Vol.

8 Issue 3 APRIL - JUNE 2023

THE DIAGNOSTICS NEWS JOURNAL Published at Agappe Diagnostics Limited on April 1st, 2023 | 62 Pages | ` 20

REMINISCENCES OF FY23
GLIMPSES INTO FY24
Mr. Thomas John

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

INDIA’S VALIANT FIGHT

AGAINST TUBERCULOSIS
Dr. Digambar Behera

PERINATAL TUBERCULOSIS
A MATERNAL RISK FACTOR
Dr. Arvind Shenoi

LABORATORY DIAGNOSIS OF
TUBERCULOUS PLEURAL EFFUSION
Dr. Manoj A. Kahar

TUBERCULOSIS
THE INDIAN SCENARIO
Dr. Thirupathi K.

TUBERCULOSIS
ENDING TUBERCULOSIS REQUIRES FOCUS ON PREVENTION AND CONTROL MEASURES
AGAPPE Branding

Range of
Biochemistry
Analyzers

Semi Automated Biochemistry Analyzer

Advanced Semi Automated Biochemistry Analyzer

270
Test/Hr

Fully Automated Biochemistry Analyzer

2 TECHAGAPPE APRIL-JUNE 2023

 240
Test/Hr

Fully Automated Biochemistry Analyzer

360
Test/Hr

Fully Automated Biochemistry Analyzer

800/1200
Test/Hr

Fully Automated Biochemistry Analyzer

TECHAGAPPE APRIL-JUNE 2023 3

EDITORIAL CONTENTS
10-12
REMINISCENCES
OF FY23 &
GLIMPSES
INTO FY24

02-03 AGAPPE - Biochemistry 32-34

04-05 Editorial Content INSPIRING
06-06 Feedback From Readers
CHRONICLES OF
07-07 Chief Editor’s Desk KEYURI
08-08 Industry Update
BHANUSHALI,
09-09 Poem - TB Vaccine
A TB SURVIVOR
13-13 AGAPPE - Premium Solutions
14-17 Tuberculosis - An Overview 35-35 AGAPPE - Mispa CountX
36-38 Laboratory Diagnosis of
21-21 Testimonials
18-20 Tuberculous Pleural
25-25 AGAPPE - Mispa Viva
LIKE A PHOENIX Effusion
26-27 Biochemical Tests 39-39 Testimonials
for Iron Deficiency SHE ROSE FROM
40-42 Tuberculosis - The Indian
Anaemia
During TB Infection
THE ASHES TO Scenario

28-31 Perinatal Tuberculosis:

BECOME A 43-43 AGAPPE - Mispa i2
A Meternal Risk Factor CHAMPION 47-47 Testimonials
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.
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.

4 TECHAGAPPE APRIL-JUNE 2023

 THE DIAGNOSTICS NEWS JOURNAL

Volume 8 | Issue 3 | April - June 2023

EDITORIAL BOARD
48-50 Aswini Diagnostic Services: EDITOR
Epitome of Trust and Meena Thomas
Excellence CHIEF EDITOR
Prof. Dr. D M Vasudevan
51-51 Testimonials
CONSULTING EDITOR
52-53 Importance of Sample Saj Mathews
Traceability EDITORIAL ADVISORY BOARD
Dr. C S Satheesh Kumar
54-56 Tuberculosis - Some Health Smitha Paul
Tips for Prevention & Sreevisakh K L
Management Sanjaymon K R
Sankar T S
Bintu Lijo

44-46 LEGAL ADVISORY BOARD

Adv. Denu Joseph
NANDITA PUBLISHING COORDINATOR

VENKATESAN:
Jayesh Kumar
DESIGN AND LAYOUT
THE AWESOME M T Gopalakrishnan

STORY OF A DIE
PHOTOGRAPHY
Nelson Thomas

HARD TB BOARD OF DIRECTORS

SURVIVOR CHAIRMAN
Joseph John

57-57 Why my Kit Shows Less MANAGING DIRECTOR

22-24 Number of Tests?

Root Cause
Thomas John

Dr. Digambar Behera EXECUTIVE DIRECTORS

Analysis - Part 4 Meena Thomas
INDIA’S 58-59 Engagements & Events
Sangeeta Joseph
Mary Baby Meleth
VALIANT FIGHT 60-60 Quiz - Tuberculosis Prof. Dr.D M Vasudevan
Rhema Elizabeth Thomas
AGAINST 61-61 AGAPPE - Point of Care
TUBERCULOSIS 62-62 We Can End TB Subscription - For subscription queries, write to techagappe@
agappe.in or call us at +91 484 2867065. Permissions - For permissions
Contact info:
to copy or reuse material from Techagappe, write to techagappe
The Manager-Corporate Communication, Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. www.agappe.com @agappe.in Letters to the editor-Email: techagappe@agappe.in
Ph: + 91 484 2867065, + 91 484 2867000, Fax: + 91 484 2867222; Mob: +91 9349011309. Postal address : The Manager-Corporate Communication,
Published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O., Ernakulam district , Kerala-683 562, India. Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O.,
Printed at Five Star Offset Printers, Nettoor, Cochin-40, for Agappe Diagnostics Limited
Printed and Published by Ms. Meena Thomas on behalf of Agappe Diagnostics Limited and Printed at Five Star Offset Printers, Nettoor, Cochin-40 and published Ernakulam district, Kerala - 683 562, India. Advertisement Queries -
from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas. Email: techagappe@agappe.in

TECHAGAPPE APRIL-JUNE 2023 5


EXCELLING IN
PUBLISHING VERY
HUMANE BASED STORIES
With all respect to the magazine, I would
like to suggest some content which can be
incorporated in the future editions. Since
Techagappe magazine is getting published
on specific cover stories, when it is com-
fortable to deal with, please consider the
very important topics like virology, infec-
tious diseases and auto immune disor-
ders, the need of those topics are very pre-
vailing in the current scenario. Your team
is excelling in publishing very humane
based stories and useful medical articles.
Dr. M Kavya,
Padma Clinic, Hyderabad.
POWER OF PRINTING
MEDIA IS PROVEN
Hats off you dear Team Techagappe for
such a wonderful magazine. In today’s life,
PHYSIOLOGICAL BOOST
TO THE DEPRESSED
SUFFERERS
We are highly thankful for having
spread your most precious valuable
information through TechAgappe jour-
nal. Every issue is placing more valu-
able details useful not only to the doc-
tors, but also to the patients. Beside
clinical advice, your journal is incul-
cating lot of encouragement and pro-
viding morale support to those suffer-
ing from the ailments. The language be-
ing lucid and information being com-
prehensive, even a lay man can easily
understand the information you are
6 TECHAGAPPE APRIL-JUNE 2023
FEEDBACK FROM READERS
HELPFUL FOR AYURVEDIC STUDENTS
We are very much impressed with
your magazine ‘Techagappe’. Our
ayurvedic students are very much ea-
ger to read its content. Through maga-
zine is based on Allopathic medicines,
the latest updates are clearly commu-
nicated in each and every edition which
will be useful to approach diseases
from Ayurvedic view. Life story ses-
sions are quite interesting. Great Job
done by Agappe team. Good Luck.
Shreya Das, Lecturer, Maria Ayurveda Medical College, Kanyakumari.
so many medical advancements are hap-
pening. But the progress of medias by
which news are getting circulated is not
appreciable. Here comes the importance
of Techagappe. We are very happy to realise
that the power of printing media is proven
when reading such a magazine where all
type of people irrespective of their pro-
fession, gender and interest would be ben-
efitted. You are requested to keep us in
regular subscription list. Wish you all
hearty blessings to continue this great
mission.
S. Sarkhel,
Director, CINPS,
Kol kata
placing. The life story sessions are very im-
pressive and provide physiological boost
to the depressed sufferers. We would like
to hear your opinion whether this type of
treatment is at the reach of the common
man.
Ramana, Bless College of Nursing, Tirupati.
PLEASURABLE READING,
SERENE PRESENTATION
Seasonal greetings Team TechAgappe!
Thank you for gifting me the latest issue of
the journal. I would say, for a clear mind,
reading should be a habit. To become it as a
habit, quality materials should be available
for us. Nowadays, a lot of magazines, from
different sectors, are available. But reading
will be a pleasure only when the magazine
has that kind of serene presentation. What-
ever shown in the journal is information.
Even an advertisement is very useful for us.
I could not read this magazine first issue
onwards. But I will read its online versions
where all the past editions are available.
Wish your team good luck. Let your great
vision and mission to help people through
TechAgappe succeed in the future also.
Mr. D. Datta, Jharkhand
INFORMATIVE AND
MOTIVATING CONTENT
Glad to say that the TechAgappe magazine
is quite good in its content presentation.
Dealing one topic, both with its theoretical
aspects and case history, is a nice way of
disseminating knowledge. Reading a case
history is more capturing and may moti-
vate the users to have regular periodic
health check-ups.
Prof. Kumari Haripriya,
College of Nursing, Trivandrum
Editorial Chief Editor’s Desk
ENDING TUBERCULOSIS
REQUIRES FOCUS ON PREVENTION
I am glad to place this 35th ed ition of
TechAgappe, the quarterly review of health and
laboratory medicine. This magazine is now regu-
lar in publication at intervals of three months. I
am also happy to report that the laboratory
community has warmly welcomed the previ-
ous issues.
In this issue, the first article is from Mr. Tho-
mas John, the Managing Director of Agappe Di-
agnostics who describes the reminiscences of
the financial year 2023 as well as the plans to be
accomplished in 2023-24. Most of the vital en-
gagements of the last year have been furnished
in a nutshell for the better understanding of all
stake holders.
The main topic for this issue is focused on
Tuberculosis – the dreaded disease which can
affect anybody at any age irrespective of their
geographical as well as demographical differ-
ences. To support the cover story, we have, as
usual, included three medical articles, three life
stories, two interviews with eminent medical
personalities, one technical article, and a few
health tips.
The first medical article is an overview of
Tuberculosis, explained with facts and figures
from my desk. The second health article dis-
cusses perinatal tuberculosis by Dr. Aravind
Shenoi from Bangalore. The third article pro-
vides a comprehensive insight into laboratory
diagnosis of Tuberculous Pleural effusion which
was written by one of our esteemed custom-
ers, Dr. Manoj A. Kahar from Gujarat. The
fourth medical story is by Dr. Thirupathi
K from Chennai who describes the Indian
tuberculosis scenario.
In the life story sessions, we are introducing
the stories of three brave women of India. The
first story is of Ms. Deepti Chavan, Mumbai
who is now living peacefully, after conquering
the bad threats of Tuberculosis that happened
in her teenage. The second story is of Ms. Keyuri
Bhanushali from Mumbai whose story is a real
example of how a youngster from India fought
and overcome TB. The third story is of Ms.
Nandita Venkatesan, again from Mumbai who
had suffered and survived Tuberculosis
threats twice in her childhood.
In this issue, you can also see interviews
with two eminent specialists. The first inter-
view is with Padma Shri Dr. Digambar Behera
from Mohali who has received 29 national and
7 international awards to his credit, including
the prestigious Padma Shri, one of the top most
honors of the Government of India. The sec-
ond Interview session is enriched with a cus-
tomer of Agappe; Dr. Rajalakshmi P C, Aswini
Diagnostic Services, Calicut, speaking about her
success stories and her vision for the future
ventures.
In the Technical session category, we dis-
cuss the importance of sample traceability in
lab diagnostics. We have also included a few
health tips for preventing and mitigating the
hurdles of Tuberculosis.
I am glad to state that we have received ex-
cellent feed back and letters of great apprecia-
tion for the last issue. Moreover, readers have
started reading our magazine online. All can
now read the magazine by browsing
www.techagappe.com.
I am sure this issue of TechAgappe will give
you valuable insights into maintaining health,
especially during this post-pandemic era.
Your constructive criticism to improve the
content will be greatly appreciated.
With warm personal regards
Dr. D.M. Vasudevan
TECHAGAPPE APRIL-JUNE 2023 7
 IVD Industry Update
WE SELL EXPERIENCE,
NOT JUST PRODUCTS
Yes, Agappe believes in providing high quality diagnos-
tic solutions to our believers, through the highest level of
customer connect by ensuring innovative and affordable
products for an everlasting relationship. We have our own
ways to connect with 45000 domestic customers and
15000 plus international associates encompassing 90 plus
countries across the globe. There came our novel Mobile
app namely AG Privilege- Customer Engagement
Programme, AG Care- the complaint registration portal
and many other innovative ideas in the IVD industry.
Any customer can enrol into AG Privilege programme
online, just by downloading the app and then he becomes
a Privilege member, by scanning a reagent or equipment
label. These bonus points in each purchase will get accu-
mulated and is added by scanning the unique code on
each and every Agappe product label. These AG Privilege
customers are categorised as Platinum, Gold, Silver &
Bronze depending on the total points gained by each cus-
tomer. They can redeem the points accrued.
8 TECHAGAPPE APRIL-JUNE 2023
Meena Thomas,
Director & COO,
Agappe Diagnostics Ltd.
AG Care - “Care with a Difference”
AG Care is the complaint registration portal in Agappe
Mobile App, the easiest way to register your complaints
with us. Our Customer Technical Support (CTS) Depart-
ment with technically competent and experienced engi-
neers will be reviewing your complaints/contact you over
phone immediately and provides a unique customer
experience by expeditiously attending to your complaints
just in 15 minutes.
CTS ensures the LEAST DOWN TIME for resolving
your inconveniences and interruptions. CTS team will
guide you to perform the test, observe protocols and give
proper guidance online if required, for instantaneous
solution. Meantime, your complaint will be assigned to
our field Mispa Care Engineers & Product Specialists to
provide hardware and reagents application support to
assure the earliest solutions reach you in time.
AG Privilege App
Agappe recognises customer as God, we know pretty
sure that we fully depend on them, rather than they de-
pend on us. With this realisation and discernment, our
service handle is always focussing on our esteemed cus-
tomers and their requirements. In order to create right
customer delight, we have a novel mobile application
platform called “AG Privilege”. It’s a customer engage-
ment programme for assuring 24x7 service to our es-
teemed customers. The mobile application has very de-
lightful features like AG Privilege, AG Care, Products, Vir-
tual Demo, Reference Range, Demo Videos, Feedback,
Enquiry and many more to interact with including feed-
back option. It’s a complete solution for all customers’
problems.
AG Privilege places our users to be a notch above the
ordinary, enabling you to easily access information about
products, scientific data and earn various rewards.
Simple process of scanning the code or downloading
from the App Store or Play Store takes you to the world
of a rewarding experience. Accumulating Ag-reward or
points with AGP is quite easy and effortless. Every time
you make a transaction such as purchasing a reagent,
service or do your first transaction via AGP app, you will
be rewarded with points. You will also be gifted with
bonus points on every birthday and anniversary. All the
Agappe reagents, equipments, consumables & PM Kits
are barcoded for our loyalty program. The customer
can scan, earn, and redeem the Agappe reagents through
this splendid loyalty program, AG Privilege.
Poem TB Vaccine

BCG-the Guardian Angel

Against Tuberculosis...
From time immemorial, Tuberculosis the greatest anathema of humans claiming millions globally,
When antibacterial protection was not in the hands of humanity as a whole, countless died,
Albert Calmette, Camille Guérin, France worked hard on weakened strain of bovine,
Named after them, Bacille Calmette Guerin or BCG the short name for vaccine.
BCG spread the globe, in total fight against TB, protecting many millions,
Preventing severe TBs, TB meningitis, miliary TB, 80% of infections
Helping reducing deaths, countless ways in new-borns,
Let our people live healthier, longer days always.
The safe & cost-effective medicine preventing TB.
BCG vaccine ever boosting the immune system very well,
All major countries legalised the vaccination across the globe ,
Healthcare workers exposed to TB, need vaccine for immunity always,
Injection at the upper arm, forms small sore, then forms a scab & scar tissue,
It’s an indicator of your TB protection, many have different size & thick scars evident.
Listen, India has the highest burden TB across universe, 2.6 million afflicted by TB in 2020,
Accounting a quarter of the global TB cases & largest burden of drug-resistant TB in the world over.

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

TECHAGAPPE APRIL-JUNE 2023 9

 AGAPPE MD’s Desk

REMINISCENCES OF FY23 &

GLIMPSES INTO FY24
Over the past year, the medical device industry has seen remarkable
advancements in technology, innovation, and patient care. From ground-
breaking developments in surgical tools to revolutionary diagnostic devices,
the industry has continued to push the boundaries of what is possible.
Despite the challenges posed by the Covid-19 pandemic, the industry has
shown remarkable resilience and adaptability, with companies rapidly
pivoting to produce critical equipment and devices to support healthcare
providers on the frontlines.
As front runners in this stride, Agappe has ex- able growth and share in Clinical Chemistry
tended its presence as well as brand reach into segment and increased closed system fully
many more domestic markets and fresh 20 odd automation sales. With regard to cardiac and
countries during FY23, in addition to the existing diabetic profiles, we achieved better overall
70 countries, last year. We have exhibited remark- growth compared to last year. During FY23,
Agappe has served the society with more than
5 million HbA1C tests through Mispa i2 and i3,
our flagship Nephelometry equipment seg-
ment.
Agappe has actively participated and spon-
sored more than 50 national and regional pa-
thologist and laboratory owners’ conferences
deliberating with many scientific seminars in
IVD. We could perform many important stra-
tegic product launches in various segments,
globalizing indigenously manufactured prod-
ucts on a large scale and successful ly win
major government tenders in fully automated
and hematology solutions. Agappe again could
show its presence in public domain with cost
effective diagnostic solutions.

R&D and Hematology

Segment
On the R&D side, we have been awarded
with multiple technology patents for the tech-
nology employed in Mispa i3 as well as mul-
tiple design registrations. One of the most
important events for FY23 is our successful
Thomas John, market entry in the Immunology segment with
Managing Director, AGAPPE CLIA Analyzer, i1000 from Maccura. Above
all, Agappe emerged as the first Indian com-
pany to have CDSCO permission for indig-
enous manufacture of CLIA reagents.

10 TECHAGAPPE APRIL-JUNE 2023

 Annual Business Partners Meet - AGAPCON INTERNATIONAL 2023 at Dubai.
In haematology segment, Agappe has
emanated as the complete solution pro-
vider in haematology products portfolio
with the successful launch of 6-part
haematology analyzers. We have indig-
enously manufactured 3-Part Hematology
analyzer Mispa CountX, with 5 Part and 6
Part Haematology systems on board to
cater the entire laboratory segments pan
India from small labs to bigger lab chains.
Other Major Strides
Agappe has successfully stepped into
Point-of-Care market segment in a big way
with multiple products and many in the
pipeline. Dedicated marketing team and
independent head for POC has been set
up and we plan to focus on POC segment
so as to build a team of comprehensive
achievers in this segment.
In POC segment, we have introduced a
new concept of analysis of maternal milk
with Crematocrit Plus Centrifuge cum
Reader to analyse the calories and Fat con-
tent in the mother’s milk with small vol-
ume of milk.
This is meant for routine testing and to
put for use in daily practice without
wasting large volume of mothers’ milk for
testing.
Besides, Chem DX is the latest POC
introduction for Clinical Chemistry
analysis, Q-3 Plus- Blood Coagulation
Monitoring Device as well as HbX HB meter
are also now in the market, specially de-
signed for emergency situations like ICUs,
Emergency rooms, OTs and ambu-
lances etc. It is a welcoming data to hear
that Agappe’s Pre-Analytical product seg-
ment is really performing well.
With regard to international business,
Agappe has made 13% growth from last
year, with special focus on region-centric
staff approach, ratio mix of 59% reagents
& 41% equipment etc. Fresh footprints ex-
pansion to Angola, Congo, Botswana, Togo,
Mozambique, Kazakhistan, Azerbaijan
etc.. have helped Agappe to have a CAGR
of 28% over the last 13 years.
Launch of Immunology Segment - Biolis
30i for selected set of countries gave us a
good impetus in FY 23 and which will give
us a good thrust in this year too. Now we
have a global presence of 90 plus Countries,
127 plus business partners, 15000 plus sat-
isfied customers, 10 countries with direct
staff operations in international trade.
Our marketing team also did wonderful
initiatives. We had our presence in more
Launch of Immunology
Segment - Biolis 30i for
selected set of countries gave
us a good impetus in FY 23
and which will give us a good
thrust in this year too. Now we
have a global Presence of 90
plus Countries, 127 plus
business partners, 15000 plus
satisfied customers, 10
countries with direct staff
operations in international trade.
TECHAGAPPE APRIL-JUNE 2023
than 7 international expos including Medica
2022, Dusseldorf, Germany, AACC in Chi-
cago and MEDLAB Dubai. Agappe On Wheels
– Nepal was a unique step from our inter-
national division covering 31 locations with
tremendous lead generation and 75% lead
conversion. In addition, Bandhan programme
and Customer group meeting in 10 plus
countries contributed very much to our cli-
entele forum.
Massive Expansion Plans
Agappe envisages massive expansion
plans for FY24 including aggressive mar-
ket penetration in the Immunology mar-
ket, affordable and better technologies for
HbA1c testing, expanding the rapids seg-
ment, revamping mid-level automation
solutions for both domestic and interna-
tional business, aggressive investments
through product placements at B2B labo-
ratories as well as new focussed entry into
the Veterinary Diagnostics market seg-
ment with a dedicated team of sales.
International division also visualises a
wider business growth through new intro-
ductions, novel customer connect activi-
ties & International expo participations.
As per predictions from various quar-
ters, India will be the hub of medical de-
vices segment like the Pharma market
within a decades’ time. India is the future,
and that our young engineers and scien-
tists have the skill and expertise to bring
in the best technology to fit the Indian
Health Care industry and thus make India
self-reliant.
We want to bring forth quality educa-
tion with government support in medical
11
 AGAPPE MD’s Desk
devices branch, inculcate cultural values,
and international exposure to contribute
young engineers and scientists in India by
acquiring skill and expertise to bring in
the best technology to fit the Indian
healthcare industry and make India self-
reliant. India has a strong education sys-
tem, with many top-tier universities offer-
ing quality programs in engineering, sci-
ence, and healthcare. With additional skill
development courses, we would like to cre-
ate a large pool of talented graduates who
have the necessary skills and expertise to
contribute to the healthcare industry.
Agappe as Partners of
Progress
Of course, we will take the support of
the Government in this endeavour. The
Indian government has been investing
Participation of Team Agappe at MEDLAB Middle East 2023, Dubai.
heavily in science and technology educa-
tion and research and has been encour-
aging innovation and entrepreneurship.
With this supportive ecosystem we hope
we can enable young engineers and scien-
tists to explore their ideas and develop
new technologies. In tune with this con-
viction, we have begun working along with
the prestigious Rajajgiri School of Engi-
neering and Technology (RSET) Cochin.
The parent University of RSET is APJ Abdul
Kalam Technological University, Kerala and
is approved by All India Council of Tech-
nical Education, New Del hi.
12 TECHAGAPPE APRIL-JUNE 2023
Our management plans to engage
closely with prime institutions to develop
a pool of talent that is prepared for the
workforce in an effort to form partner-
ships with prominent academic institu-
tions that will increase the employability
of their students. This will assist in the
acquisition of talent on a pan-India basis
to suit the expanding requirements of
Agappe. Our Training & Development wing
will identify the prominent academic in-
stitutions that have a strong focus on rel-
evant fields such as biotechnology, medi-
cal technology, and related fields as well
as institutions with a track record of pro-
ducing skilled graduates for sourcing right
students.
With these courses, Agappe hopes to
develop a talent development program,
specifically designed to prepare graduates
for our workforce. These programs could
include training on the latest industry tech-
nologies, soft skills development, and ex-
posure to the latest trends in the industry.
The short duration makes it ideal for stu-
dents who want to acquire job-ready skills
quickly and start their careers in the
biotech industry without taking a long
break from their studies. We propose to
provide assistance with placement to can-
didates to both Agappe and the trade body
partners. Again, Agappe will offer varied
streams of employment to at least 50% of
candidates who apply for these positions.
These two Institutions will collaborate to
provide candidates assistance for com-
pleting their industrial training utilising the
facilities available in Agappe.
Our management plans to
engage closely with prime
institutions to develop a pool of
talent that is prepared for the
workforce in an effort to form
partnerships with prominent
academic institutions that will
increase the employability of
their students.
The course will provide relevant and
practical skill development in the field of
biotechnology too, that is required by
Medtech industry. This will help students
to acquire the necessary skills to meet the
requirements of the industry and enhance
their employability. Besides, the hands-on
training in the latest technologies and tools
used in the biotech industry will help stu-
dents to gain practical experience and de-
velop proficiency in using these tools, mak-
ing them more job oriented. The exposure
to the operating companies will provide
inroads to the biotech industry, its work-
ings, and its trends. This will help students
to understand the industry’s requirements
and prepare them for the job market.
Upon completion of the course, stu-
dents will receive a certification that is rec-
ognized by the industry. This certification
will enhance the students’ credibility and
employability, making it easier for them
to find jobs.
Value Added Future
Growth
Our growth strategy outlined presents
a promising path forward for Agappe. By
focusing on product innovation, expand-
ing into new markets, and leveraging tech-
nology, Agappe is wel l-positioned to
achieve sustained growth in the years to
come. The adoption of a customer-centric
approach, supported by data-driven in-
sights and a commitment to excellence,
will further strengthen the competitive ad-
vantage and help it to stay ahead of the
curve in an ever-evolving business land-
scape. While challenges may arise along the
way, the organization’s dedication to de-
livering value to its customers and driving
growth through strategic investments po-
sitions Agappe for long-term success.
AGAPPE Branding

PREMIUM
SOLUTIONS

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180
Test/Hr

800/1200
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TEL: + 91 484 2867000 | agappe@agappe.in | www.agappe.com

TECHAGAPPE APRIL-JUNE 2023 13

 Article TB - An Overview

TUBERCULOSIS
AN OVERVIEW
Approximately one-quarter of the world’s population has been infected with
TB, with new infections being reported in about 1% of the population each
year. India is on top in respect of the total number of TB cases worldwide.
Prevention of TB involves screening those at high risk, early detection and
treatment of cases, and vaccination with the bacillus Calmette-Guerin (BCG)
vaccine. Public health campaigns which have focused on overcrowding,
public spitting and regular sanitation (including hand washing) have helped
to interrupt the spread the disease.
Dr. D.M. Vasudevan, MBBS, MD, FRCPath (Technical Director, AGAPPE).

Tuberculosis(TB) is an infectious disease usu- seen in skeletal remains of prehistoric humans

ally caused by the bacteria, Mycobacterium tuber-
culosis (MTB). Tuberculosis has been present in
humans since ancient times. Evidence of TB is
(4000 BC) and in spines of Egyptian mummies
(3000 BC). Charaka from India (600 BC) and
Hippocrates in Greece (460 BC) recorded the dis-
ease. Robert Koch identified and
described the specific bacillus in
1882, for which he was awarded
Nobel Prize In 1905. World Tuber-
culosis Day is celebrated on 24th
March of every year, the anniver-
sary of Koch’s original scientific
announcement. Al bert Calmette
and Camille Guerin developed the
vaccine against tuberculosis in
1906, using a weakened strain of
bovine tuberculosis; this is called
bacille Calmette Guerin (BCG). In
1946, the antibiotic streptomycin
was developed as an effective
treatment for TB. Great artistic fig-
ures who succumed to TB include
John Keats, Percy Shelley, Edgar
Allan Poe, Anton Chekhov, Franz
Kafka, Fyodor Dostoevsky, Tho-
mas Mann, Somerset Maugham,
George Orwell and Robert Louis
Stevenson.
Epidemiology
In Europe, rates of tuberculo-
sis began to rise in the early 1600s

14 TECHAGAPPE APRIL-JUNE 2023

to a peak level in the 1800s,
when it caused nearly 25% of
all deaths. By the 1950s mor-
tality in Europe had decreased.
But hopes of eliminating TB
ended with the rise of drug re-
sistant strains in the 1980s. The
subsequent resurgence of tu-
berculosis resulted in the dec-
laration of a global health emer-
gency by the World Health Or-
ganization (WHO) in 1993.
However, the total number of
tuberculosis cases has been
decreasing since 2005.
Roughly one-quarter of
the world’s population has
been infected with TB, with
new infections occurring in
about 1% of the population
each year. At present, tuber-
culosis is the leading cause of
death worldwide.
Moreover, one quarter of
the world’s population has la-
tent infection of TB. Most TB
cases occurred in the regions of South-East Cause common cause of tuberculosis, but the
Asia (44%), Africa (24%), and the Western pasteruzation of milk has almost elimi-
The main cause of TB is Mycobacte-
Pacific (18%). More than 50% of cases are nated this as a public health problem. M.
rium Tuberculosis (MTB), which can with-
diagnosed in seven countries: India (27%), africanum is not widespread, but it is a
stand weak disinfectants and survive in a
China (9%), Indonesia (8%), the Philippines significant cause of tuberculosis in parts
dry state for many weeks.Since MTB re-
(6%), Pakistan (6%), Nigeria (4%), and of Africa.
tains certain stains even after being treated
Bangladesh (4%).
with acidic solution (Ziehl-Neelsen stain- Risk Factors
India has the highest total number of ing), it is classified as an acid-fast bacil-
Persons with frequent, close contact
TB cases worldwide. But India’s estimated lus. Mycobacterium bovis was once a
with people with TB are at high risk of be-
mortality rate dropped from 55 (in 1975)
coming infected, with an estimated 22%
to 36 (in 2020) per 100,000 population per
infection rate. A person with active but
year. Programs such as the Revised Na-
untreated tuberculosis may infect 10–15
tional Tuberculosis Control Program
(RNTCP) are working to reduce TB levels Tuberculosis is closely linked (or more) other people per year. After
about two weeks of effective treatment,
among people. The World Health Organi- to both overcrowding and patients do not remain contagious to oth-
zation (WHO), the Bill and Melinda Gates
Foundation, are subsidizing a fast-acting
malnutrition. Those at high ers. Other risk factors include use of medi-
risk thus include: people who cations, such as corticosteroids, alcohol-
diagnostic tuberculosis test in India from
ism, diabetes mellitus, HIV infection, to-
2012 onwards. inject illicit drugs, people bacco smoking, malnutrition, drug abuse,
Risk Groups residing in homeless shelters, and immunosuppression.

Tuberculosis is closely linked to both medically underprivileged and Pathology

overcrowding and malnutrition. Those at
high risk thus include: people who inject
illicit drugs, people residing in homeless
shelters, medically underprivileged and
resource-poor communities, children in
close contact with high-risk category pa-
tients, and health-care providers serving
these patients. Tuberculosis is spread
from one person to another through air
from persons with active TB.
resource-poor communities,
children in close contact with
high-risk category patients,
and health-care providers
serving these patients. It is
spread from one person to
another through air.
TB infection begins when the myco-
bacteria reach the alveolar air sacs of the
lungs, where they replicate within alveolar
macrophages. Although macrophages at-
tempt to kill the bacterium, the thick, waxy
capsule of the bacteria protects them. M.
Tuberculosis is able to reproduce inside
the macrophage and will eventually kill the
immune cell. The primary site of infection
is in the lungs, generally located in either

TECHAGAPPE APRIL-JUNE 2023 15

 Article TB - An Overview
the upper part of the lower lobe, or the
lower part of the upper lobe. Transmis-
sion through blood stream can spread in-
fection to more distant sites, such as
peripheral lymph nodes, the kidneys, the
brain, and the bones. Tuberculosis is a
granulomatous inflammatory disease.
Macrophages, epithelioid cells, lymphocyes
and fibroblasts aggregate to form granulo-
mas. When other macrophages attack the
infected macrophage, they fuse together to
form a giant multinucleated cell. Bacteria
inside the granuloma can become dormant,
resulting in latent infection.
The granuloma may prevent dissemi-
nation of the mycobacteria and provide a
local environment for interaction of cells
of the immune system. However, the bac-
teria use the granulomas to avoid destruc-
tion by the host’s immune system.
Macrophagesin the granulomas are un-
able to present antigen to lymphocytes;
thus the immune response is suppressed.
Bacteria inside the granuloma can become
dormant, resulting in latent infection.
16 TECHAGAPPE APRIL-JUNE 2023
In the centre of the granuloma, there is
abornal cell death, leading to white cheesey
material, termed caseous necrosis. In many
people, the infection waxes and wanes. Tis-
sue destruction and necrosis are often
The granuloma may prevent
dissemination of the
mycobacteria and provide a
local environment for
interaction of cells of the
immune system. However, the
bacteria use the granulomas to
avoid destruction by the host’s
immune system. Macrophages
in the granulomas are unable
to present antigen to
lymphocytes.
balanced by healing and fibrosis. Affected
tissue is replaced by scarring.
Signs and Symptoms
General signs and symptoms include
a bad cough (lasting more than 3 weeks),
fever, chills, night sweats, loss of appe-
tite, weight loss, fatigue, pain in the chest,
and blood stained sputum.Significant nail
clubbing may also occur. Tuberculosis may
infect any part of the body, but most com-
monly occurs in the lungs (known as pul-
monary tuberculosis). Extra-pulmonary
TB occurs when tuberculosis develops
outside of the lungs.
Pulmonary TB
Tuberculosis most commonly involves
the lungs (in about 90% of cases). Symp-
toms may include chest pain and a pro-
longed cough producing sputum. About
25% of people may not have any symp-
toms. Occasionally, people may cough
up blood in small amounts, and in very
rare cases, the infection may erode into
the pulmonary artery, resulting in mas-
sive bleeding.
Extra-pulmonary TB
In 10-15% of active cases, the infection
spreads outside the lungs. Extra-pulmo-
nary TB occurs in the pleura (tuberculous
pleurisy), the central nervous system
(tubercouls meningitis), and the bones and
joints (in Pott’s disease of the spine),
among other sites. A widespread form of
TB is called “disseminated tuberculosis”
or miliary tuberculosis, which is a very
grave condition. People with dissemi-
nated TB have a high fatality rate.
Diagnosis
The diagnosis of active TB is based on
chest X-rays, and microscopic examina-
tion and culture of sputum or body fluids.
However, culturing of this slow growing
organism will take about 4 to 6 weeks to
get a result. Diagnosis of Latent TB relies
on the tuberculin skin test (TST).WHO rec-
ommends the use of rapid molecular di-
agnostic tests as the initial diagnostic test
in all persons with signs and symptoms
of TB as they have high diagnostic accu-
racy and will lead to major improvements
in the early detection of TB and drug-re-
sistant TB. Such rapid tests recommended
by WHO are the Xpert MTB and Truenat
assays. These nucleic acid amplication tests
as well as the enzyme adenosine deami-
nase (ADA) assay will allow rapid diagno-
sis of TB. Blood tests to detect antibodies
are not specific or sensitive.
Latent Tuberculosis
Sometimes, no symptoms are mani-
fested, in which case it is known as latent
tuberculosis. Around 10% of latent infec-
tions progress to active disease. The
Mantoux tuberculin skin test is often used
to screen people at high risk for TB. Those
who have been previously immunized with
the Bacille Calmette-Guerin vaccine may
have a false-positive test result. The test
may be falsely negative in those with sar-
coidosis, Hodgkin’s lymphoma, and in
active tuberculosis.
Treatment
Treatment of TB is mainly dependent
on antibiotics to kill the bacteria. Active TB
is best treated with combinations of sev-
eral antibiotics to reduce the risk of the
bacteria developing antibiotic resistance.
Treatment of Latent TB
Latent TB is treated with combination
of isoniazid with either rifampicin or
rifapentine.The treatment takes three to
nine months. People with latent infections
are treated to prevent them from pro-
gressing to active TB disease later in life.
Treatment of New onset TB
The recommended treatment of new-
onset pulmonary tuberculosis is six months
of a combination of antibiotics containing
rifampicin, isoniazid, pyrazinamide and
thambutolfor the first two months, and
QUICK & ACCURATE RESULTS
BEST SERVICE TEAM
only rifampicin and isoniazid for the last
four months.
Where resistance to isoniazid is high,
ethambutol may be added for the last four
months as an alternative.Drug-susceptible
TB is treated with a standard 4-month or
6-month course of 4 antimicrobial drugs.
Treatment of Recurrent
Disease
If tuberculosis recurs, testing to de-
termine which antibiotics it is sensitive to
is important before determining treat-
ment. If multiple drug-resistant TB (MDR-
TB) is detected, treatment with at least four
effective antibiotics for 18 to 24 months is
recommended.
Treatment of Resistant TB
Primary resistance occurs when a per-
son becomes infected with a resistant
strain of TB. A person with fully suscep-
tible TB may develop secondary (acquired)
resistance during therapy because of in-
adequate treatment, not taking the pre-
scribed regimen appropriately (lack of
compliance), or using low-quality
medication. MDR-TB is defined as resis-
tance to rifampicin and isoniazid. Exten-
sively drug-resistant TB (XDR-TB) is also
resistant to three or more of the six
classes of second-line drugs. This group
constitutes one in ten cases of MDR-TB.
MDR-TB is treatable and curable by using
second-line drugs. However, second-line
treatment options are limited and require
extensive chemotherapy (of at least 9
I am Sreenivasan, working at Midway
hospital for the last six months. Tal k-
ing from my experience, Agappe Mispa
- i3, is a friendly machine providing ac-
curate results within short time. Most
tests like CRP, ASO, D-Dimer, and HbA1c
are performed so fast in this machine. It
is very easy to handle this machine.
Agappe’s Service response is very quick
and effective.
Mr. Srinivasan, Lab Technician,
Midway Hospital, Chennai
TECHAGAPPE APRIL-JUNE 2023
Sometimes, no symptoms are
manifested, in which case it is
known as latent tuberculosis.
Around 10% of latent infections
progress to active disease.
The Mantoux tuberculin skin
test is often used to screen
people at high risk for TB. The
test may be falsely negative in
those with sarcoidosis,
Hodgkin’s lymphoma, and in
active tuberculosis.
months and up to 20 months of treatment)
with medicines that are expensive and
toxic.There is some efficacy with the new
drug linezolid to treat those with XDR-TB.
Bedaquline is a relatively new drug useful
against multiple drug-resistant TB. MDR-
TB remains a public health crisis and a
health security threat. Worldwide, the
treatment success rate of MDR/RR-TB pa-
tients was only 60%.
Prognosis
The risk of reactivation increases with
immunosuppressioin, such as that caused
by infection with HIV. The chance of death
from a case of tuberculosis is about 4%.
In people with smear-positive pulmonary
TB (without HIV co-infection), after 5 years
without treatment, 50-60% die while 20-
25% achieve cure.
Prevention
Prevention of TB involves screening
those at high risk, early detection and treat-
ment of cases, and vaccination with the
bacillus Calmette-Guerin (BCG) vaccine.
In children the vaccine decreases the risk
of getting the infection and the risk of in-
fection turning into active disease. Those
at high risk include household, workplace,
and social contacts of people with active
TB. Treatment requires the use of mul-
tiple antibiotics over a long period of time.
Public health campaigns which have fo-
cused on overcrowding, public spitting
and regular sanitation (including hand
washing) have helped to interrupt the
spread the disease.
17
 Story Deepti Chavan

HER REMARKABLE FIGHT AGAINT A DREADED DISEASE
LIKE A PHOENIX SHE ROSE FROM
THE ASHES TO BECOME A CHAMPION
At the age of 16, what would be a teenager’s dreams? Stylish dresses, modern
gadgets, partying with friends and lots of fun, isn’t it? But Deepti Chavan of
Borivali, Mumbai, had no such dreams but just wanted a normal life where there
are no more agonizing coughs and painful injections. She was a hapless victim of
TB, that too a dangerous drug resistant form multi drug resistant TB or MDR –
TB. Here’s the story of her remarkable fight against this dreaded disease.
Deepti’s story is inspiring to the core as it demons- depend on heavy loans to meet the expenses of her
trates how to remain strong even when we know treatment.
that any minute you could succumb to this dreaded
and most common disease. She is the embodiment The Agony Mounts
of hope and it is her ‘never give up’ attitude that makes Even after a long duration, Deepti was not get-
her a true champion now. ting the expected results with the medicines. Tests

Deepti was doing her Board

exams when she first fell sick.
Some regular treatments fol-
lowed with no results. After
some time, her doctor asked
to take her chest x-ray and it
clearly revealed Tuberculosis
to their utter dismay. “I was
just 16 and was not aware of
the social stigmas related to
TB. Doctors told me that after
taking a course of medicine for
around 6-8 months, I will be
fine. At that time, I never
thought that almost six years
of my life are going to be
wasted.” She recalls.
DEEPTI CHAVAN

Accord ing to her, those

were the most nightmarish
years of her life. She was not
sure whether she would wake
up the next morning. At one
point, she accepted the fact
that she had to live like that but
for her, it was more heart
wrenching to see her family
suffer. Though she was ready
to fight the physical battle with
the disease, it hurt her to see
her family fighting a mental
battle as the cost of the treat-
ment was mounting higher to Deepti Chavan
a staggering level. They had to

18 TECHAGAPPE APRIL-JUNE 2023

revealed that she had another
form of TB, MDR–TB (Multi Drug
Resistant TB). Some of the medi-
cines that would work well in drug
sensitive TB is not effective in this
disease condition making recov-
ery a challenge. Her parents were
told that there was only one op-
tion remaining and that would be
a surgery as a part of Deepti’s lung
was damaged.
Deepti recalls that actually the
real problem was not the disease,
but the lack of a precise diagno-
sis. When one drug stopped work-
ing, she was started on another
antibiotic and this followed as a
chain. When final ly, the actual
problem was diagnosed, her con-
dition was quite worse. She was
coughing out blood every day and
the stitches of a previous surgery
started coming out in her efforts
to cough.
“I had to take an injection ev-
ery day which was extremely pain-
Deepti Chavan with her family friends during a Holy celebration
ful. In six years, I took about 400
at her hometown, Mumbai
such injections. Every day was lit-
erally a struggle for me”, recollects Deepti. incurable and had only six months to live weeks and her symptoms like fever, cough
in his estimation. He went on telling him and loss of weight didn’t disappear, she
She remembers herself being a pretty
to give her good food and spent the re- had to drop out of her engineering course.
child. Due to the medications, her com-
maining six months happily with her, ful- “Though I underwent two lung operations,
plexion became dark. She was around 28
filling all her wishes. I had to wait for over four months to find a
kilos that time and looked almost like a
surgeon willing to operate on me the sec-
skeleton. Mirrors scared her those days As medications were changed every two ond time,”
and she never wanted to even peep into
her reflection. Their search to find a surgeon who could
do the surgery on her the second time ended
Fresh Rays of Hope As her first surgery was not a with Dr. Sripal Doshi in Jaslock Hospital. He
As her first surgery was not a success also predicted a 1% chance for her sur-
and her condition continued to deterio- success and her condition vival. Though it was expected as a 4-hour
rate, doctors advised a second surgery. continued to deteriorate, long surgery, it took almost eight hours and
Just as many doctors were unwilling to she was out of the ICU the very next day.
take up her case as it was almost a ‘gone doctors advised a second To remove her affected lung, the doctor
case’, she googled about the doctors who surgery. Just as many had to remove three of her ribs. She was
specialized in the treatment of TB. She
found out a doctor in UK who told that if
doctors were unwilling to quite disfigured in this process. Seeing the
big scar on her side, she had only one ques-
she wanted to get her treatment in UK, it take up her case as it was tion to the doctor. “How am I going to wear
would be unaffordable for her. So he rec-
ommended her to a friend of his who was
almost a ‘gone case’, she my favourite sarees now?” Now, Deepti lives
with only one lung and that too half of it.
practicing in Mumbai, Dr. Zarir Udwadia. googled about the doctors
While she was taken to the operation
After being briefed about her disease, who specialized in the theatre, when her family was all tensed,
he told them that though the case seemed treatment of TB. She found she was peacefully singing a song and
a bit difficult, he would surely give a try to promised her family that she would be back
cure her. This ignited a spark of hope and out a doctor in UK who alive in a few hours. “I was relaxed think-
welcome relief in them as one among the told that if she wanted to get ing that after the operation, my problems
doctors whom they approached previ- will be over either way – if I die, that’s the
ously blankly asked her father whether he
her treatment in UK, it would end of my misery and if I live, that’s the
was mad to treat his daughter as she was be unaffordable for her. end of my dreaded disease”, she recalls

TECHAGAPPE APRIL-JUNE 2023 19

 Story Deepti Chavan
with a winner’s smile. Deepti says that it
is not only the patient who falls ill, and
looses hope but the whole family’s hap-
piness goes down the drain during the
course of the treatment.
Traumatic Experiences
Deepthi says, “While I was hospital-
ized, I witnessed patients committing sui-
cide. Once a patient just got up from the
next bed and jumped through the win-
dow before my eyes. People give up hope
very soon. The stigma against this dis-
ease and the prolonged treatment makes
them pessimistic.
I believe that if I am given a chance to
live once again, I should live it with a pur-
pose. So, now I give counselling to the dis-
heartened patients and ask them to fight
against this disease and win back their lives
with courage”.
Deepti and her father with Amir Khan during the
programme ‘Sathyameva Jayathe’
She believes that the real enemy of this
disease is the stigma against this disease.
In India, the stigma associated with the
disease leads to the individual facing so-
cietal disapproval. When patients are di-
agnosed with diseases such as TB, the fear
of the social and economic consequences
following diagnosis can make them reluc-
tant to seek and complete the treatment.
20 TECHAGAPPE APRIL-JUNE 2023
Deepthi says, “While I was
hospitalized, I witnessed
patients committing suicide.
Once a patient just got up
from the next bed and
jumped through the window
before my eyes. People give
up hope very soon.
The stigma against this
disease and the prolonged
treatment makes them
pessimistic.
Deepti with her husband during their
family get together.
Deepti Chavan is just not a TB survivor.
She is now a committed spokesperson for TB
patients and their rights in India. She has a
message to the people who are affected with
TB. She comments, “TB has taught me a lot. It
has made me brave. I started accepting pain
due to this disease. If I could make it, surely
everyone can. Just don’t miss your medica-
tions. My mantra is simple -‘Do not let TB win.”.
Happy Ending
Of course, her most valuable victory
and asset is her husband, Neeraj Musale,
whom she got familiar through her online
chats. She had the habit of browsing the
net while admitted in hospitals. She found
him during one such surfing.
Though she stayed strong before her
family, she shared her apprehensions,
pangs and pains to him through chats. Fi-
nally, after knowing her thoroughly, he pro-
posed her over phone and they got mar-
ried as a happy ending to her story. Till
they decided to get married, they never had
met even once.
Deepti says, “He was and is my best
friend for life”. When before their wedding,
her father asked his parents about the gifts
they expected, his parents told him to ex-
plain them how they could take care of their
daughter-in-law in the best way possible
and that they expected nothing else.
Neeraj says that he has learned a lot
from his wife. He gives a STOP SPREADING
TUBERCULOSIS definition to Deepti in one
sentence and the words come from his
heart. “She is the strongest woman I have
ever met”.
Yes, she beams at this comment from
her husband, looks up at him cheerfully,
conjuring all the happiness and optimism
to share to this world.
Testimonials Brand Reach

ABSOLUTELY SATISFIED WITH

AGAPPE PRODUCTS AND SERVICES
I am Dr. P. Suryakala From Vizag. I did my PG at Andhra
Medical College and MBBS at Siddhartha Medical
College, Vijayawada. We started our lab in 1994, and
have been using Agappe products since decades. We
started enzymes of SGPT and SGOT of Agappe. Later
gradually, we increased our procurement from Agappe to
serum proteins, albumin and first Mispa-i. Till then we
had some reservations about our HBA1C results, but after
having Mispa-i, we were very much satisfied and
upgraded to Mispa-i2 also. CRP, ASO, RF routinely we
are doing with Mispa-i2. The staff is also very happy
about Agappe equipment and re-agents. We are
absolutely satisfied with Agape products and services.
Accuracy of the results is very good. We will certainly
recommend Mispa-i2. Hba1c reagent is also very good.
All the very best Agappe!
Dr. P. Suryakala, P.J. Medical Centre, Vizag.

WITH AGAPPE, WE COULD ENSURE

QUALITY AND AFFORDABILITY
I am Ms. Shobhana Soman lab in
charge at Karuna Hospital, Thodupu-
zha, Idukki District. I have been work-
ing in this lab for the past 18 years
and majority of our lab products (Mispa
Count- Hematology analyser and Mispa
Viva - semi auto clinical chemistry analyser)
are from Agappe.
The quality of Agappe reagents is
excel lent and we always receive
timely support from Agappe service
team. We are using Agappe’s AG Privi-
lege mobile application for Last 5
years. We scan all new purchased
Agappe products - equipment, re-
agents & consumables.
This is an additional benefit and a
recognition for loyal customers like
us. With easy scanning of our kits, we
have earned points and enjoyed the
benefits.
Agappe’s mobile applications is
very user friendly and a quick help for
Lab reference range for all param-
eters, easy complaint registration.
Agappe's product and service quality
are the major motivation for us to en-
sure customer satisfaction.
Shobhana Soman
Karuna Hospital, Thodupuzha.

TECHAGAPPE APRIL-JUNE 2023 21

 Interview Dr. Digambar Behera

INDIA’S VALIANT FIGHT

AGAINST TUBERCULOSIS
Padma Shri Dr. Digambar Behera who is popularly known as Dr. Dibera has 29
national and seven international awards including the prestigious Padma Shri, one of
the top most honours of the Government of India to his credit. With over 500
publications in his name, Dr. Behera had presented more than 580 papers in national
and international conferences and authored and co-authored nine books, including
‘Text Book on Pulmonary Medicine’ and ‘Text Book on Respiratory Medicine’. Also
the chairman of the National Task Force for National Tuberculosis Elimination
Programme, he is currently the Director, Pulmonary Medicine, at Fortis Hospital,
Mohali. Dr. Behera has a clinical experience of more than 40 years especially in the
treatment of Pulmonary TB. The following is a glimpse into his medical career and
his learned observations on TB treatment in India.
Dr. Digambar Behera, Chairman, National Task Force for National Tuberculosis Elimination Programme

D r. Digambar Behera was born in a rural village in

Odisha in 1953. He mostly did his schoolings in the
village and shifted himself to Cuttack, Odisha for his
pre-medical studies. He completed his MBBS at SCB
Medical College in 1978 and MD from PGI, Chandigarh.
Later he shifted to pulmonary medicine as his super
speciality. It has helped him to work in pulmonary medi-
cine at PGI for 42 long years in various roles such as a
senior resident, lecturer, assistant professor, associ-
ate professor, professor and as the Head of the Depart-
ment.

Vast Experience Dealing With

Dr. Digambar Behera
Pulmonary TB
Pulmonary Tuberculosis (TB) is one of the most
common pulmonary problems engulfing the popula-
tion of India. Almost 50% of pulmonary practises in the
past were related to pulmonary TB and it continued like
that for a very long time although now the scope of
pulmonary medicine in India has entirely changed.
The effort to curb TB in India dates back to 1962
when the Government of India introduced a National
TB Control Program (NTC). “It was never structured
back in those days. We got asthma, COPD, lung cancer,
industrial air pollution related lung diseases etc and all
these become part of respiratory medicine. Now, the
shift has focussed from TB to other respiratory dis-

22 TECHAGAPPE APRIL-JUNE 2023

eases. The focus of the pulmonary medi-
cine specialist has become diverted al-
though it was required for the development
of other areas including respiratory medi-
cine,” says Dr Digambar.
He is proud to be a part in developing
pulmonary medicine as a super speciality
in India. A DM course in pulmonary medi-
cine started back in 1989 at PGI by late Dr S
K Malik who was also the founder of the
Department of Pulmonary Medicine. “He
envisaged that handling respiratory dis-
eases needed more training. We have trained
more than 100 DM students till now and
those people are now spread all over the
world. They are now teachers and teaching
others. Many famous doctors including Dr
Randeep Guleria, the ex-director of the All
India Institute of Medical Sciences, New
Delhi and Dr Dhruv Chaudhary were trained
by us at PGI,” he recalls.
Revised National TB
Control Programme
In 1992, the WHO and UNO declared TB
as a global emergency. In 1993, the NTC was
revitalised by the Government of India as
Revised National TB Control Programme
(RNTCP) with an aim to provide treatment
and cure to at least 70-85% of the existing
TB cases in the country. DOTS (direct, ob-
serve, treatment, short course) was offi-
cially launched as the RNTCP strategy in
In India there are more than 100
types of regimes exist for the
same TB drug. There is no
standard or correct dosage.
All this bring about drug
resistance. As a result, the
patient will not get cured.
“Now knowing the patient drug
resistance pattern is as
important as diagnosing TB, the
largest national level survey for
finding out the drug resistant
TB was carried out from 2014-
2016 in India which helped us
immensely to learn the drug
resistance patterns.
1997 and by the end of
2005 the entire country
was covered under the
programme. In the NTC
program the treatment
course was of 18 months,
12 months and nine
months. It came down to
6 months even- tually.
“Now looking back, I
believe what we took up
was a herculean task.
Our TB control progra-
mme is the world’s lar-
gest and fastest growing
public health prog-
ramme. Sustaining it till
now is a great achieve-
ment.” Dr Digambar who
was the Director of the
National Institute of TB
and Respiratory Dis-
eases for five years says.
R&D Issues
Related to TB
Control
With vast R&D, the medi-
cal field has witnessed
tremendous growth and
Dr. Digambur Behra receiving Padma Shree Award
solution to several dis- from the former President of India.
eases. But little has hap-
pened in the case of TB. “The TB drug injec- resistant TB was carried out from 2014-2016
tion Streptomycin was discovered in 1943. in India which helped us immensely to learn
Another drug Rifampicin was discovered in the drug resistance patterns. One of the
early 80’s. After that for a good 15 years noth- dreaded drug resistance micro-bacteria is
ing came up. No newer diagnostics or medi- the MD RTB (Multidrug-resistant TB).
cines were discovered except for the new
TB drug Bedaquiline.
There are also other threats like RR-TB
(Rifampicin-resistant TB) or Isoniazid-re-
Usually the drug discovery itself is a sistant TB. It is estimated that about 2-3%
highly investing job. You need billions and of all newly registered TB cases will be RR-
billions of dollars for the research and for- TB. About 11% of our previously treated TB
mulation. That was not the priority for the cases will be MD RTB or RR-TB cases. They
developing nations. TB was the problem of are deterrent for TB control,” he says.
poor nations and little research was done
on it. Obviously it is our own mistake. We Measures to Efficiently
didn’t invest in research or drugs like the Handle TB
developed nations. But if you look at other
Even with RNTCP which focused to pro-
branches of medicine, there is evidently rapid
growth and development,” he points out.
vide treatment and cure to at least 70-85%
of the existing TB cases in the country, the
In India there are more than 100 types achieved percentage was around 62-64%.
of regimes exist for the same TB drug. There Among them, those who cured were around
is no standard or correct dosage. All this 85% as some might discontinue treatment
bring about drug resistance. As a result, or so. Even though it is not sufficient to
the patient will not get cured. “Now know- control TB it was a huge jump considering
ing the patient drug resistance pattern is as the earlier state of providing treatment to
important as diagnosing TB, the largest less than 10%. “Gradually with PMDT (Pro-
national level survey for finding out the drug grammatic Management of Drug Resistant
TECHAGAPPE APRIL-JUNE 2023 23
 Interview Dr. Digambar Behera
Tuberculosis) we expanded in many fronts
like diagnostics, drugs, human resources
etc and now we have got around 4700 ma-
chines for cartridge based test cal led
Truenat, the new TB molecular diagnostic
tool for the detection of TB.
We have also got more
than 80 Intermediate Refer-
ence Laboratory (IRL), six Na-
tional Reference Laboratories
and at the peripheral level Des-
ignated Microscopy Centres
(DMCs) located at District TB
centre and sub-district TB
units. The plan is to make at
least one DMC in every taluk or
block. The diagnostic expan-
sion was made very rapidly. It
will help to increase the case
detection rates,” he points out.
National
Strategic Plan for
Digambar Behera receiving Biju Patnaik Award from the
Tuberculosis (NTB) Chief Minister of Orissa Naveen Patnaik for Scientific
Dr Digambar clarifies that many
people confuse NTB strategy with
TB elimination. “If you get one case from 1,
00,000 people then we say it can be easily
eliminated. This one case can be easily elimi-
nated without creating a threat to the com-
munity or spreading. NTB strategy on the
other hand focuses on reducing the per-
centage of cases and number of deaths to a
certain level by the designated year. If the
number of cases in 2015 is ‘n’ then the num-
ber of the cases to the designated year for
example in 2025 must be reduced to 90%.
In 2035, the number of cases should be
reduced to 95% and as such. It also focuses
on providing free treatment to the patient
as most often TB treatment could drain out
all the money from the individual as well as
the family. Our PM Narendra Modi envis-
ages eliminating TB from India by 2025. It
can be achieved. Our program is quite ro-
bust. In 2021, we had 21 lakh new TB cases in
India. The 2022 figure is around 22 lakh al-
though the official figure is yet to come.
Twenty two lakh new TB cases is a huge num-
ber. Earlier we used to miss a large number
of patients what we call as the ‘missing mil-
lions’. India is a vast country and now we
have successfully reduced the gap of miss-
ing cases. More detection is happening
which is a positive thing,” he adds.
24 TECHAGAPPE APRIL-JUNE 2023
regimen and the shorter duration helps to
reduce the cost involved in treating TB pa-
tients. For drugs like Bedaquiline, Delamanid,
and Pretomanid the treatment course has
The estimated number of MD RTB cases come down from 24 months to 9 months
in India as per 2021 report was 1, 19,000 and for longer duration the maximum will
cases. But the actual detection and treat- be 18 months. “Our success rate is now
ment was only around 60,000. “It means above 70%. In the case of XDR-TB (Exten-
almost half are missing. They might be get- sively drug-resistant tuberculosis), the suc-
ting treatment from the private sector. We cess rate was just 35% which has now in-
creased considerably,” he adds.
Extending a
Helping Hand
Another good thing about this
program is providing nutrition
to the patients. They have iden-
tified that nutritional supple-
ments must be provided to
patients to tackle TB effectively.
Accordingly, during the treat-
ment period, the patients are
provided Rs.600/- per patient
every month until the treatment
is over. They are also coming
up with another program called
Ni-kshay Mitra, a crowd-
sourced programme that al-
lows organisations and indi-
Excel lence at a function in Jayadev Bhawan. viduals to ‘adopt’ TB patients.
All this help us fight TB more effectively.
don’t know for sure. We have altered our The co-operation of private sector is very
approach from passive to active to detect crucial for the success of this program in-
TB patients. Earlier it was passive report- cluding notification of the patient to the na-
ing- someone with a disease approaches tional registry.
the doctor and they inform us. Now it is
active reporting whereby we conduct Optimistic Notes on
camps at select places to identify and diag- Future of TB Treatment
nose patients with the help of others in- “One good thing now happening is that
cluding private organisations,” he explains. ICMR (The Indian Council of Medical Re-
He also points out how the new drug search) is having a TB research consortium
with a separate budget and many institu-
tions are working on various diagnostics.
Two vaccine trials for TB by ICMR TB re-
Teaching and training of TB is search consortium are coming up- they are
very important. The medical already on the 4th year of trial. It will take
another year to get the final results. It is in-
curriculum should make sure deed hopeful news,” he says.
that today’s doctor to be He also feels that the teaching and train-
trained adequately to handle ing of TB is very important. The medical cur-
riculum should make sure that today’s doc-
TB cases as the gross number tor to be trained adequately to handle TB cases
of TB cases tells us that it as the gross number of TB cases tells us that
it shouldn’t be ignored. The teaching and
shouldn’t be ignored. research must be given little more priority
The teaching and research must among the new doctors. “Our PM has made
it as a priority to get out of TB in 2025 and it
be given little more priority needs a little more attention from the medi-
among the new doctors. cal fraternity,” sign off Dr. Digambar.
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 IVD Biochemical Tests

BIOCHEMICAL TESTS FOR

IRON DEFICIENCY ANAEMIA
DURING TB INFECTION
Anaemia is a disorder which occurs when there aren’t enough
healthy red blood cells in the blood. Red blood cells that are
either insufficient or defective in the body can cause anaemia.
This leads to reduced oxygen flow to the body’s organs. One
typical form of anaemia is iron deficiency related anaemia.
Bintu Lijo,
Manager-Customer Technical Support, AGAPPE

I ron deficiency anaemia is a disorder

when there are inadequate healthy red blood
cells in the blood because of a deficiency
of iron. Our body is unable to produce
enough haemoglobin if it doesn’t have suf-
ficient iron. Hence, iron deficiency anaemia
may cause one to feel lethargic and breath-
less.
Simple testing can diagnose iron defi-
ciency in most cases. The body’s iron re-
serves must be depleted before the serum
iron concentration starts to decline. Once
the stores are used up, the concentration
of transferrin increases while the concen-
tration of ferritin decreases.
When evaluating individuals with in-
flammatory diseases, care must be taken
because a low serum iron level may not z Chest pain, fast heartbeat or shortness z An inability to absorb iron
always indicate an iron deficit. Reduced of breath z Pregnancy
transferrin levels are common in these pa- z Headache, dizziness or light-
tients. headedness Tests to Diagnose Iron
Symptoms z Cold hands and feet Deficiency
z Inflammation or soreness of your Results of tests to determine iron sta-
Initially, iron deficiency anaemia can be
tongue tus are typically confused with many other
so mild that it goes unnoticed. But as the
clinical factors.
body becomes more deficient in iron and z Brittle nails
anaemia worsens, the signs and symptoms z Unusual cravings for non-nutritive Hence combining the test results of
intensify. substances, such as ice, starch etc anaemia markers are suggested to under-
stand the iron status. This gives a more
Iron deficiency anaemia signs and symp- z Poor appetite, especially in infants and
reliable overview of the situation than any
toms may include: children with iron deficiency anemia
individual test provides.
z Extreme fatigue Causes
1. Complete blood count (CBC): A
z Weakness z Blood loss CBC counts the number of blood cells in a
z Pale skin z A lack of iron in your diet blood sample. For anaemia, your doctor

26 TECHAGAPPE APRIL-JUNE 2023

will likely be interested in the levels of the
red blood cells contained in your blood
(hematocrit) and the haemoglobin in your
blood. Numbers might be lower for people
who engage in intense physical activity and
are pregnant or older. Smoking and being
at high altitudes might increase numbers.
z A test to determine the size and shape
of red blood cel ls: Some red blood cells
might also be examined for unusual size,
shape and colour.
z Red blood cel l size and
colour: With iron defi-
ciency anaemia, red blood
cells are smaller and paler
in colour than normal.
z Hematocrit: This is the
percentage of your blood
volume made up by red
blood cells. Normal levels
are generally between 35.5
and 44.9 percent for adult
women and 38.3 to 48.6
percent for adult men.
These values may change
depending on your age.
z Hemoglobin: Lower than
normal hemoglobin levels
indicate anemia. The nor-
mal hemoglobin range is
generally defined as 13.2 to
16.6 grams (g) of hemoglobin per decil-
iter (dL) of blood for men and 11.6 to 15
g/dL for women.
2. Ferritin
Ferritin is an iron containing protein
which stores and releases iron in the
body. Iron is stored intracellularly as
ferritin. This protein helps in the body’s
iron storage, and the amount of it
reflects the overall amount of iron that
is kept there. When there is an iron
deficit, it will be low, and when there is an
iron surplus in the body, it will be high.
Low ferritin by itself can diagnose IDA
because it is the best indicator of iron defi-
ciency. Subnormal levels of ferritin can be
detected when iron stores are exhausted,
but before the serum iron level has become
affected. Ferritin thus represents the most
sensitive index of early iron deficiency.
Because ferritin is an acute-phase pro-
tein, it increases in the presence of infec-
tion, cancer, or chronic inflammation. In
case of any inflammation (usually with el-
evated C-reactive protein level), iron defi-
ciency could exist even with levels of fer-
ritin up to 100 ng/mL.
The normal range of ferritin in serum
depends on several variables, including
methodology, age, and sex. The normal
range is 25-155 microgram/L in menstru-
ating adult females and 40-260 microgram/
L in adult males.
3. Transferrin Test
Transferrin test directly measures the
protein concentration in the blood. When
your body’s stores of iron run low, your
liver makes more transferrin to get more
iron into your blood. It is a “shuttle pro-
tein”, to transport ionic iron to the liver,
spleen, and bone marrow where RBC gen-
eration take place.When iron stores are
depleted, the transferrin levels increase in
the blood. Transferrin level is affected by
liver health and dietary intake. During any
inflammatory event, the protein transfer-
rin, which may decrease, is referred as a
negative acute phase reactant. The
laboratory’s reference range for transfer-
rin is 204-360 mg/dL.
4. Iron Test
It measures the total amount of iron in
the liquid portion of the blood, nearly all of
which is bound to transferrin. Increased lev-
els of iron in serum are seen in hemo-
lyticaneamia, hepatitis and lead & iron poi-
soning. Decreased levels are found in iron
deficiency anemia, late pregnancy and can-
cer.
5. TIBC
A total iron-binding capacity (TIBC)
measures the total amount of iron that
transferrin proteins can bind in the blood.
TECHAGAPPE APRIL-JUNE 2023
Since transferrin is the primary iron-bind-
ing protein, the test is a good indirect mea-
surement of transferrin availability, the
amount of transferrin available to bind to
iron. If you have iron deficiency anaemia,
which is when there is not enough iron in
your blood, your TIBC will be high but your
iron level will be low. Although TIBC shows
how much transferrin is available; trans-
ferrin and TIBC is not the same thing.
6. UIBC
Unsaturated iron-binding
capacity (UIBC) test determines
the reserve capacity of transfer-
rin, i.e., the portion not yet satu-
rated with iron. This test is to
assess the amount of iron cir-
culating in the blood.
A low UIBC indicates that
transferrin is highly saturated
with iron, a finding consistent
with hereditary hemochroma-
tosis (HH). The sum of the UIBC
and the plasma iron is the total
iron-binding capacity (TIBC).
UIBC can be measured directly
or calculated as
TIBC – iron = UIBC.
7. Transferrin Saturation
Dividing the iron concentra-
tion by the TIBC produces an es-
timate of the percentage of occupied trans-
ferrin iron-binding sites, called the trans-
ferrin saturation (%). Under normal condi-
tions, transferrin is one-third saturated
with iron, so about two-thirds of its capac-
ity is held in reserve. (Less commonly, the
iron concentration may be divided by the
transferrin concentration, not the TIBC or
the transferrin index.)
Note: Thalassemia, an inherited condition
that results in anaemia, is sometimes
mislabelled as iron deficiency anaemia. A
thalassemia diagnosis may be delayed un-
til after the anemia doesn’t respond to
treatment with iron supplements.
Iron deficiency without anaemia can
occur when a person has normal haemo-
globin but below normal serum ferritin
and/or transferrin saturation. Iron defi-
ciency with anaemia can happen when a
person has low serum ferritin and hemo-
globin values.
Differences between the serum values
of iron-deficiency anaemia, anaemia of
chronic diseases, and anaemia of mixed
origin.
27
 Article Perinatal TB

PERINATAL TUBERCULOSIS:
A MATERNAL RISK FACTOR
Tuberculosis (TB) is a major contributor to disease burden globally.
Congenital tuberculosis is a life-threatening disease in neonates with
higher mortality rate. Perinatal transmission of infection occurs in utero
or during delivery. It is difficult to differentiate congenital infection from
postnatal. Cantwell criteria are used for the diagnosis of congenital
infection. As symptoms are nonspecific, congenital tuberculosis has to
be actively considered as a possibility to diagnose it. Isolation of
Mycobacterium tuberculosis organism either in culture or acid-fast bacilli
(AFB) smear is very essential for the diagnosis. After the diagnosis of
congenital tuberculosis treatment has to be initiated without delay.
Breastfeeding should be encouraged among mothers on treatment for
latent tuberculosis and after two weeks of treatment for active TB.
Dr.ARVIND SHENOI,
MD(PEAD)Sr. Consultant – Neonatologist & Pediatrician, Rainbow Children’s Hospital, Bangalore.

M ycobacterium tuberculosis is the caus-

ative organism of TB and is a major public
health problem. ‘‘The World Health Orga-
nization (WHO) in its 2018 report estimated
that out of 10 million cases of TB in 2017,
about 1 million occurred among children
less than 15 years. There were 234,000
deaths of children due to tuberculosis and
40,000 deaths in HIV infected children’’.

Tuberculosis of Foetus or
Newborn
There are two types of neonatal tuber-
culosis namely congenital TB and postna-
tally acquired TB. Neonatal TB is a serious
infection and the mortality rate is about
50%. 2-4 % congenital TB is contracted
during pregnancy or at the time of
childbirth and cause disease afterward.
Perinatal TB is a preferred term which
includes true congenital disease. The diag-
nostic criteria for congenital tuberculosis
were put forth by Beitzke in 1935. It was
subsequently revised by Cantwell in the
year 1994.

28 TECHAGAPPE APRIL-JUNE 2023

 Tuberculosis strikes at
women, often during pre-
gnancy, escalating health risks
that are too often overlooked.
TB in mothers increases the
risk that babies will die by six
times, and doubles the risk of
their being born prematurely
or with low birth weight.

Diagnostic Criteria nated infection involving GI tract, spleen,

z Proven tuberculous lesions plus one of
the following:
z The tuberculous lesion in a newborn
baby in the first week of life
z Primary liver complex or caseating he-
patic granulomas
z Maternal genital tract or placental TB
z Exclusion of postnatal transmission by
a thorough investigation of contacts.
Postnatal TB is contracted after birth
either by inhalation of TB bacilli or by in-
gestion of infected breast milk and the in-
fant subsequently presents with signs and
symptoms of tuberculosis along with ra-
diographic findings. It is difficult to dif-
ferentiate between true congenital TB and
those acquired postnatally, in general,
clinical presentation and management re-
main the same between two groups.
Transmission and
Pathogenesis
Perinatal transmission of tuberculo-
sis is a possibility through a multitude of
ways. Most commonly associated with
endometrial tuberculosis or disseminated
infection in mother. The hematogenous
spread can happen via the umbilical vein
or by infected amniotic fluid aspiration,
or ingestion of infected secretions.
Primary complex in the liver along with
caseating granuloma is the definitive le-
sion of congenital tuberculosis. The or-
ganisms can spread beyond the liver into
the systemic circulation causing dissemi-
kidney, adrenals, bone marrow, meninges,
and skin. Rupture of the placental tubercu-
lous lesion into amniotic fluid may cause
primary foci in the lungs or GI tract if the
fetus inhales or ingest infected amniotic
fluid. Neonate can present as sepsis-like syn-
drome if there is massive dissemination.
Clinical Presentation/
Radiographic Findings
Perinatal TB usually manifest at a me-
dian age of 24 days, but occasionally noted
at birth ranging from 1 to 84 days.
Hepatosplenomegaly and respiratory dis-
tress are the most common presentation
of congenital tuberculosis followed by
Perinatal transmission of
tuberculosis is a possibility
through a multitude of
ways. Most commonly
associated with endometrial
tuberculosis or
disseminated infection
in mother. The hematogenous
spread can happen via the
umbilical vein or by infected
amniotic fluid aspiration,
or ingestion of infected
secretions.
poor feeding, fever, failure to thrive, irri-
tability, lethargy, cough, abdominal dis-
tension, and low birth weight. Neonatal TB
may present in the form of septicemia,
persistent or recurrent pneumonia, men-
ingitis, lymphadenopathy, jaundice, as-
cites, disseminated intravascular coagu-
lation, otitis med ia, osteomyel itis,
paravertebral abscess and cold abscess.
Sometimes, the initial manifestation is
very similar to sepsis, the clinician should
have a high index of suspicion if a sick
newborn fails to improve with antibiotics
and has negative microbiological and se-
rological test results for infections. About
50% neonates have miliary disease pat-
tern in chest X-ray, rests have adenopathy
and parenchymal infiltrates.
Diagnosis
Assessment of maternal risk factor for
TB is very important in suspected con-
genital tuberculosis. Placental examination
and culture for TB bacilli should be done
if the mother presents with inexplicable
bronchitis, pneumonia, meningeal dis-
ease, endometritis or unusual uterine
bleeding. If the placenta is not available
for examination, uterine dilatation and
curettage should be considered because
endometrial culture often yields positive
results. HIV testing for a mother is very
important in suspected congenital tuber-
culosis. The diagnosis of congenital tu-
berculosis sometimes helps in the detec-
tion of undiagnosed maternal TB.
Confirmation of tuberculosis in the
neonate is done by testing body fluids for

TECHAGAPPE APRIL-JUNE 2023 29

 Article Perinatal TB
positive acid-fast bacilli smear
and cultures such as tracheal
aspirates, gastric aspirates, and
tissue biopsy. Cerebrospinal
fluid analysis for acid-fast ba-
cilli is very essential because
tubercular meningitis occurs in
1/3rd cases of congenital TB.
The PCR of bronchoalveolar
lavage fluid is an efficient mo-
dality for diagnosis in neonates.
The Mantoux test in neonates is
often negative in the initial stages
but frequently becomes positive
after a few months. Gastric and
tracheal aspirates are far more
sensitive than the tuberculin skin
test. Gastric aspirates are posi-
tive in 80% whereas, Mantoux is
positive in less than 15% of
cases. ‘‘Some newborns may
have positive interferon-gamma
release assay, but due to the lim-
ited data on the reliability of a negative test
results IGRA is not recommended by AAP
in children less than 2 years of age’’.
Ultrasound liver is crucial in case of
suspected congenital TB. Liver biopsy,
though invasive should be considered if
abnormal features are found in ultrasound
or if there is a diagnostic dilemma to look
for caseating granulomas. Liver biopsy is
100% sensitive in the diagnosis of congeni-
tal tuberculosis.
Newer methods such as LED fluores-
cence microscopy and mycobacterium
growth indicator tube (MGIT) are used for
rapid diagnosis in developed countries.
LED fluorescence microscopy is more sen-
sitive and specific in the identification of TB
bacilli compared to the existing older mo-
dalities. Gene Xpert is a rapid diagnostic
tool used in highly TB prevalent areas in-
cluding multidrug-resistant TB.
Treatment
As soon as proper culture samples are
obtained in a suspected neonatal TB, anti
tuberculosis treatment should be started
promptly. Currently, there is no specific
RNTCP treatment guidelines exist for peri-
natal tuberculosis. The AAP recommen-
dation for the treatment of neonatal tu-
berculosis includes four-drug regimen for
the first two months (intensive phase)—
30 TECHAGAPPE APRIL-JUNE 2023
isoniazid (INH), rifampin (RIF), pyrazina-
mide (PZA) and either ethambutol (EMB)
or an aminoglycoside such as amikacin.
Amikacin is most commonly used instead
of Ethambutol because neonates are at
higher risk of developing meningitis or
disseminated disease, and Amikacin has
better CNS penetration ability and bacte-
ricidal activity.
Newer methods such as LED
fluorescence microscopy and
mycobacterium growth
indicator tube (MGIT) are used
for rapid diagnosis in developed
countries. LED fluorescence
microscopy is more sensitive
and specific in the identification
of TB bacilli compared to the
existing older modalities. Gene
Xpert is a rapid diagnostic tool
used in highly TB prevalent
areas including multidrug-
resistant TB.
After the completion of the intensive
phase, the recommended duration of con-
tinuation phase is 7–10 months of Iso-
niazid and Rifampin
therapy. The total
duration of treat-
ment for neonatal
tuberculosis is usu-
al ly 9–12 months.
Prednisone (2 mg/
kg/day) should be
administered for 4–
6 weeks if TB men-
ingitis is suspected.
The drug is gradu-
al ly tapered and
stopped.
Prognosis
The mortality
rate of congenital tu-
berculosis even with
effective treatment
is 25–50%, hence, the
prognosis is guarded.
There are several re-
asons for high mor-
bidity and mortality associated with con-
genital tuberculosis.
z Nonspecific signs and symptoms of the
disease, which results in a delay in di-
agnosis.
z The false negativity of tuberculin test in
newborns poses another chal lenge
compared to in older children, which
cause further delay in diagnosis.
z Disseminated d iseases such as
meningeal and miliary tuberculosis are
common in neonates than other age
groups.
z The immune system is relatively im-
mature in neonates, so they are at risk
to develop tuberculosis disease.
Maternal Tuberculosis
Latent Tuberculosis Infection (LTBI) in
Pregnancy
Treatment of latent TB in pregnant
women should be deferred until 3 months
after delivery to reduce the risk of hepatitis.
Active Tuberculosis Disease in Pregnancy
Active TB in pregnancy is associated
with adverse fetal and maternal outcomes.
Hence pregnant mother once diagnosed
with active TB, prompt treatment should
be initiated. Active TB disease treatment
in pregnancy includes 2 months of inten-
sive phase with isoniazid, rifampin, and
ethambutol, followed by 7 months of iso-
niazid and rifampin, the total duration of
treatment is 9 months.
Management of an
Exposed Neonate
Mother with active pulmonary TB can
transmit the infection to her newborn, so
at the time of delivery baby born to a
mother with suspected or known active
disease should be separated until both
have been evaluated.
z If both mother and neonate have ac-
tive pulmonary TB, both should be
started on ATT, mother and baby need
not be separated as long as both are
ad herent, and mother should use a
mask until she is noninfectious.
z If the mother has pulmonary tubercu-
losis and neonate has a latent infection
without active disease, the mother
should be treated for active TB disease
and baby should be started on Iso-
niazid prophylaxis. Separation of
mother and baby is not required if they
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W e have wonderful ex-
perience with Mispa i3. Ini-
tially the system was kept
for 1 month evaluation and
study purpose. The per-
formance in terms of us-
ability and results, was su-
perb and hence we have
decided to purchase the
machine. Now we are us-
ing Agappe’s nephelom-
etry analyzer Mispa i3 for
more than one and half
years, and we didn’t face
any kind of the issues or
difficulties as of now. This
machine helped us a lot
during the peak Covid pe-
riod to timely support our
patients through CRP, D-
Dimer and Ferritin testing.
Currently running param-
eters with this machine are CRP, ASO,
RA, PCT, D-Dimer, Ferritin, Vitamin-D
and rarely hs-CRP. We are very much
Ma Su Hnin, Medical Technologist,
Shwelamin (Lanmadaw) Hospital, Yangon, Myanmar
are compliant to treatment and mother
should follow infection control mea-
sures such as to wear a mask.
z If the mother has active pulmonary TB
and there is no proof of active TB dis-
ease or latent infection in neonate, the
mother should be treated with ATT for
active disease and baby for latent in-
fection with Isoniazid for 3 to 4 months.
Mother and baby can be together pro-
vided they are adherent, and the mother
should use a mask.
z Once the infant completes three to four
months of Isoniazid prophylaxis, tu-
berculin skin test should be done:
z If the infant’s repeat tuberculin test is
positive, investigations should be car-
ried out to look for active disease and
the infant should be treated for either
active disease or latent infection based
on the tests result.
z If the infant’s repeat skin test is nega-
tive, Isoniazid can be stopped.
z If the mother is still contagious, both
infant and mother require re-evalua-
happy with the results generated. Now
we are planning to start performing
Urine Microalbumin.
TECHAGAPPE APRIL-JUNE 2023
tion and consultation with a TB expert.
z If MDRTB is suspected, a TB expert
should be consulted.
z RNTCP, IAP and WHO recommends
INH prophylaxis for 6 months for an
infant with latent TB infection.
Breast Feeding
Breastfeeding should be encouraged
for mothers on latent TB infection treat-
ment and after at least two weeks of treat-
ment for active Tuberculosis. The first line
ATT drugs are secreted in small amount
in breast mil k (less than 20% of therapeu-
tic infant dose)and will not cause any toxic
effects on breastfed infants. Infants on
exclusive breastfeeding receiving Iso-
niazid should be supplemented with pyri-
doxine.
Prevention
BCG vaccination is protective against
tuberculous meningitis and disseminated
form of TB. In infants receiving chemo-
prophylaxis BCG vaccine is recom-
mended. American Academy of Paediat-
rics recommends BCG vaccination after
INH prophylaxis and if follow-up is not
possible then at birth itself.
Whereas, RNTCP and IAP advocate
BCG administration at birth even for those
receiving Isoniazid prophylaxis after ex-
cluding congenital TB. ‘‘WHO recom-
mends BCG vaccination for neonates born
to mother with pulmonary TB if an infant
is asymptomatic, has no immunological
evidence of TB and is HIV negative’’. Chil-
dren in highly TB prevalent countries are
more prone to get infection early in their
life, so BCG should be administered as
soon as possible.
Conclusion
Perinatal TB carries a high mortality
rate because of the delay in diagnosis and
prompt initiation of treatment. A high in-
dex of suspicion, a detailed maternal his-
tory, and thorough evaluation of mother
and baby is very crucial in establishing the
diagnosis.
Work up for congenital tuberculosis
must include CSF analysis to look for tu-
berculous meningitis and disseminated
disease. Early diagnosis and timely com-
mencement of antitubercular therapy are
very critical in reducing the morbidity and
mortality associated with the disease. If
multidrug-resistant TB is suspected consul-
tation with TB expert is very important.
31
 Story Keyuri Bhanushali

According to WHO, Tuberculosis (TB) is one of the

world’s top infectious killer. It is airborne and can
affect any of us. Over 5000 women, men and children
still die each day from TB. With 28% cases, India is
among the eight countries accounting for more than
two-third (68.3%) of the total TB patients’ count.
The social and economic impacts are devastating
including poverty, stigma and discrimination. But
the better side is that TB is curable and preventable.
There are several stories from around the world of
TB survivors. This is one such story on how a
youngster from India fought and beat TB.

INSPIRING CHRONICLES OF

KEYURI BHANUSHALI,
A TB SURVIVOR
The Beginning
It was in November 2008, Keyuri Bhanushali who
hails from Mumbai, Maharashtra diagnosed with TB
at the youthful age of 26. The first symptom she no-
ticed was the persistent cough. She felt it needed im-
mediate medical attention and consulted her local
doctor. The diagnosis by the local doctor was that she
was allergic to sweets and fried food. She took the
advice and followed the prescribed medicines and got
rid of her cough which returned soon and this time in
the company of a low-grade fever. The doctor pre-
scribed more tests and x-ray. After looking at her x-
ray, the astonished doctor immediately referred her
to a specialist.
By now she feared the worst and the doctor im-
mediately assured her that it wasn’t cancer but TB. To
confirm it the specialist doctor recommended more
tests and they all validated it. Her immediate concern
was whether she could be infecting her family mem-
bers with such a contagious disease. “More than the
disease, it is the stigma that is harder to fight. I re-
member I went into a shell, scared that people might
keep away thinking it’s contagious. I wondered who
will marry me. Will this affect my siblings and their
chance of getting married?” recalls she.
To her slight relief the doctor said her that her TB
being extra-pulmonary was non-infectious. Reas-
sured, she started her treatment under the specialist
doctor’s observation. A week passed by and the side
effects from the medicines took a toll on her body.
To her slight relief the doctor said her
that her TB being extra-pulmonary was
non-infectious. Reassured, she started
her treatment under the specialist
doctor’s observation. A week passed
by and the side effects from the
medicines took a toll on her body.

32 TECHAGAPPE APRIL-JUNE 2023

She started vomiting and had a constant six by 2024) campaign, which calls on ev-
uneasiness in her stomach. She contacted ery eligible person with TB infection or dis-
her doctor and altered her dosage. The new ease to have access to evidence-based,
TB medication was less problematic and “India has a huge problem of shorter, less toxic TB treatment regimens.
in a short span her body also adapted to Currently, the shorter therapy protocols
the TB medication. She started to lead her
non-compliance of TB are not available in India.
‘somewhat regular life’. The doctor as- treatment which is often “India has a huge problem of non-com-
sured her that in nine months she would
be TB free and she was eagerly looking for-
triggered by the longer pliance of TB treatment which is often trig-
ward to it. treatment duration. A shorter gered by the longer treatment duration. A
shorter regimen will definitely improve
Unexpected Road blocks regimen will definitely compliance. The shortened regimen also
As it was nearing the course of nine improve compliance. The reduces the exposure of medicines and
their side effects on the liver eyes and hear-
months, she noticed a bulge on the right
side of her chest wall. She immediately
shortened regimen also ing,” points out Dr. Aarti Kinikar. Dr Salil
brought it to the notice of the doctor who reduces the exposure of Bendre, a Mumbai-based pulmonologist
also endorses this and points out that a
recommended a surgery. By then it was medicines and their side long duration of treatment also increases
near to ten months of treatment and with
the bulge she continued the medication effects on the liver eyes and the out-of-pocket expenditure which be-
comes challenging for many families. A
for another two more months. The x-ray hearing,” points out shorter regimen will definitely improve
reports showed that the glands have in fact
enlarged. For Keyuri it meant that her dis- Dr. Aarti Kinikar. treatment compliance, he adds.
ease was not cured. The doctor referred
her to another doctor at another hospital.
The new doctor was Dr Zarir F
Udwadia, India’s leading chest physician
the first to report cases of totally drug re-
sistant TB from India in 2012. After going
through her file he told her that there were
only four drugs for treating TB and blamed
the doctors on not using it properly. The
medication was altered again after several
tests. Her strain was promoted to
multidrug-resistant TB or MDR TB. For the
next two years, she underwent treatment
under him. During this period in every three
months she regularly underwent x-ray and
blood tests. The doctor made sure that
she was responding to the second line
treatment well. “I felt better and became
hopeful again. And in 2011, I was declared
TB free,” she says.
Advocacy Campaigns
She admits that her TB journey, from
diagnosis to TB free wasn’t very difficult.
But not everyone could be so lucky. For
her, the support provided by the family
helped her a lot. Her father financed the
treatment which lasted for almost three
years. Even so she had to endure the physi-
cal pain and acne due to the treatment.
“Other than these nobody around me
could tell that I was fighting a dangerous
disease. Today I advocate for the shorter
duration therapy routines that reduce pain
and speed up results. Since the TB treat-
ment is costly, we should invest in these
shorter duration treatments,” says Keyuri
who is vouching for the 1/4/6×24 (one, four,

TECHAGAPPE APRIL-JUNE 2023 33

 Story Keyuri Bhanushali
Championing the Cause
of TB Victims
In 2018, Keyuri took the central gov-
ernment announcement of al lotting
Rs.600 crore to support the nutritional
needs of al l notified TB patients and
whereby each TB patient receive Rs.500/-
per month to address his/her nutritional
needs to the social media. She voiced that
the amount was meagre and with many
complications including providing the
bank account details and other identity
details which might provide a road block
to the beneficiary. Approximately Rs.1488
crore has been paid to 57.33 lakh TB pa-
tients under Nikshay Poshan Yojana (NPY)
from April 2018 to February 2022.
A little have been done by the govern-
ment on increasing the funding or address-
ing these concerns. However a few im-
provements has been made like manda-
tory notification of all TB cases, integra-
tion of the programme with the general
health services, expansion of diagnostics
services, programmatic management of
drug resistant TB service expansion, single
window service for TB-HIV cases, national
drug resistance surveillance and revision
of partnership guidelines.
As an MDR-TB survivor, she is now
closely associated with Survivors Against
TB- a collective of survivors, advocates
and experts working on TB and related
TB services in India and in
most countries do not include
mental health support. In most
cases, TB-affected individuals
are often left on their own to
deal with their struggles.
If TB and its long treatment
with numerous side effects
were not bad enough mental
health challenges combined
with stigma make
things worse.
34 TECHAGAPPE APRIL-JUNE 2023
co-morbidities. She regularly writes in
newspapers and social media on TB and
related issues. Recently she put the focus
of how there is a high prevalence of de-
pression and other mental health con-
cerns among those affected by TB.
She points out that in many cases in-
dividuals are unable to comply with long
treatment regimens and give up. This can
increase the possibility of making them
drug resistant and also spread infection
in the community. “In India and other high-
burden countries, TB and mental health
issues exist on an epic scale.
TB and mental health remain unreco-
gnised co-epidemics often under-diag-
nosed and highly stigmatised. Those af-
fected remain ashamed to speak about it,
hide their diagnosis and remain fearful of
seeking care,” says Bhanushali.
TB services in India and in most coun-
tries do not include mental health sup-
port. In most cases, TB-affected individu-
als are often left on their own to deal with
their struggles. If TB and its long treatment
with numerous side effects were not bad
enough mental health challenges com-
bined with stigma make things worse.
TB, the Best Teacher!
“One thing I learned is that it is very
important to tal k about the stigma of TB.
Silence was not an option for me. Remem-
ber stigma impacts you deeply. If you have
TB talk to someone whom you trust. Don’t
suffer in silence. Let us fight TB together.
TB had disrupted my life on multiple
levels. I dreamt of a perfectly married life
at 26 and babies by 29 and watch them
grow for the rest of my life. All of them
went awry. Dealing with TB taught me a
few lessons. I realised that I was craving
an easy life with no difficulties. Surviving
TB turned out to be the best teacher for
me as I learnt that pain is the only way to
grow.
TB is curable. Let us collectively fight
against it. The right diagnosis, proper
treatment and the much-needed aware-
ness about it are necessary to defeat TB.
We must fight against TB, not those af-
fected by it,” adds the accountant-
turned-copywriter. Apart from that a
shorter, safer and more effective regimen
for treating TB infection, drug-susceptible
TB and drug-resistant TB are the need of
the hour.
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TECHAGAPPE APRIL-JUNE 2023 35

 Article Dr. Manoj A. Kahar

LABORATORY DIAGNOSIS OF
TUBERCULOUS PLEURAL EFFUSION
Tuberculosis (TB) accounts for millions of active disease cases and deaths in both
developed and developing countries and remains a major public health problem.
Tuberculous pleural effusion (TPE) results from Mycobacterium tuberculosis (MTB)
infection of the pleura characterized by an intense chronic accumulation of fluid
and inflammatory cells in pleural space and is a major manifestation of extra
pulmonary TB. Dr. Manoj A. Kahar M.B.B.S., M.D. (Path), Ph.D (Path), a renowned
specialist in Transfusion Science Practice (U.K.), Specialist in Stem cell Transplant
Science (U.K.) and Consultant Pathologist, Bhanumati Clinical Laboratory, Navsari
presents a well researched paper on laboratory diagnosis of Tuberculosis Pleural
Effusion.
T he pathogenesis of TB pleural effusion is due to the cobacterial antigens in the pleural space. The resulting
rupture of a subpleural caseous focus in the lung into inflammation produces lymphocytic pleuritis, which
the pleural space. TPE are thought to result from a de- decreases the amount of fluid that can be absorbed from
layed hypersensitivity reaction to mycobacteria and my- the pleural space. The combination of the extra fluid pro-
duced by the inflammation
and the decreased lymphatic
clearance leads to the accu-
mulation of pleural fluid (PF).

Pleural Fluid
Analysis &
Specimen Collection
Pleural Fluid collected in
Ethylene Diamine Tetra Acetic
Acid tube is used for Total and
Differential Counts. For doing
chemical analysis from pleu-
ral fluid, heparinized tube is
used to avoid clotting. For My-
cobacterium TB culture, the
fluid should be inoculated into
appropriate culture medium.
Physical Examination
In Pleural Tuberculosis
(PT), Pleural fluid is usually
colourless or straw/yel low
coloured and may be clear,
cloudy or serohemorrhagic.
Chemical Examination
Dr. Manoj A. Kahar TPE is an exudate with high
protein content (up to 50g/L)

36 TECHAGAPPE APRIL-JUNE 2023

in up to 70% of cases, glucose
discretely lower than serum
glycemia, and generally nor-
mal pH; lactic dehydrogenase
(LDH) is usually higher than in
serum, general ly with levels
above 500 U/L.
Microscopic Examination
Total counts may be per-
formed using haemocyto-
meter or automated call counts
can be performed using haema-
tology cell counter with Body
fluid mode.
Usually, TPE have leukocyte
counts >1000/ìL.
Cytological examination re-
veals variable cellularity with
lymphocyte predominance
(>50%) in 90% of cases; how-
ever, a predominance of neu-
trophils can be observed dur-
Pleural Fluid collected in Ethylene Diamine Tetra Acetic Acid tube is used
ing the first two weeks of dis- for Total and Differential Counts. For doing chemical analysis from pleural
ease and can persist in up to fluid, heparinized tube is used to avoid clotting. For mycobacterium TB
10% of cases.
culture, the fluid should be inoculated into appropriate culture medium.
The intense lymphocytic
infiltration that is present in
patients with TB pleuritis cov- Effusions (PPE), Empyema, lymphomas, activity of macrophages against MTB. It is
ers both pleural surfaces and prevents solid tumors, Connective tissue diseases an efficient biomarker for the diagnosis
mesothelial cells from entering the pleu- (mainly rheumatoid arthritis and systemic of PT. According to the meta-analysis con-
ral space. Pleural fluid from patients with lupus Erythematosus) and infectious dis- ducted by Jiang et al., the sensitivity and
TB rarely contains more than 5% me- eases such as Brucellosis, Q fever, Histo- specificity of IFN - a was 89% and 97%,
sothelial cells. plasmosis and Coccidioidomycosis. respectively. Although IFN-ã is more spe-
Biomarker Analysis in Tpe 2) Interferon gamma (IFN-ã) is a cyt- cific than ADA, this cytokine may be in-
okine released by activated CD4 T lympho- creased in hematological malignancies and
1) Adenosine deaminase (ADA) is an en-
cytes that increases the mycobactericidal empyema. Furthermore, its high cost, the
zyme involved in the metabolism of pu-
lack of a widely accepted cutoff and the
rines that catalyses the conversion of ad-
more laborious technique used for its
enosine and deoxyadenosine to inosine
quantification are limiting factors for its
and deoxy inosine, respectively, with am-
monia production. It is an enzyme present Adenosine deaminase (ADA) use in routine laboratory practice.
especially in activated T-cells, playing an is an enzyme involved in the 3) IGRAs are T-cell-based in vitro assays
important role in the differentiation of that measure ã-interferon release by sen-
lymphoid cells. metabolism of purines that sitized T-cells from peripheral blood or
The sensitivity and specificity of PF ADA in catalyses the conversion pleural fluid. T-cells will secrete ã-inter-
feron when they react with highly specific
the diagnosis of PT range from 88–100% of adenosine and Mycobacterium tuberculosis-specific an-
and 81–97%, respectively, with a similar di-
agnostic yield in HIV patients, including deoxyadenosine to inosine tigens, such as early secretory antigen
those with low counts of CD4 lymphocytes. and deoxy inosine, (ESAT)-6 and culture filtrate protein (CFP)-
10. QuantiFERON-TB Gold and T-SPOT.TB
Data from the literature reveal an excel- respectively, with ammonia are the only currently available IGRAs.
lent negative predictive value in the diag-
nosis of pleural TB for total ADA values production. It is an enzyme Using IGRAs for pleural fluid is not rec-
below 40 U/L and an excellent positive present especially in activated ommended for making a diagnosis of TPE,
predictive value when the level of this because of its high cost, high turnaround
marker is higher than 70 U/L.
T-cells, playing an important time and moderate performance.
Elevated PF ADA levels are not present only
role in the differentiation of 4) Other biomarkers: PF levels of
in TPE, but can be found in parapneu- monic lymphoid cells. interleukin-1â (IL-1â), interleukin-6 (IL-6),

TECHAGAPPE APRIL-JUNE 2023 37

 Article Dr. Manoj A. Kahar
and tumor necrosis factor-alpha (TNF-al-
pha) can be increased in PT, but with low
specificity for diagnostic use.
Microbiological Examination
Direct smear examination for Acid Fast
Bacilli (AFB): Presence of AFB is observed
in 7% cases (uncentrifuged fluid smear)
and <25% (cytocentrifuged fluid smears).
Low sensitivity AFB detection is due to low
bacillary load in PF; >10 bacilli/ml are re-
quired for detection in smears.
PAP-stained smear (Fig-1a) and
Haematoxylin & Eosin (Fig-1b) stained
smear showing lymphocyte rich effusion;
Mesothelial cells are absent in the picture.
Mycobacterial Culture of Pf
Despite significant advances in the
molecular diagnosis of PT in the last two
decades, Mycobacterial culture of PF re-
mains the gold standard for diagnosis al-
lowing drug susceptibility testing and
genotyping.
Automated liquid culture systems [eg.
BACTEC Mycobacteria Growth Indicator
Tube 960 (MGIT)] provides a higher and
faster yield than culture in the traditional
solid media (eg. Lowenstein Jensen or
Ogawa Medium). Sensitivity of Automated
liquid culture systems range from 40 to 60%.
Molecular Tests
Nucleic Acid Amplification Tests (NAATs)
NAATs can be used for rapid detec-
tion of MTB genome in PF. MTB detection
of most available tests is 102CFU/ml, the
result can be achieved in a few hours, and
Fig-1a
38 TECHAGAPPE APRIL-JUNE 2023
AGAPPE’S PROMPT REPLY BOOST OUR CONFIDENCE...
Dr. Ramesh Iravatham, ED & COO, Humain Health Tech, Chennai.
I’m associating with Agappe for the last 15-20 years. Mispa-i2 from Agappe,
the Semi Automated Specific Protein Nephelometry Analyzer is one of the
products we’ve been using. So far so good! I’ve had no complaints with Agappe
in its service or on any of its products. The best thing about Agappe is how they
keep the relationship with the customers. Whenever there is a query or doubts,
it is solved immediately by their authorised staffs. Such prompt reply and
action will boost the confidence in the company. I believe Agappe understands
how labs will be affected if certain machinery is out of order.
the performance of the test does not de- hibitors present in the biological matrix
pend on the patient’s immune system. or related to intracellular sequestration of
Several target genes are used in NAATs, mycobacteria, hindering DNA extraction
such as IS6110, GCRS, MPB-64, devR, or and amplification.
CD192, with different sensitivities and
Xpert MTB/RIF (GeneXpert)
specificities.
It uses a heminested real-time PCR
The contribution of NAATs for the di- assay to amplify an MTB-specific sequence
agnosis of PT is not very encouraging to of the rpoB gene, which is probed with
be used in clinical practice due to their molecular beacons for mutations in the
low and variable sensitivity. rifampin resistance-determining region.
The disappointing sensitivity of NAATs Because of the lack of literature on the
is due to low number of bacilli in PF, in- efficacy of the Xpert MTB/RIF assay for
the detection of pleural TB,
the use of this test as a di-
agnostic modality is not rec-
ommended currently.
Conclusion
PF samples are frequen-
tly, collected, handled and/or
analysed in a less than satis-
factory manner.
A meticulously perfor-
med PF analysis using ap-
propriate tests as described
above will reach a correct
diagnosis of Tuberculous
Fig-1b effusion in majority of the
samples.
Testimonials Brand Reach

AGAPPE’S EQUIPMENT QUALITY AND

SERVICES PAR EXCELLENCE
H el lo everyone! I
am Dr. Swara Patel,
consultant patholo-
gist at Insite Pathol-
ogy, Science City
road, Ahmadabad.
Here are my sincere
views about Agappe
Diagnostics. I started
my medical journey
as an MBBS student
in Mumbai, and the
completed my DCP
at Bangalore Medical
Col lege and Re-
search Institute fol-
lowed by my DNB
from Jaslok hospital
and Research Insti-
tute, Mumbai where
I started.
After that I went back
to my hometown at
Ahmedabad where I
started a smal l lab
with the dream of
setting up a 25 bed-
ded hospital and an
advanced lab. Dr. Swara Patel, Insite Pathology Laboratory, Ahmedabad.
Being a new entrepreneur I was my limited budget. That was the time when from day one there have never been
not sure that I will be able to make the first wave Covid 19 was peaking up. I any complaints from any of our pa-
such a big investment. It was at that am really very thankful that all the Agappe tients about wrong test results. It was
time I met a lot of engineers and engineers were very supportive. an inspiring experience which moti-
marketing persons from different It was a small facility where we didn’t vated me to set up another diagnos-
companies and I was real ly im- have enough space for all these instru- tic centre in Science City area.
pressed with the approach of ments. But Agappe made sure that quality It has been one year I am working
Agappe. They helped me to have a is perfect, results accurate and the ma- here and I’m using the same Agappe
quite good set up with Mispa Viva, chines installed in the proper manner. instruments here as well and even if
Mispa Ace, Mispa Clog and 3-Part Whenever I had any hardships in the ini- the workload increases from 10 to
Hematology Analyzer Mispa CountX. tial stages, they were there always to help 50-100, then also the machines per-
Thanks to Agappe, it was a very me out on a call. form up to the mark. Everything is at
budget friend ly and customer They made sure that quality and accu- par excellence. I am very satisfied
friendly proposition and I could set racy is maintained in every step. They were with the entire services provided by
my own lab within 10 days time within guiding me over phone at every stage and Agappe.

TECHAGAPPE APRIL-JUNE 2023 39

 Article Dr. Thirupathi K.

TUBERCULOSIS
THE INDIAN SCENARIO
The latest surveillance and surveys shows that the Tuberculosis (TB) epidemic
in India is larger than previously estimated. As per WHO Global TB report
2016, India has 2.8 million people diagnosed with tuberculosis. It is nearly one
third of Global TB burden. Deaths due to TB have doubled in the country from
2.2 lakh in 2014 to 4.8 lakh in 2015. India has more patients living with drug-
resistant TB than any other country in the world, with an estimated 79,000
persons becoming sick with this disease each year. India must do whatever it
can to stop the transmission of TB both within and beyond its borders and this
can best be accomplished with early diagnosis and effective treatment.
Dr. Thirupathi K, Consultant, Pulmonary Medicine, SIMS Hospital, Chennai.
In order to manage the TB crisis in India, we need Acid-Fast Bacilli (AFB) using smear microscopy,
to diagnose the disease at the earliest using newer namely ZN stain. It is simple, affordable, quick and
techniques currently available and manage the dis- also provides results within hours.
ease with proper regimens, and most importantly, Fluorescence microscopy with fluorochrome
we have to ensure that the patients are completing staining and light emitting diode technology im-
the full course of treatment. proves the sensitivity of TB detection. Still the gold
The primary method for TB diagnosis in low standard for diagnosis of TB is isolating M.tubercu-
and middle-income countries is the detection of losis in culture. Solid culture (LJ medium) takes longer

40 TECHAGAPPE APRIL-JUNE 2023

time to grow. Liquid culture media using
automated systems, such as BACTEC ra-
diometric method and mycobacterial
growth indicator tube (MGIT) are even more
sensitive and can detect growth in 1–3 weeks.
Currently, we prefer to use liquid culture
media for respiratory and extra pulmonary
samples in view of faster results.
Molecular Methods such as Gene Xpert
MTB and Line Probe Assay are available
for clinical use in India both in government
as well as private sectors. The introduc-
tion Nucleic Acid Amplification Tests has
been one of the major developments in the
diagnosis of M. tuberculosis. WHO has
advocated universal use of Xpert MTB/RIF
for the diagnosis of TB. Xpert MTB/RIF is a
commercially available diagnostic test to
test specimens for genetic material spe-
cific to Mycobacterium tuberculosis and
simultaneously detects a gene which con-
fers resistance to rifampicin, rpoB. Unlike
other commercial PCR-based tests, it is a
fully automated test. Results will be usu-
ally within 2 hours. Line Probe assay is an-
other Nucleic Acid Amplification Test,
which detects resistance to Rifampicin and
INH in addition to detecting M.tuberculosis.
It is not useful in testing extra pulmonary
samples where the bacillary load is less.
Diagnosis Challenges
Extra-pulmonary tuberculosis (EPTB)
accounts for about one fifth of all cases of
tuberculosis and a major health burden in
many forms of extrapulmonary TB (EPTB)
are paucibacillary and the diagnosis of
EPTB is therefore chal-
lenging. Acid-fast bacilli
(AFB) smear of biologi-
cal specimens is often
negative. A high level of
suspicion is important in
evaluating a patient with
presence of risk factors.
The firm diagnosis of TB
requires culturing of
Mycobacterium tuber-
culosis and it is impor-
tant for drug-susceptibil-
ity testing. Appropriate
specimens are obtained
and tested microbiologi-
cally and histologically.
Chest x-ray should be
part of the basic initial
workup and may show
evidence of active or old
TB. Testing of extra pul-
monary samples with
Bedaquiline, known as the
‘miracle drug’, is the first TB
drug to be approved by Food
and Drug Administration (FDA)
in over 40 years. The treatment
has been rolled out under the
Revised National Tuberculosis
Control Programme for
treatment of MDR TB patients.
The drug is made available in
six public hospitals in Delhi,
Mumbai, Chennai, Guwahati
and Ahmedabad.
Gene Xpert MTB is currently recommended
for lymph node samples and CSF samples.
IGRA assays namely Quantiferon Gold
TB and T spot ELISA are used for detecting
latent TB infection. As they eliminate false
positive results due to BCG vaccination and
NTM infection, they are more specific than
the conventional tuberculin tests. But at the
same time, they are expensive, not stan-
dardized and they are also not useful in
diagnosing active disease.
RNTCP India has come out with a new
recommendation to use daily ATT in treat-
TECHAGAPPE APRIL-JUNE 2023
ment of drug sensitive tuberculosis. The
initial phase should consist of two months
of Isoniazid (H), Rifampicin (R), Pyrazina-
mide (Z) and Ethambutol (E). The continu-
ation phase should consist of three drugs,
Isoniazid (H), Rifampicin (R) and Etham-
butol (E) given for at least four months.
Bedaquiline, known as the ‘miracle
drug’, is the first TB drug to be approved by
Food and Drug Administration (FDA) in over
40 years. The treatment has been rolled out
under the Revised National Tuberculosis
Control Programme for treatment of MDR
TB patients. The drug is made available in
six public hospitals in Del hi, Mumbai,
Chennai, Guwahati and Ahmedabad.
HIV & TB, the Deadliest
Duo
HIV and TB are, in fact, partners in crime,
and the world’s deadliest duo. In India,
people living with HIV accounted for 1.2
million of all new TB cases. HIV poses sev-
eral challenges to TB control. Tackling the
problem of HIV and TB co infection pre-
sents both diagnostic and therapeutic chal-
lenges. It results in more risk of infection,
disease, drug resistance, adverse drug re-
action and paradoxical reaction. Tubercu-
losis is the most important cause of death
in patients with HIV-AIDS. It is very impor-
tant to diagnose tuberculosis at the earli-
est and screen all TB patients for HIV to
address these issues.
Paradoxical reactions and IRIS (Im-
mune Restitution Inflammatory Syn-
drome) in TB infection has
long been observed in
both HIV-positive and HIV-
negative TB patients. Mul-
tiple definitions of para-
doxical reaction exist in
the literature, but essen-
tially this term refers to
the phenomenon of clini-
cal (or radiological) dete-
rioration of TB lesions or
the development of new
lesions in a patient with TB,
who has initially improved
on ATT occurring in the
early phase of treatment
(during the first 3 months).
Paradoxical reactions
manifest in a wide variety
of ways and can some-
times be life threatening or
lead to increased disabil-
ity in EPTB survivors. Both
41
 Article Dr. Thirupathi K.

paradoxical reaction and IRIS pose signifi-

cant challenges to physicians treating TB
patients in India.
The TB-Diabetes Nexus
In India since 2011, there were 61.3 mil-
lion people living with Diabetes and the in-
cidence keep on rising to epidemic levels. If
we do not seriously think about the link
between TB and Diabetes, it may begin to
derail some of the good advances made in
TB control especially in India. The link be-
tween TB and Diabetes mellitus has estab-
lished what is needed now in good quality
implementation of knowledge to screen for
both diseases and monitor this dual bur-
den of disease. It will be a meaningful strat-
egy to screen diabetic patients for the
symptoms or signs of TB and submit them
for necessary investigations to make early
diagnosis of tuberculosis. Not only that,
but it is also important to screen for Diabe-
tes or Impaired Glucose Tolerance in TB
patients as maintaining good glycemic con-
trol is important for faster cure of TB.
The Importance of
Follow up
A significant proportion of tuberculo-
sis cases were being treated by private
practitioners in Ind ia. There was no
mechanism to follow the patients treated
by them, which results in poor clinical
If we do not seriously think
about the link between TB and
Diabetes, it may begin to derail
some of the good advances
made in TB control especially
in India. The link between TB
and Diabetes mellitus has
established what is needed
now in good quality
implementation of knowledge
to screen for both diseases
and monitor this dual burden
of disease.
AGAPPE, THE NAME YOU CAN TRUST
IN IVD INDUSTRY
We are Medtech Diagnostics located at Vasant Kunj, New Del hi was established
in June 2021, started our operation with COVID-19 testing during the pandemic.
Our association with Agappe Diagnostics is comparatively new as it was only 1
year prior, we bought Agappe’s prestigious Mispa CXL Pro. We are very much
satisfied by the service provided by the company’s Mispa Care team and espe-
cially the efforts by the senior management of Agappe in hearing the com-
plaints of the customers. About the equipment, Mispa CXL Pro is very sturdy
and accurate in providing results. Since I’ve been using dry chemistry instru-
ments before this, I’ve compared the result from this machine with it and I’ve
found them to be at par with international standards. All my best wishes for
Agappe in its future endeavours.
Dr. Niti Singh
MedTech Diagnostics, Delhi.
outcomes. Finally, this situation affected facilities, registered notification of TB
the cure rates and development of drug cases also increased many folds.
resistant TB. If the TB patients diagnosed
To conclude, early diagnosis of TB us-
and treated under private sector are re-
ing the available tests and appropriate
ported to public health authorities, the
mechanisms available under the
molecular and culture methods is very
important to cut the chain of transmis-
programme can be extended to these pa-
sion of TB. By ensuring that the patients
tients also to ensure treatment adherence
and completion. The impending epidemic
are completing treatment, drug-resistant
TB will be definitely reduced. Notification
of M/XDR TB can only be prevented to a
of tuberculosis patients will be an impor-
large extent by this intervention.
tant step in ensuring follow-up. Effective
To address this situation, Government management of various immunosuppres-
of India declared Tuberculosis as a notifi- sive disorders like diabetes, HIV and or-
able disease where in, all TB cases diag- gan transplant recipients is essential in
nosed are to be reported mandatorily to handling various infectious diseases and
the public health authorities in a specified reducing the communicable nature of
format. With increasing number of health those infections.

42 TECHAGAPPE APRIL-JUNE 2023

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TECHAGAPPE APRIL-JUNE 2023 43

 Story Nandita Venkatesan

NANDITA VENKATESAN: THE AWESOME STORY OF A

DIE HARD TB SURVIVOR

Nandita who hails from Mumbai was first diagnosed with TB in 2007 while pursuing
her undergraduate course. Aspiring to be a business and financial journalist, she
was shattered at the news of her disease. The prolonged treatment and medication
affected her studies as well as her self-esteem. She had to take almost 10-15
tablets a day for almost 15 months. Despite this, she recovered and went on to
pursue graduate studies in Mass Communications. Here, Let us read the brave life
of Nandita who have survived TB twice in her life at the ages of 17 and 23.
On October 30, 2019 at the opening ceremony of the Rud hram. She received a standing ovation of those
50th Union World Conference on Lung Health which who knew her personally. Now if you are wondering
took place in Hyderabad, India, an engaging solo per- what’s so special about it, read these words she spoke
formance on stage enthralled the audience. It was soon after the performance: to the audience: “Thank
performed by Nandita Venkatesan in the traditional you everyone! My name is Nandita Venkatesan and
attire with the accompaniment of the music of Shiva this dance known as Shiva Rudhram, a rendition to
the God of the destroyer of evil is dedicated to the
exemplary courage and strength shown by every TB
survivor sitting here in this hall and to the millions of
others around the Globe. I’ve survived TB twice in my
life - at the ages of 17 and 23. My second battle against
TB robbed me of my hearing completely but it didn’t
take away my love for dance despite no longer being
able to follow any form of music. Yes, all this is in-
cluded in this performance as well or my passion of
helping others in their struggles with the disease.”
In fact, Nandita took everyone there by surprise
with her performance because, except the very few
among the audience who knew her closely, no one
else knew that the solo performer had lost her hearing
ability and she is a proud TB survivor. She lost her
hearing due to an injection while undergoing the medi-
cation on her second battle against TB. She relied on
counting and memory to be able to perform. Yet it
never appeared to be a performance by an individual
who had a disability.

Nandita’s Story: How It All

Began?
Nandita who hails from Mumbai was first diag-
nosed with TB in 2007 while pursuing her undergradu-
ate course. Aspiring to be a business and financial
journalist, she was shattered at the news of her dis-
ease. The prolonged treatment and medication af-
fected her studies as well as her self-esteem. She had
to take almost 10-15 tablets a day for almost 15 months.
Nandita Venkatesan
Despite this, she recovered and went on to pursue

44 TECHAGAPPE APRIL-JUNE 2023

graduate studies in Mass Communica-
tions.
In a study done in Cape Town, South
Africa, where tuberculosis is very com-
mon, 18 percent of the 612 study partici-
pants had tuberculosis re-infection. Four-
teen percent of those patients had been
successfully treated for their illness and
were infected again with a different strain
of TB. Nandita was diagnosed with TB
again in 2013 and this was severe too. She
underwent five major surgeries in the
space of three months including a sur-
gery to remove the infected portion of her
intestine and was bedridden for most of
the time.
“I lost around 23kg and my hair started
to lose during the period. Anything I ate
hurt my stomach and passed out undi-
gested. Small sips of water and IV fluids
replaced solid food. I felt very fearful and
helpless about what was happening. It
seemed like my life was coming to a stand-
still all over again. The side effects of a TB
drug made me deaf in November 2013. I
had not even been forewarned that this
might be a possible outcome,” recalls she.
“I felt cheated and had lost faith in science
at this point. My illness had not only shat-
tered my self-esteem and compromised
my future, but it was putting an immense
financial and emotional strain on my fam-
ily too. It took almost Rs 40 lakh for my TB
treatment alone.” For cochlear implant
“People especially women
might not ask many questions
like how TB can affect their sex
life or if missing periods is a
side effect of TB medicines or
whether they should tell their
partners about the diagnosis of
TB. Many of them see TB as a
surgery to restore her
hearing, they had to raise
funds from four donors.
The Turning
Point
Living in fear, shat-
tered and low in confi-
dence, the turning point in
Nand ita’s recovery was
when her dance teacher
invited her to take part in a
class. Nandita who always
loved to dance had been
training in the classical In-
d ian dance style of
Bharatanatyam from her
childhood itself. She felt it
was time to take charge of
her life once again despite
al l the negativity sur-
rounding her.
“I took to dance as a
way to emerge from my
closet and as a means to
regain my shattered con-
fidence. I saw it as a means
to channel my pent-up
energy and exasperation,”
she adds. She memorised
the beats, lyrics and steps
of the dance. Also with the
help of a hearing aid she
could feel the vibrations of
the rhythm. She uses
number counts to grasp
the beats. The solo perfor-
Nandita Venkatesan during
mance by her described in
a cultural progamme
the intro was the epitome
of her hard work.
doubts and I read up a lot then,” she ex-
Overcoming Challenges plains. In 2018, Nandita delivered the open-
She learnt to lip-read quite well and ing address at the UN General Assembly’s
mastered the sign language. She was able High-Level Meeting on TB. She actively ad-
to secure a job at The Economic Times as a vocates for improving patients’ awareness
business journalist. As a TB survivor she of the disease and potential side effects,
also turned into TB advocacy helping many for more funding for TB research and di-
others like her who suffer from intestinal agnostics, and for access to counselling
TB and answering their questions. for TB patients.

disease of shame and defeat
and self stigma among girls is
particularly high. Nobody
explains side effects to them. I
had no one to refer to when I
had similar doubts and I read
up a lot then,” she explains.
“People especially women might not
ask many questions like how TB can affect
their sex life or if missing periods is a side
effect of TB medicines or whether they
should tell their partners about the diag-
nosis of TB. Many of them see TB as a
disease of shame and defeat and self
stigma among girls is particularly high.
Nobody explains side effects to them. I
had no one to refer to when I had similar
In 2019 she challenged the attempt by
Janssen, a sister concern of the pharma-
ceuticals giant to extend its patent on
bedaquiline an important drug for those
with drug-resistant TB. The patent is set
to expire in 2023 and the company wanted
an extension till 2027. She lost her hearing
as they had prescribed an older anti-TB
drug, kanamycin which had side effects.
The chal lenge put forward by her to

TECHAGAPPE APRIL-JUNE 2023 45

 Story Nandita Venkatesan
A little over a year ago, Nandita with her surgeons Dr Mathur and Dr Mitali
withher audiologist Dr Rakesh.
Janssen’s application in the Indian Patent
Office might be the last hope for thousands
suffering from multi-drug-resistant TB
(MDR-TB) to get affordable bedaquiline.
WHO’s treatment recommendation for
MDR-TB in July 2018 listed bedaquiline
among the medicines to be used in longer
MDR-TB regimens and drugs like kanamy-
cin and capreomycin were no longer rec-
ommended.
Nandita was forced to use the former
drug during her treatment which robbed
her hearing because bedaquiline wasn’t
available in India at that time.
Winning Strides
From 2016 to 2020 she worked at the
ET. During September 2020, she was
awarded the prestigious Chevening -
Weidenfeld Hoffmann Trust Scholarship
to pursue Masters of Public Policy from
University of Oxford. On Twitter she wrote
announcing the news with a quote: ‘some-
times people with the worst pasts can cre-
ate a better future!’ She also wrote on how
46 TECHAGAPPE APRIL-JUNE 2023
We are to be heard, listened
and acted upon. You say you
know the science of our
disease, we say we know
the pain of living with it.
You say the diagnostics are
hard and expensive to
provide, we say that late
diagnostics destroyed our
health and lives. You say
that developing new
drugs are expensive but
we say it is more expensive
to lose our hearings, to lose
our sight and lose our
livelihood.
her father responded to the news: “Your
life remains a mystery to us! Nobody in
our ‘entire’ family has gone through what
you have, but no one has also
managed to achieve the
things you have.”
Her speech during the
50th Union World Conference
on Lung Health which took
place in Hyderabad in 2019
sums up what she has to say
to the authorities: “We have
wal ked the difficult path of
these d iseases, mind you
and we have survived. Our
voices are experiences. And
our stories count.
We are to be heard, lis-
tened and acted upon. You
say you know the science of
our disease, we say we know
the pain of living with it. You
say the diagnostics are hard
and expensive to provide,
we say that late diagnostics
destroyed our health and
lives. You say that develop-
ing new drugs are expensive
but we say it is more expen-
sive to lose our hearings, to
lose our sight and lose our
livelihood.
You say that it is difficult
to increase funding for research and de-
velopment, we say without more govern-
ment investment and support our broth-
ers and sisters will continue to die. We
don’t need you to watch us take our treat-
ment but we need holistic, integrated
people centered assistance and care. None
of us would be here without you. Your work
revolves around the diseases that we
know more intimately than we ever hope
you ever have to know.”
Her Message
Yes, Nandita believes the healthcare
systems should be strengthened. A health
crisis is never restricted to health. It heavily
impacts social, economic and mental well-
being, she points out.
As a message to other TB survivors,
she says: “The key is this: be brave; be
determined. Take it as a second chance at
life. Besides, when life pushes you over,
you ought to push back harder!” Nandita
currently works as a Data Journalist at
Mint from April 2022.
Testimonials Brand Reach

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DIAGNOSTIC SERVICE FROM AGAPPE

W e ‘We Path Laboratory,’ believes

that a well-equipped facility and su-
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inevitable for better treatment and
curative care, so we are suggesting
Agappe’s equipment and reagents
for medical assistance. We have been
associating with Agappe for the last
six years.
We are using Mispa Nano Plus, I
smart 30 pro, Mispa Viva, Mispa
Revo, Mispa Ace, Mispa Count,
Mispa Clog, and Mispa-i3. We are
delighted with the Agappe products
and its quality reports which are
pretty reliable and consistent.
Their constant updates in technol-
ogy and equipment assist us so of-
ten in providing the best service to
society.
Here we are expressing our sincere
gratitude and pleasure to use the ad-
vanced idea of Agappe for complaint
registration through the mobile ap-
plication ‘AG Care’.
We will use this one-point contact to con-
nect Agappe corporate office whenever
possible. We would say that this will help
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ers like us.
The process of registering a complaint
through AG Care is relatively simple, and
the customer technical team enables us to
solve the complaint quickly. If we require a
site visit, the service team also visits and
provides all the support.
The courteous staff is the big highlight of
Agappe. The Agappe mobile application also
provides a medium to understand the sta-
tus of the complaint and an option for rating
the Agappe products and service support.
We appreciate the quality of the ser-
vice we received from Agappe Diag-
nostics Limited. Their sincerity, com-
petence, and valuing customer’s time
shaped them as the best diagnostic
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We are experiencing premium quality
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Thanking you
Dr. Varun Gohil
HOD of Laboratory,
We Path Laboratory,
Vadodara.

TECHAGAPPE APRIL-JUNE 2023 47

 Interview Dr. Rajalakshmi P C

ASWINI DIAGNOSTIC SERVICES

EPITOME OF TRUST AND EXCELLENCE
Aswini Diagnostic Services, located at Chinthavalappu Junction, Kozhikode, Kerala
is currently an autonomous reference clinical laboratory with well trained full
time pathologists and laboratory professionals. With a track record of nearly 30
years in the field of healthcare, Aswini Diagnostic Services has earned a name
for excellence in service as well as the trust of the people of Kozhikode.
A swini Diagnostic Services, established in the year its beginning. Her son Prajesh Kurup is one of the
1994 is one of the first medical laboratories in North Managing Partners-Technical and Strategical. The
Kerala to be accredited by the National Accreditation other Managing Partners include A Gireeshan and M
Board for Testing and Calibration Laboratories (NABL) Srikumar.
an autonomous body under the Department of Sci-
ence & Technology, Government of India. It has the
Good Old Days
departments of clinical biochemistry, clinical pathol- Dr. Rajalakshmi P C who hails from Kozhikode
ogy, serology, haematology, microbiology, histopa- finished her MBBS in 1975. She was among the sec-
thology and cytology. ond batch of MD studies in Kozhikode Medical Col-
lege when the course was introduced for the first time
Dr. Rajalakshmi P C MD (PATH) Retd. Associate there. “During my third year at MBBS itself, I had made
Prof. Govt Medical College, Kozhikode and Medical my mind to become a pathologist.
Director of Aswini Diagnostic Services have been
closely associated with the laboratory almost since From 1992-94, I worked as an Associate Profes-
sor at Kozhikode Medical College and
then I was transferred to Thrissur
Medical College. But then my kids
were so small and the daily commut-
ing was so difficult and thus I took a
long leave for two years. The leave
was later extended,” she says.
It was in April 1994 Aswini Diag-
nostic Services began its operations.
“There were almost five partners and
it was my mentor Dr. Rajagopal sir
who used to helm the surgery depart-
ment in Kozhikode Medical College in-
spired me to take up a role in the pri-
vate sector although I was quite scep-
tical in the initial stage. But it turned
out to be a good going.” She adds.
She has some real ly pleasant
memories associated with the lab
right from the beginning. “The patients
in those times were really attached
to us. It was something beyond the
usual patient-doctor relationship. We
mostly knew all our patients and their
family background. They trusted us
as if we were their extended family
whereas today they have turned to

48 TECHAGAPPE APRIL-JUNE 2023

be ‘customers’ in the typical
new-generation style, she re-
calls.
“We are not Gods. We are
humans but equipped with the
knowledge of medicine. As a
doctor my aim has always been
to provide the most accurate
result and diagnosis to the pa-
tient in time. I must say that all
doctors must have a little com-
passion towards their patients.
Your timely intervention could
save lives,” she points out.
Milestones
One of the salient features
of Aswini Diagnostic Services
is that it has embraced the ad-
vancement of technology and
automation in the field of di-
agnostics. “Right from the be-
ginning itself, every week we
used to introduce a new test.
Be it in the pathology depart-
ment or micro biology or bio
chemistry. In the beginning we
Dr. Rajalakshmi receiving TechAgappe previous edition copy from
were completely dependent on
Majesh Mammen, Senior Business Manager, Trade Accounts, Agappe.
the technicians for the test re-
sults in most of the departments including mary Health Screening Camp at Chinmaya detection camp at Lions Club of Kozhikode
the bio chemistry department. Their re- School, Kozhikode for students of Grade 5, Feroke. Another health camp organised in
porting was accurate and perfect. However 6 & 7. Prior to that, it had conducted an- association with them was the free diabe-
automation in all departments has helped other primary health screening camp at tes detection camp at Mofussil bus stand,
us to get the results fast. From 1999, we Ayathan School, Kozhikode too. Kozhikode. It had also donated a water pu-
began automation in the bio chemistry de- rifier to the new block of the Government
In association with Lions Club Interna-
partment,” recalls Dr Raja- lakshmi. General Hospital (Beach, Kozhikode)
tional, Aswini Diagnostic Services had con-
thereby ensuring clean and safe drinking
Accreditations ducted a free blood pressure and diabetes
water supply for patients and staff at the
Aswini Diagnostic Services is one of the hospital.
first medical laboratories in North Kerala It also actively participates in several
to secure National Accreditation Board for awareness campaigns. Last year it had
Testing and Calibration Laboratories At present India have more organised a flashmob at Kozhikode Beach
(NABL) for biochemistry and hematology.
Both biochemistry and microbiology de- than 2 lakh children who are to raise awareness about diabetes. Through
different social media handles, the group
partment is certified by External Quality below the age of 15 years takes the awareness programs to the youth.
Assurance Scheme (EQAS)- CMC Vellore
and Dr Ram Manohar Lohia Hospital, New having Type I DM. Many of Separate camps and awareness pro-
Del hi. All routine and immunoassay pa- them don’t even have access grams are organised for the employees and
rameters are certified by BIO-RAD. The staff at Aswini Diagnostic Services. As a part
Hematology department is certified by EQAS
to insulin or glucose meter or of “Say No to Drugs” campaign, Chinmaya
AIIMS, New Delhi. strips. For some it is poverty Yuvakendra, Kozhikode organised an inspi-
rational run as a stand against drugs and in
CSR Activities while for some others it is the support of this campaign. Staff members
Aswini Diagnostic Services is in the non-availability. unavailable in of Aswini Diagnostic Services also took part
in it to send a powerful reminder to choose
forefront of conducting several CSR activi- several parts especially in a healthy lifestyle. During the FIFA World
ties for both the public and employees. They
organise regular health care camps either
Expert doctors are also Cup, it had organised a one-day Football
Tournament with the aim of promoting
associating with another organisation or on unavailable in several parts healthy lifestyle through football for its
their own. Recently it had conducted a Pri-
especially in rural areas. employees.

TECHAGAPPE APRIL-JUNE 2023 49

 Interview Dr. Rajalakshmi P C
"We, the Aswini
Diagnostics, are fully
satisfied with the quality
of Agappe’s reagent and
equipment"
The team of Laboratory Technicians at Aswini Diagnostic Services,
the autonomous reference clinical laboratory at Calicut, Kerala.
As part of WHO Cervical Cancer Elimi-
nation Day of Action 2022, Aswini Diagnos-
tic Services scheduled an awareness pro-
gram for staff members on 17-11-2022. Dr
Preeja C, MBBS, DNB conducted an aware-
ness class about the importance of cervi-
cal cancer prevention & menstrual hygiene.
Several such programs are organised for
the staff by the management.
Preventive Healthcare
“People are now very cautious. I believe
the awareness level have increased among
the people. Like without even a compul-
sion from others they are doing blood tests
and are aware of the importance of early
diagnosis. People are now aware that early
detection can be life-saving. For both the
doctor and the patient, early detection is
helpful. It also ensures improved quality of
life, points out Dr Rajalakshmi.
Pillars of the Organisation
Aswini Diagnostic Services Kozhikode
has staff strength of around 100. “They are
our greatest strength and asset. They play
a crucial role in the growth and success of
our organisation. From receiving the pa-
tient to conducting the test at the pre-
scribed time their role is inevitable. We have
also got a prompt online department which
50 TECHAGAPPE APRIL-JUNE 2023
puts up the results so that the reports can
be downloaded without visiting the office
again. It is also send to their respective
WhatsApp number if they wish so. Home
collection of samples is also available for
patients,” says Prajesh Kurup.
Future Projects
“We are in the process of expanding
now. As a first step we are now doing equip-
ment valuation as well as looking out the
"We are using Mispa-i2, the
semi-automated specific protein
analyzer for the past 12 years. It
has been a wonderful
association as Mispa-i2 has
helped us to provide high
precision and quick turnaround
results for all protein assays in
blood testing. We are highly
satisfied with Mispa-i2. Another
product we use from Agappe is
Mispa Viva".
possibilities of developing franchise model.
Regarding the laboratory segment, we
are now going to introduce genetics. We
wish to introduce tests like Fluorescence
in situ hybridisation (FISH) test which is
used to identify a variety of chromosomal
abnormalities and other genetic mutations
here as most often people might have to
visit other states or go abroad to do such
tests,” says Prajesh Kurup.
The management of Aswini Diagnostic
Services is very conservative and therefore
no hasty decisions are made with regard to
expansion. “A lot of research is done be-
fore taking the next step forward. Now, with
Covid-19, the expansion plans have been
slowed down. Also our first concern is
about maintaining quality than quantity. In
North Kerala, we are almost the pioneers
of Histopathology in the laboratory sector,”
he adds.
Association with Agappe
“We are using Mispa-i2, the semi-au-
tomated specific protein analyzer for the
past 12 years. It has been a wonderful as-
sociation as Mispa-i2 has helped us to pro-
vide high precision and quick turnaround
results for all protein assays in blood test-
ing. We are highly satisfied with Mispa-i2.
Another product we use from Agappe is
Mispa Viva, the semi-automated bio-
chemistry analyzer.
For blood tests it has been helping us
to get high accuracy, quality results with
least turnaround time and low mainte-
nance. I should also talk about the prompt
service provided by the company when in
need. Not many companies can boast about
it. Agappe however is exemplary in that re-
gard. The indigenous Research and Devel-
opment team of Agappe is also praisewor-
thy as we all know that there aren’t many
Indian companies in the IVD sector,” says
Dr Rajalakshmi.
We are now looking forward to Mispa
CXL Pro Plus, the fully automated clinical
chemistry analyzer. We have high expecta-
tions about it as we hear Mispa CXL Pro
Plus is a compact, fully automated ana-
lyzer with photometric throughput of 240
clinical chemistry tests per hour. I’ve heard
from the industry that it has excellent on-
board washing and cleaning system adopt-
ing 7 stops 11 steps ensuring minimum
carryover and precise result delivery; We
wish Agappe all the best in their upcoming
endeavours” she adds.
Testimonials Brand Reach

AGAPPE IS VERY HELPFUL IN DELIVERING

QUALITY RESULTS TO PATIENTS
We Rajmudra Lab, Lonand is using using the reagents/Equipment. Even dur- allow them to support and remote
Agappe Products from the past 3 years ing the AMC renewal also, the advantage of desktop facility so that the technical
and I am having their Mispa viva (Semi scanning kits helped me a lot to gain the team of Agappe can get the details
auto Biochemistry machine) Mispa i2 maximum profit of AMC with minimal in- online.
(Specific protein Analyzer) and Mispa vestment.
The remote desktop facility is also
CXL pro( Fully auto Biochemistry ma-
The recent facility which Agappe include licensed by Agappe and hence we don’t
chine). During the starting phase I have
in this application is the Customer Sup- need to bother about the security prob-
taken only the first two instruments
port ‘The AG Care’. We could register the lems related to this. We can also rate
and later during the last year only I have
upgraded to the ful ly
auto analyzer.

I would like to say

that after 2 years I have
upgraded on the same
Agappe instruments is
only because of the Ser-
vice Support from the
team in my area and the
quality of products pro-
vided by Agappe. The
Service support and the
Application support
which is been delivered
from them for the past
years is highly appre-
ciable.
Agappe is one of the
best companies which
offer many advantages
rather selling the goods
and services. One of the
best offers they are pro-
viding is the Mobile application of complaints directly through the application the support for the specific complaint
Agappe. The mentioned application is and even track the status of the same in the after closing the same by their team in
an all-in-one application which pro- application itself. the mobile application itself.
vide the users of Agappe products, a
very good advantage more than using Prominently after registering the com- In a glance I would like to say the
the goods from them. plaint in the mobile application, I at once support team, service, sales even the
get a call from the Agappe Customer Tech- Backoffice of Agappe are very much help-
We could gain the points in AGP and
nical Support Team, asking about the prob- ful to me in delivering quality results to
can redeem these points to get re-
lem and they were offering support online. my patients from my laboratory.
agents in free of cost. This facility which
I could say that my many complaints are
Agappe is providing is a unique facility
being solved by online.
Uday Baban Shinde
and I don’t even think that any other Rajamudra Laboratory, Satara,
company is providing this facility over The only thing I intended to do is that to Maharashtra.

TECHAGAPPE APRIL-JUNE 2023 51

 GLP Good Laboratory Practices

Sanjaymon K. R,
Associate Vice President - BD, AGAPPE.
IMPORTANCE OF
SAMPLE TRACEABILITY
The IVD testing is a sophisticated process that includes majorly
three different phases called pre-analytical, Analytical and Post-
analytical phase. The pre-analytical phase accounts for more than
60% of the errors in the laboratory which may be due to improper
sample collection, delay in sample transport, incomplete test
requisitions , improper labelling of the sample etc making it very
difficult to elude by the analysts.
Traceability is a common word used by
the laboratories now days because of the
new quality guidelines. The traceability or
the metrological traceability is defined as
‘property of the result of a measurement
or the property of the result of a measure-
ment or the value of a standard whereby it
can be related to value of a standard
whereby it can be related to stated refer-
ences, usually national or international
stated references, usually national or in-
ternational standards, through an unbro-
ken chain of standards, through an unbro-
ken chain of comparisons all having stated
uncertainties’. There are reference materi-
als or methods available nationally/inter-
nationally for the traceability which helps
in assuring the quality in the analytical
phase. This makes the analytical process
‘Controllable’.
Laboratories around the world are al-
ways looking for ways to improve the effi-
ciency of their services and one of the key
quality indicators is Turnaround time (the
time interval between the specimens re-
ceived in the laboratory to the time of re-
ports dispatched with verification). The fact
is that around 80% of hospital-attached
clinical laboratories receive complaints
about high TAT. When we investigate these
complaints on the TAT, it is being noticed
that majority of the TAT issues are due to
the pre-analytical errors. Ironically most
of these errors are beyond the control of
laboratory administration. The best way to
control the pre-analytical error is sample
traceability. Let us take some examples to
understand this concept.
Some Typical Cases
There is a patient admitted in the emer-
gency department of a hospital who came
with chest pain and the doctor wants to do
the cardiac markers for proper diagnosis.
They collected the sample pasted the label
with the patient’s name written on it and
send the sample (#1) to laboratory for test-
ing. The result came with a value which is
near to the critical point and the doctor want
to do a repeat test after one hour to rule
out the cardiac issue. After one hour again
the sample (#2) was collected and sent to
the laboratory for performing the cardiac
marker and the result came low as com-
pared to the earlier value. After seeing this

52 TECHAGAPPE APRIL-JUNE 2023

the doctor asked a repeat test for the ear-
lier sample (#1) and this time the result
came concordant with the second sample
( #2) making the diagnosis difficult. The is-
sue happened here is that in both the
samples, the name of patient, the patient
ID and the test is written and there is no
indication on the time of collection making
it difficult for the technical staff in the cen-
tral IVD laboratory to differentiate the first
and second samples. Here the constraint
was the sample traceability. If the samples
were labelled as number 1 or number 2,
the issue could have been eliminated. The
other way is to use sample barcodes with
unique algorithm (sample ID algorithm to
differentiate sample of the same patient
collected at different times)
A patient came to a laboratory for test-
ing the Fasting, PPBS, HbA1c and lipids. The
fasting blood was collected along with the
Urine samples, and after two hours, the
PPBS blood sample was collected along with
the urine sample. While checking the re-
port of the patient, the result came as nor-
mal FBS with “++” Urine Sugar and a high
PPBS with “ ++++” Urine Sugar and a high
HbA1c suggestive of poorly managed dia-
betes.
Here the issue is that the FBS value is
not correlating to the other values and while
checking it has been found that the sample
was collected in the early morning hours
and the serum got separated after four hours
because of which the blood sugar values
came down. Here the issue happened at the
phlebotomy level where the fasting sample
needs to be collected in the three different
tubes (Sodium fluoride for the FBS, Clot for
the Lipids and EDTA for HbA1c). Here the
phlebotomist missed to take the sample in
Fluoride tube and the serum which was sepa-
rated by the technical staff went for testing
inside the laboratory.
How to Eliminate Such
Issues?
There are many such pre-analytical
cases happening in the IVD laboratories
which in turn create unnecessary confu-
sion. One of the best way to elude such
errors are usage of pre- analytical auto-
mated systems like tube label lers, tube
sorters, sample processing systems which
will give a better sample traceability. In these
pre-analytical automation systems, the
samples are traceable from the time of real
sample drawn from the patient with posi-
tive sample identification and this helps to
MISPA LABEL - INTELLIGENT TUBE LABELING SYSTEM
Pre-analytics has become the need of
the time to optimally manage the pro-
ductive work and operation in a labora-
tory in a smooth ad proper way.
Mispa label is a laboratory labelling
system with specially developed labels
with specific dimension, special adhe-
sive and medical grade labels for mark-
ing of different types of blood collec-
tion tubes used in laboratory. Advan-
tages of using Lab Labelling Systems
are many as far as an effective lab is
concerned as you can very well elimi-
nate the possible errors due to mistake
in labelling and save lot of time and en-
ergy in the preparation and pasting of
proper labels on the blood collection
bottles.
Mispa Label possess 6 tube racks
with capacity of 120 tubes, automatic
tube positioning & identification, as well
as HIS/LIS with Bi-Directional connec-
tivity too. As consumables, you can
reduce the TAT. The latest tube labellers
are associated with unique algorithms
based on the ‘right tube for the right test
concept’ and hence errors because of
sample collection in wrong containers will
never occur. This also helps the phleboto-
mist to plan the volume of blood to be
drawn from the patient based on the dif-
ferent types of tubes dispensed from the
tube labeller with sample ID. Since the pre-
analytical systems are connected with the
There are innovative software
systems are available for the
laboratories with sample
traceability to reduce the pre
analytical variations and there
many processing protocols
investigated in the nursing
practices to reduce the
specimen collection errors in
the in patients.
TECHAGAPPE APRIL-JUNE 2023
have primary Labels-5 rolls of 2000 la-
bels each auxiliary Labels-5 rolls of
1500 labels each for your inventory
purpose. So, Mispa Label will be an
ideal and essential Pre-analytical de-
vice for your lab for the best results.
LIS/HIS systems, the same primary tube
can be used for testing in various instru-
ments connected to the LIS giving better
TAT.
Sample Track
Another important concept in sample
traceability is sample track, which means
that wherever a sample is collected, it is
logged in to the system through specific
online software thereby helping us to un-
derstand the issues in sample transport
(like delay in delivery, cold chain manage-
ment, etc especially in courier). This will
also help the laboratories to improve their
processes and helps at the time of valida-
tion of the results (a blood sugar value low
can be put on hold if the sample collection
to sample testing interval is more than four
hours, a coagulation result can be put on
hold if the primary sample came delayed
from a distant lab).
There are innovative software systems
are available for the laboratories with
sample traceability to reduce the pre ana-
lytical variations and there many process-
ing protocols investigated in the nursing
practices to reduce the specimen collec-
tion errors in the in patients.
53
 Health Tips for Healthy Life Style

TUBERCULOSIS
SOME HEALTH TIPS FOR
PREVENTION & MANAGMENT
Tuberculosis (TB) is a serious infectious disease caused by the
bacterium Mycobacterium tuberculosis. It primarily affects the lungs.
However, TB can also spread beyond the lungs and affect other parts
of the body, known as extrapulmonary TB. Extrapulmonary TB can
infect the lymph nodes, bone and joint infections, particularly in the
spine, hips, and knees, genitourinary system like the kidneys, bladder,
and other parts of the urinary and reproductive systems, brain and
nervous system (meningitis) or skin. Like this, TB can infect anywhere
in the body, except nails and hair, as the saying goes. Here are some
health tips for preventing and managing this infection
Dr. C.S. Satheesh Kumar,
Head - Corporate Communication, AGAPPE,
(Retd. Drugs Controller, Kerala)
Primary precaution for preventing TB is recommended that infants receive the BCG
BCG vaccine. This is included in the univer- vaccine shortly after birth.
sal immunisation programme of all major Practicing good hygiene is always an im-
nations. The BCG vaccine provides good
portant step towards healthy living. TB is
protection against TB, particularly in chil-
spread through the air when an infected
dren. In areas where TB is common, it’s
person’s coughs or sneezes. When you are
in TB infected areas, for
reducing your risk of
infection, wash your
hands frequently with
soap and water or use
an alcohol-based hand
sanitizer. Cover your
If you are a TB patient, see mouth and nose with
that you take medications as a tissue or your elbow
prescribed. Skipping doses or when you cough or
sneeze and dispose of
stopping treatment early can tissues properly.
lead to drug-resistant TB and Try to avoid close
make it more difficult to treat. contact with infected
individuals as far as
This is a big menace India as possible and wear
well as developing countries N95 masks when you
visit them is a better
are facing. option. If you know
someone who has TB,
avoid spending time
in close proximity un-
til they have com-
pleted their treatment

54 TECHAGAPPE APRIL-JUNE 2023

and are no longer co-
ntagious.
You have to main-
tain a healthy lifestyle
with balanced diet,
and regular exercise.
Managing stress can
help keep your im-
mune system strong
and reduce your risk
of contracting TB or
other infections.
In between, it is
advisable that those
who are in close con-
tact with someone
who has TB or have
symptoms such as
cough, fever, and
weight loss get tested
for TB. Whenever
your immunity is at a
lower state due to
some viral infections or other immune-com-
promised stages, early diagnosis and treat-
ment can help prevent the spread of TB and
improve your chances of a full recovery.
If you are a TB patient, see that you take
medications as prescribed. Skipping doses
or stopping treatment early can lead to
drug-resistant TB and make it more diffi-
cult to treat. This is a big menace India as
well as developing countries are facing.
It is important to practice social distanc-
ing during a TB outbreak. At the same time,
TB is not spread by shaking someone’s
hand, sharing food or drink, touching bed
linens or toilet seats etc.
Treatment and
Precautions
Treatment of TB usual ly involves a
combination of antibiotics taken for a pe-
riod of several months. The exact treat-
ment regimen will depend on the type of
TB (such as drug-sensitive or drug-resis-
tant), the severity of the infection, and the
individual’s overall health. During TB treat-
ment, it is important to take the antibiotics
exactly as prescribed and to complete the
entire course of treatment, even if the
symptoms improve or go away. MDR-TB
(multi-drug resistant tuberculosis) is a type
of tuberculosis that is resistant to two of
the most powerful first-line TB drugs, iso-
niazid and rifampicin, as well as other TB
drugs. MDR-TB can emerge in the popula-
tion through a number of ways like inad-
A well-balanced diet is an
essential component of TB
treatment as well as in
prevention. Good diet helps to
support the immune system
and overall health.
equate treatment and close contact with In addition to taking antibiotics, there
MDR TB. are several precautions that should be
taken during TB treatment. These include
The most commonly used antibiotics
isolation of the people with active TB, wear-
for treating TB are isoniazid, Rifampicin,
ing of mask, regular testing during medi-
Ethambutol, and Pyrazinamide. These an-
cation etc.
tibiotics are often given together in a com-
bination called a “TB regimen.”The typical Eating a healthy diet and getting regular
treatment regimen for drug-sensitive TB exercise can help boost the immune sys-
involves taking four antibiotics daily for two tem and support the body’s ability to fight
months as in the intensive phase, followed the infection. Some TB medications can
by two antibiotics daily for four to six cause side effects such as nausea, vomit-
months as in the continuation phase. The ing, and liver damage. It is important to re-
duration of the treatment may vary de- port any side effects to the healthcare pro-
pending on the individual’s response to the vider promptly.
antibiotics.
What Can Increase the
Risk?
A weakened immune system makes it
Eating a healthy diet and more difficult for the body to fight off TB
bacteria. People with weakened immune
getting regular exercise can systems due to conditions such as HIV/
help boost the immune AIDS, diabetes, or cancer, chronic kidney
diseases are at higher risk of getting TB.
system and support the When you live in close contact with some-
body’s ability to fight the one with TB, it can spread through the air,
infection.Some TB especially, when the person with active TB
coughs or sneezes. Close contact with
medications can cause side someone with active TB increases the risk
effects such as nausea, of infection.
Living in a high-risk area also is also a
vomiting, and liver damage. concern. TB is more common in certain
It is important to report any parts of the world, such as sub-Saharan
Africa, India, and China. People who live in
side effects to the healthcare these areas or who travel to them frequently
provider promptly. are at higher risk of getting TB. Likewise,
TECHAGAPPE APRIL-JUNE 2023 55
 Health Tips for Healthy Life Style
poor living conditions like
overcrowding, poor ventila-
tion, and lack of access to
healthcare can increase the
risk of TB transmission. As
seen in modern times, sub-
stance abuse, particularly in-
travenous drug use, can
weaken the immune system
and increase the risk of TB
infection. Again, people over
the age of 65 are at higher
risk of getting TB.
Malnutrition can weaken
the immune system and in-
crease the risk of TB infec-
tion. Healthcare workers
may be at higher risk of get-
ting TB due to their close
contact with infected pa-
tients. A weakened immune
system can increase your
risk of getting tuberculosis
as your body is unable to
mount an effective defence
against it. Causes for low immune resis-
tance include diabetes, end-stage kidney
diseases, certain cancers, cancer treat-
ment, such as chemotherapy, immunosup-
pressive drugs taken to prevent organ
transplant rejection, HIV/AIDS, etc.
Metformin, has shown to enhance the
body’s immune responses and decrease
the TB bacterial loads in the lung.
Yoga can be used as a
complementary therapy to
support the body and mind
during the healing process. It
helps you to practice breathing
exercises: that can help
improve lung function and
increase oxygenation of the
body. Yoga asanas, or
postures, can help strengthen
the body and boost the
immune system,
and reduce stress.
56 TECHAGAPPE APRIL-JUNE 2023
Diet Tips
A well-balanced diet is an essential
component of TB treatment as well as in
prevention. Good diet helps to support the
immune system and overall health.
A balanced diet that includes plenty of
fruits, vegetables, whole grains, lean pro-
teins, and healthy fats can help provide the
nutrients that the body needs for recovery.
It is important to eat a variety of foods to
ensure that you are getting all of the essen-
tial nutrients.
You need to increase Protein Intake as
it is important for building and repairing
tissues and can aid in the healing process.
Good sources of protein include lean
meats, poultry, fish, beans, lentils, eggs, and
dairy products.
Incorporating healthy fats such as
omega-3 fatty acids can help reduce inflam-
mation and improve immune function.
Good sources of healthy fats include fatty
fish, nuts, seeds, avocado, and olive oil.
Vitamin D plays an important role in
immune function and may help prevent
and treat TB. Good dietary sources of vita-
min D include fatty fish, egg yolks, and for-
tified milk and cereals. Getting adequate
sunlight exposure is also important for vi-
tamin D production. Similarly, Zinc is im-
portant for immune system function and
can help prevent infections.
Good dietary sources of
zinc include oysters, beef, pork,
chicken, beans, nuts, and whole
grains. Vitamins like A, C, E, and
D is crucial for a healthy immune
system. Vitamins A, C and E are
antioxidants that can destroy
free radicals and protect the
body from chronic diseases.
You better avoid processed
and junk foods that are high in
sugar, salt, and unhealthy fats,
which can be detrimental to
overall health and immune func-
tion. It is best to limit or avoid
these foods and instead focus
on whole, nutrient-dense foods.
Stay hydrated as far as
possible. Drinking plenty of
fluids can help prevent dehy-
dration, which can be espe-
cially important for TB patients
who may experience fever,
sweating, or other symptoms
that increase fluid loss.
Key micronutrients like selenium and
zinc are vital for triggering immune activ-
ity. Mushrooms, nuts, and seeds includ-
ing sunflower seeds, chia seeds, pump-
kin seeds, sesame, and flax seeds are rich
sources of both selenium and zinc. Pre-
fer a healthy source of unsaturated fats
from nuts and seeds. You have to avoid
high-calorie foods like porridge, peanut
chikki, rava laddoo, wheat, khichdi and
so on.
Yoga can be used as a complementary
therapy to support the body and mind dur-
ing the healing process. It helps you to prac-
tice breathing exercises: that can help im-
prove lung function and increase oxygen-
ation of the body. Yoga asanas, or postures,
can help strengthen the body and boost
the immune system, and reduce stress and
improve overall well-being and support the
healing process.
Primary complex is a form of tubercu-
losis that occurs in children. Take care not
to miss any medications and strictly fol-
low medical advice. It is important to take
precautions to prevent the spread of pri-
mary complex to other children through
proper isolation.
RCA Root Cause Analysis

WHY MY KIT SHOWS

LESS NUMBER OF TESTS?
ROOT CAUSE ANALYSIS - PART 4
A medium sized standalone laboratory is hav-
ing good workload in Clinical chemistry and im-
munology testing. They are having more than
200 samples in a day and are using automation
in both biochemistry and immunology testing.
As a part of workload calculation, they tally the
number of tests performed and the number of
kits purchased in both segment on a monthly
basis. While checking the data on a month, they
found that the CEA tests performed and the
number kits purchased are not matching.
Let us trace back the events to find the root
cause.
The laboratory is having a stable instrument
in the immunology. They are performing two
Scan QR code levels of control for the parameters performed
to read more in immunology system to assure the quality of
Every Saturday,
Agappe publishes
blogs on Root Cause
Analysis to enhance
the knowledge of
laboratory professionals.
“Browse the link
www.agappe.com/in/blog
or scan the above
QR code to read
more RCA blogs.
the results. While going through the
records, they found that the number of
calibrations performed for CEA is same
as that of the previous lot and there is no
increase in the calibration. There is no cali-
bration failure seen in the CEA calibration
history, there is no repeat run for the qual-
ity control materials, there is no repeat
for the samples, there is no spillage of the
reagents reported. While checking the CEA
testing they found that the reagent kit is
having a number of tests as 200 and after
every 100 tests , they used a new kit. To
understand the error, the section head
taken a new CEA kit and registered the
same in the system. The system showed a
test count of 200 tests. While checking again
the kit they found that the magnetic par-
ticles compartment is hav-
ing less volume. While
checking again, they found
that they are having a new
lot of CEA reagents in the
current month beginning. A
new lot reagent is ordered,
and the magnetic bead re-
agent volume is checked
with the current lot and con-
firmed that there is a vol-
ume difference. The change
in the number of tests no-
ticed by the technical staff
was not communicated in
time.
Quality Management
System Tips:
“Proper monitoring
and timely
communication
is essential for quality
assurance”

TECHAGAPPE APRIL-JUNE 2023 57

 AGAPPE Customer Engagements

GLIMPSES OF AGAPPE CUSTOMER ENGAGEMENT ACTIVITIES

The leaders of Agappe during the Annual Budget Meeting for FY 2024 at Kochi.

Agappe’s new product launch for International market during the Annual Business Partner’s Meet AGAPCON 2023 at Dubai.

Agappe’s participation in Nepal Lab Expo 2023 at Kathmandu Agappe’s International Team at MEDLAB Midd le East 2023.

Sharing TechAgappe to MEDLAB visitors at Dubai. Agappe’s participation at MEDLAB Midd le East 2023 at Dubai.

58 TECHAGAPPE APRIL-JUNE 2023

 GLIMPSES OF AGMAGIC-THE MEGA ASSEMBLY OF AG PRIVILEGE USERS AND
IMMUNOLOGY CONFERENCE AT PATNA, LUCKNOW AND SURAT

Agappe’s participation in Arab Health 2023. The Team of Agappe on Wheels at Nepal.

TECHAGAPPE APRIL-JUNE 2023 59

 Editorial Quiz & Feedback

1. On which date is the World 5. World Health Organisation rec-

Health Organization ommended a control strategy for
recognised to celebrate World TB known as:
Tuberculosis Day? A. DOTS | B. Gene therapy | C. Mor-
phine | D. MCT
A. 24 March | B. 24 April | C. 7 April |
D. 14 November 6. How does TB spread?
2. Name a causal organism that is (A) By breathing | (B) By coughing | (C)
responsible for causing TB? Singing | (D)Sneezing
A. Bacteria | B. Virus | C. Protozoa |
D. None of the above
Quiz Answers of
3. At which place the disease TUBERCULOSIS Q U I Z JANUARY -
Tuberculosis was discovered?
4. Tuberculosis can be separated into
MARCH 2023
A. The Institute of hygiene, Berlin |
B. University of British Columbia | how many categories of progres- (34rd Edition)
C. California Institute of technol- sion? 1-A, 2-A, 3-D, 4-A, 5-B
ogy | D. At Geneva, Switzerland A. One | B. Two | C. Three | D. Four

Answers of this quiz contest will be published in the next edition along with details of the winner and the prize. Participants can either hand over the answers to Agappe’s staff or send in their responses directly to
TechAgappe at techagappe@ agappe.in or post a mail to The Manager-Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district, Kerala-683562.

Kind ly let us know which section of the magazine you like more...
Poem Life Stories Good Laboratory Practices
Health Tips Medical Articles Interviews RCA

We Welcome What do you think of this edition of Techagappe? Are you happy with the overall look
YOUR FEEDBACK and feel of the magazine? Do you recommend any change of style with regard to
& presentation of articles? You can share your views with us in the space given below. All
OPEN COMMENTS you have to do is to post this sheet of paper to the address given below. The best letter
shall be featured in the next edition’s letters to the editor section.

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PIN.....................................Mob.......................................................Mail ID...............................................................
Postal address : The Manager - Corporate Communication, Agappe Diagnostics Limited, Agappe Hills, Pattimattom PO, Ernakulam district,
Kerala-683562. Email: techagappe@agappe.in Mob: +91 9349011309

60 TECHAGAPPE APRIL-JUNE 2023

AGAPPE Branding

POINT OF CARE
SOLUTIONS

Creamatocrit Plus™
Measures the creamatocrit of
mothers’ milk and estimates the
calories per ounce

Auto Dry Biochemistry Analyzer

®
ElectroMeter
Q-3 Plus
Rapid Testing System for
Monitoring Blood Coagulation
PT/ INR / APTT

Smart Vein Detecting System

Portable Hemoglobin Analyzer

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 APRIL-JUNE 2023 61

 RNI No.: KERENG/2015/62113 www.agappe.com

We Can End TB
AGAPPE in SUPPORT
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published from Agappe Diagnostics Limited, “Agappe Hills”, Pattimattom P.O, Ernakulam district, Kerala-683 562. Editor is Ms. Meena Thomas.

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open to all and no closed loops
bright as future and simple as present

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