Medgate Today, May -June 2014

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Volume V || Issue I || May - June 2014

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PainProblems Size of Prostate Could Indicate

Prof (Dr) Rajeev Sood

Opportunities in

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Healthcare Management

News Update | Doctor Speak | Expert Views | Product Line | Interview | Healthcare Management

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Editor’s note

The global infection control market will grow at a steady pace of around 6% from $10.5 billion in 2012 to $14.0 billion by 2017.

T

he rise in tide of cleaning standards and mounting pressure for sterilized and disinfected medical devices in hospitals and clinics has triggered the growth of medical sterilization and disinfection market. The increase in hospital acquired infections or nosocomial infections have forced the medical authorities to take stringent regulatory actions to curb these infections with the use of sterilized and disinfected medical devices.

Gamma and E-beam types of sterilization services are poised to have better growth over EtO in the near future due to their wider application with respect to sterilization of food, pharmaceutical, medical devices, life sciences, and cosmetic products.

Along with sterilization, cleaning and sanitation are also important activities carried out in healthcare, food, and pharmaceutical industry. Hand disinfectant market is the fastest growing segment as hands are considered to be the primary cause of cross infection. The demand for sanitizing and preservative disinfectants in food industry is also increasing due to high risks associated with foodborne pathogens along with other bacterial and viral food related infections. Increased focus on hygiene and spread of infections are the driving forces for disinfectants in the all the sectors. The endoscope reprocessing market is anticipated to show healthy growth in the near future due to continued instrument development and increasing minimally invasive surgery procedures.

Riding on these factors, along with increasing usage of single-use technology products such as medical non-wovens and face masks, the global disinfection market is expected to grow at a CAGR of more than 6.0% from 2012 to 2017.

magazine Volume - V Issue - I May- June 2014

Editor Chief Editor Editorial Advisor

National Head Business Development Manager Asst. Manager Corporate Communication

Cheif Correspondent Design and Layout Sales and Marketing Subscribtion & Cirrculation

Dr. Pradeep Bhardawaj GP Capt. (Dr.) Sanjeev Sood Dr. Sharad Lakhotia Afzal Kamal Sunder Mewadi Sonia Pandit

SA Rizvi, Dr. HN Sharma Mohd. Javed Ahmad Amjad Kamal, SY Ahmed Khan, Ranjit Shirsath Jagruti Diddi, Saba Khan All right Reserved by all everts are made to insure that the information published is correct ‘Medgate today’ holds no responsibility any unlikely errors that might occur.

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6

Nov - Dec 2013

May - June 2014 Contents

Hitex Healthcare, Industry Expert...

Understanding & Treating Heart Failure

14

Commander Manoj Kumar (Retd)

Doctor Speak & Exper Views

CEO, Hitex Healthcare

Dr. Vishal Rastogi Sr. Consultant, Cardiology

32

Fortis Escort Heart Institute

Master of the Heart

36

Dr. Aparna Jaswal

Pediatricians a Caring Hand for Children

40

Dr. Rajiva Kumar Child Specialist Muzaffarpur Bihar

Sr. Cardiologist Fortis Escort Heart Institute

Pain size of Prostate Could Indicate...

Prof (Dr) Rajeev Sood

42

Head of Dept. Urology RML Hospital

Brain Aneurysms what everyone needs...

Clinical Fellow Dept. of Neurosurgery

46

Dr. Vanita Arora

Sr. Consultant Max Super Speciality Hospital

Opportunities in Healthcare Management

54

Dr. Sudheer Ambekar

Heart Attack is not Sudden Cardiac...

Prof. M. Habeeb Ghatala Dean for Non-medical Institutions, Apollo Health City

56

Ask a Question from Healthcare Industry...

Understanding & Treating Heart Failure

A Guide for Patients and Families

Dr. Pradeep Bhardwaj

58

CEO & Executive Director Six Sigma Healthcare Ltd.

NEWS

6 Cautious optimism for new...

8 Injecting new design 17 New Central Scanning ...

18 WHO’s first global report 20 zest2014 22 Medgatetoday & MFI jointly...

24 Medical Fair India 2014...

25 Integrating Virtual Reality...

32 Nov - Dec 2013

26 GE Healthcare & CTSI...

28 XVI National Seminar...

7

NEWS Update

Exanatide an alternative to insulin for type 2 patients

for new breast cancer drug An experimental inhibitor of cyclin-dependent kinases (CDK) 4 and 6 halves time to disease progression in women with hormone receptor positive metastatic breast cancer, researchers say.

For type 2 diabetes patients not controlled with oral hypoglycaemic drugs, exanatide may be an alternative to starting insulin treatment, three year findings from the DURATION-3 trial suggest.

Their phase 2 trial involved 165 women with advanced ER positive, HER2 negative breast cancer randomised to either letrozole plus CDK4/6 inhibitor palbociclib or to letrozole only.

A weekly injection of the long- acting GLP-1 receptor agonist provided better HbA1c control and also avoided weight gain and hypoglycaemic episodes seen with glargine insulin, according

However the study authors pointed out as only 61 of the 165 patients had died so far, statistical significance should not have been expected at this point in the trial and that data were trending in the right direction.

to study published in the Lancet Diabetes and Endocrinology.However, exanatide was less well tolerated than insulin, the study showed.In the DURATION-3 trial, 456 patients - including some from Australian centres with type 2 diabetes not controlled with oral drugs such as metformin and sulfonylureas were randomised to either a once-weekly SC injection of exanatide or once daily insulin glargine.

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Cautious optimism

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Presented yesterday at the annual meeting of the American Association for Cancer Research, the results showed those on palbociclib had a median time to disease progression of 20.2 months compared with 10.2 months with letrozole only.

Overall survival was better in the palbociclib arm at 37.5 months compared with 33.3 months, but the difference failed to reach statistical significance.

The drug was generally well tolerated although adverse events included neutropenia, leukopenia, fatigue and anaemia.

RF ablation effective in Barrett’s with low-grade dysplasia Radiofrequency ablation (RFA) is far more effective than endoscopic surveillance at cutting the risk of progression to cancer in Barrett’s oesophagus with low-grade dysplasia, Dutch researchers find.In pathologist-confirmed lowgrade dysplasia, RFA cut the absolute risk of progression to high-grade dysplasia or adenocarcinoma within three years by a quarter compared with endoscopic surveillance (1.5% vs 26.5%),Absolute risk of progression to adenocarcinoma only was cut by 7.4% (1.5% vs 8.8%), the Amsterdam-based authors found.

Complete eradication of dysplasia occurred in 93% of patients undergoing RFA compared with 28% of those in the surveillance arm, they said.Treatment-related adverse events occurred in a fifth of patients in the ablation group but these were mostly mild.The most common was oesophageal stricture, which resolved with a median of one endoscopic dilation.

May - June 2014

NEWS Updat e

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May - June 2014

9

NEWS Update

Injecting new design A user-friendly approach to drug delivery device development

C

utting-edge design that puts the patient first is at the heart of a new drug delivery device for multiple sclerosis (MS) sufferers. Product design and development firm Cambridge Consultants has worked with leading pharmaceutical company Novartis and medical device manufacturer Owen Mumford – plus hundreds of MS patients – to come up with the ExtaviPro® 30G auto-injector. From its attractive visual design and ergonomic shape to its easy-toread adjustable needle depth control, the ExtaviPro 30G has been designed with the

needs of the patient in mind. More than 500 MS patients and healthcare professionals in the US, the UK and mainland Europe were involved in the development process to ensure the device was underpinned by a deep understanding of the users. An estimated 2.5 million people worldwide have MS – a disease affecting the central nervous system. Symptoms can include vision problems, tingling and tremors, dizziness, balance problems, restricted mobility, fatigue and cognitive issues.

The ExtaviPro 30G is aimed at people who suffer from relapsing forms of MS – such as clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and secondary-progressive MS

(SPMS) – who make up the majority of MS patients. They have periods when symptoms flare up aggressively, known as relapses, followed by periods of recovery – or remission. They often have to self-inject prescription medication at home to help reduce the impact and frequency of relapses.

“Our aim was to make the ExtaviPro 30G auto-injector very simple and intuitive to use, and enable one-handed injection,” said Andy Pidgeon, head of the industrial design and human factors group at Cambridge Consultants. “Its ergonomic shape leads patients to instinctively hold it correctly – which is vital for those who suffer from tremors, as having a firm grip is key to self-injecting safely.

Alogliptin safe but aleglitazar flops

T

he anti-diabetes therapy alogliptin does not increase cardiovascular mortality or heart failure in patients with recent acute coronary syndrome, according to new data.Presented Saturday at the annual meeting of the American College of Cardiology in Washington, a sub-analysis of the EXAMINE trial showed similar rates of CV mortality in type 2 diabetes patients with recent acute coronary syndrome taking alogliptin compared with placebo.There was also no increase in sudden cardiac death or in nonfatal MI and stroke, urgent revascularisation due to unstable angina or hospitalisation for heart failure with the DPP-4 inhibitor compared to placebo.Nor did alogliptin appear to induce new onset heart failure or worsen HF outcomes in patients with a history of HF and/or markers for HF, data showed. The news was less rosy for acute coronary syndrome taking alogliptin compared with placebo.There

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was also no increase in sudden cardiac death or in nonfatal MI and stroke, urgent revascularisation due to unstable angina or hospitalisation for heart failure with the DPP-4 inhibitor compared to placebo.Nor did alogliptin appear to induce new onset heart failure or worsen HF outcomes in patients with a history of HF and/or markers for HF, data showed.The news was less rosy for acute coronary syndrome taking alogliptin compared with placebo.There was also no increase in sudden cardiac death or in nonfatal MI and stroke, urgent revascularisation due to unstable angina or hospitalisation for heart failure with the DPP-4 inhibitor compared to placebo.Nor did alogliptin appear to induce new onset heart failure or worsen HF outcomes in patients with a history of HF and/or markers for HF, data showed.The news was less rosy for gastrointestinal haemorrhages and renal dysfunction, the study authors reported.These findings do not support the use of aleglitazar in this setting with a goal of reducing cardiovascular risk.

NEWS Updat e

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NEWS Update

Healthcare industry

leaders outline vision for Future of Healthcare

Devi Shetty, Naresh Trehanand Shivinder Mohan Singh predict what healthcare would be like at the recently concluded global conference in Delhi

Dr. Devi Shetty

Founder & Chairman Narayana Health, Banglore

Dr. Naresh Trehanand CMD Medanta the Medicity

Shivinder Mohan

Executive Vice Chairman, Fortis Healthcare

C

aptains of India’s healthcare industry, including Dr. Devi Shetty, Dr. Naresh Trehan, and Shivinder Mohan Singh came together on a common platform in the city recently to share their vision of the future. The doyens of India’s health sector talked on key issues plaguing India’s healthcare industry, including the lack of manpower and policy and regulatory issues as well as the need for greater integration of modern and traditional systems of medicine, better use of technology and the need to upgrade skillsets to ensure a better healthcare system for the 21st century.

Calling for major changes in the existing health system, Dr Naresh Trehan, CMD, Global Health (Medicity), said: “Healthcare is basically disease management. We should build our system from the ground up to create a new blueprint of India’s healthcare. We have over 800,000 ASHAs (Accredited Social Healthcare Activists) in India, but they are ill trained and don’t have any medical skills. Their costs are a huge burden on the exchequer and nothing gets accomplished in return. All we have to do is to upscale their skills so that they can be the eyes and ears of the healthcare system on the ground. They need to monitor hygiene and find out who in the community needs medical assistance. This will be a big help in ensuring quick diagnosis of diseases and reducing the incidence of NCDs.” 12 w w w . m e d e g a t e t o d a y. c o m May - June 2014

Talking about the acute shortage of medical specialists in the country,Dr.Devi Shetty, Founder &Chairman, Narayana Health, pointed out that whiletheUS has 19,000 undergraduate medical seats and 32,000 PG seats, in India it is the opposite – the country has close to 50,000 undergraduate medical seats but only 14,000 PG seats. “The low number of PG seats results in a shortage of specialists. This can have terrible consequences on the ground. For example, India has one of the highest maternal mortality rates in the world and this is unrelated to the amount of money we spend on healthcare. The reason is that we have created a regulatory structure where only a specialist can perform certain tasks, and the country simply doesn’t produce enough of these specialists,” he said.

NEWS Updat e

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May - June 2014 13

NEWS Update

Dr. Shetty suggested that to tide over the problem, the country needs medical educational institutions on the line of the College of Physicians and Surgeons (CPS) in Maharashtra which would offer diploma courses in fields like anesthesia, gynecology, and pediatrics to medical graduates. “This can convert the entire 50,000 medical graduates produced in India every year into specialists who can then help reduce maternal mortality in India,” he added. “If we want to deliver better healthcare outcomes, India doesn’t require money. We only require policy changes. This will not happen till the Government looks at medical education as integral part of the country’s development.”

Dr. Shetty also expressed concern about the nursing profession in India, whichhe said would die down in a few years if urgent measures are not taken. “There is zero career progression for nurses. Nursing is now considered a dead-end career. Admissions to nursery colleges in India have come down by 50%. Half of the nursing colleges in Karnataka have shut shop. In the years ahead, there will be an acute shortage of nurses in the country. There is a critical need to empower nurses by offering them a path to upgrade their skills and become specialists.About 67% of anesthesia in the US is given by nurse anesthetists. In India, we don’t allow a nurse who has worked in critical care for 20 years to even prescribe a Paracetamol tablet!” he said.

Dr. Devi Shetty highlighted the need to look for alternative ways of funding healthcare, such as by a surcharge on mobile phone bills, bring down the cost of building hospitals, develop patient management software, and establish one or two health cities with 3,000 to 5,000 beds in each metro where cutting-edge work can be done.

Outlining his views on the role of technology in ensuring greater access to quality healthcare,Shivinder Mohan Singh, Executive Vice Chairman, Fortis Healthcare, said, “Technology has played a vital role in healthcare in the last 30 to 40 years, whether it is diagnosis or treatment.

Going forward It is going to trigger more changes in healthcare than any other factor.Healthcare access will get radically transformed with technology whether it is in terms of proximity through devices planted in our bodies or by low-cost healthcare using innovative technological solutions or the speed with which information is shared.”

Singh added, “A healthcare ecosystem would be created in future where different silos begin to talk to each other about patients and exchange information. Healthcare delivery is going to become more personalized in terms of tailor-made treatments for an individual.”

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Talking about the need for better integration of different systems of medicine, Singh said: “Allopathy has taken a predominant share of the existing market in healthcare, but I think we can’t avoid for too long the benefits that other health sciences bring to the table. Some kind of integration of different health disciplines is bound to happen in future.”

He also emphasized that the onus of taking charge of one’s health has to rest on the individual. “We need to be more concerned for what we do to our health rather than what healthcare would do to us. We need to take ownership of our own bodies and mind and not outsource these to healthcare providers. People need to focus more on preventive care rather than just landing in sick care – this is going to the mantra of healthcare in future,” he said.

“The Future of Healthcare: A Collective Vision” was the first-of-its kindglobal healthcare conference that was held in Delhi in March 3-4. With participation from over 15 countries and the presence of more than 500 delegates, the two-day event, hosted by The Healthcare Alliance, saw an impressive turnout of thought leaders, policy makers, senior Government officials, and business and health leaders from India and across the globe.

New index quantifies disability in

IBD

Around 20% of people with inflammatory bowel disease have a disability that renders them incapable of fulltime work or study, Australian researchers find.Their study measured work productivity and disability in over 160 IBD patients and controls using a new IBD disability index (IBD-DI), developed from the World Health Organisation’s classification of functioning, disability and health.IBD-DI scores were an independent predictor of employment status and work hours missed, the authors from Sydney’s Concord Hospital found.One in five IBD sufferers had a moderate disability which meant they were unable to work or study full time, while seven percent had severe disability, data showed. There were no significant differences between Crohn’s and ulcerative colitis patients, and neither prior surgery nor hospitalisation predicted disability levels, the authors said.Biologics were the only drugs that significantly improved IBD-DI scores; use of these agents “may be justified on their ability to reduce disability.

NEWS Updat e

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May - June 2014 15

INTERVIEW B y Mt

Hitex Healthcare Industry Expert in Infection control

Tell us a little about yourself?

I am from the armed forces background. I had a long innings spanning more than two decades in Indian Navy. I took premature retirement and moved in to the corporate world. I must admit that the transition was not smooth. After working in several different fields ranging from education to energy, I took on the demanding assignment to set up a greenfield healthcare project.

Since you are from defense background, how would you say you have implemented the values & rules of the defense services in to your business?

Commander Manoj Kumar (Retd) CEO, Hitex Healthcare

It is not the question of rules! It is the discipline that is important. Creating Standard Operating Procedures for each department is of paramount importance.

Having created such SOP’s, the next challenge is to ensure implementation and follow up at each level.

What Armed Forces have taught is to lead by setting examples. I believe in hands on approach, do it myself before I expect any one from my team to execute the particular task. I also encourage brain storming, pushing my team to think out of the box and come up with exciting new approach.

Please shed some light on the company’s journey since inception. How is HitexHealthcare serving healthcare industry?

Hitex Healthcare is a part of Dina International, having its global headquarters at Moscow, Russia.

The group turnover is in excess of 100 million USD. Dina International has many verticals like Turnkey Hospital Projects, Trading, Manufacturing etc. Dina-Hitex based in Czech Republic, started manufacturing disposables apparels in Europe and today

16 w w w . m e d e g a t e t o d a y. c o m May - June 2014

INTERVIEW B y Mt

after two decades, they are one of the leading manufacturers in Europe.

manufacture our own laminates at Czech Republic. Usually hospitals end up using disposable drapes manufactured by SMMMS , Spunlace or spunbond non wovens which do not provide 100 % protection against strikethrough . Bi laminates and Tri laminates ensure best safety in OR. Hospitals across the world are shifting from linen to SMS, and from SMS to laminates. These laminates are impermeable and provide complete protection against body fluids such as blood, pus, saliva etc. We use only the best quality material to ensure consistency. Even the adhesive tapes used in manufacturing these drapes are dermatologically tested. The absorbency of the drapes is very high, thus providing complete protection.

With unique fluid collection pouches and proper folding of the drapes or gowns it becomes very easy for OR staff to drape the patient in a very less time and can save precious time in the OR. Saving OR time translates to higher revenue for the hospitals.

Since our promoters are of Indian origin, they decided to launch Hitex products in India. In 2011, the promoters invested in two manufacturing plants, which are located in Una, Himachal Pradesh and Gandhidham, Gujarat. Once we had built the factories with 100,000 D class clean rooms, we brought semi-automatic drape manufacturing machines from So, How has Business been? Have you had a Europe. Today in India, this machine remains the only one of its kind and produces excellent consistent quality of drapes Healthy Response in India so Far? that are required for various medical procedures.

The response has been very encouraging. The challenge has After we started production, we have received all kind of been to convert our customers from linen to disposables. quality certifications, including ISO and expect CE in next Our effort has been to do practical demonstration during procedures in OR by our team. Once the surgeon and his few months. We are manufacturing all the drapes and packs in supporting team has used our products and compared with clean room as per the EN 13795 norms. The promoters have what they have been using in the past, they on their own raise the intention to provide the same quality in India as they do the demand for our products. In the last eighteen months, our in European market. Life in India is as precious as in Europe products have been used at leading hospitals in India, Nepal ! The aim is to provide world class products at affordable etc. Apart from the super specialty hospitals, we have small prices which can contribute in bringing down the cases of nursing homes, hospitals etc also as our customers. Recently Hospital Acquired Infection. Our products are designed to we have started operations in Bangladesh. Further, we have ensure safety and comfort to patients and their healthcare exported more than twenty five 40 ft containers to Europe.. providers, who are surgeons and other hospital staff as well as to protect the expensive equipments.

What are Your Future Plans?

Elaborate on some unique products you have? How are they useful to the hospitals& healthcare Industry?

World Health Organization (WHO) data reveals that approx 8% of patients admitted in hospitals in developed countries acquires an infection. In country like India this figure will be much higher. We have the complete range of drapes, gowns, accessories etc for each type of procedure which can create a sterile field wWorld Health Organization (WHO) data reveals that approx 8% of patients admitted in hospitals in developed countries acquires an infection. In country like India this figure will be much higher. We have the complete range of drapes, gowns, accessories etc for each type of procedure which can create a sterile field which is essential to provide a barrier to passage of microorganisms and hence reduce chances of infection. The drapes have been developed in close interaction with leading surgeons in Europe. We

Currently we are focused on North and West India, soon we will extend out to East and South India as well. The idea is to provide not only good products but excellent service through dealer network as well.

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May - June 2014 17

INTERVIEW B y Mt

Soon we plan to launch Customized Procedural Trays (CPT’s) for the Indian market. We are doing good volumes in these products in Europe and we believe that CPT’s will perform well in India as well. Further, on receipt of CE, we will start export of sterile products to Europe, Middle East and other countries. We also need to expand our infrastructure like warehouse, additional clean room etc.

With Several Domestic Manufacturers of Similar Products, What Marketing Strategies do you use to Differentiate Hitex Healthcare from the Competition?

India. The consistent high quality of products designed and manufactured by Hitex is what differentiates us from our competition in India. What we are offering in India has been proven and accepted in demanding European market. We are offering our products at an acceptable price in the Indian market. We have been getting good response as we are giving better products at acceptable prices. Never the less, it is as Charles Darwin has said, “survival of the fittest” ! The hard work and discipline is the key, and I am sure with our belief in our products, technical guidance from Dina Hitex and synergy in our team, it is matter of time, we won’t have to bother about the competition !

We believe that healthy competition is good for business.

In India we have high competition since there are many manufacturers in the same field as us. Unfortunately the market is not regulated; hence it becomes difficult for Brief about R&D of your company and tell us quality manufacturers to compete with those who have about your upcoming products? not invested in infrastructure like clean room, HVAC Dina Hitex has been focusing on R&D ever since it started etc. We need laws like European Union Medical Device operations. Our team regularly visits the leading hospitals to Directive (MDD) and EU regulations. understand the needs of the surgeon and OR staff. Based on the The Indian health industry is growing at a fast pace, and there has been a rise in demand for high quality service at hospitals across the country. Along with good hospital service, we realized that the hospitals in India need high quality of healthcare products. And that is where we come in, since we identify our products as the key to providing a high quality health care experience in 18 w w w . m e d e g a t e t o d a y. c o m May - June 2014

inputs, products are designed with the correct raw material.

In turn, we interact with machine manufacturers to develop customize machines for drape manufacturing, fluid collection pouches etc . One of the researches currently in progress is to use modified cellulose in drapes. Dina Hitex has tied up with a leading medical research company in France and has started marketing the advanced Margin drapes in CABG and other cases in Europe.

INTERVIEW Product BLine y Mt

New Central Scanning Solution Uses PC-Free Network Connectivity to Provide Easy Access to Work Teams

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new line of network scanners from Kodak Alaris provides organizations with a central scanning solution that allows users to efficiently capture information from documents and route it into key business processes without the need for a dedicated PC. Until now, many organizations have been unable to automate some paper-based business processes because a PC isn’t appropriate for the work location (e.g. employees in a particular department don’t require PCs). In other instances, employees may have PCs but it’s preferable that they are limited to performing specific tasks. The KODAK Scan Station 700 Series is ideal for either scenario.

The KODAK Scan Station 700 Series connects directly to a network and sends data to multiple destinations simultaneously, including network drives, printers, FTP sites, email, portable USB drives and Microsoft SharePoint. It is designed to meet the needs of small businesses or branch offices of larger organizations in a variety of industries, including healthcare, finance, legal, government, travel and insurance.

“The KODAK Scan Station is helping a bank enhance customer relations by allowing tellers to quickly capture documents and access core functions of their business application on the touch screen without leaving the customer,” said Tony Barbeau, General Manager of Kodak Alaris’ Document Imaging division. “The Scan Station also helped the bank meet stringent requirements for user interface and document transfer security. Plus, the integration capabilities allowed the bank to create and distribute a simple application to use on the Scan Station in all of its branches.” Unlike traditional scanners or other multifunction devices, the standalone Scan Station 700 (kodakalaris.com/go/ScanStation700news) integrates network connectivity and imaging functionality to make scanning more accessible in a shared environment. The large, easy-to-navigate touch screen offers a customizable, intuitive user experience that promises fewer user mistakes and a quicker path to proficiency.

A remote administration utility allows administrators to manage, configure, and maintain multiple scanners from a single location.

In addition to the standard user interface of the Scan Station 700, the Scan Station 720 EX model extends the solution’s feature set with an integration-friendly architecture. The 720 EX allows select Alaris partners to develop and install highly specialized business applications to automate information processes with

even greater efficiency.

Other unique features of the Scan Station 720 EX include a built-in fax modem and output to the KOFAX Front Office Server.

The Scan Station 720EX design allows thirdparty applications to add value to existing capture processes, offering a powerful, customizable approach to elevate end users’ information management capabilities. Select partners can create these applications to easily look up projects, confirm deliveries, provide feedback and check the status of projects in the system, saving time and reducing administrative costs for the end user.

“Companies can save both time and money with the Scan Station 700 Series, which connects easily to other systems and is designed for either individual or multiple users. It advances the value proposition of document management by delivering many improvements across a variety of business processes,” said Will Hebert, Kodak Alaris’ Portfolio Business Manager for Document Imaging.

The Scan Station 700 and 720EX support additional accessories for greater versatility and ease of use, including the KODAK Scan Station Keyboard and Stand Accessory, the KODAK Legal Size Flatbed Accessory and the KODAK A3 Size Flatbed Accessory.

Kodak Alaris offers essential services that provide customers with the initial training and ongoing technical and business support they need to ensure robust and worry-free configuration and optimal operation of the Scan Station 700 Series. Scan Station 700 service plans and tailored expert services include Startup Assistance, Network Scanner Training, ongoing support and the latest product improvements. Kodak Alaris offers comprehensive maintenance and support plans and Professional Services that allow customers to maximize their investments. w w w . m e d e g a t e t o d a y. c o m

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NEWS Update

WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health

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new report by the World Health Organization (WHO) – the first to look at antibiotic resistance globally – reveals that this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance – when bacteria change so antibiotics no longer work in people who need them to treat infections – is now a major threat to public health.

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security.

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

The report, Antimicrobial resistance: global report on surveillance, notes that resistance is occurring across many different infectious agents but the report focuses on antibiotic resistance

in nine different bacteria responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea. The results are cause for high concern, documenting resistance to antibiotics, especially “last resort” antibiotics, in all regions of the world.

Key findings from the report include: ÂÂ Resistance to the treatment of last resort for life-threatening infections caused by a common intestinal bacteria, Klebsiella pneumonia – carbapenem antibiotics – has spread to all regions of the world.

K. pneumoniae is a major cause of hospital-acquired infections such as pneumonia, bloodstream infections, infections in newborns and intensive-care unit patients.

In some countries, because of resistance, carbapenem antibiotics would not work in more than half of people treated for K. pneumoniae infections. ÂÂ Resistance to one of the most widely used antibiotics for the treatment of urinary tract infections caused by E. coli – fluoroquinolones – is very widespread. In the 1980s, when these drugs were first introduced, resistance was virtually zero. Today, there are countries in many parts of the world where this treatment is now ineffective in more than half of patients.

20 w w w . m e d e g a t e t o d a y. c o m May - June 2014

ÂÂ Treatment failure to the last resort of treatment for gonorrhea – third generation cephalosporins – has been confirmed in Austria, Australia, Canada, France, Japan, Norway, South Africa, Slovenia, Sweden and the United Kingdom.

More than 1 million people are infected with gonorrhoea around the world every day. ÂÂ Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillinresistant Staphylococcus aureus) are 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

The available data reveal that antibiotic resistance is a burgeoning problem in WHO's South-East Asia Region, which is home to a quarter of the world's population. The report shows high levels of E. coli resistance to third generation cephalosporins

NEWS Updat e

and fluoroquinolones – two important and commonly used types of antibiotic – in the Region. Resistance to third generation cephalosporins in K. pneumoniae is also high and widespread. In some parts of the Region, more than one quarter of S. aureus infections are reported to be methicillin-resistant (MRSA), meaning that treatment with standard antibiotics does not work. In 2011, the health ministers of the Region articulated their commitment to combat AMR through the Jaipur Declaration on AMR. Since then, there has been growing awareness of the need for appropriate tracking of drug resistance, and all countries have agreed to contribute information to a regional database. “Combatting drug resistance is a priority area of work for WHO in the Region,” says Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia. “We need to act now to use antibiotics rationally, ensuring their availability for future generations.”

of tools and standards and improved collaboration around the world to track drug resistance, measure its health and economic impacts, and design targeted solutions.

resistance – such as basic systems to track and monitor the problem – show gaps or do not exist in many countries.

While some countries have taken important steps in addressing the problem, every country and individual needs to do more. Other important actions include preventing infections from happening in the first place – through better hygiene, access to clean water, infection control in health-care facilities, and vaccination – to reduce the need for antibiotics. WHO is also calling attention to the need to develop new diagnostics, antibiotics and other tools to allow healthcare professionals to stay ahead of emerging resistance.

Policy-makers can help tackle resistance by:

People can help tackle resistance by: ÂÂ using antibiotics only when prescribed by a doctor ÂÂ completing the full prescription, even if they feel better ÂÂ never sharing antibiotics with others or using leftover prescriptions.

Health workers and pharmacists can help tackle resistance by: ÂÂ enhancing infection prevention and control ÂÂ prescribing and dispensing antibiotics only when they are truly needed

ÂÂ prescribing and dispensing the right antibiotic(s) to treat the illness.

The report reveals that key tools to tackle antibiotic ÂÂ strengthening resistance tracking and laboratory capacity ÂÂ regulating and promoting appropriate use of medicines. ÂÂ Policy-makers and industry can help tackle resistance by: ÂÂ fostering innovation and research and development of new tools ÂÂ promoting cooperation and information sharing among all stakeholders.

The report – which also includes information on resistance to medicines for treating other infections such as HIV, malaria, tuberculosis and influenza – provides the This report is kick-starting a global effort led by WHO to most comprehensive picture of drug resistance to date, address drug resistance. This will involve the development incorporating data from 114 countries.

Presents by

4

Medgate today

th

MT India Healthcare Awards 2014 August 2014, New Delhi

Nomination / Sponsorship / Enquiry Ms. Sonia Pandit: +91

9899037351

sonia@medgatetoday.com www.madgatetoday.com w w w . m e d e g a t e t o d a y. c o m

May - June 2014 21

NEWS Update

zest2014

“Zest-2014”, the Annual Inter college festival, was organized by the Faculty on 12th-13th March 2014. The two-day fest was attended by more than 500 students from across 8 dental/medical colleges in NCR, who participated in more than 15 different contests and competitions.

T

Faculty of Dentistry, Jamia Millia Islamia for the past five years has become synonymous with not only competency in clinical and academic skills of the budding doctors but also grooming them for an all round personality development into socially conscious, scientifically inclined and immaculate personalities. Since the past two years one word that has been making waves and has become an inseparable part of this college is “Zest”. Not only has it touched the lives of every student in faculty of dentistry but also of students all over NCR, an event marked in the calendars of many and awaited eagerly.

– Changing Times, Changing Perception” by Dr. Jitendra Nagpal, Sr. Consultant Psychiatrist & Incharge, Moolchand Medcity. Following interesting segment of Inter-college events “PRISM” which included events like plasteromania, rangoli, inspiring wires, soap carving and matka painting, witnessed an extensive participation of students displaying their thoughts and emotions through The next day celebrations commenced with the inauguration the skills of their hands, also carrying a social message of Public Health Exhibition followed by the Inaugural with it. Other popular events included “Affiche” the onceremony presided by our Dean Prof (Dr.) Ragini, spot poster & Collage Making Competition, the “Trivia Organizing Chairperson, Dr. Tanveer Ahmad, Organizing mania” Inter-college Quiz Contest and “Folk Tales” Inter Secretary and our Guest of Honour Prof. M. Ejaz college singing & dance competition. The vote of thanks Hussain, Director, Centre for Physiotherapy & Rehab. that followed acknowledged the hard work and support Sc., JMI. This was followed by a public health awareness of all the people in and outside Faculty of Dentistry programme which included Oral health Checkup for that had made this pioneer attempt a huge success. The Children with Special Needs from Cheshire Home, valedictory ceremony recognised the contribution of all Okhla at Mobile Dental Clinic, JMI and a public health the participants, conveners and coordinators with a token awareness lecture entitled “Mental Health and Wellbeing of appreciation given by our Dean mam. he first day was the Sports day as the Jamia Sports complex was charged by not only the participants for the Inter-college Cricket Championship, the Badminton tournament, the Carrom and Chess competitions as well as by a fervent crowd of faculty as well as students supporting the spirit of competitiveness.

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POST E ve n t

Medgatetoday and MFI

24 w w w . m e d e g a t e t o d a y. c o m May - June 2014

Jointly Introduced and Organized Medical Forum

POST Event

2

014 is a special year for the MFI, 20 th International Exhibition & Conference where Medgate today & MFI jointly introduced & organized Medical Forum.

This is the first time in India where any exhibition is organizing such a medical forum. The medical Forum on Wond management and Cardiology took place inside exhibition Hall at Mumbai ,India.

Medical Forum where different nationalities were represented by over several walk-in participants who engaged in forum and visits. Medical Forum on wound management included a range of topics such as wound dressing, Complications Of Leg Wounds And Management, cosmesis in wound management, Postpartum Perineal wound management, Ayurveda & wound management, Closed Cyclic Negative Wound Therapy.

Cardiology forum included topics like recent advance on cardiology, sudden cardiac arrest, Cardiac Fitness, Cardiac - Health Awareness, treatment of cardiac Disease, Understanding Heart Attack – Prevention & Emergency, Indian Scenario of Coronary Artery Diseases and role of thrombolysis in acute Stemi With focus on Reteplase therapy.

Our prominent speakers were Dr.Rajesh Shah, Dr.Parvez Ahmed, Dr.Vanita Arora, Dr. Vivek Mahajan, Dr.Naresh Sen, Dr. Rajeev Karnik, Prof.

Dr.S.Raghupati, Dr.Narendra Pandya, et al. The participants also had the opportunity to ask questions from speakers as well as joining informal networking opportunities.

Medical Forum were supported by Fortis Hospital, Urgent Care Hospital, Max Hospital, Wound Association, TUFFT at Medical fair 2014.

As per our correspondent who interviewed some of speakers and delegates, they are satisfied with this forum and looking forward for next year in bigger way.

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NEWS Update

MEDICAL FAIR India 2014 in Mumbai High demand from exhibitors and level of internationality reflect upturn in the Indian healthcare market

The India healthcare market is booming.

The MEDICAL FAIR INDIA 2014 also benefited from this development: India’s No. 1 Trade Fair for Hospitals, Health Centres and Clinics, which took place from 14 to 16 March at the Bombay Convention & Exhibition Centre, was once again able to record an increase in visitors and exhibitors. The fair concluded successfully with a total of 443 exhibitors and 8,013 registered trade visitors, having further established its position as the most important medical event for the Indian market. The trade fair was characterised by good business and a rigorous exchange of information among experts. The exhibitors concordantly praised the successful event and have already announced their participation in the MEDICAL FAIR INDIA 2015 in New Delhi. The product portfolio at the MEDICAL FAIR INDIA encompassed innovations from around the world that specifically target the Indian healthcare market. The exhibitors presented the entire spectrum of products from all relevant sectors: medical technology, hospital, health centre and clinic

equipment, rehabilitation, equipment for pharmacies and dispensaries, and furniture. Next to numerous joint stands from China, Germany, Korea, Malaysia and Taiwan, there was a US pavilion that was supported by the US Commercial Service and the State of Illinois.

Alongside 142 domestic exhibitors, exhibitors from countries such as Kazakhstan, Pakistan, Indonesia and SouthAfrica further emphasised the international significance of the trade fair.

Important local partners and partner associations contributed to the success of the MEDICAL FAIR INDIA 2014.

Two of the most prestigious Indian associations, ADMI – Association of Diagnostic Manufacturers of India, and MSAHITA – Medical Surgical and Healthcare Industry Trade Association, provided valuable support. The assistance supplied by the Indian Association of Sports Medicine and the Indian Association of Physical Medicine and Rehabilitation should also not go without mention. Further cooperation partners included Indian hospitals such as Fortis Healthcare Limited and Indraprastha Apollo Hospitals.

Furthermore, renowned international associations and institutions supported the trade fair, such as MREPC (Malaysian Rubber Export Promotion Council), CCCMHPIE (China Chamber Commerce for Import & Export of Medicines & Health Products),

26 w w w . m e d e g a t e t o d a y. c o m May - June 2014

KMDICA (Korea Medical devices Industrial Cooperative Association), Ubi France, SAMD (Shenzhen Association of Medical Devices), Spectaris, GHE (German Healthcare Export Group), as well as ZVEI (German Electrical and Electronic Manufacturers’ Association).

The German Federal Ministry of Economy and Technology provided extraordinary support by including the event in their foreign trade fair programme with a promotion initiative.

The MEDICAL FAIR INDIA was able to significantly exceed the numbers from the previous event in Mumbai in 2012 (323 exhibitors, 6,721 trade visitors).

The simultaneous three-day conference, as well as the two-day medical forum, which dealt with current trends and topics from the industry, rounded off the widely varied supporting programme. Well-known international speakers from the industry and the healthcare system presented new discoveries in the areas of healthcare and medical technology in lectures and discussion forums.

The Next MEDICAL FAIR INDIA takes place from 21 to 23 March 2015 at Pragati Maidan in New Delhi.

Further information can be obtained at: http://www.medicalfair-india.com Düsseldorf Mr. Stephan Küppers, KueppersS@messe-duesseldorf.de, +49-(0)211-4560-7715 Düsseldorf India, Mr. Suraj Ullal, UllalS@md -india.com, +91-(22)-6678-9933.

NEWS Updat e

Integrating Virtual Reality with Video Games into Practice A New Frontier in Rehabilitation

I

n order to deliver therapeutic benefits to its patients with spinal injuries and patients who require regular physiotherapy sessions, the Rehabilitation Department of Indian Spinal Injuries Centre has introduced a unique and innovative virtual reality therapy for its patients. The virtual reality therapy aims to deliver remarkable benefits to physiotherapy patients and also help those suffering from cerebral palsy, stroke, traumatic brain injury, autism and other conditions.

The Nintendo Wii gaming console, ISIC’s latest virtual reality therapy is a device that uses accelerometers in three axes as well as an infra-red sensor bar to recognize gestures in an environment. This technology creates a video game system that relies on three dimensional movements to cue real-time responses within the game.

This virtual rehabilitation is able to provide a natural or real life environment, where individuals have the opportunity to forget about their surroundings and situations and focus directly on the task. It can be described as a simulation of real world

environments through a computer longer that usual” said Dr. Chitra and experienced through a Kataria, HOD, Rehabilitation human-machine interface.

Sciences, Indian Spinal injuries Centre.

“Initially there was a lot of pain in my arm and elbow while “Patients experience an playing but after few days the improvement in trunk control, pain reduced drastically as I limb use, balance, mobility and focused on the game and was gross and fine motor movement. determined to win,” said 27 year They can also see enhanced old Vinod Singh who met with a cognitive and executive road traffic accident that left his functioning and develop a right arm partially paralysed. greater sense of confidence and empowerment. Many elderly The therapy involves patients patients also felt that their into different sports like tennis, balance had improved as a result bowling, archery, baseball, golf, of virtual therapy”, further adds balance games, obstacle course Dr. Kataria. etc., in the gaming console which helps in the upper and the lower limb movement and balancing of the patients. Each sport requires the patient/ player to respond with specific movements to play the game. For example, movements required for the tennis game include shoulder abduction, flexion, extension, horizontal abduction and adduction as well as elbow flexion and extension.

“We have recently introduced this virtual therapy using the Nintendo Wii and the initial response has been positive as the patients tend to enjoy more and stay in the therapy session w w w . m e d e g a t e t o d a y. c o m

May - June 2014 27

NEWS Update

GE Healthcare & CTSI

Announce Strategic Partnership to Elevate the Standard of Cancer Care ●● Todevelop a network of 25 world-class cancer care centres across India

at $ 120 Million (INR 720 Crores) investment ●● To provide a comprehensive oncology service line to improve affordable access across India

G

E Healthcare, a unit of General Electric Company (NYSE: GE), and Cancer Treatment Services International (CTSI) announced today a strategic partnership to develop 25 world-class centres across India to improve access to cancer care. The network will be built at an investment of US $ 120 Million (INR 720 Crores) over a period of five years. The centers will offer latest technology for diagnosing and treating cancerand will follow the same standards of care found at the world’s top cancer hospitals delivered at affordable price points.

“At GE, we envision a day when Cancer is no longer a deadly disease. Scaling up of affordable access to Cancer care requires disruptive solutions and willing partners. We believe a partnership like this one presents a great opportunity to confront India’s cancer challenge head on,” stated John Dineen, President and CEO, GE Healthcare. He added, “Combining GE Healthcare’s innovative technology platforms with CTSI’s proven expertise in operating cancer centers affords a fantastic means to tackling cancer early in India.”

The incidence of cancer is sharply rising in India with a prevalence of 3 million cases and an addition of 1.23 million new cases every year*. The mortality rates are very high due to late detection, access and affordability to care. Estimates suggest every two minutes three patients succumb to thisdeadly and costly disease.

“CTSI has built a provenhealthcare delivery model tailored to making the highest quality cancer care accessible and affordable. When we launched our international operations, India was a natural place to start. It offers existing medical infrastructure, a pool of talented doctors and a population with the desire to embrace top-notch standards of care. Our partnership

28 w w w . m e d e g a t e t o d a y. c o m May - June 2014

with GE accelerates realization of our goal to build out a network in India and ultimately apply our model in similar markets worldwide,” added Joe Nicholas, President and CEO, CTSI. The partnership underscores four critical points to elevate the access, affordability and standard of cancer care in India. First, modern management of oncology patients requires a multidisciplinary approach, meaning that delivering cancer care according to top world standards demands interplay between a team of personnel from a wide range of medical specialties. Second, offering world-class cancer care requires adherence to welldefined, evidence-based medical protocols derived from the world’s latest medical research. Third, providing the latest therapeutic options for cancer requires expert use of cutting-edge imaging, treatment and digital recordkeeping technologies. Finally, reducing patient effort and spend through a comprehensive and transparent approach in a local, patient friendly environment.

GE and CTSI will configure the network in a hub-andspoke fashion, with all centers linked by a sophisticated IT network to a hub and supported by a multi-national group of clinicians, and administrators.The hub will be a centre of excellence with fulldiagnostic imaging and treatment capabilities while the spoke will have the ability to deliver a range of screening, staging and treatment options.

The centres will use globally proven clinical pathways and protocols to standardize the care for every patient.

The first hub center, American Oncology Institute, CTSI’s international brand, is already operational in Hyderabad, Andhra Pradesh. The first spoke or remote centre is being set up in Andhra Pradesh. The partners will provide a comprehensive oncology service line to

NEWS Updat e

interestedhealthcare providers in small and large citiesto accelerate and expand the network across India.The approach will take global standard cancer care closer to the patient and help optimize patient spend through the treatment cycle. Today a patient from a small town/rural area spends over 50% on travel and logistics for treatment.

The GE-CTSI partnership provides hospitals with cutting edge solutions that cover clinical and technical aspects necessary to offer cancer care to patients found at top hospitals throughout the United States and Europe, including clinical technology, medical physics services and a worldwide IT network. “CTSI’s centralized model features a comprehensive approach to care that combines evidence-based protocols and robust administrative support to promote consistent clinical decision-making and a patient-centric environment. In our experience, this leads to the best outcomes and service for patients,”

commented Andrew Shogan, COO, CTSI. “The partnership between GE and CTSI reflects our shared commitment to tackling cancer earlierand will offer Indian patients the same caliber of preventive, diagnostic and therapeutic options found at any leadingcancer center around the world but at affordable price points for patients in India. The Indian healthcare landscape is evolving rapidly. GE and our partners at CTSI are looking forward to being at the vanguard of this progress by setting up a complete oncology ecosystem,” concluded Terri Bresenham, President and CEO, GE Healthcare South Asia.

The partners will take steps to improve awareness and employ screening programs through all spoke centres to enable early detection of cancer. This week GE also announced the unveiling of first ever PET/CT technology to be designed and developed in India.

Specialized in Medical Equipment Transportation

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May - June 2014 29

POST E ve n t

XVI National Seminar on “Hospital & Healthcare Management, Medico Legal Systems & Clinical Research”on 2nd and 3rd May, 2014.

Dr. Rajiv Yeravdekar, Mr.Shivinder Mohan Singh Padma Bhushan Dr. S.B.Mujumdar, Adv. Ram Jethmalani, Dr. Rajani Gupte and Dr. Vidya Yeravdekar

S

ymbiosis Institute of Health Sciences (SIHS), a constituent of Symbiosis International University (SIU) organized the XVI National Seminar on “Hospital & Healthcare Management, Medico Legal Systems & Clinical Research” on 2nd and 3rd May, 2014. This seminar is organized every year with an aim to disseminate

evidence based knowledge and reach out to Healthcare professionals working across the country.

The Seminar was inaugurated by Dr. Vidya Yeravdekar, Principal Director, Symbiosis and Dr. Rajani Gupte, Vice Chancellor, SIU. Dr. Vidya Yeravdekar discussed about the future plan of setting up the Symbiosis Health Science and

30 w w w . m e d e g a t e t o d a y. c o m May - June 2014

Technology Park which will focus on research & development activity with progressive involvement of the pharmaceutical sector. Dr. Rajani Gupte brought to the attention of the gathering that the US and European Union Market are looking at India with regards to the implementation of intellectual property laws in India. This was followed by

POST Event

Dr. Rajani Gupte

Dr. Sanjay Arora

felicitation of the dignitaries and traditional lamp lighting ceremony.

Dr. Rajiv Yeravdekar, Dean, Faculty of Health and Biomedical Sciences (FoHBS) set the Pre Conference Symposium in motion by delivering a key note address on successful Healthcare Models. He shared how Symbiosis has spearheaded the Health Promotion University concept in India by providing on-campus preventive, promotive and curative services which is widely practiced across the globe.

The Pre Conference Symposium continued by way of an entertaining and intellectually stimulating session on “Successful Healthcare Models� which was anchored by Mr. Rajen Padukone (CEO and MD Manipal Health Enterprises). Dr. Harish Pillai (CEO, Aster DM Healthcare) conveyed that liberalization and the entry of global pharmaceutical companies have contributed to the growth of the Indian healthcare industry. Mr. Sudarshan Jain (MD, Healthcare Solutions, Abbott India) gave an insight about Indian Pharma industries and their contribution for contract research through the development of biosimilars, therapeutic equivalents and medical devices.

Mr. Sadananda Reddy (MD, Goldstar

Dr. Sanjay Gupte

Dr. Shreeraj Deshpande

Healthcare Private Limited) briefed about Healthcare infrastructure in various ways right from digitizing medical test, diagnostic and therapeutic procedures to enhancing the reach of Healthcare through telemedicine and Health IT. Dr. G.S.K Velu (Managing Director, Trivitron Group) enunciated that Medical electronics industry has witnessed double digit growth in recent years and this growth trajectory is expected to continue.

This was followed by scientific paper presentation by delegates.

Mr. Daljit Singh (President, Fortis Healthcare Ltd.) briefed the audience on Strategic management as an ongoing process that evaluates and controls the business and the industries in which the company is involved.

This was followedby four Master Class sessions on Game Changes in Healthcare.

Dr.Gautam Sen (Chairman, Wellspring Healthcare) put light on Transforming Healthcare Delivery for 21st Century and the Technology Boom in India. Dr. Om Manchanda (CEO, Dr LalPathLabs) talked on Indian healthcare industry, Market segments and drivers and changing market and consumer trend.

Dr.Adheet Gogate discussed on the entrepreneurial tidal wave with an out of

Dr. Rajiv Yeravdekar

the box thinking mind-set which is waiting to sweep across the Indian landscape.

Dr. Sanjay Arora, (Director Suburban Diagnostics) from the diagnostic sector, mentioned that the diagnostics franchise market is highly fragmented and yet to be tapped with a distinct possibility of more players coming here in the future.

In the concluding session for the day, Dr. Azad Moopen shared his knowledge on challenges faced by the Human resource in Healthcare industry by way of the identification, recruitment and retention of the required workforce.

Dr.Sanjay Gupte briefed about the special laws in healthcare with a focus on PCPNDT Act, Transplantation of human organ Act 1994, Surrogacy and its ethics and Maharashtra Clinical Establishment Act. Day 2 of the National Seminar began with a talk on Medical Tourism: Present & Future by Mr. Pradeep Thukral, (Founder & CEO SafeMedTrip Consultant Pvt. Ltd) who highlighted that inflated cost of treatments in the developed countries such as the USA and UK, has driven patients from such regions to look for alternative and cost-effective destinations such as India to get their treatment. Dr. Yash Paul Bhatia, (MD Astron Healthcare) spoke that when a hospital earns international

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May - June 2014 31

POST E ve n t

accreditation, the patient is assured that the facility has been inspected by an outside source and found to be of good quality.

Dr.Shreeraj Deshpande (Head, Health Insurance Future Generali India Insurance Company Ltd) discussed on the opportunities and challenges in the Health Insurance field and the role of Insurance Development & Regulatory Authority (IRDA) in guarding against the ill effects of privatization on the health care of a large segment of rural population in the country.Dr. Milind Sardesai (Assistant Director, Lupin Pharmaceuticals Limited) indulged the audience in the domain of pharmacovigillance observing that there is a need for transparencyin the pharmaceutical industry relating to the collection, detection, assessment, monitoring, and prevention of adverse effects with pharmaceutical products.

Dr.Raman Gangakhedkar (Deputy Director, NARI) stressed upon the objectives & necessity of laws in clinical research and notable incidents which triggered the need Dr. Harish Pillai, Mr.Rajen Padukone, Dr Rajiv Yeravdekar, Mr. Sadananda Reddy, Dr. Vidya Yeravdekar, Dr. Rajani. for Law in Clinical Research. Dr. Shubnum Gupte, Mr. Sudarshan Jain Singh (Chairperson, Healthcare Sector Skill Council, Advisory Committee) expressed her views on creating a robust and vibrant eco-system for quality vocational education in the world. Adv. Ram Jethmalani spoke on the important issues and training in allied healthcare & paramedics space. Mr. of surrogacy and euthanasia stating that surrogacy should not be Sandeep Ahuja (MD VLCC & Chairman, FICCI National practiced and should be substituted with adoption and euthanasia Wellness Committee) emphasized that wellness & health goes is the constitutional right of everybody. He further stated that the hand in hand in day to day life and that the scope of wellness best path to walk upon is the path of knowledge. extends beyond health by way of mental, spiritual, social wellbeing. Dr. Gopinath N. Shenoy, (Medico Legal Consultant) Dr. S.B. Mujumdar addressed the gathering & conveyed that in spoke about various legal aspects & Landmark Judgments in order to become the superpower by 2020, India must increase healthcare. He highlighted on the Drugs and cosmetics Act, the spending on healthcare. He concluded his speech by stating Drug Price Control Order, Human Organs Transplantation Act, that quality education and quality health services is the need of the country and it can be achieved only with the improvement Surrogacy Act & Clinical Establishment Act. in technology and innovation of ideas.The ISBN numbered The Valedictory ceremony was organized on 3rd May 2014 to “Symbiosis Health Times” was released by Mr.Shivinder conclude the two days XVI National Seminar on “Hospital & Mohan Singh who appreciated the efforts of Symbiosis Institute Healthcare Management, Medico- Legal Systems & Clinical of Health Sciences in organizing an Educative Seminar on a Research”. The Valedictory Ceremony was graced by Chief magnanimous level.

Guest- Shivinder Mohan Singh (Executive Vice Chairman, Fortis Healthcare Limited). The Guest of Honour for the Valedictory function was followed by Convocation Ceremony ceremony was Adv. Ram Jethmalani, (Former Union Law of PGDHHM, PGDMLS, PGDCR & PGDHIM. The certificates Minister).The ceremony was presided over by Padma Bhushan of merit were awarded byMr. Shivinder Mohan Singh. All in all, Dr. S. B. Mujumdar (President & Founder Director, Symbiosis over 800 delegates from all over India and some from abroad and Chancellor, SIU). Mr.Shivendar Mohan Singh shared his participated in this seminar. Over 80 civil surgeons, district views on changing trends in Healthcare, Infrastructure gap health officers and senior faculty of medical colleges were between the public and private sector and the necessity for deputed by the Directorate of Health Services and Directorate standardization to come in healthcare in order to provide the of Medical Education & Research thereby making it a very authentic health care service. He also mentioned that India will successful event. become the cheapest country to provide quality health services 32 w w w . m e d e g a t e t o d a y. c o m May - June 2014

POST Event

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May - June 2014 33

DOCTOR Speak

Understanding & Treating Heart Failure

A Guide for Patients and Families

Dr. Vishal Rastogi

Sr. Consultant, Cardiology Fortis Escort Heart Institute

H

eart failure (HF) is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and/or function, develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, poor quality of life, and a shortened life expectancy.

What is heart failure?

Heart failure does not mean your heart has stopped beating. HF is present when: ÂÂ Your heart muscle cannot pump (eject) the blood out of the heart very well. This is called systolic heart failure. ÂÂ Your heart muscles are stiff and do not fill up with blood easily. This is called diastolic heart failure.

Both of these problems mean the heart is no longer able to pump enough oxygenrich blood out to the rest of your body. As the heart's pumping action is lost, blood may back up in other areas of the body.

Don’t be disheartened by the word ‘failure’. For most patients, heart failure cannot be cured, but you can help to keep it from getting worse or even make it better by taking your medicine, eating the right foods, watching your fluids and exercising. If you take care of your heart, you can feel better and enjoy life more.

34 w w w . m e d e g a t e t o d a y. c o m May - June 2014

DOCTOR Speak

What happens in heart failure?

If you have heart failure, your heart may not pump enough blood to the lungs and other parts of the body during activity. This causes a shortage of oxygen and nutrients in the blood that may make you feel weak and tired. When the heart is not pumping well, it can cause a backup of blood. This backup of blood causes fluid to leak from the blood vessels into the tissues. This is called "congestion'? In the lungs, congestion may lead to difficulty breathing. In the ankles and legs, the congestion or backup of fluid causes swelling. In the belly, congestion may cause fullness or loss of appetite.

What causes heart failure?

Any disease that weakens the heart muscle can lead to heart failure. The most common causes of heart failure are: ÂÂ Blockages in the blood vessels that may lead to a heart attack ÂÂ High blood pressure that may cause diastolic heart failure ÂÂ Disease of the heart valves ÂÂ Diabetes ÂÂ Infections of the heart muscle ÂÂ Cancer drugs ÂÂ Genetic abnormalities that run in families

In many cases, the cause is never known. This is termed as ‘Idiopathic cardiomyopathy’.

What are the symptoms of heart failure? ÂÂ Weight gain of more than 1 Kg overnight or more than 2 Kg in a week. ÂÂ Shortness of breath after climbing a flight of stairs or getting dressed ÂÂ Difficulty breathing when lying down ÂÂ Cough ÂÂ Weakness or tiredness ÂÂ Swelling in your ankles or legs ÂÂ Loss of appetite ÂÂ Belly pain and fullness

If you develop any of these symptoms or they are getting worse, call your doctor or nurse.

How is heart failure treated?

There is no cure for heart failure, but you can prevent

your heart failure from getting worse and often help it get better. Here are some things that you can do to feel better. ÂÂ Take your medication ÂÂ Eat low sodium (low salt) food ÂÂ Watch your fluid intake ÂÂ Exercise ÂÂ Make lifestyle changes ÂÂ Weigh yourself every day ÂÂ

Quit smoking

ÂÂ Avoid alcohol ÂÂ

Go to your doctor's appointments

New Treatments

There have been many new developments in treating heart failure. If medication and lifestyle changes are not enough to control your symptoms, your doctor may suggest:

Cardiac Resynchronization Therapy (CRT) A normal heart sends electrical signals to both lower chambers or "ventricles" of the heart to make them pump at the same time. Sometimes in heart failure patients, the two chambers do not pump together.

A special pacemaker called CRT is a small batterypowered device that is placed under the skin that helps make the two sides of the heart beat together. It has special wires called "leads" that send tiny electrical w w w . m e d e g a t e t o d a y. c o m

May - June 2014 35

DOCTOR Speak

signals to the heart telling the heart muscle when to pump. CRT is a pacemaker that tells both ventricles to pump at the same time, so it has leads on the right and left side of the heart. CRT can reduce your heart failure symptoms and increase your ability to exercise and be more active.

Implantable Cardioverter Defibrillator (ICD) Some patients with heart failure have dangerously fast heartbeats called "ventricular tachycardia" or "ventricular fibrillation." This fast heartbeat can cause serious symptoms such as fainting or even death. An ICD is like a pacemaker that can be inserted under your skin. It can recognize a dangerous heart beat and send an electrical signal to the heart and return the heart back to a normal heartbeat. If your heart needs both a CRT and an lCD, they can be placed at the same time using one device.

Ventricular Assist Device (VAD) A Ventricular Assist Device (VAD) is a mechanical pump inserted into your body to improve blood flow. If you have severe heart failure, your heart is unable to pump enough blood to your body's organs and tissues, and a VAD may be needed. You will need open heart surgery to implant the mechanical pump. The VAD works together with your own heart to pump more effectively. VADs can stabilize your heart condition and allow you to become stronger and feel better. This option may not be possible for everyone.

Heart Transplantation Heart transplantation is an operation to replace a diseased heart with a healthy heart. Heart transplantation is a treatment used for severe heart failure when a patient may be at risk of dying. This is an option only for a few people who, except for their heart problem, are otherwise in very good health.

Research and Clinical Studies Medical research is ongoing to discover new treatments, especially for heart failure. New surgical procedures are currently being done. In addition, research using stem cells and artificial hearts are in the early stages. There are several clinical studies involving drugs and mechanical devices that are underway which may bring new treatments in the future. Fortis Escorts Heart Institute participates in many clinical studies that are ongoing.

If you are interested, you should ask your doctor or nurse about possibly enrolling in one of them.

36 w w w . m e d e g a t e t o d a y. c o m May - June 2014

DOCTOR DOCTOR Careworld Speak

DOCTORS on

TV Channel

Dr Devavrat Arya

Dr Shrilata S Trasi

DM, MD, Medical Oncologist International Oncology at Fortis, Noida

MD, DVD DDV, FCPS. Mumbai

Dr Gagan Saini

Dr Sameera Gupta

MD(AIIMS) DNB International Oncology at Fortis Noida

Physio-Occupational Therapist and Specialist Mumbai

Dr R N Jain

Dr Abhishek Bhargav

MBBS, Gen. Medidicine Central Clinic Noida

D.N.B.(Medcine) N.A.M.S.,F.R.S.H.(UK) F.I.D. Sujay Hospital Mumbai

Dr. Arun Moondhra

Dr Ravindra Dargainya

MD(Med) Sant Parmanand Hospital, Delhi

MBBS, DDV, PGDMLS CFN Sujay Hospital Mumbai

To feature in this Section please Call: +91 9811744464 w w w . c a r e w o r l d t v

.

c

o

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m May - June 2014 37

DOCTOR Speak

Master of

Heart the

Smarter, cutting-edge pacemakers, which act as a mini-heart, are helping people with coronary problems live longer and healthier.

B

y the time he turned 42, Diwakar Sharma knew he was in trouble. He had hypertension and was severely diabetic. And, he had developed diabetic cardiomyopathy - a disorder which affected the ability of his heart muscles to pump blood effectively. Sharma was put on heavy medication to control his BP and diabetes. In five years, things went from bad to worse. By the time he was 47, he could barely walk and was constantly fatigued. All he wanted to do was to either sit or lie down. By now, his heart was pumping only 25 per cent of the blood it should with each beat. "I was struggling to survive;" he says. It was around this time that Sharma, who lives in Delhi, learnt about pacemakers that did more than just correct the slow beating of the heart. These were state-of-art pacemakers that understood the heart, and could feel its rhythm and correct it. If they sensed trouble, they could even give the heart a mild electric jolt to put it back in balance - much like the shock we see being administered in the movies to bring the heart back from the brink.

Dr Aparna Jaswal sr. Cardiologist and electrophysiologies Fortis Escort Heart Institute

38 w w w . m e d e g a t e t o d a y. c o m May - June 2014

"We've had pacemakers for hearts that beat in an irregular manner for about 50 years now," says Aparna Jaswal, senior cardiologist and electrophysiologist at Fortis Escorts Heart

DOCTOR Speak

Two-and-a-half years after he got' this device, which he calls a "mini heart", Sharma says he's able to live a "normal life". "There was a time when I couldn't walk or drive and would have to call a cab to take me home from office. An outstation trip would leave me exhausted for a week." This severely affected his work which involved a great deal of travelling. With two children -one is in Class XII now and the others in Class X - he also had a family to take care of. Today, Sharma says he "travels a lot, even overseas". He goes for a walk to India Gate every evening. Tests show his heart is pumping more blood now -40 per cent, not optimum yet but it's getting there. There are still a few things he avoids though, "like walking up the stairs two or three storeys". Or doing stretching exercises lest the wires Institute in Delhi. Traditional pacemakers got the heart to attached to his heart break. beat at a particular pace, whether a person was walking, sleeping or exercising. They were not programmed to Like Sharrna, 67-year-old Manjula Malik (name understand when the body needed the heart to beat faster changed) also got a second chance at life after she (such as when climbing stairs) or when it needed it to got a biventricular pacemaker implanted five years ago. Malik suddenly collapsed while she was alone slow down (like, when resting). at home. She was rushed to the nearby hospital where 'Today's pacemakers are mature, smaller, thinner and, doctors detected the poor condition of her heart. The more importantly, compatible with diagnostic tests prognosis was bleak, But after getting a pacemaker, she such as MRI scans. The older metallic pacemakers can perform routine activities and live a healthier life. were a hazard inside magnetic scanning chambers, and Unlike the traditional pacemaker that has a single wire all patients implanted with the device would be warned providing electrical impulse to a single chamber of the of the risks to both body and device. Now the internal heart, Malik got a newer model that performed much circuit, external body and leads of a pacemaker are all better with its two leads going from the battery unit to made of non-ferromagnetic material that are unaffected both the ventricles other heart. by magnetic rays. That, say cardiologists, is critical. Of the 30,000-odd Indians who get pacemakers implanted For a procedure that allows virtually a second lease every year, about 75 per cent may need to, at some stage, of life, pacemaker implantation isn't complex. "The procedure is performed under local anaesthesia and lasts go for an MRI test. about an hour," says Jaswal. It does not require open Pacemakers have become smarter too. Take, for heart surgery. A small incision, about two-inch-long, is example, Sharma's case. Instead of going for the made in the upper chest. Leads -single, double or three, traditional pacemaker, which would only prod the heart according to the device opted for - are pushed into the to beat with metronomic regularity, the factory-owner heart and the pacer lodged under the chest muscle. After opted for the cardiac resynchronisation therapy (CRT) three to four days of hospitalisation, the person, can go heart device along with defibrillation therapy device, or home. A check-up is recommended every four to six CRT-D. The smartest of the lot, this multifunction device months. The battery is regularly monitored and needs has the ability to detect and treat dangerously fast heart replacement every seven to eight years. Researchers at rhythms, or speed up a heart that is beating too slowly, the University of Michigan are, meanwhile; workÂŹing to or give. a mild electric shock if the heart is about to let develop a new kind: of pace-maker that can be' powers you down. It is equipped to control bean rate as well as using kinetic energy generated by the vibrations in the prevent. Heart failure and, therefore, prevent sudden chest as the heart pumps blood. cardiac death.

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DOCTOR Speak

With hypertension, leading to: coronary diseases, affecting more man 100 million Indians, these pace-makers are gaining ground.

At the Ferris hospital in Delhi alone 20-30 such pacemakers are implanted every month. While it Is safe, like in every medical procedure, there is a slight risk of infection. In this case, it is one to two per cent worldwide. That's a small risk certainly for a return to a near-normal life.

LISTEN TO THE BEAT Biventricular pacemaker The electronic, battery-powered device, which is surgically implanted under the skin, helps the heart beat in a more normal way in people with heart failure.

Heart failure refers to poor ejection fraction, or EF, which is a measure of how much blood, is being pumped out of the heart's left ventricle. In simple terms, heart failure, or poor EF, means that the pumping power of the heart is weak. A normal heart pumps 50-70 per cent of full capacity, while people with heart failure show a n EF of less than 35 percent. It has leads from the battery to both ventricles of the heart.

By helping balance the pumping power of the heart, a biventricular pacemaker improves both the quality and quantity of life.

of a pacemaker. ICD improves the quantity of life and helps a person live longer.

Biventricular Implantable cardioverter defibrillator

For some patients with heart failure, the cardiac'd resynchronisation therapy works best. This is a combination of biventricular pacemaker and an implantable cardiac defibrillator. The device helps correct abnormal heart rhythm resynchronises the Implantable cardioverter defibrillator heartbeat and prevents the risk of sudden death through (ICD) automatic defibrillation. CRT-D reduces the risk of A small battery-powered device, ICD can be described sudden death and helps improve the quality of life. as an emergency room that's constantly travelling with you or an intelligent doctor sitting in your chest. It's an DOS AND DON'TS impulse generator that is implanted in patients who are If the pacemaker is implanted on the right side, use the at the risk of sudden cardiac death. The device can detect mobile phone with the left ear. cardiac arrhythmia in which there is abnormal electrical activity in the heart that can, in some cases, cause a Hand-held metal detectors (Security wands) should be cardiac arrest. What the ICD does is detect the condition avoided. People with pacemaker are given a special and correct it with a jolt of electricity. An Intelligent card which can be shown for this purpose to security device, it constantly monitors the rate and rhythm of guards at airport and malls. A pacemaker allows you the heart. The process of implantation is similar to that to use all electric appliances.

40 w w w . m e d e g a t e t o d a y. c o m May - June 2014

DENTAL S ec t ion

Don’t let

gum problems play havoc with your overall

S

wollen gums, bleeding after brushing, loosening of teeth, constant bad breath and receding gum line -- all these are signs of poor oral hygiene and its adverse impact on gums. Problems in gums in initial stages are easy to combat, but results could be as bad as loss of tooth, if not treated early.

Gum problem in early stage is known as Gingivitis, which occurs due to the formation of plaque, a sticky layer of bacteria around the teeth. Just by sticking to daily routine of brushing, flossing and tongue cleaning can help contain Gingivitis. However, any compromise with it is an invitation to plaque build-up. The result of this is release of toxins by bacteria which causes inflammation in the gums.

health!

state.

Many people do not know that gum diseases not only lead to loss of tooth, but can also be a call to many serious health issues too. So, they need to be dealt with seriously. There are countless researches that associate gum diseases with numerous health ailments. Ensuring proper oral care, henceforth, becomes more so important.

Cardiovascular diseases: Research has shown that periodontal disease may increase the risk for developing cardiovascular disease. Both periodontal disease and cardiovascular disease are chronic inflammatory diseases, so researchers believe that inflammation may account for the association between the two. Untreated periodontal disease can increase inflammation in the body, which may increase the risk for development of more severe health complications, Any signs of Gingivitis like swollen-red including cardiovascular disease. gums or bleeding should not be taken Diabetes: Diabetes and gum diseases are totally lightly. They should rather be ‘a wake-up interlinked, studies show. In fact many a times call’ to take preventive measures for damage it is the swollen gums that take the patient to a reversal. If avoided, the condition advances to dentist and ultimately it turns out to be a case of Periodontitis, a serious form of inflammation undiagnosed diabetes. In today’s world where 2 which makes gum line to recede, exposing the out of 5 people are diabetic, taking care of your roots of the teeth to bacteria attack. As gum gums is essential. If you are a diabetic and your tissues keep on getting destroyed, they are gums are not strong enough; you won’t be eating not able to hold the teeth intact, thus making well leading to a cycle of worsening sugar levels them go loose. The end outcome is nothing and inability to eat. but loss of tooth.

Dementia: The disease which hampers a person’s Periodontal disease is an advanced stage of cognitive ability, the ability to think and causes infection of the gums and its underlying memory loss, is also found to be linked with gum bone. In the stage of gingivitis, the pain is not diseases. A study from University of Central excruciating and hence people tend to neglect Lancashire School of Medicine and Dentistry it. In the absence of proper professional care points to fact that these two conditions may the same condition develops into Periodontitis be interlinked. Other researchers, who have which is totally painless. The only symptom worked on finding a link between the two, also felt by the patient is mobility of the teeth corroborated the fact that gum diseases and which signifies that the disease has consumed dementia may be linked. Studies have showed that a good chunk of the bone: the irony is that at participants who had gum diseases fared badly this stage only advanced surgical procedures in memory tests and calculations as compared to can restore the teeth and gums to a healthy people having good oral health.

Dr Simita Madan Axiss Dental

Periodontal diseases, commonly known as gum problems, can be a call to many health disorders like diabetes, cardiovascular diseases and oral cancer, among others. So any sign of gum trouble should not be ignored as it not only results in loss of tooth but can expose you to innumerable health ailments too, writes Dr Simita Madan, Axiss Dental, India’s leading multispecialty chain of dental clinics

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May - June 2014 41

DOCTOR Speak

Pediatricians

a caring hand for children In addition to playing an integral role in school and community disaster preparations, pediatricians may be the first to recognize children and adolescents with anxiety, fear and depression.

Dr. Rajiva Kumar Child Specialist Muzaffarpur Bihar, INDIA 42 w w w . m e d e g a t e t o d a y. c o m May - June 2014

P

ediatricians can play an important role in assisting parents and community leaders in protecting children from the long-term effects of disaster.

Pediatricians can help families understand what type of behavior to expect from their child after a disaster, and how parent's behavior can impact a child psychological stability.

Pediatricians should encourage families to limit watching of television coverage on the disaster.

DOCTOR Speak

But when it comes to caring for your child, it is your pediatrician who will be your support line - a best friend.

This makes the choice of a doctor for our children a critical one, though possibly, the most ignored choice in our journey as parents. Even in good health, the presence of a pediatrician remains unavoidable - what with regular check-ups in infancy, monitoring growth parameters or immunization schedules.

In addition to playing an integral role in school and community disaster preparations, pediatricians may be the first to recognize children and adolescents with anxiety, fear and depression.

In such cases, Encephalitis can be a major threat. It is a term used to describe inflammation of the membranes that surround the brain and spinal cord. This condition causes problems with the brain and spinal cord function.

The inflammation causes the brain to swell, which leads to changes in the child's neurological condition, including mental confusion and seizures.

The cause of encephalitis varies depending on the season, the area of the country, and the exposure of the child.

Viruses are the leading cause of encephalitis. Although vaccines for many viruses, including measles, mumps, rubella, and chickenpox have greatly lowered the rate of encephalitis from these diseases, other viruses can cause encephalitis. These include herpes simplex virus, West Nile virus and rabies.

(Encephalitis often is preceded by a viral illness, such as an upper respiratory infection, or a gastrointestinal problem, such as diarrhea, nausea, or vomiting.

Despite being uncommon, the symptoms and signs with which children with encephalitis present are often nonspecific. For this reason, many children are initiated on

Encephalitis can be a major threat. It is a term used to describe inflammation of the membranes that surround the brain and spinal cord. This condition causes problems with the brain and spinal cord function. The inflammation causes the brain to swell, which leads to changes in the child’s neurological condition, including mental confusion and seizures. treatment for encephalitis even if they do not really have a significant likelihood of having the syndrome. Conversely, a recent study has shown that the management of children with encephalitis is haphazard and could be improved.

Pediatricians should therefore have a safe management plan for children who present with suspected encephalitis.

We understand that children are not simply small adults.

They often present different symptoms from adults. They may need different prescriptions or treatments than adults.

We are specially trained to recognize the importance of these differences, especially with young children and newborns, said Dr. Rajiva Kumar, Pediatric training programs are searching for the optimal blend of knowledge, skill, attitudes, and experience to prepare tomorrow’s pediatricians for the new challenges and morbidities that they will face. As clinicians and educators encounter new demands on their expertise and resources, it is important to reaffirm the vital and long-standing role of pediatricians in promoting the physical, mental, and social health and wellbeing of all children in the communities they serve. w w w . m e d e g a t e t o d a y. c o m

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DOCTOR Speak

Pain

Size of Prostate

Could Indicate

Problems

I

t’s a sad fact of growing older for the male species. Most men over the age of 60 (and some in their 50s) develop some symptoms of prostate problems. The three most common disorders are benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate; prostatitis, an inflammatory infection; and prostate cancer.

The prostate’s main role is to produce an essential portion of the seminal fluid that carries sperm. This walnut-shaped gland located just below a man’s bladder starts to kick in near puberty and continues to grow and grow. This enlargement doesn’t usually cause symptoms until after age 40, and it usually doesn’t cause problems until age 60 or later,Said Dr.Rajeev Sood.

That’s why regular checkups are necessary to make sure any problems are dealt with early on.

He advised some of tests often used to check the prostate like below:

Health history and current symptoms

This first step lets your doctor hear and understand the “story” of your prostate concerns. You’ll be asked whether you have symptoms, how long you’ve had them, and how much they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or trouble passing urine.

You may be asked to give a urine sample for In most cases, cancer of the testing. prostate is slow-growing and Digital rectal exam (DRE) generally symptom-free in its DRE is a standard way to check the prostate. early stages.

With a gloved and lubricated finger, your When it is more aggressive, doctor feels the prostate from the rectum. The the mortality rate is higher test lasts about 10-15 seconds. than any cancer other This exam checks for: than lung cancer.

Prof (Dr) Rajeev Sood MCh, Consultant & Head Department of Urology

ÂÂ The size, firmness, and texture of the prostate ÂÂ Any hard areas, lumps, or growth spreading beyond the prostate

and Cancer Registry

ÂÂ Any pain caused by touching or pressing the prostate The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check the health of your prostate. PSA (Prostate-specific antigen) test

PGIMER and Doctor Ram Manohar Lohia Hospital New Delhi

The U.S. Food and Drug Administration (FDA) has approved the use of the PSA test along with a DRE to help detect prostate

Indian Parliament (Medical Centre) Nominated Hony Urologist, President of India Chairman Tumor Board

44 w w w . m e d e g a t e t o d a y. c o m May - June 2014

DOCTOR Speak

Free PSA test This test is used for men who have higher PSA levels. The standard PSA test measures total PSA, which includes both PSA that is attached, or bound, to other proteins and PSA that is free, or not bound. The free PSA test measures free PSA only.

Free PSA is linked to benign prostate conditions, such as BPH, cancer in men age 50 and older. whereas bound PSA is linked to cancer. The percentage of free PSA is a protein made by prostate cells. It is normally secreted PSA can help tell what kind of prostate problem you have. into ducts in the prostate, where it helps make semen, but sometimes it leaks into the blood. When PSA is in the blood, ÂÂ If both total PSA and free PSA are higher than normal (high percentage of free PSA), this suggests BPH rather it can be measured with a blood test called the PSA test. than cancer.

In prostate cancer, more PSA gets into the blood than is normal. However, a high PSA blood level is not proof of ÂÂ If total PSA is high but free PSA is not (low percentage cancer, and many other things can cause a false-positive test of free PSA), cancer is more likely. More testing, such as result. For example, blood PSA levels are often increased a biopsy, should be done. in men with prostatitis or BPH. Even things that disturb the You and your doctor should talk about your personal risk and prostate gland--such as riding a bicycle or motorcycle, or free PSA results. Then you can decide together whether to having a DRE, an orgasm within the past 24 hours, a prostate have follow-up biopsies and, if so, how often. biopsy, or prostate surgery--may increase PSA levels.

Also, some prostate glands naturally produce more PSA than Prostate biopsy others. PSA levels go up with age. African-American men If your symptoms or test results suggest prostate cancer, your tend to have higher PSA levels in general than men of other doctor will refer you to a specialist (a urologist) for a prostate races. And some drugs, such as finasteride and dutasteride, biopsy. A biopsy is usually done in the doctor’s office. can cause a man’s PSA level to go down.

For a biopsy, small tissue samples are taken directly from the PSA tests are often used to follow men after prostate cancer prostate. Your doctor will take samples from several areas of treatment to check for signs of cancer recurrence. the prostate gland. This can help lower the chance of missing It is not yet known for certain whether PSA testing to screen any areas of the gland that may have cancer cells. Like other for prostate cancer can reduce a man’s risk of dying from cancers, prostate cancer can be diagnosed only by looking at tissue under a microscope. the disease.

Researchers are working to learn more about: ÂÂ The PSA test’s ability to help doctors tell the difference between prostate cancer and benign prostate problems

Most men who have biopsies after prostate cancer screening exams do not have cancer.

If a biopsy is positive

ÂÂ he best thing to do if a man has a high PSA level

A positive test result after a biopsy means prostate cancer ÂÂ For now, men and their doctors use PSA readings over is present. A pathologist will check your biopsy sample for cancer cells and will give it a Gleason score. The Gleason time as a guide to see if more follow-up is nteeded. score ranges from 2 to 10 and describes how likely it is that a What do PSA results mean? tumor will spread. The lower the number, the less aggressive PSA levels are measured in terms of the amount of PSA the tumor is and the less likely it will spread. per volume of fluid tested. Doctors often use a value of 4 nanograms (ng) or higher per milliliter of blood as a sign that Treatment options depend on the stage (or extent) of the cancer further tests, such as a prostate biopsy, are needed. (stages range from 1 to 4), Gleason score, PSA level, and your Your doctor may monitor your PSA velocity, which means the age and general health. This information will be available rate of change in your PSA level over time. Rapid increases from your doctor and is listed on your pathology report. in PSA readings may suggest cancer. If you have a mildly Reaching a decision about treatment of your prostate cancer elevated PSA level, you and your doctor may choose to do is a complex process. Many men find it helpful to talk with PSA tests on a scheduled basis and watch for any change in their doctors, family, friends, and other men who have faced similar decisions. the PSA velocity. w w w . m e d e g a t e t o d a y. c o m

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DOCTOR Speak

High prevalence of Vector-borne diseases in children this year

T Dr. Sanjay Bafna consultant pediatrician Jehangir Hospital, Pune

Jehangir Hospital has examined and treated nearly 200 children suffering from vector borne diseases in one year, a major syndrome to look into

his World Health Day – 7 April – WHO is highlighting the serious and increasing threat of vector-borne diseases, with the slogan “Small bite, big threat”. Mosquito-borne dengue, for example, is now found in 100 countries, putting more than 2.5 billion people - over 40% of the world’s population - at risk according to WHO report. On this occasion of World Health Day, Jehangir Hospital talks about the present scenario of Vectorborne diseases in children.

Vector borne disease has emerged as a huge threat in Pune, where the numbers of cases have doubled in just one year. Nowadays, the risk for exotic vector-borne diseases in India has become a hot topic.

Jehangir Hospital has examined and treated nearly 200 children suffering from vector borne diseases in one year, a major syndrome to look into. Dr. Sanjay Bafna, consultant pediatrician, Jehangir Hospital talks about the current scenario and controlling measures to be taken to avoid Vector-borne diseases in children.

Dr. Sanjay Bafna, consultant paediatrician, Jehangir Hospital said “there has been a high rise in vector borne diseases in children and it is rising on a high scale due to the nonpreventive measures. The disease can lead to serious complications resulting to death.

Proper precaution and treatment needs to be taken to avoid further complications.

After all, prevention is always better than cure. Therefore on the occasion of World Health Day, Jehangir hospital has taken the initiative to spread awareness through a workshop and seminar that will help prevent such cases. “Preventive measures such as by spraying for mosquitoes, using chemicals to kill mosquito larvae, and by

46 w w w . m e d e g a t e t o d a y. c o m May - June 2014

emptying standing water from containers or covering those to prevent mosquitoes from laying eggs will help to reduce vector borne diseases”, Dr. Bafna added.

Vector-borne infectious diseases are emerging due to factors such as insecticide and drug resistance, shift in emphasis from prevention to emergency response, demographic and societal changes, and genetic changes in pathogens.

Dengue considered to be the most dangerous, has a high prevalence amongst the children in many tropical and subtropical areas of Pune. Dengue has four types of viruses. The first time infection is known as primary dengue which is usually mild and needs only supportive treatment. Repeat infection, known as secondary dengue is associated with complications like bleeding & shock.

Nearly 5 to 10% children can have serious illness that needs hospitalization and sometimes treatment in intensive care unit and the risk of death is high. The cases have doubled this year and will increase if proper care and treatments are not taken.

Pregnant women should take extra care as it can affect the child. In case of early pregnancy medical care must be taken to protect the child from getting infected. But in the last stage of pregnancy, medications are required to treat the infected baby and the mother.

High mortality rate over the years has been a major concern. Effective prevention strategies can reverse this trend. Research on vaccines, environmentally safe insecticides, alternative approaches to vector control, and training programs for health-care workers are needed.

DOCTOR Speak

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May - June 2014 47

DOCTOR Speak

Dr. Vanita Arora

‘Women are born leaders’ believes Dr Vanita Arora, who broke into the male bastion and successfully created her niche in the field of Cardiac Electrophysiology. At a time when only men dominated the field, Dr Arora did not hesitate from taking the road less travelled, and with her steeled determination she has come a long way. That she is the only woman Electrophysiologist in India speaks volumes about her penchant for doing something ‘extraordinary’ and makes her stand out of the crowd.

Dr Arora is a Senior Consultant Cardiac Electrophysiologist & Interventional Cardiologist with Max Super Speciality Hospital, Saket. She is also Associate Director & Head, Cardiac Electrophysiology Lab and Arrhythmia Services.

Heart Attack is not Sudden Cardiac Arrest

R

ajendra Tolani, 65, was hospitalized after he was found unconscious in his office by his son, Kapil, who panicked thinking he might have had suffered a heart attack. In hospital, doctors conveyed him that his father had a sudden cardiac arrest. Not knowing much about it, what he still told to the family members was that it was a heart attack.

Kapil is at no fault here. There are many like him who do not understand the difference between heart attack and sudden cardiac arrest. They take both these as one and the same thing, when it is not. In case of heart attack, there is a blockage in artery due to which the flow of oxygen-rich blood gets halted. While, sudden cardiac arrest happens when heart suddenly stops beating on account of malfunction in electrical impulses.

“Due to fat and plaque deposition in the heart’s artery, a blockage starts developing, which hampers the blood blow. On being completely blocked, it triggers a heart attack. While irregular heartbeats, known as arrhythmia, which when not treated leads to sudden cardiac arrest. Simply, heart attack takes place due to 48 w w w . m e d e g a t e t o d a y. c o m May - June 2014

‘circulation’ malfunction, while sudden cardiac arrest happens on account of ‘electrical’ malfunction in the heart,” says Dr Vanita Arora, Associate Director & Head, Cardiac Electrophysiology Lab and Arrhythmia Services, Max Hospital, Saket.

A person can be treated with a bypass surgery or angioplasty after a heart attack, while in case of arrhythmias the condition can be cured with implantation of implantation of pacemaker devices, including Implantable Cardioverter Defibrillator (ICD).

It is also treated through radiofrequency ablation, in which the doctors burn the points from where irregular beats originate.

DOCTOR Speak

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EXPERT V ie w s

Bariatric solution for Curing Diabetes Offers

New Hope

F

orty three-year-old S Nair had been diabetic for 15 years. His disease was uncontrollable and had turned him blind. Just when he had given up all hope, doctors suggested bariatric surgery to cure the condition. Just 12 days after the procedure, his insulin was back to normal and he was taken off all medication for diabetes.

The twin epidemics of type 2 diabetes and obesity are emerging as a big public health challenge for India. There are over 65 million diabetes patients in the country, with another 30 million or so in the pre-diabetes group.1 In the next 15 years, we will be hosting the biggest number of diabetics in the world. Obesity has also reached alarming proportions, with morbid obesity affecting 5% of India’s population.2 Indians have been shown to be genetically susceptible to gaining weight, especially around the waist. Both the conditions feed on each other and are a result of the modern, sedentary lifestyle, fuelled by a highfat, energy-rich diet. These place extra stress on the human body and increase the risk of premature death. Serious health conditions may arise, reducing the overall quality of life. Diabetes can cause serious problems like heart disease, strokes, blindness, kidney failure and

50 w w w . m e d e g a t e t o d a y. c o m May - June 2014

EXPERT Views

amputation. Obesity is associated with high blood pressure, diabetes, heart diseases, respiratory problems and certain types of cancer. For obese or not-soobese people whose blood sugar levels are way out of control, bariatric surgery offers a new ray of hope. The procedures (Sleeve gastrectomy, gastric bypass and other diversion procedures) induce hormonal changes in the body that reset set point for fat storage to a lower level resulting in permanent weight loss. These hormonal changes are also responsible for long term remission and resolution of type 2 diabetes.

Gastric bypass is the most popular type of bariatric surgery because it generally has fewer complications than other weight loss surgeries. In this, the size of the stomach is made smaller and food is made to bypass part of the small intestine (where most of the nutrients and calories are absorbed). As a result, the person feels full after eating much smaller quantities of food, leading to weight loss. Bariatric surgery can be done by making a big incision in the abdomen or through a small incision (laparoscopy). With advances in science, it is today considered one of the safest medical procedures of the abdomen.3 The patient is usually discharged 24 hours after surgery. The National Institutes of Health (NIH) of the US Government has recognized bariatric surgery as the only effective treatment to combat severe obesity and maintain weight loss in the long term. It is recommended if the body mass index (BMI) is 35 or higher, or if it is more than 30 with uncontrolled diabetes. Bariatric surgery results in significant weight loss (up to 97% of the excess weight) that can be sustained over years.

Research reveals that bariatric surgery can also keep diabetes at bay for many years and even reverse some of the health complications.4 The improvement in diabetes control is usually long lasting, with normal insulin levels returning within days of the surgery, long before any significant weight loss takes place.5 Many medical experts are now recommending bariatric surgery as an early treatment option for people with uncontrolled diabetes.

A study by Cleveland Clinic published in September 2013 in the journal, Annals of Surgery, showed beneficial long-term effects of bariatric surgery for people with diabetes.6 It discovered that obese patients with type 2 diabetes continue to experience the benefits

of bariatric surgery up to nine years after the procedure.

During this period, they continued to improve or reverse their diabetes, as well as lower their cardiovascular risk factors. The researchers identified long-term weight loss and a short duration of diabetes before surgery as among the main factors that resulted in higher rate of longterm diabetes remission. They concluded that bariatric surgery can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients having problems in controlling their diabetes. Surgical cure of obesity and diabetes is now in the realm of reality. Thousands of patients have benefited by drastically reducing weight and naturally controlling their blood sugar levels through bariatric surgery. w w w . m e d e g a t e t o d a y. c o m

May - June 2014 51

EXPERT V ie w s

Screening of IDA &

Thalassemia Using Automated Hematology Analyzers

Two Sides of One Coin: Microcytic Hypochromic Anemia

The Indian Anemia Story: In the Indian context, the two most common etiologies for microcytic hypochromic anemia cases are iron deficiency anemia and beta thalassemia (a genetic hemoglobinopathy). As per the WHO estimate, 80% of children, 58% of pregnant women, 30% adults in India are suffering from IDA while 3.3% of Indian population is affected by beta thalassemia.

Divya Munshi Product Management-Hematology Transasia Bio-Medicals Ltd.

In regions like Punjab, Gujarat, Rajasthan, IDA and beta thalassemia co-exist with the former being prevalent and latter present in 6.5%, 15% and 3% of their population respectively. This makes the task further difficult in the differentiation of borderline IDA and thalassemic cases.

52 w w w . m e d e g a t e t o d a y. c o m May - June 2014

EXPERT Views

Utility of automated RBC indices, for screening and differentiation of IDA and beta- thalassemia: With the advent of automation in hematology, the first line of screening of IDA and thalassemia is possible through Complete Blood Count (CBC). An automated hematology analyzer reports complete RBC count, Hb, MCV, MCH, MCHC which fall low in cases of microcytic anemia.

However, the key automated hemogram indices which help in providing first line of differentiation among such cases of IDA and thalassemia are RDW-SD, RDW-CV in combination with MCV, Automated Reticulocyte Counts and IRF (Immature Reticulocyte Counts).

Red cell Distribution Width (RDW) is a quantitative measurement of variation in red cell size provided as either Standard Deviation (RDW-SD) or Co-efficient of Variation (RDW-CV). RDW-SD is measured by calculating the width in fl. (femto liter) at a relative height of 20% above baseline of RBC curve. On the other hand, RDW-CV is measured by calculating ratio of 1SD of RBC curve to Mean Corpuscular Volume (MCV).

RDW-SD is a direct measure across the RBC histogram, hence it is ‘theoretically’ a better and more accurate Both RDW-CV and RDW-SD reflect the variability in measure of RBC anisocytosis across the entire spectrum erythrocyte size and thus measure anisocytosis, however of MCV values. On the other hand, RDW-CV shows each of these parameters has its own clinical utility. better correlation as an indicator of anisocytosis, if the

Calculation of RDW-SD and RDW-CV:

Table 1. highlights the importance of RDW-CV, RDW-SD and MCV in differentiation and prognosis of various anemic conditions MCV High

MCV Normal

MCV Low

RDW-CV High

B12/ Folate deficiency, CLL, Cold agglutinins

Early Fe or B12 folate deficiency, Anemic hemoglobinopathy, Sideroblastic myelofibrosis

Fe deficiency, Hgb-H, Red cell fragments

RDW-CV Normal

Aplastic anemia

Chemotherapy, Non-anemic hemoglobinopathy, CLL

Heterozygous thalassemia, Chronic disease

RDW-SD High

B12 deficiency, Aplastic anemia, Immune hemolysis

Acute/Chronic leukemia, Transfusion, Homozygous hemoglobinopathy

Iron deficiency, Hemolytic anemia

RDW-SD Normal

Liver disease

Secondary anemia

Early iron deficiency

Chemotherapy (during treatment)

Heterozygous hemoglobinopathiesThalassemia

RDW-SD Low

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May - June 2014 53

EXPERT V ie w s

Case studies: Illustrating the importance of RDW-CV and RDW-SD in differential screenin

Classification of Anemia based on RDW-CV and RDW-SD in combination with MCV : Determination of the MCV is routinely used in the classification of normocytic, microcytic and macrocytic anemia. MCV when used in combination with RDWCV and RDW-SD, serves as the best criteria for the classification of anemia. As the MCV is an arithmetic mean, it may exclude partial microcytosis - even in the reference range. Only in combination with the RDW-CV and RDW SD, it may indicate dimorphic erythrocytes, for example, the initial stages of iron deficiency.

The above mentioned two case studies clearly depict low MCV typical of microcytic hypochromic anemia.

In case 1, RDW-CV of 20.5% is indicative of red cell anisocytosis consistent with iron deficiency anemia, later confirmed with iron studies. Whereas in case 2, RDW-SD of 25.6% which is below normal indicative of a monotonous red cell population consistent with beta thalassemia minor, later confirmed with Hb electrophoresis.

Fig. 1: Iron Deficiency Anemia

Fig. 2: Beta Thalassemia Minor

Given the prevalence of IDA and genetic hemoglobinopathies like thalassemia in India, availability of the simultaneous reporting of RDW-CV and RDW-SD on automated hematology analyzers, goes a long way in screening these pathological conditions.

Sysmex hematology analyzers (marketed in India by Transasia Bio-Medicals Ltd.) allow a 'Simultaneous reporting of RDW-SD and RDW-CV' alongwith various MCV is in the normal range and when the anisocytosis specialized parameters like Reticulocyte and IRF which may be difficult to detect e.g early stage of IDA. While help in timely diagnosis of hemoglobinopathies. most analyzers report, either RDW-SD or RDW-CV, some recent analyzers provide ‘Simultaneous reporting References: of RDW-SD and RDW-CV’. Simultaneous reporting of 1. Shaker, M., et al. J. Pediatr. 2009, 154(1):44-49. An economic analysis of anemia prevention during infancy. these two indices helps in screening and differentiating 2.

Barbara J Connell. 2012, Hematology Tools to Aid in the IDA and thalassemia.

Diagnosis and Management of Iron Deficiency Anemia.

Other than RDW, Ret counts and IRF (Immature 3. Sysmex Lab Info: 2006, -03, ‘Referenzwertbereiche für die Hämatologie: Sysmex X-family’.

Reticulocyte Counts) available on high end 5PDA 4.

L. Thomas. 2005, Labor und Diagnose; TH-Books; 6. systems and have been identified as a useful adjunct Auflage in diagnosis and management of the above mentioned 5. Noronha JF et.al. 2005, 43(2):195-7. Measurement of pathological conditions. According to published reticulocyte and red blood cell indices in patients with iron reports, Ret counts and IRF have been found to be high deficiency anemia and beta-thalassemia minor. in cases of beta thalassemia minor and iron deficiency anemia respectively.

54 w w w . m e d e g a t e t o d a y. c o m May - June 2014

PRODUCT Line

MEDISYSTEMS hospitals. Their configuration is based upon the number of consulting rooms and waiting areas of the OPD.

Nurse-Call Systems Medisystems manufactures a wide range of Electronic Nurse-Call Systems designed to cater to all kinds of hospitals in India, from

the smallest nursing home to the largest multi-speciality hospital. The audio-visual alert protocols in these systems have been carefully designed so that staff nurses of any caliber can easily understand and adapt to them. All calls are acknowledgeable, to relieve patient stress, and no call can be cancelled or reset except by visiting the patient bedside. Even trainee nurses placed on ward duty at short notice can adapt to the systems, within minutes.

These call systems are modular, comprising a Central Display Console at the nurse-station counter (optionally, also with Ward Graphic Displays), a Bed Unit module behind each patient's bed and a Handset which reaches out to the patient through a length of flexible cable. A Door Display Unit can be mounted at the room entrance – with Nurse-Presence Registration. Emergency Alert Units are available for mounting within the toilet and within the shower stall as well.

Several other optional features include Nurse Help Request, Patient-Nurse Intercom, Code-Blue Alert, IV-Drip Alert, Instrument Alarm Relay, Additional Call Signals, Call Transfer Facility, Multifunction Handsets, Corridor Display Modules, Nurse Call Response Monitoring and an SMS Alert facility for selected emergency calls to be forwarded directly to mobile phones.

Bed-Head Panels / Head Wall Panels Bed-Head Panels or Head Wall Panels are specially fabricated for hospital use and designed to converge all the essential utilities around a patient’s bed. Standard panels are available for ICU, Wards, Private Rooms /

Suites. These circuit protected panels carry provision for medical gas, electrical power, illumination, communications, bio-signals, data and time display. A stainless steel universal medical rail for holding a range of accessories like Utility baskets, Case sheet holders, Blood Pressure instrument holders, I-V Poles, etc. is provided. PatientBed Lamps may also accompany the panels.

I D

Y S

Medisystems Bed-Head Panels are constructed from light weight extruded aluminium sheets and sections and stainless steel. The surfaces are finished with epoxypolyester paints to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non-brick walls made of siporex or gypsum board. All panels have safety partitions between high voltage, low voltage and medical gas outlets.

M

E

The systems comprise a Main Display Unit for the waiting area; door display units and desk units for the consulting rooms. The receptionist or cashier can also be connected to this system with additional desk units.

The system scrolls all un-answered calls and can also remind for any un-attended calls. Bilingual displays can also be given.

The system once installed is user-friendly, cost- effective and needs negligible support.

T S

M E

S

OT/ICU Ceiling Pendants

Medisystems OT and ICU Pendants in rigid, single arm and double arm configurations are fabricated from Aluminium and pure 304 Grade Stainless Steel sheets and extrusions.

The pendants carry provision for upto six medical gas outlets, eight electrical outlets and data terminals. They can accept entry of medical gas lines and data & electrical cables from all directions. The utility backbone supports upto 4 shelves for placement of monitoring, anaesthesiology or other diagnostic/ therapeutic instruments.

A utility pole for I-V dispensation can also be provided alongside the shelf array.

Medisystems manufactures a very wide variety of such panels to meet practically every kind of need. They are available in standardised as well as customised configurations which include horizontal, vertical or wall angular orientation, in colours and finish of user’s choice.

OPD Patient-Call Systems Medisystems OPD Patient-Call Systems are the ideal solution for queue management in the busy crowded OPDs of our country’s

CR Medisystems Pvt. Ltd. Mumbai, India Tel: 91-022-23094416, 23004930 E-Mail: medisystems@gmail.com Web: www.medisystems.in

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May - June 2014 55

DOCTOR Speak

Brain

aneurysms

Dr. Sudheer Ambekar Clinical Fellow Dept. of Neurosurgery LSUHSC-Shreveport LA-71103, USA

What everyone needs to know

B

rain aneurysms are uncommon lesions of the blood vessels of the brain. However, the morbidity and mortality associated with their rupture can be devastating. It is predicted that about 15-20% of patients with aneurysmal subarachnoid hemorrhage (SAH) die before reaching the hospital. This number is even higher in rural areas where access to a specialized center is sparse. There are almost 500,000 deaths worldwide each year caused by brain aneurysms and half the victims are younger than 50. Of the patients who survive, about half will have long term disabilities. Hence, it is very important that these lesions are identified and treated optimally at a specialized center.

Accurate early diagnosis is critical, as the initial hemorrhage may be fatal, may result in devastating neurologic outcomes, or may produce minor symptoms. Despite widespread neuroimaging availability, misdiagnosis or delays in diagnosis occurs in up to 25% of patients with subarachnoid hemorrhage (SAH) when initially presenting for medical treatment. Failure to do a scan results in 73% of these misdiagnoses. This makes SAH a low-frequency, high-risk disease. Brain aneurysms are more common in women and beyond the fourth decade of life, although they may also occur in children. Common modalities that can be employed in the initial imaging of patients with suspected

56 w w w . m e d e g a t e t o d a y. c o m May - June 2014

DOCTOR Speak

through a peripheral artery, usually the femoral artery, advancing it to the brain aneurysm clipping site of the aneurysm and delivering stents and coils to close the aneurysm.

Coils are made out of fine platinum alloy and conform to the shape of the aneurysm. The stents prevent coils from protruding into the lumen of the blood vessel and reduce the blood going into the aneurysm. While clipping yields better results for aneurysms located in the middle cerebral artery and giant or complex Brain aneurysm coiling aneurysms, endovascular therapy is better for most aneurysms, especially those located on the basilar artery.

The cost of a brain aneurysm treated doctor to a specialized center is critical in by clipping via open brain surgery optimal outcome. Lastly, there is a dire need increases by more than 100% after the to form a support group in our country that aneurysm has ruptured. The cost of creates awareness and provides appropriate a brain aneurysm treated by coiling, information and guidance to the people. which is less invasive and is done through a catheter, DMF No. Certified increases by about 26710 Cleanroom two-thirds after the aneurysm has brain aneurysm are the CT scan, CT ruptured. angiogram and the MR angiogram.

TRANSPARENT TUBING Digital subtraction angiography is Unfortunately, in the definitive method of diagnosing India, there is a lack ILICONE PRODUCT a brain aneurysm, but, is usually of awareness about done after one of the initial imaging brain aneurysms modalities indicate the possibility of a not only among the people but also brain aneurysm. among general There are two main modalities for the practitioners and PHACO SLEEVE PAD TEST CHAMBER BULB treatment of intracranial aneurysms. other specialists. It Surgical clipping has been the is very important traditional way of treatment. This for the patients to involves closing the aneurysm using a choose a treatment metal clip which prevents blood flow center which offers MAT SEPTA CAP into the aneurysm, thus, preventing both clipping via rupture. Endovascular therapy is the open surgery and newer method in which the aneurysm e n d o v a s c u l a r is obliterated using stents and coils, therapy as both VACUUM CUP BALL SEALS thus, preventing the aneurysm from the modalities are M. K. Silicone Products Pvt. Ltd. rupture. Since, none of the two complimentary to 205 & 206 Hill View Industrial Premises, Amrut Nagar, therapies is the best; they need to be each other. Also, Ghatkopar (W), Mumbai - 400 086, India.

Tel.#: 022-2500 4576 Fax #: 022-2847 5722 used complimentarily. Endovascular timely referral by E-mail : sales@mksilicone.com therapy involves inserting a catheter the primary care

S

Blue Heaven

S

w w w . m e d e g a t e t o d a y. c o m

May - June 2014 57

EXPERT V ie w s

Prof. M. Habeeb Ghatala

Opportunities in

Healthcare Management

Dean for Non-Medical Institutions Apollo Health City, Hyderabad

T

he opportunities for service and improvement in healthcare management in India are limited only by one’s own imagination. Considering expenditure, revenue and employment, healthcare is one of the fastest growing sectors. In terms of spending, it is estimated that Indian private sector accounts for more than 80% of total healthcare spending.

The factors contributing to the steady growth of healthcare industry include but are not limited to increase in population, economic growth, rapid urbanization, increase in disposable income, rising levels of education accompanied by health consciousness, medical tourism, emerging health insurance market, popularity of telemedicine, and the like.

In spite of the increase in

58 w w w . m e d e g a t e t o d a y. c o m May - June 2014

EXPERT Views

public health spending from under 1% in XI Five Year Plan to close to 3% in XII Five Year Plan (20122017), the condition of government health services ranging from Primary Health Centers (PHCs), secondary care hospitals to tertiary care teaching hospitals with an exception or two leaves a lot to be desired. With such problems in the public sector healthcare services, the private and corporate hospitals have grown and are being accepted by the populace at an unprecedented rate. Consequently, there is an urgent need in the public as well as corporate healthcare sectors for holders of allopathic and alternate medicine degrees and postgraduates in hospital and healthcare administration to assume leadership positions. The above mentioned and other nursing and allied health professional healthcare providers will assure efficient implementation of healthcare and public health programmes.

Public Sector Healthcare Services It is worthy to note as to why 80% of healthcare expenditure is going to the private sector? The simple fact is that the private sector is offering better quality of healthcare than the public sector hospitals and clinics. In order to gain confidence of the masses, especially in the rural and tribal areas, the government must strengthen, to begin with, basic public health services like treating diarrhea, improving nutrition, mother-child care, and immunizing babies. Having witnessed poor to minimally functioning, grossly

understaffed, and non-existent PHCs, it is recommended that the feasibility of Public-Private Partnership in the delivery of healthcare services be explored. The cliché, “Where there is a will, there is a way” can be tried on a carefully selected and monitored pilot basis.

If India is to reach the Millennium Development Goals (MDG) for Health by 2015 which include (1) eradicate extreme poverty and hunger, (2) achieve universal primary education, (3) promote gender equality and empower women, (5) reduce child mortality, (6) improve maternal health, (6) combat HIV/ AIDS, Malaria and other diseases, (7) ensure environmental sustainability, and (8) develop a global partnership for development, a new paradigm is urgently needed.

Public-Private Partnership Progress in public health is essentially achieved through new knowledge or new means to use existing knowledge.

It is only through this means, the National Rural Health Mission can expect to achieve the MDG. This goal will only be achieved through PublicPrivate Partnership in programmes of well managed healthcare delivery.

The start should be from primary care in the fully functioning PHCs to secondary and tertiary care hospitals championed by the private and corporate healthcare systems.

Availability of Trained Healthcare Workforce In order to meet the growing demand for professio0nally trained

healthcare administrators, an increasing number of postgraduate degree and diploma programmes have been established throughout India. Thousands of graduates are joining the healthcare workforce.

Interestingly, a majority of the graduates are working outside the four walls of the hospitals in a variety of healthcare related areas like healthcare IT, public health, hospice care, home care, assisted living, health insurance, healthcare consultancy, medical law, medical tourism, clinical engineering, hospital risk management, quality management systems, medical equipment, grant writing, long-term care facilities, research organizations, specialized healthcare, lobbying and advocacy organizations, hospital accreditation, hospital planning, hospital security, and even developing emotional intelligence among nurses which leads to enhanced patient satisfaction.

Optimal Utilization of Trained Professionals Successful implementation of healthcare programmes requires providers and administrators to be able to balance hard and soft skills.

Traditionally, the emphasis is put on “hard skills” and rightly so. The so-called “soft skills” are seen as secondary. The art lies in balancing the hard skills with the soft skills, the technical expertise with the behavioral.

To be a successful administrator of healthcare delivery systems, the administrator should have (1) strong decision-making and problem-solving skills, (2) interpersonal/team skills, (3) time management skills, (4) unique experiences, and rather importantly (5) an attitude of service – a vanishing but a prerequisite trait for delivering satisfying healthcare service.

w w w . m e d e g a t e t o d a y. c o m

May - June 2014 59

EXPERT V ie w s

Ask a Question from Healthcare Industry Expert

“Medgate today, introduce a Special Section : Ask a Question from industry expert in Hospital and Healthcare Planning, Operations, Management, Quality, Medical Education, Medico Legal & Materials Management”.

Dr. Pradeep Bhardwaj

CEO & Executive Director Six Sigma Healthcare Limited, Delhi (IIM Ahmedabad Alumnus, Listed under India’s Top 10 Doctors, Recipient of 5 National Awards) will answer your questions through his expertise knowledge & experience in Hospital & Healthcare Management. He is an expertise Healthcare Planning, Management, Medico Legal Consultant, Author’s and Visiting Professor & Faculty in leading Healthcare Management Colleges / Universities like Harvard, IIM – Lucknow, IIM-A, ISB – Hyderabad, Amity University, Symbiosis International University, AIIMS, National Board of Examinations etc. He is also Board of Advisory in many healthcare organizations / management institutes / universities. . Dr. Bhardwaj is renowned hospital and healthcare management expert, recipient of many prestigious awards like Rajiv Gandhi Award -2010, Best Medico Legal Expert.

You can mail your query at: editor@medgatetoday.com 60 w w w . m e d e g a t e t o d a y. c o m May - June 2014

EXPERT Views

Public Health is an exciting and growing field of study at National & International Level

sympathetic education in the natural history of mental health.

I am working at senior managerial level in a 100 bedded hospital at Amritsar, Punjab. Now, I m planning to ÂÂ Some Designations/ Career Options - Public Health Writer, Public Health Inspectors, Faculty, Public Health Journalist, change my career towards Public Health doing MPH Medical Investigator, Biostatical, Public Health Consultant, under Distance mode. What is the scope of Public Health NGO Director, Health Researchers, Community Health at International level? Please let me know the career, Worker, Anganwadi Manager, Disease Ecologist, Public institute & job prospectus in Public Health ?

Health Information Officer, Disaster Management etc.

Dr. Vijay Kumar, Amritsar, Punjab

Now is a great time to pursue a career in Public Health. A Why Pursue a Career in Public Health? diverse and rewarding field, public health offers meaningful ÂÂ Public health is an exciting and growing field of study. The career opportunities for people at all educational levels. No field challenges its professionals to confront complex health matter what your interests, odds are you will be able to find a issues, such as improving access to health care, controlling infectious disease, and reducing environmental hazards, position you enjoy in public health. The Master of Public Health violence, substance abuse, and injury.

(MPH) degree is the most demanding widely recognized professional credential for leadership in Public Health. The ÂÂ Public health is a diverse and dynamic field. Public Health MPH program is designed for public health leaders who aspire professionals come from varying educational backgrounds and can specialize in an array of fields. A host of specialists, to high-level roles in State, Federal, and International Health including teachers, journalists, researchers, administrators, organizations, Research and Academic Institutions, or the environmentalists, demographers, social workers, laboratory Private Sector. scientists, and attorneys, work to protect the health of the public.

Scope of Public Health Course ÂÂ Public health is a field geared toward serving others. Public ÂÂ Job availability in international organizations like WHO, health professionals serve local, national, and international UNICEF, RED CROSS, All Govt Agencies, NGO, Societies, communities. They are leaders who meet the many exciting Hospitals, International & National Healthcare Organizations challenges in protecting the public's health today and in the etc. future. ÂÂ Work for improvement of the various aspects of environment ÂÂ Public health is a rewarding field. The field of public health which may include prevention of all types of pollution-water, offers great personal fulfillment - working towards improving air, noise etc. people's health and well being is a rewarding day's work. ÂÂ Prevention of communicable diseases which can be easily done by screening the surroundings and also screening the Job Prospects in Public Health chronic ailments before it becomes too late. ÂÂ Those successfully complete the MPH programme are ÂÂ Work for improvement of conditions of employment for eligible to become healthcare professionals and managers prevention of occupational hazards. or administrators in government, non-governmental and public sector organisations and hospitals. Graduates ÂÂ Work for the prevention of conditions which may lead to can also occupy technical and leadership positions in disturbances of growth and development in maternity, the implementation of public health or community health infancy and childhood. Disturbances and defects of mentality, programmes of the State and Central governments and the personality, emotions, behavior or interpersonal relationships World Health Organization. now begin to receive the attention they warrant as we shift emphasis from concern chiefly with institutional care of the already mentally sick or socially inadequate to guidance by w w w . m e d e g a t e t o d a y. c o m

May - June 2014 61

TENDERS Update

Hospital

Ref Number: 10651936

EMD: Rs.50,000

Closing Date: 13/05/2014 at 00:00 Hrs.

Tender Number:

Closing Date: 30/05/2014 at 16:00 Hrs.

Contact Details: North Central Railway

Tender Prod. No: XX-376/SO(DO)/O tho/ 2013-14/FSC-I

Document Sale To: 27-5-2014 at 14:00 Hrs

_________________________________________________

_________________________________________________

Ref Number: 10625335

Buyer/Seller: All India Institute Of Medical Sciences

Ref Number:10676562

Tender Number:

Requirement: Supply of Modular Prefabricated Operation Theaters with various Services for OT Complex and Site preparation- 5 Nos

Tender Number:

Tender Prod. No: C&MM/TAPS-1&2/50246

Tender Prod. No: 65145001-A

Buyer/Seller: Nuclear Power Corporation Of India Limited

Buyer/Seller: South Eastern Railway

Requirement: Annual Maintenance Contract for Dental Chair. Share Like

Location: New Delhi - Delhi - India

Requirement: Supply of Scoop Stretcher Etc.

Document Fees: INR2,000

Location: Multi Location - Multi State - India

EMD: INR2,200,000

Document Fees: INR99,999

Closing Date: 10/06/2014 at 00:30 Hrs.

EMD: INR10

Document Sale To: 9-6-2014 at 0:30 Hrs

Closing Date: 29/05/2014 at 00:00 Hrs.

_________________________________________________

Contact Details: South EasternRailway

Ref Number: 10313038

_________________________________________________

Tender Number:

Ref Number: 10681204

Contact Details: A- 707 / 708, Wall Street-II, Opp. Orient Club, Nr. Gujarat College, Ellis Bridge, Ahmedabad - 380006, Gujarat - India

Buyer/Seller: Rajiv Gandhi Superspeciality Hospital

Tender Number:

Document Sale To: 13-5-2014

Buyer/Seller: Madhya Pradesh Laghu Udyog Nigam Limited

_________________________________________________

Requirement: Supply of modular & lab furniture part-2, electric ceiling fan, paints & distemper, air conditioner, digital photocopier, fire fighting chemicals, forestry saw & maintenance tools, tent & carpet items, AC pressure pipe, water field testing kits, marker pen bullet tip etc.

Tender Number:

Requirement: Supply of Illuminated Signage, Liquid Oxygen, Oxygen & other Medical Gases.

Providing of Manpower Services. Supply of Equipment for Pathology Division, Blood Department, Biochemistry Division, Radiology Division. Providing of Laundry Service. Providing of Catering Services. Supply of Hospital Furniture etc.

Location: New Delhi - Delhi - India Closing Date: 6/06/2014 at 00:00 Hrs. Contact Details: Rajiv Gandhi Superspeciality Hospital, New Delhi, India

Location: Bhopal - Madhya Pradesh - India EMD: Rs.100,000 Closing Date: 29/05/2014 at 00:00 Hrs.

Document Sale To: 6-6-2014

Contact Details: Madhya Pradesh Laghu Udyog Nigam Limited, Bhopal, Madhya Pradesh, India

_________________________________________________

_________________________________________________

Ref Number: 10626740

Ref Number: 10490881

Tender Number:

Tender Number:

Buyer/Seller: B. K. Hospital

Tender Prod. No: 60145023

Requirement: Supply of Drugs, injection, consumables, dental consumables, consumables, lab items, manifold gases, cleaning material, general stationer, printing material, signages, food articles for kitchen, bio medical bins & trolleys, hospital furniture.

Buyer/Seller: North Central Railway

Location: Faridabad - Haryana - India Document Fees: Rs.1,000

Requirement: Supply of 500 MA X-Ray Machine With Motorized Table

Tender Detail: A- 707 / 708, Wall Street-II, Opp. Orient Club, Nr. Gujarat College, Ellis Bridge, Ahmedabad - 380006, Gujarat - India Location: Multi Location - Multi State - India Closing Date: 13/05/2014 at 00:00 Hrs. Remind

Ref Number: 10666908 Buyer/Seller: Private Company Requirement: Sale of CP TI turning scrap, Generator, Instrument cabinet / Hospital beds.

Location: Multi Location - Multi State - India Closing Date: 13/05/2014 at 00:00 Hrs. Contact Details: Arshiya Supply Chain Management Private Limited Mumbai, Maharashtra, India _________________________________________________ Ref Number: 10624271 Tender Number: Tender Prod. No: wn4650-pur-0013-2014-15 Buyer/Seller: Western Coalfields Limited Requirement: Procurement of Fiber Stretcher.

Location: Yeotmal - Maharashtra - India Estimated Cost: INR95,000

Location: Multi Location - Multi State - India

Closing Date: 12/05/2014 at 15:00 Hrs.

Document Fees: INR500

Document Sale To: 10-5-2014 at 15:00 Hrs

EMD: INR10,000

_________________________________________________

62 w w w . m e d e g a t e t o d a y. c o m May - June 2014

TENDERS Updat e

Furniture Tender Ref Number: 10598167

EMD: INR95,400

Tender Number:

Estimated Cost: INR8,976,000

Tender Prod. No: 2014_GGSGH_56090_1

Closing Date: 8/05/2014 at 16:00 Hrs.

Buyer/Seller: Guru Gobind Singh Government Hospital

Contact Details: Directorate Of Health And Family Welfare Service, Chickballapur, Karnataka, India

Requirement: Supply of Hospital Furniture

_________________________________________________

Location: New Delhi - Delhi - India

Ref Number: 10490873

EMD: Rs.50,000

Tender Number:

Closing Date: 9/05/2014 at 14:00 Hrs.

Tender Prod. No: 60145006

Document Sale To: 9-5-2014 at 14:00 Hrs

Buyer/Seller: North Western Railway

_________________________________________________

Requirement: Supply of ICU Bed with Four Section PU Foam Mattress As Per Specifications Enclosed.

Ref Number: 10649005 Tender Number: Tender Prod. No: DHFWS/2013-14/IND389/ Buyer/Seller: Department Of Health And Family Welfare Services Requirement: Supply of ICU & OT Equipments ICU Ventilater, Muti Para Monitor , Arterial Blood Gas Analyzer, Electrical O T Table With Orthopedic Attachment, Ceiling O.T. Light Dual Dome To Traumacare Center.

Buyer/Seller: Guru Gobind Singh Government Hospital

Location: Multi Location - Multi State - India Document Fees: INR150 EMD: INR6,200 Closing Date: 8/05/2014 at 14:25 Hrs. Contact Details: North Western Railway _________________________________________________ Ref Number: 10592771

Requirement: Supply Of Common General Surgical Consumable & Suture Items – ,Apron Plastic Plastic, Absorbable Gelatin Surgical Sponge 70x50x10mm, Absorbable Gelatin Surgical Sponge Anal 30 X 80 Mm, Bandages – Cotton Rolled, Surgeon’s Blade– Single Use, Bed Pan Male, Blood Transfusion Set-Single Use, Adhesive Wound Dressing With Pad, Cotton-Wool Absorbant I.P., Cautery Machine Lead 3 Pin, Compatible With Available Various Cautery Machine, Complete Mask With Tubing With Nebulizer Chamber, Combined Surgical Dressing 10cm*10cm, Sterilization Wrap 90 Cm X 90 Cm, Sterilization Wrap 120 Cm X 120 Cm, Transparent Dressing 7.2cm X 5cm, Thermometer Digital, Hourly Urine Collecting Bag, Urine Collecting Bag Pead With Drain Strile Disposable, Urine Collecting Bag Adult, Yanker Suction Set, Examination Couch Roll For Patient Examination, Oxygen Mask, Cfl Tube For Phototherapy, Phototherapy Tube Light, Sensor For Pulse Oxymeter/Vital Sign Moniter, Abdominal Sponge, Abdominal Swab 6 Layer With Radio Opaque Thread And Long Tail, Zinc Oxide Adhesive Plaster, Zinc Oxide Adhesive Plaster Ip 75mm X 10m, Eye Shields, Batteries Aed Schiller, Defibrillator -Ecg Electrodes, Defibrillator Ecg Roll, Suction Machine Tubing, Defibrillator Leads, Pulse Oxymeter Battery, Pulse Oxymeter Probe With With Extension Cable, Charging Cabel & Probe Compatible With Mindray, Pulse Oxymeter Portable, Vital Sign Monitor Battery, Ecg Cable, Spo2 Probe With Extention Wire.

Location: Chickballapur - Karnataka - India

Tender Number:

Document Fees: INR550

Buyer/Seller: E S I C Hospital

EMD: INR10,000

Ref Number: 10649016

Requirement: Supply Of Medical Equipments- Anesthesia Drug Trolley (3), Crash Cart Trolley (10), Bag To Bag Connector, Refrigerated Centrifuge, Flexible Ureteroscope(1Nos), Laser Lithotripter (1 ), Rigid Ureteroscope 5-6.5Fr(1 No)Skull Fixators (Three Pin System), Automated Identification And Sensitivity Analyzer, EEG, ENMG.

Tender Number:

Location: Hyderabad - Andhra Pradesh - India

Estimated Cost: INR25,000

Tender Prod. No: DHFWS/2013-14/IND411/CALL-2

Document Fees: Rs.1,000

Closing Date: 12/05/2014 at 14:00 Hrs.

Buyer/Seller: Directorate Of Health And Family Welfare Service

EMD: Rs.10,000

Document Sale To: 12-5-2014 at 14:00 Hrs

Estimated Cost: Rs.12,000,000

_________________________________________________

Closing Date: 8/05/2014 at 16:00 Hrs. Contact Details: Directorate of Health and Family Welfare Services _________________________________________________

Requirement: Supply of imaging equipments to trauma care centre - Ventilator, ABG Machine, Bed side Monitor, OT ceiling light – double dome, OT table -3 segment, translucent top with orthopedic attachment, icu ventilater, muti para monitor, arterial blood gas analyzer, electrical o t table with orthopedic attachment, ceiling O.T. light dual dome Location: Chickballapur - Karnataka - India Document Fees: INR550

Location: New Delhi - Delhi - India EMD: INR25,000

Closing Date: 8/05/2014 at 13:00 Hrs. Contact Details: E S I C Hospital Hyderabad, Andhra Pradesh, India Document Sale To: 7-5-2014 at 16:00 Hrs _________________________________________________ Ref Number: 10598198 Tender Number: Tender Prod. No: 2014_GGSGH_56092_1 w w w . m e d e g a t e t o d a y. c o m

May - June 2014 63

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