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Medical Voice 14th May 2019

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Dr KK Aggarwal    13 May 2019

Anti Inflammatory food choices

Our diets play an important role in chronic inflammation because our digestive bacteria release chemicals that may spur or suppress inflammation.

The types of bacteria that populate our gut and their chemical byproducts vary according to the foods we eat. Some foods encourage the growth of populations of bacteria that stimulate inflammation, while others promote the growth of bacteria that suppress it.

  • Fruits and vegetables. Most fruits and brightly colored vegetables naturally contain high levels of antioxidants and polyphenols — potentially protective compounds found in plants.
  • Nuts and seeds. Studies have found that consuming nuts and seeds is associated with reduced markers of inflammation and a lower risk of cardiovascular disease and diabetes.
  • The polyphenols in coffee and the flavonols in cocoa are thought to have anti-inflammatory properties. Green tea is also rich in both polyphenols and antioxidants. [HARVARD]

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 12 May to 0830 hrs IST of 13 May, 2019)

Heat Wave:

Yesterday, Heat Wave Conditions were observed at a few places over Bihar and in isolated pockets over Vidarbha, Bihar and Gangetic West Bengal. (Annexure 1 & 2).

Maximum Temperature

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

Maximum temperature departures as on 12-05-2019: Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at most places over Bihar; at many places over Nagaland, Manipur, Mizoram & Tripura; at isolated places over East Uttar Pradesh, Odisha and Tamilnadu & Puducherry; above normal (1.6°C to 3.0°C) at most places over South Interior Karnataka; at many places over Kerala, Madhya Maharashtra, Vidarbha, Rayalaseema and Jharkhand; at a few places over Coastal Karnataka, Marathwada, West Bengal & Sikkim, Assam & Meghalaya and Andaman & Nicobar Islands and at isolated places over Telangana, East Madhya Pradesh, Jammu & Kashmir and Lakshadweep. They were appreciably below normal (- 3.1°C to -5.0°C) at isolated places over West Rajasthan; below normal (- 1.6°C to -3.0°C) at a few places over Himachal Pradesh; at isolated places over East Rajasthan, Gujarat region and West Madhya Pradesh and near normal over rest of the country.

The highest maximum temperature of 45.6°C was recorded at Bramhapuri (Vidarbha).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 13 May to 0830 hrs IST of 14 May 2019):-

Heat Wave Conditions at isolated places very likely over Telangana, Chhattisgarh and Vidarbha.

Lybrate Healthcare Monitor

Pharma News

Torrent Pharma recalls over 8 lakh bottles of hypertension drug from US, Puerto Rico

The Hindu Business Line- PTI

Drug firm Torrent Pharma Inc is recalling over 8.82 lakh bottles of Losartan Potassium tablets, used for treatment of hypertension, from the US and Puerto Rico markets on account of deviations from the current good manufacturing norms, according to a report of the US health regulator. The US-based arm of Torrent Pharmaceuticals is recalling 28,464 bottles of Losartan Potassium tablets USP in the strength of 25 mg manufactured by the parent company at its Indrad facility in Mehsana district, the latest Enforcement Report of the the United States Food and Drug Administration (USFDA) said. All the ongoing voluntary recalls of the hypertension treatment drug are class II recalls, it added. The reason for the recalls is “CGMP Deviations: FDA lab confirmed presence of an impurity, N-Methylnitrosobutyric acid (NMBA) in the finished product above the interim acceptable daily intake level of 9.82 parts per million”, the report said.

E-pharmacies find growth pill despite regulatory worries, legal tussles

Business Standard- Sohini Das

The online pharmacy space in India has seen a steady growth in 2018-19 (FY19) despite regulatory uncertainties and legal tussles. In fact, the sector managed to draw $175 million funding from private equity and venture capital players in calendar year 2018 — a 4.7x jump over the previous year. Investors have not shied away from the sector in the first four months of this year, when the total value of deals in the e-pharmacy space came in at $46 million, beating the full-year amount of $37 million in 2017, according to the data from Venture Intelligence. The top four.

Evidence based medicines is changing on a daily basis : Savitha Kuttan

ETHealthworld- Shahid Akhter

In India, we have acute shortage of specialists in tier 2 & tier 3 cities and this is a reason why the quality of healthcare providers in tier 2 & 3 cities needs to be much more familiar and updated with the latest happenings and evidence based medicines. Because in tier 1, everybody has access to specialists, when somebody gets heart pain or chest pain they can walk up to a cardiologist whereas in 2 & 3 tier cities, they are all dependent on a primary care physician. n India, we have acute shortage of specialists in tier 2 & tier 3 cities and this is a reason why the quality of healthcare providers in tier 2 & 3 cities needs to be much more familiar and updated with the latest happenings and evidence based medicines. Because in tier 1, everybody has access to specialists, when somebody gets heart pain or chest pain they can walk up to a cardiologist whereas in 2 & 3 tier cities, they are all dependent on a primary care physician.

Helping people detect oral malignancies

The Hans India- M M Farooqui

Due to low awareness levels, illiteracy and lack of preventive screening, 60% of oral malignancies, which can be diagnosed at an early stage by proper screening, are being diagnosed in the stage 2 & 3. Making the situation worse, many vulnerable patients are also turning to traditional medicine. According to a city-based NGO, the chances of cure and hope of survival is low for patients who cross the initial stage, risking their lives. The Helping Hand Foundation (HHF) has launched a first of its kind randomised population-based screening programme for oral cancer in some areas of Old City.

Hips Don’t Lie

India Legal

The Delhi High Court recently directed pharma major Johnson and Johnson (J&J) to make an interim payment of Rs 25 lakh each to four patients who had undergone revision surgeries after receiving faulty hip implants of the company. The direction was issued “without prejudice to the rights and contention of the parties” in the matter. Justice Vibhu Bakhru said the interim payment should be made before May 29, the next date of hearing. The interim order came after J&J volunteered to pay Rs 25 lakh as compensation to the affected patients. How do we decide compensation in India in cases of clinical trials? Rule 122 DAB of the Drugs and Cosmetics Rules lays down the procedure. The licensing authority, the Drug Controller General of India (DCGI), is the primary body for the causal assessment of injury/death and compensation amount to be paid to a trial participant. In case of occurrence of a serious adverse event, the Expert Committee communicates its recommendation about causality and quantum of compensation to the licensing authority, which then passes the final order. The sponsor needs to compensate the participant as per the order of the licensing authority. In case of failure to comply, the licensing authority can take necessary action as per the rule, including suspension or cancellation of the clinical trial and/or restricting the sponsor, including his representative(s), from conducting further clinical trials in India.

Healthcare News

At OMC, laparoscopy all theory, no practicals

The Times of India-Amrita Didyala

At a time when new and smart techniques are emerging in the field of medicine every day, batch after batch of doctors passing of the city’s prestigious Osmania Medical College (OMC) appear to be unequipped with a basic skill — laparoscopy Reason: The emergency department at the hospital does not have a laparoscopy machine. In fact, this has been the case for the last twothree years, said students. Laparoscopy, a minimally-invasive diagnostic surgical procedure is a basic skill required for doctors dealing with various specialities. And while it is mandatory for super-speciality medicos (PG courses), those enrolled with the OGH have not even seen the machine during the course of their study, let alone use it. “We have been told that our seniors who were studying here, until four years ago, did learn laparoscopy. But for the last two years we have not seen the machine even once,” said a PG doctor on condition of anonymity highlighting the downside of this. “It essentially means that we have to conduct open surgeries even for problems that do not require it. In our elective duty, even when we come across certain cases where the surgeon is in a dilemma about whether to operate or not, we have to cut open the patient,” the doctor added

Woman delivers stillborn, doctor booked for negligence

The Times of India-Abhishek Awasthi

A Greater Noida-based couple has lodged a complaint at Sector 49 police station, alleging that negligence of a doctor of Cloudnine Hospital had led the woman to deliver a stillborn on March 9, The couple has alleged that Dr. Pratibha Singhal, who was supposed to do the delivery, arrived late by over 2 hours, in turn delaying the surgery. They also lodged a complaint with the National Commission for Protection of Child Rights (NCPCR) on April 4, after which it sought a report from the district magistrate in seven days. According to the commission, the DM was supposed to give a report by May 9, but there has been no response yet. Ankit had complained that his wife had crossed her due date but there was no doctor available at the hospital. “Around 9.30 pm, Shweta’s labour pain started. I immediately called the doctor who had been treating my wife. She said everything was normal. However, I had requested her to come to the hospital,” Ankit told TOI.

Walk to raise awareness about lupus

The Hindu

Several people came out on Sunday morning to Cubbon Park to raise awareness about lupus, an autoimmune disease. The Lupus Awareness Walk, organised by the Lupus Trust India, saw participation of several members of the trust, patients, and well-wishers.“Lupus is an autoimmune disease in which our immune system becomes hyperactive. The system that is supposed to protect our body starts attacking our own body. It’s like the good guy attacking the good guy,” said Yogesh Preet Singh, a rheumatologist. “It is a disease that has no boundaries. It usually affects people in the most productive period of their life, that is between the ages of 15 to 45, and can affect any organ such as the eyes, liver, skin, brain, kidney,” he said. As the symptoms often mimic other disorders, early diagnosis is a problem.

Trial of new generation of surgical robots claims success

Financial Times- Clive Cookson

A medical start-up based in Cambridge in the UK has claimed success in the first clinical trial of a new generation of surgical robots. Doctors at the Deenanath Mangeshkar Hospital in Pune, India used CMR Surgical’s Versius robotic assistants to operate on 70 patients who required keyhole or minimal access surgery for a variety of gynaecological and gastrointestinal problems, some minor and some major. The first 30 patients in the trial have had a 30-day follow-up that showed no adverse events, according to Dhananjay Kelkar, the surgical team leader: “The system has been shown to be highly effective.” The remaining 40 are part of the next phase of the trial.

Timely medical attention only way to cure asthma

The New Indian Express

Asthma is a chronic disease usually characterised by airway inflammation and narrowing of the airways, which can vary over time. The reasons for the prevalence of asthma can be attributed to air pollution, smoking, incorrect treatment in children, seasonal viral infections such as common flu and the ignorance amongst parents. Many doctors point out that it is significant to change the perception of Asthma and Inhalation Therapy. "While inhalation treatment can play a crucial role in reducing the impact of asthma on people’s lives, compliance is crucial. Inhaled medicines help to deliver the drugs directly to the lungs. But we need patients to adopt the treatment as they are prescribed in order to get the full benefit,” says Dr Paramez A R, Consultant Pulmonologist, Lisie Hospital, Kochi. The self-treatment by many patients are proved to be fatal, say doctors. "It is important to understand being symptom-free does not mean one is free of the disease. Always, consult a doctor before taken such steps. Asthma requires long-term treatment. Many patients once they feel better to stop taking their inhalers. This can be dangerous since discontinuing treatment means stopping the very thing that is keeping them fit and healthy," added Paramez.

Doctors told to render better services

The Hans India

District Collector Hanumantha Rao said that the negligence towards the patients would not be tolerated. He visited the area hospital, here on Sunday. Speaking on the occasion, the Collector told the doctors to extend medical assistance on par with the private and corporate hospitals. He directed the doctors that the patients should not go for private hospital, they should be treated well here only. "Do not demand money from the visiting patients. Taking Mother Terisa as ideal, show concern for them. Work hard for selecting your hospital in Lakshya programme. If could achieve it, you will get more funds from the Central Government for development," the Collector said. He went around all the wards and appreciated the staff for their work. He interacted with patients and inquired how the medical assistance they receive. Later, he made women workers to cut the cake on the occasion of Mothers Day

Worrying Signs For India As More Than 50% Medical Colleges Produce Zero Research

India Times- Poorvi Gaur

In a country that produces 50,000 doctors every year, a recent medical conference in the national capital revealed shocking statistics - over the last 10 years,332 out of the 576 medical teaching institutions have failed to produce even a single research paper. President of the Association of Diplomate of National Board (DNB) of Doctors, Dr. Jateen Ukrani raises concern for the medical science community. “Research is supposed to be the foundation stone of medical teaching and training.If our colleges are not producing enough research, how do we as doctors keep up to being efficient?” The medical education system in India is one of the largest in the world,60 per cent of the colleges of which lie in the private sector. While the number of medical colleges in India has grown exponentially, there is still almost no published research work from many institutions where hundreds of postgraduate students write a thesis for their exams.

Detecting bacterial infection in minutes

Health Issues India- Nicohlas Parry

Bacterial infections are a major issue in India. From tuberculosis to standard food poisoning, they account for many of the most common infectious conditions in the country. Diagnosis can often take several days, or even weeks, if the facilities in the area are not prepared to analyse bacterial samples. A new device developed at Penn State University in the US may change this. Current blood tests use growth medium to amplify the numbers of bacteria in a sample to a detectable level. Depending on the type of bacteria present this may take some time. Incorporating further tests for antibiotic resistance delays this further. Doctors in these cases may diagnose based on symptoms alone and prescribe antibiotics just in case it is a bacterial infection. The issue with this situation is that many infections — bacterial or otherwise — mimic closely the symptoms of the flu. By overprescribing antibiotics where they are not needed, the risk of patients developing antibiotic resistance is increased.

New biomaterial can address microbial infections on medical implants

Medical Dialogues

Researchers at Hyderabad-based Indian Institute of Chemical Technology have identified a new biomaterial to prevent microbial infections on medical implants like urethral catheters. Studies have shown that around 70–80% of hospital-acquired infections are due to the use of urethral catheters. It has been found that as the catheter is inserted into the bladder through the urethra, the chance of developing catheter-associated infections enhances three to seven percent with each day of catheterization. This may mean additional financial burden for patients since these infections cause serious complications. Urethral catheter-associated infections frequently arise from diverse poly-microbial communities. The problematic microbes causing biofilms include Candida albicans (C. albicans), Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa, and Escherichia coli. Candida albicans and Staphylococcus aureus are the worst offenders. The ability of Candida albicans to form a biofilm, its high rate of proliferation and defense escape strategies makes this fungal species drug-resistant accounting for about 30% of inpatient deaths. Staphylococcus aureus also is a highly prevalent pathogen in catheter-associated urinary tract Infections in children.

Treatment with Resistant Antibiotics, Delay in Diagnosis: Hiranandani Hospital, 2 doctors told to pay Rs 10.25 lakh compensation

Medical Dialogues

Mumbai: The State Consumer Redressal Forum has quashed the judgment given by District Forum and held two treating doctors and a Tertiary Care Hospital negligent and deficient in providing service for diagnosis and treatment of a 73-year old cancer patient. The forum directed them to pay a compensation of Rs 10.25 lakh for the damage caused during the treatment. The case goes back to 2005 when the elderly lady was admitted at Dr L H Hiranandani Hospital, Powai with complaints of fever with riggers. She was diagnosed with urinary tract infection and was treated by a urologist. The CT scan revealed that she had Pyelonephritis for which she received treatment. At the time of discharge, she was advised to get a weekly urine routine test and fortnightly urine culture and sensitivity test. And also there was OPD (Out Door Patient) follow up by the patient for 94 days.

Sakra World Hospital Launches Institute of Pediatrics with Pediatric Super Specialty Facilities

India Education Diary

Sakra World Hospital, announced the launch of Institute of Pediatrics with Pediatric Super Specialty Facilities today which will be spearheaded by Dr. Surender Kumar Yachha, who joined the hospital recently. This newly launched centre is well equipped for performing various pediatric complex surgeries (Neonatal & Urology), Diagnostic and Therapeutic Pediatric endoscopy and has the capability of performing Endoscopy on digestive system on all children including the newborns. Nearly 40% of Indian population are children*, but the availability of Super Specialists to treat critical diseases are not enough across the nation. The Sakra Institute of Pediatrics and Pediatric Super Specialty seeks to address this concern by providing all Super Specialty services under one roof.

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