Medgate Today Magazine - Mar-Apr 2016

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Volume VI || Issue VI || Mar-Apr 2016

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Medical TechnologyIndustry in India

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BRAIN CANCERA CANCER thAt lAsts loNgER IN lIfE

BRAIN CANCERA CANCER thAt lAsts loNgER IN lIfE

MR solutIoNs BRINgs PREClINICAl MRI IMAgINg solutIoNs

MR solutIoNs BRINgs PREClINICAl MRI IMAgINg solutIoNs

Medical TechnologyIndustry in India

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Finance Minister Arun Jaitley presented India's national budget for 2016-17 in the LokSabha recently, which is a sigh of relief for the farmers while causing the affluent to raise an eyebrow. The budget mostly focuses on the rural economy. The budget for the fiscal year begins on April 1, 2016. Speaking of the longstanding growth and the sustainability of the nation, the Finance Minister fixated on the chief aspects – farmer rights, agriculture, manufacturing, employment opportunities, social welfare, infrastructure and investment, banking and policy reforms, education and health amendments, fiscal control and tax reforms. I believe there’s been a vast comfort in the healthcare domain for few factions. For instance, the charges on dialysis procedures for patients with kidney disorderswill be reduced and dialysis facilities will be available at all district hospitals. This will serve as a huge relief for renal patients, because every 17 out of every 100 people suffer from kidney diseases. Of this, 6% have stage III kidney disease which necessitates medical attention and, in some cases, costly treatment like dialysis or transplant.It is also heartening to know that the government will also provide health insurance of up to Rs 1 lakh for the underprivileged families whereas senior citizens will get additional healthcare cover of Rs 30,000 under the new scheme. Likewise, the PM Jan AushadhiYojana will be strengthened and 300 generic drug store to be opened.To sum it up I think, health sector has got a fair share which was needed in terms of the people who were in dire need of proper healthcare.This will certainly act as animpetus for investment in healthcare segment and assist in enhancing affordability and accessibility of quality healthcare. However, a question will still remain that how Government will run dialysis centres, when we are battling for skilled work force like dialysis technicians? Similarly, there are very fewer facilities in tier 2 and tier 3 cities which can provide a holistic care to the needy and an insurance holder.Furthermore, encouragingdoctors to serve in the semi urban and rural areas have not been highlighted. There has likewise not been any emphasis on sorting the manpower issues in healthcare with great scarcity of doctors and medical caretakers hampering our endeavors in supplying health coverage.Healthcare sector was also hoping to get a positive response from the government to its approvals of exempting of healthcare services from GST, increment of tax holiday for instituting healthcare facilities for a long duration in non-metro areas, increase in tax exclusion on preventive health checkups and establishing regulated funds for health and healthcare. I also feel that the government has not addressed the issue of recent increase in import duty on medical equipment and devices. The medical technology division is still at its nascent stage with manufacturing limited to less complex devices. 75% of medical gizmos are still being imported and therefore the duty increase will result in increase in healthcare cost. It is time that the government understands that health is a critical marker of economic improvement and work towards an all-encompassing vision for healthcare."

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Contents

The Next level Healing with the New Medical Technology ��6By 2025 India will Procure 10 percent of the Bio-medical Market, says Union Minister ��6New Drug Delivery System that Targets Inflammation Points in Body ��8Earlier Diagnosis of Fungal Lung Infection can now be Possible ��8MR Solutions brings preclinical MRI imaging solutions to the Netherlands ��10Amniotic Membrane can be the New Wound Healing Technique ��12Frost & Sullivan Spotlights Carestream’s Innovation and Continued Success in North ��12Alzheimer’s Disease Market Will More than Double to $10�4 Billion by 2021, says GBI Research ��1424MRC Network Declared the Winners of 2015 Leaders Awards (Healthcare) ��16Xviii National Seminar on Hospital & Healthcare Management, Medico Legal Systems ��18Comment on Budget 2016-17��206 Things You Should Know About Zika Virus ��22Post budget reaction from healthcare industry ��24BRAIN CANCER A cancer that lasts Longer in life ��26 Prevalence of Gestational Diabetes is High but Can be Controlled with Right Medical Intervention ��28Is Preventive Operation catching up in India? ��30Genomics Driving Personalization of Healthcare ��34GI Emergencies A Diagnostic Challenge ��38Electrosurgery ��40Pros And Cons Of Bariatric Surgeries��44In Rendezvous with Ramakanth Desai ��46Interview with Shashank ND ��54Combating Diabetes: The not so sweet Indian Scenario� ��56Amulet Innovality The New Leader in Digital Mammography ��58HealthNet Global Limited Advances ��60Lowering the burden of disease and overall healthcare cost through safe injection practice regime ��61Family Matters Heart Disease Lurking in Your Family Tree ��62Does my heart pump enough? The EF number reveals it all ��63

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36 48Is your Child a Victim of

Attention Deficit Hyperactivity Disorder (ADHD)?Dr. Rajiva Kumar

Emphasis on Health Programmes

Dr. Jitendar Kumar Sharma

ZIKA Virus Public health emergency of International Concern

Dr. M. Wali

Commemorating Triumphs and Transforming Futures

Mr. Sushil Bagga

In an exclusive interview, Dr. Ashok Seth

talks about his typical work day, his hobbies and inspirations.

Medical Technology Industry in India ��64COVER STORY

UpdateNEWS

www.medegatetoday.com March-april 20166

The Next level Healing with the New Medical

TechnologyA team of researchers at the Massachusetts Institute of Technology (MIT) are in the process of developing a novel wearable device that will change the way how doctors diagnose and treat patients. It is a polymer network that is synonymous to the human tissue. It is a hydrogel, consisting mostly of water and 5-10 per cent of polymer. It is extremely elastic and can stick easily to surfaces. This gizmo is exclusively designed to be compatible with the human body – both inside and out. Because of this compatibility principle, a new class of biomedical devices can emerge.Xuanhe Zhao, an associate professor of mechanical engineering, MIT said that electronic tools such as sensors and drug delivery devices can be embedded into this matrix to achieve smart applications. These types of applications can turn a usual band-aid into a gadget that can autonomously monitor and heal wounds. For instance, if a sensor detects an abnormal increase in temperature it will send out a command that can deliver a specific drug to that specific location.The researchers are now calibrating the properties and functionality of their hydrogels. They believe that soon healing everything from a cut to an ulcer will be as easy as putting on a band-aid.

A U.S committee of researchers and ethicists are given a green signal by the U.S government to create “three-parent babies” in clinical IVF experiments, as long as certain guidelines are followed. These babies can be conceived by a procedure known as mitochondrial replacement therapy or three-person IVF. The target is to prevent rare genetic disorders that impairs energy-producing mitochondria from being passed from a mother to her child. The methodology involves the scientists to extract and discard the nucleus of a donor egg containing healthy mitochondria and then infuse the nucleus from a mother's egg. Sperm from the father fertilizes the egg, resulting in an embryo. Thus, the principle is that the majority of the genetic information should come from the mother and father, and only a trifle amount of DNA should come from the donor’s mitochondria. In the United Kingdom, three-person IVF is already legal but the US FDA has requested that a jury convened by the Institute of Medicine to inspect whether ethical considerations should prevent clinical studies in the United States.This panel concludes in a report published in the journal Science, that it is ethical to conduct the experiments, but the technique should be limited to making baby boys. The reason is to avoid 'germline modification' of future generations because mitochondria are usually inherited from the mother. The team also advises that 3 way IVF should be restricted to women with serious mitochondrial diseases. Likewise, an expecting mother’s health and the skills of the scientists should be taken into account before approving studies.The FDA carefully reviewed IOM committee recommendations and stated that the latest federal budget prohibits the agency from reviewing applications 'in which a human embryo is intentionally created or modified to include a heritable genetic modification. Consequently, the mitochondrial replacement therapy or three-person IVF for the prevention of transmission of mitochondrial disease is not approved and cannot be practiced in the United States at this time.

By 2025 India will Procure 10 percent of the Bio-medical Market, says Union Minister

Department of Biotechnology, Ministry of Science and Technology, Government of India organized a conference at the CSIR Science Centre, New Delhi on 'Med-Tech Innovation for Make-in-India'. Hon'ble Union Minister for Science and Technology and Earth Sciences, Dr. Harsh Vardhan was present at the conference and shared insights on the current and future endeavors and possible scenario of medical market in India. Dr. Harsh Vardhan informed that Indian medical technology market was valued at US$6.3 billion in 2013 and is the fourth largest in Asia. He also stated that the current penetration levels of 8% implies a domestic market of $20-25 billion. Dr Vardhan said addressing the conference, ''Globally the medical technology market is expected to be $600 billion by 2025 implying a manufacturing base of $200 billion by then". He also confirmed that India will capture 10% of that share by 2025 in line with China's share today. This will lead to an opportunity of at least $20 billion by 2025. Dr.Vijay Raghavan, Secretary, DBT, and other senior DBT officials were present at the event.Realizing the demand for medical technology innovation, the Department of Biotechnology is promoting this sector by supporting a range of programmes pan India ,which have fruitfully resulted in affordable products of societal and public health relevance.

Report by U.S Scientists Confirms Three Parent IVF is Safe and Ethical.

UpdateNEWS


Medical engineers at the University of Exeter have devised a new diagnostic technique that can help doctors detect the spores of the fungus, Aspergillus fumigatus, sooner and help decrease the risk of death in patients with weakened immune systems.Aspergillus fumigatus are miniscule ubiquitous spores that are present in the air and breathed in by humans on a daily basis. People that have healthy immune systems are not adversely affected by the spores as they get destroyed before they can grow and infect the body. But in patients with a weak immune system, the fungus faces little resistance. Once it enters the body, the fungus settles into the lungs and spreads from there, causing invasive pulmonary Aspergillosis and sometimes even death. Currently, this infection causes an estimated 200,000 deaths globally, each year.The best way to prevent death is to detect the spores early and subject them to specific and targeted treatment, but till recently this was not possible as there were no quick and reliable method of diagnosis.A team of medical engineers led by Professor Christopher Thornton, Associate Professor of Fungal Immunology at the University of Exeter, and Director of ISCA Diagnostics, have collaborated with scientists from the Tübingen University and University

Hospitals, Universitätsklinikum Essen, Paul Scherrer Institute, to design a novel diagnostic process. They've tested their new diagnostic methodology in a disease model.The procedure involves tagging radioactively labeled antibodies to the infecting structures formed by the growing fungus. This makes fungus visible to physicians. The researchers used a combination of MRI and PET imaging to identify the spores and to rule out other bacterial and viral lung infections. This an easier and faster way of detecting the spores than the existing method which involves taking tissue or fluid samples from the lungs of immuno-compromised patients with abnormal symptoms.Professor Thornton confirms that in the future patients can avoid the tedious, time-consuming, and sometimes dangerous procedures, currently in practice. And doctors can detect the spores early on and gain valuable time for successful treatment.This innovative technology has the scope to bring about a paradigm shift in medical and healthcare practice globally and will help pave the way for better diagnosis of other potentially fatal diseases.

New Drug Delivery Systemthat Targets Inflammation Points in BodyA researcher at the University of California has developed a new device that can carry drugs to points of inflammation in the body. Dr. Ghada Mutlaq Al-Mutairi holds a doctorate in chemical engineering and has received a global innovation award from HIN, the largest organization endorsing scientific research in the United States.Her technique was recognized as one of the four most phenomenal inventions by the United States Congress in 2012. Her device provides a way to penetrate the body, detect inflammation, and provide treatment using nano-capsules containing the drug.She confirmed that the technology has been successful in treating eye and rheumatoid patients in the United States, with possible applications in other fields including agriculture, engineering and manufacturing. Al-Mutairi said the development took 10 years, and by 2011 they were able to produce a substance that interacts with the inflammation and by 2013, they we were able to develop the nano-capsule technology that does not dissolve in water and only opens on contact with inflammation in the human body.Dr. Ghada's invention has caught the interest of many pharmaceutical, chemical, engineering, and solar companies around the world. A Japanese agricultural company and Pfizer has also purchased a license for its use Currently, she is working with her brother Dr. Khaled Al-Mutairi, a well-known plastic surgeon in the United States, to support research in plastic surgery, specifically developing a new chemical to rid the body of excess fat.

Earlier Diagnosis of Fungal Lung Infection can now be Possible

UpdateNEWS


MR Solutions will be displaying its latest cryogen free 3T and 7T preclinical, multi-modality MRI models to the imaging science community at the 11th European Molecular Imaging Meeting on March 8 – 10, 2016 in Utrecht, in the Netherlands. This is an annual event organized by the European Society for Molecular Imaging, of which MR Solutions is a member. Dr David Taylor, CEO of MR Solutions commented: “We will be showing off our latest scanners which offer multi-modality scanning (including PET or SPECT) and better performance, all at a very competitive cost.” MR Solutions, which is based in Guildford, UK, is the world’s largest independent developer and manufacturer of preclinical MRI technology and remains the only company to deliver a commercial cryogen free 3T and 7T range of preclinical bench top MRI scanners. To provide the SPECT images, MR Solutions has devised a system where the four gamma camera heads and focusing collimator can be easily clipped on to the front of the bore of the MRI scanner to provide state of the art 3D SPECT images. The SPECT images can be registered with the MRI images providing anatomical-functional

combined capability. The SPECT gamma camera can also be used independently. The PET capability is provided by solid state detectors which are incorporated in the bore of the MRI scanner. The scanner combines the exquisite structural and functional characterization of tissue provided by MRI with the extreme sensitivity of PET imaging for metabolism and tracking of uniquely labelled cell types or cell receptors. This is particularly useful in oncology, cardiology, and neurology research. MR Solutions’ range of cryogen free, Benchtop, 3T to 7T MRI scanners with 16, 31 and 72 cm bores has become a complete game changer in the field of preclinical scanning. The technology not only provides superior soft tissue contrast and high spatial resolution, a vastly reduced stray magnetic field and all the benefits that brings but also allows the magnetic field strength to be easily varied. MR Solutions has over 30 years’ experience and in excess of 1000 installations across the world. This includes sales of their MRI spectrometers. Its scanners are renowned for their excellence in terms of superior soft tissue contrast and molecular imaging ability.

TEKNIMED, designer, developer and manufacturer of innovative surgical products, will showcase its latest innovations for the Indian market at Medical Fair India 2016. The company recently registered a list of products 100% made in France which are now or will be available soon in India. TEKNIMED will first present its OPACITY+ product, low viscosity bone cement dedicated to vertebroplasty and kyphoplasty surgeries for spine application. The product has already been certified for the Indian market and is available. Three other products (CEMFIX 1/3, GENTAFIX 1/3/3MV and EUROSCREW PLA and PLA/TCP) are being tested to receive certifications as per Indian regulations and will be available in India in April this year.CEMFIX and GENTAFIX are PMMA cement (respectively with and without antibiotics) with low, medium and standard viscosity dedicated to any knee, shoulder or hip prosthesis surgeries. EUROSCREW PLA and PLA/TCP resorbable interference screws are dedicated to ligamentoplasty surgeries.TEKNIMED has strong expectations from the Indian market, as said by Ms. Isabelle Iversenc, APAC and MEA Export Manager: “India is a highly dynamic market. Key words to enter this market: Innovation, quality and well-priced products. With our arthroplasty and vertebroplasty range of products, we have the solutions to meet the requirements of Indian healthcare sector for innovative surgical and biomaterial products”.

Teknimed to Launch New Biomaterials & Surgical Solutions in Orthopaedics and Spine Surgery in India

MR Solutions brings preclinical MRI imaging solutions to the Netherlands

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UpdateNEWS


The rate of diabetes continues to rise and foot ulcers and chronic wounds are its by-product, leading to amputations in severe cases. To combat it, medical experts are now turning to wound dressings, derived from human amniotic membrane, a tissue found in the human placenta. This innovative approach gives another option to patients whose wounds do not heal using existing treatments. The technique uses a material that would otherwise end up discarded as medical waste after child birth.Amniotic membrane is the innermost layer of the placenta consisting of a thick basement membrane and an avascular stromal matrix that covers the placenta as a fetus develops. 'Water breaking' is when this protective layer ruptures. During parturition, the membrane comes out of the woman's body along with the rest of the placenta. When this membrane is put on the wound, the wound starts to heal faster. The amniotic membrane resembles a piece of standard cling wrap, but it is a haven of various proteins, growth factors and stem cells. The stem cells are scraped away when the membrane is prepared for use as a wound covering, leaving behind the intricate network of the proteins. This scaffold is rich in a certain protein called collagen whose functions are replacement of dead skin cells.According to a report by the Centers for Disease Control and Prevention, diabetic ulcers affect 15 percent of people with diabetes during their lifetimes, and these wounds lead to more than 70,000 amputations annually. The wounds develop due to high levels of blood sugar which damages the nerves over time. This nerve damage, called neuropathy, interferes with the body's normal protective mechanisms. People with diabetes may not sense that they're putting too much pressure on one part of a foot for long periods of time, producing painful sores. The disease can also dry out skin, leading to cuts on the foot a person with diabetes may not even feel. Poor blood circulation means broken skin takes longer to heal, increasing the risk of infection.The products are available in the market and could potentially be employed by any physician and specialized wound care centers. Amniotic membrane is relatively free of any side effects when used in the sheet form and tissue rejection or allergic reactions have not been reported. The natural antigens that detect a foreign entity are not present in this exclusive environment. The only backdrop of using amniotic membrane products is that the cost to cover one wound can be incredibly high. They come in different sizes and the price can range from $400 to $4,000 easily. However, its applications extend beyond aiding people with diabetes. It can help those with burns or diseases such as Epidermolysis Bullosa, a painful genetic disorder in which the skin surface peels away.

Frost & Sullivan has awarded Carestream Health its 2016 North America Frost & Sullivan Award for New Product Innovation Leadership for innovation focused on value-based imaging that solves real-life problems and addresses unmet customer needs.By empowering numerous new points-of-care and specialties with advanced, easy-to-use and cost effective imaging modalities, Carestream is expanding its value proposition well beyond the centralized imaging departments, through its best-of-breed imaging and informatics solutions, to areas such as orthopedics, intensive care, emergency department, intra-operative and bedside imaging.The award focuses on all aspects of the company’s digital medical imaging portfolio which includes new fluoroscopy and ultrasound systems; new cone-beam CT technology; and a vendor neutral enterprise imaging Clinical Collaboration Platform.“A result of Carestream’s commitment to innovation is its latest flagship digital radiography (DR) product, developed using proven, in-house detector technology,” said Frost & Sullivan Industry Principal Nadim Michel Daher. “This next-generation product builds off of its predecessor, the first-of-its-kind ‘DR retrofit’ offerings. It supports a higher level of workflow productivity, dose efficiency and image quality, without requiring heavy investments.”Carestream is set to replicate the success of its DR systems in the fluoroscopy department with the launch of the DRX-Excel Plus, its multi-purpose fluoroscopy/radiography equipment. This device was developed in response to the relative lack of product and technology innovation in this specialty area. It presents healthcare providers with considerable savings by enabling them to share flat-panel detectors among multiple radiography and fluoroscopy rooms and systems. Similarly, Carestream’s recent entry into ultrasound modality is a perfect example of the design philosophy at the company. The Touch Prime and Touch Prime XE premium ultrasound imaging systems underline Carestream’s focus on performance and usability across its product lines. Carestream was able to optimize features based on the actual needs of ultrasound professionals. The all-touch control panel, which is extremely easy to clean and offers tactile feedback on home keys so that operators can stay focused on the patient, is garnering praise from the marketplace. The user interface also can be customized to the preferences of the sonographer.

Amniotic Membrane can be the New Wound Healing Technique

Frost & Sullivan Spotlights Carestream’s Innovation and Continued Success in North American Medical Imaging Market

Company focuses on innovation to elevate value of diagnostic imaging that helps facilities enhance

patient care and clinical collaboration


DOCTORSPEAK

IntroductionZika virus is an emerging mosquito born virus that was named from Zika forest of Uganda, where the virus was first isolated in the year of 1947. It is customary to name such uncommon virus along the area where they are found such as Ebola was identified in a village near river Ebola.World Health Organisation (WHO) has taken notice of Zika virus because cases were reported outside African continent through travelers for the first time in Switzerland, Sweden, USSR, possibly in United States of America. Brazil was worst hit as around four thousand children who were born with microcephaly out of mothers who suffered from Zika virus during pregnancy. Since this virus otherwise do not produce fatal illness like Swine flu, Bird Flu, Ebola and other virus illnesses so scare of this viral disease is not much as it is self-limiting and till date no treatment is available but what is important to note is if the pregnant lady specially till fourth month of pregnancy catch this infection is result in disabling conditions which effects the new born there bran and their head size named accordingly as Microcephaly which is a

rare neurological condition in which an infant's head is significantly smaller than the heads of other children of the same age and sex. It is a life crippling state of child. So it signifies that it should be dealt with very stringent manner so that new born do not suffer and therefore WHO rightly raised an alarm. There was another reason like Ebola why WHO declared it as public health emergency of International concern (PHEIC) on 1st February, 2016. because countries affected by the virus do not have sufficient resources to combat it hence resource mobilization and contribution towards research and to fight this menace needs finances. Hon’ble Union Health minister Shri J P Nadda, Secretary Department of Health and Family Welfare Shri B P Sharma and Dr Jagdish Prasad, Director General of Health Services Union Health Ministry have taken adequate measures and issued guidelines on the Zika virus disease in the light of the current disease trend, and its possible association with adverse pregnancy outcomes to prevent a public outbreak and for the thorough preparedness.A review of vaccine and trials are underway.Brazil which was affected by the Zika virus tried to dodge the virus fear with the celebrations for Rio-de-Janeiro carnival as the annual mega-bash famed for lavish and traditional samba parades and all night dancing could not come at a better time for enhancing the morale of citizens of this country but with full awareness and vigil.Symptoms: The most common symptoms of Zika are fever, maculopapular rash, joint pain, malaise or conjunctivitis .Other common symptoms include muscle pain and headache. The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. The illness is usually mild with symptoms lasting for several days to a week. People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika.

Public health emergency of International ConcernZIKA VIrus

Diagnosis:Physician may order specialized blood tests to look for Zika or other similar viruses like dengue or chikungunya. If you have recently traveled, tell your physician when and where you travelled so that he is aware of your travel history completely.Treatment: Treat the patient symptomatically : Drink plenty of fluids to prevent

dehydration of the patient. Be particularly vigilant for the 2 hours

after sunrise and the 2 hours before sunset. Take adequate rest. Can take medicine such as acetaminophen

to relieve fever and pain. Do not take aspirin and other non-steroidal

anti-inflammatory drugs until Dengue can be ruled out.

Consult and report to the physician as and when required.

Prevention:We can prevent Zika by avoiding mosquito bites because Mosquitoes that spread Zika virus bite mostly during the daytime.Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites Wear long-sleeved shirts and long pants. Use Environmental Protection Agency

(EPA)-registered insect repellents only. Do not use insect repellent on babies

younger than 2 months of age. Do not apply insect repellent onto a

child’s hands, eyes, mouth, and cut or irritated skin. You can rather apply on the margins of cot, Dr M. Wali suggests.

If you use both sunscreen and insect repellent, apply the sunscreen first and then the repellent.

Currently in our country National center for Disease Control (NCDC), Delhi and National Institute of Virology (NIV), Pune have the capacity to provide live diagnosis on Zika in acute feverish stage as these institution have been marked as the apex laboratories to support the outbreak investigations and confirmation of lab diagnosis

Dr. M. waliPadma awardee

Consultant Physician to Hon’ble President of indianorth avenue, new Delhi

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