Editor in Chief Dr KK Aggarwal, Padma Shri Awardee


Dated: 3rd June, 2019

Does vasectomy increase prostate cancer risk over time?

Vasectomy was found to be associated with a small but significantly increased risk of prostate cancer over the long run in a report of a comprehensive analysis of Danish nationwide registries led by Anders Husby, MD, Statens Serum Institut, Copenhagen, Denmark.

Vasectomy is associated with a long-term increased risk of prostate cancer, which manifests itself from 10 years after the procedure. However, the absolute increased risk of prostate cancer following vasectomy is small and similar to the increased breast cancer risk in women following oral contraceptive use. The study was published online May 23 in the Journal of the National Cancer Institute.

This report can change the way national cancer programs run in the country and needs a statement from the health ministry.

Study

The investigators used Danish national health registers to establish a nationwide cohort of 2,150,162 Danish males born between January 1937 and December 1996. The analysis involved some 53.4 million person-years of follow-up, or an average follow-up of 24.8 years per male.
At the end of the analysis, vasectomized men had a 15% increased relative risk of prostate cancer compared with the nonvasectomized men.
The association between time since the procedure was done and the risk of both low and intermediate-to-advanced stage tumors was similar, except for the first year following vasectomy where investigators found a 3.5-fold higher risk of vasectomized men presenting with low-grade prostate cancer compared with men who had not undergone the procedure.

When restricting the analysis to metastatic and extracapsular prostate cancer, the study still found a statistically significant increased long-term prostate cancer risk associated with vasectomy.

In contrast, men who had undergone a vasectomy had, on average, a lower risk of other cancers compared with nonvasectomized men, suggesting that men who chose to undergo vasectomy are, on average, healthier than the general population.


Added versus natural sugars

Natural sugars are present in foods such as fruit, vegetables and dairy, while added sugars are added to foods and beverages during manufacturing, processing, or preparation.

Our bodies do not need, or benefit from, eating added sugar. The greatest sources of added sugar in the diet are the sugary beverages, followed by sweets and grains such as ready-to-eat cereals. Intake of added sugar, particularly from beverages, has been associated with weight gain and higher risk of type 2 diabetes and cardiovascular disease.

Natural and added sugars are metabolized the same way in our bodies. But for most people, consuming natural sugars in foods such as fruit is not linked to negative health effects, since the amount of sugar tends to be modest and is “packaged” with fiber and other healthful nutrients.

The 2015–2020 Dietary Guidelines for Americans and the World Health Organization (WHO) both recommend that added sugar be limited to no more than 10% of daily calories.

The updated Nutrition Facts Panel, expected to be rolled out in 2020 or 2021, will prominently feature a line disclosing added sugar along with the corresponding 10% daily value, to help consumers gauge their added sugar intake.


Healthcare News Monitor

Pharma News

Pharma cos give MPT a miss, route exports via Mumbai

The Times of India- Paul Fernandes & Newton Sequeira

Goa’s pharmaceutical industry has an estimated turnover of more than Rs8,000 crore, but Mormugao Port Trust (MPT), which presently relies on coal handling operations, continues to be out of the pharmaceutical industry’s loop, as manufacturers route their exports through Mumbai. Goa boasts of around 70 pharma units and an identical number of ancillary ones, and it is no wonder that today the state accounts for 10% of India’s pharmaceutical output. However, for logistical reasons, pharma goods continue to be taken by road to Jawaharlal Nehru Port Trust (JNPT), Navi Mumbai, for shipment. The pharma industry has a few complaints to cite. With a feeder vessel operating just once a week between Goa and Colombo, multi-national drug manufacturers say they prefer to send the finished product to JNPT where the consignment is immediately loaded onto a container vessel. “Cargo is accumulated at MPT till a ship can sail. A week’s delay at the port is the real hurdle,” president of Goa Pharma Manufacturers Association Pravin Khullar said. Others claim that movement of containers at MPT is risky as pharmaceutical goods need to be delivered quickly. “The mother vessel will come only if the volume is there, the volume will come only if the mother vessel is there. Companies say they will come only if the mother vessel is there,” a senior official at MPT said.

Indian pharma firms compliance with USFDA norms improving of late

Business Standard- Sohini Das

While the recent book by investigative journalist Katherine Eban's Bottle of Lies has raked up a dated controversy surrounding drug-manufacturing practices in India, the largest supplier of generic medicines to the US, the local industry here feels that they have been unfairly targeted. Even recent statements by the US Food and Drug Administration (US FDA) support the generic manufacturers in India and China. Moreover, recent data showed Indian drug exporters had been able to score with the US FDA and the inspection outcomes had improved — the number of cases classified as .

Maha FDA to take action against wholesalers supplying allopathic drugs to homeopathy doctors

Pharmabiz- Shardul Nautiyal

The Maharashtra Food and Drug Administration (FDA) is devising an action plan to take action against wholesalers who supply allopathic drugs to bogus physicians and homeopathic doctors. It is also observed that homeopathic doctors used to sit at pharmacy outlets for consultations to fulfill their mutual vested interests. Homeopathy practitioners, other than dispensing their medicines to their patients, also started selling them over the counter. According to Maharashtra FDA Commissioner Dr Pallavi Darade, “If any fake doctor stocks or keeps allopathic medicines for sale, without any valid drug selling licenses, legal action under the provisions of Drugs and Cosmetics (D&C) Act will be taken.”

Karnataka DC department detects 15 NSQ drugs, seizes unlicensed blood bank and a pharmacy outlet

Pharmabiz- Nandita Vijay

The Karnataka drugs control (DC) department has recently detected 15 not-of-standard quality (NSQ) drugs during its routine inspections conducted across retail outlets in the state. The state DC department had randomly collected drug samples from pharmacy outlets across the state for the purpose. It has also uncovered the operations of a non-licensed blood bank in Belgaum and a pharmacy outlet in Bengaluru selling various diabetic formulations without permission. The enforcement teams have been on the job with their surprise inspections. The drugs were tested at our drug testing lab in the state and the reports have been informed to the pharma companies to take stock of the situation and recall the drugs from the market, Amaresh Tumbagi, Karnataka drugs controller, told Pharmabiz.

Maharashtra FDA to form society for establishing PMRU to monitor drug price violation

Pharmabiz- Shardul Nautiyal

In order to expedite the mechanism to control overpricing of drugs in the state, the Maharashtra Food and Drug Control Administration (FDA) has sent a proposal for formation of Maharashtra State Price Monitoring and Resource Unit (PMRU) Society to the state medical education and drug department (MED) for approval. The Maharashtra FDA had earlier given its consent to the national drug price regulator National Pharmaceutical Pricing Authority (NPPA) to set up drug price monitoring cell in the state two years ago. PMRU is aimed at keeping a tab on drug price ceiling violation and to ensure that the purpose of the Drug Price Control Order (DPCO-2013) is achieved effectively and in a proper manner. “PMRU is required to be run by a registered society in compliance to the norms under the society law. We also recently made a presentation on the same to MED Secretary. The issue is under consideration,” informed Maharashtra FDA Commissioner Dr Pallavi Darade.

Consistent and accurate records lead to hassle free pharma exports: Anand Iyer

Pharmabiz- Nandita Vijay

Complete, consistent and accurate records throughout the data lifecycle leads to hassle free exports of pharmaceuticals. Data helps us to make decisions and good data helps us to make better decisions. Consistently good data helps us to make better decisions that we can trust, said Anand Iyer, Business Head – South Asia UL. The regulatory expectations when pharmaceuticals are marketed globally mandate lab controls that are scientifically sound, secure from alteration and prevention of deletion and data loss, he added. At the recently concluded Pharmexcil event on recent advancements on the regulatory landscape for emerging markets, Iyer in his presentation on Data Integrity – Importance of Audit Trails, said that even back-up data must be exact and complete. Original records should be easily accessed and companies should ensure that production controls are accurate and complete meeting the required standards of the manufacturing requirements of that country to be exported.

Senior PCB officials in Telangana concerned over water bodies becoming breeding ground for MDR bacteria

Pharmabiz- A Raju

Senior officials of the Pollution Control Board (PCB) in Telangana have expressed concern that almost 90 per cent of water bodies in and around Hyderabad have become dumping yards as all the sewages from households, factories and industries are being dumped into these water bodies causing severe water pollution in the area. Apart from causing water pollution, senior environmental scientists from Telangana PCB are also concerned that untreated water from factories, households and some solid wastes which may have been dumped into these water bodies may have also made these water bodies a breeding ground for multi-drug resistant (MDR) bacteria.

Certara introduces next-generation data repository, Certara Integral

Pharmabiz

Certara the global leader in model-informed drug development, regulatory science, real-world evidence and market access services, announced the introduction of Certara Integral, its next-generation data repository for collecting, managing, and storing multiple types of data sets for analysis, sharing and reporting of clinical pharmacology, pharmacometrics and other relevant clinical data. “As the amount and accessibility of clinical and regulatory data has exploded, so has the need for systems and infrastructure that can streamline complex decision-making,” said Michael Eckstut, senior vice president and head of Certara’s pharmacometrics software group. “In developing Integral, we combined the knowledge gained by our 175 drug development, clinical pharmacology and pharmacometrics scientific experts, with the software development skills of our pharmacometrics and scientific informatics teams to create a unique multi-functional product. We believe that Integral will follow the adoption curve established by Certara’s other industry-leading technologies, such as Phoenix, D360, and Simcyp.”

Healthcare News

Sex test: Doctor, aide arrested

The Times of India

A government doctor and his aide were arrested for their alleged involvement in sex determination activities in Sriganganagar on Sunday. Doctor Atul Bansal is posted at Jaid primary health centre as medical officer had allegedly nexus with one Simran, who was posted at a private hospital on Meera Marg, where she was working as public relation officer. PCPNDT cell officials said that the accused doctor had been posted in Sriganganagar since May 2017. Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) cell conducted a decoy operation to nab the accused doctor and his aide. PCPNDT cell roped in a pregnant woman and sent her to accused doctor expressing willingness to know the sex of the foetus.

IMA, ADP cross swords over usage of ‘Dr’

The Times of India

A tussle has ensued between Indian Medical Association (IMA) and Association of Doctor of Pharmacy (ADP) over granting of ‘Dr’ prefix. ADP has condemned the statement by IMA that pharm D graduates are not qualified enough to use the prefix ‘doctor’ as directed by the Pharmacy Council of India (PCI) recently. On May 29, the IMA headquarters in Delhi had issued a statement stating that they have written to the Union health ministry and Medical Council of India (MCI) on the inappropriateness of the announcement by PCI regarding using the prefix ‘doctor’ and urged the PCI to take back the order terming it ‘unlawful.’

Minor hospitalised after illegal abortion

The Times of India

A minor was admitted to the government hospital in Banswara after developing complications following an illegal abortion. Police has registered a case under POCSO section against a youth who allegedly got the 17-year-old girl pregnant. The accused had taken her to MP for an abortion, claims police. The tribal girl is a student of Class X was admitted in the hospital on Saturday evening in a critical condition following the illegal abortion. Tejaswini Gautam, SP, Banswara said, “The girl knew the accused for last one year but being a minor, her consent is irrelevant. Moreover, after impregnating her, the accused who is an adult, took her to MP for the abortion. She is currently recovering in the hospital here.” The 21-year-old accused is being interrogated to get the details of the doctor and medical staff who carried out the abortion. “The girl is unable to recollect the exact details of where the procedure took place. Since she is still in the hospital, we are refraining from questioning her intensively. The accused has claimed that he took her to somewhere in the border town of MP for the abortion. Once we have the details, then the doctor and the medical staff also become co-accused in the case,” added the police official.

Brain-dead patient saves lives of four

The Times of India

Pune: Four people with end-stage organ failure got a new lease of life after the relatives of a 50-year-old brain-dead man donated his vital organs on Sunday. The patient was declared brain-dead at KEM hospital on Saturday. He was suffering from intra cerebral bleeding due to hyper tension. He was admitted on May 26. “A team of doctors operated on him. He was recovering well and was shifted to the general ward,” said Jasmeet Kaur Arora, the liver transplant coordinator at KEM hospital. “On Saturday, his condition deteriorated suddenly and he was declared brain-dead. We then took his wife, son and relatives’ consent to donate his vital organs,” Kaur said. His heart, kidney and liver were allocated to patients at Ruby Hall Clinic, Deenanath Mangeshkar hospital and KEM hospital respectively. “We created a green corridor from KEM to Pune airport to transport the harvested lungs to Global hospital in Chennai,” said Kaur, who along with senior transplant doctor Rohini Sahasrabuddhe completed the task.

Hospitals see increase in patients with cramps, fever in Delhi

Hindustan Times

With the maximum temperature touching 46°C in Delhi and the India Meteorological Department sounding the red alert, hospitals across the city have seen an increase in patients coming with heat-related rashes, cramps, exhaustion and sometimes heatstroke. “We see around 300 patients in the medicine out-patient clinics every day at Safdarjung, now 25 to 30 of these 300 patients are coming in with heat related illnesses. Most of them come in with fever, cramps, and vomiting and can be treated at the clinic. But, some of them require hospitalisation to recuperate,” said Dr BK Tripathi, head of the department of medicine at Safdarjung hospital. Even private hospitals have seen a spurt in cases.

Doctors missing in action

The Hindu Business Line- TV Jayan

The numbers on paper don’t square up with those on the ground. First the good news. India is pretty close to having the bare minimum human resources required for meeting its health challenges. According to the World Health Organisation, the minimum threshold of skilled health professionals required in a country is 22.8 for every 10,000 population. A study published this week showed that we now have nearly 20.6 doctors and nursing professionals available per 10,000 and thus we are closing the human resources for health gap.

Gujarat High Court dismisses doctor's plea against transfer from Civil Hospital

Daily News & Analysis

The Gujarat High Court has dismissed a plea filed by a government medical officer, who had moved to court against his transfer from Civil Hospital, Ahmedabad, to Government Hospital, Savarkundla. The doctor—Maheshkumar Kapadia—had alleged that he was being made a scapegoat and victimised since he had raised his voice against the mismanagement, poor administration, and irregularities prevalent in Civil Hospital. Kapadia had also threatened to commit suicide due to the alleged "harassment" faced by him. The petition was dismissed by the division bench of Acting Chief Justice AS Dave and Justice Biren Vaishnav. The court termed the allegations, complaints, and representations, made by the doctor against Civil Hospital administration, including its superintendent MM Prabhakar, as "reckless" and "without any documentary proof". The court also held that the transfer of the petitioner was within the four corners of law and qualified staff was required for the Savarkundla Hospital for providing medical services.

Mumbai: 1st Caval valve implant done at Jaslok Hospital

Daily News & Analysis

For the first time in India, Caval Valve Implantation (CAVI) was successfully performed on a patient suffering from Carcinoid heart disease, at Jaslok Hospital and Research Centre, on April 10. The patient was a 55 year old male, who was diagnosed with severe tricuspid valve regurgitation. This problem causes the blood to flow backward in the right upper atrium when the right lower ventricle contracted and also leads to a leaky pulmonary valve to carcinoid heart diseases. The patient developed recurrent right heart failures along with excessive abdominal swelling, liver congestion and swollen feet. He was constantly losing weight and had a dismally poor appetite, which lead to serious fatigue. The patient was deemed unfit for valve replacement surgery by two cardiothoracic surgeons; hence, he resorted to medical therapy for about 2-3 months, which was not helpful.

Dr Payal Tadvi suicide: How JJ handled harassment complaint, KEM offers counselling to PG students

The New Indian Express- Tabassum Barnagarwala

On Saturday, as he addressed the first-year postgraduate students of gynaecology in Grant Medical College, head of department Dr Ashok Anand said, “These three years will be full of stress, you can be expected on duty any time during emergency, you cannot leave hospital without informing us. But try to enjoy your MD, eat well, rest when possible and work together as a team.” Following the suicide of Dr Payal Tadvi, a second-year gynaecology student in TN Topiwala National Medical College, medical colleges are reassuring that students about ways to cope with mounting work pressure. While Nair hospital unit head Dr Y I Ching Ling was held responsible in an anti-ragging committee report for neglecting complaint of harassment, Grant Medical College, attached to JJ hospital, has set an example with a case of harassment it handled swiftly, preventing a possible suicide.

MAA ENT Hospital holds free surgeries for poor

The Hans India

Jubilee Hills: MAA ENT Hospital and MAA Research Foundation conducted their 58th live surgical workshop on June 1-2. National and international faculty Dr Trifon from Greece, Padmashri Dr Hans from Delhi and Dr Ravi Ramalingam from Chennai were the faculty for the workshop. More than 100 ENT doctors from all over India attended the workshop. The faculty performed more than 25 surgeries on sinus and ear-related problems using the latest equipment from US and Germany, at the state-of-the-art ENT hospital – MAA ENT Hospitals, Jubilee Hills.

Kerala woman gets chemotherapy after wrong cancer diagnosis, loses hair, income

India Today

A 38-year-old woman in Kerala's Kottayam underwent chemotherapy although she didn't have cancer. After being wrongly diagnosed of having cancerous cells in her breast, she was given chemotherapy at the Kottayam Government Medical College and Hospital. Now she has lost all hair and suffers from a lingering discomfort that has stopped her from going to work. Rajani is the sole breadwinner in the family, said a report in The Times of India. She was given the so-called treatment in March while the incident has come to light only now after she raised a complaint with the hospital. Rajani went to the hospital after she developed a lump of her breast. Two of her samples were collected and sent to a private laboratory near the hospital and another to a government facility.

100 city docs come together for right to die with dignity, sign ‘living will’

Mumbai Mirror- Lata Mishra

Doctors who signed their living wills in Juhu on Sunday Over a year after the Supreme Court legalised passive euthanasia and upheld the right to die with dignity as a fundamental right, over 100 doctors in the city on Sunday prepared their ‘living wills’ and vowed to encourage their patients to follow suit. A living will, that has to be signed when a person is of sound mind and body, allows doctors to withdraw life support if and when the patient cannot be resuscitated and slips into a permanent vegetative state. The SC order was passed in March last year, but awareness on passive euthanasia, even among the medical fraternity, is still poor. Sunday’s session, organised by the Indian Medical Association (IMA) and doctors who have been advocating living wills for years, was a step towards rectifying this. Doctors were given three-page declaration forms to sign, which stated that they do not want to be resuscitated in case they enter a permanent vegetative state or are terminally ill. Dr Roop Gursahani, senior neurologist and consultant at PD Hinduja Hospital, said besides poor awareness, “complicated” procedures are discouraging people from drawing up their living wills. As per the SC’s order, when a patient is terminally ill and is undergoing prolonged treatment despite no chance of survival, the treating doctor will have to first inform the hospital, which will then set up a medical board to study the case. If the board certifies pulling the plug, the hospital will inform the collector.

Eastern India's largest trauma care centre ready for launch

Millennium Post

The first Level– I Trauma Care Centre in the Eastern India is ready to be thrown open for public at the SSKM Hospital which will facilitate immediate resuscitation, emergency life-saving surgery, close monitoring, investigation, rehabilitation post surgery/treatment. All the necessary infrastructure has been put in place at the 244-bed state-of-the-art trauma care centre (TCC), housed in a 10-storeyed building on the SSKM hospital premises. It will be the largest TCC in the eastern region which has been demarcated as Level –I on the basis of its infrastructure facilities. Bengal government has spent the entire cost of Rs 250 crore for setting up a world class unit. Prof (Dr) Raghunath Misra, medical Super-cum-vice-principal of the SSKM Hospital said there will be three separate zones in the TCC —'Green Zone', 'Yellow Zone' and 'Red Zone'. The 'Green Zone' will be meant for the patients requiring minor surgical interventions. These patients will be shifted to general bed after the surgery, while the 'Yellow Zone' will accommodate the patients who need to be put under observation.


Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 02nd June to 0830 hrs IST of 03rd June, 2019)

Heat Wave:

Severe Heat Wave conditions observed in most parts over West Rajasthan. Heat wave conditions in many parts with severe Heat wave in isolated pockets over East Madhya Pradesh and Vidarbha. Heat wave conditions to severe heat wave in isolated pockets over south Uttar Pradesh. Heat Wave conditions observed in some parts over East Rajasthan, West Madhya Pradesh, Haryana and Marathwada and in isolated pockets over Gujarat state and Telangana. (Annexure 1 & 2).

MAXIMUM TEMPERATURES

Maximum Temperature more than 45.0°C were recorded in most parts over West Rajasthan; in many parts over East Rajasthan and Vidarbha; in some parts over Haryana & Delhi and Madhya Pradesh and in isolated pockets over Uttar Pradesh, Gujarat state, Chhattisgarh, Telangana and Marathawada.

Maximum temperature departures as on 02-06-2019: Maximum temperatures were markedly above normal (5.1°C or more) at most places over West Rajasthan; at a few places over East Rajasthan and at isolated places over Madhya Maharashtra and Marathwada; appreciably above normal (3.1°C to 5.0°C) at most places over Madhya Pradesh and Vidarbha; at many places over Telangana; at a few places over Konkan & Goa, Coastal & North Interior Karnataka, Kerala & Mahe, Rayalseema, Gujarat and Andaman & Nicobar Islands; above normal (1.6°C to 3.0°C) at most places over Punjab, Himachal Pradesh, Jammu & Kashmir and Haryana, Chandigarh & Delhi; at many places over Tamilnadu, Puducherry & Karaikal. They were markedly below normal (-5.0°C or less) at a few places over Bihar and Sub-Himalayan West Bengal & Sikkim and at isolated places over Gangetic West Bengal and near normal over rest parts of the country.
Yesterday, the highest maximum temperature of 48.9°C was recorded at Churu (West Rajasthan).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 03rd June to 0830 hrs IST of 04th June 2019):-

Heat Wave conditions in most parts with severe heat wave in isolated pockets very likely over West Rajasthan. Heat Wave conditions in some parts with severe heat wave in isolated pockets very likely over Madhya Pradesh. Heat wave conditions in some parts over East Rajasthan and in isolated pockets over Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, Chandigarh & Delhi, Uttar Pradesh, Saurashtra & Kutch, Vidarbha and Marathwada.


Breaking the silence on Chagas disease

On 22 May, World Heart Federation (WHF) held a WHA side event, in collaboration with the Chagas Coalition and the Drugs for Neglected Diseases initiative (DNDi), titled Chagas Disease: Breaking the Silence.
The event aimed to raise awareness of Chagas Disease, especially in light of the upcoming WHO Roadmap on neglected tropical diseases (NTDs), and to support the campaign for an official WHO World Chagas Day, which was approved just a few days later by the World Health Assembly.
Here are some key facts about Chagas disease.....read more


Eliminated measles has made a comeback in the US

971 cases of measles have been reported in the United States this year as per the CDC. The year now has the greatest number of cases in a single year in nearly three decades. The number of cases in 1994 was 963, which was lower than in 1992 when there were 2,237 cases. Cases have been reported in 26 states this year so far.
Measles was officially eliminated in the United States in 2000, meaning it was no longer continuously transmitted in the country.
Before widespread use of the highly effective measles vaccine, around 30-40 lakh people got measles each year in the US with 400 to 500 deaths and 48,000 hospitalizations. ...read more


Understanding exact speech