Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 03nd May, 2019

Long-term mortality risk linked to poor sense of smell

More evidence has linked loss of smell with long-term mortality among older adults, independent of commonly suspected confounders, a study published online in Annals of Internal Medicine shows.

Poor olfaction was associated with 46% higher mortality at year 10 and 30% higher mortality at year 13 compared with good olfaction.

This elevated risk can be only partially explained by dementia or Parkinson disease and weight loss.

Data from the Health ABC (Health, Aging, and Body Composition) cohort was analysed, which enrolled 3075 well-functioning, community-dwelling adults aged 70-79 years, between 1997 and 1998.

The researchers used BSIT scores to classify participants as having good, moderate, or poor sense of smell. Participants repeated the BSIT test at four subsequent appointments. During 13 years of follow-up, 1211 participants died.

Poor sense of smell was associated with a 46% higher mortality at year 10 compared with a good sense of smell, 1.46; 95% confidence interval after adjusting for a variety of demographic and socioeconomic factors.

At year 13, poor sense of smell was associated with a 30% higher mortality vs good sense of smell.

Laying groundwork for LATE

A key recommendation was for routine autopsy evaluation and classification of LATE. The researchers suggest the autopsy diagnosis be in three stages, according to where in the brain TDP-43 is detected:

  • Stage 1: amygdala only
  • Stage 2: amygdala and hippocampus
  • Stage 3: amygdala, hippocampus and middle frontal gyrus

AMR a 'global crisis,' UN report says

1.TB is becoming untreatable

2.lifesaving medical procedures like surgeries carry increasing risks because of "alarming levels" of resistance to antimicrobial drugs

3. Resistance to antibiotics, antivirals, antifungals and antiprotozoals, which has been seen in countries of all income levels, is now a "global crisis,"

4. Drug-resistant diseases cause at least 700,000 deaths globally a year, including 230,000 deaths from multidrug-resistant tuberculosis

5. 10 million people may die annually by 2030 as a result of drug-resistant diseases.

6. Two million Americans develop antibiotic resistance infections each year, and 23,000 die from those infections

7. 6 out of every 10 infectious diseases found in humans are spread from animals, the CDC estimates.

8. In the United States, the CDC describes three "urgent" antimicrobial resistant threats: C. difficile or C. diff, Carbapenem-resistant Enterobacteriaceae (CRE) and N. gonorrhoeae

9. Five recommendations: Accelerate progress (including implementation of One Health National Antimicrobial Resistance Action Plans); innovate to secure the future (including development of new antimicrobials); collaborate for more effective action; invest for sustainable response; and strengthen accountability and global governance.

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 01 May to 0830 hrs IST 02 May, 2019)

Heat Wave:

Yesterday, heat wave conditions were observed at a few places with Severe Heat wave at isolated places over Vidarbha. Heat wave conditions were observed at isolated places over East Uttar Pradesh (Annexure 1 & 2).

Maximum Temperature

Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at isolated places over Uttarakhand and West Bengal & Sikkim; above normal (1.6°C to 3.0°C) at most places over Uttar Pradesh, West Madhya Pradesh, Bihar and Vidarbha; at a few places over Saurashtra & Kutch and Konkan & Goa and at isolated places over Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, Chandigarh & Delhi, Rajasthan, Nagaland, Manipur, Mizoram & Tripura, Marathwada and East Madhya Pradesh. Yesterday, the highest maximum temperature of 47.1°C was recorded at Brahmapuri (Vidarbha) (Annexure 1 & 2). Temperatures Recorded at 1430 Hours IST of Today, the 02

Temperatures Recorded at 1430 Hours IST of Today, the 02nd May, 2019

  • Brahampuri & Chandrapur (Vidarbha) recorded the maximum temperature of 45.0°C each (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by 1-3°C at most parts of Tamilnadu & Puducherry, Assam and Meghalaya and Kerala and at one or two pockets of Jammu & Kashmir, Himachal Pradesh, Vidarbha, Sub Himalayan West Bengal, Rayalaseema, Coastal Andhra Pradesh, south Interior Karnataka and West Madhya Pradesh.(Annexure 4).

Healthcare News Monitor

Ayurveda bridge course comes into force in Maharashtra

Health Issue India- Kerean Watts

The idea of allowing ayurveda, yoga, naturopathy, unani, siddha, and homoeopathy (AYUSH) practitioners to practise allopathic medicine featured in the Centre’s proposed National Medical Commission Bill. It was met with derision from doctors. Former Indian Medical Association (IMA) President Dr K. K. Aggarwal said the move would serve to promote quackery and lead to “half-baked” doctors, potentially endangering the lives of patients. Even AYUSH practitioners expressed misgivings. The Central Council of Homoeopathy (CCH) wrote to the Parliament, asserting “the basic principles of treatment of homoeopathy are exactly opposite to that of so-called modern medicine.” They added that “at an international level, this bill is going to be a matter of ridicule.”

Chronic kidney disease can be debilitating in the longer term

The Indian Awaz

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “CKD is characterized by a gradual loss of kidney function over time and may eventually lead to kidney failure, leading patients to undergo dialysis or a kidney transplant. The signs and symptoms are not noticeable until the disease is fairly well advanced, and the condition has become severe. By this time, most of the damage is irreversible. At an advanced stage of CKD, dangerous levels of fluid, electrolytes, and wastes can build up in the body. Those with underlying conditions such as diabetes, high blood pressure, cardiovascular disease, abnormal kidney structure, and a family history of the disease are at more risk. Additionally, those who smoke and are obese can also be potential candidates for CKD over the longer term.” Some symptoms of this condition include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, decreased mental sharpness, muscle twitches and cramps, edema, persistent itching, chest pain, shortness of breath, and hypertension.

Pharma News

Substandard drugs are a bigger problem for India than fakes

The Economic Times- Kiran Kabtta Somvanshi

The US has blamed India for being a major source of counterfeit drugs globally, but for pharma companies in the country, substandard medicines pose a bigger problem than what has been flagged by their largest market overseas. According to the US Trade Representative office’s annual report on intellectual property protection and review of notorious markets for privacy and counterfeiting, studies have suggested that up to 20% of all drugs sold in the Indian market are counterfeit — posing serious threat to patient health and safety. India has trashed the report, calling it an attack on cheap generic drugs, of which it is the world’s largest exporter. A review of the annual reports of the country’s top 10 pharma companies shows that words like “counterfeit”, “spurious" or “fake” drugs do not find any mention. But this does not mean that they don’t suffer from the problem of counterfeit drugs.

Yaba tablets, the ‘crazy medicine’, worth Rs 8 crore seized; 2 held

The Tribune

The Border Security Force (BSF) and Silchar police have arrested two persons with 80 bundles containing 1.6 lakh Yaba tablets worth Rs 8 crore. A raid was conducted on Wednesday at ‘New City Lodge’ at Kaithal Point on Hailakandi Road in Silchar following a tip-off by BSF’s intelligence wing. The arrested persons were identified as Biplab Dey and Sahajalal Miah, both from Tripura, a BSF release said. During the year, BSF has so far seized 1,60,170 Yaba tablets and 2,848 Ketamine tablets. Such frequent seizures and apprehension would definitely dent the syndicate involved in smuggling activities, said a senior BSF official. Yaba, a Thai word for “crazy medicine”, is a mix of methamphetamine and caffeine that comes in different flavours and colours. Inhaling its fumes or snorting the crushed powder induces a hyper-alert state so exhilarating that users have been tempted to give up on heroin and ganja. There is also a crystalline variant of this drug known as ‘Ice’, made up entirely of methamphetamine.

How SIRO Clinpharm is trying to regain its lost glory on favourable conditions

moneycontrol- Viswanath Pilla

SIRO Clinpharm, one India's oldest clinical research organisation (CRO) promoted by Daftary family that also owns Bharat Serums & Vaccines, is eyeing a comeback on rising offshoring of clinical trials in India by global drug makers. Founded in 1996 by Gautam Daftary, SIRO conducts clinical trials from Phase II to Phase IV on Indian patients for various multinational and domestic drug makers. CRO’s like SIRO are on a recovery path after clinical trial approvals by the Drug Controller General of India (DCGI) hit a bottom of 17 in 2013 from over 500 in 2010, following a public interest litigation (PIL) filed by Swasthya Adhikar Manch in Supreme Court and subsequent findings by a Parliamentary Committee about many irregularities in clinical trials, including lack of consent and compensation mechanism to the clinical trial subjects, falsification of data and alleged government failure to monitor clinical trials.

Donation of TB drug bedaquiline based on Indian govt's request to USAID: J&J


Johnson & Johnson (J&J) said its decision to donate 10,000 courses of multi drug-resistant tuberculosis (MDR-TB) medicine bedaquiline free of cost to India was based on the Indian government’s request before the United States Agency for International Development (USAID). “Johnson & Johnson did not solicit direct requests from governments as part of the bedaquiline donation program,” the company said in a statement. “The Indian government independently approached USAID, which administered the donation program, to request an additional 10,000 courses of bedaquiline, bringing the total requested and agreed to 20,000,” the statement added.

Natco Pharma receive USFDA approval for generic Bosentan Tablets; stock up ~1%

India Infoline

Natco Pharma Limited received the final approval of Abbreviated New Drug Application (ANDA) from the US Food and Drug Administration (USFDA) for Bosentan tablets in the strengths of 62.5 mg and 125 mg. Bosentan is used for the treatment of patients with pulmonary arterial hypertension, the company said in the filing. The tablets of Natco are marketed by its partner Lupin and are a generic version of Actelion Pharmaceuticals Ltd’s Tracleer tablets in the same strengths. "As stated by our partner, Lupin, as per IQVIA MAT March 2019 data, Bosentan tablets 62.5 mg and 125 mg had an annual sale of around $84.8mn in the US market", the company added.

US drug authority says some sleeping pills have serious side-effects, need warning on label

The Print- Himani Chandna

The American health watchdog, the US Food and Drug Administration (FDA), has asked manufacturers of sleeping pills to print an emphatic warning about the rare but life-threatening side-effects of these drugs on their packaging. The warning will be printed in a label box — the most prominent of warnings — to ensure that patients and their healthcare professionals take note of the more serious side-effects. “The new warnings will be required for eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, and Zolpimist),” said the FDA in a press statement issued Tuesday. The FDA has stated that under its latest safety review, it has found 66cases of adverse events in which patients who had taken the drugs were engaged in activities such as driving and sleepwalking while they were not fully awake, leading to the death and injuries.

India Must Carefully Navigate Regulatory Challenges Posed by E-Pharmacies

The Wire- Siddharth Sonkar and Ashna Ashesh

Last week, the Delhi high court issued notices to the Centre and some online pharmacies including Dunzo Digital and IMG Technologies. The court was hearing a contempt petition that alleged non compliance of an earlier order that had stayed the sale of drugs by online pharmacies. With the next hearing for this matter scheduled on May 9, 2019, the fate of investors in online marketspace is looming with uncertainty. Lack of accessibility and affordability significantly impair public health administration in India. For instance, the first pharmacy in Chattisgarh’s remote Abujmarh forest – a Maoist stronghold – became operational only last week. Before this, locals were forced to travel 70 kilometres to access a proper pharmacy. Online pharmacies have become a significant channel to actualise last-mile access to medicines by effectively bridging logistical barriers. Adopting the internet as a medium to facilitate access by way of delivering medicines to doorsteps is particularly beneficial for the differently-abled, elderly and sick patients. Andy Miah and Emma Rich in their book The Medicalisation of Cyberspace acknowledge the instrumental role of online pharmacies in attaining egalitarianism in public healthcare.

Over 20% medicines at public healthcare of Chhattisgarh outdated

The Hitavada

It is really a shocking factor that 21 per cent of drug or medicine samples collected from different public healthcares consist of civil hospitals, community health centres, primary and sub-primary health centres and 7% from retail as well as wholesale medical stores were declared as not of standard quality. These samples were collected in a period of 2015 to 2018. Even many of them crossed their expiry date and still they were used to give patients in their various ailments. As per WHO order, expired medicines can cause harmful effects to the human body including death, cancer and dangerous infections. According to the sources of Food and Drug Control Department of Chhattisgarh, of the total 1,590 samples collected from retails, wholesalers and public healthcare in all parts of Chhattisgarh in time duration of 4 years (2015-2019), 311 samples of drugs or medicines were not of standard quality and many of them crossed their expiry date too.

Healthcare News

Himachal doctor gets US award

The Times of India

Dr Jatinder Kumar Mokta Professor of Medicine at Indira Gandhi Medical College and Hospital Shimla received the American College of Clinical Endocrinology Service Award for promotion of endocrine health 2019 on April 25 at Los Angeles, USA. He is not only the first Indian Doctor but first non American doctor to get this award. Last year Dr Mokta had received the American College of Physician’s Oscar Award for his community service in the field of medicine. Recommended By Colombia President of American College of Endocrinology at Los Angeles presented him the award. Mokta hails from village Kairo tehsil Jubbal of Shimla district. He attributed his awards to his family members for their enormous encouragement and cooperation, his parents, teachers and dedicated his awards to his parents. He said it was great movement when he was introduced to the gathering of more than 500 doctors from all over the world and the name of Shimla and Himachal Pradesh was announced. He said that American College of Clinical Endocrinology is the largest clinical Endocrinology Organization in the world and to get this world he is happy.

‘Mumbai is facing severe blood shortage’:founder of Think Foundation

Hindustan Times

With most people out on summer vacation, the city is facing a shortage of blood, experts have claimed. At least 25,000 donors are needed every month to meet the city’s blood requirement. Vinay Shetty, founder of Think Foundation, which organises blood camps in the city, has termed it a “crisis”. “Many patients and their relatives called us through the month of April, saying even the blood banks don’t have blood. While the city faces shortage every year during summer and Diwali, the situation is serious this year,” he said. An official at JJ Hospital’s blood bank said none of the negative blood types were available at the hospital. “We have been facing shortage for the past three weeks,” the official said. Dr Mamta Manglani, who heads a facility, MCGM- Comprehensive Thalassemia Care, Paediatric Hematology-Oncology and Bone Marrow Transfusion Centre, Borivli, said many thalassemia patients are facing trouble.

Specialized critical care at home: improving patient outcomes


India is home to the world’s second largest population, inclusive of the elderly. The 2011 Population Census of India stated that there were almost 104 million people (age 60 or above) in India. A recent report by the United Nations Population Fund and HelpAge India forecasts the number of elderly in India to reach 173 million by 2026. In this aging population, often severe health complications turn into chronic ailments. Thus, the number of patients receiving medical assistance is ever increasing. However, in India, the infrastructure has not kept up the pace with the rising demand for quality healthcare and innovation and affordability are required. Therefore, adoption of specialized home care is becoming the norm to reduce the burden on hospitals. In fact, time has come that the specialty hospitals also focus on areas like diagnosis, surgeries, and acute care services.

Scooter-borne first responders could prove vital for emergency healthcare

EThealthworld- Alnoor Peermohamed

Imagine this — a team of scooter-borne first responders equipped with a smartphone and portable ECG machines are stationed nearby to reach within 10 minutes as soon as a person experiences a heart attack or stroke. The emergency calls to a command centre are automatically directed to the responder who can reach the fastest. Complex routing algorithms using geo-location data and cell phone triangulation are fed into AI to select the quickest route. The ECG scan of the patient is then relayed to a team of experts at a hospital. If flagged as a heart attack or stroke, the system deploys an ambulance to collect the patient. This emergency response protocol is vital, since there is a golden hour to administer treatment before the damage to the patient is irreparable or fatal. It is also a major issue for doctors in large metros where traffic snarls negate the presence of several high-quality cardiac care centres.

Sunil Gavaskar to sponsor 34 life-saving heart surgeries of children from economically deprived sections


Former India captain Sunil Gavaskar on Thursday announced that he will sponsor 34 lifesaving heart surgeries during the opening of Sri Sathya Sai Sanjeevani International Centre for Child Heart Care in Kharghar, Navi Mumbai. The paediatric heart surgeries are for children from economically and socially challenged sections of society and will be carried out over the next few months. The state-of-the-art centre in Navi Mumbai is all set to be the first such centre in the west zone and will provide free of cost services and the first paediatric cardiac surgery is scheduled for later this month. Speaking to the attendees, Sunil Gavaskar said, "These tiny tots are waiting for their hearts to be healed. Paediatric cardiac treatment should be within the reach of every child and every parent irrespective of financial or social status. I am pleased that Sri Sathya Sai Sanjeevani Centre is now open in Mumbai and will provide precious life-saving service to the people."

Its Time to Have Universal Healthcare as a Public Service – and a Right

The Wire- Soumitra Ghosh

Hardly a day passes without a news media report of a major violation of the right to health and healthcare in our country. The state of the healthcare system is such that those who are the most vulnerable are still the least likely to receive quality healthcare to live healthy lives. Interestingly, in the 2019 election manifesto, Congress has promised to enact the Right to Healthcare Act. The Right to Healthcare Act would guarantee every citizen of this country, healthcare services. In other words, all contacts between patients and doctors, all diagnostic investigations, and all medical and surgical treatments would be made entirely free. The Congress’s proposal for healthcare is a counter to BJP’s Ayushman Bharat scheme. While it is heartening to note that healthcare is finally receiving attention from the political parties, one is not sure if they would walk the talk (after the verdict) given their poor track record of keeping poll promises.

Patients suffer as Govt fails to bring cancer treatment facilities under one roof in GMC

Greater Kashmir-Zehru Nissa

Cancer treatment facilities at Government Medical College (GMC) Srinagar are being run from three hospitals making patients suffer, even as a proposal for setting up a full-fledged center for treatment of the deadly disease is gathering dust for past one decade. A senior doctor said if a patient is diagnosed with cancer at any of the GMC hospitals his/her treatment often takes place at three different hospitals. For seeking opinion of surgical oncologist, the patient has to go to Super Specialty Hospital (SSH) while as for radiation oncology the patient will need to go to SMHS Hospital, the doctor said. For medical oncology the services are available at Kashmir Nursing Home, he added.

Chronic kidney disease can be debilitating in the longer term

The Indian Awaz

Preterm and early term birth are strong risk factors for the development of chronic kidney disease (CKD) from childhood into mid-adulthood, suggests a study published in the BMJ. Preterm birth (before 37 weeks of pregnancy) interrupts kidney development and maturity during late-stage pregnancy, resulting in fewer nephrons forming (filters that remove waste and toxins from the body). Of all the patients who develop end stage kidney failure in India, only 10% to 15% get proper treatment. About 6000 undergo kidney transplant, 60,000 undergo hemodialysis, and another 6000 prefer to take peritoneal dialysis in a year. About six-lakh people die for want of renal replacement therapy. Of all the patients who develop end stage kidney disease, over 90% needing renal replacement therapy die because of inability to afford care and 60% of those who start on treatment drop midway due to financial reasons. As of May 2017, there are over 130, 000 patients receiving dialysis and the number is increasing by about 232 per million population.

Cheap Chinese medical degrees may no longer be an easy option for Indian students

The Print

Indian students looking to secure cheap Chinese medical degrees will no longer trip over the language question. The Chinese Ministry of Education has restricted domestic universities from drawing foreign students with promises of “bilingual” curriculums. It has issued a list of 45 universities that teach medicine in English, while directing all other colleges to only offer lessons in Chinese. China hosted more than 23,000 Indian students at its universities last year, according to its Ministry of Education, a large number of whom, around 7,000, were enrolled to study medicine. Medical education in China is known to be much cheaper than in India — some courses cost as less as a tenth of those at Indian private colleges — but the 45 universities that offer MBBS in English only have an annual quota of close to 3,400 seats, according to the Medical Council of India. The remaining aspirants so far found an alternative in 214 bilingual universities that claimed to offer lessons in both English and Chinese.

Understanding a good CSR project

Last week in a meeting the concept of CSR was discussed. The discussion point was what is a good CSR project? And, the consensus that emerged was "sustainability of a project" and not the project itself.
This reminded me of the “navnidhis” mentioned in Hanuman Chalisa, which talks about eight types of wealth (ashta laxmi) and nine types of sustainability of that wealth.
Navnidhi (nine types)
1. "Padma" when the impact lasts forever....read more

FDA on endocrine drugs

  • The FDA has approved the monoclonal antibody romosozumab to treat osteoporosis in postmenopausal women at high risk for fracture
  • The FDA issued a complete response letter declining to approve a new drug application for oral sotagliflozin a first-in-class dual SGLT1 and SGLT2 inhibitor for adult with type 1 diabetes
  • FDA approved an oral hydrogel therapy that induces feelings of fullness without adding calories for adults with overweight and obesity.....read more

  • eSpiritual

    Do Your Duty with Discipline and Devotion