Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 21th May, 2019

People with calcium stones should not cut back dietary calcium

It may be surprising, but results of a randomized clinical trial show that people with calcium kidney stones should not cut back on dietary calcium. In fact, they should consume the recommended daily allowance of calcium (1,000 mg/day for women younger than 50 years old and men younger than 70, and 1,200 mg/day for women over 50 and men over 70).

Why? Calcium binds to oxalate in the intestine and prevents its absorption through the gut, so there is less in the urine to form stones. Ideally, calcium should come from food.

Foods high in oxalates (nuts, spinach, potatoes, tea, and chocolate) can increase the amount of oxalate in the urine. Consume these in moderation.

Potassium citrate is another medication that can bind to calcium and help keep calcium oxalate and calcium phosphate in the urine from forming into stones.

Hypertension during pregnancy can be detrimental to mother and baby: HCFI

Awareness must be raised on preventive measures during and after pregnancy

New Delhi, 17th May 2019: National studies show that prevalence of hypertension among the Indian urban middle-class men and women is 32% and 30%, respectively. Factors such as family history, age, gender, diabetes mellitus, kidney disease, obesity, alcohol consumption, smoking, physical inactivity, and stress increase the risk. Despite this, not many people are aware of the condition or do not take preventive measures at an early stage.

Research indicates that women with high blood pressure, especially during pregnancy, are at a two-fold risk of heart failure post-delivery.[1] The need of the hour is to monitor women before discharge and after giving birth, through the postpartum period.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Hypertension during pregnancy can be detrimental to both the mother and the baby. Women with high blood pressure can develop resistance in their blood vessels. This hampers the flow of blood throughout the body including the placenta and uterus leading to problems with fetal growth. It can also cause premature detachment of the placenta from the uterus, disruption in the flow of oxygen to the placenta leading to delayed fetal growth, or in worst cases even stillbirth. If not closely monitored before, during, and after childbirth, it may become a major cause of heart problems including heart failure in such women. Some other fatal repercussions of high blood pressure include pre-term birth, seizures, or even death of the mother and the baby.”

Heart failure, or peripartum cardiomyopathy, can occur up to five months after giving birth. Some symptoms of this condition include tiredness, shortness of breath, swollen ankles, swollen neck veins and feeling of missed heartbeats or palpitations.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “It is imperative for women diagnosed with hypertension to remain hospitalized for some time. Although the damage caused by peripartum cardiomyopathy to the heart is irreversible, it can still function with the help of some medications and treatment. In severe cases, a heart transplant may be recommended. Women must take steps to bring blood pressure under control from the time they wish to conceive, through certain lifestyle changes.”

Drugs such as beta-blockers can help reduce blood pressure. Diuretics are another class of drugs that help lower blood pressure by removing excess water and salt from the body. Some other treatment options include coronary artery bypass surgery and implantable cardioverter defibrillators.

Some tips to control and prevent high blood pressure from HCFI

  • Monitor your blood pressure before, during, and after pregnancy.

  • Consume less salt as a high intake can raise blood pressure.

  • Be physically active even during pregnancy. Sedentary women are likely to gain more weight than required, which can increase the risk of hypertension.

  • Make sure you are not taking medication that can raise blood pressure levels. If you already have high blood pressure, talk to your doctor about the steps that need to be followed.

  • Get regular prenatal checkups.

  • Tobacco and alcohol are not safe during pregnancy and must be avoided.

  • Healthcare News Monitor

    Be careful of the amount of exposure to the sun during peak summer: HCFI


    Statistics indicate that the incidence of skin cancer is about 70% more in Indian men than women. It is one of the most common types of cancers around the world and can even occur without regular sun exposure. May is observed as the skin cancer awareness month and the need of the hour is to raise awareness on how to protective oneself from the condition. Skin cancer occurs when there is unchecked growth of unnatural skin cells or tissues. The causes range from genetic factors to exposure to ultraviolet radiation. Although melanoma is the least common form of skin cancer, it accounts for majority of deaths due to the condition. Most skin cancers can be easily prevented by practicing sun safety measures. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, "Melanoma is one of the deadliest forms of skin cancer and develops in melanocytes or the pigment cells present in the skin. It can spread to other parts of the body (metastasize) and cause serious illness and death. One can use the ABCDE rule to spot signs of melanoma: A symmetry – one part of a mole or birthmark doesn't match the other; B order – edges are irregular, ragged, notched, or blurred; Color – this is not the same all over and may include shades of brown or black, sometimes with patches of pink, red, white, or blue; Diameter – spot is larger than ¼ inch across – about the size of a pencil eraser; Evolving – mole is changing in size, shape, or color."

    Pharma News

    Cancer drug could be repurposed to treat brain aneurysms

    Business Standard

    Drugs used for the treatment of cancer patients can also be used to treat brain aneurysms, claims a study. The study was published in the 'American Journal of Human Genetics'. Brain aneurysms are a bulge in a blood vessel caused by a weakness in the blood vessel wall. As blood passes through the weakened blood vessel, blood pressure causes a small area to bulge outwards. Treatment is difficult, involving complex surgery which is currently only attempted in select cases. Researchers have found a safer and more efficient possible treatment involving 'Receptor tyrosine kinase inhibitors'; a class of drug currently used to treat cancer.

    Orchid Pharma says closer to resolution as RP has received three plans

    Business Standard

    Orchid Pharma Ltd is one step closer to finalising its second attempt to find a resolution plan under the Corporate Insolvency Resolution Process (CIRP) it initiated earlier, as the Resolution Professional (RP) received three resolution plans as on May 17, 2019. The National Company Law Tribunal (NCLT) had earlier cancelled the resolution plan by US-based Ingen Capital after it refused to infuse the upfront amount, seeking certain data from the pharmaceutical company. According to a company filing with the exchanges, Orchid Pharma has said that the RP has received three resolution plans from prospective resolution applicants as on May 17, 2019. Resolution plans were invited on April 10, as per the order from NcLT on February 28, 2019, and the last date of submission of the plans was on May 10, which was later extended to May 17.

    8th Annual InnoPack Pharma Confex Set to Engage Industry Audience

    Business Standard- PTI

    CPhI Conferences, a division of UBM India, which hosts a number of successful pharmaceutical conferences, has announced the 8th Annual InnoPack Pharma Confex slated for 21 - 22 May, 2019 at The Sahara Star, Mumbai. The Confex promises to be the biggest platform for professionals from the Pharma packaging industry to congregate, network, exchange ideas and knowledge, form alliances and shape the future of the pharma packaging industry, all under one roof. The Indian pharmaceutical industry is undergoing fast paced changes. According to the recent report from Research And Markets, the Indian generics market is witnessing rapid growth opening up immense opportunities for firms. This is further triggered by the fact that generics worth over $40 billion are going off patent in the coming few years which is close to 15% of the total prescription market of the US. The Indian Pharmaceutical Industry is growing at 11% annually, and is ranked fourth globally in terms of volume, and thirteenth in terms of value. The Global Pharmaceutical Packaging Equipment market accounted for $5.98 billion in 2017 and is expected to reach $12.25 billion by 2026 growing at a CAGR of 8.3%. The pharmaceutical packaging market is increasingly playing a vital role in ensuring overall patient safety by carrying key information pertaining to product manufacturing, ensuring traceability of products and the industry is thriving with modernization due to several drivers. There is a growing regulatory thrust in this direction with complete unit level track and trace, innovations, patient safety and consumer preference becoming an everyday reality.

    New computer programme can help develop precision medicine

    Business Standard- PTI

    Scientists have developed a new computer programme to find out a person's genetic makeup, an advance that brings precision medicine a step closer. The programme, called Flye, provides a step-by-step procedure for computers to assemble genomes -- a person's complete set of genes -- and enables the process to be much faster and more accurate than current best-practice methods. "The breakthrough would lead to better prevention, prediction and diagnosis of illnesses, as well as improved treatment, disease management and cures," Yu Lin, a researcher at Australian National University (ANU). "We hope our innovation will help people to live longer and better -- particularly people suffering from diseases that are not currently treatable," said Lin.

    Investors keep food firms on warning over antibiotics

    ET Healthworld- Reuters

    An investor group managing some $5 trillion said it was pleased with the steps taken by fast-food companies to cut the use of antibiotics in their products and will continue to monitor firms as its three-year-long engagement comes to an end. Resistance to antibiotics has been flagged as a major risk to public health and economic growth by policymakers and the investor action formed part of global efforts to fight back by curtailing their use in the food chain. Since launching its engagement in 2016, the Farm Animal Investment Risk and Return (FAIRR) coalition said it had engaged with 20 companies worth a combined $280 billion. The companies were asked to establish a policy to phase out routine, non-medical use of antibiotics across their supply chains; specify clear targets and timelines for implementation; and report more transparently on their activities.

    Change name if drug contents altered: Central Drug Standard Control Organisation

    The New Indian Express

    The country’s drug regulator has warned manufacturers and marketers of pharmaceutical formulations against changing the contents of drug formulations without changing the brand name. In a circular, the Central Drug Standard Control Organisation has directed the state drug controllers and its zonal and sub-zonal officials to consider legal measures to discourage the unethical practice of pharma companies marketing formulations after changing their contents without changing the existing brand name. In the circular, the Drug Controller General of India said that it wanted the enforcement officers and drug controllers to ensure that formulations with changed contents were not marketed in the country with the old brand names as it confused both, the prescribers and the patients. The circular also said that the licensing authorities should not permit sale of formulations with changed compositions without a change in the brand name. The initiative follows complaints that some drug manufacturing companies, after changing the active pharmaceutical ingredients (APIs) of a drug formulation, were continuing with marketing the products with the old, registered brand name.

    Glenmark launches new diabetes medicine

    The New Indian Express

    Glenmark Pharmaceuticals, a research-led global integrated pharmaceutical company, announced the launch of its new diabetes medicine ‘Remogliflozin’ in Kerala. The drug is meant for the treatment of type-2 diabetes mellitus (T2DM) in adults. The launch took place at The Gateway Hotel, Kochi on Monday. Being developed by a Japanese firm, India is the first country where remogliflozin is being launched. The tablets will be available as Remo and Remozen in India. The launch is happening in India because it is known as the diabetic capital of the world. Remogliflozin has been studied in 26 clinical trials globally, covering around 2,500 patients from various ethnicity. This drug is has been introduced with the aim of making medicine affordable to more people. “Many are deprived of diabetes drug because of the high economic burden. This is where Remogliflozin is introduced. This can be afforded at Rs 25 per day,” said Alok Malik, senior VP of Glenmark. “The drug also provides cardio-protective benefits by way of reducing weight and blood pressure,” he said.

    Cure the illness from within

    The Pioneer-Tanu Priya

    In recent times, India has earned the distinction of being the “pharmacy of the world” for championing the cause of supplying affordable drugs to many countries. The pace at which the “pharmacy of the world” is growing, there’s no denying that India is utilising its full potential. That the domestic market grew by Rs 1.1 trillion in 2016-2017 and that India accounts for 20 per cent of the global export volume speaks volumes about our place in the global market. The Indian pharmaceutical market (IPM) is expected to grow at 9-12 per cent CAGR between 2016 and 2021. Owing to an increase in Government spending in the healthcare sector and with the launch of schemes like Ayushman Bharat, the domestic market is expected to witness further expansion in the near future. However, this is just one side of the story. On the other side, standard procedures, as mandated by the World Health Organisation (WHO) and also required by Western drug-regulating authorities like the Food and Drug Administration (FDA), to approve a batch of drug upon its import, are often sidelined.

    Healthcare News

    Civil Hospital emergency ward’s shift irks patients

    The Times of India- Shilpy Arora

    The entire emergency ward of the Civil Hospital has been relocated in order to renovate the entire premises of the 200-bed hospital. While emergency services, maternity ward, NICU (Neonatal Intensive Care Unit) and out-patient wards for physicians, paediatrics, dermatology and mental health are moving to the Sector 10 hospital, OPD for ENT, orthopaedics, physiotherapy and dentistry will move to a polyclinic in Sector 31. Even though there is still a doctor in Civil Hospital to help patients in case of emergency, both doctors and patients have raised concerns over shifting different departments to different locations, as they feel services will be affected and patients will have to bear the brunt.

    Ponda hospital without physician for five months

    The Times of India- Suraj P Kaisuvker

    Ponda: The Ponda sub-district hospital has been virtually saving lives of heart patients via consultation on WhatsApp as the health department has failed to appoint a physician since January. The facility, which caters to around 12,000 patients per month, was upgraded to a sub-district hospital on December 19, 2012, when it was shifted to a 220-bed fully furnished building. The upgrade was aimed at offering better secondary care facilities to people in the Ponda taluka and surrounding areas, but the hospital lacked several necessities, including medical and paramedic staff. On getting a patient with a history of heart ailment or symptoms related to it, consultants or medical officers at the hospital send an electrocardiograph (ECG) of the patient on WhatsApp to Dr Eddy D’Mello, an expert at Hospicio, Margao, almost 17km away from the sub-district hospital. The Ponda hospital consultants then treat the patient according to the telephonic advice received.

    5 kg tumour removed from man’s head

    The Times of India

    Madurai: A rare benign tumour weighing 5 kg was removed from a 31-year-old man at the superspecialty wing of Government Rajaji Hospital (GRH) in Madurai recently. The surgery was performed on Sakthivel of Dindigul on May 16 and he was doing fine, said neurosurgeon Dr J Srisaravanan, who led the team which operated on him. The senior doctor said he had never seen as big a benign tumour in the head in over 15 years’ time. “The procedure was carried out for close to 10 hours and we were able to remove the benign scalp tumour completely. The patient is fine, “he said.

    Patient's kin "manhandle" doctor at NIMS

    Business Standard- PTI

    Hyderabad” Some relatives of a 28-year-old man, injured in a road accident, allegedly assaulted a doctor at the state-run Nizam's Institute of Medical Sciences here Monday accusing him of negligence in treating the patient, police said. The incident occurred at around 6 am when some attendants of the patient "manhandled" senior medical officer Dr Anvesh. They also hurled abuses at the duty hospital staff and accused the doctor of "negligence" in treating the patient, police said based on a complaint lodged by the duty resident doctor. The patient, who was rushed to the hospital following injuries he sustained in the accident after his motorcycle skidded off the road, was brought in at 4.22 am, police said. The patient was given necessary treatment and shifted to the CT scan room by 5 am and then taken to the ultrasound room. The attendants found it apparently locked following which they immediately started manhandling the doctor, police said.

    Mumbai: Despite rare, fatal heart condition, 39-yr-old gets new life

    Daily News & Analysis

    A 39-year-old man has received a new lease of life after he was diagnosed with a rare disease called Viral Carditis which resulted in his heart swelling up. A viral infection of the heart, the condition is also known as Post-Viral Dilated Cardiomyotherapy. It is a rare health condition and in some cases, can prove to be fatal. The condition had caused his ejection fraction, which is the amount of blood that the heart pumps out, to drop from the normal 55 to 65 per cent to a low 17 per cent and was only two per cent away from requiring a heart transplant. It had also caused his valves to become weak and his heart had increased in size along with the presence of fluids around the organ. "When he first came to me his ejection fraction was 17 per cent and this is usually not correctable and had it went below 15 per cent then the only treatment possible was a heart transplant. I prescribed him a combination of medication, which is used especially in the United States and Europe and when he came for a follow-up after almost two months, his ejection fraction had increased to 55 per cent. There was no fluid around his heart," said Dr Rohan Sequiera, Consultant General Medicine at Jaslok Hospital and Research Centre.

    9 things the doctor wishes you knew about diabetes

    Bangalore Mirror

    Worldwide diabetes has increased more than 4 times since 1980. Prevalence is increasing particularly in Asian countries with almost 98 million people in India have diabetes (49% of the world’s diabetes burden). India’s IT capital ranks fourth in diabetes prevalence in a 2017 study with 20.74% of Bengaluru’s tested population suffered from diabetes. Adults across genders in the age groups of 46-60 and 61-85 showed the highest diabetes prevalence, 26.71% and 27.01% respectively. In our practice the prevalence in patients below 25 years is around 5% and the type 1 diabetes children is around 3%. Diabetes leads to complications in many parts of the body and risk of dying prematurely. A large proportion of diabetes and its complications can be prevented by a healthy diet, regular physical activity, maintaining a normal body weight and by avoiding tobacco & alcohol consumption.

    Doctors manage attachments from Health Deptt to GMCs; pose themselves as ‘Consultants’

    State Times- Vivek Sharma

    Making mockery of the system and to befool the innocent poor patients, the junior most doctors of the Health Department, attached to the Government Medical College (GMC) Hospital or Super Specialty Hospital (SSH) are impersonating themselves as consultants. In close vicinity of the GMC and SSH, a doctor has displayed a poster of a private clinic with his name inscribed prominently at the Maheshpura Chowk. Nobody in the GMC has ever taken note of this brazenness which is on display at a public space. When STATE TIMES inquired from the building owner, he put the blame on the doctor, who was recently attached to the SSH in Department of Nephrology. “We know the ‘Consultant’ tag depicted by Dr Raju Bhandari is fake, so we have asked him to get it removed,” said Vijay Bhardwaj, Director of Bhardwaj Agencies and Chemist, adding “If not removed, we are also planning to lodge complaint with police.” Bhardwaj reacted when he spotted STATE TIMES’ camera. This is not an isolated case. In Jammu, most of the attached doctors in GMC pose themselves as Consultants to befool the patients. In most of the crossings, these fake boards are on display.

    Telangana Govt wants doctors to work more

    Telangana Today- M.Sai Gopal

    The State government wants doctors at all teaching hospitals in Telangana to spend more time in outpatient departments so that they can provide service to a larger number of patients on a daily basis. To make this happen, the State government has also issued a circular to all the teaching hospitals defining the working hours of doctors. Senior health officials said the State government wants doctors to provide consultation to patients between 9 am and 2 pm in place of the existing consultation timings of 9 am to 12 noon. The authorities have also asked teaching hospitals to increase the registration time of OP patients till 12 noon. At present, every day, in the morning hours, a large number of patients flock to government hospitals from distant places to access OP facilities at top tertiary hospitals. However, a majority of them are sent back because the OP registrations are closed by 10 am at teaching hospitals.

    Current Temperature Status and Warning for next 24 hours

    Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 20 May to 0830 hrs IST of 21 May, 2019)

    Heat Wave:

    Yesterday, Heat Wave Conditions observed in some part of Madhya Maharashtra and in isolated pockets over Vidarbha and Telangana. (Annexure 1 & 2).

    Maximum Temperature

    Maximum Temperature more than 40.0°C were recorded at most places over Bihar, Uttar Pradesh, Madhya Pradesh, Madhya Maharashtra, Marathawada, Vidarbha, Chhattisgarh, Telangana and Rayalaseema; at many places over Jharkhand, Rajasthan, Gujarat Region, North Interior Karnataka; at a few places over Haryana, Chandigarh & Delhi, Saurashtra & Kutch, Coastal Andhra Pradesh, Tamilnadu & Puducherry and at isolated places over Odisha and Gangetic West Bengal.

    Maximum temperature departures as on 20-05-2019 Maximum temperatures are markedly above normal (5.1°C or more) at a few places over Madhya Maharashtra; appreciably above normal (3.1°C to 5.0°C) at many places over North Interior Karnataka, Rayalaseema and Jharkhand; at a few places over Telangana, Tamilnadu & Puducherry and Gangetic West Bengal and at isolated places over Vidarbha and East Madhya Pradesh; above normal (1.6°C to 3.0°C) at most places over Kerala and Bihar; at many places over Uttarakhand, Sub-Himalayan West Bengal & Sikkim, Chhattisgarh and South Interior Karnataka; at a few places over Saurashtra & Kutch, Assam & Meghalaya, West Madhya Pradesh and Odisha and Gujarat Region, Himachal Pradesh, Uttar Pradesh and Andaman & Nicobar. They are appreciably above normal (-3.1°C to -5.0°C) at a few Places over Jammu & Kashmir, West Rajasthan and Haryana Chandigarh & Delhi and at isolated places over Coastal Andhra Pradesh and near normal over rest of the country.

    Yesterday, the highest maximum temperature of 45.9°C recorded at Bramhapuri (Vidarbha).

    Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 21 May to 0830 hrs IST of 22 May 2019):-

    Heat Wave Conditions in isolated pockets very likely over Telangana, Rayalaseema, Madhya Maharashtra, Marathwada, Vidarbha, Chhattisgarh and Odisha. (For significance of colour code and criteria for Heat Wave, kindly refer to Annexure-3 at end of this document)

    Assistant Ambulance Officers: Save a Life First

    Reproduced from: http://www.indialegallive.com/viewpoint/assistant-ambulance-officers-save-a-life-first-65657, published May 19, 2019
    The debate over Assistant Ambulance Officers is needless, as in any medical emergency, what is vital is to save the life of the patient, even by a bystander
    A scheme started by the Delhi government in February seems to have run into trouble and has reached the Delhi High Court. A PIL has said that Assistant Ambulance Officers (AAOs) who are assigned the job of driving two-wheeler First Responder Vehicles should also be trained paramedics. However, the Delhi government has said that they will not transport patients and will only give basic medical assistance until an ambulance arrives.....read more

    The Indian Imperative For A Safer Alternative To Smoking

    Reproduced from: http://www.businessworld.in/article/The-Indian-Imperative-For-A-Safer-Alternative-To-Smoking/18-05-2019-170453/, published May 18, 2019
    The imperative for including technological innovations such as ANDS and tobacco harm minimization as a supplementary tools to our existing arsenal of tobacco control measures should be, in my considered opinion, the collective priority of the public health communities and governments across the globe to adequately and effectively address the scourge of tobacco and its adverse effects
    Tobacco smoking is one of the biggest public health threats to the world today. Ironically, it is a totally avoidable habit, affecting both the users and the bystanders....read more


    What is consciousness?