Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 25th May, 2019

Beer before wine and you’ll feel fine: Is it true?

Assumption”: If you start with wine and then drink beer, the carbonation in beer makes you more easily or quickly absorb alcohol from the wine. In theory, this leads to greater inebriation and a worse hangover.

Study: Researchers enrolled 90 adults between the ages of 19 and 40, randomly assigning them to one of three groups:

  • Group 1 drank beer until their breath alcohol level was at least .05%, then drank wine until it was at least .11%. That’s well over the limit of what can get you charged with drunk driving in the US.
  • Group 2 drank wine until their breath alcohol level was at least .05%, then drank beer until it was at least .11%
  • Group 3 was allowed to drink either only wine or only beer until their breath alcohol level was at least .11%

After a week or so, the experiment was repeated. This time, though, members of Groups 1 and 2 swapped, so that the order of the wine or beer they drank was reversed from the initial assignment. For Group 3, wine drinkers were provided only beer and vice versa.

The groups were similar with respect to gender, body size, drinking habits, and frequency of hangovers. Hangover symptoms were assessed after each drinking session.

Results: There was no correlation between hangover symptoms and whether subjects drank only wine, only beer, or switched between them in either order. The best predictors of a bad hangover were how drunk the subjects felt or whether they vomited after drinking.

Alcohol is absorbed rather well and rather quickly, regardless of its source.

Regardless of your drinks of choice or the order in which you drink them, what matters most is drinking responsibly, never driving under the influence, and knowing when to quit. [Harvard Newsletter, The American Journal of Clinical Nutrition, Volume 109, Issue 2, February 2019, Pages 345–352]

Always obey the patient’s wish

A Montana hospital has been ordered to pay more than $400,000 ( 2.8 crore) in damages to the estate of a man after jurors found the hospital, on two consecutive days, violated the man’s wishes not to be resuscitated, reports FOX 28 news.

The jury found St. Peter’s Health in Helena and Dr. Virginia Lee Harrison negligent for violating Rodney Knoepfle’s patient rights.

Jurors awarded $209,000 in damages for medical costs and $200,000 for mental and physical pain and suffering.

Knoepfle filed the lawsuit after medical teams performed cardiopulmonary resuscitation on him on March 21, 2016, and, despite confirming his do-not-resuscitate order, the next day used ventilation and adrenaline after he became unresponsive with a very low heart rate.

His wishes not to be resuscitated were included in his patient chart, had been expressed verbally to his doctors and he wore a blue wristband indicating he did not wish to be resuscitated or intubated.

After the second resuscitation, Harrison wrote in Knoepfle’s chart that he and his wife “DO NOT WANT INTUBATION or CPR again” but would want treatment up to that point.

Knoepfle had a pacemaker implanted and was released to a nursing home on April 1, 2016.

He died in March 2018 at age 69.

Healthcare News Monitor

Pharma News

Exclusive: JPMorgan cuts ties with OxyContin maker Purdue Pharma - sources

ET Healthworld- Guest Article

JPMorgan Chase & Co has cut ties with Purdue Pharma LP over the OxyContin maker's alleged role in the U.S. opioid crisis, forcing it to find a new bank to manage cash and bill payments, people familiar with the matter said on Thursday. The move makes JPMorgan, the largest U.S. bank by assets, the most high-profile corporation known to have distanced itself from Purdue and its wealthy owners, the Sackler family, amid thousands of lawsuits alleging the company pushed addictive painkillers while downplaying their abuse and overdose risks. JPMorgan's decision also underscores a drive among U.S. banks to reassess their relationships with clients and industries in response to controversy and political debates over matters such as immigration detention and mass shootings.

Expect cheap blood tests & drugs within first 100 days of Modi 2.0

The Print-Himani Chandna

Over the first three months of a second term earned with a resounding margin, the Narendra Modi government may surprise patients with more affordable medicines as well as cheap blood tests. Sources in the Department of Pharmaceuticals and the government’s drug-pricing watchdog, the National Pharmaceutical Pricing Authority (NPPA), which fall under the Union Ministry of Chemicals and Fertilizers, told ThePrint that they are set to launch a host of measures to make healthcare cheaper for the common Indian. The proposals are all part of the 100-day plan prepared by the ministry, in keeping with a government directive issued ahead of the elections.

Total Brain develops Personalized Medicine Test for treatment predicting remission of depression symptoms when using main psychotropic drugs


Total Brain sponsor of the iSPOT-D study (International Study to Predict Optimized Treatment in Depression), has successfully developed an objective Personalized Medicine Test to determine who is more and less likely to respond to three of the most common antidepressant medications. The test is based on a clinical and genetic analysis of over 1,000 patients' antidepressant drug response rates. While the final scientific validity of the test is subject to the results of a full replication of the study, these results help support the value potential of the iSpot assets. Total Brain continues to work with a New York-based investment bank in evaluating its strategic alternatives for iSpot, including finding a commercialization partner who would work to successfully replicate the initial findings of the test before subsequently monetizing it. Major depressive disorder is one of the most common psychiatric disorders in the US, with over 15 million people impacted and costing $100 billion annually, of which less than half achieve symptom remission with the first medication tried. Primary care physicians (PCPs), psychiatrists and other clinicians face daily challenges of objective decision making for treatment options in depression.

OncoSec announces positive results from phase 2 KEYNOTE-890 study of TAVO in combo with Keytruda to treat heavily pretreated chemotherapy/radiotherapy refractory mTNBC


OncoSec Medical Incorporated, a late-stage cancer biotechnology company developing gene-based intratumoral immunotherapies, announces interim data from KEYNOTE-890, an ongoing phase 2 study of TAVO (intratumoral IL-12) in combination with Keytruda in patients with heavily pretreated, metastatic, chemotherapy refractory triple negative breast cancer (mTNBC). Patients who previously failed an average of 3.5 prior lines of chemotherapy were enrolled in KEYNOTE-890 to evaluate if the addition of TAVO (IL-12) could provide meaningful clinical activity when combined with Keytruda, an anti-PD-1 checkpoint inhibitor. Heavily pretreated patients with refractory mTNBC (average of 3.5 prior lines of chemotherapy) showed a rapid tumor reduction of 20% or greater at the initial 3-month evaluation in the first five of 10 patients. Two patients had a partial response, one with a 66% tumor reduction, including a significant reduction of liver lesions, and four patients had stable disease, three of which reported a 20% or greater tumor reduction. These preliminary findings, when compared to the results of KEYNOTE-086, which demonstrated a 5.3% response rate in mTNBC patients treated with Keytruda monotherapy, suggest TAVO's ability to unlock Keytruda's potential anti-cancer efficacy in this very difficult to treat patient population. Four of the six patients who experienced tumor reductions have an ongoing response as of May 9, 2019.

Centaur Pharma's Pune facility receives NAI with zero 483 observations from US FDA


Mumbai based leading pharmaceutical company Centaur Pharmaceuticals' Pune facility has received no action indicated (NAI) compliance status with zero 483 observations from the US FDA. This is based on US FDA inspections of the finished dosage facility in the second week of May, 2019. This comes as a major development for the pharma industry as NAI is a significant comment for an Indian pharma company considering the increasing global regulatory scrutiny in the last few years. The US FDA audit concluded with zero 483 observations and the outcome of inspection was also categorized as NAI which signifies compliance and conformance to applicable cGMP regulations. In addition to US FDA accreditation, the said facility also conforms to MHRA (UK), TGA (Australia), Health Canada, MCC (South Africa) and WHO-GMP standards. NAI inspection classification occurs when no objectionable conditions or practices are found during the inspection or the significance of the documented objectionable conditions found does not justify further actions.

Letco Med launches new industry-leading website and e-commerce solution making easier for compounding pharmacies to do business

Pharmabiz- Wayne

Letco Medical, L.L.C, a leading supplier of quality compounding products, supplies, and equipment, announced to its customers the launch of a new web-based e-commerce solution on April 11, 2019. Committed specifically to serving the needs of the compounding industry, Letco Med implemented a comprehensive, one-stop solution for customer ordering and self-service that reduces valuable pharmacy time spent on purchasing, inventory management, document retrieval, and pricing analysis, enabling compounders to spend more time with patients. Letco partnered directly with customers to identify opportunities to transform the online ordering experience. Those insights, along with the evolving needs of compounding pharmacies, were used as inputs to the design and implementation of the most advanced web-based ordering platform in the industry. Customers can now quickly locate products, select from greatly expanded shipping options, and easily access account-specific pricing and specials. Letco's new solution also provides a unique and customizable portal where customers can access a broad array of compounding formulas, product pedigrees, safety data sheets, certificates of analysis, invoices, delivery tracking, and more. Besides the enhanced functionality, Letco also debuted a fresh, contemporary design for a better user experience overall – across all web-enabled devices, including mobile.

Healthcare News

Water crisis hits hospitals in Hyderabad-Karnataka

The Times of India- Sunitha Rao

A sterilisation camp was recently cancelled at a Kalaburagi government hospital as the medical team realised the facility didn’t have enough water for over 30 surgeries. The Kalaburagi case is only the tip of the iceberg: the public healthcare sector in Hyderabad-Karnataka is reeling under a severe water crisis. With borewells running dry, government hospitals are not just dealing with shortage of drinking water. Primary health centres (PHCs) and public hospitals in districts like Bidar, Kalaburagi and Ballari are resorting to minimal water usage. “A maximum of 30 surgeries are done at one sterilisation camp in a day. This means, the operation theatre has to be readied for one surgery after the other. Due to lack of sufficient water to sterilise equipment in the OT and sanitise the area, the camp was scrapped at the last minute,” confirmed Dr Shivaraj Hede, joint director, health and family welfare department (Kalaburagi division).

Staff crunch ails govt-run psychiatric hosp in Pune’s Yerawada

Hindustan Times

India’s largest hospital for psychiatric treatment, the government-run Regional Mental Hospital at Yerawada, Pune, is facing acute staff shortage which is affecting patients with serious mental illness. According to Dr Abhijit Phadnis, medical superintendent of the hospital, the hospital that houses at least 1,260 patients, have only two psychiatrists on duty and 11 vacancies. The authorities of the government-run Regional Mental Hospital have asked the Maharashtra government to approve 20 additional positions of psychiatrists. Dr Phadnis said, “The requisition for filling vacancies was sent to the state government last month and this is being followed up with daily reminders. The issue has, however, not progressed satisfactorily.”

Doctor commits suicide in Mumbai hospital; family alleges ragging by seniors

The Indian Express- Tabassum Barnagarwala, Sagar Rajput

Claiming that she faced ragging by her seniors, a post-graduate medical student on Wednesday committed suicide in hostel room of Topical National Medical College, attached with BYL Nair Hospital. The second-year student of Gynaecology and Obstetrics department, Payal Tadvi (27), was found hanging in her room that she shared with three other students, at 7.30 PM. Nair hospital has also set up an internal committee of five members, including dean, head of departments, and representatives from Maharashtra Association of Resident Doctors (MARD), to look into the allegations of ragging against three seniors, identified in police complaint as Dr Hema Ahuja, Dr Ankita Khandelwal, an Dr Bhakti Mahire. After conducting preliminary investigation, the Agripada police registered a FIR under abetment to suicide and relevant section under Scheduled Caste and Scheduled Tribes (Prevention of atrocities) Act, anti-Ragging and Information Technology Act on Thursday while they are yet to make an arrest.

Doctors remove 8 spoons, 2 screwdrivers, 2 toothbrushes and a knife from man’s stomach

The Indian Express

A 35-year-old man reportedly swallowed eight spoons, two screwdrivers, two toothbrushes and one kitchen knife. Doctors were able to remove it from his stomach Saturday. The man was admitted to Shri Lal Bahadur Shastri Government Medical College in Mandi in Himachal Pradesh. When the man was admitted to the hospital, he had objects protruding from his stomach, ANI reported.News agency ANI quoted Dr Nikhil as saying, “After investigation, it was found that some metallic objects were inside his stomach. Our team of surgeon immediately operated him. He is stable now.” The doctor added that the patient was suffering from a mental illness and called it a ‘rare case’.

Madhuri Kanitkar takes charge as Major General Medical, Udhampur

The Indian Express- Anuradha Mascarenhas

Major General Madhuri Kanitkar, who completed more than two years as dean of AFMC in Pune, took charge Friday as Major General Medical, Udhampur in charge of combat medical care for the Northern Command sector of Jammu and Kashmir and Ladakh. The Northern Command is an operational command of the Indian Army engaged in counterinsurgency and counterterrorism operations in Jammu and Kashmir. She is also the third woman in the country and the first paediatrician from the armed forces who has been selected for the rank of Lieutenant General. Kanitkar had earlier told The Indian Express that she had been empanelled but the rank will be assumed only when the vacancy comes up at the end of the year.

GOP, Dems team up to address 'surprise medical bills'

ET Healthworld- AP

Plunging ahead despite paralyzing partisanship in the nation's capital, senior lawmakers of both parties Thursday proposed legislation to tackle "surprise medical bills" and other concerns, from prescription drug costs to uneven vaccination rates. The draft bill from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., echoes a time when health care issues often led to dialogue and cooperation between political parties. Alexander chairs the Health, Education, Labor and Pensions committee, while Murray is the ranking Democrat. "We can make progress when both sides are at the table ready to put patients and families first," Murray said in a statement. Alexander said he wants to bring the bill to the Senate floor in July and get legislation on President Donald Trump's desk.

Floating hospitals to the rescue in climate change hit Bangladesh

Deccan Chronicle- Kavita Mallya

The ‘chars’ or islands of Bangladesh have been victims of climate change. They are constantly changing their shape and form due to eroding. This process has unfortunately quickened by extreme rainfall that is a result of climate change. This erosion has created multiple hindrances to daily life, but the biggest disadvantage is not being able to build permanent structures, especially hospitals. To address this issue, Bangladesh now has floating hospital ships that are run by non-government organisations. They are equipped with medical facilities and doctors and provide free medical treatment to the people in the ‘chars’.

How Ladakh’s 1st gynaecologist changed the face of women’s health in India’s cold desert

The Better India- Rinchen Norbu Wangchuk

Every Thursday, Dr Tsering Landol, a retired gynaecologist, conducts a clinic with the Ladakh Heart Foundation, a charitable medical facility. Here, she screens, counsels and guides women patients, particularly those who are pregnant. “We prepare them for all pregnancy-related eventualities, counsel them on the precautions they need to take, and address hygiene and nutrition-related concerns,” says the Padma Shri award-winning doctor who is also Ladakh’s first gynaecologist, to The Better India.

Delhi HC awards Rs. 50 lakh compensation to doctors, nurse killed in Faridabad air ambulance crash

Bar & Bench- Aditi Singh

The Delhi High Court has awarded a sum of Rs. 50 lakh each as compensation to the legal heirs of the two doctors and one nurse who were killed in the air ambulance crash in Faridabad in 2011. While the owner of the air ambulance service, Air Charters Services Pvt Ltd., has been directed to pay Rs 7.5 lakh as per the statutory liability under the Carriage by Air Act 1972, United India Insurance Company Ltd has been directed to pay an amount of Rs. 42.5 lakh with interest @6 percent per annum from the date of filing of petitions. The order was passed by a Single Judge Bench of Justice Suresh Kumar Kait in petitions by the legal heirs of the deceased doctors and nurse seeking compensation from Air Charters and its insurance company United India Insurance.

Private hospital chief arrested for cheating staff in Hyderabad

Telangana Today

The Rachakonda police on Friday announced that Braunwald Hospitals chairman Dr. Narendra Vikramaditya Yadav was arrested on charges of cheating his employees. His wife, Divya Rawat, is absconding. In a press release here, the Rachakonda police said the Kushaiguda police had on April 30 received a complaint from Dr. Khaja Faizoddin stating more than 100 persons, who were working in Poulomi Hospitals in Kushaiguda in various wings, were cheated by Dr. Yadav, who had on January 1, taken over the management of the hospital. On the same day, Yadav and his wife had given regular pay rolls and appointment letters on the name of Braunwald Hospitals. New employees were hired and appointments letters were also issued accordingly.

Current Temperature Status and Warning for next 24 hours

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

Heat Wave:

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


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

Yesterday, the highest maximum temperature of 46.6°C recorded at Chandrapur (Vidarbha).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 25 May to 0830 hrs IST of 26 May 2019):-

Heat Wave Conditions in many parts to severe heat wave conditions in isolated pockets over Vidarbha; in some parts over northeast Madhya Pradesh and in isolated pockets over Telangana, Madhya Maharashtra, Marathwada, Chhattisgarh, Odisha, Jharkhand and East Uttar Pradesh.

Clinical Practice Guidelines 2019

Treatment of diabetes in older adults: 10 Key Takeaways

This year, the Endocrine Society released clinical practice guidelines on the diagnosis and management of diabetes and its comorbidities in older adults aged 65 years and above published May 1 in the Journal of Clinical Endocrinology & Metabolism.
Here are 10 key takeaways from the guidelines.
1. Screen for diabetes and prediabetes (fasting sugar, A1c, 2-hour OGTT) in patients aged 65 years and older without known diabetes.
2. Periodically screen older patients with diabetes for undiagnosed cognitive impairment. If mild cognitive impairment present, simplify medication regime and glycemic targets to improve compliance........read more

A new technique reduces risk of obstruction in heart valve replacement

Researchers at the National, Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), 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 findings are published in the Journal of the American College of Cardiology online on May 20, 2019.
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.......read more

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