Editor in Chief Dr KK Aggarwal, Padma Shri Awardee                                                                                Dated:2 November,2019

EVALI Update

E-cigarette, or vaping, product use associated lung injury (EVALI) is an acute or subacute respiratory illness that can be severe    and life-threatening.

Vaping is the process of inhaling an aerosol created by heating a substance such as nicotine or tetrahydrocannabinol          (THC) with a battery-operated electronic device such as an electronic cigarette (e-cigarette).

More than 1400 cases have been reported; approximately 70 percent have been male, and 80 percent are under 35 years old     (range 13 to 75 years).

EVALI was initially recognized in the summer of 2019.

Approximately 30% of patients have underlying asthma

The exact pathogenesis of EVALI is unknown.

EVALI suggests acute lung injury, possibly reflecting a spectrum of disease processes, rather than a single process. No     evidence of an infectious etiology has been identified.

The key risk factor for EVALI is use of an e-cigarette or similar product; no single constituent has been identified that is common to all cases.

While the majority of patients report use of products containing tetrahydrocannabinol (THC; 75- 80%), approximately 40% used both THC and nicotine-containing products and 15% used products with nicotine but not THC.

The mean duration of symptoms prior to presentation is 6 days with a range of 0 days to 2 months.

Respiratory symptoms include dyspnea, cough, chest pain (sometimes pleuritic), and hemoptysis. Approximately, one-third of patients may progress to acute respiratory failure requiring mechanical ventilation. Subjective fever is reported by 85%; gastrointestinal symptoms are also common and include nausea, vomiting, diarrhea, and abdominal pain.

  Criteria used as a case definition

  o Use of an e-cigarette or related product (“vaping” or “dabbing” or “dripping”) in the previous 90 days

  o Lung opacities on chest radiograph or computed tomography (CT)

  o Exclusion of lung infection based on negative influenza polymerase chain reaction (PCR) or rapid test (unless out of season), viral respiratory panel, and, as clinically indicated, urine antigen tests for Legionella and Streptococcus pneumoniae, blood cultures, sputum culture (if producing sputum), bronchoalveolar lavage (if performed), and testing for HIV-related opportunistic infections

  o Absence of a likely alternative diagnosis (e.g., cardiac, neoplastic, rheumatologic)

While most used aerosolized products, some dripped the substance onto the heating element (called “dripping”) and others used highly concentrated nicotine or THC prepared in a wax-like substance and smoked in a pipe (called “dabbing”). It is also possible that the process of mixing and heating active and inactive components could lead to production of toxic new agents (Source Uptodate).

The first triple combination therapy for cystic fibrosis

The first triple drug combination therapy - elexacaftor/ivacaftor/tezacaftor (Trikafta) – has been approved by the US FDA, for the treatment of patients 12 years and older with cystic fibrosis, who have at least one F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which comprises 90% of all patients who have cystic fiborsis.

Mechanism of action: The three drugs in the combination drug target the defective CFTR protein and enable the protein made by the CFTR gene mutation function more effectively. ....read more

Why daan or charity is important?
Srimad Bhagwad Gita has described four Yugas – Sat Yuga, Treta Yuga, Dwapar Yuga and Kal Yuga - depending upon the nature of the collective consciousness of the people. It describes four pillars of Dharma and they are truthfulness (satya), hard work (tapas), purity of mind (pavitrata) and charity (daya and daan).

Whether a person is a Satyugi or Kalyugi is decided by presence of some or all the four characteristics as mentioned in Srimad Bhagwad: Truthfulness (Satya), Selfless hard work (Tap), positive thoughts (purity) and Daya & Daan (Charity). ....read more

Man Vachan Kaya
Man vachan kaya are the three fundamental principles used to define non-violence (ahimsa) and truthfulness (satya). Being truthful means whatever you are thinking, speaking and doing, it is the same.

You should be one in whatever you think, do or speak. Ahimsa is the fundamental principle of Jainism, which means you should be non-violent not only in your actions but also in your speech and thoughts. Being truthful makes you Satyugi. ....read more

Healthcare News Monitor

Only one allopathic govt doctor for 10,926 people in India: Report
ET Healthworld- PTI

There is only one allopathic government doctor for every 10,926 people in India against the WHO's recommended doctor-population ratio of 1:1000, stated a government report. Compiled by the Central Bureau of Health Intelligence (CBHI), the National Health Profile, 2019, stated that the number of registered allopathic doctors possessing recognised medical qualifications (under the MCI Act) and registered with state medical councils for 2017 and 2018 was 43,581 and 41,371, respectively. "At present, an average population served by a government allopathic doctor is 10,926," the report said. The report, however, highlighted that there has been a marked improvement in the number of dentists. The number of dental surgeons registered with the central/state dental councils up to December 31, 2018, was 2,54,283. There has been a steady rise in the number of registered AYUSH doctors in India from 7,73,668 in 2017 to 7,99,879 in 2018. AYUSH has the maximum number of registered ayurvedic doctors (55.47 per cent) followed by registered homeopathy doctors (36.69 per cent) in India.

Half of India's adolescents are either short, thin, overweight or obese, says NITI Aayog-UNICEF report
DNA India-Nivriti Mohan

Half of India's adolescents (10 to 19 years) — almost 63 million girls and 81 million boys — are either short, thin, overweight or obese says a report released in a high-level meeting at the NITI Aayog, together with UNICEF India, on Thursday. The report says that over 80 percent of adolescents also suffer from 'hidden hunger', i.e. the deficiency of one or more micronutrients such as iron, folate, zinc, vitamin A, vitamin B12 and vitamin D. The new report reveals that almost all adolescents in India have unhealthy or poor diets. This is the main cause for all forms of malnutrition.

Odisha health minister orders probe into violation of protocol during dental surgery of HIV patient; no one at risk, says hospital
Firstpost – PTI

Odisha Health Minister NK Das has said that a probe has been ordered into the alleged violation of protocol in the surgery of an HIV positive infected patient by the dental wing of VIMSAR in Burla. The Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla has set up a committee to be headed by the HoD of the Tuberculosis and Chest department, to probe into the alleged violation of protocol in the surgery of an HIV positive infected patient by the dental wing of the hospital. "Action will be taken against the person if there is any violation in the protocol for the HIV patients," the minister said on Wednesday. Superintendent of VIMSAR, Lalmohan Nayak on Wednesday said life of no other patient was put to any risk in the process, though the committee will find out if there were any lapses by the operating surgeon. "The Head of the Department (HOD) of Tuberculosis and Chest, Prabhati Dutta will head the probe team and would submit the report to the government," said Nayak. Nayak also said that the Department of Dentistry which was closed for fumigation after the alleged violation of protocol in surgery of an HIV positive patient was reopened on Wednesday. Meanwhile, the assistant professor of Department Dentistry, VIMSAR, PK Swain, who performed the surgery on the HIV positive patient on 28 October, said that he did the surgery on "humanitarian ground" and did not put "any life at risk" in the process.

IPC asks pharmacy institutes to mandate use of PvPI-ADR mobile app for reporting ADRs to promote patient safety
Pharmabiz India - Shardul Nautiyal

As part of its ongoing sensitisation programme on pharmacovigilance methods for reporting adverse events, the Indian Pharmacopoeia Commission (IPC) has recommended to pharmacy institutes to mandate use of PvPI-ADR mobile application by the students for reporting adverse drug reactions (ADRs) to promote patient safety. Through this mobile application named “ADR PvPI” Android mobile app, related images of ADR and lab investigation reports can be attached in a user-friendly manner for clinical assessment and signal detection as part of pharmacovigilance. The mobile application which has been developed keeping in mind the patients, consumers and healthcare professionals is available online for stakeholders. IPC, the National Co-ordinating Centre (NCC) for Pharmacovigilance Programme of India (PvPI) has developed the android mobile app which empowers all the healthcare professionals and consumers for ADR reporting. IPC is an autonomous institution of the ministry of health and family welfare created to set standards of drugs in the country. The mobile application for ADR reporting has been developed to also have administrative control of data with IPC, NCC-PvPI. This will empower all the healthcare professionals and consumers for ADR reporting with features like supports source document and image attachment, healthcare professionals as well as consumer reporting, XML generation and auto filling of report details to save time.

Telangana DCA issues notices to 35 pharmacies for selling habit forming and antibiotics drugs as OTC drugs
Pharmabiz India - A Raju

The Telangana Drug Control Administration (DCA) has issued notices to 35 pharmacies in Hyderabad and Ranagareddy districts for selling habit forming, various antibiotics and pregnancy termination medicines without doctor’s prescription. In an investigation conducted by the state DCA, it was found that a majority of pharmacies in the state are indiscriminately resorting to over the counter (OTC) sale of habit forming, various antibiotics and pregnancy termination medicines without doctor’s prescription, flouting the Drugs and Cosmetics Act and Pharmacy Act. According to senior officials from DCA Hyderabad, during their field investigation it has been found that a majority of the pharmacies in the state were violating the pharmacy regulations and were selling over the counter various habit forming and antibiotic drugs without any prescription from a registered practitioner. “In our investigation, we could identify as many as 35 errant pharmacies in the Hyderabad and Rangareddy district limits. We have also issued notices and sought explanation from them within 15 days. Except one or two, a majority of recipients of notices have yet to furnish their explanation. We are going to take stringent action against the errant pharmacies. Apart from penalising them for the violation, we may also issue closure notices soon,” informed a senior officer from DCA, Rangareddy district.