Vol.

10 Issue 01 OCTOBER - DECEMBER 2024

THE DIAGNOSTICS NEWS JOURNAL Published at Agappe Diagnostics Limited on October 1st, 2024 | 62 Pages | ` 20

AGAPPE’S GROUND BREAKING

COLLABORATION WITH FUJIREBIO
Mr. Thomas John

PATHOLOGY
AN OVERVIEW
Prof. Dr. D. M. Vasudevan

CLINICAL PATHOLOGY IS THE CORNERSTONE

OF CANCER DIAGNOSIS AND TREATMENT
Prof. Dr. G. K. Rath

CODE OF ETHICS AND ITS RELEVANCE

IN LABORATORY MEDICINE
Prof. Dr. Sudip Kumar Datta

ELIMINATING CERVICAL CANCER

A GLOBAL STRATEGY AGAINST HPV
Prof. Dr. Sachin Kolte

THE ROLE OF HISTOPATHOLOGY IN

CANCER DIAGNOSIS AND TREATMENT
Dr. Harpreet Walia

CLINICAL PATHOLOGY
THE FIELD OF LABORATORY MEDICINE FOCUSES ON DIAGNOSING DISEASES THROUGH THE ANALYSIS OF BLOOD, TISSUES, AND BODILY FLUIDS.
AGAPPE Branding

First Make in India “CLEIA”

Immunoassay Technology Pioneering
with Novel “BIOMARKERS”

No Reagent Smaller
Wastage Pack Sizes
High
Performance No Carry Japanese
Assay with Over Technology
<5% CV

F ully Aut oma t e d Immunoa s s ay Analyz er Fully Automated Immunoassay An alyz er

Powered by Mono Cartdrige based CLEIA Technology Powered by Mono Cartdrige based CLEIA Technology

Top Notch Precision & Accuracy in Every Test

2 TECHAGAPPE OCTOBER-DECEMBER 2024

Biomarker Panel for
ALZHEIMER'S
DISEASE

β-Amyloid 1-42

β-Amyloid 1-40

Total Tau

Phosphorylated Tau - 181

ACHIEVE UNPRECEDENTED EFFICIENCY

by automating your entire CSF biomarker panel

TECHAGAPPE OCTOBER-DECEMBER 2024 3

EDITORIAL CONTENTS...
10-13
REVOLUTIONIZING
INDIAN
DIAGNOSTICS
AGAPPE’S GROUND
BREAKING
COLLABORATION
WITH FUJIREBIO
02-03 Immunology Solutions 18-19
04-05 Editorial Content THE POWER OF EARLY DIAGNOSIS

06-06 Feedback from Readers THE INSPIRING

07-07 Chief Editor’s Desk
JOURNEY OF
08-08 Agappe Diagnostics
RADHIKA,
the Total Solution A CANCER
Provider SURVIVOR
09-09 Pathologists:
A Day in White
14-17 Pathology - An Overview
23-23 Sero-Immunoassay 20-22
24-26 Clinical Pathology is the HINDLABS
Cornerstone of Cancer
Diagnosis and SPREADING ITS
Treatment WINGS ACROSS
27-27 Mispa Fab 120 THE COUNTRY
Views and opinions expressed in this magazine are not necessarily those of Agappe Diagnostics Limited, its publisher, or editors. We do our best to verify the information published but do not take any responsibility for the absolute accuracy of the
information. We do not take responsibility for returning unsolicited material sent without due postal stamps for return postage. No part of this magazine can be reproduced without the prior written permission of the publisher. Techagappe publishers reserve the
right to use the information published herein in any manner whatsoever.

Caution: After going through the techniques, procedures, theories, and materials that are presented in Techagappe, you must make your own decisions about specific treatment for patients and exercise personal/professional judgment for further clinical
testing or education and your own clinical expertise before trying to implement new procedures.
Contact info: The Manager-Corporate Communication, Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. www.agappe.com

4 TECHAGAPPE OCTOBER-DECEMBER 2024

 THE DIAGNOSTICS NEWS JOURNAL

Volume 10 | Issue 1 | October-December 2024

46-49 Dr. Biswajit Mohanty

A Visionary Journey in
Diagnostic Excellence EDITORIAL BOARD
54-55 How to Prevent EDITOR
Pre Analytical Errors Meena Thomas

in Clinical Laboratory? CHIEF EDITOR

Prof. Dr. D M Vasudevan
56-58 Comprehensive Health CONSULTING EDITOR
Tips for the Prevention
34-36
Dr. C.S. Satheesh Kumar
& Management EDITORIAL ADVISORY BOARD
Vineeth P Mathew
DR. SUNIL KUMAR’S 59-59 Root Cause Analysis-10 Smitha Paul
JOURNEY AND 60-60 Quiz & Feedback Sreevisakh K L
Sanjaymon K R
INSIGHTS INTO 61-61 Agappe Gurukul Sankar T S

MODERN
Bintu Lijo
62-62 HPV Vaccine LEGAL ADVISORY BOARD

VETERINARY Adv. Denu Joseph

SCIENCE
PUBLISHING COORDINATOR
Jayesh Kumaran
DESIGN AND LAYOUT
M T Gopalakrishnan
28-29 Automating the
Hematopathology PHOTOGRAPHY
Medical Laboratory Nelson Thomas

30-33 Eliminating Cervical BOARD OF DIRECTORS

Cancer: A Global
Strategy Against HPV- 50-53 CHAIRMAN
Joseph John
Related Cancers FRANCE LAB COMPANY MANAGING DIRECTOR

REVOLUTIONIZING
Thomas John
37-37 Mispa Hx50

EGYPT’S
EXECUTIVE DIRECTORS
38-41 Codes of Ethics & Its Meena Thomas
Relevance in Laboratory
DIAGNOSTIC
Sangeeta Joseph
Medicine Mary Baby Meleth

42-45 The Role of Histopathology LANDSCAPE WITH Prof. Dr. D M Vasudevan

Rhema Elizabeth Thomas
& Histopathologist in
Cancer Diagnosis
CUTTING-EDGE
SOLUTIONS
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and Treatment agappe.in or call us at +91 484 2867065. Permissions-For
permissions to copy or reuse material fro m Techagappe,
write to techagappe @agappe.in Letters to the editor-
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Published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. ager-Corporate Communication, Agappe Diagnostics Lim-
Contact: Ph: + 91 484 2867000, Fax: + 91 484 2867222; Printed at Five Star Offset Printers, Nettoor, Cochin-40, for Agappe Diagnostics Limited
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ited, “Agappe Hills”, Pattimattom P.O., Ernakulam district,
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“Agappe Hills”, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas. techagappe@agappe.in

TECHAGAPPE OCTOBER-DECEMBER 2024 5

 FEEDBACK FROM READERS
tent. Here at TechAgappe, I would
say, it touches the mind of read-
ers, and even the advertisements
TechAgappe
benefit us. I could not read this
magazine's first issue onwards
A treasure
as I am a new customer of trove of
Pleasurable
Agappe. But I know I can read its
online versions where all the
information
reading, serene past editions are available. Let I got introduced to
your grand vision and mission Agappe's technical
presentation help people through TechAgappe magazine, Tech-
succeed in the future. Agappe, very recently.
As I am a privileged customer Out of my curiosity, I
of Agappe Diagnostics, I am Dr. Swara Patel, Ahmedabad.
perused through the
getting TechAgappe magazine
at regular intervals. Reading Informative and previous editions, and
which have now left me
should be a habit for every-
body to upgrade their knowl- motivating content anticipating for the up-
coming issues. The
edge. To sharpen this habit, Pleased to say that AGAPPE’s
magazine has a unique style
quality materials should be IVD news journal ‘TechAgappe’ tions with ease. I find the
to elucidate facts. The reader
available around us. Today, we is undoubtedly excellent in its magazine a treasure trove of
is taken through the motivat-
are getting many types of best presentation. Detailing a information. The health tips
ing real-life saga and inter-
magazines from different sec- specific subject with its aca- and other articles are im-
views, which cement those
tors. But reading will be a plea- demic aspects and case studies mensely helpful.
positive thoughts and strong
sure only when the magazine is really an enjoyable practice of Mr. Joydeep Pal
willpower can take us through
has that kind of serene pre- spreading knowledge among Chowdhury, North Tripura.
any life-threatening situa-
sentation and valuable con- the public. Teaching a life story

is more effective to motivate ing life stories and interviews.

people to undergo regular health Dr. Anand Shankar, Bangalore.
check-ups periodically. All the
best wishes.
Padma Shri Dr. Sunkara
A valuable
Venkata Adinarayana Rao, contribution to the
Vizag.
public
Inspiring work and We were extremely glad to re-
motivating life ceive the past ed ition of
TechAgappe magazines which
stories highlighted various topics. The
life stories are inspiring and in-
As a customer of AGAPPE, Jayadev
still positivity in the readers.
Memorial Rashtrotthana Hospi-
Storehouse of latest information tal receiving Techagappe regu-
The scientific articles are abun-
dant sources of updated infor-
I would like to express by sincere gratitude for including my larly. I find every edition valu-
mation. Health tips provide us
name in the mailing list of TechAgappe, ‘The Diagnostics News able. The past issues which
a great way of leading a good
Journal’, which is a storehouse of latest information in a very cover many vital topics provided
lifestyle. The whole content of
lucid style. The quality of the journal is really awesome. As a excellent information on various
the magazine is 100% worthy
regular reader of many other magazines, I could clearly iden- health disorders. The presenta-
for general public. I owe my
tify the uniqueness of this magazine. We thoroughly enjoy tion is commendable, and the
sincere gratitude to Agappe
and truly benefit from reading your established and interna- overall quality of the journal is
team for your valuable contri-
tional journal. All the best team TechAgappe! Keep inspiring! impressive. I encourage the
butions to the health industry.
team to continue their inspiring
Dr. N. K. Sardana, Jalandhar. work, particularly the motivat- Koushik Manna, Kolkata.

6 TECHAGAPPE OCTOBER-DECEMBER 2024

Editorial Chief Editor’s Desk

THE 41ST EDITION'S COVER STORY

FOCUSES ON CLINICAL PATHOLOGY
I am delighted to present the 41st edition of her triumph over its challenges offer valuable in-
TechAgappe, our quarterly review of health and sights for our readers.
laboratory medicine. As always, we continue to
In the success stories section, we highlight two
publish this magazine regularly every three
remarkable organizations. First, we explore the
months, and I am pleased to note that the labora-
story of HLL Lifecare Limited, with a special focus
tory community has warmly embraced our pre-
on Hind Labs, a public support initiative estab-
vious issues.
lished by the Government of India to provide af-
In this edition, we begin with a message from fordable diagnostic solutions to rural populations.
Mr. Thomas John, Managing Director of Agappe The second story profiles Dr. Sunil Kumar, a vet-
Diagnostics, who shares details of significant erinary surgeon at Felican Multi Specialty Pet Hos-
events hosted by AGAPPE in Kochi and Delhi. pital in Kochi, who shares his expertise on respon-
These events marked the announcement of a stra- sible pet care and the essential role of pet owners.
tegic partnership with the Japanese giant, Fujirebio
Additionally, we feature interviews with three
Holdings Inc., for the transfer of CLIA-based tech-
esteemed specialists. Our first interview is with
nology. This collaboration is set to revolutionize
Dr. G. K. Rath, Head of the National Cancer Insti-
immunology solutions in Indian healthcare.
tute (India) and Chief Radiologist at Dr. BRA Insti-
Our cover story focuses on pathology, high- tute Rotary Cancer Hospital, New Delhi. Next, we
lighting its various branches and emphasizing the speak with Dr. Biswajit Mohanty, Managing Direc-
critical role it plays in disease diagnosis and treat- tor of GenX Diagnostics, Bhubaneswar, a valued
ment. To support this theme, we have included AGAPPE customer. Finally, we have an interna-
four medical articles, three inspiring life and suc- tional perspective from Mr. Morris Henain, Gen-
cess stories, three interviews with prominent eral Manager at France Lab Company, Egypt.
medical professionals, one technical article, and
In our technical section, we address the im-
a selection of health tips.
portance of preventing pre-analytical errors in clini-
The first medical article, from the chief cal laboratories—an essential factor in ensuring
editor’s desk, provides an overview of pathology, the reliability of IVD testing. We also share health
covering its diverse branches. The second article, tips related to pathology and broader health con-
with input from Dr. Sachin Kolte, Professor at cerns.
VMMC and Safdarjung Hospital, Delhi, delves into
I am proud to share that we have received ex-
global strategies for eliminating cervical cancer,
cellent feedback and letters of appreciation for our
with a focus on HPV-related cancers. The third
last issue. I am confident that this issue will pro-
piece, by Dr. Sudip Kumar Datta, Head of Lab
vide you with valuable insights on maintaining
Medicine at AIIMS, New Delhi, explores the im-
health, particularly in the post-pandemic era. As
portance of ethical standards in laboratory medi-
always, we welcome your constructive feedback
cine. The fourth article, contributed by Dr.
to help us improve our content.
Harpreet Walia, Head of Pathology at Sohana Multi
Super-Speciality Hospital, Mohali, discusses the With warm personal regards,
pivotal role of histopathology in cancer diagnosis
and treatment.
In our life story section, we feature the inspir-
ing journey of Radhika Menon, a cancer survivor
from Kerala. Her battle with cervical cancer and Dr. D.M. Vasudevan

TECHAGAPPE OCTOBER-DECEMBER 2024 7

 IVD Industry Update

AGAPPE DIAGNOSTICS
THE TOTAL SOLUTION PROVIDER
Agappe has embarked on an extraordinary journey that
began humbly in 1995 and has since evolved into a
leading player in the IVD industry. From its humble
beginning with 5 staff & 800 sq ft area, we have
blossomed into the largest IVD manufacturing facility
in the country, with 5 branch offices and one fully
owned subsidiary in Swiss. Agappe, presently serves
over 60,000 customers in India and 20,000 across 90
countries, poising to cement its position as the Total
Solution Provider for IVD diagnostics, in India & across
the world.
Meena Thomas, Director & COO, Agappe Diagnostics Ltd.
A defining moment came with the launch tology in India. We are also into Immunol-
of Mispa i2, a breakthrough product capable ogy, coagulation, urine chemistry, electro-
of detecting 26 blood protein parameters. lyte, rapids, serology, molecular diagnos-
This innovation transformed diagnostics tics, control & calibrators, pre-analytical
for small rural labs by offering a cost-ef- and again in POCT & Vetcare, unlike any-
fective solution without compromising on one in our segment in India.
quality.
Agappe’s foray into the Immunology
With the introduction of Mispa i3, a car- CLIA business is another milestone, posi-
tridge-based fully automatic nephelometer, tioning the company as the first manufac-
Agappe bagged the National Award in 2018 turer of CLIA reagents in India. The vision
for the “Indigenous Development of Tech- of becoming a Total Solution Provider is
nology and Commercialisation” from epitomized by our collaboration with glo-
Honourable President of India, Shri. Ram bal leaders like Fujirebio Inc. Japan. This
Nath Kovind. strategic partnership, set to launch mono- Scan and watch our new corporate
cartridge-based innovative neurodegenerative video in our official YouTube Channel
Our ability to manufacture cutting-edge
testing solutions by September 2024, deliv-
products like affordable patented nephelo-
ering rare & advanced diagnostic solutions
meters & pre-analytical tube labeller, he-
like â-Amyloid 1-42 and Phosphorylated growth, ensuring that advanced diagnostic
matology analyzers, and RT-LAMP analyz-
Tau, crucial for early detection of Alzheimer’s technologies are accessible to all.
ers, which were vital during the COVID-19
disease and other neurological conditions,
pandemic proved our strong will to take up This journey, from our humble begin-
among other 200 parameters, being incor-
the lead faster than any other competitors. nings to becoming a trailblazer in diagnos-
porated in our menu in phased manner.
tics, now encompassing majority of IVD test
Our contribution during the pandemic
Looking ahead, our mission is clear: to solutions available in the spectrum, stands
was noteworthy, supplying 70% of COVID
transform itself into the ultimate Total So- as a testament to our unwavering commit-
prognosis test kits like CRP, D-Dimer, Fer-
lution Provider in the IVD diagnostics seg- ment to innovation, excellence, and service.
ritin, nationwide. This demonstrated our
ment, offering comprehensive solutions As the only company in the country with
ability to respond swiftly to urgent
that meet the needs of rural, medium- such extensive segment coverage, we re-
healthcare needs.
sized, and large laboratories alike. The main dedicated to setting new benchmarks
We are now leading player in Clinical company’s focus on quality, affordability, in the industry and delivering unparalleled
chemistry, Immunochemistry and Hema- and innovation continues to drive its quality and reliability.

8 TECHAGAPPE OCTOBER-DECEMBER 2024

Poem Pathologist

Pathologists: A Day in White…

In sterile light, the pathologist wakes day & night, working on human blood and tissues
Unravelling the underlying causes of different infectious diseases in the mankind
From dawn till dusk, in silence they toil down harder, checking body tissues,
Interpreting results, with steady hands& shrewd mind every moment.

In past, microscopes hummed& slides were inspected, tedious

New transformations& technology bringing more efficiency
From blood to any tissues, your ailments are discovered,
Guiding U safely through life’s storm to resolve early.

When Covid struck, they stood their ground,

Tracking every virus as it spreads around.
Worked with every swab, with every stain
Supported fight against all menacing strains.

In labs, they fight the rare, unseen, with courage,

Ensuring life stay clean & healthy, for your wellbeing
Collaborating with doctors, hand’n hand, providing fitness
Assisting in interpreting results for the best course of treatment.

Behind each diagnosis, they silently stay, with dedication & optimism
Helping to keep disease at bay, though their life is in peril, insecure always.
Acting as detectives in medicine, they uncover the root cause, bringing rays of hope
For pathologists, we’re forever in their debt, guardians of life, we’llnever forget, never ever.

Dr. C. S. Satheesh Kumar, Head-Corporate Communication, Agappe Diagnostics Ltd., (Retd. Drugs Controller, Kerala).

TECHAGAPPE OCTOBER-DECEMBER 2024 9

 AGAPPE MD’s Desk

REVOLUTIONIZING INDIAN DIAGNOSTICS

AGAPPE’S GROUND BREAKING
COLLABORATION WITH FUJIREBIO
THE LANDMARK LAUNCH OF IN-VITRO BIOMARKERS
The partnership between Agappe Diagnostics and Fujirebio has ushered in a new
era for India’s healthcare sector. This groundbreaking collaboration introduces
advanced in-vitro biomarkers, revolutionizing diagnostics with cutting-edge CLEIA
technology. By blending Agappe’s deep understanding of the Indian market with
Fujirebio’s global expertise, this venture promises to make high-quality, affordable
diagnostic solutions accessible nationwide. The journey toward a healthier India
has taken a monumental leap, making this a story you can’t afford to miss.
The collaboration between Agappe Diagnostics and a homegrown champion of diagnostic solutions. The fusion
Fujirebio Holdings marks a pivotal moment in India’s of these two leaders is set to transform diagnostic healthcare
healthcare landscape. This partnership, announced in Janu- in India by making advanced diagnostic tools more acces-
ary 2024, brings together the innovation and expertise of sible to common masses. Agappe’s deep understanding of
Fujirebio, a global leader in in-vitro diagnostics, with Agappe, the Indian market, combined with Fujirebio’s cutting-edge

(From Left) Adv. C.N. Mohanan, Secretary - CPI(M), Ernakulam District, Shri. S. Harikishore, MD-KSIDC, Kerala, Shri.
APM Mohammed Hanish, Principal Secretary-Industry, Kerala, Shri. P.V. Srinijin, Member of Legislative Assembly, Mr. Goki
ISHIKAWA - President & CEO Fujirebio Hold ings Inc, Mr. Thomas John, Managing Director, AGAPPE, Shri. Pinarayi
Vijayan - Hon'ble Chief Minister of Kerala, Shri. P Rajeeve - Hon'ble Minister for Law, Industries & Coir, Kerala, Shri. Benny
Behanan, Member of Parliament, Mr. Shigekezu TAKEUCHI, Director, Chairman, President & Group CEO, H.U. Group
Hold ings Inc, Mr. Joseph John, Chairman, AGAPPE during the event held at Le Meridien, Kochi.

10 TECHAGAPPE OCTOBER-DECEMBER 2024

technologies, promises to enhance the qual-
ity, precision, and availability of diagnostic test-
ing across the country.
The introduction of Chemiluminescence
enzyme immunoassay (CLEIA) technology
through this partnership is a significant step
forward for Indian diagnostics. CLEIA is a
highly sensitive technique used to detect
specific proteins, hormones, or markers in
biological samples, which makes it vital in
diagnosing a wide range of diseases. By
employing Alkaline Phosphatase (ALP) as a
label, CLEIA can generate luminescent prod-
ucts, providing results with exceptional ac-
curacy. This enzymatic application allows for
the precise quantification of analytes, giving
healthcare professionals reliable tools to
make informed decisions. The key advan-
tages of CLEIA include its high sensitivity,
specificity, and wide dynamic range, en-
abling the detection of very low concentra- (From Left) Shri. Ravindra Pratap Singh - Joint Secretary Dept. of
tions of biomarkers, making it indispens- Pharmaceuticals (DoP), Mr. Thomas John, Managing Director, AGAPPE,
able in modern diagnostics. Mr. Takashi ARIYOSHI, Minister & Dy Chief of Mission, Japanese Embassy,
Mr. Shigekezu TAKEUCH, Director, Chairman, President & Group CEO, H.U.
One of the standout aspects of the Group Hold ings Inc during the lunch of Mispa i121.
Agappe-Fujirebio collaboration is the
Thyroid disorders, Cardiac conditions, Fer- solutions in managing neuro- degenerative
indigenization of CLEIA technology in India.
tility issues, and, notably, neuro degenera- diseases is becoming increasingly urgent.
Agappe is the first Indian company to lo-
tive d iseases like Alzheimer’s. These The collaboration between Agappe and
cally manufacture CLEIA reagents, a critical
biomarkers will significantly enhance early Fujirebio ensures that the Indian healthcare
development in reducing the country’s reli-
detection and diagnosis, enabling more system is equipped to tackle these chal-
ance on expensive imported diagnostic tools.
timely interventions and improving patient lenges with precision and efficiency.
This move aligns with the Indian government’s
outcomes.
“Make in India” initiative, fostering self-reli- Delhi Event: The grand inauguration held
ance in advanced healthcare technologies. For example, the development of Alzheimer’s in Delhi on January 10th, 2024, marked a sig-
By producing high-quality reagents locally, biomarkers will allow for earlier diagnosis nificant moment in the history of Indian
Agappe ensures that the benefits of ad- of the disease, which could slow the pro- healthcare. The event commenced with the
vanced diagnostics are available at a more gression through appropriate treatment and pre-recorded video presentation from Shri.
affordable cost, without compromising on lifestyle modifications. This is especially Prataprao Ganpatrao Jadhav, Union Minis-
quality. This is a mono-cartridge method important in India, where the aging popula- ter of State for Health, Family Welfare &
using the instruments Mispa i60 and Mispa tion is growing, and the need for effective AYUSH, underscoring the government’s
i121. Indigenisation of the manufacture of keen interest in this groundbreaking initia-
instruments are also under discussion. tive. He could not physically present for the
event as he was in Maharashtra on that day.
The Agappe-Fujirebio partnership is not
just about bringing cutting-edge technology The Agappe-Fujirebio The launch of Agappe’s pioneering
“Make in Kerala for the Globe” In-Vitro
to India but also about making it affordable
and accessible to all, especially in rural ar- partnership is not just about Biomarkers signalled a transformational leap
in the diagnostic capabilities of India. These
eas. Diagnostics have traditionally been ex- bringing cutting-edge biomarkers, developed in collaboration with
pensive and difficult to access for a large
portion of India’s population, particularly technology to India but also Fujirebio Japan, set the stage for cutting-edge
diagnostic tools, designed to detect critical
those living in underserved regions.
Agappe’s commitment to providing cost-
about making it affordable diseases such as Alzheimer’s, Epilepsy, and
effective solutions aims to bridge this gap. and accessible to all, Cancer at early stages.
With local production of diagnostic reagents
and equipment, the overall cost of testing is
especially in rural areas. This collaboration embodies the spirit
of “Make in India,” propelling India towards
expected to decrease, allowing for more Diagnostics have traditionally a future where locally manufactured diag-
widespread availability.
been expensive and difficult to nostic tools meet global standards, driving
down costs, and improving accessibility.
One of the most exciting aspects of this
collaboration is the innovation in bio mark-
access for a large portion of The event brought together industry
ers for critical diseases such as Oncology, India’s population. leaders and experts, each providing deep

TECHAGAPPE OCTOBER-DECEMBER 2024 11

 AGAPPE MD’s Desk an impact on the world stage. The panellists
acknowledged that this localization not only
reduces costs but also ensures quicker ac-
A key focus of the event cess to diagnostic tools, thereby bridging
the healthcare accessibility gap for rural and
insights into the significance of the collabo-
ration. Mr. Takashi Ariyoshi-san, Minister
was the transformation remote populations in India.
& Deputy Chief of Mission from the Japa- brought by localization, and The second panel discussion focused on
nese Embassy, emphasized the importance
of India-Japan collaborations in advancing
this was explored in the first the future of healthcare, particularly in the
realm of neurodegenerative diseases. Titled
healthcare technologies. Shri. Rajeev Singh panel discussion titled “Make “Pioneering Biomarkers for Dementia Diag-
Thakur, Additional Secretary of the Minis-
try of Commerce & Industry, highlighted
in India for the Globe.” The nosis,” the discussion brought to light the
immense potential of early diagnosis in con-
how the Agappe-Fujirebio partnership aligns discussion revolved around ditions like Alzheimer’s Disease. Alzheimer’s
with the government’s vision of boosting
local manufacturing while leveraging global
how India’s growing is a growing concern in India, as the elderly
population continues to rise.
expertise. healthcare needs can be met
The introduction of novel bio markers,
Mr. Shigekezu Takeuchi-san, Chairman by leveraging local developed in partnership with Fujirebio, is a
and CEO of H.U. Group Holdings, echoed
these sentiments, praising the partnership for manufacturing capabilities. breakthrough in this area. These biomarkers
allow for the early detection of dementia, a
its potential to not only enhance India’s diag- stage where intervention through lifestyle
nostic infrastructure but also export world- Agappe’s ability to produce CLEIA reagents changes and medication could slow the pro-
class health care products globally. These locally positions the company as a trailblazer gression of the disease, offering patients a
speeches collectively emphasised the col- in import substitution, drastically reducing better quality of life for a longer period.
laborative strength of Indian and Japanese the country’s dependency on foreign im-
expertise in healthcare innovation, fuelling the ports. By manufacturing advanced diagnos- The panellists emphasized the significance
Make in India initiative and setting new bench- tic tools within India, Agappe is ensuring that of this innovation in the Indian context, where
marks for the diagnostic industry. costs are kept lower, making sophisticated neurodegenerative diseases are often diag-
healthcare more affordable for the Indian nosed late, leading to limited treatment op-
A key focus of the event was the trans-
masses. tions. With the early diagnosis tools now avail-
formation brought by localization, and this
able through this collaboration, the future of
was explored in the first panel discussion The conversation also highlighted the
dementia care in India looks promising.
titled “Make in India for the Globe.” The dis- importance of accreditation and standard-
cussion revolved around how India’s grow- ization in achieving this vision. With regula- The development of these biomarkers
ing healthcare needs can be met by leverag- tory frameworks tightening globally, adher- doesn’t just address Alzheimer’s but opens
ing local manufacturing capabilities while ing to stringent standards becomes essen- doors to a broader spectrum of neurode-
adhering to global quality standards. tial for Indian companies seeking to make generative and critical diseases. This aligns

(From Left) Mr. Thomas John, Managing Director, AGAPPE, Mr. Goki ISHIKAWA, President & CEO Fujirebio Holdings Inc,
Mr. Shigekezu TAKEUCHI, Director, Chairman, President & Group CEO, H.U. Group Hold ings Inc, Shri. Rajeev Thakur -
Additional Secretary, DPIIT, Ministry of Commerce & Industry, Mr. Takashi ARIYOSHI, Minister & Dy Chief of Mission,
Japanese Embassy, Shri. Ravindra Pratap Singh - Joint Secretary Dept. of Pharmaceuticals (DoP), Prof. (Dr.) Goura Kishor
Rath - AIIMS Jhajjar, DRBRAIRCH, Prof. Radiation Oncology, Mr. Joseph John, Chairman, AGAPPE & Dr (Col.) Deepak
Kumar Mishra, Lab Director, Tata Medical centre, Kolkata during the event held at India Habitat Centre, Delhi.

12 TECHAGAPPE OCTOBER-DECEMBER 2024

with India’s pressing need to cater to its ag-
ing population. As India witnesses a demo-
graphic shift, with a rapidly growing elderly
population, the healthcare system needs to
be equipped to handle the challenges that
come with it. Early diagnosis, facilitated by
these novel biomarkers, could be a game-
changer in managing not just dementia but
other age-related conditions.
The collaboration is a bold step towards
making India a global leader in healthcare
diagnostics, with technology that benefits
the masses by making early diagnosis af-
fordable and accessible.
Cochin Launch Event: The Cochin launch
on January 12th, 2024, was a momentous
occasion that projected Kerala’s pivotal role
(From left) Mr. Joseph John, Chairman, AGAPPE, Mr. Goki ISHIKAWA,
in shaping the future of healthcare diagnos-
President & CEO Fujirebio Holdings Inc, Mr. Thomas John, Managing Director,
tics in India. The event was graced by the
AGAPPE, Shri. Rajeev Thakur - Additional Secretary, DPIIT,
Hon. Chief Minister of Kerala, Shri. Pinarayi
during the lunch of Mispa i60.
Vijayan, whose presence signified the im-
portance of this landmark initiative. industry, capable of meeting the growing companies. He also outlined the state
demand for affordable, accurate, and reli- government’s commitment to providing
Alongside him were other notable fig- able diagnostics. a conducive environment for such initia-
ures, including the Minister of Industry, P.
In his keynote address, Minister of In- tives, through policies that support indus-
Rajeev, MP Benny Behanan, and MLA
dustry P. Rajeev highlighted Kerala’s role trial growth, innovation, and investment
Srinijin, whose collective presence added to in healthcare infrastructure.
the gravity of the occasion. The event as a hub for innovative healthcare solu-
brought together the state’s political and tions, focussing on the state’s rich tradi- There was a panel discussion in Cochin
business leaders to celebrate the launch of tion of medical excellence and scientific on Changing Landscape of First time “Make
Agappe’s second equipment manufactur- innovation. Shri. Rajeev outlined Kerala’s in India” Novel Biomarkers for Dementia
ing unit at KINFRA and the inauguration of vision of becoming a key driver in the glo- (Alzheimer’s Disease) Early Diagnosis to
the “Make in Kerala for the Globe” In-Vitro bal healthcare market by focusing on ad- Prevention”, where leading neurologists and
Biomarkers initiative. vanced medical technologies and high- pathologists from Cochin as well as
quality manufacturing. neighbouring districts & states joined.
The event marked the official unveiling The Minister praised Agappe’s efforts
of Agappe’s new state-of-the-art facility, Moderated by Dr. Sukesh Nair from
in pioneering indigenous manufacturing of CMC Vellore and Dr. Mathew Abraham from
dedicated to the manufacturing of high- diagnostic tools, noting that the collabo-
tech d iagnostic tools. This new unit Aster Medcity, the panel delved into the sig-
ration with Fujirebio is a model for future nificance of early diagnosis and interven-
strengthens Kerala’s position as a key partnerships between Indian and global
player in the global healthcare market, ca- tion in Alzheimer’s Disease. With novel
pable of producing world-class diagnostic biomarkers now being produced locally, the
equipment at competitive costs. conversation highlighted how serendipity
and these advancements could revolution-
The “Make in Kerala for the Globe” ini- The “Make in Kerala for the ize dementia care, enabling earlier detection
tiative was the centrepiece of the Cochin
event, showcasing Kerala’s potential to be- Globe” initiative was the and better preventive strategies, especially
in the Indian context.
come a global leader in diagnostic manu- centrepiece of the Cochin In conclusion, the Cochin event was a
facturing. This initiative reflects the core vi-
sion of driving world-class healthcare diag- event, showcasing Kerala’s celebration of Agappe’s achievements, as
well as a powerful statement of Kerala’s role
nostics production from the heart of India. potential to become a global in shaping the future of global healthcare.
Through this project, Agappe aims to leader in diagnostic The ongoing partnership between Agappe
provide access to advanced diagnostic so- and Fujirebio holds great promise, with the
lutions that cater to a wide range of medi- manufacturing. This initiative potential to revolutionize patient care both
cal needs, including oncology, neurology,
pulmonology, and gastroenterology. The
reflects the core vision of in India and across the world. Through local
manufacturing, cutting-edge technology,
project’s international aspirations were driving world-class healthcare and a shared commitment to innovation,
echoed by the dignitaries, who noted how
Cochin’s new unit positions India as a
diagnostics production from this collaboration is poised to elevate
healthcare standards, making high-quality
competitive player in the global healthcare the heart of India. diagnostics accessible to all.

TECHAGAPPE OCTOBER-DECEMBER 2024 13

 Article Prof. Dr. D. M. Vasudevan

PATHOLOGY
AN OVERVIEW...
Pathology is an important medical discipline that provides
proper diagnostic information to patients and clinicians.
It influences nearly every aspect of patient care, from
identifying cancers to guiding the treatment of chronic
illnesses through precise laboratory testing. The diagnostic pathology focuses on
examining structural and functional changes in cells and tissues to pinpoint the
cause of diseases. Since all diseases cause some form of alteration in cell
morphology and function, pathologists play a key role in uncovering these changes
to deliver accurate diagnosis.
Prof. Dr. D. M. Vasudevan, MBBS, MD, FRCPath: Technical Director, Agappe Diagnostics Ltd.
Pathology name originates from the Latin wordspathos ations of cells (morphologic changes), and the conse-
(suffering) and logos (study), so literally means the study quences of changes (clinical manifestations) of the dis-
of suffering. A physician practicing pathology is called a ease. A clinical laboratory provides accurate diagnostic
pathologist. Pathology is concerned with disease and cel- services and thus improves the patient’s disease condi-
lular dysfunction. Pathology refers to the diagnosis of the tion. The goal of all laboratories is to provide high-quality
disease, mostly through analysis of tissues, human cells services that focus on patient safety and satisfaction. They
or blood samples. It also addresses the cause, mecha- also strive to improve healthcare through ongoing educa-
nisms of development (pathogenesis), structural alter- tion and innovation. Pathologists must show profession-
alism and care for every patient.
Modern pathology began to take shape
in the 19th century when doctors realized
that germs, or microbes, could cause vari-
ous diseases. The development of the mi-
croscope played a crucial role in advanc-
ing medicine, allowing doctors to study
tissues more closely. By the early 20th cen-
tury, pathology had divided into several
specialized fields, leading to the creation
of many modern specialties in both pa-
thology and diagnostic medicine. These
subspecialties continue to shape and ad-
vance the practice of modern medicine.
Such subspecialities are as follows:

Anatomical pathology
Anatomical pathology is a medical
specialty that is concerned with the diag-
nosis of a disease based on the gross,
microscopic, chemical, immunologic and
molecular examination of organs, or tis-

14 TECHAGAPPE OCTOBER-DECEMBER 2024

sues. It is one of two main divisions of the
practice of pathology, the other being clinical
pathology, the diagnosis of disease through
the laboratory analysis of bodily fluids and
tissues. Histopathology refers
A pathologist’s role is essential in all as- to the microscopic
pects of medicine as it will provide informa-
tion to decide the best treatment policy for examination of various
patient recovery. Microscopic analysis can human tissues. For
provide further insight into which drugs or
other treatments will be the most suitable. histopathological
There are two methods of obtaining samples
for diagnostic microscopy: histology and
examination, the tissue
cytology. Histology will involve the removal is removed from the
of a tissue sample to be able to assess both
tissue and cell morphology.
body and placed in a
Cytology involves taking samples of free
fixative that stabilizes
cells separate from the structure of the tis- the tissues to prevent
sue often obtained by fine-needle aspiration.
Cytology is cheaper, faster, and less inva-
decay.
sive than a histological sample, however, also
has higher rates of error. It is generally used
before histology as a preliminary test. Mi-
croscopic diagnosis is based on the pattern slides are then interpreted by the patholo- markers. Clinical pathology is concerned with
recognition skills of the pathologist to dif- gist. the diagnosis of disease based on the analy-
ferentiate the normal from the abnormal; sis of bodily fluids, using the tools of chem-
and to distinguish between inflammation Chemical Pathology istry, microbiology, hematology and mo-
and neoplasm. Chemical Pathology is also known as lecular pathology. Clinical pathologists learn
to administer a number of visual and mi-
Cytopathology Laboratory Medicine or Clinical Biochemis-
try, which analyses and interprets the chemi- croscopic tests and utilize automated ana-
Cytopathology or cytology is a branch of cal components in body fluids, such as blood lyzers and cultures. Chemical pathologists
pathology that studies and diagnoses dis- and urine. The work involves overseeing and use these test results to assess the overall
eases on the cellular level. It is usually used interpreting a wide range of laboratory tests, health of patients and aid in the diagnosis,
to aid in the diagnosis of cancer, but also including tests for glucose, electrolytes, en- monitoring, and management of various
helps in the diagnosis of certain infectious zymes, hormones, and other biochemical medical conditions.
diseases and other inflammatory conditions
as well as thyroid lesions, diseases involv-
Molecular pathology
ing sterile body cavities (peritoneal, pleural, Molecular pathology is a recently devel-
and cerebrospinal), and a wide range of oped branch of clinical biochemistry and is
other body sites. Cytopathology is generally
used on samples of free cells or tissue frag- Cytopathology or cytology is a focused upon the diagnosis of disease
through the examination of molecules
ments, in contrast to histopathology, which branch of pathology that within organs, tissues or body fluids. It deals
studies whole tissues.
studies and diagnoses with the study of DNA, genes, and proteins.
Molecular pathology is commonly used in
Histopathology diseases on the cellular level. It the diagnosis of cancer and infectious dis-
Histopathology refers to the microscopic eases. It is primarily used to detect various
examination of various human tissues. For is usually used to aid in the types of cancers and infectious diseases.
histopathological examination, the tissue is
removed from the body and placed in a fixa-
diagnosis of cancer, but also Advanced techniques include polymerase
chain reaction (PCR), multiplex PCR, DNA
tive that stabilizes the tissues to prevent helps in the diagnosis of micro-assay, in situ hybridization, DNA se-
decay. The most common fixative is forma-
lin, although frozen section fixing is also
certain infectious diseases quencing, molecular profiling of pathogens,
and analysis of bacterial genes. Techniques
available.To see the tissue under a micro- and other inflammatory used are based on analyzing samples of DNA
scope, the sections are further stained to
reveal cellular components; counterstains
conditions as well as thyroid and RNA.

are used to provide contrast. Histochemis- lesions, diseases involving Hematopathology

try refers to the science of using chemical
reactions between certain chemicals and
sterile body cavities and a Hematopathology or hematology is the
study of diseases of blood cells (white blood
components within tissue. The histological wide range of other body sites. cells, red blood cells and platelets) and the

TECHAGAPPE OCTOBER-DECEMBER 2024 15

 plished by a combination of microscopic
Article Prof. Dr. D. M. Vasudevan examination of the tissue and may involve
evaluations of molecular properties of the
tissue by immunohistochemistry or other
tissues comprising the hematopoietic sys- laboratory tests.
tem. The hematopathologist reviews biop-
sies of lymph nodes, bone marrows and There are two major types of specimens
other tissues involved by an infiltration of Dermatopathology is a submitted for surgical pathology analysis:
biopsies and surgical resections. A biopsy
cells of the hematopoietic system.
subspecialty of anatomic is a small sample of tissue taken from a dis-
Medical pathology. Dermatologists eased organ for examination. There are dif-
Microbiology ferent types of biopsies, including core bi-
These pathologists are concerned with
are able to recognize most opsies, where large-bore needles are used,
the detection and characterization of infec- skin diseases based on their often with the help of imaging techniques
like ultrasound or CT scans.
tious agents. They specialize in the study of
microorganisms (bacteria, viruses, fungi,
appearances. Sometimes, a Excisional biopsies, commonly per-
and parasites) that cause infectious diseases conclusive diagnosis may formed on skin lesions and gastrointestinal
in humans. They play a crucial role in the polyps, are also widely used. The patho-
diagnosis, treatment, and prevention of in- not be possible, when a logist’s analysis of the biopsy is essential for
fectious diseases. Their work involves iden- skin biopsy is taken to be making a diagnosis and can distinguish be-
tifying and characterizing disease-causing tween different types and stages of cancer.
microorganisms from patient specimens, examined under the
such as blood, urine, sputum, or tissue microscope using usual Dermatopathology
specimens.
histological tests. Dermatopathology is a subspecialty of
Blood Bank/Transfusion anatomic pathology that focuses on the skin.
Dermatologists are able to recognize most
Medicine Surgical pathology skin diseases based on their appearances.
These physicians specialize in managing Surgical pathology involves the gross Sometimes, a conclusive diagnosis may not
blood products, ensuring safe blood trans- and microscopic examination of surgical be possible, when a skin biopsy is taken to
fusions, and studying the immune response specimens, as well as biopsies submitted be examined under the microscope using
to transfusions. Their work involves blood by surgeons or other practitioners. Often usual histological tests. In some cases, ad-
typing & compatibility testing, blood dona- an excised tissue sample is the best and ditional specialized testing needs to be
tion & testing, transfusion management, most definitive evidence of the disease. performed on biopsies, including immuno-
immunohematology, and transfusion safety. These determinations are usually accom- histochemistry, flow cytometry and molecu-
lar analysis.

Neuropathology
Neuropathology is the study of diseases
Blood Bank physicians of the nervous system, usually in the form
specialize in managing of surgical biopsies. If a disease of the ner-
vous system is suspected, and the diagno-
blood products, ensuring sis cannot be made by less invasive meth-
safe blood transfusions, ods, a biopsy of nervous tissue is taken from
the brain or spinal cord to aid in diagnosis.
and studying the immune A biopsy is usually requested after a mass is
response to transfusions. detected by medical imaging.

Their work involves blood Pulmonary pathology

typing & compatibility Pulmonary pathology is a subspecialty
of surgical pathology that deals with the di-
testing, blood donation agnosis and characterization of diseases of
the lungs. Diagnostic specimens are often
& testing, transfusion obtained by bronchoscopic transbronchial
management, biopsy, CT-guided percutaneous biopsy, or
thoracic surgery.
immunohematology,
and transfusion safety. Renal pathology
Renal pathology is a subspecialty of sur-
gical pathology that deals with the diagnosis
and characterization of disease of the kid-

16 TECHAGAPPE OCTOBER-DECEMBER 2024

 ADVANCING ALZHEIMER’S DISEASE STUDIES THROUGH HIGH-
THROUGHPUT DIGITAL PATHOLOGY: A PARADIGM SHIFT
A recent study conducted by a
multidisciplinary team at Rush Uni-
versity Medical Center (RADC) intro-
duced a digital pathology pipeline de-
signed to evaluate Alzheimer’s dis-
ease pathologies, including beta-amy-
loid plaques and tau neurofibrillary
tangles.
The digital quantification of these
markers proved to be both efficient
and consistent, with results repro-
ducible across various magnifications
and repeat scans. Moreover, the pipe- Scan to read the report
line successfully replicated the antici-
pated regional patterns of pathology.
noses of normal cognition, mild cognitive quantification of Alzheimer’s dis-
The data also demonstrated impairment, and dementia. ease-related pathologies and en-
strong correlations with previous ables the integration of new data
manual and stereological assess- This innovative digital pathology pipe- with historical datasets in ongoing
ments, as well as with clinical diag- line allows for high-throughput, reliable brain aging research.

neys. The renal pathologists work closely Medical Imaging cal imaging include radiology, magnetic reso-
with nephrologists and transplant surgeons, nance imaging, medical ultrasonography
who typically obtain diagnostic specimens Medical imaging generates visual repre- (ultrasound), and functional imaging tech-
via percutaneous renal biopsy. The renal sentations of the interior of a body. Medical niques such as positron emission tomogra-
pathologist utilizesmicroscope, and immu- imaging reveals details of internal physiology phy (PET).
nofluorescence to obtain a definitive diag- that help medical professionals plan appro-
nosis. priate treatments for tissue infection and Pathology informatics
trauma. These diagnostic techniques are of-
Oral and maxillofacial ten performed in combination with general Pathology informatics is a subfield of
pathology pathology procedures and are often essen- health informatics. It is the use of informa-
tion technology in pathology. It encompasses
tial to developing a new understanding of
Oral and Maxillofacial Pathology is one the pathogenesis of a given disease. Ex- pathology laboratory operations, data analy-
of the specialties of both dentistry and pa- amples of important subdivisions in medi- sis, and the interpretation of pathology-re-
thology. The specialty focuses on the diag- lated information. Data sources are from
nosis, clinical management and investiga- molecular testing, digital imaging, tele patho-
tion of diseases that affect the oral cavity logy and other databases.
and surrounding maxillofacial structures
including the salivary gland, bone and soft Key aspects of pathology informatics in-
tissues. Pathology informatics is the clude the following: Laboratory information

Forensic pathology use of information technology management systems (LIMS)manage com-

puter systems specifically designed for pa-
Forensic pathology focuses on deter- in pathology. It encompasses thology departments. These systems help in
mining the cause of death by post-mortem pathology laboratory tracking and managing patient specimens, re-
examination of a corpse or partial remains. sults, and other pathological data. Digital pa-
The methods forensic scientists use to de- operations, data analysis, and thology involves the use of digital technology
termine death include examination of tis-
sue specimens to identify the presence or
the interpretation of to create, manage, and analyze pathological
images. This includes side scanning and au-
absence of natural disease and other mi- pathology-related tomated image analysis. Telepathology is us-
croscopic find ings, interpretations of
toxicology on body tissues and fluids to de-
information. Data sources are ing technology to enable remote pathology
consultation and collaboration. Quality as-
termine the chemical cause of overdoses, from molecular testing, digital surance (QA)is a very important aspect of
poisonings or other cases involving toxic
agents, and examinations of physical
imaging, tele pathology and pathology services. QA implements infor-
matics solutions to ensure the quality and
trauma. other databases. accuracy of pathology processes.

TECHAGAPPE OCTOBER-DECEMBER 2024 17

 Story Cervical Cancer Survivor

THE POWER OF EARLY DIAGNOSIS

THE INSPIRING
JOURNEY OF RADHIKA,
A CANCER
SURVIVOR
Cancer is a word that instils fear in the hearts of millions. But for some, it becomes
CERVICAL CANCER SURVIVOR

a part of their story-a story of courage, resilience, and triumph. This is the story of
Radhika Menon, a vibrant 38-year-old woman from Kerala, India, whose life was
turned upside down when she came to know about the cancer diagnosis. However,
thanks to early detection and the crucial role played by histopathology, Radhika’s
story didn’t end in tragedy but became a beacon of hope.
Radhika Menon was always the heart and soul of her nothing alarming, but Radhika wasn’t convinced. Some-
family. As a successful marketing executive and mother thing didn’t feel right. Trusting her intuition, she sought a
of two young children, her life was brimming with re- second opinion. This decision would prove to be life-
sponsibilities and joy. Balancing work, family, and social changing.
commitments, Radhika never missed her morning yoga
sessions or her children’s school events. She was the
The Turning Point: Histopathology
epitome of good health—at least on the surface. Comes to the Rescue
In the summer of 2021, however, Radhika began notic- Radhika’s second consultation was with Dr. Aravind,
ing subtle changes in her body. Initially, it was nothing more a senior oncologist at one of Kerala’s leading hospitals.
than slight discomfort in her abdomen, accompanied by He advised her to undergo a more detailed examination,
fatigue. Attributing these symptoms to her hectic sched- including a biopsy. Although the initial tests were incon-
ule, she brushed them aside, thinking a few days of rest clusive, Dr. Aravind suspected something amiss and rec-
would fix everything. Little did she know, her body was ommended a histopathological examination of her tissue
sending warning signs of something far more sinister. samples. This decision turned out to be crucial.
Histopathology is the study of tissue samples under a
The Moment of Realization: When microscope to detect abnormalities, especially cancer-
Symptoms Escalate ous cells. It is a definitive diagnostic tool, often referred to
as the “gold standard” in cancer diagnosis. In Radhika’s
Weeks passed, and Radhika’s symptoms grew worse.
case, the histopathology report revealed early-stage ova-
She began experiencing sporadic episodes of severe ab-
rian cancer, a finding that hadn’t been detected through
dominal pain, bloating, and occasional bleeding between
other screening methods.
menstrual cycles. The severity of these symptoms com-
pelled her to visit a local doctor, who suggested a round Early diagnosis through histopathology played a piv-
of routine tests and an ultrasound. The results showed otal role in saving Radhika’s life. Dr. Aravind explained to

18 TECHAGAPPE OCTOBER-DECEMBER 2024

her that ovarian cancer, often referred to as undergo early treatment. Dr. Aravind ex-
the “silent killer,” is notorious for being di- plained how histopathology not only identi-
agnosed late, as its symptoms are vague and fies cancer cells but also provides crucial
mimic other common ailments. In Radhika’s Histopathology is one of the information about the type, grade, and
case, the cancer was still in its early stages behaviour of the tumour. This information
and had not spread to other parts of her most crucial steps in cancer was vital in designing a personalized treat-
body. Immediate treatment could offer her diagnosis,” Dr. Aravind ment plan for Radhika, improving her
a very high chance of survival. chances of a full recovery. “Histopathology
emphasized. “It gives us is one of the most crucial steps in cancer
The Emotional detailed insight into the diagnosis,” Dr. Aravind emphasized. “It gives
Rollercoaster: Coming to us detailed insight into the disease, allowing
Terms with the Diagnosis disease, allowing us to us to choose the most effective treatment

The diagnosis hit Radhika hard. The very

choose the most effective options. In Radhika’s case, it saved her life.”

mention of cancer shook her to her core. treatment options. In The Road to Recovery: A
“When the doctor said the word ‘cancer,’ I
Radhika’s case, New Beginning
felt like the ground beneath me had col-
After months of treatment, Radhika
lapsed,” she later recalled. Fear, anxiety, and it saved her life. emerged victorious. Her post-treatment
disbelief took over as she grappled with the
possibility of a life-threatening illness. The scans showed no signs of cancer, and her
the knowledge that her cancer had been doctors declared her in remission. Though
thought of leaving her children motherless
caught early. The doctors reassured her time the journey had been arduous, Radhika was
haunted her.
and again that her chances of recovery were filled with a sense of gratitude. She knew that
But amidst the turmoil, there was hope. excellent because of the timely intervention, the outcome could have been very different
The early detection meant that her cancer aided by histopathology. had she ignored her symptoms or delayed
was treatable. After an emo- seeking a second opinion.
tional conversation with her
Today, Radhika is a passion-
family and friends, Radhika
ate advocate for early cancer
made up her mind—she was
screening and diagnosis. She
not going to let cancer define
often shares her story at can-
her. She would fight.
cer awareness events, empha-
The Treatment: A sizing the importance of listen-
ing to one’s body and not ig-
Gruelling Journey noring warning signs, no mat-
to Recovery ter how trivial they may seem.
Her message is clear: early di-
Radhika’s treatment plan
agnosis can save lives, and his-
was aggressive but necessary.
topathology plays an indis-
She underwent surgery to re-
pensable role in that process.
move the cancerous tissue,
followed by multiple rounds Conclusion: A
of chemotherapy. The che-
motherapy sessions were
Story of Hope
gruelling, leaving her weak and Radhika’s journey from
nauseated. She lost her hair, a cancer diagnosis to recovery
part of her identity that she underscores the critical role of
cherished, but she never lost early detection in cancer treat-
her resolve. ment. Her story is a testament
Throughout her treat- to the importance of trusting
ment, her family was her big- one’s instincts and seeking
gest source of strength. Her medical advice promptly.
husband took a leave of ab- Thanks to the timely interven-
*Symbolic picture: Respecting the patient's health-related data privacy, real personal information is hidden.
sence from work to care for tion and the life-saving capa-
her, and her children, though young, under- The Role of Histopathol- bilities of histopathology, Radhika now has
stood that their mother was fighting a tough the chance to live a long and healthy life,
battle. Her friends organized prayer groups
ogy: The Unsung Hero in watching her children grow up.
and regularly checked in on her. Radhika of- Cancer Diagnosis
In her words, “Cancer may have been a
ten spoke of how their support kept her go-
It was histopathology that had uncov- part of my story, but it is not the end of it.
ing during the darkest days.
ered the cancer in its nascent stage, making Early diagnosis gave me a second chance at
However, what kept her spirits high was Radhika one of the fortunate few who could life, and for that, I am forever grateful.”

TECHAGAPPE OCTOBER-DECEMBER 2024 19

 Story Hindlabs Diagnostic Centre

Serving 50000+ Customers Everyday

Covering 4000+ hospitals across India
Making difference over last 11 years
High Quality Services
Affordable rates

HINDLABS SPREADING
ITS WINGS ACROSS
THE COUNTRY...
HLL Lifecare Limited, originally established as a manufacturer of natural rubber
latex condoms, has subsequently evolved into a leading healthcare organization
in India known to every Indian as a great brand. With 55 years of delivering
consistent quality, HLL has spread its wings to diversify into a healthcare
major, with great emphasis on healthcare services network including affordable
pharmacies, diagnostic centres, and crucial roles in ensuring vaccine security
of the nation. As the organisation continues to grow, it remains committed to
addressing the nation’s healthcare needs with excellence and innovation.
H industan Latex Limited (HLL), a central is a leading provider of hospital supplies, launch of ‘Medigard’ surgical and exami-
public sector enterprise under the Minis- pharmaceuticals, personal hygiene items, nation gloves, followed by the production
try of Health & Family Welfare, India, was and diagnostic kits, serving both domestic of Mala-D Oral contraceptive pills in 1993.
established in 1966 with its commercial pro- and international markets. Its commitment In 1995, HLL achieved a significant 71%
duction debuting in 1969 in Thiruvanantha- to innovation and quality has positioned growth in exports, entering competitive
puram, Kerala, through a technical collabo- HLL as a key player in the global healthcare markets in the USA, Europe, and Africa with
ration with Okamoto Industries, Japan. Ini- industry. By 1976, HLL doubled its condom its renowned contraceptive brands. Over
tially focused on contraceptives, HLL quickly production capacity from 144 million to 288 the years, HLL expanded its product line,
expanded its portfolio to include a wide million pieces annually. In 1992, HLL ex- introducing Copper-T Intra-Uterine Devices
range of healthcare products. Today, HLL panded into hospital products with the (IUDs), producing ‘Hydrocephalus Shunts’,

20 TECHAGAPPE OCTOBER-DECEMBER 2024

and diversifying into surgical sutures. Ad- lished a Central Project Monitoring and
ditionally, the company developed ‘HL Quality Assurance Department in Mumbai.
Haemosafe’, an instant needle and syringe This central unit connects and monitors
destroyer. Today, HLL offers a broad range Each district has a dedicated every lab, enabling real-time tracking and
of products, including hospital products,
pharmaceuticals, Ayurvedic products, vac- district manager who, along assessment of various metrics, such as
quality control systems, performance of
cines, personal hygiene items, and diagnos-
tic kits, solidifying its position as a com-
with lab managers oversees tests, inventory management, machine
breakdowns, staff attendance, and logistic
prehensive healthcare provider. operations at the regional management etc. The system allows

Hindlabs labs. They also closely Hindlabs to maintain strict quality control
across its entire network.
In 2008, as part of its diversification ef-
monitor the performance of Each district has a dedicated district
forts, HLL Lifecare Limited ventured into services like timely and manager who, along with lab managers and
new sectors of healthcare, including diag-
nostics. Initially, the company had no plans proper collection of samples, lab coordinators, oversees operations at
the regional labs. They also closely moni-
to establish a chain of laboratories; its in-
volvement began as an extension of the
sample transportation, pre tor the performance of services like timely
and proper collection of samples, sample
Central Government Health Scheme analytical quality transportation, pre analytical quality man-
(CGHS). HLL was tasked with setting up a
diagnostic lab at R.K. Puram, Delhi, specifi-
management and timely test agement and timely test completion and
report delivery etc.
cally for CGHS beneficiaries. Despite hav- completion and report A key component of quality assurance
ing no prior experience in the diagnostic
field, HLL accepted the challenge and suc- delivery etc. at Hindlabs is the centralized QA dashboard,
cessfully established the lab within the set
timeframe, offering a full range of pathol-
ogy services.
Though it started on a small scale, the
R.K. Puram lab quickly gained popularity.
In response, CGHS requested HLL to ex-
pand by setting up collection points at vari-
ous locations. Around the same time, the
Kerala Government approached HLL to es-
tablish MRI and CT scan centres in Govern-
ment Medical Colleges. This led to a Memo-
randum of Understanding (MoU) with the
Kerala Health Department to set up radiol-
ogy services at these medical colleges.
The radiology division soon became a
significant revenue generator for HLL,
prompting the company to create a dedi-
cated healthcare services section. The diag-
nostic labs were then branded as “Hindlabs”.
Following this success, CGHS requested
another pathology lab in Mumbai, as well as
labs for the newly established AIIMS cen-
Dr Renjith MC, Head - Operations & Quality Assurance, Hindlabs, Maharashtra.
tres, further expanding HLL’s presence in
the diagnostic field. came a challenge, prompting the expansion through which the quality control of every
of labs. Today, Hindlabs operates 140 labs machine can be monitored. The software
Expanding across in Maharashtra, with plans for further ex- supporting this system was developed in-
Maharashtra pansion to meet increasing demand. The
number of public healthcare facilities ser-
house and is customized to meet the spe-
cific needs of the labs. This system inte-
In 2016, HLL Lifecare Limited secured a viced has also risen from 2000 to 3500, with grates various departments, such as inven-
tender to establish and operate pathology samples collected and sent to the nearest tory management and biomedical services,
labs for the Government of Maharashtra, Hindlabs for testing. into a single platform. Hindlabs currently
leading to the expansion of Hindlabs across employs 153 pathologists/specialist , and
the state as a hub & spoke model. Initially, Ensuring Quality: The about 850 lab technicians. Eight of its labs
operations began in 2017 with 95 labs serv- Core of Hindlabs’ Success in Maharashtra have received NABL ac-
ing 2000 public healthcare facilities. As pa- To ensure the highest standards across creditation, with five more in the process.
tient numbers grew, sample collection be- all its labs in Maharashtra, Hindlabs estab- The goal is to have at least one NABL-ac-

TECHAGAPPE OCTOBER-DECEMBER 2024 21

 Story Hindlabs

credited lab in each of Maharashtra’s eight

divisions. The largest processing centre for
Hindlabs in Maharashtra is located in
Kharghar, Navi Mumbai act as the refer-
ence lab. The service is completely IT driven
from sample collection to reporting with
centralised monitoring & coordination with
real time dashboards.
These tests are provided free of charge
to poor patients, ensuring they receive the
medical care they need. This patient-cen-
tric approach has helped Hind Labs bal-
ance service quality with affordability and
the services are provides to Primary Health
centres, Rural Hospitals and District Hos-
pitals.
Through this service scheme Hindlabs
has even extended its presence to remote
areas of Maharashtra, including Gadchiroli,
Kurkheda, and Sironcha.During these pe-
riod, more than 58 million patients availed
the diagnostic services through the hub Ms. Priya chitriv, Central Quality Assurance Manager, Maharashtra receiving
and spoke model services provided by HLL TechAgappe from Mr. Dennies Daniel, RSM at AGAPPE.
in Maharashtra.
In Maharashtra, the Labour Department Association with Agappe initiated in 2022, has positioned Agappe as
has chosen Hindlabs as its partner for con- Diagnostics Ltd. the partner for Hindlabs’ biochemistry
needs. Smaller labs across Maharashtra are
ducting annual health screenings for con-
Meanwhile, Hindlabs has emerged as equipped with the Mispa Nano Plus, while
struction workers. This initiative, launched
one of the largest customers of Agappe Di- the BS-390 serves district headquarters, and
in 2019, involves comprehensive health
agnostics Ltd., acquiring over 90 machines, the high-volume hub locations rely on the
checks for construction workers and their
including the Mispa Nano Plus and BS-390 Toshiba TBA-120FR. With plans to acquire
families, including doctor consultations,
Chemistry Analyser. Their collaboration, additional machines, the number of Agappe
BMI measurements, eye and ear screen-
units is expected to be more than 100 within
ings, lung function tests, and blood sample
the next month.
collections for a range of investigations
such as CBC, basic biochemistry param- Hind Labs is particularly impressed with
eters, hormonal testing, and more. In total, The presence of skilled, Agappe’s robust service network across
each beneficiary undergoes 37 tests as part
of the program. Today, Hindlabs serves
region-specific service Maharashtra. The presence of skilled, re-
gion-specific service engineers ensures
around One Lakh construction workers per engineers ensures timely timely and efficient maintenance, which is
month under this scheme. vital for Hindlabs to meet the policy’s strict
and efficient maintenance, testing deadlines. Agappe’s technical team
Quality as the Foundation which is vital for Hindlabs to not only excels in swift service but also pro-
of Success vides top-tier training to Hindlabs’ staff,
meet the policy’s strict boosting the accuracy and reliability of test
At the heart of Hindlabs’ success is its
unwavering commitment to quality. From testing deadlines. Agappe’s results.
centralized monitoring and advanced tech-
nology to ensuring patient affordability and
technical team not only As Hindlabs continues its dynamic
growth and expansion, its successful part-
accessibility in even the most remote re- excels in swift service but nership with Agappe Diagnostics remains
gions, Hindlabs continues to set the bench- also provides top-tier training a cornerstone of its commitment to deliv-
mark for diagnostic services in India. With ering high-quality, timely healthcare ser-
its expanding network and focus on pa- to Hindlabs’ staff, boosting vices across India. With a sharp focus on
tient-centred care, Hindlabs is poised to
play an even greater role in the nation’s
the accuracy and reliability quality, service, and innovation, Hindlabs
is well-positioned to further strengthen its
healthcare system in the years to come. of test results. presence in the diagnostic sector.

22 TECHAGAPPE OCTOBER-DECEMBER 2024

AGAPPE Branding

We Enable
Laboratories to
Stay in Control Patient-like

Accuracy Independence
Patient-like QC materials
Standard ISO 15189 for medical laboratories
clearly states: “The laboratory shall use
quality control materials that react to the
examining system in a manner as close as Lot-to-lot
possible to patient samples”. Multicontrols
consistency

Quality Trust in
a bottle
Controls Seronorm™
Immunoassay

1800 425 7151 / 1800 891 7251/ 1800 270 7151 +91 9745794444

“Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India.
TEL: + 91 484 2867000 | agappe@agappe.in | www.agappe.com

TECHAGAPPE OCTOBER-DECEMBER 2024 23

 Interview Dr. Goura Kishor Rath

“CLINICAL PATHOLOGY
IS THE CORNERSTONE OF
CANCER DIAGNOSIS AND “
TREATMENT
Dr. G.K. Rath Speaks on Advancements,
Challenges, and the Future of Oncology

Dr. G.K. Rath’s journey in transforming cancer care in India is nothing short of inspiring. As a
pioneer in oncology, he has revolutionized treatment methods, making cancer care more
effective and accessible. In this interview, he shares valuable insights on his experiences,
challenges, and the future of cancer therapy, offering a rare glimpse into his relentless
dedication and innovative spirit that continues to shape the future of oncology in India.
Dr. G.K. Rath’s monumental contributions at AIIMS became a beacon of hope for can- Cancer Institute at AIIMS campus,, Jhajjar,
to cancer care in India have earned him a cer patients, drawing individuals from and Chief of DRBRAIRCH, he further solidi-
revered status, making introductions almost across India and abroad. This center is the fied his standing as a leader in cancer care.
redundant. As the former Head of the DR apex center for teaching & research in the
BRAIRCH, at the All-India Institute of Medi- country. His tenure as head of the National Even at 73, Dr Rath remains relentless in
cal Sciences, New Delhi, Dr. Rath has played his pursuit of knowledge. His passion for
a pivotal role in transforming the cancer staying current with medical advancements
treatment landscape in the country. With a is nothing short of inspiring. We found Dr.
Rath attending a medical conference in New
career spanning over 45 years, he has been
a trailblazer in bringing advanced radiation
Pathology is the most Delhi, where he shared his thoughts: “I at-
therapy techniques to India, changing the critical diagnostic tool in tend medical conferences to stay updated.
Journals in my field are also invaluable re-
approach to cancer treatment fully.
cancer care, not radiology sources. In any profession, staying in-
Dr. Rath’s influence extends far beyond
clinical care. A passionate researcher and or genomics. You simply formed is important—if you don’t stay up-
dated, you get outdated.”
educator, he has published extensively in cannot treat a patient These words reflect the unwavering com-
both national and international medical
journals, contributing significantly to the without a confirmed mitment of a man whose legacy continues
global knowledge pool on oncology. An un-
wavering advocate for cancer awareness
pathology report. I never to shape the future of oncology in India and
beyond.
and prevention, his efforts have been rec- begin treatment unless the Tech Agappe: What sparked your inter-
ognized with numerous prestigious awards.
He is a member of AERB (Atomic Energy
pathology is certain because est in oncology at a time when cancer
Regulatory Board). it guides the entire was a poorly understood disease in India
with limited resources and scarcity of spe-
Under his visionary leadership, DRBRAIRCH course of action. cialists?

24 TECHAGAPPE OCTOBER-DECEMBER 2024

Dr. Rath shared, “When I completed my When it comes to seeking a second opin-
MBBS, cancer wasn’t a major concern— ion, especially in oncology-related pathol-
while communicable d iseases were. I ogy, I strongly recommend it. In fact, up to
wasn’t interested in oncology at all; my goal three opinions can be valuable, particularly
was to specialize in surgery. But the Direc- The most important quality when the diagnosis comes from a less ex-
tor of AIIMS at that time had a vision and
insisted that I should pursue oncology, be-
for both pathologists and perienced pathologist. This isn’t because
errors are common, but rather to ensure
lieving it would turn out to be an important radiation specialists is a absolute accuracy. A second or third opin-
branch in medicine in future. That’s how I
ended up in oncology.. My approach is
commitment to patient- ion can give both the doctor and the patient
greater confidence in the diagnosis and the
simple: I either convince someone, or I get centred care. The focus treatment plan.” In cancer, unlike other
convinced! I became Head of the Depart-
ment in 1983, just nine years later.
should always be on the their chronic diseases, first treatment has to be
the best treatment.
TA: First things first- Is cancer curable?
needs and concerns. They TA: Now, you are a renowned radiation
Dr. Rath: “Yes, among many non-commu-
must work well as specialist who has handled several com-
plex cases. Tell us, what are the qualities
nicable diseases, only cancer is 50% cur- multidisciplinary teams, you expect in an excellent pathologist?
able. It is 50% preventable & 50% early di-
agnosable also. While it’s a leading cause collaborating with surgeons, Also, the qualities you want in your jun-
iors to be good radiation specialists.
of death in India, unlike chronic conditions oncologists, radiologists and
such as diabetes or high blood pressure, Dr. Rath: “The most important quality for
which can only be managed & controlled, other related professionals. both pathologists and radiation specialists
cancer can be fully cured, when detected is a commitment to patient-centred care.
early. The three key therapies used in can- cytology for diagnosis, but not anymore. The focus should always be on the patient’s
cer treatment are surgical oncology, radia- Cytology can lead to a wrong diagnosis in needs and concerns. They must work well
tion oncology, and medical oncology, and 1-3% of cases. as multidisciplinary teams, collaborating
it’s important to combine them closely with surgeons, medical
judiciously under one roof for oncologists, radiologists and
the best outcomes. Addition- other related professionals.
ally, CAR T cell therapy, Proton
A willingness to embrace new
& Carbon therapy are promis-
technologies and stay updated
ing new development that holds
with the latest research is essen-
great potential for the future of tial, particularly in cancer. Clini-
cancer therapy.”
cal expertise is crucial, along
TA: What is the importance with the ability to adapt to re-
of Pathology in oncology? cent management strategies.
Also, what is your take on tak- Above all, empathy is key—both
ing a second opinion on di- pathologists and radiation spe-
agnosis? cialists need to understand the
emotional and physical chal-
Dr. Rath: “Pathology is the lenges their patients undergo
most critical diagnostic tool in and offer compassionate care
cancer care, no other diagnos- throughout their treatment jour-
tic test. You simply cannot treat ney.”
a patient without a confirmed
pathology report. I never begin TA: As an experienced doctor
treatment unless the pathology you have met scores of patients
is certain because it guides the from d ifferent circumstances.
entire course of action. Among How do you handle challeng-
the various methods, histopa- ing cases?
thology holds the greatest im- Dr. Rath: “As a radiation on-
portance. cologist, I’ve faced many chal-
Other tools like imaging, tu- lenging cases, with patients who
mour markers and assays are are often anxious, emotional. In
helpful but not definitive like India, it’s common for several
histopathology. An error from family members to accompany
a pathologist can lead to seri- the patient, forming a ‘small
ous consequences. Dr. G. K. Rath and Mr. Joseph John, Chairman - AGAPPE crowd’ around them. I use this
Diagnostics Ltd. jointly lighting the lamp at a function as an opportunity to calm the
In the past, we relied heavily on held at India Habitat Centre, Delhi. patient. When I enter the room,

TECHAGAPPE OCTOBER-DECEMBER 2024 25

 Interview Dr. G. K. Rath

I’ll often ask casually, ‘Who’s the patient

among you all?’ This lightens the mood and
boosts the patient’s confidence, as he/she
may feel they don’t look like a patient, even
though I already know who they are. We call
this approach ‘Art of medicine,’ and it re-
ally helps to relax difficult patients & rela-
tions. Sometimes, unconventional methods
are needed to cheer them up.
One important thing I do is switch off my
mobile phone before seeing a patient. Many
patients travel long distances just to con-
sult us, and it would be inappropriate and
rude to take calls during their appointment.
Giving them my full attention is essential to
showing respect and care during these of-
ten-tough times.”
TA: As a rad iation specialist, what are
the most significant challenges that test
your expertise and what makes your work
truly rewarding?
Dr. Rath: “The most significant challenge
in my work is diagnosing the disease. Some-
times, even with all our efforts, we can’t
detect the cancer cells. However, we can’t
let the patient succumb to cancer when our
experience strongly suggests it’s there.
Imagine a room designed for 300 people, Dr. G. K. Rath receives TechAgappe 40th edition from Ms. Rhema Elizabeth
but 3,000 are crammed inside—it’s chaos. Thomas, Director - AGAPPE at a function held at India Habitat Centre, Delhi.
Similarly, when cancer is small, the cells
are easier to identify, but as the tumor grows, some cells die, making detection chemotherapy used to cause severe vom-
harder. In such cases, we must make clini- iting, but today, new and advanced medi-
cal decisions along with other specialists in cations have greatly reduced this side ef-
a combined tumor board and seek the fect. However, there are still challenges
patient’s & relation’s consent to proceed. to address, like hair loss during treatment.
The most rewarding The most rewarding part of my work is
While it’s not permanent—most patients
part of my work is seeing seeing patients survive. We use radiation
regrow their hair within six months after
treatment—it’s something we’re working
patients survive. for head and neck cancers, breast can-
cer, lung cancer, and many more. Now a
to overcome.
Nothing compares to that days, most cancers are treated using a Another promising area is CAR T cell
combination of treatments—surgical, therapy, which is currently quite expen-
sense of satisfaction. med ical, and rad iation—known as sive. However, I believe that with time, the
Radiation therapy, multimodal treatment. This approach has costs will decrease, making this advanced
treatment more accessible to patients.
improved outcomes for many patients.”
which is nuclear The future of radiation oncology lies in
TA: What innovative advancements and
medicine, is commonly developments do you envision for the fu-
improving outcomes with fewer side ef-
fects.”
used in thyroid cancer ture of radiation oncology and improve
patient outcomes?
Dr. Rath’s unwavering dedication to ad-
treatment. Interestingly, Dr. Rath: “Our primary goal as doctors
vancing cancer care and his optimistic vi-
sion for the future offer hope to count-
we’ve observed a higher is to Cure & improve the quality of life for less patients. His commitment to improv-
number of thyroid cancer patients. We’re focused on reducing the
side effects of treatments by minimizing
ing treatments while reducing side effects
continues to inspire the next generation
cases in Kerala. the number of drugs used. For example, of oncologists.

26 TECHAGAPPE OCTOBER-DECEMBER 2024

AGAPPE Branding

Precision in
Every Lab
Savings in
Every Test Throughput
up to

120 T/H

FREEDOM
FROM
MANUAL
WORK

Fully Automated Biochemistry Analyzer

Ease of Operation : All in One Touchscreen PC

Perform each Test in New Cuvette : Ensure CV < 1%
Eco Friendly Equipment : Water Consumption only of 1.8L/Hr
Intelligent QC Management : QC rules as per NABL/NABH Requirements
Compact System : Requires Very Less Space

1800 425 7151 / 1800 891 7251/ 1800 270 7151 +91 9745794444

“Agappe Hills”, Pattimattom (PO), Dist. Ernakulam, Kerala - 683 562, India.
TEL: + 91 484 2867000 | agappe@agappe.in | www.agappe.com

TECHAGAPPE OCTOBER-DECEMBER 2024 27

 IVD Biochemical Tests

AUTOMATING
THE HEMATOPATHOLOGY
MEDICAL LABORATORY
The evolution of hematology equipment has revolutionized blood
diagnostics, transforming routine lab tests into powerful tools for
precise disease detection. From basic 3-part analyzers to advanced
6-part systems, these technological advancements have drastically
Bintu Lijo improved speed, accuracy, and detail in blood analysis. This journey
Sr. Manager-Customer Technical through cutting-edge innovations offers an exciting glimpse into how
Support, Agappe Diagnostics Ltd.
hematology continues to shape modern medicine, promising even
more groundbreaking breakthroughs in healthcare diagnostics.
Hematopathology, or hematology, fo- lowing for faster, more accurate, and de- blood tests in clinical settings, allowing labo-
cuses on the study of blood cells—WBC, tailed blood analysis. Starting from the early ratories to process blood samples quickly
RBCs& platelets-and the tissues that make 3-part differential systems to today’s so- and efficiently.
up the hematopoietic system. This medi- phisticated 6-part analyzers, each techno-
cal specialty plays a crucial role in diagnos- logical advancement has paved the way for Key Features of 3-Part Analyzers:
ing diseases that affect the blood and bone more efficient diagnostics.  WBC Classification: The analyzer breaks
marrow, such as leukaemia, anemia, and down WBCs into three categories—lympho-
clotting disorders. Hemato pathologists A. The 3-Part Differential
cytes, mid-cells, and granulocytes.
routinely review biopsies of lymph nodes, Analyzer: A Foundation for
bone marrows, and other tissues to iden- Routine Hematology Testing  Use Case: It is ideal for small labs, basic
tify the presence of disease-causing cells. clinical settings, or general health check-
The introduction of the 3-part differential ups where a more detailed WBC breakdown
With the technology, automation plays a
analyzer was a major milestone in the auto- is not necessary.
pivotal role in shaping the future of diag-
nostics. mation of hematology testing. This early in-
novation provided essential data on WBC  Technology: The 3-part analyzer relies on
Over the years, hematology equipment has classification, RBC counts, and platelet impedance technology, which classifies
undergone significant transformations, al- numbers. It laid the foundation for routine cells based on their size.

28 TECHAGAPPE OCTOBER-DECEMBER 2024

Limitations:-Part Analyzers cannot distin-  Advanced Applications: This capabil- grate AI and machine learning to analyse
guish between different types of granulo- ity is especially important in oncology, blood data with unprecedented accuracy.
cytes, which are vital for diagnosing more disorders, and intensive care units, where
 AI-enabled analyzers will have the po-
complex conditions like leukaemia, severe early detection and intervention are critical
tential to predict diseases before symp-
infections, and eosinophilia. While they met to patient outcomes.
toms appear.
the needs of basic medical care for years,
Why It’s Important: The ability to detect
the growing demand for more detailed Next-Generation Flow Cytometry:
immature granulocytes early can be life-
blood analysis led to the development of
saving, particularly in high-risk situations  Future analyzers will use advanced flow
more advanced systems.
such as sepsis, where rapid diagnosis is cytometry techniques to profile blood cells
B. The 5-Part Differential vital for effective treatment. Patients un- in greater detail, providing high-resolution
dergoing chemotherapy or intensive care, imaging of specific cell characteristics.
Analyzer: Greater Detail 6-part analyzer offers clinicians a more de-
 This technology will allow for more per-
for Better Diagnosis tailed and accurate picture of the patient’s
sonalized treatment plans, especially in
immune response. The 6-part analyzer en-
The 5-part differential analyzer represented cancer and autoimmune disease manage-
ables faster, more informed decisions,
a significant leap forward in hematology ment.
which is crucial in saving lives in critical
testing. Unlike the 3-part analyzer, 5-part
care situations. Integration with Genomics and
analyzer offers a much more detailed break-
Proteomics:
down of white blood cells. It divides WBCs
into five distinct types, providing a clearer  Future analyzers will be able to provide
and more comprehensive view of blood cell insights into the genetic and protein makeup
activity. of cells, potentially lead ing to break-
throughs in diagnosing complex diseases
What It Improved:
such as genetic disorders and cancers.
 WBC Classification: The 5-part analyzer
Why Choose the HX Series?
classifies WBCs into five categories—neu-
trophils, lymphocytes, mono cytes, eosi- Among the cutting-edge hematology ana-
nophils, and basophils. lyzers available today, the Mispa HX series
stands out for its advanced 3rd Generation
Why It Mattered: This enhanced level of Technology. The HX series combines
detail allowed physicians to make more pre- Nucleic Acid Fluorescence Staining with Tri-
cise diagnoses, especially in cases involv- Angle Laser Scattering to deliver highly ac-
ing immune responses, infections, allergies, curate results, making it one of the most
and cancers. With the 5-part analyzer, labs innovative tools in hematology diagnostics.
could handle more complex cases such as
autoimmune disorders and allergic reac- Unlike traditional chemical stains, the HX
tions with improved diagnostic accuracy, series uses a specialized fluorescent stain-
especially for complex conditions that re- How It Works: The 6-part analyzer uses a ing solution that directly targets DNA or
quire a deeper understanding of the im- combination of impedance, laser flow RNA within cells. This approach highlights
mune system’s activity. cytometry, and fluorescence to differenti- the nucleic acid concentrations in each cell,
ate blood cells based on their size, com- resulting in a much clearer and stronger
C. The 6-Part Differential plexity, and fluorescence intensity. This fluorescent signal.
Analyzer: Taking Blood Diag- advanced technology ensures greater ac- The HX series offers unmatched precision
nostics to the Next Level curacy and depth in blood profiling, giving in differentiating white blood cells, particu-
clinicians the tools they need to make faster, larly abnormal cells, which is critical for di-
The major innovation in hematology came more precise diagnoses in urgent cases. agnosing complex medical conditions.
with the development of the 6-part differ- Whether you’re dealing with leukaemia, au-
ential analyzer, which can detect immature D. The Future of toimmune disorders, or severe infections,
granulocytes (IGs). Immature granulocytes Hematology: What’s Next? the HX series provides the accuracy and
are typically found in the bone marrow and detail needed to make informed clinical de-
are rarely present in the blood of healthy While the 6-part analyzer represents a sig-
cisions. Its cutting-edge technology ensures
individuals. However, when detected in the nificant step forward in blood diagnostics,
that your laboratory is equipped to handle
blood, they can signal severe infections, the future of hematology is filled with even
even the most complex diagnostic chal-
bone marrow disorders, or early signs of more exciting possibilities. With advance-
lenges, providing faster, more reliable re-
sepsis. ments in artificial intelligence (AI), machine
sults that improve patient care.
learning, and next-generation flow cyto-
What It Added: metry, hematology equipment is set to revo- In summary, the Mispa HX series repre-
 Immature Granulocyte Detection: The lutionize diagnostics even further. sents the future of hematology diagnos-
6-part analyzer can identify immature granu- tics, offering labs a powerful tool that com-
AI and Machine Learning Integration:
locytes, allowing for earlier detection of se- bines precision, speed, and advanced tech-
vere infections or bone marrow conditions.  Future hematology equipment will inte- nology to improve patient outcomes.

TECHAGAPPE OCTOBER-DECEMBER 2024 29

 Article Human Papillomavirus

ELIMINATING CERVICAL CANCER:

A GLOBAL STRATEGY AGAINST
HPV-RELATED CANCERS
A concise summary of the key takeaways from the conversation with
Prof. Dr. Sachin Kolte of VMMC and Safdarjung Hospital, Delhi.

Eliminating cervical cancer is within our reach, thanks to a global

commitment to combat HPV-related cancers. With HPV being a leading
cause of cervical cancer, prevention through vaccination, regular
screening, and early treatment is more crucial than ever. Despite
alarming statistics, the World Health Organization’s strategy aims to
eliminate this disease by 2030, offering hope for a future where cervical
cancer is no longer a threat to women’s health worldwide.
What is HPV and Cervical related cancers can affect both men and the WHO-European Region, 30,000 women
Cancer women, and while vaccination efforts have
improved awareness and prevention, many
die from cervical cancer every year. The
highest rates of cervical cancer incidence
Human papillomavirus (HPV) is one of people remain unvaccinated or unaware of and mortality are in low- and middle-in-
the most common viral infections, and in the risks. The data is alarming, that in 2020, come countries. This reflects major ineq-
recent years, it has become a significant more than 600,000 women were diagnosed uities driven by lack of access to national
health concern due to its link to various with cervical cancer worldwide and about HPV vaccination, cervical screening and
cancers, particularly cervical cancer. HPV- 342,000 women died from the disease. In treatment services and social and eco-
nomic determinants. Cervical cancer can
be cured if diagnosed at an early stage and
treated promptly.
India boasts a population
of 511.4 million women The Global Burden of
Cervical Cancer
aged 15 years and
India boasts a population of 511.4 million
above who run the women aged 15 years and above who run the
danger of developing danger of developing cervical cancer. Based
on current figures, 77348 women die from
cervical cancer. Based cervical cancer and every year 123907 women
on current figures, are diagnosed with the condition.

77348 women die from Recognizing the global burden of HPV-

related cervical cancer, the World Health Or-
cervical cancer and ganization (WHO) has launched a compre-
every year 123907 hensive strategy to eliminate cervical can-
cer as a public health issue by 2030. Their
women are diagnosed plan aims to vaccinate 90% of girls with the
with the condition. HPV vaccine by the age of 15, ensuring wide-
spread protection. Additionally, 70% of
women are to be screened with a high-per-

30 TECHAGAPPE OCTOBER-DECEMBER 2024

 Raising public awareness and improving access
to HPV-related services are essential for preventing
and controlling cervical cancer. Vaccinating
adolescent girls is the most effective long-term
solution to reduce cervical cancer risk. The benefits
of HPV vaccination are immense, especially when
introduced and maintained in national immunization
programs. High vaccination coverage also leads
to herd immunity, which protects unvaccinated
individuals and enhances the community-wide
protective effect.

formance test by the ages of 35 and 45. The skin contact during vaginal, anal, or oral sex. Vaccination between the ages of 9 and
strategy also prioritizes treatment, with a In many cases, the virus clears up on its 14 is a highly effective way to prevent HPV
goal to treat 90% of women with pre-can- own, but in some cases, it can persist and infection and the cancers it can cause. Cur-
cerous conditions and ensure that 90% of cause serious health issues. rently, six HPV vaccines are available glo-
women with invasive cancer receive appro- bally, all of which protect against high-risk
Raising public awareness and improv-
priate care. HPV types 16 and 18, the main culprits be-
ing access to HPV-related services are es- hind most cervical cancers. Despite this,
WHO’s Strategy to sential for preventing and controlling cer- fewer than 25% of low-income countries
vical cancer. Vaccinating adolescent girls is
Eliminate Cervical Cancer the most effective long-term solution to
have integrated the HPV vaccine into their
by 2030 reduce cervical cancer risk. The benefits of
national immunization schedules. A stark
disparity exists, with 95% of adolescent
HPV vaccination are immense, especially
WHO has set forth a comprehensive girls who have received at least one dose of
when introduced and maintained in national the vaccine living in high-income countries.
strategy to eliminate cervical cancer as a
immunization programs. High vaccination
public health threat by 2030. This strategy
focuses on three key goals: widespread HPV
coverage also leads to herd immunity, HPV Screening and
which protects unvaccinated individuals
vaccination, high-performance cervical
and enhances the community-wide protec-
Testing Methods
screening, and effective treatment for pre-
tive effect. Screening for cervical disease starting
cancer and invasive cancer. Central to this
plan is the target of vaccinating 90% of girls at age 30 can effectively detect early signs
with the HPV vaccine by the age of 15, pro- of cervical cancer, and treating these pre-
viding critical protection against the virus. cancerous lesions can significantly reduce

WHO also recommends DNA testing as

Raising public awareness cancer incidence. Cytology-based screen-
ing, such as Pap smears, has proven suc-
the primary method for cervical cancer and improving access to cessful in countries with high coverage,
screening, as it has proven to be more ef- particularly in settings where resources al-
fective than traditional methods like Pap HPV-related services are low for patient follow-up, diagnostic tests
smears or visual inspection with acetic acid essential for preventing and (like colposcopy and pathology), and com-
(VIA). DNA-based HPV testing is highly ac- prehensive disease management.
curate in detecting precancerous changes controlling cervical cancer.
However, in low-and middle-income
and cervical cancer, making it the most re- Vaccinating adolescent girls countries, implementing cytology-based
liable screening option currently available.
is the most effective long- screening programs has been challenging,
often resulting in low coverage rates. In
HPV is over 100 different types, which
can be categorized into two groups: low- term solution to reduce these resource-constrained settings, visual
risk HPV, which can cause genital warts and
minor cellular changes, and high-risk HPV,
cervical cancer risk. The inspection of the cervix with acetic acid
(VIA) followed by immediate treatment (the
which is linked to cervical cancer and other benefits of HPV vaccination “screen and treat” approach) is a feasible
cancers, including oropharyngeal cancer.
Most individuals will contract HPV at some
are immense, especially alternative. However, the quality of VIA de-
pends heavily on the provider’s expertise,
point in their lives, often through skin-to- when introduced. and its sensitivity can vary.

TECHAGAPPE OCTOBER-DECEMBER 2024 31

 Article Human Papillomavirus Group 3: HPV types 6, 11 as not classifi-
able or low risk.
The potential role of HPV testing in cer-
vical cancer screening programs has been
Treating Cervical Cancer: under consideration for several years and
Early Detection Saves Lives is felt to be promising for women with atypi-
cal squamous cells of undetermined sig-
Timely d iagnosis and referral for The potential role of nificance.
women with suspected or confirmed cer-
vical cancer are essential for saving lives
HPV testing in cervical “In India we have less tests compared
and preventing disability. Managing inva- cancer screening programs to the west. We basically do more colpos-
copy and acetic acid test, biopsy and pap
sive cervical cancer requires access to well-
equipped health facilities with qualified pro-
has been under smear to detect HPV. PCR based HPV test-
viders and the availability of pathology, consideration for several ing methods are now preferred, and Hy-
brid Capture Assay (HCA) is one of the most
medical imaging, surgery, radiotherapy,
and chemotherapy.
years and is felt to be widely used technique since 2001. HCA uses

Early-stage cervical cancer is highly

promising for women signal amplification techniques. Signal am-
plification is an alternative to enzymatic
treatable with surgery and/or radiotherapy, with atypical squamous amplification that amplifies and detects the
offering a five-year survival rate of over 80%
in countries with timely diagnosis and qual- cells of undetermined signal generated by an external probe mol-
ecule that binds to the target nucleic acid.
ity care. The WHO recommends surgery significance. The signal produced is directly propor-
and radiotherapy, with or without chemo-
therapy, as cost-effective treatments for The International Agency for Research tional to the amount of target present in
early-stage cervical cancer. Even locally on Cancer (IARC) classifies human papillo- the reaction mix, and therefore this method
advanced cases can be cured with high- mavirus types into four groups based on is also suitable for developing quantitative
quality concurrent chemoradiation. their risk of causing cancer. assays. The sensitivity and specificity are
determined by the design of the probe
HPV-associated tumours include vulvar  Group 1: HPV types 16 and 18 as carcino- molecule that recognises the target se-
cancer, penile cancer, genital warts, oropha- genic to humans and other types include quences,” said Dr Sachin Kolte, Professor,
ryngeal cancer, cervical cancer, and anal 31,33,39,45,51,52,56,58,59 Department of Pathology, VMMC &
cancer. Although not all cases of these can- Safdarjung Hospital, New Delhi. “It is a quali-
Group 2A: HPV type 68 as probably car-
cers are caused by HPV-factors such as tative detection and detects 5 low risk and
cinogenic to humans
smoking, genetics, and environmental ex- 13 high risk type. HCA can distinguish be-
posures also play a role-vaccination and Group 2B: HPV types 26,30,34,53,66,67, tween high risk and low risk but genotyping
screening can significantly reduce the risk 70,73,82,85,97 as possibly carcinogenic to of HPV cannot be done,” added him.
of HPV-related cancers. humans
Another testing method is Cervista HPV
HR which was approved by FDA in 2009.
“The Cervista HPV HR test is an in vitro di-
agnostic test for the qualitative detection
of DNA from 14 high-risk HPV types (16, 18,
31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68)
in cervical specimens. However, the
Cervista HPV HR test cannot determine the
specific HPV type present.
The Cervista HPV HR test uses the In-
vader technology, a signal amplification
method for detection of specific nucleic acid
sequences. This method uses two types of
isothermal reactions: a primary reaction
that occurs on the targeted DNA sequence
and a secondary reaction that produces a
fluorescent signal. However, it has the dis-
advantages of cross reactivity of probe with
untargeted HPV type and the lack of inter-
nal control,” saids Dr Kolte.
The BD Onclarity HPV Assay, FDA-ap-
Dr. Sachin Kolte receives TechAgappe 40th edition from Mr. Saji Daniel Mathew, proved in 2018, uses RT-PCR to amplify
Vice President - Institutional Business, AGAPPE. DNA, targeting the E6/E7 region of the HPV

32 TECHAGAPPE OCTOBER-DECEMBER 2024

 ENHANCING LIVES WITH ADVANCED DIAGNOSTICS
AED HOSPITAL'S JOURNEY WITH AGAPPE DIAGNOSTICS
A ED Hospital, the first Endocrine design, coupled with its cost-efficiency,
Treatment and Research Center in makes it an invaluable asset to our lab.
Kukatpally, Hyderabad, commenced its The Mispa i180, with its automated
journey in April 2010 with a vision to chemiluminescence immunoassay
enhance the quality of life for patients system, has consistently delivered de-
with hormonal disorders. pendable outcomes. Its performance,
Our primary focus has been on edu- quick reporting, and ease of use make
cating people about the adverse effects it suitable for a wide range of medical
of a sedentary lifestyle and motivating laboratory applications.
them to adopt a healthy lifestyle with a We are immensely satisfied with
nutritious diet. Our success is rooted the performance and quality of these
in our dedication to prescribing the cor- products. After extensive use of our
rect hormonal dosages, a practice that initial semi-auto biochemistry analyzer,
has earned us appreciation and trust Dr. Ravi Muppidi we donated it to a friend in the labora-
from numerous patients. tory industry, where it continues to
In the same year of our inception, liability, and superior calibration stability. perform exceptionally well without re-
we began our association with Agappe Its design and functionality perfectly meet quiring major servicing.
Diagnostics. Starting with a Semi Auto the needs of our entry-level to medium- Our strong association with
Biochemistry Analyzer, we soon up- volume lab. The reagent and sample tray, Agappe Diagnostics is also due to their
graded to the Mispa Nano Plus fully with its 24-hour cooling system, ensures timely availability of reagents and ex-
auto biochemistry analyzer. Today, our optimal performance and efficiency. This cellent service quality. We rely heavily
laboratory is equipped with the Mispa advanced benchtop equipment has signifi- on their products, and their support
Nano Plus Fully Auto Clinical Chemis- cantly improved our lab’s operational ca- has been a cornerstone of our success.
try Analyzer, BC 5140 Cell Counter, and pabilities. I, Dr. Ravi Muppidi, am very happy
Mispa i180 CLIA Analyzer. The BC-5140 has been particularly ben- with Agappe Diagnostics and their prod-
The Mispa Nano Plus is an outstand- eficial for our diagnostic needs, providing ucts. Their commitment to quality and
ing piece of equipment, offering high accurate CBC and 5-part white cell differ- service has been instrumental in AED
throughput, grating photometry for re- ential results. Its compact and user-friendly Hospital’s development and success.

genome, rather than the L1 region, which is that the test can be done with a low vol- The Global Impact of Pre-
can be detected during HPV integration. This ume (1 ml) of sample.
automated test detects 14 high-risk HPV
venting Cervical Cancer
types, including individual identification of The automated system is designed to WHO estimates that by 2045, the global
types 16, 18, 31, 45, 51, and 52, while group- provide high output. The limitation is that cervical cancer incidence rate could drop
ing the remaining 8 high-risk genotypes. it does not determine the type of HPV,” by 42%, and by 97% by 2120, preventing over
says Dr Kolte. The Roche Cobas HPV test, 74 million new cases. Additionally, 62 mil-
Designed to reduce false positives by lion deaths could be averted by 2120 if pre-
FDA-approved in 2011 (Thin Prep) and 2016
avoiding cross-reactivity with low-risk vention programs succeed. These out-
(SurePath), detects HPV 16 and 18 indi-
types, the test is not suitable for pregnant comes depend on integrating cervical can-
vidually, along with a pooled result for
women or those with prior excisional or cer prevention into healthcare systems,
other high-risk genotypes from a single
ablative surgeries. False negatives can oc- focusing on vaccination, screening, and
sample. Using PCR amplification and
cur with samples containing mucin, treatment, with primary care serving as the
nucleic acid hybridization, it identifies 14
acyclovir, or clindamycin cream. key entry point for timely interventions.
high-risk HPV types.
APTIMA HPV testing method which Cervical cancer prevention must be in-
uses target amplification was approved by The test has a large capacity, process- tegrated into national health systems to
FDA in 2012. It can detect E6/E7 mRNA tran- ing up to 280 samples per day with auto- ensure widespread access to vaccination,
scripts of 14 HR HPV and is more specific mated quality controls. However, it is rela- screening, and treatment. This holistic ap-
and be a better cancer risk predictor than tively expensive, has low specificity, and proach addresses inequities and supports
the HPV-DNA test. “The first FDA approved may show positive results in regressive long-term public health goals. Primary care
test for HPV, Aptima HPV assay maximises lesions. Despite these limitations, it re- is key in promoting HPV vaccination, early
the benefits of screening while minimising mains a widely used and validated method detection, and timely referrals, crucial for
the potential harm. The greatest advantage for HPV detection. effective cervical cancer prevention.

TECHAGAPPE OCTOBER-DECEMBER 2024 33

 Interview Dr. Sunil Kumar
TRANSFORMING PET CARE

DR. SUNIL KUMAR’S JOURNEY AND INSIGHTS INTO

MODERN VETERINARY
SCIENCE...
This interview with Dr. S. Sunil Kumar, founder of Felican Pet Hospital, offers deep insights into
the evolution of veterinary care in Kerala. Dr. Sunil shares his journey of establishing Felican, the
challenges and advancements in pet healthcare, the importance of responsible pet ownership,
and the role of vaccination and nutrition in pet well-being. He also reflects on his experience
with Agappe, highlighting their contributions to the growing field of veterinary diagnostics.
Nestled in the vibrant town of Tripunithura, wide range of services including a clinical labo- tors are always available to handle urgent
Kochi, Felican Pet Hospital stands as a bea- ratory, grooming centre, pet shop, in-patient cases, from critical injuries to life-threat-
con of love, care, and dedication to our facility, and boarding services – making it a ening illnesses. This, coupled with their pet
furry companions. Established in 2011 by one-stop solution for pet owners. ambulance facility, underscores Felican’s
the esteemed Dr. S Sunil Kumar, who What sets Felican apart is its unwaver- mission to be there for pets at every step of
boasts more than two decades of experi- ing commitment to providing round-the- their journey.
ence in veterinary and animal sciences, clock care, with 9 qualified doctors and 38 Dr. Sunil Kumar’s illustrious career be-
Felican has grown into Kerala’s premier ded icated staff members across its gan at the Department of Animal Husbandry,
destination for all pet care needs. Dr. Tripunithura and Muvattupuzha branches. Government of Kerala, and he further en-
Kumar’s passion for animals shines through The hospital is equipped with a 24x7 emer- riched his expertise through training in wild-
every aspect of this hospital, which offers a gency service, ensuring at least two doc- life management at the Smithsonian Insti-

34 TECHAGAPPE OCTOBER-DECEMBER 2024

tution, Washington D.C. Renowned for his Pets have transformed into family
skills in treating large wild animals, includ- members, and it’s this deep bond that in-
ing elephants, Dr. Kumar brings a unique spired us to create a hospital that truly ca-
blend of experience and compassion to his ters to their every need. Felican is the real-
work. His dedication extends beyond his Dr. Sunil reflects on the ization of that dream.”
practice, as he has authored two insightful
books on pets, “Naikkalude Lokam” (The
remarkable evolution in pet TA: How do you look upon the changes
World of Dogs) and “Arumakalude Lokam” diagnosis with a blend of that have happened in the d iagnosis of
pet animals?
(The World of Pets).
nostalgia and excitement. Dr. Sunil reflects on the remarkable
Felican Pet Hospital is more than just a
healthcare facility; it’s a nurturing sanctu-
“In the past, diagnosing evolution in pet diagnosis with a blend of
ary where pets are treated like family, with pets was a challenge nostalgia and excitement. “In the past, di-
agnosing pets was a challenge due to lim-
warmth, expertise, and the highest stan-
dard of care. Excerpts from the interview. due to limited tools and ited tools and technology,” he shares. “For
example, conditions like diabetes in pets
TA: What motivated you to start Felican technology,” he shares. were hardly ever identified, often contrib-
Pet Hospital in Kochi? uting to unexplained deaths.”
Dr Sunil: “When I graduated from the mals. Many pet owners faced the distress- Today, much of the machinery used for
College of Veterinary and Animal Sciences, ing challenge of traveling all the way to pet d iagnosis mirrors human med ical
Mannuthy, in 1989, the veterinary field in Bengaluru or Chennai for specialized treat- tools, making breakthroughs in biochem-
Kerala was vastly different. Back then, the ments. Recognizing this gap and sensing istry, hematology, and serology invaluable
primary focus was on livestock, as the an opportunity to make a difference, I envi- for accurate disease identification. How-
state’s priority cantered around meeting sioned a place where all pet care needs could ever, Dr. Sunil acknowledges a downside:
the demands for milk, eggs, and meat. Vet- be addressed under one roof. “We’ve become quite dependent on ma-
erinary doctors were almost entirely dedi- chines, which, in a way, has reduced op-
This vision led to the establishment of
cated to the care of large animals, and the portunities for developing hands-on vet-
Felican Pet Hospital in Kochi in 2011, fol-
idea of specialized pet care was nearly un- erinary skills. Nowadays, treatments often
lowed by a daycare facility in Muvattupuzha.
heard of. However, over the next two de- don’t begin until lab results are in.”
At Felican, we pride ourselves on being a
cades, a significant shift began to unfold
one-stop destination for pets, offering ev- Yet, he’s optimistic about the advances
As lifestyles evolved, especially with the erything from basic care to complex treat- in dry chemistry, noting, “It made things
rise of Gen Z and changing family dynam- ments. Our veterinary nurses, trained in- incredibly convenient, with results ready
ics, small pets started becoming integral to house with hands-on experience, embody in just 10-15 minutes, compared to the
our homes. Social media and modern in- our ethos of compassion and expertise. longer, costlier biochemistry tests.” Dr.
fluences played a huge role in this transi- We’ve built a 24-hour facility equipped to Sunil eagerly anticipates the introduction
tion, turning pets into beloved companions handle emergencies such as snake bites, of pocket PCR machines in India. Inspired
rather than mere watchdogs. Despite this automobile accidents, and poisoning cases, by what he saw in Singapore, he describes
growing trend, Kerala lacked the facilities with advanced surgical options like chemo- how these devices, with their user-friendly
and expertise to cater to these small ani- therapy and oncology. interfaces and ready-to-use cartridges,

RELATIONSHIP WITH AGAPPE DIAGNOSTICS LTD.

“I was among the first custom- He adds, “One improvement
ers to experience Mispa Ace by I’d love to see from Agappe Di-
Agappe and their dry chemis- agnostics is the introduction of
try analyzers. I must say, a Projector-in-assay. Nonethe-
Agappe has truly established less, the hormone-less test has
itself in the field of dry chemis- been extremely beneficial.” Dr.
try,” Dr. Sunil reflects. “The Sunil appreciates Agappe’s
auto dry chemistry analyzer timely delivery of reagents and
offers a great advantage, pro- service support, expressing,
viding comprehensive results “I’m genuinely satisfied with
with just one sample. For in- their promptness.” Yes, Dr.
stance, with the Mispa Sunil’s experience reflects the
ChemDX, we can access com- growing importance of ad-
plete profiles like liver and kid- vanced diagnostics in veterinary
ney with ease, making it incred- care, showcasing Agappe’s role
ibly convenient for us.” in this evolving journey.

TECHAGAPPE OCTOBER-DECEMBER 2024 35

 Interview Dr. Sunil Kumar and regular grooming, especially for hairy
breeds. “If you can’t commit to these as-
pects, it’s best not to get a pet,” he advises
thoughtfully.
could revolutionize workflows. “Imagine, a and loyalty regardless of life’s ups and Interestingly, Dr. Sunil notes a shift in
simple, efficient process where you get re- downs, but this also means that respon- pet preferences, with the cat population on
sults in less than 90 minutes,” he says with sible pet ownership is crucial. “Unfortu- the rise in Kerala. “Cats have become more
enthusiasm. nately, we’ve seen instances in the news popular than dogs in some households,
where people abandon their pets as they partly due to certain religious beliefs that
Dr. Sunil’s vision paints a picture of a age or develop health problems. This is
future, where technology and veterinary discourage keeping dogs. Meanwhile, pet
heartbreaking and highlights the need for birds are gaining popularity among
care blend seamlessly, enhancing the abil- understanding what it means to be a com-
ity to provide timely, effective treatments Millennials and Gen Z as well,” he adds, re-
mitted pet owner.” flecting on how pet trends evolve with chang-
for pets.
For those considering a dog, Dr. Sunil ing lifestyles and preferences.
TA: What are the common diseases advises first asking, “Do I truly need a dog,
you get to see on pets now? What are the TA: How important is vaccination for
and can I care for it properly?” If the an- pets?
recent advancements in various depart- swer is yes, the next step is selecting the
ments in veterinary science? right breed. “It’s essential to discuss this Dr. Sunil stresses the crucial role of vac-
Dr. Sunil shares insights into the rising decision with all family members,” he cination in keeping pets healthy. “Canine
health challenges faced by pets today. “Tick stresses. “In Kerala, we’ve noticed a trend Distemper and Canine Parvovirus are two
fever has become a common struggle for where teenagers often choose a dog with of the most dangerous viral diseases for
pet owners, and cases of kidney and liver their parents’ consent, but later, as they dogs in Kerala, often leading to death,” he
explains. “Unfortunately, there’s no cure
once a pet contracts these diseases, but
vaccinations can effectively prevent them.”
For puppies, vaccinations should be given
in the 6th, 9th, and 12th weeks to ensure
protection.
Vaccination is also essential for pre-
venting zoonotic d iseases, which can
spread between animals and humans. “Ra-
bies, for example, is a serious concern and
requires a vaccine in the 12th week and then
annually,” he advises. Another zoonotic
disease, Leptospirosis, has seen a rise in
cases among dogs, posing a risk to humans.
Dr. Sunil emphasizes that as veterinary
doctors, they play a vital role in protecting
humans from such diseases.
TA: Saying goodbye to your dog
Dr Sunil: “Euthanasia is a part of treat-
ment in veterinary science. We call it ‘put to
sleep’. Cases such as full paralysis,
failure in dogs are increasingly frequent,” leave for education or work, the responsi-
untreatable bed sores, bone cancer etc. are
he notes, attributing part of the issue to the bility falls on their parents. If it’s a larger
often taken for it. If the treatment doesn’t
widespread use of commercial pet foods breed like a Golden Retriever or Labrador,
work the only thing we could do is to end
made with sub-standard ingredients. Skin older parents may struggle with their care,
their suffering. We do it for pets after get-
diseases are also on the rise, adding to the especially if they’re not prepared for the
ting the consent from the owners.
list of concerns. physical demands.”
Funeral of animals especially in cities
TA: As a veterinary doctor, what are your Dr. Sunil also points out that space
are problematic especially those who re-
tips on selecting a pet? matters. “If you have a small house, own-
side in the flats. A crematorium for ani-
ing a large dog breed can be challenging.
Dr. Sunil emphasizes that choosing a mals is a requirement in every city. Cur-
They need room to move, exercise, and
pet is a significant commitment that re- rently we inform the municipality and they
thrive, and without adequate space, their
quires thoughtful consideration. “When take the deceased body of the pet for burial.
well-being can be compromised.”
selecting a pet, especially a dog, it’s impor- In Singapore, they have animal cremation
tant to realize that it’s a long-term ‘con- Beyond choosing the breed, responsible services which provides the ashes of the
tract’ – potentially lasting up to 15 years,” pet care involves ensuring timely vaccina- pet after cremating it. We need such kind of
he explains. Dogs offer unconditional love tions, obtaining the mandatory pet license, services in our cities too.”

36 TECHAGAPPE OCTOBER-DECEMBER 2024

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TECHAGAPPE OCTOBER-DECEMBER 2024 37

 Article Dr. Sudip K. Datta

CODE OF ETHICS &

ITS RELEVANCE IN
LABORATORY
MEDICINE
Currently diagnosis and management of patients in Clinical Practice
is very much dependent on laboratory diagnostics. Laboratory
Medicine, like any other branch of Medicine, is therefore, mandated
with ethical usage of materials and data obtained from patients.
Several countries, professional societies and the have developed
policies and guidance materials on ethical issues related to laboratory
medicine. However, ethical standards and practices vary between
different cultures, geographies, legal architecture and according to
available resources. In this article, we try to understand the challenges
presented in terms of Ethics, where there are constraints of
resources.
Dr. Sudip Kumar Datta Like in any branch of medicine, which involves guidelines to professional members of those
Additional Professor and Head taking decisions about the wellbeing of indi- organizations.
Dept. of Lab Medicine, All India vidual patients as well as catering to the overall The International Federation of Biomedi-
Institute of Medical Sciences, well-being of the society through continued cal Laboratory Science advises to maintain
New Delhi. learning through scientific observation and in- strict confidentiality of patient information and
terventions on patients, Laboratory Medicine test results, safeguard the dignity and privacy
is also mandated with ethical usage of patient of patients and above all be accountable for
data and other materials for the optimum uti- the quality and integrity of clinical laboratory
lization of the same for benefit of the individual services being provided.
and the society. “Decisions about diagnosis,
On similar lines the American Society of
prognosis and treatment are frequently based
Clinical Pathologists advise laboratory profes-
on results and interpretations of laboratory
sionals to treat patients and colleagues with
tests. Irreversible harm may be caused by er-
respect, care and thoughtfulness; perform du-
roneous tests.”
ties in an accurate, precise, timely and respon-
A Code of Ethics may be described as an sible manner; and safeguard patient informa-
expression of basic values - the principles and tion as confidential, within the limits of the
standards by which we should conduct our- law. As can be observed from above, most
selves. Numerous laboratory professional or- organizations and code of ethics focus on sev-
ganizations have developed code of ethics, with eral points while prescribing a guideline for
common principles of conduct which act as Laboratory Medicine professionals.

38 TECHAGAPPE OCTOBER-DECEMBER 2024

 There are several areas in Laboratory
Medicine practice where the formulation and
implementation of ethical guidelines present
challenges. These include consent from pa-
tients including consent for unforeseen com-
plications, usage of leftover samples and
biobanking, considerations in genetic testing,
reporting implications in incidental findings,
error disclosure, role of laboratories in test
utilization, direct to consumer testing and
emerging diseases setting.
All of the above considerations relevant
to Laboratory Medicine has been addressed
elegantly in a recent article by Gronowski et
al. In this paper we would focus on the chal-
lenges faced in resource limited settings.
Resource allocation is not uniform all
over the world. Especially in developing Most often the laboratories receive patient samples for
countries, healthcare facilities have to work
with several constraints. These may range testing. In such a setting obtaining consent for such exercise
from inadequate manpower, lack of train- is the responsibility of the treating physician. In the hospital
ing, less availability of latest equipment or
methods, lack of adequate facilities for staff, setting this is often ‘implied’, especially when the patient is
and an ever-increasing load of patients. In admitted and sometimes not in a position to give consent.
these above-mentioned scenarios it is often
difficult to conform to the highest standards
of ethics. In resource limited settings, handling of ing principles of ethical code. When using
left-over samples becomes yet another chal- leftover samples for research, risk can be
I. Consent lenge. Laboratories often facilitate add-on minimized by removing patient identifiers.
tests on these leftover samples to minimise Personal identifiers may be removed and
Most often the laboratories receive pa- turn-around time (TAT). However, the in- replaced with a code i.e. deidentified or
tient samples for testing. In such a setting formed consent process must include pro- anonymized, i.e. identifiable information, if
obtaining consent for such exercise is the visions for the same and abide by the guid- collected, identifiers are not retained and
responsibility of the treating physician. In cannot be retrieved. Biobanking, defined as
the hospital setting this is often ‘implied’, a resource that holds human biological
especially when the patient is admitted and samples and/or data to facilitate research
sometimes not in a position to give consent. over time is also coming up in the develop-
Hence, it is often a practice to take a blanket
consent for such diagnostic tests which do
In resource limited settings, ing countries in recent years, especially in
the settings of emerging and exotic diseases.
not add significant risk to the patient. handling of left-over samples Often these are associated with storage of
However, it is a good practice to take becomes yet another left-over samples in resource constrained
parts of the world.
consents for such diagnostic procedures
which might be adding significant risk to
challenge. Laboratories often
However, the process of informed con-
patient’s life. In resource limited settings facilitate add-on tests on sent should abide by the general principles
which includes lack of manpower and time,
the ideas of beneficence and non-malefi-
these leftover samples to of ethics. In normal circumstances mostly
two options are explored for such initiatives
cence should prevail. More importantly, in minimise TAT. However, the regarding consent: (i) recontacting patients
certain parts of the world, literacy and lan-
guage issues may be a significant problem. informed consent process and get consent for each new research study,
which is logistically difficult, time-consum-
Hence, implementation of a uniform ethics must include provisions for ing, and expensive, and hence often practi-
code presents a challenge.
the same and abide by the cally not feasible in resource constrained
settings; or (ii) allow patients to give a broad
The problem sometimes escalates due
to some unforeseen complications arising guiding principles of ethical consent that allows for future use of the
out of some diagnostic procedures and
must be accounted for in the informed con-
code. When using leftover samples. However, the more general the
consent becomes, the less informed it gets.
sent process. The Laboratory, thus, should samples for research, risk II. Genetic testing
be able to always abide by the ethical prin-
ciples of respect for persons, beneficence,
can be minimized by In principle, the ‘right to autonomy’
even on a case to case basis. removing patient identifiers. should allow people to decide whether ge-

TECHAGAPPE OCTOBER-DECEMBER 2024 39

 Article Dr. Sudip K. Datta
The emergence of COVID-
netic testing is to be performed or not. How- 19 and some other novel
ever, different governments have different
policies regarding ‘newborn screening’,
diseases in recent years
which is performed automatically, without have presented a new
physician orders. Once a disease or risk for
disease is detected, patients and physicians challenge to ethical
face a dilemma whether to disclose the re- principles. A lot of
sults of the tests to other family members
who we now know to have increased risk. questions have come up
This may help individuals and the society as
a whole device better preventive and thera-
in these unusual
peutic strategies and hence the principle of circumstances like how
beneficence overrides the individual’s right
to autonomy. If the disease detected are
the decisions are taken to
treatable, the benefit to the public outweighs ascertain which risks
the autonomy of the individual.
are acceptable for
III. Incidental findings laboratory workers.
These are results that have potential
health or reproductive importance and are
unintentionally discovered while process- most important amongst them is the fear of leagues also act as a barrier of appropriate
ing for other tests. Incidental findings may retribution from their colleagues, peers, su- error disclosure. Hence, appropriate mecha-
be carefully evaluated of the benefits against pervisors, treating physicians and above nisms for error disclosure and mechanisms
the potential risks and may involve evaluat- all their patients. Sometimes there is inad- to protect the lab professional may increase
ing the result’s accuracy, significance to equate understanding of the consequences the effectivity of error disclosure.
health, and clinical actionability. In the re- of the error leads to the belief that eventual
source limited settings in developing coun- outcome would have been the same. The V. Test utilization
tries, it often has other ramifications like cost fear of being penalised because of disclo-
of treatment and potential benefit of such One of the major problems in resource
sure is another barrier hence often people
treatment. Moreover, societal benefits must limited settings is inappropriate test utiliza-
risk being caught. Fear of improperly con-
also be considered simultaneously before tion. In developing countries like India
veyed error disclosure by physician col-
ruling in favour of patient’s autonomy. healthcare system is run parallelly through
government and private mechanisms. In the
IV. Error disclosure private setting patients generally pay from
out of their pocket to meet the expenses
Disclosure of errors in Laboratory Medi-
cine setting comes with unique challenges
One of the major problems incurred during their treatment etc. Only a
related to error reporting because the labo- in resource limited small percentage of patients are covered
under insurances. On the other hand, in the
ratories usually have no relationship with
the affected patient. Hence the disclosure
settings is inappropriate government facilities the services are either
has to happen through the treating counter- test utilization. In developing free or at a subsidized rate.
parts. Several barriers to disclosing error However, the waiting periods in those
exist viz. unclear definitions of error, fear
countries like India systems are long and often the ancillary fa-
that patients may not understand the error, healthcare system is cilities are inadequate, hence not preferred
worry that clinicians may not be able to prop- by people who can afford. Hence, inappro-
erly explain the error, and disclosure of er- run parallelly through priate test utilization is a problem in both
ror that was actually committed by some- government and private the scenario: in the private setup unethical
one else. The process of disclosing medical practices for profiteering might be discour-
errors is gradually becoming formalized into mechanisms. In the private aged by the labs; in government set up in-
the health care process. setting patients generally appropriate test utilization should be dis-
couraged as it leads to misutilisation of
Clinical laboratories should have poli-
cies and procedures for detecting errors that
pay from out of their public money.
affect patient care and for informing both pocket to meet the Laboratorians should advocate for
providers and patients. But several appre-
hensions exist among professionals inhib-
expenses incurred during proper test utilization and communicate
with physicians when they feel testing has
iting them to participate in the process. The their treatment etc. been ordered inappropriately. Inappropri-

40 TECHAGAPPE OCTOBER-DECEMBER 2024

ate laboratory testing can potentially lead tect other patients? But most importantly in
also to false positive results that can lead to resource limited settings where there is
unnecessary testing and intervention or shortage of appropriate personal protective
even misdiagnosis, and increased costs for equipment (PPE) creating awareness among
the pa tient and society as a whole. DTC laboratory testing lab staff about the level of PPE required for
A lot of factors lead to poor test utiliza- is growing rapidly all each lab activity. Importantly, there should
be initiatives to spread awareness among
tion: large and growing number of tests, lack over the world along staff to mitigate their apprehensions.
of proper physician training, difficult to use
direct order entry and electronic medical with the developing world. On the other hand, laboratories should
record systems, and demand from patients
themselves as exposure to internet infor-
DTC allows consumers ensure access to laboratory testing for all
patients who require testing. However, the
mation leads patients to demand certain to order their own laboratory low capacity of resource limited settings in
tests.
tests providing greater analysing samples through appropriate test-
ing methods often leads to unethical prac-
VI. Direct-to-Consumer autonomy in some cases, tices. However, development of a policy in
(DTC) testing is more accessible than sync with legal requirements and local needs
often addresses the issue.
DTC laboratory testing is growing rap-
idly all over the world along with the devel-
going through standard Overcoming Challenges
oping world. DTC allows consumers to or- healthcare providers and Overcoming the above-mentioned chal-
der their own laboratory tests providing
greater autonomy in some cases, is more
may be less expensive. lenges in Laboratory Medicine in resource
accessible than going through standard limited settings is difficult, but not impos-
healthcare providers and may be less ex- sible. The most important step to ensuring
pensive, which is also a source of justice for VII. Emerging disease ethical standards and practices in the labo-
ratory must be recognised as a shared re-
patients with limited financial means. How-
ever, it has several limitations; consumers
setting sponsibility between all the laboratory staff.
are less likely to properly interpret their own The emergence of COVID-19 and some It is important that the roles of each of them
laboratory tests and may find erroneous in- other novel diseases in recent years have are defined and all are made to understand
formation without expert guidance. This presented a new challenge to ethical prin- the accountability associated with their jobs.
becomes even more evident in low-preva- ciples. A lot of questions have come up in This would be possible through repeated
lence disease which increases the chances these unusual circumstances like how the training of the staff at all levels.
for false positive results. Hence, although
not directly under the purview of the labo-
decisions are taken to ascertain which risks
are acceptable for laboratory workers. Who
Conclusion
ratories ethically laboratories are bound to decides what risks to patients are accept- It can be well appreciated that ensuring
provide support to their customers. able to protect laboratory workers or to pro- adherence to ethical standards is a challenge
in the resource limited settings.
The challenges vary from place
to place and the solutions need
Disclosure of errors in to be tailored to practical situa-
Laboratory Medicine tions. Addressing these issues
in the form of policy at the level
setting comes with of the country, local administra-
tion or even at the hospital/labo-
unique challenges ratory level may help in provid-
related to error ing a guideline improving ethical
practices.
reporting because the Framework for addressing
laboratories usually ethical issues encountered in the
have no relationship practice of laboratory medicine
need to be addressed and train-
with the affected ing of staff in this regard needs
patient. Hence the to be undertaken to ensure
compliance to ethical require-
disclosure has to ments. We must constantly re-
mind ourselves of the code of
happen through the conducts and ensure we do the
treating counterparts. This article includes excerpts from a previously published eJIFCC
article, reproduced in TechAgappe with permission from the author
right thing because ethical issues
and publisher; scan the QR code to read the original eJIFCC article.
are often hard to deal with be-
cause they create dilemmas.

TECHAGAPPE OCTOBER-DECEMBER 2024 41

 Article Dr. Harpreet Walia

THE ROLE OF HISTOPATHOLOGY & HISTOPATHOLOGIST IN

CANCER DIAGNOSIS
AND TREATMENT
Histopathology, the study of tissue changes caused by disease, is
a critical component of cancer diagnosis and treatment. As cancer
Dr. Harpreet Walia, continues to be a leading cause of mortality worldwide, accurate
MBBS, DNB (Pathology), and timely diagnosis is essential for effective patient management.
MNAMS, MHA.
Head-Department of Pathology,
This article explores the role of histopathology & histopathologists
Sohana Multi Super-Speciality in cancer diagnosis, the techniques involved, contributions to
Hospital, Mohali. treatment decisions, and the future directions of the field.

Understanding thology in oncology are to confirm the pres-

Histopathology ence of cancer, determine the type and grade
of the tumor, and assess its stage. This infor-
Histopathology involves examining tissues mation is vital for establishing a prognosis and
under a microscope to identify abnormalities guiding treatment options. Its significance can
in cellular structure and organization. Histo- be summarized in several key areas:
pathologists, the specialists who practice his-
1. Accurate Diagnosis
topathology, analyze biopsy samples obtained
from patients. The primary goals of histopa- I firmly believe that “Right treatment starts
with the right diagnosis”. Histopathology pro-
vides with the definite evidence of the disease,
confirming the presence and type of cancer.
Histopathology This accuracy is essential for appropriate pa-
serves as a quality tient management and treatment planning.
control measure in 2. Tumor Classification

oncology, ensuring The tumors are classified into specific

types and subtypes, which is vital for deter-
that diagnoses are mining the most effective treatment strate-
accurate and gies. Different cancers have unique biological
behaviors and responses to therapy.
consistent, which is 3. Grading and Staging
vital for patient Histopathological analysis allows for the
safety and effective grading of tumors based on their aggressive-
treatment. ness and staging based on their extent of
spread. This information is critical for prog-
nosis and helps guide treatment decisions.
4. Immunohistochemistry (IHC) & Molecu-
lar Profiling
Advancements in histopathology, includ-
ing immunohistochemistry and molecular

42 TECHAGAPPE OCTOBER-DECEMBER 2024

techniques, enable the identification of spe-
cific biomarkers. This facilitates personal-
ized medicine, allowing treatments to be
tailored to individual patients based on their
tumor characteristics.
5. Monitoring Treatment Response Histopathology
Repeat biopsies can be performed to informs the
assess changes in tumor characteristics
during treatment. This monitoring helps
extent of surgical
clinicians evaluate the effectiveness of intervention
therapy and make necessary adjustments.
required, ensuring
6. Guiding Surgical Decisions
Histopathology frozen sections inform
that all cancerous
the extent of surgical intervention required, tissue is removed
ensuring that all cancerous tissue is re-
moved while preserving healthy tissue
while preserving
whenever possible. healthy tissue
7. Prognostic Information whenever
Histopathological findings provide im- possible.
portant prognostic indicators, helping pre-
dict patient outcomes and survival rates,
which aids in treatment planning and coun-
selling.
8. Research and Development offers all the benefits offered by a core bi- ded in paraffin wax, allowing for thin slicing.
opsy, In addition, when entire tumor is re-
Histopathology is essential in clinical Sectioning: Using a microtome, the tis-
moved, an excisional biopsy most often
research, contributing to the development sue is cut into thin sections (typically 4-5
becomes a part of treatment approach.
of new therapies and improving our un- micrometers thick) for slide preparation.
derstanding of cancer biology. 2. Tissue Processing 3. Staining
Once collected, tissue samples undergo
Histopathological processing to prepare them for microscopic Staining techniques enhance the visibil-
Techniques examination. This involves: ity of cellular structures under the micro-
scope. The most common stain used in his-
1. Biopsy Collection Fixation: The tissue is preserved in for- topathology is Hematoxylin and Eosin
The first step in histopathology is ob- malin to prevent degradation. (H&E), which provides contrast between cell
taining tissue samples through various bi- Embedding: The fixed tissue is embed- nuclei and cytoplasm. Special stains and
opsy methods. Common techniques in- immunohistochemical techniques may also
clude: be employed to identify specific proteins or
markers associated with certain cancer
Fine-Needle Aspiration Biopsy (FNAB): types.
This minimally invasive procedure uses a
thin needle to extract cells from a suspi- Pathologists examine 4. Microscopic Examination
cious mass, particularly in soft tissue or
lymph nodes. The tissue thus obtained
stained slides under a Pathologists examine stained slides
under a microscope, looking for abnormal
helps in quick diagnosis with fair accuracy. microscope, looking for cellular features such as atypical nuclei,
In addition, flowcytometry can be done or
cell blocks can be prepared which enable
abnormal cellular features nization.
mitotic figures, and architectural disorga-
The findings are then classified
further ancillary studies. such as atypical nuclei, according to established criteria (most
Core Needle Biopsy: This method uses
a slightly larger gauge needle to remove a
mitotic figures, and commonly used are the College of Ameri-
can Pathologists or CAP criteria), aiding in
core of tissue, allowing for more compre- architectural disorganization. diagnosis and establishing the extent of
hensive analysis. The tissue obtained gives
a better view of the tumor tissue which aids
The findings are then cancer.

in better diagnostic accuracy and scope for classified according to Role of Histopathology
ancillary studies.
established criteria aiding in and Histopathologists in
Cancer Diagnosis
 Excisional Biopsy: In this surgical ap-
proach, the entire tumor or a significant
diagnosis and establishing Histopathology is often referred to as
portion of it is removed and examined. It the extent of cancer. the gold standard in cancer diagnosis. The

TECHAGAPPE OCTOBER-DECEMBER 2024 43

 Article Dr. Harpreet Walia and estimate outcomes.
4. Molecular Profiling
Advancements in histopathology have
led to the integration of molecular tech-
histopathologists are pathologists with spe-
niques. Immunohistochemistry (IHC) can
cial interest and expertise in diagnosing tis-
identify specific biomarkers that may guide
sue biopsies. They contribute towards:
1. Confirmation of Cancer
In this era of targeted therapies. For instance, the ex-
pression of PD-L1 can influence the use of
Histopathology provides definitive evi-
“Personalised medicine”, immune checkpoint inhibitors in certain
dence of cancer through the examination of the characterization of cancers.
tumor tissue. Imaging techniques such as
X-rays or MRIs may suggest the presence of tumors through Role in Treatment
a tumor, but only histopathological analysis histopathology allows for Decisions
can confirm whether it is malignant.
2. Tumor Typing
personalized treatment Histopathology is instrumental in guid-
ing treatment decisions for cancer patients:
Identifying the specific type of cancer is
approaches. Each tumor 1. Personalized Medicine
crucial, as treatment protocols can vary sig- carries a personal In this era of “Personalised medicine”,
nificantly between types. For instance,
breast cancer can be classified into vari-
molecular signature. the characterization of tumors through his-
topathology allows for personalized treat-
ous subtypes, including hormone recep- By understanding the ment approaches. Each tumor carries a
tor-positive, HER2-positive, and triple-
negative. Each subtype has distinct biologi- specific molecular and personal molecular signature.
By understanding the specific molecu-
cal behaviors and treatment options. histological features lar and histological features of a tumor,
3. Grad ing and Staging of a tumor, oncologists oncologists can tailor therapies to indi-
vidual patients. For example, the presence
Histopathology helps determine the
grade and stage of cancer, which are vital
can tailor therapies to of certain mutations may indicate eligibil-
for prognosis and treatment planning. individual patients. ity for targeted therapies and hence, better
response to treatment.
Tumor Grade: This indicates how much
the cancer cells differ from normal cells, Tumor Stage: This describes the ex- 2. Monitoring Treatment Response
which correlates with aggressiveness. tent of cancer spread within the body, of- Histopathology can also play a role in
Higher-grade tumors typically indicate a ten using the TNM system (Tumor, Node, assessing treatment response. In some
worse prognosis. Metastasis) as per the CAP criteria. Staging cases, biopsies may be repeated after a
helps clinicians devise treatment strategies period of treatment to evaluate changes in
tumor characteristics. This can
inform clinicians whether to
continue, modify, or change
Histopathology can also treatment strategies.

play a role in assessing 3. Surgical Planning

Histopathological findings
treatment response. In can influence surgical deci-
some cases, biopsies sions, such as the extent of re-
section required. Frozen sec-
may be repeated after a tion is a specialized intraopera-
period of treatment to tive technique in which, if a tu-
mor is found to be more ag-
evaluate changes in gressive or the tumor margins
tumor characteristics. are found positive, a decision
upon a more extensive surgi-
This can inform clinicians cal approach as required may
whether to continue, be taken.

modify, or change 4. Prognostic Assessment

treatment strategies. Histopathology provides

valuable prognostic informa-
tion. Certain histological fea-
tures can indicate likely out-

44 TECHAGAPPE OCTOBER-DECEMBER 2024

comes, helping clinicians and
patients make informed deci-
sions regarding treatment and Histopathologists' job
care planning.
requires sitting for long
Challenges faced by hours while continuously
Histopathology and
Histopatholo gists viewing through the
Despite its critical role, histopa- microscope and at the
thology faces several challenges: computer screen. This
1. Interpretation Variability
might lead to back ache,
Histopathological d iag-
noses can be subjective, with neck pain and eye strain.
variability among pathologists These are tackled by most
in interpreting slides. This un-
derscores the need for stan- pathologists with daily
dardized criteria and ongoing exercise, a healthy routine
education in the field.
2. Limitations in Detection
and following
While histopathology is the 20-20-20 rule
highly sensitive, it is not infal- for eye health.
lible. Some tumors may exhibit
histological features that are
challenging to classify. In such
cases, IHC and molecular pro-
filing can be of immense help.
of whole-slide imaging and artificial intelli- comprehensive cancer profiles. This is help-
3. Access to Expertise gence (AI) for analysis, is revolutionizing ing develop more and more treatment op-
the field. AI algorithms can assist in identi- tions with improvement in our understand-
In some regions, access to qualified
fying patterns. AI-supported histopathol- ing the tumor biology.
pathologists may be limited, hindering
ogy enables more efficient diagnosis by
timely and accurate cancer diagnosis. In 3. Enhanced Training Programs
automatically marking suspicious regions,
addition, pay disparity for the amount of As the complexity of cancer diagnosis
allowing experts to focus on high-priority
expertise required leads to fewer patholo- increases, enhanced training programs for
areas.
gists taking up the role. Efforts to improve pathologists are essential. Continuous edu-
access to pathology services are crucial for 2. Integration of Genomics
cation in new technologies and evolving
better cancer outcomes. The integration of histopathology with treatment paradigms will ensure that pa-
4. Occupational challenges genomic data is paving the way for more thologists keep contributing their best as
partners in cancer care.
Histopathologists job requires long
hours of continuous viewing through a mi- Conclusion
croscope, and at the computer screens.
This leads to excess eye strain and neck Histopathology and Histopathology and histopathologists
play an indispensable role in the diagnosis
pain. In addition, long hours of sitting are
required. These are tackled by most pa-
histopathologists play an and treatment of cancer. From confirming
malignancy and determining tumor type,
thologists by following 20-20-20 rule (after indispensable role in the grade & stage to guiding personalized treat-
every 20 minutes of work, gaze at a dis-
tance of 20 metres away for 20 seconds).
precise diagnosis and ment plans, histopathology is integral to
modern oncology. It’s role in diagnosing,
Daily physical exercise or walking helps treatment of cancer. classifying, and guiding the treatment of can-
counter the deleterious health effects of
long sitting hours. From confirming malignancy cer directly impacts patient care and out-
comes, making it the cornerstone of mod-
Future Directions to determining tumor type ern oncology practice.
The future of histopathology in cancer and grade, histopathology As the field continues to evolve, embrac-
diagnosis and treatment is promising,
driven by technological advancements and
provides critical information ing new technologies and approaches will fur-
ther enhance its impact on cancer care, ulti-
research: guiding tailored treatment mately improving patient outcomes and sur-
1. Digital Pathology plans, making it imperative in vival rates. The future of histopathology is
bright, with vast potential to redefine how we
Digital pathology, which involves the use modern oncology. understand and treat cancer.

TECHAGAPPE OCTOBER-DECEMBER 2024 45

 Story Dr. Biswajit Mohanty

DR. BISWAJIT MOHANTY

A VISIONARY JOURNEY IN
DIAGNOSTIC EXCELLENCE
Dr. Biswajit Mohanty, a pioneering figure
in medical diagnostics in India, has carved
an extraordinary path in his 30+ year ca-
reer, redefining healthcare standards and
quality, in Odisha and beyond. From his
early days as a junior resident to his cur-
rent role as the Managing Director and
Chairman of GenX Diagnostics,
Bhubaneswar, Odisha, Dr. Mohanty’s jour-
ney is marked by unwavering dedication,
cutting-edge innovation, and an unrelent-
ing pursuit of excellence.
With his leadership, GenX Diagnostics
has evolved into a premier diagnostic cen-
tre, showcasing the true potential of com-
bining medical expertise with entrepre-
neurial spirit. This is the story of a man
who transformed challenges into opportu-
nities and set new benchmarks in diagnos-
tic healthcare.
Today they have eight laboratories
across Odisha- three at Bhubaneswar (at
Saheed Nagar, Chandrasekharpur and near
AIIMS Hospital) and others at Jagatsinghpur,
Dhenkanal, Burla, Berhampur and Jeypore
with around 180 staff working in two shifts.
They have 18 doctors including two cardi-
ologists providing service at their labs. “We
are not a technician’s lab. We are a doctor’s
lab,” beams Dr Mohanty proudly.

MC Vellore- shaping the

future
Dr. Biswajit Mohanty, a visionary leader in diagnostics, has
Dr. Mohanty began his medical journey
revolutionized healthcare in Odisha with his journey from CMC with an MBBS degree from VSS Medical
Vellore to founding GenX Diagnostics. Over a 30+ year career, College, Burla, Odisha, in 1985. As a young
he’s established state-of-the-art labs, led Apollo’s NABL doctor, he was selected for the Junior Resi-
dent program at CMC Vellore, where he was
accreditation, and pioneered affordable diagnostics. Today, as appointed to the Department of Cardiol-
Chairman of GenX, he continues to set new benchmarks, offering ogy for nearly eight months. This period
marked a transformative phase in his ca-
cutting-edge services, weathering fierce competition, and reer, coinciding with the evolution of CMC
building strong industry partnerships, with MedGenome. Vellore’s Endocrine services, which began

46 TECHAGAPPE OCTOBER-DECEMBER 2024

as an Endocrine Clinic within the Depart- samples for the then 850-bedded hospital.
ment of Medicine before growing into a full-
Dr. Mohanty fondly recalls the empha-
fledged Department of Endocrinology and
sis on patient interaction at JIPMER. “I used
Metabolism by 1995.
For the past five years, to go to the wards and check the case sheets
with junior doctors before conducting tests.
“The duty time for the junior resident
doctor was more like 24x7 and a two-hour Dr. Biswajit Mohanty’s It gave us a clear understanding of the
break for food and others. A senior doctor
will be put in duty when I was away. Com-
GenX Diagnostics patient’s needs and ensured accurate re-
sults,” he reflects. This hands-on approach
ing from a state medical college to an insti- has enjoyed not only enhanced patient care but also fos-
tute like CMC was a real eye opener for us.
I was not used to defibrillators or cardiac
a fruitful association tered a valuable learning environment for
junior doctors. “But now, most doctors don’t
monitors in the Cardiology ICU. with Agappe Diagnostics, visit the patients,” he points out, highlight-
ing a shift in medical practice over the years.
However, the Department Heads were integrating their
very helpful. Within a week, we learned all
advanced technology The stint at Nepal
techniques. At that time the only multi-
storey building at CMC was of the Endocri- to enhance laboratory Dr. Mohanty had a short stint at Nepal
when his Professor who was the Dean at
nology department. It gave me a feeling that
medical / diagnostic investigations are efficiency and accuracy. JIPMER went to Nepal to become a Medical
equally important like everything else,” re- Director for a new medical college estab-
in Biochemistry, Dr. Mohanty faced a lished there. “My professor wanted me to
calls him.
choice between offers from Delhi and accompany him and to lead the biochem-
One memorable experience involved a Pond icherry. He chose JIPMER, istry department at the Bharatpur Medical
highly respected pioneer in Bone Marrow Pondicherry, believing its less crowded College, Chitwan, Nepal. Since MD in Bio-
Transplantation Services, who brought his environment would be more conducive to chemistry was hard to find, I had plenty of
mother for treatment. Unaware of his iden- learning. His decision paid off when, within opportunities. I was at Nepal for almost
tity, Dr. Mohanty followed the standard pro- just four months, he was entrusted with four years,” he says.
tocols meticulously. “After listening to my overseeing the central laboratory by the
explanation, he simply walked out. It was only dean. “I was initially reluctant to take up the Dr. Mohanty’s Journey
then that I learned this ‘gentleman’ was a charge,” Dr. Mohanty admits. “Coming with Apollo Hospitals,
prominent figure in the field,” Dr. Mohanty from a state medical college, I knew the
central medical college scenario was en-
Bhubaneswar
shares with a smile, emphasizing the culture
of humility and protocol adherence at CMC. tirely different. The lab at JIPMER operates In 2001, amidst the turmoil following the
24x7, unlike the state labs that close at 5 Nepalese royal family massacre, Dr.
During his tenure in CMC, Dr. Mohanty PM.” However, with the dean’s full support, Mohanty returned to Pond icherry and
also discovered he was colour blind during he quickly mastered the role, managing 40- joined Mahatma Gandhi Medical College
a routine staff health check-up, a diagnosis 45 technicians and handling 400-500 daily and Research Institute as an associate pro-
that would steer his future ca-
reer choices. “This meant I
couldn’t pursue Surgery, Pathol-
ogy, or Microbiology,” he says.
Instead, he applied for General
Medicine and Biochemistry as
alternatives, ultimately securing
a position in Biochemistry at Shri
Ram Chandra Bhanja (SCB)
Medical College & Hospital in
Cuttack, Odisha.
Dr. Mohanty’s journey at
CMC Vellore not only broadened
his medical knowledge but also
instilled a sense of dedication,
discipline, and an appreciation
for medical protocols, shaping
him into the accomplished pro-
fessional he is today.

JIPMER,
Pondicherry
In 1992, after earning his MD Dr. Mohanty receives an award recognising his laboratory as the best in class.

TECHAGAPPE OCTOBER-DECEMBER 2024 47

 Story Dr. Biswajit Mohanty 2011, and Apollo Hospital Bhubaneswar
became the first in Odisha to earn NABL-
EL accreditation.
By 2018, when Dr. Mohanty left Apollo,
fessor. Tasked with developing the central the laboratory had grown into the largest in
laboratory, he appointed and trained tech- Odisha, performing nearly all tests in-
nicians, acquired cutting-edge machinery, house. “Back then, people believed certain
and efficiently established the lab’s opera-
tions. His dedication paid off, and he was
While Mispa Label, tests could only be done in Delhi or
Mumbai, never in Bhubaneswar. I broke
later promoted to professor, a position he used for over a year, which that conviction,” he proudly states, reflect-
held until 2009. has been instrumental in ing on his incredible journey of transform-
ing healthcare standards in Odisha.
Around this time, a friend and former reducing pre-analytical
colleague from CMC persuaded Dr. Mohanty
errors. “In the busy A New Chapter:
to send his CV to Apollo Hospitals, Chennai,
Dr. Mohanty’s Journey as a
which was planning a new hospital in
Bhubaneswar, Odisha. Surprisingly, without
mornings, when sample Leader and Entrepreneur
any interview, Apollo offered him a posi- intake is at its peak, Mispa Dr. Mohanty embarked on a different
tion, agreeing to every condition he proposed.
The only request from Apollo was that Dr. Label ensures accurate path when he joined as a NABL-EL Asses-
sor, quickly rising to become a Lead As-
Mohanty bring a resident doctor along. “It labeling, significantly sessor within a short period of time. His
was a unique situation where I felt completely
trusted and empowered,” he recalls. minimizing mistakes that expertise and dedication soon earned him
the role of Lead/Technical Assessor for
Assigned the monumental task of set- could compromise patient SAARC countries. “My assessment work
ting up the laboratory from scratch, his prior safety,” he emphasizes. in Nepal was a particularly enriching expe-
rience,” he recalls.
experience managing central laboratories
helped him handle the challenge effortlessly. Over his career, Dr. Mohanty conducted
“I was responsible not just for biochemistry A turning point came when the Vice more than 350 NABL-EL and over 200 NABH
but for pathology, histopathology, and mi- Chairperson of Apollo Hospitals visited the accreditations, also contributing signifi-
crobiology,” Dr. Mohanty notes. He carefully facility. Dr. Mohanty boldly declared his in- cantly to NABH-EL and NITI Aayog’s KPI ini-
selected technicians, provided rigorous tention to pursue NABL-EL accreditation. tiatives. He is uniquely trained with a Six
training, and ensured the lab functioned “It had only been two months since the lab Sigma Black Belt from the Indian Statistical
seamlessly. Within a few months, each de- became operational, and she was as- Institute, Hyderabad—making him the only
partment was flourishing under its own head, tounded,” he recalls with pride. Unfazed, medical doctor from Odisha to hold this
thanks to his leadership. he initiated the accreditation process in distinction, a skill that greatly enhanced his
process management and
assessment reports.

In 2018, Dr. Mohanty de-

cided to take the entrepre-
neurial plunge. “I thought, if I
could set up successful labs
for others, why not create my
own?” he muses. Partnering
with the Sri Chaitanya Insti-
tute of Vaishnava Culture
(SCIVC) in Bhubaneswar,
known for its philanthropic
endeavours, he established a
lab that matched big chains
in infrastructure but offered
affordable prices for the com-
mon man. Remarkably,
within six months, the lab
achieved NABH accreditation,
followed by NABL-EL ac-
creditation in the next six
months. “We even had the RT
PCR test from the very begin-
Dr. Mohanty with his colleagues and well wishers at GenX Diagnostics, Bhubaneswar. ning,” Dr. Mohanty proudly

48 TECHAGAPPE OCTOBER-DECEMBER 2024

shares, cementing his reputation as an
innovative leader in healthcare.
Rising to the Chal-
lenge: Dr. Mohanty’s
Response During
COVID-19
Amid the COVID-19 pandemic, the
Odisha Health Department requested
Dr. Mohanty’s lab to begin RT PCR test-
ing for the virus. “We were already
equipped with two RT PCR machines,
so after ICMR approval, we swiftly be-
gan testing,” he recalls. Unlike many
others, they collected samples directly
from patients, reaching a peak of 1,500
tests per day. Additionally, they ar-
ranged for home sample collection
with strict safety protocols, ensuring
convenience and care for all.
Beyond COVID-19 testing, Dr.
Mohanty’s lab, GenX, excelled in rare
diagnostic tests. “In renal histopathol-
ogy, most hospitals relied on us, es- Dr. Mohanty with Mr. Satyajit Mohapathra, Regional Manager - AGAPPE CDx.
pecially for kidney transplants. We
were ready with this from day one,” he Commenting on the evolving IVD indus- to work as expected.” This adaptability gives
shares proudly. GenX also boasts nine con- try, Dr. Mohanty observes a significant shift GenX an edge, reinforcing their commitment
sultants each in pathology and radiology, in favour of Indian companies. “The domi- to delivering accurate diagnostics tailored
unmatched by any other lab in Odisha. nance of foreign companies in setting prices for the Indian market.
“We’re the only stand-alone lab in Odisha has diminished due to the rise of strong
offering Flow Cytometry,” Dr. Mohanty Indian competitors,” he explains. He fur-
A Trusted Partnership with
points out, underscoring his lab’s pioneer- ther points out, “Indian reagents are often Agappe Diagnostics Ltd.
ing role in the state’s healthcare landscape. better suited to our environment. We’ve
For the past five years, Dr. Mohanty’s
had instances where foreign reagents ei-
Facing Competition: ther provided inaccurate results or failed
GenX Diagnostics has enjoyed a fruitful as-
GenX Diagnostics’ Path to sociation with Agappe Diagnostics, integrat-
ing their advanced technology to enhance
Growth and Expansion laboratory efficiency and accuracy. “Mispa
In 2023, GenX Diagnostics took a bold i2, Mispa i3, and Mispa Label have become
step by applying for an IPO to raise funds integral to our operations,” Dr. Mohanty
for expansion. “The laboratory business is Dr. Mohanty shares. He praises the Mispa i2, a semi-
automated specific protein analyzer, for its
fiercely competitive now, with some new-
comers offering blood tests at incredibly
acknowledges the critical precision and rapid results.
low prices, which impacts us significantly,” role Agappe Diagnostics The recently acquired Mispa i3 has also
Dr. Mohanty admits. Despite the pressure,
GenX has remained steadfast in maintain-
has played in elevating their proven to be a reliable addition, while Mispa
Label, used for over a year, has been in-
ing affordable pricing since its inception, lab’s performance. strumental in reducing pre-analytical errors.
without ever compromising on quality.
As he looks forward to the “In the busy mornings, when sample intake
“We’ve always aimed to make high-qual- is at its peak, Mispa Label ensures accurate
ity diagnostics accessible to everyone,” he future, he expresses labeling, significantly minimizing mistakes
emphasizes. With a vision to expand and confidence that Agappe that could compromise patient safety,” he
emphasizes. Dr. Mohanty acknowledges the
establish more collection centers across
Odisha, GenX Diagnostics sought financial will continue to innovate, critical role Agappe Diagnostics has played
support, which led to MedGenome step-
ping in as a strategic partner. As a result,
supporting GenX Diagnostics in elevating their lab’s performance. As he
looks forward to the future, he expresses
they decided to forgo an IPO. Today, GenX in delivering top-notch confidence that Agappe will continue to in-
Diagnostics proudly operates as a subsid-
iary of MedGenome, paving the way for
diagnostic services to the novate, supporting GenX Diagnostics in de-
livering top-notch diagnostic services to the
continued growth. community. community.

TECHAGAPPE OCTOBER-DECEMBER 2024 49

 Interview Mr. Morris Henain

FRANCE LAB COMPANY

REVOLUTIONIZING EGYPT’S DIAGNOSTIC
LANDSCAPE WITH CUTTING - EDGE SOLUTIONS
In the fast-paced and ever-evolving field of laboratory diagnostics,
one company in Egypt has distinguished itself as a leader—France
Lab Company. Established in 2014, the company has made
remarkable strides in providing high-quality laboratory kits and devices
to hospitals, laboratories, and clinics across Egypt. In this interview,
Mr. Morris Henain, General Manager of France Lab Company, shares
insights on the company’s growth, its successful partnership with
Agappe Diagnostics Ltd., and how it envisions the future of the
laboratory industry in Egypt.
TechAgappe: Can you share the story behind the
founding of France Lab Company and its evolution
into a key player in the Egyptian laboratory mar-
ket?
Morris: France Lab Company was born in March 2014,
specializing in the importation of high-quality labora-
tory kits and devices. Building on eight years of prior
experience in distributing laboratory equipment, we
quickly expanded our reach, strategically serving labo-
ratories, hospitals, and clinics across Egypt. Our turn-
ing point came in 2017 when we partnered with Agappe
Diagnostics Ltd., a collaboration that greatly acceler-
ated our growth by harnessing Agappe’s technical and
practical expertise.
Today, France Lab stands as a leading player in the
Egyptian market, with three main branches in Cairo,
Alexandria, and Asyut, with network of sub-distribu-
tors covering all regions. Our dedicated engineers work
closely with these partners, ensuring seamless distri-
bution and exceptional after-sales service throughout
Egypt.
TA: What core values and business ethics guide
France Lab Company in its operations and rela-
tionships with clients and partners?
Morris: Our core values, to which we are committed
for the benefit of our customers and partners, include
integrity, teamwork, accountability and innovation. We
prioritize authenticity and honesty in all our interac-
tions. We foster a collaborative environment where
team members value and respect one another, as well
as our customers and partners. We ensure that we Mr. Morris Henain
fulfil our commitments and deliver on our promises.

50 TECHAGAPPE OCTOBER-DECEMBER 2024

 Mr. Morris Henain, General Manager - France Lab Company and his Team members with Mr. Thomas John,
Managing Director - AGAPPE and Mr. Sreevisakh K. L, Head - International Business, AGAPPE.
We believe that innovation is fundamental ing that all are well-versed in the latest tech- TA: Could you provide an overview of your
to our success. nological advancements and service tech- product portfolio and the types of labo-
niques, thereby enhancing overall service ratory devices and reagent kits you of-
TA: How does France Lab Company en-
quality. fer?
sure quality in its products and services,
and what measures do you have in place We value customer feedback and satisfac- Morris: We are working mainly in AGAPPE
to maintain high standards? tion from laboratories, hospitals, and clin- medical laboratory analyzers and kits such
ics and promptly address their concerns. as protein analyzers, chemistry analyzers,
Morris: France Lab Company ensures ex-
hematology analyzers and its reagents.
ceptional quality in its products and ser- Through these robust measures, we main-
Mispa i2 and Mispa i3 are major equipment
vices through a holistic and meticulous tain consistent excellence, earning trust and
comes under the category ‘Protein Estima-
approach: credibility in the Egyptian market.
tion’. Mispa Viva and Mispa plus are the
Strategic partnerships with trusted manu- semi-automated clinical chemistry analyz-
facturers with renowned suppliers like ers. Mispa CXL pro Plus and Mispa CX4 are
Agappe Diagnostics Ltd allow France Lab the fully automated solutions in biochem-
to source high-quality laboratory kits and Strategic partnerships istry analysis. In Hematology, we have Mispa
devices that meet stringent international count plus and Mispa HX 58 from AGAPPE.
standards. This partnership ensures that with trusted manufacturers
TA: How has the long-standing partner-
the products are backed by Agappe’s ex-
pertise and reliability.
and renowned suppliers ship with Agappe Diagnostics Ltd. con-

France Lab implements rigorous quality

like Agappe Diagnostics Ltd tributed to your success and growth in
the industry?
control at every stage of importation and allow France Lab to
Morris: The enduring partnership between
distribution, ensuring that every product
meets precise specifications. Maintaining
source high-quality France Lab and Agappe Diagnostics Ltd. has
close communication with suppliers fur- laboratory kits and devices been a cornerstone of our success and
growth, contributing to our journey in nu-
ther guarantees adherence to high-quality
benchmarks. to serve our customers merous ways:

Our team of skilled engineers works to- that meet stringent Agappe Diagnostics is renowned for its
gether with distributors and clients, provid- international standards. high-quality, innovative diagnostic solu-
tions. By aligning with these premium prod-
ing comprehensive after-sales support, in-
cluding regular maintenance, troubleshoot- This partnership ensures ucts, we can consistently deliver top-tier
ing, and user training. This ensures optimal
equipment performance and longevity.
that the products are laboratory kits and devices that meet glo-
bal standards, significantly elevating our

France Lab invests in continuous staff train-

backed by Agappe’s reputation within the Egyptian market.

ing for engineers and sales teams, ensur- expertise and reliability. Agappe brings invaluable technical exper-

TECHAGAPPE OCTOBER-DECEMBER 2024 51

 Interview Mr. Morris Henain

tise & knowledge, which has greatly en-

hanced our capabilities in product installa-
tion, maintenance, and troubleshooting. This
shared knowledge ensures our clients re-
ceive impeccable after-sales service and
technical support, fostering long-term trust.
The collaboration with Agappe has bol-
stered France Lab’s credibility and market
presence, enabling us to forge strong rela-
tionships with hospitals, laboratories, and
clinics nationwide. This trust has paved the
way for larger contracts and strategic op-
portunities, reinforcing our industry posi-
tion.
Agappe’s dedication to innovation has al-
lowed France Lab to expand its product
range, introducing state-of-the-art diag- Mr. Morris Henain with Dr. Sukesh C. Nair - Professor (Pathology) and Head of
nostic tools and devices to the Egyptian the Department of Transfusion Medicine at CMC Hospital, Vellore.
market, keeping us at the forefront of in-
and how have they been received in the been well-received in the Egyptian market
dustry advancements.
market? due to their high efficiency, precision, and
Agappe’s global presence and strong brand cost-effectiveness. Feedback from hospitals,
Morris: France Lab’s passion for promot-
reputation have provided France Lab a dis- clinics, and laboratories has been over-
ing Agappe’s nephrology protein estima-
tinct competitive edge, setting us apart from whelmingly positive, with many citing the
tion analyzers, Mispa i2 and Mispa i3, is
other distributors. devices’ ease of use and the reduction in
driven by several key factors like:
turnaround time for critical nephrology tests.
This partnership has been instrumental in
As experts in the field knows, Mispa i2 and
France Lab’s journey to becoming a trusted France Lab is dedicated to ensuring that
Mispa i3 analyzers represent cutting-edge
leader in Egypt’s lab-diagnostics industry. these devices operate at their full potential
advancements in nephrology diagnostics.
by offering strong after-sales support, in-
TA: What drives your passion for promot- These devices offer precise protein estima-
cluding training and maintenance. This
ing Agappe’s nephrology protein estima- tion, which is crucial for early detection and
commitment has enhanced customer sat-
tion analyzers, Mispa i2 and Mispa i3, management of kidney disordes. France Lab
isfaction and contributed to the positive
is passionate about offering such technol-
market response.
ogy that can make a real difference in pa-
tient outcomes. In promoting Mispa i2 and Mispa i3, France
Lab sees the opportunity to not only drive
As experts in the field By promoting these analyzers, France Lab
aims to improve the healthcare standards
business growth but also contribute to im-
knows, Mispa i2 and Mispa by increasing the diagnostic accuracy and
proving diagnostic and healthcare out-
comes in Egypt.
efficiency in Egypt’s healthcare sector.
i3 analyzers represent These tools enable faster, more reliable re- TA: How would you describe your experi-
cutting-edge technologies sults, which help healthcare providers of- ence working with Agappe’s interna-
fer better treatment plans for patients with tional department, and what aspects of
which offer precise protein nephrological issues. this collaboration have been most ben-
estimation, is crucial for We could always align with market needs of
eficial?

early detection and our country with the support of Agappe. Morris: Working with Agappe’s interna-
Kidney diseases are a significant health tional department has been a highly posi-
management of kidney concern in Egypt, and there is a growing tive and enriching experience for France
disordes. France Lab is demand for reliable, accurate nephrology
analyzers. Mispa i2 and Mispa i3 meet this
Lab. This collaboration has been instru-
mental in driving our growth and enhanc-
passionate about offering demand with user-friendly interfaces, ro- ing our operational efficiency. Several as-
such technology that can bust performance, and affordability, mak-
ing them accessible to laboratories and clin-
pects of the partnership stand out as par-
ticularly beneficial:
make a real difference in ics of various sizes.
We have seamless communication and
patient outcomes. The Mispa i2 and Mispa i3 analyzers have support from the international department

52 TECHAGAPPE OCTOBER-DECEMBER 2024

at Agappe & they are consistently respon- TA: How do you envision the future of
sive and cooperative. Their open lines of the laboratory industry in Egypt, and
communication have ensured that any con- what role do you see France Lab Com-
cerns, from product queries to shipment Technical expertise and pany playing in that future?
details, are handled swiftly and efficiently.
training from Agappe’s Morris: The future of Egypt’s laboratory in-
Technical expertise and training from dustry is set for remarkable growth, fuelled
Agappe’s international department are international team are by technological advancements, rising de-
comprehensive and hence our team is fully comprehensive and hence mand for precise diagnostics, and ongoing
equipped to install, service, and maintain healthcare investment. The industry is rap-
any products. This technical backing has our team is fully equipped to idly moving toward greater automation and
enabled our engineers to confidently handle install, service, and maintain integration of technologies like AI, big data,
Agappe’s devices, which is essential for and machine learning, enhancing diagnos-
delivering high-quality after-sales service any products. This technical tic accuracy, speeding up lab processes, and
to our clients. backing has enabled our improving data management.
Agappe’s international team has shared valu-
able insights into global market trends and
engineers to confidently As healthcare evolves, there will be a grow-
ing demand for advanced diagnostics, in-
strategies. This guidance has helped France handle Agappe’s devices, cluding molecular diagnostics, genomics,
Lab stay competitive and make informed
decisions on expanding our product offer-
which is essential for and personalized medicine, enabling early
detection and tailored treatments for con-
ings and improving service quality. delivering best services. ditions like cancer, genetic disor-
ders, and chronic diseases.
With increased regulation, there
will be a stronger focus on quality
control, accreditation, and inter-
national standards, driving labo-
ratories to adopt advanced equip-
ment and standard ized proce-
dures.
Collaboration between healthcare
providers, academic institutions,
and the private sector will foster
innovations addressing Egypt’s
unique healthcare challenges, such
as cost-effective diagnostics for
diabetes and cardiovascular dis-
eases. In this evolving landscape,
France Lab will play a pivotal role,
leading the industry with cutting-
edge solutions, commitment to
quality, and ded ication to ad-
dressing Egypt’s healthcare
needs.
In conclusion, the future of Egypt’s
laboratory industry is bright, with
the potential for incredible ad-
vancements in diagnostic technol-
Mr. Morris Henain with Mispa - i 60, the newly launched equipment of AGAPPE. ogy and healthcare outcomes.
France Lab aims to be a driving
Whenever challenges arise, whether related between their manufacturing units and our force in this transformation, playing a piv-
to logistics, product customization, or cli- distribution channels has been critical in main- otal role in shaping the industry by deliver-
ent-specific needs, Agappe’s international taining our inventory and meeting market ing innovative solutions, expanding acces-
department is proactive in finding tailored demand. Overall, our experience with sibility, and ensuring that the highest qual-
solutions. This level of collaboration has Agappe’s international department has been ity standards are met across the board.
fostered a strong and trusting partnership. marked by professionalism, expertise, and a Through our continued efforts, we believe
Efficient Supply Chain Management of genuine commitment to mutual success. we can help revolutionize diagnostics in
Agappe played a key role in ensuring timely These factors have strengthened our partner- Egypt and contribute to a healthier future
deliveries and smooth supply chain opera- ship and contributed to France Lab’s growth for the nation, thereby contributing to a
tions. Their ability to coordinate effectively and reputation in the Egyptian market. healthier future for the nation.

TECHAGAPPE OCTOBER-DECEMBER 2024 53

 GLP Good Laboratory Practices

HOW TO PREVENT
PRE ANALYTICAL ERRORS
IN CLINICAL LABORATORY?
Accurate test results are the cornerstone of effective healthcare, and it all
starts with preventing pre-analytical errors in clinical laboratories. These
errors, which occur even before testing begins, can lead to incorrect
diagnoses and treatments. This article delves into the root causes,
preventive strategies, and advanced technologies that can help minimize
these errors, ensuring reliable results and better patient outcomes. Let’s
explore how to elevate laboratory precision and patient care.
Sanjaymon K. R, Associate Vice President - BD, AGAPPE.

B y understanding the causes and impact give very high values for the analyte giving 4. Sample Storage: Incorrect storage con-
of pre-analytical errors, laboratories can wrong diagnosis of the patient. ditions of samples, such as temperature
take steps to enhance efficiency, improve or light exposure(e.g. Bilirubin), can degrade
2. Sample Collection:Proper Sample col-
accuracy, and ensure patient safety. analytes.
lection is a must to assure the result qual-
Some Common Causes of ity. Incorrect specimen type (Serum/ 5. Haemolysis: The rupture of red blood
Pre-analytical Errors are Plasma/Whole blood), insufficient volume,
improper handling, or delays in transpor-
cells can interfere with a variety of tests like
Potassium
given below tation can compromise sample integrity and
6. Lipemia: The presence of excess lipids
1. Patient Preparation: Inadequate fast- will give non-correlating results, once
in the blood can cause turbidity and inter-
ing, dietary restrictions, or medication use tested.
fere with spectrophotometric measure-
can affect test results. This is one of the 3. Sample Labelling: Errors in labelling ments.
most common causes of errors in the test- can lead to misidentification of patients and
ing. Sometimes the inadequate fasting may 7. Icterus: Jaundice, characterized by el-
samples.
evated bilirubin levels, can interfere with
certain tests (e.g. Creatinine).

Preventing Pre-analytical
Errors
1. Standardized Procedures and train-
ing: Implementing clear and standardized
procedures for patient preparation, sample
collection, handling, and storage can help
reduce errors.It is always better to display
the Sample collection Chart in the phle-
botomy stations as a ready reckoner
2. Quality Control Measures: Implement-
ing quality control measures, such as pro-
ficiency testing and internal quality assess-
ments, can help identify and address er-
rors.
3. Automation: Automation of pre-ana-

54 TECHAGAPPE OCTOBER-DECEMBER 2024

lytical processes, such as sample labelling for laboratory staff can ensure they are their competency through simulations and
system sample transport system and au- well-equipped to handle samples correctly observations.
tomatic centrifugation, can reduce the risk and identify potential errors.
c. Quality Control Checks: Implement
of manual errors happening in these areas.
10. Real-Time Monitoring: Utilizing real- quality control checks, such as verifying
4. Barcode Technology: Using barcode time monitoring systems for temperature, patient identification and checking for
technology to track samples throughout the humidity, and other critical factors can help haemolysis, lipemia, and icterus before pro-
laboratory can help prevent mix-ups and prevent sample degradation during stor- cessing samples.
errors in labelling. This will help in the com- age and transportation. 2. Sample Storage and Transportation:
plete sample traceability and will help us to
11. Risk Assessment and Mitigation: a. Temperature Monitoring: Use tempera-
identify the areas of improvement with
Conducting regular risk assessments to ture-controlled storage units and transpor-
proper data collection and analysis.
tation containers to maintain proper
5. Review Meetings: Implementing a cul- sample integrity.
ture of continuous improvement with pe-
riodical review meetings can help identify b. Timely Processing: Ensure that samples
and address the root causes of pre-ana- are processed within specified timeframes
lytical errors. to prevent degradation.
Mispa Label is a smart & innovative
Focus on Prevention: Key solution for simplified pre-analytics.
c. Emergency Procedures: Develop proce-
dures for handling samples in case of trans-
Strategies Ease of use, minimal human error, portation delays or equipment failures.
connectivity & best turnaround time
1.Patient Preparation & Education: Pro- 4. Haemolysis, Lipemia, and Icterus:
in Mispa Label makes it a perfect
viding clear and concise patient education
pre-analytical solution. a. Prevention: Educate patients about fac-
materials on proper fasting, sample collec-
tion techniques, and medication interac- tors that can contribute to haemolysis,
tions can significantly reduce pre-analyti- lipemia, and icterus, such as vigorous ex-
cal errors. ercise, excessive alcohol consumption, and
certain medical conditions.
2. Clear Instructions: Provide patients with
clear and easily understandable instruc- b. Early Detection: Implement procedures
tions regarding fasting, dietary restrictions, for early detection of haemolysis, lipemia,
and medication use. and icterus during sample processing.

3. Patient Reminders: Use automated sys- c. Alternative Tests: Consider alternative

tems or patient portals to send reminders tests or sample preparation methods that
about upcoming appointments and neces- are less susceptible to interference from
sary preparations. haemolysis, lipemia, and icterus.

4. Consent Forms: Ensure that patients sign Future Trends in Pre-ana-

consent forms acknowledging their under- lytical Error Prevention
standing of the necessary preparations.
1. Advanced Automation: The develop-
5. Improved Labelling Systems: Imple- ment of more advanced automation sys-
menting robust labelling systems with tems can further reduce the risk of manual
barcode technology and electronic health errors and improve efficiency. Total Labo-
records can help prevent sample mix-ups identify potential pre-analytical error ratory Automation systems from Sample
and misidentification. hotspots can enable laboratories to imple- collection, sample sorting to sample ar-
ment targeted prevention strategies. chives are helping the laboratory profes-
6. Barcode Technology: Use barcode tech-
sionals to reduce the pre analytical errors.
nology to track samples throughout the Specific Strategies for
laboratory, reducing the risk of 2. Artificial Intelligence (AI): AI can be
misidentification.
Different Pre-analytical used to analyse data from pre-analytical
Errors processes and identify potential errors or
7. Electronic Health Records (EHRs): In-
1. Sample Collection: trends.
tegrate sample labelling with EHRs to en-
sure accurate patient identification and re- By addressing pre-analytical errors, clini-
a. Standard Operating Procedures: De-
duce manual errors. cal laboratories can improve the accuracy
velop and implement standardized oper-
and reliability of test results, enhance pa-
8. Double-Checking: Implement a double- ating procedures for sample collection, in-
tient safety, and contribute to better
checking system to verify that sample la- cluding proper techniques, specimen types,
healthcare outcomes. A focus on preven-
bels are correct and match the patient’s and handling requirements.
tion through education, technology, and
information.
b. Training and Competency Assessment: quality control measures is essential for
9. Enhanced Training Programs: Regu- Regularly train laboratory staff on proper minimizing these errors and ensuring the
lar training and competency assessments sample collection techniques and assess integrity of laboratory results.

TECHAGAPPE OCTOBER-DECEMBER 2024 55

 Health Tips for Healthy Life Style

COMPREHENSIVE
HEALTH TIPS FOR
THE PREVENTION
& MANAGEMENT

HEMATOPATHOLOGY RELATED DISORDERS

Maintaining healthy blood is essential for overall well-being, as
blood-related disorders can significantly impact our quality of
life. This article offers comprehensive tips on nutrition, exercise,
lifestyle habits, and preventive care to help you manage and
prevent blood disorders. From boosting immunity to promoting
better circulation, these practical insights will guide you toward
a healthier blood system, ensuring vitality and longevity. Dive
in to discover how to nurture your blood health!
Dr. C. S. Satheesh Kumar, Head-Corporate Communication,
Agappe Diagnostics Ltd., (Retd. Drugs Controller, Keala)

H ematopathology is a subspecialty of pa- To maintain a healthy blood system and

thology focused on the study of diseases circulatory system, it’s essential to focus on
and disorders of the blood, bone marrow, a combination of lifestyle choices, habits,
and lymphatic system. This branch involves and preventive measures. These can help
the diagnosis of conditions that affect the avoid common lifestyle-related disorders
production and function of blood cells as and promote long-term health.
well as disorders involving blood-forming
A balanced diet is essential for main-
tissues like the bone marrow and lymph
taining healthy blood cell production and
nodes.
overall circulatory health. Adequate iron in-
Disorders diagnosed in hematopathology take is crucial for producing healthy red
embrace n-number of disorders such as blood cells, and can be obtained from lean
anemia, leukaemia, lymphomas, multiple meats, leafy greens, beans, and fortified ce-
myeloma and plasma cell disorders, coagu- reals. Vitamin B12 and folate, found in foods
lation disorders, immune-mediated hema- like eggs, dairy products, poultry, and leafy
tologic disorders, bone marrow failure syn- vegetables, are equally important for red
dromes, infectious and reactive lymphad- blood cell production, including thrombocy-
enopathies etc. topenia. Antioxidants, present in fruits like

56 TECHAGAPPE OCTOBER-DECEMBER 2024

berries, citrus, and vegetables such as spin- lowering cholesterol and improving blood
ach, protect blood vessels from oxidative sugar control.
damage. Omega-3 fatty acids, found in fatty
Kidney health is essential for effective
fishlike salmon and mackerel, help reduce Cardiovascular exercises blood purification, as the kidneys filter waste
inflammation and improve heart health.
like walking or jogging, and toxins from the blood. Staying hydrated
Regular physical activity is vital for main- is crucial, as dehydration can impair kidney
taining a healthy circulatory system. Cardio-
improve heart function, function and lead to long-term issues. Lim-
vascular exercises like walking, jogging, regulate blood pressure, iting alcohol consumption and avoiding
smoking are equally important, as both can
swimming, or cycling improve heart func-
tion, regulate blood pressure, and boost cir- and boost circulation. place strain on the kidneys and reduce their
culation. Strength training, through resis- Strength training, through ability to filter the blood. Smoking also dam-
ages blood vessels, increasing the risk of
tance exercises, helps regulate blood sugar,
prevents diabetes, and enhances cholesterol resistance exercises, helps heart disease. Additionally, controlling salt
levels, contributing to overall blood vessel
health. Flexibility exercises, such as yoga and
regulate blood sugar, intake is vital for kidney health, as excessive
sodium can cause stress on the kidneys and
stretching, not only improve mobility but prevents diabetes, and contribute to high blood pressure. Aim for
less than 2,300 mg of sodium daily, or as
also help reduce stress and promote better
blood circulation, which is crucial for main-
enhances cholesterol levels, recommended by healthcare professionals.
taining healthy blood vessels and overall contributing to overall blood Liver health is crucial for filtering toxins
well-being.
vessel health. from the blood, and maintaining it requires
Yoga can improve circulation, lower mindful dietary choices. Avoiding processed
blood pressure, and reduce stress, which tices, deep breathing exercises, and engag- and high-fat foods helps prevent the liver
can positively affect conditions such as hy- ing in hobbies can significantly reduce stress from becoming overworked, reducing the
pertension, anemia, and cardiovascular levels, promoting better heart health and risk of developing fatty liver disease, which
health.Recent studies on yoga’s impact on overall well-being. can impair its detoxification function. Addi-
the immune system and blood disorders tionally, moderating alcohol consumption is
Maintaining healthy cholesterol and
have shown promising results. A 2023 study vital, as excessive alcohol intake can dam-
blood sugar levels is essential for cardio-
titled “Effects of Group Trauma-Sensitive age liver cells and hinder its ability to effec-
vascular health and preventing long-term
Yoga on Inflammatory Markers and Psycho- tively cleanse the blood.
damage to blood vessels. Limiting refined
logical Well-Being in Women Veterans with sugars in the diet helps prevent insulin re- Adequate sleep is essential for overall
PTSD” suggests that yoga can positively in- sistance, a key factor in the development of health and recovery, as poor sleep is linked
fluence immune responses by reducing in- Type 2 diabetes, which can harm blood ves- to elevated BP, a higher risk of heart disease,
flammation and improving mental health. sels over time. Incorporating healthy fats, and impaired blood sugar control. To sup-
Research papers indicate yoga helps man- such as those found in olive oil, avocados, port cardiovascular health and maintain
age autoimmune disorders by strengthen- and nuts, supports good cholesterol (HDL) balanced blood sugar levels, it’s crucial to
ing the immune system through consistent levels while lowering bad cholesterol (LDL). aim for 7-9 hours of restful sleep each night.
practice. Additionally, consuming fibre-rich foods like Consistent, quality sleep helps the body re-
Maintaining a healthy weight is essential whole grains, vegetables, and fruits aids in cover, promotes proper functioning of the
for preventing lifestyle-related disorders like
high blood pressure, diabetes, and cardio-
vascular diseases, especially when excess To maintain a healthy blood system
fat accumulates around the abdomen. A key
factor in weight management is regulating
and circulatory system, it’s essential
fat intake by avoiding trans fats and limiting to focus on a combination of
saturated fats, which helps maintain healthy
cholesterol levels. This, in turn, prevents lifestyle choices, habits, and
plaque build-up in arteries, promoting bet- preventive measures.
ter heart health and overall circulatory sys-
tem function. These can help avoid
Managing blood pressure is crucial for common lifestyle-related
protecting the heart and blood vessels from disorders and promote
long-term damage caused by hypertension.
Regular monitoring and maintaining a low- long-term health.
sodium diet are effective strategies for keep-
ing blood pressure within a healthy range.
Additionally, managing stress plays a vital
role, as chronic stress can elevate blood
pressure. Incorporating mindfulness prac-

TECHAGAPPE OCTOBER-DECEMBER 2024 57

 eases or chronic infections can heighten
Health Tips for Healthy Life Style cancer risk. Proper medical care for inflam-
matory conditions can mitigate this risk.
Overall, by reducing chemical and radiation
exposure, strengthening immune health,
managing inflammation, and moderating al-
Limiting alcohol consumption cohol consumption, individuals can signifi-
is another critical step, as cantly lower their chances of developing
blood-related cancers and promote long-
heavy drinking is linked to term health.
increased risks of certain blood To manage thrombocytopenia (low
cancers, including non- platelet count), a nutrient-rich diet is essen-
tial. Vitamin C aids iron absorption and
Hodgkin lymphoma. Managing strengthens immune health, so eat fruits like
chronic inflammation is also oranges and berries. Vitamin K, found in leafy
vital, as long-term greens, helps blood clotting. Additionally,
avoid blood thinners like aspirin and NSAIDs
inflammation from autoimmune unless prescribed, as they reduce clotting.
diseases or chronic infections Managing stress through relaxation tech-
niques, such as meditation and yoga, can
can heighten cancer risk. support immune and platelet health.
Proper medical care for Managing thrombocytosis, or elevated
inflammatory conditions can platelet counts, involves several lifestyle and
dietary adjustments. First, take medical help
mitigate this risk. making changes to iron intake, as reducing
iron may help in cases of reactive thromb-
circulatory system, and contributes to long- behaviours and reducing high-risk expo- ocytosis caused by iron deficiency. Limiting
term well-being. sures help protect against these infections. processed foods and excess sugar is im-
While sunlight mainly impacts skin cancer portant, as these can trigger inflammation
Additionally, regular health check-ups,
risk, extreme or prolonged exposure to UV and worsen high platelet levels. Instead, fo-
including blood tests, are essential for early
radiation can also affect blood cells, so us- cus on consuming whole, anti-inflamma-
detection of disorders like diabetes, high
ing sun protection is recommended. tory foods. Incorporating omega-3 fatty ac-
cholesterol, and kidney or liver problems.
ids from sources like fish, flaxseeds, and
Monitoring hemoglobin and blood counts Limiting alcohol consumption is another
walnuts, curcumin supplements can help
through regular screening helps identify critical step, as heavy drinking is linked to
reduce platelet activation and aggregation,
early signs of anemia or other blood-related increased risks of certain blood cancers, in-
lowering the risk of blood clots. These ad-
disorders. cluding non-Hodgkin lymphoma. Managing
justments, combined with medical guidance,
chronic inflammation is also vital, as long-
To minimize the risk of blood-related can help manage elevated platelet counts and
term inflammation from autoimmune dis-
cancers, it’s essential to reduce exposure prevent complications like thrombosis.
to harmful chemicals and rad iation,
Maintaining good hygiene and prevent-
strengthen the immune system, and adopt
ing infections are vital for protecting the
healthy lifestyle habits. Reducing exposure
to pesticides and chemicals, such as opting
Maintaining good hygiene and blood and circulatory system. Bloodborne
infections, such as hepatitis and HIV, can
for organic foods and avoiding long-term preventing infections are vital cause significant harm, making it essential
contact with benzene found in industrial
emissions, gasoline, and cigarette smoke, can for protecting the blood and to practice safe habits like avoiding unpro-
tected exposure to infected blood and fol-
lower the risk of blood cancers like leu- circulatory system. lowing proper hygiene routines. Vaccina-
kaemia. Similarly, limiting unnecessary ex-
posure to radiation from X-rays, CT scans, Bloodborne infections, such tions, such as hepatitis and flu shots, are
also crucial in preventing complications that
and radiation therapy is crucial, as exces- as hepatitis and HIV, can can impact both the blood and immune sys-
sive radiation can elevate cancer risk.
Strengthening the immune system
cause significant harm, tem. Additionally, mental health plays a key
role in circulatory health. Chronic stress can
through timely vaccinations against viruses making it essential to practice elevate blood pressure and affect heart
linked to cancers, such as hepatitis B and
human papillomavirus (HPV), is another key
safe habits like avoiding health, so managing stress through medita-
tion, exercise, and therapy is important.
preventive step. Preventing chronic infec- unprotected exposure to Positive social connections and maintaining
tions like HIV and Epstein-Barr virus (EBV),
which are associated with lymphomas, is
infected blood and following a positive mindset can further reduce the
risk of heart disease, contributing to overall
equally important. Practicing safe proper hygiene routines. well-being and a healthier lifestyle.

58 TECHAGAPPE OCTOBER-DECEMBER 2024

 RCA Root Cause Analysis

WHY IS THE DOWNTIME

HIGH FOR MY INSTRUMENTS?
ROOT CAUSE ANALYSIS - PART 10
A regional hospital has a state-of-the-art central laboratory with
automated instruments to accommodate the workload. One day, the
Quality Manager (QM) received a call from the emergency department
about the delay in reports. Let us trace the events to find the root
cause.
The laboratory usually has a TAT of one hour
for most of the samples received from the emer-
gency room. While checking with the technical QUALITY
staff, the QM found that from the day before, the MANAGEMENT
biochemistry instrument had been having more
downtime than before, causing significant dis- SYSTEM TIPS
ruption to operations. To understand the issue,
they checked the machine log and found multiple
logs in the machine saying that the water was
“Usage of scheduler
empty. for maintenance
The machine has more than 400 T/H through- will reduce errors”
Scan QR code put and is connected to an online water supply
to read more for internal washing. They have a water treat-
ment plant and an overhead tank to store the
treated water. While checking the water tank, they
found that the level was lower than usual. To un-
derstand the issue, they checked the water plant
and found reduced output water flow. Since the
water output is reduced while continuously work-
ing, the water in the tank becomes empty faster,
creating the issue.
The water plant was then checked, and they
noticed that one of the filters used in the inlet
pipe was choked; hence, the water inflow was
low. Since this happened gradually, nobody saw
this low flow rate. Further checking found that
the preventive maintenance (PM) for the water
treatment plant was due for the last three months.
After further discussion with the maintenance
team, they noticed that the next scheduled PM
written on the water treatment plant is 6/9/2024
Root Cause Analysis (RCA) is a critical tool in laboratory instead of 9/6/2024. This error happened by the
medicine to identify, understand, and address underlying engineer while performing the last PM and past-
ing the PM due sticker on the machine. Both the
issues that lead to errors or suboptimal outcomes. engineer and the maintenance team overlooked
this and created the issue.

TECHAGAPPE OCTOBER-DECEMBER 2024 59

 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Editorial Quiz & Feedback

CHECK YOUR KNOWLEDGE IN CLINICAL PATHOLOGY

Discover more about pathology by taking this engaging quiz
1. What is the primary purpose of 7. Which type of pathology focuses
histopathology? specifically on diseases of the
a) To examine cellular morphology blood?
b) To diagnose blood disorders a) Cytopathology
c) To assess tissue architecture b) Histopathology
2. Which technique is commonly used c) Hematopathology
in cytopathology to collect cells for 8. What is the role of immunohis-
examination?
a) Biopsy b) Fine needle aspiration
Pathology Quiz tochemistry in histopathology?
a) To stain cells for cytological
c) Blood smear examination b) To identify specific
5. What is the main advantage of digital
3. In hematopathology, what does a pathology over traditional methods? proteins in tissues
complete blood count (CBC) assess? a) Faster slide preparation c) To analyze blood cell morphology
a) Tissue structure b) Blood cell b) Improved visualization and remote
types and counts c) Genetic muta- access c) Reduced need for staining
QUIZ ANSWERS OF
tions
6. In histopathology, what staining JULY - SEPTEMBER 2024
4. Which imaging technique is increas- method is most commonly used to
ingly used in digital pathology? identify cancerous tissues? (40th Edition)
a) MRI b) Whole slide imaging a) Hematoxylin and eosin (H&E) 1-A, 2-A, 3-D, 4-A, 5-B, 6-A
c) Ultrasound b) Wright's stain c) Giemsa stain
Answers of this quiz contest will be published in the next edition. Participants can either hand over the answers to Agappe’s staff or mail their responses directly to techagappe@agappe.in or post a mail to
The Manager-Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562.

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