Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 16th May, 2019

Antibacterial Envelope to Prevent Cardiac Implantable Device Infection

NEJM ABSTRACT: Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections.

A NEJM PUBLISHED, MEDTRONIC SUPPORTED STUDY conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations. Patients who were undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator were randomly assigned, in a 1:1 ratio, to receive the envelope or not.

The primary end point was infection resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death, within 12 months after the CIED implantation procedure. The secondary end point for safety was procedure-related or system-related complications within 12 months.

A total of 6983 patients underwent randomization: 3495 to the envelope group and 3488 to the control group. The primary end point occurred in 25 patients in the envelope group and 42 patients in the control group.

The safety end point occurred in 201 patients in the envelope group and 236 patients in the control group.

The mean (±SD) duration of follow-up was 20.7±8.5 months. Major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group.

THE STUDY CONCLUDED THAT Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications.[N Engl J Med 2019; 380:1895-1905]

Increasing age and respiratory symptoms were indicators of infectivity of Nipah virus

Nipah virus is a highly virulent zoonotic pathogen that can be transmitted between humans.

A Bangladesh NIH funded study used data from all Nipah virus cases identified during outbreak investigations from April 2001 through April 2014 to investigate case-patient characteristics associated with onward transmission and factors associated with the risk of infection among patient contacts.

Of 248 Nipah virus cases identified, 82 were caused by person-to-person transmission, corresponding to a reproduction number (i.e., the average number of secondary cases per case patient) of 0.33. The predicted reproduction number increased with the case patient’s age and was highest among patients 45 years of age or older who had difficulty breathing.

Case patients who did not have difficulty breathing infected 0.05 times as many contacts as other case patients did. Serologic testing of 1863 asymptomatic contacts revealed no infections. Spouses of case patients were more often infected (8 of 56 [14%]) than other close family members (7 of 547 [1.3%]) or other contacts (18 of 1996 [0.9%]). The risk of infection increased with increased duration of exposure of the contacts and with exposure to body fluids.

The study concluded that increasing age and respiratory symptoms were indicators of infectivity of Nipah virus. Interventions to control person-to-person transmission should aim to reduce exposure to body fluids. [ N Engl J Med 2019; 380:1804-1814]

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 14 May to 0830 hrs IST 15 May, 2019)

Heat Wave:

Yesterday, Heat Wave Conditions observed in isolated pockets over Vidarbha(Annexure 1 & 2).

Maximum Temperature

Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at isolated places over Gangetic West Bengal, Coastal Andhra Pradesh and Tamilnadu & Puducherry; above normal (1.6°C to 3.0°C) at most places over Rayalaseema and North Interior Karnataka; at many places over Nagaland, Manipur, Mizoram & Tripura, Bihar, South Interior Karnataka, Kerala, Lakshadweep and Andaman & Nicobar Islands; at a few places over Jammu & Kashmir, Vidarbha, Telangana and Coastal Karnataka and at isolated places over Odisha, Madhya Maharashtra and Marathawada. Yesterday, the highest maximum temperature of 45.2°C was recorded at Chandrapur (Vidarbha)(Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 15 th May, 2019

  • Chandrapur (Vidarbha) recorded the maximum temperature of 45.6°C (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by by 1-3°C at many parts of Himachal Pradesh,East Madhya Pradesh and Jharkhand; at some parts of Vidharbha, Telangana, Chhattisgarh, Gangetic West Bengal and Odisha and one or two pockets of Coastal Andhra Pradesh,Bihar, Assam & Meghalaya, West Madhya pradesh, Gujarat, Rayalaseema and Kerala (Annexure 4).

  • Healthcare Monitor

    This disease is becoming an epidemic in India since the last few years. See how can take measures to prevent it!

    OBN- D Madhav SD

    In the last 26 years, the burden of cancer in India has doubled. Breast, cervical, mouth and lung cancers are 41 percent of the burden of disease in the country. Creating awareness on the importance of prevention requires time. Figures also show that the number of patients requiring the first chemotherapy between 2018 and 2040 will increase from 98 million to 15 million. A study published in The Lancet, Oncology suggests that in the lower and middle-income countries, there is a steady increase in the number of patients eligible for chemotherapy from 63% to 2040 to 67% in 67%. Padma Shri, Dr. K.K.Agarwal, President, Heart Care Foundation of India (HCFI) says, “The prevalence of cancer in our country is not uniform, there is a difference in the types of cancer, which affects people based on rural and urban settings. In rural women, cervical cancer is the most common, Whereas, breast cancer is the most severe in urban women.

    Half of Indians unaware of their hypertension status and have not received a diagnosis


    According to a recent study, only 3 out of 4 individuals in India with hypertension have ever had their blood pressure measured. Only about 45% had been diagnosed, and only 8% of those surveyed had their blood pressure under control. More than half the number of Indians aged 15 to 49 years with hypertension were not aware of their hypertension status. The awareness level was lowest in Chhattisgarh (22.1%) and highest in Puducherry. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, "The prevalence of hypertension in Indian adults has shown a drastic increase in the past three decades in urban as well as rural areas. It is important to get an annual checkup done after the age of 30 even if you have no family history of hypertension, are not diabetic or don't have any other lifestyle-related disorder. For those in the high-risk category, a checkup is advised every month. Hypertension can be prevented provided a person makes necessary lifestyle changes right at the outset. It is also imperative to spread the message of prevention and encourage people across various age groups to check their blood pressure at regular intervals."

    Pharma News

    Pharma Fares Better

    Business Today-PB Jayakumar

    The efforts of Indian drug makers to satisfy the ever increasing stringent manufacturing benchmarks of the United States Food and Drug Administration (USFDA) have started yielding results. In 2018, India, which has the largest number of US regulator approved pharmaceutical plants outside the US, got only 15 warning letters (warning to stop production if shortcomings are not sorted out within a specified period), lower than 19 for US companies and 24 for Chinese companies. In 2015, India had topped the list with nine warning letters and almost all leading drug companies exporting to the US had to face manufacturing standard issues with their plants.

    NPPA caps prices of 9 non-scheduled cancer drugs by up to 87%


    In continuation to its efforts to bring down drugs prices, India’s drug pricing regulator on Wednesday capped the prices of 9 non-scheduled cancer drugs by up to 87%, capping their trade margin at 30%. The National Pharmaceutical Pricing Authority (NPPA) under the ministry of chemicals and fertilizers has put out the list of 9 anti-cancer non scheduled medicines whose MRPs have been cut by up to 87 %. The new list of drugs is in continuation to the government’s efforts to curb profiteering on these vital drugs. In February this year, the government had capped 42 cancer drugs at 30%. The move was expected to reduce prices of cancer drugs by 85% and covered 72 formulations and 355 brands. According to the government, the price cut was expected to benefit about 22 lakh cancer patients in India and would result in annual savings of around ?800 crore to the patients.

    Ex-FDA chief Scott Gottlieb endorses use of generic drugs

    The Economic Times- Divya Rajagopal,

    The US generic drug industry, dominated by Indian companies, has found a surprising champion in former US Food and Drug Administration head Scott Gottlieb. He’s come out in support of generic drugs, which have been facing negative publicity over quality issues. Gottlieb, 46, who resigned in the middle of his tenure in March this year, has been tweeting to convince patients that generic drugs are safe, a move that should boost the image of several manufacturers, including Indian pharma companies that have been criticised in the past for poor quality standards.

    Johnson & Johnson to submit applications for at least 10 new drugs by 2023


    Johnson & Johnson said on Wednesday it expected to file marketing applications for at least 10 new drugs between 2019 to 2023, to strengthen its pharmaceuticals unit which has been a major growth driver. This is part of the healthcare conglomerate's plan to deliver above-market growth through 2023 at its Janssen unit, it said. The plan comes ahead of J&J's business review, scheduled later on Wednesday. The company said it would discuss four medicines that are new to J&J's pipeline of drugs at its review as well as therapeutic areas such as gene therapy and RNA therapeutics.

    Researchers develop mobile image recognition system for drugs

    BioSpectrum India

    A recent study showed that older elderly people consume medicines on an average of 7.3 drugs per day. A wrong drug taken affects the curative effect and harms life. Associate Professor of Medicine at National Yang Ming University, Taiwan, Dr Yu-Chun Chen developed a novel mobile phone drug image recognition system - "AIGIA Pharmacist". Professor, who is also a general physician at Taipei Veterans General Hospital, mentioned that the consumers and health care assistants can now identify the medicine at home by just clicking a photo with their own mobile phone. According to the survey in Taiwan, there are about 500,000 elderly people over the age of 65, who suffer from multiple chronic diseases and needs long-term care. However, for convenience many of their drugs are provided in kit form for easy recognition; yet, elderly have problems with memorizing the prescription of each drug and recognising similar looking pills/capsules. The small size of the pills, similar colour and the names of the drugs are easily confused by the elderly. Additionally, it could also lead to repeated consumption of same medicine leading to adverse health effects.

    ‘Bottle of Lies’: Book on Generic Drugs ‘Exposes’ Indian Companies


    ‘Bottle of Lies’ opens a can of worms for Indian drug companies. The new book by Katherine Eban, called an “invaluable exposé” by The New York Times, alleges severe cases of quality compromise by Indian big pharma exporting generic drugs to the United States (US). Drug makers in India have relied on Americans to buy a big chunk of their produce for a long time now. Nearly 40 percent of US’ generic drugs come from India, states Evan. The book argues that these generic drugs are “poisoning” people.

    Indian pharma companies feel the heat of price-fixing charges by US govt: All you need to know

    Qrius- Prarthana Mitra

    Of the 20 major pharmaceutical firms named in a recent antitrust lawsuit filed by 44 American states, seven of them are Indian. Sun Pharma’s US arm, Taro, Zydus, Lupin, Aurobindo Pharma, Dr Reddy’s, Wockhardt, and Glenmark Pharma, have been accused of conspiring to inflate prices of generic drugs, by over 1000% in certain cases. Other firms under the scanner include reputed multinational firms like Heritage Pharma, Apotex, Par Pharma, Pfizer, and Sandoz. The 524-page lawsuit charges them with collusion with the world’s largest manufacturer of widely-prescribed generic drugs, Israeli pharma company, Teva Pharmaceuticals. This is quite possibly the largest cartel case in the history of the US pharma industry.

    Healthcare News

    Rims becomes first hospital in J’khand & Bihar to start cardiology doctorate courses

    The Times of India

    State-run premier health institute Rajendra Institute of medical sciences in Ranchi has become the first medical college in Bihar and Jharkhand which will offer doctorate of medicine degrees in cardiology, starting from this session. A notification to this effect was issued by Medical Council of India (MCI) on Monday evening, accrediting the cardiology department of Rims to take admission for two doctorate seats starting this academic session. Medical Sciences (AIIMS), New Delhi, and Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata which offers doctorate courses in this field. The MCI notification comes after its team paid a visit to the hospital on April 23 and took stock of the preparations by Rims before providing the accreditation. “The MCI team was very happy with the faculty profile and the infrastructure which we have in place for starting the elite course. We are a team of four doctors and all have doctorate degrees, and these went in our favour,” said Dr Prashant Kumar, associate professor at cardiology department of Rims.

    Bengaluru hospital sees 20% rise a year in eye disease

    The Times of India

    A child rubbing her eyes must not be ignored as it could be a symptom of a serious eye infection given high air pollution levels, warn ophthalmologists. “Dryness and inflammation are a vicious combination which leads to allergies. When children continuously rub their eyes due to allergies, it could lead to keratoconus,” said Dr Raghu Nagaraju, senior consultant, cornea and refractive surgery, Dr Agarwal’s Eye Hospital, on Wednesday. In 2017-18, the hospital had 400 patients with keratoconus and in 2018-19, there were 480 cases, a 20% increase in a year. Keratoconus, a progressive disease in which the cornea becomes thin and bulges into a conelike shape, eventually affects vision. Dr Ravi, medical director and senior consultant of the hospital, said one in every 1,500 children in India suffers from the disease and children between 10 and 15 years are especially susceptible. “This condition is also suspected in cases where blurred vision doesn’t improve even after wearing spectacles. Parents should limit children’s exposure to smart screens and avoid artificial light,” said Dr Preeti DK, consultant ophthalmologist.

    Hospital to get notice for absence of fire-fighting system

    The Times of India

    The Vadodara Fire and Emergency Services will issue a notice to the administration of Faith Hospital on Thursday in connection with the fire that had broken out on the terrace of the hospital on Tuesday evening. Fire officials said that the hospital will be questioned over the absence of fire bowsers, smoke detectors and other fire-fighting services even as it had facility for in-house patients among others. Although it had portable fire extinguishers, it endangered the lives of patients, their relatives and its own staff as it did not have automatic fire-fighting system. While the hospital will be slapped with the notice on Thursday, its administration showed readiness on Wednesday to install the fire bowsers and smoke detectors. “They informed us that the systems will be installed as soon as possible, yet we will be giving them the notice,” said in-charge chief fire officer Deepak Gunjal. The hospital will remain out of operations until the systems will be installed. The fire that broke out late on Tuesday evening had created panic among the patients and their relatives until they were rescued. The blaze began on the terrace probably due to short-circuit in the solar panel or because of cooking on the terrace.

    Private hospitals exaggerating GRH deaths: Govt docs

    The Times of India

    The Tamil Nadu Government Doctors Association (TNGDA), Madurai, has come down heavily on private hospitals in the city for exaggerating the three deaths at the Government Rajaji Hospital (GRH) on May 7 and said that it was for “ulterior motives”. In a statement, the TNGDA claimed that the “exaggeration of an accident or even a lapse” would lead to the public lose hope on government hospitals and added that demands for compensation already led to many false claims of negligence and harassment of doctors. “Public losing faith on government hospitals, in the long run, may be forced to adopt unscientific practices or mobilise funds to pay for unaffordable treatment at big private hospitals,” the statement said. Madurai district president of TNGDA, Dr K Senthil said that though the association would welcome a detailed inquiry into the deaths and even stern action against those responsible if at all there was any lapse, it was strongly against private hospitals trying to spread exaggerated allegations. “It is unfortunate that the chairman of a corporate hospital has filed a public interest litigation case in which there is also a mention about the three deaths. Preliminary inquiry says the death wasn’t due to power outage and it looks like it was just an accident,” he added.

    Consumer Act should not be extended to doctors: Pawan Bansal

    The Times of India

    Congress candidate Pawan Kumar Bansal on Tuesday interacted with the medical fraternity at Indian Medical Association (IMA) complex in Sector 35. He was presented a charter of issues ailing allopathic doctors at local and national level. There are 1,200 IMA doctors in the city. Assuring redressal of their demands, Bansal said, "I feel that the interference of the government must stop as far as the Consumer Act is concerned as doctors are professionals and not businessmen. Therefore, the Consumer Act should not be extended to doctors. In fact, during my tenure I had permitted doctors to run their consultation work from their homes measuring 2 kanal or above." Bansal, however, admitted that he was not conversant about the entire issues related to the medical fraternity. "But if voted to power, I shall deliberate upon these problems and see how some of them can be implemented," he said.

    Most ignored signs of cancer!

    The Times of India

    We all know cancer is becoming more common than any of us would like and doctors everywhere say that early detection is the key to treatment and better recovery. However, there are some signs that a lot of us overlook, which could be 'signs of cancer' in both men and women. We don't intend to scare you with this article - it is an effort to increase awareness about cancer signs and symptoms that often go unnoticed. If you have been ignoring a shooting pain or a strange sensation in bones, it could be a sign of bone cancer. Another sign is swelling or fractures. It is best to get yourself tested to rule out the possibility of bone cancer.

    How a deadly fungus colonized India’s ICUs

    MINT- Srishti Choudhary

    In the second week of April, a 62-year-old patient was admitted to the intensive care unit (ICU) of a tertiary care hospital in Chennai with a slew of vague, generic complaints—ranging from “weakness" to “tiredness". He was passing blood in his stool, and an investigation revealed that multiple blood transfusions he had undergone in previous hospitals had caused a reaction, which led to acute renal failure. After a few days, he developed a raging fever and, inexplicably, a chest infection. Even as the doctors swiftly put him on systemic antibiotics for drug-resistant bacterial infection—a common suspicion in such cases—they sent off his samples to a lab. The blood cultures showed the growth of an unusual fungus, identified as Candida auris (C. auris), which showed resistance to the most commonly available antifungal drugs, including Fluconazole.

    ‘Heart diseases, infection leading killers in Delhi’: Reports

    Hindustan Times-Anonna Dutt

    Cardiovascular diseases, infections and respiratory diseases accounted for two in every five deaths recorded in Delhi in 2017, the state government’s Annual Report on Registration of Births and Deaths which is based on reports of the city’s three corporations, said. The report says there were three plague deaths and five deaths due to cholera. Heart disease and stroke accounted for 19.25% of all deaths in 2017, which is a 1.6 percentage points increase over reported deaths in 2016. Infectious and parasitic diseases caused 14.78% of all deaths; followed by respiratory ailments, which led to 8.405% of deaths. “This is the trend that we see across the country; now fewer people are dying of infectious diseases and increasing longevity is leading to more deaths from lifestyle-related diseases. Heart diseases and strokes are accompanied with diabetes and hypertension, so it is important to address them,” said Dr Dilip Kumar, senior consultant of medicine, Safdarjung hospital.

    AIIMS imposes conditions for holding event; doctors term order arbitrary, illegal

    Milliennium Post

    A section of AIIMS faculty members have termed as "arbitrary and illegal" the administration's imposition of conditions for holding a session to discuss caste discrimination at institutes of higher learning, and said it was an attempt to curb their fundamental rights. The organisers have postponed the event, which was to be held on Monday, in protest and have also sought revocation of the terms. A group of doctors, belonging to the forum AIIMS Front for Social Consciousness, had decided to hold a discussion on the topic "Ambedkar's views on Social Relations: Caste discrimination in Institutions of Higher Learning" and had written to the administration to book a lecture hall for the same. In its reply, the AIIMS registrar issued certain directions for the event to be conducted.

    AI can beat doctors in predicting heart attack


    Artificial intelligence-based systems can predict death and heart attack in patients suffering from chest pain with greater accuracy than humans, says a new study. Doctors use risk scores to make treatment decisions, but these scores are based on just a handful of variables and often have modest accuracy in individual patients. Through repetition and adjustment, machine learning, the bedrock of AI, could exploit large amounts of data and identify complex patterns that might not be evident to humans, said the study presented at the International Conference on Nuclear Cardiology and Cardiac CT (ICNC) 2019 in Portugal. "Doctors already collect a lot of information about patients, for example, those with chest pain. We found that machine learning can integrate these data and accurately predict individual risk. This should allow us to personalise treatment and ultimately lead to better outcomes for patients," said study author Luis Eduardo Juarez-Orozco of the Turku PET Centre in Finland.

    Doctors perform ‘India’s first Total Marrow Irradiation Procedure’ to save Omani patient from blood cancer


    Indian doctors performed a sophisticated medical procedure known as "Total Marrow Irradiation"(TMI), conditioning protocol prior to bone marrow transplant, in order to treat a 35-year-old Omani patient who was battling for life with Chronic Myeloid Leukemia (CML), which is a rare blood cell cancer that begins in the bone marrow. Doctors at Chennai’s Apollo Proton Cancer Centre in Chennai have termed it "India’s first total marrow irradiation procedure". The hospital says that India is the third country to perform this procedure after the USA and Italy. The patient, Fatima, an Omani nurse, was diagnosed with the third and last stage of blood cancer. Her white blood cells (WBC) count had shot up to over a lakh, whereas the ideal count was between four thousand and eleven thousand.

    GB Pant hospital unsafe, vulnerable in case of fire

    Daily Excelsior

    The GB Pant Children Hospital in Srinagar, which houses the neonates, is unsafe and highly vulnerable in terms of measures available to tackle with the fire incidents as per the safety audit carried out by the Fire and Emergency Services. The Fire and Emergency Department said it has repeatedly been writing to the hospital administration; however, there has not been much compliance from them. The audit has termed the children’s hospital as ‘highly vulnerable’ out of all the hospitals in Srinagar. Bashir Ahmad Shah, Deputy Director Fire and Emergency Services told Excelsior that while most of the Valley hospitals are not up to the mark in terms of safety against fire incidents, GB Pant tops the list. “We have been carrying the safety audits of the Valley hospitals, while almost all the hospitals are not up to the mark in terms of safety, GB Pant is the most unsafe and is highly vulnerable when it comes to the safety against fire incidents,” he said.

    Breaking news: EXTEND expands thrombolysis window to up to 9 hours after stroke

    Using perfusion imaging to identify patients with salvageable brain tissue following ischemic stroke is the key to extending the window for thrombolysis out to 9 hours.
    The results of the EXTEND trial show that more patients presenting between 4.5 and 9 hours treated with tPA (alteplase) under these conditions achieved a score of 0 or 1 on the modified Rankin scale (indicating no deficits or minimal deficits, respectively) than those give placebo.
    The EXTEND trial is published in the May 9 issue of The New England Journal of Medicine. The results were first presented at the International Stroke Conference (ISC) in Hawaii earlier this year.....read more

    Vedic health: S and H sibilants

    In mantra or Akshar Yoga there is a special mention of sibilants of the HS sounds.
    In the first week of May, I was in Antigua for the GAPIO meeting and found that the GAPIO meet was full of energy. The people in the meet had some S/h or H in their names. To name a few they were Dr Sanku, Dr Sibal, Dr Sudhir, Dr Krishan, Dr Ramesh, Dr Shankar, Dr Sharma, Dr Singhal, Dr Sheth and Dr Hemadhri.
    This was a coincidence, but it reminded of a Vedic saying that it's the people who make any organization vibrant....read more


    Swayambhu or self-manifested