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Keynote Address Ind J Clin Biochem (Dec 2012) 27(Suppl 1):S1–S114 DOI 10.1007/s12291-013-0298-z KEYNOTE ADDRESS RISK MANAGEMENT BEYOND PATIENT SAFETY Endang Hoyaranda Prodia Group - Jakarta – Indonesia Managing risk in the medical laboratory is not merely iden- involve e.g. medical record data loss due to insufficiently tifying and controlling laboratory error sources which cause functioning back-up systems, unsustainability of manage- direct harm to patient, e.g. a hyperglycemic glucose result ment functions due to change of officers or malpractice when the patient is hypoglycemic. This aspect of risk to or fraud by officers, etc. patients has been a subject of various quality control and A risk management program which covers the prevention quality assurance as well as certification and accreditation and mitigation of all possible hazards, even indirectly, to programs and education sessions for decades. The medical the healthcare system, should be in place at all medical laboratory professionals worldwide has become increasingly settings including laboratory medicine. aware and knowledgeable about the potentials of direct hazards to the patient by understanding various principles Among various mechanisms to manage risk, the medical and techniques like Pareto, FMEA (Failure Modes and Ef- laboratory management should verify the frequency vs the fects Analysis) and FRACAS (Failure Reporting, Analysis impact of each identified hazard in each type of possible and Corrective Action Systems). risk like the security risk, competency risk, business risk, etc, and then categorize each risk against action taken Apart form the direct hazards imposed to the patient, a if risk arise. The whole process should be implemented number of other risks may indirectly affect the patient. in the routine system to prevent hazards arising without Although indirectly affecting patient safety, these risks being noticed. may be recognized too late to prevent harm. This may 123 S2 Ind J Clin Biochem AWADHESH SARAN MEMORIAL ORATION INTEGRATED YOGA FOR THE MODERN LIFESTYLE Dr HR Nagendra Abstract: In today’s world health scenario there are many signals are released. Immediately after injury, endorphins factors driving the growth of diseases, but most experts allow animals to feel a sense of power and control over agree that changes in lifestyle including diet are the major themselves that allows them to persist with activity for attributes. As developing countries rapidly industrialize, an extended time people tend to do work involving less physical activity. In Yoga, ‘Cure’ is possible due to the treatment of the root At the same time, the availability of food that is cheap cause of the disease. Through Yoga emotional imbalances but high in calories becomes more common. Stress and are brought down by the art of sublimation of emotions. other psychological phenomena also play a key role in They eradicate the root cause of the diseases, Ādhi. Ad- widespread illnesses. The trend emerging is that the age vanced yogic techniques harness energy to bring about ranges have been dropping and people are getting sick powerful healing of dreaded diseases like Cancer. in the prime of their life. Further, Yoga can create an enhanced feeling of well- Medical professionals base their practice on this matter- being and take us to the state of ever-lasting, permanent based concept using pharmacological and surgical interven- bliss! tions which give symptomatic relief but not the cure as these NCDs have multidimensional etiology. How does Yoga work? According to Taittiriya Upanishad, human beings live a 5-sheathed existence! The Annamaya Yoga offers solutions as it is multi-dimensional; hence can Kosha, Pranamaya Kosha, Manomaya Kosha, Vijnanamaya offer a total solution. It is here that India has to make Kosha and Anandamaya Kosha! The Annamaya Kosha cor- its great contributions, as India has the complete knowl- responds to the body. The Pranamaya Kosha corresponds edge base, which is contained in the Vedas. Coming from to the life-energy which manifests as breath. Manomaya the root vid jnane, the Vedas treasure us with the total kosha corresponds to the mind, Vijnanamaya kosha to knowledge - a knowledge-base much needed for us in the the intellect and Anandamaya kosha to bliss! Yoga helps modern era to meet the challenge. us progress from the grosser physical instincts to the Derived from the verbal root Yuj, the term yoga means divine, subtle bliss. joining; joining our small individual personality with all Swami Vivekananda categorized Yoga in to four streams pervasive cosmic personality; raising us from an animalistic including Raja Yoga, the path of Will Power, Karma Yoga level to the highest levels of perfection, featured by total or the path of Action, Bhakti yoga or the path of Emotions freedom, knowledge and bliss as shown below. and Jnana yoga or the path of Intellect. Based on these Yoga as is commonly understood is not merely practices four streams of yoga, we have developed an Integrated of Asanas as physical exercises. Yoga is a lifestyle where Approach to Yoga Therapy (IAYT) to deal with all Koshas. we are able to live without any conflict, in a state of Our efforts have been to develop specific yoga modules harmony with ourselves and with others around us. Yoga for all NCDs consisting of generalized stress release and leads ultimately total freedom, total power, total knowl- life-style change modules couples with specific modules edge and total bliss! for specific diseases. All of us know that Endorphins function as neurotransmit- Research Evidence: A brief summary of the research ters. They resemble opiates in their abilities to produce done over the last THREE decades published in indexed, analgesia and a feeling of well-being. We now know that peer-reviewed national and international journals will be when a nerve impulse reaches the spinal cord, endor- presented. phins that prevent nerve cells from releasing more pain 123 Ind J Clin Biochem S3 MRS & PROF. G. P. TALWAR ORATION DISEASE MODULATING ROLE OF “MEMBRANE COMPLEMENT REGULATORY PROTEINS” AND THEIR SIGNIFICANCE AS EMERGING BIOMARKERS OF SYSTEMIC AUTOIMMUNE DISORDERS Nibhriti Das Department of Biochemistry, AIIMS In the late 19th century, Hans Ernst August Buchner Complement mediated tissue injury due to exagger- found that blood serum contained a “factor” or “prin- ated complement activation is a key mechanism in the ciple” capable of killing bacteria. In 1896, Jules Bordet, a pathophysiology of autoimmune disorders like Systemic young Belgian scientist in Paris at the Pasteur Institute, Lupus Erythematosus (SLE) and Rheumatoid arthritis (RA)., demonstrated that this principle had two components: one Animal experiment have, suggested disease modulating that maintained this effect after being heated, and one role of complement regulatory proteins in these disorders. that lost this effect after being heated. The heat-stable Their potential as biomarkers and therapeutic targets had component was responsible for the immunity against also been envisaged. These aspects, however, had not specific microorganisms, whereas the heat-sensitive (heat- adequately been explored in humans. labile) component was responsible for the non-specific In India, triggered by the pioneering work of Professor LM antimicrobial activity conferred by all normal serum. This Srivastava in the Department of Biochemistry, AIIMS, we heat-labile component is what we now call “complement” took up studies to assess the relations of Erythrocyte CR1, earlier known as “alexine.” The term “complement” was soluble CR1 and urinary CR1 with the pathophysiology of introduced by Paul Ehrlich in the late 1890s. glomerulonephritis and their significance as prognostic and Today, complement, in immunology, is a complex system of differential markers of different classes of nephritis,. more than 30 soluble and cell surface proteins comprising We developed a robust method for monitoring soluble of zymogens, receptors and regulatory proteins. Zymogens CR1 levels for our studies and, also a C1q-based Mancini on activation by immune complexes and specific molecular technique to detect and quantitate immune complexes in patterns by antibody dependent classical pathway and serum samples. antibody independent alternative and, MBL pathways generate inflammatory anaphylotoxins & chemotaxins We observed marked declines in the levels of urinary CR1 C3a, C5a, opsonins C3b, C4b and membrane attack com- in patients with SLE which correlated very significantly with plex C56789n, that act in concert to eliminate infectious the glomerular expression of CR1. This observation though microorganisms causing the lysis of foreign and infected unexpected, brought us to suggest and report urinary CR1 cells, the phagocytosis of foreign particles and cell debris, as a marker of glomerular involvement in SLE. and the inflammation of surrounding tissue. Exaggerated With this finding, we, for the first time envisaged disease activation however, bring about cellular damage and acquired impairment of CR1 synthesis in SLE. Earlier, stud- pathological manifestations to the host. A large number of ies remained confined only to E-CR1 and modulation in the Complement regulatory proteins protect the host against levels of cell surface CR1was considered to be due only complement mediated injury in normal health. Interest in to shedding of CR1 from the cell surface by proteolytic membrane-bound complement regulatory proteins geared cleavage. up with the discovery of complement receptor1 (1953, RA Nelson) followed by several others
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