Editor in Chief Dr KK Aggarwal, Padma Shri Awardee
Dated: 24th April, 2019
Quit smoking before planning to conceive a baby
Smoking during pregnancy is linked with negative health outcomes. Research indicates that smoking cessation during pregnancy may reduce the risk of pre-term birth. The findings, published in the JAMA Network Open journal, showed that the probability of pre-term birth decreased with earlier smoking cessation in pregnancy - up to a 20% per cent relative decrease if cessation occurred at the beginning of pregnancy.
The World Health Organization (WHO) estimates that every year, about 15 million babies are born prematurely around the world amounting to more than one in 10 babies born globally. The rate of preterm birth across 184 countries ranges from 5% to 18% of babies born. In India, the figure stands at 3.5 million babies out of the 27 million babies born every year.
Premature birth is one that happens before 37 weeks of pregnancy. A normal pregnancy usually lasts about 40 weeks. A baby born prematurely has less time to develop in the womb and often has complicated medical problems. Many preterm babies who survive suffer from various disabilities like cerebral palsy, sensory deficits, learning disabilities and respiratory illnesses. The morbidity often extends to later life, causing physical, psychological, and economic stress to the individual and the family.”
Preterm babies are small in size, sharper looking and have a disproportionately large head, less rounded features than a full-term baby, fine hair covering much of the body and low body temperature. Labored breathing or respiratory distress and lack of reflexes for sucking and swallowing are further signs of a preterm birth.
While preterm births cannot be attributed to one particular reason, the predisposing risk factors include age at pregnancy; previous preterm birth; multiple pregnancies; infections and chronic conditions such as diabetes and high blood pressure; stress; genetic factors and nutritional disorders. Lifestyle is increasingly becoming an important factor for preterm births. Identification of risk factors and educating the pregnant woman about the signs and symptoms of preterm labor during antenatal care can prevent preterm births.
Some tips from HCFI
1-in-5 US Kids Drink No Water During a Given Day
One fifth of US children and young adults said they drank no water on a given day and that they consumed almost twice as many calories from sugar-sweetened beverages (SSBs) as those who drank water.
Dr Asher Y. Rosinger, PhD, MPH, assistant professor of biobehavioral health and anthropology, Pennsylvania State University, University Park published their findings online today in JAMA Pediatrics.
On a given day, 79.9% of participants said they drank plain water. Drinking no water in a day was associated with intake of 92.9 kcal (P < .001) and 4.5% (P < .001) more calories from SSBs among those aged 2 to 19 years, after adjustment for sociodemographic variables.
Kids [who] did not consume any plain water (from tap or bottled water) consumed almost twice as many calories and percent of total calories from sugary drinks than kids [who] consumed water. And for the sample overall that translated to nearly 100 extra calories on a given day.
Metformin May Stop Weight Regain After Initial Loss
Metformin may not only lower blood glucose levels, it may also help people who lose weight keep it off, according to the results of a long-term follow-up study. Among patients in the Diabetes Prevention Program (DPP) trial who lost at least 5% of their initial weight at 1 year (after being randomized to metformin, intensive lifestyle, or placebo), those in the metformin group who continued on metformin in the follow-up observational Diabetes Prevention Program Outcomes Study (DPPOS) had the greatest weight-loss maintenance 5 to 14 years later.
Those who lost weight initially after 1 year had remarkable maintenance of the weight loss with metformin, something we had never known before [Kishore M. Gadde, MD, Pennington Biomedical Research Center, Baton Rouge, Louisiana]. The study by John W. Apolzan, PhD, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, and colleagues was published online April 22 in the Annals of Internal Medicine.
FUROPED SHORTAGE: Will DCGI Intervene
Few days back I visited Satya Shai Hospital in Ahmedabad. They are doing a wonderful job of providing free heart surgeries to children. During the visit I came a genuine issue: shortage of Fruoped (syrup furosemide) in the market. For children with heart failure it is a life-saving diuretic.
In June 2018, The National Pharmaceutical Pricing Authority increased the per unit price of furoped from 29 p per ml to Rs 2.60 p.
In an order in November 2017, the price of Furoped was reduced by 92% with the MRP coming down from Rs 106 to Rs 10.
Now the price of a 30 ml bottle is about Rs 78.
Before the November price revision which was undertaken by NPPA without access to market data, the monthly sales of the drug were to the tune of approximately Rs 30- 35 lakh. Supplies dwindled to about 40% in the aftermath of that decision.
The continuing shortage of any life saving drug is a matter of concern. All paediatric cardiologist, after reading this blog, if find the drug is still in shortage should raise their concern. I am sure the DCGI will make sure the shortage is taken care of.
Healthcare News Monitor
Aditya Birla Sun Life Mutual Fund has sought the Securities and Exchange Board of India’s approval to launch Aditya Birla Sun Life Pharma & Healthcare Fund, according to information on the regulator’s website. The open-ended equity scheme will deploy at least 80 percent of its assets in equities and equity-linked instruments to companies in the pharma, healthcare and allied sectors, and the balance may be allocated to other equity and equity-linked instruments. It also has the provision to invest up to 20 percent in Real Estate Investment Trusts (REITs), Infrastructure Investment Trusts (InvITs) and debt and money market instruments.
The Hindu Business Line- PTI
New Delhi: The country’s pharmaceutical exports rose 11 per cent to $19.2 billion in 2018-19, mainly driven by higher demand in regions such as North America and Europe, as per a Commerce Ministry data. The pharma exports in 2017-18 stood at $17.3 billion and $16.7 billion in the previous fiscal. North America constitutes about 30 per cent of Indian pharma exports, followed by Africa and the European Union with 19 per cent and 16 per cent share, respectively, according to the data. According to industry experts, the Chinese market is also gradually opening up and the government is working to push India’s exports there as it holds huge potential.
The Hindu Business Line- Yogesh Sharma
Hyderabad: Chemotherapy is one of the most widely used treatments for cancer. It involves single or combination of drugs that prevent cancer cells from dividing and growing. Most cancer patients who have to undergo chemotherapy treatment worry about the associated adverse side effects caused to healthy cells. Scientists have been working to find ways to minimise side effects while maintaining effectiveness of chemotherapy. A group of Indian researchers have now developed a hydrogel-based cancer treatment method. In conventional chemotherapy, drugs being administered get diffused immediately resulting in an uncontrolled and unpredictable pattern of drug release. This burst of drug causes damage to surrounding healthy cells. To overcome this problem, researchers have developed a superstructure of cyclodextrin and polyurethane polymer. It acts as a drug depot and releases drug in a slow and controlled manner, increasing its efficiency.
The Times of India
Chennai: The Central Drugs Standard Control Organization (CDSCO) has directed drug manufacturers to revise safety data for various antibiotics based on signals it received from the pharmacovigilance programme, drugs control director-general of India S Eswara Reddy said.
The Hindu- Bindu Shajan Perappadan
Blanket implementation of price controls has contributed to a drastic fall in Foreign Direct Investment (FDI) in the medical device sector, say industry insiders, pointing to a reduction from $439 million in 2016 to $66 million in 2018. “Data released by the Government Department for Promotion of Industry and Internal Trade clearly show this decline which has happened even though FDI is allowed through automatic route,” said Mr. Pavan Choudary, heading the Medical Technology Association of India (MTaI). The Association represents leading global medical technology companies with a substantial footprint in India. “We posit that this decline was the unintended consequence of the well meaning intention but the anomaly needs to be corrected,” Mr Choudary said.
Medical dialogues- Garima
Pune: The civic body has set up medical support cells at its hospitals and has made arrangements to provide first aid kits as well as ambulances to election centres with the aim to effectively tackle emergencies during the polling on April 23 and 29. The measures have been undertaken by the Pune Municipal Corporation (PMC) to extend prompt medical care to employees and voters at the polling booths. “We have deployed two ambulances with doctors in eight designated areas. The first aid kits have been distributed to 552 polling stations,” said Sanjeev Wavare, assistant medical officer of health, PMC.
The Times of India-Umesh Isalkar
New Delhi: An online platform for medical professionals, M3, Inc. of Japan has announced the acquisition of a majority stake of India based Neuroglia Health Private Limited (NHPL), a startup that provides web-based applications for Doctors and Medical students in India, for an undisclosed amount. This move marks M3’s foray into case-based problem-solving community platform and Medical test preparation business in India, in addition to its existing business Health Impetus Private limited (HIPL). HIPL (under the brand name of M3 India) currently runs Online portals that help Indian Doctors stay abreast with the latest in research, medical news, evidence-based medicine, practice guidelines and expert articles etc. Commenting on the acquisition, Amit Singh, CEO of HIPL (M3 India) said, “With this majority acquisition, M3 India will now be able to reach out to 450,000 Doctors in India on a consolidated basis, while enhancing the utility and satisfaction levels among Doctors by leveraging the strengths of both platforms. It will also enable M3 India to escalate its marketing support and market research businesses to pharmaceutical and medical devices companies through an expansion of doctor membership and enhancement of medical education contents.”
Each morning at 7.30am, the street outside Tata Memorial Hospital in Parel is abuzz with activity. People are queuing up a short distance away as volunteers and employees from a local NGO swiftly hand out packets of milk, along with freshly made chapatis and fruits like bananas, apples and sweet lime. Hot breakfast items such as dal rice, khichdi and lapsi (a coarsely ground wheat-based dish) are also served on a rotational basis each day. The people lining up for this meal are cancer patients and family members of those undergoing treatment at the Tata Memorial Hospital, but living outside on the pavement. Over 600 such underprivileged people benefit from these meal services on a daily basis, thanks to these warriors who are trying to ease their financial burden.
A unique telemedicine mobile application, called 'SeekMed' has been launched recently to connect the patients from anywhere in the country with the top doctors of India, mostly based in Tier I cities and working with India's top hospitals. This app for the first time has brought leading doctors who have been awarded for their contribution to the field of healthcare, majority of doctors on the platform are recipient of Padma Awards and awards like B C Roy. Top doctors from India's leading hospitals like AIIMS, Sir Ganga Ram Hospital, PSRI and others can be contacted directly through video consultation feature of the App at a reasonable consultation fees. This application is available and can be downloaded for free from the Google Play Store. "The idea is to bridge the huge gap between the quality of the healthcare available in big cities and those in smaller towns and remote areas by increasing access and affordability, with a few simple clicks, patients can find leading doctors & send appointment requests. Patients can upload any number of files that can be accessed from anywhere," said Alok Awasthi, Founder of SeekMed.
In Story of the Week our focus is on the Medical Council of India’s guidelines barring candidates with disabilities from studying medicine. This week’s focus is specifically on candidates with blood disorders. Currently midway through his Doctor of Medicine degree in Mumbai, Dr Venkatesh, like other post graduate medical students, puts in long grueling hours at the hospital every other day. Venkatesh is specializing in pediatrics and studying medicine is a childhood dream. Nothing has come in the way of this goal, not even the low phases in health that he has experienced as a hemophiliac. This commitment and dedication to the job is what most of us are looking for in a doctor when we go seeking treatment. Yet the Medical Council of India (MCI)’s new guideline for MBBS admissions completely discounts students with over 80% disability is certain categories from applying under the disability quota. This includes blood disorders like thalassemia, haemophilia and sickle cell disorder.
Telangana Today- T. Karnakar Reddy
Sangareddy: A young doctor travelled to nine countries where dragon fruit is cultivated to grow the exotic fruit in Telangana State, after he saw a few enthusiastic farmers in India struggling to reap dividends by cultivating this crop. Cultivating dragon fruit by identifying heat-tolerant and high-productive varieties, Dr Srinivasa Rao Madhavaram (33) has transformed his dragon fruit farm literally into a research centre, where an enthusiast farmer can learn everything about the fruit’s cultivation without spending a rupee. He has also found ways to get yield round the year to produce 15 tonnes on each acre annually. Dr Rao, born and brought up in Kukatpally and completed MD (General Medicine), took up the cultivation in 11 acres of land his family owned at Aliyabad in Sangareddy district.
Ludhiana: The Medical Council of India (MCI), nodal centre for faculty development, Christian Medical College, Ludhiana, is conducting a 7-day MCI Advance Course in Medical Education (ACME) from April 22-28. The programme trains 50 faculty members from various medical colleges of the country in advance medical education technology and methodologies, including curriculum development in alignment with the new curriculum of MBBS, innovative teaching learning, assessment methods, leadership skills, mentorship, scholarship and modules on attitude, ethics and communication. Dr William Bhatti, Director, CMC, appreciated the role and support of MCI and the Department of Medical Education, CMC, in training the faculty of various medical colleges.
ETHealthworld- Shahid Akhter
The trend is increasing over the last few years. Primarily because in India we have around 491 medical colleges, 60,000 seats and approximately 13-15 lakh medical aspirants. They appear for NEET examination with dreams in their eyes to become doctors. Almost about eight and a half lakh qualify the NEET examination but only about 60,000 are able to get seats, out of which roughly 50% seats are in private medical colleges. Most of them are unaffordable for a common medical aspirant. Therefore, they have no option but to choose 'Education Abroad'. There are lots of options for education abroad such as they can go to Russia, China, Caribbean, Philippines or Ukraine where quality medical education is provided based upon the needs of those countries. Also, it is quite affordable as compared to the medical education in our country. This trend over a period of time is going to increase because our country needs more doctors.
The Times of India-Chaitanya Deshpande
Nagpur: Maharashtra University of Health Sciences (MUHS) has declared that more than 91% of the total 1,245 candidates have successfully cleared the modern mid-level service providers course. The much talked about bridge course allows Bachelor of Ayurveda Medicine and Surgery (BAMS) doctors to practice allopathy to a certain extent at Health and Wellness Centers (HWCs) across the state. On the very same day, on April 21, the Indian Medical Association (IMA) issued an official statement calling the mid-level service providers a ‘myth’. “Mid-level providers are myth. Government falling for this myth only exposes the shallow thought-process and utter disregard for human life,” says a statement issued by IMA national president Dr Santanu Sen. The statement further lambasts the idea of bridge courses, terming it as an attempt to provide half-baked medical care to citizens, which is dangerous. “The conditional postings are unacceptable and they are nothing but cruel exploitation of hapless young graduates,” the statement says, targeting appointment of BAMS doctors at HWCs in Maharashtra.
Current Temperature Status and Warning for next five days
Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 23rd April to 0830 hrs IST of 24th April, 2019)
Yesterday, no heat wave conditions were observed over the country.
Maximum Temperature more than 40.0°C was recorded at most places over Rajasthan, West Madhya Pradesh, Vidarbha; at many places over East Madhya Pradesh, Marathwada, Gujarat Region; at a few places over Haryana, Chandigarh & Delhi, Madhya Maharashtra and at isolated places over Punjab, Uttar Pradesh, Jharkhand, Saurashtra & Kutch, Chhattisgarh, Odisha, North Interior Karnataka, Telangana, Rayalseema and Tamilnadu & Puducherry.
Maximum temperature departures as on 23-04-2019: Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at most places over West Rajasthan; at many places over Jammu & Kashmir and at a few places over Himachal Pradesh, Punjab, Haryana, Chandigarh & Delhi, West Madhya Pradesh, Arunachal Pradesh and Assam & Meghalaya; at isolated places over East Rajasthan, Gujarat and Konkan & Goa; above normal (1.6°C to 3.0°C) at many places over Nagaland, Manipur, Mizoram & Tripura; at a few places over Uttar Pradesh, East Madhya Pradesh, Madhya Maharashtra, Marathwada and Gangetic West Bengal; at isolated places over Andaman & Nicobar Islands, Jharkhand, Chhattisgarh, Vidarbha, Telangana and Karnataka. They were below normal (-1.6°C to -3.0°C) at most places over Bihar; at a few places over Uttarakhand, SubHimalayan West Bengal & Sikkim and Odisha; at isolated places over Tamilnadu & Puducherry
The highest maximum temperature of 45.1°C was recorded at Bramhapuri (Vidarbha) over the country.
Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 24th to 0830 hrs IST of 25thApril 2019):-
Heat Wave conditions likely in isolated pockets(<25%) over West Rajasthan.
Life and Death Matter
Reproduced from India Legal, Published April 29, 2019, p.44-45
Drinking water reduces intake of sugary beverages by children
Children and young adults who do not drink water during the day drink more sugary beverages and thus consume more calories from these sugary drinks, suggests a new study published April 22, 2019 in JAMA Pediatrics. Plain water was defined in the study as tap or nonsweetened, noncarbonated bottled water.