Electro Sensors (E.S) LD TECHNOLOGY

1. E.S Complex and Health Care Software Solution New approach of the Homeostasis evaluation, Medical Screening and assistance to the treatment management plan Electro Sensors (E.S) LD TECHNOLOGY

2. Medical office / Telemedicine/hospital triage lab tests Imagery Positioning Fast Check up Screening tool 1 Signs and symptoms Diagnosis Diagnosis 2 3 Assistance to the therapeutic decision Follow up

3. LD TECHNOLOGY • PRODUCTS • ES COMPLEX • Combination of Technologies • 1)Spectrometry Technology: • - SpO2% • - Digital Pulse Analysis & CO • - Heart Rate Variability • 2) Bio Impedance Technology: • EIS : Living Tissue state • (Bipolar very low frequency) • ES-BC: Body Composition • (Tetra polar 50 KHz) • SERVICES • HEALTH CARE SOFTWARE SOLUTION • Statistical Software of Analysis • - Screening / Early detection • - Educational 3D virtual Modeling • Follow up • Algorithms • + • TELEMEDICINE & ONLINE CONSULTATION

4. BENEFITS SAVE TIME & ORGANIZATION RESULTS IMMEDIATELY AVAILABLE HOMEOSTASIS SCORE SCREENING / EARLY DETECTION ADJUNCT TO THERAPEUTIC MANAGEMENT ADJUNCT TO THERAPEUTIC FOLLOW UP PATIENTS’ COMPLIANCE TELEMEDICINE & ONLINE CONSULTATION

5. ES Complex features Products combination are performing the measurements of human body signals such as : • O2 saturation of hemoglobin • vascular waveform • Heart rate detection • conductivity of human body pathways • body resistance The Signals processing analysis provide physiologic makers intended for use to estimate : • Oxygen distribution • Macro-circulation • ANS level activity • Micro-circulation • ATP pump/ Living tissue pH • Body composition

6. Non-invasive measurement in 2 minutes

7. ResultsImmediately available

8. System Applications • Cardio Vascular Disorders & Hypertension • Diabetes • Thyroid Disorders • Hepatitis • Prostate Disorders (cancer) Screening / Early detection Assistance to the Therapeutic decision Monitoring

9. E.S ComplexNew approach of the Homeostasis evaluation

10. What is the homeostasis ? Homeostasis is the property of an open system, especially living organisms, to regulate its internal environment so as to maintain a stable condition, by means of multiple dynamic equilibrium adjustments, controlled by inter-related regulation mechanisms. The term was coined in 1932 by Walter Cannon Complex systems, such as a human body, must have homeostasis to maintain stability and to survive. These systems do not only have to endure to survive; they must adapt themselves and evolve to modifications of the environment.

11. ES Complex: New approach of the Homeostasis = The Homeostasis score Blood pressure measurement Bioimpedance Low frequency Living tissue indicators Hemodynamics Indicators Oxygen distribution Bioimpedance at 50 KHz Body Composition indicators Heart Rate variability ANS level activity Combination of technologies and interpretation in score color coded

12. What is the Homeostasis Score ? The homeostasis score is the patient potential adaptation or responses • first of all , it depends from Genetic • Could be affected by lifestyle, or disorders, or diseases or current treatment or environmental factors. • Decreased with age. • It should be considered for any treatment plan and follow up

13. How the Homeostasis works H. SCORE > =20 H. SCORE < 17 H. SCORE < 20 and > 17

14. Benefits of the Homeostasis Score ? • from Lippincott : “Disease or death is often the result of dysfunction of internal environment and regulatory mechanisms. Understanding the body’s processes , responses and functions is clearly fundamental to the intelligent practice of medicine.”

15. Homeostasis score in daily practice ? • Detection of the needs of treatment and/or Emergency • Important factor to consider in therapeutic management plan • Follow up for any treatment

16. E.S ComplexHow the Homeostasis Score is performed ?

17. Risk Classification Blood Pressure Data Hemodynamic Data Oxygen Distribution Data Good Autonomic Nervous System Data Body Composition Data Body tissue Data Emergency Brain tissue Data

18. DPA and NIBP Results/Hemodynamic Fast interpretation :Score and color coded Vascular wave analysis from the digital oximeter Cardiac output Systemic vascular resistance Mean arterial Pressure Reflection Index Large artery stiffness Vascular stiffness Index Small artery stiffness DEI : Peripheral vessel stiffness VO2 Oxygen consumption DO2 Oxygen delivery SpO2 % Hb O2saturation

19. How the BP Class is performed

20. How the DPA Class is performed Class 6 Class 5 Class 4 Class 3 Class 2 Class 1 Classification of the digital Pulse Analysis (DPA) waveform according to Dawber et al. From the SDPTG With increasing age and/or presence of vascular disease, the waveform changes from class 1 to class 5. The change in contour can be interpreted in terms of earlier arrival of a pressure wave reflected from the peripheral circulation. Dawber TR, Thomas HE Jr, McNamara PM. Characteristics of the dicrotic notch of the arterial pulse wave in coronary heart disease. Angiology 1973; 24:244–255.

21. How the O2 Class is performed According to the SPo2 % and DO2 and VO2 SPo2 % > 94 , DO2 >< 1000-1200 and VO2 >< 200-300 Class 4 SPo2 % > 94 , DO2 >< 1000-1200 and VO2 >300 Class 3 SPo2 % > 94 , DO2 >< 800-1200 and VO2 < 200 Class 2 SPo2 % < 94 , DO2 < 800 and VO2 < 200 Class 1

22. HRV Results/ ANS Fast interpretation :Score and color coded SDNN Mains heart rate variability analysis from the digital oximeter HF related to the parasympathetic activity Total power related to the vagal modulation Heart rate Stress Index related to heart work LF/HF Sympathetic/parasympathetic activity ratio SDNN related to vagal activity

23. How the ANS Class is performed According to HRV LF and HF

24. BC Results / Life style Fast interpretation :Score and color coded Estimated body composition parameters from the bioimpedance tetrapolar mode BMI Fat Free mass Fat mass Total body water Extra cellular water Intra cellular water

25. How the BC Class is performed The most commonly used definitions, established by the World Health Organization (WHO) in 1997 and published in 2000,

26. Bioimpedance Results / Living tissue Fast interpretation :Score and color coded Body and brain Living tissue Indicators from the bioimpedance bipolar mode SDC+: Measurement of the conductivity from anode to cathode related to 02 interstitial fluid And sodium ions density related to the ATPase pump activity Delta (SDC+ minus SDC-): related to the interstitial fluid chloride ions /H+. Alpha parameter: related to the conductivity permittivity and to the volume of the interstitial fluid

27. How the Body tissue Class is performed According to the acid tissue ( SDC+ or delta) The tissue can be acid by hypoxia (SDC+ < N) or hyperchloremia (Delta < N) The alpha parameter > N is aggravating factor and will reduced the score by -1

28. How the Brain tissue Class is performed According to the brain living tissue blood flow

29. Homeostasis score Results Maximum Score = 30 Very Good = 27-30 Good = 24- 27Normal = 20-24Warning = 17-20 Low = 10-17 Poor < 10 

30. Evaluation of the homeostasis Score

31. Homeostasis Score follow up Homeostasis score and each class Follow ups

32. 20

35. Health Care Software SolutionStatistical Analysis New Approach in Medical Screening and assistance to the therapeutic management plan

36. Principles of Screening HCSS Screening score is complying with World Health Organization guidelines: • A test used in a screening program, must have good specificity in addition to acceptable sensitivity. • The test should be acceptable to the population. Fast, low cost and non invasive • There should be an agreed policy to explain clearly the test to the patient . • The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.

37. What is a disease screening Score ? • The intention of disease screening test or disease trend, is to identify the possibility of disease or disorder without symptoms . • The screening score of a disease/disorder is related to the statistical analysis of the specificity and sensitivity of the markers related to the disease or disorder. • The screening score should be used to indicate the need for further evaluation – not as a basic for diagnosis

38. How the screening Score is used ? Positive Screening score Supplementary Exam Prevention Negative Positive Lifestyle intervention Practitioner Therapeutic plan

39. Hypertension Health Care Software Solution New approach of the Diseases Screening : The Diseases Screening Score Artery Stiffness BP/ CO Cardiovascular diseases Cholesterol E.S Teck Data HCSS Screening from statistical analysis HCSS Algorithms programming Microcirculation Diabetes Body Composition Oxygen distribution Thyroid dysfunction ANS activity

40. Diseases Screening Score Results

41. How the diseases screening score is performed ? • Using a theoretical framework for performing meta-analysis of ES Complex data obtained from disparate studies allows a calibration of the data from such studies and tests into a unified probability scale which can be used in screening score. • We apply the methods of Monastra et al. (1999) and Robeva et al., 2004

42. META-ANALYSIS INCREASE SPECIFICITY & SENSITIVITY LD Technology Clinical Studies Statistical Health care software runs Algorithms SCREENING Publications Indicators with High Specificity & Sensitivity

43. Why the Screening ?

44. Diabetes Screening Diabetes challenge Left undiagnosed, diabetes can lead to serious complications such as heart disease, stroke, blindness, kidney damage, lower-limb amputations and premature death. Data from National Commission for Macroeconomics and Health Government of India: New Delhi 2004: India has the world's largest diabetes population The number of diabetics in the country is expected to touch 50.8 million by the year 2012. Cost of Diabetes (around 1/3 of India GDP) With drug companies threatening to up the prices of medicines like insulin, the cost of treatment is likely to double in the next few months. (higher than INR30.000 / patients) Average minimum annual expenditure of a newly diagnosed diabetic, who has been prescribed only tablets for controlling sugar, was Rs 15,550. It includes costs of drugs and laboratory tests. If the person has hypertension and cholesterol, the cost increases by at least Rs 2,000.

45. Cardiovascular diseases screening Cardiovascular diseases especially coronary heart disease (CHD) has emerged as epidemic in India. Data from National Commission for Macroeconomics and Health Government of India: New Delhi 2004: In India, hypertension will increase from 16.3 percent to 19.4 percent between 1995 and 2025. The total number of CHD patients in India at turn of the century was 30 million (5.3% of the adult population) which would increase to more than 60 million (7.6%) by the year 2015. Population-based studies in India have shown that only a quarter of the patient population is aware of the condition and of these less than 10% are on proper therapies and controlled COST OF CHD With 7.5 million CHD patients who could be on some form of treatment, the minimum costs would be INR 40 billion (£520 million) annually and if all the patients were on treatment the corresponding cost would be INR 160 billion (£2.1 billion). Therefore, at current retail prices the CHD polypharmacy would cost the economy Indian Rupees 40–160 billions (£ 0.5–2.1 billion)

46. The World Health Organization (WHO) predicted net losses in National Income from Diabetes and Cardiovascular disease of $336.6 billion in India Source: IDF, Diabetes Atlas, 4th edition, Last updated 2-5-2010 by bisl.wd.

47. Thyroid dysfunction screening • 9.5% of subjects had elevated TSH; most of them had subclinical hypothyroidism (normal T4 with TSH >5.1 IU/mL) • Among the subjects already taking thyroid medication (almost 6% of study population), 40% had abnormal TSH levels, reflecting inadequate treatment • Among those not taking thyroid medication, 9.9% had a thyroid abnormality that was unrecognized • There may be in excess of 13 million cases of undetected thyroid failure nationwide The Colorado Study At a statewide health fair in Colorado (N=25 862), participants were tested for TSH and total T4 levels Canaris GJ, et al. Arch Intern Med. 2000;160:523-534.

48. Underlying pathophysiology

49. Why the diabetes Screening ? Loss of -cell function occurs before diagnosis 100 Conventional Diagnosis 80 Up to 50% loss 60 -cell function (%) 40 20 0 1 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 2 3 4 5 6 Time from diagnosis (years) Holman RR. Diabetes Res Clin Prac 1998; 40 (Suppl.):S21–S25.

50. Why the diabetes Screening ? Diet Sulfonylurea or insulin MedianHbA1c(%) 6.2% upper limit of normal range 0 3 6 9 12 15 Years from randomization Glycemic control declines over time 9 8 7 6 0 UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352:837–853.