lipophilic drug to combat restenosis. The drug once delivered in the vascular wall reaches bottom levels in vascular cells within 24 hours.

My advice would be to learn about the disease, various causes affecting and controlling the above parameters, so that the Quality of Life improves. No foreign body in the body is the best solution.

The technology is gradually picking up, especially in certain indications like small vessel disease, ISR and Bifurcations (side branches). It’s just an effort, to heal the unhealed.

Sep - Oct 2013

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