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Medical Voice 1st June 2019

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Dr KK Aggarwal    01 June 2019

People with borderline high QT interval in ECG should not consume energy drinks

A clinical trial reports that energy drinks can prolong QTc interval in ECG and raise blood pressure in volunteers

Packed with caffeine and ingredients like guarana, taurine, ginseng, and B vitamins, these drinks promise to boost concentration, improve physical performance, and reduce fatigue.

In the largest randomized, controlled clinical trial on the subject to date, researchers from the University of the Pacific in Stockton, CA, along with collaborators from other institutions, identify how energy drink consumption affects the heart.

For the study, published in the Journal of the American Heart Association, lead study author Sachin A. Shah, a professor of pharmacy practice at the University of the Pacific, enrolled 34 adults aged 18 to 40. After an overnight fast, the volunteers consumed two 16-ounce bottles of either one of two energy drinks or a placebo, which contained carbonated water, lime juice, and cherry flavoring. The study was double-blinded.

The researchers then measured the ECG and blood pressure readings every 30 minutes for a total of 4 hours and found a significant change in the QTc interval. A QTc interval of 450 milliseconds (ms) in men and 460 ms in women is considered the maximum for a healthy heart rhythm.

With QT interval propagation, a persons risk of experiencing life-threatening arrhythmia and sudden cardiac death increases.

While consumption of the placebo drink caused a maximum change in QTc interval of an average of 11.9 ms, the two energy drinks resulted in average maximum changes of 17.9 ms and 19.6 ms. Importantly, the researchers saw significant changes in the QTc interval length up to 4 hours after the volunteers had consumed the energy drinks.

According to FDA QTc prolongation over 10 ms prompting further investigation.

The researchers also found an average maximum change of 3.5 mmHg in diastolic blood pressure and 4.6 to 6.1 mmHg in systolic blood pressure when the study participants had consumed the energy drinks.

Caffeine in the energy drinks may have contributed to the change in blood pressure, but only to some extent. Other ingredients, particularly taurine, could also play a role.

None of the participants experienced QTc intervals over 500 ms. Clinically, a QT/QTc interval over 500 ms or a change over 30 ms warrants careful monitoring.

Eliminated Measles has come back in USA

971 cases of measles reported in the United States this year as per USFDA. The year now has the greatest number of cases in a single year in nearly three decades. The number of cases in 1994 was 963, which was lower than in 1992 when there were 2,237 cases.

Measles was eliminated in the United States in 2000, meaning it was no longer continuously transmitted in the country. Cases have been reported in 26 states this year so far.

Before widespread use of the highly effective measles vaccine, around 30-40 lakh people got measles each year in the United States with 400 to 500 deaths and 48,000 hospitalizations. Today in India around 27 lac children get measles.

Measles is preventable but also is highly contagious. The attack rate in a susceptible individual exposed to measles is 90 percent.The period of contagiousness is estimated to be from five days before the appearance of rash to four days afterward. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public places,even in the absence of person-to-person contact.

During the first few weeks after contracting measles, a child’s immune system becomes weakened, and a normal cold or diarrhoea can become a life threatening illness.

Vaccines are safe, they do not cause autism. In communities with 95% or more of residents who are vaccinated against the virus, herd immunity works. Thats when unvaccinated people are protected because so many of those around them are.

At 9 months and then again at 18 months every child needs to get the MR vaccine.

Healthcare News Monitor

Pharma News

The Pharma Giant in making announces IPO and expansion in MENA

Business Standard-ANI

In a cloud of an organised healthcare ecosystem, the demand for speciality chemicals and pharmaceutical products is unprecedented. The global pharma industry reached new heights in FY18, estimated to be over $1.11 trillion. By FY20, the figure is set to surge to over $1.44 trillion. With new government policies in place to promote optimum development of the healthcare infrastructure, Sudarshan Pharma has announced an IPO (Initial Public Offering) in June to fuel growth prospects and deliver incremental returns to shareholders. Currently, Sudarshan Pharma works with one of the most reputed clientele - including names like Cipla, Sandoz, Sun Pharma, Jubilant Life Sciences, Lupin, Teva, etc.

Purdue and Indian universities to collaborate on entrepreneurship and pharmaceutical sciences initiative

ET Healthworld

Purdue has just announced a partnership with two Indian universities in the state of Andhra Pradesh -- Andhra University and Sri Venkateswara University -- to collaborate on capacity-building activities focusing on entrepreneurship and pharmaceutical sciences. The partnership is part of the government of India’s Rashtriya Uchchatar Shiksha Abhiyan (RUSA) program, intended to improve the quality of Indian state public institutions, recognizing that the development of the country’s entrepreneurial talent is critically important to job creation and overall economic prosperity. According to Suresh Garimella, executive vice president for research and partnerships, “Purdue has been consistently recognized for its award-winning programs in fostering entrepreneurship, startups and commercialization of university research, and is uniquely positioned to collaborate with these institutions on capacity-building activities that fuse together entrepreneurship and pharmaceutical sciences.”

Digging Deeper | Indian Pharma tastes its own bitter medicine: Seven companies named in the US price-fixing lawsuit

Moneycontrol- Harish Puppala & Rakesh Sharma

May has been a sweltering summer for some big name Indian pharmaceutical companies. Two weeks ago, news broke that charges were filed by 44 American states alleging collusion among 20 drug makers to raise prices and allocate product markets among themselves. Israeli firm Teva was allegedly the epicentre of the ring which includes reputed multinational firms such as Pfizer and Sandoz. Seven Indian pharma companies, including Taro Pharmaceutical Industries (a subsidiary of Sun Pharma), Glenmark, Dr Reddy’s and Aurobindo Pharma were also named in the complaint.

Telangana again fails to get additional seats for pharma courses

The News Indian Express- Sadaf Aman

While All India Council for Technical Education (AICTE) has approved over 57,000 new pharmacy seats in 842 colleges across the country citing increased demand, however, no such luck for Telangana this year too as no fresh seats were added or permission for new pharma colleges were granted by the technical body. The seats have been augmented for diploma, undergraduate and postgraduate levels. Telangana currently has 8,800 seats in 120 colleges. Experts, however, caution that lack of additional seats should not be interpreted as lack of demand for the courses. After a lull of two years, the college managements claim that there is more demand for the courses this year.

Consistent and accurate records lead to hassle free pharma exports: Anand Iyer

Complete, consistent and accurate records throughout the data lifecycle leads to hassle free exports of pharmaceuticals. Data helps us to make decisions and good data helps us to make better decisions. Consistently good data helps us to make better decisions that we can trust, said Anand Iyer, Business Head – South Asia UL. The regulatory expectations when pharmaceuticals are marketed globally mandate lab controls that are scientifically sound, secure from alteration and prevention of deletion and data loss, he added. At the recently concluded Pharmexcil event on recent advancements on the regulatory landscape for emerging markets, Iyer in his presentation on Data Integrity – Importance of Audit Trails, said that even back-up data must be exact and complete. Original records should be easily accessed and companies should ensure that production controls are accurate and complete meeting the required standards of the manufacturing requirements of that country to be exported.

5th edition of Pharmac South to give special attention to Ayush products from five south Indian states

Pharmabiz

As many as 300 exhibitors and nearly 10,000 potential visitors are expected to attend this year’s Pharmac South, the fifth edition of the series, which will open at the Chennai Trade Centre on June 28. In the two days program, four scientific sessions on different topics and a buyer-seller meet will be conducted for supporting the industry in addition to one motivational speech on marketing. As a shift from manual promotion to digital marketing of branded products, Indian Drugs Manufacturers Association (IDMA) wanted to hold one digital marketing session, on the second day, for marketing officers of the companies in the southern states. Experts of digital marketing will train the delegates in the afternoon session of the second day. In the morning session on the second day, a comprehensive regulatory conclave will be held with participation from CDSCO officials, state drugs control officials from Tamil Nadu, Pondicherry, Karnataka and Kerala. SV Veeramani, the past president of the IDMA and managing director of Fourrts Laboratories, Chennai, said the team of organizers is trying to bring the DCGI to deliver a speech on the latest trends in regulatory affairs.

IMA vehemently opposes PCIs circular issued to universities to prefix Dr before the names of Pharm D graduates

Pharmabiz

Coming down heavily on Pharmacy Council of India (PCI) for its recommendation to universities to prefix Dr before the names of those who pass out the Doctoral Pharmacy (Pharm D) course, the Indian Medical Association (IMA) has asked the national pharmacy education regulator to withdraw the contentious circular issued to the universities in this regard by the PCI Registrar last week. In a statement issued on May 29 against the circular of the PCI, the IMA says that the PCI’s circular is unlawful, and in violation of the rules and regulations governing the practice of modern medicine in the country. On several occasions, the Supreme Court of India held that only a person holding a registration with the ‘Medical Council of India’ or the state medical councils is entitled to practice modern system of medicines. As per the judgments and rulings of the apex court, the pharmacists cannot use ‘Dr’ prefix with their names. They are supposed to work under a medical supervision and in any case, cannot be the first contact person for an illness.

Roche, GE Healthcare introduce NAVIFY Tumor Board with medical imaging capabilities

Pharmabiz

Roche announced the release of NAVIFY Tumor Board 2.0, the first collaboration product from the partnership with GE Healthcare. Incorporating medical image viewing and storage capabilities with other patient data, the product enables tumour boards - multi-disciplinary teams who determine treatment plans for cancer patients - to have a more comprehensive view of each patient in one place. Bringing together patient medical records from various systems for review by tumour boards can be time-consuming and cumbersome. The integration of GE Healthcare’s medical image viewer into NAVIFY Tumor Board 2.0 enables radiologists to upload their patient records to the same dashboard where patient files from other disciplines in the cancer care team are stored. Having complete patient diagnostic information in one location helps specialists use the limited time they have during tumour boards to review all relevant files quickly and align on the best possible treatment plan for each cancer patient. “This new version of NAVIFY Tumor Board is the first product developed in partnership with GE Healthcare and demonstrates our shared vision of accelerating personalised healthcare,” said Michael Heuer, CEO Roche Diagnostics. “Our mutual focus is on delivering clinical decision support solutions that enable healthcare professionals to make faster, more confident decisions, allowing more personalized treatment based on truly integrated diagnostics.”

Healthcare News

Government to rejig doctor postings to better use specialists

The Times of India

The Directorate of Medical Education has initiated a process to shuffle and post 900 doctors, including specialists who have been posted at places that do not utilise their potential. The directorate said many specialists in the state, particularly those on the clinical side (such as ophthalmology and paediatrics), were posted at non-clinical wings because either there were no doctors available for the posts or the doctor had requested such a posting. “We are making amends. We want to place the right specialists at the right places,” said director of medical service Dr A Edwin Joe. “We have enough doctors in most specialities. If we don’t need specialists in a particular department, we send them to district headquarters hospitals. This would mean they will have work for the directorate of medical services. This will also ensure specialty services in rural areas.” Recently, several doctors were redesignated to suit Medical Council of India norms. “Several assistant professors were designated as associate professors. Some associate professors were made professors. This has created some vacancies which we need to fill,” he said. Counselling for the new postings will be held for a week.

Ahmedabad: This heart doctor has a winking artery sign to his name

The Times of India-Radha Sharma

Ahmedabad: When south Indian actress Priya Prakash Varrier winked in a video that went viral, it flipped millions of hearts online. In Ahmedabad, a heart doctor found his pulse racing when he spotted a coronary artery winking at him some 10 years ago. The cardiologist chased the winking artery and has been recently rewarded with an eponym - Kamal Sharma sign - by the prestigious Indian Heart Journal, the official journal of Cardiological Society of India. Essentially, this sign can indicate Ventricular Septal Rupture (VSR), a serious complication of heart attack, with which a patient has a 99% chance of dying if left untreated.

Meet Doctor Suresh Rajan and the Collector from Virus

The Times of India

Doctor Suresh Rajan is busy learning the dialogues, while the collector is busy swiping through his phone! Actor Kunchacko Boban recently shared a video of him sitting with actor Tovino Thomas. The video shows actor Kunchacko memorizing the dialogues and Tovino checking out the phone. As the post says, actor Kunchacko will be playing Doctor Suresh Rajan and Tovino Thomas will be playing an officer, a Collector in the upcoming Aashiq Abu starrer Virus. Directed by Aashiq Abu, Virus portrays the gloomy period that Kerala had to go through, during the Nipah virus outbreak. The upcoming Malayalam movie is inspired by true events that took place during the epidemic. M-Town is eagerly waiting for the film, ever since the title of Virus was announced. The screenplay of the film is crafted by Muhsin Parari, Sharafu, and Suhas. Sushin Shyam has composed the music, Saiju Sreedharan is the editor, and Rajeev Ravi is the man behind the camera.

Hospital clowning launched at Chennai’s Institute of Child Health to keep children Happy

The Times of India- Pushpa Narayan

Happy and happier staff – that’s what the state health department wants to have in the Institute of Child Health in Egmore here. Tamil Nadu health minister C Vijaya Baskar on Friday inaugurated a creative art therapy centre and hospital clowning, where can walk in for laughter and fun. Later he opened a crèche, where doctors, nurses and other staff can leave their children while they are at work. “While working with children, we did not want medical professionals to be worried about their kids. The theatre has a medical purpose. Keeping children happy will help them heal faster. We have seen this happen on this campus. We have now given artists a dedicated room for this,” he said.

Bhopal cops in heroic rescue act after fire breaks out in hospital

The Times of India

Two policemen turned out to be angels in khaki when a hospital in Nishatpura caught fire on Friday afternoon. They not only carried patients to safety but also had the presence of mind to call a crane and demolish part of the wall so that the smoke would escape and the building wouldn’t turn into a gas chamber. Fire broke out in the operation theatre of the hospital on Karond Bypass Road around 2pm. Within minutes, thick, black smoke started spreading through the building. His colleague, constable Sundar Singh Rajput, had also seen the fire and joined him. Nagendra said that when they reached upstairs, they found two patients lying in bed in a room next to the smoke-filled OT. “They were having difficulty breathing. We cradled them in our arms and ran out of the building,” said Nagendra.

10 city hospitals flout waste disposal norms, get notice

The Times of India

Kanpur: Regional Pollution Control Board (RPCB) has issued notices to 10 city-based hospitals for not complying with the National Green Tribunal (NGT) directives regarding disposal of biomedical waste. The RPCB has also intimated the UP Pollution Control Board and the district administration for further action. RPCB officer Ghanshyam said, “My office had inspected 10 hospitals to check the compliance of NGT directives and found that they were flouting norms and not taking proper care while disposing off biomedical waste. The 10 hospitals are: Mariyampur Hospital, Upper India Exchange Hospital, LLR Hospital, Regency Hospital, Manyawar Kanshi Ram Hospital, New Angel Hospital, Shreya Hospital, Bharat Hospital Barra, Satya Trauma and Maternity Hospital and Apoorva Diagnostic Centre.”

‘Doctor vacancies to be filled up on priority’

The New Indian Express

HEALTH Minister and Jharsuguda MLA Naba Kishore Das on Thursday said his immediate focus would be to fill up vacant doctor posts Government hospitals across the State. The Health Minister said he will give special attention to issues related to district headquarters hospital here and the VIMSAR, Burla. A fact finding team will be sent to VIMSAR soon to find out various problems in the MCH and based on its report, remedial measures will be taken in a time bound manner, Das said. With Das’ ministerial berth, Jharsuguda happens to be the only district among 13 other districts in Western Odisha which got representation in the Cabinet. He said the Health Department is a challenging assignment but he would do his best to take Government’s schemes to people and resolve all issues related to the health sector.

Government hospital gets nod for organ transplantation

The Hans India

District Collector S Satyanarayana said that Government General Hospital here has been accorded permission for organ transplantation. It would be the first hospital in Rayalaseema region that has been granted permission. The Collector has handed over the certificate of permission to the hospital superintendent Dr P Chandrasekhar and cardiothoracic surgeon Dr Prabhakar Reddy at his camp office here on Friday. Speaking on the occasion, the Collector said any braindead person can donate their organs to the hospital within three hours after the death.

Palakkad: VACB report mum on deaths at district hospital

Deccan Chronicle

The recent report of vigilance inquiry conducted into the alleged corruption, maladministration and medical negligence by officials and doctors at district hospital here has shed light on several shocking anomalies in the functioning of the hospital. Youth Congress leader Boban Mattumantha had approached the VACB in February last year and the vigilance sleuths from the regional unit in Ernakulam, led by Officer R. Vivek Kumar, conducted the inquiry. Though the report has several findings pointing to possible corruption in the hospital administration, it is silent over several shocking cases of alleged apathy including delayed emergency care to three kids who were rushed to the hospital in 2013 and 2014 after snake bites. All the three kids died. Also, there is no mention of a complaint regarding an aged man receiving anti-rabies injection when he sought treatment for vomiting in 2013.

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 31st May to 0830 hrs IST of 01st June, 2019)

Heat Wave:

Heat wave conditions with Severe heat wave in some parts over Madhya Maharashtra. Heat wave conditions in some parts with Severe heat wave at isolated pockets over West Rajasthan. Heat wave conditions with Severe heat wave at isolated pockets over Uttar Pradesh. Heat wave conditions in most parts over Punjab and Vidarbha; Heat wave conditions in many parts over Haryana & Delhi; in some parts over East Madhya Pradesh and Marathwada and in isolated pockets over East Rajasthan, West Madhya Pradesh, North Interior Karnataka and Jharkhand. (Annexure 1 & 2).

MAXIMUM TEMPERATURES

Maximum Temperature more than 45.0°C were recorded in most parts over Punjab and Vidarbha; in many parts over West Rajasthan and Haryana & Delhi; in some parts over East Madhya Pradesh and in isolated pockets over East Rajasthan, Uttar Pradesh, Marathwada and Jharkhand.

Maximum temperature departures as on 31-05-2019: Maximum temperatures were markedly above normal (5.1°C or more) at many places over Madhya Maharashtra; at isolated places over Himachal Pradesh, West Rajasthan, East Madhya Pradesh and North Interior Karnataka; appreciably above normal (3.1°C to 5.0°C) at most places over Punjab, Haryana, Chandigarh & Delhi, Vidarbha and Marathwada; at many places over Jammu & Kashmir, Uttarakhand, East Rajasthan, West Madhya Pradesh, Coastal Karnataka and Jharkhand; at a few places over Rayalaseema and Kerala; at isolated places over Saurashtra & Kutch and Telangana; above normal (1.6°C to 3.0°C) at many places over West Uttar Pradesh, Gujarat region, Konkan & Goa, Chhattisgarh, South Interior Karnataka and Tamilnadu & Puducherry and at isolated places over Odisha and Lakshadweep. The highest maximum temperature of 49.6°C was recorded at Ganganagar (West Rajasthan).

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 01st June to 0830 hrs IST of 02nd June 2019):-

Heat Wave in most parts with severe heat wave conditions in some parts very likely over West Rajasthan. Heat Wave conditions in many parts with severe heat wave in isolated pockets very likely over Punjab, Haryana, Chandigarh & Delhi and Madhya Pradesh and Heat Wave conditions in some parts with severe heat wave in isolated pockets very likely over Vidarbha, Uttar Pradesh and East Rajasthan. Heat wave conditions in isolated pockets over Jammu & Kashmir, Himachal Pradesh, Uttarakhand, Chhattisgarh, Marathwada, Telangana, Jharkhand and North Interior Karnataka.

 

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