October 26, 2016

ARE YOU HEADED FOR A BREAK-UP?

Osteoporosis is affecting people in their 20s and 30s. Doctors are calling it an epidemic. 
How safe is your lifestyle?
That constant ache in your back could be osteoporosis – even if you’re 
still in your 30s. Rajesh Patil, a construction supervisor in Mumbai, was diagnosed 
with osteopenia at the age of 33. A sedentary lifestyle combined with long hours of 
standing and no exercise at all had combined to weaken his lower body. ’When I 
saw his x-ray and MRI scans, I couldn’t believe I was looking at the bones of 
a young man,’ says his doctor, orthopaedic surgeon Rajesh Badiyani.

The brittle bone disease is usually associated with women over 50, but sedentary 
lifestyles, unhealthy diets and Vitamin D deficiencies are seeing earlystage 
osteoporosis pop up in men and women as young as 35. “It’s become an epidemic,” 
says Dr Amit Nath Mishra, senior orthopaedic consultant at Max Hospital, Noida. 
“The numbers have shot up in the last decade and almost 30% of the patients under 
40 that come to us today have early-stage osteoporosis.”

Osteoporosis is a silent disease and most people don’t realise their bones are 
weakening until a spinal disc collapses or they suffer compound fractures after a 
simple fall.

Among the red flags to watch out for are acute Vitamin D deficiency combined with 
chronic pain in the back or legs, since Vitamin D helps the body absorb calcium.

“You also have a higher chance of developing early-stage osteoporosis if you have 
or had an endocrine disease such as disorder of the parathyroid glands, thyroid 
dysfunction, diabetes or kidney disease, or if you have taken steroids to treat 
conditions such as asthma, premature menopause, testosterone failure or any other 
hormonal disorder,” says Dr SV Madhu, head of the endocrinology department 
at Delhi’s Guru Teg Bahadur hospital.

“If you spend most of your time sitting at a desk, indoors, and you have aches in 
your limbs or back, you must get a bone densitometry test,” Dr Mishra adds.

For Mumbai-based construction supervisor Rajesh Patil, 35, the trouble began four
 years ago. A sedentary lifestyle combined with long hours of standing and no 
exercise at all combined to weaken his lower body.

“I was in near-constant pain for 18 months before I saw a doctor. I ignored it because
it was mild and that was a big mistake,” he says. By 33, the pain had become so 
severe that he had to see a doctor, and was diagnosed with osteonecrosis, a 
condition marked by low blood supply to the bones, and osteopenia.

The pain had been caused largely by the osteonecrosis, as a result of which 
Patil had been moving around even less than usual, worsening his osteopenia.

“When I saw his x-ray and MRI scans, I couldn’t believe I was looking at the 
bones of a young man,” says Dr Rajesh Badiyani, the orthopaedic surgeon at 
Fortis hospital in Navi Mumbai who treated Patil. “If the osteopenia had developed 
into full-blown osteoporosis, he would undoubtedly have suffered fractures in his 
lower body. As it is, he needed hip replacement surgery and months of physiotherapy 
and vitamin and calcium supplements before he regained his health.”

HOW TO FIX IT

She was only 15 when her cortisol hormone levels went through the roof, leading to 
weakened bones and Cushing’s disease. “I began to put on weight at a terrifying rate,”
 Anand says. “By the time I was diagnosed, I weighed about 130 kg and my condition 
had got so bad that my shins would ache when I walked.”

Today, Anand weighs a healthy 54 kg and is osteopaenic, a pre-osteoporosis condition 
in which the bones themselves have strengthened, but the body is still not absorbing 
as much calcium as it ought to.

“If the cause of the osteoporosis is hormonal and is identified and treated, it will most 
likely reverse the condition,” says Dr Madhu of GTB hospital. “We are seeing a 
growing number of spine, hip and forearm fractures among people in their 30s as a 
result of early-stage osteoporosis,” says Dr Badiyani. Additional factors causing weak 
bones in young adults include higher incidences of smoking, and teenagers 
crash-dieting. “Smoking leads to low bone metabolism and a decrease in bone mineral 
density,” says Dr DD Tanna, orthopaedic surgeon at Mumbai’s Jaslok hospital. 
“Dieting causes youngsters to end up deficient in proteins and vitamins at a crucial 
juncture when their bones should be growing and strengthening.” Regular exercise,
a nutritious diet, calcium supplements and plenty of sunshine helped Sakshi Anand, 
29, deal with her prema- ture osteoporosis.

BALANCE IS KEY

The first step is to eliminate pain. “Many people diagnosed with osteopenia or 
osteoporosis think the more they work out, the better they’ll get, but this can cause 
muscle fatigue,” said Lipi Verma, senior physiotherapist at AktivOrtho, New Delhi.

“Physiotherapy can help here, especially for people with osteopenia.”

Start with low-stress routines like head rotations, shoulder movements and movements 
of other joints along with proper breathing. “Later, you can move on to strength 
training and balance or agility training like standing on one leg and running an 
obstacle course,” Verma says.

CAN YOU REALLY TRUST VIRTUAL DIAGNOSES?

How accurate are virtual diagnoses? Can artificial intelligence outperform IRL 
(in real life) doctors in diagnostic accuracy?

Not quite, concluded a study by researchers at Harvard Medical School last week. 
Their findings, published in JAMA Internal Medicine, revealed that doctors make 
a correct diagnosis more than twice as often as 23 commonly used symptom-checker apps.

Computer checklists and other idiotproof apps are routinely used to reduce medical 
errors, evaluate diagnoses and streamline infection-prevention protocols in clinics 
and hospitals, but their increasing use outside hospitals by people with no medical 
training is a potential risk.

With algorithms taking health diagnosis to anyone with a smart device, millions are 
going online to self-diagnose before deciding whether they need a doctor at all.

And people seem to trust the online diagnosis implicitly. Almost half (47%) of more than 2,000 people surveyed in the UK said they had looked up their symptoms online before visiting a doctor; one-fifth said they had questioned their doctor’s diagnosis based on online information; and half would have preferred their doctor give them whatever prescription, treatment or referral they requested based on their selfdiagnosis, reported the BMJ on Thursday.

DOCS USUALLY DO KNOW BETTER

By insisting that your app knows best, you not only risk annoying the doctor on whose skills you are depending to restore your health, you are also risking your health itself. Human doctors know their job better than virtual ones, even though they are not always right.

And doctors do dramatically better than algorithms when the diseases are rare, severe and more difficult to diagnose, with computers faring better with less acute and more common conditions.
Physicians, too, make diagnostic errors – not recognising symptoms, diagnosing later rather than sooner – 10% to 15% of the time, found the Harvard study that judged the skills of 234 internal medicine doctors on 45 clinical cases, involving both common and uncommon conditions.

For each case, doctors were asked to give the most likely diagnosis, and two additional possible diagnoses. Doctors made the correct diagnosis the first time, 72% of the time, compared with 34% for the digital platforms. Eighty-four percent of clinicians listed the correct diagnosis among the top three possibilities, compared with 51% for the digital symptom checkers.

The Harvard study concludes that computer-based algorithms are best used along with human decision-making, to reduce diagnostic errors.

SYMPTOM CHECKERS

Online symptom-checkers also go wrong in triage advice, but they are better than phone triage services and Internet searches, found a study published in the BMJ last year. Symptom checkers hosted by medical schools (including Harvard Medical School), hospitals, insurance companies and government agencies (including the UK’s National Health Service) ask users to list their symptoms and use methods such as multiple choice checklists and free text entry to offer a list of potential illnesses that could cause the listed symptoms and suggest whether they need a doctor immediately, over the next few days, or whether the problem can be treated at home. The BMJ review of 23 widely used symptomcheckers found that they provided correct triage advice in 58% of cases, with the checkers doing better in more critical cases, correctly recommending emergency care in 80% of urgent cases. In comparison, online search engines led to content that prescribed emergency medical treatment 64% of the time. Diagnoses, however, varied across apps. Checkers with the most accurate diagnoses (Isabel, iTriage, Mayo Clinic, and Symcat) were not on the list of the programmes that did the best job of recommending the appropriate level of care for a given case (Healthychildren.org, Steps2Care and Symptify).

HOW TO CHOOSE A GP

So, if you want quick medical advice, where do you go?

Go to a symptom-checker, but treat it as an enabling tool and not a clinician. Doctors bring experience, observation and physical examination into the equation, which leads them to the correct diagnosis more often.

It’s important to have a general physician who either lives near you or responds quickly to emergency texts or calls. Since house calls are not possible, you should be able to call him or her to guide you in an emergency. Make a list of your symptoms and the questions you want answered before calling, to save time.

Always mention your prescription medicines, surgeries and treatments you’ve undergone, and pre-existing conditions such as high blood pressure, diabetes or thyroid disorders. It helps if your general physician is attached to a multispecialty hospital so he can review your treatment course in case you need hospitalisation.

HEARING PROBLEMS? IT COULD ALL BE IN THE BRAIN

The reason you end up repeating yourself so often at family dinners may have nothing to do with hearing—instead with how the aging brain perceives speech amid background noise. Researchers at the University of Maryland found that older adults struggle to follow speech amid background noise, even when their hearing is found to be normal on clinical assessment. The study, published by the Journal of Neurophysiology, states that adults aged 61 to 73 with normal hearing scored worse in noisy environments than youngsters between 18 and 30.

PUT IT OUT. WEED DOESN’T HELP YOU SLEEP


Marijuana users may say a joint a day helps them sleep better, but a new study by the Boston University School of Public Health has found that daily marijuana users actually scored higher on the Insomnia Severity Index and on sleep disturbances compared to occassional smokers. The study, published in the Journal of Addictive Diseases, examined sleep patterns of young adults in their 20s. The findings indicate that while occasional marijuana use doesn’t disrupt sleep, heavy or daily marijuana use is actually associated with sleep difficulties.

October 25, 2016

Relief for diabetes patients as drug prices drop to half

The price of diabetes drugs have halved in the past nine months, bringing relief to around millions of diabetics in India.

PRICE OF 10 TABS OF 20MG EACH

A new class of medicine — belonging to the gliptin family — has lowered the cost of drugs by 50% in less than a year. Of the 68 million diabetics in India, about 1.85 million are on gliptin therapy to manage their type-2 diabetes.

The price came down from `156 a pack in January to `79 in September, thanks 
to aggressive pricing by domestic companies.

An average daily price for other diabetes drugs stands at `45 against ` 5 to `7 
for teneligliptin-based drugs, launched last year.

Glenmark launched teneligliptin under the brands Ziten and Zita Plus at 
a breakthrough price of `19.90 a tablet when most gliptins were priced at around `45.

Today, 30 companies, including Glenmark, Mankind Pharma, Zydus, Eris Life 
Sciences and Intas, are making about 34 brands of drugs from the teneligliptin molecule.

“While most of the gliptins were imported, teneligliptin is the only gliptin to 
be manufactured in India ... With the launch of this, the daily cost of treatment for 
gliptin therapy has come down dramatically,” said Glenn Saldanha, 
chairman, Glenmark Pharmaceuticals.

According to a conservative estimate, a diabetic on gliptin treatment saves more 
than `9,000 a year on medicine.

Mankind Pharmaceuticals, the maker of diabetes drug Dynaglipt, expects prices to 
fall further.

“We are planning to manufacture this molecule (bulk drug) at our new plant, which 
is set to start in January. We may see further cost benefits that may allow prices 
to reduce further,” said RC Juneja, the chief executive officer of Mankind Pharma.

Gliptin therapy is safer, with almost negligible side-effects, experts said. The country’s 
antidiabetes market is one of the fastest-growing segments, with a growth rate 
exceeding 25% at `7,638 crore, says data of the All India Organisation of Chemists 
and Druggists Association.

Source : Hindustan Times

October 24, 2016

Wanbury under Lens for Illegal Export of Diabetes Drug

The Indian drug regulators, who were grappling with issues of quality, have a new beast 
to deal with -illegal export of drugs through repackaging by third party sources, a 
menace that adds to the growing number of quality issues for the drug industry.

Mumbai-based Wanbury Ltd, one of the leading active pharmaceutical ingredients 
(API) manufacturers of metformin hydrochloride -a diabetic drug -was caught 
by the MaharashtraFood and Drug Administration for illegally exporting this
drug to Mexico, Brazil, Bangladesh and Pakistan.

The total value of these drugs was worth `47 lakh. Wanbury had export orders
of 650 metric tonnes per month from these countries, but it had the capacity to
manufacture only 300 metric tonnes. However, to overcome this shortage, Wanbury
had outsourced the manufacturing of metformin to a company called Pharmaceutical 
Products of India Ltd (PPIL).

“Wanbury just removed the label of PPIL that did not have any export licence, 
and without doing any processing on the product obtained from it, merely stuck 
its own label -Wanbury -and exported it,“ said Maharashtra FDA in a press note.

Wanbury did not respond to an email query sent by ET, and repeated phone 
calls to the company's MD were unresponsive. Senior officials from the Mahrashtra 
FDA said that this is just the tip of the iceberg and there are several companies that 
are under the regulator's glare for indulging in similar practices. “Both the companies 
formed an unholy alliance which was mutually beneficial, but it could have led to 
disastrous effects on the drug exports of our country, as the Drugs and Cosmetics 
Act treats such exported products as spurious,“ the FDA explained. The investigation
also revealed that records for manufacturing and testing were not maintained by PPIL 
and books were fudged to show as if the entire stock of drugs was
manufactured byWanbury itself.

But despite these findings, the regulator has not yet suspended the manufacturing 
licence of Wanbury as the matter has moved to a different jurisdiction. The investigation 
by the Maharashtra FDA comes at a time when Indian drug companies are battling 
a perception issue of quality in its export markets. The total legal fees that drug 
companies had spent in FY1516 was about `5,000 crore, according to data from ET intelligence.

October 21, 2016

Haryana Medical Students


Stress hormone in hair can predict IVF success, says study



21 October, 2016

A study conducted by Indian-origin researcher found that elevated levels of 'stress hormone'
cortisol measured in hair can predict success rate of conceiving through In Vitro
Fertilisation (IVF).  The findings suggests that the levels of a hormone when measured
in hair can significantly predict the likelihood of pregnancy in women undergoing IVF treatment.
The study was published in the journal Psychoneuroendocrinology.
This technique provides more reliable measure of hormonal function compared to
other techniques using saliva, blood and urine that measure only short term levels of
the hormone.
The study provide the first proper evidence that long-term levels of cortisol, which are
affected by many lifestyle factors including diet, exercise, caffeine and most notably
stress, may play an important role in determining reproductive outcomes.
A total of 135 women were observed for the study, 60 percent of whom became pregnant
following IVF treatment. Eighty eight women provided hair samples and the rest submitted
salivary samples for the measurement of cortisol. After analysing both types of cortisol 
data, researchers found that short-term salivary cortisol measurements were not 
related to pregnancy but in contrast the hair cortisol concentrations were.
The findings suggest that 27 percent of the variance in pregnancy outcome was
accounted for by hair cortisol concentrations after controlling for other known factors that
are linked to IVF success such as age, body mass index (BMI), number of eggs retrieved
and the number of eggs fertilised.
"Researchers have been interested in the role that cortisol may play in determining
 reproductive outcomes for some time now, not least because cortisol is typically elevated
in relation to stress," said lead researcher Kavita Vedhara, Professor at the University of
Nottingham School of Medicine.
"While these results do not specifically implicate stress, they do provide preliminary
evidence that long-term cortisol levels are associated with a reduced likelihood of
conceiving. A range of factors are likely to account for that, stress being one
possibility," Vedhara added.

October 20, 2016

Library Press Clipping Service


Only Better Healthcare can Cure Tuberculosis
(The Economic Times: 20.10.2016)

http://epaperbeta.timesofindia.com/Article.aspx?eid=31816&articlexml=Only-Better-
Healthcare-can-Cure-Tuberculosis-20102016020018

The World Health Organisation's (WHO) Global Tuberculosis Report says India has 2.8
million people afflicted by the disease, 27% of the global total for 2015. Of these, 
79,000  had multidrug resistant TB, 13.6% of the global total. The stock-out of TB
drugs caused by pusillanimous officials' failure earlier this decade to renew a vital 
contract to supply the drug would have contributed to the rise of the potent 
multi-drug resistant variant of the disease.

These figures reflect a dysfunctional healthcare system, besides low levels of income,
nutrition and awareness. The private sector's often callous attitude to treatment of TB 
goes unchecked by regulation. The government's Revised Tuberculosis Control 
Programme provides for free-of-cost TB medicines through the public healthcare 
system, but given  that public healthcare is either non-functional or overburdened, 
even the poor, at least a  third, choose private care. The official figures do not account
for those accessing the  informal sector -studies estimate that nearly 50% of TB cases 
are outside any organised  healthcare system. Poor diagnostics hamper treatment. The 
treatment plan offered outside  the public system is often not in line with the 
WHO-prescribed Directly Observed Treatment  Short (DOTS) and DOTS plus courses. 
Instead, high-dosage antibiotics are prescribed,masking TB symptoms and building 
drug resistance. Nearly 57% of TB cases in rural India are linked to malnutrition.

Funding for TB has gone up. But we also need better surveillance in the private 
sector, improved reporting, diagnosis and treatment. Counselling and support of patients 
to ensure that they complete their course of treatment are imperative. A functional 
public healthcare system is the first step.

October 04, 2016

2016 Nobel Prize: Yoshinori Ohsumi from Japan awarded the Nobel Prize in Medicine

Yoshinori Ohsumi is a Japanese cell biologist who specialises in autophagy and is a professor in Tokyo Institute of Technology ‘s Frontier Research Center. Today, Ohsumi has been awarded the 2016 Nobel Prize in Physiology or Medicine for his discoveries of mechanisms for autophagy(Autophagy is an intracellular degradation system that delivers cytoplasmic constituents to the lysosome. Despite its simplicity, recent progress has demonstrated that autophagy plays a wide variety of physiological and pathophysiological roles, which are sometimes complex). Ohsumi, 71, of the Tokyo Institute of Technology discovered the mechanisms that allow cells to break down and recycle unwanted components.The concept was first studied closely in the 1960s when cells were observed destroying their own contents by enclosing the item in a form of sack and then transporting it to a recycling unit known as the lysosome for destruction.The Nobel Assembly at Karolinska Institutet decided to award the prize to Ohsumi as his discoveries led to a new paradigm in the ‘understanding of how the cell recycles its content’. Here’s a list of other awards he has received till date: 
·          Fujihara Award, Fujihara Foundation of Science (2005)
·         Japan Academy Prize, Japan Academy (2006)
·         Asahi Prize, Asahi Shimbun (2009)
·         Kyoto Prize for Basic Science (2012)
·         Gairdner Foundation International Award (2015)
·         International Prize for Biology (2015)
·         Keio Medical Science Prize (2015)
·         Wiley Prize in Biomedical Sciences (2016)
·         Nobel Prize in Physiology or Medicine (2016)
 ‘His discoveries opened the path to understanding the fundamental importance of autophagy in many physiological processes, such as in the adaptation to starvation or response to infection,’ a statement on the official website of the Nobel Prize said. It said that mutations in autophagy genes can cause disease, and the process is involved in several conditions including cancer and neurological disease.The 2015 Nobel Prize in Medicine was awarded for discoveries concerning novel therapies against river blindness, lymphatic filariasis and malaria to William C. Campbell, Satoshi Omura and Youyou Tu.