Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 09th May, 2019

Perfusion imaging may guide thrombolysis up to 9 hours after onset of stroke: EXTEND

The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. This treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging.

The EXTEND trial is a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging

The use of alteplase between 4.5 and 9.0 hours after stroke onset or at the time the patient awoke with stroke symptoms resulted in a higher percentage of patients with no or minor neurologic deficits than the use of placebo. There were more cases of symptomatic cerebral hemorrhage in the alteplase group than in the placebo group.

A total of 113 patients were randomly assigned to the alteplase group and 112 to the placebo group. The primary outcome (score of 0 or 1 on the modified Rankin scale) occurred in 40 patients (35.4%) in the alteplase group and in 33 patients (29.5%) in the placebo group (adjusted risk ratio, 1.44; 95% confidence interval [CI], 1.01 to 2.06; P=0.04). Symptomatic intracerebral hemorrhage occurred in 7 patients (6.2%) in the alteplase group and in 1 patient (0.9%) in the placebo group (adjusted risk ratio, 7.22; 95% CI, 0.97 to 53.5; P=0.05)... (Source: N Engl J Med 2019; 380:1795-1803; published May 9, 2019)

Three Latin American countries highlight how road safety can be improved

Three Latin American countries – Salvador, Mexico, Uruguay - implemented measures to reduce speed, limit drink-driving, and ensure that all motorcycle users wear helmets, that all car passengers wear seat-belts, and that children use car-seats. The countries also passed and enforced laws, reducing both mortality and road traffic accidents.

The three examples highlighted by the Pan American Health Organization (PAHO) within the framework of the ongoing Fifth United Nations Global Road Safety Week, are from Brazil, Mexico and Uruguay.

  • The program “Life Not Traffic Program of Salvador” implemented by Salvador de Bahi´a brought together a variety of institutions with the common goal of reducing road traffic deaths and injuries. As a result, in 2017 there were 121 fatal accidents, compared to 266 in 2010 – a reduction of 54%.
  • The example of Mexico shows how the health sector should and can take leadership and join forces with other sectors, something that has saved around 10,000 lives in 5 years. The story of Guanajuato exemplifies how policies promoted at the national level can be translated into concrete measures and initiatives at state and municipal levels and implemented on the ground by enthusiastic and committed teams.
  • Uruguay highlights the positive results that can be achieved in reducing road-traffic mortalities following the approval and implementation of a national agency to promote national legislation that addresses the main factors affecting road safety, such as speed and alcohol. It also highlights that in order to keep moving forward, constant challenges much be faced, such as achieving compliance with laws at the local and subnational levels, particularly those aimed at protecting the most vulnerable road users, such as pedestrians and motorcyclists.

(PAHO, May 6, 2019)

Physical and mental health of older adults linked to optimism, wisdom and loneliness

Researchers from the University of California San Diego School of Medicine analyzed how factors such as wisdom, loneliness, income and sleep quality, impact the physical and mental functioning of older persons.

The findings published in the May 8, 2019 issue of American Journal of Geriatric Psychiatry show that physical health correlated with both cognitive function and mental health.

  • Specifically, cognitive function was significantly associated with physical mobility, wisdom and satisfaction with life.
  • Physical health was associated with mental well-being, resilience and younger age.
  • Mental health was linked to optimism, self-compassion, income and lower levels of loneliness and sleep disturbances.

“Psychological traits like optimism, resilience, wisdom and self-compassion were found to be protective, while loneliness seemed to be a risk factor. An 85-year-old can be functioning better than a 65-year-old due to protective and risk factors.”

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 07 May to 0830 hrs IST 08 May, 2019)

Heat Wave:

Heat wave conditions were observed in isolated pockets over East Uttar Pradesh, Coastal Andhra Pradesh and Vidarbha (Annexure 1 & 2).

Maximum Temperature

Maximum temperatures were markedly above normal (5.1°C or more) at isolated places over Coastal Andhra Pradesh; appreciably above normal (3.1°C to 5.0°C) at many places over Uttarakhand, East Uttar Pradesh and Bihar; at a few places over Punjab; at isolated places over Himachal Pradesh, West Rajasthan, West Uttar Pradesh and Tamilnadu & Puducherry; above normal (1.6°C to 3.0°C) at most places over Haryana, Chandigarh & Delhi, Nagaland, Manipur, Mizoram & Tripura, Vidarbha, Telangana, Marathawada and Rayalseema; at many places over East Rajasthan, Jharkhand, West Bengal & Sikkim and North Interior Karnataka; at a few places over Jammu & Kashmir and Odisha and at isolated places over Saurashtra & Kutch, East Madhya Pradesh, Madhya Maharashtra, Konkan & Goa, Coastal Karnataka and Kerala. Yesterday, the highest maximum temperature of 46.2°C was recorded at Bramhapuri (Vidarbha) (Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 08th May, 2019

  • Bramhapuri (Vidarbha) recorded the maximum temperature of 46.4°C (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by 1-3°C at most parts of Jammu & Kashmir; at many parts of Coastal Andhra Pradesh and Gangetic Wet Bengal; at few places over Vidarbha and Tamilnadu & Puducherry and at one or two pockets of Himachal Pradesh, Uttarakhand, Punjab, Haryana, delhi, madhya Pradesh, East Uttar Pradesh, Jharkhand, Chhattisgarh and northeastern states (Annexure 4).

Healthcare News Monitor

Pharma News

Health min officials attending pharma lobby ‘summit’ raises eyebrows

The Times of India

Several civil society groups have written to health minister JP Nadda (https://timesofindia.indiatimes.com/topic/JP-Nadda) expressing concern over the participation of senior officials of the ministry and the Central Drugs Standard Control Organisation (CDSCO) in a meeting in the US organised by an American biopharmaceutical industry lobbying group. The 13th Annual BioPharma & Healthcare Summit scheduled for Thursday has been organised by the USA-India Chamber of Commerce (USAIC), which is dominated by pharmaceutical transnational corporations. The letter to the minister pointed out that many of these companies were also members of the US pharmaceutical industry trade group, Pharmaceutical Research and Manufacturers of America (PhRMA) whose “lobbies often attack India’s intellectual property regime and drug regulations”. “The USAIC Summit’s agenda is dominated by transnational companies and their interests. These kinds of conferences are often used for lobbying and advancing industry interests. The participation of policy makers and regulators in such meetings sends a wrong signal and increases the Indian government’s vulnerability to undue corporate influence from pharmaceutical transnational corporations on India’s policy making and regulations,” stated the letter.

Turmeric’s cancer preventive properties: Sharda University inks research pact with pharma company


The School of Dental Sciences, Sharda University has signed an agreement with a nutri-pharmaceutical company, Oncocur India, to conduct research on properties of turmeric to combat oral cancer minus side effects. Nano-Curcumin, a component of turmeric could hold the key to preventing the progression of abrasions that lead to oral cancer. The current treatment for commonly found oral lesions or white patches in the mouth consists of medications that have serious side effects, whereas the proposed treatment uses nano-curcumin derived out of turmeric to resolve abrasions. Nano-curcumin is well tolerated by the body and has next to no side effects. It is expected to cure tobacco and stress-induced white patches in the mouth along with ulcers that persist even after treatment. “The research will aid better, faster and effective cancer and pre-cancer diagnosis, care and management. As part of the studies conducted by the department on oral pre-cancer, the research is a great step towards delivering cutting edge treatment to cure cancer in the preliminary stages,” said Dr. Deepak Bhargava, Professor and Head of Department of Oral Pathology at Sharda University.

Medicine scam: one batch traced to Pathankot Military Hospital

The Hindu- Raina Assainar

The investigation into the the medicine scam of 12 batches has traced one batch of medicines to Pathankot Military Hospital in Punjab. “Prima facie, we believe, one batch of medicines was leaked from Pathankot Military Hospital by an insider. By interrogating each accused, we found the reverse trail,” a source from the Crime Branch said. Tushar Doshi, Deputy Commissioner of Police, Crime Branch, said, “We have sent a letter to Pathankot Military Hospital about our findings. They have assured us of an internal inquiry to find the culprit.” The latest arrest made by the Crime Branch was from Jammu. The accused identified as Dinesh Mahajan, who was nabbed in April, revealed that he used to buy Galvus 50 mg, manufactured by Novartis, from someone from the military hospital.

Indian scientists discover how serotonin helps brain cells cope with stress

The Hindu Business Line- Dinesh C Sharma

Serotonin is a chemical that relays information from one part of the brain to another, and is known to play a key role in a number of functions ranging from sleep to social behaviour. Now Indian scientists have discovered that serotonin boosts energy production in brain cells and helps them survive under stress. This new knowledge can potentially be used to develop anti-stress drugs in future. The study by scientists at the Mumbai-based Tata Institute of Fundamental Research (TIFR) has found that the neurotransmitter boosts the number of mitochondria in brain cells. Mitochondria in brain cells generate energy to carry out cellular functions and play a role in survival of brain cells under stress. In addition, serotonin also increases production of energy by mitochondria.

Only 45 Chinese varsities can admit Indian students

The Hindu- Sarena Josephine M

Every year, a number of students from Tamil Nadu, and across the country, seek admission for MBBS in universities/colleges in China. This year, the Ministry of Education of China has issued an official communication in which they released a list of 45 Chinese universities that are authorised to admit international students for a MBBS degree in English, and has strictly prohibited teaching the course under a bilingual (English/Chinese) model. With the National Eligibility cum Entrance Test held and admission season a round the corner, the Tamil Nadu Medical Council has advised students seeking admissions for MBBS abroad, including China, to check if the university/medical college is recognised and the standard of teaching and facilities available.

Chemicals in sunscreen may seep into the bloodstream: FDA study

The Indian Express

Dermatologists always advise people to apply sunscreen before stepping out in the sun, but the results of a small clinical trial by researchers at Food and Drug Administration in the US have indicated that the UV-blocking chemicals in sunscreens seep into the blood cells. Though, there’s no evidence as to what the molecules do inside the body, it is understood to have serious repercussions for sunscreen manufacturers going forward, and may change the options found in drugstore shelves. “Everyone had always thought that because these are intended to work on the surface of the skin that they wouldn’t be absorbed, but they are,” mentioned Theresa Michele, director of the FDA’s division of nonprescription drug products, and co-author on the FDA-funded study. Her team found that it took only a few hours after the application of sunscreen for the photoprotective chemicals to infiltrate the bloodstream.

How Modi govt’s strategic plan helped open 5,000 Jan Aushadhi Kendras and deliver 1,000 medicines at less than half the market price

OpiIndia- Dhairya Roy

Medicare is becoming significantly expensive year-on-year. Medicines account for nearly 70% of total treatment costs. Branded medicines are sold at higher prices due to the associated patent protection, advertising expenses and high-profit margins. It is estimated that branded medicines cost anywhere between 30-90% more than their equivalent generic medicines. Such high prices mean that quality branded medicines are out of reach for more than 40% of the Indian public, considering mainly the poor and disadvantaged. Guaranteeing fair prices for medicines has always been a major concern for the Government of India. Despite several regulatory and fiscal measures, the cost of medicines is still on the rise. To combat the escalating costs of medicines, ‘Pradhan Mantri Bharatiya Jan Aushadhi Kendra’ was launched by the Government of India in the year 2008. The first Kendra was opened in Amritsar in Punjab. The initial target for implementation during the 11th five-year plan starting in 2008-09 was to cover 630 districts of the nation. Further subdivisional major towns and village centres were to be covered by 2012.

Healthcare News

Health dept to collect feedback of patient

The Times of India

Giving importance to feedback of patients, health department will introduce IT-based ‘Mera Aspataal application’ to collect patients’ feedback about their experiences in community health services (CHCs). The health department is taking measures to find gaps in service delivery to the patients coming to CHCs. For the purpose, it has decided to seek feedback of patients. “Mera Aspataal application will also be introduced at the level of CHC,” said Dr Samit Sharma, special secretary (health), health department. Giving importance to feedback (http://timesofindia.indiatimes.com/topic/feedback) of patients, health department will introduce IT-based ‘Mera Aspataal application’ to collect patients’ feedback about their experiences in community health services (CHCs). The health department is taking measures to find gaps in service delivery to the patients coming to CHCs. For the purpose, it has decided to seek feedback of patients. “Mera Aspataal application will also be introduced at the level of CHC,” said Dr Samit Sharma, special secretary (health), health department.

Yenepoya Medical College Hospital is now NABH accredited

The Times of India-Kevin Mendonsa

The National Accreditation Board for Hospitals and Healthcare Providers (NABH), a constituent board of Quality Council of India has awarded accreditation to Yenepoya Medical College Hospital, Deralakatte, Mangaluru. The accreditation is effective from March 31, 2019 till March, 2022 subject to continuous compliance to NABH standards. The award of accreditation is mainly based on the organization ensures commitment to create a culture of quality, patient safety, efficiency and accountability towards patient care. The certificate of accreditation was unveiled at a ceremony held on recently at Yenepoya Medical College Hospital by Yenepoya Abdulla Kunhi, chancellor, Yenepoya (Deemed to be University). He called for persistent endeavors by all the stakeholders to deliver high quality of patient care all times. Farhaad Yenepoya, pro chancellor , Dr M VijayaKumar, vice chancellor, Raghuveer , pro – vice chancellor, Dr Gangadhar Somayaji, registrar, Dr Moosabba, dean, Yenepoya Medical College , Dr M A Wani , senior consultant and Dr S Padmanabha , medical superintendent were the dignitaries present during the ceremony. Dr Mohammed Amin Wani, senior consultant of Yenepoya Hospitals and former chief operating officer of Yenepoya Medical College Hospital was felicitated for his leadership and contribution to the hospital during the ceremony.

Pune activists propagate compulsory thalassaemia trait testing

Hindustan Times- Nozia Sayyed

In an attempt to avoid birth of children affected with thalassaemia, the thalassaemia society of India, Pune chapter, has proposed mandatory trait test for those who wish to get married, to the state health department. Giving details, Dr Nita Munshi, president of thalassaemia society of India, Pune, said, “We have been conducting thalassaemia screening camps and lectures in colleges since December 2018 and have received a good response so far.” Wednesday, May 8, is celebrated as World Thalassaemia Day. Thalassaemia is a blood related genetic disorder, which includes lack of genes responsible for production of haemoglobin. The severity of the disease depends on the mutations involved in the genes.

Is there AI doctor in the house?

Mint- Leslie D'Monte

Seven years ago, when Dr Naresh Trehan of Delhi’s Escorts Heart Institute and Research Centre (he’s now chairman and managing director of Medanta) used a robotic arm with an endoscopic camera attached that could provide a three dimensional (3D) image of organs, the news was received with a sense of awe. Today, cardiac surgeons routinely use 3D printers to generate replicas of the hearts of patients to strategize for complex procedures. Moreover, hospitals like All India Institutes of Medical Sciences (AIIMS), Max Super Speciality Hospital, Apollo and Fortis Healthcare all use 3D printed organ replicas. Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) doctors, for instance, have also used 3D printers to fix skull deformities.

Healthcare by non-doctors an underused resource: Public Health Foundation of India

Daily News & Analysis

Even though the health sector employs five million workers in India, the skilled health professional density of the country is much lower than in other countries, revealed a recent talk organised by the Public Health Foundation of India on 'Healthcare by Non-Doctors: An Underused Resource'. As per the World Health Organization, India is among the countries with a critical shortage of 'skilled' healthcare providers with a 20.7 Human Resource for Health (HRH) as compared to the 22.8 HRH threshold per 10,000. As per the government data available, India had 19,80,536 registered nurses and registered midwives (RNRM), 8,41,279 ANMs, and 56,367 lady health visitors until January 2016. But with the merging of nursing and midwifery, when the ANMs graduate, they are expected to perform routine nursing tasks and some basic midwifery, mostly under doctors' supervision.

Hyderabad: Summer classes anger doctors

Deccan Chronicle- Durga Prasad Sunku

ome private medical colleges are conducting classes even during the summer holidays. The Kaloji Narayana Rao University of Health Sciences has sent a circular declaring month-long summer vacation, but some private colleges have ignored this. They claim to be running special classes and are charging hostel and transport fees from students, alleges Telangana Junior Doctors Association (TJUDA). TJUDA president Vijender Goud said, “Many private colleges are not declaring the holidays and charging students hostel fee and transportation fee. The Medical Council of India curriculum is the same for all colleges and it clearly stipulates in how many hours a subject should be completed. The university has clearly given instructions to all the colleges to declare a summer holiday. that the private colleges are running the colleges for earning profits by charging fees.”

Mind crucial in obesity treatment

Deccan Chronicle

The management of overweight with strict instructions on healthy diet and structured exercises comes a cropper in majority of patients because most of them are mentally unprepared or lack the mental stamina to stay the course. A team of doctors and dieticians debated on two dozen topics related to weight gain and safe management strategies in Kochi the other day at the first ever meeting of the State chapter of All India Association of Advancing Research in Obesity (AIAARO). Experts stressed the need for incorporating multiple members in a team, especially a psychologist for motivating the subjects to adhere to the weight loss regimen. Internet is filled with propaganda on weight-reducing remedies, many of which result in serious adverse events to the liver and kidney.

Key innovations in joint replacements

Deccan Herald- Dr Ramneek Mahajan

What was once a critical imperative is now a strategic shift in the field of healthcare, innovation is changing the world around us. Advancements in the medical device industry have dramatically improved patient outcomes and promised predictable results. A perfect example of this can be seen in the knee replacement surgeries where innovative surgical techniques and implant designs have reduced recovery time. Today, a new knee almost mimics the original knee. Making use of gender-specic prosthetics, minimally invasive surgery techniques and computer-assisted navigation systems — knee replacement procedures are raising the hopes in many cases where there was none before.

Aster starts finance service centres in its hospitals to help patients

The Economic Times

Aster DM HealthcareNSE -1.46 % has launched Aster financeNSE -0.46 % service centre across all its existing 11 hospitals and the two upcoming ones of the group in the country to provide funds for needy patients. Aster Easy Care has been developed in association with BajajNSE -0.56 % Fin Serve and Federal Bank to provide patient funding which can be repaid in monthly instalments (EMIs) over a period of one year. The interest cost of the loan is borne by Aster DM Healthcare. Speaking about the initiative, Dr. Azad Moopen, founder chairman and managing director of Aster DM Healthcare said, “Aster Financial Service Centre is launched to take care of the financial requirements of needy patients who struggle when a large amount for treatment is required. The AFSC is a single window, a hassle-free service being introduced for the first time in India. The philosophy behind starting this is to make sure that a patient who is coming to our hospitals must be treated if there is a bed or investigation slot available, through the various services offered through the centre.”

India will need 7,300 cancer doctors by 2040 as chemotherapy need and cancer cases rise

Health Issues India- Kerean Watts

By 2040, the number of people living with cancer who require chemotherapy will increase significantly worldwide. The burden will be most pronounced in low- or middle-income countries, including India, home to the third largest cancer patients in the world. This is according to researchers who have conducted a study published today in The Lancet. The study surveyed the number of cancer cases which required chemotherapy in 2018, and to what extent such cases are likely to increase by 2040. It estimates that the number of cancer cases necessitating first-line chemotherapy treatment will increase by 53 percent, from 9.8 million in 2018 to fifteen million in 2040. 67 percent of such patients will reside in low- or middle-income countries. For India, the estimates are dire. “For India in particular, our study estimates approximately 670,000 new cases of cancer requiring chemotherapy in 2018 if there were full application of evidence-based guidelines,” Dr Brooke Wilson, the study’s first author, told Health Issues India. “By 2040, we estimate over 1.1 million new cases per year needing chemotherapy, and demand may be as high as 1.2-1.5 million if we account for more advanced stages of disease at presentation as compared to US and Australia data.”

Never too old to fix your heart: Improving lives of our precious senior citizens without surgery

The News Minute

At the age 86, Saradhal Alagappan is India’s oldest patient to receive the MitraClip, a revolutionary cardiac therapy which is transforming the lives of India’s elderly cardiac patients. When Saradhal was hospitalized recently, she was found to have torn a chord that was essential for the functioning of a valve in her heart. This caused the valve to leak heavily and pushed her into heart failure. Her symptoms were so severe that over the past year she has been hospitalized 6 times and was confined to a wheelchair due to shortness of breath. She was refused surgery due to her age and frailty, and medication was no longer able to control her symptoms. Now, thanks to the MitraClip, she is enjoying badminton rallies with her grandchildren. “This is just one story. There are many such stories of the elderly getting back to active lifestyles after such therapies,” says Dr Sai Satish, Senior Interventional Cardiologist at Apollo Hospitals, “And many more stories are waiting to happen.”

Safe disposal of expired and unused medicines

It is the usual tendency to throw the unused and expired medicines in the household trash, which is then collected by the waste collector or thrown into vacant plots in the neighborhood or on the streets. But this is approach to drug disposal is hazardous to the environment and thence to life.
Through the waste (in the open or landfills), these medicines may pollute water sources and also enter the soil. There are chances of accidental exposure to these medicines for waste pickers or children. Then, there is the hypothetical risk of these drugs being recycled back into the market.....read more

The top three antibiotics prescribed worldwide
Penicillins with ß-lactamase inhibitors, 3rd-generation cephalosporins and fluoroquinolones are the top three antibiotics prescribed worldwide

The first Global Point Prevalence Survey (Global-PPS) compared antibiotic use and resistance across 303 hospitals in 53 countries.
Internet-based survey – included all inpatients receiving an antimicrobial who were on the ward at 0800 hours on one specific day between January and September 2015.
Key findings

  • 34.4% hospitalized patients receive antibiotics, with huge variations among hospitals and countries.....read more


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