Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 23rd May, 2019

CDC recommendations for screening and testing health care personnel for tuberculosis.

A systematic review of evidence published after release of the 2005 CDC guidelines for preventing Mycobacterium tuberculosis transmission in health care settings found that a low percentage of health care workers have a positive tuberculosis test at baseline and upon serial testing. The CDC published its conclusions in the May 17 Morbidity and Mortality Weekly Report.

Health care workers should be considered to be at increased risk for tuberculosis if they answer “yes” to any of the following statements: residence for a month or more in a country with a high tuberculosis rate; current or planned immunosuppression, including HIV, receipt of an organ transplant, treatment with a tumor necrosis factor-alpha antagonist, chronic steroids, or other immunosuppressive medication; or close contact with someone who has had infectious tuberculosis since the last test.

Recommendations for testing U.S. health care personnel have been updated to include:

1.tuberculosis screening with an individual risk assessment and symptom evaluation at baseline (preplacement)

2.tuberculosis testing with a tuberculin skin test for people without documented prior latent tuberculosis

3.no routine serial tuberculosis testing at any interval after baseline in the absence of a known exposure or ongoing transmission,

4.encouragement of treatment for all health care personnel with untreated latent tuberculosis, unless treatment is contraindicated,

5.annual symptom screening for health care personnel with untreated latent tuberculosis, and

6.annual tuberculosis education of all health care personnel.

Novel technique reduces obstruction risk in heart valve replacement

Researchers at the National, Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, have developed a novel technique that prevents the obstruction of blood flow, a common fatal complication of transcatheter mitral valve replacement (TMVR). The new method, called LAMPOON, may increase treatment options for high-risk patients previously ineligible for heart valve procedures. The Journal of the American College of Cardiology (link is external) published the findings online on May 20.

TMVR is used to treat mitral valve stenosis, a narrowing of the valve that restricts blood flow into the main pumping chamber of the heart. It also treats regurgitation, which occurs when the valve leaks and causes blood to flow back through the valve. Untreated, these conditions can cause pulmonary hypertension, heart enlargement, atrial fibrillation, blood clots, and heart failure.

For elderly or frail patients, TMVR offers a less invasive alternative to open heart surgery. During TMVR, doctors replace the mitral valve by delivering an artificial valve through a a catheter, through blood vessels and into the heart. But in more than 50 percent of patients, the heart’s anatomy gets in the way. The heart leaflet is pushed back and blocks blood flow. This is known as left ventricular outflow tract (LVOT) obstruction, a common and the most life-threatening complication of TMVR.

To increase the availability of TMVR for this subset of patients, Khan and colleagues at NHLBI and Emory University developed a procedure that makes an intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction, dubbed LAMPOON.

In the LAMPOON procedure, the operator inserts two catheters through the patient’s groin, and then through the blood vessels until it reaches the heart. The doctor then uses an electrified wire the size of a sewing thread woven through the catheter to split open the leaflet. At that point, the patient is ready to undergo TMVR.

Surgeons cut out the leaflets when they replace valves. They can do it, because they have cut open the chest and the heart and can clearly see the problem. LAMPOON is designed for patients who need a new mitral valve, but can’t, or may not want to undergo open heart surgery.

Between June 2017 and June 2018, the LAMPOON study enrolled 30 patients, median age 76, considered at high risk for surgical valve replacement and at prohibitive risk of LVOT obstruction during TMVR.

All patients survived the procedure and 93 percent reached the 30-day survival mark, which compares favorably to a 38 percent reported with other methods. The primary outcome of the study, which combined a successful LAMPOON, followed by a successful TMVR without reintervention, was achieved in 73 percent of the patients.

Healthcare News Monitor

People with diabetes must be cautious during Ramazan fasting

The Indian Awaz

India has the third-largest Muslim population and a majority of them keep fast during holy month of Ramazan. This number will also constitute people living with diabetes and thus, the need of the hour is to fast while exercising caution. Fasting can bring about metabolic changes and they must adjust their diet plan during Ramadan. There is a 12- to 15-hour gap in between meals which can become a problem for those with diabetes. It is therefore advised that they consume regular and timely meals. People with Type 1 diabetes are at a higher risk compared to those with type 2 when fasting during the holy month. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Ramadan this year will continue till the month of June and the fasting period will be longer due to daylight hours. It is imperative that people living with diabetes consult their doctor and monitor blood glucose levels regularly. People with type 1 diabetes and a history of recurrent hypoglycemia have a higher risk during fasting. In those with Type 2 diabetes, there is a likelihood of hypo- and hyperglycemia. A patient’s decision to fast should be made after ample discussion with his or her physician concerning the risks involved. Patients who insist on fasting should undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. The management plan must be highly individualized. Close follow-up is essential to reduce the risk for development of complications.

Healthy diet and lifestyle can help avert metabolic disorders: HCFI


A recent study has found that people exposed to chemicals have an increased risk of acquiring metabolic disorders. They found that certain chemicals can lead to impaired liver function and thereby an increased likelihood of obesity, diabetes and heart disease. The need of the hour is to raise awareness about the incidence and prevention of metabolic disorders. Common additives used to manufacture plastics can be found in everyday items including milk, bottled water, instant coffee, perfume, makeup, shampoo, toys and food packaging. Exposure to certain chemicals called endocrine disruptors can also cause infertility and other issues. Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, "Our internal and external environment can affect our metabolism. Our bodies are composed of five elements, and all of them are responsible for different functions. For example, air and space affect movement; fire and water affect metabolism; and water and earth affect all secretions and structures. The three negative emotions that are responsible for diseases include 'ignorance, hatred and desire.' Physical sickness is caused by hatred, which further leads to disharmony of the bile. Diseases that stem from the middle and upper part of the body are caused by the mental emotion called hatred. In Ayurveda, this is called as 'Pitta' disorder and the person experiences metabolic and digestive issues. They can also be caused by eating unhealthy food or exposure to harmful chemicals and substances."

Pharma News

Health Canada approves Mylan & Biocon's biosimilar of cancer drug Herceptin

The Times of India- PTI

Biotechnology major Biocon and Mylan NV Wednesday said Canadian health regulator Health Canada has approved Mylan's biosimilar Ogivri co-developed with Biocon, used for the treatment certain breast and stomach cancers. Ogivri is a biosimilar to Hoffmann-La Roche's Herceptin. Mylan plans to launch the product this quarter and anticipates potentially being the first company to offer a trastuzumab biosimilar in Canada, the companies said in a joint statement. Ogivri is the first trastuzumab biosimilar approved in Canada and the second biosimilar from Biocon and Mylan's joint portfolio approved in the market, it added. Biocon Biologics Chief Executive Officer Christiane Hamacher said, "We are pleased to enable access to Ogivri, a high-quality biosimilar trastuzumab co developed and manufactured by Biocon as an affordable treatment option for HER2- positive breast and gastric cancer patients in Canada."

Indian firm to end Kazakhstan’s dependence on imported insulin

Hindustan Times- Rezaul H Laskar

Kazakhstan is set to overcome its dependence on imported insulin with an Indian firm planning to produce the drug at a facility in Almaty, reflecting the growing interest in Central Asia among India’s pharmaceutical companies. Indian and Kazakh officials admit bilateral trade, currently worth nearly $1 billion, has been held back by lack of connectivity and lack of information on both sides. The Kazakh government has stepped up efforts to woo Indian investors to overcome these problems, with 12 Indian firms participating in last week’s Astana Economic Forum. India’s RV Healthcare has inked a long-term agreement with the Kazakh health ministry to supply insulin and cancer medicines over 10 years. The firm’s new plant in the suburbs of Almaty is set to begin producing insulin within three years, after the drug is registered with local authorities.

Generic drugs can reduce the economic burden of diabetes: Dr. Vinaytosh Mishra

ET Healthworld- Guest Article

Diabetes is rising like an epidemic in India. According to Diabetes Atlas 2017 published by International Federation of Diabetes, 72.9 million people are living with diabetes in the country. This number is expected to become 134.3 million by years 2045. Moreover, 42.2 millions of Indians are living with undiagnosed diabetes, which constitutes 57.9% of the total population living with diabetes. The number of patients living with diabetes is bound to increase in the near future due to ongoing large-scale urbanization and increasing life expectancy. Diabetes is a physiological state in which there is a persistently higher level of glucose in the blood. This situation may adversely affect the organs like eye, heart, kidney, and skin to name a few. According to reports, a person living with diabetes has two times higher chance of getting a heart attack, which is a major cause of mortality in the case of diabetes. With the progression of diabetes, we witness the comorbidity and hence increase in the cost of diabetes management.

Pharma cos gear up to outsource FM services to address market needs & stricter global regulations

Pharmabiz- Shardul Nautiyal

Indian pharma companies are today outsourcing integrated facility management (FM) services as a major strategy to address market needs and stricter global regulations. According to experts, as production of generics is huge, pharma companies are now looking to outsource their non-core activities to meet US FDA’s strict regulatory scrutiny to manage risks better. With India being world’s largest exporter of generic drugs, pharmaceutical is going to be a large segment as the FM industry matures in India. “This is one of the reasons why the facility management market in India with regards to the pharma industry has seen progress over the years. It is evolving especially in the pharma product manufacturing space. Though the market is still fragmented but more and more pharma players have now started adopting the integrated facility management model,” says Purvin Patel, CEO, ISS Facility Services India Pvt. Ltd, which has a reputed clientele base of companies.

PCI should have conducted feasibility study & situation assessment prior to introduction of Pharm D in India: PS Bhagavan

Pharmabiz- Nandita Vijay

The Pharmacy Council of India (PCI) should have conducted a feasibility study, situation assessment and gap analysis prior to the introduction of Pharm D course in the country. For a mega programme like Pharm D, healthcare providers and the Medical Council of India should also have been consulted on the viability of this course and whether the role of a clinical pharmacist would be relevant in a hospital environment, opined PS Bhagavan, former deputy director, Karnataka Health and Family Welfare Department. Doctors are not recognising the role of a pharmacist in healthcare practice even as the job of a clinical pharmacist is to ascertain whether the prescribed medications are meeting the patients’ health needs, he added. When a dedicated six-year course was devised to fit into the healthcare system, it was necessary to stimulate the demand for the course to ensure supply of Pharm D professionals, Bhagavan told Pharmabiz. The intent to create a pool of clinical pharmacists was to avoid medication errors and put in place an Evaluated Evidence based Therapeutic System (EETS). The know-how to counsel the patient on the drug and give the feedback on the therapy compliance to the doctor could prevent considerable non- compliances in treatment protocols, he said.

India’s Biggest Drugmaker Plans to Start Developing Its Own Medicines

Bloomberg Quint- Ari Altstedter

You’d be hard-pressed to find someone who’s lost more during the recent upheaval in the generic drug business than Dilip Shanghvi: He forfeited $17 billion to be precise, plus the title of India’s richest man. After a four-year decline that erased 65% from the value of Sun Pharmaceutical Industries Ltd., the drugmaker he founded, Shanghvi is preparing to bounce back. He’s doing it by borrowing a page from Big Pharma’s playbook: investing in higher-margin patented medicines rather than relying solely on copying drugs.

Lupin launches asthma drug in the US

Ultra News- Soumya Thomas

Pharmaceutical major Lupin said it launched the asthma drug Budesonide Inhalation Suspension ampules in the US market. Budesonide Inhalation Suspension ampules are a generic equivalent of Pulmicort Respules Inhalation Suspension drugs of UK-based pharma firm AstraZeneca. Budesonide Inhalation Suspension ampules had annual sales of approximately USD 385.4 million in the US. Budesonide is used to control and prevent symptoms such as wheezing and shortness of breath caused by asthma. The medication belongs to a class of drugs known as corticosteroids. It works directly in the lungs to make breathing easier by reducing the irritation and swelling of the airways. It is also used as a prophylactic therapy in children from 12 months to 8 years of age.

Panacea Biotec gets USFDA nod for chemotherapy drug Azacitidine

Medical Dialogues- Farhat Nasim

Azacitidine is a chemotherapy drug used to treat myelodysplastic syndromes (MDS) with annual sales of about USD 110 million in US markets as per IQVIA data as of December 2018. Indian research-based pharmaceutical and health management company Panacea Biotec’s Oncology Parenteral Formulation Facility at Baddi, Himachal Pradesh has recently received United States Food & Drug Administration (USFDA) approval for manufacture and supply of Azacitidine Injection, 100 mg/vial, for the US market. New Delhi: Azacitidine is a chemotherapy drug used to treat myelodysplastic syndromes (MDS) with annual sales of about USD 110 million in US markets as per IQVIA data as of December 2018. “Panacea Biotec’s state-of-the-art pharmaceutical formulation facility at Baddi is already approved by the National Regulatory Authority (NRA) of India and USFDA for other oral solids and injectable products,” said Panacea in a filing.

Healthcare News

Number of women burns victims at Victoria Hospital dips in two years

The Times of India- Sunitha Rao R

The number of women patients at the burns ward of Victoria Hospital has not only declined but has also been lower than that of male patients for two years. Doctors see this as a sign of the reduction in women using inflammable substances like kerosene to commit suicide. The burns ward in the government-run hospital is the only specialty centre in the city that sees cases of over 30-40% burns, apart from St John’s Hospital. While 612 women were admitted to the ward in 2016, the number fell to 377 and 347 during 2017 and 2018 respectively. The number of women admitted in the first four months of 2019 is 124, far less than the 136 the ward saw during the corresponding period last year. While 540 men were admitted in 2016, the figures stood at 372 in 2017, 477 in 2018 and 157 this year.

Patient steps into hospital bathroom shaft, dies

The Times of India

A 65-year-old patient fell off the sixth floor and landed in fourth floor through bathroom shaft, while he had gone to the washroom at Government Multispeciality Hospital in Sector 16, Chandigarh. He succumbed to his injuries on Tuesday. The victim was admitted in the hospital and gone to the toilet when he accidentally fell from there. He was rushed to Postgraduate Institute of Medical Education and Research (PGI) where he died during treatment. Hospital authorities have marked inquiry into the incident and Sector 17 police is investigating the matter. No FIR has been lodged in the case so far. The deceased has been identified as Rampal, a resident of Dhanas. Rampal was admitted with ascites in the geriatric ward at the sixth floor of the government hospital on May 14.

Vigil at hospitals to be stepped up

The Times of India

Authorities on Wednesday decided to increase special protection force (SPF) as well as special police outposts at Nizam’s Institute of Medical Sciences and all teaching hospitals in the state in view of the recent attacks on medical staff. The decision was taken after a high-level meeting by the state health minister over increasing security concerns in government hospitals. While a few hospitals such as Osmania General Hospital, Gandhi Hospital and Niloufer Hospital already have 6-15 members of SPF force, there is need for increasing SPF deployment in other hospitals, officials said. Health minister Etela Rajender assured doctors at NIMS that he would deploy special protection force (SPF) at the hospital. The latest attack on a casualty medical officer (CMO) at NIMs yet again exposed the poor state of security at government hospitals, where attacks were carried out in the presence of private security guards, several times in the past.

Kerala boy with nose ailment gets operated for hernia; doctor suspended

Hindustan Times

The Kerala government on Wednesday suspended a senior doctor of Manjeri Medical College Hospital in Malappuram for performing a surgery on a seven-year-old boy for hernia instead of getting his nose treated. The victim, Muhamad Danish, was admitted to the hospital for an operation to remove polyps from his swollen nose. At the same time, a six-year-old boy Dhanush was also admitted to the hospital for hernia surgery. When Danish returned from the operation theatre on Tuesday with a heavy bandage on his stomach and a free nose, his parents suspected something was wrong and made inquiries with the hospital staff. They got to know about the two patients, who had similar sounding names. Initially, there were many attempts to cover up the incident. When his parents questioned the doctors, they said Danish also had a hernia problem. Luckily, the nose surgery was not done on Dhanush. Later, both Danish and Dhanush underwent their respective surgeries without any mix-up. The parents of Danish filed a complaint against the erring doctors.

Two infants die at Giridih hospital, kin rough up doctors

Hindustan Times- Manish Raj

Two infants, born on May 19, died at a government hospital in Giridih district early morning on Tuesday after being given an immunisation vaccine, triggering violence by the family members who alleged medical negligence and roughed up doctors and some staff members at the hospital. The police said no case was registered as no written complaint was received from either side. While one of the families is from Mufassil area of the district, the other is from Giridih town. Family members claimed the infants developed medical complications after being administered a wrong injection by one of the doctors of the hospital. Dr Ramrekha Prasad, civil surgeon, Giridih Sadar Hospital, said they had organised a routine immunisation programme for infants on Monday morning and several infants, including the deceased, were administered the vaccines.

In climate change-hit Bangladesh, hospital boats keep healthcare afloat

The Indian Express- TRF

Living on a secluded island in northern Bangladesh, several hours from the nearest hospital, Abdul Jalil believed he was destined to die blind. That changed earlier this month when the 67-year-old underwent free cataract surgery on a ship moored next to his home. “I can’t wait for my eye bandage to come off,” Jalil told the Thomson Reuters Foundation. “It’s been so long since I last saw my son properly. I think I have forgotten how he looks.” Jalil lives on an island formed about two decades ago on the Jamuna River from sand and silt deposits. These islands – known as chars in Bangladesh – are constantly changing shape as they erode and reform, a process that is quickening as a result of more extreme rainfall associated with climate change.

Refrain from online ads, TNMC advices doctors

The New Indian Express

After complaints that some doctors are placing online advertisement to promote their practice, the Tamil Nadu Medical Council (TNMC) has sent advisory to all deans of medical colleges and medical associations, Tamil Nadu and Puducherry, to advise registered medical practitioners (RMPs) to refrain from such activities. Violation will be viewed seriously, the council said. In its advisory dated May 21, Registrar, TNMC, said,” It is brought to the notice of this council that some registered medical practitioners are engaged in placing online advertisement to promote their practice. All the RMPs are advised to refrain from such activities. Any violation will be viewed seriously”. “As per the Professional Conduct, Etiquette, and Ethics Regulations notification clause 6.1.1 of the Medical Council of India, it is a misconduct for an RMP to advertise about themselves, their practice, qualifications, associations, affiliations, honours and skills in order to solicit patients and professional gain (except for formal announcement for a short period as exempted in the said clause),” the Registrar added in the advisory.

Charitable clinics to the rescue of patients

The Tribune- Rakesh Kochar

INDIA fares poorly on the health index. With only 1% of GDP being spent on health and a shortage of six lakh doctors, we are way off the desired standards. Added to this is the rural-urban divide with more than 80 per cent of doctors serving in urban areas, whereas 70 per cent of population residing in villages. A number of suggestions have been made to improve the situation. These include barefoot doctors, bridge course for AYUSH doctors, dentists and compulsory rural posting of all fresh MBBS graduates, among others. All these have been non-starters.

Tripura health minister caught govt doctor in illegal abortion

United News of India

The Chief Medical Officer of South Tripura district has lodged an FIR against the medical officer in-charge of Birchandramanu primary health centre Dr Ajoy Biswas for illegally aborting in hospital taking money after he was caught by health minister Sudip Roybarman today. The health minister told media persons that he accompanied by the director and secretary health services raided the hospital based on secrete information that the accused doctor has been doing the same practice for long time and today, the doctor was caught when aborting the baby of a seven months carrying mother. “Last night, I got the information from a source and this morning I re-confirmed that the patient is going for abortion. It was a deal of Rs 50,000 with the doctor. I called up the officials to accompany me but did not tell them the exact destination and purpose of visit. We straightway went inside the labour room and caught Dr Biswas red handed,” Roybarman said.

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 22 May to 0830 hrs IST of 23 May, 2019)

Heat Wave:

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


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

Maximum temperature departures as on 22-05-2019: Maximum temperatures are appreciably above normal (3.1°C to 5.0°C) at most places over Madhya Maharashtra, Vidarbha, Kerala and Jharkhand; at a few places over Himachal Pradesh and Uttarakhand; above normal (1.6°C to 3.0°C) at most places over Madhya Pradesh, Marathwada and Rayalaseema; at many places over Punjab, Tamilnadu & Puducherry, Coastal & Interior Karnataka, Telangana, Chhattisgarh, Bihar and Nagaland, Manipur, Mizoram & Tripura; at a few places over East Uttar Pradesh, Lakshadweep, Gangetic West Bengal and Odisha and at isolated places over Andaman & Nicobar Islands, Gujarat, Sub- Himalayan west Bengal & Sikkim and West Uttar Pradesh. They are below normal (-1.6°C to - 3.0°C) at many places over Assam & Meghalaya and Arunachal Pradesh; at a few places over Coastal Andhra Pradesh and near normal over rest of the country.

The highest maximum temperature of 46.5°C recorded at Bramhapuri (Vidarbha).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 23 May to 0830 hrs IST of 24 May 2019):-

Heat Wave Conditions in some parts with severe heat wave in isolated pockets very likely over Vidarbha and heat wave conditions in isolated pockets over Telangana, Rayalaseema, Madhya Maharashtra, Marathwada, Madhya Pradesh, Chhattisgarh, East Uttar Pradesh, Odisha, Jharkhand and Tamilnadu.

Vedic Health: Ayurveda and Evidence-Based Research

There are six types of evidences accepted in the literature.

1.Pratyaksha: What is seen or observed directly. These are observational studies and accepted in the scientific community.

2.Anumana or the evidence based on the inference of a defined hypothesis

3.Upamana are the evidences based on analogies

4.Arthapathi are the evidences, which are based on circumstantial evidence

5.Anupalabdhi is an evidence based on the theory of negation ......read more

NPPA has slashed the prices of 9 non-scheduled cancer drugs by up to 87%

The National Pharmaceutical Pricing Authority (NPPA) has slashed the prices of 9 non-scheduled cancer drugs by up to 87%
An office memorandum issued by the drug pricing regulator in New Delhi said, the maximum retail price of 500 mg chemotherapy injection pemetrexed, which is used to treat lung cancer, has come down from 22 thousand rupees to 2 thousand 800 rupees.
The price of 150 mg Erlotinib tablets will cost now cost 2 thousand 400 rupees instead of 8 thousand 800 rupees.
In February this year, the government had capped 42 cancer drugs at 30%. ...read more

Man Vachan Kaya