frontier lifeline hospital honoring the women of the world, frontier lifeline hospital and frontier...

Dr. K.M. Cherian's

FRONTIER LIFELINE HOSPITAL(A Unit of FRONTIER LIFELINE PVT. LTD.)

VOL.NO.17 ISSUE NO.12 NEWS OF THE QUARTER APRIL 2015

Frontier Pulse April 2015

FROM THE CHAIRMAN’S DESK

Dear Friends,

“Make in India & Made for India”

The Hon’ble Prime Minister of our country has been visiting advanced

nations to get support for his campaign of “Make in India”. During all his

visits, he emphasized the need for large scale investments in India from

the advanced economies but at the same time called upon the NRI’s to

support his campaign by investing money and transfer of technology.

The manufacturing industry contributes to about 16-17% of India’s GDP;

the “Make in India” campaign aims to increase this to about 25% by

2022. The current contribution of medical devices is less than half a percent of the total

manufacturing output, which, with the present campaign, should increase significantly by 2022.

There are 25 segments identified for the “Make in India” campaign to bring India to the global

manufacturing map. Pharma and Healthcare are among these 25 segments. In fact, the medical

device sector has been identified by the government task force as one of the five key sectors which

can be a driver for the “Make in India” campaign.

We, on our part, have started India’s First Basic Medical Science Park, “The Mediville”. This is an area

which is quite new to the industry, finance, bureaucracy and other fields. The gestation period taken

to make a “Basic Medical Science Park” with research is very long and the few people who ventured

into it all have failed. There has been no cooperation from the banks and the financial institutions.

They need quick money which is not possible in this field. Bureaucracy is also unfortunately not very

conducive to your needs. We have the first medical SEZ in the country. Contrary to the expected

single window clearance, in our experience we had to cross many windows. Obviously, the delay

causes loss of production and all the other infrastructure such as water, electricity, etc are a big

stumbling block for progress.

Culturally, we are not a risk taking nation. The few who take risks and have succeeded have done

exceedingly well. The others who have failed have never been able to recover . We pray to the

Almighty that our attempt in materializing our dream of the first SEZ in Basic Medical Sciences and

research will succeed so that we can also help the nation to “Make in India” campaign successful.

Jai Hind !!!

1

Dr. K.M. Cherian, MS, FRACS, DSc[Hon], DSc[HC], DSc Chairman & CEO

MS, FRACS, DSc[Hon], DSc[HC], DSc


NEW IMPLANTABLE DEVICE TO PERMANENTLY TREAT HYPERTENSION SUCCESSFULLY

TESTED AT FRONTIER LIFELINE HOSPITAL

Dr Ajeet Arulkumar

thOn 20 March 2015, for the first time in the world, an external aortic counter pulsation device was

implanted and evaluated in humans at Frontier Lifeline Hospital. Preliminary results of the study showed

very promising results in increasing coronary flow and reducing blood pressure. This breakthrough study

was a result of collaboration between Frontier Lifeline Hospital and the Australian Government.

The innovative device named the Bio Q CA device, was developed by Dr Peter Walsh from Australia. The

device itself is very simple and consists of an inflatable and complaint

balloon which when implanted wraps around the ascending aorta and

augments the “wind kessel” effect of the aorta. The device would be useful

in hypertensive heart failure by directly treating aortic stiffness (increasing

aortic distensibility; increasing expansion and contraction).The device is

minimally invasive, non-blood contacting, failure mode safe, and requires

no pump, leads, or ECG timing, and would be a cost effective approach.

After extensive and successful animal studies, it was decided to proceed

with first in humans study. After Ethical committee clearance and informed

consent, 2 hypertensive patients were identified who were awaiting

coronary artery bypass surgery.

The BioQ device was implanted after exposing the aorta and before the

initiation of bypass. The implantation of the device itself took less than 5

minutes. All physiological parameters including cardiac output, heart rate,

LVEF, valve regurgitation and aortic stiffness were measured continuously for 20 minutes during which the

device was in place. Specially designed high frequency probes were also used to accurately measure

coronary artery flow. The device was then removed and the CABG surgery proceeded as before.

Analysis of the data revealed that in both patients, the coronary flow increased significantly when the device

was in place. There was also a small drop in both systolic and diastolic. Heart rate, cardiac output, pulmonary

artery systolic and wedge pressure remained unchanged. Both the patients recovered well after the bypass thand were discharged on the 7 postoperative day.

While the initial results of the device are very optimistic, further evaluation with more number of patients is

definitely required. Whether the device would meet its intended goal of being a cost effective and

permanent way to benefit hypertensive heart failure patients can be ascertained only after a larger

randomized trial.

During the subsequent press meet, the Australian team was grateful to Dr. K M Cherian and his team for

performing this land breaking trial. As a successful outcome of this study, further collaboration between

Australia and Frontier Lifeline Hospital is being planned.

Cardiologist, FLL

2

SCIENTIFIC UPDATE

The BioQ CA device

Frontier Pulse April 2015 3

th26 January 2015

Dr R aghavan Subramanyan, S enior Consultant – Cardiologist at Frontier Lifeline, hoisted the National flag at FLL premises to

thcommemorate the 66 Republic Day of India, this day being celebrated to honour the Constitution of India which came into force on the same day in the year 1950.

st31 January 2015

Dr K M Cherian was invited as the Guest of Honor for the inauguration of “Mahatma Gandhi University of Medical Science Multi Specialty Hospital” at Jaipur where the Chief Guest for the function was Hon'ble Chief Minister of Rajasthan, Smt Vasundhara Raje Scindia Ji.

nd2 February 2015

Frontier Lifeline (FLL) has signed an MoU with Mahatma Gandhi University of Medical Sciences and Technology (MGUMST), Jaipur to extend its assistance in terms of Heart & Lung Transplantation Programme in MGUMST cardiac centre. Dr A K Sharma, Registrar, MGUMST & Dr K M Cherian, Chairman,

CEO, FLL exchanged the MoU on behalf of their respective institutions.

rd3 February 215

Bidding Good-Bye to His Excellency, Mr. Masanori Nakano, Consul General of Japan and Mrs. Keiko Nakano at the Farewell reception hosted by the Indo-Japan Chamber of Commerce.

Republic Day Celebration @ Frontier Lifeline!

Inauguration of Mahatma Gandhi University (MGUMST), Jaipur

MOU with MGUMST

Farewell to Japanese Consul General

EVENTS OF THE QUARTER

Dr K M Cherian during the inauguration of MGUMST-flanked by Hon'ble CM of Rajasthan,

Smt Vasundhara Raje Scindia (left) & Dr Swarankar (right)

Dr K M Cherian & Mrs Sandhya Cherian with H.E. Mr. Masanori Nakano, Consul General of Japan

Dr Subramanyan addressingthe gathering after hoisting

the National Flag


th17 February 2015

A n M O U w a s s i g n e d b e t we e n Lithuanian University of Health Sciences and Frontier Lifeline in February, 2015, in the presence of the Lithuanian Honorary Consul General, Mr. Kiron Shah.The purpose of the MOU was to develop Nursing and Medical Undergraduate and Post Graduate e d u c a t i o n , t o p a r t i c i p a t e i n comparative Research studies, and foster mutual collaboration between the two Institutions.

th20 February 2015

The Pediatric Cardiac Surgical Centre atSri Sathya Sai Sanjeevani Hospital was inaugurated by Dr Raman Singh, Chief Minister of Chattisgarh in the presence of Dr M S Valiathan & Dr K M Cherian. Sri Sathya Sai Sanjeevani Hospital were kind enough to honour the tireless efforts of two pioneers

and living legends, Prof M S Valiathan & Dr K M Cherian for their outstanding contributions in Pediatric Cardiac Surgery by inaugurating twin operating rooms in their names “MS Va l i a t h a n Pe d i a t r i c C a r d i a c Operating Room & “KM Cherian Pediatric Cardiac Operating Room” solely by the legends. The Hospital has dedicated the Operating Rooms named after them to the service of children in need of life saving heart surgery.

Frontier Lifeline signs MoU with Lithuanian University !

Inauguration of Sathya Sai Sanjeevani Hospital, Raipur

Mr Kiron Shah flanked by Dr K M Cherian &Ms Jurate after inking MoU with Lithuanian University

Dr Raman Singh, Dr K M Cherian, Dr Krishna Manohar@ Sri Sathya Sai Sanjeevani Hospital


th8 March 2015

In honoring the Women of the World, Frontier Lifeline Hospital and Frontier Mediville organized a unique Heart Health Conference today at Frontier Mediville, Elavur. The Chief Guest Mrs. Letika Saran, Former DGP of Tamil Nadu inaugurated the occasion. Dr. Swaran Singh, IAS along withDr K M Cherian, CEO and Chairman - Frontier Lifeline Hospital and other dignitaries were also present.

The conference begun with a walk around Noah's Ark – Asia's largest pathology museum. Mrs.Letika Saran, Former DGP of Tamil Nadu inaugurated the conference and spoke on the need for awareness in women about the heart disease and supreme importance of regular exercise and good habits. Ms.Reena Raju, a recipient of Heart Transplantation from Frontier Lifeline about 6 years ago spoke on her life experience before and after the procedure.

The Key note speakers for the conference comprised of Mrs. Alarmel Valli - renowned Bharata Natiyam dancer who shared about “Dance with your heart”, Dr Sowmya Ramanan - Cardiac surgeon, FLL discussed about Cardiovascular disease (CAD) in women”, Dr Harapriya- Cardiologist, FLL enlightened on “Stress and CAD” & Dr. Sylvia Almeida - Pediatric cardiology, FLL discussed about nutrition in Diabetic women.

This one day conference, exclusively was conducted more importantly to analyze, interpret and draw conclusions especially for the sake of Career Women who neglect heart health. The event came to an end with “Heart Healthy High Tea”.

International Women's Day (IWD) 2015 – Theme – MAKE IT HAPPEN J

Dr K M Cherian presenting momento to theChief Guest Ms Letika Saran (Former DGP)

Ms.Reena Raju (record holder in Limca Book)presenting a copy of the Book to Dr K M Cherian

Key Speakers at IWD-2015


Launch of C-R-Y Clinic !

GRADUATION DAY CEREMONY @ FRONTIER MEDIVILLE !

The same day, FLL launched India's first Cardiovascular Risk in Young (C-R-Y) Clinic which was inaugurated by Dr. Swaran Singh, IAS. The C-R-Y Clinic will provide evaluation and treatment for people at risk and the families due to genetic pre disposition.

Soon after the launch, Dr. R. Rajaram Anantharaman, Sr Consultant Cardiologist – Frontier Lifeline Hospital shed a light on C-R-Y- Clinic that, “Screening for family members also can be done with diagnostic test such as ECG or Echo etc for specific genetic change in a family. At the moment, no family screening is set up in our country and C-R-Y clinic at FLL will be the first one to offer genetic screening as well as genetic consulting where the cause may be genetically inherited. These families are seen as a priority. Patients diagnosed with potentially inherited heart diseases, such as cardiomyopathies (heart muscle diseases), rhythm disorders, etc. are also seen “

Frontier Lifeline is also aiming to launch advanced heart failure and transplant assessment clinic to assist and provide treatment for patients suffering from advanced heart failure that requires treatment like special pacemakers like CRTD, VAD, Cardiac transplant and milirinone therapy.

Frontier Mediville offers many unique Para-Medical Undergraduate and Graduate Courses that are not available anywhere else in the Country. These Under graduate programs in Basic Sciences, Allied Health Sciences and Nursing provide plenty of opportunities to students who want to follow the Medical stream. It also conducts a Diploma program in Stem Cell and Tissue Engineering affiliated to The University of Madras. The Research wing is recognized by The University of Madras, The Pondicherry University and The Tamilnadu Dr MGR Medical University for conducting various research leading to PhD degrees in several disciplines like Biotechnology, Biochemistry, Pharmacology and Toxicology.

Regular Workshops, Symposia and Trainings that are being conducted at Frontier Mediville in the areas of Genetics, Stem cell technology, Tissue engineering, Biostatistics, Biochemistry, Molecular biology, Cell culture, Nanotechnology, and Techniques in Toxicology sets it apart from other Colleges in the area of Life sciences.

State-of-the-Art class rooms, Simulation centers, Auditorium and Library are impeccable and can be compared to the very best in the world. Well equipped labs are available where students can obtain hands- on- training in Stem Cells, Genetics and Tissue Engineering. Frontier Mediville has gained reputation not only among the students from Chennai and other districts of Tamilnadu, but also other states of our country.

Dr Swaran Singh IAS, launching the C-R-Y Clinic together withDr Anantharaman & Dr K M Cherian


Dr .K.M.Cherian being a visionary had started unique programs for students who wanted to do Medicine but could not, due to various reasons. Physician Assistant program started by him nearly three decades ago has become so popular that many Universities and Hospitals across the country are running this program now. Similarly, the Cardiac Care Technologists and Perfusion Technologists have carved a niche for themselves in the field of Cardiovascular Medicine.

There has always been an emphasis on hands on training where the students are rotated in all departments of hospital. The graduates of these programs are confident to work in any field of medicine that they would like to.

The “ Graduation Day “of the 2010 and 2011 batches of Students of The Tamil Nadu Dr. M. G. R. Medical U n i v e r s i t y , C h e n n a i B.Sc.Physician Assistants viz Ms.Aarthi K, Ms. Monisha K, Ms. Rabiya Sulthana A,Mr.Rakesh J and Cardiac care Technology Graduates viz Mr.Avinash R ,Mr.Prashanth G, Ms. Preethy Sunny, Mr.Senthil Kumar S and Ms .Surya Nancy S as well as Physician Assistant graduates of Birla Institute of Technology and Science, Pilani viz Ms. Ann Rose Alapatt, Ms. P.Aruna, Ms. Adlin Emilya John, Ms. M.M. Vinitha and

Ms. Ruby Edison was celebrated with great fervor on 08.03.2015 at Frontier Mediville which was witnessed by their proud parents and the faculty of both Universities.

The ceremony was organised by Ms.Farida Farzana, PA Program Coordinator. It was a momentous occasion for all the students who received their degree certificates from Chairman and CEO, Dr.K.M.Cherian.

It was very encouraging to note that all the students who had graduated from each of the Allied Health Courses were already employed at various Hospitals across the country!!

th9 March 2015

In another significant achievement, Hindustan University inked an MoU with Frontier Lifeline Hospital. This was signed by Mrs.Sandhya Cherian, Director, Frontier Lifeline Hospital and Mr. Ashok Verghese, Director, Hindustan University. This MoU facilitates to bridge the gap between Academic and Industrial

MoU signed between Hindustan University & Frontier Lifeline Hospital (FLLH)

Graduation Day Ceremony of The 2010 & 2011 batch of graduates


requirements. B. Sc. courses in Anesthesia Technology, Cardiovascular Technology and Perfusion Technology will be offered jointly. The duration of each program will be 3 years. Frontier Lifeline Hospital, being a front runner in treating end stage heart disease, would contribute its expertise by lending it's vast infra-structure

facilities and exposing the students to the latest emerging modes of therapies including Nuclear Medicine, ECMO, Electrophysiology and Stem cell therapy. All students would get hands-on practical training and exposure to real-time environment at Frontier Lifeline Hospital. This unique program helps students become employable in Healthcare industry by exposing them to the latest trends and practices of the industry. The MoU also facilitates participation in Joint Research Projects.

th18 March 2015

Mr.Bhavani Shankar who underwent historic double heart transplant along with Mr Sanjay (in one night) at Frontier Lifeline Hospital operated by Dr K M Cherian in the year 2009 recently got married to Ms.Thara. Dr K M Cherian attended the wedding reception and wished the couple a long life filled

with joy, happiness and lots of love.

th24 March 2015

Frontier Lifeline Hospital (FLLH), India and University of New South Wales (UNSW), Australia are collaborating on exploring new medical technology opportunities that can improve the lives of India's poor and marginalized communities. One such project is exploring the potential to develop a new low cost cardiac device being developed by a team of scientists led by the UNSW's Associate Professor Craig McLachan. The exploration of new cardiac technology projects has gained the support from the Australian Government.

Wedding Reception

MOU signing with University of New South Wales (UNSW)

Ms.Sandhya Cherian, Director, FLL & Mr Ashok Verghese,Director, Hindustan University exchanging the MoU @ FLL

Dr K M Cherian during the wedding reception ofBhavani Shankar & Thara

H.E.Sean Kelly, Australian Consul General & Dr K M Cherian after MoU exchange


th28 March 2015

The graduation ceremony of 2009 batch of GSL Medical College & General Hospital, Rajahmundry, thAndhra Pradesh took place on 28 March 2015. Dr K M Cherian was invited as the Chief Guest for the

Convocation Ceremony and gave away the certificates to all graduates wishing them a bright future.

st31 March 2015

The Rotary Club of Madras invited Dr K M Cherian to deliver a talk on “Make in India – Our Medical Initiative” set up at Frontier Mediville. Dr Cherian went on to talk of successful heart transplants he had done, and described the first Research & Training Centre in Basic Medical Sciences & Bio Hospital, the first in Asia & one of just 18 in the world. The Frontier

Mediville Biomedical Science Park is coming up and have recently ventured into a project to create the first bio prosthetic valve project in Asia. Only TTK is doing this at the moment, at a cost of Rs 20,000 per valve. The imported valve costs Rs 50,000.

With the help of G eorgia Tech's Cardiovascular Fluid Mechanics Lab, Dr.Cherian and his team believe they can manufacture heart valves in Mediville for

much affordable rates. If Dr. Cherian is successful in this venture, the Bio hospital will be the first in the country to contribute to “Make in India- Medical Initiative”.

“May there be many like Dr.Cherian who come back and make this nation soar”

GSL Medical College – CONVOCATION 2015

Rotary Meet – Taj Connemara

Dr K M Cherian handing over degree certificates to the graduates of GSL medical college.


AWARDS & ACHIEVEMENTS

A cash prize of Rs.5000/- each was awarded to the best outgoing students. The medals and the cash prize were sponsored by Ms.Padmaja, Chief Scientific Officer - Microbiology department, in memory of her Mother Smt.P.Prameela Devi.

Pursuing Cardio thoracic surgery has been a childhood dream of mine and I completed my MS and MCH at Medical College, Calicut after my MBBS at Medical College, Trivandrum. Despite a large incidence of cardiac ailments in India, surgical cure is limited by the financial ability of the patient to fund treatment, in the absence of universal healthcare and insurance cover. In such a scenario, standard treatment protocols become irrelevant and there is an urgent need for research and technology aimed at the bottom of the pyramid. I feel any success in this regard would have far reaching implications for cardiac care in South Asia and Africa, both regions where in a large section of the population has still not risen beyond poverty. This thought motivated my decision to join Dr.K.M.Cherian Heart Foundation in Chennai India, the only private institution in India pursuing cardiovascular research. Dr Cherian has been a pioneer of cardiac surgery in India since performing India’s first successful Coronary Artery Bypass Surgery in 1975. He also performed the country’s first heart transplant after legalization of brain death, the first Heart- Lung Transplant, the first Paediatric Transplant and the first TMR (Laser Heart Surgery). During my tenure at Dr.K.M.Cherian hospital, along with clinical training; I was privileged to be associated in a small way with India’s first ever science park Frontier Mediville where in I was exposed to the ongoing scientific research into stem cell implants. Frontier Lifeline Hospital has pioneered the use of animal’s heart valves for

STAFF CORNER

My Experience as a Francis Fontan Fellow

Dr.Alarmel valli, renowned Bharatanatyam dancer, presented the medal for the best outgoing student of Birla Institute of Technologyand Science, Pilani to Ms. Ann Rose Alapatt.

Ms.Letika Saran, Former DGP of Tamil Nadu,presented the medal for the best outgoingstudent of The Tamil Nadu Dr. M. G. R. MedicalUniversity to Mr.Prashanth G.


replacement, when repair or replacement of the diseased heart valves of these patients is not possible. Our Homograft bank is the oldest in India and our Xenograft bank the only one in India has been functioning since 2002. Several hundreds of patients have benefited from this facility available at Frontier Lifeline Hospital.

I was pleasantly surprised when I was awarded the esteemed Francis Fontan Prize from European Association for Cardio Thoracic Surgery (EACTS) on October, 2013 for continuing my work on Pulmonary Valve Replacement. It was a dream come true to be on the same stage and to receive an award from Prof. Francis Fontan himself during the EACTS annual conference in Vienna. However, the reality of being awarded a prestigious fellowship and an award in the name of one of the greatest cardiac surgeons ever in history of cardiac surgery comes with a lot of responsibility. The aim of my application was to get an opportunity to study the use of RVOT conduits and also management strategies in Tetralogy of Fallot. I chose to split my fellowship year between Medical school of Hannover (MHH) and Centre Hospitalier Universitaire Bordeaux (CHU Bordeaux).I joined the Department of Angeborne Herzfehler at MHH, headed by Dr. Axel Haverich.

I began working with Dr.Alexander Horke in October 2013 at the congenital heart surgery department of MHH. As is well known MHH is currently working on use of decellularised homograft conduits in pulmonary and aortic positions. My personal experience at Frontier Lifeline Hospital, India with the decellularised xenograft tissue was the reason for my interest in the work being done at Hannover. At MHH, I was immediately received with great warmth and friendliness and made a part of the Paediatric Cardiac Surgical team. One of the highlights of the fellowship has been the chance to work in animal labs and performing animal experiments with my colleagues. At MHH, I had the opportunity to try possible techniques of reconstruction and creation of neo-leaflets in bicuspid pulmonary valves in Tetralogy of Fallot in explanted bovine hearts, which was in continuation of the work I was involved with in India.

Subsequently, I had the opportunity to visit the Congenital Cardiac Surgery departments of University Hospital Zurich headed by Dr.Michael Hubler and also spend a month working with the unit headed by Dr. Emre Belli in Center Chirurgical Marie Lannelongue at Paris. Interaction with both these teams was

Dr Sowmya Ramanan with MHH & CHU faculty


interesting and informative, especially with regard to the use of other commercially available xenograft conduits such as the Contegra and Hancock. I was able to discuss the practical aspects of the implantation of these conduits, the reasons for the surgeons preferring these conduits and aspects which they feel are important in improving longevity of these conduits.

In April this year, I joined the cardiac surgery department at CHU Bordeaux headed by Dr.Xavier Roques, and I was able to work with Dr.Francois Roubertie in the Congenital Cardiac Surgical team. At CHU Bordeaux too I was able to get a good exposure to both clinical work and research activities. I was involved with Dr. Roubertie in creating piglet models of right ventricular dysfunction. These piglets were then followed up with MRI scans and to study cardiac function and then the hearts subjected to cellular extraction for cellular conduction studies after three months.

Training at MHH and CHU Bordeaux has given an opportunity to consolidate and put in perspective the data and experience that I have from working at various centres in India. A major obstacle to quality health care in our country is affordability. Visiting European centres has been an opportunity to analyse challenging clinical situations and make the best possible decisions for each patient sans financial considerations.

There is of course a personal side to the whole experience. One of the interesting and challenging aspects of the fellowship has been learning two languages, meeting new people, making new friends and learning several new things from them. To think about the physiology of complex congenital heart diseases during discussions in German and French is undeniably a hard task but not a totally impossible one.

As a woman, it has been an uphill task to pursue cardiac surgery in India and senior colleagues (especially Dr. K.M Cherian) and my family have been an unfailing source of support and encouragement. Most of all, I recognize the sacrifice made by my 6 year old daughter ,who has been staying away from me for the duration of this fellowship.

I express my gratitude to Professor Francis Fontan and the EACTS committee for having chosen me for this fellowship. To be awarded this fellowship has been a great personal encouragement for me. I hope to live up to the expectations placed on me by EACTS while selecting me for this fellowship and hope to continue work in this field until we can make a difference and enable children with congenital heart diseases to lead a better life.

Cardio Thoracic SurgeonFrontier Lifeline Hospital

Dr Sowmya Ramanan


BIRTHDAY BASH !

“Birthday celebrations are good times to celebrate life, friends, and family”th 26 February 2015

“Sharon & Shereen Birthday Celebrations...

th 8 March 2015His family has made his birthday all the more memorable...

Frontier Lifeline Family wishes Dr.K M Cherian & his Grand Daughters many more happy returns with lots of love, today and everyday !

HAPPY BIRTHDAY J

FRONTIER LIFELINE CAMPS

Date Location No. of PatientsScreened

24-12-2014

01-01-2015

24-01-2015

04-03-2015

07-03-2015

282

63

56

74

182

Anbu Hospital (Kumbakonam)

CMCHIS (Uthukottai - Thiruvallur Dist.)

CMCHIS (veerapuram - Thiruvallur Dist.)

L & T (Manappakkam - Chennai)

M.G.R. Adarsh - School (Mogappair)

... with their Appacha around"


DIGNITARIES SPEAK

Wonderful facility. We were very impressed. Thank you for your hospitality. Dr Cherian, you have done an amazing job for your country.

Boston Children’s HospitalUSA

-Christopher Baird

B i o r e s o u r c e w e a l t h i s tremendous. Excellent museum on par with Western countries. Good luck and Good wishes for a wonderful future to serve local, regional & natural communities.

Univ of Madras

- Ramaniban ,

Amazing work. Only can be described as next to God Himself

CSIR, New Delhi-Sridhar Sivasubbu

PATIENT TESTIMONIALAccolades From Patients – January / March 2015

I am very much grateful for the hospitality and kindness showed on me by the director of this prestigious institution and also Dr. Anantharaman who took utmost care and efficiency in taking CAG when some people in the medical field doubted angiography procedure at 81 years of age possible.

Mr. T. Arunagiri

K. Vevekanadan

I really thank all staff in the hospital. Each and everybody were very helpful and courteous. Our special thanks to Dr. Sanjay Cherian and Dr. Ajeeth Arul

Kumar. Very special thanks to surgery team and staff nurses especially in General ward. Thanks to security and ward boys.

Today if I am alive in the world today, it is because only this hospital saved my life. Doctors and other services are very very satisfactory.

A. Kulanthai

I am returning with full satisfaction. I came as a sick man and returning at least 20 years younger. I am highly thankful to Dr. Cherian and his team, especially Dr. Anand

and Dr. Sanjay for their personal touch.

Mr. K. Nagarajan

It is one of the best hospitals in Tamil Nadu for Cardiology treatment.Staff are very co operative entirely.

Mr. K. Venkata Raju


FRONTIER MEDIVILLE

WELCOME ABOARD J

Please welcome Dr. V Amritha, MVSc., as she joins the team at Frontier Mediville. She is a graduate of the TANUVAS. Both during her undergraduate and postgraduate studies she has been the recipient of the TANUVAS Merit Scholarships. During her academic career she has participated in several research projects and presented papers at scientific meetings. She has completed an externship in small and large animal surgical techniques at the Virginia-Maryland University in the United States. She was awarded the Young Surgeon Award in 2014 by Indian Society for Veterinary Surgery. She was a teaching assistant at the College of Veterinary Sciences, Sri Venkateshwara Veterinary University, Tirupati for a period of 6 months. She will be a valuable asset in expanding our animal husbandry division both for farm and experimental animals.

The Frontier Mediville Medical Science Park is situated on about 365 acres of environmentally friendly land, 45 miles from the metropolis of Chennai, South India. Its mission is to “enhance human health, lengthen life, and reduce the burdens of illness and disability.” To achieve this goal, scientists both mural and extramural through worldwide use animals in all areas of research, training, and biological testing. Animal research plays a crucial role to understand diseases and in the development of effective medical treatments. The testing is done following CPCSEA [Committee for the Purpose of Control and Supervision of Experiments on Animals, Govt of India] guidelines and under constant scrutiny by the Institutional Review Board.

Commonly used in biomedical research as “models” for human disease, animals are also used in basic biomedical research (research for general understanding); behavioral research such as psychology and addiction studies; military, space, and agricultural research; product development and drug testing; and science education. Historically, the concept of “animal models” of human health problems was formulated in response to concerns about infectious diseases. The basic assumption was that if animals used in laboratories experimentally contracted an infection and were cured, there was a high probability of stopping the same disease in humans. As originally conceived, to be a valid model of human health concerns, the animal disease must have the same biological mechanisms, symptoms, and responses to treatment as the theoretically similar human counterpart. In turn, failure to meet one or more of these criteria invalidates the animal model - we see this occur again and again in all areas of disease research.

Research animals provide scientists with complex living systems consisting of cells, tissues and organs. Animal models can interact and react to stimuli, giving researchers a picture of a compound moving through a living system and an idea of how those stimuli might react in a human being. Animals are biologically similar to humans in many ways and they are vulnerable to over 200 of the same health problems. This makes them an effective model for researchers to study.

In an attempt to overcome the limitations of animal models, researchers are genetically engineering

Animals in Research and Testing at Frontier Mediville Medical Science Park

Dr V Amritha, Veterinary Surgeon,

Frontier Mediville


animals, by removing or adding genes they believe relate to specific human diseases. The underlying assumption here is that these new genetically constructed animals will be more human-like. This technology is commonly used in mice and rats and the number of genetically altered (transgenic) animals being produced for research has grown exponentially over the past ten years. Scientists also breed these animals to produce offspring whom they hope will express the desired traits or will be more susceptible to the disease or disorder they are studying.

Before conducting research on animals, scientists make absolutely certain that they are needed for their experiments. For more than 50 years, scientists have relied on the “3Rs”: Refinement of tests so animal distress or pain is minimal, Reduction of the number of animals used in one particular study, and the Replacement, whenever possible, of animal experiments with non-animal experiments.

At Frontier Mediville scientists are also making significant breakthroughs in stem cell research and the use of Xenografts to replace diseased hearts. To date about more than 900 cases have been successfully treated at the sister institution, Frontier Lifeline Hospital and Dr. KM Cherian International Center for Cardiovascular Disease.

The Frontier Mediville animal facility is specially designed to house the animals used at the center. The animals are housed in a 15,000 sq feet facility capable of housing different species in both indoors and

out. The Quarantine section ensures that incoming animals are held in strict isolation. All animals are acquired from CPCSEA approved vendors. The facility is under the overall supervision of a Veterinarian. By training and employing local community members, Mediville has created a social program of economic development for these underprivileged communities.

At Frontier Mediville bioscience park, a desalination plant using Solar power provides lab grade water. Hence, renewable ecofriendly methods are used when and wherever possible.

As far as animals are concerned, the following animals are approved by the Government Animal regulatory body:

Large Animal Facility at Frontier Mediville Animal OT at Frontier Mediville


The Frontier Mediville animal facility is credentialed by approval, from CPCSEA, to breed and test on small animals and to test only on large animals.

Prof. of Allied Health Sciences, Frontier MedivilleDr George Jacob

Rat

Mice

Hamster

Guinea pig

Rabbits

Sheep

Pigs

Rattus sp [Wistar albino]

Mus musculus

Cricetinae sp

Cavia porcellus

New Zealand White Rabbits ( Oryctolagus cuniculus )

Madras Red breed; Ovis aries

Yorkshire

rd th23 – 25 March 2015

Frontier Mediville conducted three days hands on training program on “Real Time qPCR & Gene rd thExpression Analysis” from 23 to 25 March 2015. Dr. S. Senthil Kumar Ph.D., Senior Research Scientist was

the course coordinator. The workshop has been well received and provided hands on training in gene expression analysis of quantitative real time PCR. There were about 19 participants including post graduates and research scholar from various institutions viz., Meenakshi Medical College, Kanchipuram, Sree Balaji Dental College & Hospital, Prathyusha Institute of Technology and Management, University of Madras, K.S.Rangasamy College Of Technology, Ramachandra University, Vels University, Chennai, Veterinary college and Research Institute, Namakkal , JIPMER, Puduchery, Yogi Vemana University, Kadappa, and IRT-Perundurai Medical college, Perundurai. The workshop has ended on a high note with a good feedback from the participants. The participants were very much interested to have future relationship with Mediville for their research work.

Workshop on “Real Time qPCR & Gene Expression Analysis

Dr S Kumar, HOD, R & D, handing over thecertificate to one of the participants

Frontier Mediville Faculty with theparticipants who attended the workshop


Paper Presentation / Conferences / Workshop attended th th24 – 25 January 2015

Mr.Anand Duraiswamy, Ph D student, at Frontier Mediville (affiliated under University of Madras) under the guideship of Dr. Sheela has presented a paper for the International Conference on Bioscience, Biochemistry and Bioinformatics ( ICBBB - 2015) held at Taipei, Taiwan on January 24th and 25th, 2015.

th th4 -6 February 2015

vAn oral presentation on “Biomedical Evaluation of Chitosan-Gelatin Transdermal Patch Embedded With Bio-Silver Nanoparticles as A Wound Dressing Material:-An in vitro study” was presented by Sneha Paul, Changam Sheela Sasikumar and Sanjay M Cherian at the International conference on Nanoscience and nanotechnology conducted by SRM university in association with Shizuoka University, Japan, Institute of Geological and Nuclear Sciences, New Zealand.

th th26 & 27 February 2015

vThe Abstract – “Morinda citrifolia L. Rubiaceae -an energy supplement: Elucidate an increased resistance to oxidative damage via defending human blood components (An in-vitro study)” was presented by Sridevi Nagalingam, Changam Sheela Sasikumar and Cherian K M. & has won Third Prize at the National Symposium on “Recent advances in Biomedical technology – RABT 2015” which was organized by Department of Biotechnology, Thiruvalluvar University, Vellore.

vSneha Paul, Dr. Chengam Sheela Sasikumar, Dillip kumar Bishi, Anita RJ Singh, Sanjay M Cherian Kotturatha Mammen Cherian won the Best paper award for their presentation on, “Antimicrobial Activity of Cotton Fabric Incorporated with Silver Nanoparticles synthesized from Ganoderma lucidum (Mushroom)” at the “International conference on nanomaterials: Science, Technology And Application” conducted by B.S Abdur Rahman University, University of Minnesto and University of Maria.

vDr. C. Sheela Sasikumar delivered a talk on Herbal Medicine, a potential source of treatment for Diabetes mellitus (DM)-International Conference on Recent Discoveries of Diabetic Biomarkers and Challenges Ahead, ICMR, SERB and DST-2015.


vSneha Paul , G.Jayanthi ,C.Sheela Sasikumar, M.D. Bala Kumaran, D.J.Mukesh Kumar and P.T.

Kalaichelvan delivered a poster presentation on, “In vitro Anti-Inflammatory and Antimicrobial Activity of Bio-Silver Nanoparticles Extracted from Medicinal Mushroom” at the National conference on Algaelogy, Mycology and Plant pathology conducted by University of Madras.

Publications:

1. Duraiswamy A, Shanmugasundaram D, Changam Sheela Sasikumar ,Sanjay M Cherian and Cherian K M – “Development of an anti-diabetic formulation (ADJ6) and its inhibitory activity against alpha amylase and alpha glucosidase”, Journal of Traditional and Complementary Medicine (2015).

2. Sneha paul, Changam Sheela Sasikumar,Aiswaraya Jayan, Sanjay M Cherian and KM Cherian – “Extraction and purification of chitosan from chitin isolated from sea prawn (fenneropenaeus indicus)”, Asian journal pharmaceutical and clinical research ; Vol 7, issue 4 (September-October), pg 201-204, 2014.

3. Sneha paul, Changam Sheela Sasikumar, Anita RJ Singh – “An antioxidant and bioactive compound studies of Parmelia perlata, Ganoderma lucidum and Phellinus igniarius -supplimentory drug”, Asian journal pharmaceutical technology innovative; Vol 2, issue 7 (August-September), pg 13-22,2014.

4. Sneha paul,Changam Sheela Sasikumar, Anita RJ Singh – “Synthesis Of Silver Nanoparticles By The Green Reagents (Polyphenolic compounds)Prepared From Ganoderma Lucidum,Phellinus Igniarius and Parmelia Perlata” . International Journal of Pharmaceutical and chemical Sciences Volume 3, Issue 4, Oct-Dec 2014

5. Sneha Paul, Changam Sheela Sasikumar & Anita RJ Singh – “Preliminary Investigation of Synthesizing Silver Nanoparticles from the Different Biological Source: - A Modern Ecofriendly Tool”, International Journal for Pharmaceutical Research Scholars, 2015, 4(1), 135-148.

6. Sneha paul, Changam Sheela Sasikumar, Sanjay M Cherian and KM Cherian – “Biomedical Evaluation of Chitosan-Gelatin Transdermal Patch Embedded With Bio-Silver Nanoparticles as A Wound Dressing Material:-An in vitro study”, International Journal of Chem Tech Research ; Vol.7, No.2, pp 740-746,2015 .

7. Senthilkumar S, Anitha C, Vignesh S, Shanmugapriya R, and Cherian KM. – “Detection of biofilm formation and mecA gene from clinical isolates of Staphylococcus sp”., Advances in Medicine and Pharmacy; 2014.

8. Anitha C, Sujatha Kabilan, Rajnish KN,Santhosh Kumar A, Illaikiam Rasikan, Senthilkumar S, Vincent S, Gunasekaran P, Rajasekharan Sikhamani, Pushkala M, Padma Krishnan. 2014. “Molecular characterization of Pseudomonas sp isolated from lower respiratory tract infections”. BMC Infect. Dis. 14: P17.


ST GREGORIOS CARDIO VASCULAR CENTRE, PARUMALA

AN UPDATED REVIEW ON KAWASAKI DISEASE

Kawasaki disease is a systemic vasculitis that affects mainly young children under 5 years of age. Although over 45 years have passed since Dr Tomisaku Kawasaki first reported Kawasaki disease, its cause remains unclear. Possible infectious agents or other non infectious triggering agents may behind the Kawasaki disease. Super antigen from infectious agents also may trigger the immune complex vasculitis. Efforts to isolate the causative agents of KD should focus on the microbiology of aerosols. Recent studies by Dr. Jane C Burns et.al on environmental trigger opened up new light on causative agents and results suggest that the environmental trigger for KD could be wind-borne.

Analyses of genetic susceptibility to Kawasaki disease are contributing to the development of new treatments for Kawasaki disease. Macrophages and neutrophils which are activated by various inflammatory cytokines mediated by IL-17 that is produced by T-helper cells (Th17) involve in the vasculitis. Recent advances in gene analysis studies of Kawasaki disease were reviewed by Kei Takahashi and team (Table 1), contributing not only to prediction of disease susceptibility but also to improving our understanding of the pathogenesis of Kawasaki disease and development of new improved therapies. In addition, Th17/Treg imbalance may be an important factor causing disturbed immunological function. IL-17 induced by Th17 cells have proinflammatory properties and act on inflammatory cells, thereby inducing expression of cytokines and chemokines and resulting in tissue inflammation.

Table 1. Susceptibility genes for Kawasaki disease recently reported

Gene Mothods

ITPKC Linkage analysis

CASP3 Linkage analysis

BLK GWAS

CD40 GWAS

FCGR2A GWAS

TGFB2, TGFBR2, SMAD3 Association study

HLA GWAS

BLK ; B lymphoid kinase, CASP3; Caspase3, HLA; HUMAN leucocyte antigen, ITPKS; Inositol tri phos Kinase, TGF; Transforming Growth Factor, FCGR2A, low-affinity immunoglobulin gamma Fc region receptor II-a.

Coronary arteritis begins 6-8 days after the onset of KD and leads to inflammation of all layers of artery, begins as edematous dissociation of tunica media and infiltration of monocytes and lymphocytes. However, many neutrophils also were seen. Periarteritis further damage elastic lamina, SMC, leading to intense damage and dilate the artery. Inflammatory infiltration continues till 25th day of KD, then gradually decrease in number. Most often we may not give much attention towards KD myocarditis. Myocarditis is a well-recognized component of Kawasaki disease, with left ventricular dysfunction


occurring in more than half of the patients during the acute phase of the disease, and may be transient. In KD, myocarditis develops even earlier than Epicardial coronary arteritis; it peaks by disease day 10 and then disappears gradually after day 20. Inflammatory cell infiltration, consisting mainly of lobulated leucocytes and large mononuclear cells, was seen in the myocardial interstitium in all cases. It is well known that TNF-alpha is a key inflammatory cytokine that is initially produced by T lymphocytes, followed by a secondary TNF-alpha release from monocytes/macrophages. TNF-alpha mediates endothelial cell activation through increased expression of adhesion molecules and also upregulates expression of chemokines that are important in the orchestration of leukocyte–endothelial cell interactions. Hence role of Infliximab in treating KD is important.

Various studies on animal models on vasculitis induced by candida albicans cell wall, lactobacillus casei, serum albumin from horse serum in murine and swine models , mimicking almost all features of Kawasaki disease showed immune complex vasculitis may be involved in pathogenesis. Recent publication on rabbit model of arteritis displayed histopathological and ultrastructural features similar to those of KD. Breakage of the internal elastic lamina, a key factor in aneurysm formation. Therefore, weanling rabbits, and swine model may serve as an experimental model for IC vasculitis that mimics KD than murine model.

Kawasaki disease is diagnosed on the basis of characteristic clinical signs and symptoms. The principal symptoms of Kawasaki disease are a fever persisting for 5 days or longer, bilateral conjunctival injection, changes in the lips and oral cavity, polymorphous exanthema, changes in the peripheral extremities and acute nonpurulent cervical lymphadenopathy. At least five of those principal signs and symptoms should be present for a diagnosis of Kawasaki disease. Erethema around the BCG scar, perianal excoriation, ‘Beaus line’ on nail bed etc. will give additional confirmation on KD. IVIG resistance to initial IVIG dose is around 15-20%.

• Kawasaki patient rarely present with hypotension so called Kawasaki shock syndrome. And hyponatremia is a presenting symptom. Hence checking for electrolyte during acute phase is justifiable.

• Rarely papillary edema can develop. Hence Fundus exam also necessary to r/o papilledema

• Asymptomatic pyuria may be associated with co incidence of severe coronary artery lesion, so that we must overlook for the urinary pus cells as an add on confirmatory diagnosis of KD for the early treatment.

Dr Burns had observed important clues and some differences are noticed in clinical Presentation of KD in India as follows

• Higher proportion of patients are older patients (>5 years). In US & Japan, less than 5-years age group.

• Early Peeling in the acute phase of fever often within 10 days as opposed to desquamation occurring after 10-14 days in Japan and US


•

• Peeling and thrombocytosis can establish diagnosis of KD in India.

Recent review on pathogenesis again prompts us to investigate new drugs in KD. TNF-á is a pleiotropic inflammatory cytokine that has been strongly implicated in the development of aneurysm formation in patients with KD. Infliximab and Etanercept are examples of these TNF-á receptor antagonists. Etanercept, although a TNF-á antagonist, has different mechanisms to infliximab. Infliximab is a chimeric monoclonal immunoglobumin-G (IgG) antibody that targets transmembrane TNF-á. This damages the

15cells which express TNF-á, including cardiomyocytes. On the other hand, etanercept is a soluble fusion protein receptor that works more broadly on TNF (both TNF-á and lymphotoxin), and binds to only circulating TNF-á, thereby avoiding the adverse effect seen in infliximab. But we need more studies and both drugs plays important role as a pharmacological agents in recrudescent fever after first dose of IVIG or as a first line therapy. Markedly activated neutrophils or high plasma neutrophil elastase in patient with KD have been implicated in poor response to IVIG. Ulinastatin is a urinary tripsin inhibitor and has a property to inhibit neutrophil elastase. Treated with Ulinastatin as Initial treatment for KD, resulted in lower incidence of CAL in which 3% as opposed to 7% in control group. Methotrexate is a folic acid antagonist suppresses lymphocyte proliferation and has role in modulating cytokines especially IL-6 highly expressed in KD. INOSITOL TRIPHOSHATE 3-KINASE C act as a negative regulator of T-cell activation and activated T cells may play a pivotal role in pathogenesis of KD. Cyclosporin will suppress the activity of T cell.

Studies have demonstrated the pivotal role of Tumor Necrosis Factor (TNF)-a-mediated matrix metalloproteinase (MMP)-9 activity , in modulating key pathogenic stages of disease leading to coronary artery damage and also in the pathogenesis of elastin breakdown in a murine model of KD, Lactobacillus casei cell wall extract-induced coronary arteritis. Doxycycline inhibits T cell activation and TNF-a production in peripheral immune cell and also inhibits directly MMP-9 enzymatic activity derived from TNF-a-stimulated vascular smooth muscle cells. Therefore, doxycycline can mitigate TNF-a-induced MMP-9-mediated coronary elastin breakdown and improve coronary outcome. Antioxidants such as high dose of vitamin ACE has a greater role in mitigating coronary artery lesion as an add on drug therapy. Additional IVIG shows 71% response & 30% resistance. In such cases Steroid pulse therapy (Methyl Prednisolone) to resistant IVIG cases may give 100% response. Personally I feel that in all cases of IVIG resistant group, we should start multiple or in combo drug therapy in which steroid pulse therapy could be essential to prevent further damage of coronary arteries.

Thrombocytosis more frequently occur in Indian children

Dr Saji Philip, DCH, F. Card, Ph.D, FAHASecretary General

Kawasaki Disease Foundation of India, Kerala


PARUMALA CAMPS

Date Location No. of PatientsScreened

10-01-2015

14-02-2015

42

56

Maramon

Karunagappally

THE STUDY L'ECOLE INTERNATIONALE

KINDERGARTEN GRADUATION CEREMONYAN EVENING TO REMEMBER

Graduates walking the red carpet and standing confidently on stage is indeed a proud moment for any teacher or parent; especially, when it is the tiny tots graduating from Kindergarten to Primary school.

The Study believes in giving a befitting ceremonial appreciation to the kindergartners as they march forward on to the next big stage in their lives. And a witness would be surprised at the level of professionalism displayed by the graduates !

thThe 9 Kindergarten Graduation ceremony for the year 2014-15 started with a ceremonial, majestic march down the red carpet to the dais. A standing ovation was given to the newly minted graduates in appreciation of their completion of Early Childhood Education.

The Principal Mrs. Alice Kisku welcomed the dignitaries and the parents. The Kindergarten Coordinator Mrs.Jessy Joseph walked us through the paths walked by these tiny tots in the past two years. Allan Peters, the President of the graduating class spoke on behalf of the graduates. He shared his experiences and expressed his gratitude to all those who played a role in moulding them.

The Chief Guest for this august occasion was Mrs.Vidhya Ramkumar, Chairman of Pondicherry Women and Child Welfare Commission. She shared information regarding child abuse statistics and the role of

parents and teachers in safeguarding children from this crime.

It was a joy to have our Vice Chairman Dr.Sanjay Cherian and Mrs. Cherian in our midst. Dr.Sanjay Cherian addressed the gathering. He reminiscenced his own march through his school years and imparted some nuggets of wisdom to the tiny tots. This marked the end of the Kindergarten Graduation.

Kindergarten graduates all set toreceive their certificates

Kindergarten Graduation Ceremony


But the day was far from over ! The kindergartners had yet to showcase their cultural talents ! The budding performing artists of The Study had an aural treat for the audience in the form of instrumental music. Twinkle Twinkle, Mary had a little lamb and up, down March were a few tunes they played. Their talent was well appreciated by the audience.

The grand finale to the evening was the age old fairy tale ‘Snow White and the Seven Dwarfs’. The students of the senior kindergarten presented a feast to all our senses. The big realistic backdrops, the authentic and cute props, the colourful costumes and the set of three stages brought the fairy tale ear in our midst. The palace of the stepmother looked rich and scary, the dwarfs’ house was cute with tiny furniture and furnishings arranged there and the mine in the forest was rocky and dark. The background music and the pre-recorded dialogues in the voices of the kids added a touch of professionalism to the show.

But it was the little actors who stole our hearts and the show ! Their body language and facial movements were captivating and gave life to the characters they portrayed. The delicate flowers swayed in the gentle breeze, the sprightly animals ran around the forests and the merry dwarfs were the cynosure of all eyes ! The beautiful Snow White, the charming Prince and the little Evil Queen gave award worthy performances.

As the curtains were drawn in another exquisite production from The Study, the future opened to the possibilities of these young and talented artistes.

Principal The Study L’ecole Internationale

Ms. Alice Kisku

Snow White & the Seven Dwarfs

Rev.Dr.Andrew Selvarajan Chaplain - Cum Spiritual Advisor

Mrs. Shery Vicent

Always prayers have their own strength. In this hospital, healing is done not with surgery only but also with God's spirit. My son Antony already had 3 open

thheart surgery and one angioplasty. This was the 4 open heart surgery and doctor expected many complications this time. But GOD is the real healer. He did everything fine. Our son is good in health now. Thank you all.

FROM THE CHAPLAIN'S DESK

TESTIMONIAL

EDITORIAL BOARD

Ms. Priya Latha Kumar, Secretary to Dr KM Cherian

Dr. Usha Raghavan, Head – Quality & Accreditation

R 30 C Ambattur Industrial Estate Road, Mogappair, Chennai - 600 101, India.

frontierlifeline.comTel No.: +91-44-42017575, 26564224 / 6252, Fax No.: +91-44-26565150

email: drkmc@ , website: www.frontierlifeline.com

Dr. K.M. Cherian's

FRONTIER LIFELINE HOSPITAL

Surgeries - 222

Out-patients - 3925

Cath /

Intervention - 512

Medical Treatment - 183

Surgeries - 89

Out-patients - 6687

Medical Treatment - 183

Cath/Interventions - 813

PATIENTS FROM FOREIGN COUNTRIES - FEB 2004 TO MARCH 2015

FRONTIER LIFELINE JANUARY '15 - MARCH '15

PARUMALA JANURAY '15 - MARCH '15

INPATIENT DOMICILE DISTRIBUTION FEB 2004 TO MARCH 2015

Chennai City 21072 202 208 221

Other parts of TN 10269 61 58 65

Andaman & Nicobar 76 2

Andhra Pradesh 1039 11 11 3

Assam 40 2 1 1

Bihar 34 1

Chattisgarh 48

Delhi 41

Goa 18

Gujarat 646 2 5 4

Hariyana 8

Himachal pradesh 3

Jammu & Kashmir 9

Jharkand 46

Karnataka 151 1 1

Kerala 385

Kolkata 2

Madhya Pradesh 102 1 2

Maharastra 399 3 1

Manipur 2

Meghalaya 3

Nagaland 1

New Delhi 1

Orissa 56

Patna 1

Pondicherry 615 1 4 3

Pune 1

Punjab 14

Rajasthan 35

Tirupura 4

Uttar Pradesh 68

West Bengal 304 1

TOTAL 35493 285 287 304

Afghanistan 4

Albania 2

Austria 1

Australia 3

Bahrain 165 4 3 4

Bangladesh 84

Bhutan 2

Brunei 1

Cambodia 1

Canada 2

China 1

Congo 2

Dubai 8

Egypt 1

Ethiopia 5

Eritrea 1

Fiji 198

Guyana 80 1

Indonesia 2

Iraq 2269 9 11 4

Japan 2

Isreal 1

Kenya 116

Korea 2

Malaysia 21

Maldives 56

Mauritius 7 1

Muscut 20 2 1

Myanmar 17

Nauru 11

Nepal 6

Nigeria 27

Oman 76

Pakistan 21

Papua New Guinea 2

Rwanda 2

Saudi Arabia 2

Serbia 1

Singapore 7

Sri Lanka 141

south Africa 2

Somalia 1

Sudan 10

Switzerland 1

Tanzanya 32 1

Thailand 3

UAE 77

USA 12

Uganda 189

United Kingdom 4

Uzbegistan 1

Yemen 7

TOTAL 3706 13 16 12

March-15Jan-152004 to Dec 2014STATES OF INDIA Feb-15

March-15Jan-152004 to Dec 2014STATES OF INDIA Feb-15

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