Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 27th April, 2019

Medtalks with Dr K K

1.Boston Scintific announced earlier this week that they have received U.S. FDA approval for the LOTUS EdgeTM Aortic Valve System. It is the only FDA approved aortic valve that gives the option to reposition and completely recapture the valve once it has been fully deployed.

2.Researchers have identified new mechanisms that can explain why some gut bacteria metabolites from dietary nutrients can be potentially beneficial (such as short-chain fatty acids modulating blood pressure) while others may be potentially harmful, such as trimethylamine N-oxide (TMAO) that can affect cholesterol metabolism, promote atherosclerosis, and increase thrombosis risks.

What’s the Difference Between Perfectionism and OCD?

OCD is driven by perfectionism, but it’s not the same.

People with obsessive-compulsive disorder know that their behavior is problematic but they can’t stop it. People with perfectionism don’t care – it makes their lives orderly.

OCD is a mental health disorder that involves repeated, unwanted thoughts or urges that cause a person anxiety. In order to reduce that anxiety, the individual performs a compulsive action or ritual – sometimes one that isn’t necessarily related to the fear or anxiety that they’re trying to overcome.

They may understand that what they’re doing is irrational but still spend hours a day doing it.

Sometimes people have fears of germs; sometimes it’s the need for counting or certain things to happen in certain quantities.

Sometimes it’s just an obsessive thought that they can’t get out of their head.

They know that they shouldn’t have to do it, but they must do it, because to not do it means to have an increase in their level of anxiety that’s intolerable.

The whole process is very bothersome to the individual.

How it relates to perfectionism

Someone who has perfectionism as a personality trait may also have habits or rituals that they follow rigidly, like a certain morning routine or a way of organizing their desk at work. But they’re not necessarily doing it out of anxiety.

They’re content to do those things because it works well for them, even if it drives everyone else crazy.

This personality trait is usually associated with good organization and goal-oriented behavior. Healthy perfectionism may drive some people to achieve excellence.

But, on the other hand, these high standards can also drive people to be extremely critical of themselves and others.

Perfect is the enemy of good.

When perfectionism becomes problematic, the individual themselves is usually the last one to know.

Antibiotics linked to heart attack and stroke

ESC WHF: Women who take antibiotics over a long period of time are at increased risk of heart attack or stroke, according to research carried out in nearly 36,500 women.

The study, published in the European Heart Journal [1] today (Thursday), found that women aged 60 or older who took antibiotics for two months or more had the greatest risk of cardiovascular disease, but long duration of antibiotic use was also associated with an increased risk if taken during middle age (aged 40-59). The researchers could find no increased risk from antibiotic use by younger adults aged between 20-39.

Antibiotics alter the balance of the micro-environment in the gut, destroying “good” probiotic bacteria and increasing the prevalence of viruses, bacteria or other micro-organisms that can cause disease.

The researchers studied 36,429 women who took part in the Nurses’ Health Study, which has been running in the USA since 1976. The current study looked at data from 2004 to June 2012. In 2004 the women were aged 60 or older, and they were asked about their use of antibiotics when they were young (20-39), middle-aged (40-59) or older (60 and older). The researchers categorised them into four groups: those who had never taken antibiotics, those who had taken them for time periods of less than 15 days, 15 days to two months, or for two months or longer.

During an average follow-up period of nearly eight years, during which time the women continued to complete questionnaires every two years, 1056 participants developed cardiovascular disease.

After adjustments to take account of factors that could affect their results, such as age, race, sex, diet and lifestyle, reasons for antibiotic use, overweight or obesity, other diseases and medication use, the researchers found that women who used antibiotics for periods of two months or longer in late adulthood were 32% more likely to develop cardiovascular disease than women who did not use antibiotics. Women who took antibiotics for longer than two months in middle age had a 28% increased risk compared to women who did not.

These findings mean that among women who take antibiotics for two months or more in late adulthood, six women per 1,000 would develop a cardiovascular disease, compared to three per 1,000 among women who had not taken antibiotics.

Found an association between long-term use in middle age and later life and an increased risk of stroke and heart disease during the following eight years. As these women grew older they were more likely to need more antibiotics, and sometimes for longer periods of time, which suggests a cumulative effect may be the reason for the stronger link in older age between antibiotic use and cardiovascular disease.

The most common reasons for antibiotic use were respiratory infections, urinary tract infections and dental problems. [ESC]

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 25 April to 0830 hrs IST 26 April, 2019)

Heat Wave:

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

Maximum Temperature

Maximum temperatures were markedly above normal (5.1°C or more) at a few places over Arunachal Pradesh and Assam & Meghalaya; appreciably above normal (3.1°C to 5.0°C) at most places over Vidarbha and Nagaland, Manipur, Mizoram & Tripura; at many places over Haryana, Chandigarh & Delhi, West Madhya Pradesh, Marathwada and Sub-Himalayan West Bengal & Sikkim; at a few places over Himachal Pradesh, East Madhya Pradesh and Madhya Maharashtra; at isolated places over Rajasthan; above normal (1.6°C to 3.0°C) at most places over West Uttar Pradesh, Bihar, Jharkhand, North Interior Karnataka, Telangana and Rayalseema ; at many places over Punjab, Uttarakhand, Gujarat Region, East Uttar Pradesh, Chhattisgarh and Kerala; at a few places over Saurashtra & Kutch and Coastal Karnataka; at isolated places over Gangetic West Bengal, Odisha, Konkan & Goa, South Interior Karnataka and Tamilnadu & Puducherry Yesterday, the highest maximum temperature of 46.5°C was recorded at Khargone (West Madhya Pradesh) (Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 26 th April, 2019

  • Akola (Vidarbha) recorded the maximum temperature of 46.1°C each (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by 1-3°C at most parts of Gujarat and Jharkhand; at many parts of Jammu & Kashmir and Odisha; at a few places over West Rajasthan, Uttar Pradesh, Punjab, Uttarakhand and Vidarbha and at one or two pockets of Himachal Pradesh, Gangetic West Bengal, Bihar, Chhattisgarh, Konkan & Goa, Coastal Andhra Pradesh and Tamilnadu & Puducherry (Annexure 4).

Healthcare News Monitor

New AIIMS in J&K to have ‘bunkers’ as safety measure

Hindustan Times- Rhythma Kaul

“Risk of life is not a concern for medical professionals as hospitals are often high-risk areas. Security is a concern; so long as there is a sense of security and good incentives, people will work there,” said Dr KK Aggarwal, president-elect of the Confederation of Medical Associations in Asia and Oceania.

Pharma News

Price cap on onco drugs: Will it have the desired impact?

Express Pharma- Akanki Sharma

NPPA’s recent move to cap the price of 42 non-scheduled cancer drugs has evoked mixed reactions from the industry. While some berated it as a hasty decision, others have lauded it and believe that it will be beneficial in the long run By Akanki Sharma. The price cap on 42 non-scheduled cancer drugs by the National Pharmaceutical Pricing Authority (NPPA), which was set to be a relief for cancer patients is just a pyrrhic victory, inform experts, as cancer patients still feel the sting of ‘out-of-pocket-expenses.’ Some stakeholders — drug manufacturing firms, hospitals and pharmaceutical associations — believe that the move was implemented in haste and it needs a ‘re’view.

About one-third of the revenues generated by drug companies is spent on transportation

Express Pharma- Lakshmipriya Nair

Snowman Logistics, an integrated temperature-controlled logistics services provided has been increasing its pan-India presence with strategically located temperature controlled warehouses, including key markets of Mumbai, Chennai, Bengaluru and Kolkata. Manoj Pant, Regional Business Manager – West, Snowman Logistics, speaks on the technological transformations in pharma logistics and how his company is poised to serve the pharma sector, in an exclusive interaction with Lakshmipriya Nair. What are the significant changes and improvements that technology has ushered into the logistics industry to meet the demands of an evolving pharma industry? The biopharma segment is heavily dependent on the cold chain industry, with exports expected to grow by 18 – 20 per cent in terms of value, between 2017 and 2022 (Source- CRISIL report). The cold storage capacity while having grown 1.2 times between 2012 to 2017, has faced several challenges in this time too. Although the cold chain in terms of pharma is maturing fast, there remain several challenges on the development of a very strict cold chain protocol. Broad challenges are evident in the supply and distribution chains of pharma products. While most cold chain players operate in multiple segments to ensure better margins and diversification, a few target only the pharma and biopharma segments where margins are higher as quality has to be maintained. The industry is still undergoing constant technological advancements to ensure smooth operations where the quality of pharma products is unhindered.

The road not taken, a missed chance for medical devices

The Hindu Business Line- Jyothi Datta

The Drugs Technical Advisory Board does not recognise devices as different from drugs. Earlier this month, the Drugs Technical Advisory Board took up a long pending issue — the proposal for a roadmap to regulate medical devices and to outline the human resources required to support it. For a segment so integral to healthcare, medical devices have remained largely on the fringes of the regulatory attention that pharma gets, for instance. Presently 23 (of 5,000) devices are regulated under the Drugs and Cosmetics Act and another 12 are to come under it by 2020. These include equipment such as MRIs and CT scans. The DTAB has further recommended the inclusion of surgical gowns, drapes and incision drapes as drugs. “DTAB deliberated the matter and agreed to notify all medical devices as drug under the Section 3(b)(iv) of the Drugs and Cosmetics Act, 1940 and also to provide exemptions in the Rule 90 of the Medical Device Rules, 2017 during the transition period. The Board further agreed that CDSCO (Central Drugs Standard Control Organisation) should be strengthened with respect to manpower and infrastructure to regulate all medical devices,” according to minutes of the DTAB meeting.

Antibiotic resistance fatal for the future

First Post

The word ‘antibiotic’ is commonly understood to mean medicine that is destructive to bacteria. The word ‘biotic’, however, derives from the Greek biotikos, which means ‘fit for life’. That may be the cruel twist in the tale of these modern-day wonder drugs, that they are no longer on our side in the struggle of life. Sir Alexander Fleming discovered the first antibiotic, penicillin, in 1928. Since then, different antibiotic groups have been discovered which have successfully helped to treat bacterial infections and saved millions of lives. Since then, severe overuse and abuse of antibiotics has been the prominent feature of their use by humans. Overuse of antibiotics in plants and livestock animals has also increased its concentrations in humans via the food chain. It has been overused in diseases as simple as cold and cough in humans and in crops and livestock for prevention instead of cure. Consequently, the effectiveness of this class of drugs has slowly diminished, resulting in the phenomenon of antibiotic resistance, or AR, the ability of bacteria to evade the action of an antibiotic. In other words, the antibiotic can no longer kill the bacteria, which can now continue to cause prolonged inflammation in our body that can be fatal at times.

Jamia Hamdard in collaboration with CSIR organises a session on Phytopharmaceuticals


The Department of Pharmacognosy & Phytochemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi in collaboration with CSIR-IIIM Jammu organised a one-day interactive session in its campus. The UGC-SAP sponsored event focussed on Phytopharmaceuticals: Development, Regulatory, IPR & Marketing Challenges’ and discussed the developments milestones and technical aspects of Phytopharmaceuticals in India. The session was inaugurated by Pro Vice Chancellor of Jamia Hamdard University, Dr. Ahmad Kamal and Chaired by Prof. Vidhu Aeri (HOD) Pharmacognosy and Phytochemistry, Jamia Hamdard University. Prof. S.S Handa (Former Director – Indian Institute of Integrative Medicine), Dr. D.B Narayana (Former Director – Regulatory Affairs- Uni Lever), Mr. Amit Sharma, Director – (Sanat Products Limited and Hindustan Herbals Limited) , Dr. U.V Babu (Himalayan Drug company), Dr. Neeraj Tandon (Head – ICMR) and Dr. B.P Panda ( Jamia Hamdard) were amongst several others attended the session.

Growing urbanisation and the need for motorbike ambulances

MINT- Neetu Chandra Sharma

They say necessity is the mother of invention, and right they are. As urbanisation makes rapid strides, roads have been clogging up with heavy traffic, making accessing emergency healthcare a challenge. This has led to solutions like Motorbike ambulance. In the last five years, India has witnessed the launch of this service in various parts of the country ranging from un-serviced extreme rural areas, to hills and fast developing metros. Eventually, the idea drew the government’s attention also. The Indian Council of Medical Research (ICMR), country’s apex research organisation on Thursday launched a pilot project “Mission DELHI (Delhi Emergency Life Heart-Attack Initiative)’’. Under the project, in a range of 3KM around All India Institute of Medical Sciences (AIIMS) people may soon be able to call (toll free no’s 14430 and 1800111044) for a motorbike borne emergency medical assistance unit in the eventuality of heart attack or chest pain. The project has institutional support from Cardiology and Emergency Medicine departments of AIIMS and funding from ICMR.

Homeopathy -The Medicine of the Future

Life Plus Health-Joseph Ronson

India is known to be the world’s second most populous country with over 100 million people who are wholly dependent on homeopathic treatment and remedies. Three Best Rated® interviewed two homeopathic doctors, who practice in an award-winning homeopathic clinic, to learn more about “The Medicine of the Future.” “Homeopathy is a holistic system of medicine,” Dr. Dattatray says. Homeopathy is an alternative method of curing sufferings that makes the person better both physically and mentally. It has the ability to stimulate the immune system to cure the problem by itself. The substance (or remedy) will cause certain ailments when taken in a large quantity but will cure the same ailments when the substance is taken in extremely minute quantities. It works based on the principle “like cures like.” “We not only treat physical ailments alone. But, a suffered person’s past, feelings, family history, mind, anxieties and stress, dreams, and spirit are also taken into an account for diagnosing and prevention.” Dr. Dattatry explains. This analysis helps the physician to find the correct homeopathic Similimum for the patient. It also helps to develop trust and bond with the patient.

Healthcare News

Illnesses are the Number One route to bankruptcy!

Deccan Chronicle

Medical care is escalating and is unaffordable. In 2016 the World Bank pointed out, India was losing 6 percent of its GDP due to "premature deaths and preventable illnesses." The industry is paid based on the quantity of care delivered. A doctor gets paid more if he performs more procedures or sees more patients, not if he keeps patients healthy. One of the biggest and most important challenges you face is our failing health care system. Virtually every measure shows that we suffer poorer health and more chronic disease. We have a disease management and symptom relief system, not a health care system. We treat end-stage disease and not prevention of the true causes of disease.

View: When care for profit model overrides innovation

The Economic Times- Swami Subramanian

The faith of Indians in healthcare is abysmally low - this resonated last week when a foreign national, in a series of tweets, lamented the death of his mother due to “medical negligence” and “malpractice” in a corporate hospital in India. Indians responded with sympathy and understanding. Many of them shared their own experience with corruption in healthcare in India. Rising incidents of patient’s families attacking doctors is symptomatic of the erosion of faith Indians have had in doctors. How did we get here? The avarice of doctors (and hospitals) was given wings by for-profit healthcare in the 1980s. It has been shown, even in tightly regulated healthcare systems across the world, that injection of profit motives in healthcare quickly corrupts the system, diverting resources away from what is good for patients to what is good for the enterprise. Underinvestment in government healthcare leaves patients dependent on corporate healthcare that prioritises profit over care.

In a first, Mumbai hospital claims injecting stem cells saved infant’s life

Financial Express-Swapna Raghu Sanand

In a first, a city hospital in Mumbai claims to have used stem cells to save a prematurely born ten-month-old baby’s life. According to news reports based on the press conference held by the doctors of the hospital, a prematurely born baby was suffering from lung disease and was put on a ventilator immediately after birth. At the time, the baby’s lungs were extremely under-developed. No other treatment options seemed to be working and the doctors were on the verge of giving up hope when the idea of using stem cells came as a potential breakthrough to save the baby’s life. Meanwhile, the hospital’s claims have raised concerns about the non-compliance of norms pertaining to the use of stem cell research in a medical procedure.

Auto driver's negligence costs 2 lives

The Hans India

Two innocent persons lost their lives in a road accident on Friday due to the negligence of a seven-seater auto driver. The accident happened when M Saidi Reddy (32), belonging to Cheriyal village in Siddipet, was dropping his sister-in-law Kanaka Mahalakshmi at Aurobindo Pharma where she works. She resides at Jyothinagar in Bollaram. According to police, a Tata Ace passenger auto driver stopped his vehicle on the left side of the road at IDA Bollaram municipal office in Patancheru mandal of Sangareddy district. He opened the door of his cabin without minding the steady traffic on his side. The door hit the bike of Saidi Reddy. Both the persons on the bike fell on the road and came under the wheels of a lorry which was coming from their right side. Saidi Reddy died on the spot while his sister-in-law suffered serious injuries. Police and locals shifted both the victims to the Patancheru regional hospital for emergency treatment.

MCI tells state to implement EWS quota in med colleges

The Tribune- Balwant Garg

For the implementation of 10 per cent reservation for Economically Weaker Section (EWS) candidates in MBBS and MD/MS courses in eight medical colleges of the state, the Medical Council of India’s Board of Governor (MCI BoG) has asked the Director of Medical Education and Research (DMER) and secretary, medical education, Punjab, to enhance the existing number of seats so that EWS reservation does not affect other candidates. While this 10 per cent reservation on MBBS seats will be implemented from the current academic session (2019-2020), the reservation in post-graduate medical courses (MD/MS) will be implemented from the next academic session (2020-2021).

Quiz contest held for medical students

The Hans India

Sri Padmavati Medical College for Women (SPMC-W) of SVIMS University has successfully conducted third AP state-level medical quiz competition 'Hayagreeva' in physiology on Friday for MBBS students. Earlier in the day, SVIMS Director Dr TS Ravikumar has inaugurated the competitions by lighting the lamp. Speaking on the occasion, the Director said that the aim of conducting this quiz competition was to inculcate the interest on medicine among students and to cull out their intelligence. Students have been participating in the competitions every year with zeal and spirit. He asked the students to sharpen their knowledge and provide quality health care to the patients.

150-300 minutes physical activity offsets the harm from prolonged sitting

What bad food you eat may not matter, if you take enough amount of good food. And, if you sit for prolonged periods (6 or more hours daily), but replace the sitting time with exercise of at least moderate intensity, and with vigorous-intensity exercise, you can reduce the excess cardiovascular (CV) mortality risk.

The excess all-cause and CV mortality risks caused by regular, prolonged sitting is mainly seen in people who achieve less than 150 minutes of physical activity in a week. Those who maintain physical activity 150 to 200 minutes per week can considerably offset this excess risk; 300 minutes per week is even better.....read more

NIH statement on World Malaria Day 2019

Statement of B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D., National Institute of Allergy and Infectious Diseases

Eliminating malaria - one of the world's oldest and deadliest diseases - remains a critically important public health and biomedical research challenge. Despite remarkable advances in reducing malaria incidence and deaths since 2000, recent progress has become stagnant and has even reversed in some regions. The World Health Organization (WHO) estimates that in 2017 about 219 million cases of malaria occurred worldwide and approximately 435,000 people died of the disease. Unfortunately, malaria cases increased from 2016 to 2017 in the 10 highest-burden countries in Africa, and the number of cases per 1,000 in populations at risk remained at 59 from 2015 to 2017.....read more


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