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Volume VIII || Issue V || Jan-Feb 2018

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Urology

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Latest Advancement in Radiology & Imaging

Medical Device ASIA | November-December 2017 2017 | 61

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2018

Volume - VIII Issue - V Jan-Feb 2018

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2018

Advance Media Group , Publisher of Medgate Today Magazine , Wishes you a Happy New Year 2018 This Magazine will cover the recent advancement in Uology & Radiology , designed to offer a state of the art overview of the fastest developing areas of urology and Radiology related diseases. The editorial board has taken views from various experts on the subject have enlisted several contributing authors who are qualified leaders in their respective fields. New Vistas for Medical Applications Opened Up with Handheld 3-D & Digital Imaging System. The major product segments of medical imaging devices analyzed in this study include Computer Tomography (CT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Ultrasound, X-Ray, Nuclear Imaging and PACS. Global market for Medical Imaging Devices, estimated at US$30.2 billion in 2013 and US$32.3 billion in 2014, is further projected to exceed US$49 billion by 2020, thereby maintaining a CAGR of about 7% between 2010 and 2020.

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Volume - VIII Issue - V Jan-Feb 2018

Contents NEWS UPDATES

Planmed Clarity™ 2D digital mammography system receives FDA approval �� 06 Inputs from experts at Fortis La Femme on pollution impacts on the health of pregnant women �� 06 ‘Diabetes with Delight’ �� 08 Triesta Unit of HCG to Combine with Strand Life Sciences �� 08 Dr. L H Hiranandani Hospital inauguratesfirst MUHS recognized Fellowship Program on Obesity �� 10 Wockhardt Group Hospitals conducted its 5th Annual Infection prevention and control conclave �� 10 Netherlands Cancer Institute grants exclusive license to Desktop Genetics for TIDE �� 12 Abbott and YRGCARE Announce Unique Collaborationto Study HIV and Viral Hepatitis Patterns in India �� 12 PRE BUDGET Budget Expectations by Medical Device Industry �� 13 Budget 2018: Strengthening of public infrastructure �� 16 Interview

Dr. Tonmoy Das, Chief Nephrologist, Apollo Hospitals Guwahati Apollo �� 18 Dr Jignesh G Thakker, Organizing Chairman, AOCR 2018 �� 20 Debayan Ghosh, Founder & President, Epygen Biotech PVT. LTD. �� 22 Doctor Speak 10 Essential Health Tests for Every Woman �� 23 Immunotherapy with “Dendritic Cells” Helps Cancer Patients Row The Life Boat �� 24 Medical innovations: Making big breakthroughs in kidney failure treatment �� 26 Enlarged Prostate - Prostatic Artery Embolization (Pae) �� 28 Testing, Testing and over testing... �� 29 Advances in Prostate Cancer �� 30 Hospital Lab Management Techmed Growth Story �� 32 EXPERT VIEWS

Urinary incontinence and UTI detection and treatment �� 33 Time for Structured Risk Management in Healthcare �� 34 The Rising Prowess of Techno-Healthcare simplifying life �� 35 Cover Story

Advancements in Radiology! �� 36 Latest Technological Advancement in Radiology �� 38 Ms. Rushda Parveen,

Healthcare Infrastructure & Medical Equipment Planning

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NEWS Update

Planmed Clarity™ 2D digital mammography system receives FDA approval The United States Food and Drug Administration (FDA) issued an approval letter for the Planmed Clarity™ 2D full-field digital mammography system on December 28th, 2017. The Planmed Clarity 2D system is an elegant digital mammography system, which provides great image quality, optimal ergonomics, and excellent usability for breast cancer screenings. In addition to screening mammograms, the system supports diagnostic work-up examinations and biopsy procedures. According to Jan Moed, Managing Director of Planmed Oy, the FDA approval for the system is an important milestone for the Planmed Clarity™ product family: “We are excited that we can now introduce our fantastic Planmed Clarity 2D system in the United States. The system received the European Economic Area’s CE mark

in early 2016 and it’s also available in Latin America, Africa, Australia, and Asia. The feedback and response the system has received from other markets has been really positive, and I believe this will be the case in the U.S. market as well. It is a complete and cost-effective solution without compromising quality.” The functional design of the unit guarantees optimal ergonomics for both the radiographer and the patient. The compact and eye-pleasing design relieves patient anxiety, and the flexible compression paddle adapts to patients of all sizes making the patient experience comfortable and relaxed. “Planmed Clarity’s customizable image processing options serve various radiology needs. The system also features a stable digital detector which makes it suitable for working in extreme conditions, such as

humid environments or mobile clinic installations. With this unit we’re truly addressing the needs of the radiologist, radiographer, and the patient without forgetting the investment views of the clinic management,” stated Planmed’s Clinical Director Jukka Erkkilä. Planmed products are sold, marketed and supported in North America by Planmed USA, Inc. (Roselle, IL).

Inputs from experts at Fortis La Femme on pollution impacts on the health of pregnant women Fortis La Femme is a unique facility, inspired by the core belief that a woman is a very special person with special needs. They provide comprehensive clinical and holistic care designed just for women which covers every stage of a woman's life from menarche to menopause. Medical care at the hospital includes Obstetrics (Painless Labor), Gynecology, Neonatology (Level III NICU), Anesthesia, General & Laparoscopic Surgery, Cosmetic Surgeries and Genetic & Fetal Medicine. Fortis La Femme provides comprehensive clinical and holistic care designed just for women which covers every stage of a woman's life from birth, adolescence, motherhood, to menopause and beyond. As we all know, Pollution cause defects during pregnancy or on new born baby, exposure to ambient levels of air pollutants are associated with low birth weight. Apart from factors such as lifestyle, late pregnancies, and weight issues, pollution is also emerging as a major cause for concern and if the mother is breathing polluted air, it is bound to impact the development of the unborn child from that pollution has a cascading effect on the child’s future development risk of contracting illnesses. 6

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Ms. Anika Parashar, COO, Fortis La Femme along with her Doctors welcomes all sorts of interactions and queries around it. Here are a few points they can discuss in detail:  Be aware of the pollution levels so that you can take appropriate and timely precautions.  Consume a healthy diet that can help flush out toxins from the body. Stay hydrated by drinking plenty of water. Keep filters on air conditioners and heaters clean. Try using natural household cleaners instead of those laden with chemicals

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NEWS Update

‘Diabetes with Delight’

by Dr AnoopMisra, Fortis C-DOC Chairman, launched today at World Book Fair2018  Event witnessed the author in conversation with Padma Shree awardee Vinod Dua, and FICCI Chairman Dr. Narottam Puri  The book is an interactive and engaging manual on preventing and managing diabetes with vital messages, FAQs and busting of myths

iabetes with Delight, a comprehensive manualon diabetes by Dr Anoop Misra Chairman, Fortis C-DOC, was launched todayat the World Book Fair 2018 at Pragati Maidan. The event witnessed Padma Shree awardee and leading television personality, Vinod Duaand FICCI Chairman, Dr. Narottam Puriin conversation with the author. The book published by Bloomsbury, is an insightful and educative guide which enables readers to understand how diabetes can affect our mental, emotional and physical wellbeing and can be prevented as well as managed effectively through some simple, methodical steps. The impact potential of such a book is far reaching as it has a strong narrative that is not built on people’s experiences, rather on scientific evidence-based research. The national guidelines that have been formulated for obesity, exercise and diabetes form the back bone of this book, in addition to inputs from clinicians and nutritionists. The book is able to put across suggestions and management tips in a helpful, easy-to-understand and simple manner. Important, vital messages, dialogue boxes and FAQs

make the content of the book extremely interactive and friendly. The most important contribution of the book is that it demystifies a much-feared chronic ailment, enabling people with diabetes as well as general readers to adopt preventive measures not only for diabetes but also related non-communicable diseases such as hypertension, obesity, polycystic ovary syndrome, high cholesterol and cardiac ailments. Dr Anoop Misra, Chairman Fortis C-Doc shared, “I have attempted to do away with a verbose, clinical narrative and make the content of the book engaging. Certain concepts which are not fully understood, such as fasting, are made clearer. For many aspects related to diabetes, longstanding myths are addressed and facts are established. The book caters to a wide audience as well including non-diabetic people as well) as it provides several strategies that can promote a healthier lifestyle among everyone. Further, I have also given an extensive history of the disease and how it affects South Asian, particularly, the Indian population in particular along with the types, determinants, signs, symptoms and complications related to

diabetes. Ultimately through this book, I want people to feel empowered enough to change their lifestyle, control their diabetes and prevent further any associated complications morbidities.” According to the WHO, diabetes is a chronic condition having no cure, which occurs when the pancreas is not able to produce insulin or when the body cannot effectively use the insulin it produces. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Diabetes is also known as an “opportunistic killer” as it mostly occurs due to the opportunities provided by patients in form of bad lifestyle and disciplinary inconsistencies. Thus, healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.

Triesta Unit of HCG to Combine with Strand Life Sciences

Strategic initiative creates integrated platform dedicated to next generation precision medicine Healthcare Global Enterprises, Ltd. (HCG:NSE) today announced execution of definitive agreements for the business combination of its Triesta Sciences business unit (“Triesta”) with Strand Life Sciences Pvt. Ltd. (“Strand”). Strand, established in 2000 as a spin-off from the Indian Institute of Science, is a bioinformatics company working with global technology vendors and research laboratories, and is the leader in genomic testing for cancer and inherited diseases in India. Triesta, a unit of HCG, offers comprehensive molecular diagnostics services and research services in the field of oncology. The combination of Triesta and Strand creates an integrated platform with end to end capabilities in precision medicine - proprietary analytics, clinical research, access to the HCG biorepository, genomic technologies, assay development and validation and a network of laboratories offering a broad menu of tests. 8

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Dr. B.S. Ajaikumar, Chairman and CEO of HCG, said “Strand and Triesta have been working together in bioinformatics and clinical genomics. We are now excited to combine our strengths and resources towards redefining precision medicine. In an era of data driven healthcare, Strand’s exceptional team of computer and life scientists with access to a well annotated clinical substrate, provides a unique opportunity to create exceptional value.” Dr. Ramesh Hariharan, Founder and CEO of Strand, said “Triesta and HCG have been pioneers in bringing the latest advancements in molecular biomarkers into clinical practice in the country. Together we are well on the path to building Asia’s leading integrated analytics driven diagnostic and genomics research company. Through this alliance we will work together to be at the forefront of precision medicine”.

NEWS Update

Dr. L H Hiranandani Hospital inauguratesfirst MUHS recognized Fellowship Program on Obesity A unique program focused to create awareness about obesity and train a doctor to become a specialist in managing obesity Dr. L H Hiranandani Hospital, a super specialty hospital in Mumbai initiated ‘first-of-its-kind’ Fellowship Program on Obesity. This is the first such program to berecognised by Maharashtra University of Health Sciences (MUHS). It is designedwith an aim to train a doctor to become a specialist in managing obesity. It is planned keeping in mind the entire medical and mental support system necessary for doctors, who will receive comprehensive training for effective management of obesity from a distinguished faculty who themselves are medical experts. Dr. Sujit Chatterjee, CEO, Dr L H Hiranandani Hospitals, said,“Dr. L H Hiranandani Hospital reinforces the importance of healthy living and this initiative is a step in this direction. This initiative is one of the many essential elements of the comprehensive health safety initiative to tackle obesity in India which is undertaken by the hospital and is also addressed by the Maharashtra University of Health Sciences. As a responsible healthcare services provider, we intend to create awareness about obesity

and enable current and upcoming healthcare professionals to become a specialist in managing obesity.” Obesity is considered to be a modern ailment that requires an urgent attention as it is strongly linked to 110 serious diseases. Talking about the growing prevalence of obesity in rural and urban India, Dr.Vimal Pahuja,General Physician and programme co-ordinator, Dr L H Hiranandani Hospitalsaid, “The world statistics place India on a very high level as far as obesity prevalence and numbers are concerned. According to National Family Health Survey-4, obesity burden doubled in the last decade. The obesity prevalence in rural areas is also increased by two fold in the last 2 years suggesting that the burden of obesity is rising proportionally in rural parts of India as well.” “Obesity is currently not included in academia due to which there is limited understanding of the subject among medical professionals. In this one-year programme we aim to attain understanding of the disease and moving away of it being

only treated at a cosmetic level. I would like to congratulate Dr. L H Hiranandani Hospital& MUHS for taking the first step towards including obesity in academia” said,Dr. Jayashree Todkar, First lady bariatric surgeon of India and Asia. The doctors will be nominated by MUHS for this program while the course curriculum is designed by the medical experts keeping in mind that India is to become the obesity capital in next 10 years. The doctors will be trained to manage obesity with a multidisciplinary approach to ensure that they are able to make a lasting difference to the health and life of patients while educating other stakeholders on the precautionary measures to reduce obesity prevalence across India.

Wockhardt Group Hospitals conducted its 5th Annual Infection prevention and control conclave Wockhardt Group Hospitals conducted its 5th Annual Infection prevention and control conclave in Mumbai on 6&7 Jan 2018. The conclave was attended by over 500 participants from across the country and had infection control experts from leading healthcare organizations across the country as faculty including Dr Thomas Kozlowski from JCI . Speaking at the inauguration Dr Clive Fernandes Organizing Chairman IPCC, Group Clinical Director, Wockhardt Hospitals and Consultant JCIsaid “At Wockhardt hospitals our philosophy is that No one should contact an infection in the hospital that they didn’t come in with”. This conference is our endeavor to spread 10 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

awareness of good infection practices among health care organizations. Having experts in the field of Infection control address the audience and answer their questions helps as many organizations have the intent and the desire to learn good infection control practices what they require is a bit of guidance from time to time and what better than getting that guidance from the doyens in Infection control. This was a unique platform wherein so many Infection control professionals were on the same platform at the same time. In a first of its kind Wockhardt Hospitals also conducted a one day conference on “Safe Medication Management and

Use” on 5 Jan 2018 that was attended by about 150 participants. The conference was innaugrated by Mr D R Gahane, Asst Commissioner FDA and Dr Thomas Kozlowski JCI.

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NEWS Update

Netherlands Cancer Institute grants exclusive license to Desktop Genetics for TIDE TIDE detects genome editing-mediated indels and calculates the efficiency of CRISPR using Sanger DNA sequencing data Desktop Genetics Ltd (DTG), a biotech company globally recognised for its leadership in gene-editing bioinformatics, acquired exclusive worldwide licensing rights for TIDE (Tracking of Indels by DEcomposition), from the Netherlands Cancer Institute (NKI). The TIDE technology will allow investigators to quantitatively assess genome editing on the DESKGEN Cloud, the free CRISPR design software from DTG. TIDE is a web tool that rapidly calculates the efficiency of CRISPR using Sanger DNA sequencing data. The proprietary decomposition algorithm, also determines the frequency of different repair products in the cell population. TIDE was developed by the van Steensel lab and published in Nucleic Acids Research (Brinkman et al., 2014). The tool is the first of its kind for detecting genome editing-mediated indels and has been cited in over 150 publications. TIDE will be added to the DESKGEN Cloud platform, which offers a CRISPR Knockin and CRISPR Knockout design tool, Genome Editor and Guide Picker. With this expansion, DTG becomes the first company to offer a full end-to-end CRISPR software solution from design to analysis, streamlining the

planning and execution of experiments by allowing all relevant data to be stored in one place. Professor Bas van Steensel, PhD Professor and Group Leader at NKI, commented: “This collaboration is a great opportunity for both parties as it allows TIDE to be managed and to grow in an environment of synergistic design tools, developed by an outstanding team. With this collaboration, TIDE could reach more scientists around the world, gain new functionality and continue to support ground-breaking CRISPR-enabled research.” Victor Dillard, COO at DTG said: “We are proud to integrate TIDE into the DESKGEN platform. This is a natural addition for our users and we look forward to expanding the capabilities of TIDE alongside our own DESKGEN artificial intelligence capabilities.” Riley Doyle, CEO at DTG said: “The free tools we offer allow scientists to efficiently store and manage their experiments, which could save them hours. We look to continue providing a one-stop platform for accurate and reproducible CRISPR investigation design for academic and private institutions, alike.”

Abbott and YRGCARE Announce Unique Collaborationto Study HIV and Viral Hepatitis Patterns in India Strengthening India’s efforts in combating HIV and hepatitis viruses, Abbott has announced its partnership with Y.R. Gaitonde Centre for AIDS Research and Education (YRGCARE) to study the country’s viral diversity to improve accuracyof diagnostic tests. Abbott will provide study protocol and diagnostic equipment and YRGCARE will help in screening and sequencing rich patient data from infected populations in India. HIV and viral hepatitisare among the biggest public health threats in India today as they can produce many genotypes*, which keep combining to formrecombinant strains or mutations making detection trickier. Therefore, understanding the distribution of genotypes and recombinants is critical to the development of diagnostic tests. With more than 2.1 million people living with HIV, India has the third largest HIV incidence in the world with a large part co-infected with hepatitis C virus (HCV). People who inject drugs (PWID) and sex workers are identified as key affected populations for which the epidemic is growing. 12 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Speaking about the partnership Dr Sushil G Devare, Director of Diagnostics Research at Abbottsaid,“In the fight against HIV and viral hepatitis, we are pleased to collaborate with YRGCARE as they are pioneers of AIDS research and have extensive experience in understanding the HIV patient communities across the country. With sequence data generated under this partnership, Abbott endeavours to understand new viral mutations and variations of HIV and HCV leading to the development of newer tests and diagnostic kits to improve detection. We are confident that our joint efforts will offer unique insights into the genetic diversity of HIV and HCV including those that are found in higher risk groups like PWID.” Dr Sunil Suhas Solomon, Chairman, YRGCARE said, “We are excited to partner with Abbott to study emerging patterns of HIV and viral hepatitis in India. Drug using populations or PWIDs in India bear a disproportionate burden of HIV and HCV, and it’s critical to understand the transmissions in this group. Sequencing data in these affected populations will help us understand the evolutionary nature of the viruses enabling optimal treatment

interventions to maximize impact.” Established more than twenty years ago, Abbott’s Global Surveillance Programmespans 40 countries across six continents, identifying and characterizing more than 5,000 virus strains, ensuring that current diagnostic tests to detect a wide range of HIV and hepatitis viruses and determine the need for newer tests to stay ahead of evolving viruses. India is the latest addition to Abbott’s recent surveillance efforts in Asia-Pacific to provide new insightson the strains and transmission of these viruses specific to India. Abbott is the only diagnostic test manufacturer with such a unique, longstanding and large-scale virus Surveillance Programme. Besides India, Abbott has collaborated with partners in China, Australia, Vietnam, Laos and Pakistan to ensure its Surveillance Programmecovers key regions. In addition, Abbott works with commercial partners in Nepal the Philippines as well as the Red Cross in Thailand to gain access to circulating strains of HIV and hepatitis viruses, thus ensuring a real representation of the prevalent infections.

PRE

Budget

Mr Rajiv Nath Forum Coordinator, Association of Indian Medical Device Industry (AiMeD)

Budget Expectations by Medical Device Industry

Govt. needs to introspect why even after 3 years of “Make in India” campaign, the Medical Device Manufacturing is still floundering in India

pplauding Govt’s achievements, in the year 2017, Mr. Rajiv Nath, Forum Coordinator, AiMeD said “Even though the year 2017 witnessed significant developments in the medical devices sector but there is an urgent need for the Govt. to accelerate further reforms and supportive measures in the year 2018 inorder to boost medical device manufacturing within the country, reducing huge import dependency in this sector which is still at 70-90%, minimizing outgo of foreign reserves, and making quality healthcare affordable and accessible to the masses at large.

Predictable tariff strategy for investors: “To implement “MAKE IN INDIA” on ground and exploit potential effect on exports, and the 70% import dependent, over $10 billion Indian Market of Medical Devices domestic manufacturers seek a long term and predictable tariff strategy for investors who will only invest if they find it viable and profitable to manufacture Medical Device in India”– Mr. Rajiv Nath, Forum Coordinator (AiMeD)  Basic Custom Duty (BCD) on Medical Devices having export turnover of more than:  Rs. 100 Crores (in any one of last 3 financial years), should be at least 15%, considering WTO Bound Rate for 40%.  Similarly, for Rs. 10 Crores to Rs. 100 Crores, BCD should be 10% and for R s. 5 Crores to Rs. 10 Crores, BCD should be 7.5% and for  Less than Rs. 5 Crores, BCD could be at 5% or higher. The linkage of growing exports is to demonstrate growing capability and international competitiveness of these Devices to silence critics or India will forever remain import dependent on unaffordable Medical Devices. 14 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Increase in Basic Custom Duty ranging from 0 - 7.5% to 5 - 15% The availability of GST Credit to importers has led to reduced cost of procurement and the only protection domestic industry now has, is Basic Custom Duty. Against the range of 0% to 7.5% Basic Duty on nearly 90% Medical Devices, the WTO (World Trade Organization) Bound Rate is 40% which means Nations under WTO can increase duty up to a maximum of 40%, if they so wish. Other BRICS Countries have Duty Rates as follows: Import Duty on Medical Devices (HS Code 9018) in BRICS Countries Products/ Countries Brazil Russia India China South Africa Medical Devices (HS Code 9018) 14% 0%-15% 7.50% 3.3%-17% 0%-20%

The point we at AiMeD have been trying to make for a long time is that nominal import duty on critical items which can be made in India is not protectionism but sound Make in India economics to revive the floundering manufacturing sectorand the preferred policy tool the world over to boost domestic industry and employment. And we have already seen the beneficial impact of such steps in sectors like telecom, automobile and more recently in Electronics. Whereas we have allowed even Indian Manufacturers of Medical Devices to turn to cheaper imports. The sector where manufacturing is thriving in India are Automobiles with 60% to 100% Basic Custom Duty(BCD), Motor Cycles with 60% - 75% BCD and Bicycles with 30% BCD. To boost domestic manufacturing of Mobile Handset and Components, Government imposed a differential duty of 10-12.5 %. And the net result has been that every imported

PRE

Budget brand stepped forward to put a factory in India - whether Chinese or Taiwanese or American, including Apple.

Dr. P.M Bhujang Budget expectations - Association of Hospitals (AoH)

With introduction of GST the differential Duty advantage was no more there and all foreign investors who had stepped forward were feeling stressed. The Govt. rightly revised custom duty on Electronics upto 20% recently to maintain the investment climate and same is sought for Medical Electronics where import dependency is 90% !

“Healthcare services have played a major role in nation building with the governments focus on developing more and more hospitals in the country. In order to meet these objective it is important that the services rendered to hospitals should keep away from the ambit of GST. The hospitals should be allowed to claim refund of GST on inputs as it will help the Health Care industry in cost optimization by making the healthcare more affordable. Additionally charitable hospitals should be exempted from GST/ Central Excise/ Service Tax on supply of Disposable, Medicines Implants, stents and Lenses so that more Indigent and poor Patients can be provided Free and concessional Medical Services, as more funds will be available to serve more needy patients. The exemption on GST on the inputs will reduce the cost to the hospitals and consequently cost of medical services to a patient, says Dr. P.M Bhujang- President, Association of Hospitals.”

Though 2017 has been a very eventful and progressive year for the presently valued $10 billion Indian Medical Device Market starting from: M edical Device Rules 2017. The new rules to regulate medical devices heeded the industry’s long standing demand to have medical device rules separate from drugs.  NPPA capping the prices of Stents followed by orthopedic knee implants as well in a move to make Medical Devices more affordable and allowing Ethical Market competition.  Subsequently, the National Regulatory Authority, CDSCO coming up with classification of Medical Devices.  Mandatory display of MRP on all imported (and indigenous) medical devices.  Notification of accredited certified bodies under Quality Council of India for ICMED Certification  Inauguration of Medical Device Parks in Andhra Pradesh and in Telangana  Formation of Kalam Institute of Technology to promote indigenous R&D etc etc. But the year 2018, will be a year to watch out for which would clarify further course of action to make medical devices more affordable.Much more needs to be done as the relief of correcting inverted duty structure needs to be similarly extended to other Medical Devices many of which are not in Chapter 90. Till now, there have been some significant measures and corrective steps but what we really expect is that this budget outlines and ensures a broad, country centric and comprehensive road map for boosting medical device industry within the country.

Specific Expectations from this Budget Session:  Extension of Inverted Duty Tariff Rationalization to Medical Electronics & Diagnostic.  I ncrease in Basic Custom Duty ranging from 0 - 7.5% to 5 - 15%, as access to GST credit has made imports cheaper against earlier protection of 7.5+6+4 %. Indian Manufacturers have only 7.5% protection now.  MoH to review & discuss Medical Devices Bill for Law drafted in 2016 with stakeholders

Dr. Dharminder Nagar MD of Paras Healthcare on Budget Expectation. We sincerely hope healthcare industry would be given some leeway in terms of GST implementation. This will ensure better services to patients by healthcare providers. This will also result in greater accessibility of care and services by the common man. The government must also come out with clear roadmap to make medical insurance more popular. It must also exclude the medical insurance premium exempt from GST. Given the acute shortage of manpower, there is need to industry representation in central universities and even medical colleges so that healthcare industry can source talent appropriately" said Dr Dharminder Nagar MD, Paras Healthcare.

Ms. Ameera Shah MD& Promoter, Metropolis Healthcare This year has been an important one for healthcare. Various initiatives ruled under the National Health Policy have helped in larger strata of the Indian population to access medical services at affordable prices. Post introduction of GST, the tax rate on medical devices was pegged at 12%, this, if reduced further can positively affect the overall cost structure thereby providing cost effective healthcare services to the society. The last budget had a lot of focus on policy direction and targets for elimination of chronic diseases which is laudable. In addition to increased spending, we also hope that this year’s budget with address the National Health Protection Scheme and also set impetus to generate demand for health insurance through additional exemptions. w w w.medegatetoday.com Jan-Feb 2018

PRE

budget

Love Bhardwaj

Project Manager at Messe Duesseldorf India Pvt. Ltd.

Budget 2018: Strengthening of public infrastructure, Healthcare accessibility in rural areas and more focus on Make in India policy:

ith increase in population, burden on healthcare services is increasing tremendously. The existing infrastructure is not enough to serve the needs of the growing population. The public healthcare institutions are under-financed and short staffed. This is where the Union Budget 2018 should emphasis on. The central and state governments do offer universal healthcare services and free treatment and essential drugs at government hospitals. However, the hospitals are, as we said, understaffed and under-financed, forcing patients to visit private medical practitioners and hospitals.

Healthy Rural: Healthy India: Consequently, the rural population mostly relies on alternative medicine and government programmes in rural health clinics. According to health information 31.5% of hospitals and 16% hospital beds are situated in rural areas where 75% of total population resides. With the higher spending power of consumers in towns and cities the majority of Indian healthcare professionals are concentrated around urban areas, leaving rural areas under served. India currently spend 4.2% of its national GDP on healthcare, need of the hour is that there should be significant increase in health care expenditure from the current allocation. 16 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Expanding Insurance Coverage: The government should find ways to cover the uncovered population under health insurance. Most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance. In fact, recent world health statistics have indicated that India has the highest out of pocket private healthcare costs for families, among many other comparable developing nations.

Make In India: India need to focus on Make In India to lower the hospitals bills as Half of the total material bills for most hospitals are on devices, implants and consumables and a large part of the devices and implants are imported items. Start-ups are investing in healthcare sector from process automation to diagnostics to low-cost innovations. Policy and regulatory support should be provided to make healthcare accessible and affordable. The central government assigns national priority to the healthcare agenda, commits to spending more on public health and defines a holistic framework for an India-centric health system. The government should set clear priorities, clarify roles, and establish enabling incentives and regulations for stakeholders. Health care in India has come a long way but it also has a long way to goâ&#x20AC;Ś.

INTERVIEW

EVERY SPECIALITY HAS A REPUTATION AN ITERVIEW WITH NEPHROLOGY EXPERT Dr. Tonmoy Das Tell our readers about your healthcare related education, training and experience?

Dr. Tonmoy Das

Chief Nephrologist Apollo Hospitals Guwahati Apollo

Dr. Tonmoy Das who is a Nephrologist from Apollo Hospitals Guwahati, had done DM in 1990 from PGIMER (Chandigarh) and in 1985 and MBBS in 1980 from Guwahati Medical College. He is a rank holder in all three professional examinations. He has many years of experience in the field of Nephrology. From 1986 to 1988, he was a Registrar in the Department of Nephrology, Guwahati Medical College and after that he joined as Associate Professor, Department of Nephrology, Guwahati Medical College. Then after he joined Down town hospital as Consultant-Nephrologist. Dr. Tonmoy das is promoter and founder Director of International Hospital Guwahati (Now Apollo Hospitals Guwahati, Unit: International Hospital). Since 1999 till date. Dr. Das has been associated with this esteemed organization and serves entire North eastern region. Dr. Tonmoy Das has a long list of achievements in his professional journey as an expert in Nephrology. Describe your personality as a Nephrologist? A Nephrologist with many years of wide ranging experience in Nephrology at some of the best medical institutes in North East India like Guwahati Medical College and Hospital, Down-town hospital and Apollo Hospitals Guwahati (Unit: International Hospital). Expertise in treating critically ill patients with acute and chronic renal failure, patients on dialysis and renal transplant. Experienced in managing difficult and high risk renal transplants cases. Tries to pursue medical care with compassion and perfection. As a Nephrologist always try to be helpful to North East Society which was lacking woefully in facilities for Renal Care with only two designated centers; one in government and one in private sector in 1990. But even these facilities were also deprived of requisite infrastructures for CAPD as well as Kidney Transplants. Have initiated CAPD and Kidney transplant program in North East 1994 in Guwahati Medical College and 1996 in Down Town Hospital and since 2010 Apollo Hospitals Guwahati. Tell us about the rise in kidney diseases? Kidney diseases are rapidly increasing globally and reaching epidemic proportions. In India, there is a significant burden of kidney diseases, Chronic Kidney Disease (CKD) in particular. In the absence of a renal registry in India, the real extent of

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INTERVIEW CKD is unknown, but with rising prevalence of diabetes and hypertension in the country, the prevalence of CKD is expected to increase. The causative factors for CKD in India are essentially the same as that in the developed nations. Diabetes and hypertension remain the major causes of renal failure. What are the criteria transplantation?

for

undergoing

kidney

Kidney transplant criteria encompass a number of elements. Criteria for a kidney transplant take into account both the recipient’s and donor’s requirements. There are many considerations that must be looked at, from both the patient’s (recipient) and the kidney donor’s perspectives. These include medical, psychological, logistical and financial considerations.

Transplant Criteria - for The Recipient Not all cases of renal failure require a kidney transplant. Only patients who have been diagnosed with chronic end stage renal disease. This is the most severe stage of kidney failure, where the kidneys have suffered irreversible damage and can no longer perform their function.

Kidney Transplant Criteria - for a Donor A kidney transplant donor (kidney donor) is someone who is willing and able to donate one of the kidneys, for kidney transplant. A kidney donor may be either alive or deceased (in this case kidneys can be used to save two lives). The criteria for a donor depend on whether the donor is living or deceased. Basically, the following two (2) kidney transplant criteria are required for a deceased donor. The donated kidney must be healthy. The blood and tissue profiles must be similar to the recipient. Now a day’s across blood group transplant is a well established entities.

what are the best and worst aspects of Nephrology? The best aspects are learning to apply knowledge, skills and aptitudes to solve challenging problems. There are excellent teaching and research opportunities. The specialty is growing and a career in nephrology is secure and rewarding. The worst aspects are arguably the frustration of not being able to provide optimal care to some patients e.g. shortage of donor organs for kidney transplantation and financial burdens to the families in a developing country like India. Chronicity of disease and the requisite of involvement of family in care are the other problems. How much hygiene matters in the process of dialysis at home? Very much. Specially hand hygiene. Preventing the transmission of infections involves several links in the chain involving the patients, the dialysis procedure and ancillary care and waste disposal measures. Any suggestions for our readers to cure kidney diseases?

There’s no cure for chronic kidney disease (CKD), but treatment can help relieve the symptoms and stop it getting worse. Following measures can help in reducing the burden of Renal disease to some extent Lifestyle Modification specially in people with family history of Diabetes, hypertension, CAD, dyslipidemia,  Good control of Diabetes and Hypertension. Regular follow up with the Physician  Regular follow up for Renal stone disease and childhood renal disease  Avoiding nephrotoxic drugs  Misuse of NSAIDS  Adherence to dietary restrictions in Renal disease.

Where is Nephrology going as a specialty in your hospital Apollo, Guwahati? The Department of Nephrology at Apollo Hospitals Guwahati attracts a huge number of patients from all over the North East and is considered one of the vibrant Renal Center of North East. Led by Chief Nephrologist Dr. Tonmoy Das and his team including Dr. Mitul Bora and Dr. Dhrubajyoti Choudhury among other highly committed team members, the department has infrastructure to deal with all types of Kidney diseases. There is a 17 bedded Dialysis ward with state of art HaemoDialysis Machines backed up by Swedish R.O System. The Department has successfully conducted around 300 Renal Transplants till date. Established the first successful running program for Kidney Transplant in North East. w w w.medegatetoday.com Jan-Feb 2018

INTERVIEW How newer technology enables ease in diagnosis of Radiology - 3D & 4D technology has paved a way in Digital Radiology What are the current issues that the radiology sector in India is grappling with? Radiology in India is currently in a good space, however ongoing issues regards PC PNDT Implementation, Turf Erosion, and Trade Coordination are some areas where the current IRIA Office Bearers team is involved to solve issues across these levels.

What should the industry expecting from the AOCR 2018 clubbed with the 71st Annual Conference of IRIA ?

Dr Jignesh G Thakker

Organizing Chairman, AOCR 2018 Tells us about the latest trends in radiology world wordover? Continuous advances in Radiology are taking place across the World. With better resolution, faster machines, more of Multimodality Imaging is coming to the fore. The Ultrasound goalpost has also been widened with superb 3D & 4D imaging and a more common use of Contrast in Ultrasound Imaging. The AOCR 2018 is a perfect showcase for Delegates to see the latest in machine advancement and technology in India.

What are the business opportunities that the Indian radiology industry can look up to in 2018? The Radiology Industry is rapidly growing with a significant penetration of Advanced machines now extending to Tier II & Tier III towns. With availability of such equipment though All India distribution, people across all strata of India are likely to benefit. Radiologists and entrepreneurs from across the country are likely to see the best technology available in India. This is likely to fuel purchases across India, and hence growth of Radiology across India over the next few years. 20 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

The 17th Asian Oceanian Congress of Radiology and the 71st Annual Conference of the Indian Radiology and Imaging Association (IRIA) will be held at Renaissance Mumbai Convention Centre Hotel, Powai, Mumbai from the 25th - 28th of Jan, 2018. With 4 days of lectures spread across 6 Halls, 5 halls for presentation of scientifc papers, E posters on screens across the conference arena, more than 20,000 sq feet of space for Scientific Exhibits, Mumbai Chaat Street, 3 consecutive nights of top-notch social events, and stay available at the venue itself for those taking the residential package, this event is packed with tremendous academics and enjoyment for all delegates who will be attending AOCR2018, an event reaching Indian shores after a gap of 25 years. A strong participation from AOSR group of countries is expected for this event, with a heavy dose of International and National faculty that will make this a not-to-miss event in the annals of Radiology conferences in India. We have geared ourselves to showcase an academic and cultural extravaganza and look forward to your presence at this event, an event that is reaching Indian shores after a gap of 25 years. We will leave no stone unturned to ensure a wonderful experience for the delegates. It is a great opportunity to meet friends, network, watch legends give cutting updates, see budding talent amongst indian radiologists, be a part of exciting on site quiz contests, see new equipment showcased at the Trade Exhibit, and enjoy wonderful cultural events that showcase Indiaâ&#x20AC;&#x2122;s rich heritage across three social events during the course of the event.

How many radiologist and allied industry representatives are you expecting? We expect more than 4000 Radiologists to take part. More than 2500 have already registered for the conference upto October 31, of which more than 30% are radiology students. The participation is expected to cross 4500 Delegates, if we include Trade, Industry & AOSR representatives. Our focus is on making it a great learning experience for Radiology residents.

INTERVIEW What is the focus for this year? The focus for this year is Advanced Imaging Across Asia. This conference is being held in association with the Asian Oceanian Society of Radiology (AOSR) by the Indian Radiological & Imaging Association (IRIA), and more than 25 International Speakers are expected to share their experiences from across the Asian Oceanian region.

expected, and the interest from your Radiology blood is heartening to say the least. Three Social Events will be held, and will also include high voltage performances by stars from Bollywood, and culminating with a Entertainment performance on Saturday night.

What are the scientific programmes focussing on? What are the kind of topics that will be covered?

How will this year’s gathering be different from All modalities of Radiology under all subsections will be covered by International, Asian and the best of Indian Faculty. Topics the previous ones? Six dedicated halls for scientific sessions, and five halls for Paper Presentations have been planned at this event. The 6 session halls will have LED screens with digital screening of all lectures. We are planning a green conference with minimal use of paper and all updates and notifications on our Mobile App and via SMS. Mumbai is the commercial capital of the country and the Local Organising Committee (LOC) is working hard to cover all facets of the event to make it successful. We are already primed to be the highest attended conference of Radiology ever in the country. More than 1000 papers and posters are expected for this event. A huge registration of Radiology students and resident doctors is

across NeuroRadiology, Chest Radiology, ABdominal Imaging, OBGY Imaging, and all other important subsections of Radiology will be covered.

Are there any learnings from the previous years that you would like to incorporate this year? Our focus this year is on a dynamic website and Mobile app (AOCR 2018) that has already been launched. We will be providing live feeds of key moments of the conference through our Live Updates section on the Mobile App. Our FB page also showcases the event as we countdown to Jan 25.

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INTERVIEW Epygen emerge as a leading biotech innovator enhancing human life. of million dollars. In comparison, a generic drug takes at the most about two years and costs one tenth of the price compared to a biosimilar drug. How Maharashtra has the potential to contribute to the Biotech Industry but can do better with improved facilities and regulations.

Debayan Ghosh Founder & President, Epygen Biotech PVT. LTD.

How policies for Biotech and Pharma industry should be different from one another As we know that biosimilars are far more complicated than the average medicine as they are produced using living cells and have a few caveats, unlike generics which are chemicalbased drugs like antibiotics that can be interchangeable with branded versions. Biosimilar productsare approved by FDA on the basis of being highly similar to an already approved biological reference product, unlike a generic drug.It takes much more time, energy, and money to get a biosimilar approved, compared to a generic medicine. For example, where a generic chemical drug has to pass through a few head to head comparisons to be registserd as authentic, a recmbinant biotech biosimilar drug passes through an battery of around 50 characterization tests followed by some phases of Clinical trials, including 100s of patients. To develop a biosimilar, it could take anywhere from 5 to 10 years and can costs 100s 22 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Since several decades, Maharashtra had been one of the most preferred destinations for the pharmaceutical industry, and attracted investments in Drugs and Pharmaceuticals. The state contributes about 40% of the total pharmaceutical turn over. However, Biotechnology industry requires an Ecosystem, which will allow the state and federal governments to have a deeper understanding of this field, from the regulatory perspective. The set of rules that apply for pharmaceutica industry will not apply for biopharaecuticals. To take a leaf from Bangalore, the Centre for Cellular and Molecular Platforms (C-CAMP) in Bangalore helps in developing and establishing new highend technologies, drives academic and Industrial Research and Development and promote entrepreneurship with strategic nucleation of biotechnology industry with an aim of developing and making available new platforms. Just like the Bangalore Bio Cluster, there is a need to develop such platforms in every state of the country, in order to captilizethe full potential of Biosimilars. Maharashtra is one such state, where there is immense potential of developing a C-CAMP like ecosystem.Apart from the core healthcare biotech, there are so many fields of biotechnology like industrial, animal, agriculture, ocean and marine biotech which can fuel such an ecosystem in this state.

About Debayan Ghosh Debayan Ghosh Co-founded and built Epygen in the year 2006 with a vision to emerge as a leading biotech innovator enhancing human life. Having worked for leading Biotech companies in the United States and India for more than a decade prior to founding Epygen, Debayan realized the potential for biotechnology to shape tomorrow’s world as Epygen’s tagline says “building future strand by strand”. Through his education and experience, he observed how modification of proteins using the recombinant path revolutionized areas from critical healthcare to chemicals and clean energy. Leading a team of scientists, technologists and business professionals at Epygen’s labs, manufacturing facilities and offices in Dubai, India and USA, innovation for sustainable development has been his key focus. Currently, Debayan and his team are in the process of completing the Regulatory Pathway of cardiovascular Thrombolytic Recombinant Protein drug for patients in Indian subcontinent and the underprivileged of the world. His aim is to produce this Life-Saving drug to address the mid income strata and bottom of the pyramid and his target launch date is in 2018. Unlike most Biotech drugs, this drug will be produced at an affordable cost, while maintaining highest international quality standards. He will oversee the entire operations at Epygen Biotech, leading a qualified team of scientists and research experts. Prior to starting Epygen, Debayan served as the Regional Director at Dyadic International of Jupiter, Florida. During his seven years stint with Dyadic, he was instrumental in monetizing its recombinant technology platform through the New York Stock Exchange. Prior to this, he worked with Asia’s biotech leader Biocon for five years, developing enzyme technology and global business.

DOCTOR SPEAK

10 Essential Health Tests for Every Woman

maintain healthy bones and calcium absorption, as calcium depletion sets in with age.

Blood pressure screening Check your blood pressure every two years starting at the age of 18. Ideal blood pressure for women is less than 120/80 mmHg (millimetres of mercury). In case of persistent high-blood pressure, do a stress test as well.

Blood glucose tests Women should get a blood glucose test every three years starting at age of 45 to test for diabetes or pre-diabetes. However, if you have a family history of diabetes, then begin early and start getting your blood sugar checked in your 30s itself.

Cholesterol check

Dr Anita Suryanarayan Vice President (South India & Sri Lanka), Metropolis Healthcare

he modern woman plays many roles, and her health is of paramount importance in helping her get through the day. Every woman’s health is dependent on and affected by a variety of factors. It is important that every woman after a certain age, goes for regular physical check-ups to be forewarned of any ailment. Diseases like diabetes, blood sugar, calcium deficiency, thyroid malfunction and such can be detected with simple tests, undertaken periodically. Here are 10 important health tests that every woman should make note of

Body Mass Index Check Body Mass Index (BMI) is a measure of body fat based on the individual’s height and weight. There are multiple apps and online BMI Calculators that can calculate your BMI by dividing your weight in kilograms by your height squared in metres, on entering your height, weight, gender and age. The BMI Calculator then analyses the intensity (high, medium or low) of the individual’s BMI and compares the data with others in the same height and age bracket.

Anaemia Check A person is considered anemic if they have a low count of RBCs in the body. Lowhaemoglobin (HGB) level in the red blood cells leads to low absorption of oxygen in the blood, physical weakness or dizziness.

Vitamin Deficiency Check It is common to find Indian women who have a deficiency in Vitamin D and B12. A deficiency in Vitamin B12 for women who are planning for a pregnancy or are pregnant could result in a problematic pregnancy. Vitamin D is extremely critical to

Women should have their cholesterol checked, at least periodically, post 25, to decrease the risk of heart diseases. If the results are normal, the AHA recommends testing once in three years.

Pap smears and pelvic exams Recommended to begin at 21 or even earlier if women are sexually active, this is an important test to reduce risk of cervical cancer, which is the second leading cause of death in women.

Mammograms and breast exams A manual exam where a doctor tests for lumps and abnormalities is recommended from the age of 20 up until 40. It is recommended to do a mammogram every one or two years beginning at age of 40, as recommended by the American Cancer Society.

Bone density screening Women should start getting screened for osteoporosis with a bone density test at age 65. However, those who have been detected with calcium deficiencies or have a personal or family history of fractures should get a dexa scan earlier.

Colon cancer screening It is ideal to begin a colon cancer screening at age 50 and is typically performed once in five or ten years depending on the technique used. With normal results, a flexible sigmoidoscopy needs to be repeated every 5 to 10 years and a colonoscopy only every 10 years. The non-invasive virtual colonoscopy is another option. Those with a greater risk of colon cancer may need earlier or more frequent cancer screening tests.

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DOCTOR SPEAK

IMMUNOTHERAPY WITH “DENDRITIC CELLS”

HELPS CANCER PATIENTS ROW THE LIFE BOAT CANCER BY NUMBERS Cancer is a lethal disease that is swallowing India silently. Even those types of cancer which were once known to be rare are no longer rare. With this fatal disease on a rise, it is taking lives of many with each passing day. As per the reports “In India, approximately 4.5 lakhs people are living with the disease, and there are more than 7 lakhs new cases being registered yearly and 5,56,400 deaths which are known to be cancer-related. Also it is estimated 71 percent of all cancer-related deaths are happening in the age group between 30 to 69 years.” In women cancer cases as well as mortality is uphill. The main reason can be attributed to low awareness and late detection. As per the data “Our country stands third after China and USA for the highest number of cancer cases among women which are growing per annum at 4.5-5%.” Among men lung, oral and stomach cancers are the leading causes of death due to this noxious disease. Today many causes are known that play a role in the development of cancer, and many more factors are at least suspected of contributing to the emergence of cancer. Therefore, it is rather questionable whether a single main cause for the development of cancer will ever be identified. However some obvious reasons due to which cancer is on a rise in India is due to Tobacco, excess exposure to ultraviolet radiation, consuming carcinogenic chemicals and food and too much exposure to rays and emissions of ionizing radiation.

CANCER IS A COMPLEX DISEASE About one hundred different types of cancer are known in humans, and all are different from one another such as the average age at which they appear, the growth rate and the tendency to metastasize. From newborn babies to aged people, everyone is at risk of cancer.

Dr. Hari Goyal, Oncologist, Artemis Hospital, Gurgaon 24 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Every disease has some reason so does cancer! Many reasons have invited this deadly disease. There are many kinds of cancers attacking our body, regardless of our sex or age. Furthermore incidence of cancer is higher in the metros than in the rural areas due to the changing lifestyle and imitation of the western lifestyle. Therefore it is better to have a healthy diet, exercise well and be cancer-free.

DOCTOR SPEAK

“IMMUNOTHERAPY IS A NEW CLASS OF CANCER TREATMENT” Considering the impact and progression of cancer, Immunotherapy is a new class of cancer treatment. Scientists working on immunotherapy have basically taken a diverse route by tricking the body’s own defences into combating the rival cancer within. For centuries, this has been an aspiration of medical scientist which has become a reality! One of the most recent, innovating and exciting cancer treatments is Immunotherapy with “dendritic cells”. It is infusing a new ray of hope for the cancer patients. Countless research and treatment facilities worldwide are increasingly turning towards this dendritic cell therapy; in fact even modern nations like USA have well accepted and approved this treatment. Prostate and pancreatic cancers have even got FDA approval for using Immunotherapy for its treatment in the country.

IMMUNOTHERAPY WITH “DENDRITIC CELLS”OFFERS SECOND CHANCES TO PATIENTS Although Immunotherapy has been there in the country in the form of vaccine and injections since the last 4-5 years but the results and success rate were not very promising and encouraging. On the other hand the effectiveness of a treatment with dendritic cells has been encouraging. It has been proven in

the case of skin, kidney, breast, pancreatic, colon, ovarian and prostate cancer. There are effective implementations of the therapy with LANEX-DC. This has been bought in the country by LDG INDIA. The results are astounding and encouraging. It utilizes better technology, technique and scientists. Cancer patients who have used this therapy as compared to those who undergone the previous and other versions of Immunotherapy, there has been an increase in quality of life, helped in prolonging the life span, controlling and abolition of symptoms by facilitating them live a routine life. Also for most types of cancer there exist standard treatments which have been developed over decades. It is recommended to make use of these treatments and supplement them with immune therapy, since it is known that tumour cells damaged by chemotherapy or radiation are much easier to destroy with immune cells than undamaged tumour cells. Treatment with dendritic cells is also often used when conventional therapies have not been successful. In addition, treatment with dendritic cells is a gentle treatment in contrast to other forms of treatment, such as chemotherapy or radiation. Also compared to other forms of treatment, side effects only occur very rarely after vaccination with dendritic cells.

EVERYTHING IS CHANGING AND SO HAS THE IMMUNOTHERAPY TECHNOLOGY AND TECHNIQUE As indicated above there are other similar medical facilities already available in India that have been in use for a few years and which gives vaccination in 6 cycles. But at LDG INDIA clinic the same treatment is done in only 1 cycle and the treatment is like injecting immunity medicine into the body. The facility basically provides a special type of vaccination, required to treat any type of cancer (except-blood cancer), at any stage. It is a unique vaccination which is made from patient’s blood and infused in the body which boost their immunity and help in curing the disease naturally. A patient can take the vaccination while taking chemotherapy, it will averse the side effects and help a patient live a routine life. Doctors like me who have recommended this for the patients are now satisfied with the results and calling it encouraging. Some of them also believe immunotherapy has the potential to cure some cancers too! w w w.medegatetoday.com Jan-Feb 2018

DOCTOR SPEAK

Medical innovations:

Making big breakthroughs in kidney failure treatment Dr. Sunil Prakash

Director and Senior Consultant, Nephrology & Renal Transplant Services, BLK Centre for Renal Sciences and Kidney Transplant, BLK Super Speciality Hospital

Nearly 2.5 lakh people in India die due to kidney diseases every year and this has emerged as a major challenge for the medical fraternity. However, over the years some medical innovations are making big breakthroughs in kidney treatment. Artificial Kidney, Portable Dialysis Machine and Stem Cell Therapy are among those innovations which are proving very effective. Moreover, new advancements in kidney treatment could end the need for compatible donors as well. Kidney diseases occur when an individual suffers from a gradual and permanent loss of kidney function over time. These could be acute or chronic renal diseases. In acute kidney disorder, an individual may have temporary functional loss whereas during chronic the kidneys become irreversible and therefore fail to perform daily functions. Due to this abnormality, acids, waste and fluid keeps building up inside body, thereby causing weakness, vomiting, ankle swelling and poor sleep, besides being host of other cardiac and pulmonary diseases. In critical conditions, the patients are advised to be on dialysis frequently. But to lead a good quality of life and to regain back the normal kidney function, kidney transplant is the only available option. However, to get a compatible donor kidney has always raised concerns as average waiting time to receive a kidney from a deceased donor is extremely variable ranging from months to years, depending on the blood type. Even though dialysis is regarded as the only successful therapy it has several limitations. One possible reason is that the quality of life of patients who are on dialysis is suboptimal, besides the cost of these procedures is too high. They are not rehabilitated in their jobs. Thus, the medical fraternity had been always in search of some alternative treatment options to avoid dialysis and kidney transplantation, especially in the end stage renal disease (ESRD) patients. With new technological advancements in kidney treatment, the need for dialysis centres or the long wait for a matching donor is soon expected to become things of the past. Also, as a result of these new technical devices people with Chronic Kidney Disease (CKD) will be able to have more control over managing their personal health and improve the quality of their lives.

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DOCTOR SPEAK

Let’s track down a few such medical innovations which are expected to make some big breakthroughs in kidney failure treatment:

Artificial Kidney: At least 2.5 lakh people in India die due to kidney diseases every year. Therefore, with this artificial kidney expected to hit the market by end of this decade it is believed that the patients struggling with the end-stage renal disease will get a fresh lease of life. The device can be implanted in the abdomen and will be powered by the heart. It is designed to filter the blood and perform other kidney functions, including production of hormones, and it helps to assist in blood pressure control. Unlike conventional haemodialysis, which merely filters toxins from the blood, the artificial kidney is expected to have a membrane that filters the blood and has a bio-reactor comprising living kidney cells that are exposed to the blood during dialysis. Success rates of artificial organ transplant surgeries have made advances, so this artificial kidney may enhance the patient's quality of life as well as extend their productivity. Portable Dialysis Machine: This innovative device is expected to act as a promising substitute for dialysis machine. Though, frequent dialysis offers better outcomes but the current dialysis machines aren’t portable. They limit patients’ freedom of movement and ability to engage in the normal activities of daily living. To the contrary, portable dialysis machine is a belt that performs 'dialysis on the go' and it could soon change the lives of people with chronic kidney failure. Basically, it's a dialysis machine that a patient can wear around their body. It connects to a large vein in the body through catheter which has filters to separate water, salts and minerals out of the blood. The filters have to be timely replaced and chemicals added once a day to clean the water filtered out.

crossroad with the application of innovative and novel technologies that hold considerable promise for the near future. Stem cells are characterized by their ability to self-replicate and undergo multi-lineage differentiation to produce functional tissue. There is hypothesis that stem cells can be directly employed at the site of kidney damage with the catheter based injections, wherein they can facilitate regeneration of damaged nephrons by producing new podocytes, thus aiding in Kidney failure treatment. This strategy of using an individual's own cells is beneficial as this reduces the risk associated with the immune rejection in terms of organ transplantation.

The stem cell procedure consists of these steps:  Source extraction  Isolation, analysis and concentration of the stem cells in the laboratory.  Stem cell implantation  Post treatment care However, so far substantive success has eluded the researchers. The injected cells fail to make scaffolds and are destroys. Still research goes on to overcome the current road blocks and there is hope in near future for definitive regenerative renal therapies.

The device aims to replace dialysis machines, which require patients to visit a clinic several times a week.

Stem Cell Therapy: Finally, stem cells hold promise, both for kidney disease and as a source of tissues and organs. In summary, nephrology is at an exciting w w w.medegatetoday.com Jan-Feb 2018

DOCTOR SPEAK

ENLARGED PROSTATE PROSTATIC ARTERY EMBOLIZATION (PAE) Dr. Pradeep Muley

Head Interventional Radiologist, Fortis Hospital, VasantKunj

male reproductive gland that produces the fluid that carries sperm while ejaculation is known as the Prostate. An enlarged prostate means the gland has grown bigger and it usually happens to all the men as they grow older. The prostate is located around the urethra, through which urine passes out of the body. It is also called Benign Prostate Hyperplasia (BPH). It cannot be considered as a cancer, and also doesn’t raise any risk for prostate cancer. Its actual cause is still unknown. Testicles may play a role in the growth of the gland. But a eunuch men who has been castrated at a younger age, they do not develop BPH. If the testicles are removed after a man develops BPH as a result the prostate begins to shrink in size. Digital rectal examination, prostatic specific antigen (PSA), transrectal ultrasound, urine analysis etc are some of the diagnostic test to recognize the BPH.

Symptoms for Prostate Gland Enlargement:  Hitch starting urination & weak urine stream.  Dribbling at the end of urinating.  Urgent need to urinate albeit not being able to completely empty the bladder  Blood in the urine  Straining to urinate  Hankering like to urinate three or more times per night. Development of enlarged prostate increases with the age, it has also been said that every men will face an enlarged prostate if they live long and BPH is so common. If there is a disease the treatment is also there but the choice of the treatment is based on the severity of your symptoms and to the extent they are affecting your daily life or routines. There are certain surgeries to get rid of this disease. Most of the surgeries are temporary 28 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

and are required to done again after a period of time only one was found to be affective and that is transurethral resection of the prostate (TURP). The surgery is effective enough to stop the symptoms but there are complications of such types of surgeries as TURP required a doctor to insert a device up the urinary tube and remove the prostate. Any type of prostate surgery cause side effects such as blood loss, blood in the urine, semen flowing backward into the Bladder instead of out through the penis during ejaculation, water intoxication and urine incontinency, loss of bladder control etc. Now a procedure has been developed and that is “Prostatic Artery Embolization” or PAE. This surgery is far better than TURP. Under this surgery the patients are admitted to the hospital at the day of the procedure. Embolization is performed under local anesthesia by unilateral approach, usually the right femoral artery. Initially, pelvic angiography is performed to evaluate the various arteries. Then an angiography catheter is introduced in right femoral artery advanced in the ostium of the prostatic artery before embolisation. For embolization, PVA particles are injected causing slow flow or near stasis in the prostatic vessels with interruption of the arterial flow and prostatic gland opacification. When embolization of the both prostatic arteries is finished, the catheter is removed. After 6-8 hours patients can start walking. As a result the men undergoing this surgery will not feel a pain at all. He will be able to walk after few hours and leave the hospital after the procedure is done. PVE has many advantages like can be performed on any size prostate unlike TURP, contains no side effects like TURP does, no blood loss or risk of blood transfusion, no sexual dysfunction, no surgical ugly scars and also makes the faster recovery 

DOCTOR SPEAK

Testing, Testing and over testing...

Dr. C.N. Srinivas

MD (Path), DNB (Path), IFCAP Head – Clinical Lab, Head Transplantation Immunology and Consultant Pathologist at MIOT Hospitals, Chennai

PROLOGUE A patient attends OP in physician clinic with fever and obviously in pain and but with such nonspecific symptoms. After careful examination of the patient, the doctor decides to take support from laboratory. The answer, for many care providers, lies in laboratory tests – and the more, the better, in some cases. Who knows what might turn up in the patient’s blood counts, metabolic panels, or renal function? Why risk not testing for something that might provide an answer, when it’s so easy to tick every box on the requisition sheet? Laboratories and clinicians should know that more isn’t always better. Unnecessary tests cost the laboratory time and resources. They cost the patient withanxiety, discomfort, and even more severe consequences, such as hospitalinduced anemia arising from too many blood draws. Moreover, benefits are never guaranteed; increased testing may not actually reveal the issues affecting the patient, whereas it can result in unnecessary interventions or feed into a never-ending cycle of tests. So why do doctors continue to order tests their patients don’t need?

THE DANGERS OF EXCESSIVE TESTING Several studies have shown that excessive lab testing can lead to hospitalacquired anemia. which in turn can lead to unnecessary blood transfusions and worse patient outcomes. Additionally,

labs ordered without a high pre-test probability for a disease state are difficult to interpret and often lead to more unnecessary testing, which further contributes to rising costs and patient harm. It’s a vicious cycle. And, of course, whether one test or a dozen too many, phlebotomy can be a painful experience for patients, so it can lead to patient dissatisfaction. In this era of patient-centered care, our first priority is the physical health of those entrusted to us – but we must also be aware of the psychological stressors of hospitalization, and that includes those that arise from medical testing

OVER-TEST: DESPITE RECOMMENDATIONS TO THE CONTRARY Many reasons for the overtesting are quoted in literature and survey to lack of knowledge of lab costs, provider inexperience, change in clinical status, fear of missing a diagnosis, or diagnostic uncertainty. In some cases, the practice is actually patient-driven(Googlified patient); patients want to know if they have a particular problem, and they request or even pressure doctors to do the testing for them, even in situations where it may not be necessary. In addition the “kickbacks”, “Discounted packages” , “Clubbing” “ Free tests “ are a force for over utilisation. WHAT EDUCATIONAL INITIATIVES MIGHT ENCOURAGE PHYSICIANS TO ORDER FEWER TESTS? The key is to focus on educating providers about the appropriate indications for various laboratory tests. These recommendations can be decided by collaborating with various subspecialty experts to form a unified set of indications for various lab tests (perhaps starting with the most expensive and frequently misused). It’s also important to educate providers on the downstream effects of unnecessary testing. Ordering lab tests without a clinical reason makes the results difficult to interpret. If there is an abnormal value, additional unnecessary testing is often

ordered – only to find out, ultimately, that there wasn’t even a problem in the first place. These “cascade” effects contribute to wasted value, patient dissatisfaction, and possibly unintended complications. A major contributing factor to overtesting is that labs like CBCs and Profiles are ordered to repeat daily on patients admitted to the hospital – but patients don’t necessarily need these tests every single day of their hospitalization. The most common lab tests(CBC, Renal package, LFT and so on) are the ones often ordered as daily repeating labs for hospitalized patients – but they have the potential for significant downsides if the patient has been clinically stable. In the setting of clinical stability, abnormalities on these lab tests are difficult to interpret and often prompt additional testing, which can lead to excessive phlebotomy and hospital-acquired anemia. Anecdotally, I also feel as though rheumatologic tests (such as ANA, dsDNA, or anti-Smith antibody) are also frequently ordered inappropriately and can lead to further unjustified testing on patients. Both pathologists and primary care providers should pay attention to ordering patterns for these kinds of labs – and speak up when excessive testing carries the potential for harm. Be aware, though, that your mileage may vary. Over-utilized lab tests often differ between institutions depending on patient population and providers’ preferences. They can collaborate with other subspecialty experts to determine standard indications for different lab tests – perhaps starting by targeting the tests that are most expensive, or most often misused. They can educate providers on appropriate indications for different lab tests to help avoid unnecessary testing. They can even help develop safe testing algorithms – for instance, to build lab test orders that reflex to additional tests if (and only if) the first result is abnormal. These initiatives can potentially save a lot of tests from being ordered in the first place, improving the overall health and happiness of our patients.

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Advances in Prostate Cancer What is Prostate Cancer? Prostate cancer is a cancer that arises in the prostate gland, a small reproductive organ in men that is responsible for producing the seminal fluid that nourishes and transports the sperm. The exact cause is not known, however it arises when normal prostate cells undergo mutations, proliferate rapidly and accumalate to form a tumor.

Rise of Prostate Cancer Prostate cancer is rising fast and becoming an epidemic globally as well as in India. The rate of prostate cancer is 10 per one lakh population that is higher than in other parts of Asia and even Africa. Prostate is the second leading cause of cancer in men in metros like Kolkata, Delhi, Pune and Thiruvananthapuram. One of the reasons that has contributed to this rise is increased screening for PSA levels.

Diagnosis of Prostate Cancer Before the treatment comes the diagnosis. There are many ways of diagnosis. Even the process of diagnosing whether a person is suffering from this cancer is not has evolved over the years. The traditional method to diagnose is to check serum PSA levels followed by a Digital rectal examination (DRE). A change from prior values (more than 0.35 ng/mL/year for a PSA of <4.0 or 0.75 ng/mL if the PSA is >4.0) should be considered suspicious. Transrectal ultrasound (TRUS) is used to confirm the abnormalities detected on DRE as well as guide sites for a sextant biopsy. This creates black & white images of prostate gland using sound waves and may show the tumor as a isoechoic to hypoechoic area. But a newer way is to measure blood flow within prostate gland using Colour Doppler imaging that has made the prostate biopsies more accurate and the results are more dependable by helping to know which part of the prostate gland is to be sampled.

Dr. Aditi Dewan

Pathologist, CORE Diagnostics 30 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Magnetic resonance imaging (MRI)-targeted prostate biopsy is being evaluated as a method to improve the accuracy of TRUS biopsy. Clinical settings in which this approach may have utility include patients with a rising PSA and a prior negative biopsy, and those men with prostate cancer who will be managed with active surveillance. MRI-guided biopsy may also have a role when patients are being considered for salvage prostatectomy. The 12 core biopsy is now preferred over sextant biopsy technique as the latter misses out upon 30% of prostatic carcinomas.

DOCTOR SPEAK

Treatment of Prostate Cancer For men with newly diagnosed prostate cancer, the most important factors in selecting the initial treatment include the following:  Anatomic extent of disease (tumor, node, metastasis stage)  Histologic grade (Gleason score/grade group) of the tumor  Serum PSA level  Estimated outcome with different treatment options  Potential complications with each treatment approach  The patient's general medical condition, age, and comorbidity, as well as individual preferences Thus, the initial management of men with newly diagnosed prostate cancer needs to incorporate a consideration of the prolonged natural history of the disease and the risk for progression to disseminated, potentially fatal disease

technique has been used in a number of countries and is being tested for its safety and efficacy in other countries.

Hormone therapy Androgen dprivation therapy (ADT) maybe used in cases with advanced prostatic carcinomas that cannot be treated by RT or surgery or before or in adjunct to radiation therapy to shrink the size of the tumor. There are new forms of hormone therapy that have been developed now. These may work even if standard hormone therapies are no longer working. Some of these are Abiraterone (Zytiga) and Enzalutamide (Xtandi).

Chemotherapy There is no definite role of chemotherapy(CT) in combination with RT. Recent studies have demonstrated that many chemotherapy drugs combined wIth ADT have shown promising results. These include docetaxel, estramustine and predisone. Recent studies have also

found that in males with metastatic prostate cancer, putting chemotherapy to use earlier in the course of the disease might help them live a longer life.

Immunotherapy Doctors are also relying on immunotherapy. The aim of immunotherapy is to improve the body’s immune strength to help fight or kill cancer cells. Prostate cancer cells express a number of tumor-associated antigens that can serve as targets for immunotherapy. The limited immune response to prostate cancer in vivo has been attributed to evasion of immune system recognition by decreased immunogenicity of surface antigens or blunted effectiveness of the immune response mounted against them. Several approaches have been studied to circumvent defective presentation of antigen to effector cells and/or enhance the responsiveness of the patient's own immune system.

Early Stage Cancer Treatment Treatment planning needs to incorporate the natural history of the disease and the risk of progression, since many of these cancers are biologically indolent and may never threaten the health or life of the patient. For patients diagnosed with prostate cancer confined to the prostate, standard management options include radical prostatectomy, radiation therapy (external beam, brachytherapy), and, for carefully selected patients with very low or lowrisk disease, active surveillance. Ablation therapy: Cryotherapy, highintensity focused ultrasound (HIFU), and photo-dynamic therapy have been used to selectively destroy tissue. These ablation techniques can be applied either to the entire prostate gland or to focally destroy the part of the prostate gland thought to be involved by tumor. This kills cancer cells in the gland by heating them through highly targeted ultrasonic beams. This w w w.medegatetoday.com Jan-Feb 2018

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Hospital Lab Management Techmed Growth Story Dr. Raja Ramanan, a doctor by profession, holds more than a decade of experience. After completing his DNB in general surgery in 2007, he commenced operating at several hospitals around the city, where he noticed that gap in the healthcare market in which laboratory services in small and mid-size hospitals were either inadequate, untimely or of poor quality. The subsequent delay in treating and operating his patients had inspired him to set up Techmed. Dr. Raja has also shown excellent leadership during the tough times at Techmed and was instrumental in holding his team together which then came out unscathed. . is also a avid cricketer and has represented the U-19 Cricket Team of Tamil Nadu.

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India has been witnessing a healthcare boom, with news from all around about addition of new healthcare facilities – diagnostic centers to large multi-specialty hospitals. The diagnostic industry perse has been abuzz with private equities and venture capitalists pumping in funds to increase the share of the organized sector, which is roughly 30% of the Indian-diagnostic market size. Techmed Healthcare has been a pioneering organization in the field of Hospital Laboratory Management, the country’s first of its kind. It was the brainchild of Dr. T. G. Raja Ramanan, a general surgeon who, while working in a multi-specialty hospital had experienced struggles in the form of inordinate delay and reliability in laboratory reports, went on to conceptualize the idea of providing end-to-end solution to a clinical lab in a hospital. From a single entity in 2008, Techmed has now grown to serve more than 40 healthcare institutions spread across 3 States – Tamil Nadu, Karnataka and Odisha. Dr. Wasim Mohideen, another physician, soon joined Dr. Raja to strengthen the whole idea and gave shape to his dreams, who is also on the board of Techmed as its Director.  “We have built Techmed on 5 core values – Reliability, Innovation, Differentiation, Growth& Friendly” says Dr. Raja. The unique B2B2C business model of Techmedallows hospitals to join hands with it as the laboratory expertise partner. While hospitals continuefocusing on their core functions, Techmedoperates the laboratory in a professional, structured and profitable manner. The company operates the entire laboratory of a hospital by leveraging the equipment to its maximum and provides reports with remarkable turn-

around-times, enabling the Doctors to take well-informed decisions. Techmed also manages the medicolegal abilities, which is crucial, given the noticeable trend towards evidencebased medicine. T echmedhas been accredited by NABL and the labs produce thousands of uncompromised results every day, generated through some of the world’s most trusted and state-ofthe art equipment & reagents, driven by a team of professionals. It further consolidates the precision and security by following universal lab procedures and protocols like barcoded tubes, running operations on a bi-directional platform, to name a few.  Some of the features unique to Techmed are, (i) the laboratory reports are authorized only by Doctors, and not by lab technicians (ii) To share knowledge and sensitize physicians &specialists about the various methods of testing available and guide them choose the right method for the patients to enable better diagnosis and plan treatments (iii) consultants receive direct alerts about the critical values and are recorded(iv) a dedicated 24x7 helpline to facilitate clinical discussions between consultants and reporting pathologists.  As part of its expansion plans, Techmed has been aggressive towards increasing its presence in West & Eastern parts of the country. “We have doubled our revenues from the previous fiscal and are poised to become a global company with Sri Lanka being our first international destination, likely to commence operations soon” says an enthusiastic Dr. Raja. In the foreseeable future, Techmedwill focus towards creating its first laboratory, which could be India’s first fullyautomated one, which will limit human intervention, except for some crucial segments. With such a vision and robust plans in place, Techmed is soon to attract its Series-C funding, expected in the last quarter of this fiscal.

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Urinary incontinence and UTI detection and treatment UTI and urinary incontinence are separate problems but maybe interrelated. UTI can cause incontinence and vice versa. Urinary incontinence is a very distressing symptom which increases the morbidity of life and can be a cause of social embarrassment. It is important to diagnose the type of incontinence to correctly treat the same. For this careful analysis of symptoms is very important. History and examination is done and incontinence demonstrated by coughing or straining. Urinalysis is done to detect infection in urine as sometimes infection presents with incontinence.

Other investigations done Record maintenance- How much you drink, when do you urinate, amount of urine produced. This is all relevant information for incontinence diagnosis and treatment  Post void residual urine is measured. Sometimes bladder is not completely empty after voiding and may cause incontinence  Uroflowmetry may be done. It tells all about the flow and speed of urine  Bladder training can be done.  Fluid and diet management. This includes avoiding certain food groups like alcohol, caffeine. Fluid intake is reduced more near bedtime.  Losing weight can solve major issues  Physical activity  Going to toilet every 2-4 hours rather than waiting for urge  Pelvic floor muscle exercise. Also called as kegel's exercise which if practiced regularly and according to instructions, improves both urge and stress incontinence  Electrical stimulation of the pelvic floor muscles by electric stimulation can be helpful for pelvic floor strengthening

Medication Medication to calm down an overactive bladder maybe helpful. There are drugs which increase the amount of urine that the bladder can hold. Topical estrogen in form of vaginal cream can help by rejuvenating the tissues on the urethra and vaginal areas. Devices can be inserted in the vagina to prevent leak like urethral insert or vaginal pessary.

Surgery  Botox injections  Nerve stimulation  Sling procedures  Bladder neck suspension  Prolapse surgery  Artificial urinary sphincters These surgeries can help according to the diagnosis

General measuresTo reduce the inconvenience

discomfort

and

 Pads  Protective garments  Intermittent catheterisation  Skin care- Clean skin properly. Allow it to air dry. You can use creams like petroleum jelly or any other good moisturiser to protect the skin from urine.  Avoid frequent washing and douching Some people avoid going out and limit their social life because of embarrassment. But treatment is available, all you need to visit a urologist or a urogynaecologist.

 Sexual intercourse  Diabetes  Pregnancy  Poor personal hygiene  Kidney stones  Decreased immunity

Symptoms

 Strong and frequent urge to urinate  Pain while urination  Cloudy, bloody or foul smelling urine  Pain abdomen  Nausea, vomiting  Fever  Malaise Diagnosis is made by urine test and culture of urine.

Treatment

 Antibiotics according to the culture report should be taken and full therapy should be completed  Plenty of fluids  Pain medication  Cranberry juice  Hygiene  Cleaning from front to back and not the vice versa  Urination and cleaning after sexual activity  Cotton and loose fitting undergarments This is a small information regarding the various urinary problems faced more by females and with a few precautions and preventive measures can be avoided and treated with ease.

UTI-

It is a type of infection of the urinary tract i.e. the urethra, bladder, ureters or kidneys. Women are more prone to it because of the short length of the urethra. Incidence of UTI can increase in the following circumstances w w w.medegatetoday.com Jan-Feb 2018

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Time for Structured Risk Management in Healthcare

R Venkatakrishnan FCA DISA (ICAI)

Partner, RVKS and Associates, Chartered Accountants

he macro-economic conditions are getting more difficult by the date. VUCA is the new normal, where Volatility, Uncertainty, Complexity and Ambiguity are huge drivers that are hurting all industries and healthcare cannot choose to believe that it is not going impact it in a big way. Given such a situation it is not going to be long before the weak, unprepared and underprepared are going to drop by the wayside! The weakness of an organization is not going to be determined by its size or financial muscle but it ability to be agile to risks both macro and micro. The agility will only come from being conscious of the different type of risks that it is exposed to and having an appropriate risk mitigation plan to counter it! Risk management may sound a very complicated term but if we look at the same smaller modules and processes it would be easier handle the same with far greater ease. Some very common areas where many companies choose to ignore are discussed under.

Concentration Risks Let us take the simple case of where does the revenue or sales come from? The normal thumb rule is that it would not 34 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

be prudent for anorganization to have its revenue dependent from any single source. It could be from a single area, person, equipment. It is possible that the concentration may be inevitable, in which case it is even more critical and important that organization protects itself. With healthcare delivery getting localized the risk associated such exposure is even more pronounced. Imagine a case where a large source of patients is from anarea and a competitor sensing the opportunity decides to put up facility in that place. We have seen similar situation wherein significant portion of revenues/profits are derived from an equipment and that breaks down frequently or for prolonged periods of time. These cannot be corrected overnight but then organizations should make a conscious effort to reduce the risk over a period! In India ITC did manage this risk very well. When most of their revenues and profits were coming in from sale of tobacco products they made a conscious effort to change their revenue mix. Over the years it has brought down the revenues to less than 50% but profits may take a little longer! The key issue is that is to ensure that take the right path to reduce the risk of excessive reliance on product group or customer!

Technology There is hardly a day when you are not middle of an intense discussion on the impact of disruptive technology. Technological obsolescence is the order of the day and critical that organization donâ&#x20AC;&#x2122;t get saddled with white elephants that turns out to be a noose around the neck. Healthcare facilities may do well in finding alternative methods, like operating leases, to get access to equipment albeit at marginally higher per unit cost price.

Regulatory & Policy Risks Healthcare has for too long been outside the purview any serious regulatory or policy controls. This is set to change as

public opinion, thanks to a very (hyper) active social media. This is bound to increase in the times to come with increasing public awareness, very active and sometimes even investigative press, use of Right to Information Act even by competitors and judicial pronouncements. Policy makers tend to step in to ensure that governments in power are not subject to great embarrassment. This was evident when policy controls were brought in on pricing of medical devices and even some pharma products. Such abrupt changes could potentially send revenue/ business models into a toss and could spell serious trouble. Changes to and stricter implementation of laws like the Clinical Establishment Regulation Act, Accreditations will subject healthcare facilities not only to higher level of scrutiny but in some cases, may find some costs going up in the short term.

Risk Assessment & Review Mechanism The list could go on and this is only illustrative. It is for each organization to determine the nature of risks it is exposed to. The risks could both internal and external. A logical approach to assessing these and then reviewing it periodical intervals! The review mechanism should also facilitate a mechanism to prioritize the risk and find options to mitigate the same. Prioritization should be based on the probability of occurrence, frequency, impact and ability to detect in time to take actions. The objective of the exercise should be to ensure organization is proactive rather being reactive to the event. Many a times we are excellent fire fighters because we invariably are also responsible for the fire. Risk management is like insurance, the need for it is never appreciated till the event happens. Unfortunately the contrary we tend to crib and complain about the costs associated with it. Risk management should be viewed more as an investment rather than cost!

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The Rising Prowess of TechnoHealthcare simplifying life

health threats and examining digital information like x-rays machines and CT scan machines also contribute to the benefits that information technology brings to healthcare.

Analytics Mr. Shuvankar Pramanick Gr. CIO, Paras Hospital

he advent of techno-healthcare, promises to improve and save countless lives all around the world. Techno-healthcare is a broad field where innovation plays a crucial role in sustaining health. Areas like biotechnology, pharmaceuticals and information technology along with the development of medical devices and equipment have made significant contributions to the healthcare industry. From development of adhesive bandages and ankle braces to complex more innovations like MRI machines, robotic prosthetic limbs and artificial organs, technology has made a remarkable impact on healthcare. Doctors are able to carry out better diagnosis, surgical procedures, and improved patient care due to technology. The change is palpable with the way doctors and patients interact with each other nowadays.

Mobility With doctors and hospitals incorporating technology in their systems, more and more fuctions are carried out effortlessly and efficiently. Physicians have been given the gift of mobility. Doctors now have access to all kind of information required, be it drug information, research or studies, patient history or records and much more, within mere seconds. With the ability to effortlessly carry mobile devices around throughout the day, information is never too far from them. Devices that aid in identifying potential

Predictive algorithms hold immense potential in solving some of the acute problems faced by the healthcare system and delivery in India. With this technological development, doctors are able to diagnose their patients more precisely. Analytics are being applied in other countries for diagnosis and the same technology can be adopted in India. This helps the doctors in discovery of a new source of data which helps them draw the complete picture about the diseases of the patients. This also makes possible the complete analysis of a medical problem like diabetes or any other problem and then find a revolutionary solution.

Digital The push towards digitization augers well for the healthcare industry. Digitization is helping in conversion of patient records from paper driven to electronic storage systems. This is resulting in more efficient delivery of healthcare to the patients as their medical history and even treatment is no longer tied to one location and can be sent for reference and cross checking to any part of the world in no time. With Aadhar number linkage of the health records of the patients, there will be further simplification of the process of getting OPD appointments in hospitals. Patients need not stand in long queues and just need to mention their Aadhar numbers and forego the process of registration at hospital counters.

Patient Care Another key area that has benefited from techno-healthcare is patient care. The use of information technology has made patient care much more reliable at hospitals. Nurses and doctors working at the frontline now regularly use handheld computers to record important real-time patient data and then share it instantly within their updated medical history. It is an excellent contribution of technology to health care industry. Being able to store lab results and other crucial patient data at one centralized area has altered the level of care and efficiency a patient can expect to receive when they enter the hospital.

Medical Research An improved level of efficacy in data collection means that an immense pool of patient history and case studies is now available to scientists online, who can easily study extensive patient case studies and make medical breakthroughs at a faster rate. Scientists and physicians are persistently conducting research and finding new procedures to prevent, diagnose and cure diseases in a more efficient way and develop new drugs and medicines that can reduce the symptoms or treat ailments in a quicker way.

Vaccines Through the use of technology in medical research, scientists have also been able to study and examine diseases on a cellular level and produce vaccines against them. These antibodies against life-threatening diseases like malaria, polio, MMR, etc, prevent the onset of diseases and save millions of lives all around the planet. In fact, according to World Health Organization estimates, vaccines save about 3 million lives each year and prevent million others from contracting deadly viruses and diseases.

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Advancements in Radiology!

Dr. Meinal Chaudhry HOD- Radiology, Aakash Healthcare Super Speciality Hospital

adiology as a discipline has been through numerous technological development since thetime it was accidentally discovered. The traditional perception of the radiologist in a dark room in front of a view box just for interpreting images is rapidly becoming obsolete. From "just a helping hand" or "back stage medical performer”, Radiologists have become the patient care team in the fore front by adding a lot of value in patient health outcomes. Working alongside healthcare practitioners, radiologists are integral to the care of patients by guiding the Physician choose the right modality for Diagnosis, making accurate diagnoses, prognosticating the outcomes, monitoring response to treatment and performing imagingguided treatments. In contemporary times artificial intelligence and machine learning are already changing the dynamics of radio diagnostics with R&D projects are sprouting everywhere. Artificial

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intelligence can free up radiologists to perform other more important tasks, such as aligning and patients’ clinical, imaging information. With more time at hand for each patient radiologists can be more visible to patients, actively involved in patient care. AI improves clinical outcome by creating and identifying things that radiologists cannot, for instance an algorithm, which can look through hundreds of head CT slices to find irregularities so quick that a human being can never replicate, and if the AI spots any abnormalities, it will flag the examination as a high priority for a radiologist to thoroughly scrutinise the case. With the current trend of technological advancements in radio diagnostics a few years from now no medical imaging study will be reviewed by a radiologist until it has been prescrutinised and evaluated by AI. This pre-analysis will enable radiologists to separate pressing items on imageinterpretation worklists from the items that can wait. The virtual doctors’ doctors will work 24/7/365 and have no falloff in diligence due to fatigue, monotony, interruptions or distractions. Developers and scientists are looking

at a future in which AI becomes a routine part of radiologists’ daily lives, making their work more efficient, accurate, satisfying and valued. Improving patient outcomes is its primary goal. Artificial Intelligence can and ostensibly across the globe improved radio diagnosis. A San Francisco-based start-up called Enlitic is already pursuing this opportunity by sending software engineers to about 80 medical imaging centres in Australia and Asia, bringing with them a deep learning algorithm designed for use on picture archiving and communication systems (PACS). So will this technology make Radiologists obsolete? is the next question. This innovation has been linkedto autopilot in aviation. The innovation did not replace real pilots. On long flights, it becomes easier for captain to turn the autopilot on, but as mentioned earlier – technology has its flaws – they are useless when it comes to quick decisions, therefore the combination of machines and human beings is the way to go. There is also plenty of on-going research to teach algorithms to detect various diseases. IBM launched

COVER STORY

an algorithm called Medical Sieve qualified to assist in clinical decision making in radiology and cardiology. The “cognitive health assistant” is able to analyse radiology images to spot and detect problems faster and more reliably. The developers are hoping that the algorithm eventually becomes smart enough to identify the signs of disease in every imaging modality, which might include magnetic resonance imaging (MRI), computed tomography scan (CT), ultrasound, X-ray and nuclear medicine. But development of algorithm is not an easy task. So to tide over the time Scientist have come up with a smart way of AI called “Swarm AI” in wich multiple radiologists from around the world can give their opinion on a particular imaging test which removes the difficulty of single radiologist opining on an “ambiguous or equivocal” case.

Recent advances in print and segmentation software have made it extremely easy to automatically or semiautomatically extract the surface of area in question from three-dimensional (3D) medical imaging data. This has made it possible for clinicians to create anatomical models using a standard computer with very little anatomical know how. 3D printers, that were earlier used in industrial applications, are now available for home use thanks to low-cost desktop alternatives. This technology enables fast creation of 3D models without the need for classical manufacturing expertise. In present day availability of 3D printers and cutting-edge segmentation algorithms have led to an increase in use of 3D printing in medicine that has received interest due to a multitude of potential medical applications. This technology works for numerous organs and anatomical regions of interest.

There are reports of its use in creation of models of liver, lung and ribs from CT scan data. Continuing technological innovation in Radiology is leading to more sophisticated techniques that results in prompt and specific diagnosis, present day radiologists add value beyond just image interpretation. Going further ahead with technological advancements, Multimedia Enhanced Reporting in Radiology (MERR) now radiologist link the virtual images within the report where the treating physician can just click on that link to see insides the body of the patient and correlate it with the findings in the report. (So, all the broth is cooked, treating physician has just to dig the spoon right in and eat it.) So with such advancements coming in the field of radiology, the coming years will definitely have a lot of sunshine in the dark field of Radiology

COVER STORY

Latest Technological Advancement in Radiology

Dr. Saket Rupramka Radiology Dept. Head, Park Hospital Gurgaon

The healthcare industry in India is changing with time and new method and opportunities are providing doctors and physicians to adapt to latest technological advancements. The trends in the industry, especially in radiology, can play a key role in experimental research in the coming years. 38 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

adiology is the use of medical images to diagnose disease within the body which helps in proper treatment of disease. There are several ways used to diagnose diseases such as X-ray, ultrasound, computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI). The X-rays are produced by a combining ionizing radiation and light that strikes a photosensitive surface. It produces a latent image which is then processed. The computed tomography is the workhorse of radiology, while Ultrasonography uses acoustic energy above the audible frequency of humans to produce images. It is one of the cheapest and harmless technologies in radiology and is used to examine imaging of children and pregnant women. Magnetic resonance imaging uses potential energy stored in the bodyâ&#x20AC;&#x2122;s hydrogen atoms. These atoms are manipulated by strong magnetic fields and radio frequency pulses to produce energy that is used by computer programs to generate two-dimensional and threedimensional images. The nuclear medicine modality such as the positron emission tomography uses a gamma camera or a positron emission scanner to record radiation emerges from the patient.

COVER STORY

research in the coming years. The imagebased techniques and methods need to be more refined and before being implemented in radiology. This requires an in-depth knowledge based on research and development. Precision medicine is one such example as it improves the health of the patients as they prescribe unique or personalized medicines. For example, two persons suffering from cancer may not require same medicine as each person has different needs and requirements to fight the problem. This engages patients more in personalized medicines due to the help of mobile technology and the internet. Besides this, automated emailing and engaging portals are also playing a major role in providing electronic access to medical records, tests, images and other reports of a patient. The radiology is also expected to have a new platform where patients can also schedule procedure and follow-up examination reminder or to check doctorâ&#x20AC;&#x2122;s qualification, etc. With the information technology development and the use of artificial intelligence (AI) in medicine, we

are enhancing our future and health. Advanced techniques of quantitative imaging, AI applications, clinical decision support systems, and big data analysis are some of the examples of radiology-specific trends that are expected from IT development in the near future. The increase in the number of wearable devices has helped many patients and doctors to treat the problem at an early stage. The hospitals and other healthcare providers are also expected to have such devices for the staff including doctors and nurses to manage their workloads. This will reduce their time and increase efficiency and will result in better and improve patient treatment. In a way, technology is reshaping the healthcare sector in India, especially the radiology department in every aspect to enhance our lifestyle and health. Our healthcare providers should also adapt to these changing trends and latest technologies to fight against lifethreatening diseases.

The person who performs radiology is called a Radiographer or Radiologic Technologist. The radiologist (doctor) reads the images and sends the report to the physician whom you have consulted. The physician, after reading the radiology report carries out the procedure to treat the disease. The healthcare industry in India is changing with time and new method and opportunities are providing doctors and physicians to adapt to latest technological advancements. The trends in the industry, especially in radiology, can play a key role in experimental w w w.medegatetoday.com Jan-Feb 2018

DOCTOR SPEAK

Should You Get a Knee Replacement Surgery?

Dr. P.P Kotwal

M.B.B.S, M.S (Ortho) HOD, Orthopaedics, PSRI Hospital

nee Replacement Surgery has always been associated with skepticism around the potential risk benefit ratio. This surgery has its own share of associated risks and entails a recovery and rehabilitation process. The final take on whether or not to undergo total knee replacement is both a practical and personal decision. While there may be not set criterion to evaluate when a knee replacement surgery becomes compulsory, an experienced orthopedic surgeon would usually follow a methodical procedure to evaluate the benefits of the surgery vis-a-vis the risks. The prime consideration for surgery happens when other alternatives options no longer help in addressing the physical challenges. Even then there might be few patients who cannot undergo surgery because of their age, weight, medical conditions, even though a surgery would have been beneficial for them.

Few generalized conditions, where surgery is necessary are:

A persistent pain in the knee joint that has worsened over time.  Pain that prevents you from sleeping.  Your ability to exercise has worsened over time and leads to knee aches.

 Your mobility has decreased over time with difficulty in walking and climbing stairs. M edications like NSAIDS aren’t offering enough relief.  Your basic life activities have become painful.  You feel pain in rainy weather. T he pain prevents you from sleeping.  You have restricted knee motion and degree to which you can bend your knee has decreased.  Your knees swell in the morning lasting for about 30 minutes.  Your joints make a grating sound. A ny previous knee injury. According a Dr. Prakash Kotwal, an ex-AIIMS orthopedic surgeon currently practicing at PSRI Hospital, You must not delay or decline a knee replacement surgery after your physician has recommended it. Delaying might eventually lead to difficulty to perform routine activities due to persistent pain, loss of functionality, extension of deformities beyond the knee joint and overall reduction in quality of life. To summarize, when all preventive and supportive measures like lifestyle changes, use of medication and injections, strengthening exercises, alternative treatment methods including acupuncture, as well as surgical procedures, like arthroscopy, fail, knee replacement surgery is advised. w w w.medegatetoday.com Jan-Feb 2018

EXPERT VIEWS

Healthcare Sector Evolution:

Innovations & Initiatives Vivek Tiwari

Founder & CEO, Medikabazaar

ealthcare is going to rapidly evolve in India with overall healthcare sector is expected to touch the revenue of US $ 280 Billion by 2020.The sector is poised to become the largest employment oriented sector in the economy with workforce in this sector expected to be at 7.4 Million by 2022. It is a high time that government should realize this neglected sector as a greater economic development activity at national level. The healthcare is traditionally seen as social sector with lesser government focus with low percentage of GDP spend on healthcare. In the last decade or so, the consumer spend has shifted from curative to preventive healthcare with greater awareness on health & fitness and with more diagnostic labs and preventive check up clinics coming up in the country. With rising incidence of chronic and non communicable diseases burden in India, the healthcare spend is likely to go very high in the near future as well. Our country still is majorly not represented by health coverage especially in tier 2 and tier 3 cities and even with the efforts taken by the government lately; the poorly penetrated health coverage is going to be a greater challenge for healthcare affordability. As per industry experts, the answer to decreasing the burgeoning healthcare cost burden lies in bringing systematic efficiency in the healthcare sector with focus on cost management, efficiency and operational excellence. The basic challenge equation is Time and Cost management leading to efficiency in output. There are traditionally three cost challenges healthcare institutions must start looking at; cost reduction, cost elimination and cost avoidance.

The key factors for healthcare sector growth and sustainable efficiency will be adoption of technology and setting up a seamless patient data management record. The advent of mobile technology and e-commerce growth in India, the healthcare sector is also witnessing growing interest of entrepreneurs willing to take up the challenge in building up innovative and cost effective digital platforms for patient data record management, telemedicine, medical appointment tool, diagnostic or medical test enrolment and hospital supplies / procurement platforms. The basic challenge still lies with adapting of these technological platforms in tier II& III cities& rural areas with biggest challenge of costing. Also with rising focus on technology adoption in healthcare; the demographic shift will fuel the growth of this sector. The way technology had changed the consumer landscape of banking and telecommunications industry, it is yet to create such disruption in healthcare sector. India still needs to witness the likes of telecommunication and BFSI revolution in healthcare. Today more than half of the population do not have access to primary healthcare in the country and with technology, this can be provided at half of the cost of traditional solution. The core idea is to have healthcare access should be without an excessive burden on the masses. The main aim is to create an access with an adequate level of affordability with special attention to the vulnerable groups such as children, women, disabled and the aged. Some of the provisions made during Union budget 2016-17 by the government of India for promotion of Indian healthcare industry have been well accepted. National dialysis service program to be initiated in all the district hospitals to accommodate the increasing demand of dialysis sessions has been well accepted in the dialysis fraternity. Under the national health assurance mission, government will provide citizens with free drugs and diagnostic treatments as well as insurance cover to treat serious ailments. The E-health initiative, which is a part of Digital India drive launched by Indian Governmant, aims at providing effective and economical healthcare services to all. The E-health initiative program aims to make use of technology and portals to facilitate people maintain health records and book online appointments with various departments of different hospitals using eKYC data of Aadhaar number. In the nutshell, technology has anexceptional role in increasing healthcare access and decreasing cost burden on healthcare. The Government has to take more initiatives to boost this sector with inclusion of both private and public sector.

42 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

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INTERVIEW

Fujifilm pioneer in the development and application of imaging and information innovations to healthcare technologies

FujiFilm is the one of the pioneer in the Indian Radiology Market. What are the strategies of the company for India? Fujifilm, we are continuously innovating, creating new technologies, product and services and depending on the market demand we will be introducing new products. We are introducing Endoscopy, Bronchoscopy and new DR machines which would help in early detection of cancer. We are concentrating more on customer service by increasing our manpower and service centres.

Please elaborate the Journey of Fujifilm from film making to healthcare since inception?

Chandrashekhar Sibal EVP & Head Medical Division, Fujifilm India

44 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Fujifilm was established in 1934 with the aim of producing photographic films. Over the decades the company has diversified into new markets and built a strong presence around the globe. In the year 2000, when the wave of digitalization led to the decline of film demand, Fujifilm considered this to be an opportunity instead of a crisis. In response to this, Fujifilm HQ implemented management reforms aimed at effecting drastic transformation of its business structures. The company utilized its core technologies and diversified to form six new business fields: “Healthcare”, “Highly Functional Materials, “Document Solutions”, “Graphic Arts”, “Optical Devices” and “Digital Imaging”. While most film manufacturers recognized this fundamental change, Fujifilm adapted to this shift much more successfully and its diversification efforts also succeeded.

INTERVIEW Fujifilm has leveraged its imaging and information technology to become a global presence known for innovation in healthcare, photo imaging, graphic arts, recording media, industrial products, optical devices, highly functional materials and other high-tech areas. The Company is continuously innovating-creating new technologies, products and services that inspire and excite people everywhere. Their goal is to empower the potential and expand the horizons of tomorrow’s businesses and lifestyles.

Please describe the latest innovations of Fujifilm into breast Cancer? How Fujifilm is contributing in detection of breast cancer in India? Breast cancer is the most common cancer in females worldwide and India is not an exception. It is steadily increasing in our country. The National Cancer Registry projects that the number of breast cancer cases will rise from 1.34 lakh in 2015 to 1.79 lakh by 2020. It is estimated that 1 in 28 women is likely to develop breast cancer during her lifetime, with the incidence rising in the early thirties and peaking at ages 50-64 years. With an annual incidence of approximately 1,44,000new cases, breast cancer has now become the most common female cancer in urban India. According to experts, most of the cases in India are diagnosed very late resulting low survival rates. The World Health Organisation estimates that more than 60% of the women in India were diagnosed with breast cancer at stage III or IV. Lack of awareness of cancer and screening for disease are significant contributory factors for the relatively late stage of the disease presentation and consequently low reported cancer incidences in India. Fujifilm India Pvt Ltd, a pioneer in the development and application of imaging and information innovations to healthcare technologies, had partnered with different institutes all over India for the installation of its 50 Micron 3D Mammography machine - a highly advanced breast cancer diagnostic machine that has made early detection of breast cancer a reality for women. Fujifilm’s advanced tomosynthesis technology reveals the internal structure of the breast thus simplifying the detection of lesions that gets overlooked in a routine mammography. FFIN conducted a symposium in Delhi with Batra Hospital, Mumbai with NM Medical Center, Chennai with SRMC and Kolkata with Peerless Hospital followed by press conference to generate the awareness about the cause.

In our continues effort to generate awareness about this noble cause, we have tied up with PINKATHON (women Marathon) as a “Wellness Partner” and educate the women of the country that how early detection saves life. We are installing mammography units in mobile vans to generate the awareness to the masses and screening women with potential risk of breast related diseases, one such example is Indian Cancer Institute at Delhi. To generate the awareness we also conduct patient awareness programs in association with hospitals like Tata Memorial Centre ACTREC , NM medical Mumbai, Action Balaji cancer hospital Delhi, SRMC Chennai, Shankra Cancer Hospital Bangalore.

Please let us know your merger & acquisition of Sonosite and the focus on point of care ultrasound machines. FUJIFILM SonoSite, Inc., the innovator and world leader in bedside and point-of-care ultrasound and an industry leader in ultra-high-frequency micro-ultrasound technology, delivers solutions that meet imaging needs of the medical community. In March 2012, US based SonoSite became a wholly owned subsidiary of FujiFilm Holdings corporation. Since its inception, SonoSite’s lightweight, robust products have created and led the point-of-care ultrasound market. From sophisticated urban hospital emergency departments to clinics in austere, remote villages, SonoSite systems are used by over 21 medical specialties and provide clinicians around the world with a cost-effective tool for improving patient safety and workflow efficiency. Currently, SonoSite has in excess of 145 patents and holds a number of prestigious design awards. It continues to be the world leader in point-of-care ultrasound. SonoSite’s compact systems are expanding the use of ultrasound across the clinical spectrum by cost-effectively bringing high-performance ultrasound to the point of patient care.

Any plan to launch your new Products at AOCR 2018 Fujifilm India is planning to launch new DR System in association with local X-Ray manufacturer. This floor mounted DR system would be in two variants 15 KW and 30 KW with high frequency generator. With features like low x-ray radiation with high quality images, this system is very easy to use and install with improved workflow.

w w w.medegatetoday.com Jan-Feb 2018

INTERVIEW Interview with Mr. Kannan Neelakanta about recent development in breast screening & thermography Please discuss in brief your journey into product development and the products that have been developed? Being in the medical instrumentation space from 1991, I was fortunate to have developed friendship with doctors who were clinically brilliant and were focused on providing the best of care to their patients. Many of the improvements, that they required in imported products for better outcomes were not a priority to global players. In the past twelve years with inputs from Radiologists, Clinicians and Technologists, we have been able to develop six innovative products that were conceptualized, designed, clinically tested with regulatory certifications. These products have been well received in India and have also been exported.

Kannan Neelakanta

Head - New Product Development, CURA Healthcare 46 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Two of these products received patent grants. During the conceptualization phase, we evaluate various technologies, their impact and associated risks. To move from a mindset of developing cheaper products to innovative products required acceptance from colleagues and investors and I am thankful that such an environment exists in CURA healthcare. What are the areas Indian companies can concentrate and what is the focus of CURA Healthcare?  All clinicians across the world would require better technologies that are affordable and provide clinical value. In India, healthcare providers are already providing advanced care at low prices when compared to developed or other developing countries. This requirement forces them to look at equipment providers who can give robust, reliable product with low life cycle costs (Capex consumable and service cost).  CURA continues to provide equipment/product/services that are innovative, affordable and reliable. CURA continues to work with Clinicians, service providers, to understand critical gaps and then identify solutions that will fill the gap.  The Dialyzer reprocessing solutions, Integration of Masimo, Suntech modules with our patient monitoring systems, Virtual Medical Center for Teleconsulting, Breast Screening system (illumina360°) are key products that have been completely designed developed in India. All of the above products have the necessary certifications and have been well received in India and abroad. Please elaborate about your product for breast screening and its salient features?  Breast thermography has been approved as an adjunct device by US FDA, many clinicians in India still

have negative thoughts about this technology.  illumina360° is an effort that would revolutionize screening and cancer monitoring for Breast. The focus was to develop a product that would provide status of the breast and understand whether the breast tissues are normal or abnormal. Once classified as abnormal, clinicians can utilize other imaging modalities like Ultrasound, X-Ray Mammography, MRI, PET to identify the exact location of the lesion or cause and then take Biopsy to classify the type of lesion (Cancerous or Benign).  In India Breast screening per se is nonexistent due to low awareness, selfneglect, perceived pain of compression during X-Ray Mammography, cultural issue of exposing Breast to a third person etc. In India, the number of cancer cases in the age group of 3040 years has doubled as per Cancer. org information. Almost 50% of the women who develop breast cancer die whereas in advance countries the survival rate is close to 90%. Early detection would allow the patient to have a very fulfilling life.  illumina360° allows the examination of breast without touching, without exposure to others and does not require ionizing radiation or contrast. It is useful for evaluating Breast health for all women from 18 years onwards. This is the only system that captures the 360° information of breast skin temperature. It is the only system where the IR camera visualizes only the Breast tissue and is not influenced by the temperature information or radiation from other parts of the body (like chest, abdominal region).  illumina360° obtains the Breast Temperature information in a controlled environment. The design also allows the clinician to change the environmental temperature and monitor how the Breast tissue responds

INTERVIEW to the changed environment. The information can be used by clinicians to corroborate during ultrasound exams. It can be operated easily by a technician. The information provided by the system is completely digital and can be easily transmitted.  The clinical outcomes of over 5000 examinations have shown exciting clinical outcomes with early detection of breast tissue changes, effects of drugs on breasts given to patients during neo adjuvant chemotherapy.  The grant of patent for illumina360° reinforced our belief that we can create a product that is unique, clinically relevant.  We should also thank all the Radiologists, Clinicians who have evaluated the product and provided us with inputs that made the product provide very high accuracy, specificity.  Our special thanks to BIRAC for providing Grant and loan for

developing the product. The product had received many innovation awards including Medicall 2013, BIRAC 2017 innovation award. What are the challenges to develop a product and expectation from Govt. side?  In India, core technologies for sensors, detectors and other critical components are not available. Many a time, In India most manufacturers are actually integrating various components and calling this as product development. The focus need to shift to develop critical core technologies, components, algorithms etc. There are many brilliant clinicians in India who are willing to partner and can provide critical inputs that can help develop excellent products. The talent pool to develop products are also available.  Universities and institutions can help a lot. Many a time a student develops a product idea/algorithm up to a lab level and then graduates.

If the idea/algorithm can be followed up or researched for subsequent years by the institution,it can create technologies that can benefit a large pool of manufacturers.  Currently the Government of India has many schemes that can help companies to work on concept development, product development and commercialization. Institutions like BIRAC allow companies to buy technology licenses and develop products. It is for companies to leverage and create products and technologies. CURA believes that Medical Devices/Instrumentation segment can provide India with the same leverage that software contributed to India’s development during the early 90’s. With large population, requirement of affordable healthcare, Indian companies that meet this requirement becomes relevant in at least 65-70 countries.

EXPERT VIEWS

Dr Sarika Gupta Radiology as a discipline of medicine has seen unprecedented growth in the past three decades. Technological innovation allows us to get a peek inside the human body like never before, making the field of radiology extremely exciting and fairly lucrative. Private practice in radiology started with the establishment of radiologist owned diagnostic centres, making them a visible and important part of patient care. The radiology department in a hospital, however was largely seen as an ancillary service to the clinical departments. The industrialisation of healthcare in the last 10 years or so also led to consolidation in the business of radiology, with many standalone diagnostic setups being taken over by large players who now employed radiologists in relatively monotonous fixed hour jobs. In the hospitals, the faster image transmission through PACS significantly reduced the interaction between radiologists and clinicians, relegating radiologists to the periphery of patient care and making them nearly invisible. The marketing in the business of medical imaging is completely centred around equipment (the number of CT slices and the MR teslas) rendering the man behind the machine irrelevant. The criterion for judging the efficiency of a radiologist also shifted from their ability to make diagnosis to only the number of scans reported in the day. These all seem to be the reasons for the high rate of burnout and attrition in the field of radiology. There is therefore an imperative need for the radiologists to come out of oblivion and reinvent themselves. How do we do it? The answer lies in one simple word, the big C of healthcare -Communication.Communicate with four key stakeholders in your work- your patients, the referring physicians, the hospital administration and the radiologists especially in your area of practice. The first tip from the trenches is “talk to the patients”. Making a real connection with the patients and talking to them, even for a little time about their diagnosis can go a long way in establishing your role as a healthcare provider. This human engagement not only makes you feel good, it also helps in improving your visibility to the leadership and solidifying the role of radiologists in the care team. The second tip is “talk to the referring physician”. Effective communication with clinicians is as important as giving them good quality images and the right diagnosis. Surveys conducted in the USA amongst the clinical fraternity regarding what they 48 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

Radiology Practice in the 21st Century– Reinventing to Stay Relevant look for in their radiologists, put superior communication skills at the top of the list. Picking up the phone and talking to the referring doctor can enhance your ability to make and convey the right diagnosis more than anything else. A fast turn around time is also a demand of most clinicians especially in the hospital set up. Even in the trickiest cases, a quick verbal interaction with the clinician will satisfy him and buy you more time to make a good formal report. The third tip is “talk to the administrator”, yes that young MBA sorts whom you don’t normally pay much heed to. Radiologists need to get in sync with the hospital administration. Conventionally, in most medical setups the administrators and the doctors seem to be at loggerheads, either failing to understand the challenges of the other. It would do everyone some good if the channels of communication with the administrators improve. Radiologists need to learn the basic finance model of an imaging department and also become active contributors in the process of radiology equipment procurement. With a little financial learning, radiologists can help the hospitals make more cost-effective decisions. It would also become easier then for the radiologists to convey their challenges to the management team making the entire system of work more synchronised, overall a happier place of work for everyone. The fourth tip is “talk to other radiologists”. Ensure a dialogue with other radiologists in your practice area and otherwise. This is especially important for people running their own diagnostic centres. Collaboration with other radiologists will help keep the pricing of tests especially CT and MR more realistic and also ensure that insane discounts do not become the only way of competition. Growth via partnerships with other radiologists with focus on subspecialty imaging, may remain the only likely option for smaller practices to upscale and reach the level necessary in the era of organised and industrialised healthcare. This actually might be the ideal middle path for imaging specialists, with promise of greater autonomy, good work satisfaction and a fair financial return in the business of radiology. While there is no doubt that radiology as a specialty will continue to play a vital and evermore important role in patient care, radiologists will need to work harder to establish their relevance in the business of healthcare. A greater engagement with patients and other stakeholders will take us a long way to achieve that.

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INTERVIEW

The New Vistas in Healthcare Diagnostics A breakthrough was required and hence, Healthians was conceptualised in 2014. We launched our services in February 2015. We directly go to the patients saving them up toÂ 50% compared to the traditional route. Also, we have kickstarted the informed wellness market in India where we not only cater to people who are unwell but also to young people whom we inspire and educate to measure their health with accurate diagnostics and support them in altering their lifestyles.

Now a dayâ&#x20AC;&#x2122;s Home healthcare is into trend. What is your vision on this?

Deepak Sahni Founder & CEO, Healthians

Brief about your journey into healthcare?

The idea of home-based pathology testing crystallised in April 2014, after my 14year exposure (direct and indirect) to healthcare services. In 2006-08 in my personal capacity, I had represented India in the USA, pitching the country as an ideal medical tourism destination. An association was created, and I helped individual hospitals set up their international patient departments, and in making a sound digital presence. It is during this period that I realised that unlike the US hospitals, Indian hospitals do not offer alternative therapies to their patients and have a single businessfocused approach. All research, marketing and solutions are focused on the sick or the 'sickness industry' and post-disease phase, wherein the cost, efforts and stress involved are way too high. By 2013, I had a clear vision to focus on a patient-centric activity to fill a major gap in healthcare activities in our country. The first contact point of the disease and wellness industry is diagnosis and this became our patient-centric area of focus. Currently, this business is either commission-based or franchise-based, wherein 50-60% of the price is absorbed in paying commissions. This cost burden is very conveniently shifted onto patients. 50 Jan-Feb 2018 w w w. m e d e g a te to d a y.co m

The traditional Indian healthcare ecosystem is based on the practise of a person who needs a service going to the service provider (doctors, hospitals or diagnostic services). This is now changing. Now the service providers are reaching out to people and providing services in the comfort of their home. The demand for home healthcare has seen a robust upward trend in recent times in both Tier 1 & Tier 2 cities. This is sure to grow bigger in the coming years. Though a small segment of such services were always available, it was more centred on personal contacts and was high-priced. The quality of services also varied with each experience. However, the home healthcare industry is evolving. Quality healthcare services at affordable prices are the need of hour for every Indian. The industry is trending towards better patient services, convenience and affordability. This is especially true when we talk about anything that is less serious in nature. The users are ready to accept new services and the difference they experience makes them talk about it. The combination of affordability, quality, convenience and increasing penetration is making healthcare at home accessible to many people. We now see more and more people accepting home healthcare. Diagnostic @ home as a basic service should have started long back. It is only in the last couple of years that a lot of action is seen in this sector. We are the pioneers in diagnostic services at home sector.

The positive response we have received proves that if a better, convenient and affordable service can make someone take better care of their health, then people are willing to use such services more. The idea of taking preventive and regular checkups to improve health is still in its nascent stage in India. There is a huge unmet demand which was not tapped earlier. Our vision is to make high quality diagnostic services available at the doorstep of every Indian. By eliminating the middle men fees, which is paid by customers, we are bringing these services at affordable price for all.

What is the concept of Healthians? How you are serving your customer at home healthcare?

Healthians is a home based diagnostic service provider with a 360-degree approach to monitoring health. Diagnostics at home is our forte. But, we are not limited to providing diagnostic test and reports only. Educating people about the power of preventive checkups and making corrective lifestyle measures to improve their health is the essence of our services. Tests can be booked on phone, through app or website or by uploading prescription. This is followed by samples being collected free of cost from your home. We have our own sample collector team which is highly trained. We work only with NABL labs hence guarantee accuracy and reliability. Further on, reports are delivered online, through the app or through courier. Once the reports reach the customers, each customer is entitled to a free doctor and nutritionist consultation. Understanding complicated medical reports has always been a challenge for the common man and our free doctor consultation service is designed to cater to this problem. Our doctors explain the test results to the users in simple language and clears all their doubts. Further, on the basis of the diagnostic investigations done from us, symptoms and lifestyle inputs submitted on the App, a Smart report is generated for each user.

INTERVIEW Smart report analyses the personâ&#x20AC;&#x2122;s health trends and is available on the App. This is a more descriptive form of medical test report and is comprehendible by a layman. If the report has some parameter value out of place, which may be an indicator of some complications, corresponding follow-up tests are recommended. With recommendations like which specialist to visit and lifestyle and dietary advice, we help patients to take the right decisions timely. Also, journals and articles on various diseases, their prevention and cure are sent regularly to our users.

How is preventive health & wellness applicable for the diagnostics sector? How you are contributing towards a healthy nation?

Now-a-days, nothing is shocking when it comes to a disease defeating someone. Cases of a fitness freak getting a heart attack or a stroke or a 25 year old becoming diabetic with no family history or a young fit mother detected

with cancer have become common. What is more worrisome is that most of the NCD's (non communicable and lifestyle related diseases) do not come with clear symptoms. By the time a person is diagnosed, it is sometimes too late. Therefore, there is an obvious need of awareness towards prevention and adopting wellness. Diagnostic test, health checkups or a simple blood test is the first step towards prevention. A routine blood test can today screen almost entire body parameters that could atleast indicate if something is wrong. While activities like yoga, gym, running and playing are important steps towards being fit, they do not completely rule out that you are healthy. A diagnostic screening is the only way to validate this assumption. But it should be done in the right frequency and repeated as per your age, lifestyle and gender. Soon, we would not hear of someone being caught unaware about his health condition if he /she believe in regular health checkups.

At Healthians, our vision is to add 10 healthy years to every Indians life. For this we offer convenience, reliability, accuracy and affordability to our users making it easier for them to get tested on time. There are two major factors that make most people shy from preventive healthcare. First is the cost burden and second is the ambiguity surrounding the reports. People donâ&#x20AC;&#x2122;t understand their reports and even if they do, they have no clarity about how and what to do next. Our services are the solution to both these issues. Our doctor and nutritionist team and our AI supported app, is designed to cater to this ambiguity and help people understand their health inside-out better. People are being educated about the benefits of regular monitoring of health. We provide quality diagnostic services at home at affordable prices so that more and more people are able to continuously screen, monitor and improve their health conditions.

DOCTOR SPEAK

Career in Diagnostics is poised to become India’s most satisfactory jobs by 2020`

Dr. Ruchi Gupta

Founder and CEO, 3hcare.in

ealthcare industry is one of India’s vastly expanding sectors in terms of economy, and anyone in pursuit of a fulfilling career has more than just a chance to establish themselves in it. The industry basically deals with hospitals, diagnostics, medical devices, and medical tourism. Though Indian healthcare is showing an exponential growth, the scope of development is yet to be explored. Students at the doorstep of their career should be aware that how big and diverse this field will be by the end of 2020. And with more private players coming forward with better public – private partnerships, this field is estimated to grow at a compound annual rate of 25% during this 5 year tenure. Many students are confused with what to opt for after completing their graduationwhether to go for low salary job or pursue further studies. Majority of them do their post graduation to get a decent job. Diagnostics is one such segment in the field of healthcare management that has brilliant prospects in job environment and a profitable career option. Besides getting lucrative remunerations, this also helps to achieve the goal of service to mankind. Healthcare operates in various segments of which the diagnostics segment is at a boom. Pathology, the type of diagnosis of human diseases by laboratory methods has open scope in areas either as a diagnostician, teacher or an investigator. Pathologists in clinical laboratories practice as consultant physicians, to analyse the laboratory reports for better diagnosis and treatment of a patient.

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One of the most interesting and fascinating fields in this segment is genetic testing and research in molecular biology. With Unfolding opportunities in this field, career in genetic biomarkers are continuing to expand. A molecular biologist focuses on the genetic changes to assist in curing and slowing down of disease infestation. And screening in newborn is necessary as it helps in identifying genetic disorders and treats early in life. Another field of diagnosis is radiology that deals with diagnosing and treating diseases with medical imaging techniques. With the increasing demand for radiologists in India, this field ensures a better career path and the occupation is expected to grow faster than any other. A radiology technician has an option to work as ultrasound technician, X-ray technician, MRI technician, CT technician and medical professional. With an immediate and sustainable demand for technologists in hospitals, clinics, and physicians’ offices, the field of radiography continue to show higher than average job growth into the future. Job scenario for those planning to start their careers in radiology are expected to remain high, particularly for those interested in working for general medical and surgical hospitals. Radiation technicians can work in urgent care facilities, clinics, equipment sales, and private offices. Radiologic technology is a fascinating subject to study which in addition to providing certificate to work in the state of residence, also prepares a career in healthcare industry that s challenging, important and gratifying. Being one of the heart warming jobs, position of a radiologist holds 15th rank among the best jobs in this industry and considered one of the smartest choices to opt for. According to IBEF, the overall healthcare market is worth $ 100 billion and is expected to reach 280 billion by 2020. The Indian medical tourism will reach $ 10 billion with 2 times growth in health care IT market is expected by 2020. The data promises to provide a huge boost in generating employment opportunities in the upcoming

years in the field of healthcare management. With several big investments being made in this sector, the functioning of the industry has become more professional, organised and efficient. Besides the urgent need for trained doctors and nursing staff, efficient management is required in various measures of the field. As far as job opportunities are concerned, diagnostic management professionals are required not only in hospitals and clinics, but also in healthcare NGOs, hospital consultancy companies and IT industry involved in developing software and imaging equipments. IT firms like Dell, Accenture, Delloite etc hire such professionals. In case of a fresher, who has no work experience, the industry hires them as technicians and with the training and experience gained they will reach the zenith within few years. Looking for future experts, lack of talent is currently a drawback. The industry is growing at a swift rate, though the talent still is lagging. To nurture today’s talent for a long term with focus on quality, opens up scope for many. Being a young industry open in the market, the learning curve will definitely be sharp and the talent will be nurtured to withhold greater responsibilities at a younger age. The industry is trying to seek out people who have a high moral purpose, eager to learn and lead. This will create an impact in advancing in the healthcare world by providing promising opportunities that will reshape and redefine it. With the growing science and technology, use of medical apps have been on a rise and made IT considerably more understanding. The role of a technician has undergone a major change over the past decade. Most modern hospitals and healthcare establishments’ are in requirement of experienced technicians and radio-interventionist equipped with multi-disciplinary skills. The healthcare industry desires a skilled workforce of professionals involved in research, market shaping and development and most importantly customer centric roles. India is the potential place to attract healthcare industry with its highly skilled specialised workforce 

DOCTOR SPEAK

New Age Solutions for Cataract Provide Better Vision,

Reduce Spectacle Dependency

Dr Mahipal Sachdev

Padma Shri Awardee, and Opthamologist and Chairman of Centre for Sight, Delhi,

ver 80 Lakh people suffering from blindness in India, and 62% of the disease burden is shared by cataract. For combating cataract, doctors advocate awareness for available options of restoring sight with quality of vision post-surgery. New intraocular lenses technology and extended range of vision lenses provide better vision quality. Posing as a major healthcare challenge, India is a home of over 80 Lakh blind people in the country. The definition of blindness, which was changed earlier in 2016 by the Indian Government, identifies a blind person as someone who has less than 3/60 vision in better eye is understood to be blind.

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One of the major factors causing loss of vision world over is cataract, which accounts to approximately 62% of blindness in India. Although government efforts are aiming towards restoring sight, a major focus on spreading awareness on quality of vision postsurgery is much needed. Dr Mahipal Sachdev, Padma Shri Awardee, and Opthamologist and Chairman of Centre for Sight, Delhi, says, “I have been treating more than 200 cataract patients every month. In a world governed by screens and social media, we are glued to our digital devices day in and out. Thus, impeccable intermediate vision has become a priority for younger and older generations alike. Fortunately, today, cataract is easily treatable and advanced ophthalmology solutions such as extended range of vision lenses are available to enable patients lead highly active lifestyles with good quality of life even post cataract surgery.” With the growing desires of leading an independent, active life, vision loss due to cataract at any age comes as a big impediment to hopes of people. The eye ailment is not preventable but is treatable through intraocular lenses (IOLs), which are used to replace the natural eye lenses. However, with modern advancement in IOLs, patients have more than one alternative. While elaborating on the treatment options available Dr Mahipal Sachdev

reflects, “Post-surgery quality of vision is an important aspect that determines the quality of life. With monofocal IOLs, spectacles become a necessity. Even with progressive glasses, eyes take time to adjust while shifting from near to distance vision. This aberration is little but not completely corrected with multifocal lenses. However, the new extended range-of-vision lenses give impeccable clarity and contrast of vision, and reduce dependency on spectacles. The night vision through these lenses is uninterrupted with reduced incidence of halos or glares, quite common in the more popular multifocal lenses. The new lens also caters to distant, near and intermediate vision with seamless transition. ” Although usually considered as an age related disease but cataract is not restricted to older population now. Factors like diabetes, long-term use of steroid medicines, prolonged exposure to indoor pollution and even ultraviolet rays can lead to cataract at young and old age. Today, cataract surgery is considerably a straightforward day care procedure, with vision being restored to patients within hours of surgery. The surgery today is possible to be done with just eye drop anesthesia, with no eye pad or stitches. Patients return home and can resume daily activities the same day. Post-surgery, careful post-operative care ensures a safe and speedy recovery.

INTERVIEW

Neuberg Diagnostics is a new-generation PathLab Alliance with a rich history and extraordinary technical expertise. Technocrat, serial entrepreneur, Healthcare industry expert – Dr GSK Velu is all these, and more. More importantly, Dr Velu is a visionary and a man who has his heart in the right place his chief aim in life is to make healthcare available & affordable to the common man across the nations. A selfmade man who lost out on many golden opportunities in life due to circumstances beyond his control, which would have made a lesser human bitter but Dr Velu chose to follow his heart and render yeomen’s service to fellow humans for over 30 years now with dedication, hard work and passion.

Dr. GSK Velu

Founder & Chairman, Neuberg Diagnostics

Dr. Velu has been awarded several recognitions and has been named as "parallel entrepreneur" by Forbes and "first generation serial entrepreneur" by many. Dr.Velu's vision, determination and futuristic approach to make healthcare accessible and affordable to one and all made it possible for the tens of thousands of people across the globe to have cost effective access to medical technology, diagnostic services, eye care, dental care, super speciality hospital care and dialysis services. Your journey into healthcare since inception? My upbringing is from a very small village and the healthcare infrastructure at that point of time in my native was very poor. I understood the drawbacks arising due to lack of affordable healthcare services when I was a child and I believe somewhere in the back of my mind I have always been fascinated with the healthcare industry. And maybe from the selection of my subjects during my college life to my first job in a healthcare company was subconsciously a part of my fondness for this field. I firmly believe that a good healthcare policy covering physical health, health infrastructure and availability of preventative care can lead a country to prosperity. In India and many developing nations across the world, healthcare technology, medical education, healthcare services & delivery are the sectors that require focus and upliftment. For last over 30 years, I have committed myself to this cause and my primary focus is to make sure that all my projects provide better technology access, advanced medical education & world class healthcare services to the masses at an affordable cost. All my ventures since inception are healthcare focused. Starting from Trivitron, which is manufacturing & delivering highest quality Medical technology products to Healthcare providers across the Globe and have manufacturing and R&D

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INTERVIEW setups in multiple locations Globally, Maxivision Eye hospital which provides best-in-class eye-care services, Apollo white dental chain - India’s largest chain of Dental Clinics & unique dental spas with 80+ Dental Clinics across the country, mentor & shareholder in Kauvery Group of Hospitals which cater to the super specialty healthcare needs of Middle Class and Lower Middle class population across Tamil Nadu including Tier 2 & 3 towns and recently launched Neuberg Diagnostics - a Global Pathology brand, operating in India, UAE, Sri Lanka, South Africa with actively performing 5000+ varieties of pathological tests, promoting prevention and early diagnosis, & conducting over 16 Million Tests Annually.

transparent in whatever we do! Neuberg is adapting new generation advanced techniques from developed markets like US and Europe and we are also establishing strategic collaborative ventures with like-minded partners. We aim to Promote Wellness and Early Diagnosis as structured disease management programs for rare diseases using the most advanced technologies and best-in-sector human resources assisted by data science and AI tools while ensuring Ethical Principles are intact. Neuberg Diagnostics aims to become the most respected and trusted Diagnostic Partner in Asia & Africa by deployment of new-gen technology operated by best-in-class laboratory professionals.

You are very much into Medical equipment and technology, what motivates you open diagnostics chain?

Neuberg Diagnostics is a new-generation PathLab Alliance with a rich history and extraordinary technical expertise. Through alliances with legacy brands like Anand labBangalore, Supratech - Ahmedabad, Ehrlich lab - Chennai, Global- South Africa, and Minerva Labs - Dubai, Neuberg Diagnostics come with a PathLab experience of over 200 years. Apart from the coming together of leading players in this field, we are also launching new laboratories in Hyderabad, Vijayawada in India and already started a lab in Cochin. We are looking at expanding our Collection Centre network to 300 + in the country within the next 12 months. We are also evaluating a direct presence through partnerships in USA and Europe. We have entered into a partnership with a reputed group in Sri Lanka to set up a reference lab at Colombo.

I believe that the only constant in life is change! As I mentioned, my dream has always been to make worthy additions in Healthcare Ecosystem which in-turn can benefit the population of all classes and across all geographies. I was never away from the Diagnostics Service industry. This is my second innings and I think I am fortunate to use all my expertise to build an International Diagnostics Chain keeping the basic philosophies of Adherence to Quality, Technological advances and Customer friendly services intact. My first PathLab venture was commencement of Premier Diagnostics in 1991 partnering with my first boss. Second was co-promoting Metropolis from 1998 to 2015. Since my exit in Year 2015, I see lot of changes in this sector. It has become crowded and quality and ethics are being compromised. I want to bring an approach of transparency in whatever we do. With Neuberg Diagnostics, we brought together the extra ordinary expertise in diagnostics and we stand for one central principle of “Transparent Ethical Patient Centric Approach" and will bring state of the art technology in Clinical Laboratory Medicine within reach of common man in India and in all developing countries.

What is the Diagnostics?

philosophy

Neuberg

Our vision is to win the battle against disease by making the most advanced diagnostics tests accessible to every common man across the globe. Philosophy of Neuberg Diagnostics is to unite like-minded & leading labs across different cities of the developing world and emerging markets, have the best world class technologies available for screening, follow all the regulatory norms and have a human connect with every patient by listening to them and by being

Elaborate your future expansion plans?

Whatare your expectationsto the Union Health Budget 2018? In the Budget we need policies promoting Insurance Coverage for Out Patient Diagnostics Services, Higher Tax exemption for Annual preventive Heath checkup’s and increased focus for PPP in the Diagnostics Services sector.

What are the latest innovations in Diagnostics sector and future of diagnostics Industry? New Generation Pathologists are keen to adopt new areas in diagnostics like Genomics (using genetics to diagnose complex hereditary diseases), Metabolomics (diagnostics at the Metabolite level), Proteomics (Study of Proteins for Infectious Diseases/ Cancers) & Digital Pathology / Radiology to enhance personalized medicine and drive companion diagnostics and patient care. Clinical Labs are looking to Big Data Analytics to provide meaningful insights in prognostic & diagnostic information to aid effective treatment protocols through Theranostics 

w w w.medegatetoday.com Jan-Feb 2018

EXPERT VIEWS

Fate of the Four: Why 2018 will be a landmark year for GE, Siemens, Canon and Philips  GE talks of breaking up industrial conglomerate on further poor financial news, raising questions over structure and future of GE Healthcare division  Siemens Healthineers announce significant cost-cutting initiative ahead of planned IPO in March 2018  Canon completes acquisition of Toshiba Medical in early January 2018, globally rebranding the business to Canon Medical Systems  Philips looks well-set from spate of recent acquisitions to capitalise, but has challenges of its own around integration and interoperability With the new year dawning, the competitive landscape for global medical technology is mired in uncertainty. Of the “big four” vendors (GE Healthcare, Siemens Healthineers, Philips and Toshiba Medical Systems) three are undergoing radical change, creating perhaps one of most volatile competitive market environments for some time. Add to this the visible presence of new market entrants from informatics, outsourcing, consumer technology and the rapidly growing artificial intelligence sector, and one thing is certain: market change is coming.

already outlined plans for the sale and spin-off of multiple business areas, attention will also no doubt fall on the future of GE’s healthcare business. While a sale is highly unlikely given GE Healthcare is one of the more profitable business divisions of the conglomerate, a restructured relationship with its parent, or separation into its own entity, now looks more likely. GE Healthcare should view this not as a negative, but as an opportunity to reset its vision and strategic agenda. Too often over the last decade it has over-reached into new markets with speculative acquisitions, only to make minimal impact on market share or profitability - some have even been multi-milliondollar write-offs.

Healthcare: Back to basics

Yet, GE Healthcare still holds a very strong hand, with one of the largest customer bases globally, a thriving life-sciences division and fingers in almost all diagnostic and clinical IT markets. Therefore, it should re-focus on its core markets and maximise the potential of its strongest assets; imaging, clinical care and lifesciences. All three of these sectors are entering a new stage of development. Value-based care models and healthcare provider need for analytics and operational intelligence offer the opportunity to significantly improve GE’s healthcare business performance.

Via the acquisition of telehealth service providers C30 Medical Corporation and AcuteCare Telemedicine (ACT), 2017 saw InTouch Health further expand its capabilities to include physician support services. The latest multi-billion hit to GE has more than likely forced the hand of new CEO John Flannery towards some form of major restructure. Having

Therefore, while the crumbling conglomerate might be faltering, which in turn may have some impact healthcare deals that are linked with other GE business units such as energy and industrial, there is little reason why GE Healthcare should not be looking to profit from its position, if it sticks to what it knows best.

Below, we provide our take on the latest developments and postulate as to where it could all be heading:

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Siemens Healthineers: Filling the Gaps The oft-discussed minority stake IPO of Euro 47B valued Siemens Healthineers on the Frankfurt exchange has been dragging on for some time, with more questions than answers until late 2017, when a final date of March 2018 was announced. The reasoning behind the spin-off seemed relatively sound at the time; raising capital from one of Siemens most stable and profitable business units, while also “freeing” the Healthineers business unit from the complex industrial conglomerate, to increase opportunity and flexibility for future partnerships. However, the latest announcement of almost Euro 240m of cost-cutting initiatives per year, to be realised in 2020, raises a few questions. At facevalue, this may be a signal to potential stakeholders in the IPO that Siemens is serious (and willing to make some painful decisions) about making Germany’s largest IPO in 20 years a success. If much of the cost-cutting comes from the “de-coupling” from the Siemens conglomerate, then this would seem straightforward. Yet, with Siemens AG remaining a majority stakeholder in the new public company, it would be surprising if this was the complete story. Instead, it may be that Siemens is also using the IPO as an opportunity for some significant “housekeeping” and refinement of its own portfolio. Perhaps most concerning is the lack of clarity around future target markets; Siemens Healthineers has technically excelled in certain markets for some time, such as big iron imaging modalities and advanced radiology, yet has done little to fill in the gaps in its portfolio, such as clinical care, non-radiology health informatics, and digital pathology. If all

EXPERT VIEWS

the IPO provides is more capital for Siemens AG and a slightly leaner, more profitable Siemens Healthineers, one could argue that an opportunity to really challenge GE and Philips as a dominant force in diagnostic and clinical IT has been missed.

Canon Medical Systems: At risk of missing the age of informatics Canon’s acquisition of Toshiba Medical Systems has been playing out for some time. The latest development for the two firms signalled the cohesive start of their new venture, globally re-branding under Canon Medical Systems. However, the work for the new Canon Medical Systems business is only just starting. While the acquisition was a good one for both parties, given the complementary nature of their portfolios in medical imaging, lingering concerns still exist. Firstly, as with many Japanese industrial conglomerates, apparent cohesiveness between business units and regional teams is rarely the case. Toshiba already had some issues of its own, with a “house of brands” approach to subsidiaries such as Vital Images and Olea Medical. Canon also had a similar approach, with regional subsidiaries often operating independently (e.g. DelftDI) and with little cohesive

marketing or branding. While the re-brand goes some way to solving this (though for some reason the Vital Images and Olea Medical brands remain) the new venture will need to quickly “bed-in” with core messaging, marketing and sales operations, especially given the increasingly “single-vendor” focus of healthcare providers when it comes to tendering and procurement. Perhaps more worrying is that the new venture has done little to aid what was the biggest issue for Toshiba and Canon pre-acquisition: a lack of global presence in healthcare informatics. In diagnostic and clinical care health provision, analytics and operational intelligence are going to be the new growth markets and battlegrounds for the leading health technology vendors. Apart from market leadership in advanced visualisation for radiology and cardiology (Vital Images) the new Canon Medical Systems business has very little health informatics coverage in comparison to its peers. Therefore, to really become a world-leading health technology vendor, it will quickly need to establish a strong partnership model or strategy to address this need.

w w w.medegatetoday.com Jan-Feb 2018

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