Editor in Chief Dr KK Aggarwal, Padma Shri Awardee
Dated: 30th April, 2019
Now gallium-68 PET scan for recurring prostate cancer
Scientists in California have published results with an experimental imaging technique that detects recurring prostate cancer with the best accuracy.
The Gallium-68 PET scanning. Two tracers have been approved so far by the FDA for use in prostate cancer diagnostics: one called choline C11 and another called fluciclovine-18-F.
In this the tracer used was gallium-68, which has yet to win regulatory approval in the United States. Gallium-68 has the advantage of binding specifically to a protein called prostate-specific membrane antigen (PMSA), which is highly expressed on metastatic cells and shows up better on PET imaging than the current FDA-approved agents.
Gallium-68 PET scans produced positive results in 75% of the men, and the likelihood of a positive hit grew as their PSA levels increased. For instance, 38% of men with PSA levels of 0.5 nanograms per milliliter (ng/mL) or less were flagged by PET scanning, compared to 97% of the men with PSA levels of 5 ng/mL or higher.
Benefits and risks of TAVR
The initial clinical trials of TAVR, begun in 2007, evaluated TAVR in patients who were too ill to be considered for SAVR. These trials showed benefit at extending quality and length of life in patients with severe AS. Since that time, trials have been performed comparing TAVR to SAVR in patients who are considered high risk and intermediate risk for traditional SAVR. In each of these studies, TAVR was shown to be no worse or even better than SAVR. Because of the quick recovery with TAVR, it soon became the standard of care for intermediate and high surgical risk patients with AS.
The recent news about TAVR concerns clinical trials conducted on patients who are considered low-risk surgical candidates.
The PARTNER 3 Trial and the CoreValve Low-Risk Trial were presented at the recent American College of Cardiology Meetings in March 2019. Both trials showed significant benefits of TAVR compared to SAVR, including reduced rates of death, stroke, and repeat hospitalizations. It is expected that TAVR in low-risk patients will gain FDA approval in the near future. When this occurs, TAVR will be the standard of care or all patients with AS.
While TAVR has major benefits, there are certainly risks involved, as there are for any major heart procedure. These risks may include heart attack, stroke, bleeding, and need for emergency surgery, but these risks are low. There is also potential damage to the electrical system of the heart that may result in the need for the placement of a permanent pacemaker. [Harvard]
Canagliflozin aids additional weight loss after refractory bariatric surgery
Adults who underwent bariatric surgery and experienced diabetes remission but later regained weight and redeveloped the disease experienced weight loss and improvements in cardiometabolic parameters after 6 months of canagliflozin therapy, according to study data presented at the AACE Annual Scientific and Clinical Congress.
Canagliflozin doesn’t rely on insulin. It results in the elimination of glucose in the kidneys. At 6 months, BMI for participants in the canagliflozin group decreased from a mean of 39.6 kg/m² to 38 kg/m², whereas those in the placebo group experienced a mean 3 kg/m² BMI gain.
Patients assigned canagliflozin also experienced a mean 32.9 mg/dL reduction in fasting blood glucose at 6 months, in addition to a reduction in C-reactive protein.
“13 Reasons Why” associated with increase in youth suicide rates?
NIH: The Netflix show “13 Reasons Why” was associated with a 28.9% increase in suicide rates among U.S. youth ages 10-17 in the month (April 2017) following the shows release, after accounting for ongoing trends in suicide rates, according to a study published today in Journal of the American Academy of Child and Adolescent Psychiatry.
The number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period examined by the researchers. When researchers analyzed the data by sex, they found the increase in the suicide rate was primarily driven by significant increases in suicide in young males. While suicide rates for females increased after the show’s release, the increase was not statistically significant.
“13 Reasons Why” is a web-based series that tells the story of a young girl who kills herself and leaves behind a series of 13 tapes detailing the reasons why she chose to end her life. Although this show has received critical acclaim, it has also generated questions regarding how the show’s portrayal of suicide affects young people who watch it. The series premiered on Netflix on March 31, 2017.
Researchers data included information about the deaths of individuals between the ages of 10 and 64 that occurred between Jan. 1, 2013, and Dec. 31, 2017, a timespan that encompassed the period before and after the release of the series.
The researchers found that the rates of suicide for 10- to 17- year-olds was significantly higher in the months of April, June, and December 2017 than were expected based on past data. This increase translated into an additional estimated 195 suicide deaths between April 1, 2017, and Dec. 31, 2017. The observed suicide rate for March 2017 — the month prior to the release of “13 Reasons Why” — was also higher than forecast. The researchers note that the show was highly promoted during the month of March, exposing audiences to the show’s premise and content through trailers. The researchers did not find any significant trends in suicide rates in people 18- to 64 years of age.
The researchers also analyzed deaths due to homicide during the same period, to assess whether other worldly social or environmental events after the release of the show might have influenced suicide rates. Homicide rates can be influenced by some of the same social and environmental factors as suicide rates. The researchers did not find any significant changes in homicide rates following the release of the show. The lack of change in homicide rates during the period of interest lends some strength to the idea that changes in suicide rates were influenced by the show and not some other environmental or social factor that occurred during this period.
Youth may be particularly sensitive to the way suicide is portrayed in popular entertainment and in the media.
Current Temperature Status and Warning for next five days
Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 28 April to 0830 hrs IST 29 April, 2019)
Yesterday, Severe heat wave conditions were observed at some parts over coastal Saurashtra and isolated pockets over Vidarbha. Heat wave conditions were observed at isolated pockets over Gujarat Region, Marathwada, Madhya Maharashtra and Madhya Pradesh (Annexure 1 & 2).
Maximum temperatures were markedly above normal (5.1°C or more) at a few places over Gujarat state and at isolated places over Madhya Maharashtra; appreciably above normal (3.1°C to 5.0°C) at most places over Vidarbha; at many places over Jammu & Kashmir, Himachal Pradesh, Jharkhand, Gangetic West Bengal, West Madhya Pradesh, Marathawada and Nagaland, Manipur, Mizoram & Tripura; at a few places over East Madhya Pradesh and Bihar and at isolated places over Odisha and Telangana; above normal (1.6°C to 3.0°C) at most places over Uttarakhand, Punjab, Uttar Pradesh and Chhattisgarh; at many places over Rajasthan, Rayalaseema and North Interior Karnataka; at a few places over Haryana, Chandigarh & Delhi, Konkan & Goa and Kerala and at isolated places over Tamilnadu & Puducherry and Andaman & Nicobar Islands.Yesterday, the highest maximum temperature of 47.5°C was recorded at Khargone(West Madhya Pradesh) (Annexure 1 & 2).
Temperatures Recorded at 1430 Hours IST of Today, the 29 th April, 2019
Healthcare News Monitor
The Times of India
Diabetics in the country have something to cheer about. A completely new drug in the SGLT2 Inhibitor (sodium glucose co-transporter-2) family is being introduced here for the first time globally, which promises to disrupt the anti-diabetes market by lowering cost of therapy by nearly 60%. The drug offers an affordable treatment for millions of type 2 diabetese patients to tackle the debilitating disease which gradually attacks and weakens all body organs. Remogliflozin, developed by Mumbai-based Glenmark, will be priced around Rs 25 for daily therapy, as against other drugs in the same class available between Rs 55-60 per day. This marks the first global approval to a new drug application by the regulator for an SGLT2 Inhibitor in India. SGLT2 Inhibitors are one of the fastest-selling diabetes drugs globally, totalling $9 billion, while in India they grew by 10 times over three years to nearly Rs 600 crore. At present, the same class of drugs available here are all patented.
The Hindu- N.Ravi Kumar
India will be sending a high-level delegation to the first meeting of the working group on pharmaceuticals, with China, scheduled in Beijing next month. An initiative under the India-China Strategic Economic Dialogue (SED) Mechanism, the working group meeting comes in the backdrop of growing efforts by India to increase pharma exports to China. In doing so, the emphasis has been on impressing upon China to make the drug registration process easier for Indian pharma companies. “There is a need for strengthening our exports to China and also to reduce import dependence from China, which could be achieved with regular trade and bilateral discussions,” a communication from the Pharmaceuticals Export Promotion Council of India (Pharmexcil) to its members said.
Malaria remains a vexing public health problem for India. With nearly 4 lakh cases of malaria and 85 malarial deaths in 2018—these numbers are from the National Vector Borne Disease Control Programme, WHO pegged death alone at nearly 17,000 in 2017—it has one of the worst country-malaria-burden in the world. Indeed, official data is likely skimming the surface, with, as per The Indian Express, an estimated 60-80% of patients in urban areas treated at private establishments, most of which don’t report cases to the official data-collector. What makes India’s problem particularly acute is that some of its poorest and most remote regions account for the bulk of the malaria burden. Odisha, Jharkhand, Chhattisgarh, Meghalaya, Arunachal Pradesh, Mizoram and tribal areas of Maharashtra and Madhya Pradesh report 90% of the notified cases.
Financial Express- Rajiv Nath
Thirty years have gone by since the 1st medical device was regulated as a drug but a comprehensive regulatory framework still remains elusive. India imports 70-90% of its medical devices of which the vast majority are unregulated for quality and safety. While many of these products may have regulatory certifications in other countries, the reality is that a considerable number of them are being exported from countries that do not regulate their exports. Our policymakers are surprisingly undecided and seem to be in no urgency to usher in a “Patient Safety Medical Devices Law” to protect patients, even after the recent ICIJ implant files or J&J incident, or the most recent ban on Trans-vaginal Pelvic Mesh by US FDA.
Daily News & Analysis-Cheena Kapoor
A report released by an ad-hoc United Nations agency alarmed the world on Monday by highlighting the growing crisis of pathogens getting resistant to drugs meant to fight them. Experts from the Interagency Coordination Group (IACG) urge nations across the world to come together for immediate coordinated action to curb antimicrobial resistance (AMR), a phenomenon with disaster written all over it. At least 700,000 people die every every year globally due to drug-resistant diseases, including 230,000 from multidrug-resistant tuberculosis. This could rise to 10 million a year by 2050, without sustained efforts towards containment, 2.4 million of them in high-income countries alone, counting from 2015. And the damage to the economy could be as catastrophic as the 2008 global meltdown: by 2030, AMR could force up to 24 million into extreme poverty.
Researchers claim to have found a combination of existing drugs which can be effective against blood cancer that affects mainly older adults. Researchers tested to see if existing drug arsenic trioxide (ATO) was effective in combination with all-trans retinoic acid (ATRA) in both the mouse model and in humans. They determined that the combination proved 'powerfully and exquisitely effective' against acute myeloid leukaemia (AML). While most patients initially respond to chemotherapy against (AML), more than half of those who respond will eventually relapse as the cancer cells develop resistance to treatment. The experiment identified key processes these cancer cells use to develop or evolve against drug in response to therapies according to the study published in the Journal of Cell Research. Moreover, the team demonstrated that a combination of drugs already in use for the treatment of another type of leukaemia worked equally as well against this form of AML in both in vitro and in vivo setting.
Business Today- Joe C Mathew
At a time when world's largest market for pharmaceuticals, the US is sparing no words to accuse India as a source of counterfeit medicines, and complaining about India's intellectual property protection policies and drugs and medical device pricing regulatory systems, an industry veteran - Gurpreet Sandhu - is attempting to build an organisation that can bridge the advocacy gap between India and the US. Delhi based Sandhu, the managing director of privately held Reva Pharma, has taken the lead in setting up a global not for profit think tank - Council for Healthcare and Pharma (CHP). The Delhi headquartered think tank plans to open offices in the US, Japan and other countries. The Council is hitting the road running, as its first programme, Legislative Day at Capitol Hill, Washington D.C, for US Congress members and opinion makers, is on April 30.
The New Indian Express
A wide range of capsules, tablets and churans are sold across the country under the labels ‘herbal medicine’ and ‘ayurvedic medicine’. These are manufactured by a number of companies — ranging from the well-known to the never-heard-of. However, there is no organisation to certify the genuineness of these products. Same is the case with biosimilars, which are expected to revolutionise the treatment of various diseases across the world. As per a Confederation of Indian Industry (CII) report, the biosimilar market in India is expected to cross the `2.5 lakh crore mark by 2030. However, there exists no concrete regulatory process to monitor the quality of biosimilars in India. But the Hyderabad-based Centre for Cellular and Molecular Biology (CCMB) is set to change this, by playing a significant role in the regulation and quality-testing of both biosimilars and herbal medicines. The Centre recently signed a Memorandum of Understanding (MoU) with the Indian Pharmacopeia Commission in this regard.
The Quint- Jyoti Joshi & Isabel FROST
The possibility of a post-antibiotic era looms large. Antimicrobial resistance (AMR) is an emerging threat that will impact not only the treatment of common infections but hip and knee replacements, organ transplants, cancer chemotherapy, and many of the advances of modern medicine. It signifies the ability of the bacteria that cause infections to survive in the presence of the drugs that were commonly used to kill them. However, while drug-resistant bacterial infections threaten populations around the world, more people in low- and middle-income countries (LMICs) die because they lack access to antibiotics.
The Times of India– Durgesh Nandan
Alternative and herbal medicines may not always be without side-effects. Doctors say unmonitored use of such medication, as also long-term drugs for ailments such as TB and body-building protein supplements, may lead to liver failure even among patients with no history of liver disease. Take the case of Rashmi Khare (name changed). The 27-year-old Delhi girl was admitted to Institute of Liver and Biliary Sciences (ILBS) with acute liver failure resulting in internal bleeding and fatigue. She had been on medication for TB for a long time but the drug’s effect on the liver was not monitored. “She is being managed well with plasma exchange therapy. But the need for a transplant in future cannot be ruled out,” said Dr S K Sarin, director, ILBS. Dr Sarin added that he gets one to two cases of drug-induced liver failure every week. “Alternative medicines or herbal drugs are the most common culprits followed by anti-tubercular medications, body-building protein supplements, painkillers and antibiotics,” he said. Dr A S Soin who heads the liver transplant unit at Medanta Medicity in Gurgaon and Dr Subhash Gupta of Apollo hospital also confirmed the trend. In a recent study, conducted by ILBS in collaboration with experts from 29 countries, doctors found one out of every 10 patients suffering from chronic liver disease developed acute failure of the organ due to drug toxicity
The Indian Express
Painting a dire picture of a future with drug resistance, a UN report has warned that drug-resistant diseases could cause 10 million deaths each year by 2050 and damage to the economy could be as catastrophic as the 2008-2009 global financial crisis. According to the report, by 2030, antimicrobial resistance could force up to 24 million people into extreme poverty. “The economic impact of uncontrolled antimicrobial resistance would also be catastrophic. As drug-resistant pathogens spread, health care expenditures would increase dramatically, and sustainable food and feed production – including global trade in food, feed and livestock – will increasingly be at risk,” said the UN ad hoc Interagency Coordinating Group (IACG) on Antimicrobial Resistance (AMR).
Deccan Herald- Niranjan Kaggere
As the country is observing Immunisation Week, the demand to include cervical cancer vaccine into Universal Immunisation Programme (UIP) is fast gaining momentum. India alone accounts for about 25% of global deaths due to cervical cancer. Though the government is yet to take a formal stand on the introduction of the Human Papilloma Virus (HPV) vaccine, the medical practitioners have vociferously urged the government to include the vaccine into UIP. According to medical experts, cervical cancer is the second most common cause of deaths among Indian women aged between 15 and 44 years. “About 1.2 lakh women are suffering from cervical cancer in India. The Indian Council of Medical Research has revealed that less than 30% women in India aged between 30 and 49 years have been screened for cervical cancer,” said a senior doctor at the Kidwai Memorial Institute of Oncology.
The occurrence of cancer is increasing globally as well as in India. As per ICMR (Indian Council of Medical Research) 17 lac new cancer cases will be diagnosed annually by 2020. Head and neck cancers account for about 30% of all cancers in India. Of these, about 1/4th cases are found in men and 1/10th are found in females.. Poverty, illiteracy, late diagnosis (about 60 to 80 % patients consult doctors during advance stages) and lack of access to healthcare pose major challenge in management of head and neck cancer. In our country, about 70 to 80 % cancer patients consult specialists during advanced stages and hence, poor outcomes are quite likely. According to various surveys by concerned authorities, 50 % of cancers in India can be attributed to lifestyle or bad habits which include consumption of tobacco (chewing or smoking), alcohol, other forms of addiction, obesity etc.
The Travancore Cochin Medical Council for Indian System of Medicine has issued a 15- point instruction to the practitioners of modern medicine in Kerala. Every practitioner should display the registration number given by the state medical council. The investigation reports of scanning, pathology, microbiology and biochemistry should contain the doctor's name, registration number and MCI recognized qualifications. The medical practitioners practising in private clinics/hospitals should display the registration certificates in front of their respective establishments. Every practitioner should display the registration number accorded to him/her by the state medical council in the clinic and in all prescriptions, certificates, money receipts given to the patients. The doctors should display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships.
News Today- Bhavani Prabhakar
Despite rules, several pharmacies in the city continue to distribute medicines and drugs over the counter. Among the lot, the sale of antibiotics is something that healthcare experts raise their concern over. Speaking about the intensity of the problem, Fortis Malar Hospital senior consultant physician and diabetologist, Dr Vinod Prem Anand, stated that the phenomenon is widely prevalent. “The situation will not change unless rules are implemented strictly. In the case of other countries like the US, one can get basic medicines for treating cold/cough whereas in India, it is easy to get any tablet – from painkillers to antibiotics – without prescription,” said Dr Vinod. Experts call for a policy on antibiotics to curb such irrational practices. Doctors Association for Social Equality general secretary, Dr G R Ravindranath, said, “The Centre had announced the same two years ago, but it has not seen the light of day yet. The policy should speak about rational usage and protocol for doctors to suggest.” Such indiscriminate practices raise the question of the amount of research carried out in the sector to develop new combinations. When asked about this, experts unanimously stated that there has not been much research in the field and point to the lack of funding from the government. “In the last 10 years, only 16 antibiotics have made their way to the market. Pharmaceutical companies are not investing much in this sector,” said Dr Ravindranath.
Mumbai Mirror- Altaf Patel
The question of doctors having amorous relationships with patients keeps cropping up. I am sure it is viewed differently in different countries. Public displays of affection in India - even kissing your own spouse in the street - may be considered indecent and you risk police action. This is in sharp contrast to the West, where you often see young and even old couples kissing in public. Politicians in the West kiss their spouses on TV xand during election campaigns, and I think that is to give the public an impression that they are in a serious and committed relationship. A report in The Times of India made me aware that the Medical Council of India (MCI) recently adopted guidelines for sexual boundaries for doctors. The guidelines were actually framed by the Indian Psychiatric Society. The MCI claims that it was forced to issue some guidelines on sexual conduct after taking suo moto cognisance of a case involving a doctor of Indian origin in the US in 2017. Although many say there is nothing new in the guidelines, the important thing to note is that sexual activity between a doctor and patient, even if consensual, is against good practice guidelines. Even if a patient initiates such activity, it is unethical for a doctor to enter such a relationship. A relationship with a former patient is also to be discouraged and considered unethical.
Mirror Now News
After emergence of a number of measles cases last year, the health department in Gurugram has planned to expand surveillance of the contagious diseases to prevent it from spreading further. Compared to 2017, nine cases of measles were reported in 2018. The district health department said there were only two reported cases of disease in 2017. According to a report in Hindustan Times, Dr Jaiprakash Rajliwal, district immunisation officer, said “Measles cases are a result of vaccination refusal. We are planning to intensify the surveillance. Households and families will be targeted.” The health department Officials also said that every case showing fever and rash case will be probed in a detailed manner to tackle the measles outbreak. Officials say the immunisation drive has already started in the district.
The Economic Times- Kiran Kabtta Somvanshi
Hospital companies in India are having to walk a tightrope. They are facing pressure from several stakeholders: from government to bring in transparency and rationale in billing; from patients for accessibility and affordability of treatment; and from shareholders and PE investors to deliver profitable growth and ensure commensurate returns on bourses. Controlling costs and figuring out ingenious ways to improve realisations within the regulatory constraints seem to be the golden mean. A host of reasons are forcing private healthcare companies to rein in costs more keenly now.
The New Indian Express
Offering comprehensive, convenient healthcare and dental care solutions for all age groups, the Capstone Clinic opened a new outpatient centre at Tirumurthy Nagar in Nungambakkam recently. V Jagannathan, CEO, Star Health Insurance, Mallika Srinivasan, CEO, Tractors and Farm Equipment limited and Prathap Chandra Reddy, founder, Apollo Hospitals Group were the chief guests at the inauguration. “We recognise the ever-increasing need for one-stop clinics that can effectively address family medicine, giving all members of the family access to best-in-class specialists. Focus on women’s wellness, attention on health of growing children, eldercare and the prevention of lifestyle diseases for people in the prime of their life are areas that we believe this clinic can address,” said Dr V Ramasubramanian, one of the founders of Capstone Clinic, specialist in Infectious Diseases, adolescent and adult vaccinations and travel medicine.
The Times of India- PTI
Advances in artificial intelligence (AI) technology have made it possible to detect mental disorders such as anxiety and depression from cues in a person's voice, but doctors warn that adopting such tools in haste may prove to be counterproductive. Despite staggering number of patients being reported to suffer from disorders like depression, India struggles with the stigma of mental health diseases -- deterring patients from getting the right help in time. AI-based vocal analytics may allow patients to detect the disease at home by just speaking into a smartphone application -- eliminating the need to be physically present at treatment facilities for diagnosis. "This technology will be helpful to people who are bound by the stigma of going to a doctor for therapy or diagnosis," Dr Rajendra Singh, a psychiatrist based in Bhopal, told PTI.
BD (Becton, Dickinson and Company), a leading global medical technology company, has launched a new patient safety program for hospitals, called Preventing Risks of Infections and Medication Errors in IV Therapy (PRIME). Aimed at addressing the two critical challenges in a hospital setting - infection prevention and medication safety – PRIME is developed by Joint Commission International for Patient Safety, with sponsorship by BD. Speaking about JCI’s initiation of PRIME with BD, Dr. Marwa J. Zohdy, Vice President, Global Consulting Services, Joint Commission Resources/Joint Commission International (JCI) said, “The preparation and administration of medication is critical to safe, high-quality patient care around the world. At JCI, we recognize a fundamental need on this topic, and the unique PRIME program addresses that need. Leading experts from JCI with the support of BD have created a practical curriculum that will bring critical skills to life.”
Owing to a shortage of lab technicians, work is getting affected on a daily basis at the medical laboratory of the Civil Hospital. Notably, the number of patients at the hospital has almost doubled in the past six years. But, the medical lab is being managed with the existing staff. With an increase in the number of patients, the burden on the existing staff has also increased and so does the chances of errors. A lab technician in the medical laboratory requires technical knowledge and expertise to ensure that diagnosis is done in an accurate manner. To avoid errors and reduce the burden from the existing staff, the district Health Department has instructed them to collect samples till 11 am on a daily basis.
The Medical Council of India (MCI) has written to the deans of all medical colleges asking them to upload the time table for teaching of the revised competency-based Undergraduate (UG) curriculum on their websites latest by May 1. The new curriculum will applicable from the new academic year beginning in August. “It was decided earlier by the Board of Governors that the dean/principal of all medical colleges under the MCI would upload the yearly time table for UG teaching on their website latest by May 1,” the letter noted.
Hindustan Times- Sutirtho Patranobis
Only 45 universities in China are qualified to teach MBBS degrees in English and are authorised to admit foreign students including those from India, the Chinese ministry of education (MoE) has said, warning that teaching MBBS courses under a bilingual curriculum in English and Chinese is “strictly prohibited”. The MoE statement comes ahead of the 2019 admission season when thousands of Indians students are expected to apply to medical colleges across China. “Schools not listed (in the list of 45 universities) shall not recruit undergraduate students majoring in clinical medicine (teaching in English) to come to China, but only undergraduate students majoring in clinical medicine taught in Chinese,” the MoE statement said.
Reproduced from India Legal, Published May 6, 2019, pg. 29
Loneliness in older adults: A new epidemic of society
Loneliness is the new epidemic of society today. Loneliness is particularly common in older adults, whose children have grown up and left the nest and are busy with their lives.