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New Launch Foley Catheter
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Editors Note
The Global Nephrology and Urology Devices Market is Forecast to Reach $24.2 billion in 2017 Nephrology and Urology Devices Market to 2017 - Usage of Incontinence devices by the Elderly Population to Drive Market The global market for nephrology and urology devices is forecast to exceed $24.2 billion by 2017 with a compounded annual growth rate (CAGR) of 7.2% from 2010 to 2017. Incontinence devices worth $8.7 billion; renal dialysis equipment worth $6 billion; and lithotripters worth $0.2 billion constitute the nephrology and urology market in 2010. The incontinence devices market was the largest segment in 2010, with a 58% share, the remaining 42% was contributed by renal dialysis equipment and lithotripters. The total market is expected to be driven through 2010-2017 by the increasing prevalence of diabetes and hypertension, a rapidly aging population and a shortage of kidney donors for transplant. The market is expected to be driven by demand from the US, Japan, Germany, Brazil and Canada. The focus of these countries is on technological advancements in minimally invasive surgeries such as extracorporeal shock wave lithotripsy (ESWL) and laser lithotripsy. ESWL has brought enhancement in surgery, over open surgery and increased the adoption rates of patients for minimally invasive surgery. A shortage of donors for kidney transplantation will lead to the growth of the renal dialysis devices market with more patients undergoing renal dialysis procedures. The growing incidence of end-stage renal disease and increased reimbursement levels for renal dialysis will support the growth of the renal dialysis equipment market. Moreover, strong pipeline products with better operational efficiency, safety and effectiveness are expected to drive market growth.
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Jan - Feb 2014
ONTENTS 06
Jan-Feb 2014
ICICI Lombard and CNBC -TV18 Recognize India’s Best hospitals at the ‘India Healthcare Award’s
08 Indian Spinal Injuries Centre to organise India’s First Ever ....... 10 New Lease of Life A World Class Facility With International....... 18 Neonatal Survival - GE unveils a suite of solutions designed...... 20 F DA approves first gel for sealing corneal incision after ............. 26 Don’t let Urinary Disorder throw your life off track!
Worldwide Achievers Felicitated the Winners of Healthcare Excellence Awards 2013
27 ‘She’swaps kidney to save husband’s life
12
16
Sameer Bhati bags Worldwide Achievers Healthcare Excellence Award 2013
28 Common Diseases among Children during winter season 32 What is the best best way to treat coronary artery disease 34 IT enabled USICON 2014 A step ahead in Urology 38 Sharper ultrasound images could improve diagnostics 40 Clinical Gynaecologic & Infertility 52 High Pressure in veins of the leg can lead to Leg Ulcers
19 Smart Global diversifies its healthcare portfolio, launches Smart Living
54 The Pharmaceutical Sector of India
22
56 Hospital Furniture Tender
49
Exclusive Interview
Dr. R. Chandrashekhar
28
DOCTOR Speak
Dr. Rajiva Kumar Prof (Dr ) Rajeev Sood (MSMCH) RML HOSPITAL
Jan - Feb 2014
44
Have you crossed 50? Stay guarded against Prostate Cancer
Dr. Dinesh Batra
Director, Cygnus Medicare
HEALTHCARE IN INDIA... NEXT TRANSFORMATION IN TIER 2 CITIES.
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NEWS UPDATE
ICICI Lombard and CNBC -TV18 Recognize India’s Best hospitals at the ‘India Healthcare Award’s
• 27 hospitals recognized for outstanding service • Awards for District Hospitals included in this year's edition ICICI Lombard and CNBC -TV18 today announced the winners of the prestigious ‘India Healthcare Awards’. An initiative to recognize and honor India’s finest health care service providers witnessed more than 3500 hospitals from metro, non-metro as well as districts participating for the honors. A total of 27 awards were conferred at a grand function organized at The Taj Palace , New Delhi. The award ceremony was felicitated by Dr. Montek Singh Ahluwalia, Deputy Chairman, Planning Commission of India. The winners include reputed Hospitals like Tata Memorial Hospital, Hinduja Hospital Mumbai; Lilavati Hospital & Research centre, Mumbai and Fortis Escorts Heart Institute, New Delhi among others. Mr. Bhargav Dasgupta said “It’s been a memorable journey since we partnered with CNBC TV-18 in 2010 to introduce the India Healthcare Awards. Now in its fourth year, this platform has evolved considerably to become a benchmark that recognizes and acknowledges the efforts of the Leaders in the Healthcare Provider Fraternity. Receiving over 3,500 nominations this year is a testimony of the response that it has been able to garner and showcases the quality and rigorous methodology that the 6
jury has been able to set to decide the Winners”. On this occasion, Mr. Anil Unniyal, CEO, CNBC-TV 18 and CNBC Awaaz commented “Our association with ICICI lombard is by far one of the most gratifying ones as it supports the health ministry’s relentless efforts in making good quality medical services affordable to the masses and medical insurance becomes an extension of this service. There is a need to educate the masses about the importance of insurance and these awards will help provide impetus to the good work done bye these. We hope these awards become most the coveted industry recognition and create an industry benchmark in itself” The India Healthcare Awards are conferred on the Best hospitals across different areas of specialization and geographies based on a rigorous and objective evaluation process. The exercise spans three phases: Nominations, Short listing by India’s leading research agency – IMRB (based on scope of service, infrastructure, patient safety record and innovation & research) followed by final selection of the short listed hospitals by an eminent jury of experts from related fields. The categories in which awards are conferred include General Service, Tertiary Care Hospitals (multi and single specialty hospitals), Rashtriya Swasthya Bima Yojana award to hospitals for outstanding service to the community and WHO Awards for excellence in Primary Healthcare. Jan - Feb 2014
NEWS UPDATE
Indian Spinal Injuries Centre to organise India’s First Ever International Conference on Universal Design and Assistive Technology to cater to the needs of the Physically Disabled Indian Spinal Injuries Centre announced its first International Conference on Universal Design and Assistive Technology to cater to the needs of the physically disabled. Under the theme of Universal Design and Assistive Technology, UniDAT to be held in India from 19th to 21st December 2013, will emphasize on specialized technology tailored to the needs of individuals with functiona Major HPS Ahluwalia, Patron, UniDAT and Chairman, ISIC, says “The Department of Assistive Technology was started in 2006 with the intention of letting people in India witness the latest trends, practices and services for people with disabilities. This conference will serve as a unique opportunity for exhibitors, professionals, individuals and service providers to come together and gather information on the world of assistive technology in India.” Speaking about the initiative Dr. A. K. Mukherjee, President, UniDAT and Director General, ISIC, says, “The role of assistive technology in the welfare of persons with disabilities has been well recognized at the global level through UNCRPD and the World
MediBiz TV, First Global Healthcare TV Channel launched in December 2013
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orld’s first 24-hour healthcare channel – Medi BizTV will be launched at IMA hall in Kochi on December 21, 2013. The channel that will go on air worldwide across 130 countries will be uplinked to the world through Satellite APSTAR-7 and would cover Asia, Africa, and Australia and Europe.
“Medi Biz TV has been planned with a great number of programmes dedicated to the healthcare sector. All the programmes have been planned to be informative and innovative at the same time entertaining. We hope to see Medi BizTV bring out benign changes in the healthcare sector,” said Sohan Roy, the think tank behind this project. 8
Report on Disabilities. However, a large section of people with disabilities in the developing world do not have access to assistive technology thereby hampering their inclusion & participation in the society. Today the time is ripe to focus on assistive technology, one of the pillars of rehabilitation.” Dr. H. S. Chhabra, Organizing Chairman, UniDAT and Medical Director & Chief of Spine Services, ISIC further adds, “ISIC has been promoting the use of assistive technology and its concepts for almost 6 years now. Given the importance of Assistive Technology and its impact on people’s lives, there is a need for information dissemination and more brainstorming on such important issues. UniDAT 2013 will not only provide such a platform, it will also provide an opportunity for experts and academicians to interact with the industry and distributors through a trade show. The blend of both research and application of assistive technologies is the best approach in making this world a better place for persons with disabilities.” “There is a need for proper clinical assessment and service delivery when it comes to assistive technology and unfortunately, in India a large percentage of population is wheelchair bound. By bringing together the industry experts, physiotherapists and occupational therapists, and assistive technology engineers on one platform, we are hopeful that UniDAT will help to fill the gap borne out of the lack of integration of individuals with disabilities and special needs in the existing environment,” says Mr. Nekram Upadhyay, Organizing Secretary, UniDAT.
Medi BizTV is promoted by Biz TV Network, a renowned name in the entertainment sector. They are the pioneers of the world’s first maritime channel – Marine Biz TV. Sohan Roy, the maverick young businessman and mariner is the inspiration behind this project. This Guinness Book entrant who is already a well-known name in the film world is all set to mark his magical presence in the healthcare sector through Medi Biz TV. He is also the director of highly acclaimed Hollywood movie DAM 999 which got selected for the 54th academy awards. Some of the programmes planned in the MediBiz TV are on Motivational and spiritual aspects of life; lifestyle diseases; healthy eating habits, Fitness, Baby Care, Yoga, Medical Wonders and Medi News. Along with the launch of Medi Biz TV, Biz TV Network is also announcing the Medi BizTV Global Awards (India) 2013. BizTV network intends to honour medical practitioners for their contribution to the field of Medicine & Healthcare. Award categories include Life Time Achievement, Young Doctor Achiever of the Year, Best Pharmacists, Best Doctor in Ayurveda, Best Hospital Chain, Best Medical Insurance Company, Best Pharmaceutical Company, Best Innovative Diagnostic Company and Best Medical Television programme. Jan - Feb 2014
Jan - Feb 2014
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NEWS UPDATE
NEW LEASE OF LIFE A WORLD CLASS FACILITY WITH INTERNATIONAL EXPERTISE Dharamshila Hospital And Research Centre has achieved another pioneering step by commissioning 21 bedded World Class BMT (Blood and Marrow Transplantation) Centre. Dharamshila BMT Centre has International expertise for Blood and Marrow stem cell transplantation. Autologous, Matched Allogeneic, Cord Blood and Haplo-identical transplantation is now available at Dharamshila Hospital. The BMT Centre offers transplant as a treatment option for a variety of congenital and acquired disorders of children and young adults e.g. Hematopoitic (blood) malignancies and solid tumours, inherited immune deficiency syndrome, bone marrow failure syndrome and inherited metabolic diseases.
WHAT DIFFERENTIATES DHARAMSHILA BMT CENTRE FROM OTHER BMT CENTRES OF INDIA • BMT PHYSICIANS with international experience and reputation • A unique facility created to the highest specification to prevent infections following BMT. This has been achieved by creating a germ-free environment with stainless steel and vinyl surfaces along with unique airconditioning system, providing Class 100 clean room environment to every patient in a 4 bedded BMT unit, apart from 2 step down rooms, 11 IPD and 4 day care beds for patients with blood disorders. 10
• INHOUSE STEM CELL PROCESSINGAND BMT LAB ►
Magnetic Separation of Cells using MACS Technology.
► Long
term cryopreservation of stem cells at -1900 C liquid nitrogen freezer in vapour phase
► HLA
► Comprehensive
► NK cell and mesenchymal cell cultures and cell therapy
► Molecular
► Flowcytometry
► Detection
► Conventional and Real Time PCR for Viral Pathogens
► Drug
► RAPID
typing, NK cell genotyping and CD34 + stem cell estimation donor selection for Haploidentical BMT based on NK-KIR profile diagnosis for leukemia
based diagnostics for leukemia, lymphoma and Aplastic anemia of Minimal Residual Disease (MRD)
Levels for BMT
Bacterial and Fungal Cultures with detection and sensitivity
• BLOOD BANK advanced blood transfusion services comprising of automated component extraction, leucoreduction, apheresis, red cell serology and irradiation of blood / blood products. • PROFESSIONAL MANAGEMENT by a highly trained, experienced and dedicated team of Haematooncologists, Medical Oncologists, Radiation Oncologists, Surgical Oncologists, Oncopathologists, Clinical Psychologists, Counsellors, Nurses and other support staff. Jan - Feb 2014
NEWS UPDATE
Worldwide Achievers Felicitated the Winners of Healthcare
Excellence Awards 2013 Worldwide Achievers Healthcare Excellence Awards 2013 winner’s honoured by SHRI DR. C.P. THAKUR (Member of Parliament (RajyaSabha): Vice-President of BhartiyaJanata Party & Former Cabinet Minister Govt. of India) and SHRI PROF. M.C. MISHRA(Director, All India Institute of Medical Sciences, New Delhi).
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orldwide Achievers is one of the leading market research company organized Healthcare Excellence Awards 2013 with Media Partner: Headlines Today, Print Media Partner: Drugs Today, Magazine Partner: Medgate Today Ceremony to felicitate India’s top Doctors, Clinics & Hospitals, Healthcare Providers, Nursing Homes, Medical Devices and Hospital Equipment Companies, Diagnostic Laboratories, Medical Educational Institutions, Nursing Training Centres, Health Insurance Companies.. The event was held at Hotel The Ashok in New Delhi on 19th December 2013. Worldwide Achievers Healthcare Excellence Awards 2013 aims at felicitating organizations and individuals for their contributions to the industry by innovating for increased efficiency and improved performance of healthcare delivery at large. The Worldwide Achievers Awards have emerged as the most credible and coveted in the industry within a short span of time.
Bombay Hospital, Indore
CIMS Hospital Pvt. Ltd.
Clinic Dermatech Pvt. Ltd.
Worldwide Achievers has initiated the Healthcare Excellence Awards 2013 - country’s most authoritative awards for the healthcare industry. The awards were based on a comprehensive market research study and opinion surveys conducted by Worldwide Achievers. 12
Cloudnine (Kids Clinic India Pvt. Ltd.)
Jan - Feb 2014
NEWS UPDATE SHRI DR. C.P. THAKUR (Member of Parliament (RajyaSabha), Vice-President of BhartiyaJanata Party & Former Cabinet Minister Govt. of India) and SHRI PROF. M.C. MISHRA (Director, All India Institute of Medical Sciences, New Delhi) were the chief guest & Guest of Honor at the gala ceremony and gave away the award certificates to the winners, which included organizations/ Individuals from all across India. Healthcare Excellence Award For Multi Super Specialty Hospital & Research Centre of The Year - Medanta – The Medicity, Healthcare Excellence Award For Best Spinal Injuries Hospital of The Year - Indian Spinal Injuries Centre,
Dr. Ashok Kapse (Kapse Children Hospital)
Dr. Deepak Surya
Dr. Gurava Reddy (Sunshine Hospitals)
Dr. Jayant Thomas Mathew Jan - Feb 2014
Healthcare Excellence Award For Cord Blood Bank - Regenerative Medical Services Pvt. Ltd. (BABYCELL), Healthcare Excellence Award For India’s Best Healthcare Barrier Protection Company -J. K. Ansell Ltd., Healthcare Company of The Year - Samsung India Electronics Pvt. Ltd., Healthcare Excellence Award For Best Healthcare Insurance Company - Star Health And Allied Insurance Company Limited, Healthcare Excellence Award For Orthopaedic Dr. Gurava Reddy (Sunshine Hospitals), Healthcare Excellence Award For Ophthalmology - Prof. Dr. Ashok Garg, Healthcare Excellence Award For General & Oncology Surgery - Prof. Dr. Shashanka Mohan Bose, Healthcare Excellence Award For Sports Physiotherapy - Dr. Deepak Surya, Healthcare Excellence Award For Healthcare Marketing - Mr. Sameer Bhati (Star Imaging & Path Lab Pvt. Ltd.), Healthcare Excellence Award For Best Multi Specialty Hospital in Chhattisgarh -Fortis OP Jindal Hospital And Research Centre, Healthcare Excellence Award For Best Children’s Hospital in Mumbai - Surya Children’s Hospital, Healthcare Excellence Award For Best Medical Centre in Tamilnadu - Sri Ramachandra Medical Centre, Healthcare Excellence Award For Best Skin & Hair Transplant Center in Punjab - GH Derma Center, Healthcare Excellence Award For Pathology in Delhi - Dr. Vishu Bhasin (Dr P. BhasinPathlabs (P) Ltd.), Healthcare Excellence Award For Eye Specialist in Chandigarh - Grewal Eye Institute Pvt. Ltd., Healthcare Excellence Award For Best Pediatrician in Kolhapur (Maharashtra) - Dr. Santosh Nimbalkar, Healthcare Excellence Award For Multispecialty Hospital in Indore - Bombay Hospital, Indore, Healthcare Excellence Award For Best Innovative Hospital in Gujarat - CIMS Hospital Pvt. Ltd., Healthcare Excellence Award For Ayurveda in Delhi/NCR - Dr. Nilima Jain, Healthcare Excellence Award For Best Angioplasty Specialist - Dr. Keyur Parikh , Healthcare Excellence Award For Best Skin Care Clinic in Delhi - Clinic Dermatech Pvt. Ltd., Healthcare Excellence Award For Nephrology in Kerala - Dr. Jayant Thomas Mathew, Healthcare Excellence Award For Outstanding Research & Contribution For Dengue in Surat (Gujarat) - Dr. Ashok Kapse (Kapse Children Hospital), Healthcare Excellence Award For Radiology in Delhi - Dr. Parveen Gulati (Dr. Gulati Imaging Institute), Healthcare Excellence Award For Best Clinical Sexologist And Psychiatrist in Delhi - Dr. Rajesh Birman (Dr. Birman’s Healing Way), Healthcare Excellence Award For Best Cardiologist in Mumbai - Dr. Rahul R Gupta, Healthcare Excellence Award For Best Maternal & Neonatal Hospital in Bangalore -Cloudnine (Kids Clinic India Pvt. Ltd.), Healthcare Excellence Award For Hearing Care in Delhi Dr. Raj Sharma (Priority Hearing India), Healthcare Excellence Award For Ophthalmology in Kota (Rajasthan) - Suvi Eye Institute & Lasik Laser Center, Healthcare Excellence Award For Best Psychiatry Dr. NeeleshTiwari (World Brain Center Hospital),Healthcare Excellence Award For Pulmonology- Dr. Kailash Nath Gupta, “Healthcare Excellence Award For Best Cardiology Consultant in Rajasthan”- Dr. Naresh Sen, Healthcare Excellence Award For Best Diagnostic and imaging centre in northern region, Star imaging & Pth lab Pvt. Ltd., Healthcare Excellence Award For Best Radiologist in Delhi, Dr. Sameer Sood According to P K Choudhary, Vice President, Worldwide Achiever Private Limited, “The winners have exemplified Healthcare Provider amongst their peers in respective industries and regions. Almost all the winners scored extremely well in our study due to their dedication to customer satisfaction and best business practices. We hope that other players in the industry and region will try to emulate their success story and give them tough competition next year.”
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NEWS UPDATE
Dr. Kailash Nath Gupta
Dr. Nilima Jain
Dr. Rajesh Birman (Dr. Birman’s Healing Way)
Star imaging & Pth lab Pvt. Ltd
Dr. Parveen Gulati (Dr. Gulati Imaging Institute)
Dr. Santosh Nimbalkar
Dr. Naresh Sen
Dr. Rahul R Gupta
Dr. Vishu Bhasin (Dr P Bhasin Pathlabs (P) Ltd.)
Dr. Neelesh Tiwari (World Brain Center Hospital)
Dr. Raj Sharma (Priority Hearing India)
Fortis Op Jindal Hospital And Research Centre
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Jan - Feb 2014
NEWS UPDATE
GH Derma Center
Mr. Sameer Bhati (Star Imaging & Path Lab Pvt. Ltd.)
Samsung India Electronics Pvt. Ltd.
Grewal Eye Institute Pvt Ltd
Prof. Dr. Ashok Garg
Sri Ramachandra Medical Centre
Indian Spinal Injuries Centre
Prof. Dr. Shashanka Mohan Bose
Surya Children’s Hospital
J.K. Ansell Ltd
Regenerative Medical Services Pvt. Ltd.(Babycell)
Suvi Eye Institute & Lasik Laser Center
Jan - Feb 2014
15
NEWS UPDATE
Sameer Bhati bags Worldwide Achievers
Healthcare Excellence Award 2013
Sameer Bhati
Sr. Manager Marketing & Operations
He started many innovative & social services with company & individual capacity. Being member of National Thalassemia Welfare Society he launched many campaigns at corporate level. His knowledgeable articles on this topic are pioneers. He brings all hospitals & Educational institutes in a single platform from where awareness about this Blood disorder is increased in the general public. He is exactly doing the same thing with another noble cause i.e. “Save Girl Child”. He is a perfect balance of Business & Social responsibilities. From time to time he is organizing Blood donation camps to Gyne camps for social cause on one side & other side at company level he starts new product line in their services. He brings all the religious institution to a single roof against fighting Thalassemia & Female feticide. In Yr. 2013 his Research Paper Abstract was selected for International Conference on Research in Marketing (ICRM 2013)" IIT Delhi, Curtin University & XLRI Business School 16
For his efforts either in business world or social world, he is felicitated from time to time.
In Yr. 2013 he won • A IIMS Best Healthcare Excellence Aw a r d , in Yr.2013 he won three awards, • Worldwide Achievers Healthcare Excellence award 2013, • BrandAcademy Healthcare Excellence Award & • Six Sigma Healthcare Excellence award 2013 in the category of “Best Healthcare Marketing”.
Many religious trusts appointed him as their “Medical officer” or Chair Person. He is designated as Advisor Editor for the Health magazines (Samachar Saransh and Swasthya Surbhi) Presently he has the honor of being Member of Quality Council of India, Indian Association of Radiological Technologists etc. Most of the Market gurus & experts from the industry recognized him as the future Industry leader. We are hopeful that in near future he will come out with new methodologies so that we could also get a company like Toyota in our land too. Jan - Feb 2014
Jan - Feb 2014
17
NEWS UPDATE
Neonatal Survival - GE unveils a suite of solutions designed in India, from the ground up,to improve access to quality care GE Healthcare, the US$18 billion healthcare business of General Electric Company (NYSE: GE) today introduced a suite of new innovative solutions for the survival and growth of neonates in the primary care settings. Over the last decade there have been many advances in neonatal care, yet birth asphyxia and hypothermia remain leading causes of infant death and disabilities like blindness worldwide. There is a huge need to improve access to innovative solutions offering clinical performance, ease of use and affordability.
Nonsurgical treatment improves symptoms in women with pelvic floor dysfunction One in three women suffer from pelvic floor dysfunction (PFD), a range of symptoms which include bladder and bowel problems as well as pelvic pain, according to the American Urogynecologic Society. Now, University of Missouri researchers have demonstrated that a comprehensive, nonsurgical treatment significantly improves symptoms in women with PFD. “Pelvic floor rehabilitation is effective in helping women overcome pelvic floor problems with little or no medication,” said Julie Starr, a doctoral student in the Sinclair School of Nursing and a family nurse practitioner at the University of Missouri Women’s Health Center. “The treatment involves muscle strengthening for improved bladder control and muscle relaxation for those with symptoms of constipation and pelvic pain.” Starr and other MU researchers analyzed data from nearly 800 women with symptoms of pelvic floor dysfunction who underwent therapy for bowel, urinary or pelvic pain, and sexual dysfunction. The researchers found patients who completed at least five comprehensive pelvic floor rehabilitation therapy sessions reported an average of 80 percent improvement in three main areas: urinary incontinence, defecatory dysfunction and pelvic pain. 18
“Innovation is critical to tackle the huge neonatal mortality in India and around the world, and GE Healthcare is on the frontline of accessible solutions,” said Rita M. Barksdale, Global General Manager, Maternal Infant Care, GE Healthcare.“Pre-term births, neonatal hypothermia, birth asphyxia, lack of oxygen circulation and jaundice are some of the largest causes for neonatal morbidity and mortality. These deaths and disabilities formed in the process of survival are preventable with access to quality critical care solutions like Warmers, Resuscitation, CPAP (breathing support for under-developed infant lungs) and phototherapy devices. While Lullaby Warmer and Lullaby Resus suite of solutions are designed in India for India, they will also benefit the entire world” Making high-quality thermoregulation highly accessible:The new Lullaby Warmer Primeis an easy to use infant warmer that makes safe and reliable thermoregulation accessibleforprimary care settings even in remote and rural areas. By delivering uniform thermoregulation and consistently maintaining prescribed temperatures, the Lullaby Warmer Prime helps caregivers save precious young lives. The single-function buttons and easy-tofollow graphic instructions make operation simple, even when skilled caregivers are unavailable. The Lullaby Warmer Prime is designed to operate in tough conditions and is equipped with a re-usable probe made with Kevlar, the same material used in bullet-proof vests for reliability. The system can work without a voltage stabilizer and has been designed to withstand heavy voltage fluctuations prevalent in rural areas of India and operates on 50% lesser electricity than comparable systems.
FDA approves Mekinist in combination with Tafinlar for advanced melanoma U. S. Food and Drug Administration approved Mekinist (trametinib) in combination with Tafinlar (dabrafenib) to treat patients with advanced melanoma that is unresectable (cannot be removed by surgery) or metastatic (late-stage). In May 2013, the FDA approved both drugs as single agents to treat patients with unresectable or metastatic melanoma. Melanoma is the most aggressive type of skin cancer and is the leading cause of death from skin disease. The National Cancer Institute estimated that 76,690 Americans would be diagnosed with melanoma and 9,480 would die from the disease in 2013. Mekinist and Tafinlar are used to block signaling in different sites of the same molecular pathway that promotes cancer cell growth. They are specifically indicated as a combination therapy for patients with melanoma whose tumors express gene mutations called BRAF V600E and V600K. The BRAF protein is involved in the regulation of normal cell growth, but it is mutated in approximately half of melanomas arising from the skin. Jan - Feb 2014
NEWS UPDATE
Smart Global diversifies its healthcare portfolio, launches Smart Living mart Living is the flagship initiative S of Smart Health City S mart Global plans to invest about $250 million in the healthcare initiatives and make Saket City Hospital a 1,000-bed unit by 2016 SmartGlobal, a US$ 2 billion diversified conglomerate announced the launch of ‘Smart Living’, a unique and holistic initiative that aims to provide comprehensive curative, regenerative and preventive solutions. The launch witnessed discussions by distinguished panelists including Dr Pervez Ahmed, Vice Chairman &Lead Director, Saket City Hospital; Dr Roger J. Howe, PHD, Executive Chairman, Stemedica USA and Chief Executive Officer, Stemedica International; Dr Jeya Prakash, Director, Medical Park and Aesthetic Surgeon & Age Management Consultants and Sameer Maheshwari, Founder CEO, HealthKart. Singer Ms Carlyta Mouhini gave a scintillating live performance on Senorita song from the blockbuster movie ‘Zindagi na milegi dobara’at the launch event. Commenting on the launch, Dr. B.K Modi, Chairman, Smart Global, said “As India continues to advance and raise its benchmark of development, the need for a modern, proactive and sensitive healthcare ecosystem is most immediate. Smart Living will offer the best expertise and the highest quality of services. By 2016, we aim to invest about $250 million in the healthcare initiatives and make Saket City Hospital a 1,000-bed unit. Smart Health City is a $3-billion project and we are confident that we will contribute significantly to the growth and development in this segment. Delhi will be the first Global City coming out of India.” “We see a tremendous opportunity in our Smart Living initiative which is set to revolutionize the healthcare sector. Our main vertical for growth in India will be healthcare segment. We have already invested $100 million in developing the healthcare facilities in India, which includes refurbishing of the Saket City Hospital in Delhi as well as the Smart Living initiative”, he further added. Jan - Feb 2014
ad vez Ahecmtor, r e P . r D an & Dir td Chairm Hospital Pvt L ity Saket C
Dr. B.K
Chairma
Modi
n, Smart
Global
Smart Health City is based on the concept of adopting a holistic and mindful approach to wellness through curative and preventive intervention. Smart Health city represents the healthcare vertical of the Group comprising Saket City Hospital and Smart Living. Smart Health city will consist of facilities offering premium, multi-dimensional services in wellness in the fields of Yoga, Meditation, Age Management, Stress Management, Assisted Living, Vipassana, Stem Cell Therapy, Wearable Health Devices, Wellness Spa, Aesthetic Medicine, etc. All these services will be offered through experts with whom Smart Health City have exclusive tie ups and partnerships. Smart Health City shall also house facilities like Alternative medicine block, convention centre, medical office building, research & testing centre, medical recuperation, serviced apartments, education & training block and residential block. Smart Health City will be located at Saket in South Delhi, spread over an area of 15 acres and is expected to be completed in a phased manner by FY 2016/2017. Jones Lang La Salle has been appointed as the infrastructure partner for Smart Health City. Speaking at the event, Dr Pervez Ahmed, Chairman & Director, Saket City Hospital Pvt Ltd and Chairman & Managing Director - Aapka Urgicare Pvt Ltd, said, “In today’s era, Technology has left behind medicine and we will see Telemedicine and clinical research to create benchmark in the segment. Saket City Hospital and Smart Living will be leading pioneers for all edge cutting technology in the healthcare segment”. 19
NEWS UPDATE “The FDA has approved gels like ReSure for sealing small incisions in other parts of the body, such as the lungs, but this is a first-of-its-kind for the eye,” said Christy Foreman, director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health. A cataract is a gradual clouding of the eye’s lens that results in vision loss. Cataracts are often the result of aging, but can have other causes. According to the National Institutes of Health, by age 80, more than half of all Americans have either a cataract or have had cataract surgery. Cataract surgery is a procedure to restore vision by removing the eye’s natural lens and replacing it with an artificial lens.
FDA approves first gel for sealing corneal incision after cataract surgery The U.S. Food and Drug Administration today approved the first gel sealant for use in stopping fluid from leaking through the incision in a patient’s cornea after cataract surgery with intraocular lens placement in adults. Prior to today’s approval, stitches were the only option for closing a leaking corneal incision after cataract surgery.
During cataract surgery, an eye surgeon makes a small incision in the cornea through which the patient’s natural lens is removed and the artificial lens is inserted. In many cases the incision is small and self-sealing after the artificial lens is in place. However, if fluid leaks from the incision, the surgeon may need to close the wound. The ReSure Sealant kit comes as two liquid solutions that the surgeon mixes together just prior to sealing the incision. Using a foam-tipped applicator provided in the kit, the surgeon applies the mixture directly to the incision. Within 20 seconds of applying the liquid to eye tissue, a gel forms that adheres to the eye and seals the incision. The gel gradually breaks down over the course of seven days and is cleared from the body by the eye’s natural tears. States. Over time, high blood sugar levels can increase the risk for serious complications, including heart disease, blindness, and nerve and kidney damage. “Controlling blood sugar levels is very important in the overall treatment and care of diabetes, and Farxiga provides an additional treatment option for millions of Americans with type 2 diabetes,” said Curtis Rosebraugh, M.D., M.P.H., Director of the Office of Drug Evaluation II in the FDA’s Center for Drug Evaluation and Research.
FDA approves Farxiga to treat type 2 diabetes The U.S. Food and Drug Administration today approved Farxiga (dapaglifozin) tablets to improve glycemic control, along with diet and exercise, in adults with type 2 diabetes. Type 2 diabetes affects about 24 million people and accounts for more than 90 percent of diabetes cases diagnosed in the United 20
Farxiga is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that blocks the reabsorption of glucose by the kidney, increases glucose excretion, and lowers blood glucose levels. The drug’s safety and effectiveness were evaluated in 16 clinical trials involving more than 9,400 patients with type 2 diabetes. The trials showed improvement in HbA1c (hemoglobin A1c or glycosylated hemoglobin, a measure of blood sugar control). Farxiga has been studied as a stand-alone therapy and in combination with other type 2 diabetes therapies including metformin, pioglitazone, glimepiride, sitagliptin, and insulin. Farxiga should not be used to treat people with type 1 diabetes; those who have increased ketones in their blood or urine (diabetic ketoacidosis); or those with moderate or severe renal impairment, end stage renal disease, or patients on dialysis. Jan - Feb 2014
COVER STORY
Have you crossed 50? Stay guarded against
Prostate Cancer
Prof (Dr ) Rajeev Sood (MSMCH) RML HOSPITAL
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Jan - Feb 2014
Cover STORY
O
f the 7.6 million deaths due to cancer worldwide, onesixth are caused by prostate cancer which is also today the second most frequently diagnosed cancer after lung cancer. A disease whose risk increases proportionately with age, prostate cancer is growing in incidence as life expectancy increasing. 70 % of all prostate cancers are diagnosed in men over the age of 65. It is still unclear why this increase with age occurs for prostate cancer but studies suggest that after 70, most men have some form of prostate cancer, even though there may be no outward symptoms. The prostate is an exocrine gland of the male reproductive system, and is placed directly below the bladder. Roughly the size of a walnut, it is through the prostate that the urethra (– the tube carrying urine and semen out of the body )- goes through. Besides producing a fluid that forms part of the semen and protects the sperm, the prostate gland also plays a role in urine control. Traditionally, the incidence of prostate cancer has been the highest in the United States and Europe and lower in countries of South and East Asia. However, with increase in life expectancy, adoption of newer lifestyles and screening using prostate specific antigen (PSA), the incidence of prostate cancer is on the rise in low and middle income countries like India as well. In India, where life expectancy has increased from 61.97 in 2001 to 65.48 in 2011, prostate cancer incidence is growing by 1% every year. However, not many people are aware of this problem and its Jan - Feb 2014
Doctors suggest how increasing life expectancy in India may increase the burden of the disease treatment options to prevent it from turning fatal. We need to up the ante against the disease by spreading awareness about prostate cancer, its risks and ways to curtail it. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause any serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
Before we discuss the prevention and treatment options, here is a quick look at some key facts about Prostate Cancer. ne new case occurs every 2.5 O minutes and a man dies from prostate cancer every 17 minutes. nonsmoking man is more likely A to get prostate cancer than lung, bronchus, colon, rectal, bladder, lymphoma, melanoma, oral and kidney cancers combined.
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NEWS COVER UPDATE STORY
ecause prostate cancer is a B relatively slow-growing cancer, the 5-year survival rate for prostate cancer diagnosed at all stages is 98%. The relative 10year survival rate is 84% and the 15-year survival rate is 56%. In the West, where a number of celebrities and high profile people have spoken publicly about the disease, awareness has steadily risen. Hollywood stalwarts Robert De Niro and Michael Douglas have undergone treatment for prostate cancer, so has South Africa’s iconic former President Nelson Mandela and former US Secretary of State Colin Powell. Age, genetic predispositions and diet all seem to have a direct correlation with the risk of prostate cancer. Some studies have also indicated that men with sexually transmitted diseases too have a higher chance of getting afflicted with prostate cancer.
about the disease remains low. It is important to note that there are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may appear: A frequent need to urinate, especially at night weak or interrupted urinary A stream Blood in urine or semen Hence, it becomes important to immediately visit a doctor if any of these symptoms are observed. The good part is that prostate cancer is a relatively slow-growing cancer, and the survival rate is hence high. The treatment options include surgery (prostatectomy), radiotherapy, hormonal therapy using androgen-depriving drugs, depending upon the stage and level of the cancer.
However, in India the awareness 24
Jan - Feb 2014
NEWS UPDATE
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COVER STORY
Don’t let Urinary Disorder throw your life off track! D GCI recently allowed use of botulinum Toxin type A for treating problem of frequent urination in certain neurological conditions An injection of botulinum toxin type A can offer relief for up to 12 months
A
string of meetings, conferences, media engagements, coupled with a lot of travelling, kept Ms Simran Maurya a lot preoccupied. Knowing full well that being a CEO of a fledgling Event Management company was not a cakewalk, she did not shy away from putting in her best possible efforts to make her venture a successful enterprise. Meeting new people for business purposes and put across her brilliant ideas effortlessly made her clinch important deals. All this gave her a high. But it was then. Now it is a lot different for her. She lives in isolation, stays away from business meetings she once loved to be a part of, and avoid travelling. In her absence the business has suffered a significant setback, and her dream has fallen apart. From a highpoint, her life has taken a treacherous turn to hit a low. Her story is not very different from Ramanathan Krishnan, who had been waiting to see her daughter tie knot. Having brought her up single handedly after his wife passed away many years ago, Krishnan had been living for just this one day. But when the time finally came, he decided to stay in Bangalore and not participate in the ceremony in Delhi, despite continuous pleadings from his daughter whom he held so close to his heart. Situations for both Maurya and Krishnan had been different but one ailment that forced both of them to cut off from the public life – Urinary Incontinence. The problem is not restricted to just the two of them it is common among many people in India. Urinary Incontinence and the trigger factors In common parlance, it is a condition in which a person loses control over the bladder. The bladder is an expandable structure in our body. It stores urine and by way of expansion and contraction of bladder that happens due to change shape in shape of transitional epithelial cells, it eliminates the waste liquid from the body. In a normal person, the bladder sends a signal to the brain intimating it the need for urination. But in the persons suffering from this disorder, the neurons get dysfunctional, thus disrupting the signal system. For this particular reason, the person loses control over bladder (expansion and contraction), and urinates frequently involuntarily. The disorder is more common in women as compared to men. There are a number of reasons for urinary incontinence, and it may occur due to the loss of higher control of micturition, which normally controls urination. It could also occur due to a set of neurological conditions such as Spinal Cord Injury, Multiple Cclerosis, Parkinson’s Disease and Neurogenic Detrusor Overactivity (NDO). In men, neurogenic cause like neuro injury, Parkinson’s Disease, cerebral palsy, brain haemorrhage, multiple sclerosis or Alzheimer’s triggers the condition, but in women the reason is idiopathic, meaning by in this case the cause is not known. Lifestyle, frequent pregnancies and hormonal changes are contributing factors in the case of women.
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Dr N K Mohanty Head Urology Saket City Hospital
As per Dr N K Mohanty, Head, Urology, Saket City Hospital, New Delhi, among the patients he attends to for the disorder, 85 per cent of them are women. Often, at the time of childbirth when a woman undergoes mental and physical stress, loss of support of the urethra could lead to leaking of small amounts of urine during coughing, sneezing and lifting. It is also considered as a condition of stress incontinence. Whereas urge urinary incontinence is caused by uninhibited contractions of the detrusor muscle associated with a neurological condition, causing leaking of large amounts of urine without sufficient warning to allow the individual to attend nature’s call well in time. Frequent urination brings embarrassment to the person suffering from the ailment and they are often mocked at by others. To save themselves from the shame and humiliation, the suffering persons start living a life of seclusion. In certain cases, urinary incontinence even becomes a cause of marital discord. Due to low levels of awareness, many cases go untreated and many patients keep suffering in silence. “We have witnessed cases where the problem of loss of bladder control has thrown the lives of married couples out of gear, even forcing them to consider divorce. There is need to educate people and raise awareness that this is a medical problem and they should not be embarrassed to seek help. With medical intervention, the problem can be managed and controlled and life can become easier,” says Dr Mohanty. Treatments for the disorder Traditionally, Urinary Incontinence patients are treated with lifestyle modifications -- they are asked to include more fibrous food in diet and eat healthy, quit smoking and avoid alcohol use, and maintain a healthy weight, among others. Besides, medication and pelvic exercises help contain the condition. In a major development, The Drug Controller General of India (DGCI), the nodal agency for approving the use of a medical drugs in India, recently gave a go ahead for the use of botulinum Toxin A for treating the symptoms of urinary incontinence in certain neurological conditions. Once injected into the detrusor, botulinum toxin type A works as purified protein that blocks overactive nerve impulses that trigger excessive muscle contractions. Although the effect is not permanent, it may last up to 12 months depending upon the individual condition, providing ample relief to the person suffering from the debilitating ailment. The treatment can help bring back the normal functioning of the urinary bladder from an overactive state, with no significant intervention required to follow during recovery period. So, if medicine and exercise have failed to make a difference in your lives, you have another treatment mechanism for controlling overactive bladder in NDO. The procedure takes 30 just minutes on a whole and can provide a long lasting relief. Jan - Feb 2014
COVER STORY
‘She’
swaps kidney to save husband’s life Yuvraj Kheche and Amol Maid unknown to each other but sufferings were parallel as both underwent through a sad face of life leading to ‘kidney failure’. Being in dialysis since years they felt vulnerable and lost hope to live a long and a cheerful life. Yuvraj was lucky enough to receive a kidney donated by his brother but all his aspirations went in vain when his body rejected it a year after the transplant.
Dr. Mahesh Rokde Nephrologist Jahangir Hospital (Pune)
After the awful pain and hindrances underwent by Yuvraj and Amol, their wives were strong-willed to donate their kidneys to their husbands but were fated as their blood groups did not match. They urged the doctor to find a donor .After the elongated effort done by Dr. Mahesh Rokde (nephrologists at the Jehangir hospital) he examined a couple destined to look forward for the same. It was a sheer luck that the blood groups of their wives matched with each other’s husbands. The Jehangir hospital has seen a rare case like this where the spouses donated kidneys to each other’s husband. The hospital is pleased enough to save the life of the two escorting their life ahead with happiness and success.
Jan - Feb 2014
“We were lucky that the surgery took place in the same hospital. I would like to congratulate the surgical team for bringing up success in the surgery. Soft transplant with two unknown is difficult but we are happy that we could resolve it”. Said Dr. Mahesh Rokde. “I could not stand by the pain my husband suffered and not a soul was ready to give a kidney. So I decided to go for swapping, which truly helped me and I am thankful to the team of Jehangir to do the needful”. Said Preeti Maid, wife of Amol Maid. “My husband was on dialysis since years. I was the only hope that could lend a hand to him. We were also suffering from a lot of financial crisis and were very much worried about my kids and their future. But now we are pleased to be out of the crisis”. Said Suvarna Kheche, wife of Yuvraj Kheche. It is great to see such rare cases where two unknown people meet to help each other. We are delighted to witness the couples living a joyful and a cheerful life.
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DOCTOR SPEAK
Dr. Rajiva Kumar Child Specialist Muzaffarpur Bihar, INDIA
Common Diseases among Children
during winter season Every year around this time, we pediatricians start to see a steady stream of sniffling, coughing, feverish children. Still, many parents wonder whether they really need to be bringing their children in for garden-variety winter illnesses. 28
W
inter is in full swing and temperatures are
plummeting across the country. The cold brings with it a host of illnesses that seem to affect almost every household. Here is a quick rundown of various winter illnesses along with symptoms and remedies. Many parents of young children talk to me about how difficult it is to deal with the seemingly constant series of illnesses their child picks up winter season. Jan - Feb 2014
DOCTOR SPEAK Bronchitis: Bronchitis is an inflammation (irritation,
swelling) of the airways caused by virus, bacteria or allergies. Cause: Mostly a viral infection. Can also develop during other infections such as common cold and influenza (flu) Symptoms: Cough (without sputum / bulgham), headaches, difficulty in breathing, chest discomfort, mild fever. Treatment: Lots of rest and fluids. Use of steam vaporizers is recommended to make it easy for the child to breathe. See your doctor if symptoms persist. Sinusitis: Sinuses are moist air spaces between the bones around our noses. Sinusitis is an inflammation (irritation and swelling) of the sinuses, usually caused by viral infection following a cold. Sinusitis can also be bacterial or an allergic reaction. Cause: Infection of the sinuses which can be viral, bacterial or due to an allergy. Common Cold: A child is likely to get a cold six to ten times Symptoms: Nasal congestion, nasal discharge, pressure a year mostly during winter months. The higher frequency and pain around the nose and feeling of pressure in the of colds during winter months is due to lower humidity / head. May also cause a recurrent sore throat and cough. dryness and dusty conditions that can help spread viruses. Treatment: Consult a doctor to see if the condition is Cause: Colds are caused by a virus that infects the due to virus, bacteria or an allergy and follow his / her upper respiratory system (nose, sinuses, throat, airways). instructions. In case of bacterial infection doctor may Symptoms: Sneezing, coughing, a stuffy or runny nose, prescribe antibiotics. In case of an allergic condition he / sore throat. Sometimes these may be accompanied by she may prescribe antihistamines (a medicine used to treat conjunctivitis (pink eyes), muscle aches, fatigue, headaches, shivering, and loss of appetite. Mild fever is also experienced. allergies and hypersensitive reactions) Use of humidifier or Treatment: There is no known cure for the Common steam vaporizers is recommended to help ease breathing. Cold. We recommend lots of fluids and rest and use of a Pneumonia: Pneumonia is an infection of the lungs and a decongestant to unblock a child’s nose and anti pyretic in serious condition when it comes to children. Pneumonia can be case of fever. If a child develops high grade fever or has caused a virus, bacteria or fungi. Pneumonia can also begin after difficulty breathing immediately consult your doctor. one of the infections described above i.e. cold, flu. Pneumonia Flu: Flu or Influenza is a more severe disease than the can be avoided in children by ensuring a good diet to build common cold. It is an infectious disease (that can be up their immune systems and through proper immunization. transmitted from one person to another) that affects nose, Cause: The viruses and bacteria that cause Pneumonia are usually throat, airways and, occasionally, lungs. Flu is particularly found in fluid from the mouth and nose of an infected person. dangerous for young children and can lead to more It is usually spread when an infected person coughs or sneezes. severe conditions such as Pneumonia which can be fatal. Symptoms: High fever, shortness of breath, difficulty Cause: Viral infection that is easily transmitted in breathing, cough (with sputum / bulgham), chills from one person to another via droplets and small / shivering , loss of appetite, chest pains, wheezing, particles when an infected person coughs or sneezes. It usually spreads quickly in seasonal outbreaks. and vomiting. In some children the only sign of Symptoms: The most common symptoms of the Pneumonia can be high fever for more than 4 days. disease are chills, fever (usually above 101), sore throat, Treatment: If your child shows any of the signs described muscle pains, severe headache, coughing, weakness / above, consult a doctor immediately. Especially in the fatigue, nausea and vomiting and general discomfort. case where your child has difficulty breathing, his lips and Treatment: We highly recommend that if you fingernails have a bluish / grey color, has high fever over 102° suspect your child has Flu immediately consult Fahrenheit / 38.9° Celsius (100.4° Fahrenheit / 38° Celsius in your family doctor or a pediatrician (child doctor). infants under 6 months of age). Jan - Feb 2014
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EXPERT VIEWS
The fusion of Critical Care Skills, Technology, and Imagination & Compassion is a solution that fired the idea of creating a world class integrated Critical Care delivery System in India to provide “Intensive Care beyond Boundaries”.
Dr Raajiv Singhal
T
he Criti Next ICU enables a remote hospital to provide advanced consultation, care and monitoring to their critically ill in-patients without having to physically transfer them to super-speciality hospitals. Transporting a critically ill patient from one facility to another, especially a distant hospital, can be risky. Patients are at the risk of clinical deterioration that may lead to adverse events including threat to life, due to the stress caused by transportation. However, Criti Next eICU helps provide expert care to the patient at the local hospital helping avoid inter-hospital transfer and risks. ICU care at local hospital allows patient to get better support from family as well as help reduce costs by shortening the stay in ICU. Criti Next addresses the shortage of critical care staff in remote areas and enables physicians in remote units to manage ICUs more efficiently. Remote ICU Monitoring Technology combined with expert set of eyes can help reduce medical errors and infection within ICUs leading to reduction in patient mortality by upto 60%. Each year, an estimated 10% of all hospital admissions require ICU care. The statistics are staggering – just 70,000 well equipped ICU beds against an estimated demand of 400,000 ICU beds to provide critical care for approximately five million ICU cases per year. It is equally alarming to see the non-availability of qualified intensive care specialists.
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Only 6000 intensivists/Anesthetists are catering to the critical care needs of five million patients! Well-equipped ICUs, qualified intensivists and 24/7 availability are key determinants of successful outcomes. Criti Next is a solution to bridge this huge gap of ICU beds by providing specialist care at the point, where it is needed in a cost effective way. It also provides successful evidence based outcomes helping standardize the critical care for the patients irrespective of where they live. Dr. Amit Varma, Executive Director CritiNext, Director Critical Care Medicine , Fortis Escorts Group of Hospitals Dr Raajiv Singhal – VP – Fortis Escorts Heart Institute, New Delhi & CG says – we have covered 6, 2nd tier cities of India & have more than 215 E ICU beds it includes Raigarh, Raipur, Agra, Dehradun & Amritsar. It has 24*7 cover by Intensivists & hundreds of life saved till date. Our upcoming sites would be Varanasi, Goa,Ranchi, Manipur,Bangladesh. Jan - Feb 2014
Doctor SPEAK
What is the best best way to treat coronary artery disease Dr Ajay Kaul DIRECTOR, DEPARTMENT OF CARDIOVASCULAR SURGERY, FORTIS ESCORTS HEART INSTITUTE, DELHI
At Fortis Escorts heart Institute we have standardized the use of both internal mammary artery and in almost 80% of our patients we use bilateral IMA with excellent long term results. There are no cuts on the legs and patient has a fast recovery. We are all aware that Indians have one of highest incidence of Diabetes, hypertension and heart disease in the world. “ Heart attack� is one of the commonest cause of death in our country. Heart attack occurs due to coronary artery disease. Coronary artery bypass grafting is a well a establish therapy for patients with multi vessel coronary artery disease with excellent short and medium term results. However even after a successful operation the occurrence of new obstructions may cause problems as the years go by. These new obstructions may developed either in patients own coronary arteries or in by-pass grafts particularly sephenous vein grafts. This is particularly important when one considers that graft occlusion can result in recurrence of angina, rehospitalisation, reintervention. 32
Within 5 years of surgery approximately 20% of saphenous vein grafts develop partial or total obstructions andby 10 years after operation almost 50% of saphenous vein grafts are either totally obstructed or show some angiographic evidence disease. Failure of vein grafts over the long term remains a significant problem effecting outcomes after cardiac bypass surgery and it is the single greatest cause of the need for repeat surgery for bypass grafting Fortunately there have been other bypass grafts available that are resistant to late failure- one of them is internal mammary artery which gives excellent long term results. It also at the moment is the best way to reduce, reintervention in coronary artery disease Studies of angiograms performed after bypass surgery have shown that not only did the Left Arterial Mammary to LAD graft have a more than 90% chance of functioning well early after operation, but that these grafts continued to function well for many years and that even 20 years after operation the development of obstructions in these grafts is extremely uncommon. Presently long-term follow-up studies from the Cleveland Clinic Foundation have shown that bilateral IMA grafts further decrease the long-term risks of death and reoperation when compared to patients receiving only one IMA graft. The use of both IMAs as bypass grafts is a more complicated. In spite of these good results total arterial grafting has yet to become the standard approach for patients undergoing CABG. Large registries suggest that the use of total arterial grafting is limited to approximately 10% of all patients undergoing CABG worldwide. In conclusion using both internal mammary arteries is the best way to treat coronary artery disease. It gives excellent long term results which cannot be matched by any other form of treatment for coronary artery disease. Jan - Feb 2014
Next Issue March 2014
India’s top health & Medical Magazine
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Tel: +91 11 2698 1342
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Jan - Feb 2014
33
Healthcare
IT
IT enabled
USICON 2014
A step ahead in Urology
the few specialties of medicine that exploits all arenas of technology to their hilt.
Dr. Raman Tanwar
Web and IT Coordinator USICON 2014
USICON 2014 is an attempt to grow in the field of urology, on the soil of new technology, amidst the light of awareness. The grounds have been laid not just for Uro-specialists from all over the globe but also the common man. Literacy has diversified and found newer meanings. In the modern world literacy exceeds mere ability to read and write. Literacy has endorsed the foundations of a better survival and it is apt to include e-literacy as an essential part of this term. A humble attempt at bringing technology a step closer to Uro-practitioners is the mobile application. The application is a wonderful example of how technology can simplify lives and provide much information in so little a platform. As urologists we have been reaping the benefits of advances in technology and delivering those boons to our patients. We have been applying newer developments on a constant basis to our armamentarium, and it is proud fact to be stated that urology is one of
34
The mobile application integrates academics, interaction, information, tourism, business and latest advances into one. It has over 20 features which will help delegates to organize themselves and make the maximum out of USICON. The application allows the delegates to see the complete program organized neatly by day, location and sub specialty. Sessions can be added to a customized schedule, making the whole academic program personalized to ones area of interest. You can add various activities going on during the conference to your to do list. Scientific program has been linked to abstracts, speaker notes and faculty information and CVs so that you can tailor your schedule using a pool of extensive information. A simplified and unified
search comes handy when sessions and events have to be filtered based on specialty, field of interest and name of speakers and chairpersons. The complex layout of the venue has been simplified using the inbuilt maps which help delegates find their way in time. Dinner and cultural activities at other venues have also been included and linked to Google maps for easy navigation. From within the maps it’s simple to jump to any hall and see the sessions planned during the congress. The application also helps delegates to cover tourist locations and enjoy local and daylong tours encompassing various spots throughout north India by
Jan - Feb 2014
NEWS UPDATE
Jan - Feb 2014
35
HEALTHcare
IT
helping them select and providing a detailed itinerary. It also provides a list of eat-outs, hangouts, hotels and must see places that are located in the vicinity of the conference venue. It is easy to personalize the application by using your social media profile to log in. Once authenticated the delegate can exchange virtual business cards with other delegates and contact them at the preferred contact using email, social media or voice number. Latest changes and updates can be conveyed to the delegates in real time using messages and push notifications. The exhibitor section provides details about the various stalls and exhibitors taking part in the conference and newer products that have been launched in the urological industry. It is possible to search exhibitors, and locate them on the exhibition ground using maps and add them to the to-do list. It is also possible to click and share photographs on the cloud album for everyone to appreciate. A rich collection of abstracts is available offline within the app, which are searchable and represent the latest and leading research projects going on in the country. E-Posters have been linked to relevant abstracts which can be viewed online using the Smartphone. The application is linked to online resources in urology and the popular social media links for this event. The mobile application, featuring a large number of features is going to be a useful tool in our hands to enjoy and participate in this event with full vigor. The conference also features a unique delegate tracking system using Radio frequency tags. Each unique ID tag with also serve as a USI membership ID tag which will make attending conferences and credits simplified. The radio frequency system will allow recording of the activity of delegates in real time and provide authentic credit hours based on attendance. Many unique features and services can be provided to members and delegates using this system. Submission of research work in a virtual format is also being encouraged in USICON 2014. E-Posters will allow a larger section of the scientific community to appreciate and provide feedback about the presenters 36
research work. We are hoping to receive e-posters in a large numbers and these will be linked to the mobile application and web portal for viewing even after the conference. USICON 2014 is not only going to be a step forward in upgrading the knowledge of delegates with the latest advances but also in spreading awareness towards burning issues like Uro Genital cancers, Organ donation and Men’s health. It’ll be our keen endeavor to spread the light of knowledge to surgeons and the public at large. Jan - Feb 2014
TECHNOLOGY
UPDATE
Sharper ultrasound images could improve diagnostics New system developed at MIT allows precise measurements and tracking of disease progression
U
ltrasound images, known as sonograms, have become a familiar part of pregnancy, allowing expectant parents a view of their unborn child. But new research at MIT could improve the ability of untrained workers to perform basic ultrasound tests, while allowing trained workers to much more accurately track the development of medical conditions, such as the growth of a tumor or the buildup of plaque in arteries. The improvements to this widely used technology could provide detailed information far beyond what is possible with existing systems, the researchers say. The work, led by Brian W. Anthony, co-director of MIT’s Medical Electronic Device Realization Center (MEDRC) and director of the Master of Engineering in Manufacturing Program, was recently presented at the International Symposium on Biomedical Imaging in Barcelona, Spain.
There are two key elements to the improvements engineered by Anthony and his team. First, the researchers devised a way to adjust for variations in 38
the force exerted by a sonographer, producing more consistent images that can compensate for body motions such as breathing and heartbeat. Second, they provided a way to map the exact location on the skin where one reading was taken, so that it can be precisely matched with later readings to detect changes in the size or location of a tumor, clot or other structure. Jan - Feb 2014
TECHNOLOGY
UPDATE
Together, the two improvements could make sonography a much more precise tool for monitoring the progression of disease, Anthony says. The devices are currently undergoing three clinical trials, including one at Boston Children’s Hospital focused on monitoring the progression of patients with Duchenne Muscular Dystrophy (DMD). In that trial, Anthony says, researchers are trying to determine “how fast the muscle deteriorates, and how effective different medications are.” It’s important to have a reliable way of monitoring changes in muscle, he says. The study is aimed at determining whether ultrasound analysis can serve as a convenient,
image varies as the force increases, which can provide important diagnostic information about the elasticity of skin, muscle and other tissues. To provide accurate positioning, a tiny camera and lens mounted on the probe can reveal skin patterns that are distinctive and constant, similar to fingerprints. “Skin patterns are pretty unique,” Anthony says; his team’s system, using software to compare new images with earlier ones, “can get you back to that same patch of skin,” something that is impossible to do manually. Anthony likens that precise positioning to “an on-thepatient GPS system” for locating structures in the body. The ability to take images over time from exactly the same position makes it possible to monitor changing tissues quite precisely: The imaging system can determine the volume of a near-surface tumor or other feature to within an accuracy of 1 to 2 percent, he says. There are existing ways to get this kind of accuracy, but these require expensive specialized equipment that few hospitals have. Besides the potential for these advanced diagnostic capabilities, enhanced control over testing could make it possible for relatively untrained health care workers to administer basic ultrasound pregnancy tests — especially in remote, underserved areas where trained sonographers may not be available. The various control techniques “take the uncertainty out” of the process, Anthony says.
noninvasive, clinically meaningful way of monitoring disease progression in DMD. The new device maintains constant force through the addition of a force sensor to its probe tip and servomotors that can respond almost instantly to changes in force. That, in turn, makes it possible to analyze how the
Jan - Feb 2014
Craig Steiner, an anesthesiologist at Chester County Hospital in Pennsylvania, says, “I’m excited about the prospects” of these improved systems. “The reproducibility of the scan with consistent pressure and picture quality would help with remote readings of locally done scans. This could be relevant for teleradiology, which is an area ripe for expansion.” Steiner adds: “The field of ultrasound is still developing. Ultrasound will partially replace CT scans, reduce radiation exposure to patients and make diagnosing easier when away from the high-cost hospitals. It can help our world provide care at a more reasonable cost with a new paradigm of care.” 39
DOCTOR Speak
Clinical Gynaecologic & Infertility Dr. Suman Bijlani Gynaecologist, Obstetrician & laparoscopic Surgeon
R
eproduction is one of the complex, yet wondrous events in human physiology. Nature has given attention to every detail, and a series of events in both the man and woman, ultimately culminate into biological union and the beginning of a new life.
The fertilized egg,again aided by muscular movements of the tube, then moves into the uterus, whose inner lining is already prepared by hormonal changes, for implantation. The egg then implants into the uterus, obtains nourishment, and begins to grow. Fertilization does not occur in every cycle. The chance of conceiving in every cycle is about 25% for a woman younger than 30, and about 15% for a woman who is 35 plus. Most couples would take about 5 to 6 cycles of regular intercourse to conceive and about 85% would have conceived by the end of one year. The causes of infertility in the woman could be as follows:
Ovulatory dysfunction (failure of ovaries to produce eggs) – this is commonly seen in the older woman (more than 35), PCOS, obesity, stress, thyroid dysfunction and Yet, sometimes, untoward happenings can mar this women with irregular cycles or ‘hormonal imbalance’. flawless chain of events and the couple find themselves Tubal factor – the fallopian tubes are diseased and this at a loss. affects their function of sperm and ovum transport.
Infertility, in medical terms, is described as the failure to conceive after one year of regular, unprotected intercourse. This definition is not inflexible, and anxious couples or those older than 35 are offered treatment sooner.
Sometimes the tubes may be completely blocked not allowing the gametes to pass through at all! Sexually transmitted infections such as gonorrhoea, chlamydia, and tuberculosis in our country, are the commonest causes of tubal disease.
To understand why fertility failure occurs, one must Pelvic disease- Any inflammatory disease of the pelvic organs can lead to formation of fibrous bands known as understand the process of reproduction. adhesions within the pelvic cavity, which may distort After being deposited in the vagina through intercourse, millions of sperms, by virtue of their motility (they have tails), move across the cervix into the uterus and further into the fallopian tubes. Around the time of ovulation (egg rupture),the cervical mucus becomes thin and watery to facilitate this passage. Chemical signals from reproductive secretions and the female egg guide the sperm to the site of fertilization, viz the fallopian tubes. If the woman is in her fertile period, meaning peri-ovulatory (near the time of ovulation), her ovum(unfertilized egg),after being released from the ovary, gets sucked into the fallopian tubes and travels through tubal action, up to the mid-tube, where it lies in wait for the sperm. One of the many sperms would penetrate the ovum, an event termed as fertilization. 40
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DOCTOR SPEAK the anatomical relationship between the various pelvic organs. This directly affects the ability of the tubes to pick up the ovum and transport it across. Endometriosis and infections are common causes of this condition.
times. Increased caffeine consumption (more than 300 mg per day) can reduce fertility in women, albeit the exact reason is not known. 300 mg is about 2 cups of coffee or 5 cups of tea.
Uterine factor-the uterine cavity may be distorted by the presence of anatomical defects such as a septum which may interfere with implantation. Fibroids in the inner aspect of the uterus or ‘adhesions’(fibrous bands within the uterus) may also be responsible for failure to implant.Tuberculosis is again one of the common causes of intra-uterine adhesions.
So, limit your coffee/tea intake and if you are trying for a test tube baby, abstain altogether for best results. Maintain ideal body weight Body mass index between 20 and 23 is ideal. Women who are overweight tend to have ovulatory problems and PCOS, while very lean women may not have enough estrogen to form eggs and prepare theisr uterine lining.
Cervical factor- the cervical mucus may be thick and impenetrable, as a result of longstanding infection or the Overweight women would benefit from losing even 5 to cervical canal may be partially closed due to inflammation 10% of their body weight, even though they may not be able to get back to an ideal weight for height. Anorexic (stenosis). women should seek treatment to gain weight to restore Multiple factors- in many cases, there may be more normal cycles and ovulation. than one cause. For example, she may have tuberculosis with damaged tubes and uterus, or endometriosis, where Plan pregnancy before 35 ovulation and tubes may both be affected. Focus on career and late marriages are now the reason
Unexplained infertility- there is a subgroup of patients, more and more women are pushing pregnancy to a later age. Research has shown that fertility declines after 35 wherein no cause is found for fertility failure. significantly for women, as the quality and quantity of Lifestyle changes to aid fertility: her eggs suffer. Miscarriages become more common as Give up smoking (or at least cut down) do genetic defects in the offspring. Whenever possible, Smoking affects the ability of the ovaries to produce eggs it is better that women prioritise pregnancy planning to as well as the hormone estrogen, especially in women optimise fertility outcome. who smoke more cigarettes and over a long period of Practice safe sex time. Smoking thus reduces fertility. In addition, it increases your chances of miscarrying or getting an More relevant today than at any other time, this dictum ectopic pregnancy. Women who smoke also jeopardise could save many women from the devastating effects of their partner’s sperm counts and function due to effects sexually transmitted infections. Blocked fallopian tubes, inflammation of the uterine lining and cervix as well as of passive smoking. Moderate your alcohol intake There is no doubt that moderate to heavy alcohol intake interferes with ovulation and may increase your risk of developing endometriosis, and promote hormonal imbalance. Whether light drinking harms her fertility potential,is controversial. It is advisable to abstain, or at least limit alcohol to minimum possible, if you are trying to conceive. Limit caffeine intake Caffeinated drinks such as coffee, tea, colas and chocolates form a regular part of our diet in today’s Jan - Feb 2014
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DOCTOR Speak Stress Management Stress can affect the higher organs in our brain (the hypothalamus and pituitary), which can lead to suppression of reproductive hormones, leading to anovulation and menstrual disturbances. Moreover, stress can affect her libido and frequency. The unfortunate scenario is that fertility treatments by themselves are extremely stressful and couples have to battle emotional, financial and social pressures during the course of the treatment. The couple has to support each other and may seek the help of a professional counsellor whenever necessary. Most fertility clinics provide support in the form of their own counsellors. pelvic adhesions can result from these infections.
Tips for women to protect themselves from sexually transmitted infections: • Minimise number of sexual partners, one would be ideal • Use condoms whenever there may be a risk of contracting infection • Test self and partner prior to marriage (pre-marital counselling) or before indulging in sex • Avoid abnormal sexual practices • Watch out for foul smelling white vaginal discharge, especially if accompanied by pelvic pain and painful urination (may signal sexually transmitted infection) Exercise regularly Moderate exercise in the form of walks, swimming, jogging or work outs at the gym, can improve pelvic circulation, general health, maintain body weight and ward off depression. Choose a simple, easy to perform exercise regimen and throw in variety to keep up the pace. Eat healthy There is no particular ‘fertility diet’, however, the importance of a balanced diet consisting of all essential nutrients cannot be undermined. Many micronutrient deficiencies can disturb the delicate balance of hormones and reduce fertility. 42
One last word from a doctor’s perspective. Often we come across couples who are at the tethers of their patience, and have sought the best possible treatments and cannot understand ‘why it is them’ or how the most expensive doctors and treatments failed to work. We must understand human limitations. Medical science has not been able to control birth and death and sometimes we have to bow down to the will of the Almighty.
10 monthly mistakes you make when trying to conceive: • Having timed intercourse just before or after periods (the most fertile period is around mid-cycle) • Having sex during periods (this can increase your chance of getting infections) • Using lubricants like creams, gels and oils (these can harm sperms) • Ignoring white discharge and urinary complaints (treat infections promptly) • Drinking excess caffeinated drinks or alcohol or smoking • Avoiding exercise for fear that it may prevent pregnancy • Eating unhealthy • Trying too hard (that can sky-rocket stress levels) • Crying every time you get your period (remember a normal couple has just about 20% chance of conceiving each cycle) • Not taking folic acid supplements
Jan - Feb 2014
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EXPERT VIEWS
HEALTHCARE IN INDIA...
NEXT TRANSFORMATION IN TIER 2 CITIES.
H
ealthcare in India has changed faster than any other Industry in last 40 years and all stakeholders of healthcare like professionals, patients, infrastructure and technology had the taste of this change. The technology is the fastest to change. Automation in Diagnostics, advancement in Imaging, Invention of Minimal Access Surgery , Robotic Surgery, Advanced Radiotherapy, Stem Cell and Gene Therapy are few of the latest developments in healthcare in technology. Patients are also partly responsible for and impacted by this change. The profession which used to run on the principle of blind faith on the medical professionals definitely required some logical change but has drifted over board to such a level that it starts from total mistrust and sometimes lands the patient himself in trouble. Patient has to undergo unnecessary investigations because of the fear in minds of the Doctors of being sued subsequently. Result is that most of the time patient is taking decision on perceptions rather than realities. In the event of any mortality or morbidity, patients ‘relatives are not in position to understand the difference between acceptable complications and negligence. In seventies most of the professionals who chose to enter this profession were attracted towards it because of the respect they got from the society. There was hardly any private sector. Doctors used to be contended with Govt. jobs and were treated next to God. In last 40 years there is so much commercialization in medical profession that the very purpose of those who enter the profession is different. The new breed who is now entering the profession are attracted to so called corporate world because of commercial reasons rather than respectful status. Doctors who get the hefty packages are under tremendous pressure to perform by
Dr. Dinesh Batra Director, Cygnus Medicare
A Man Behind Changing Healthcare Scenario in Haryana either means to justify their pay packets and in the process, suffer huge damage to their independence and self-respect. There are perceptible differences in the infrastructure in all these years. Private sector started as small clinics being run by General Physicians. Slowly developed to very small nursing homes owned by Doctors followed by mid- level 50 bedded multi- specialty nursing homes which were ill equipped to handle serious emergencies and used to refer patients at last moment to higher govt. centers thereby resulting in to a lot of casualties during transit. In last 15 years the corporate world has taken over the healthcare in a very big way,thereby practically forcing all mid level nursing homes to close down at least in the Metropolitan and Tier 1 cities and now the same revolution has started happening in Tier 2 cities. We at CYGNUS have very closely understood and analyzed this evolution and found out that most of the tier 2 cities of India are today ripe for private sector super-specialty hospitals. There are two specialties , trauma and cardiology where in serious emergency situation even seconds count. Unfortunately till now most
EXPERT VIEWS of the patients in such situations are being referred to higher centers from tier 2 cities thereby causing a lot of mortalities on the way. Cygnus has recognised this grave need of the people at large in our country and has already started creating such tertiary care hospitals in district towns. We started our journey from Delhi and Haryana and today there are10 such network hospitals being run by Cygnus. Haryana typically has 21 districts, out of which three districts namely, Gurgaon, Faridabad and Hisar are already served by tertiary care facilities and Cygnus has decided to serve tertiary care facilities in rest 18 districts in the next 18 months. We have been able to commence such hundred bedded hospitals in 5 districts of Haryana, namely Sonepat, Panipat, Karnal, Kurukshetra and Bahadurgarh with huge acceptability and success. In last few years, we have been listening in various healthcare conferences about huge challenges in terms ofreadiness of specialists and nurses to settle down in tier 2 cities, a very high Capex of 40 lacs per bed to create such facilities, a very low price point etc. But with a lot of experience and innovation we the team of Cygnus management have been able to tackle all these challenges and succeeded in creating an asset light, highly replicable model of tertiary care hospitals in District towns of India with a proven track record of viability. We invite all the stakeholders in Healthcare to study this model and join this evolution so that more and more tier 2 cities are benefited sooner than later. Cygnus Medicare is working on following Broader Goals. ✔ To maintain highest level of quality,we decided to do more and more of less and less.We decided to choose some specialized surgeries which are not routinely available in all hospitals and decided to provide the best technology manpower and world class service delivery in those areas e.g. Joint Replacements,Spine surgery , Neurosciences, Laser Prostatectomy, Bariatric surgery,cochlear implants, IVF and Minimal Access Surgery. We are very proud to claim that in these fields Cygnus is now rated as one of the serious player in this part of the world and patients from throughout the world including RUSSIA, IRAQ,AFGANISTAN,ETHIOPIA and NIGERIA, come to these INSTITUTES FOR SPECIALIZED SURGERIES and treatment in these fields. Jan - Feb 2014
✔ Cygnus is very conscious of the challenge of fight against infection in most of the hospitals.We spend huge money on infrastructure and surveillance to fight against this menace. Our quality team ensures that all clinical and managerial Quality indicators are very strictly adhered. ✔ As mentioned earlier biggest casualty of this evolution has been the ethics and falling faith of patients in this profession. We have developed a system of multispeciality meeting daily on all patients in preoperative and immediate postoperative period. Most of the doctors are constantly motivated on ethics and those who follow strict Ethical standards are promoted by the hospital ✔ Medical Audit is another area in which we concentrate a lot. Till now all institutions of substance including us are focusing on internal medical audit. We firmly believe that the day external medical audit is adopted, it will go a long way in improving the quality and ethical standard of any hospital we understand this is highly challenging to make a consensus in this regard within the hospital but with our strong will and commitment towards this goal we will be able to achieve this sooner than later. ✔ Despite the key player in the whole game throughout this revolution, it is the Doctor who has slogged,suffered and felt exploited the most. Whether it was long years of study and hard work,late settlement in life,late marriage,erratic work schedules, neglect of family, deficiency of equipment/ manpower or lack of money in the initial years,wrath of consumer protection act,ill perceptions in the public mind or diminishing respect in the present era,prohibitive cost of present day technology,keeping pace with the ever-changing skill set, it is the Doctor who is at the receiving end always. We at CYGNUS feel the pain of a doctor and we have huge respect for this profession and we believe in cordial relationship of doctor and management for normal working of a hospital. With these priority issues in mind, Cygnus has ventured into Healthcare with very strong capability to Operate and manage Hospitals, to provide world class skills in superspecialties to different hospitals, to provide management consultancies to various Hospitals, to help various hospitals for Quality Accreditation, to establish various hospitals from scratch on Turnkey basis, to take over sick units for turn around and to help various units for business development. 45
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Dr. R. Chandrashekhar Chief Architect Ministry of Health & Family Welfare (Govt of india)
As you are Chief Architect, Govt of India (MOHFW) and having huge experience in Healthcare Architecture & Design, Please share your views to young architects while designing a hospital? Medical Architect is one who brings synergy in Clinician, Nursing, Public Health Engineering and Administrators Viewpoints to arrive at Design Parameters of Hospital. He is trained in this field of Micro specialty to understand the basics of Healthcare Architecture in terms of Patient safety, Infection control, Ideal Indoor Air Quality to give an environment which helps in faster healing of Patient. What are the recent advancement in Healthcare Architectures & designs? The designs are more patient centric and staff centric by using Evidence Based Design in bringing healing environment. More focus on CARE vs CURE. You have made many big Healthcare institutions like AIIMS and Multi speciality hospitals in Govt. sector, what challenges you are facing? • C rowd management is biggest challenge which we have tried to solve by using IT. • T he use of Technology to reduce the shortage of trained Manpower
and District Hospitals where there is shortage of Doctors and Specialists. • Similar efforts in Medical Educations • P PP (Public Private Partnership) in setting up Diagnostic units in major Govt. Hospitals as Diagnostic equipment. Involves huge amount of investment. Are you concerned about environmental and social sustainability in your buildings? If so, what role does green building play into your work? Yes, I am very much concerned about environmental and social sustainability in all healthcare buildings Sustainable Healthcare buildings are the Focus of the Health Ministry, thus all newly built Healthcare Infrastructure are mandatory to have ECBC (Energy Conservation Building Code)and 3 star GRIHA (Green Rating of Integrated Habitat assessment) Compliance. Who inspires you? Who is your role model? The sufferings of patient in general hospitals inspires me to do something for the betterment of the masses thru my expertise in the field. Gurudev Swami Sivanada of Rishikesh, who himself was a doctor, reached out to community to heal the sufferers is my Role model.
• Use of Tele Medicine Network to access to PHC Jan - Feb 2014
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EXPERT VIEWS
The role of companion diagnostics in drug development and delivery of targeted therapies:
Big Pharma embraces diagnostics
Dr. Firoz Ahmad
Research scientist Research & Development SRL Limited
Dr. B.R. Das
President & Research Innovation Mentor-Molecular pathology and Clinic Research Service SRL Limited
Fairy tales are more than true; not because they tell us that dragons exist, but because they tell us that dragons can be beaten 50
W
ell this quote holds true for any cancer survivor simply because even if the dragon (cancer) has appeared in their life, it can be beaten by keeping a positive attitude and employing the most efficacious treatment. While these parameters remain crucial, a lot more goes into saving a precious life! In this context, one should commend the role played by the research activities of drug manufacturing companies which strive hard to bring to the shelf newer and more efficacious drugs to fight cancer. Having said that, Companion Diagnostics is a relatively new concept that’s hitting the frontlines of drug discovery and it appears to be promising in changing the way drugs are made and marketed. Under a companion diagnostic plan, a new anti cancer agent and a genetic test are co-investigated and co-developed. While the new anti cancer molecule aims at upgrading the chemotherapy of cancer, its companion diagnostic test aims at determining cancer patients in whom the new drug would be efficacious. Using a companion test – whether it looks for genetics, proteomic, or gene expression markers – to predict whether or not a drug will work in someone or what kind of dose a patient should take; is becoming more common and according to experts, will eventually become the norm in the near future. This type of test is classified as a predictive test and a prerequisite for implementation of stratified and personalized medicine- “the right treatment to the right patients at the right time” In the last decade, most of the major pharmaceutical companies have adopted new programs to develop companion diagnostic products. The old model of single biomarker test Jan - Feb 2014
EXPERT VIEWS results being used to select oncology treatments, monitor the effects of those therapies, and switch therapies as treatment resistance emerges is no longer viable. The trend has changed now and pharmaceutical companies are very much interested in moving products with more and more new biomarkers with more effective and lesser toxic impact. The global medical fraternity has expressed great enthusiasm and optimism towards giving an impetus to companion diagnostic plans. This progress in the segment of companion diagnostics has been possible only due to rapid advances in new technologies, especially molecular diagnostics, a stream of scientific research which plays a vital part in companion diagnostics. Diagnostic industry giants like Qiagen, Abbott, Roche and Illumina realize that a strong relationship between the pharmaceutical and diagnostics industry is crucial in next few years. The first diagnostic test to be associated with a drug debuted in 1998 wherein the U. S. Food and Drug Administration (FDA) had approved Herceptin® therapy for breast cancer patients with HER2 overexpression. Similarly, the year 2005 witnessed another historic approval from FDA, where it gave the green signal to Gleevec® (Imatinib), a targeted therapy that homed in on the unruly protein and prevented it from sparking the chain of events that led to chronic myeloid leukemia (CML). The most recent data from the journal ‘Cancer’ shows that nearly 70 percent of patients treated with the drug are still alive 10 years after diagnosis. Ever since then, the FDA has approved a multitude of targeted therapies that interfere with cellular processes to combat cancer. Gene mutation analysis, as a precursor to targeted therapy has become the standard of care for certain tumor types. For example, the companion test-TheraScreen® which checks epidermal growth factor receptor (EGFR) mutation status is used to predict whether a patient with non small cell lung cancer will respond to Roche/OSI Pharmaceutical’s Tarceva (erlotinib) and AstraZeneca’s Iressa (gefitinib). Similarly, knowing the mutation status of the KRAS gene helps the clinician to decide whether a patient with metastatic colon cancer will respond to cetuximab or panitumumab because these drugs work only for patients whose tumors are not mutated. Likewise, companion diagnostic tests have been developed for several other targeted anti cancer therapies.–For example, c-kit mutation for the use of imatinib in gastro intestinal stromal tumor, CD20 overexpression for the use of rituximab in chronic lymphocytic leukemia, and estrogen receptor overexpression for the use of tamoxifen in breast carcinomas. Jan - Feb 2014
Adding to the handful of tests used to guide clinical decisionmaking around chemotherapy, two developments in 2011 really captured the industry’s attention. In a first for the agency, FDA granted landmark approvals for two drugs and their corresponding companion diagnostic tests. First came approval for BRAF V600E mutation testing (Cobas 4800 BRAF V600E kit) in patients with metastatic melanoma as a precursor to receiving vemurafenib; and then days later FDA approved EML4-ALK1 gene rearrangement testing in patients with late-stage non-small cell lung cancer (NSCLC) as a pre-requisite to receiving crizotinib. Vemurafenib was specifically designed to target the mutant BRAF protein which is found in 60% melanoma cases and clinical evidence has demonstrated prolongation in overall survival with Vemurafenib in patients with BRAF V600E mutation. Likewise, past clinical evidence also supports the fact that around 2—7% of NSCLC cases carry the fusion transcript EML4-ALK-1 and it is this genetically abnormal subgroup of NSCLC patients who are responsive to Crizotinib therapy. Though a marked increase has been anticipated in the number of companion diagnostic products, it is not going to happen overnight. The change has begun and there are tangible examples on the market today. Effective collaboration between the pharma and diagnostic industry will hold the key for future success of companion diagnostics. It can be simple and straightforward for a diagnostic company to design and develop a good and robust assay, but to actually link that assay to drug response needs a clinical trial, and that needs the pharma industry’s buy in. Hence a collaborative “Pharma-Diagno” effort is warranted for effective codevelopment of drugs and diagnostics. The regulatory hurdles encountered in co-development trials, the need for adherence to guidelines and early early consultation with the FDA when developing an in vitro companion diagnostic device (or test) should be emphasized.
References: • Baselga J (2011) European Multidisciplinary Cancer Congress, Stockholm 23-27 September 2011 • Barrett JC, Clin Chem ;59:198–201. • Chapman PB et al.. N Engl J Med ; 364:2507-2516. • Sai-Hong Ignatius Ou (2011). Drug Des Devel Ther.; 5: 471–485.
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Doctor SPEAK
High Pressure Ramesh Kaushal Tripathi
M.B.B.S, F.R.C.S, F.R.A.C.S (Vascular), Director, Narayana Hrudayalaya Institute of Vascular Sciences Narayana Hrudayalaya Hospitals
A
in veins of the leg can lead to Leg Ulcers
leg ulcer is simply a break in the skin of the leg, which allows air and bacteria to get into the underlying tissue. This is usually caused by an injury, often a minor one that breaks the skin. Vascular Leg Ulcers are chronic ulcers that fail to heal quickly and generally occur from the pre-tibial region (below the knees) to the toes.
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70 to 90% of all Leg Ulcers result in venous ulcers, which can be very painful. They arise primarily when venous valves that exist to prevent backflow of blood do not function properly, causing the pressure in veins to increase. Failure of the arteries to pump blood results in Leg Ulcers and their recurrence rate is as high as 65 to 95%. Jan - Feb 2014
DOCTOR SPEAK that can lock 25 times the volume of exudates and even Bacteria (in case of Infection). The exudate is trapped within the fibers of this AquacelAg/ Aquacel Dressing and becomes a soft cohesive gel ensuring atraumatic removal and causes no damage to healthy granulation tissue. In case of Infected Wounds, a Dressing that effectively kills Bacteria made of Ionic Silver should be used and ideally Aquacel Ag, which has a broad-spectrum antibiotic effect, should be used.
Stress and hypertension: The main cause of Leg Ulcer While high pressure in veins is the primary cause of Leg Ulcer other indicative factors could include stress, hypertension, stroke and heart attack. Any patient suffering from the aforementioned problems should keep an eye and be aware of an imminent danger of vascular leg ulcers. Vascular leg ulcer can be healed by either applying strong sustained compression with a bandage or a stocking, and by treating the underlying cause of the ulcer. One of the most effective methods of treatment is application of a firm compression bandage or a graduated elastic medical compression stocking to a leg with an ulcer. This will lead to about 70% of ulcers healing within six months. Usage of dressings could also address the issue faster and more effectively.
Benefits of appropriate dressings The aim of applying a dressing to an ulcer is to provide conditions for the ulcer to allow healing. The first stage is to clean the ulcer and this can be done by gentle washing in salt water. Cleaning debris and dead tissue that accumulates on the surface of the ulcer between dressing changes, can help ulcer healing. A simple, non-sticky dressing which can also lock the exudates is ideal. A right choice of dressing here is Aquacel which is a HydroFiber Dressing Jan - Feb 2014
Why is a moist wound dressing environment necessary A moist wound environment physiologically favors cell migration and matrix formation accelerating the healing of wounds. Dry dressings, except over intact skin, are considered injurious and can cause dryness of the wound, which reduces new tissue formation, as well as removing new healthy granulation tissues during dressing changes. Gauze dressings that are widely used today has a major disadvantage of strikethrough where the chronic exudates come in contact with the Healthy PeriWound Skin and cause maceration of the surrounding skin. This in turn increase the wound size and depth thus leading to delayed wound healing. Silver Ion Dressings like Aquacel Ag, which will kill the Bacteria in case of Infected Wounds, can provide the ideal moist wound condition and can also lock the exudates within its fiber and prevent peri-wound maceration. Also, there will be fewer dressing changes thus not disturbing the Healthy Granulation tissue. Hydrocolloid dressings like DuoDerm also provides an acidic environment and has a Bacteria Viral Barrier providing an occlusive environment facilitating wound healing. Both Aquacel Ag and DuoDerm are moist dressings and facilitates wound healing rapidly unlike Gauze Dressings.
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EXPERT VIEWS
THE PHARMACEUTICAL SECTOR OF INDIA HISTORY
The h istory of pharmacy as an independent science is quit old . The earliest know compilation of medicinal substances was the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC . However ,the earlist text as preserved dates to the 3rd or 4th century AD.
T
he Government of India on 11th August 1930 , appointed a committee under the chairmanship of Late Col. R.N. Chopra to see into the problems of Pharmacy in India and recommend measures to be taken . This committee published its report in 1931.It was reported that there was no recognized specialized profession of Pharmacy . A set of people Known as compounders were filling the gap . just after the publication of the report Prof. M.L. Schroff [Prof. Mahadeva Lal Schroff] initiated pharmaceutical education at the university level in the Banaras Hindu University and Started a 3- year regular bachelor of pharmacy course . In 1935 United Province Pharmaceutical Association was established which later converted into Indian Pharmaceutical Association . The Indian journal of pharmacy was started by Prof . M.L. Schroff in 1939. All India Pharmaceutical Congress Association was established
R.L. Gupta
Chairman IEC Group Of College
in 1940. In 1945 the Drugs Rule under the Drugs Act of 1940 was established . The Drugs Act has been modified from time to time and at present the provisions of the Act cover Cosmetics and Ayurvedic ,Unani and Homeopathic medicines in some respects .In 1946 the Indian Pharmacopoeia List was published under the chairmanship of late Col. R.N. Chopra . It contained the list of drugs used in India at that time which were not included in the British Pharmacopoeia, and in 1948 the Pharmacy Act was established under which the PCI was established in 1949. Post-independence, the pharmacy profession and education have undergone a sea change as a provider of healthcare services in India.
PHARMACY EDUCATION IN INDIA Presently, the Pharmacy education in India consists of a variety of courses, namely Diploma in Pharmacy, Bachelor of Pharmacy, Master of Pharmacy, Master of Science in Pharmacy, Master of Technology in Pharmacy, Doctor of Pharmacy, and Doctor of Philosophy in Pharmacy. Recently, newer specialized subjects such as Pharmacy practice, quality assurance, industrial pharmacy , pharmaceutical biotechnology, clinical pharmacy, drug regulatory affairs, bioinformatics, etc. Have been introduced in the postgraduation level. Currently there are over a million pharmacists in India with around 55% of them in community, 20% in hospital, 10% in industry & regulatory and 2 % in academia in India. Formal Pharmacy education leading to a degree began in 1937, with the introduction of a 3 year industry – oriented Bachelor of Pharmacy course. To meet the varying needs of the profession at different levels the following pharmacy programs are offered in India today : Diploma in Pharmacy [D . Pharma.] Bechelor of Pharmacy [B .Pharm.], Master of Pharmacy [M .Pharm.], practice based Doctor Of Pharmacy [Pharm. D.] and Doctor of Philosophy in Pharmacy [Ph. D. ]. To practice as a pharmacist in India, one needs at least a diploma in pharmacy, which is awarded after 2 years and 3 months of pharmacy studies & practical training. These diploma –trained pharmacists are currently the mainstay of pharmacy practice in India. Every year nearly 20,000 D. Pharm , 30,000 B. Pharm, 6000 M. Pharm and 700 Pharm.D. students graduate in the Country. Pharmacy Council of India [PCI] is statutory body established in 1949, for regulating pharmacy education and practice of pharmacy profession in India . PCI is actively working towards strengthening and upgrading the industry & community. In 2003, the Pharma Vision 2020 Charter was released by the then President of India, Dr. A.P.J. Abdul Kalam , at the 55th Indian Pharmaceutical Congress at Chennai.
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Jan - Feb 2014
EXPERT VIEWS There is no doubt that currently there is enormous gap existing between education and practice of pharmacy. Most of the academic institutions providing education in pharmacy are away from practice environment. The overall basis of pharmacy education is still extra biological synthesis, physicochemical studies, analysis, and manufacturing aspects of drug . It is a common feeling that the medical practitioner is better placed for pharmacists job than the pharmacists themselves. The dispensing services are poor. The syllabus and duration of the two-year diploma course in pharmacy education in India is completely outdated and irrelevant in the present industry context. It is a heterogeneous mixture of clinical and industrial subjects. Since clinical subjects are there PCI comes into the picture and AICTE came in because of industrial orientation of pharmacy syllabus . pharmacy as a nascent science developed like this in the last century. During 1940 and 50s , hospitals and industries were established in large numbers in India. Consequently, pharmacists and pharmaceutical chemists were required in huge numbers. Although there is a growing strength of pharmacy workforce in our country , the curriculum still fails to meet the international standers. To promote excellence and uniformity in pharmacy education, the pharmacy Council of India has formed a national task force for quality assurance. With growing government investments towards development of infrastructure and research facilities, India can provide a strong workforce in the global front.
PHARMACEUTICAL INDUSTRY IN INDIA It is exciting to be part of the Pharmaceutical industry in India today. In 2007, the turnover of the Indian Pharmaceutical Industry was USD 8.4 billion, with additional USD 5.8 billion generated from export . If we take a look at the top 10 pharmaceutical companies in India, more than 50% of their annual turnover comes from exports. India exports to over 100 countries & also boasts of having the largest USFDA approved facilities outside USA. The number is rising every. Years as Indian companies keep on adding facilities to cater to the increasing demand. India is the 3rd largest manufacturer of pharmaceuticals in Jan - Feb 2014
the global market in terms of volumes of sales. In term of value, India is 14th globally which clearly shows that the prices of medicines in India are lowest in the world India has slowly but surely emerged as the global outsourcing hub be it for manufacturing or R&D, Clinical research or basic drug discovery. The reasons are not hard to fathom. Indian Pharmaceutical companies have also been making increasing forays into the global generics market , which is continuously increasing because of many of the blockbuster drugs going off patent, Identification of molecules going off- patent, well thought out time lines, speed of doing development work and good regulatory understanding are some of the key factors that define success in the generic industry; attributes that are the forte of Indian companies.
Table
EMPLOYMENT DATA FOR PHARMACEUTICAL SECTOR Year
No of employees
Mar 1995...................................... 1,81,497 Mar 1996...................................... 2,04,609 Mar 1997...................................... 2,11,614 Mar1998....................................... 1,89,295 Mar 1999...................................... 2,13,999 Mar 2000...................................... 2,43,410 Mar 2001...................................... 2,33,704 Mar 2002...................................... 2,26,416 Mar 2003...................................... 2,23,556 Mar 2004...................................... 2,40,791 Mar 2005...................................... 2,65,396 Mar 2006...................................... 2,90,021 Mar 2007...................................... 3,36,211 Mar 2008...................................... 3,53,692
Indian Pharmaceutical industry is expected to grow at 19% in 2013 . Indian is now among the top five Pharmaceutical emerging markets. There will be new drug launches,
new drug filings, and Phase 2 clinic trials throughout the year. On back of increasing sales of generic medicines, continued growth in chronic therapies and a greater penetration in rural markets, the domestic pharmaceutical market is expected to register a strong double – digit growth of 13-14 per cent in 2013. Moreover , the increasing population of the higher-income group in the country will open a potential US$20 billion by 2015, making India a lucrative destination for clinical trials for global giants. Further estimates the healthcare market in India to reach US$ 31.59 billion by 2020.
REGULATION OF THE PHARMACEUTICAL SECTOR The National Pharmaceutical Pricing Authority [NPPA], an independent body of exports, has been established on 29th August 1997 under the Ministry of Chemicals and Fertilizers, Department of Chemicals and Petrochemicals. The Authority is entrusted with the task of price fixation / revision and other related matters such as monitoring the prices of decontrolled drugs and formulation and to enforce and implement the provision of the Drug [Price Control] Order [DPCO], NPPA is mandated for pricing of drugs and DCGI is the authority for ensuring standards for manufacturing and quality of drugs in addition to the basic element of introducing the drug itself in the country for any therapeutic treatment. India is signatory to the WHO certification protocol on the quality of pharmaceuticals products and has therefore accepted the WHO-GMP standers as integral part of the standards for export of Pharmaceuticals products . As per arrangement, WHO-GMP certification is granted by the office of the DCGI [CDSCO] and State FD As. The certification is for two years at a time . It is estimated that at present about 800 unites are certified by CDSCO for WHO-GMP production. As there are about 10,000 plus Pharma SME units in the country, therefore, the number or WHO-GMP standard units needs to be raised to at least 2000 by the end of the 12th plan in 2017 to enable the SME sector to increase and sustain its participation in the Pharma Industry growth process.
55
GOVT. TENDERS
Hospital Ref Number: 9854106 Tender Number: Buyer/Seller: North Western Railway Requirement: Supply of Paint Enamel Synthetic Exterior Finishing Pale Cream, paint Ready Mixed Black Brushing, Finishing Anti Tracking Vanish, Rivet MS, Brake Equalizer, Clamp Assembly, Disc Lamp Red, Bar Split Stretcher, Hexagonal Head Screw, Locking Bolt, Flexible Hose with Adopter, Tension Bracket Complete, Air brake Pipe, Flexible PVC Conduct Pipe, Liquefied Petroleum Gas, Modified larger After Cooler Core Assembly, paint Enamel Synthetic Brillent Green Exterior Finishing, Thinner, Cord Flexible Twin Core PVC, Coupling, Fan Assembly Radiator Location: Jaipur - Rajasthan - India Closing Date: 27/02/2014 at 00:00 Hrs URL : www.ireps.gov.in _________________________________________________ Ref Number: 9734445 Tender Number: Buyer/Seller: Department Of Atomic Energy Requirement: Supply of dental chair unit whip down delivery system. Location: Mumbai - Maharashtra - India Document Fees: Rs.700 EMD: Rs.250,000 Closing Date: 12/02/2014 at 16:30 Hrs _________________________________________________ Ref Number: 9758035 Tender Number: Tender Prod. No: Tender Notice No. 2 Buyer/Seller: North Central Railway Requirement: Hiring of one ambulance equipped with all facilities viz Drivers, Stretcher and stretcher bearers, oxygen cylinder, cabinet for first aid box etc. for round the clock ambulance services at the N.C.Rly. Central Hospital. Location: Allahabad - Uttar Pradesh - India Document Fees: INR2,140 EMD: INR25,200 Estimated Cost: INR1,260,000 Closing Date: 10/02/2014 at 00:30 Hrs. Contact Details: North Central Railway Allahabad, Uttar Pradesh, India Document Sale To: 10-2-2014 _________________________________________________ Ref Number: 9810416 Tender Number: Tender Prod. No: 50131213-A Buyer/Seller: North Western Railway Requirement: Supply of bar split strectcher for fpl . facing point lock bgsa -5988 / alt-1 or latest irs s-10. Location: Multi Location - Multi State - India Document Fees: INR150 Closing Date: 7/02/2014 at 14:25 Hrs. _________________________________________________ Ref Number: 9549866 Tender Number: Buyer/Seller: Chandigarh Administration Health Department Requirement: Purchase of Dental Chair Unit, Medicines for School Health Scheme, Dental OPG Machine. Hiring of Vehicles for Various Schemes & Programmes of Health Department, Single Puncture Laparoscope for Female Sterilization, Operating Laparoscope & its Accessories, Electro Hydraulic Operating Table, OT Light Shadowless Mobile Single Dome. Corrigendum - Supply of Operating
56
Laparoscope & its Accessories Location: Chandigarh - Punjab - India EMD: Rs.120,000 Closing Date: 6/02/2014 at 00:00 Hrs _________________________________________________ Ref Number: 9834409 Tender Number: Buyer/Seller: Indian Bureau Of Mines Requirement: Supply of Gps, Engineering Seismograph, Resistivity Meter, Water De-Ionoser, Fume Hood, Cathode Lamps, Digital Camera, Magnetic Susceptibility Meter, Digital Binoculars, Canvas Tent 1-‘X14’, Full Hd Cam Corder With In-Built Gps & Projector Along With Tripod Stand. Location: Nagpur - Maharashtra - India Document Fees: Rs.300 EMD: Rs.25,000 Closing Date: 4/02/2014 at 15:00 Hrs _________________________________________________ Ref Number: 9841001 Tender Number: Buyer/Seller: Indian Bureau Of Mines Requirement: Supply Of Gps, Engineering Seismograph, Resistivity Meter, Water De-Ionoser Fume Hood, Cathode Lamps, Digital Camera, Magnetic Susceptibility Meter, Digital Binoculars, Canvas Tent 1-‘X14’, Full Hd Cam Corder With In-Built Gps & Projector Along With Tripod Stand Location: Nagpur - Maharashtra - India Document Fees: Rs.300 EMD: Rs.25,000 Closing Date: 4/02/2014 at 15:00 Hrs _________________________________________________ Ref Number: 9861289 Tender Number: Buyer/Seller: Indian Bureau Of Mines Requirement: Supply of GPS, Engineering Seismograph, Resistivity Meter, Water De-lonoser, Fume Hood, Cathode Lamps, Digital Camera, Magnetic Susceptibility meter, Digital Binoculars, Canvas Tent, Full HD Camcorder with in built GPS & Projector along with Tripod Stand Location: Nagpur - Maharashtra - India Closing Date: 4/02/2014 at 15:00 Hrs _________________________________________________ Ref Number: 9816234 Tender Number: Tender Prod. No: GTNo 10/CNC/NS/13-14/ST Buyer/Seller: All India Institute Of Medical Sciences Requirement: Purchase of inter operative cranial nerve monitoring system, intra operative monitoring system, water jet and electrosurgical unit with workstation, flat panel image intensifier with 3D c arm, ultrasonic dissector / aspirator, electro surgery OT table, molecular resonance generator, video polysomnography lab system, video EEG with cortical stimulation, state of the art latest generation high end peripheral intravascular ultrasound machine, new state of art 128 slices or higher CT scanner system with buy back of Old CT scanner Location: New Delhi - Delhi - India Document Fees: Rs.1,000 EMD: Rs.120,000 Closing Date: 4/02/2014 at 12:00 Hrs. Contact Details: All India Institute Of Medical Sciences Ansari Nagar, New Delhi, India _________________________________________________
Ref Number: 9784351 Tender Number: Tender Prod. No: G.T.No.16/CNC/NS/13-14/ST Buyer/Seller: All India Institute Of Medical Sciences Requirement: Supply of Neuro Surgery OT Table Location: New Delhi - Delhi - India Document Fees: INR1,000 EMD: INR200,000 Closing Date: 4/02/2014 at 00:00 Hrs. Document Sale To: 27-1-2014 _________________________________________________ Ref Number: 9644228 Tender Number: Buyer/Seller: Department Of Atomic Energy Requirement: Supply of Glove Boxes, Maltic Ha,ber Alpha Spectrometer, Slat Drying System, Model based FPGA Design, Synthesis & Verification Tools with Workstations, upgradation of TPDRO with Quadrupole Mass Analyzer, Sloe Strain rate Testing (SSRT) System with an autoclave for Stress Corrosion Cracking Studies, Fume Hood of Different Types, LT Copper cables, MI Type Discrete level Proble, Dynamic Signal Analyzer Location: Bangalore - Karnataka - India Document Fees: Rs.735 EMD: Rs.500,000 Closing Date: 3/02/2014 at 00:00 Hrs. _________________________________________________ Ref Number: 9857205 Tender Number: Tender Prod. No: 880/HR/G-1/2013-14 Buyer/Seller: Supplies And Disposals Requirement: Supply of C-Arm Compatible Orthoperdic OT Table, battery Operated Power Drill (Ortho), Elevating Pedestal Autopsy Table, Dental X-ray machine, Combination of Microwave Diathemy & Traction with Couch, Sabla Training Kits, Consumable Group Cotton Wool Absorbent (Surgical) & Crape Bandages Location: Chandigarh - Haryana - India Closing Date: 3/02/2014 at 00:00 Hrs URL www.tenders.hry.nic.in _________________________________________________ Ref Number: 9671765 Tender Number: Tender Prod. No: P-4/611/PC/BSF/2013/684/624648 Buyer/Seller: Border Security Force Requirement: Procurement of C Arms Table (Assy items- Orthopaedic OT Table), Qty- 02 Nos Location: New Delhi - Delhi - India EMD: INR200,000 Closing Date: 22/01/2014 at 11:00 Hrs. Document Sale To: 22-1-2014 at 10:00 Hrs _________________________________________________ Ref Number: 9553029 Tender Number: Buyer/Seller: Department Of Health Requirement: 1. Supply of dental chair unit, medicine, dental OPG machine, single puncture laparoscope, operating laparoscope & its accessories, electro hydraulic operating table, OT light shadow less mobile single dome etc. 2. Hiring of vehicle. Location: Chandigarh - Punjab - India EMD: Rs.120,000 Closing Date: 22/01/2014 at 00:00 Hrs. Contact Details: Department Of Health Chandigarh, Punjab, India _________________________________________________
Jan - Feb 2014
GOVT. TENDERS
l Furniture Tender Ref Number: 9859400 Tender Number: Tender Prod. No: 43 to 47/SVP/2013-14 Buyer/Seller: Sardar Vallabh Bhai Patel University Of Agricultural And Technology Requirement: 1. Supply of Books for University Library. 2. Work Contract on various section, hostel, research unit & agriculture science centre, etc of University. 3. Supply of Genomics Work bench for Bioinformatics lab. 4. Printing of Annual Agriculture Technical Guide-2014. 5. Supply of Plumbing & Stationery items. Location: Meerut - Uttar Pradesh - India Estimated Cost: Rs.9,000,000 Closing Date: 21/01/2014 at 15:00 Hrs. Contact Details: Sardar Vallabh Bhai Patel University Of Agricultural And Technology Meerut, Uttar Pradesh, India _________________________________________________ Ref Number: 9845417 Tender Number: Buyer/Seller: National Rural Health Mission Requirement: Supply of NCMC equipments to health institutions in different districts of Assam (Digital Weighing Scale (infant), Adult weighing Scale (digital), Infantometer & Stadiometer. Location: Multi Location - Assam - India Document Fees: Rs.1,000 EMD: Rs.30,000 Closing Date: 21/01/2014 at 14:00 Hrs _________________________________________________ Ref Number: 9773876 Tender Number: Buyer/Seller: Central Coalfields Limited Requirement: Supply of Hospital equipments Stretcher Trolley, Deluxe Bedside Locker, Saline Stand (5=Winged Base), Bedside Stool, Foot Step, Bedside Table, Instrument Trolley Location: Bokaro - Jharkhand - India Document Fees: Rs.1,000 EMD: Rs.3,718 Estimated Cost: Rs.185,900 Closing Date: 21/01/2014 at 13:00 Hrs. Document Sale To: 20-1-2014 at 17:00 Hrs _________________________________________________ Ref Number: 9777413 Tender Number: Buyer/Seller: Punjab Health Systems Corporation Requirement: Single running rate contract for Purchase of Various essential drugs, surgical consumables & other medicines, material & furniture/equipment - Consumables, X-ray films & hospital furniture. Location: Mohali - Punjab - India Document Fees: Rs.1,000 Closing Date: 21/01/2014 at 11:30 Hrs. Document Sale From: 26-12-2013 Document Sale To: 20-1-2014 _________________________________________________ Ref Number: 9815239 Tender Number: Tender Prod. No: Bid Reference no. Rate Contr Buyer/Seller: Department Of Health And Family Welfare Requirement: Rate contract for purchase of consumables, X-ray films and hospital furniture Location: Mohali - Punjab - India Document Fees: INR1,000 EMD: INR50,000 Closing Date: 21/01/2014 at 00:00 Hrs. Document Sale To: 21-1-2014 at 11:30 Hrs _________________________________________________
Jan - Feb 2014
Ref Number: 9815248 Tender Number: Tender Prod. No: 4 of 20 Buyer/Seller: Department Of Health And Family Welfare Requirement: Rate contract for purchase of consumables, x-ray films & hospital furniture. Location: Mohali - Punjab - India Document Fees: INR1,000 EMD: INR100,000 Closing Date: 21/01/2014 at 00:00 Hrs. Document Sale To: 21-1-2014 at 11:30 Hrs _________________________________________________ Ref Number: 9815248 Tender Number: Tender Prod. No: 4 of 20 Buyer/Seller: Department Of Health And Family Welfare Requirement: Rate contract for purchase of consumables, x-ray films & hospital furniture. Location: Mohali - Punjab - India Document Fees: INR1,000 EMD: INR100,000 Closing Date: 21/01/2014 at 00:00 Hrs. Document Sale To: 21-1-2014 at 11:30 Hrs _________________________________________________ Ref Number: 9737350 Tender Number: Buyer/Seller: Advanced Centre For Treatment, Research And Education In Cancer Requirement: Supply, Installation And Commissioning Of Patient Transfer Slide Location: Mumbai - Maharashtra - India EMD: Rs.1,200 Closing Date: 20/01/2014 at 17:30 Hrs _________________________________________________ Ref Number: 9764241 Tender Number: Buyer/Seller: Advanced Centre For Treatment, Research And Education In Cancer Requirement: Supply of Patient Transfer Slide For The Year 2013-2014 Location: Mumbai - Maharashtra - India EMD: Rs.1,200 Closing Date: 20/01/2014 at 17:30 Hrs _________________________________________________ Ref Number: 9549274 Tender Number: Buyer/Seller: Indian Institute Of Technology Requirement: Purchase of Equipments viz lab furniture for chemistry wet lab, high resolution FESEM, wide angle X-ray diffraction system, GPU cluster for real time processing of 3D objects in motion & magnetic welding & forming set-up Location: Medak - Andhra Pradesh - India Closing Date: 20/01/2014 at 15:00 Hrs _________________________________________________ Ref Number: 9774866 Tender Number: Buyer/Seller: Orissa Small Industries Corporation Limited Requirement: Supply of Equipments, Instruments & Furniture - Dental Chair, Mobile Suction, Ultraviolet Sterlization System, Camp Dental Chair, Hot Air Steriliser, Extraction Forceps for Rate Contract for a period of 01 (one) year from the date of communication of approved rate by the competent authority Location: Burla - Orissa - India Document Fees: Rs.5,000
Closing Date: 20/01/2014 at 14:00 Hrs. Document Sale To: 20-1-2014 at 13:30 Hrs _________________________________________________ Ref Number: 9764997 Tender Number: Buyer/Seller: Military Engineer Services Requirement: Special Repairs/Replacement of Locker Bed Side Steel Etc at Bengdubi Military Station under Ge Bengdubi. Location: Darjelling - West Bengal - India Document Fees: Rs.500 EMD: Rs.68,000 Estimated Cost: Rs.3,400,000 Closing Date: 20/01/2014 at 00:00 Hrs. Contact Details: Parveen Angurala Military Engineer Services Darjelling, West Bengal, India Tel: 03532480225 Fax: 03532480225 _________________________________________________ Ref Number: 9841986 Tender Number: Buyer/Seller: Indo Tibetan Border Police Requirement: Supply of Medical Equipments – Stethoscope Superior Quality, BP Instrument Digital, BP Instrument hg, Height Measuring machine wall fixing, Digital Weighing Scale, ENT Diagnostic set, Hospital Semi Fowler Bed with Laminated panels, Patient Examination table, Folding Steel Wheel Chair, Ambu bag Adult & paid, patient Waiting Chair 3 seater, Nebulizer Location: New Delhi - Delhi - India EMD: Rs.10,000 Estimated Cost: Rs.500,000 Closing Date: 20/01/2014 at 11:00 Hrs. Document Sale To: 20-1-2014 at 9:00 Hrs _________________________________________________ Ref Number: 9774866 Tender Number: Buyer/Seller: Orissa Small Industries Corporation Limited Requirement: Supply of Equipments, Instruments & Furniture - Dental Chair, Mobile Suction, Ultraviolet Sterlization System, Camp Dental Chair, Hot Air Steriliser, Extraction Forceps for Rate Contract for a period of 01 (one) year from the date of communication of approved rate by the competent authority. Location: Burla - Orissa - India Document Fees: Rs.5,000 Closing Date: 20/01/2014 at 14:00 Hrs. Document Sale To: 20-1-2014 at 13:30
57
NEWS UPDATE
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Objective Scaling Up Best Practices in Healthcare Major policy Gaps and Possible Solutions Redefining Role of Private sector in healthcare including Hospitals/ Pharmaceutical/ Medical Devices and Medical Diagnostic Companies Importance of Traditional Indian Health Practices Utilization of ICT in enabling healthcare delivery and management Pioneering models for increasing access to healthcare Value of a Comprehensive Health Insurance Policy to serve health needs of the people TOPICS State of Indian Healthcare System
KEY INVITED DIGNITARIES/ SPEAKERS Shri Ghulam Nabi Azad, Hon’ble Union Minister, Ministry of Health & Family Welfare, Govt. of India Significance of private sector in healthcare delivery services Smt. Santosh Chowdhary Hon’ble Minister of State, Ministry of Health & Family Welfare, Govt. Pioneering models of Healthcare Delivery of India Innovative ways to enhance the access to healthcare and Shri Rana Kapoor, President, ASSOCHAM and Managing Director & CEO, YES Bank Ltd Scaling up the best Practices Shri Keshav Desiraju, IAS, Secretary, Ministry of Health & Family Welfare, Govt. of India PARTICIPANTS PROFILE Padmabhusan Dr. B. K. Rao, Chairman – Government officials, Indian and foreign diplomats and ASSOCHAM National Council on Healthcare and healthcare policy makers Hospitals Well-informed speakers working on the various aspects Shri Bhaskar V Iyer, Chairman, ASSOCHAM of Indian healthcare industry national council on Drugs and Pharmaceuticals Hospitals representatives Dr. Mahesh Chandra Misra, Director, AIIMS Pharmaceutical, Medical devices and Medical Dr. H. K. Chopra –Co-chairman – ASSOCHAM Diagnostic companies national council on Healthcare and Hospitals Business/ Research partners Shri Umang Chaturvedi, Co-Chairman, Entrepreneurs in healthcare domain ASSOCHAM National Council on Drugs and Pharmaceutical Medical insurance / banking institutions Dr. Naresh Trehan, Chairman and Managing NGO’s functioning in areas of Indian healthcare Director, Medanta - The Medicity Features & Opportunities Shri Sushobhan Dasgupta, Managing Director, Exhibition Stalls Johnson & Johnson Medical India, Vice President Poster Session – Asia Pacific, LifeScan Compendium Of Case Studies Of Best Practices Shri Prabal Chakraborty, VP & Managing Advertisement In Souvenir Director at Boston Scientific Company India Partnership opportunities Dr Nandakumar Jairam, Chairman and Group Medical Director, Columbia Asia Hospitals, India Shri Mukul Bagga, Managing Director, Quest Diagnostics in India Shri Aijaz Tobaccowalla, Managing Director of Pfizer Limited and Wyeth Limited Interested participants please send your nominations to the undersigned. Attractive Speaking Slot / Branding Opportunities available For further details, please contact: Dr. Om. S Tyagi Direct Line: 011-46550584 ombeer.tyagi@assocham.com
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