Medgate Today-May June 2018 by Medgate Today

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Volume IX || Issue I || May-June 2018 An Advance Media Publication

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EDITOR SPEAK

Medgate Today is on its Growth Path

We are very grateful for YOUR continued trust and support. Let me start with my favorite slogan “ANNIVERSARY IS THE CELEBRATION OF TRUST, SERVICE & RELATIONS” We feel immense pleasure, pride and happiness to let you know that Medgate Today magazine has completed successfully its Nine years. Advance Media Group started its first edition of Medgate Today magazine in 2009. Since then, the Magazine has seen remarkable growth, both in popularity and in reputation. It has also seen tremendous growth in the number of readers across India and overseas. Medgate today has now become a bench mark for healthcare professionals including policymakers & Providers. We have touched almost all healthcare verticals like Home Healthcare, Healthcare IT,Healthcare Architecture & Designing ,Medical devices, Diagnostics, Healthcare Insurance & Healthcare providers. Some of these verticals are relatively new disciplines in healthcare industry, which have grown rapidly in the last decades and continue to evolve. The aim and scope of the Magazine is the same as it was at the time of its inception. The magazine aims at promoting India as a Medical tourism hub, Helping Startups with funding, Healthcare Consultancy, assisting Procurement of Quality medical devices even in tier 1-2 cities, bringing awareness of new technology to doctors and healthcare providers, and setting new benchmarks in Quality management .

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Volume - IX Issue - I May-June 2018 Editor Feature Editor Editorial Advisor

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We express our sincere thanks to the members of our editorial board, Sales & Marketing Force and Design team for their hard work and also to the editorial staff at Springer for their continuous support. Thanks are also due to our readership, to all contributors to the Magazine, and to the many colleagues & Ex-Colleagues who serve our company.

THANK YOU to all our readers & Advertisers.

Dr. ma Kamal

Dr. Sarika Gupta, Veteran healthcare writer, thinker and famous Radiologist joined our editorial board and continues to be involved as an honorary editor, Dr. M. Wali, Dr. Naveen Nishchal and Mr Manish Rastogi continue to be our esteemed advisors.

Finally, we specifically wish to acknowledge contributors, Subscribers, Readers, guest authors, Exhibition & Conference organizers. We are confident that the readers will find Medgate Today Magazine interesting and useful, and we hope that the new research in Technology and IT Infrastructure will help enlighten the healthcare fraternity. We look forward to this, and we also hope and believe that the success of this Magazine will continue accordingly.

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We are very grateful to our Readers & Advertisers for your continued trust and support Our Magazine

I would like to congratulate team Advance Meda Group. Publishe of Medgate Today Magazine for completing 9 years of success in healthcare Media Industry. Medgate Today has achieved tremendous growth and has built immense goodwill in the Healthcare Sector by sheer dint of their hard work and dedicated beneficial service to the stakeholders It a remarkable achievement which one can legitimately feel proud of Medgate Today endeavours to bring out the best health story and deissiminates information about the latest technology for doctors, patients and the entire health community including policy makers. One finds the magazine very insightful, instructive and full of well researched quality content.

Welcome to

Shri Ashwini Kumar Choubey Minister of State, Ministry of Health and Family Welfare

I wish the Medgate Today every success In their toudable endeavour to serve the health sector of India to the best of there abilrty

We Congratulate Advance Media Group the Publisher of Medgate Today Magazine for completing 9 years - an excellent Magazine on Healthcare & Medical Devices. Medgate Today Magazine has been contributing in educating People and creating awareness about Healthcare. Medgate Today role is appreciable as a bridge in the Healthcare arena and this media organization is very much centric to objectivity and reports without any prejudice approach on healthcare issues in India and abroad therefore maintaining the code of ethics and standards of healthcare journalism. We wish Advance Media Group and you all the very best for your future endeavors.

Mr. Rajiv Nath

Forum Co ordinator, Aimed

Congratulations to Advance Media Group, Publisher of Medgate Today Magazine for completing 9 years in News/Media Industry. Medgate Today has built eminent goodwill in the Healthcare Sector. I am happy to note that Medgate Today provides excellent coverage to health issues, latest technology for doctors and entire health community including policy makers.

We are very grateful to our Readers & Advertisers for your continued trust and support

My best wishes for your continued excellence and performance in this field.

Dr. Pallavi Jain Govil

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NEWS

C o n t e n t s

Update

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HMD launches pioneering, India’s First “Made in India” Dispovan Insulin Pen Needle” ��

Eating right and keeping well during Ramadan:

Toshiba Corporation Welcomes Nobuaki Kurumatani as Chairman and CEO �� Breathe Clean Air With Panasonic This World Asthma Day �� Researchers create self-healing bones �� India amongst the nations affected by one of the biggest threats to global health �� National Health Policy & NHPS to drive ‘Health for All’: NATHEALTH �� Australian university UNSW research holds out hope for thalassemia patients �� Apollo Children’s Hospitals Performs World’s first DUCTAL Stenting on the smallest baby �� UP, MP& Rajasthan Share the highest burden of Asthma in Northern India �� Irritable Bowel Syndrome (IBS) is the 2nd most common cause of work absenteeism in India �� Buy Indian Policy for Medical Devices- Lacks Boldness, Lost Opportunity �� Barriers impede biosimilar market entry into the US despite the BPCIA, says GlobalData �� Liver Function Abnormalities Observed More in Men from North India, an analysis from SRL Diagnostics �� Premature ovarian failure is a cause of infertility in 16% of women in Delhi �� The Darker-Side of Social Media �� Gut Bacteria helps keep immune system healthy �� Importance of Critical Care-New Trends, how awareness and education will help make a difference �� 6 advises you can give to a couple facing fertility issues �� Medical Value Travel in India �� Quality and safety are inextricably linked �� Where Are We in HIV Vaccine Research? �� DIAGNOCON 2018 - a first-of-its kind Conference for the business of Diagnostics �� Universal Healthcare is Incomplete without Unconditional Healthcare Access �� Snowballs - A revolutionary cooling underwear aimed at tackling infertility in men launches in India �� Delivering Healthcare at people’s doorstep possible by 2022, say experts at Ayushman Bharat Summit �� Medical Fair India Continues On Course For Growth �� 2nd VOH International Conference ��

The Women I enjoy working The Women Still Leader Leader & Social in Pharma Deprived of in Healthcare Motherhood? Worker industry.....

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World Health Creativity: An Antidote to Day 2018: Depression

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EXCELLENCE

NEWS Update

HMD launches pioneering, India’s First “Made in India” Dispovan Insulin Pen Needle”

industan Syringes & Medical Devices (HMD) one of the largest manufacturers of Disposable Syringes in the World and the largest for Auto Disable syringes has today launched most revolutionary and pioneering, India’s First “Made in India” Dispovan Insulin Pen Needle” to provide better comfort for people with diabetes at the 4th Medical Expo Indore 2018. The Dispovan Insulin pen needle is a precision engineered, yet affordable sterile single use pen needle, which can be universally fitted on all international brands of Insulin Pens. With features like, ergonomic shape for improved skin contact and grip, extra thin wall, multi-bevel, tapered point, Dispovan Insulin pen needle is designed and manufactured by HMD with intent to offer a much less painful injection experience for diabetic patients. According to Mr.Rajiv Nath, Jt.Managing Director of Hindustan Syringes & Medical Devices (HMD), “We are

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particularly excited about the prospects of our latest offering ” Dispovan Insulin Pen Needle” manufactured in our state of the art manufacturing facilities, which will end India’s import dependency and the monopoly of BD. Patients will now be able to access an affordable quality product, which they need not reuse because it is expensive. We have received excellent feedback and clinical acceptance from the end users of a comfortable injection and glad that our investments in high end technology are giving us a competitive edge.” “With the launch of ‘Dispovan Insulin Pen Needle’ we will contribute towards our ongoing commitment of making healthcare affordable for common people in India” said Mr.Pardeep Sareen, Chief General Manager-Marketing of HMD . “Why reuse a pen needle”, he quipped “when Dispovan makes it affordable for single use? Reuse of a Insulin pen needle could increase the following :  Bacterial growth on the needle – Risk of injection  Experiencing pain when injecting  Risk of lipohypertrophy (lumpy skin) occurring  Risk of the very fine tip of the needle breaking off  The above stated risks will grow with each re-use”, he adviced. Dispovan Insulin Pen Needle is manufactured at HMD’s Faridabad-Ballabgarh plant. The new plant is spread on an area of 5.5 acres and will have the capacity to initially produce over 100 million units per annum of ‘Dispovan Insulin Pen Needle’ to meet the rising export and domestic demand for its new technology. Every Needle point is checked online by a Digital Vision Camera System for a defective, blunt needle point and such needles, which can be potentially painful are rejected automatically on line, he explained. The proprietary dry silicon coating used by us makes the needle surface slippery to ensure comfortable injection. Dispovan Insulin Pen Needle has needle gauge option of 31G & 32G with needle length of 5mm & 4mm respectively and comes in purple and green colour shade to enable visual recognition of needle size. The pricing of the Becton, Dickinson and Company (BD) pen needle is Rs.14 MRP whereas HMD has initially kept the MRP of its’ Dispovan pen needle for Rs.12. Dispovan pen needle is economical to patient by at least 15 %, as compared to imported pen needles. Unlike prices of imports that are volatile and linked to ever changing exchange rates and steady devaluation of Indian rupee that makes imports expensive, the made in India product has relatively stable pricing.

NEWS Update

Toshiba Corporation Welcomes Nobuaki Kurumatani as Chairman and CEO Nobuaki Kurumatani today took office as the first Chairman and CEO of Toshiba Corporation (TOKYO: 6502) to be appointed from outside the company in over 50 years. Commenting on his appointment as Representative Executive Officer and Chairman and CEO, Mr. Kurumatani said, “I am honored to be appointed CEO, and very much aware of the responsibilities I take on. Toshiba is not just any company. Its corporate DNA has realized countless Japan- and world-first technologies and products, made Toshiba a source of pride in Japan for nearly 145 years, and also made us a global leader. “I believe that helping Toshiba back on its feet is my true calling. I am here at Toshiba to support change and transformation, and I see my role as to

build on the company’s resilience and to lead its recovery. To secure growth, we must radically improve our earning power and reinforce our finances. We must move out of our comfort zone and promote fundamental reforms.” Mr. Kurumatani most recently served as President of CVC Asia Pacific Japan (CVC). Before joining CVC in May 2017, he was Deputy President and a Director of Sumitomo Mitsui Financial Group, one of the largest financial institutions in Japan, where his career was devoted to corporate planning, public relations and internal auditing. He is a graduate of the University of Tokyo, where he studied Economics. Satoshi Tsunakawa has taken on a new role in Toshiba as Representative Executive Officer and President, and

Chief Operations Officer (COO). From today on, Mr. Kurumatani and Mr. Tsunakawa will together execute the management of Toshiba Group.

Breathe Clean Air With Panasonic This World Asthma Day With constant rise in pollution level, India’s lungs have been choking and Asthma is becoming one of the most common respiratory diseases. According to WHO, India has around 15 to 20 million asthmatics and the number is rising every year. This chronic disease cannot be cured but can be controlled to reduce and prevent asthma attacks. To raise awareness on the issue, World Asthma Day is celebrated on first Tuesday of May and the theme for this year is “NEVER TOO EARLY, NEVER TOO LATE. It’s always the right time to address airways disease.” The theme provides a call to action for both patients and healthcare providers worldwide to take actions and ensure that the asthma is controlled. Air pollution makes breathing difficult for a healthy individual, but can make conditions worse for those already suffering with asthma. The levels of PM 2.5 virus, one of most deadly forms of pollutants, is recorded to be 10 times higher than the safety limit in the air we all breathe. However, people are unaware that indoor air pollution is more polluted than the outdoor air. We spend maximum of our time indoors, and thus, it is important to keep an eye on the air quality behind our doors. While air outside is often outstep the line of control, we can mitigate the unhealthy air inside our homes using products which help in purifying indoor air. Reinforcing its commitment to provide ‘Quality Air for Life’, Panasonic offers a range of air purifying products such as airconditioners and air-purifiers, that helps to easily clean and freshen up the household air. ‘Air Purifying’ Invertor Air-conditioners Panasonic recently introduced its new range of inverter airconditioners, inbuilt with its patented air purification system called Nanoe™ Technology that actively removes PM2.5 and airborne particles giving upto 99% clean air. The Nanoe™ Technology uses nano-sized electrostatic atomised water particles to deodorise, inhibit bacteria and virus growth, remove dust and 99% of PM2.5 to 10 May-June 2018 w w w. m ed e g a te to d a y.co m

purify the air in the room even when the cooling function of the airconditioner is turned off. The three stage purification system ensure pure and healthy air. The new ‘Air-Purifying’ inverter air conditioners are available at all leading retail outlets from a starting price of INR 39,000 to INR 72,000 and in 0.8T, 1.0T, 1.5T, 2.0T variants. Air-Purifiers Panasonic offers a wide-range of air-purifiers as one of the best solutions to improve the indoor air-quality. The specially designed air-purifiers are equipped with Nanoe technology, which enhances the quality of indoor air by filtering out harmful particles including PM2.5. In addition, the Econavi technology minimizes unnecessary operations by monitoring the daily life pattern of the user, creating a favourable environment for the members as well as pets. The airpurifiers offers two types of air-filters - the Composite Air Filter which can inhibit 17 kinds of virus, bacteria and allergens up to 99%, while the HEPA Composite Air Filter can remove 99.7% particles from the air. Moreover, the house-dust catcher helps in eliminating big particles such as hair, fine dust particles and germs, and the 3D circulation airflow increases the efficiency of the air-purifier. Available in stylish and compact designs, the air-purifier range caters to room sizes from 283 sq. ft. to 452 sq. ft.

Multispeciality Minimal Access Surgery Training Courses

NEWS Update

Researchers create self-healing bones

Researchers from the Center for Composite Materials at the National University of Science and Technology MISiS (NUST MISIS) have recently developed a self-healing material for bone implants. The material was based on a shape memory polymer, which can be restored to its original structure upon the local application of heat. The findings of this research were presented during the Healthcare of the Future: The Latest Promising Innovations Moscow-Delhi video conference, which was held at Rossiya Segodnya International Multimedia Press Center. The discussion centers around the possibility of replacing parts of fractured bones of small and large sizes, as well as surgically removing bone tissue fragments that are affected by malignant tumors. The human body lacks the required resources for selfhealing large amounts of bone tissue and hence the need for implants arises. If the implanted material is subject to cyclic loading (which commonly happens upon the replacement of bone fragments in limbs, especially in legs), cracks may form in the material. These cracks are very hard to manage and impossible to prevent, but it is possible to create an implant made from self-healing material.

“We are currently developing an approach toward using shape memory materials,” said Fyodor Senatov, Candidate of physical and mathematical sciences and a research assistant at NUST MISIS’ Center for Composite Materials. “Initially, the implant has its own defined shape. When a deformation appears caused by a crack, we can apply heat and the material returns to its original structure. In order to possess this shape memory effect, the polymer must contain both a fixed phase (either chemical or physical crosslinks, molecular entanglements or intermolecular interactions) and a soft phase, which is responsible for the entropic elasticity of macromolecules and allows the material to be temporarily deformed. Imagine the polymeric material, from which an implant is made, as being a spring placed inside gelatin. As you deform this piece of plastic, the spring gets stretched out inside. Thick gelatin will prevent the spring from recoiling. But if we heat the gelatin up, it will become soft, and the spring will be able to return to its original shape,” Senatov added. The driving force behind the material’s ability to restore its shape is the change in the polymer’s molecular mobility and its switch from a more structured temporary configuration, following the deformation, to a thermodynamically favored configuration with higher entropy and less internal energy. 12 May-June 2018 w w w. m ed e g a te to d a y.co m

Today, researchers from various laboratories all over the world are carrying out tests on animals to study the possibility of applying heat to such implants locally, without damaging the neighboring tissues. In order to heat up the implant, researchers conduct minimally invasive surgery by making a small incision to bring the waveguide directly to the replaced bone fragment. The main problem is that the implant’s shape can only be restored at temperatures above 50ºC, a temperature that can cause serious damage to living cells. Moreover, the temperature activating the shape memory effect is way too high for the polymers that are used in bone implants. If we decide to make implants more similar to bones, to make them able to withstand great cyclic loads, the heating temperature will be even higher – about 60-70ºC. These temperatures, without a doubt, will simply destroy the neighboring tissues. “Unfortunately, so far humans have not developed a material, which is both solid and strong and able to change its structure under acceptable temperatures,” Senatov explained. “I think we will have to keep experimenting with careful heating technology or optimize implants by creating composite materials and altering their internal structure. We have already “fumble” for materials like this, but so far they can self-heal only at 50ºC.” Now the researchers from the NUST MISIS’s Center for Composite Materials are using various polymers, mainly those which are bioresorbable, or biodegradable, as a foundation for the production of implants. Implants from these materials can be used to replace smaller bone fragments – one of the most in-demand operations in oral and maxillofacial surgery. For replacing larger bone fragments, medical professionals use implants made from ultra-high molecular weight polyethylene. The polymer’s density can be increased via the introduction of other particles, such as hydroxyapatite – the mineral base of bones and teeth. To obtain the necessary temperature, researchers can use direct heat, electric current, ultrasound or an alternating magnetic field. In order to achieve heating by using a magnetic field, they introduce special magnetic nanoparticles into the polymer. Upon the application of an alternating magnetic field, these particles start warming up and begin transferring heat to the surrounding material. Now researchers are experimenting with the composition of these materials, trying to increase their density and reduce the temperature required to heat them up.

NEWS Update

India amongst the nations affected by one of the biggest threats to global health  Aetna

International white paper highlights antibiotics resistance as a serious hazard to public health Lakh deaths per year due to Antimicrobial Resistance. Expected to reach 1 Crore per annum by 2050  Antibiotic consumption to increase by 99% in BRICS countries  Agricultural consumption of antibiotics expected to rise by two-thirds by 2030 causing a serious threat to environment  7

ndia is amongst the world’s largest consumers of antibiotics for human health. A recent white paper by Aetna International titled ‘Antibiotic resistance: Toward better stewardship of a precious medical resource’ highlights the need for immediate action to contain the situation. Multiple factors, such as high burden of disease, poor public health infrastructure, rising incomes and the unregulated sale of cheap antibiotics have amplified the crisis of antibiotics resistance in India. Antimicrobial Resistance (AMR) is causing around 7 Lakh deaths worldwide and the death toll may reach 1 crore per annum by 2050. A 12-country survey by the World Health Organisation in 2015 demonstrates that at least 75 percent of respondents from four countries including India reported taking an antibiotic within the last six months, compared with just 35 percent of those from Barbados. As per a Lancet report, resistant infections are more expensive to treat and patients infected with resistant strains of bacteria are more likely to require longer hospitalisation. In the US alone, over 2million people suffer from illness due to drug resistant bacteria every year. This costs the United States an additional Rs.1,30,000 Crores(20 billion US dollars) in healthcare spends. In BRICS countries, antibiotic consumption is expected to increase by 99%. Agricultural consumption of antibiotics, which is primarily used to promote growth and not treat disease in animals, was estimated at 63,151 tons in 2010 and is expected to rise by two-thirds by 2030. Research shows that 75-90% of antibiotics given to animals pass through to the environment. This promotes drug resistant bacteria that infect humans and animals. A partial solution to the problem of antibiotic usage in agriculture would be to reduce people’s reliance on meat as a source of nutrition. The UK-based Academy of Nutrition

and Dietetics advocates that going meat-free for one day a week can improve your health and the environment. Addressing the growing concerns around the Antibiotic Resistance worldwide, one of the contributors to the whitepaper, Dr. Prashant Kr Dash, Chief Medical Officer, vHealth by Aetna said, “The majority of Indians think antibiotics can cure illnesses such as common cold and gastroenteritis, which is a wrong perception. The majority of these infections are caused by viruses and antibiotics have no role in their treatment. This problem of inappropriate antibiotic use is compounded by their easy availability at pharmacies. In many cases, patients experience unwanted serious side effects of antibiotics like an allergic reaction, diarrhea, vomiting, kidney failure, changes in blood sugar levels and toxic effects on the heart and liver. This persuaded us to collate this study which will create awareness on the issue and draw attention to the alarming health crisis being faced globally.” On Aetna International’s plan tocombat antibiotic resistance in India, Mr. Manasije Mishra, Managing Director, India Health Organisation & Aetna India said, “Antibiotic resistance is a crisis that effects everyone globally. We need to address this issue now with a global, multifaceted strategic solution. In India, with our vHealth by Aetna teleconsultation service, Aetna is taking a threestage approach that emphasizes antimicrobial stewardship in clinical training audit medical consultations, the identification incorrect antibiotic usage in patients and offers counseling on appropriate usage, dosage, duration and rationale of using antibiotics. By these means, we are initiating steps to help combat the growing threat of AMR in the country.”

As per the World Health Organisation (WHO), Nipah Virus is a newly emerging zoonosis that causes a severe disease in both animals and humans. At a time when virus related diseases like Dengue rise every year, spreading of Nipah Virus and its management is definitely something that needs urgent attention so as not to make matters worse in the coming days. Both the State and Central governments,as well as private players also have to work together to address the situation Unfortunately, there is no cure for this virus yet. Nipah virus is transmitted from animals to human beings and fruit bats of Pteropodidae family are known to be natural hosts of this virus. Timely screening and diagnostic tests for those who may be in high risk zone, like the 14 May-June 2018 w w w. m ed e g a te to d a y.co m

family members of those who are exhibiting symptoms of Nipah virus infection would be necessary and would go a long way in containing the spread of the disease. These people have to be examined properly with all relevant diagnostic tests. The disease is known to have 70% mortality. While the governments have issued advisory, in case of infection, early diagnosis is the key. As a leading pathology lab, our test profiles include early detection of such infections. Tests that are conducted includes isolating virus attempts and real time polymerase chain reaction (RT-PCR), in which from throat and nasal swabs, cerebrospinal fluid,

urine, and blood should be performed in the early stages of disease. Antibody detection may be used later. In cases where patients don’t survive, immunohistochemistry on tissues collected during autopsy may be the only way to confirm a diagnosis said by Ms. Arunima Patel, Managing Director, iGenetic Diagnostics.

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Features of AHU Without Duct Patented Innovative Solution for Air Condition of OT  Ductless Air Handling System needs to start just one hour before the operation starts to get Class ll Air Quality in entire Operation Theatre.  Ducted Air Conditioning System for OT has to keep on round the clock may be with temperature control (with VFD) but our Ductless AHU has to keep on just 1 hour before to get desired air quality (Class ll) in entire OT.  HEPA Filter needs to be replaced once in a 2 year as compared to ducted system required replacement of HEPA thrice in a year so saves maintenance cost.  Ducted laminar air flow system (LAF) required Robotic duct cleaning before changing HEPA Filter and duct insulation and maintenance required periodically and costly.  AHU without duct maintain all NABH requirement by giving 20air cycles / hour, positive pressure2.5 Pascal CLASS II Air Quality and With Laminar Air Flow Class I (0-10) Air Quality Get on of table & Routine Cleaning can be done from Inside OT by any non technical OT staff.

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NEWS Update

National Health Policy & NHPS to drive ‘Health for All’: NATHEALTH • NATHEALTH to help accelerate partnerships among various stakeholders National Health Policy and National Health Protection Scheme (NHPS) are the main drivers for achieving the goal of Universal Health Coverage (UHC) and with these strong catalysts, Indian healthcare sector has geared up to provide access to affordable quality healthcare. Healthcare federation of India – NATHEALTH on the eve of Ayushman Bharat Diwas. The provision of Rs. 5 lakh per family for 10 crore families or 50 crore beneficiaries across the country could go a long way to achieve the goals of UHC. NATHEALTH, a multisegment collaborative platform, has extended all its support to stakeholders for the successful implementation of the world’s largest government-funded health insurance programme. “In 2017, the government announced the National Health Policy NHP-2017, with major focus on quality and affordable healthcare to all...The government’s focus on Universal Health Coverage (UHC) is expected to offer several opportunities for diverse stakeholders of healthcare sector and contribute to health & wellbeing of the Nation as a whole.. Now, NHPS/ M(National Health Protection Scheme or Mission) announced in the recent Union Budget, should help in taking forward the goals set in the Health Policy... Healthcare Providers, Health Insurers, Diagnostics, MedTech and other stakeholders need to collaborate in order to contribute to the success of NHPS.. NATHEALTH is making all possible efforts to enable significant partnerships among various stakeholders,” said Mr Anjan Bose, Secretary General, NATHEALTH According to NATHEALTH, focus on prevention and wellness under AB-NHPM will help achieving the goal of Swasth Bharat. The government has shown its full commitment towards the early implementation of Ayushman Bharat-National Health Protection Mission (AB-NHPS) by rolling out the first health and wellness centre at Bijapur district in Chhattisgarh, as promised by the Govt in the recent Budget Announcement of 1.5 Lakh Health and Wellness Centres across the Nation. Mr. Daljit Singh, President, NATHEALTH, said, “Over the years NATHEALTH has been emphasizing on promotion of prevention and wellness by all stakeholders to achieve the goal of Swasth Bharat. It is very promising to note that the very first HWC is well equipped to transform primary healthcare with holistic and inclusive approach. Along with child and mother care, the centre would provide facilities for both communicable and non communicable diseases. Adding yoga as a facility clearly indicates that we now have a robust primary healthcare ecosystem with focus on prevention and wellness.” “Stakeholder engagement is the key to effective implementation of these policies and schemes. The government has been engaging with various segments while creating a new institutional framework to take Indian healthcare ecosystem to the next level. As part of Ayushman Bharat Mission, NHPS 16 May-June 2018 w w w. m ed e g a te to d a y.co m

would require strong partnerships among stakeholders and with this collaborative spirit, we should be in position to make our healthcare ecosystem robust and more inclusive,” Mr. Daljit Singh further added. Presently, a very small percentage of the population in the country has health insurance coverage. Out-of-pocket expenses are very high at around 60% and the new scheme is expected to help people to meet their healthcare needs. Economic Survey 2017-18 has also flagged the issue of high levels of Out-ofPocket Expenses on health, which adversely affects the deprived sections and widens economic and social inequalities. Appreciating the government's plan of setting up of over 1,50,000 health and wellness centres throughout the country, NATHEALTH said that this move along-with expanding networks of hospitals are outstanding examples of an integrated approachtowards enabling Universal Health Coverage for the people of the nation. According to NATHEALTH, inadequate access to capital has been one of the biggest roadblocks for the growth of Indian healthcare sector. Today, the government spends only about 1.4% of its GDP on healthcare, which is one of the lowest spends globally. There is a need to focus more on raising investment in healthcare in the country. The government needs to play the role of a powerful catalyst by creating an enabling ecosystem which draws investments from both domestic and international players to achieve the goal of Universal Health Coverage. Once investment goes up, the government would be in a better position to push reforms with promotional policies. Awareness, Accessibility, Affordability, Accountability and Quality are priorities for the healthcare sector. Digital Health plays a critical role in driving the priority. For effective implementation, NHPS needs to be digitally empowered in terms of collection and sharing of data. Mr. Daljit Singh further said, “The Health Policy envisages setting up a regulatory body-National Digital Health Authorityto govern and regulate digital health. Going forward, for an efficient and effective mass mediclaim scheme, NATHEALTH hopes that the Authority would be established immediately to leverage the benefits of digital health. Digital health would be a very powerful catalyst in realising the goal of Health for All.” On the occasion of Ayushman Bharat Diwas- April 30th, NATHEALTH urged all stakeholders to work in a collaborative spirit to empower and reinvent the sector. Flexible and adaptive operating models need to be in place for optimising nontraditional resources and partnerships. Overall, the sector needs to move forward with an innovative mindset to focus on quality and affordability.

NEWS Update

Australian university UNSW research holds out hope for thalassemia patients Researchers at the University of New South Wales (UNSW) in Sydney, Australia, have used CRISPR gene editing technology to introduce beneficial natural mutations into blood cells to boost production of foetal haemoglobin. The method could lead to new therapies for sickle cell anaemia and other blood disorders, says the university. The research solves a 50-year-old mystery about how these mutations -- which are naturally carried by a small percentage of people -- operate and alter the expression of human genes. The details of the study, carried out by an international team led by UNSW scientist Professor Merlin Crossley, is published in the journal Nature Genetics. Genome editing or gene editing give scientists the ability to change an organism's DNA. These technologies allow genetic material to be added, removed or altered at particular locations in the genome.

"Our new approach can be seen as a forerunner to 'organic gene therapy' for a range of common inherited blood disorders including beta thalassemia and sickle cell anaemia," said Professor Crossley, who is also UNSW Deputy Vice-Chancellor Academic. "It is organic because no new DNA is introduced into the cells. Rather, we engineer in naturally occurring, benign mutations that are known to be beneficial to people with these conditions. It should prove to be a safe and effective therapy, although more research would be needed to scale the processes up into effective treatments," he added. People with thalassemia or sickle-cell anaemia have defective adult haemoglobin -- the vital molecule that picks up oxygen in the lungs and transports it around the body -- and require life-long treatment with blood transfusions and medications.

According to UNSW, it has engaged in a series of initiatives with the Indian government, higher education institutions, and corporations for sharing and transfer of its vast pool of tech expertise. This sets UNSW apart from host of other institutions that see India as a one-way street to train Indian students. UNSW is home to more than 52,000 students from nearly 130 countries.

Apollo Children’s Hospitals Performs World’s first DUCTAL Stenting on the smallest baby • Two-week-old girl child was brought to Apollo Children’s Hospitals with

deeply cyanosed (blueness all over the body) and low birth weight of 1.19 kg • As part of the procedure, a stent was deployed in the closing PDA to keep it open so that the baby survives Apollo Hospitals, Asia’s largest and most trusted multi-specialty chain of hospitals has given a new lease of life to a two-week-old girl child by performing a life-saving ductal stenting procedure in a very small baby weighing 1.19 kg. This is the first procedure to be done in such a small baby in the world, without surgery. The baby along with her mother, Revathy was brought to Apollo Children’s Hospitals in a critical condition with deeply cyanosis (blueness all over the body) and oxygen saturation levels at 45% (normal 96-100%). The investigations revealed that the child had a condition called Pulmonary Atresia with ventricular septal defect (VSD). This means that supply to the lungs from the heart was totally cut off. The baby was surviving in the mother’s womb with the help of a tube (PDA) supplying to the lungs from the body tube (aorta). After birth, the PDA in the baby had nearly closed and there was no supply to the lungs, making the baby blue. It was important for the baby to have adequate blood supply to the lungs to survive. 18 May-June 2018 w w w. m ed e g a te to d a y.co m

But being a very small baby, surgery was extremely risky, and therefore the doctors performed a procedure where they deployed a stent in the closing PDA to keep it open so that the baby could survive. This procedure is done only in a few centers in the world. Explaining the procedure further, Dr. Muthukumaran CS, Consultant, Interventional Pediatric Cardiologist, Apollo Children’s Hospitals said, “We undertook the procedure as an emergency. As arteries in such babies are very small, we accessed the right femoral vein (thigh vein which takes blue blood to the heart) through which we passed a wire, and with x-ray guidance reached the closing PDA through the heart. Being extremely low weight, the baby did give some trouble during and after the procedure, but our expert anesthetic team managed it very well. The heart rate dropped to 70, but we promptly stented the PDA and opened the tube. The baby’s saturation improved to 85% and she was taken off the breathing machine. The baby stayed in the ward for one more day and was discharged”.

Apollo Children’s Hospitals is equipped with state-of-the-art Azurion Cath Lab with 3D facilities, and it is the only children’s hospital to acquire this facility. It also has a surgical and ICU facility right next door for managing any eventualities. A number of heart conditions can be corrected by pinhole technique without scars. Apollo Children’s Hospitals has done more than 4000 such procedures in children, including valve replacement without surgery. The child is at home and is recovering well. Once she grows, (she is now 1.8 kg), she will need to undergo a corrective surgery where a valved tube will be placed from right side of the heart to the lung tube.

NEWS Update

UP, MP& Rajasthan Share the highest burden of Asthma in Northern India

prescribing inhaler devices to at least 40% of their asthma patients in the first clinic visit.

 On the occasion of World Asthma Day, experts strongly recommend use of inhalation therapy to improve disease status, control symptoms, reduce the number and severity of exacerbations  Welcome the ‘ Winds of Change’ with Inhalation Therapy to lead a normal-active life

tates of Uttar Pradesh, Madhya Pradesh, Rajasthan and Punjab in the northern part of the country are witnessing the alarming number of Asthma cases and high level of mortality rate due to the disease. The experts strongly recommend inhale therapy that can improve disease status, control symptoms, reduce the number and severity of exacerbations and improve quality of life.

Although contemporary inhaled therapy for asthma has the potential to control disease, as control is often not achieved in real-life practice in most patients. As per the Asia-Pacific Asthma Insights Management (AP-AIM) Survey, all asthma patients in India are either uncontrolled or party controlled. Poor inhaler technique is a key reason for this poor control. Many patients find pMDIs difficult to use correctly. Poor handbreath co-ordination is one of the most commonly reported errors with pMDIs. DPIs are breath-actuated and hence overcome the problem of hand-breath coordination. However, a significant proportion of patients fail to use their DPI correctly as well. One of the common errors made by patients with a DPI is the failure to inhale forcefully and deeply through the device, leading to insufficient drug delivery.

Alarm bells were ringing. According to the study, in 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease (COPD) as the top two causes.However, the therapeutic revolution not just brought the change in solution with new technology but the change in patients (asthmatic) outcome. Modern devices has made it easy for patients to lead a NORMAL-ACTIVE life and the fear of stigma has been taken over by the health habits’ of asthma management. Increased awareness about inhalation treatment (including nonsufferers) to overcome social stigma; the assurance that inhalation is safe and reliable and to know that asthma can be controlled and thus is not a hindrance in living a full life were the major concern areas.

Speaking on the disease management challenges, Dr ShyamKukreja, HOD Paediatrics Department, Max Hospital, Patparganj, said, “ The key challenges in the management of asthma include improving compliance and developing effective and easy-to-use inhalers. Many patients frequently underutilise their medications or use their inhalers incorrectly, which can be detrimental to maintaining disease control. This can cause them to switch to oral therapy, which can be disastrous.” Dr. Sandeep Nayar, Senior Consultant & HOD, Respiratory Medicine, Allergy & Sleep Disorder, BLK Super Speciality Hospital, says, “Inhalation therapy remains the best form of drug delivery in asthma as it delivers drugs directly in the lungs. Hence the action is quick & lesser dose is required to improve the symptoms. Since dose required is less, the side effects also are significantly decreased. Inhalation therapy not only treats the patients suffering from breathlessness but also prevents further attacks of asthma. These inhalers are handy, easy to carry and patient friendly as they are very simple to use. Patients are advised to carry them in their pockets so that they can be immediately used to overcome asthmatic attacks. Inhalation therapy can be administered in different forms i.e. Metered Dose Inhalers, Dry powder Inhalers or nebulisation depending upon patients age and symptoms.”

Speaking on the occasion of World Asthma Day, Dr. Karan Madan, Assistant Professor, Department of Pulmonary Medicine and Sleep Disorders, AIIMS said, “Today inhalation therapy is the mainstay of treatment for asthma. Inhaled medicines are integral to the management of respiratory diseases like asthma. They deliver drugs directly to the lungs and hence act faster and at a lower dose, thereby reducing the risk of side effects. Inhaled medications have been shown to improve disease status, control symptoms, reduce the number and severity of exacerbations and improve quality of life.”

Innovation and unique products are giving patients the choice of treatment. And equally improving treatment outcomes through adherence initiatives to advice patients about taking treatment regularly and using inhalers correctly and devising user friendly diagnostic tools and new inhalation devices to enhance the standard of respiratory care in India. In these past 60 years, patients not only fought the disease but phobia/ myths associated to it. Increasing public awareness and acceptance of inhalation therapy through mass media and social media has brought more patients into correct treatment.

The various inhaler devices available include the pressurized metered-dose inhalers (MDIs), dry powder inhalers (DPIs) and nebulisers. Approximately 90% of physicians in India reported

It is important to remember that “breathing freely starts with talking freely”. Let us welcome the ‘Winds of change’.

According to an ICMR Study, with over 57 lakh cases, Uttar Pradesh tops the list in prevalence of Asthma cases and mortality rate 22 per 1,00,000 people. Rajasthan and Madhya Pradesh also have high level of prevalence with nearly 24 lakh and 21 lakh people suffering with the disease. In Rajasthan mortality rate is even higher than UP at 23 per lakh people whereas in MP mortality rate at 14 is less than compared to neighbouring Uttar Pradesh and Rajasthan. Punjab sees eight people out of one lakh dying because of the disease.

w w w.medegatetoday.com May-June 2018

NEWS Update

Irritable Bowel Syndrome (IBS) is the 2nd most common cause of work absenteeism in India & negatively impacts quality of life reveals survey by HCFI • Medical Practitioners surveyed feel that peppermint oil is a safe and better treatment option that can help alleviate symptoms • Over 3000 patients and 300 medical practitioners participated in the survey A study conducted by the HCFI, a leading National Health NGO has revealed that about 5-10% of the population surveyed experiences symptoms of Irritable Bowel Syndrome (IBS) such as abdominal pain, diarrhea, constipation or incomplete evacuation. Yet, majority of them do not seek medical help. The study aimed at analyzing IBS from the physician and patient’s point of view – awareness about the disease, its impact on day-today life and treatment options. It is interesting to note that even though 84.6% of the respondents felt that abdominal pain or other symptoms of IBS cannot be ignored, an overwhelming 58% of them use over-the-counter medications for relief and did not see a doctor. Given the impact of IBS on a person’s day-to-day life, it is important to raise awareness about IBS amongst both the medical fraternity and patients about IBS. Speaking about this, Dr. Philip Abraham, Consultant Gastroenterology, P.D Hinduja Hospital, said, “IBS is a chronic common condition of the digestive system and is second only to the common cold as a cause of absence from work. This condition often begins in young adulthood with women twice as likely as men to be diagnosed with it. Most people with IBS have a mild form of the disorder and can cope quite well without getting any treatment. However, sometimes, the symptoms are so strong that it can significantly affect everyday lives, causing distress. A number of natural therapies have been used for the treatment of IBS. It is possible to relieve the symptoms of this condition through antispasmodics. Peppermint oil has emerged as a safe treatment option for the condition.” The most common symptom of IBS is abdominal pain with changes in bowel habits (diarrhea and/or constipation). Abdominal pain is typically crampy and varies in intensity. Some people notice that emotional stress and eating worsen the pain, and that having a bowel movement relieves the pain. Women may notice an association between pain episodes and their menstrual cycle. Dr Chetan Bhatt, Gastroenterologist, Sir H N Reliance Foundation Hospital, Mumbai, opined, “Currently, there are many challenges that cloud the diagnosis and subsequent management of IBS. Some of these include lack of consistent biological markers, reliance on patient symptoms for diagnosis, difficulty in quantifying symptoms objectively, varying symptoms among individuals, and the fact that many organic conditions can masquerade as IBS. Lack of awareness about the condition among people and the medical fraternity at large further exacerbates the problem.” 20 May-June 2018 w w w. m ed e g a te to d a y.co m

The results of the survey conducted amongst the medical practitioners on the treatment methodologies for IBS revealed that almost 55.9% of the doctors use a symptom directed, multi drug approach in the treatment of IBS; 54.5% doctors prescribe antispasmodics; and another 30.8% prescribe antibiotics, antispasmodics. About 80% of the doctors surveyed believe that an ideal antispasmodic for the treatment of IBS should offer relief from symptoms of abdominal pain/discomfort, bloating/flatulence and complete evacuation and also possess minimum side effects. Peppermint oil has emerged as a good option since almost half of the participating doctors feel that it is effective in relieving abdominal pain, gas, bloating and fecal urgency through its selective effect on the smooth muscles of the intestine. Speaking about the need to raise awareness Dr KK Aggarwal – President HCFI said, “A simple mantra that everyone must remember is that if there is no pain, it can’t be IBS. Raising awareness about the disease incidence is key. ” There is an unmet need in the treatment of IBS, as despite the wide variety and effective treatments available, most patients do not get appropriate treatment. More widespread knowledge and proper use of available therapies (such as diet restriction and peppermint oil) will enable both the physicians as well as patients in achieving a better quality of life and relief from symptoms. Some interesting insights from the patient survey include the following.  84.6% said that pain in abdomen and altered bowel habits cannot be ignored  58.3% people self-treat symptoms with over-the-counter drugs  33.3% feel that the condition is not serious enough to contact a doctor  8.3% would seek no treatment at all  46% say IBS hampers their daily life  50% of them said they would take multiple drugs including antibiotics, antispasmodics etc., each time they have an attack  41.6% opted for diet change or probiotics for each attack

EXPERT VIEWS

Eating right and keeping well during Ramadan: An expert guide Swapping fried food for grilled goodness, ditching samosas, swerving sugar and salt, and spending nights drinking as much water as possible could help millions of Muslims across the globe tackle the challenges of Ramadan.

• Excess salt causes extreme thirst during the day – experts say that meals with high salt are not ideal to eat during night time hours because they can cause thirstiness during the day and is best to be avoided.

Students and academics at Birmingham City University in the UK have come up with a guide which aims to help people observing the month of Ramadan to make sure they eat right and look after their systems.

• Keep energised without water or snacks – experts advise that there are small things you can try each day to keep you alert and maintain your energy. Things like taking small breaks from revision or work and going on small walks, writing daily to-do lists or listing what you’re finding difficult and working on combatting these, and planning meals to make sure you’re eating the rights things to get good energy levels can all have a bit impact.

Academics and students on the University’s Sport and Exercise and Nutrition courses, including Dr Huda Al-Kateb, Dr Matt Cole and PhD researcher Ayaz Safi, have written up a guide featuring tips on nutrition, hydration and exercise to help people fasting for Ramadan to keep to a regular routine as much as possible. The points were written up based on analysis of the common foods consumed during the month, along with reflection on what foods are best at providing sufficient energy throughout the day. The experts have also featured advice on energy and activity to support wellbeing. The experts have written up a guide on tips for things to try out, avoid or swap for the month to look after the body: • Water, water and more water during night time hours – experts advise to drink as much water as possible during Iftaar and Suhur times, especially if hot weather is expected during the day. • Learn the importance of balance – when fasting your body is deprived of nutrients that your system needs. The experts emphasise that it is so important to make sure that when you can eat, you keep your meals balanced so that you feed your system enough nutrients from each group. • Think about the alternatives – swap deep frying for grilling, baking or shallow frying and swap heavier foods for lighter alternatives. For example, swap cake and chocolate for fruit and yoghurt. • Fitness and fasting can work together – gym enthusiasts can stick to their routine of working out every day. Light exercises are great to keep blood flowing and the system working. Cardio exercises are also fine to do when fasting as long as you don’t overdo it.

Dr Huda Al-Kateb, Programme Leader BSc Food and Nutrition at Birmingham City University, said: “During Ramadan, the hunger and dehydration might affect our cognitive abilities which often means that our ability to make wise choices when it comes to what food and drink that we consume during after the period of breaking the fast. • “We as a generation are much more aware of our health and wellbeing now so it is a good time to make people aware of what is and isn’t good to eat during Ramadan.” • The month of Ramadan, which begins on May 16 sees a large number of Muslims across the world observe 30 days of fasting during daylight hours, which means they cannot eat any food or drink any water or other drinks until the sun sets. The month teaches self-discipline, resilience and awareness of what it can be like for those living in poverty. • Ayaz Safi, a PhD Researcher and Assistant Lecturer in the Sports Science department, has also contributed to the list of tips. He said: • “Ramadan is a very challenging month for everyone who observes it and we’re fortunate to have experts in the University who can advise on the do’s and don’ts to make sure people look after themselves, eat the right things and overcome another challenging month. • “I regularly fast, so many of the points are what I have learned along the way. Making small changes like swapping foods, balancing your meals and doing light exercise can help you stick to as normal a routine as possible and make a difference to how you get through the day.”

May-June 2018

NEWS Update

Buy Indian Policy for

Medical DevicesLacks Boldness, Lost Opportunity • Lost Opportunity - partially supportive to Make in India has intent but opportunity lost in actual delivery • No Preferential Pricing for Indian Devices • No preference to ICMED certification to promote quality • No penal action based disallowance to use exclusionary 3rd Country Regulatory Approvals like USFDA in Tenders • No stated preference for India Design Mark to promote indigenous product development. lowest is Indian, no added advantage of course.

Mr. Rajiv Nath

Forum Co ordinator, Aimed Mr Rajiv Nath, Forum Coordinator, (AIMED) Association of Indian Medical Device Industry has expressed deep concern over the Guidelines for implementing the provisions of Public Procurement (Preference to Make in India) Order (PPO) issued by DoP. “Government of India has the intent but lacks boldness - half hearted attempts will get half hearted results. It is a clear case of a lost opportunity to promote indigenous manufacturing of medical devices to boost ‘Make in India’ initiative,” said Mr. Rajiv Nath If lowest price of tender bid is imported Indian Manufacturers (who meets criteria of Domestic Content) has option to match lowest price and seek 50% of tender. If 22 May-June 2018 w w w. m ed e g a te to d a y.co m

DiPP/ DoP need to do a study of gains made (if any) by any MSME in winning Tenders in past by matching L1 Pricing of imported Chinese products to win 20% of Tender under the MSME Policy . If an Indian manufacturer finds it unsustainable to match L1 of lower priced Chinese Imports to get 20% of the business as was earlier too possible then what is the use of this Policy to get 50% of the tender ? We can match prices of any country other than China as it has no global market economies but a subsidized state sponsored eco system. How can we compete with low priced imports from china with nonremunerative, non- sustainable pricing unless Indian Govt. has supportive Policies, Mr. Nath asked insisting India needs to follow the UN system of procurement based on sustainable costs and not based on L1 Lowest pricing that motivates some manufacturers to cut corners in regard to quality and service delivery of product and give poor image to Brand India. Regretfully to compete with low priced Chinese imports that are flooding the market, there is No Preferential Pricing for

Indian Devices - World Bank provides for this. GoI is strangely shy - though GFR ( General Financial Rules) of Ministry of Finance permits. The guidelines issued by DoP in its present form does not provide Preferential Pricing for Indian Devices, no incentives on maintaining and improving Quality, indigenous development and no redressal / no penal action based disallowance to use exclusionary 3rd Country Regulatory Approvals like USFDA approval in Tenders. It doesn’t provide preference for ICMED certification by Quality Council of India to promote quality and no stated preference for India Design Mark to promote indigenous product development. The following suggestions made by us to give encouragement & boost Manufacturers producing in India over imports have not been considered e.g.,  Preferential Pricing for Domestic Manufacturers based on World Bank norms.  Preference for ICMED / ISO Certified Manufacturers to boost quality.  Preference for Design India Certified

NEWS Update

the health sector and in creation of forward and backward linkages for medical devices production. The policy also seeks assured purchase by Government health facilities from domestic manufacturers, subject to quality standards being met.” Similarly clause 13.13 talks about incentivizing Private Sector in proposed strategic purchase by Government .Clause 18 advocates the need to incentivize local manufacturing considering the over 70% import dependency.

Manufacturers to boost indigenous development.

Domestic Medical Device Manufacturers are being repeatedly sidelined.

 Timely payment against Govt. Supplies.

Background Note : India is import dependent on Medical Devices at over 70 -90% for its needs and has an import bill of over 27,500 Cr Rs. Indian manufacturers via their Association AiMeD have been highlighting the need for India to address this import dependency as they are many time unable to win public healthcare tenders and loose out to lower priced imports especially from China due to low tariff protection with import duty in most cases a maximum of 7.5% or they looseout to American competition for Tenders where Bid specifies USFDA approval as a mandatory qualification required.

Many Countries have a Policy to encourage Domestic Manufacturing. Even USA has a Buy American Policy to 1stconsider allocating supply to US Companies to US Public Healthcare and Overseas USAID procurement. Indian Exporters to the US are challenged with inability to sell to US Defense Forces while appointing Distributors. (In fact their new President has threatened some major Automotive Manufacturers to either manufacture in USA or pay hefty fees, just to encourage Domestic Production). Similarly, to support the ‘Make in India’ Policy the Public Procurement Order 2017 has been issued by DIPP on 15 June 2017 whereby Purchase Preference shall be given to Local Suppliers in all Procurement undertaken by Govt. procuring entities for domestically manufactured good with minimal local content of 50% and the Nodal Ministry may prescribe a higher or local percentage and the manner of calculating it

The MOH&FW in its recently stated Health Policy states in clause 13.11 “ towards furthering Make in India , the private domestic manufacturing firms / industry could be engaged to provide customized indigenous medical devices in

The Dept. of Pharmaceuticals on Friday, 18th May 2018 posted Guidelines for implementation of Public Procurement Order in respect of Medical Device Sector. Under the New Guidelines the 50% Domestic Content has been revised to read:

 Penal provision against Hospitals that keep exclusionary compliance Clause of USFDA Certification as 3rd Country Regulatory approval. What's meant by Preferential Pricing? How does World Bank support Indigenous manufacturers in a developing country? World Bank has a clause to support domestic manufacturers by adding 15% to import CIF price of imported goods for the sake of bid comparison and thereafter the lowest price is winner. So if Indian manufacturer wins he will supply at his bid price, not at a higher price By denying preferential pricing to genuine Indian manufacturers, the policy guidelines can be said to be bordering on encouraging ‘Pseudo manufacturing’, he felt. It is sad that genuine concerns and suggestions of

Category of Medical Devices

% of Minimum Local Content

% of Local Content proposed to be increased in phased manner over next three years

Medical disposables and consumables

50%

50% to 75%

Medical electronics, hospital equipment, 25% surgical instruments

25% to 45%

Implants

40%

40% to 60%

Diagnostic Reagents/IVDs

25%

25% to 45%

The critical amendment by Dept of Expenditure last year of its GFR 2017 clause 153 paves the way for Reserved Items and other Purchase/Price Preference Policy sub clause (iii) states that the Central Government may, by notification, provide for mandatory procurement of any goods or services from any category of bidders, or provide for preference to bidders on the grounds of promotion of locally manufactured goods.” w w w.medegatetoday.com May-June 2018

NEWS Update

Barriers impede biosimilar market entry into the US despite the BPCIA, says GlobalData

As a result of biosimilars slow entry into the US market, the FDA is taking proactive measures to ensure the continued growth of the biosimilars market by educating patients and physicians through online resources and information campaigns to encourage more competition and lowered prices of biologics, according to GlobalData, a leading data and analytics company. Despite the FDA implementing the Biologics Price Competition and Innovation Act (BPCIA) in 2010 to create an abbreviated pathway for biosimilar drug approval, there are only nine biosimilars available on the US market to date and it is estimated that only 3% of spending on biologics may face competition from biosimilars, according to The New England Journal of Medicine. A superficial detail that presents an educational barrier is the recent biosimilar naming system employed by the FDA. They require the biosimilar to include the non-proprietary name and a suffix that identifies the manufacturer in order to improve pharmacovigilance, but this results in confusion for physicians and patients who might be led to believe that the clinical

effects of the biosimilar differ from the original product. Antoine Grey, MBiochem, Pharma Analyst at GlobalData, comments: “Without a meaningful drive to educate physicians, biosimilars are likely to be dismissed as less effective than their reference products, therefore the financial incentive for entering the biosimilar market is significantly reduced.” Another barrier reducing financial incentive is the tendency of pharmacy benefit managers (PBMs) to continue favoring the original product over the biosimilar, despite discounts. This is because the initial discounts on biosimilars of 15–20% are offset by the likely small population of patients being initially moved to the biosimilar. Grey continues: “As a result, biosimilar sponsors are unable to offer large patient volume-based rebates on their products and PBMs therefore try to limit biosimilar uptake so as to maintain rebate payments.” On top of lacking financial incentives to use biosimilars, manufacturing a biosimilar that is interchangeable with its reference product is no easy feat. A biosimilar designated as interchangeable can replace the reference

biologic at the pharmacy without the permission of the prescribing physician, but FDA draft guidance from January 2017 means biosimilar manufacturers may have to conduct additional clinical studies to demonstrate that “the risk in terms of safety or diminished efficacy of alternating or switching between use of the biological product and the reference product is not greater than the risk of using the reference product without such alteration or switch.” Due to the difficulty of conforming to the FDA’s guidance, no biosimilar has yet been designated interchangeable as of April 2018. The manufacturing process of biosimilars is more expensive and complex compared to generic small molecules which is relatively straightforward. Reference product producers tend to be secretive about their manufacturing practices even after patent expiry, delaying biosimilar development. Furthermore, small molecules can be characterized by analyzing their end products. Grery adds, "The process is not as simple for biologics, therefore biosimilar manufacturers may struggle to replicate the reference product even with a sample of the biologic."

Sleep can affect the incidence of chronic kidney disease Only about 10% to 15% of kidney patients get requisite treatment

Sleep duration is extremely vital for kidney disease patients, a recent research has indicated. It can influence the health-related quality of life (HRQOL) experienced by individuals with chronic kidney disease (CKD). Sleep of adequate quantity and quality is essential for homeostatic regulation, and excess sleep is associated with metabolic diseases such as obesity, diabetes, and hypertension, all of which are risk factors of CKD. Of all the patients who develop end stage kidney failure in India, only 10% to 15% get proper treatment. About 6000 undergo kidney transplant, 60,000 undergo hemodialysis, and another 6000 prefer to take peritoneal dialysis in a year. Rest of around six-lakh people die for want of renal replacement therapy. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President, Heart Care Foundation of India, said, “CKD is characterized by a gradual loss of kidney function over time and may eventually lead to kidney failure, leading patients to undergo dialysis or a kidney transplant. The signs and symptoms are not noticeable until the disease is fairly well advanced, and the condition has become severe. By this time, most of the damage is irreversible. At an advanced stage of CKD, dangerous levels of fluid, electrolytes, and wastes can build up in the body. Those with underlying conditions such as diabetes, high blood pressure, cardiovascular disease, abnormal kidney structure, and a family history of the disease are at more risk. Additionally, those who smoke and are obese can also be potential candidates for CKD over the longer term.” Some symptoms of this condition include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, decreased mental sharpness, muscle twitches and cramps, edema, persistent itching, chest pain, shortness of breath, and hypertension. 24 May-June 2018 w w w. m ed e g a te to d a y.co m

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Some key measures to keep kidney diseases at bay is to monitor and treat conditions and diseases like obesity and Dyslipidemia, respectively. If blood pressure and blood sugar can be kept under control, more than 50% of CKD can be prevented.” Some tips from HCFI. • Keep fit and active, it helps reduce your blood pressure and on the move for kidney health. • Keep regular control of your blood sugar level as about half of people who have diabetes develop kidney damage. • Monitor your blood pressure. It is also the most common cause of kidney damage. The normal blood pressure level is 120/80. Between this level and 129/89, you are considered prehypertensive and should adopt lifestyle and dietary changes. • Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with CKD. Reduce your salt intake. The recommended sodium intake is 5 to 6 grams of salt per day. In order to reduce your salt intake, try and limit the amount of processed and restaurant food. • Maintain a healthy fluid intake. Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing CKD. • Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50%. • Do not take over-the-counter pills on a regular basis: drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.

NEWS Update

Liver Function Abnormalities Observed More in Men from North India, an analysis from SRL Diagnostics • Analysis done basis more than 4.24 lakh samples gathered over three years • Three main liver tests indicated higher abnormalities in men as compared to women As per WHO (World Health Organisation), liver disease has been the most common cause of death in various countries, with India standing at number 10 in the overall ranking. There has been a paradigm shift in the dynamics of liver cirrhosis, with about 10 lakh new patients being diagnosed with it every year in India contributing markedly to the global burden of morbidity, mortality and increased death rate year-on-year.

On the occasion of World Liver day, SRL Diagnostics – a leading diagnostic chain in India – revealed that Northern states may have a higher number of undetected liver-related diseases than other parts of India. The analysis of the test results was gleaned from the four main parameters: SGPT, SGOT, ALP and Bilirubin, along with total protein and albumin. The data is based on more than 4.24 lakh tests done at SRL Labs across India, between the year 2015 and 2017 as part of health checkups for liver function. Alanine aminotransferase (ALT or SGPT), Aspartate aminotransferase (AST or SGOT), alkaline phosphatase (ALP) and Serum Bilirubin are the major biomarkers, which are used in the diagnosis of liver dysfunction. The function of these enzymes is to help speed up (catalyze) the routine and vital chemical reactions in the liver. When liver tissue is damaged, the enzymes come out in blood. Bilirubin is a product of liver’s normal process of breaking down old red blood cells. A healthy liver can normally get rid of bilirubin, but an unhealthy one throws it back to blood. Of all the sample data analyzed, 23.38% individuals showed higher-thannormal SGPT levels while 18.72% individuals showed higherthan-normal SGOT levels, while 16.84% individuals showed higher-than-normal ALP levels. In a gender-wise analysis, men had higher abnormal SGPT and SGOT levels (28.59% and 20.99% respectively) compared to women (15.97% and 15.47% respectively). Similarly, Bilirubin levels were also higher in men (21.82%) compared to 13.45% in women. Though women reflected slightly higher ALP levels (17.18%) compared to men (16.59%). It was also observed that while younger age groups had more liver enzyme abnormalities, older groups had more of albumin and total protein abnormalities. Commenting on the same, Dr B.R Das, Advisor and Mentor R&D, SRL Diagnostics said, “Liver abnormalities are increasing in India, because of rising obesity, alcohol abuse and liver infections. Also, liver disease is no longer restricted to age, as people below the age of 40 are also witnessing incidence of liver diseases. However, the symptoms of liver disease usually do not appear till the disease is well advanced. So, early diagnosis is the key to a better state of liver.”

“Liver is a highly resilient organ. Hence it takes a lot of abuse before throwing up symptoms. Thus, it is imperative that regular health check-up tests are done to catch any anomaly at a relatively early stage, which will allow for easier treatment and increased chances of managing the disease with medication and lifestyle changes. This is especially true for people who live a sedentary lifestyle and do not adhere to a balanced diet regime. Preventive attitude towards health can save a person a lot of trouble in the treatment process,” adds Dr Das

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NEWS Update

Premature ovarian failure is a cause of infertility in 16% of women in Delhi

Most hormonal imbalance is a reflection of lifestyle choices: Nova IVI Fertility consultant Ankita (name changed), aged 33, was married for 7 years and had not conceived yet. She had a history of diabetes and hyperthyroidism. The couple underwent 6 cycles of IUI and 1 self-cycle of IVF, all in vain. When they visited Nova IVI Fertility in New Delhi, it was found that Ankita did not have any eggs left in her ovaries (her AMH being very low and too low follicular count). She was then advised for ICSI with donor eggs. The treatment was a success, and Ankita finally conceived. Dr. Parul Sehgal, Fertility Consultant at Nova IVI Fertility, New Delhi said, “Premature ovarian failure (POF), also referred to as premature ovarian insufficiency, is a condition where there is a physiological decrease in the number of eggs in the ovaries, which could impact the chances of pregnancy at a younger age (less than 35 years). Normally, follicles in the ovaries supply women with eggs until around the age of 40 to 45 – the average perimenopausal age when the supply of eggs is used up. In POF cases, women as young as 30 years old are seen with no eggs in the reserve.” Research shows that nearly 1-2% of Indian women experience signs of menopause between 29 and 34 years of age. Additionally, this figure goes up to 8% in the case of women between 35 and 39 years of age. A study done by Nova IVI Fertility and IVI, Spain concluded that the ovaries of Indian women age six years faster than that of Caucasian women. The implications of this are very serious – couples these days ape the West and delay marriage and thereby pregnancy, unaware that the biological clock of Indian women ticks faster. A more recent analysis found the common causes of infertility in Indian women under the age of 36 to be: 26 May-June 2018 w w w. m ed e g a te to d a y.co m

 Polycystic Ovarian Syndrome (PCOS) is seen to be the most common cause of female infertility, which occurs in about 20% of women  An alarming 18-20% of young women suffer from a low ovarian reserve or premature ovarian failure. Low ovarian reserve is generally believed to occur with advanced age (over 35)  Women cannot conceive naturally if the fallopian tubes are damaged. Tubal factor infertility accounts for about 9% of all infertility cases  Endometriosis – a condition wherein the tissue that lines the inside of a woman’s uterus (endometrium) grows outside the uterus causing painful menstruation – occurs in about 5% of infertile women “Infertility, or the inability to conceive a child naturally, affects both men and women equally. Calling infertility a female problem is a common misconception. The incidence of male infertility is on the rise and it is rampant in cities where people are prone to a stressful lifestyle. Male factor is found in nearly 45% of infertility cases. Many male fertility problems go undiagnosed and untreated, either because attention focuses on their partner or because men are reluctant to get help or unable to find it when they seek,” added Dr. Parul Sehgal. Causes and symptoms of Premature Ovarian Failure (POF) When the ovaries fail, they don't produce normal amounts of oestrogen hormone or release eggs regularly. Lesser number of eggs in the ovaries reduces women’s fertility potential, and makes it difficult

for them to conceive. Lifestyle changes such as smoking, contraceptive pill use, previous ovarian surgeries, anticancer therapies and familial POF are some of the known reasons for low ovarian reserve at a rather young age. Some of the known causes of POF are previous surgery on the ovaries for benign cysts, endometriosis, excessive drilling for polycystic ovaries, etc. X chromosome abnormalities, autosomal causes, galactosemia, autoimmune disorders, cancer treatment, Turner’s syndrome, enzyme defects, and environmental toxins are some other factors leading to early menopause. In some cases, POF may be genetic and run in families. In many cases, the cause cannot be found (idiopathic). Symptoms of POF include having no periods or irregular periods. At times, a woman may get normal periods for a few months and then skip it for the next few months. They may also have other symptoms of early menopause like hot flashes, night sweats, sleeping problems, anxiety, mood swings, vaginal dryness, energy loss, low sex drive, painful intercourse, and bladder control problems. In a country with a population of 1.32 billion, it is estimated that a whopping 30 million couples suffer from infertility. What is even more worrying is the rising incidence of young women facing infertility. A condition which was predominantly seen among older couples, infertility is now seen more frequently in women who are younger than 35 years of age. It is therefore strongly recommended that even young women in their 20s and 30s who face complications in conceiving should immediately visit a fertility expert. Early detection would provide better opportunity for early intervention.

EXPERT VIEWS

The Darker-Side of

Social Media Dr. Naveen Jayaram Department of Psychiatry, Sakra World Hospital, Bengaluru.

In less than two decades of its creation social media has become an inseparable part of our life. It once again stands to prove the fact that man is a social being. The launch of good quality phones in affordable prices and internet packages have further boosted the social media usage in India. Social media helps us maintain connection with friends, family and professional contacts. It helps us create a persona of ourselves and makes us more accountable for our actions. The network of support provided through social media helps people achieve their goals. It helps us understand and accept various new trends in the norms of the society and find like minded individuals. But why does using social media feel so good? The answer is Dopamine. It is a feel-good hormone created inside our body. It is the same chemical which makes us feel good when we consume chocolate, alcohol, smoke or gamble. The lack of age restriction and ease of access has lead to a steep rise in the usage of social media, specially among the millennials. But though it is a driver for change there is a darker side of social media. Social media addition is something each of us are familiar with. Addiction is a compulsive behaviour that leads to negative effects. In this case constantly checking the phone for updates and spending sleepless nights. People build using virtual persona using social media and their happiness is linked to the appreciation of their peers. Lack of the desired response leads to low-self-esteem and in certain cases causes depression. In a time where there is increasing stress from educational institutes and family teenagers today try and use social media as a coping mechanism. They utilize social media to create an ideal personality to try and become highly self-involved that often cannot relate to the realities of life. They are more prone to addiction and it can affect their functionality, which results in poor grades, unsuccessful relationships etc. Coupled with constant posts from friends often leads in creating a sense of insecurity among the teenagers. It false sense of accomplishment becomes hardwired in their brain and as they 28 May-June 2018 w w w. m ed e g a te to d a y.co m

age they fail to form meaningful relationships and often leads to stress. These traits are not specific to teenagers alone, even adults are often victims of social media addiction. It may be as innocent as clicking a photograph prior to ever meal, regular check-in, posts or stalking people. Social media has become more than a tool to communicate. The addiction to social media is stronger than that to drugs. A recent study revealed that people who tend to spend more time on social media are at a higher risk of depression. The social comparison, a belief that leads to inaccurate selfevaluation leads to identity crisis. How to cope with social media addiction The first step towards the solution is the acceptance of the problem. It takes time and conscious effort into breaking the habit. Support of family and friends is equally important as it can help boost the morale. The first step would be to time the period of usage of social media allowing to create time for other activities. Substitute social media time into other activities like sports, hobbies, pets etc. These activities would lead to a more positive release and would help concentrate better. It is important to realise that while social media is an important aspect it needs to be controlled or might lead to creation of a false sense of reality. It is important for parents to understand and help children release stress in a more positive manner.

INTERVIEW

The Women Leader in Healthcare The New Vistas in IVF Sector Please tell us about your journey since inception in the world of Obs & Gynee? My journey has been enriching throughout the years. I was trained in UK and Middle East, after obtaining MBBS, DGO, DNB, MNAMS and M. Med Science in Assisted Reproductive Technology from the University of Nottingham, U.K, I got the opportunity to associated with renowned centers such as Nurture IVF Centre, Nottingham, UK and Farah IVF Centre and Hospital, Jordan. With dedicated years of hard work in India, England and other places, I was able to acquire prodigious expertise in reproductive endocrinology, infertility, ART, High Risk Pregnancy Management, Laparoscopic surgeries and Hystroscopic Surgeries- that too with Minimal Invasive Surgeries. Excelling in all aspects of infertility treatment required constant learning and acquiring new skills. Providing a wide range of services including infertility assessment, embryo development, Intra-cytoplasmic sperm injection, Assisted hatching, Cryopreservation of semen, embryos and ovarian cortical patches has resulted in helping in a very large number of patients not only in India but across the globe.

– Dr. Archana Dhawan Bajaj

My journey is full of joy and at times disappointment too. Sometimes, it was a complete ecstasy when you see a childless couple of 25 years getting their bundle of joy. No words can describe the great feeling swamping me. But at the same time, you have to be ready to accept the failures and be part of the trauma that such failures entail for childless couples. This emotional element is always there, in every IVF case. Over the last 2 decades, I have been passionately working towards bringing best practices to India. The journey so far has been fulfilling.

Please let us know about difference between IVF & Obstetrics & Gynaecology departments? Is there any special training or courses required? Gynaecology is the science of medicine which focuses on treating diseases of the female reproductive system. It can be described as an overarching concept which covers diseases, complications and issues related with females. This mostly involves treatments related to female genital and urinary tract/organs. Obstetrics deals with childbirth and pregnancy. Therefore, most of the modern world Gynaecologists can fit in the role of an obstetrician since it only assists them better to understand the patient’s biology and accordingly treat them. IVF is a specialty that comes under Assisted Reproductive Technology (ART) used for infertility treatment. In simple terms, it is a medical procedure through which an egg is extracted from the female's ovaries and fertilised with sperm in a laboratory. The fertilised egg, called an embryo, is inserted to the woman's womb to grow and develop. Thus gynaecology, Obstetrics and IVF are related to female reproductive system where gynaecology is a blanket concept dealing with a woman’s healthcare not necessarily pregnancy (with a focus on their genitals and urinary organs), while obstetrics deals with a female going through the different phases of pregnancy and lastly IVF is a medical procedure which treats infertility.

Dr. Archana Dhawan Bajaj Gynaecologist & Obstetrician, Nurture IVF Centre

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There are specialised courses both in the field of IVF training and obstetrics while Gynaecology is a field of medicine which can be studied by pursuing an MBBS program which ranges anywhere between 4 to 5 years followed by a 12 months’ internship. For IVF and Obstetrics courses there are eligibility requirements like a BSc, MSc or any other degree with a life sciences background.

INTERVIEW Since you have worked in different part of the world, please let us know about the cause of Infertility and regional effect in different countries? Infertility is a global phenomenon. In a layman language primary infertility is defined as ‘inability to have any live birth’ and secondary infertility as ‘inability to have an additional live birth’. There are several reasons for infertility for both men and women. The most common cause of infertility in females are problems with Ovulation, Damage to Fallopian Tubes or Uterus, or Problems with Cervix. Age also contributes to infertility as woman ages, her fertility naturally tends to decrease. For men, hormonal imbalances, infections, ejaculation issues and stress may result in infertility. With advancement of ART or IVF, developed countries have successfully been tackling the reproductive health challenge. However, developing countries and low income countries are still struggling with the problem. Studies reveal secondary infertility is most common in regions of the world with high rates of unsafe abortion and poor maternity care, leading to post-abortive and postpartum infections. Sub-Saharan Africa still remains a global ‘hot spot’ of secondary infertility, affecting more than 10% of reproductive-aged women overall. Other high-prevalence regions include South Asia, East Asia and the Pacific, Central and Eastern Europe and Central Asia. it is ironical that women are often blamed for infertility, even when it is their husbands who are the infertile partners. Male infertility remains a ‘hidden’ reproductive health condition, even though it contributes to more than half of all cases of childlessness globally. To deal with the problem, I would say that the emergence and expansion of ART have been a positive force.

What are the common cause of Infertility in Men & Women? As I said earlier, the most common cause of infertility in females are problems with Ovulation, Damage to Fallopian Tubes or Uterus, or Problems with Cervix. Age remains a critical issue that contributes to infertility woman’s fertility naturally tends to decrease with age. The common causes of infertility in men include Varicocele, Infection, Ejaculation issues, Hormonal imbalance and Life style issues. Varicocele is the condition when the veins around the testicles swell and results in making your sperms of inferior quality. Sometimes infection may affect your sperm production and quality. Further retrograde ejaculation may cause infertility and it occurs when semen enters the bladder instead of emerging out from the penis during the time of sexual excitement.

Some health conditions that trigger retrograde ejaculation include Diabetes, Spinal Injuries, Medications, Surgery of the bladder and prostate or uthera. Moreover, Hormonal imbalances in Hypothalamus, Pituitary, Thyroid and Adrenal Glands can cause infertility. Reproductive health is intrinsically linked with sex. Issues related with sex can cause infertility in men like erectile dysfunction, premature ejaculation, psychological problems that reduce libido etc. Lifestyle issues like- stress, obesity, alcohol, drugs and smoking can also make you more prone to infertility.

Your message to the newly married couple? My messages to the newly married couple would be to focus on healthy lifestyle for themselves. Plan and maintain your reproductive health well. First I would like to recommend a Thalassemia trait test done for the newly-weds, infact this test is recommended before marriage to avoid a thalassemia major child being born out of thalassemia minor parents. While the couple is planning to start a family, pre conception counselling is must to conclude a pre-conception risk assessment for identifying any risks / complications of pregnancy. Incase you are unable to conceive within a year of marriage, there is no need to panic or lose confidence in the process of reproduction. Natural process is always better however, we have now advanced Assisted Reproduction Techniques to make couples attain parenthood. w w w.medegatetoday.com May-June 2018

EXPERT VIEWS

STILL DEPRIVED OF MOTHERHOOD?

COMMON STRUGGLES IN CONCEPTION AND THEIR SOLUTION With nonstop Mother's Day endorsements and mothers of all age, shapes and sizes being features in news stories feature moms of all ages, shapes and sizes can be a ruthless reminder that your dream of becoming a mother is incomplete. It is a rather difficult period to cope up with the fact that you are childless and infertile. So, all those women who felt empty, lonely and incomplete this mother’s day, let this be the last year of harrowing. Take an optimistic step forward with advanced fertility treatment such as IVF; also remember to overcome its hurdles and leave no stone unturned.

Hurdles of Advanced fertility treatment: IVF Planning and opting for IVF pregnancy is a stressful and emotional task for every couple as this advanced fertility treatment has its own challenges. Many patients undergoing IVF face repeated IVF failure cycles. Success of IVF depends on a lot of factors such as the age of the woman, the quality of the embryo, status of the uterus etc, but one of the principal factors to consider for maximizing the

chances of implantation during an IVF treatment is a receptive endometrium. Researchers in a study have suggested that if a woman is unable to achieve pregnancy even after repeated IVF treatments there is a possibility that these treatments are being performed in the "wrong window of implantation". About 28% of the IVF cycles are done on the wrong day. In an IVF treatment, the focus is usually on the quality of the embryos, looking for the ones which are more likely to result into a successful pregnancy after transferring them to the uterus. But in this process, the function of the endometrium, the lining of the uterus which houses the embryo allowing for its implantation, is often forgotten. For successful implantation the lining of the uterus (endometrium) is equally important as the quality of embryos. Endometrium is the inner lining which is prepared every month to accept the embryo, indeed this is the area where the embryo implants and stays during gestation. Embryo implantation can only be successful if it is carried out between 19-21 days of the menstrual cycle. This is the window of implantation. It is the personalized timing that's unique and specific for each woman. There are many couples who are deprived of the joy of parenthood due to a displaced window of implantation.

ERA ensures a successful embryo implantation To help the couples who are suffering from regular implantation failures, Igenomix has a patented test named Endometrial Receptivity Analysis (ERA), after 10 years of research in this field “ERA has given hope to the couples who want to conceive through assisted reproductive technique. ERA is a state of art diagnostic method evaluating the endometrial receptivity and is performed using NGS technology. ERA determines if the woman is receptive or not, on the day when the biopsy is performed. If the result is positive then that is the window of implantation for that particular patient. Therefore ERA is a personalised genetic test that leads to a "personalised embryo transfer" (PET), a timing based on the test performed on an individual. If the result of the test is negative then a second biopsy is suggested to validate the displacement.” Says Dr. Rajni Khajuria, Lab Director at Igenomix. ERA test by Igenomix analyses the activities of the genes of the womb lining to pinpoint a woman's optimum time for treatment. A personalised window of implantation can increase your chances of a successful pregnancy by 60%. So, if you are childless this mother’s day, take a positive step forward with IVF and ERA and don’t lose hope! 32 May-June 2018 w w w. m ed e g a te to d a y.co m

INTERVIEW

The Women Leader & Social Worker

Working on Women Empowerment, Women Health & Hygiene Tell us your journey since inception? Myself Pari Hamdule A Single Parent who believes in being empowering oneself. Journeys in life have always have all kind of up n downs but that has not deterred my moment n fire in me Infect it has made me more stronger to take all kind of challenges. For me I want to look beyond the I ME and MINE. There is always learning in every step one take. Todays women I feel are fearless and ready to take all kind of challenges as a Single Parent I have removed the fear from me as I feel to motivate myself and empower myself to attain a focus and strike a balance. A women is more confident when she is healthy haven hearty so I decided that why not Hand hold

as many women I can to attain the financial independence so have decided to see different contingency products that are the most in today’s time and a necessity in everyday life. To make this more sustainable I have started a NGO called Tuba Foundation (launched on 1st May 2016.) Tuba Foundation is a platform where it handhold the less fortunate to exhibit them in a confident themself It helps in Education/ learn and earn programs sanitation n health and also creating Awareness programs.

Your personality as a women leader, specially working on women’s hygiene. What are the major steps taken by you in this direction? Tuba WINGS has uplifts the rural sector and wants to uplift these women and make them leaders n entrepreneurs You can feel our presence in 175 parts of Maharashtra to name some, Baramati, Satara, Vita, phaltan, jejuri, Kolhapur, Malegaon, Pune, etc. etc. We are installing 500 vending machines n 500 inclinators this month to mark the Pad man and respect his contribution to our society.

Tell us about your organization “Tuba Foundation” and its vision & mission? TUBA Foundation wants to see our women independent and financially strong .As it’s rightly said a happy home is where a women is healthy n strong Mission of TUBA FOUNDATION ‘EACH ONE REACH ONE ‘

What is your future plans to empower women? Creating awareness in disposal is another medium that we feel that will bring the change as a product responsibility and pledge to save our environment by bringing means by recycling our product waste. As Women I feel the change should come from within us in respect to all changes that need a change in society.

Your message to the women in society?

Pari Hamdule Co-Founder Tuba Foundation

We want to empower our women of society by standing strong and not being gender bias caste or creed Live life king size. Live with Dignity, as it’s your right!!!! Walk with pride And Run with all and see the world is all yours... w w w.medegatetoday.com May-June 2018

DOCTOR SPEAK

I enjoy working in Pharma industry since it gives immense opportunity to stay ahead in scientific knowledge & information I Joined Pharma industry in 1990 after doing my M.Sc (Biochemistry), Scholarship in Pharmacology & Diploma in marketing. I have about 28 years of experience in Pharma industry into various segments such as Oncology, Cardiovascular, neuropsychiatry & Dermatology. Most of my experience has been into dermatology, about 18 Years. I enjoy working in Pharma industry since it gives immense opportunity to stay ahead in scientific knowledge & information, dealing with educated people (mainly Health care professionals), travel & satisfaction of achievement. Challenges as a woman leader Though things have changed significantly over a period of time since the time I joined in 1990. At that time, there were negligible no of Woman working in this Industry since it involved travel. Male colleagues/subordinates were not very open to take opinions or tasks. Travel was not very safe & organized during those days & support system not adequate to take care of children. Therefore, that involved lot of planning & hard work to make work life balance. At times the life gets restricted to work & family & no time for yourself. Moreover, I have worked in ‘Start up companies’ at senior positions, most of my career which throws a lot of challenge dealing with multiple departments & diverse work which was not my forte or never handled before. Everyone looks at me for the solution without me having anyone to suggest. However, I think these challenges have made me stronger & independent & keeps me continuously strive for improving my skills enhance my

Dr. Apratim Goel

Dermatologist and Laser Surgeon Cutis Skin Solution. Mumbai

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learning at fast pace which gives me satisfaction in my life. With this experience, I was ready to tackle all hurdles and challenges of launching India operations for Merz in 2015. About Merz Pharma, a global leader in aesthetics 110 years ago, on March 9, 1908, Friedrich Merz founded the Chemische Fabrik Merz & Co. in Frankfurt am Main, Germany. Today, the traditional company in Frankfurt is still family-owned, but it has evolved from a mid-sized pharmaceutical company into a leading global provider in the fields of medical aesthetics and neurotoxins.

Recent accomplishments/ achievements According to Philip Burchard, CEO, “In the past 110 years, Merz has continued to reinvent itself and has successfully built new businesses again and again.” Our motto: “Trust yourself, be different, and invent products that are truly needed.” Presently it is one of the leading companies worldwide in the area of medical aesthetics and offers an unparalleled product portfolio.

Products offered by Merz India The product range available in India extends from a particularly pure Botulinum toxin to an ultrasound lifting procedure to a Hyaluronic acid based Dermal filler to Skin tightening medical device. Successful regional products accompany these fields of businesses from the Merz Consumer Care division, which offers over-the-counter medicines and dietary supplements. Xeomin is a particularly an innovative product of pure botulinum toxin. The botulinum toxin brands available in the market have complexing proteins in their formulation. Merz R & D and production technology stabilized botulinum toxin even without these complexing proteins. The absence of these complexing proteins minimizes the risk of immunogenicity development in the individual. Botulinum toxin is popularly used for Aesthetic procedures at regular intervals to continue looking beautiful. Botulinum toxin is also a common treatment to improve patient’s quality of life in post-stroke spasticity patients. India is currently facing the challenge of a high stroke incidence where post-stroke spasticity is a common disability amongst such patients. If a regular user of Botulinum toxin develops immunogenicity to the molecule, then this therapy will not be effective at this stage of life. Thus, Merz India innovated the pure botulinum toxin that has no complexing proteins and hence minimal risk of immunogenicity. Many doctors in India are happy with this innovation and are using pure botulinum toxin for treating their patients. Dr. Apratim Goel, Dermatologist & laser surgeon, Cutis Skin solution, Mumbai, also expresses that

DOCTOR SPEAK

Gut Bacteria helps keep immune system healthy

Dr Roy Patankar

A leading Gastroenterologist & Director of Zen Hospital Gut and stomach plays an important role in maintaining the overall health of the body. The gut helps other organs to stay healthy as the good bacteria within the stomach help in digestion by breaking down carbohydrates into small chain fatty acids that promote its absorption. In the absence of good bacteria, carbohydrate breakdown stops, can lead to diarrhea. This makes it essential to consume a balanced diet which includes enough fruits, vegetables, curds and fermented foods. Ensure to maintain a balanced diet at all times. As antibiotics are not able to figure the appropriate bacteria to kill, it ends up harming some of the good bacteria. This has a huge impact on the gut bacteria and affects the immunity system as well. In certain countries in the western world, fecal transplantation has been introduced to balance out the bacteria in the gut. This has been getting a good response in other countries, however within few years it will hopefully be introduced within India as well.

Homemade yogurt is the best remedy to generate probiotics; it has protective bacteria that helps improve gut. There are no food items that can help the bacteria to foster. However, oral antibiotics, surgeries or chemotherapy can lead to reduced number of good bacteria in the stomach or gut. Our digestive health is directly impacted by the foods we eat and the lifestyle we live. By taking steps to improve your digestive health, you'll help your digestive system to function more efficiently, improving your overall health and sense of well-being. Regular consumption of balanced diet helps to maintain the flora in the gut which helps in maintaining good health. Try these 10 tips for better digestive health: Eat a high-fiber diet: To consume a diet that's high in fiber A high-fiber diet helps to keep food moving through your digestive tract, making you less likely to get constipated. High-fiber diet can also help you prevent or treat various digestive conditions, such as diverticulosis, hemorrhoids, and irritable bowel syndrome (IBS). In addition, it can help you achieve or maintain a healthy weight. Get both insoluble and soluble fiber. It's important to consume both types of fiber, since they help your digestive system in different ways. Insoluble fiber, also known as roughage, can't be digested by the body and therefore helps add bulk to the stools. Soluble fiber draws in water and can help prevent stools that are too watery. Good sources of insoluble fiber include wheat bran, vegetables, and whole grains; get soluble fiber from oat bran, nuts, seeds, and legumes. Limit foods that are high in fat. In general, fatty foods tend to slow down the digestive process, making you more prone to constipation. But since it's important to get some fat in your diet, it’s said that pairing fatty foods with high-fiber foods can make them easier on your digestive system.

Choose lean meats. Protein is an essential part of a healthful diet, but fatty cuts of meat can lead to uncomfortable digestion. When you eat meat, select lean cuts, such as pork loin and skinless poultry. Incorporate probiotics into your diet. Probiotics are the same kind of healthy bacteria naturally present in your digestive tract. They help keep the body healthy by combating the effects of a poor diet, antibiotics, and stress. In addition, probiotics can enhance nutrient absorption, may help break down lactose, strengthen your immune system, and possibly even help treat IBS. It is recommended that people eat good sources of probiotics, such as low-fat yogurt or kefir, on a daily basis. Eat on schedule: To consuming your meals and snacks on a regular schedule can help keep your digestive system in top shape. Aim to sit down for breakfast, lunch, dinner, and snacks around the same time each day. Stay hydrated. Drinking plenty of water is good for your digestive health. Fiber pulls water into the colon to create softer, bulkier stools, allowing them to pass through more easily. Skip the bad habits: smoking, excessive caffeine, and alcohol. Liquor, coffee, and cigarettes can interfere with the functioning of your digestive system, and lead to problems like stomach ulcers and heartburn. Exercise regularly. Regular exercise helps keep foods moving through your digestive system, reducing constipation. Exercise can also help you maintain a healthy weight, which is good for your digestive health. Make it a point to work regular exercise into your weekly schedule. Manage stress. Too much stress or anxiety can cause your digestive system to go into overdrive, according to Adams. Find stress-reducing activities that you enjoy and practice them on a regular basis. w w w.medegatetoday.com May-June 2018

EXPERT VIEWS

World Health Day 2018: Universal Health Care for all Universal Health Care has become a fundamental principle guiding much of Public Policy and Healthcare Services in countries around the world. The basic premise of this construct is to alleviate the financial costs associated with healthcare while increasing individual access to these services. The World Health Organisation has designated the theme for 2018’s World Health Day to be ‘Everyone, Everywhere’, an indication that nations around the world are aspiring to provide higher accessibility of healthcare to their citizens. Time is therefore right for stakeholders in the public and private healthcare delivery systems and the medical education ecosystem to collaborate and drive the agenda of universal healthcare coverage for India.

Vishal Bali

Co-founder and Chairman, Medwell Ventures

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The Government seems to have given the principle a tacit approval, as demonstrated by the impetus placed on Public Healthcare in the 2018 Budget. Upon implementation, India is set to have the world’s largest public health care programme that would cater to half a billion of its citizens. Modicare has lofty goals to fulfill as it aims to ensure that nearly 10 crore vulnerable families would be entitled to coverage of up to Rs 5 Lakhs a year. India is amongst the group of countries with the lowest proportions allocated to healthcare globally. This policy would help ensure a minimum standard of coverage offered to citizens, improving accessibility and health outcomes for the masses. Apart from this, there are indications of a New Pharmaceutical Policy that is likely to be introduced that would run in tandem to help ensure the effective implementation of the Modicare plan.

While a change in public policy and discourse is one end of the spectrum that governs Universal Healthcare, it’s effective implementation is governed by stakeholders in the Healthcare Industry. For a country where public healthcare spending has traditionally been less than 1% of its GDP, private healthcare delivery has taken monumental strides to improve accessibility and delivery of healthcare services in the country. The start up ecosystem in healthcare which has contributed to the rise in use of digital technologies in various facets of healthcare has also played an important role in the market. Right from the use of health applications by consumers, data mining and analytics for personalized service offerings, digitization of health information and records, or even leveraging Artificial Intelligence (AI) for a varied array of functions specific to the industry, the trends in healthcare seem to move towards improving access, delivery and personalisation. The diagnostics industry is similarly transforming disease detection with innovative technologies. Another important trend seen is a rise in the adoption of Home Health Services, where access to quality healthcare is not limited to institutions like hospitals; instead, it can be delivered to the patients' doorstep. This would make it easy for individuals to access Clinical and Non- Clinical Care despite time, distance, monetary and other restrictions. All these changes happening in the industry will collectively contribute to the idea of Universal healthcare in India. When these trends are analyzed cohesively, they leave us with the impression that the consumer with various new technologies at their disposal will define the movement of Universal Healthcare. This is a promising sign for the future and hopefully will lead towards a healthier country.

DOCTOR SPEAK

Importance of Critical Care-New Trends,

how awareness and education will help make a difference

ntensive care medicine, also referred as 'critical care medicine' is a speciality concerned with management of critically ill patients who are at-risk, or have developed potentially life threatening failure of any of the body organ systems. It is a speciality involving holistic care of all aspects of critically ill patients. This includes diagnosis, monitoring, treatment and organ support for acute illness, patient safety, end of life care, ethics and the support of families. While other specialities have a predefined role of managing a single organ, in intensive care medicine, the entire spectrum of medical and surgical pathologies are managed. It is a lifesaving and dynamic branch with the responsibility of managing the sickest of patients in hospital. An intensivist is able to provide advanced organ support during critical illness and co-ordinates with other specialities for the care of ICU patient. Till about two decades ago, there was a scarcity of a structured training program in ICU management. But there are now formal recognised courses in our country in the field of intensive care medicine like FNB (Critical care Medicine) by National board of examinations, IDCCM and IFCCM courses run by the Indian society of critical care medicine (ISCCM). MCI has recognised critical care medicine as a superspeciality. Of late awareness about critical care and intensive care facilities has come into focus. There is increased understanding among general public about the difference in care between an ICU and ward patient. Recently several TV channels had shown several ICUs in big cities with no MBBS doctors. Now the authorities have made it mandatory to have qualified and ICU trained doctors to work in ICU. This should be ensured at all times. A well-equipped ICU is able to provide facilities i.e. respiratory support, renal replacement therapy (kidney support), radiologic bedside investigations, echocardiography, ECMO therapy, IABP (for support to the heart) to name a few. Also, in-house microbiological (infection) and several radiological investigations facilities are a must. Because of the very nature of high tech, high intensity work involved, the care

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in ICU thus comes at a substantial cost. To be able to deliver optimal care lot of equipments, and manpower like intensivists, nurses, technicians, physiotherapists, dieticians, occupational therapists are required. There are scant data on the organisational aspects, case mix and practice patterns in India. A closed ICU is defined as one in which final orders for the patient were written by the ICU team; an open ICU defined as one in which care of the patient was directed by non-ICU doctor teams, and orders could be written by nonICU team doctors. The most common ICU is however an open ICU with mandatory critical care consultation, with shared responsibility of ICU and non- ICU teams. As Comparative data with the west is lacking about critical care facilities no conclusion can be drawn, but it is understood that with rising number of private sector hospitals and upgrading govt hospitals the focus has been on providing better critical care services. This is both in terms of number of beds, ICU armamentarium and services. Upgrading ambulance services – both road and air ambulance has further pushed the need of ICU beds in super specialty centres. Upto 15-20% of the beds are being dedicated to Intensive care in recent times.

A hospital information system with electronic record keeping is not available universally but hospitals are realizing the importance of digital records / data and imaging. This enables bed side viewing of results, prescriptions, safety alerts apart from faster data transfer and safe record keeping. In future the advances in the field of genomics and metabolomics will give us better understanding of the disease process and hopefully a treatment modality that will be individually tailored to the patient. Conclusion Critical care medicine is an important part of healthcare system in the developed world and is one of the fastest growing medical fields especially in terms of patient numbers. It is now slowly being felt and recognized in developing countries where a major challenge is to ensure adequate infrastructure, training, equipments and funding for these newer members of the critical care arena.

The need for ICU care is being emphasized for advanced monitoring as it contributes to – pre emotive / timely diagnosis and management that provides medicolegal safety. In the Indian context the major challenge is providing adequately trained nursing staff and paramedics. As the nursing turnover is high due to several reasons, going abroad being foremost – a fresh look at developing a staff retention policy is needed. Technicians (dialysis/radiology) physiotherapists dieticians, occupational therapists are not readily available at all centres. Telemedicine is an important modality in these times. Several satellite ICUs can be linked and expert opinion can be sought in real time. There are no head to head trials demonstrating a direct benefit of eICUs but it is presumed that remote expert opinion and supervision would translate into benefit of the critically ill in these ICUs but cannot be compared with closed ICUs.

Dr. Yatin Mehta Chairman Institute of Critical Care and Anaesthesiology, Medanta – The Medicity

DOCTOR SPEAK

6 advises you can give to a couple facing fertility issues Dr. Lavanya Kiran, Gynecologist at Narayana Healthcare’s Women’s and Child Institute has written a piece on "6 advises you can give to a couple facing fertility issues". Planning a baby is one of the biggest steps in a couple’s life. As one in every six couples face fertility problems in India, this whimsical process of making a baby ends up becoming strenuous and stressful for many. Well, even though some fertility problems are not preventable, there are certain vital actions one can take to help initiate your new beginning. So, if any of your close ones have been trying to get pregnant for quite some time without success, Dr. Lavanya Kiran, Gynecologist at Narayana Healthcare’s Women’s and Child Institute gives you six smart tips that you SHOULD share with them. These will ease their stress and help them get pregnant faster.

Eat healthy

While many couples don’t focus on this, food and fertility are closely linked. Help your body in conceiving by consuming a balanced nutritious diet of vegetables rich in vitamins & iron like spinach, broccoli etc., whole grains (whole wheat, brown rice, millets etc.) and protein like paneer, eggs, fish, soya etc. Also, reduce the intake of processed foods, maida and sugar from your diet.

Be fit and active

By this, we definitely do not mean over exerting yourself. But following a daily regime of doing moderate physical activity improves hormone balance, blood flow and maximizes your chances of getting pregnant. Avoid straining yourself in order to stay slim, instead maintain a healthy weight. Try brisk walking, light jogging, cycling and sports like swimming to help overcome infertility.

Track your fertile days using a Fertility Monitor

Reduce stress and anxiety

We know how daunting the process of getting pregnant is. However, letting yourself get affected by the constant pressure of starting a family can affect the chances of getting pregnant. Stress and anxiety tend to reduce the release of fertility hormones and can even suppress ovulation. So, the next time you think your stress levels are reaching for the roof, try meditating or doing yoga to calm your nerves.

Share your feelings and talk about it

Building up emotions within oneself is really not ideal for getting pregnant. Talking about it out to your partner or a confidante will not only help you relieve yourself of the builtup tension but they might be in a better position to share a viable solution. Many times, talking to friends and family and sharing your inner thoughts can help you combat bouts of anxiety.

Reduce caffeine and stop alcohol consumption

Cutting down on caffeine and eliminating alcohol can also improve your chances of conception. While moderate amounts of tea or coffee is safe, you shouldn’t have too much. Alcohol, on the other hand, is definitely a no by all means and can aggravate problems like irregular periods and lack of ovulation. Fertility issues are very widespread these days and affect millions of couples in India. These simple tips of following a healthy lifestyle and tracking fertile days using fertility monitors can go a long way in helping couples conceive naturally.

It is possible to get pregnant only during a few days every cycle. That is why it important for couples to educate themselves about their most fertile days as every woman has her own unique cycle which is controlled by their hormone levels. Therefore, using fertility monitors which identify up to 6 fertile days of your cycle can help you a lot. Fertility monitors from brands like Inito, Daysy etc. are gaining popularity as they can help you identify up to 6 fertile days of your cycle. These are at home tests that make tracking your ovulation cycles easy and convenient and have been proven to increase chances of getting pregnant naturally. w w w.medegatetoday.com May-June 2018

DOCTOR SPEAK

Creativity: An Antidote to Depression “Be positive in the spirit of something that is dark to you” "It is very important for us as human beings to have a power within us to convert negativity into positivity. With this even if at the end of the day, any negative comes to you it will be an opportunity and a challenge to take out something positive out of it. If you can be creative about it and challenge your mind, heart and senses and be positive in the spirit of something that is dark to you, it can still bring out the light. It will be the reflection of your own confidence, virtue and strength”. This World Health Day 2018, let’s throw some light on stress, anxiety and depression affecting an individual’s physical, mental and emotional health. It begins a fight within ourselves each day while keeping up the pace to survive with growing expectations, technologies and cerebrally focused culture. Too much stress or anxiety caused by negative thoughts and emotions which surrounds us may often lead to depression. The best way to combat it is expressing it in different ways. It is said that creativity is an antidote to depression, stress, and anxiety. Creating something original out of your feelings or mood can be satisfying in itself. Dr. Ranju Nakipuria, MBBS MS (Gynaecologist and Obstetrician), said, “Most of the people have gone through the phase of unhappiness, sadness, dullness of different intensity at different ages.mostly this phase is temporary and passes off with a favorable atmosphere.If it persists more than two weeks, it should be considered as depression which is a mental illness.In severe cases, there is a suicidal tendency also”. “Like other diseases, it it treatable. Psychiatrist mostly advice antidepressants along with counseling sessions.Other health issues should also be treated simultaneously”, she added. Sagar K. Datta, Author, Sanaz, said, “In order to be the practitioners of positivity, serenity, optimism and goodness to fight any negative feeling amongst us or to have it remove and to particularly combat depression, it is very important that we preach, we serve ourselves and pursue a positive or any possible creative activity which allows our heart, mind and soul to vent out everything that is between us”.

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“My way of trying to vent out depression was to convert it into a beautiful phrase, verse or a Shayari which is meaningful and well understood. I found my peace of solace in Shayari”, he added. On World Health Day 2018, as an individual, let’s take a step towards maintaining our mental health through creativity. It is the quintessential antidote for the hectic, too often virtual, the approach we take to live today. You don't have to be an artist to create a masterpiece, and you don't have to show your work to anyone if you don't want to. Just keep it to yourself. It is never too hard to get started. Pick up an old hobby or look for a new one, try one of these tips:

Pen it down Maintain a journal or a diary. With this, you will have a space to share each day’s activity, thoughts (positive or negative), secrets and whatnot. Use it to write down fears and worries. Sometimes, having an outlet in this way can be soothing and ease your mind. Another good way is to write at least five things down every day that you are grateful for. This forces us to think more positively and can help to remind us that things are never that bad.

Modeling clay Remember how much fun it was to play with modeling clay. No one is stopping you from doing the same. Become a careless and happy kid again! Make square apples or circular bananas, or different, unusual animals, just make anything you like. Mold it the way you want it to be!

DOCTOR SPEAK

Paint it out:

Create your life.

Every time you create art, you are taking a picture in time. Like a snapshot from a dream, it can reveal what you need to know, and it's yours to keep. Let your mood choose the colors and your thoughts shape the painting. It will reveal the world you want to live in.

Create it through everything you deal with. Use art in multiple manners such as painting, photography, poetry, designing and created a career built on your passion. Even when you want to end it all, you will be able to create a life. Try to find the light within you and go straight through it and come up with something brighter. I created myself as I wanted to be.

Connect with friends and family: This can be one of the hardest things to do when feeling depressed, but it is one of the most rewarding activities. Force yourself to go out. Isolating oneself from others may seem a good idea, but put a limit on it and then get out there again. This can have a huge positive effect on your mood. Build relationships with your family and friends, it will help you build yourself again. Mold in your path in a way that will work for you. Not everyone is same anyway!

Being an individual you have to paint your own canvas. The outcome will be happiness, understanding and a positive life to live. And at last, don’t miss your doctor’s appointment. It is always necessary to consult a professional and follow the guidelines.

Plan a vacation: Plan a vacation and do it. Trips often work as a “restart” button. Travel solo or with friends it is a wonderful way of learning how other people live, how they cope, how they enjoy, what they eat, etc. As a result, you are inspired and eager to enjoy life to the fullest. Choose any place you want. It’s up to you!

Forgive Others: When we hold a grudge, we are the ones that feel the anger. The person whom we are angry with is probably merrily going about their business completely oblivious to your feelings. Don’t allow others to have this power over you. They have may have caused you grief in the past, try not to allow that grief to continue – it only affects you, not them. Find a way to forgive – they are not worthy of your time. Lighten the emotional load and you will improve your mood and help you to overcome negativity.

Don’t give up Depression can make you want to hide away from the world and disappear. It’s okay to take some time out, but give yourself a time limit and then do something productive to improve your mood. Depression can be well managed and there can be a wonderful life beyond depression. Hang in there and keep the faith.

w w w.medegatetoday.com May-June 2018

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Natural remedy for Sleeplessness or Insomnia

Dr. Naresh Arora

The author is Founder of Chase Aromatherapy Cosmetics

This is a very common scenario in worldwide nowadays. Millions of people find difficulties to fall asleep according to biological clock. You want to sleep early, but your mind runs you to another direction, it insists you to chat with a friend, or scroll Facebook aimlessly or watching a video on Youtube. Beside try to sleep you get glued into the social media. This sleeplessness is called â&#x20AC;&#x2DC;Insomniaâ&#x20AC;&#x2122;. Among the various Life Style Disorders affecting all and sundry are Hyper tension, Stress, Depression and INSOMNIA. High paced life style, increased time tables and the desire to earn quick 42 May-June 2018 w w w. m ed e g a te to d a y.co m

DOCTOR SPEAK

bucks have added to this suffering. Over worked body and mind, haphazard diet scheduling and over dependence on Junk Food also leads to such life style disorders. Insomnia can affect a person for many reasons. This disorder takes a toll on a person’s physical and mental health, both. Study says in USA 30-40% adults are affected by Insomnia, where 10-15% adults state that they are facing this disorder as a chronic one; in India more than 10 million adults are facing this sleep disorder problem. The main reasons behind it is a person is trying to accomplish all his jobs, all his duties in one order; means he has to earn more money, so he stays late at office; he also has to attain a party, so he attends the party after the office. Everything in his life is perfect but one thing is missing, that is sleep. Many of us don’t know that our brain has a sleep cycle and a wake cycle. If sleep cycle is on working mode then the wake cycle remains off as it will rise when sleep cycle stops working. So when someone get affected by Insomnia his these two cycles work on the either side of the biological system. This unhealthy sleep habit can affect a person’s life very badly. A person finds difficulties in falling asleep and staying asleep; and this leads to low energy, concentration problem, mood swings, low performance in school or work.

sleep disorder. You can use Basil (Tulsi) Oil, cedar wood oil, cypress oil, juniper berry oil, lavender oil, rosemary oil and winter green oil. Just put 1 or 2 drops into the water bucket. Essential oil has one special thing in it, it is transcutaneous, means it can invade your skin and enter into it.

Most of people who suffer from this sleep disorders face so many problems in daily life. A person drowns into stress, facing some psychological disorder too. They may encounter with anger, as their mind is not working properly. Some people stay late at office, they work late by sitting on a chair, this leads to affect your spinal cords and can create back pain.

Warm water works wonder on our tired body. If someone has no time for a hot shower before heading the bed, he can put his legs in warm water for hours. It is a really helpful way to relax after a long hectic day. In this remedy, the foot hydrates your skin, smoothens your muscles and help you to relax and this leads you to fall asleep soon you hit the bed.

A person affected by Insomnia need to consult a doctor if his problem stays more than 3 or 4 weeks. Some people are afraid of treatment as they feel with the medicines side effects which will affect more. But it can be cured by natural remedies too. All you have to do is maintaining a right lifestyle for you and sleep according to your biological clock. We all need the 8 hours of sound sleep to lead a good life. Sleep is really important for our health. One, who faces Insomnia, can try a simple natural remedy in home; before going to bed take a warm shower. It is like an exercise, the hot shower will help you to fall asleep soon you hit the bed. After the hectic whole day you need to calm your muscles and cool down your body to get a beautiful sleep for which you may have to dip your feet in luke warm water in a foot bath tub or Bucket.

In that way essential oils can affect your body chemistry and the aroma helps you to head the mesmerizing world of falling asleep. Lavender, Jasmine, Neroli, Ylang-ylang are very useful for this natural oil therapy for Insomnia. Scientists say that the oil, specially the lavender one, takes an entry to your blood cells after the 5 minutes of applying. The soothing and calm effect of essential oil can prevent you from sleeplessness. The smell directly hits your brain and evaporative natural compounds of the oil are inbreathed.

For decongest/ relax your body muscles and tissues, you may add one teaspoon of Epsom salt/ Dead Sea salt. Foot bath also prevents your skin from unwanted bacteria, decreases your leg pain that you gained from the whole day. In that warm water you can also put some essential oil to help you more to relax. Essential oils are very useful for this w w w.medegatetoday.com May-June 2018

EXPERT VIEWS

Medical Value Travel in India M edical Tourism Market is projected to grow from US$56.333 billion in 2018 to US$136.591 billion in 2023, growing at a CAGR of 19.38% over the forecast period. Continuous rising medical costs in the U.S. and Europe with improved standards of healthcare technology in developing nations like India and China are driving the growth of medical tourism industry. Other factors such as rising aging population worldwide, availability of affordable world-class medical facilities in emerging economies, and high medical insurance costs in developed regions are also boosting the demand for medical tourism globally. APAC region has become the new hub for the medical tourism industry as countries in this region comprise high standards of hospitality with wide exposure to latest technology in the medical sector. Availability of low priced medical treatment options coupled with improved infrastructure in terms of healthcare facilities is making Asia Pacific an attractive location for medical tourism. While countries such as Thailand, India, and Malaysia have already become key regions for medical tourists, several new countries like UAE and Taiwan are becoming new players in the global medical tourism industry. Growing demand for specialized surgeries such as breast augmentation, dermabrasion, and rhinoplasty and better pricing of such cosmetic surgeries in these countries will further fuel the growth of medical tourism market during the forecast period. Medical Tourism in India is on a faster pace of growth compared to the previous years. The growth percentage is almost 25 per cent in Medical Tourism. The specialising hospitals in India also are gearing up their Patients Relations Protocols to make the patient experience comfortable. The official figure of the

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Deepak Pawar

Trade Fairs Division, Federation of Indian Chambers of Commerce (FICCI) Ministry of Tourism suggests that there was an increase of 1,27,142 foreign patients during 2016 compare to the figures of 2015. In 2016, Medical Tourism arrivals was 3,61,060. The Indian Medical Tourism Industry is expected to grow to US$8 billion by 2020 from the US$3.9 billion of 2016.â&#x20AC;?

Opportunities for India Thus in order to emerge as preferred global destination for MVT, India needs to diversify its sources of medical tourism and offerings to create a strong value proposition

EXPERT VIEWS

In the short term

Registration of medical facilitators

India can focus on increasing penetration in its established markets with offerings where India enjoys a clear edge.

 NABH has started accreditation programme for empanelment of facilitators.

In the medium term

 As of now 6 Medical Facilitators has been certified by NABH and are listed on their website. Another 4 have applied

India should focus on developing other regions which contribute to majority of MVT patients like US by leveraging its existing treatment capabilities. Within new offerings, India can start building its credibility in treatments like weight loss surgery, spine surgery and infertility etc. to further penetrate into its traditional patient sources. In the long term, India needs to target remaining regions like Canada, Eastern Europe etc.; it also needs to expand footprint in offerings such as cosmetic surgery to effectively tap into these regions

Summarizing FICCI Activities

We at FICCI closely working with the Government of India for the Promotion of MVT in India

 A sub-committee was set up by FICCI MVT committee, to address the various issues faced by medical facilitators and hospitals in managing international patients  Committee has outlined series of recommendations to facilitate the engagement between healthcare facilitators and healthcare services providers in India

Self regulation by providers

 FICCI has created a task force that is working on creating a framework for grading of hospitals  The framework will leverage experience of from other

international accreditation programs for MVT Some of the Key Recommendations of FICCI to Govt. of India  Approximate range of medical treatment expense and duration is now being mentioned on the portal managed by Streamline the visa issuance process Introduction of E-visa for Medical tourists

SEPC i.e. Indiahealthcaretourism.com

 Separate category of visa has been launched i.e. “e-Medical visa” for short term medical treatment

 Select hospitals catering to MVT travelers have published tariffs of 10 most common procedures, on their website

 Applicants from nearly 161 countries are eligible for e-tourist visas

We need to resolve following issues for the growth of MVT Industry in India

 Window for application under e-visa scheme has been increased from 30 days to 120 days

 Visa Regulations  Visa Regulations

 Provision has been given for multiple entries (up to three)

 Registration & Guidelines for Facilitators

 Visa fees for travellers coming from Oman has been reduced

 Price Regulation & Capping  Wages

Build on ‘Brand India’ as medical value destination  Patient Rights  Ministry of Commerce and Industry along with Service export promotion council (SEPC) has launched a healthcare portal, Indiahealthcaretourism.com  Portal provides comprehensive information to medical travelers

 Streamlining Health Insurance  Self Regulation by Providers  Grading of Hospitals

 Portal highlights capabilities / advantages of India as MVT destination such as availability of more than 20 JCI accredited hospitals, zero waiting time, availability of qualified medical staff etc.  Government has set up separate immigration counters and facilitation desks at key Indian airports namely, Delhi, Mumbai, Kolkata, Chennai, Bengaluru and Hyderabad to assist medical tourists  The Ministry of Home Affairs has done away with the FRRO clause for medical patients with only exceptions being Pakistani and Afghanistan nationals that still need to register at FRRO / police stations w w w.medegatetoday.com May-June 2018

DOCTOR SPEAK

Quality and safety are inextricably linked Quality in health care is the degree to which its processes and results meet or exceed the needs and desires of the people it serves.

The components of a quality management system: that can be implemented. One of the fundamental steps to Reliable processes. Decreasing variation and defects focusing on achieving better outcomes. Using evidence to ensure that a service is satisfactory. Patient safety is the central aim of quality. Patient safety (WHO) is the prevention of errors and adverse effects to patients that are associated with health care. Safety is what patients, families, staff, and the public expect from Healthcare organizations. While patient safety events may not be completely eliminated, harm to patients can be reduced, and the goal is always zero harm. Organizations are complex environments that depend on strong leadership to support an integrated patient safety system that includes the following: 1. Safety culture. 2. Validated methods to improve processes and systems. 3. Standardized ways for interdisciplinary teams to communicate and collaborate Safely integrated technologies. In an integrated patient safety system, staff and leaders work together to eliminate complacency, promote collective mindfulness, treat each other with respect and compassion, and learn from their patient safety events, including close calls and other system failures that have not yet led to patient harm.

achieving and sustaining improvement in patient safety and the quality of care is to become a learning organization. A learning organization is one in which people learn continuously, thereby enhancing their capabilities to create and innovate. Learning organizations uphold five principles: team learning, shared visions and goals, a shared mental model (that is, similar ways of thinking), individual commitment to lifelong learning, and systems thinking. In a learning organization, patient safety events are seen as opportunities for learning and improvement. Therefore, leaders in learning organizations adopt a transparent, non punitive approach to reporting so that the organization can report to learn and can collectively learn from patient safety events. In order to become a learning organization, an organization must have a fair and just safety culture, a strong reporting system, and a commitment to put that data to work by driving improvement. Leaders, staff, Clinicians and patients in a learning organization realize that every patient safety event (from close calls to events that cause major harm to patients) must be reported. When patient safety events are continuously reported, experts within the organization can define the

Key Terms to Understand

Patient safety event: An event, incident, or condition that could have resulted or did result in harm to a patient. Adverse event: A patient safety event that resulted in harm to a patient. Sentinel event: A subcategory of Adverse Events, a Sentinel Event is a patient safety event (not primarily related to the natural course of the patient’s illness or underlying condition) that reaches a patient and results in any of the following: Death or Permanent harm or Severe temporary harm. Close call or “near miss,” “no harm,” or “good catch”: A patient safety event that did not cause harm as defined by the term sentinel event. Hazardous (or “unsafe”) condition(s): A circumstance (other than a patient’s own disease process or condition) that increases the probability of an adverse event. An event analysis will identify systems-level vulnerabilities and weaknesses and the possible remedial or corrective actions 46 May-June 2018 w w w. m ed e g a te to d a y.co m

Dr. Rajeev Boudhankar Chief Executive officer, Bhatia Hospital

DOCTOR SPEAK

problem, identify solutions, achieve sustainable results, and disseminate the changes or lessons learned to the rest of the organization. In a learning organization, the organization provides staff with information regarding improvements based on reported concerns. This helps foster trust that encourages further reporting.

A fair and just safety culture:

A fair and just culture takes into account that individuals are human, fallible, and capable of mistakes, and that they work in systems that are often flawed. A fair and just culture holds individuals accountable for their actions but does not punish individuals for issues attributed to flawed systems or processes. Care team members should never be punished for reporting the event, close call, hazardous condition, or concern.

Data use and reporting systems:

An effective culture of safety is evidenced by a robust reporting system and use of measurement to improve. When there is continuous reporting for adverse events, close calls, and hazardous conditions, the organization can analyze the patient safety events, change the process or system to improve safety, and disseminate the change or lessons learned to the rest of the organization. Organizations can engage frontline care team members in internal reporting in a number of ways, including: Create a non punitive approach to patient safety event reporting. Educate care team members on identifying patient safety events that should be reported. Provide timely feedback regarding actions taken on patient safety events.

Effective use of data:

The effective use of data enables organizations to identify problems, prioritize issues, develop solutions, and track to determine success. Objective data can be used to support decisions, influence people to change their behaviors and to comply with evidence-based care guidelines. Turning data into information is a critical competency of a learning organization and of effective management of change. When the right data are collected and appropriate analytic techniques are applied, it enables the organization to monitor the performance of a system, detect variation, and identify opportunities to improve. This can help the organization understand the current performance of its systems and help predict its performance moving forward. After data has been turned into information, leadership should ensure the following:  Information is presented in a clear manner.  Information is shared with the appropriate groups throughout the organization .  Opportunities for improvement and actions to be taken are clearly articulated  Leadership provides care teams with time, resources and opportunities for participating in improvement efforts as part of daily work.  Improvements are celebrated or recognized.

A proactive approach to preventing harm:

Proactive risk reduction prevents harm before it reaches the patient. By engaging in proactive risk reduction, an organization can correct process problems in order to reduce the likelihood of experiencing adverse events. In a proactive risk assessment, the organization evaluates a process to see how it could potentially fail, to understand the consequences of such a failure, and to identify parts of the process that need improvement. A proactive approach to hazardous conditions should include an analysis of the related systems and processes, including preconditions(inadequately trained), supervisory influences(inadequate supervision) and organizational influences(inadequate staffing).

Encouraging patient activation

Patient activation is inextricably intertwined with patient safety. Activated patients are less likely to experience harm and unnecessary hospital readmissions. Patients who are less activated suffer poorer health outcomes and are less likely to follow their provider’s advice. A patient-centered approach to care can help organizations assess and enhance patient activation.

This includes adopting the following principles:

 Patient safety guides all decision-making.  Patients and families are partners at every level of care.  Patient- and family-centered care is verifiable, rewarded and celebrated.  The Clinician responsible for the patient’s care, discloses to the patient and family any unanticipated outcomes of care, treatment and services.  Staffing levels are sufficient, and care teams have the necessary tools and skills.  The organization has a focus on measurement, learning and improvement.  Care team members and Clinicians must be fully engaged in patient- and family-centered care, as demonstrated by their skills, knowledge and competence in compassionate communication.

w w w.medegatetoday.com May-June 2018

DOCTOR SPEAK

Where Are We in HIV Vaccine Research?

amfAR Krim Fellow brings us up to speed for National HIV Vaccine Awareness Day, May 18 Dr. Rogier Sanders is a professor of virology at the University of Amsterdam and holds a faculty position at Weill Cornell Medical College in New York City. He was one of the first recipients of an amfAR Mathilde Krim Fellowship in Basic Biomedical Research in 2008. “At a critical moment in my career,” said Dr. Sanders at the time, “the Krim Fellowship helped me move forward.” Today he is mentor to Dr. Marit van Gils of the University of Amsterdam, a 2016 Krim Fellow. Since May 18 is HIV Vaccine Awareness Day, amfAR’s Dr. Rowena Johnston spoke to Dr. Sanders about his vaccine work and the prospects for achieving an effective vaccine in the foreseeable future.

You’ve spent your career studying the HIV envelope protein. What got you interested in it?

I started on this while doing my master’s thesis project with John Moore. The protein immediately caught my interest because it’s crucial in so many ways. In terms of molecular virology, it’s the mechanism by which the virus enters cells. It also plays a crucial role in how the virus escapes from humoral immunity. Third, it will be important to induce antibodies against the envelope protein for a vaccine, and because the envelope protein is so good at evading immunity, this will be quite a challenge. Fourth, the envelope protein can also be a target for therapeutic interventions – there are already licensed antiretroviral drugs against the envelope, and we’ve done some therapeutic work ourselves. This variety of approaches you can take when considering the envelope protein leads to synergy. For example, by looking at the way the virus escapes from therapeutics, we were able to obtain virus mutations that helped us develop a stabilized form of the envelope protein in a conformation that resembles what you find in people living with HIV, which we have used in our vaccine projects You and John Moore worked together to describe the SOSIP trimer in 2002. What is it, and where has that research led? The SOSIP trimer is a soluble and stabilized version of the functional envelope spike. In a person living with HIV, the envelope protein comes in many forms, most of which are nonfunctional. The virus probably uses these as part of a decoy system – the immune system makes antibodies against the decoys. So if we want to force the immune system to make broadly neutralizing antibodies, we hypothesized it would be essential to generate a mimic of a stable, functional version of the envelope protein trimer. We were shown to be correct because SOSIP was the first protein shown to consistently induce neutralizing antibodies that ere effective against viruses derived from patients. There is still difficulty in making antibodies that can neutralize different HIV strains, but various research groups are making progress in this area. When we generated an updated version of the SOSIP trimer in 2013, we quickly realized it would make a good tool to search for broadly neutralizing antibodies in the blood of patients. We collaborated with Dennis Burton’s lab and isolated an antibody called PGDM1400, 48 May-June 2018 w w w. m ed e g a te to d a y.co m

Dr. Rowena Johnston one of the most potent and broadly neutralizing antibodies we have, and this antibody is currently being tested as a therapeutic. The SOSIP trimer was also important for enabling the definition of the structure of the envelope protein. The structure of the protein has now been solved by electron microscopy.

What are you currently working on?

Mostly we continue to work with SOSIP trimers, with a large part of our effort directed towards germline targeting. When the immune system sees a virus, for example, and starts to make antibodies against the virus, it keeps tweaking the antibodies it makes to come closer and closer to the best and most effective version of the antibody. Various research groups have discovered that this process itself, and not just the final product, is important to the effectiveness of antibodies. So we are using SOSIP trimers to get this antibody-making process started, based on the hypothesis that presenting the vulnerable antibody epitopes in their natural context (i.e., the envelope trimer) might optimize the final product. Along these lines, we’re characterizing some very interesting patients in the Amsterdam cohort, who naturally make exceptionally potent antibodies. We are using SOSIP trimers based on the patient’s virus isolates to recapitulate the process these patients’ exceptional antibodies went through to become so potent. Several SOSIP proteins will be tested in clinical trials in 2018−2019. For now they will be injected as proteins, boosted by an adjuvant, and we’ll be looking to see whether it is safe and what kinds of immune responses they induce in humans. In the longer-term future, we hope to use nanoparticle delivery of SOSIP trimers, because we’ve learned from vaccines against human papillomavirus (HPV) and hepatitis B that displaying the proteins on a nanoparticle can induce very potent antibodies.

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Robots and Healthcare Experts are bringing revolutionary change and saving life together Innovative technology in the healthcare field, medical providers and the patients now they can look forward to a brighter, cost effectiveness and more healthy future. In the healthcare industry, medical robots play a vital role in performing complex tasks that require brief attention to every detail because one wrong move may lead to death. As with many robotic medical applications, the robot merely augments the surgeon’s or technician’s skill. Fundamentally, this machine is only a computer-enhanced master–slave telemanipulator which allow the remote manipulation of the instruments in the operative field. The surgeon himself has to perform the operation. The Robot does not do the operation on its own. In this article, we are going to talk about Medical robots in healthcare. THE term robot is a master–slave machine which has taken the speciality of surgery by storm. It has refined a surgeon’s capacity to do precise movements in confined spaces, with minimal blood loss and good surgical outcomes.

Dr. Aditya Pradhan Senior Consultant, Urology, Andrology & Renal Transplant, BLK Super Speciality Hospital

Probably the most widely known medical robot is the Da Vinci Surgical System made by Intuitive Surgical. The teleoperated robot-assisted surgical system has been used successfully on millions of patients since it was cleared by the company based in California, U.S.A. Indications for use include minimally invasive thoracoscopic, cardiac, urological, and gynecologic procedures. The whole system has been designed to enhance a surgeon’s manipulative skills. The machine cuts out all tremors from the surgeon’s hand so that the operative movements are smooth. All the movements of the robotic instruments can mimic a human hand and go even

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beyond the capacity of flexibility of the wrist and fingers of a human hand. When combined with a highly magnified 3 dimensional high definition vision of the surgical field, there is a many fold enhanced capability of doing very precise surgical steps like cutting, suturing etc even in difficult to reach areas in the body like deep in the pelvis or chest. The system consists of 3 components the PATIENT CART which has the robotic arms. These hold surgical instruments that are introduced into the patient through small ports of about 8 mm size. The surgeon operates the machine sitting at the ROBOTIC CONSOLE. By looking inside the view port he sees a highly magnified image of the operative area. At his wrist are 2 manipulators for the robotic arms which move the robotic instruments inside the patient and carries out the operation. At his foot are the additional controls for cautery and switching of movements between the 4 robotic arms. The third component is the IMAGE CART which has an Image Monitor to see the operative field, the Master Controller of the entire robot and communication/ video recording channels.

ADVANTAGES The Da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on a patient-side assistant to position the camera correctly. In contrast, the Da Vinci System's design allows the surgeon

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Radical Prostatectomy operations are done robotically. The other operation includes Parital Nephrectomy for Kidney Cancers, Radical Cystectomy for bladder Tumors, Robotic Pyeloplasty for narrowing of the Pelvis of the kidney etc. The other areas where robots are commonly used are in Gynaecological malignancy like cancers of the Cervix, Ovary or Uterus. It is often utilized also in Chest and Cardiac Surgery and Bariatric Surgery. In all these procedures the big difference noted between Robotic surgery and Conventional open Surgery is less bleeding, less post operative pain and less hospital stay. While some of these advantages were also noted in Laparoscopic Surgery, Robotic Surgery scores far higher than Laparoscopic Surgery in all these dimensions and beyond The operative cost of a Robotic Procedure is higher than conventional or Laparoscopic Surgery. However this is more than compensated by a shorter stay in hospital, with a quick and comfortable recovery. to operate from a seated position at the console, with eyes and hands positioned in line with the instruments and using controls at the console to move the instruments and camera precisely By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the Da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For the patient, a Da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the Da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities

BLK Super speciality Hospital will soon be launching the Centre for Robotic Surgery and offer this cutting edge technology to their patients.

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DISADVANTAGES  Cost of the Device

 LOSS OF TACTILE OR HAPTIC SENSATION The surgeon does not have a “feel “which is often an important aspect of the tissues for the surgeon to judge the nature of disease. Newer technologies are being developed to overcome this problem and may be resolved within some time.

APPLICATIONS of the Da Vinci Robot There has been an explosive development in the scope of Robotic Surgeries in all streams of surgery. By far the frontrunner has been Urology. World over the majority of

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The device itself costs upwards of INR 14 crores and then requires annual maintenance and disposable instruments. This has probably been the biggest hindrance to its widespread use but, as with other new technologies, this is likely to come down with time and greater availability.

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DIAGNOCON 2018 -

a first-of-its kind Conference for the business of Diagnostics

Paniel

Founder & Chief Strategist, AMEN Organized by AMEN, one of India's most successful Healthcare Conference Managers, and Thyrocare, the World's largest Diagnostic center and Pathology lab, DIAGNOCON 2018 held on the 27th of April 2018 at Bengaluru, turned out to be a huge success with participation from various Labs, Diagnostic centers and related businesses from across the country. The Conference, as expressed by a few of the Delegates, was a much needed initiative to bring people from the Diagnostics business on one platform. Speakers and Panelists from across the country shared immense knowledge on various topics and issues related to the Diagnostics business.

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Dr A Velumani, Creator, Thyrocare started off the Conference with his story and the making of Thyrocare. "If you have not seen poverty, you have not seen life", he said. "In 1982 I did not know where the Thyroid was located. In 1992 I finished my MSc and PhD in Thyroid Biochemistry. In 2002 I am running the world's largest Thyroid testing laboratory" he revealed while elaborating on his Topic 'Focus gives Success'. "I focused on the 15 gram gland in the human body and built a brand around the gland", he quipped.

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Assurance & Lab Services , Columbia Asia Hospitals, Dr. Nivedita Jayaram, Lab Director and HOD- Clinical Biochemistry, Strand Life Sciences Pvt. Ltd. and Dr. S K Saran, Consultant, SKS Health Management Advisors

Mr. Kishor Joshi, Global Head – BD & Sales, Teleradiology Solutions spoke on Teleradiology & Emerging Technologies - A pathway for a distributed Diagnostics in a connected World. "300 million is the expected geriatric population in India by 2050 and nearly 270 million Indian’s will be ‘middle class by 2020", he said, while talking about why Diagnostics will grow. "Sub-specialty Tele Radiology reporting, Tele 3D Services for Radiology, Tele-Echo Services to Children's hospitals in India, Artificial Intelligence in Radiology & other Diagnostics etc. are some of the Emerging technology areas within Tele-diagnostics", he added. "Customer focus drives success and is the Key to win, not price alone", said Mr. Bharath Uppiliappan, COO, Dr Lal Pathlabs, while speaking on Pathology Business : Patient Focus. "The Diagnostics' Industry is geared up for INR 600 billion boom driven by Increase in Evidence based Treatment, Focus on Preventive Disease and Wellness and Demand for services for Lifestyle diseases ", he added. He also enlightened the audience on the growth story of Dr Lal PathLabs and their future plans. Mr. Rahil Shah, CEO, NM Medical, Mumbai threw light and shared his knowledge on Innovation & Technology in Diagnostics' Management - Latest Trends & Strategies. He spoke about the Challenges in today's Diagnostic procedures and how they can be tackled effectively with Technology. "The Key Trends in the next 3 years would be 1. Interplay between all disciplines (AI powered

precision medicine) 2. Standardization, Productivity, Efficiency (Automation in Lab & Imaging, Remote Control Cockpit, AI to make Radiologist job easier) 3. Diagnopeutics (Hybrid imaging & therapy) 4. Collaboration & Planning (3D Printing & Mixed Reality) 5. Patient powered healthcare & OPD Insurance (Digitization - Healthcare 4.0)", he said. Mr. Laxman T L, Alumni-IIMB, presented his thoughts on Marketing Labs & Diagnostic Centers. Branding Strategies, Challenges and Ethics. Speaking specifically about challenges and ethics, he stressed on the recently released National Healthcare Policy - 2017 by the government which emphasized on the need to increase regulatory supervision in the sector. He also shared details of branding and marketing strategies implemented by various Labs and Diagnostic Chains and centers across the country and their impact on business development. In addition to talks and presentations by experts, the Conference also had 3 Panel Discussions by almost 5 industry experts in each session. Moderated by Ms. Subhashini Sathyanarayan, Director - Hospital Strategies, K-Arogia Healthcare, the first Panel Discussion was on the Topic Quality Management, Accreditation and related challenges in Diagnostics. Panelists included Ms. Achala Mohan, ConsultantSystem Certification and Accreditation Centre for Management of Quality and Innovation, Bengaluru; Col. Dr Sudipta Datta , (Formerly) Senior VP - Quality

The 2nd Panel was focused on Law & Medico Legal Issues in Diagnostics' Management. Dr. S V Joga Rao, Advocate & Medico Legal Expert, Legalexcel, Bengaluru; Dr. Santosh Saklecha, Director Santosh Diagnostics & Group of Institutions Bengaluru and Dr. Leena Appicatla, Technical Head - South, SRL Diagnostics, Bengaluru formed the group of Panelists for this power packed session moderated by Dr. U K Ananthapadmanabhan, Director, Tenxhealth Technologies, Chennai. The session included discussion on how ethical practices, good patientdoctor communication, Documentation Standards, Regulations, accreditation and Technology can help minimize medico legal complications. The role of NABL in minimizing medico legal complications was also discussed. The Future of Diagnostics in India. Labs in 2025, the 3rd and last Panel Discussion of the day was moderated by Mr. N J Gowri Shankar, Chief Consultant, HSB Consulting, Chennai. Panelists for this session included : Mr. Suman Katragadda, Co-founder & CEO, K-Arogia Healthcare, Mr. Bharath Uppiliappan, COO, Dr. Lal Pathlabs, Dr. S P Ganesan, Medical Director, Hitech Diagnostic Center, Chennai, Dr. Babli Dhaliwal, Director & Technical Head, Central Lab, Bengaluru and Mr. S V Satyanarayana, Strategic Advisor - Healthcare. "We are absolutely thrilled with the success of this Conference and extremely motivated and excited to announce our next edition in 2019", said Mr Paniel, the Founder and Chief Strategist of AMEN. In addition to Thyrocare, the Conference was also Supported by Dr Lal PathLabs, MedReach Events, K-Arogia Healthcare, Actify Data Labs, Benson Medical, FQI – Foundation for Quality in India, and Live Health. Medgate Today Magazine was the official Media Partner for the Conference. w w w.medegatetoday.com May-June 2018

EXPERT VIEWS

Universal Healthcare is Incomplete without Unconditional Healthcare Access Ajoy Khandheria Founder, Gramin Health Care

In the 58th session of the World Health Assembly (2005), universal healthcare was defined as providing access to key promotive, preventive, curative and rehabilitative health intervention for “All” at an affordable cost. In countries where the majority of population either fall in the middle class category or live below poverty level,ensuring healthcare for all means government has to increase public spending. Government of India, for years has spent around1% of GDP on healthcare. In a country where 1 out of 5 people is poor, providing free healthcare to needy was forsaken by law makers. Asymmetricalaccess to all privileges has created a huge gap between people and resources. However, the 2018 Union Budget has ushered insome changes promising a positive transformation in the existing scenario. Shifting gears from the traditional announcements pertaining to the health sector, the most neglected public interest, “healthcare”, hasreceived highimportance. Governmenthas taken responsibility to ensure that health coverage is accessible to the low income strataof the society.

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EXPERT VIEWS

Universal Healthcare Access: A Goal Worth Striving For Universal healthcare access might seem to be an idealistic dream, but it is a worthy goal to strive for. Economies across the world focus on drafting policies of various natures whether it be Obamacare in United States orthe healthcare systems of countries like Britain and Canada, which have made much progress in the direction. In the Indian healthcare scenario, Modicare is being seen as the next big transforming agent. However, universal healthcare is incomplete without unconditional healthcare access, an element which is elusive to discussions around the topic. The idea being that anyone who needs healthcare services should receive healthcare services, without being discriminated by colour, caste, creed, country, race, ethnicity and religion. In a secular democratic republic country like India, two other factors play a major challenge in universal healthcare access, cost and criticality.

How Healthcare Gets Denied Healthcare is not only inaccessible to a large population in the country, but it is also denied to lakhs by being unaffordable. Urban India can still afford medical attention which involves 70% out of the pocket expenditure. Reimbursement of the money comes later through insured agreements. According to the World Bank and National Commission's report on Macroeconomics, only 5% of Indians are covered by health insurance policies. A public health report conducted in 2015 suggested that only 25% Indians have access to healthcare while it is estimated that around 75% of people in India are without healthcare coverage, something which the present government is trying to better by rolling out Ayushman Bharat policy. The plan intends to cater around 10 crore families with health coverage of up to 5 lakhs. However, lack of adequate healthcare facilities, poor and irregular services, absence of doctors and medically trained staff to work in rural India are ground challenges that make healthcare inaccessible to the masses. Only few private players are working in the rural areas, and mostly NGOs with their inconsistent delivery are active seasonally in these regions. In our experience of establishing ourselves as a profit making enterprise while introducing healthcare delivery in rural region, we have realized the value of being physically present through our 100 plus centres (and growing), delivering consistent care.

As outreach initiatives to neighbouring villages, we also run 700 camps,monthly, taking healthcare at the door step of the farmer. Private, for profit enterprises will be complimentary to Ayushman Bharat policy to implement the ambitious plans.

Treatment Denied for Being Critical? Another factor, “criticality” of the patient, needs a due mention. Denying treatment knowing the severity of a patient’s disease is an important malpractice in the healthcare industry which should be corrected. Owing to the duty centric directives of the Medical Council of India’s Code of Ethics Regulations (2002), the doctor’s duty to treat a patient drives more focus than the patient’s right to receive due medical care. On the ground, patients who are deemed as critical and beyond saving are often refused treatment, despite in recent years the judiciary has established right to health, and by implication, healthcare as a fundamental right. Denial of treatment as of today does not stand to be a cognizable offense. As a result, serious patients lose critical time, making their condition worse. Here a larger issue also need to be addressed by being sensitive to the healthcare providers. India also stands to be a land where expectations from doctors are only second to Gods. Also, best healthcare facilities and premium services have a price attached to it, which hurts the family especially if the patient does not survive. Masses need to be sensitized that money cannot ensure life and also towards the humane nature of doctors and practitioners.Taken for granted health and demand for absolute health from doctors thinking them to be god has exerted huge pressure on medical professionals. Dissociating” godliness” from medical professional will pave the way for unbiased treatment. Only a collaboration of unconditional treatment and health awareness can mark the success for universal healthcare scheme. It is only through a strong collaboration and engagement amongst government, NGO, people, and private players can the need for stronger policy mandating unconditional healthcare access be drafted. While universal healthcare will ensure health coverage for all, unconditional healthcare will ensure dignity for all. India today has the potential to become a super economy; it will only be possible when equality and just unconditional healthcare access becomes an essential pillar to the idea of universal healthcare.

w w w.medegatetoday.com May-June 2018

PRODUCT LINE

Snowballs - A revolutionary cooling underwear aimed at tackling infertility in men launches in India Heat: it’s bad for the testicles and lowers sperm count. Forty percent of couples’ fertility issues originate with men, and the major cause of those issues is heat. For men who are trying to conceive a baby, the ideal temperature to store their sperm needs to be slightly cooler than their core body temperature. That’s why the testicles are found outside the body. But now Snowballs are here to help. Snowballs- a revolutionary new cooling underwear aimed at tackling infertility in men has finally launched in India. Snowballs cooling underwear is the brainchild of American Joshua Shoemake, and Snowballs cooling has been scientifically proven to encourage healthy sperm and testosterone production in men by lowering scrotal temperature on a consistent basis, thus improving fertility. Snowballs are a comfortable, stretch organic cotton boxer-brief, combined with a removable ergonomic frozen SnowWedge, which keeps men cool and help them succeed naturally before investing in other risky, more invasive fertility solutions. Snowballs was first launched in the U.S. in 2013 and is available worldwide, with distribution centres in the U.S., Europe, and now India. Shoemake came up with the idea for Snowballs after a friend of his was told by a doctor to cool his genitals in order to help him conceive a baby. They started researching cooling devices, chemical compounds, organic cotton, and ergonomic underwear, eventually soliciting factories all over the world to help produce underwear that would be comfortable and convenient. 56 May-June 2018 w w w. m ed e g a te to d a y.co m

Since the mid-1960s, scientists have been aware that scrotal cooling can improve male fertility, but no controlled tests were done until the mid-1980s when the advantages of cooling were first clinically shown. By then, however, fertility had become a lucrative medical industry, and doctors found it in their interest to promote the most expensive treatments. Simpler, organic possibilities were dismissed despite an increasing number of studies confirming their effectiveness. Regarding the launch in India, Shoemake says, “We had received hundreds of emails over the past few years from Indian men desperately looking for ways to improve their fertility.” He adds,” Male infertility accounts for roughly 40% of all infertility in the world, and the problem is growing fast. India is no exception. Here are just a few statistics from the World Health Organization: 1218 million Indian couples are diagnosed with infertility each year; over the past 30 years, the sperm count of a normal Indian adult male has gone from 60 million/

ml to 20 million/ml; and sperm quality in India is declining by 2% every year. Despite these alarming trends, the rate of infertility treatment is surprisingly low in India, partially because of the expense of IVF, but also because of a reluctance of men to seek help”. The Snowballs Fertility Pack, which retails at INR 4500, includes two pairs of stretch organic cotton boxer-briefs, three unique cooling SnowWedges, and A Gentleman’s Guide to Cooling, a booklet detailing what else men can be doing to maximize their chances at fatherhood. Snowballs is available at www.snowballsunderwear.in and at Amazon.in.

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Delivering Healthcare at people’s doorstep possible by 2022, say experts at Ayushman Bharat Summit

Summit to Realize Ayushman Bharat’s Goal by 2022 Ayushman Bharat Healthcare Summit for Successful Thrust to Ayushman Bharat Ayushman Bharat Healthcare Summit (ABHS) was organised on 16th May at Taj Diplomatic Enclave. The summit brought together all the stakeholders of Ayushman Bharat Program (ABP) like Ministry of Health & Family Welfare, Niti Aayog, State Governments like UP to deliberate upon design and implementation of ABP. Shri Ashwini Kumar Choubey, Minister of State, Ministry of Health and Family Welfare was the Chief Guest on the occasion, while Sidharth Nath Singh (Health Minister, UP) was the Guest of Honour. Hon’ble Sh. Ashwini Kumar Choubey firmly assures “Ayushman Bharat is a people’s movement. It is through mass participation that we can make it successful and mass participation can only follow mass awareness. In this context, what you are doing here today is important. We have to get everyone together on this

and achieve the goal of a healthy, strong, empowered Bharat – Ayushman Bharat”. Ayushman Bharat scheme will reach out to benefit over 10 crore families or nearly 60 crore people with a government funded health insurance cover of INR 5lakhs per person. This is touted to be the world’s largest government health insurance program. Stressing on the need for Summits like ABHS, Swadeep Srivastava, Founding Partner and CBO India Virtual Hospital (IVH) said “Ayushman Bharat is poised to transform healthcare delivery in the country. This massive undertaking will be successful only with active participation of people from all walks of life. We at IVH and Business World believe that this can be achieved by creating conversations around this program which is exactly why we have assembled here today”. All participating experts agreed that the success of this program depends on mass participation and spreading awareness about it would help take discussions out of conference halls into drawing rooms. “Ayushman Bharat is a comprehensive health and wellness mission. We do intend to provide financial protection for hospitalised patients through this but more than that we want it to be a mass movement at the primary healthcare level that will help India reap the rewards of its rich demographic dividend”, said Dr Vinod K Paul, Member, Niti Aayog. Dwelling on the specifics of Ayushman Bharat, Dr Paul pointed out that beneficiaries would be automatically

enrolled under the scheme based on SECC data (Socio Economic Cast Census). The beneficiaries would also be able to avail portability under the scheme and would be treated anywhere in the country with their home state paying for it. Commenting on the occasion, Mr Sidharth Nath Singh, Minister of Health, Government of Uttar Pradesh said, “Ayushman Bharat is a dream come true for health ministers across the country. It will certainly help us address imbalances at the primary and secondary healthcare levels. In fact, this scheme will go a long way in helping us realise our intent of delivering healthcare to the remotest corners of the state through more than 140 CHCs that we have recently set up under the PPP model. The Summit is likely to come up with reliable, sustainable, accessible, and affordable designs, models and policies to implement ABP and bring quality healthcare at the door-step of every Indian by 2022.

w w w.medegatetoday.com May-June 2018

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8th MT India Healthcare Awards 2018 held at Mumbai & Announces Winners of The Year

Medgate Today world’s foremost and India’s leading healthcare and medical magazine organized the “8th MT India Health Care Awards 2018” on March 16, held at Medical Fair India 2018 at Bombay Convention & Exhibition Centre, Mumbai Maharashtra. These awards aim to recognize and honour the leaders in healthcare. Doctors, healthcare professionals, hospitals and health corporations, from all over India nominated themselves for the awards. The selection criteria was a three months screening process, basedon the profile, assessment of achievements and visions, comprehensive online research, customer reviews andpatient satisfaction. Last but not the least, the recommendationfrom the eminent panel of jury was the deciding factor for the winning ticket. Ashwini Kumar Choubey - said, I am happy to learn that over two dozen different companies, organizations and imminent experts including doctors, hospital, medico-technocrats. healthcare product manufacturers, are going to be awarded for their outstanding contribution in the healthcare sector during the year 2017-18. I am sum that the conferment of awards will give encouragement and stimuli to the people, institutions / organizations working in the healthcare sector. “As pathfinders in healthcare, these medical and healthcare experts have the vision, knowledge, resources and the experience to make this country great. They are truly, our greatest asset today and tomorrow, and their support and leadership has made India a better nation.These awards intend to inspire others towards big achievements”, said Mr. Afzal Kamal, Founder & Editor of Medgate Today. Dr. Naveen Nishchal,Chairman, VOH. Mr. Joy Chakraborty, President,VOH-Western region, Dr. M. Wali, Dr. Rajesh Shah Mr. Horst Giesen,Global Portfolio Director, Healthcare and Medical Technologies,Messe Düsseldorf GmbH and Mr. Thomas Schllit,Managing Director,Messe Düsseldorf India Pvt. Ltd. were also present at the occasion along with other dignitaries. The 8th MT India Healthcare Awards 2018 was held on March 16th and 31 professionals were recognized under different categories. The winners are: 58 May-June 2018 w w w. m ed e g a te to d a y.co m

Healthcare Awards HONOURING

EXCELLENCE

2018

Healthcare Awards HONOURING

EXCELLENCE

NAME Sir Ganga Ram Hospital A. J. Hospital & Reasearch Centre, Manglore Anup Institute of Orthopedic & Rehabilation Wadia Hospital International Fertility Centre PushpawatiSinghania Research Institute Sri Ramachandra Medical College & Research Institute (Deemed University) Vanguard Diagnostics( P) Ltd Ohum Healthcare Solutions Pvt Ltd Technomed India Medinain Al-Med Equipments Sai Sumeet Appliances Medikabazar C4 Complete Concept Ninad Raje Dr. Ramesh Sadasivan Dr. Ashish Singh Dr.B.K.Rana Mohd. Ameel Braj Kishore Mishra Dr. Prashanth S Acharya GAURAV MALHOTRA Dr. Sunil Khetarpal Dr. Parul Rajesh Shah Dr. M. Wasim Ghori Dr. Mahesh Gupta Dr. Minnie Bodhanwala Prof. Dr. Sanjeev Bagai Dr. S. P. Byotra Dr. Dinesh Kadam

COVER POST

AWARD CATEGORIES Best Multispecialty Hospital of India – Not for Profit Most Emerging Pvt. Hospital of South India STORY EVENT Best Single Specialty Hospital ( Orthopedics ) of North India Most Admired Hospital ( Not For Profit ) Most Promising Chain IVF Best Hospital in Management & Operations (National Award) Best Medical Entrepreneurship award under the category of best Medical College (private) Best Healthcare Manufacturing Company of the year (In-Vitro Diagnostics) Best Healthcare IT company for Clinical Transformation Best company in OT Table and OT light Most Emerging company in OT Table and OT light Innovative Solution of Infection Control in Modular OT Innovative Designer & Consultant in Modular OT Manufacturer Most Emerging Company in Healthcare Most Healing Environment for Treatment Iconic personality of the year Healthcare Entrepreneur (Home Health Care) Young Doctor of the Year ICONIC PERSONALITY OF HEALTHCARE Outstanding contribution in Medical Devices & Healthcare Technology Best Healthcare Journalist of The Year 'Best Ayurveda Healthcare Practitioner - Entrepreneur of the Year' Healthcare personality of the Year ( Editor’s Choice) Healthcare Personality of the Year(Editor's Choice).) Best Doctor in Ayurveda Young Entrepreneur of the Year (Art in Healthcare) Life time Achievement of the year (Editor’s Choice) Life Time Achievement Award. Life time Achievement Awards in he field of Noenatal & Pediatrics Life Time Achievement Awards (In the field of outstanding services in Medicine Most Enterprising Plastic Surgeon of the Year

w w w.medegatetoday.com May-June 2018

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A National Conference on Interdisciplinary approach to Healthcare, a three day mega event began on May 3, 2018 with Connexions workshop.

An introduction to the workshop & opening address was given by Dr. Rajiv Yeravdekar, Dean, Faculty of Health & Biological Sciences, Symbiosis International (Deemed University) wherein he mentioned that in an individual, emotional quotient is more important than intelligence quotient. He further announced the establishment of the Symbiosis Centre for Emotional Wellbeing. He stressed on the importance of building awareness around the critical role of emotions in teaching, learning, and educational wellness and effectiveness. Dr. Rajiv further mentioned that the Symbiosis Centre for Emotional Wellbeing is based on research and design oriented holistic interdisciplinary educational approach that support people of all ages in developing emotional intelligence and the skills to thrive and contribute to society. The first session was on emotional intelligence & leadership in healthcare by Mr. Virender Kapoor, an internationally acclaimed motivational speaker. Mr. Kapoor spoke on how the skills in emotional intelligence (EI) help healthcare leaders in understanding, motivating & engaging their team better than a conventional approach to leadership in healthcare. He pointed out that leadership is not a science but itâ&#x20AC;&#x2122;s an art. This session gave a new perspective to healthcare leaders and was hugely applauded by the audience The second session by Mr. Ashish Bhatia, Regional Director COO (North and East) Fortis Healthcare India, discussed on the primary requisites & skills required to become a hospital CEO. He spoke on the methods of making your hospital a superbrand by mainly focusing on the essentials of patient satisfaction, patient centric services, clinical engagement & community connect. Dr. Parag Rindani, Associate Vice President, Wockhardt Hospitals, spoke on the challenges faced by hospitals in supply chain management. The main challenges in supply chain management includes items expiring on shelves before reaching consumers & inefficient manual processes and how introduction of information technology can streamline the process & reduce revenue leakage. 62 May-June 2018 w w w. m ed e g a te to d a y.co m

Curtains were raised on the much awaited SYMHEALTH 2018, a National Conference on Interdisciplinary Approach to Healthcare, organized by the Faculty of Health & Biological Sciences (FoHBS), Symbiosis International (Deemed University), SIU Standing true to its promise, the multi-disciplinary conference underscored the importance of applying integrative strategies to the theory and practice of health sciences. The conference forged new dialogues amongst various stakeholders of the healthcare community, bringing in new insights and perspectives from other fields and offered a platform on which to foster intellectual fellowship amongst all stakeholders. Most importantly the conference shaped up as an instrument of global advances in healthcare. The Inaugural ceremony was graced by Air Marshal Pawan Kapoor, AVSM, VSM** (Retd), Former Director General Medical Services (Indian Air Force). The ceremony was also graced by Dr. Vidya Yeravdekar, Pro Chancellor, SIU and Dr. Rajani Gupte, Vice Chancellor, SIU. Dr. Rajiv Yeravdekar, Dean, Faculty of Health & Biomedical Sciences, SIU, welcomed the dignitaries and spoke on the emerging concept of interdisciplinary approach to healthcare, whereby in this era of globalization & knowledge explosion, the shackles of tubular approach must be broken. He described SYMHEALTH 2018 as a confluence of various important stakeholders involved in optimum healthcare delivery. Dr. Rajani Gupte remarked that healthcare is on the horizon of a radical change with evolving technologies making inroads such as artificial intelligence in diagnostics. She mentioned about Telebehavioral health which creates, promotes, and maintains access to behavioral health services through technology. Telebehavioral health offers aid by eliminating travel time and expense for both providers and consumers. Dr. Vidya Yeravdekar announced the opening of Symbiosis Hospital & Research Centre, a standalone hospital made to cater to nearby 23 adopted villages in Mulshi Taluka which are currently poorly served by healthcare facilities. She also mentioned about the Symbiosis Health Science & Technology Park where innovation will be the focus and which will make the Lavale campus of Symbiosis as the university campus of 21st century.

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Air Marshal Pawan Kapoor addressed the audience by appreciating the efforts taken by Symbiosis & was impressed by the service given by Symbiosis to the community. He observed that India is the leading producer of generic drugs and it is the need of the hour to harness technology to ensure that the 4 A’s of healthcare are fulfilled i.e. accessibility appropriateness, approachability & achievability to all. He further quoted that every year in India; millions of people above the poverty line go below the poverty line because of a health event. The factor that puts this problem in a vicious circle is the lack of affordable and adaptable health insurance policies. He also mentioned the requirement of a Swasth Bharat Abhiyaan on the same grounds as Swacch Bharat Abhiyaan. The first session was on digital healthcare by Mr. Tirupathi Karthik, CEO, Napier Healthcare Solution. Mr. Karthik spoke on the biggest challenge plaguing healthcare in current scenariopoor accessibility. The antidote to this is technology which enables an organization to sustain growth. Mr. Karthik explained about the block chain technology which is an incorruptible digital ledger of economic transactions that can be programmed to record not just financial transactions but virtually everything of value. Dr. H.P Singh, Chief of Medical Administration, Indian Spinal Injuries Centre, Delhi; spoke on managing standalone super specialty center. Dr. Singh began his session by mentioning that healthcare was the key focus under the 12th five year plan (2012-2017). Healthcare spending as a percentage of GDP (2015) is 42%. The scenario of healthcare in India is growing at a compounded annual growth rate (CAGR) of 15%. This acceleration can mainly be attributed to urbanization & increase in spending of middle class on healthcare. Mr. Anthony D’Costa, Product Manager, Halyard Health India, Pvt. Ltd. discussed on Performance Standards of Medical Textiles. He began by explaining that textile material for medical and healthcare products ranges from simple gauze or bandage materials to scaffolds for tissue culturing and a large variety of prostheses for permanent body implants. He discussed on the differences between woven & spun less materials. He concluded by stressing on the need to shift from reusable to disposable medical textiles. Mr. Shishir Gupta, National Manager- Strategy &Innovation, Roche Diagnostics, expressed his views on how changing landscape of diagnostics. He mentioned that diagnostics is the silent champion of healthcare which gives the patient the power of knowing the clinical outcome along with the cost of the treatment. He mentioned about the introduction of Public Private Partnerships (PPP) in diagnostics & its positive impact on a larger scale. Dr. Rajeev Boudhankar, Chief Executive Officer, Bhatia Hospital, Mumbai spoke on Healthcare quality & patient safety. He expressed his views that keeping patients safe in a health care setting is fundamental to achieving high-quality health care for all. Thus can be achieved through initiatives aimed at increasing patient safety through prevention strategies focused on adverse drug events and health care-associated infections. Healthcare safety & quality is all about managing patient with collective mindfulness, respect & compassion. The session on achieving operational excellence in healthcare was conducted by Mr. Dilip Jose, MD &CEO Manipal Health Enterprises. Healthcare personnel must actively participate in performance improvement efforts and must be open to changes. Change management & process improvement are two important factors that assist organizations in achieving organizational excellence.

Ms. Jayata Sharma, Founder & Editor HealthBiz Insights touched upon the topic of Healthcare & media relations. She mentioned that healthcare & media must work in synergy to achieve positive outcome as media is responsible for creating negative as well as positive image in public’s perception. The post tea break proceedings of day one of SYMHEALTH 2-18 began with two parallel sessions. The first session was chaired by Dr. Nilima Kadambi, Executive Director, Pharma division, Belle Sante, Bengaluru, India. The speaker for this session, Dr. Geeta Bhardwaj GM-Operations, MD India Healthcare Services Pvt. Ltd., addressed the gathering on Health Insurance: Dynamics of Cancer Care Economics. She explained how early detection of cancer can contribute to reduction in the cost of treatment. Also end of life & palliative care were also touched upon by Dr. Bhardwaj in her talk. The second parallel session on plagiarism in clinical trials by Dr. Viraj Suvarna, Medical Director, Boehringer Ingelheim, Mumbai that plagiarism is a serious offence and can lead to consequences ranging from rejection of work to academic charges & even termination of concerned. This can be avoided by following correct citation method. The day concluded with sessions on healthcare associated infections, Dr. Rohini Kelkar Director Laboratories, Professor and Head, Dept of Microbiology, Tata Memorial Centre, Mumbai who highlighted on her three decade journey in infection control starting from the introduction of sterilization process to reporting & recording infection control rates & finally the era where management is now willing to invest in quality infection control procedures. The day concluded with session on India: An ultimate destination for medical value travel? by Mr. Anurav Rane, Founder & CEO- Plan my medical trip. He explained how India with its quality healthcare services & economical treatment options has established itself as a global destination for medical tourism. Around 1000 to 1200 healthcare professionals, from across the country comprising of professionals from diverse verticals of the healthcare sector including domains of Hospital & Healthcare Management, Medico Legal Systems, Medical Insurance, Clinical Research, Healthcare IT professionals, General practitioners, Specialists & Doctors from Allied Health Sciences, Policy makers & Administrators, Representatives of the Pharma sector, Representatives of Civil Society Organisations and Representatives of private and public Healthcare sector organizations participated in this event.

Day 2

Opened up with an invigorating talk on Home healthcare by Dr. Gaurav Thukral, Executive VP, Health Care at Home India Pvt. Ltd. The scope of home healthcare has increased over the past five years due to the growing elderly population. He mentioned about the numerous benefits of home healthcare such as changing the point of care, moving from episodic to continual care, reduction in cost of treatment, improved outcomes through utilization of technologies. Home healthcare has evolved from basic home healthcare to setting up of functioning ICUs at home. The second session of the day was an engaging talk on Healthcare startup- opportunities & challenges by Dr. Shyam Vasudevrao, Founder and Director Forus Health, Renalyx and Rx DHP. He mentioned that healthcare is a continuous process and we need to reach, connect, sustain and treat people using technology available at w w w.medegatetoday.com May-June 2018

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our disposal. He explained how technology can make healthcare more affordable even for families who depend on daily wages. Multiple tests requiring multiple equipment start-up costs can now be performed on one comprehensive unit thereby reducing the time required for detection & also the cost of detection. Dr. Rajendra Patankar, COO, Nanavati Hospital, Mumbai discussed on the sensitive topic of managing consultants in tertiary care hospitals. Healthcare is complex wherein availability of good doctors is impactful but giving a good amount of time to patients is also critical. To garner the trust of consultants, the hospital administrator must involve the consultants in decision making process. Also focus must be given by hospital administrator for engaging all part time consultants into a full time assignment thereby increasing their involvement. Engaging consultant is critical. A doctor busy continuously seeks feedback on services. A more skilled doctor with poor communication may not be as effective as someone with good people skills. Mr. Meghraj Gore, Vice President – Operations, Fortis Healthcare Limited spoke on Financial planning for sustainable hospitals. He pointed out that sustainability is managing three bottom-lines i.e. profits, people and planning. 60% population prefers private setup for healthcare services. Healthcare industry is the largest provider of employment especially women workforce. We now have a Government with ambitious healthcare agenda. Today we have a deficit of 10,000 hospitals of 100 beds each. As per WHO recommendation, we are still in deficit of 3.5 lac doctors and 8 lac nurses into the system. Nearly 80% of doctors are located in urban areas serving only 28% of Indian population. 5 Fundamentals of financial planning are patient’s satisfaction, growth, cash, gross contribution and velocity. To be sustainable hospital must be frugal in adopting technology, reduce waste, focus key competency. The session on training & development for healthcare professionals was conducted by Dr. Rakesh Varma, Managing Director, Falcon Skills: Current grow areas in healthcare are changing point of access i.e. home healthcare, harnessing technology and artificial intelligence in healthcare, medical value travel tourism, new areas like geriatrics, mental health, sports medicine and wellness services and Telemedicine. Infant mortality rate in India is 48%. He further outlined a few barriers to learning and development such as poor interface between formal education and industry for e.g. No formal training for doctors and nurses on communication skills. Most hospitals lack formal training department. Most hospitals don't consider training of manpower in their budget. Dr. Sanjay Gupte, Former President, The Federation of Obstetric and Gynecological Societies of India gave the audience food for thought with his discourse on Legal aspects of healthcare delivery. A doctor can be held vicariously liable on case of negligence in account of nursing staff. Proper recording of vital signs ie pulse, temperature, blood pressure etc is very important. Arrangement of an appropriately qualified locum is required when a doctor plans for going on vacations to avoid potential litigations. All hospitals must provide treatment irrespective of a case being medico legal case. All hospital must treat emergency patient without demanding deposit. During an emergency real and valid consent can be sought, which means patient must have competence and capacity to consent and the consent must be voluntary. The valedictory ceremony on May 5, 2018 was graced by Shri. Girish Mahajan, Minister for Water Resources & Medical education, Govt. 64 May-June 2018 w w w. m ed e g a te to d a y.co m

of Maharashtra, Dr. Ravi Wankhedkar, National President, Indian Medical Association, Dr. S.B. Mujumdar, Chancellor, SIU, Dr. Rajani Gupte, Vice Chancellor, SIU & Dr. Rajiv Yeravdekar, Dean, FoHBS Dr. Rajiv Yeravdekar welcomed the honorable guests and appealed to Shri Mahajan to spearhead medical reforms policy. He further appealed to the Minister that Symbiosis be allowed to conduct the bridge course in pharmacy. He stressed that human capital must be invested upon and man management is fundamental for any successful healthcare organization. The session was presided over by Dr. S. B. Mujumdar, Founder & President, Symbiosis International (Deemed University.) Dr. Mujumdar mentioned that this is a unique audience consisting of a mixture of 1000 doctors, nurses and medical administrators. He also mentioned that representatives from 20 states have come to attend SYMHEALTH 2018. Symbiosis apart from academics also has a unique feature of being a health promoting university. Shri. Girish Mahajan, Minister for Water Resources & Medical education, Govt. of Maharashtra remarked that he is very happy to be invited to Symbiosis. Shri. Girish Mahajan (Minister) also said that he always wanted to become a doctor, however, he is now glad to be looking after a portfolio that is to do with medical education. Good education, physical and emotional fitness is a need of the hour especially in doctors. Every Zilla should have medical college so that common man gets the services. Tribal areas are vastly affected and education is also less. A new bill is coming up against cut practice of doctors. Our government has taken control of admissions so only a talented student can become doctor. Fees regulatory authority is started. Research should also be done in Indian scenario and not do what the foreign countries are done. We have talent in India and all sectors are changing. Symbiosis has only one goal is education and never asks for anything. He was positive that if Symbiosis wants any help from the government they are always welcome. Dr. Ravi Wankhedkar, National President, Indian Medical Association IMA is largest ass of practicing doctors with 3 lac strong community. IMA is for better health of community. Not only doctor but entire community is responsible for good health. Everyday some doctor is assaulted. There has to be a strong central legislation to safeguard doctors. IMA doesn't want to agitate but since last 70 yrs. all stakeholders are not consulted when devising policies for better patient care. India produces 67k MBBS and 30 K come from other countries and soon every third doc of world will be an Indian. He also added that max suicides happen in medical students or doctors. IMA has started addressing this issue and started mentorship programme. Around 1000 to 1200 healthcare professionals, from India, comprising of professionals from diverse verticals of the healthcare sector including domains of Hospital & Healthcare Management, Medico Legal Systems, Medical Insurance, Clinical Research, Healthcare IT professionals, General practitioners, Specialists & Doctors from Allied Health Sciences, Policy makers & Administrators, Representatives of the Pharma sector, Representatives of Civil Society Organisations and Representatives of private and public Healthcare sector organizations participated in this event.

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MEDICAL FAIR

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continues on course for Quality and quantity of visitors makes for high spirits among exhibitors

MEDICAL FAIR INDIA, India’s No. 1 Trade Fair for Hospitals, Health Centres and Clinics, impressively continues its rate of growth and keeps pace with the positive trend in the industry. This conclusion can be drawn from the successful course of MEDICAL FAIR INDIA 2018 in Mumbai. 16 – 18 March saw 12,350 trade visitors come to the Bombay Convention & Exhibition Centre to learn from 551 exhibitors about innovations for health care and current trends. “This means that the number of visitors has gone up yet again by 15% compared to the event at the same location two years before. In interviews exhibitors said they were very satisfied with the quality of visitors and their demands,” explains Thomas Schlitt, Managing Director at Messe Düsseldorf India, and adds: “Rising incomes, population growth and increasing health consciousness all result in steady market growth and a call for improved health care. This is also reflected by the development of MEDICAL FAIR INDIA. It is not only a platform for supply and demand. It is also about joint ventures for product development, manufacturing and sales.” Since there are currently only about 60 national medical device technology producers, the majority of products and technologies for medical needs are imported. This opens up excellent business opportunities for multinational vendors. At the same time, there is a need for them to closely cooperate with Indian partners so as to rise to the challenges specific to the Indian market in an optimal way. Underlining this on behalf of many exhibitors, Simon Bensassi, International Sales Director of Surgival from Spain, said: “This was the first time we have participated at MEDICAL FAIR INDIA. We have reached many high-quality visitors. 66 May-June 2018 w w w. m ed e g a te to d a y.co m

INDIA

growth

What was especially important to us was gaining insights into the Indian market. Who are the decisionmakers? What about the government and what about pricing? How much is invested and where? These were questions we had interesting conversations about.” Brian Krawczyk, Director of Global Business Development at VIA Global Health (USA), also believes his company has achieved the aims it set itself for participation at the trade fair: “To us this was an extremely useful event for finding good distribution partners in India.” John Mason, Sales Director at Seers Medical (Great Britain), shares his view: “There was a very good mixture of visitors from both private and public health care. Visitors come from all over the country. We will also be taking part in MEDICAL FAIR INDIA 2019 in New Delhi.”

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Also taking positive stock was the Brazilian manufacturers’ association ABIMO. Karina Yamamoto (Trade Promotion Coordinator) emphasised: “The Indian market is developing at warp speed and it is very important for us to get a foot in the door here and learn to understand the market. In addition to Indian visitors we also succeeded in making contacts in Bangladesh, China and even Saudi Arabia and the United Arab Emirates.” Again, the integral programme components of the trade fair made MEDICAL FAIR INDIA 2018 even more attractive for visitors. Worth mentioning here is CLIN LAB INDIA, a conference with exhibition organised by Scherago and Messe Düsseldorf India; in terms of content it focuses on molecular diagnostics, point-ofcare applications and immune-biological laboratory medicine. The increasing digitalisation of medicine was centre stage at the ‘International Conference on Digital Health and Medical Equipment’ by Voice of Healthcare and the Lounge Area ‘FTR4H’ (Future for Health) played a prominent role within the trade fair as a platform for the creative start-up community. Here the discussions related to presentations and brief lectures revolved around sounding out the market relevance and maturity of innovations and placing young entrepreneurs with potential business partners. MEDICAL FAIR INDIA is held alternately at venues in Mumbai and New Delhi every year. Focal ranges include: medical products and medical device technology, laboratory technology and diagnostics, equipment and furnishings plus furniture for hospitals and health centres and the global trend areas of Health IT and Mobile Health solutions, to name but a few themes. The target group encompasses decision-makers from the medical field (such as physicians and medical professionals), hospital managers as well as representatives from the medical trade and industry. Due to its spectrum of topics covered the event is equally attractive for architects and building planners, for enterprise consultants or for the scientific and research community. The next MEDICAL FAIR INDIA will be held from 21 to 23 February 2019 – in keeping with the schedule – in New Delhi, at the Pragati Exhibition Center. All details relating to MEDICAL FAIR INDIA are available online at: http://www.medicalfair-india.com. w w w.medegatetoday.com May-June 2018

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Future of Healthcare

2 VOH International Conference nd

Mumbai is commercial capital of India, also a preferred test market for disruptions of all kinds. VOH Mumbai Conference theme was “Disruptions in Healthcare”. These disruptions have been new normal in healthcare industry. It is akin to medical technology’s gorilla war in whole healthcare industry as disruption’s frequency is high but impact is deep as well as long lasting. So, VOH Mumbai Conference, was an preemptive and preventive endeavor to present industry experts’ strategic inputs to manage disruptions. After common inaugural ceremony of medical fair as well as VOH conference, conference started with key note speech of VOH Mumbai Conference Chairman & VOH President (West ) Mr. Joy Chakraborty . Mr. Chakraborty while welcoming

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the delegates, stressed the need for such events to facilitate intra industry dialogues to discuss & solve healthcare issues in collaborative manner. The key note speech was followed up by panel discussion on medical device regulations and price control ,well moderated by Mr. Mohammed Ameel, who sought views from panelists on safety regulations and affordability. The esteemed panelists were Ms. Mala Vazirani, Mr. Rajiv Nath, Mr. Jatin ,Dr.Abhijeet M Dashetwar, Mr. Sumeet Marwah, Mr. Gopakumar and others. The panel discussion was followed up by one of the leading healthcare consultants Ms Jagruti Bhatia, who made a powerful presentation on hospital infrastructure of 21st century amidst all probable disruptions. Ms. Jagruti drew on her illustrious and multifaceted experience and gave audience enough insights which could safely be incorporated into their hospital planning in any disruptive scenarios. As growing disruptions have rendered many hospital vulnerable (sick), Dr. Akash Rajpal in his presentation on restructuring of sick hospitals shared his strategic

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thoughts to pull sick hospitals out of red. From sick hospital to panel discussion on healthcare financing, conference moved on seamlessly. Dr. Velumani, Ms. Jagruti Bhatia, Mr. Venkatakrishnan, Mr. Vishal Gandhi and other panelists shared words of financial wisdom & freedom. Dr. Velumaniâ&#x20AC;&#x2122;s advisory was indeed a pleasant and thought provoking experience for audience . To augment the disruption theme, Mr. Vivek Tiwari a prominent thought leader who also heads one of the most happening brands in heathcare, Medika Bazaar, and Mr. Rajendra Kadu, who is an authority on Medical equipment, shared their perspectives on disruptive trends in procurement. The first day was given a fantastic finishing touch by Dr. Clive Fernandes, Wockhardt hospital who educated audience on difference between domestic and international Quality Accreditions. Day 2 of conference started with an excellent presentation by Dr. Sarthak Bakshi on mother of all disruptions, Artificial Intelligence and Machine Learning. In subsequent presentation, Dr. Aniruddha Malpani, a healthcare management thinker as well as founder of HELP (Health Education Library for people) enthralled the audience with his presentation on information therapy for patient education. Ms. Yasha Pandit ,Principal Consultant, PwC, in her presentation â&#x20AC;&#x153;Technology disruptions: Are hospitals ready, emphasized the preparedness of hospitals to manage disruptions. 72 May-June 2018 w w w. m ed e g a te to d a y.co m

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Dr. Abhijeet M Dashetwar, Executive Director, Redbulb Medical Technologies Pvt Ltd., made an excellent and thought provoking presentation on “Public healthcare”. Dr. Abhijeet is one of the champions of Public Healthcare cause .Thereafter conference touched upon financial disruptions i.e. “Risk”. Mr. Venktakrishnan shared his perspectives on healthcare risk management. Post lunch on day 2 conference resumed with panel discussion on healthcare quality. Dr. B.K. Rana, Mr. Swadeep Shrivastava, Ms. Garima Jain and other panelists discussed an urgent need for quality in bettering delivery of healthcare . Conference was concluded with Product Presentations of three leading healthcare companies represented by Mr. Samir Shah, India representative of MREPC on “Know Your Medical Gloves ; Mr. Zakir Hussain, MD, Almed Equipment, on “Innovative Solutions for Infection Control in OR”; and Mr. Anubhav Thakur, MD, Accurex Biomedical Pvt. Ltd., on “Advances in Diagnostic Testing Technologies :POCT”. Post conference audience feedback was excellent and audience did share their favorite topics with VOH team with a request to include in upcoming VOH conferences . Apart from this many business opportunities were created by this conference and that made us to tag these conferences as : VOH Conferences: Take away References and Inferences . w w w.medegatetoday.com May-June 2018

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Hospital Planning & Infrastructure summit is a gathering of those involved in planning, designing, and building healthcare facilities across the region and brings experts together to uncover and discuss solutions to the challenges involved in building and retrofitting world-class hospital infrastructure in India. The H.P.I. Summit was held in Kolkata on the 18th of May'18 at Radisson Ballygunge, presented by Ideas Exchange (IDEX). The summit is a one day conference which includes panel discussions, networking sessions followed by designated speaker sessions. Keeping in mind the needs & trends in the current healthcare industry, globally as well as in India the theme of the summit is "Delivering the future of Healthcare Design: Smart & Sustainable" The Kolkata summit opened with a Panel discussion on how technology integration transforms patient experience & clinical outcomes followed by another panel discussion on challenges in hospital procurement & vendor management. Our expert set of speakers further held a session on the following topics: - Reducing hospital acquired infection by integrating futuristic strategies - What does it take to build a smart & sustainable hospital A talk on Integrated OR-Empowering surgical teams - Healthcare delivery Jio'fied; breaking boundaries in healthcare access And lastly the most waited session, the Big IDEX Debate on factors that will challenge the future of healthcare delivery in India. H.P.I. Summit in Kolkata witnessed a total 112 delegates from the following hospitals & organizations: Ruby General Hospital, Neotia Group, Narayana Super Speciality Hospital, AMRI Group, Divine Nursing Home, Fortis, All Asia Medical Institute, GNRC Hospital Ltd, Medica Superspeciality Hospital, Tata Medical Centre, Belle Vue Clinic & Nil Ratan Sircar Medical College & Hospital. The team of speakers & panellist included Dr Kunal Sarkar — Senior VP; Director & Head of Cardiac Surgery & Medica Superspeciality Hospital, Mr Sanjeev — MD & CEO; Mediff Technologies, Mr Joy Basu — Vice President; Apollo Gleneagles Hospital Kolkata, Mr Ravi Sinha, Country Director — India & SAARC countries;Ortho Clinical Diagnostics, Ms Soma Chakraborty, AVP-Operations & External Liaisoning; Medica Superspecialty Hospital, Dr Anupama 74 May-June 2018 w w w. m ed e g a te to d a y.co m

Shetty, General Manager — CSR; Narayana Health, Dr Rupali Basu, Non-Executive Director, IQ City Medical College and Narayana Multi Speciality Hospital, Mr Rupak Barua, CEO; AMRI Hospital, Dr Satyajit Bose, Chairman and Cardiac Surgeon; Mission Hospital & Dr Alok Roy, Chairman; Medica Synergie Pvt Ltd. & a few more. H.P.I. Summit was organised by Ideas Exchange (IDEX) & supported by Corian Design & Stryker as the Gold Partner, Elta Fans Pvt Ltd, Eubiq India Pvt Ltd, Neotia Healthcare Initiative Ltd & Mediff Technologies Pvt Ltd as the Bronze Partner & lastly by ASP; Johnson & Johnson & Ortho Clinical Diagnostic as the Session Partner followed by Hosmac as the Knowledge Partner. The Ideas Exchange, a division of IX Events Ltd has unique experience in the world of conferences and exhibitions. They have assembled a team of professionals that provide outstanding value and service to the European, African and Indian markets. Our expertise covers a wide variety of business sectors: from pharmaceutical to beauty, infrastructure to corporate governance. We focus on businessto-business exhibitions and conferences. Our offices are based in Mumbai (India), Johannesburg (South Africa) London (England), but our capabilities extend across Asia, Africa and Europe. We stage our own branded events and work internationally to make our events relevant to their geographical market. We produce everything from hotel-based conferences to major international exhibitions where our vision is to have business communities solve the big challenges of today and overcome the hurdles of tomorrow through our ideas exchanges. Adding to the Kolkata Summit, H.P.I. would like to further announce an invitation for the upcoming summits & exhibition as mentioned below: H.P.I. Summit Kochi: 6th July 2018 H.P.I. Summit Ahmedabad: 24th August 2018 H.P.I. Summit & Exhibition Mumbai: 12th - 14th October 2018 at Bombay Convention & Exhibition Centre

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