Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 25th April, 2019

Medtalks with Dr K K

1. Asian individuals with diabetes have substantially increased risk for all-cause and cause-specific death, according to a study published online today in JAMA Network Open.


1. Exercise is a key way to prevent or help relieve sciatica. Consider these types: Aerobic exercise: walking, jogging, swimming, and cycling candancing, and other activities that increase your heart rate without causing more pain if you already have sciatica. Strength training: exercises using free weights or weight machines, or isometric exercises, which involve contracting muscles without obvious movement. Flexibility training: yoga, tai chi, Pilates, and similar activities that increase both flexibility and strength.

2. Strengthen your core: abdominal muscles, Muscles in the back, sides, pelvis, and buttocks also are part of your core. Strengthening all of these muscles helps to support your spine. Many types of exercise, including yoga and Pilates, can strengthen the core muscles. For example, planks and bridges are movements that target the core.

3. Avoid sitting for long periods: Take frequent breaks, or try a standing desk. Less sitting is better.

4. Manage your weight: Even minor weight loss will reduce inflammation and pressure on the spine.

5. Practice good posture: To prevent slouching, pull your shoulders down and back. Imagine your shoulder blades touching. If you work at a computer, take frequent breaks. Position your monitor so you can see it without bending your head down or tilting it back. [Harvard tips]

How much time the children can spend time online

The World Health Organization issued strict new guidelines Wednesday on one of the most anxiety-producing issues of 21st century family life: How much should parents resort to videos and online games to entertain, educate or simply distract their young children?

The answer, according to WHO, is never for children in their first year of life and rarely in their second. Those aged 2 to 4, the international health agency said, should spend no more than an hour a day in front of a screen.

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 24 rd April to 0830 hrs IST of 25 th April, 2019)

Heat Wave:

Yesterday, heat wave conditions observed at isolated pockets over West Madhya Pradesh. (Annexures 1 & 2).

Maximum Temperature

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

Maximum temperature departures as on 24-04-2019: Maximum temperatures were markedly above normal (5.1°C or more) at many places over Arunachal Pradesh; appreciably above normal (3.1°C to 5.0°C) at most places over Nagaland, Manipur, Mizoram & Tripura; at many places over Himachal Pradesh, Haryana, Chandigarh & Delhi, West Madhya Pradesh and Assam & Meghalaya; at a few places over Rajasthan; at isolated places over Gujarat region and East Madhya Pradesh; above normal (1.6°C to 3.0°C) at most places over Vidarbha and Marathwada; at many places over West Uttar Pradesh, Madhya Maharashtra and Sub-Himalayan West Bengal & Sikkim; at a few places over Chhattisgarh, Karnataka, Kerala and Lakshadweep; at isolated places over East Uttar Pradesh and Gangetic West Bengal. They were appreciably below normal (- 1.5 to -3.0°C) at many places over Jammu & Kashmir; below normal (-1.6°C to -3.0°C) at isolated places over Jharkhand, Odisha and Andaman & Nicobar islands and normal over rest of the country.

The highest maximum temperature of 45.6°C was recorded at Khargone (West Madhya Pradesh).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 24 th to 0830 hrs IST of 25 th April 2019):-

Heat Wave conditions likely at isolated pockets (<25%) over West Madhya Pradesh.

Healthcare News Monitor

Pharma News

India may be the 'global pharmacy' but Indians have poor access to drugs

The Telegraph

Misnomers can, at times, be misleading. In spite of being known as the ‘pharmacy of the global south’, drug prices in India are prohibitive for vast sections of the population. Recent findings of the World Health Organization discussed at its Fair Pricing Forum show that close to 40 per cent of essential drugs in India with the lowest maximum retail price are valued significantly higher than estimated production costs. The assessment also highlighted “exorbitant” profiteering by pharmaceutical companies. Such extortion has been made possible by lax and poorly-thought-out policies. Take, for instance, the decision to exempt ‘innovative’ medicines developed by foreign companies from price control for five years in order to give Indians quick access to drugs, which are currently only available abroad. How many people can afford these costly new treatments? What drives prices higher is that India — in spite of the misgivings of experts — follows a market-based pricing pattern. Drug prices are calculated by taking the average costs of top-selling brands. This allows pharma companies to make money that is, at times, 10 times the production cost, suggest two independent studies. There are other such loopholes in the Drugs (Prices Control) Order, 2013 — vaccines with two or more active pharmaceutical ingredients do not fall under its purview — that allow manufacturers to bypass legal hurdles while fixing prices.

Top pharma companies eyeing Bharat Serums and Vaccines

Money Control-Viswanath Pilla

Bharat Serums and Vaccines (BSV), the Mumbai-based biopharmaceutical firm known for its niche and differentiated products, is back in the news again. Quoting sources, The Economic Times reported that a consortium of private equity firm Carlyle and Zydus Cadila is competing with private equity group Advent International to acquire BSV. The report said two parties have submitted non-binding offers in the range of Rs 3,450-3,600 crore ($500-520 million). BSV couldn't be reached for a comment. A member of Daftary family told Moneycontrol that the reports of promoters exiting weren’t true. Rumours of Carlyle as a potential buyer have been doing the rounds for more than five years. Dr Reddy's, Mankind and Goldman Sachs are other names that have emerged.

Jhunjhunwala increases stake in DHFL, is cautious on auto holding

Business StandardJash Kriplani

“Pharma is one sector where demand cannot go down. Most medicines used in US are made by Indian players. It is a sunrise industry, and it cannot become a sunset industry,” Jhunjhunwala said recently, while speaking at the launch of ITI Mutual Fund. Jhunjhunwala has also entrenched his position in the luggage maker VIP Industries. His stake went up by 130 bps to 5 per cent in the March quarter. Luggage is another industry that analysts expect to do well as they see consumers shifting to organised players and also move towards premium luggage products. Firstsource Solutions is the other stock where Jhunjhunwala increased his stake (36 bps) in the March quarter. At the end of the March quarter, Jhunjhunwala held positions in 29 companies. Some of these include Rallis India (9.2 per cent stake), Escorts (8.16 per cent), NCC (10.7 per cent), SpiceJet (1.25 per cent), and CRISIL (5.49 per cent).

Why brand Saridon clicks with all despite competition and a brief ban

Business Standard-Sohini Das

Every second, 21 consumers in India pop a Saridon to relieve themselves of a pounding headache. In ten years, Saridon, whose brand licensing rights were picked up by Piramal Enterprises in the 1990s from pharma major Roche, has grown 20 times. It now has a turnover of Rs 100 crore from Rs 5 crore a decade ago and accounts for a fourth of the Piramal group’s revenue within its consumer products division. Plans are afoot to grow its retail presence aggressively in addition to launching a host of new variants in the future. For a humble headache pill, developed by Roche in Switzerland and brought to India by the company in 1969, the journey over the last five decades has been barely easy. Formulation changes have been par for the course, not to mention that the brand has had to contend with a wide array of painkillers including tablets and balms. Some of them have been deeply entrenched in Indian homes (such as Tiger and Amrutanjan balms) and replacing them with strips of Saridon has been an uphill task, say industry experts.

Ban On Sale of Medicines Online: HC Notice to Centre, E-pharmacies on Contempt Plea


The Delhi High Court Wednesday issued notices to the Centre and some e-pharmacies on a contempt petition alleging non-compliance of the court's order staying sale of drugs and prescription medicines by online pharmacies. A bench of Chief Justice Rajendra Menon and Justice A J Bhambhani sought responses of the Ministry of Health, Central Drugs Standard Control Organisation, Drugs Controller of Delhi and various private e-pharmacies on the contempt plea. The court put up the contempt plea for May 9, when the main petition seeking a ban on "illegal" sale of drugs and medicines online is also listed. Petitioner Zaheer Ahmed, represented through senior advocate Arvind Nigam and advocate Nakul Mehta, said in the contempt petition that despite the stay order by the high court on sale of medicines online, the government has willfully and deliberately not taken any action to stop it.

Explained: First malaria vaccine tested in Malawi. Why this is big for India

The Indian Express

The pilot tests in Malawi of the world’s first malaria vaccine is the biggest public health news break his year. The vaccine, to be administered to children under two years, will also be introduced in Ghana and Kenya in the coming months. At a time when the very scientific basis and veracity of vaccines are being challenged and doubted as the rising insurance of vaccine hesitancy shows, the malaria vaccine pilots is a reinforcement of the age-old adage of medicine – prevention better than cure. It is also important because as global warming becomes more and more severe there are predictions of vectors such as mosquitos seeing an explosive rise the world over, including in areas where they are traditionally not found

Delhi HC allows Alembic, Natco to export Bayer drug for specific purposes

MINT-Prathma Sharma

The Delhi high court on Monday has allowed Alembic Pharmaceuticals and Natco Pharma to export cancer drug (sorafenib) and a blood thinner (rivaroxabin) for development, clinical trials and regulatory clearances. A divison bench of Justice S. Ravindra Bhat and Justice Sanjeev Sachdeva has agreed with the majority of the findings of the single bench comprising of Justice Rajiv Sahai Endlaw. “Sale, use, construction of patented products (by individuals and entities that do not hold patents) in terms of Section 107A of the Act for purposes both within the country and abroad is authorized and legal provided the seller ensures that the end use and purpose of sale/export is reasonably related to research and development of information in compliance with regulations or laws of India (or the importing country), for its submission in accordance with such laws. The impugned judgment of the learned single judge and the findings recorded on this aspect are accordingly affirmed. A dispute about the sale, i.e. whether it is legitimately related to the reasonable end use or purpose of research etc. for submission of information is properly the subject matter of a civil suit in which the full range of reliefs available in law can be granted having regard to the circumstances and the evidence led," the order reads.

US FDA finds quality, data issues at Dadra plant of Sun Pharma

The Indian Express- Prabha Raghavan

The US Food and Drug Administration (US FDA) has found several deficiencies, including those relating to medicine quality as well as data collection and maintenance, during a recent inspection of one of Sun Pharmaceutical Industries Ltd’s largest drug making units in India. The regulator, which inspected the drug giant’s unit in Dadra late in March, has issued 11 observations on the site. “There are no written procedures for production and process controls designed to assure that the drug products have the identity, strength, quality, and purity they purport or are represented to possess,” US FDA investigators observed in their 10-page Form 483 to Sun Pharma, a copy of which The Indian Express has reviewed. An FDA Form 483 is issued to companies upon completion of an inspection when investigators observe conditions deemed to violate US drug regulations. In the Form 483 to Sun Pharma, investigators further observed that the Dadra facility’s quality control unit “lacks authority to fully investigate errors that have occurred.” Explaining this observation, the investigators added that, specifically, the quality unit does not always ensure errors are fully investigated.

Indians have poor access to essential anti-cancer drugs: report

MINT- Neetu Chandra Sharma

Despite India being the largest manufacturer of generic medicines in the world, there is a lack of availability of essential anti-cancer drugs for treating childhood cancers. Findings of a new study have revealed that availability of these anti-cancer drugs in both public and private sector pharmacies in the national capital New Delhi is far below the World Health Organization’s (WHO) prescribed standards. The study titled ‘Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India’ was led by the George Institute for Global Health in collaboration with the University of Sydney, Cankids India, Max Super Speciality Hospital, and Boston University School of Public Health.

Healthcare News

15 lysed blood deaths in Tamil Nadu: Doctors, staff face no action

The Time of India- Pushpa Narayan

Citing lack of evidence, the state health department may not file criminal complaints or initiate action against doctors and paramedics after the death of at least 15 pregnant women and new mothers who were given spoilt or lysed blood at three government hospitals. The three-member inquiry committee that inspected government blood banks in Dharmapuri Krishnagiri and Hosur, where the deaths were reported more than a month ago, has told the government that they are "now maintained as per standards". "As of now we have not found evidence for initiating action against doctors, nurses or lab technicians," said the director of medical education, Dr A Edwin Joe, who was given the report of the committee headed by the deputy director of medical services Dr V P Harisundari. In March, the state health department said nearly 15 women had died due to the side-effects of “lysed” blood transfusion. State health secretary Beela Rajesh ordered criminal action as well as disciplinary proceedings against blood bank officers — Dr M Chandrasekar of Dharmapuri government medical college and hospital; Dr Narayanaswamy of Krishnagiri district headquarters hospital; and Dr Sugantha of Hosur government hospital — besides more than a dozen staff nurses and lab technicians. She had also wanted complaints filed with the state medical council.

Social organisations launch crusade against cancer

The Tribune

Office bearers and activists of various social organisations announced to launch a crusade against cancer that has since been identified as a menace in the society. The announcement was made during a concluding session of screening camp and seminar held by local unit of rotary club at MGMN Senior Secondary School here on Wednesday. Assistant Governor Avtar Krishan Sharma inaugurated the camp and Ahmedgarh SDM (Sub Divisional Magistrate ) Vikramjeet Singh Panthey was the chief guest. A team of oncologists lead by Dr Shamim from Baba Farid Medical College examined about 200 persons and conducted diagnostic tests, including mammography and prostrate imaging in Gunvanti Bansal Cancer Detection mobile laboratory.

Docs warn against buying glittering veg

The Times of India- TNN

Consumption of vegetables soaked in chemicals, adulterated groceries and vegetables with pesticide residue could have an adverse effect on humans in the long run, say doctors. Expressing shock over the alleged practice of vegetables being soaked in chemicals, the doctors ring the alarm bell saying that it will be a double-whammy for the consumers who take pesticide-induced and chemical-soaked vegetables. "We should check whether the chemicals have carcinogens because a lot of chemicals, which are being used in the market, have carcinogenic effect. When we use a chemical which is causing damage to one of the organs over a period of time it can become a carcinogen," said chairman of Dr G Viswanathan Speciality Hospitals, Trichy - general surgeon Dr K Govindaraj on Wednesday. Doctors warn of serious health complications such as cancer for taking such food items in the long-run.

Doctors at Sakra World Hospital Save Life of a Five-Year-Old Suffering from Rare Liver Condition

APN News

Doctors at Sakra World Hospital have recently saved the life of a five-year-old Assamese girl suffering from rare liver disease by performing an emergency liver transplant. Koel Bohra (name changed) visited Sakra World Hospital after complaining of rapidly progressive jaundice that developed within the span of a week. “Initial investigations revealed that her bilirubin was 34mg% and, the International Normalized Ratio (INR) was 6.6. High bilirubin level in blood is indicative of jaundice and is normally less than 1mg%. The INR reflects coagulation function of the liver. A value of over 6.5 revealed that the liver was not producing enough protein required for clot formation in the body. Hence, Koel was diagnosed with acute liver failure,” said Dr. Sadiq Sikora, Director – Gastrointestinal Surgery, Sakra World Hospital.

The brewing crisis…

Greater Kashmir

About two years ago, Stanford University’s Dr. John P AIoannidis, who currently is considered the most-cited physician, wrote in the prestigious Journal of Clinical Epidemiology: “Under market pressure, clinical medicine has been transformed to finance-based medicine…In many places, medicine and health care are wasting societal resources and becoming a threat to human well-being. Science denialism and quacks are also flourishing and leading more people astray in their life choices, including health. We have supported the growth of principal investigators who excel primarily as managers absorbing more money.”

Healthcare– using a band-aid for a surgical operation

Free Press Journal-R N Bhaskar

In some ways this was to have been expected. Last week the government suddenly proposed through Niti Aayog, its policy advisory arm.In some ways this was to have been expected. Last week the government suddenly proposed through Niti Aayog, its policy advisory arm.In some ways this was to have been expected. Last week the government suddenly proposed through Niti Aayog, its policy advisory arm., that it would soon invite discussions with representatives of the medical profession for promoting a ‘Bridge Course’ to create cadres of mid-level health practitioners. Niti Aayog plans allowing dentists to practice mainstream medicine in various health centres. According to media reports – there is nothing reported on Niti Aayog’s website http://www.niti.gov.in/ – it wants to allow dentists (BDS certified) to practice mainstream medicine (MBBS- or allopathy) in various health centres. Niti Aayog, along with the health ministry, is believed to be examining such a proposal. particularly in areas where there is a crisis of MBBS doctors.

Hospital flouts Ayushman Yojana norms; fined Rs 11.8 lakh

The Times of India- Shivani Azad

The Uttarakhand health department on Tuesday imposed a penalty of Rs 11.82 lakh on Shri Mahant Indiresh Hospital in Dehradun for violating norms under the Atal Ayushman Yojana. According to the order issued by the department, the hospital had discharged a heart patient on January 21 even though she was referred to undergo cardiothoracic and vascular surgery. The order also stated that the hospital had asked the patient’s family to pay Rs 2.36 lakh even though Ayushman Yojana provides cashless treatment. Victim Pinki Prasad’s husband had sat on a protest at tehsil district administration office and wrote a letter to CM Trivendra Singh Rawat for help but did not get a response. Some days later, the patient died without treatment. The department has also found out that estimate of Rs 2.36 lakh given to the family was incorrect and in violation of the MoU signed between hospital and state. “Hence, five times penalty of the amount was suggested, which they have to submit within one week,” states the order signed by the director of national health mission in Uttarakhand, Yugal Kishor Pant.

AIIMS launches 'SAATHI' lab to protect elderly from hip fracture

Millennium Post

All India Institute of Medical Science (AIIMS) orthopedic department established a lab and developed a training program for the senior citizen to protect them from having a hip fracture. Doctors at AIIMS introduced "Save the Hip Initiative" in which eight weeks training program scheduled to give expert guidance to the senior citizens. The 'SAATHI' (Save the Hip Initiative) lab was inaugurated by Dr Randeep Guleria, Director of AIIMS, which will study and recognise the risk of falling of the elderly and also teach them the ability to balance their body. "The purpose is to save elderly from falling, as well as protecting their hip fractures," said expert. The expert also said that during the old age, human body becomes weak, which makes it difficult to handle and balance, hence, the biggest reason for hip fracture among the elderly is a sudden loss of motor function in their legs.

College signs pact to sell device to treat dry eye

The Hindu

The Kasturba Gandhi Nursing College, a constituent college of Sri Balaji Vidyapeeth, a deemed to be university, has launched a medical device for treating the dry eye syndrome, an ophthalmic condition that can cause redness, irritation, fatigue or even blurred vision. The “duo sense optic care wear” developed at the SBV is touted to be unique as it allows both hot and cold application to soothe the eyes. SBV-MIPTECH (Mission for Intellectual Property and Technology Transfer) has inked a technology transfer memorandum of understanding with Medizones, a health care company. Subhash Chandra Parija, Vice-Chancellor of SBV, said the wearable device, much like spectacles, contained layers of fluid which would offset many problems associated with dry eyes. The institution would continue to push for innovation in the field of health care, he added. Dry eye syndrome has been identified as a most common problem in India with a prevalence of 32% which is higher than the global prevalence.

PG Medical: Radiology is hot this summer

The Times of India

In a reversal of trends, radiology followed by dermatology have emerged as the top programmes for postgraduate medical courses, beating traditional favourites like orthopaedics, surgery, gynaecology, paediatrics and medicine. The high demand for radiologists and dermatologists, better job opportunities, better working hours and lower professional risks are a few reasons for these programmes being more sought after. The shift began about five years ago and the change has become evident in the PG medical admissions process that is under
way for government colleges, as radiology and dermatology require higher qualifying scores than other programmes. The Admission Committee for Professional Postgraduate Medical Courses (ACPPGMC) recently began its admission procedure for postgraduate medical courses in Gujarat, based on scores obtained in NEET PG. The final merit list was released last month.

Chandigarh: Librarian at GMCH-32 honoured for her study on medical research in India

The Indian Express- Sumedha Sharma

Dr Har Kaur, librarian at Government Medical College and Hospital, Sector 32, has been conferred with the Dr Kautilya Shukla Award for ‘best paper’, during a conference held at IIHMR University, Jaipur, on April 21. She received the award for her research, ‘Mapping of Medical Research of India’. Dr Har Kaur is the first recipient of this award from Tricity and has published 30 national and International publications. The award was presented by Dr R L Raina, vice-chancellor of GMCH, Dr D V Singh, chief librarian of Delhi University, Dr P K Gupta, former director of Rajasthan University and P R Meena, president of Federation of Health Science Library Association India. “No research work in this arena has been done so far. I have tried to collate the data related to medical research in top 10 medical institutions in India over a decade, on the basis of their contribution, ranking and quality. Nowadays, researchers are carrying out study on various topics without working on its quality. The work is getting published in different journals but there is no one to keep a check whether their research is making any real contribution or not. There is a need of real research in this field as it can help solve various illnesses. This award is very prestigious and it motivates me to contribute more in this field of research,” Dr Har Kaur told Newsline.

Antibiotics are prescribed more often during teleconsultations

NIH: In direct-to-consumer telemedicine visits people use their personal devices to connect with doctors. Using telemedicine for children, particularly for acute problems like respiratory tract infections, can be harmful.
The situations include colds, sore throats, and ear infections. Kids may not be able to describe their symptoms. Specific physical exams or tests might also be needed that aren't possible during telemedicine visits. For example, diagnosing an ear infection requires the doctor to look inside the ear canal. Diagnosing strep throat requires a strep test.....read more

All pregnant women should be screened for asymptomatic bacteriuria

All pregnant women should be screened for asymptomatic bacteriuria with urine culture, reiterates the United States Preventive Services Task Force (USPSTF) in its updated draft guidelines, which also continue to recommend against screening for asymptomatic bacteriuria in nonpregnant adults.
However, in these guidelines, the USPSTF has changed the grade for pregnant women one level, from an "A" to a "B", based on new evidence that shows a significantly lower risk of pyelonephritis than found in previous reviews, leading to a reduction in the magnitude of benefit......read more


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