Editor in Chief Dr KK Aggarwal, Padma Shri Awardee
Dated: 23th June, 2019
Libido-Boosting Drugs May soon be available
The US FDA has approved bremelanotide (Vyleesi, AMAG Pharmaceuticals), a first-in-class melanocortin 4 receptor agonist for hypoactive sexual desire disorder (HSDD) in premenopausal women. It joins flibanserin (Addyi, Sprout Pharmaceuticals), the only other FDA-approved HSDD treatment for premenopausal women.
HSDD affects approximately 10% of all premenopausal women. It is largely underrecognized. These women have issues with their relationships; they often have issues concentrating at work and image difficulty. The effects extend way beyond the bedroom.
Bremelanotide is designed to be self-administered subcutaneously with a disposable autoinjector at least 45 minutes before an anticipated sexual encounter. Users don't see the needle and it can be pushed against the abdomen or thigh.It adjusts the balance between the neural pathways that excite and inhibit to restore sexual desire.
The most common adverse events were nausea, flushing, and headache.
Flibanserin, another drug is taken every night at bedtime, and acts through specific serotonin receptors (5-HT1A agonism and 5-HT2A antagonism) to reduce serotonin inhibition of sexual desire and arousal. Each of the drugs works in about 50% of premenopausal women with HSDD.
There's no easy way to determine whether a woman has increased serotonin inhibition, reduced excitatory activity, or both. If her serotonin inhibition is increased, flibanserin may be best and if excitatory activity has dropped, bremelanotide may be better. If it's both, maybe a combination would be helpful.
Increasing global recognition for tobacco harm reduction
The following quotes demonstrate an increasing global recognition for tobacco harm reduction.
“We (in 2007) suggested that making effective, affordable, socially acceptable, low-hazard nicotine products available to smokers as a market alternative to tobacco could generate significant health gains, by allowing smokers to stop smoking tobacco, without having to stop using the nicotine to which they are addicted. As most of the harm caused by smoking arises not from nicotine but from other components of tobacco smoke, the health and life expectancy of today’s smokers could be radically improved by encouraging as many as possible to switch to a smoke-free source of nicotine.” Royal College of Physicians, Nicotine without smoke, 2016.
“We will help people quit smoking by permitting innovative technologies that minimise the risk of harm. We will maximise the availability of safer alternatives to smoking.”UK Department of Health, Towards a smoke-free generation, 2017......read more
Bihar children deaths: Could refeeding syndrome precipitated by litchis be the cause?
What do we know so far about these deaths: Mostly malnourished children < 10 years old, linked to lychee orchids, convulsions early in the morning, no fever, high mortality the same day, all had low sugar but mortality still high even after infusing sugar.
This only means that some other metabolic factor is also at play apart from the sugar.
What might be happening? If significantly malnourished children, who have not eaten food for more than 3 days eat oral carbohydrates (litchi in this case), it can cause electrolyte and fluid shifts that may precipitate disabling or fatal medical complications......read more
The Science behind Training and Development
Training in any field requires gaining knowledge, skills and positive mental attitude towards the object of learning.The knowledge is everything about what and why. In Yoga, it correlates with the Gyan (Gnana) Marg. The skill is all about how to do it and correlates with Karma Marg.A positive mental attitude is linked to willingness to do any work or in other words, one’s Astha in that action. In Yoga, it is synonymous with Bhakti Marg.......read more
Current Temperature Status and Warning for next five days
Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 21 June, 2019 to 0830 hrs IST 22 June, 2019)
Yesterday, Heat wave conditions in some parts with severe heat wave at isolated pockets were observed over Vidarbha.
Maximum temperatures were markedly above normal (5.1°C or more) at many places over Vidarbha and at isolated places over Madhya Pradesh, Telangana and Madhya Maharashtra; appreciably above normal (3.1°C to 5.0°C) at most places over Marathawada; at many places over North Interior Karnataka, Uttarakhand, Nagaland, Manipur, Mizoram & Tripura and Arunachal Pradesh; at a few places over Sub-Himalayan West Bengal & Sikkim and at isolated places over Konkan & Goa and East Uttar Pradesh; above normal (1.6°C to 3.0°C) at many places over Bihar and Jharkhand; at a few places over Saurashtra & Kutch, Coastal & South Interior Karnataka, Tamilnadu & Puducherry, Assam & Meghalaya and Andaman & Nicobar and at isolated places over Gujarat Region, West Uttar Pradesh and Gangetic West Bengal. Yesterday, the highest maximum temperature of 42.4°C was recorded at Ganganagar (West Rajasthan).
Temperatures Recorded at 1430 Hours IST of Yesterday, the 22 th June, 2019
Healthcare News Monitor
The New Indian Express
KOCHI: In a major breakthrough to unearth the source of the Nipah virus in the current spell of the disease in central Kerala, the National Institute of Virology (NIV), Pune, has identified the presence of the deadly virus in 12 fruit bats out of the 36 samples tested at the premier institute.
However, over 100 blood and sputum samples of fruit bats were collected from areas of Thrissur, Paravoor, and Thodupuzha. The NIV is yet to confirm the exact area of the bat population from which the virus was identified.
Union Health Minister Harsh Vardhan, in a written reply in the Lok Sabha, said, “NIV, Pune, deputed special teams to collect samples from Pteropus or fruit bats, which are the main reservoir of Nipah virus. Out of the 36 species tested for Nipah, 12 (33 per cent) were found positive for ‘anti-Nipah bat IgG antibodies’.”
Over more than 150 children have lost their lives in Muzaffarpur, Bihar and neighbouring districts over the past few days due to Acute Encephalitis Syndrome. Several reports have linked the deaths to eating lychees. This has created fear among the people about the summer fruit. People on social media are circulating a message along with a video asking people, particularly children, to stop eating lychee. They claim eating the fruit might cause a life-threatening fever to children. In a Facebook post by Live India 24x7, it said, "For your information: You are all advised to stop eating lychee for now. Never give lychee to your kids; else they will suffer from 'chamki' fever. The health ministry has declared it "incurable". Till the time the virus is in complete controlled, stay away from consuming lychee." According to a report in India Today, it is a misleading claim. According to doctors and the Union health ministry, there could be many factors behind the deaths. There is neither any government advisory on lychee nor has it been declared hazardous or unsafe for human consumption by any credible organisation. A short video attached with the viral post shows a worm inside a lychee. The post has been shared over 900 times.
The Sri Krishna Medical College and Hospital (SKMCH) of Muzaffarpur has been in the news for all the wrong reasons over the last one month. So far, over 130 children have lost their lives here due to Acute Encephalitis Syndrome (AES). The hospital is overcrowded by the patients suffering from AES and there is no end to new patients. The situation has at the hospital has raised serious questions over the state government’s claim of providing quality health treatment to the public. Usually, in an ICU, a patient whose condition is critical is kept under observation of medical experts and there are strict restrictions on the admission of patients’ attendants. However, scenes at the SKMCH’s ICU are completely different. The state-run medical college and hospital is overcrowded and as a result, doctors re forced to accommodate three to four patients on one bed in ICUs. Several kids have been given a place on the floor of the ICU. The hospital is the lone such facility in the region where super-specialty treatment is provided to the patients. Perhaps this is the reason why SKMCH has been the first preference of the locals. The hospital has a special ward and other facilities for treatment of AES. However, the number of patients the hospital has been drawing in the last few weeks have made the situation worse and doctors are finding it difficult to deal with it.
Five-year-old Soni Khatun was playing in the midday sun last week when she began to vomit and lose feeling in her hands. Her mother, a poor labourer living in rural India, borrowed money to take her to hospital. Five hours later, Soni was dead, one of the 118 children to die this month from Acute Encephalitis Syndrome (AES), or ‘brain fever’, in one district of eastern Bihar state. “I still see her in my dreams,” said Sahana Khatun, Soni’s mother. “I can’t accept she is gone.” The deaths were preventable, doctors say, if poor families had access to good food, clean water and better medical care in Muzaffarpur district, 80km from the state capital Patna. The epidemic has sparked a debate over growing inequality in India and focused attention on a free health care scheme for the poor — known as ‘Medicare’ after Prime Minister Narendra Modi — eight months after it was launched. The precise causes of AES, which killed more than 350 in Bihar in 2014, are not known, though a majority of medical professionals say it is linked to a ferocious heat wave that has gripped Bihar for the last month.
As many as 5,322 Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) Kendras were functional in the country as on June 10, 2019, the government said Friday. Minister for Chemicals and Fertilizers D V Sadananda Gowda in a written reply to the Rajya Sabha said that 39 PMBJP centres have been opened in North-East and Naxal-affected areas in financial year 2018-19. "As on 10.06.2019, 5,322 Kendras are functional under PMBJP. Out of these, 144 PMBJP kendras are run by persons belonging to SC/ST community," Gowda said. In a written reply to another question, Gowda said: "Bureau of Pharma PSUs of India (BPPI) has entered into contracts with 154 WHO-GMP certified pharmaceutical manufacturing companies for procuring quality generic medicines and other surgical & consumables to be sold under PMBJP." The objective of the PMBJP scheme is to make quality medicines available at affordable prices for all, particularly the poor and disadvantaged, through PMBJP Kendras to reduce out of pocket expenses in healthcare.
The New Indian Express-IANS
Now that the doctors' strike has been called off, the moot question is, will this find space in the news again only when another doctor is roughed up or killed by disgruntled relatives? With the Supreme Court ruling out protection to doctors at the cost of public money, yet another question is, at whose cost is a politician given protection? Why are the doctors less deserving? If a solution to the mob violence against doctors and their properties is not found then medical profession will be considered "dangerous" and the clamour to take up medicine as a career will go down. As members of a profession which is supposed to respond to human suffering, doctors have a social responsibility. But will society reciprocate? There is an outrage when it comes to violence against women, children or the common man. People gather in large numbers with placards and raise slogans on the injustice meted out. Rightfully it exerts pressure on the concerned establishments to act. But have we seen an outrage, eve, when a doctor is grievously injured by a mindless mob? Why don't we see people on the streets holding placards and seeking action against those unleashing violence on the medical fraternity?
The Times of India
Built at a cost of Rs 650 crore in 2013, the Kalpana Chawla Government Medical College and Hospital (KCGMC) had raised hopes of better medical facilities for the people of Karnal and adjoining districts. But, of late, the hospital itself seems to ailing, with no less than 342 doctors -- including those on contract, leaving the institution. Currently, the KCGMC is facing acute shortage of doctors and specialists, which has badly affected its functioning. In response to an RTI petition filed by activist Rajesh Sharma, the authorities concerned came up with some shocking revelations. More than 7,000 patients left the hospital without informing the authorities between 2017 and April this year, and as many as 12,936 patients were referred to other medical institutions from 2015 to April 2019. However, since the Rs 650-crore facility is fully air-conditioned, the institution has been footing a monthly electricity bill of over Rs 60 lakh! Sharma, who had sought information on the number of doctors who have resigned from the medical college, the number of patients, who “absconded” without intimating the authorities, and the detail of the electricity bill. Besides, he had also sought to know how many patients were referred to other hospitals. According to the RTI reply, 342 doctors have left the medical college since its inception in 2013. Out of them, 48 were regular doctors and they put in their papers before completion of their respective tenures. In all, 3,163 patients had left the hospital without informing the authorities in 2017, and 3,164 in 2018. Another 959 patients absconded up to April this year, even though the rule says an admitted patient has to inform the authorities before leaving the hospital.
Financial Express-Guest Article
With the escalating cost of healthcare facilities, many people in India started to opt for generic medicines. The solution of generic medicines is way cheaper than branded drugs and is backed by the Government of India which made it mandatory for the physicians to prescribe the generic names. Generic medicines are affordable versions of the branded drugs which are introduced once the patent acquired by the drug manufacturer expires. These drugs are dispensed either by a brand or salt name. Generic medicines are usually identical as a proprietary drug that has a brand name because of which the chemical composition of the medicine is sold as. Without any difference, the generic drug is the same in potency, dose, and method of intake, quality, and implications and works the same as the branded medicine. As per Indian household, the term ‘generic’ implies the drug is a cheaper, less effective and duplicate version of the brand name product. In reality, generic drugs are of the same quality and as effective as of the branded medicine. These medicines might contain Inactive Pharmaceutical ingredients like suspending agents, demulcents etc which do not disturb the body for curing illness. There are different phases through which a drug is developed and reviewed. As per the FDA (Food and Drug Administration), the authority is responsible for the evaluation of the drugs as a generic medicine. The conducted studies show that both branded and generic medicines are bio-equivalent. The authority also confirmed that the generic medicines have the same amount of pharmaceutical ingredients and adhere to the manufacturing practices requirement but differ in size, color and shape.