Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 02nd May, 2019

Medtalks with Dr KK

1. NAFLD is associated with an increased risk of AF in middle-aged and elderly individuals (especially in those with type 2 diabetes). However, the observational design of the eligible studies does not allow for proving causality. [Liver International. 2019;39(4):758-769. ]

2. Upfront delayed-enhancement cardiac magnetic resonance (DE-CMR) imaging identifies a different or new culprit lesion than standard angiography in nearly one in three patients presenting with non-ST-segment elevation myocardial infarction. The study showed that the infarct-related-artery (IRA) could not be identified by invasive coronary angiography in 37% of 114 patients with NSTEMI. [April circulation]

3. The 2015 Youth Risk Behavior Surveillance survey, conducted among 9th to 12th graders, two thirds of whom were girls, found that almost half of teenage e-cigarette users were trying to lose weight.

Four keys to prevent cardiovascular disease

Harvard: An estimated 80% of all CVD cases — heart disease, heart attack, heart failure, and stroke — can be prevented. The key is to control high blood pressure and high cholesterol and to maintain healthy habits, such as exercising regularly, eating a plant-based diet, getting enough sleep, and not smoking.

Exercise: Federal guidelines recommend 30 minutes of moderate-intensity exercise five times a week. "Doing more is better. Walk for five minutes every two hours.Do a set or two of push-ups either on the floor or against the kitchen counter.

Perform up to 10 repetitions of stand-and-sit exercises, where you rise from a chair not using your arms and then sit down again.

Also, look for opportunities to do extra movements. For example, wash your car instead of using the drive-through car wash, park farther away from the grocery store, take the stairs, and do simple yard work like weeding, planting, and raking. Every bit of everyday movement can count toward your overall exercise requirements.

Diet: Focus on plant foods, and you should minimize your intake of red meat, especially processed meat.

Sleep: Guidelines from the American Academy of Sleep Medicine and the Sleep Research Society recommend adults get at least seven hours of sleep per night on a regular basis. Studies have found that getting less than this amount is associated with heart disease risk factors like higher stress, increased inflammation, high blood pressure, and weight gain.

Sleep apnea, also can raise your risk. In fact, a report published online Feb. 12, 2018, by the Journal of Sleep Disorders & Therapy found that people with sleep apnea are more likely to also have heart failure, an irregular heartbeat, and diabetes.

Numbers: lower Bp, lDL-C, AC, fasting sugar < 80

Guidelines proposed for newly defined Alzheimer’s-like brain disorder

NIH Excerpts : A recently recognized brain disorder that mimics clinical features of Alzheimer’s disease has for the first time been defined with recommended diagnostic criteria and other guidelines for advancing and catalyzing future research. Scientists from several National Institutes of Health-funded institutions, in collaboration with international peers, described the newly-named pathway to dementia, Limbic-predominant Age-related TDP-43 Encephalopathy, or LATE, in a report published on April 30, 2019, in the journal Brain.

Alzheimer’s is the most common form of dementia, which is the loss of cognitive functions — thinking, remembering, and reasoning — and every-day behavioral abilities. In the past, Alzheimer’s and dementia were often considered to be the same. Now there is rising appreciation that a variety of diseases and disease processes contribute to dementia. Each of these diseases appear differently when a brain sample is examined at autopsy. However, it has been increasingly clear that in advanced age, a large number of people had symptoms of dementia without the telltale signs in their brain at autopsy. Emerging research seems to indicate that the protein TDP-43 — though not a stand-alone explanation — contributes to that phenomenon.

What is TDP-43?

TDP-43 (transactive response DNA binding protein of 43 kDa) is a protein that normally helps to regulate gene expression in the brain and other tissues. Prior studies found that unusually misfolded TDP-43 has a causative role in most cases of amyotrophic lateral sclerosis and frontotemporal lobar degeneration. However, these are relatively uncommon diseases. A significant new development seen in recent research is that misfolded TDP-43 protein is very common in older adults. Roughly 25 percent of individuals over 85 years of age have enough misfolded TDP-43 protein to affect their memory and/or thinking abilities.

TDP-43 pathology is also commonly associated with hippocampal sclerosis, the severe shrinkage of the hippocampal region of the brain—the part of the brain that deals with learning and memory. Hippocampal sclerosis and its clinical symptoms of cognitive impairment can be very similar to the effects of Alzheimer’s.

Recent research and clinical trials in Alzheimer’s disease have taught us two things: First, not all of the people we thought had Alzheimer’s have it; second, it is very important to understand the other contributors to dementia.

In the past many people who enrolled in clinical trials likely were not positive for amyloid. “Noting the trend in research implicating TDP-43 as a possible Alzheimer’s mimic, a group of experts convened a workshop to provide a starting point for further research that will advance our understanding of another contributor to late life brain changes.

LATE is an under-recognized condition with a very large impact on public health. They emphasized that the “oldest-old” are at greatest risk and importantly, they believe that the public health impact of LATE is at least as large as Alzheimer’s in this group.

The clinical and neurocognitive features of LATE affect multiple areas of cognition, ultimately impairing activities of daily life. Additionally, based on existing research, the authors suggested that LATE progresses more gradually than Alzheimer’s. However, LATE combined with Alzheimer’s—which is common for these two highly prevalent brain diseases—appears to cause a more rapid decline than either would alone.

Healthcare News Monitor

Infections becoming untreatable as antibiotic resistance rises around the world

Express Healthcare

Speaking about this, Dr KK Aggarwal, President, Heart Care Foundation of India (HCFI), said, “Antibiotic resistance is a growing concern and its impact on patients and communities is known to us all. This is a public health problem, one which is rapidly spreading across the globe, with not enough resources to control it. It has made it harder for us to treat many infections such as typhoid, pneumonia, tuberculosis. Antibiotic resistance prolongs hospitalisation, increased cost of treatment and increases the risk of death. Several studies have corroborated its adverse impact on health. Doctors as well as patients should be aware about and advocate judicious use of antibiotics. Over prescription and self-prescription, both, need to be checked.” The report noted that the world is already feeling the economic and health consequences as crucial medicines become ineffective. Without investment from countries in all income brackets, future generations will face the disastrous impacts of uncontrolled antimicrobial resistance. Adding further, Dr Aggarwal, said, “One of the biggest reasons for the misuse of antibiotics is buying them over the counter without consultation with a doctor. Before prescribing antibiotic, always ask yourself: Is it necessary? What is the most effective antibiotic? What is the most affordable antibiotic? What is the most effective dose? What is the most effective duration for which the antibiotic should be administered?”

Pharma News

CSIR will prepare Ayurvedic medicines in 36 labs under MoU signed with Ayush Ministry

Daily News & Analysis

Under the recent Memorandum of Understanding, which was signed between the Council of Scientific and Industrial Research (CSIR), and the Ayush Ministry, the CSIR will prepare Ayurvedic medicines in 36 laboratories across the country. The MoU was signed for cooperation in research and education in areas of traditional systems of medicine and its integration with modern science. The Ministry has also revealed that new Ayurvedic drugs will soon be available in the market as CSIR has already been working on them and there has been a growing interest of traditional medicines worldwide, there is a need of multipronged and innovative approaches for the acceptance of this science.

Doc held for selling govt medicines illegally

The Tribune- Aparna Banerji

A BAMS doctor has been arrested for stacking and selling medicines meant for free government supply at her private (commercial) establishment here yesterday. A huge stock of medicines, meant to be provided for free at government hospitals and not allowed to be sold by private practitioners, were seized from the private hospital being run at Buttran village in Bhogpur. Among the medicines recovered from the hospital include 1,675 tablets, seven syringes with catheters, 31 injections, including tramadol, and several allopathic medicines. Bearing the words ‘Punjab Government Supply’ and ‘Not to Be Sold’ on their labels, these medicines were found illegally stacked up at Neelam Sharma Memorial Multi-specialty Hospital in Bhogpur. Revelations regarding the same were made after teams of the Drug Department, Narcotics Control Bureau and the STF raided the hospital premises on Tuesday. The police also reached the spot and an FIR under Sections 22, 61 and 85 of the NDPS Act and 420 of the IPC was lodged against the doctor.

J&J directed to pay over Rs 2 crore to 2 patients for faulty hip implants

Business Today

The Central Drugs Standard Control Organisation (CDSCO) on Tuesday directed pharmaceutical major Johnson & Johnson to pay compensation of Rs 1.01 crore and Rs 90.26 lakh to two patients, both from Uttar Pradesh, who had received faulty hip implants made by the firm. The country's drug regulator wants the compensation to be paid within 30 days from the date of receipt of the order. This is reportedly the highest compensation received for medical negligence in India. The first patient to be compensated by the US headquartered company on the same grounds was awarded over Rs 74 lakh in March while the second patient was awarded Rs 65 lakh. The faulty articular surface replacement (ASR) hip implants had been manufactured by DePuy International Limited, a J&J subsidiary. The parent company had recalled the faulty implants in 2010, globally, after studies red-flagged a higher-than-usual rate of revision surgeries. Subsequently, in 2017, the government constituted a central expert panel to investigate patient complaints about ASR hip implant devices. The committee headed by Dr Arun Kumar Agarwal, former dean of Maulana Azad Medical College, found that J&J had "suppressed" facts on the harm of surgeries, and recommended compensating the patients.

Serdia is committed to launch new drugs in diabetes and cardiology : Dr. Georges Jabre

EThealthworld- Shahid Akhter

Shahid Akhter, editor, ETHealthworld spoke to Dr. Georges Jabre, CEO of Serdia Pharmaceuticals (India) Pvt. Ltd, Mumbai to know more about Serdia Pharmaceuticals and their healthcare initiatives in India. Healthcare in India: Observation We see a big development in chronic diseases and unfortunately, the population that is of concern is the young one. All the work is done and developed by the ministry of health and all the healthcare professionals who are aiming very rapidly to raise the awareness of these diseases and bring the best way of managing them for the future of the population in India. This combat will give its fruits in the coming months to years but what it needs is a strict collaboration between all the actors of the healthcare profession. All the expertise that exists today in India will be unable to battle against this epidemic and will be costing in the future years a lot of deaths, unfortunately. Today, we join our efforts to what all our government in India and the healthcare professionals are doing in order to combat these diseases and elongate the survival with the best quality of life for the population.

Can we cure cancer with a vaccine? By Roy de Souza


Big pharma and biotech companies have invested billions in new ways to cure cancer. But for tough metastatic cancers (those that have spread throughout the body), they have mostly not succeeded. Most of the drug discovery efforts look for chemicals that will kill the cancer cells themselves. That is a good strategy. However using the body’s powerful immune system is another good way to kill cancer cells. New immunotherapy treatments, such as Ipilimumab (invented by Jim Allison who just won a Nobel prize) now prove that our own human T-cells can kill cancer and cure patients. Vaccines work by creating new T-cells, so did anyone try to cure cancer with a vaccine? As a reminder, smallpox killed 300-500 million men, women and children in the 20th Century. Today it kills no one. How did this happen? Scientists and doctors invented a harmless looking pin prick that injected a small piece of smallpox protein under the skin. It was named a vaccine and it has saved hundreds of millions of people from death by smallpox. Vaccines have also had huge successes in yellow fever, tuberculosis, polio, and many more. However vaccines are not only useful to prevent a disease.

Top Pharmas lose plea against GIC Re in Delhi HC

Asian Age- Falaknaaz Syed

High premium rates for companies buying insurance covers for their plants, machinery, and properties are here to stay, as the Delhi High Court has dismissed a petition of pharma majors — Cadila Healthcare, Wockhardt, Biocon and Lupin — against the new rates of state owned reinsurer, General Insurance Corporation of India (GIC Re). Justice Vibhu Bakhru of the Delhi High Court, while dismissing the petition of pharma companies last month, said that “Plainly, it would not be permissible for this court to supplant its opinion regarding quantum of premium that ought to be charged by GIC. GIC is fully entitled to determine the rates at which it offers re-insurance in respect of risks covered by various insurance companies.” GIC Re, the country’s largest reinsurer, passed an endorsement via circulars on February 12 and 21, stating that insurers wanting to utilise its treaty (an arrangement where capital is pooled by various reinsurers to provide reinsurance support to insurance companies) will have to quote higher premium rates effective March 1 for providing covers to companies in eight sectors that were reporting high claims.

Questions raised over J&J's India-specific donation of TB drug bedaquiline

Moneycontrol- Viswanath Pilla

Johnson & Johnson's (J&J) decision of donating 10,000 courses of multi drug-resistant tuberculosis (MDR-TB) medicine bedaquiline free of cost in India is under the scanner. The US-based healthcare product major is already facing multiple regulatory investigations in the country over the safety of its products. Bedaquiline that replaces older, more toxic TB treatments, was the first drug resistant-TB medicine to be developed in over 40 years. The drug reportedly improves cure rates with fewer side-effects. "If used in its entirety, this could help catalyse significant progress against MDR-TB in India," J&J said in a media statement. Through its subsidiary Janssen, J&J had donated over 10,000 courses of bedaquiline in 2016 as part of a global donation programme, operated in partnership with the US Agency for International Development (USAID). The company said it supports the government's 'Make in India' programme and partnered with local manufacturers to produce bedaquiline for global use, including India.

Zydus Cadila gets USFDA nod to market 2 generic drugs

Business Medical Dialogues

Drug firm Zydus Cadila Tuesday said it has received the final nod from the USFDA to market generic Bosentan tablets and Trientine Hydrochloride capsules in the US. The company has received final approval from the US health regulator to market Bosentan tablets USP in strengths of 62.5 mg and 125 mg and Trientine Hydrochloride capsules USP in the strength of 250 mg, Zydus Cadila said in a statement. “Both products will be manufactured at the group’s formulations manufacturing facility at SEZ, Ahmedabad,” it added. While Bosentan tablets are a generic version of Tracleer tablets, Trientine Hydrochloride capsules are a generic version of Syprine capsules, Zydus Cadila said. Bosentan is used to treat high blood pressure in the lungs, it added Trientine works by removing copper from the blood. It is used to treat Wilson’s disease, a genetic metabolic defect that causes excess copper to build up in the body. It is recommended to patients who cannot take penicillamine, Zydus Cadila said. The group now has 265 approvals and has so far filed over 350 abbreviated new drug applications (ANDAs) since the commencement of its filing process, it added.

Healthcare News

Women more at risk for cancer, says study

The Hindu- Shoubhik Ghosh

55% women and 45% men diagnosed with the disease from 2011 to 2018 Women have a higher risk of getting cancer as compared to men, a private study carried out at Jupiter Hospital, Thane, said on Thursday. Dr. Manish Chandra, senior radiation oncologist with the hospital carried out the survey from 2011 to 2018 on 6,000 patients who underwent radiation therapy for cancer. According to the study, cancer affected around 55% of women (3,300 patients) as compared to 45% of men (2,700 patients). Of these, 20% live outside Mumbai and Thane. As per the report, men mostly suffered from head and neck cancer, which covers the region between the collarbone and the eye. Most cases were of the tongue and the cheek, the report said. It affected 77 % men and 23% women out of the total number of patients surveyed.

CallHealth, LiveHealth join hands to integrate over 5,000 diagnostic labs

Business Standard

Integrated healthcare platform CallHealth today announced a tie-up with LiveHealth, a SaaS (rental or pay-as-you-use mode)-based collaborative report management solutions enterprise that automates the entire life cycle of a customer's diagnostic assessment journey. Using this collaboration, CallHealth plans to integrate with over 5,500 diagnostic labs and imaging centres by the end of the current financial year. "The tie-up with LiveHealth will not only help create deep integration with the provider ecosystem, but will also change the speed and manner in which customers can access, interpret and use their diagnostic report results. This partnership will thus enable faster sample collection, instrument interfacing and bar coding, comprehensively manage the customer's health information and ensure reports provide real-time intuitive health insights that are instantly accessible to the customer," CallHealth CEO Hari Thalapalli said.

Healthcare: The right prescription

Fortune India- Debojyoti Ghosh & Ashish Gupta

Ranjan Pai, chairman of Manipal Education and Medical Group (MEMG), had a simple brief for his team during a brainstorming session sometime in early 2018: He wanted to connect with patients after they left the premises of his hospitals. The reason: to come up with ideas that could be potential business opportunities. “We realised that people don’t want to travel long hours for every medical need to big hospitals unless it is necessary or for specialised treatment and doctor consultations,” Pai tells Fortune India. People in Bengaluru, also known as the Silicon Valley of India, on average spend at least an hour each day commuting because of the city’s dreadful traffic snarls. “Is there a way people can travel to our hospitals only when there is a need while they can sort out most of their healthcare requirements digitally, through an app,” Pai thinks aloud.

5% of newborns have split spine defect

The Hans India

Spina bifida (Split Spine) is a birth defect with incomplete closing of the backbone and membranes around the spinal cord. This defect is usually found in the lower back of the baby and in rare cases, may be found in the middle back or neck. Mother's health condition during pregnancy plays a vital role in determining the defect. Apart from genetic conditions, environmental factors may also be a cause in developing split spine. Lack of folic acid in the mother has been one of the most common reasons, which is why mothers are prescribed rich supplements of vitamin B. Types of this neural tube defect Depending on the amount of closing in the backbone, this defect is divided into two types namely – Spina bifida occulta – this is the mildest form of split spine where the outer part of some of the vertebrae is not completely closed and the split is so small that the spinal cord does not even protrude. Unlike other types, is very difficult to screen and asymptotic in most of the cases. Though most people are diagnosed with occulta incidentally during spinal X-rays, it is profound in 15% of the world population.

Indian army will train doctors at high altitude

The Hans India

For the first time in the history of Armed Forces, INDIAN ARMY will impart High Altitude Training to private medical team of Six Sigma at High Altitude Warfare School, Gulmarg, Kashmir. In India, Six Sigma is the only non-government organization in India, that is trained by the maximum number of Military & Para Military Forces- Airforce, ITBP, BSF, CRPF & NDRF. Six Sigma Healthcare is prominent medical organization for providing free MOUNTAIN MEDICINE SERVICES at high hills. Without any help or donations at Any Time - Any Where- Any Weather- Any Height Six Sigma is always ready for duty. Six Sigma Healthcare is remembered after God when someone is in trouble or someone is lost in the hills. Exercise includes the exercises on Mountain Medicines, Latest Mountain equipment, Rock climbing, River crossing, Peak climbing, Rappelling, Basic life support , Advance Cardiac life support, Communication on High Altitudes, Glacier and Avalanche Rescue etc.

Technology has reduced burden of disease in the Northeast

Daily News & Analysis

On April 17, 2019, the World Health Organization (WHO) released its guidelines on digital health interventions. In the guidelines, recommendations were made on using appropriate digital technology to achieve the aim of Universal Health Coverage. The recommendations analyse methods used in eHealth. Mobile phones or tablets are being used to collect data on births, deaths, medical supplies and stocks. Telemedicine, a method of using information and communication technology (ICT) to provide medical services remotely, aides in diagnosis, monitoring and therapy of patients. It also provides remote training to healthcare workers in rural areas. Digital software can monitor the health status of patients remotely and even use algorithms to help a health worker diagnose and plan treatment for a patient.

Ahmedabad: Dehydration, gastro cases surge as mercury climbs

Daily News & Analysis

Data shared by 108 emergency service suggests that this summer heat related cases have been on the rise both in the city and the state. In Ahmedabad alone the cases of gastroenteritis and dehydration two of the most commonly reported cases during summer increased from 198 in March to 328 in April, this year. The cases have also doubled since 2017. Against just 170 cases, the number has surged to 328 cases in 2019. The overall number of calls being handled by the service has also seen a surge from 4545 in the year 2017 to 5137 in 2019 for the month of April. It should be noted that despite a spell of rain, the city has seen at least two heat waves this month. Dr Vivek Dave, a critical care specialist with Narayana Multispecialty Hospital said cases of heat related ailments often can be put in three categories, those of heat related exhaustion, cramps and stroke.

Nandurbar's boat ambulance will kick back to life soon

Daily News & Analysis

Maharashtra state's boat ambulance which is lying unused in Nandurbar district since few months will soon be functioning again. According to the state government's officials, they have hired a team of doctors, paramedic staffs and ASHA workers who will be assigned one-week shifts on a rotation basis to keep the ambulance functional. The boat ambulance service was launched a few years ago to provide medical facilities to over 30 tribal villages in the Nandurbar district which are not well connected by roads. Chetan Salve, an activist with Narmada Bachao Andolan NGO, said, "Currently only one doctor is deployed in the ambulance. The other posts have been sanctioned on paper. We hope that other staff will be appointed soon. With only one doctor assigned with multiple charges, villagers are facing inconvenience."

'99 Not Out!': A tale of how to live a long and healthy life

Mint- Neetu Chandra Sharma

Longevity and wellness are becoming challenging by the day. In her upcoming book ‘99 Not Out!’, biological scientist, Sujata Kelkar Shetty talks about how to live a long and healthy life at a time when pollution has become a key cause of death and what once used to be dreadful diseases like hypertension, diabetes, kidney and heart ailments have now become lifestyle diseases. Shetty did her post-doctoral training at the National Institute of Child Health and Human Development, National Institute of Health, Bethesda, Maryland, US. She also studied how mental stress negatively impacts physical health. Shetty’s book talks about behavioural practices that can slow down the ageing process while keeping disease at bay. It shares evidence-based practices from various diciplines-Ayurveda, yoga and Western medicine-that promote longevity, while keeping bodies healthy and minds alert.

India fights diabetic blindness with help from AI

Gulf News- Cade Metz

The Aravind Eye Hospital will treat anyone who comes through the door, with or without money. Each day, more than 2,000 people arrive from across India and sometimes other parts of the world, crowding into the hallways and waiting rooms of this 43-year-old hospital at the southern end of the country. On a recent morning, Vt Muthusamy Ramalingamm, a local resident, walked into a room on the second floor, sat down and rested his chin on a small desktop device that pointed a camera into his eyes. A technician tapped on a screen at the back of an eye scanner, and within seconds a diagnosis appeared on a computer against the wall. Both eyes showed signs of diabetic retinopathy, a condition that can cause blindness if untreated. In most hospitals and clinics around the world, trained physicians make this diagnosis, examining a patient’s eyes and identifying the tiny lesions, haemorrhages and discoloration that anticipate diabetic blindness. But Aravind is trying to automate the process. Working with a team of Google artificial intelligence researchers based in California, the hospital is testing a system that can recognise the condition on its own.

In a first, a drone delivers kidney to a transplant patient


A kidney patient, who waited eight long years for a donor, was able to finally undergo a transplant. Thanks to a drone which ensured the organ was carried in the minimum time possible. In a successful attempt at enhanced organ transportation, the drone carried the organ in a 2.7-mile test flight that lasted 10 minutes from Baltimore's St. Agnes Hospital to the University of Maryland (UMD) medical center, Engadget reports. The kidney was then successfully transplanted to a 44-year-old woman from Baltimore. The project demonstrates the potential of unmanned aircraft systems for providing organ deliveries in cases when it is faster, safer, and easily available than traditional transport methods

Building consensus on off-label uses of sildenafil

We are building consensus on the off-label uses of sildenafil. The current indications approved by DCGI are as follows:...read more

US FDA clears heat-not-burn tobacco device for sale

The US Food and Drug Administration has cleared a heat-not-burn tobacco device designed as an alternative to conventional cigarettes, for sale in the United States.

The product consists of a tube that gently heats up sticks of tobacco instead of burning them, making what is inhaled less harmful than conventional cigarette smoke.
The FDA said the marketing of the devices is "appropriate" for public health because "the products produce fewer or lower levels of some toxins than combustible cigarettes." The agency also said it has placed stringent marketing restrictions on the products in an effort to prevent minors from using the device......read more


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