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Volume V || Issue V || Jauary-February 2015

The Gateway to Health & Medical World

Radiology and Medical

Devices Sector

Advances in Renal cell carcinoma

Urology

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EXPERT Contents Update

50 NEWS FDA approves Opdivo for for advanced... 8 Symbiosis International University (SIU)... 10 Shri Shripad Yesso Naik at CII... 12 President launches Pulse Polio Programme for 2015... 13 Dr. Mohanâ&#x20AC;&#x2122;s Diabetes Specialities Centre... 18 Doctor Speak

Fainting: A benign thing, or a

Advances in

Radiology and Medical

harbinger of death?

Devices Sector

& Dynamic Entrepreneur Young

Understanding

Cardiac Emergencies

MYTHS AND REALITIES OF CORONARY HEART DISEASE

Advances in

Renal cell carcinoma

Differential Diagnosis of

Abdominal Distention Revolutionizing Oral Dentistry through Digital Imaging 8

Hospital Mergers

and Acquisitions

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Oral Health FOR CHILDREN

News UPDATE

FDA approves Opdivo for advanced melanoma T he U.S. Food and Drug Administration today granted accelerated approval to Opdivo (nivolumab), a new treatment for patients with unresectable (cannot be removed by surgery) or metastatic (advanced) melanoma who no longer respond to other drugs. Melanoma is the fifth most common type of cancer in the United States. It forms in the body’s melanocyte cells, which develop the skin’s pigment. The National Cancer Institute estimates that 76,100 Americans will be diagnosed with melanoma and 9,710 will die

from the disease this year. Opdivo works by inhibiting the PD-1 protein on cells, which blocks the body’s immune system from attacking melanoma tumors. Opdivo is intended for patients who have been previously treated with ipilimumab and, for melanoma patients whose tumors express a gene mutation called BRAF V600, for use after treatment with ipilimumab and a BRAF

FDA clears test that helps predict the risk of coronary heart disease

Study data show test predicts risk better in black women he U.S. Food and Drug Administration today cleared a new screening test that predicts a patient’s risk of future coronary heart disease (CHD) events, such as heart attacks. FDA cleared the test for use in all adults with no history of heart disease, but studies submitted by the company and reviewed by the FDA show that the test is better at discerning this risk in women, particularly black women.

“A cardiac test that helps better predict future CHD risk in women, and especially black women, may help health care professionals identify these patients before they experience a serious CHD event, like a heart attack,” said Alberto Gutierrez, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. “We hope the clearance of this test will improve preventative care and reduce CHD-related mortality and morbidity in these patients.” The PLAC Test for Lp-PLA2 Activitymeasures the activity of lipoprotein-associatedphospholipase A2 (Lp-PLA2) in a patient’s blood. Lp-PLA2is a biological marker for vascular inflammation, a condition associated with the buildup of plaque in the arteries that supply blood to the heart. Over time, this buildup can result in a narrowing of the arteries and lead to CHD. Patients with test results that show Lp-PLA2activity greater than the level of 225 nanomoles per minute per milliliter (nmol/min/mL) are at increased risk for

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a CHD event. Patients with test results below this level are at decreased risk for a CHD event. According to the U.S. Centers for Disease Control and Prevention, heart disease is the leading cause of death in the United States for people of most racial/ethnic groups, including blacks, Hispanics, and whites. People of all ages and backgrounds are at risk of heart disease and around the same number of men and women die of the disease each year. The most common type of heart disease is CHD, killing more than 385,000 people annually. Almost two-thirds of women and half of men who die suddenly of CHD have no previous symptoms.

News UPDATE

Shri Shripad Yesso Naik at CII Health Summit: Time to make “Health for All”a reality

hri Shripad Yesso Naik, MoS, Ministry of Health & Family Welfare said that it is time to make ‘Health for All’ a reality, here today. He stated that people of the country should have access to affordable and quality healthcare. The health strategy of the government needs to take healthcare to the doorstep of the people.The Minister stated that skilled and trained manpower formed a critical component of this strategy. Shri Shripad Yesso Naik was delivering the keynote address at the 11th India Health Summit organized by CII on the theme “Health for All: Call for Action”. The Minister highlighted the initiatives of the Ministry of Health & Family Welfare in providing healthcare in the country, including achievements under the National Health Mission, the Universal Immunisation Programme for the children, providing healthcare services for mother and child, and addressing challenges posed by non-communicable diseases such as diabetes, cancer, hypertension etc. Shri Naik stated that significant achievements have been achievements in addressing TB and Malaria, while there are concerted efforts being made to eliminate Filaria and Kala Azar. The Minister said that efforts are being made to reduce the Out of Pocket expenses on healthcare by the common man in the country, which are substantial. The National Health Assurance Mission is a noteworthy step in this direction, he mentioned.Shri Naik stated that technology can be effectively used to bridge the geographical distance. Telemedicine is being used to address the constraints and challenges of the terrain in the country, he informed.

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The Health Summit is a timely opportunity to talk on the topic of “Health for All”, the Minister said. He added that all stakeholders in the healthcare sector need to work towards this aim. Shri Lov Verma, Secretary, Ministry of Health & Family Welfare, in his address highlighted the primary pillars of the National Health Assurance Mission which include preventive and promotive healthcare; provisioning of free essential drugs, diagnostics and healthcare services; and strengthening the tertiary tier.The key concerns in healthcare in the country are equity, affordability, accessibility and quality, he noted. He stated that while we are ahead on the globalparameters in MMR, we are well on way to achieve the MDG milestone for IMR and below-five mortality rates. The summit will have panel discussions and presentations on topics such as economics of healthcare deliver; challenges of sustainability in quality healthcare delivery; real solutions in virtual healthcare; preparing workforce for meeting the challenges in healthcare; Make in India: unlocking the potential in healthcare sector; and Swachh and Swastha Bharat: laying the foundation of a healthier India. Present during the inaugural session of the two-day 11th India Health Summit were Dr Naresh Trehan, Chairman, CII National Committee on Healthcare; Shri Harpal Singh, Chairman Emeritus Fortis Healthcare Ltd., and Shri Rahul Khosla, Co-Chairman, CII National Committee on Healthcare.

News UPDATE

President launches Pulse Polio Programme for 2015

Shri J P Nadda credits sustained hard work and support of volunteers and partners for ‘Polio Free India’ The President of India Shri Pranab Mukherjee launched the Pulse Polio programme for 2015 by administering polio drops to children less than five years old, at the Rahstrapati Bhawan, here today. Tomorrow is the National Immunization Day. Around 174 million children of less than five years across the country will be given polio drops as part of the drive of Government of India to sustain polio eradication from the country. Speaking at the function on the eve of the National Immunization Day, the Union Minister for Health & Family Welfare Shri J P Nadda applauded the sustained hard work of nearly 23 lakh volunteers and 1.5 lakh supervisors, along with donor partners for eradicating polio from India. The Health Minister stated that there has been no case of wild polio since 13 January 2011. India was certified Polio Free last year, and is part of the 11 countries of South-East Asia Region of WHO (along with Bangladesh, Bhutan, Democratic People's Republic of Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste) which are polio free. Affirming that India is looking forward to playing a major role in the implementation of “Polio endgame strategy”, the Minister informed about introduction of inactivated polio vaccine in routine immunization program and a switch from trivalent OPV to has also been issued as per WHO guidelines to bivalent OPV six months later in a synchronized vaccinate all travellers who are travelling between manner globally. India and eight polio-infected countries comprising The Health Minister stated that efforts to keep the Pakistan, Afghanistan, Nigeria, Cameroon, Syria, country polio free are being sustained. Being mindful Ethiopia, Somalia & Kenya. Moreover, Emergency of the risk of importation from other countries Preparedness and Response Plan (EPRP) has been including the neighbourhood, immunity against polio infection is maintained through National and put in place under which Rapid Response Teams Sub National Polio rounds along with sustained (RRT) have been formed in all States/UTs to high quality polio surveillance. A travel advisory respond urgently to any importations.

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Interview

Akhil Solutions: Simplifying Healthcare with“Miracle” Range of Software Solutions

“MIRACLE” for the Healthcare Sector

Sanjay Jain Managing Director Akhil Systems Pvt. Ltd.

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With continued focus in the healthcare sector, Akhil Systems has been providingsolutions to numerous health institutions a user friendly range of software products over the years. Itis an interactive solution for locating any type of information related to patients and hospital as well. It’s a comprehensive solution comprising of specialfeatures such as electronic charting, electronic prescriptions, document scanning, bar code recognition, strong billing, and Corporate & Insurance management integrated with financial accounting. It also offers an integration facility to manage Q-systems, SMS Gateways, e-mails, lab reports and web portals with dedicated post implementation support services.“This indicates the capability of our solution

News UPDATE

Dr. Mohan’s Diabetes Specialities Centre launches its 20th state of the art facility in Kukatpally, Hyderabad

Dr. Mohan’s Diabetes Specialities Centre, a leading Diabetes Specialities Chain in India, inaugurated it’s 20th branch in Kukatpally, Hyderabad on Friday, 12th December 2014. This most modern Centre for Diabetes was dedicated to the city by its Chairman, Dr. V Mohan, a Padmasri Awardee, in the presence of Ms. Rekha Thankappan, Chief Executive Officer and several other dignitaries. The centre will be functioning at ‘Sivam Complex, Plot No C/16, Road No 1, K.P.H.B Colony, Beside Sankya Hospital, Kukatpally’, from today. Dr. Mohan’s Diabetes Specialities Centre in Kukatpally houses state-of-the-art facilities for management of diabetes and its complications. It has a Diabetology unit, ECG facility, blood collection facility, Nutrition and Dietetics unit, pharmacy and specialized diabetic foot wear. Well experienced and seasoned Diabetologists will manage this new centre along with a team of well-trained staff.

but also specialized services for treating common symptoms associated with the condition”, explained Dr. Ranjith Unnikrishnan, Vice Chairman of DMDSC. “Established in 1991, Dr. Mohan’s Diabetes Specialities Centre is recognized by the World Health Organization (WHO) and International Diabetes Federation. With 19 branches in India and one in Muscat and more than 3.2 lakh registered patients, DMDSC is one of the largest diabetes centers in the Dr. Anjana, Joint Managing Director of the hospital country, “ said Mrs. Rekha Thankappan, CEO of said, “A recent survey reveals that Type 2 diabetes DMDSC. and hypertension are fast emerging as twin epidemics In a recent survey by The Week Magazine along with in Telangana and AP as 24% of the population have Nielsen, Dr. Mohan’s Diabetes Specialities Centre been identified with both the problems. We have been (DMDSC) was ranked as the ‘Best Standalone constantly creating awareness among the people Diabetes Hospital in India’. DMDSC has got this about Diabetes and it’s complications as it could cost credit for the 3rd time in a row. them their vital organs like Eyes, Feet, Kidney and For further details: Feet”, “With 66 million people with diabetes and Saravanan, DGM Marketing 77.2 million with pre-diabetes, India is home to the Dr. Mohans, Diabetes Specialities Centre. second largest number of people with diabetes in Mobile: 0 97909 50801 the world. We, at DMDSC, aim to provide quality E-mail: saravanan.as@drmohans.com but affordable treatment not only for diabetes

“This is our 3rd Centre in the city of Hyderabad located ideally in Kukatpally for the benefit of patients living in this part of the city. We practice the treatment protocols matching International standards aiming at providing complete diabetes care with all required specialties under one roof and this facility will be one such place for the patients,” said Dr. Mohan, Chairman of the hospital.

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News UPDATE

Nanavati Super Speciality Hospital Radiology Head, Dr. Deepak Patkar elected as chairman of “Indian College of Radiology and Imaging” Dr. Deepak Patkar, one of the leading consultant radiologists in the country and head of Department of Radiology of Nanavati Super Speciality Hospital, has been elected as the chairman of Indian College of Radiology and Imaging (ICRI), an academic wing of Indian Radiology and Imaging Association. The appointment is for two years from January 2015 to December 2016. Dr. Patkar has been fellow of Indian college of Radiology and had already been elected as secretary of ICRI in 2008 and 2009. A globally reputed radiologist, he has been in the profession for 24 years in the UK and in India. He is also Director of Teleradiology Diagnostic Services Pvt. Ltd., dealing in teleradiology with clients in US, Africa and the Middle East. He has been associated with Nanavati Super Speciality Hospital since last 22 years and has been responsible for setting up the new radiology wing there. Dr. Patkar has been the Organizing Secretary of National Conference of Indian Radiological and Indian Association – 2007, Mumbai. He has delivered more than 1200 lectures and orations at national and international conferences including ‘India meets ESR’ at European congress of Radiology

in, 2008 at Vienna. He has more than 150 international publications predominantly on Neuro and Musculoskeletal MRI related topics, one of the best being ‘Central Nervous System Tuberculosis: Pathophysiology and imaging findings’ published in Clinical review articles of Neuroimaging Clinics of North America. Speaking of his selection as chairperson, Dr. Patkar said, “It is a great honour and privilege to be elected as Chairman for the ICRI. During its 36 years of journey ICRI has helped many budding radiologists to quench their thirst for knowledge through its various academic projects and programmes”. Dr. Deepak has the mastery, commitment, passion and strong sense of giving back and to reach to students of various fields other than Radiology like Biomedical and IIT students. He has successfully organized many national as well as international conferences.

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News UPDATE

WHO urges coordinated action against antibiotic resistance

eeking accelerated efforts to address the burgeoning problem of antibiotic resistance, the World Health Organization today called upon Member States of the South-East Asia Region to scale up national action plans to combat this daunting public health threat. “We must act urgently. The world is heading for a postantibiotic era which will be devastating in this age of emerging infectious diseases. If we do not use antibiotics rationally, we will lose the power to fight common infections and minor injuries. We need to step up efforts to prevent antimicrobial resistance and change how we prescribe and use antibiotics,” said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, at the launch of a four-day regional meeting on antimicrobial resistance (AMR) in Jaipur. The regional meeting focuses on developing and strengthening country-level plans, building national capacities and developing mechanism for generating information on the magnitude, trend, and the burden of AMR in Member States. WHO has prioritized AMR in view of the serious health, political and economic implication of drug resistance. A regional strategy on prevention and containment of antimicrobial resistance was developed by WHO in 2010 which was endorsed by all Member States. The strategy focuses on improving intersectoral collaboration, strengthening regulatory mechanism for assuring quality, standardized and rational use of antibiotics, boosting national capacity for laboratory-based surveillance of AMR, reducing burden of infectious diseases, enhancing hospital infection control practices and educating and empowering communities. In 2011, the health ministers of the Region made a

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commitment to prevent and contain AMR through the ‘Jaipur Declaration’. Since the Declaration, Member States have initiated a comprehensive and integrated national approach to combat antimicrobial resistance. National focal points have been designated; multisectoral steering committees formed and national antibiotic policies are being developed in most Member States of WHO’s South-East Asia Region. Capacities are being built for undertaking laboratory-based surveillance of AMR to support development of evidence-based treatment guidelines and evaluate the impact of efforts to address AMR. Special attention is being paid to reducing healthcare associated infections by improving infection control practices and building capacity of prescribers for rational and evidence-based use of antimicrobial agents in humans as well as animals. Earlier this year, a WHO report flagged AMR as a big problem globally and also in WHO’s South-East Asia Region which is home to a quarter of the world’s population. The report, ‘Antimicrobial resistance: global report on surveillance’ noted that globally, resistance is occurring across many different infectious agents, but focused on antibiotic resistance in nine different bacteria responsible for common as well as 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. The World Health Assembly has now urged WHO to develop a global action plan against AMR by 2015. The plan is being organized around five main areas of concern: awareness; information on the magnitude of the problem; economic impact; rational use of antimicrobials and preventing infection.

News UPDATE

Healthcare Awards H ono u rin g

E x ce l l ence

21st March 2015, Pragati Maidan, New Delhi held alongside

MEDICAL FAIR INDIA 2015

MEDICAL FAIR INDIA 2015 TO GIVE A FILLIP TO INDIAN MEDICAL INDUSTRY

21st Edition of Medical Fair India 2015, the much awaited event for the Indian Medical Industry to take place from 21st-23rd March in Pragati Maidan, New Delhi

edical Fair India 2015, the most influential trade fair for medical products, pharmaceutical products, medical technological products and health care service facilities; in its 21st edition will showcase the latest technological advancements in a vastly diversified medical sector. Medical Fair India 2015 the flagship brand of Medica- the worldâ&#x20AC;&#x2122;s largest annual medical event held in DĂźsseldorf, Germany. The event will be flagged off from March, the 21st to 23rd, 2015 at Pragati Maidan, New Delhi and would prove to be the bellwether amongst the medical events in the country. The current edition of Medical Fair India comes with a special focus on Hospital Infrastructure and planning, witnessing participation from over 20 countries with dedicated country pavilions from the U.S and the U.K, Germany, Taiwan, Korea, Belgium, China, Italy, Malaysia and Singapore. The event will have nearly 500 exhibitors from India and abroad showcasing their products and services which will help visitors to identify new providers, new agents and joint venture partners. It is aimed at sourcing out new products and technologies and to find new suppliers for stakeholders in the medical industry. Medical Fair India 2015 will be attended by a wide spectrum of experts in the medical field like doctors, practicing physicians, veterinarian, dentists, physiotherapists, ergo-therapists. The visitor profile will also include professionals like hospital directors/ managers, hospital owners, hospital administration managers and staff, medical specialists and superintendents, service providers. Biologists, microbiologists, biochemists from the research community along with general service providers like process engineers, NGOs for rehabilitation aids, distributors, visitors from academics and universities and visitors from government and international agencies will also be

a part of the event. Medical Fair India 2015 will have special features like the co-inciding of the 5th edition of Medgate Today Healthcare Awards. The coveted award platform evaluates hospitals, companies and healthcare professionals on their outstanding performance in healthcare and life sciences sector. Also, for the first time in the country, the event will have specific conferences on Hospital Infrastructure and Planning with the theme of Challenges and solutions in hospital planning and the second conference will be on Medical Device & Technology with the theme of Connect, Engage and Explore. Indian healthcare expenditure is amongst the lowest globally and there are significant challenges to be addressed both in terms of accessibility of healthcare service and quality of patient care. A significant portion of the Indian population is unable to access healthcare service because of inadequate healthcare infrastructure. Accessibility to healthcare infrastructure on an overall basis is relatively imbalanced and is extremely limited to rural areas of the country. The existing healthcare infrastructure is unplanned and is irregularly distributed. Further, there is a severe lack of trained doctors and nurses to service the needs of the large Indian populous. Healthcare infrastructure (majorly hospitals) requires necessary attention for India to revolutionize its medical and healthcare industry. The event serves as a perfect platform to network with thousands of healthcare professionals along with generating business and increasing sales. The conference topics and Speaker sessions will provide valuable insights on new trends which could widen the customer base and help companies to stay ahead of competition. With participation from international

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Cover STORY

Advances in Renal cell carcinoma Multiparametric MRI is showing great potential to improve characterizing solid renal tumor types

enal cell carcinoma (RCC) accounts for 2% to 3% of cancers worldwide and the rate has increased 2% per year for the last 6 decades. About 25% to 30% of patients with RCC present with metastatic RCC at diagnosis. Although the 5-year survival rate is 96% for patients with stage I RCC, it is only 23% for those with advanced disease. Since advanced RCC is highly resistant to radiation and chemotherapy, historically the standard of care has been cytokine therapy. However, this treatment provides limited clinical benefit and is associated with significant

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toxicity. Despite the promise of approved targeted therapies a complete response is rare and patients often become resistant/refractory to first line treatment. New agents with improved efficacy and decreased toxicity are needed as treatment options in first line or subsequent settings. Multiple targeted and immunomodulatory agents are in phase II/III development for advanced RCC. The management of renal tumors has progressed considerably over the past few years. Advances in abdominal imaging mean that kidney cancer can be detected at an earlier stage. Laparoscopic

Dental CARE

Revolutionizing Oral Dentistry through Digital Imaging Today conventional radiography comprising traditional oral X Rays is being replaced by digital imaging technology, writes Dr. (Capt) Sandeep Sharma Senior Dental Consultant Axiss Dental, India’s leading multi-specialty chain of dental clinics.

ver the past 20 years, the world has been swept away by a digital revolution that has in many ways redefined our lives. From communication, to entertainment, to medicine, to books, no field has been left untouched by digitization. Be it the proliferation of mobile phones or the trickling down of Internet, India too has been dramatically affected by what is often described as the Third Industrial revolution. As the old music records were converted into CDs, books became e books, letters turned into email, film making bid adieu to film reels and computers and smartphones became the central feature of our lives, how could the field of medicine remain untouched by the digital revolution? In medicine the benefits of digital radiography or tele radiology have been immense. While digital

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X Rays have resulted in better and more accurate diagnosis, their shareability has meant that a doctor sitting in India can share a digital film with a counterpart in the United States and seek his or her opinion on an important case. In the field of medicine, digital radiography is today more a norm than exception. However, in oral dentistry this usage is still relatively new.

Digital Imaging and Dentistry

Much like in the field of medicine, digital imaging is also revolutionizing oral dentistry with far reaching consequences on the way teeth problems are diagnosed, treated and evaluated. The advanced technology provides a valuable tool to medical practitioners in the field to measure cosmetic and health outcomes, such as tooth whitening, plaque, and gingivitis.

Doctor SPEAK

One of our patients, a 32 year old male presented to us with advanced kidney disease and was put on urgent hemodialysis. Need for kidney transplant was explained to patient but only blood group matched donor in the family was his mother. She was investigated and found unfit because of medical reason. After explaining the cost and long term outcomes of ABOi transplant, patient’s wife (blood group A+) was accepted as donor. Patient’s blood group was O+ positive.

After achieving minimum target antibody levels in the blood of recipient, kidney transplant was done. Patient started passing good amount of urine post transplant and there was fall in serum creatinine to normal level over next 3 days. Patient was discharged on post operative day 8 with serum creatinine of 1.0 mg/dl. Now Now he is 6 months after transplant and going for his work everyday.

Other facilities for kidney failure patients at PSRI Hospital:

Patient was admitted about 2 weeks before provisional transplant date and immunosuppressant drugs started. Plasmapheresis was done to remove preformed ÂÂ antibodies against donor blood group antigen on ÂÂ alternate day basis. Plasmapheresis is a procedure in which plasma containing antibodies removed from the blood by a cell separator. Intravenous albumin ÂÂ and normal saline were used as replacement fluid. Each plasmapheresis was followed by intravenous immunoglobulin. Patient was dialyzed on alternate ÂÂ day basis during hospital stay. We checked routine ÂÂ blood parameters regularly. 

Laparoscopic donor nephrectomy Donor swapping (when a living kidney donor is incompatible with the recipient, exchanges kidneys with another donor/recipient pair). Kidney transplant in complex cases (marginal donors, difficult vascular anatomy) Pediatric kidney transplant CRRT (slow continuous hemodialysis in hemodynamically unstable patients)

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Industry WATCH

Swati Bagga has taken the control and responsibility to launch the multinational medical giant, Welfare Medical, in India

Swati Bagga & Sushil Bagga

& Dynamic Entrepreneur Young

www.m e d e g a t e t o d a y. c o m January-February 2015

Expert VIEWS

Assisted Reproductive Technologies

ioneered by Robert Edwards & Patrick Stoptoe in the seventies, Assisted Reproductive Technology (ART) is a rapidly evolving subspecialty of medicine dealing with Infertility. Infertility is a significant problem, affecting 10-15% of couples and is the answer to all infertility problems. At the same time, it is a subject of moral controversy and ethical criticism, ever since its conception. ART involves handling of both human eggs and sperms outside the human body and mainly involves IVF-ET (In Vitro FertilizationEmbryo Transfer) and ICSI (Intra Cytoplasmic Sperm Injection). By definition, IUI (Intra-Uterine insemination is not considered as an ART. Louis Brown, the first miracle baby born through IVF, silenced many a debates and simultaneously gave birth to many worries! It was expected that Louis Brown would be born with multiple defects, as human sperms and eggs were fiddled with, for the very first time. But when Louis Brown was born as a healthy normal baby with no defects, the fears of a “Franken Stein baby” were put to rest! ART has truly paved the path for childless couples to have their own babies!

Dr. Duru Shah Scientific Director Gynaecworld and Gynaecworld Fertility Center

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Invitro fertilization – embryo transfer Invitro fertilization – embryo transfer typically involves stimulating the ovaries with fertility drugs to have large numbers of eggs growing, contrary to a natural cycle, where only one egg grows every month. When these eggs reach a size of 18 – 20 mm, they are retrieved from the woman’s body, using a trans-vaginal approach with the assistance of ultrasound. The retrieved eggs are fertilized in a dish with the sperms,

Healthcare Management

Hospital Mergers

and Acquisitions

Prof. M. Habeeb Ghatala Dean, Apollo Hospitals Group (Retd.) Hyderabad

www.m e d e g a t e t o d a y. c o m January-February 2015

ergers and Acquisitions (M&As) have become an indispensible part of Indian corporate environment. There have been a total of 480 deals amounting to $27.4 billion during 2013 involving Indian companies. It is predicted that with the improvement in economy and coming in force of the provisions of Companies Act 2013, will pave the way for a number of M&A transactions in all the sectors including healthcare. It will also make corporate restructuring process smooth and efficient. M&As in India are governed by the Companies Act 1956 under Section391 to 394. Although M&As may be instigated through mutual agreements between

Market OVERVIEW

Customs Duty and the end patient pays around Rs 1.5 lakhs for the same. Hence there is no rationale for Zero Customs duty for any Finished Goods imports and there should be atleast 20% customs duty exemption between Finished Goods imports and Raw Materials/ Components import for ultimate manufacturing in the country. Hence there is an urgent need to boost innovation and manufacturing in this Industry of 35,000 crs with over 80% imports and as a largest

Medical Technology company of Indian Origin with 8 Functional US FDA and/or CE certified facilities and 4 R&D facilities, Trivitron is in the forefront of interacting with government through various industry associations like FICCI, AIMED and Assocham to create the right eco system for the Medical Devices Industry to remove import dependency and make India Outward looking with substantial exports in around 5 to 10 years from now."

Global MRI Market

MRI is undoubtedly one of the most acceptable and advanced imaging modality in Radiology today .Unlike X-ray and X-ray based systems it do not do harmful radiation or make side effects for the patient . Over the last 20 years, MRI has transformed with lot of advancements and became one of the most popular imaging modality. There is great progress in resolution, speed , depth, contrast making the MR equipment more acceptable and affordable. MRI systems are now also available as combination or fusion equipments for PET and Therapy application . In recent times, CT PET is become very popular and useful and is a critical component for diagnosis , but it has some serious limitations other than radiation . Accuracy of diagnosis is affected by the artifact produced by sequential acquisition instead of simultaneous acquisition. Its image capabilities can be seriously affected by issues of attenuation correction and artifacts. MRI has many advantages scoring over these critical issues, and also have a large variety of protocols that selectively enhance contrast and thus provide enhanced tissue contrast which can be utilized for dynamic contrast-enhanced imaging, diffusion imaging, functional MRI, and many such

studies . Also MR spectroscopy is become a very good study for detection of organ-specific abnormalities like cancerous tumor . In short , with many recent advances in the Technology, MRI is become more powerful and accurate than ever.

We can list out few key drivers for global MRI Market growth: ÂÂ Rapid growth of new Diseases and rising no of cancer patients ÂÂ Greater demand for cost-effective and healthcare solutions

affordable

ÂÂ Arrival of New technologies driving innovation in Healthcare ÂÂ Increased awareness among patients and doctors about dangers of radiation ÂÂ Open and Hybrid l MRI systems to drive further demand , especially for claustrophobic patients ÂÂ Growing use of MRI techniques by non-radiologists and new Cardiology MR applications ÂÂ Steady reimbursement and other government funding possibility ÂÂ Ever-growing global population and emerging economies

At the same time the challenges for MRI Market are

ÂÂ Import duty for MRI units and spare parts for many countries ÂÂ Limited availability of venture capita ÂÂ Reduced hospital budgets ÂÂ Increasing prevalence of lifestyle-related diseases

Som Panicker Vice President Sanrad Medical Systems

ÂÂ Natural or increased competition from CT systems and CT PET systems ÂÂ

Shortage of dedicated MRI technologists and skilled manpower

ÂÂ High cost of capital equipment and Helium Issues ÂÂ Lack of long-term data on use of MRI in patients

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Market OVERVIEW

and lack of Market study

affordability is growing . With this advantages big Ă&#x201A;Ă&#x201A; Unknown biological effects of high Tesla MR usage combined , global MRI market will get opportunities in emerging markets of India , China, Despite these market challenges, Global MRI market is expected a steady growth which is still Russia and Latin America. in its initial growth stage in many countries. Rapid To give some idea of the market size and projections, and Continued growth in this sector will be fueled by new Technology and innovations, cost reductions, Global MRI systems market is expected to grow Insurance reimbursementa, and a special focus on from $3.7 billion in 2012 to over $9.2 billion by 2020, emerging markets. increasing at a Compound Annual Growth Rate One interesting aspect is about emerging Markets, (CAGR) of 11.8% during the forecast period. still permananet type MR can be the best cost The recent economic slowdown made some impact effective solution for small and medium cities and places where uninterrupted power supply is on MRI system sales, especially competitor a problem . Emerging economies such as China technologies are cheaper offering same imaging and India are expected to continue to provide quality and resolution. opportunities for revenue growth for the global MRI market. According to one of the market study US and Europe MRI markets are slowed down , the Indian and Chinese markets accounted for compared to the past , but surely it will regain and 3.6% and 16.5% of global MRI systems revenue in the market will continue growing. 2012, respectively; this share is expected to increase further next few years as physicians tend to prefer New changes in Medical insurance reimbursements, MRI Other aspects are the growth in Medical the increasing aging population, rising occurrence of Insurance coverage and falling prices. disease and the growing demand for advanced MR Emerging Markets like India , China, Russia and systems will act as major drivers for continued growth Latin America , demand for low cost MRI systems in the market. Despite cost- effective measures are growing and no of MRI procedures are also implemented by healthcare authorities, the safety increasing making bright days for MRI market. and efficacy of MRI techniques will continue to drive Also with the increase of average income , the new sales in developed and emerging markets.

www.m e d e g a t e t o d a y. c o m January-February 2015

Market OVERVIEW

The market has grown out of mere x-ray diagnosis...

Kalyanraman. S General Manager Marketing and Corp Accounts CURA Healthcare Pvt Ltd

Indian Imaging and Radiology market is pegged at around ` 3500 crore and is growing @ 17-18% p.a. New advancement in imaging & digital radiology equipments

Indian Radiology and Imaging market has come a long way to become an all important element in the value chain for healthcare provider. The market has grown out of mere x-ray diagnosis to high end imaging diagnostic equipments such as PET CT, Nuclear medicine, CT, MRI of highest orders, digital x-ray, wide applications of color Doppler etc. More than new advancement in equipments, it is more of newer applications of existing modalities which has gained momentum. For example, earlier USG was used only for OBG. Now USG is used by almost across specialties. Moreover, with increased incidences of Non-Communicable Diseases, imaging diagnosis is being used more than ever.

Feature products of cura in imaging devices

CURA has been pioneering in Imaging diagnostics space with digital radiography system, patented design DR solutions, pre-owned CT, MRI, Mammo and BMD. Recently CURA has acquired DE Healthcare which has the ultrasound DNA in it, thus CURA forayed into Ultrasound and Color Doppler segment. CURA has

launched couple of new Dopplers in mid segment with new features. Our new dopplers are: Vinno is an innovative solution catering to imaging diagnostic specialists. Vinno symbolizes image quality and redefined workflow. Its innovative RF platform removes the need for hardware pre-processing and demodulation of traditional ultrasound platform. This state-of-the-art, first of its kind platform used in an ultrasound/color Doppler system primarily aims at improving the image quality of the system. Vinno allows all RF signals for computing, which is over 40 times of data size than currently used in conventional ultrasound systems. Vinno offers very high quality 3D/4D rendering, Super resolution volume imaging technology and 2D image in any angular slice. Most important is the super high frequency probe ranges (1.0 to 25.0 MHz) for various applications. S8EXP - S8 exp has new VISTA platform , which can offer you better image ,with technologies like PIH (pulse inversion harmonic). S8 exp has 20 kinds of probes for option, like CWD/ PWD pencil probes, phased array for adult, pediatrics , neonate; Other features include Elastography, Real Panoramic, Color Panoramic imaging, better patient information management etc. eZono 4000: Ultrasound-guided regional anaesthesia is increasingly popular, offering the user a number of advantages over alternative methods of nerve localization (neurostimulation or paraesthesia). eZono4000 is an innovative, first of its kind Ultrasound guided needle visualization in regional anesthesia and nerve block. eZono 4000 offers unique solutions to address the real life challenges facing clinicians every day, when using ultrasound at the point of care. The product is a robust, portable, very easy to use ultrasound system designed specifically for anesthesia. It incorporates many special features suggested by practicing anesthesiologists.

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Doctor SPEAK

Understanding

Cardiac Emergencies Cardiac emergency - Signs and Symptoms

Crushing chest pain is the most obvious symptoms, but not all heart attacks begin with it. In fact, some heart attacks cause no symptoms at all. This is more common in people who have diabetes. Sometimes there may be mild chest pain and discomfort.

There are several types of cardiac emergencies where immediate action is required; one has to understand that these can even lead to death. So, symptoms and signs are very important as timely recognition can save life of the person.

Recognizing Cardiac Emergency Symptoms

The symptoms may vary from person to person.

CHEST PAIN

Chest pain can be very deceptive. It is a subjective discomfort experienced by the individual which may be of cardiac or noncardiac in origin. In the short term, the safest course is to always assume it is cardiac. Crushing chest pain is the most obvious symptoms, but not all heart attacks begin with it. In fact, some heart attacks cause no symptoms at all. This is more common in people who have diabetes. Sometimes there may be mild chest pain and discomfort. That can occur at rest or while one is doing some activity. Depending on oneâ&#x20AC;&#x2122;s age, gender, and other medical conditions, symptoms may be more or less severe. Chest discomfort that feels like pressure, fullness, or a squeezing pain in the center of your chest; it lasts for more than a few minutes, or goes away and comes back may be due to heart attack. Pain and discomfort that extend beyond your chest to other parts of your upper body, such as one or both arms, back, neck, stomach, teeth, and jaw.

OTHER SYMPTOMS

Dyspnea (difficulty in breathing) Dyspnea can often be a clue that heart failure is present. Heart failure should be suspected especially if the person has trouble while breathing in lying posture, a condition referred to as orthopnea.

Dr Sameer Shrivastava Director, Non-Invasive Cardiology Fortis Escorts Heart Institute

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Palpitations

They are often described as a pounding in the chest or an awareness of rapid or skipped heartbeats. These sensations can be caused by a wide variety of cardiac arrhythmias (abnormal heart beating). Persistent palpitations should be

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evaluated to rule out life threatening arrhythmias. Syncope (loss of consciousness) If person has episodes of sudden dizziness, vertigo or brief loss of consciousness accompanied by weakness , it may be due to decrease perfusion to the brain. Also in such people Arrhythmias such as transient asystole( cardiac arrest), ventricular fibrillation or tachycardia(life threatening abnormal heart beating), bradycardia (slow pulse rate) can be the culprits. Other causes may be pulmonary hypertension (increase in right sided heart pressures).

Coughing

Conditions related to heart that can lead to coughing could be pulmonary hypertension (right sided heart failure) or pulmonary edema (heart failure). The presence of bloody sputum can be due to heart failure. Other symptoms, such as sudden onset severe backache (upper part), cold sweats, nausea or vomiting, anxiety, indigestion, and unexplained fatigue One has to remember that chest pain and discomfort are the most common heart attack symptoms for both men and women. But, women are more likely than men to also experience other symptoms, too. These might include shortness of breath, nausea and vomiting, unexplained extreme fatigue, and neck, shoulder, upper back, or abdominal pain.

Signs of cardiac emergency Once the person has one of the above symptoms than the things one should look for in such persons is ÂÂ Tachycardia(fast heart rate)

ÂÂ Elevated Or Low blood pressure ÂÂ Cyanosis (bluish discolouration seen in extremities) could be due to lack of oxygen supply. ÂÂ Diaphoresis (profuse sweating) could be due to heart attack or heart failure. ÂÂ Anxiety or confusion secondary to oxygen deprivation. ÂÂ Pedal edema(swelling of the feet)- When edema is present, it can indicate heart failure for which the cause has to be evaluated. ÂÂ Engorged( Visible veins), pulsating neck veins (late signs)when present indicates heart failure. ÂÂ Sudden loss of responsiveness. No response to tapping on shoulders. Does nothing when you ask if he is okay. Could be sign of cardiac arrest or cardiac arrhythmias. ÂÂ No normal breathing. The victim does not take a normal breath when you tilt the head up could be due to heart failure.

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Fainting: A benign thing, or a

harbinger of death?

Dr Anil Saxena

Director Electrophysiology & Cardiac Pacing Fortis Escorts Heart Institute

e have all seen or heard about someone fainting at the sight of blood, a gory incident, or during pain. Fainting, or syncope as it is medically called, is not a rare occurrence. It is also called ‘passing out’ in common parlance. Nearly everyone faints once in a while during a lifetime. A large number of these episodes are the so-called ‘benign common faints’. However, syncope, in certain situations, can be a harbinger of sudden death: the only difference being that in syncope, one wakes up. Fainting occurs usually when the blood pressure drops, and blood supply to brain is transiently compromised. Various symptoms may precede fainting, such as feeling of weakness, sweating, pale skin, nausea, loss of body muscle tone etc. This prodromal phase may last few seconds to a couple of minutes. Once the person faints and falls, blood supply to brain is restored, and the episode of unconsciousness ends. The majority of fainting episodes are benign, and occur because the nervous system is not able to maintain the appropriate degree of reflex constriction in blood vessels that leads to fall in blood pressure. These episodes usually have no consequences other than the injuries that might occur due to fall. Common situations, which trigger an episode, are sight of blood or injection syringe, painful stimuli, exposure to hot weather, and any acutely distressing event.

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In presence of heart disease, fainting can be due to dangerous rhythm disorders of heart, which may often be fatal if left untreated. This is particularly true if the pumping capacity of heart is reduced due to previous damage. Therefore, if fainting occurs in a patient having heart disease, it should be investigated carefully and appropriate treatment given. Patients with slow heart rhythm need a pacemaker, which is an implantable electronic device that keeps giving electrical pulses to heart, and maintains heart rate. On the other hand, some patients are vulnerable to sudden death due to extremely high heart rate called ventricular tachycardia and fibrillation. These arrhythmias can be fatal if not treated urgently by an electrical shock. Such patients need implantation of a defibrillator, which keeps monitoring heart rhythm, and delivers a shock promptly on sensing a life threatening heart rhythm. Undiagnosed and unexplained fainting can be troublesome to treat, and all effort should be made to monitor heart rhythm during an episode. For this, a number of monitoring systems have evolved which monitor heart rhythm for variable length of time. A Holter monitor is most commonly used which records ECG for 24 hours, but is not of much help as fainting is very less likely to occur in such a short duration. An external loop recorder monitors rhythm for one week, and keeps sending ECG to a web based analysis system which alerts physician in case of a significant arrhythmia. An even more advanced system is implantable loop recorder that can record and store ECGs over a period of 2-3 years, and can be very helpful in diagnosing infrequent episodes of fainting. If you see a person faint, or about to faint, the immediate thing to do is to help the person lie down. If the person regains consciousness quickly, he or she should continue lying for about 10 minutes, and should be given fresh air and water to drink. If one is unconscious, the person should be turned to one side to avoid tongue falling back and obstructing airway. One should check for breathing and pulse, and call an ambulance if the person is unresponsive. If there is no pulse and breathing, resuscitation should be started by chest compressions while waiting for ambulance to arrive. In many western societies, routine resuscitation training to maximum number of people has brought down mortality due to sudden cardiac death significantly. Families of patients with significant heart disease should actively seen training in resuscitation. This can make the difference between life and death if the patient gets an episode of cardiac arrest.

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Dr Praveer Agarwal

Director Interventional Cardiology, FEHI

oronary Heart Disease (CHD):- Is the commonest verity of heart Disease. It occurs as a result of critical blockages in coronary arteries (arteries supplying blood to the heart), compromising blood supply to the heart muscle and manifesting as angina pectoris, acute myocardial infarction (heart attack), or sudden death.

FAQ Coronary Heart Disease (CHD): Is it curable?

No, it is not curable. The disease course can be modified by proper medical therapy and intervention at appropriate time.

Medication of proven CHD: Is it life long?

Yes, it is life long. Depending upon parameters and symptoms the drugs and doses are modified.

What are the risk factors?

Age, Male gender, family history of premature CHD, high blood pressure, Diabetes Mellitus, smoking, tobacco chewing, high blood cholesterol, obesity, sedentary life style and psychosocial factors.

Can CHD be controlled by modifying risk factors? Yes, it may reduce the risk or slow down the progression of CHD.

Can I develop CHD without risk factors?

Yes, one can develop CHD but risk of premature CHD is slim provided lifestyle is healthy.

Bypass surgery (CABG): Is it a cure for CHD?

No, it is only palliation. There is about 1-2% mortality and about 2-3% morbidity in bypass surgery. The recovery is about 2-3 monthsâ&#x20AC;&#x2122;. About 2/3 of patients usually come back by 10 years with some or other problem.

Angioplasty (stenting): Is it a cure for CHD?

No, it is again palliation. It is a low risk procedure in majority o patients. Done as a percutaneous procedure

MYTHS AND REALITIES OF CORONARY HEART DISEASE (as angiography) without any incision or General Anesthesia (GA). With the newer Drug Eluting Stents, the success is nearly 100% and recovery is quick (within 07 days). The blockages may recur within 6-8 months if at all (in <10% of patients). After that period, the further chances of recurrence are less.

Medication for high cholesterol: Is it life long?

Yes, in majority of patients. But the doses can be adjusted depending upon the levels and side effects.

Can I develop CHD without high cholesterol levels?

Yes, you can develop CHD without high cholesterol levels because cholesterol is not the only risk factor.

Is yoga a substitute for physical exercise for prevention of CHD? No, it is complementary to exercise.

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Abdominal distension may be generalised or may be localised to a discrete mass or enlargement of an organ. The main causes of generalised abdominal distension are easily remembered by the five Fs:  Fat (obesity)  Faeces (constipation)  Fetus (pregnancy)  Flatus (gastrointestinal)  Fluid (ascites)

Differential Diagnosis of

Abdominal Distention

C Dr. Rajiva Kumar Child Specialist Muzaffarpur, Bihar, India

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onstipation generally is defined as infrequent or painful defecation. It often is due to passing large hard stool infrequently which causes painful defecation and then withholding behaviors. As stool withholding continues, the rectum dilates and gradually accommodates with the normal defecation urge disappearing. Chronic rectal distension results in both loss of rectal sensitivity, and loss of urge to defecate, which can lead to encopresis. Abdominal distention because of stool retention occurs frequently. Treatment includes colonic evacuation, establishing regular bowel habits, eating a balanced diet with dietary

RNI No. DELENG/2010/33833

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