Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 22 th April, 2019

Candida auris: The emerging superbug

1.Candida auris (C. auris), an emerging fungus which can cause deadly bloodstream and infections in people with weakened immune systems, has presented a serious global health threat

2.Currently, there are 617 clinical cases of C. auris reported in the United States as of Feb. 28, including 587 confirmed and 30 probable cases, according to the CDC.

3.Most C. auris cases in the United States have been detected in the New York City area, New Jersey, and the Chicago area.

4.It is highly drug-resistant, which means it is resistant to multiple antifungal drugs commonly used to treat Candida infections.

5.It is transmitted in healthcare facilities. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

6.It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.

7.Since 2016, increasing numbers of infections have been reported from various American states, and from over 20 countries.

8.According to the CDC, 30 to 60 percent of people with C. auris infections have died.

9.Most C. auris infections are treatable with a class of anti-fungal drugs called echinocandins. However, some C. auris infections have been resistant to all three main classes of anti-fungal medications, making them more difficult to treat.

10.He said the infection would not pose threats to healthy people, as it always hits those with severe sickness. There is no need for the public to worry about it.

The mainstay of infection control measures for C. auris in acute care hospitals and high acuity post-acute care settings is as follows:

  • Placing the patient with C. auris in a single-patient room and using Standard and Contact Precautions.
  • Emphasizing adherence to hand hygiene.
  • Cleaning and disinfecting patient care environment and reusable equipment (daily and terminal cleaning) with recommended products.
  • Inter-facility communication about patient’s C. auris status at transfer to another healthcare facility.
  • Screening contacts of newly identified case patients to identify C. auris colonization.
  • Conduct surveillance for new cases to detect ongoing transmission.

FDA on endocrine drugs

1. The FDA approved the monoclonal antibody romosozumab to treat osteoporosis in postmenopausal women at high risk for fracture

2. The FDA issued a complete response letter declining to approve a new drug application for oral sotagliflozin a first-in-class dual SGLT1 and SGLT2 inhibitor for adult with type 1 diabetes

3. FDA approved an oral hydrogel therapy that induces feelings of fullness without adding calories for adults with overweight and obesity

4. FDA issued a safety labeling change order to Sprout Pharmaceuticals for the serotonin receptor agonist flibanserin ordering a modification to the boxed warning that states alcohol use is contraindicated when taking the drug.

5. FDA approved testosterone undecanoate in an oral capsule to treat men with certain forms of hypogonadism, the agency announced in a press release. The approval marks the first new oral testosterone replacement product in more than 60 years.

6. The FDA approved marketing of a generic version of testosterone gel 1.62% as replacement therapy for men with hypogonadism.

Healthcare News Monitor

Dated: 21-22th April, 2019

Superbug fast becoming global health threat; present in India: experts

The Statesman

C. auris is a deadly infection; immunocompromised persons are more vulnerable to develop this infection. People who recently had surgery, live in nursing homes, or who have breathing tubes, feeding tubes or central venous catheters are especially at a higher risk, said Dr KK Aggarwal, former IMA president. Patients can remain colonised with C. auris for a long time and the fungus can survive on hospital surface for a long duration. This facilitates spread of C. auris between patients in healthcare facilities, he says. C. auris can cause different types of infections, including bloodstream infection, wound infection, and ear infection. The symptoms of C. auris infection are not easily identifiable as the patients are already critically ill.

Attack on doctors: Will Delhi govt’s new order against violence in hospitals change things?

The New Indian Express

At Pitampura’s Bhagwan Mahavir Hospital, a patient was rushed to the emergency ward four years ago. As doctors turned their attention to him, his relatives demanded that they be allowed into the ward. An argument ensued, and ended with the relatives raining blows on the doctor. Within 16 hours, another case was reported from Babu Jagjivan Ram Memorial Hospital in Jahangirpuri. The two incidents had pushed 20,000 resident doctors at government hospitals to launch a strike, demanding improved security inside hospitals.

A handful of VVIP deaths in recent times puts the focus back on the landmark judgment of the apex court last year where it held that the right to die with dignity is also a fundamental right

India Legal

By Dr KK Aggarwal

We often see that politically sensitive deaths are put on hold until the security threat is over or to avoid violence and unrest. Sometimes, this is done to deal with the politics of succession. According to a recent report in The Times of India, which later created a controversy, former Tamil Nadu CM J Jayalalithaa died on December 4, 2016, at 5.15 pm and not on December 5, when her death was announced to the public; this was done in view of security reasons. Similarly, a view abounds that former Prime Minister Indira Gandhi was taken to the All India Institute of Medical Sciences (AIIMS) in New Delhi at 9:30 am on October 31, 1984, after she was shot by her own security guards, but fearing violence, it was only late in the evening that she was declared dead. Very recently, speculation raged over whether the chief minister of a western state, although clinically dead, was being kept alive with some specific purpose in mind. Maharaj Ashutosh’s frozen body has been kept for the last five years on the grounds that he is in samadhi and will come back to life.

Nutritional deficiency should be addressed at a young age


Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India, said, "Micronutrient deficiencies or deficiencies of vitamins and minerals, often referred to as hidden hunger mainly due to diets inadequate in fruits and vegetables as well as whole grains and millets, are not apparent but considered ubiquitous. The primary reason for this deficiency is the availability of foods rich in carbs, sugars and fats, but lacking in vital vitamins and minerals. This is also aggravated by the fact that the consumption of junk food is increasing among educated, wealthier households in India. Although any individual can experience micronutrient deficiency, pregnant women and children are at greatest risk of developing deficiencies." NIN recommends consumption of 400 grams of fruit and vegetable per day for normal people, of which 100 grams should be fruit. Fruits and vegetables are rich sources of micronutrients and egg, milk as well as flesh foods are also good sources.

Pharma News

Torrent Pharma recalls over 10.78 lakh bottles of hypertension drug from US

The Times of India-PTI

New Delhi, Apr 21: Drug firm Torrent Pharmaceuticals Inc is recalling over 10.78 lakh bottles of hypertension treatment tablets from the US and Puerto Rico on account of deviations from current good manufacturing norms, as per a report of the US health regulator. The US-based arm of Torrent Pharmaceuticals is recalling 133,992 bottles of Losartan Potassium tablets USP in the strength of 25 mg manufactured by the parent company at its Mehsana facility, the Enforcement Report of the USFDA said. The company is also recalling 476,340 bottles of Losartan Potassium tablets USP, 50 mg from these markets, the United States Food and Drug Administration (USFDA) said. Torrent Pharmaceuticals Inc is recalling 121,668 bottles of Losartan Potassium tablets USP, 100 mg from America and Puerto Rico, it added. The company is also recalling multiple lots of Losartan Potassium / Hydrochlorothiazide tablets USP 50mg/12.5mg.

Local pharma companies to challenge MNCs in pneumonia vaccine space

The Prime Time

India has the highest burden globally for pneumonia-related child deaths. In 2016, the number of pneumonia deaths among children under five was 158,176 in India, according to the Pneumonia and Diarrhoea Progress Report released in 2018-end by International Vaccine Access Centre (IVAC) at the Johns Hopkins Bloomberg School of Public Health. Over two-thirds of the global burden of pneumonia and diarrhoea mortality occurs in just 15 countries and nearly half a million pneumonia and diarrhea deaths still occurred in two countries — India and Nigeria.

Barcoding raw materials used in drugs to become mandatory

Hindustan Times- Rhythma Kaul

New Delhi: The Union health ministry will make it mandatory for all active pharmaceutical ingredient (API) packages to be barcoded to detect spurious drugs and monitor imported and indigenously produced raw materials used to manufacture medicines. APIs are critical components that make drug formulations potent against disease. There are about 2,500 APIs that are used to create hundreds of thousands of drug formulations. “Raw material is usually supplied in bulk and its authenticity affects the final product. After the barcoding rule is implemented, the misuse of names and brands and sale of counterfeit drugs should come down significantly,” said Dr S Eswara Reddy, drugs controller general of India (DCGI).

Medicine labels in regional language

The Hindu-Bindu Shajan Perappadan

Move to curb fake, expired drugs. In order to counter fake, sub-standard and expired drugs, the Union Health Ministry has said Hindi and regional language will be used in the tendering process. “Drug names and expiry date during tendering will be in Hindi/regional language too for — polio drop and Iron tablets — procured for children under the government programmes,” said a senior health official. The Drugs Technical Advisory Board (DTAB) recently recommended that government procurement agencies should take necessary steps in the tendering process to include the regional language, along with English, on the label of iron tablets and polio drops in government programmes.

Government mulling to allow dentists practice modern medicine

MINT-Neetu Chandra Sharma

After heated opposition over government’s proposal to let AYUSH practitioners practise modern medicine, India’s policy think tank NITI Aayog is now exploring the option of allowing dentists to practice family medicine through a bridge course. The proposal has already received a nod from Prime Minister Office (PMO) on 9 April 2019. According to officials in the ministry of health and family welfare, the notion is to scale up the medical education in India. “In the said meeting it has been inter-alia decided to explore the option of allowing dentists to practise family medicine/main stream medicine following a bridge course. Accordingly, a meeting to discuss issues on leveraging dentists to provide primary health care thereby reducing the gaps of current shortfall of doctors in the country is scheduled to be held on 22 April 2019," stated Jyoti Khattar, senior research officer (Health) in her letter to Dental Council of India (DCI). Mint has reviewed the letter.

TN Guv bats for synergy betweeen modern & ancient medicines

Business Standard-PTI

Tamil Nadu Governor Banwarilal Purohit Sunday advocated interaction between modern and ancient medical traditions so that patients could reap its benefits. Inaugurating the "9th Reticon-2019," a conference on research and advances about the retina, Purhoit said newer technology in surgical management of retinal diseases offered a significant improvement in the success rate of surgeries. "While the system of medicine in which you have been trained has its own benefits, it is important that there is a continuous interaction between different medical traditions.

Prescription medicines, antibiotics being sold over the counter in Delhi

Hindustan Times

Many pharmacies across Delhi are selling prescription medicines for heart diseases, depression, pain and antibiotics for infection without a prescription, showed a visit to 10 pharmacies outside major public hospitals in central and south Delhi. Two online pharmacies refused to sell the same without prescription but arranged for a free consultation with a doctor, who sent the needed prescription. Six pharmacists dispensed medicine without a prescription, five provided bills for schedule H medicines they sold illegally, but four refused because the medicines sought were addictive.

Carlyle-Zydus and Advent join race to acquire Bharat Serums and Vaccines Ltd

The Economic Times- Reghu Balakrishnan

MUMBAI: A consortium of Carlyle and Zydus Cadila is competing with private equity group Advent International to acquire Mumbai based bio-pharmaceutical company Bharat Serums and Vaccines Ltd. (BSV). The two have submitted non-binding offers in the range of Rs 3,450-3,600 crore ($500-520 million), said multiple sources aware of the matter. They are up against domestic pharma companies Dr Reddy's Labs, Chrys Capital-backed Mankind Pharma and Goldman Sachs which have also made offers in the range of Rs 3,000 crore ($400-440 million), said one of the persons cited above.

National Institute of Nutrition to conduct pre-clinical drug development course

The Hans India

The National Institute of Nutrition (NIN), in association with UK-India Education and Research Initiative (UKIERI) and Ministry of Skill Development and Entrepreneurship (MSDE), is calling for applications from interested academicians for its five-day 'Train the Educator' course on 'Developing and Sustaining India's Capacity for Pre-Clinical Drug Discovery'. The course, which will be held at Indian Council of Medical Research (ICMR) -NIN, Hyderabad, between July 8 and 12, has been designed for educators, trainers, who are interested in continuing professional development in laboratory animal sciences.

Ayurveda research not getting priority in India: Expert

The Tribune

Panchkula: Over 100 Ayurvedic doctors from Haryana, Himachal, Punjab, Maharashtra and Karnataka participated in the national Ayurvedic workshop “Care and Cure” held at the Mansa Devi Temple complex in Panchkula today. The Ayurvedic experts observed that level of education in Ayurveda has increased but there was a need to increase quality of medicines and Ayurved graduates must stick to pure Ayurveda. Dr BN Kaushal, former chairman, Haryana Ayurveda Board, said every other person in Europe and America talks about research, however, research on Ayurveda does not get priority in India. He said no nation can progress without science and technology.

Healthcare News

Bottlenecks in better healthcare

The Pioneer-Savitha Kuttan

Timely training of primary-level doctors can help face the scourge of non-communicable disease that threatens the country and its citizens today. As India aspires to achieve the status of an economic superpower, the country needs to maintain good health of its vast population. In addition, when the health aspect comes into play, the role of doctors becomes all the more important. The ailing primary healthcare set-up in India has failed to keep pace with latest developments, thereby increasing the load on tertiary centre. Initially, the primary healthcare system was seen as a guard against preventing the burden of diseases to an advanced stage and to get preventive and cost-effective treatment. However, gradually, that role became redundant with the lack of trained and qualified physicians. Hence, the entire burden fell on hospitals in cities and urban areas.

This Doctor Is Making Healthcare Very Cheap For All, And His Idea Is The Future Of Medicine

India Times

Healthcare can be expensive, even more so in countries like the US. Even with medical insurance, and sometimes because of it, the treatment you're able to afford can be limited. Now, this doctor is trying to change that fact by upturning the whole system. Iora is a new healthcare group set up by CEO Rushika Fernandopulle. As a doctor fifteen years ago, he realised that the sort of treatment he wanted to give patients wasn't covered by their insurance. So he decided he'd switch things up.

ICMR Invites Doctors, Experts, Societies to submit scientific evidence for stem cell therapy

Medical Dialogues

In view of the increasing misuse of stem cell therapy and applicability in the country lying in the grey area, the Indian Council of Medical Research (ICMR) has now invited expert stakeholders including clinicians and representatives societies of professional to provide the current status of evidence-based use of stem cell therapy in diseases that their specialty deals with if any. The evidence shall be used to draft stem cell therapy guideline. The Last date for submission on the feedback is 30th April 2019 Stem cell research is a very active area of research around the world. The current research focus is to understand the biology of stem cells and their potential clinical applications in a range of human diseases. However, as a proven therapy, stem cells are currently considered as a standard therapy option only in certain haematolymphoid and immunological conditions, as listed in the National Guidelines for Stem Cell Research (NGSCR-2017).

‘India needs more eye doctors’

The Hindu

India is expected to have a large diabetic population of about seven crore by 2025. The progression and severity of diabetic retinopathy is directly related to the duration of diabetes and early medical intervention is necessary to prevent visual impairment, Governor Banwarilal Purohit said here on Sunday. While speaking at the 9th edition of RETICON, an annual conference on retina surgery, he said the number of eye doctors in the country definitely needs to increase. “The population of the blind in India is estimated to rise to 1.5 crore by 2020. There are only about 15,000 ophthalmologists in India who are registered with the All India Ophthalmic Society. It gives us a ratio of about 1 ophthalmologist for about a lakh people,” he said.

Doctors seek protection bill from Ranchi candidates

The Times of India

Ranchi: Issue of Medical protection bill and clinical establishments Act 2010 were raised vehemently by the doctor’s community during an interaction with the candidates of Ranchi Parliamentary constituency on Sunday. Indian Medical Association Ranchi chapter in collaboration with Junior Doctors Association of RIMS had organised a debate between the candidates to raise issues of medical fraternity. The doctors demanded implementation of Medical protection Bill at the earliest which is stuck in Jharkhand assembly. Apart from that they also asked the candidates to provide relief to doctors from several provisions of Clinical establishment Act, 2010 which are becoming an obstacle in running small clinics.

Microbiologists seek role in treatment

The Telegraph- G. S. Mudur

Indian medical microbiologists have asked medical education regulators to modify the postgraduate MD microbiology course to build a cadre of infectious disease specialists and expand microbiologists’ role in the treatment of patients. The Indian Association of Medical Microbiologists (IAMM) has asked the Board of Governors of the Medical Council of India to change the degree title to MD clinical microbiology and change its curriculum to enhance clinical training for microbiologists. Doctors who complete the MD clinical microbiology course should have the clinical competence to assess, investigate, diagnose and treat any patient with an infection, including tropical infections, sepsis, community-acquired or emerging infections, the IAMM has proposed. “The existing MD microbiology curriculum is not patient-centred — it is entirely sample-centred and laboratory-oriented,” said Raju Ravikumar, professor of neuromicrobiology at the National Institute of Mental Health and Neurosciences and a member of IAMM.

Large public hospitals far more cost-effective: Government

Hindustan Times-Anonna Dutt

Large and busy public hospitals in Delhi are among the most cost-effective, with the average cost of treating a patient at the state government’s busiest hospitals — Lok Nayak and Guru Teg Bahadur (GTB) — being a fraction of what is spent by superspeciality centres such Delhi government’s Institute of Liver and Biliary Sciences (ILBS). In 2018, the average cost of treating one patient at the 1,837-bed Lok Nayak hospital was ?2,234, and ?1,188 at the 1,512-bed GTB, reveals Delhi government’s outcome budget data. “?2,000 cost per patient is not much. If you go to the private sector, just the consultation fee can come up to ?5,000. And, the revenue costs of the government and the private sector are incomparable; here there are rules for everything, we have to employ a certain number of people, we cannot ask them to do anything other than what they were hired for, we need to pay them according to the scale, and we cannot stretch their shifts unlike the private hospitals. The costs are offset by the number of patients we treat,” said Dr Kishore Singh, medical director of Delhi government’s biggest, Lok Nayak Hospital.

Indore: MGM Medical College admin to review assessment system

Free Press Journal

Shocked by failure of 25 MBBS final year students in internal and practical examination, Mahatma Gandhi Memorial Medical College administration has decided to review the internal assessment process.In a meeting held on Friday, college administration raised concern over it as dean Dr Jyoti Bindal sought explanation from all the department heads. Addressing the faculty members, Dr Bindal said, “Meritorious students who topped in entrance exam can get admission in MGM Medical College. What happens in these five years is that students who topped in entrance exam failed in internal assessments even after getting good marks in theory part.” Dr Bindal directed department heads to review internal assessment system and decided to give internal assessment marks on quarterly basis so that students can improve in subjects they are weak by the time final assessment is carried out. College administration has decided to set accountability of teachers over poor marking and told them to monitor the performance of medicos.

Madurai medical college still awaiting MCI nod to increase seats at medical college

The New Indian Express

MADURAI: More than a year after Minister of State for Health and Family Welfare told the Parliament that the number of MBBS seats in Madurai Medical College would be increased to 250 from August 2018, the college is yet to get the approval from Medical Council of India (MCI). In February last, Minister of State for Health and Family Welfare Ashwini Kumar Chaubey, in a written reply, told the Parliament that in Tamil Nadu, the number of MBBS seats in government medical colleges in Madurai, Tirunelveli, Kanniyakumari and Coimbatore would be increased by 345. According to the announcement, the number of MBBS seats in Madurai Medical College will be increased from 155 to 250. However, the announcement by the Centre was not effected as approval from Medical Council of India (MCI) was pending until the time of admissions in August last year.

Time to fight for the rights of mentally challenged people

The Indian Medical Association (IMA) and Indian Psychiatric Society have condemned the title and poster of a soon to be released film "Mental Hai Kya". They have also asked the producer of the film to withdraw the trailer and also change the title and content, if it has any such provocative sequence, dialogues or songs. The film is a dark comedy centered on the lives of its two protagonists, both of whom show suicidal tendencies.
The title of a recent film "PK" may be an oblique reference to "somebody who is drunk". Films like "Munna Bhai MBBS", "Gabbar is Back" had also projected the medical profession in a bad taste.....read more

Not eating good food vs eating bad food

Results of a systematic analysis for the Global Burden of Disease Study 2017, published online April 3, 2019 in The Lancet show that dietary factors accounted for 11 million deaths in 2017 and inadequate intakes of healthy foods caused more deaths compared to excessive consumption of unhealthy diet. And, improvement of diet could potentially prevent one in every five deaths globally.
Analyses of data from epidemiologic studies showed that globally, the largest deficiencies in healthy food consumption were related to nuts, seeds, milk, and whole grains, whereas sugary drinks,....read more


Think differently in mythology