Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 17th May, 2019

Antibiotics in outer space

Becker's Hospital Review, from January through May 15.

Antibiotics should be used with caution in outer space since they may quickly fuel drug resistance in bacteria, researchers report in mBio.

The researchers found E bacteria treated with antibiotics in a simulated microgravity environment rapidly developed resistance to antibiotics.

The bacteria was still resistant to the drugs over time even when they were no longer exposed to an antibiotic.

This finding is especially concerning for astronauts, who may have suppressed immune systems due to microgravity, sleep deprivation, isolation or microbial contamination.

Consumer products that contain triclosan is fueling antibiotic resistance

The use of consumer products that contain the chemical triclosan is fueling antibiotic resistance, according to a study in Antimicrobial Agents and Chemotherapy.

Triclosan is the active ingredient in many products marketed to have antibacterial properties, such as toothpaste, mouthwash and cosmetics.

Researchers at Washington University in St. Louis examined whether triclosan could protect bacteria from antibiotics designed to kill bacterial cells. They monitored bacterial cells' survival after exposure to antibiotics.

Triclosan increased the number of surviving bacterial cells substantially as per Petra Levin, PhD, a professor of biology at Washington University.

Normally, one in a million cells survive antibiotics, and a functioning immune system can control them. But triclosan was shifting the number of cells. Instead of only one in a million bacteria surviving, one in 10 organisms survived after 20 hours.

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 16 May to 0830 hrs IST of 17 May, 2019)

Heat Wave:

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

Maximum Temperature

Maximum Temperature more than 40.0°C were recorded at most places over East Madhya Pradesh, Vidarbha, Marathwada, Rayalaseema, Telangana; at many places over East Uttar Pradesh, Chhattisgarh, North Interior Karnataka; at a few places over Bihar, Madhya Maharashtra, Tamilnadu & Puducherry; at isolated places over West Uttar Pradesh, Bihar Jharkhand, Odisha, Gangetic West Bengal, East Rajasthan, Gujarat State and Coastal Andhara Pradesh.

Maximum temperature departures as on 16-05-2019: Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at isolated places over North Interior Karnataka, Madhya Maharashtra; at a few places over South Interior Karnataka, Rayalaseema and at isolated places over Tamilnadu & Puducherry; above normal (1.6°C to 3.0°C) at most places over Kerala; at many places over Gangetic West Bengal and Jharkhand; at a few places over East Uttar Pradesh, Bihar, Vidarbha, Odisha, Telangana, and Coastal Karnataka and at isolated places over East Madhya Pradesh. They were markedly below normal(-5.1 or less) at many places over Jammu & Kashmir; at few places over Haryana Chandigarh & Delhi; appreciably below normal (-3.1°C to - 5.0°C) at many places over West Rajasthan and Himachal Pradesh; below normal (-1.6°C to - 3.0°C) at many places over East Rajasthan; at a few places over Gujarat Region and at isolated places over West Madhya Pradesh and near normal over rest of the country. Yesterday, the highest maximum temperature of 46.0°C was recorded at Chandrapur (Vidarbha).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 17 May to 0830 hrs IST of 18 May 2019):-

Heat Wave Conditions at isolated places very likely over Vidarbha and Telangana.

Healthcare Monitor

Hyderabad: Many Indians suffer from high blood pressure unknowingly

Deccan Chronicle- Durga Prasad Sunku

Many Indians are not aware that they suffer from hypertension. The prevalence of hypertension in Indian adults has increased in the past three decades in urban and rural areas. Hypertension is a major risk factor for cardiovascular disease, a leading cause of death in India. Hypertension generally doesn’t show any outward signs or symptoms but silently damages blood vessels and other organs. People should be aware that it is not a disease but a sign that something is wrong in the body, say doctors. According to a Global Burden of Diseases study hypertension has caused 1.63 million deaths in India since 2016. Dr Shiva Raju, consultant physician and diabetologist, KIMS Hospitals, Secunderabad, said, “Earlier, hypertension was defined as BP (blood pressure) exceeding 140/85 mmhg, but now it is defined as 130/80 mmhg and above. That makes a huge number of people fall into this category unknowingly.” Dr K. K. Aggarwal, president-elect Confederation of Medical Associations in Asia and Oceania, says that hypertension is not a disease but a sign that something is wrong in the body. “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 check-up 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,” he advises.

Pharma News

Pharma cos can’t sell tweaked drugs under old brand name

The Times of India- Rupali Mukherjee

Certain widely selling old household brands may find it tough to remain on shop shelves if a government directive is anything to go by. The government has ordered state drug controllers not to allow companies to market drug formulations in which the composition has been tweaked, while retaining the old brand name. Plugging a legal loophole, the Drugs Controller General directed state regulatory authorities on Thursday to “discourage the practice of marketing of drug formulations with changed composition, without changing the brand name”, official sources told TOI. In effect, certain companies will not be allowed to retain the brand name in medicines that have undergone a change in raw material (active pharmaceutical ingredient, or API). It could not be ascertained whether this would apply with retrospective effect. For example, when codeine (as a composition) was banned, companies like Pfizer changed the cough preparation and relaunched it, but retained the brand name Corex, which has a huge recall. The government feels retaining the brand name in a new formulation where an ingredient has been tweaked is misleading and harmful for patients. While companies argue since they have invested in building a brand and it enjoys loyalty, they should be allowed to benefit from its value.

Need a new brand name if composition of drug is changed: Pharma regulator

The India Express- Prabha Raghavan

India’s apex drug regulatory body has asked its officials to take “all measures” to prevent companies from retaining the same brand name for different formulations. The regulator’s move aims to prevent patients from accidentally taking the wrong medicine in cases where pharmaceutical companies change the composition of their drug brands, but continue to sell the new formulation under the old brand name. According to a notification issued on Thursday by the Central Drugs Standard Control Organisation (CDSCO), the practice of changing the key therapeutic ingredients in a drug formulation without changing the brand name “is not only misleading but may also result in undesirable pharmacological effects as the consumer would take the formulation assuming that it has the earlier composition.” The Indian Express has reviewed a copy of this notification, which was issued to all zonal and sub-zonal CDSCO offices. The issue has been under discussion for “quite some time now”, stated Drug Controller General of India Eswara Reddy in the notification. The notification comes nearly eight years after the issue was deliberated by the Drugs Consultative Committee in three separate meetings held between 2008 and 2011.

What's bugging Indian, Chinese medicine companies making crucial heart drug

Business Standard- Anna Edney

A pair of drugmakers in India that the U.S. is counting on to produce generic blood-pressure pills after a far-reaching recall have been faulted by regulators for quality-control issues. Cadila Healthcare Ltd. and Alkem Laboratories Ltd. both won approvals in March from the Food and Drug Administration to make generic versions of valsartan for the U.S. market. Neither company made any of the recalled valsartan, but both companies have recently been cited by agency inspectors for quality-control failures that echo problems at other drugmakers renewing questions about the safety of some of the world’s most widely prescribed medicines. Workers ignored testing data showing product flaws; destroyed records indicating that drugs were failing key quality measures; and didn’t properly clean equipment, FDA inspection reports stated. Inside one factory, inspectors said they saw swarms of insects.

Can Indian pharma weather the twin-storm in US of price-fixing and quality?

Business Today- E Kumar Sharma

Leading Indian generic pharma companies have come under the spotlight in the United States. This time for all the wrong reasons. They figure among 20 global generic companies facing, arguably, the largest ever lawsuit in the US. As many as 44 out of 50 states in United States of America (USA) have jointly come together accusing these companies of price-fixing conspiracy and violation of federal anti-trust laws and a number of state laws. Figuring among them are some of the biggest names from India - Dr Reddy's , Aurobindo, Lupin, Glenmark, Wockhardt and Zydus apart from Taro, the US subsidiary of the largest Indian pharma company Sun Pharma.

Tweaking formulations: DCGI asks state FDAs to act against errant pharma companies

Moneycontrol-Viswanath Pilla

The Drug Controller General of India (DCGI) has directed drug controllers of all states and union territories to take action against manufacturers who are changing the active pharmaceutical ingredients (APIs) in a drug formulation but retaining the brand name of the old formulation. "..,the Drug Consultative Committee (DCC) unanimously resolved that the change of formulation composition without changing the brand name is not only misleading but may also result in undesirable pharmacological effects as the consumer would take the formulation assuming that it has the earlier composition," said Eswara Reddy, DCGI in a note on May 16 to state drug controllers. DCCI also recommended that this practice needs to be discouraged and State Drugs Controllers should ensure that the same brand name should not be permitted to be retained by the manufacturers if the composition of APIs in the new formulation is changed.

Antibiotic-Resistant Bacteria Found in Food: What, Why & How You Can Deal With It

The Better India-Vidya Raja

Did you know that India is one of the largest consumers of antibiotics in the world? Naturally, their misuse and overuse is rampant. As a result, ‘super bugs’, that are resistant to all known types of antibiotics, are starting to thrive. In this article, we look at what antibiotics are, why we develop a resistance to them, the connection between the food we eat and antibiotic resistance, and ways in which we can curb it. Antibiotics are medicines used to prevent and treat bacterial infections. They work by stunting the growth or by destroying the bacteria in the body. Over time, bacteria develop resistance to the medicine. This can lead to prolonged illness and even increased mortality. An antibiotic-resistant bacteria will survive and multiply within the host body despite being exposed to antibiotics. This is a major hurdle in treating a particular disease.

Delhi HC Restrains Hyd-Based Natco Pharma From Making Cancer Drug Ceritinib Claimed To Be Patented By Novartis [Read Order]

Live Law- Akanksha Jain

The Delhi High Court has restrained Hyderabad-based Natco Pharma from manufacturing fresh stock of drugs comprising of compound named 'Ceritinib' meant for treatment of non small cell lung cancer but allowed it to sell the existing stock keeping in the interest of the patient community. Justice Pratibha M Singh passed the order while directing Natco to file response to the injunction application moved by Swiss Pharma major Novartis which claimed to have been granted patent for Ceritinib which it said was a "novel and inventive compound" for treatment of non small cell lung cancer (NSCLC). Novartis claimed that the suit patent was filed as a Patent Convention Treaty application claiming priority since 2007, and was granted on 28th September, 2015. Novartis said it was forced to move court for injunction after it came across 'Ceritinib capsules' launched by Natco under the mark NOXALK at a pharmaceutical conference at Kolkata on March 29.

Healthcare News

HC orders demolition of 6 floors of city hospital; calls erring officials ‘traitors’

The Times of India-TNN

Chennai: Officials who fail to stop construction of illegal buildings are traitors of the nation, said Madras high court, taking exception to the fact that a city hospital built nine floors though it had been permitted to have only stilt-plus-three floors. Frowning at Billroth Hospital for having constructed six illegal floors at its facility in Shenoy Nagar, the court has now ordered the demolition of all floors beyond the legally permitted 3rd floor. A division bench also ordered disconnection of electricity to all floors beyond 3rd floor by May 31 and restrained the hospital administration from admitting any new patient beyond 3rd floor with immediate effect. A livid division bench comprising Justice S Vaidyanathan and Justice Subramonium Prasad also nominated advocate T Mohan as amicus curiae and tasked him, along with principal secretary/member-secretary of CMDA to be present at the site and supervise the demolition process. They shall also arrange for take photograph and videograph of the demolition process, and furnish the details in court by June 24, when the case is scheduled to be taken up for further hearing. “The present case is a classic example and revolves around the illegality committed by the hospital authorities, who, though obtained a plan for constructing three floors, had constructed nine floors unauthorizedly,” said the judges.

Maternal deaths drop in govt hosp

The Times of India-Pratiksha Ramkumar

The Coimbatore Medical College Hospital (CMCH) has managed to reduce maternal deaths by 12% to 47 last year from 54 in 2017. This is the lowest number of maternal mortality rate recorded in the hospital in the past five years. Hospital authorities said they managed to achieve this feat by consciously increasing the number of senior staff on duty and acquiring more diagnostic equipment. Data with CMCH, the tertiary care hospital for the entire western region, shows that the number of maternal deaths, which marginally increased in 2017 due to more admissions and deliveries, fell sharply in 2018. The hospital recorded 52 deaths in 2015, 53 in 2016 and 54 in 2017. However, the number dropped to 47 last year. It is to be noted that the number of deliveries has steadily been increasing in the hospital. The hospital, which had just 6,000 deliveries in 2015, performed 8,227 deliveries last year. According to the hospital authorities, of the 47 deaths, in at least 10-15 cases patients were either brought dead or shifted to the hospital in critical conditions. “They were not regular patients of the hospital.

Donor’s name added to accused list

The Times of India-Siva G

Rattled by the kidney scam, which came to light last week, a few people’s organisations staged protest in front of a private hospital in the city. They alleged that many hospitals have become illegal kidney hubs and demanded that the government cancel the licences of hospitals found involved in such scams. The district administration too has turned their focus to hospitals in the city where organ transplants are done. Meanwhile, the three- member committee investigating the scam visited Sraddha hospital once again on Thursday evening to verify a few documents. They will submit a report by Friday evening or Saturday morning. “Once the committee submits the report, we will focus on other hospitals involved in organ transplantations. We will set up a separate mechanism to verify the records. Action will be taken against any hospital found to have flouted the set norms,” said district collector K Bhaskar.

Ignoring hypertension may lead to heart attack, stroke

The Times of India- TNN

Despite hypertension being one of the major risk factors for heart diseases, kidney failure and brain stroke, people often deliberately or inadvertently ignore it. According to city-based doctors, persistent ignorance towards hypertension leads to major health hazards. “The biggest challenge is hypertensive people not being aware of their blood pressure and even if they are aware, more than 50% do not treat it adequately,” said Dr Sudhir Bhandari, principal and controller, Sawai Man Singh Medical College. Dr Bhandari adds that hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths in India. The WHO rates it as one of the most important causes of premature deaths worldwide. High blood pressure (BP) is ranked as the third most important risk factor for cardiovascular health status. Even though, hypertension is taking a toll on the health of increasing number of people, it is seen that people are not taking proper precautions and treatment.

Mumbai: Doctors say prevalence of high BP is going up in youngsters

Daily News & Analysis

As per the doctors, unhealthy habits, lack of exercise and stress are few of the major reason for hypertension disease. The prevalence of hypertension in young and working adults is going up. Dr Pravin Kulkarni cardiologist, Global Hospital Parel, Mumbai said, "The scariest trend is the number of young patients with hypertension. One in three or four individual is a hypertensive. In the youngsters of age group 18-25, one in the eight is now hypertensive. Lack of physical activity, unhealthy eating habits lack of sleep and stress is causing a sudden surge in hypertension." The doctors recommend people to stay physically active and exercise regularly. Dr Kulkarni, added, "To de-stress, one can opt for relaxation techniques like yoga and meditation. Follow proper sleep hygiene and see to it that you sleep at least 7-8 hours."

Lisie Hospital doctors save 9-day old infant with heart ailment

The New Indian Express

Fear and trepidation had gripped young Jamsheela’s heart, when she arrived at Lisie Hospital, nine days ago, with her one-day-old infant who suffered from a serious cardiac problem. She was, however, all smiles on Thursday, relieved that the first phase of treatment had been successfully completed by the team of doctors at Lisie. At the press conference held at the hospital, joy and exuberance, at having successfully treated the infant’s condition was writ large on the faces of doctors and staff, as they celebrated the occasion. According to the doctors, when the infant was brought to the hospital from Malappuram, she was diagnosed with a ventricular septal defect, with pulmonary atresia. “It was a joint effort of a team of doctors here - the child did not have the valve and artery carrying blood to the lungs from the right ventricle of her heart, and there was a hole in the walls separating the lower chambers of the heart. The timely intervention of the doctors helped the infant survive,” said Head of Paediatric Cardiology Department, Dr Edwin Francis at the press conference.

Nurses, building bridges between doctors and patients

ET Healthworld- Col Binu Sharma

Doctors are often considered no less than God for us, saving and curing us from various illnesses, ensuring that we lead a healthy life. However, while doctors usually receive the appreciation and gratitude due to them, there are some people in the medical systems who give more than they receive. Doctors might not always have all their time to spend with one patient. But we cannot ignore the fact that patients require treatment and time beyond medicines and surgeries too and that is where nurses come into picture. More than patient treatment, patient care is highly significant and goes beyond the medical aspect. It is not an uncommon understanding that patients often go through stress and anxiety about their conditions, their disease, injuries, medical proceedings, surgeries, or recovery. Hence it becomes crucial that the patient’s emotional needs are adhered to as much as their physical condition. Nurses in a hospital set-up facilitate this aspect quite well in by their display of empathy, and their availability. Nurses nurture a synergized relation with patients, and stand tall as the back-bones of the hospital, being there for the doctors as well as the patients.

Doctors unveil first child blast wound manual

ET Healthworld- AFP

Doctors and rights activists unveiled on Thursday the world's first field manual for the treatment of child casualties from explosions, which they say cause almost three-quarters of juvenile deaths and injuries in war zones. The guide was put together by British aid agency Save the Children and experts at Imperial College London at the request of Syrian medics working in the bloody eight-year civil war. "It starts from the point when something goes 'bang' and a child is exposed to that explosion," former British army surgeon Paul Reavley, one of the manual's authors, told AFP.

At least 400 Pakistanis infected with HIV after doctor used contaminated syringes

The Hans India

Parents nervously watch as their children wait to be tested for HIV in a village in southern Pakistan, where hundreds of people have been allegedly infected by a doctor using a contaminated syringe. Dispatched to keep order, police scan the anxious crowd as families hustle into one of five different screening rooms set up in the last month in the village of Wasayo, on the outskirts of Larkana in Sindh province. Health officials say more than 400 people, many of them children, have tested HIV positive in recent weeks as experts warn of a surge in infection rates across Pakistan, due to the use of unsanitary equipment and rampant malpractice, often at the hands of quack doctors.

For some trauma doctors, clash with NRA proves therapeutic

Reuters- Daniel Trotta

A recent clash with the National Rifle Association (NRA) has shown some doctors who treat gunshot victims a way to heal their own trauma: through activism against gun violence. With rates of post-traumatic stress disorder (PTSD) on par with that of Iraq and Afghanistan war veterans, trauma surgeons have found that speaking out helps them cope with the hopelessness and anger that come from seeing gunshot victims repeatedly wheeled into the trauma bay. “Working in advocacy is a way to deal with burnout,” said Dr. Jessica Beard, a trauma surgeon at Temple University Hospital in Philadelphia. The doctors’ clash with the NRA began in November after the American College of Physicians published a paper about reducing firearm injuries and deaths in the United States. The NRA answered with a tweet admonishing “self-important anti-gun doctors to stay in their lane.”

Hips Don't Lie

Reproduced from http://www.indialegallive.com/health/hips-dont-lie-65357, published May 12, 2019
J&J has been told to pay Rs 25 lakh to each patient who underwent surgery due to its faulty implants. Is this enough and how are compensations calculated?
The Delhi High Court recently directed pharma major Johnson and Johnson (J&J) to make an interim payment of Rs 25 lakh each to four patients who had undergone revision surgeries after receiving faulty hip implants of the company. The direction was issued without prejudice to the rights and contention of the parties" in the matter. Justice Vibhu Bakhru said the interim payment should be made before May 29, the next date of hearing. The interim order came after J&J volunteered to pay Rs 25 lakh as compensation to the affected patients.....read more

Physician leaders reaffirm opposition to IAAF rules

The World Medical Association has reaffirmed its opposition to IAAF gender rules for classifying female athletes as 'contrary to medical ethics'.
In a letter to the International Association of Athletic Federations, the WMA says 'we stand firm against any practice requiring physicians to use their competence and skills for any other purpose than providing medical care in the best interest of their patients and in respect of their dignity'.
The IAAF rules require women athletes with specific differences in sex development to medically reduce their natural blood testosterone....read more


Should doctors smile while talking to their patients?