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Monthly Newspaper Vol - 1, Issue - 13

Delhi awash with spurious drugs reveals RTI reply

Treatable depression the leading cause of suicides

MCI recommendation - Six Medical Colleges stare at closure

New Bill to distinguish between drugs and medical devices

P3Medical Institutions P4Medical Pharmacy P16Medical MixP2Medical City

RNI No. DELBIL/2012/45560DL(E)-20/5415/2012-14July 1st - 31st, 2013 • ` 10/- • New Delhi

“You can never cross the ocean until you have the courage to lose sight of the shore.”

—Pablo Picasso

B R A I N Y Q U O T E S

NPPA Announces Ceiling Prices of Notified Drugs/Formulations

The National Pharma Pric-ing Authority (NPPA) has an-nounced its much-awaited ceiling price for 283 Drugs in India, fixing the maximum price that pharma companies can charge for these drugs. In the coming days the ceiling price of more drugs will be fixed. For the notified ceiling prices visit: http://www.nppaindia.nic.in

The ceiling prices are being announced in batches and this is an ongoing process.

drugtodayonline.comPh.: (011) 22792078, 22792554

MK SINGH

Teams from the Central Drugs Standard Control Organisation (CDSCO) left for the Paonta Sa-hib and Dewas plants of Ran-baxy Laboratories in mid-June where they conducted "thor-ough examination" as regards the quality, safety and efficacy of drugs being manufactured at these sites, highly placed sourc-es have indicated.

This has followed the supply of certain documents and its contentions by Ranbaxy to the CDSO. The same was provided by Ranbaxy in response to a notice earlier issued by CDSO to it dated May 31, 2013, which directed Ranbaxy Labs to pro-vide facts, documentary evi-

dence and clarifications on the quality, safety and efficacy of its drugs moving in India that are manufactured at Paonta Sahib and at Dewas, prior to conduct-ing thorough examination by CDSCO teams at these two sites from June 10.

The Drugs Controller General of India has directed Ranbaxy Labs to provide facts, docu-mentary evidence and clarifica-tions on the quality, safety and efficacy of its drugs moving in India that are manufactured at Paonta Sahib and at Dewas, pri-or to conducting thorough ex-amination by CDSCO teams at these two sites from June 10.The Drugs Controller General of In-dia, Dr. G N Singh, has directed

Mandatory HIV Testing for Doctors’ SakeMADHurI SHuKlA

With an estimated 2.5 million people already having contacted AIDS in India, doctors are scared that they may contact this dreaded dis-ease while performing surgery on a patient who might have AIDS. The problem is becoming even more serious with more and more foreign na-tionals coming to specialty hospitals in India for treatment and the doctors treating them not sure about their HIV-status.

Patients who have AIDS pose risk not just to the doctors and paramedical workers, but also to fellow patients. Also, in case a patient is dis-covered to have AIDS, the cost of follow-up ac-tions in the hospital are quite expensive and rigorous, since a lot of material with which the patient might have come in contact would have to be suitably condemned and incinerated.

A renowned surgeon at a private hospital of Delhi told DTMT that getting a HIV test in ad-dition to a Hepatitis B & C is mandatory at most private hospitals as per the standard protocol guidelines of that particular hospital. He point-ed out that this is not refusal to perform sur-

DCGI team examines Ranbaxy's plants

BS rAWATNEW DElHI

The Kalawati Saran Children’s Hospital located in Delhi has admitted in response to an RTI query that a total of 10,081 (ten thousand and eighty one) chil-dren died in the hospital between January 2008 and July 2012, and that of the 25 ventilators in the hospital as many as nine were “non-functional” at the time of re-plying to the RTI query.

Surprisingly, however, the hos-pital still maintains that as re-gards the Department of Pediatric Surgery, “no death of a patient can be attributed to the lack of avail-ability of ventilators”.

However, the Hospital does not explain why ten thousand kids

have died in the hospital in less than five years, meaning six child deaths every day.

That the situation is not im-proving in the hospital as far as the continuing deaths of children is concerned can be understood from the reply to further RTI query which reveals that as many as 619 more children died in this hospital between October 2012 and January 2013.

The reply to the RTI query also reveals that “there are no ventila-tors in Unit-I of the hospital” and that “when a patient needs venti-lator care, we seek the service of the Pediatric Intensive care.” The reply also reveals that the same is the condition in the Unit-III of the hospital, which also has no

Kalawati Saran Hospital a Death Trap for Children?

MK SINGH

After the banning of the drug Dextropropoxy-phene and formulations containing this drug

through a notification on May 23, 2013, the Indian Ministry of Health and Family Welfare fol-lowed it up by banning three more drugs -- Analgin, Piogl-itazone and Deanxit through another notification. It is under-stood that more drugs, including Buclizine, are under the scanner, and may be banned sooner rath-er than later.This stringent action by the In-dian government has come fol-lowing complaints against the drugs that it received as also the recommendations of the Par-liamentary Stading Committee to which assurances had been

given by the Ministry.The Ministry, through Gazette

notifications, suspended the manufacture for sale, sale, and distribution of the drugs that have been banned with imme-diate effect. This was after the Indian Government was satis-fied that these drugs and the for-mulations containing them were likely to involve risk to human beings and alternatives to the drugs were available.

The ministry, in consideration of the safety of the population due to their side effects, had been scanning the drugs, which have a substantial annual sale.

Pioglitazone, a thiazolidinedi-one compound acts as a peroxi-some proliferator activating re-ceptor (PPAR)-y with potential benefits on insulin resistance. The drug was approved in the

year 2000 for the indication as an adjunct to diet and exercise to improve glycemic control in pa-tients with type 2 diabetes.

Regulatory authorities in France suspended the use of medicines containing pioglita-zone in 2011. The suspension fol-lowed a study mentioning that there was approximately 1.2 fold increase in the risk of bladder cancer in patients exposed to Pi-oglitazone compared to patients never exposed to Pioglitazone. Earlier too a similar drug, Rosigl-itazone, was banned due to its adverse cardiovascular effects.

New Drug Advisory Commit-tee (NDAC) in its meeting last year did not recommend the ap-proval of Fixed Dose Combina-tion (FDC) of Metaformin+Pioglitazone+Glimepiride as there

Four drugs banned in India, more on radar

FIr against Apollo Hospital, its 6 docs.BS rAWATNEW DElHI

The Delhi Police has registered an FIR and is in-vestigating the case against the Apollo Hospital and six of its senior doctors for causing death due to negligence, in the matter of the death of the hospital’s 70-year-old patient in 2009. The FIR was registered after three years of the oc-currence when the deceased Pawan Kumar Jain's daughter, Meenakshi, approached the courts. The FIR was registered under Sections 304-A, 465, 471 and 34 of the Indian Penal Code at the Sarita Vihar Police Station.

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DruG TODAY MEDICAl TIMES1st - 31st July 2013, New Delhi2 Medical City

B S rAWAT

The Delhi government’s reply dated May 30, 2013 to an RTI

query has confirmed the wide-spread existence of spurious drugs in Delhi to such an extent that the patients can not be sure that the medicines that they are buying from the market and get-ting from Government Hospitals are genuine or not.

The Drug Control Department of the Delhi Government has in-formed RTI activist R H Bansal, who is the General Secretary of the International Human Rights Vigilance Council, that between April 2008 and March 2013, as many as 110 samples of medicines that it lifted in Delhi failed to pass the test of genuineness. The De-partment further confirmed that in the case of another 170 sam-ples lifted during the same pe-riod, the results of the test are awaited. Ironically, the Depart-

ment lifted only 2452 samples in this five year period, which is just 40 samples a month in a huge city like Delhi. This means that more than 4.5 percent of the samples lifted by the Department failed to pass the test of genuine-

ness, which indicates that fake drugs are rampant in Delhi.

Even the Government Hos-pitals in Delhi did not fare any better. The Department lifted 166 samples in the five year period from Government Hospitals in Delhi, which are less than three samples per month. However, seven of these lifted samples of drugs failed the test of genuine-ness, indicating that the patients run the definite risk of being ad-ministered non-genuine drugs even in Government Hospitals in Delhi. Bear in mind that as per the RTI reply, the result of 18 samples lifted from the Govern-ment Hospitals are still awaited.

The Drug Control Department dodged the question regarding the names of the drugs that had failed the test and the companies who manufacture these failed drugs by saying in the reply that this information is not available in a collated manner but is con-

tained in the Sample Registers of the Department.

Clearly, the Department could have easily collated this infor-mation about the names of the fake drugs and the companies manufacturing them from its own registers, rather than hiding this information from the public. Clearly, the Drug Control Depart-ment does not realize that fake drugs to the tune of 4.5 percent in Delhi must be tackled on a war footing and that it is the job of this very department to combat the menace of fake drugs, rather than hide it from the RTI activ-ists and push the issue under the carpet. RTI activist R H Bansal, understandably, is not satisfied with this reply by the Delhi Drugs Control Department to his RTI query and will go in appeal to get the names of the drugs that failed the test and the companies that manufactured the non-genuine drugs.

Delhi awash with spurious drugs

BS rAWATNEW DElHI

Doctors working at the Lok Nay-ak Hospital located at Delhi Gate at the edge of the Walled City of Delhi, live in constant fear, and have taken unprecedented steps to save them-selves from physical assault by rel-atives of patients.

Every other day there is an inci-dent of relatives of patients man-handling and threatening doctors and the meagre security that has been provided is no match to the ferocity of the virtual ruffians who attack the doctors.

Even lady doctors and nursing staff have been brutally beaten up.

This is why "panic buttons" have been installed at the desks of the hospital's staff. If any member of the hospital's staff is assaulted, anyone can press the strategically-located panic button and designated teams of ward-boys and physically strong members of the staff will rush to the rescue of their colleague.

The shattered glass panes all over the hospital bear witness to past vi-olence in the corridors and rooms. Most senior staff who run the hos-pital prefer to seat far away from the main entrance in the interiors of the hospital for fear of assault and even in these remote parts of the hospital they sit behind double grills.

The moment the panic button

is pressed, even the local police is alerted that ruffians are attack-ing the hospital staff and they too swing into action.

Attacks happen not just when a patient dies, but even when rela-tives want only their patient to be attended, at the exclusion of others.

As many as 20 CCTV Cameras have also been installed all over the emergency ward of the hospital to keep track of the developing vio-lence and alert everyone the mo-ments violent people enter the hos-pital. Posters have been put up all over the hospital informing every-one that they will be liable to pay up Rs 5000/- if they indulge in attacks on hospital staff.

Four additional police personnel are also deployed in the hospital to work alongside the regular guards. The hospital has put in place its rapid response team to help vulner-able doctors.

The doctors have struck work-several times to demand stringent action against the accused and bet-ter security arrangements. But the situation is still persisting.

"Security has deteriorated in the past one year. A few days back, rela-tives beat up our colleague and two nursing attendants badly," said a senior doctor in the casualty ward.

The patient's relatives slapped the doctor, threatening him with dire consequences if the patient did not response immediately.

"Panic Button" is Doctors' lifeline at LNJP Hospital

Blood donation far short of requirementDTMT NETWOrKNEW DElHI

There were several govern-ment hospitals located in the peripheral areas of Delhi which are devoid of the neces-sary services including blood banks. Precious time is wasted in arranging blood in emer-gency cases.

At present there are eight regional blood transfusion centres (RBTCs) in Delhi and there is need to inter-connect them.

Now the Delhi government has decided to set up blood storage units in all 100-bed-plus hospitals to make blood available to patients in emer-gency.

On the occasion of Interna-tional Blood Donation Day on June 14, 2013, Dr AK Gupta of the Delhi State AIDS Control Society said “Blood dona-tion is the biggest heroic act which saves many precious lives. Voluntry blood dona-tion would help in ensuring sufficient blood supply to hos-pitals, where there are daily requirements. He added that young blood donors who can regularly donate their blood are needed to meet the re-quirement of blood by donat-ing blood twice a year

Dr R N Makroo, director, Department of Transfusion Medicine & Molecular Biology, Indraprastha Apollo Hospi-tals, said, "Most volunteers are one-time blood donors. We need regular repeat donors." Dr Makroo further informed that to improve blood safety it is necessary to test the blood by Individual Donor Nucleic Acid Test (ID-NAT) for HIV, Hepatitis B Virus and Hepa-titis C Virus to decrease the window period transmission of these dangerous infections.

According to the World Health Organisation, if one per cent of a country’s popula-tion donates blood, it would be sufficient to meet the nation’s basic blood requirements. Against the requirement of about nine to ten million units of blood, the annual collection in India is only seven million units.

Elections boost healthcare, is it for real?DTMT NETWOrKNEW DElHI

Healthcare spending in Delhi is abysmally low and the Delhi government re-cently announced it will build twelve more hospi-tals in the city.

With Assembly elections in Delhi nearing, hospi-tal projects, on paper for many years, are now be-ing treated like the most urgent thing to do. Delhi Health Minister A.K. Walia announced that construc-tion of a 200-bed mul-ti-specialty hospital in

Ambedkar Nagar will start from September 1, a month before elections. Interest-ingly, on March 29 a similar announcement was made.

The Dwarka hospital pro-ject is a case in point where Rs 567 crore has been spent over 17 years but the hos-pital is not ready yet. Way back in 1996, Department of Health decided to con-struct a 500-bed facility in the Dwarka area of Delhi through the PWD. A year later, the land for this was allotted by the DDA It took 3 years for preliminary drawings to be prepared

and approved by the Direc-torate of Health Services in July 2000. The approval of the Delhi Urban Art Com-mission was received in March 2001. However, af-ter six years, in November 2007, Delhi Chief Minister Sheila Dixit announced a 750-bed hospital (now christened the Bharat Rat-na Indira Gandhi Hospital with 250 more beds than earlier envisaged) and said it would be constructed on a 15-acre plot in Dwarka, to be operational by 2015. This is the state of affairs after 17 years.

MK SINGH

The Ministry of Health and Family Welfare, through a Gazette notification on May 23, 2013, suspended the manufacturing and marketing of Dextropropoxyphene in India with imme-diate effect. The move followed observations/recommendations contained in the 59th report of Health & Family Welfare Department-re-lated Parliamentary Standing Committee pre-sented recently.

Dextropropoxyphene is an opoid analgesic meant for treating mild pain coupled with local anesthetic effects. It is, however, also endowed with a series of severe adverse effects includ-ing sinus tachycardia, hypotension, orthostatic hypotension and decreased libido. The suspen-sion will have a major impact since the drug possess a huge market share of 190.1 crore.

The drug was under the radar of the Indian government as the US had already banned it in 2010 citing serious toxicity to the heart. Apart from the US, the drug was also banned in countries like Australia, European Countries and Canada. Banning by the USFDA and EMA compelled the Indian Government to set up a committee a couple of year s ago to thoroughly examine the marketing and formulation of the drug.

The Action Taken Report of the Ministry on the functioning of Central Drug Standard and Control Organisation (CDSCO) submitted to the Parliamentary Standing Committee stated that wherever a drug is banned due to adverse drug reaction in countries with well developed and efficient regulatory system viz. USA, UK, EU, Australia, Japan and Canada, the manufac-ture, import and marketing of such drug would be immediately put under suspension in India till the safety of the drug is examined and es-tablished.

Therefore, the Indian Health Ministry has suspended the manufacturing along with mar-keting of Dextropropoxyphene and all formu-lations containing it with immediate effect. It is clear that this suspension will continue till the safety of the drug is established in the country.

Government Bans Dextropropoxyphene with Immediate Effect

Delhi-based RTI activisit R H Bansal, who has brought to the fore lot of hitherto unknown shocking facts about the health-care system in the country. It is unfortunate that Mr. Bansal is under threat and is traumatized that those he is expos-ing will do him physical harm.

DruG TODAY MEDICAl TIMES1st - 31st July 2013, New Delhi 3Medical Institutions

MARS HEALTHCARE PVT. LTD.5777, BASTI HARPHOOL SINGH, SADAR THANA ROAD, DELHI-110006TEL.: 011-23511893, 23545562FAX : 011-23673632EMAIL : maneet.marshealthcare@gmail.com

NUTRACEUTICALS DIVISON

M

PHYTOEXTRACTS/ORGANIC MINERALS/ESSENTIAL OILSCOLCHICINE EP/USPCAPSAICIN POWDER USPCINNAMON BARK EXTRACTCHROMIUM PICOLINATECHROMIUM POLYNICOTINATECURCUMIN 95%CALCIUM DOBESILATE EVENING PRIM ROSE OIL 9.5%GARCINIA CAMBOGIA POWDERGUGGUL EXTRACT POWDERGLUCOSOMINE & SALTSGREEN COFFEE BEAN EXTRACTGREEN TEA EXTRACT 50%, 90%HORSE RADISH EXTRACT POWDERLUTEIN ESTERS 10%, 20%PIPER LONGUMPOLICOSANOL 90%QUININE SULPHATEROSEMARY EXTRACTSAW PALMETTO 45% 85%THIOCOLCHICOSIDETURMERIC ROOT EXTRACT 95%TRIBULUS TERRESTRISCARDAMOM OIL, WHEAT GERM OIL

ALPHA LIPOIC ACIDASTAXANTHIN 1.5% TO 10%ASHWAGANDHA EXTRACTBLACK PEPPER OLEORESIN 40%BETA CAROTENE 10%, 20%, 30%BOSWELLA SERRATE 65%BETA GLUCANEDHA 40% 20% 10%GYMNEMA SYLVESTRE 25%GRAPE SEED EXTRACT 50% 90%GINGER EXTRACTGINSENG EXTRACT 5 TO 30%GINGKO BILOBALIQUORICE EXTRACT L-SELENO METHIONINE (L.S.M)LYCOPIN 6%, 10%MUCUNA PRUIENS (20% L-DPOA)METHYL SULFONYL METHANEOMEGA 3 FATTY ACIDSPIRULINAYOHIMBINE 8%, 98%ZINC MONO METHIONINEZEAXANTHIN 5%ZINEGIBER EXTRACT

JIVIKA MITTAlNEW DElHI

Residents of Loknayak Puram in Delhi are shifting to other places in face of immense health problems. Recent water tests reveal that the water in the area is carcinogenic.

Area residents suffer from skin problems, rashes, itching, allergy and hair fall. They also fall prey to many diseases.

It is shameful that drinking water, which is the most basic necessity is not available even in the capital of the nation. Loknayak Puram has no supply of municipal water either, forcing residents to use bore-well water.

In 2004-2005 DDA built 5541 LIG flats at Bakarwala, Loknayakpuram and possession was given in 2006.

Saurab Kumar, General Secre-tary, Pocket 1, Loknayak Pyuram, Bakkarwala said, “Though DDA has provided four ROs for the residents but they are not sufficient as the requirement of the area is much higher than the capacity of these ROs. Therefore, we have put a limit of 20 liters water per day for each family so that the demand of drink-ing water of all the residents can be met. For other requirements, we have to make do with this poison-ous water. ”

The president of the area RWA has several times brought this mat-

ter to the notice of DDA authorities in the last one year. Seven years have passed but neither DDA nor MCD is paying any heed.

In Jan-Feb, 2012, the then Chief Engineer of DDA understood the problem and agreed to pro-vide some additional ROs for the area but some people inside DDA dropped the idea saying that the additional ROs are not required.

"We are looking into this matter and have forwarded the file to the concerned authority," said a senior official of the DDA.

The government should take ur-gent remedial action so that people are saved from using carcinogenic water in the national capital.

Six Medical Colleges stare at closureJIVIKA MITTAl

Playing with the career of the students can be harmful for pri-vate medical and dental colleges.

In view of the increasing in-cidents of corruption in some private medical colleges, the Medical Council of India (MCI) has recommended closure of six such colleges. Five among these are in UP and one in Haryana.

Subharti Medical College, Meerut; S T College, Gurgaon; Santosh Medical College, Ghazi-

abad; School of Medical Science and Research, Greater Noida; Saraswati Institute of Medical Sciences, Hapur and Ram Medi-cal College, Hapur, are the six colleges which are in the danger zone.

The sources allege that these medical colleges used to sell their medical seats charging crores of Rupees for every seat they would reserve even before the decla-ration of the All India Common Entrance Test’s result. Sources indicate that the current rate for

a radiology seat is Rs. 2.25 crore.The MCI took this strong action

in response to many complaints by top-doctors, media and some medical bodies. The decision to recommend closure was made in an MCI meeting under the chair-manship of Dr KK Talwar. The ministry asked MCI to present all the evidence. The Board of Di-rectors of MCI has already made their final recommendation for closure to the Ministry.

The MCI appears to be moving in the direction of canceling the

Sanction letter which was grant-ed to run these hospitals.

Ministry sources say that they cannot shut down these colleges immediately as they are running for long time and the future of students studying in these col-leges should not be jeopardized.

A needful step should be taken urgently as these medical colleg-es put a huge question mark on the quality of medical education which is being provided by these private colleges across the nation under the guidance of MCI.

DTMT NETWOrKIn a shocking case, a neonate brought to Sir Ganga Ram Hospital had turned blue due to intake of contaminated water.

The doctors found that the 23-day-old baby was suffering from blue baby syndrome or methemo-globinemia, owing to which the whole body of the baby including lips, hands, feet, etc., has turned blue in colour.

Tests revealed that the Methemoglobin level in baby’s body was 67 percent against a normal of less than 1 per cent.

Enquiry showed that the mother was not able to breast feed the baby. Therefore she was giving the baby packaged formula milk after mixing it with the ground water in village Dhamori Khurd, Gautam Budh Nagar, UP. Doctors suspected that the contamination of water could be the cause of baby’s condition.

A sample of the water was sent for testing. The lab report confirmed that the water had 27 ppm of Nitrate against a normal of less than 10 ppm.

“The condition would be critical if the level of Methemoglobin is more than 80 per cent”, said Dr Sastish Saluja, Vice-Chairperson, Department of Neonatology, Sir Ganga Ram Hospital.

Hemoglobin in human body has ferrous form, which changes to ferric form after coming in con-tact with some chemicals and also by pollutants, which results into Methemoglobin and changes the colour of the blood to blue.

“We treated the child with Methyline blue by giving it orally to him, which has the property to reverse ferric form of the blood to ferrous form. The results were quite satisfactory, as within 12 hours, the colour of the baby reverted back to normal”, added Dr Saluja. Doctors discharged the baby the next day, after examining him thoroughly as he was doing quite well.

Methemoglobinemia is a blood disorder in which an abnormal amount of methemoglobin (a form of hemoglobin) is produced. Hemoglobin is the molecule in red blood cells that distributes ox-ygen to the body. Methemoglobin cannot release oxygen. This leads to an overall reduced ability of the red blood cell to release oxygen to tissues which can cause shock, seizures (fit) or even death in severe cases.

Contaminated water causes blue baby syndrome in neonate

Delhi colony relies on carcinogenic groundwater

New Director at BMHrC

It is reliably learnt that the Bhopal Memo-rial Hospital and Research Centre located in the capital city of Madhya Pradesh to provide health-care to the Bhopal gas trag-edy victims will soon have a new Director. This development will take place even as doctors from this hospital have approached the Hon'ble Supreme Court with the plea that they be allowed to treat private patients in this hospital on the earlier arrangement of keeping 30 per-cent of the fee received.

DruG TODAY MEDICAl TIMES4 Medical Pharmacy 1st - 31st July 2013, New Delhi

Drug inspector's report need not be signed by manufacturing chemist

Legal Column

For any legal query you can write us at: drugtodaymedicaltimes@gmail.com

Query: “If a drug inspector inspects a licensed pharmaceutical unit and submits his report to the licensing authority without getting it signed by the technical staff (approved manu-facturer's chemist / Pharmaceutical Chemist), will the report be consid-ered as valid or invalid under the Drugs and Cosmetics Act 1940 ?”

According to the Drugs & Cosmet-ics Act 1940 and Rules 1945, section 22 of the Act empowers the Drug In-spector to inspect, within his jurisdic-tional area for which he is appointed to inspect, any premises wherein any Drugs and Cosmetics is being manu-factured, and the means employed for standardizing and testing the drug or cosmetic. He has also the power to in-spect any premises where in any drug or cosmetic is being sold, or stocked or exhibited or offered for sale or distributed and prepare his report in writing as per Rules thereunder. It is not necessary that the report must be signed by the manufacturing chemist etc., because the Drug Inspector pre-pares the inspection report as per his own observations. Sometimes it may

be against the manufacturer or their staff i.e. manufacturing and analytical chemist etc. In these circumstances it is possible that the concerned person does not sign or receive the inspection report. Rule 52 of the Drugs & Cosmetics Rules (1945), provides that after inspecting the manufacturing unit, it is the duty of the Drug Inspector to send the inspec-tion report forthwith to the controlling authority, a detailed report indicating the conditions of the licence and pro-visions of the Act and rules thereunder which are being observed and the con-ditions and provisions, if any, which are not being observed. The report of the Drug Inspector is a valid report and acceptable. The signature of man-ufacturing chemist or other staff of the manufacturing unit are not required.

RAMESH CHAND, ADVOCATErameshchand48@gmail.com

Mob-09810129898

gery, but simply following guidelines of the hospital. He stated that the policy has been framed keeping in mind the inflow of for-eign patients and also as a safety measure for spread of infection to other pa-tients in the hospital.

He also clarified that if the patient is found to be HIV positive, they are sen-sitive enough to not de-clare it in public. The pa-tient can be a carrier of the disease or an affected in-dividual. Patients are giv-en proper counseling, so as to provide them treat-ment and prevent spread of infection to other fam-ily members.

With so much research and development focused on universal HIV testing how important is under-going a HIV test before entering an operation the-atre? What if the doctor insists that the patient un-dergo HIV test? And what if on patient’s refusal to undergo the test, the doc-tor refuses him treatment? Was the doctor right in refusing treatment of the patient?

Kartika Sharma, prac-ticing Advocate in the Delhi High Court explains, “With consumer cases against doctors on the

rise, it is time to empha-size that medical profes-sionals who perform their duties with devotion and sincerity too have their rights. The best solution is to balance the oath and their personal rights. The doctor under the Hippo-cratic Oath is duty bound to treat a person, but un-der the same Oath he also pledges to guard his life and art. A doctor too has a Right to Live as funda-mental right guaranteed under the Constitutional Law of India. He also has a right to take decisions for his own betterment. If a patient does not agree with the method of treat-ment doctor, under rea-sonable circumstances (i.e. the patient in no way adversely is affected or prejudiced by the with-drawal of treatment), may refuse to treat the patient.”

So, should there be mandatory HIV testing in hospitals? Guidelines on HIV testing released by NACO and Ministry of HFW states that “Manda-tory testing is not cost-ef-fective and is rather coun-terproductive. Voluntary screening after counseling on identified high risk group is more effective and productive for behav-

ior change and case man-agement. Routine manda-tory HIV testing should not be undertaken for the benefit of the health care workers. Rather practice of standard work precau-tions will be more benefi-cial in light of the window period and other blood transmitted infections like Hepatitis B and C.”

The only mandatory testing that WHO and UN-AIDS support are screen-ing for HIV and other blood-borne infections of all blood destined for transfusion or for manu-facture of blood products and screening of donors prior to all procedures in-volving transfer of bodily fluids or body parts, such as artificial insemination, corneal grafts, and or-gan transplant. WHO and UNAIDS do not support mandatory or compulsory testing of individuals on public health grounds.

Dr AK Gupta, Addl. Project Director-cum-Technical Lead of Delhi State AIDS Control Society states that “The doctors should view all patients as potentially infected with HIV. They are supposed to follow all the universal guidelines of safety and hygiene for all patients, ir-

respective of their HIV sta-tus. Tests should be done only on high risk groups such as pregnant women, Tuberculosis patients and patients suffering from sexually transmitted dis-eases (STDs).”

“Some doctors, espe-cially the private ones do have a phobia of getting the infection during a sur-gery. But they should be extra-cautious while deal-ing with each and every patient. In general cases the private doctors end up referring HIV positive patients elsewhere suc-cumbing to their pho-bia of getting the infec-tion themselves” added Dr Gupta. Dr. Gupta also informed that a survey conducted by DSACS this year in a hundred private hospitals in Delhi, found that private hospitals are conducting mandatory HIV testing of all cases ad-mitted in the hospital as a routine without pre-test counseling or consent of the patient and none of the 41 pregnant women de-tected HIV-positive dur-ing 2012-13 subsequently delivered in any of these private hospitals of Delhi and were stated to have been referred to nearest Government-hospitals. Hence, Dr. Gupta contends that universal HIV-screen-ing would deprive HIV-

positive patients of the care available in private hospitals.

He further warned there can always be a possibil-ity of the patient acquiring the infection during the window period (time af-ter the test and before the surgery). What would hap-pen then, if universal pre-cautions of highest degree are not maintained?

To answer doctor’s ap-prehensions of acquir-ing HIV, even after due precautions, he says that post-operative prophy-laxis is always given in such cases.

According to National AIDS Research Institute, Pune, HIV virus does not survive at room tempera-ture, due to its fragile na-ture. But, some scientific studies have also found that HIV can sometimes survive in dried blood at room temperature for up to six days. In such a case should only disposables be used in an operation thea-tre? Can a government or private hospital afford to use only disposables, in-cluding bed sheets? As the debate rages, some ques-tions remain unanswered. Should govt.protect one group's right to privacy or another group's right to life or just focus on the overall control of spread of infection?

DTMT NETWOrK

The United States Food and Drug Administration (USFDA) seems to be getting harsh on Indian drug manufacturers. Recently, two Dabur India manufacturing units in Himachal Pradesh came on the radar of USFDA in which the authority has imposed an import alert.

The move (import alert) fol-lows the seizure of unapproved products from these facilities found in the US market. The controversial products includ-ed Dabur’s Meswak toothpaste, manufactured at its Baddi fac-tory and fairness cream bleach, manufactured at its Nalagarh unit.

Dabur India said the products “seem to be part of an unau-thorised export by an independ-ent trader, without any consent or knowledge” of the company and it had already taken up the matter with the USFDA.

A company spokesperson, as reported in a section of the me-dia, claimed Dabur did not ex-port these products from India to the US. “Indian companies

regularly get such alerts from authorities in the US and other developed countries. Based on these alerts, we prepare a dos-sier and submit relevant infor-mation to the authorities within the stipulated time, after which these matters are resolved,”

Dabur sells many leading brands in the US from its port-folio, including hair oil and shampoo under the Vatika and Amla brands. It also sells Meswak in the US. However, the company official clarified, most of these products, includ-ing Meswak, are sourced from Dubai. “The products have been seized in the US because the batches were manufactured in our facilities in India, which are not registered there,” the offi-

cial said.Dabur became the third Indi-

an company after Wockhardt’s, RPG Life Sciences and Ran-baxy to come under the US FDA scanner within a month.

In May, the regulator placed an import alert on Wockhardt’s drug manufacturing facility in Waluj. Pharmaceutical compa-ny RPG Life Sciences received a warning letter for violations of norms at manufacturing units in Ankleshwar and Navi Mum-bai. And, Ranbaxy Labs had ear-lier pleaded guilty in the US for making fraudulent statements to the regulator to gain drug ap-provals. It also paid a penalty of $500 million to settle issues, in-cluding criminal ones, with the US Department of Justice.

USFDA too tough on Indian firms?

DCGI team examines ranbaxy's plantsContinued from page 1

Ranbaxy Labs Ltd. to "immediately sub-mit the factual status" in the matter of the "quality, safety and efficacy of drugs" being manufactured at the Paonta Sahib and Dewas facilities of the company.In a recent order dated May 31, 2013, the DCGI refers to the "recent court order against Ranbaxy in connection with ir-regularities brought out by one of its employees".It may be noted that India's

Central Drugs Standards Control Organ-ization (CDSCO) has been asked to "ex-amine this issue thoroughly". The DGCI has also directed Ranbaxy to "provide documentary evidences and their clarifi-cation with regard to the effect on prod-ucts moving in India under Rule 21(b) of the Drugs and Cosmetics Rules, 1945. It is after that the CDSCO will take "further action" in the matter.

Mandatory HIV testing for Doctors' sakeContinued from page 1

MK SINGH

The Central Drugs Standard Control Organization (CDSCO) has served a notice on Panacea Biotec Ltd. directing it to submit its reply as to why it had "over-labelled/relabeled Pentavalent vaccine of batch no. P1062/SBP-A without prior permission of Licensing Authority, as part of its investigation into the report-ed death of a baby in Chandi-garh due to Pentavalent vaccine.

The notice dated June 11, 2013, directs Panacea Biotec to reply within ten days of the receipt of notice failing which further appropriate action will be initi-ated under the provisions of the Drugs and Cosmetic Act 1940, and Rules framed thereunder.

The notice first refers to a joint investigation conducted on April 26, 2013, at the licenced premis-es of Panacea Biotec located in Okhla, New Delhi. This inspec-tion was by a team comprising of inspectors from CDSCO, NZ, Ghaziabad, CDSCO HQ, New Delhi, and State Drugs Control Dept. Delhi. The team was in-vestigating the case of death re-ported of a baby in Chandigarh due to Pentavalent (EasyFive TT) vaccine manufactured by Panacea Biotec. The notice also

states that "it was observed by the investigating team that the said impugned batch of vaccine was overlabelled/relabelled and distributed in the market with-out the permission of the licens-ing authority under Rule 21(b) and whereas the Licensing Au-thority had directed them not to over-label or relabel the various batches of Pentavalent vaccine for domestic use.

The notice directs Panacea Bi-otec to explain why it had rela-belled/overlabelled Pentavalent vaccine of batch no. P1062/SBP, Mfg. date April 2011, Exp. date March 2013, by new brand name of Easyfive-TT with batch No. P1062/SBP-A Mfg. date April

2011, Exp. date March 2014. One significant factor appar-

ent from the notice is that the brand name appears to have been changed in overlabelling/relabelling and also that the Ex-piry date has been increased by one full year, again apparently without permission. It remains unclear, however, how the re-ported death of the baby can be linked to this relabelling. If relabelling without permission is the only offence that the in-vestigators have found in the reported case of the death of the child, which the notice links to pentavalent, then it would amount to making a mountain out of a molehill.?

Case of Baby's Death in Chandigarh:

CDSCO directs Panacea Biotec to explain relabelling of Pentavalent

The notice directs Panacea Biotec to explain why it had relabelled/overlabelled Pentavalent vaccine of batch no. P1062/SBP.

DTMT NETWOrK

To arrest the movement of adulterated active pharmaceuticals ingredients (API), the Central Health Ministry is mulling implementing checks and balances for the same. The move in the offing includes picking samples of APIs right at the el-ementary (port of entry) stage itself and getting them tested with a view to ensur-ing the quality of formulations in the mar-ket.

The initiative follows recommendations by the Parliamentary Standing Committee attached to the Ministry on the function-ing of the Central Drugs Standard Control Organisation (CDSCO) some time back.

The standing committee also empha-sised that the drug regulatory authority of the country from which it is imported, af-ter an intensive scrutiny, will certify good quality for every batch of each API. How-ever, sources close to the development said that the Ministry is not in favour of such a mandatory certificate, especially in the wake of the hardships now being faced by the Indian exporters in view of the sim-ilar directive by the European Union.

Currently, China caters the huge de-mand from India for APIs for the domestic production of bulk drugs.

India, in a welcome move had begun the practice of checking the GMP facilities of foreign manufacturing sites some time back. Six bulk drug manufacturing units in China were inspected in May 2011. Reg-istration Certificate and Import License of one unit so inspected was cancelled. In March 2012, four manufacturing units in China were inspected. In one case, Regis-tration certificate was cancelled.

Stringent measures in the offing for quality API imports into India

DTMT NETWOrK

A move to clearly distin-guish medical electronic devices from drugs is in the offing. Ministry of Health and Family Welfare has re-cently proposed a new bill incorporating this which is likely to be placed in parlia-ment soon. Once enacted, it will provide a stimulus to the medical devices sector.

Dr A K Panda, joint sec-retary, Ministry of Health & Family Welfare, while addressing the global con-gress on ‘Investment Op-portunities in Medical Electronics & Devices’ or-ganised by FICCI in asso-ciation with the Ministry of Health and Family Welfare recently on the theme ‘Har-nessing Medical Technol-ogy for Inclusive Health-care in India’ talked of the new bill.

Currently the biggest iss-wue before the medical de-vices sector is in the realm

of regulation as the Drug & Cosmetics (D&C) Act, 1940, does not define medical devices. Hence, medical devices are currently noti-fied as drugs under the cur-rent framework of the law. Therefore, all the attending rules and regulations of the D&C Act, which were de-signed for drugs (pharma-ceuticals), were applicable to these medical devices, he said.

In addition, Dr Panda said that for the first time in the 12th Plan, the Govern-ment of India has allocated Rs.1800 crore to extend fi-nancial support to states and UTs to strengthen the regulatory system of medi-cal electronics and devices in the country. The major part of this grant will be spent on procuring techni-cally qualified manpower and establishing more laboratories, training acad-emies, diagnostic labs, and capacity building.

India’s medical devices market is of almost $3 bil-lion and is growing at a rate of 15 per cent. Hence the growth potential is im-mense and now healthcare is also a top priority for the government, said Dr Gau-tam Khanna, chairman, FICCI Medical Device Fo-rum & executive director – Healthcare, 3M.

Dr A Didar Singh, secre-

tary general, FICCI, said that India lacked technol-ogy and investment in this sector. “We should import technology from abroad and also look for ways to acquire investments from overseas. Then medical equipments and devices could be produced and manufactured in India and the cost of healthcare will eventually come down.

New Bill to distinguish between drugs, medical devices for regulatory purposes

(The views expressed in this column are those of the author and do not necessarily represent

the views of, and should not be attributed to, Drug Today Medical Times.)

ventilator. However, the reply given by the Pub-lic Information officer (Pediatric Surgery) of the Hospital, Dr. Rajiv Chadha dated September 5, 2009, reveals that there are only six ventilators in the Pediatric Surgery Ward of which only two Res Med Ventilators are in working order. Now, if only two pa-tients could be put on ven-tilator at one time in this unit, how can it be logi-cally said that no patient died due to lack of ventila-tors in the entire hospital dealing with children?

That the Hospital is not being totally transparent as regards the non-func-tional ventilators is clear from the reply which says, “So far as the question of non-functional status of ventilators is concerned,

it is not a constant posi-tion and whenever any ventilator went out of or-der, the concerned firm is informed telephonically to send service engineer and repair the same.” If this was really the case, as many as nine ventilators would not be out of or-der from the 25 installed in the hospital. The Hos-pital Management needs to wake up to the real-ity and take urgent steps to improve the situation, lest patients start feeling scared of going to Kala-wati Saran Hospital.

This situation is a pity indeed considering the fact that the Kalawati Sa-ran Hospital is the central government’s only Hospi-tal dedicated to children in the entire country. It is located just next to Con-

naught Place, and very near the Parliament and the seat of the govern-ment and just two kilom-eters from the office of the Indian Health Ministry.

The RTI applicant, Raj Hans Bansal of Delhi, told DTMT "Kalawati Saran is a specialised children's hospital and if so many children are dying here, what would be the posi-tion in other hospitals like Safdarjung Hospital. It may be shocking. I have filed a complaint with NHRC for necessary ac-tion."

Mr. Bansal says that besides the lack of func-tioning ventilators, the shockingly unhygienic conditions in the hospital may be responsible for so many deaths of children at Kalawati Saran Hospital.

Kalawati Saran Hospital a Death Trap ...Continued from page 1

Dabur's Meswak toothpaste has come under USFDA scanner

DruG TODAY MEDICAl TIMES 5Medical Paramedical1st - 31st July 2013, New Delhi

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DTMT NETWOrK

Even as due to lack of resources most vulnerable people in India re-main untreated, it is inexplicable why a whopping number of gluco-strips purchased by the government for carrying out diabetes tests on crores of people are being wasted and are left unused.

It is learnt that under a Govern-ment scheme, some five crore peo-ple were to be tested for diabetes by the end of the year 2012.

This scheme was launched after the creation of new digital finger-pricking blood sugar machine by BITS-Pilani, for which Indian Coun-cil of Medical Research (ICMR) put in Rs 25 lakh in grants for Research & Development.

The Government planned to screen all adult males above 30 years of age, and pregnant women of all age groups, for diabetes in 100 districts across 21 states. According to reports, under this scheme 5.6 crore gluco-strip and 28,116 gluco-meters were sent to these 21 states in 2010. According to the ministry’s report, only 20.55 lakh people had been tested which is a fraction of the target.

Instead of allowing the states to purchase the gluco-strip, gluco-meter and lancet according to need, the central government itself made all purchases and supplied to the states.

Out of 5.6 crore gluco strips, 3.7 crore gluco strips are lying un-used, whereas the target date was end-

2012.This was the dream project of In-

dia’s Health Minister Ghulam Nabi Azab and was supposed to be ex-tended to rural areas this year.

“There were some loopholes at the implementation stage which re-sulted in the delays in this project,” said sources in the Indian Council of Medical Research.

It is a pity that while patients have to spend at least Rs 13 for a gluco-strip, crores of such strips are lying unused with the govern-ment.

While launching any scheme, the government should first be sure of its feasibility, so that the govern-ment’s money doesn’t go down the drain and the scheme actually ben-efits the needy.

JIVIKA MITTAl

Recently when I tuned into a leading radio channel I came across an ad which tom-tommed a private doc-tor as the best one in providing ho-meopathic medication.

A pertinent question which came to mind was: Can docs advertise in India? Aren’t hospitals and doctors barred from advertising?

Persuasion is the crux of the ad-vertisements which some doctors in today’s time find as a tool to attract the vulnerable patients by enticing them with their prominent ads in or-der to make a fast buck.

Ethically, advertising is a strict "no" for the medical fraternity. The medical profession has always been considered as something noble and with a strong orientation towards service to humanity which is far re-moved from exaggeration and hy-perbole.

The (Professional Conduct, Eti-quette and Ethics) Regulations, 2002

notified by the Medical Council of India (MCI) stipulates that a physi-cian shall not use of his/her name as the subject of any advertising or publicity through any mode either alone or in conjunction with others in a manner that "invites attention to him or to his professional position, skill, qualification, achievements, attainments, specialities, appoint-ments, associations, affiliations or honours and/or of such character as would ordinarily result in his self aggrandizement". It also adds that physicians cannot endorse any drug, surgical or therapeutic appliance or any commercial product apparatus by lending his name, signature, or photograph in any form or manner of advertising through any mode. A doctor is also not permitted to boast of cases, operations, cures or rem-edies or permit the publication of reports thereof through any mode.

MCI very often encounters in-stances of doctors and hospitals that advertise themselves, and the fre-

quency of such cases has increased in the last decade.

“If any medical practitioner is found to be guilty of advertising his service or expertise, then the appro-priate Medical Council may award such punishment as is deemed nec-essary or may direct the removal altogether or for a specified period, from the register, the name of the delinquent registered practitioner”, said an MCI official.

But in most cases MCI lets the err-ing doctors go just by giving them a warning or just debar them from rendering their services for a short span of time say 15-30 days. Recent-ly, in April this year, the Ethics Com-mittee of MCI removed the names of a group of doctors from the Indian Medical Register/State Medical Reg-ister for a period of 15 days as their names and photos were published in a newspaper advertisement. It is a moot point whether such a mild ac-tion is a real deterrent to unethical behaviour?

Health ministry's dream-turned nightmare

MCI is soft on doctors who advertise

BS rAWATNEW DElHI

Many Uttrakhand disaster survivors may suffer deep psychological shock; acute stress reaction or psy-chotic breakdown. They may have escaped death but witnessed hundreds, including their loved ones, die in front of their eyes. In the weeks and months to come, many survivors will continue to experience mental distress which will

be a challenge to the men-tal health community.

Doctors say expert help is needed to avoid further damage of the survivors. They may need more than medical care for their trau-ma as well.

The tales of horror from the devastating floods in-clude that of 38-year-old Rama Devi, who says she can’t understand anything. Our lives have changed in an instant.

"The victims of incidents

like these suffer psycho-logical trauma. We call it Post Trauma Stress Dis-order (PTSD) in medical terms," said Sunil Mittal, Director, Delhi Psychiatry Centre.

"The post-disaster trau-ma occurs when someone experiences a direct or in-direct loss," Dr Mittal said.

"After a situation that posed a threat to one’s life and integrity, this is how the human brain reacts. Someone may have seen

the floods; someone may have seen dead bodies. After the incident is over, they get flashbacks and they get anxiety attacks," Dr Sameer Kalani of Cos-mos Hospital told DTMT.

"It happens because of lack of Serotonin, a nuero-chemical. A person may be sitting quietly and sud-denly a flashback may oc-cur and he would have an anxiety attack," Dr Kalani explained.

"It's a devastating condi-

tion and people need some kind of solace," he said.

"The mind tries to sup-press the trauma and in an attempt to avoid it, flashbacks are created. The most important thing is a ventilation; talking about the trauma helps a lot," Dr Kalani added.

"We are mostly getting calls from people whose family members are miss-ing. These people have a sense of hopelessness. There are others whose

family members have come home, or some fam-ily members have come while some are missing. The common problems these people are facing are a sense of anxiety, sleep disorders and depression," Kalani stated.

Realizing the need for immediate mental health intervention for the vic-tims, experts and doctors in Delhi are also helping the patients through a Cri-sis Intervention Helpline

– 9910135295, 9910135205. The helpline is operating to help them overcome psychological trauma, depression, insomnia & other sleep disorders. Any person facing any trauma due to the disaster may call and they will be pro-vided with immediate psychological guidance & counseling.

In the case of the Uttara-khand tragedy, people are not able to come to terms with the sheer ferocity

of nature’s wrath and are asking themselves why this tragedy occurred and whether there is God and if He is there, why did He do this to those who had only gone on a pilgrimage.

While immediate help would help victims of PTSD overcome the situ-ation and go on with their lives, prolonged treatment would be required in se-vere cases and normalcy would be restored only over a period of time.

uttarakhand tragedy has created large scale trauma requiring clinical treatment

BS rAWATNEW DElHI

The Indian Medical Association up in arms against a move by the Union Health and Family Welfare Ministry aimed at enabling doctors under the Indian System of Medicine (ISM) to practice modern medicine.

Dr Narender Saini, Hony. Secretary General of the association address-ing the press in New Delhi has called the move “unconstitutional”. “Are the lives and health of the common peo-ple of India so cheap that someone with half-baked knowledge should be allowed to prescribe medicines for cure just because there is a shortage of qualified allopathic doctors in In-dia? Through this move the Govern-ment is actually encouraging quack-ery and endangering the lives and

health of its people", he said.Dr KK Agarwal, member of IMA,

said, “The letter by the Ministry has noted that according to direction of the Supreme Court (in case of Dr. Mukhtiyar Chand vs State of Punjab) an ISM qualified person can practice modern system of medicine provided such professionals are enrolled in State medical register for practition-ers of modern medicine maintained by State medical council.”

“We just want to note that as per the Medical Council of India rules only allopathic doctors can be part of the registry. We suggest that ISM doctors study allopathic medicine from a government recognised col-lege and enroll themselves with the State council, we would then have no problem,” said a senior doctor.

Citing acute shortage of allopathic

doctors for primary health centres and sub-centres as a major hurdle in making the health care mechanism more effective, a letter by the Union Health and Family Welfare Ministry Joint Secretary Dr. Vishwas Mehta to the Govt. of NCT of Delhi said: “One of the option that has been under consideration of the Government to mitigate such shortage is the inte-gration of the ISM qualified doctors in the mainstream and pool in 7 lakh such doctors available in the country with allopathic doctors to enhance the availability of doctors and out-reach of health care services.”

The letter stated that Dept. of Ayush has taken an in-principal approval to empower ISM qualified doctors to practice modern system of medicine in a limited way and constituted a committee to examine the issue.

IMA opposes allopathy-practice by ISM "quacks"

DruG TODAY MEDICAl TIMES6 Medical Review 1st - 31st July 2013, New Delhi

KNOW YOur ENEMY :

Where did the sleep fairy vanish?

Remember the days when your m o t h e r sang you a lullaby to sleep, or when she would tell

you that a sleep fairy comes each night to sprinkle some fairy dust on you, to make you sleep early. Oh, as kids, how we longed to stay awake till the wee hours? Coming back to current times -- busy schedules, work pressures, deadlines, body craving for rest, a hundred things constantly running through your mind, and all you need is peaceful sleep. When was the last time you slept like a baby? Can’t remem-ber? Well, sleeplessness is a com-mon problem that can take a toll on your energy, mood, health, and overall ability to function during the day.

For people having trouble sleep-ing, medical science does have a temporary solution to this, in the form of sleeping pills. But, these pills can help only when used oc-casionally, as they may lead to dependence or addiction if used regularly for an extended period.

Sleeplessness or insomnia is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired. While the term is sometimes used to de-scribe a disorder demonstrated by medical evidence of disturbed

sleep, insomnia is often practically defined as a positive response to either of two questions: "Do you experience difficulty sleeping?" or "Do you have difficulty falling or staying asleep?

This problem is more prevalent than estimated. Generally, people tend to ignore its symptoms, un-less it takes a massive form. Re-cently, Bollywood too picked up this topic, for a film named, Sona Spa. The film’s futuristic take on the problem of insomnia showed a spa where the insomniacs can buy sleep. Sleep workers sleep on your behalf thus enabling you a better life! The film did not fare well, but it did discuss an important subject.

What makes us sleep? We all have a biological clock that main-tains a daily rhythm for many of our physiological processes. It is called the circadian pattern. It is typical of someone who rises early in the morning, eats lunch around noon, and sleeps at night (10 p.m.). Although circadian rhythms tend to be synchronized with cycles of light and dark, other factors, such as ambient temperature, meal times, stress and exercise can in-fluence the timing as well.

Insomnia can occur at any age, but it is particularly common in the elderly. Insomnia can be short term (up to three weeks) or long term (above 3–4 weeks), which can lead to memory problems, de-pression and irritability.

Most people suffering from an anxiety disorder or depression

have trouble sleeping. What’s more, sleep deprivation can make the symptoms of anxiety or de-pression worse. If your insomnia is caused by anxiety or depres-sion, treating the underlying psy-chological issue is the key to the

cure. Sometimes medications also cause insomnia.

Because different people need different amounts of sleep, in-somnia is defined by the quality of your sleep and how you feel after sleeping—not the number of hours you sleep or how quickly you doze off. Even if you’re spending eight hours a night in bed, if you feel drowsy and fatigued during the day, you may be experiencing in-somnia.

Symptoms include difficulty falling asleep despite being tired, waking up frequently during the night or too early in the morning, trouble getting back to sleep when awakened, exhausting sleep, rely-ing on sleeping pills or alcohol to fall asleep, daytime drowsiness, fatigue, or irritability and an over-all difficulty in concentrating dur-ing the day.

The good news is that most cas-es of insomnia can be cured with

changes you can make on your own—without relying on sleep specialists or turning to sleeping pills.

Our brain produces the hor-mone melatonin to help regulate the sleep-wake cycle. As mela-tonin is controlled by light ex-posure, not enough natural light during the day can make our brain feel sleepy, while too much artificial light at night can sup-press production of melatonin and make it harder to sleep. To help naturally regulate your sleep-wake cycle and prepare your brain for sleep, increase light expo-sure during the day. Take breaks outside in sunlight, remove sun-glasses when it’s safe to do so, and open blinds and curtains during the day. Also, limit artificial light at night. To boost melatonin produc-tion, use low-wattage bulbs, cover windows and electrical displays in your bedroom, avoid bright light and turn off television and com-puter screens at least one hour before bed. If you can’t make your bedroom dark enough, try using a sleep mask.

Sleep isn’t exactly a time when your body and brain shut off. While you rest, your brain stays busy, servicing the body, prepar-ing it for the day ahead. Without enough hours of restorative sleep, you won’t be able to work, learn, create, and communicate at a level even close to your true potential. So, get cozy under your blankets and doze away.

Get ComfortableMake sure you have a comfortable bed and a quiet place

to sleep. Bed should not be too hard or too soft. The best sleep environment is one that is dark, quiet, comfortable, and cool. If you get up during the night, try to manage with as little light as possible, or no light at all, since light reacti-vates our waking-time chemicals and biological functions.

Switch off Electrical DevicesTurn off unnecessary electrical equipment or move them

out of the bedroom – for example, mobile phone chargers. Keep electrical alarm clocks and mobiles a few feet away from the bed. Electrical devices create force-fields which can disturb our brain and disrupt our sleep.

Opt for Soothing Alarms Use a gentle alarm for waking. Sudden abrupt waking

makes it more difficult to establish a smooth sleep rhythm. Keeping the alarm clock away from the bed will also re-duce the tendency to 'clock-watch'. Clock-watching keeps the brain stimulated and anxious, so don't do it.

Limit Caffeine and AlcoholCaffeine stimulates your brain. Limit your coffee intake

to two cups a day. Starting at noon, consume no foods or beverages that contain caffeine. Although alcohol can make you feel drowsy and may actually put you to sleep, it has the unpleasant side effect of waking you up later on in the night with a headache, stomachache, or full bladder.

Keep a Fixed Sleeping ScheduleTry to establish a regular bed-time pattern, even on

weekends! If you can't sleep one night, get up at your usual time the next morning and don't take any naps. If you nap, you'll have more trouble getting to sleep the next night, thereby compounding your insomnia.

Take a Warm BathIt's a great way to relax your body. Don't overdo it, how-

ever. You merely want to relax your body, not exhaust it.

Drink Warm MilkA glass of warm milk 15 minutes before going to bed will

soothe your nervous system. Milk contains calcium, which works directly on jagged nerves to make them, and you, relax.

Secrets to sleeping soundly

MADHurI SHuKlA

Direction of your head while sleeping has a strong effect on your overall well-being.

Earth has a magnetic pole stretch-ing from north to south, with the positive pole at the north and the negative pole at the south. Our bod-ies have a similar magnetic stretch with the positive pole at the head and the negative one at the feet.

According to the laws of magnet-ism, like poles repel and unlike poles attract. When we lay our heads on the north side, the two positive sides

repel each other and there is a strug-gle between the two. We lose out to the earth’s greater magnetic force, and suffer from headache and heav-iness in the morning.

But when we lay our heads in the southern direction, there is mutual attraction and we wake up fit, fresh and free.

We also know that our planet re-volves from west to east, and the sun's magnetic field enters earth from the eastern side. This magnetic force enters our head if we lie with head on the east and exits through the feet, promoting cool heads and warm feet as per the laws of magnet-ism and electricity. When the head is laid towards the west, cool feet and hot head, result in an unpleasant start to the morning.

Sleep direction decides your morning mood

DISCOVERY OF ANAESTHESIA DTMT NETWOrK

Can you dare to imagine yourself, going in for a

minor surgery without anaes-thesia? Ever wondered how patients were operated upon when anaesthesia was not discovered? Anaesthesia - the taken for granted drug, allows patients to undergo surgery and other procedures with-out the distress and pain they would otherwise experience.

Anaesthesia comes from Greek meaning "without sen-sation". It is a pharmacologi-cally induced and reversible state of loss of responsive-ness, loss of skeletal muscle reflexes, decreased stress re-sponse, or all of these simul-taneously.

An alternative definition is a "reversible lack of aware-ness," including a total lack of awareness (e.g. a general an-esthetic) or a lack of aware-ness in a part of the body such as a spinal anesthetic. The pre-existing word anesthe-sia was suggested by Oliver Wendell Holmes, Sr. in 1846 as a word to use to describe this state.

There is an interesting episode, linked to the use of chloroform as an anaesthetic.

Sir James Young Simpson, a Scottish Baronet, is an im-portant figure in the history

of medicine. He introduced ether (which had been devel-oped as an anaesthetic in the USA) to United Kingdom ob-stetric practice on January 19, 1847.

But, he was still in search of something better. In 1847, Simpson discovered the prop-erties of chloroform during an experiment with friends in which he learnt that it could be used to put one to sleep. Dr Simpson and two of his friends, Drs Keith and Duncan used to sit every evening in Dr Simpson's dining room to try new chemicals to see if they had any anaesthetic effect.

On 4 November, 1847, they decided to try a ponderous material named chloroform that they had previously ig-nored. On inhaling the chemi-cal they found that a general

mood of cheer and humour had set in. But suddenly all of them collapsed only to regain consciousness the next morn-ing. Simpson knew, as soon as he woke up, that he had found something that could be used as an anaesthetic. They soon had Miss Petrie, Simpson's niece, try it. She fell asleep soon after inhaling it while singing the words, "I am an angel!" It was very much a matter of chance that Simp-son survived the chloroform dosage he administered to himself. If he had inhaled too much, subsequently passing away from an overdose, chlo-roform would have been seen as a dangerous substance. However, if Simpson had in-haled slightly less it would not have put him to sleep.

He championed the use of chloroform against medical, moral and religious opposi-tion. Some autobiographies state that it was not until Queen Victoria used this an-aesthetic during the birth of her eighth child, Prince Leo-pold, in 1853 that its use be-came generally accepted. It was his willingness to explore the possibilities of the sub-stance that established his ca-reer as a pioneer in the field of medicine and made our treat-ments pain and stress free. Thank you Dr. Simpson.

Anaesthesia comes from Greek meaning

"without sensation". It is a pharmacologically induced

and reversible state of loss of responsiveness, loss of skeletal muscle

reflexes, decreased stress response, or all of these

simultaneously.

KAPIl PAl

1. Myth: Acne is caused by not wash-ing the face regularly

Fact: Acne is not caused by dirt. There is no scientific research which proves that acne is caused or cured by washing. Antibacterial face wash may prove beneficial in mild acne. How-ever, excessive washing (more than twice a day) and scrubbing of the face may worsen the acne. Acne is a disease of hair follicles. In younger adults, the oil glands are blocked with dead skin cells. Inside the blocked oil glands, the bacteria grow which consequences in throbbing whiteheads (white coloured pus filled acne).

2. Myth: Sharing towels can spread acne

Fact: Sharing towels doesn’t spread acne. Acne is not a communicable disease—it doesn’t spread from one person to another. Acne is caused by increased hormone level at puberty. Some bacteria, for instance Propioni-bacterium acnes which are known to play a role in acne, can’t survive in open environment. It lives deep in the oxygen free environment of hair fol-licles— Propionibacterium acnes can’t grow on oxygen-rich surface of towel.

3. Myth: Acne is caused by impure blood

Fact: Acne is a hormonal disease and has no connection with infection or impurity of blood. It is highly em-phasized in alternative medicine that impure blood or buildup of internal toxins is the reason behind acne erup-tions. The impure blood theory is very old and has no relevance in modern medicine. There is no study which proves the effectiveness of the over-the-counter blood purifiers in acne.

4. Myth: Acne is caused by diges-tion problems—Detox may avert it

Fact: Many people have false belief that indigestion causes acne. Detox is a trendy word these days on the web. Many claims made by detox promot-ers are miraculous weight loss, im-proved digestion, better skin and hair. The concept of detox is irrational and unscientific; it may do more harm than good.

5. Myth: Acne don’t need any treat-ment

Fact: Parents often believe that acne is a normal process of adolescence not worthy of treatment. However, permanent scarring and disfiguring of face can result from such decisions. Youngsters afflicted with acne should visit a dermatologist rather than test-ing countless over-the-counter (OTC)

products on their face. OTC products may worsen the acne. In most cases, acne can be controlled, but can’t be cured completely.

6. Myth: Too much sunlight can cause acne

Fact: Too much sunlight may cause tanning and hyper pigmentation. However, it does not cause acne.

7. Myth: Squeezing the acne may prevent its return

Fact: Squeezing the acne is a big no in acne. This practice should be avoid-ed as it produces permanent scarring of the skin.

8. Myth: All acne will disappear within one week of treatment

Fact: Overnight results should not be expected from acne treatment. The response to acne treatment is slow and sometimes disappointing. Some medications, such as tretinoin and isotretinoin, when applied on skin are not absorbed well into the hair folli-cles. Acne therapy needs at least 2-3 weeks to show noticeable results.

9. Myth: Facial massage may pre-vent acne.

Fact: In contrast to this popular be-lief, facial massage can exacerbate the acne. A study conducted in India con-cludes that facials cause acne in 33.1% of subjects. Acne is most commonly arising on cheeks induced by vigorous massage on face.

(Based on inputs from Dr. Kapil Jain, MBBS, DDVL, MDMA, Cosmetologist

and Dermatologist, The Skin, Jain Skin Hair Cosmetology and

Laser Centre, www.theskin.in, Rohini, Delhi)

Myths and facts about acne

Sharing towels doesn’t spread acne. Acne is not a communicable

disease—it doesn’t spread from one person to another. Acne is caused

by increased hormone level at puberty.

When we put our heads on the north side, the two positive sides

repel each other and there is a struggle between the two.

We suffer from headache and heaviness in the morning

Madhuri Shukla Most cases of insomnia can be cured with changes you can

make on your own or turning to sleeping pills.

DTMT: Tell us about your childhood. Dr Vishwa Mohan Katoch: My primary and higher secondary education was in govt. schools at Kotla, Jalari and Nadaun (Hamirpur-H P). My father had his social and political engagements at our parental village of Dhaniri-Harsi and Palampur. We were brought up at Jajoli-Jalari, where my mother inherited property from her parents. Most of my value system came from my mother who was a teacher and taught values of silent struggle, respect for elders & teachers and humility. Grandmother taught her value of simple hard work. Other women from the family – my sister, my wife and most importantly my daughter, have tremendously influenced my personality in terms of love, family values and commitment. All teachers from primary school onwards encouraged me to scale greater heights in academics. My youngest brother was born when I had already moved to Pre-Medical at DAV Chandigarh. I was quite successful in school, being placed in merit list of Panjab University in all examinations.

DTMT: Were you always interested in science, even as a young person? DVMK: Yes, I was all the time interested in science but the vision of what type of science I would pursue was not clear. I wanted to be an agriculture scientist inspired by big names of Agriculture science at that time. I even got admission at HP Krishi Vidyalaya, Palampur. One of my father's friends

advised my father that I should go for medicine. Then I joined Pre-Medical at DAV Chandigarh. It was the turning point in my career. I topped the merit list for Himachal Pradesh, joined HP Medical College, and completed MBBS with distinction in many subjects. Destiny directed me to medical research as my career. One day in 1975 while coming for lunch to my hostel in Shimla, one of my seniors showed me an advertisement from ICMR for a Talent Search Scheme exam. I appeared and got selected but the road ahead was unchartered and the subject was also not decided. I just wanted to match the subject with opportunities for research in ICMR Institutions. I did residency in Medicine & Gynae and Obstetrics but then stopped at Medical Microbiology, considering that a career in infectious diseases would be most rewarding. After completing my MD from AIIMS, New Delhi, a journey for next 30 years of active science in microbiological and molecular biological aspects of leprosy and tuberculosis began. Talent Search Scheme connected me to my wife Kiran, who was my batch-mate and had not only a successful career as a physician scientist, administrator, but also a builder of family. There were many important landmarks of working in USA, UK and Agra till November, 2008, when I was selected as Secretary of newly created Department of Health Research in the Ministry of Health and Family Welfare and Director –General, ICMR.

DTMT: If not a scientist, what would you have been? DVMK: I would have preferred to be a politician. Right from childhood to working with political persons closely, I have firmly believed that politicians with commitment for improving lives of masses do bring change.

DTMT: Do you think India does not give R&D its due? (In context to Brain Drain) DVMK: Not true. Several departments invest significantly in science. It is another matter that compared to developed countries it is quantitatively smaller. The earlier bureaucratic hurdles are now no longer there. I am planning to restart the National Talent Search Scheme along with conducive surroundings for best brains (researchers and doctors). Most students who have gone abroad wish to come back and serve the nation due to the favourable environment for them here. Increased investments have to be supported by plans to increase human resources by having many more positions with career assurances for well performing persons. A large number of scientific and academic positions are needed to provide opportunities to talented people and also achieve desired output. Even presently employed persons are not optimally trained and utilized to play their due role.

DTMT: Five years down the line, where do you see ICMR?DVMK: ICMR is a 101 year old organization and keeping in view the investment made into it, it has made many significant contributions. Now it is part of Department of Health Research in MOHFW. I would like ICMR to continue to be fulcrum of this new department. Five years from now, I would like it to be much more focused as a public health research organization with its wings spread into all geographical areas of the country whose top priority will be health of our marginalized communities.

DTMT: One extra-ordinary invention that you have been waiting for?DVMK: I have been waiting for inventions which would make the treatment of presently untreatable cancers possible at affordable cost to poorest of poor.

DTMT: After getting numerous awards, and tremedous achievements what do you look forward to?DVMK: For me the nation and its people are more important than awards and achievements. They are just a societal recognition and so it’s not my achievement. Yardstick of my achievement should always be known as an imprint in medical science which has made difference to the people by improving diagnosis or ushering effective treatment or making things accessible to common people. The country has selected me to render my services, so the credit goes to the system. If after 5 years people remember me by and my work, then that is not my achievement, the credit goes to the government.

DTMT: Any advice for young scientists? DVMK:Enjoy science and consider it vehicle of change and self-fulfilment.

DTMT: 3 things that make you smile. DVMK: A kid’s smile, marginalised people getting justice and people’s motivation to the empowerment of our country.

DruG TODAY MEDICAl TIMES 7Medical Voice

FROM THE EDITOR’S DESK

Medical negligence is very much in the news these days, what with an FIR having been registered recently in Delhi against as many as six senior doctors of a leading group of state-of-the-art private Hospitals in the apparent case of the death of a patient due to heart attack when his heart medicines were withdrawn for an operation and thereafter never restarted, as per the FIR.

And, separately, the shocking fact has emerged in the public domain brought to the fore through an enquiry whose report has come in early

June, 2013, by a board of doctors, that as many as 30 percent of child deaths out of a random sample of 20 such deaths picked up at the Kalawati Saran Hospital in Delhi were due to medical negligence, more specifically, negligence by the doctors. It may be noted that some ten thousand children have died in this hospital in a span of less than five years, some three thousand of them first day deaths.

The enquiry revealing deaths in the Kalawati Saran hospital due to negligence was conducted by a board of doctors from the All India Institute of Medical Sciences and the Board itself was constituted by the National Human Rights Commission.

These figures are startling indeed and do indicate that there is a rot that has set in into the system and a complete overhaul of the hospitals, in both the public and the private sector will have to be undertaken to restore the shaken faith of the patients.

If such is the state of affairs in the national capital, one can well imagine what would be the situation in the remote and rural parts of the country.

Very recently, this newspaper conducted a case study by going to the village of the for-mer President of India, Mr. R venkataraman, in a remote part of Tamil Nadu, to fathom the working of the primary health centre located there. At the time of our surprize visit, the doctor was found to be absent, the attending nurse was watching TV and the lo-cal populace had no faith in the Primary Health Centre and preferred to spend much more money in private hospitals rather than have to go to the Government-run primary health centre.

While the funds are sent from New Delhi to the states to set up primary health centres even in the most remote areas to deliver health-related schemes to the beneficiaries, another incredulously shocking report has recently come from Kerala where a man had to carry his pregnant wife on his shoulder for some 40 kilometers to reach an appropri-ate Government Health Centre. The ordeal took such a toll on the patient that when she finally reached the Secondary Healthcare Centre, the child died while the lady survived. When the authorities in Kerala were contacted, an amazing stand was taken by them that the nature of the patient's condition was such that she could not be treated in a Primary Health Centre, but only in a secondary one. The question that begs an answer is why the patient could not have been interned in a primary Health Centre and the staff from the secondary Health Centre could have gone in a vehicle to the patient? Perhaps, the life of the child could have been saved, had that been done.

Clearly, negligence seems to have become systemic in our healthcare delivery system, even in the best facilities, and the medical professionals will have to live their profes-sional oath to stem this rot.

Time to Stem the rotAll Pervasive Medical Negligence

History makers

Combined Hospital Turns New leafSir, This is to bring to the attention of

the readers the fact that the Combined Hospital in Ghaziabad, which was earlier quite filthy, is now spic-and-span appar-ently with the efforts of the new CMS. Even the earlier practice of charging patients money under the table for opera-tions that should be conducted free in a government hospital, have now become a thing of the past. I recall a story car-ried earlier in your esteemed newspaper pointing out this corrupt practice, which has clearly worked this wonder. I thank DTMT, and also the hospital administra-tion for responding to the needs of the patients.

Meena KumariGhaziabad

rMl Without X-ray MachineSir, This is to bring to your attention the

fact that the Dental X-ray machine in the Ram Manohar Lohia Hospital in Delhi, which is a government hospital, has been "out of order" for almost one year. An X-ray is a prime requirement prior to any dental procedure and patients have to go outside the hospital and spend money from their pocket, to get the preliminary investigations done.

Enquiries reveal a totally callous atti-tude of the big-wigs in the hospital, which is why every one says that a working X-ray machine will not be available here for at least six more months.

One wonders what will happen if a VIP walks in, since this hospital is located bang in the middle of the VIP district of Delhi. Perhaps, a working machine is reserved only for the VIPs and not for common patients. One does not grudge anything to the VIPs, but please also take care of the common man.

Ram Singh,Delhi

lETTErS TO THE EDITOr

1st - 31st July 2013, New Delhi

“Failure is the condiment that gives success its flavor.”

Quote of the month

— Truman Capote

Sushruta Sushruta was a surgeon who lived in 6th cen-tury BC India. Known as the “Father of Surgery”, he was the author of the book Sushruta Sam-hita, in which he described over 120 surgical instruments, 300 surgical procedures and classified human surgery in 8 categories. He lived, taught and practiced his art on the banks of the Ganges.

upendranath BrahmachariRai Bahadur Sir Upendranath Brahmachari, a scientist from Bengal synthesized Urea Stibamine in 1922 and determined that it was an effective substitute for other antimo-ny-containing compounds in the treatment of Kala-azar. His discovery saved millions of lives in India, especially in severely-affected Assam.

ICMR DG, Who Lives His ValuesAs part of our series to bring into spotlight distinguished medical professionals, we zeroed in on Dr Vishwa Mohan Katoch, the Director-General of the Indian Council of Medical Research, as the Personality of the Month. Dr. Katoch's is a story of an ordinary Indian reaching the very top through the sheer dint of hard work and doing landmark research in India and abroad, while his value system has

PERSONALITY OF THE MONTH

remained rooted in the Indian soil. His humility speaks volumes as he remains reticent in talking of his achievements. The family values he has inherited, and also imbibed from younger ones, are indeed timeless. The nation is fortunate to have people who identify themselves with the common Indian, at the helm of affairs. In an informal conversation with MK Singh & Madhuri Shukla, Dr Katoch speaks about his life and times. Here are some excerpts:

RAPID FIRE

All-TIME FAV rEAD I love to read all newspa-pers, their editorials and opinion articles

Among countries with com-parable development indica-

tors, India has the potential to address many of its challenges with unique homegrown re-sources. The information tech-nology sector, for example, has transformed the country’s economy and is currently help-ing expand access to a wide range of quality services for some of the poorest in India. India’s space and atomic energy programs are outstanding ex-amples of indigenous technical ingenuity.

As economic growth con-tinues to decelerate, it is criti-cal that we do not forget the important role of indigenous scientific innovation, in par-ticular, to improve livelihoods and promote well-being. To quote Jawaharlal Nehru, “It is science alone that can solve the problems of hunger and poverty, of insanitation and il-literacy.”

Child health is one area where investments in innova-tion can result in tremendous social and economic returns.India nearly halved child mor-tality rates between 1990 and 2010. Improved healthcare services and access to simple health interventions, such as oral rehydration therapy to address severe cases of di-arrhea, have contributed to this encouraging reduction of child deaths.

However, in 2010, experts estimate that almost 17 lakh children less than five years of

age died in India. This is still far too many. Pneumonia and diarrhea, together account for a significant proportion of these deaths. There are even more hospitalizations and out patient visits from these two diseases. They each take a tremendous emotional and financial toll on Indian fami-lies and we need to take these threats seriously. It is unac-ceptable that children die of preventable and treatable ill-nesses. All families in India deserve equal access to health innovations that could help children and protect children.

Diarrhea is caused by sev-eral different organisms and is most often spread through contaminated food or water and person-to-person con-tact. Certain types of diarrhea are more serious than others. Acute watery diarrhea is asso-ciated with rapid dehydration that can last for hours or even days. If fluids and electrolytes are not replenished, diarrhea can be life threatening. Chil-dren who suffer from malnu-trition are more vulnerable to the causes of diarrhea. In an unfortunate twist, diarrhea also in turn perpetuates mal-nutrition and leaves children prone to infections.

To address an issue such as diarrhea, safe water and sanitation do matter, but re-quire large-scale investment in infrastructure and in main-tenance by the government. For individual and commu-

nity level management of di-arrhea, you need to bring the lab to the field to understand what causes the disease. Some of the first studies here aimed to determine the cause of se-vere diarrhea in India – the kind that causes life-threaten-ing dehydration. Researchers found that a viral pathogen called rotavirus was the most common cause. Rotavirus is of particular concern because it is so ubiquitous, leaving nearly all children – rich and poor – at risk. However, out-comes vary greatly depending on the family’s circumstances. For a child of high socio-eco-nomic status with consistent access to care, the virus will likely cause only minor ill-ness. For less fortunate chil-dren, it could be a death sen-tence if appropriate care is not provided or is provided late in illness.

To reduce the burden of di-arrhea in India, we must try to reach all children with a com-prehensive package of proven interventions. This includes access to oral rehydration therapy, zinc supplementa-tion and exclusive breastfeed-ing for the first six months of a child’s life, and improve-ments in hygiene, sanitation, and drinking water. However, because rotavirus is so con-tagious and resilient, these approaches alone will not adequately prevent diarrhea. Vaccination against rotavi-rus offers significant hope for

protecting children from this disease.

If rotavirus vaccines were introduced at current immu-nization levels, we could save tens of thousands of lives, and even more hospitalizations and outpatient visits. This could save India more than Rs100 crore in annual medical costs. The savings to families would also be significant.

Having contributed signifi-cant funding, the government has been a terrific supporter of developing new rotavirus vaccines in India. As with the rotavirus vaccine develop-ment efforts, we have the re-sources and the capacity in India to address our most pressing health needs, if we use a strategic approach that prioritizes problems and then makes a concerted effort to address them. However, de-velopment of a product such as a vaccine is not sufficient, we must also work together to develop and implement poli-cies that ensure that everyone has access to the fruits of our scientific endeavors.

(The author is Professor, Department of Gastrointestinal

Sciences at Christian Medical College, Vellore, India. She heads

the Wellcome Trust Research Laboratory at CMC.. The views

expressed in this article are those of the author and do not neces-

sarily represent the views of, and should not be attributed to,

Drug Today Medical Times.)

Reducing India's Burden of Diarrhea

BOrN ON 18th February 1953

PlACE OF BIrTHHamirpur (Himachal Pradesh)

HOBBY/ PAST-TIME reading , listening to old music, especially those of Asha Bhosle

FAV HOlIDAYDESTINATIONAncestral Home at Jalari

FAV. DISH Kadhi-Chawal

readers are welcome to write to us on any health and medicine related issue. We will be glad to publish the same on merit after suitable editing.

You may email us at —drugtodaymedicaltimes@gmail.com

Visit us at drugtodayonline.com

Vaccination against rotavirus offers significant hope for protecting children from diarrhea, says Dr. Gagandeep Kang

SOUTHINDIA

DruG TODAY MEDICAl TIMES8 Medical Nation 1st - 31st July 2013, New Delhi

DTMT NETWOrKHYDErABAD

For the ones who are wishing to spend their retirement days in a peaceful environment a new destination is on of-fer. An initiative has been taken by Heritage, an el-derly care services com-pany, that has launched

‘Kshetra’, a housing op-tion for senior citizens looking for a hassle-free life and a calm and car-ing environment.

Kshetra, the home for elderly which is located

at Moinabad, was re-cently inaugurated by Nicola Watkinson, sen-ior trade and investment commissioner, Minis-ter Commercial (South Asia), Australian Trade Commission (Australian government).

This is the first such in-itiative by the company, which is looking forward

to do more with the help of foreign investment, discussions for which are under progress with the governments of Australia and Sweden.

“There are thousands

of senior citizens who don’t have children to take care of them or their families are not will-ing to look after them. Our home will provide them with the facilities they need in their own homes,” said Dr KR Gan-gadharan, founder and director of Heritage El-der Care Services.

Kshetra offers spa-cious accommotion, ele-gant common rooms and a multitude of services along with medical care by professional doctor and nurses.

DTMT NETWOrKBANGlOrE

With the rising pressure on the environment due to increasing energy con-sumption, global warm-ing and emission, the cor-porate world in Bangalore has adopted measures to maintain environment-friendly standards.

Growing pollution due to increased emission, felling of trees, higher energy consumption and carbon footprint has re-sulted in higher temper-atures, climate change, melting glaciers and in-

creasing number of natu-ral disasters. To control the situation and reduce their carbon footprint, companies like Wipro, Ac-centure, Infosys, GE and Symantec have adopted sustainability measures.

“This year’s theme is centred around food,” said Vice-president and head of sustainability of Wipro Ltd. Narayan P S. He informed that Wipro has sustainability initia-tives in their campuses in the form of recycled water, use of renewable energy, recycling of e-waste and organic waste

converter.The sustainability re-

port of Infosys stated that their campuses use renewable energy and are energy efficient. They have sewage treatment plants where the waste water generated from their campuses is treated and the recycled water is

then used for landscap-ing and flushing purpos-es. The company follows green initiatives such as using renewable energy sources, recycling water, efficient use of power, re-ducing emissions, etc.

A zero waste water dis-charge facility has been installed at the GE India Technology Centre in Bangalore. The facility utilises an on-site waste water treatment plant for domestic and industrial effluents saving up to 250 KL of water on the site per day.

However, Accenture is

high on its carbon foot-print due to high emis-sions resulting from business travel and office energy consumption. The company is promoting eco-efficiency by having employees work for at least one week a month at their local-office loca-tions and the remainder weeks of the month at the client site.

In their efforts to con-serve resources and stay environmentally safe, Symantec builds and op-erates facilities according to recognised environ-mental standards.

DTMT NETWOrKCHENNAI

Indian Institute of Tech-nology Madras, has de-signed an affordable and accessible eye screening technology Eye PAC to help doctors screen pa-tients faster and confer immediate diagnostic so-lutions.

The computing tech-nology has been devel-oped by the Healthcare Technology Innovation Centre (HTIC), a multi disciplinary R & D cen-tre at IIT Madras. HTIC is a joint initiative of IIT-Madras and Department of Biotechnology (DBT), Government of India that brings together health-

care professionals and engineers, industry and government to develop healthcare technologies for the nation.

The technology extracts error free information from eyes and can screen a large number of patients for further eye treatment

in a short period of time. Earlier, patients had to spend half a day in hos-pital for proper screen-ing of the eyes, but this innovation requires only five minutes to screen a patient. After screening, the needy patients are referred for further treat-

ment. “Considering the short-

age of doctors, we felt that there was a need for a technology that allows eye screening to be done even by a non expert. This can act as a first level of screening so that only the needy patients are

referred to the experts,” said Dr. Mohanasankar, IIT Madras faculty mem-ber, who heads HTIC. Eye PAC can screen and create diagnostic solutions for a range of vision threat-ening diseases such as glaucoma, diabetic retin-opathy and age-related macular degeneration.

Eye PAC supports 3ne-thra, an ophthalmic imag-ing system developed by Forus Health, an Indian Med-tech company. Eye PAC, combined with 3ne-thra, enhances visual ap-pearances of eye images and locates disease signs that may lead to immi-nent vision loss. The time taken is not more than 5 minutes per screening.

DTMT NETWOrKHYDErABAD

The Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, secured the prestigious National Accreditation Board for Hospitals’ (NABH) accreditation after two years of rigor-ous work in this direc-tion.

“With this, the insti-tute has become the first certified trust hospital in cancer care in the country to be awarded accreditation by NABH,” said Nandamuri Bal-akrishna, chairman BIACH & RI, while an-nouncing awarded ac-creditation at a function. Following the accredita-tion the hospital’s re-sponsibility towards patients has increased,

added Balakrishna fur-ther explaining, “we will not stop here and will go for international ac-creditation and recogni-tion.”

BIACH & RI had al-ready been awarded the certification in Interna-tional Standard for Oc-cupational Health and Safety (OHSAS 18001) becoming the first Cer-tified hospital in Hy-derabad on occupa-tional health and safety management systems.

National Accreditation Board for testing and calibration of Labora-tories (NABL) accredi-tation is yet another milestone in its quests to deliver international quality healthcare.

Maintaining the stand-ards of NABH accredi-tation is a challenge, however, the institute is looking forward to take up any kind of challeng-es to provide better and affordable healthcare services to the patients.

According to Bal-akrishna his late father and former chief min-ister of Andhra Pradesh N T Ramarao’s intention behind establishing the hospital was to provide world class health care at affordable cost to the common man and the institute is working to achieve his dream.

A home after retirementCorporates working on green mission

DTMT NETWOrKCHENNAI

Tamil Nadu Government has come up with the initiative to in-troduce ‘Regenerative Medicine’ in veterinary care and would set up a Stem Cell Research Centre at Tamil Nadu Veterinary and Ani-mal Sciences University (TANU-VAS). This would be a first of its kind initiative in the country.

Once thought unimaginable, Regenerative Medicine acceler-

ates the healing process to fully restore the health of damaged tis-sues and organs by the adminis-tration of stem cells. It is a branch of medical science that deals with the replacement or regenera-tion of cells, tissue and organs, to counter chronic diseases that de-bilitate organs and hence bodily function. It includes bio-medical approaches to clinical therapies that involve the use of stem cells by injection of stem cells or pro-genitor cells. Stem cells are gen-

erally obtained from bone mar-row, placenta and fat tissue of animals and human beings.

Making a statement in the TN Assembly, Chief Minister J Jay-alalithaa said the government would set up a 'Stem Cell Re-search Centre' at Tamil Nadu Vet-erinary and Animal Sciences Uni-versity at a cost of Rs 6.46 crore. The government has also allo-cated Rs 8.81 crore for installing 53 ultra sound scan units in vet-erinary hospitals across the state.

"The government has decided to set up the Stem Cell Research Centre at TANUVAS consider-ing the benefits the Stem Cell Research will bring to human health in the future", she added.

TANUVAS has been collabo-rating with The Michigan State University, Virginia Maryland Regional College of Veterinary Medicine and Wakeforest Insti-tute of Regenerative Medicine, North Carolina for stem cell research.

TANuVAS to have ‘regenerative Medicine’ for veterinary care

BIACH & rI awarded NABH Accreditation

IIT Madras develops affordable eye screening technology

Twenty five-year-old Priya Kukreja (name changed), a

young working professional, never thought of unexpected health exigencies at her age – un-til she accidently slipped on ice and broke her elbow. Instead of wasting any time or resorting to home remedies to relieve her of pain, her parents simply rushed her to the hospital to get immedi-ate medical attention. This saved her elbow.

Complicated fractures with multiple bone pieces were de-tected on X-ray when the young lady was examined. Immediate medical attention was required as there was pain, swelling, de-formity and restricted movement at the right elbow.

A complex operation was per-formed, and bone pieces were fixed with special plates and screws. After three months of the procedure, she is now able to move her arm normally. This would not have been possible if any delay or wrong treatment would have been provided to the patient. It was only prompt ac-tion from her family as well as timely medical treatment and surgery that did not let her case become worse.

Anatomy and Treatment of El-bow Fractures

The elbows are one of the most important parts of the upper limb and their fractures can become quite troublesome if you don’t treat them properly. Complica-tions such as loss of movement, deformity and stiffness can arise due to elbow fractures.

These can happen after a fall or hit on the elbow, and could be accompanied by sprains and dislocations. Some people think home remedies can cure the pain, swelling or stiffness after an ac-cident and do not bother to go to the doctor – leading to more suf-fering and a possibility of a worse scenario. It is best to consult an expert orthopaedic specialist for any such injuries, rather than be sorry later.

X-rays, CT scans and MRI scans can show the entire picture and the extent of damage to the bones. If there is not much harm to the bones, increasing early move-ment is emphasised, or moderate treatment such as sling, cast or splint is used. Displaced or unsta-ble fractures more likely require surgery to realign and recon-struct the damaged bones.

It is important to unite the bones in a proper position with the help of surgery performed by expert specialists. The joints have to be reconstructed in a perfect manner so that the bones do not fit like a jigsaw puzzle after an ac-cident, but as they are supposed

to be. Only this can lead to nor-mal functioning after the proce-dure.

As there are various types of el-bow fractures such as radial head and neck fractures, and olecra-non fractures; it becomes very important that correct identifica-tion is done by the doctor before going in for surgery. Implants, fragment excision, open reduc-tion and internal fixation, and bone graft are among the various surgeries that can be done to cor-rect the bone deformities.

For children, this becomes cru-cial as the examination of their elbows could be difficult because of the growing skeleton’s chang-ing anatomy and the delicate condition of the fractures.

Women with osteoporosis, children and old people are es-pecially prone to worse forms of fractures as their bones are weak and more likely to be brittle.

Fractures of the elbow are not always so dangerous but it is bet-ter to be very cautious after an in-jury and get appropriate medical advice and care so that the situa-tion does not worsen. Being alert and not laidback after an injury can help the patient restore regu-lar movement soon.

- Dr GK AgrawalHOD Orthopaedics,

Fortis Hospital, Shalimar Bagh, New Delhi

(Views expressed in this articleare of the author and do not

necessarily represent the views of, and should not be attributed to,

Drug Today Medical Times.)

Quick treatment for broken elbow!Quick medical treatment and surgery are needed to avoid worsening of an elbow fracture after an injury

MADHurI SHuKlA

“There is increased iodine requirement during pregnancy which can be easily met by iodized salt. During pregnancy daily iodine requirement is 250 micro-grams” informs Dr Dhanwal.

The type of salt you consume dur-ing pregnancy, might well determine the overall IQ level and academic bril-liance of your child.

It is well-known that iodine defi-ciency causes goitre, but an insufficient uptake of this micronutrient, especially during pregnancy, can also lower of the baby’s IQ and reading abilities.

A study published recently showed that even women who had just a mild iodine deficiency were more likely to give birth to babies with lower verbal IQ scores, as well as lower reading abilities than women who got enough of the mineral.

A group of researchers from Surrey and Bristol universities, led by Profes-sor Margaret Rayman of the Univer-sity of Surrey, in Guildford, UK, used samples and data from Bristol-based Avon Longitudinal Study of Parents and Children (ALSPAC), also known as 'Children of the 90s'.

This was a long-term health research project in which data and samples of more than 14,000 mothers in UK en-rolled during pregnancy in 1991 and 1992 at ALSPAC was used. The health and development of their children was thereafter followed in great detail.

The researchers measured the iodine concentration in urine samples taken in the first trimester from 1040 preg-nant women. Following World Health Organisation (WHO) guidelines on rec-ommended concentrations of iodine during pregnancy, they classified wom-en who had an iodine-to-creatinine ra-tio of less than 150 μg/g as being iodine deficient, and those with a ratio of 150 μg/g or more as iodine sufficient. Over

two-thirds (67%) of the sample was io-dine-deficient.

Mental development of the women's children was assessed by measuring child IQ at age 8, and reading abil-ity at age 9. Adjusting the results for external factors likely to affect these scores, such as parental education and breast-feeding, the researchers found that children of women in the iodine-deficient group were significantly more likely to have low scores (lower quar-tile) of verbal IQ, reading accuracy, and reading comprehension. Moreover, the lower the mother's concentration of iodine was the lower were the average scores for IQ and reading ability in the children.

According to Professor Rayman, "Our results clearly show the importance of adequate iodine status during early pregnancy, and emphasize the risk that iodine deficiency in the mother can pose to the developing infant, even in a country classified as only mildly iodine deficient."

Iodine is an essential micronutrient for cell metabolism, a process which converts food into energy. Iodine also

facilitates thyroid function, which reg-ulates the rate of metabolism and the production of thyroid hormones.

Dr Dinesh K Dhanwal, Endocrinolo-gist and Director Professor of Medicine, Maulana Azad Medical College, says that mild hypothyroidism during preg-nancy is usually asymptomatic (does not show symptoms). “Patients with overt hypothyroidism may have extra weight gain, constipation, cold intoler-ance, mental and physical fatigue and a neck swelling suggestive of goitre. Hypothyroidism during pregnancy can affect the outcome of the foetus. Wom-en with low thyroxin levels, can have children with cognitive delay in early childhood and upto a 7 point lower IQ level, leading to a change in scholastic abilities,” adds Dr Dhanwal.

The key to avoid chances of hypo-thyroidism during pregnancy is to con-sume iodized salt.

“There is increased iodine require-ment during pregnancy which can be easily met by iodized salt. During preg-nancy daily iodine requirement is 250 micrograms” informs Dr Dhanwal.

He further informs that the ideal TSH during pregnancy should be <2.5 in 1st trimester, <3 uIU/ml during 2nd and 3rd trimester.

Dr Seema Kapoor, Professor, Pae-diatrics, Maulana Azad Medical Col-lege, says“Thyroid testing of pregnant women is recommended and a non-debatable issue in the health interest of neonates. Every child deserves a healthy start in life. TSH levels can be checked at birth. Its deficiency is the most common preventable cause of mental retardation. Effective treatment is available”.

She explains the economic benefits of thyroid testing and asks, “As a coun-try, is diagnosis at an early stage more affordable, or the expense of bringing up a mentally challenged young gen-eration?”

low Iodine in moms, low IQ babies

“There is increased iodine requirement during pregnancy

which can be easily met by iodized salt. During pregnancy, daily iodine

requirement is 250 micrograms” informs Dr Dhanwal.

EASTINDIA

DruG TODAY MEDICAl TIMES 9Medical Nation1st - 31st July 2013, New Delhi

A step forward towardsCharity

On every purchase of

DTMT`1/- goes for treatment of a needy!

DISHA TOMAr

Government has been constantly taking many initiatives to provide healthcare support in the rural and remote areas, however, the health needs of many communities are still not adequately met.

Lack of healthcare pro-fessionals and medical fa-cilities in rural and remote areas poses a challenge to the country’s equitable healthcare delivery. Re-cruiting and retaining an appropriate and adequate-ly trained medical staff in these areas is also a major issue as most specialists show reluctance to work in isolated areas.

Evidently, there is no one model capable of ser-vicing the health needs of diverse rural and re-mote communities. In a recent heart wrenching case, a tribal youth from a remote village in Kerala carried his seven-month pregnant wife on his back and walked for an entire day to get her treated in the Pathanamthitta dis-trict hospital of Kerala. The woman was later shifted to

Government Medical Col-lege, Kottayam. Ayyappan succeeded in saving his wife, Sudha, but the couple lost their child.

A week before the in-cident Sudha developed convulsions and her body was swelling. After a week the duo left their home in Konni forest in the morn-ing while it was raining heavily. Ailing Sudha could not walk and so Ayyappan made a sling out of a piece of cloth and carried her on his back. They spotted a vehicle in the late even-ing when Ayyappan had already walked for 40 kilo-meters.

“He might have failed to save his child, but he could save his wife,” quoted Kun-jamma Roy, Head of the

Department of Gynaecol-ogy at the Kottayam Gov-ernment Medical College Hospital. The woman, when admitted, was suf-fering from oedema, high blood pressure and con-vulsions, informed Dr Roy.

Ayyappan married Sudha eight months ago and the couple lived with Sudha’s father and two sisters. Ac-cording to Ayyappan when Sudha became pregnant there was no doctor any-where around whom they could consult. Recently she developed fever and they met a homoeo doctor, said Ayyappan. The couple had no money and was cared for by a non-governmental organization at Kottayam Medical College.

When contacted, Mr

Rajeev Sadanandan, Prin-cipal Secretary to Depart-ment of Health and Family Welfare, Kerala, told DTMT “Primary healthcare cen-tres (PHC) are available at short distances, but the woman was severely mal-nourished and had com-plications with her preg-nancy. In such a condition she had to be taken to the secondary health care cen-tre. She had convulsions and swelled up body that had to be operated by a specialist.”

It is shocking that in the 40 km stretch there was no specialists available. Could not treatment have been given by rushing a doctor to the patient who could be interned in a primary health centre? The area

does not have the 102 Am-bulance service initiated for pregnant women by the government. According to Sadanandan, “The 102 am-bulance service has been implemented in only two districts of the state that does not cover Pathanam-thitta district to which the duo belong”. It may be not-ed that the 102 ambulance service was launched long back by the government of India but many states, including Kerala, are still to implement it. As per the August, 2012 data no am-bulances were functional at PHCs in Kerala.

It is well known that healthcare facilities are widely distributed among the urban population, de-spite the fact that the rural and remote communities experience more health re-lated problems.

Our country is fast be-coming a hub for medi-cal tourism where people from other countries visit to get quality and afford-able medical treatment. However, most of these facilities are simply not available to Indians in re-mote areas.

DTMT NETWOrKASSAM

After the success of the floating clinics, Assam is all set to in-troduce a floating hospital. The North Eastern Council (NEC) has sponsored a Rs 4 crore project of a hospital ship to be implemented by the Centre for North East Studies and Policy Research (C-NES). The ship is under construction at Pandu Port in Guwahati on the Brah-maputra river and is being built by M/S P Das and Company.

Alleviating the misery of the most marginalized and poor-est communities living on hun-dreds of small islands, called Sapories, on the river Brahma-putra, Assam Boat Clinics now serve almost a million people in need of dire medical atten-tion.

Begun as a pilot project, these especially designed and out-fitted boat clinics today reach out to lakhs of underprivileged people living in remote river is-land areas.

Over 30 lakh people, i.e. al-most 10 per cent population of Assam, dwells in these iso-lated patches of land on the Brahmaputra river far from the mainland. Education, health-care facilities and other basic amenities are a far cry for these communities.

The innovative programme of boat clinics in Assam was initiated by C-NES with finan-cial support from the National Rural Health Mission (NRHM) in co-ordination with govern-ment of Assam to reach out to these island dwellers.

The programme is operat-ing via its 15 independent units

in 13 far-flung north-eastern districts. It aims at providing medical assistance, especially to the mothers and children, in order to bring down Maternal Mortality Rate (MMR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR) in the State which are amongst the highest in India. Each boat clinic has a 15 member staff including doc-tors, laboratory technicians and nurses.

These boat clinic teams go on trips every 4-6 days and conduct 1-2 camps per day. The

boats are modified to make a health clinic that provides basic provisions including an OPD and a cabin for ANC checkup. There is a district of-fice for each boat clinic which is headed by a District Program Officer (DPO). The DPO is re-sponsible for the implementa-tion of the program in the tar-geted communities along with the medical officer and sup-porting clinical staff.

Village Health & Sanitation Communities, ASHA workers and AWW workers actively par-ticipate in the program. Yearly targets and monthly plan of ac-tion is prepared in consultation with the district health depart-ment. Medicines and vaccines are supplied by the Joint Direc-tor of Health Services through the district drug stores as per the indent. Close coordination

is maintained with the district NRHM unit. On camp days the boat clinic teams carry with them medicines, reagents, vac-cines, food and drinking water.

The boat clinics have reg-istered a remarkable success and their efforts have been instrumental in removing su-perstitions among illiterate is-land dwellers which had made them resist immunization of children, adoption of fam-ily planning measures, use of iron-folic acid tablets by preg-nant women etc. Till March 31, 2012, Boat Clinics had con-ducted 7803 health camps with 6,31,646 health checkups, 74,066 routine immunisations, 32,779 ANC, 8,116 PNC, 28,112 Vitamin A, 11,748 special vacci-nation, 6,716 IPPI, and 1,65,445 family planning item distribu-tion.

DTMT NETWOrKKOlKATA

Belle Vue Clinic, Kolkata, has launched a unique financial scheme ‘Healthy Heart For All’ (HHFA) whereby the heart pa-tients can choose to undergo advanced treatment at an af-fordable rate.

The clinic has partnered with India Medtronic, headquar-tered in Mumbai, to extend its scheme of Equated Monthly Installment (EMI) under the HHFA. "We have started the EMI scheme for cardiac pa-tients as a major problem in India is affordability," quoted Munish Sehegal, business model innovator of India Medtronic.

Reportedly, one fifth of the deaths in India are due to coronary heart diseases. There are an estimated 45 million patients of coronary heart diseases in India. As per the current projections, India will have the largest cardiovascu-lar disease burden in the near future. Mortality rate due to heart diseases goes up mainly due to unaffordability and lack

of awareness.The scheme has been creat-

ed to benefit all. Patients cov-ered under health insurance and also who have no health insurance or cannot get easy loans, can avail the benefits of the scheme. HHFA provides loan assistance at easy install-ments for stents, implantable

cardioverter defibrillators, pacemakers, triple chambers pacemakers and implants.

EMI scheme for heart patients in West Bengal

Tribal man carries pregnant wife 40 km to get treated

Healthcare in isolated areas remains cause of concern for nation

Sex ratio improves among Odisha's tribal populationDTMT NETWOrKBHuBANESWAr

According to the latest Census results, sex ratio among the tribal popu-lation of Odisha has im-proved appreciably. Al-though the state contin-ues to report high female foeticide, its tribal popula-tion has provided a ray of hope. A 26 point increase has been registered as the sex ratio among tribals, which has jumped to 1,029 females for every 1,000 males in 2011 from 1,003 in 2001.

Released in May, 2013, the Primary Census Re-port 2011 showed that ST population in the state has increased from 89,94,967 in 2001 to 95,90,756 in 2011. The ST population rose by 14,45,675 in a dec-ade thus registering 17.7 per cent growth rate. In terms of gender composi-tion, there were 48,63,024 females as compared to 47,27,732 males.

As per the report, the overall state population stood at 4,19,74,218 and the overall ST share in state population rose from 22.1 per cent in 2001 to 22.8 per cent in 2011. Chief

Minister Naveen Patnaik, who released the census abstract here said popu-lation of the State has in-creased at 14 per cent, a rate lower as compared to the last decade when the rate was 16.3 per cent.

The CM was quoted as saying, “It was the consist-ent efforts of the Govern-ment in the field of girl child education and wom-en empowerment that the female population growth rate has risen from 13.67 per cent in last decade to 14.43 per cent during 2001-2011.” The overall sex ratio of the state rose by 7 points from 972 in 2001 to 979 in 2011. Further, the

Director, Census Opera-tions, Bishnupada Sethi informed that highest number of ST population was recorded at Mayurb-hanj where their number stood at 14,79,576, where-as Puri had the lowest with just 6,129.

Scheduled Caste (SC) population of the state recorded a growth of 18.2 per cent in a decade which is higher as compared to ST population. SC popu-lation rose by 7 points, increasing to 71,88,463. The proportion of the SC population has risen to 17.1 per cent which stood at 16.5 per cent in the last decade.

A Floating Hospital on the Brahmaputra

Four test HIV positive with infected blood transfusionDTMT NETWOrKGuWAHATI

In a recent mishap, at least four people reportedly tested positive for HIV infection after having received blood transfu-sion at the district civil hospital Mangaldai, in Darrang district, Assam.

The matter came to light when the youth, whose blood was transfused to four patients, test-ed HIV-positive. He is currently undergoing treatment at Anti-Retroviral Therapy (ART) centre of Gauhati Medical College and Hospital (GMHC).

Soon after the episode, a high-level probe into the matter was ordered by Assam Chief Minis-ter Tarun Gogoi. A criminal case against those responsible for the transfusion was filed there-after.

The government doctor, Dr Jiten Saharia, in-charge of

the blood bank at the district civil hospital and two labora-tory technicians, Padmadhar Barua and Ranjit Deka, were placed under suspension after the confirmation of the case. The concerned staff did not properly test the donated blood before forwarding it for transfu-sion.

According to Gogoi, the inci-dent is of criminal nature. He was quoted as saying, “If they have carried out blood transfu-sion by taking blood from a do-nor without conducting proper tests, then it is surely a case of criminal negligence. Depart-mental action like suspending the guilty government official will not suffice. There should be criminal charge against officials found guilty."

The chief minister ordered scrutiny in all government and private blood banks to avoid any such incident in future.

NORTHINDIA

DruG TODAY MEDICAl TIMES10 Medical Nation 1st - 31st July 2013, New Delhi

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DTMT NETWOrKSHIMlA

The Himachal Pradesh Government has planned to launch a heli-ambu-lance scheme for the patients in remote and tribal areas.

There has been a lack of specialist doctors and medical staff in the tribal areas and so the heli-am-bulance would air-lift the patients from these areas to other parts of the state where better medical fa-cilities can be provided.

To bring this into ef-fect a proposal has al-ready been submitted to the Union Government. Transferring special-ists to the tribal areas of Kinnaur, Lahaul-Spiti and Pangi-Bharmaur re-gions of Chamba district is not possible for the government as the state is facing acute shortage of medical staff. Report-edly, many of the spe-cialists posted in these areas somehow manage transfers or show disin-clination to join the duty.

In villages surround-ing Lahaul-Spiti district there is hardly any spe-cialist doctor available to cater to the needs of about 33,000 tribal pop-ulation. Adding to the poor health services in these areas posts of gy-necologists, general sur-geon, pediatrician and radiologist have been

lying vacant for years as no one is willing to take up the charge in the area that exhibits heavy snowfall for about six months that isolates it from rest of the world.

“The government has decided to start heli-ambulance scheme in tribal areas of the state under National Rural Health Mission (NRHM) to ensure specialized treatment for tribals. Discussions have been held with the Union gov-ernment on the issue and final nod is awaited,” Principal Secretary for Health Ali Raza Rizvi has said. He further added, "If the Union govern-ment approves the pro-posal, then the proposal would be put up before the cabinet to get re-quired clearances and then the tender process would be started. After getting Centre's nod, the process would be completed within six months".

Air-ambulance to serve patients in tribal areas

DTMT NETWOrKJAMMu

Jammu and Kashmir government, facing se-vere shortage of funds in most sectors, has come up with the decision to introduce Public Private Partnership (PPP) mode to install diagnostic cen-tres at the government medical colleges and al-lied hospitals across the state.

In the first phase, the Department of Medical Education is working on the proposal to equip government medical colleges and hospitals in Jammu and Srinagar with CT scan, MRI and other similar equipments to be run by private play-ers.

“High cost equipments are purchased but they are not being maintained. This is one of the rea-sons that the government wants private players to take on the critical diag-nostic equipments in the two hospitals”, a senior government functionary was quoted as saying by a daily.

He added that the only

CT scan machine availa-ble at Government Medi-cal College and Hospital Jammu (GMC&H) was lying defunct as the gov-ernment was not having the requisite funds to ensure its regular main-tenance.

Admitting to the fact that the department is contemplating to intro-duce PPP mode in the two

medical colleges, Minis-ter of Health & Medical Education, Taj Mohi-ud-Din said, “We do not have enough funds to repair the machine, which has been purchased for Rs 8 crores. We have an inno-vative idea of introduc-ing PPP mode to tackle such problem of defunct machines including MRI, CT scan and others equipments”.

PPP mode would in-volve private partners to install their own equip-ments at government run institutes, while the gov-ernment would fix the di-agnostic charges for the patients. “This will be a partnership venture and state government will surely earn out of it as well”, the Minister added.

low on funds, J&K to introduce diagnostic centres through PPP

MK SINGH

Following the Bhopal gas tragedy of 1984, con-

sidered to be the world’s worst industrial disaster till date, a high quality healthcare system for the survival of the thousands of victims was the need of the hour.

The Bhopal Memorial Hospital Trust was es-tablished in 1998 in ac-cordance with the orders of the Hon’ble Supreme Court of India, and sub-sequently a 350 bedded multi specialty tertiary care hospital named Bho-pal Memorial Hospital and Research Centre (BMHRC) came into being in July, 2000. With the establish-ment of this hospital, the entire gamut of healthcare services were provided to the victims under one

roof, which were earlier scattered in small facilities across Bhopal.

The primary objective of the trust was to pro-vide free treatment to the survivors. Later, Justice A. H. Ahmadi became the chairman of BMHT/RC. Apart from treating the gas victims, the doctors were allowed to treat other patients also under a rev-enue sharing model. In the model, it was unanimously decided by the Trustees that 30% of the fees from patients would go to the doctors and the remaining 70% to the trust.

With the passage of time, the survivors alleged that they were subjected to dis-crimination while getting treatment. They said that the doctors were more inclined towards private patients as they were get-

ting paid for that. Moreo-ver, sources tell DTMT that some doctors were earning Rs. 2 to 2.5 lakh per month through the revenue shar-ing model.

Taking cognizance of the matter and to safeguard the rights of the victims, the apex court, in a wel-come move, dissolved the trust in 2010 and asked Department of Biotechnol-ogy (DBT) and Department Atomic Energy (DAE) to look after the functioning of the hospital w.e.f 20 July 2010. The administrative charge of the Hospital was given to the Indian Coun-cil of Medical Research in 2012. A senior IAS officer, T.S. Jawahar, was appoint-ed to look into the matter and address the grievances of the victims. At present, the Bhopal Memorial Hos-pital and Research Centre

is fully owned by the Gov-ernment of India which bears all the expenses of the hospital.

Under ICMR, the pri-mary objective of the hospital is to treat the vic-tims. There are almost 3.5 lakh registered victims

with identity cards who are entitled to free treat-ment. “We have advertised in newspapers in Bhopal calling upon victims to get their I-cards. I personally visit Bhopal every fort-night or so to monitor the status and also meet the

victims to sort out their grievances. For the same I have taken some initia-tives. For instance, right now, right here I can see the bed occupancy of each ward, how many beds are given to victims and how many to others”, explained Mr. Jawahar to DTMT.

On being asked why patients other than the victims are still getting at-tention at the Hospital, Mr. Jawahar said that only the vacant beds are supposed to be given to non-victims, “If patients (gas victims & others) come simultane-ously, priority is given to the victims. Beside this, we have established a griev-ance cell so that the vic-tims can directly meet the directors of the hospital and give their complaint in a written form and the cell is replying to each

and every letter inform-ing what action they have taken on the complaint.” On the issue of discon-tent he said “As for those (doctors) who came here thinking of their private share and are not getting it right now, I cannot stop them from leaving. But I must say that those who are leaving unhappy over their condition, I have as-sured that we will definite-ly make them happy and improve their condition. We are providing all facili-ties under the rules.”

The bone of contention among doctors working in the Hospital is the salary. Earlier, under the revenue sharing model, the doctors had earned huge monetary benefits. In view of the Supreme Court order the doctors were barred from this private income. Cur-

rently, the revenue gener-ated from the private pa-tients is going to the gov-ernment. The government has provided all the perks and pay provided by the sixth pay commission. The doctors are also getting Non Practice Allowance. Meanwhile, the doctors at the Hospital have filed a petition in the apex court seeking reinstatement of the earlier. The writ peti-tion is scheduled to be posted for hearing in the Hon’ble Supreme Court on 19 July 2013.

The view of the Hon’ble Supreme Court of India in this matter will be eagerly watched, since it will clar-ify whether doctors can legitimately be granted the right to earn private in-come from practice while still holding a government job.

DTMT NETWOrKrANCHI

Rajendra Institute of Medical Sciences, the so called multi-specialty hospital in the city, has been facing severe dearth of ambulances and man-power. As against the bed strength of 950, the hos-pital runs only five am-bulances.

The ambulances serv-ing the patients, although equipped with all the necessary facilities, are not properly maintained. Of the five ambulances two are designed to han-

dle cardiac patients and only three ambulances are available for general patients. According to sources, even in such a dire situation the hos-pital officials use ambu-lances for their private purposes. Reportedly, the hospital does not support any help-line for patients to call during

emergencies.Besides, there is also a

shortage of drivers and trained staff to handle critical patients carried in the ambulances. An ambulance team must comprise of well trained qualified paramedic or other registered health-care professionals as nurses to avoid any crisis

while taking care of pa-tients inside the ambu-lance. "Of the five, at least a couple are idle owing to no drivers," sources told a daily.

Due to the ongoing shortage of trained man-power, in most of the cases patients have to ar-range their own private vehicles to meet their need. "We are taking the issue seriously and soon there will be an increase in number of ambulanc-es and staff to facilitate the ambulance service for patients," stated Dr SK Choudhary, Medical Superintendent RIMS.

DTMT NETWOrKSHIMlA

The state capital of Himachal Pradesh was recently declared as smoke free at a function organized by HP Volun-tary Health Association (HPVHA) and district ad-ministration.

Shimla was declared smoke free under the Tobacco Control Act of 2003. While declar-ing the city smoke free, Deputy Commissioner Dinesh Malhotra was quoted as saying, “A sur-vey was conducted on scientific methodology by IGMC Shimla on five indicators and the report by the agency indicated 92.17 per cent compli-ance of these indicators. The compliance was 89.64 per cent in rural areas and 96.65 per cent in urban areas.”

Dr. Ramesh, Medical Superintendent, IGMC hospital Shimla, in-

formed that the compli-ance report of the survey was based on findings on active smoking in public and work places, avail-ability of ash trays and lighters, butts of ciga-rettes, smell of cigarettes smoking and warning signage.

“16 per cent in the age group of 15 to 17 years and 21 per cent in the age group 18 to 19 were smokers in Himachal Pradesh, signifying the need for creating more awareness among col-lege and university-go-ing students,” stated an official from HPVHA.

BS rAWATNEW DElHI

Tobacco was a foreign plant introduced by Vas-co da Gama in India. Its leaf contains about 4000 chemicals out of which 60 are known to cause cancer in humans by affecting cell DNA, RNA and protein, says Dr. Puneet Gupta, Di-rector, Oncology Services Division, of Metro Hospital and Cancer Institute.

According to Dr. Gupta these 4000 chemicals es-sentially protect leaves from pests being natu-ral pesticides. However, the human use is just to abuse a single chemical called nicotine which itself can not cause cancer. The nicotinic receptors in the human body become de-pendent and then usher in the abuse.

Also, when a few of these 4000 chemicals catch fire, as in cigarettes or cigars, they turn carcinogenic. When tobacco combines

with alcohol the cancer causing potential becomes very strong. This is why Dr. Gupta is totally against the consumption of the combo of tobacco and alcohol by humans and advises that it should be avoided at all cost.

Today, it is a fashion amongst youths to smoke. Managing unpleasant situ-ations, stress, depression, loneliness, fear and anxiety are some of the most com-mon reasons why youth take to tobacco. Psycho-logical intervention, such as behavioural therapy, telephone support and

self-help materials are ef-fective in helping smokers kick the butt, psychiatrists say.

Dr Sunil Mittal, leading psychiatrist and director of Cosmos Institute of Mental Health and Behavioural Science (CIMBS), opines that the effectiveness of psychological interven-tion in smoking cessation is well established.

"Based on research, it has been confirmed that nicotine is a drug as hard as heroin or cocaine. To-bacco consumption along with alcohol and other substances worsen the ef-

fect of tobacco,” Dr Mittal said.

Experts say smoking and tobacco consumption is harmful to human body and prolonged use causes cancer of head and neck, lungs, food pipe, cervix, kidney, pancreas, breast etc., besides damaging heart, lungs and brain. .

Many cancer centers in India are ill equipped and do not have total anti-can-cer team of full time cancer specialists, cancer surgery or radiation therapy spe-cialists. The modern lin-ear accelerator radiation facilities are almost seven times lesser than the need.

The latest anti cancer tar-get drugs and fentanyl skin patches for cancer pain management are not easily available at many hospi-tals and medical colleges in India. India has only one cancer facility, located in Delhi, that trains and certi-fies nurses in cancer care approved by the Nursing Council of India.

Will SC allow BMHrC Doctors private income?

Cancer care woefully inadequate in India

Shimla declared ‘smoke-free’ under tobacco control act

lack of ambulances and trained staff at rIMS

DTMT NETWOrK

It is now mandatory for MBBS graduates aspiring to pursue post-graduation pro-gramme to undertake one year rural posting to be eligi-ble for the course.

In making this mandatory requirement, the Govern-ment's objective is to im-prove rural healthcare in In-dia. Only the MBBS doctors who have undertaken one year rural posting will be al-lowed to sit for post-gradua-tion entrance examination.

It is understood that the de-cision will be applicable from the next academic session (2014-15).

There is an extreme short-age of doctors in the rural areas of the country. Report-edly, only 26 per cent doctors work in rural areas serving 76 per cent population of the country. The doctor to popu-lation ratio in rural areas is just 3 per 10,000, while it is 13 per 10,000 in urban areas.

To address the crisis, the MBBS graduates were pre-

viously given incentives to work in rural areas. Doctors who worked for one year got 10 marks while those who worked for three years got 30 marks for admission in PG. However, this failed to overcome the situation. The former health minister An-bumani Ramadoss the put forward a one-year compul-sory stint proposed in 2007.

The proposal for one year mandatory rural posting has been signed now and the MBBS graduates undertak-ing the program will be reg-istered as doctors by MCI. They will be paid as full-time MBBS doctors.

"Those candidates who do not want to do a rural post-ing would be free to practice MBBS after they get their degrees following the intern-ship. The MBBS course struc-ture and duration will remain the same. The only change is one year rural posting will be made the eligibility condition for those wanting to pursue MD and MS,” informed a sen-ior MCI official.

rural stint made mandatory for doctors to pursue PG

Based on research, it has been confirmed that nicotine is a drug as hard

as heroin or cocaine. Tobacco consumption along with alcohol and

other substances worsen the effect of tobacco

The Supreme Court may clarify whether government doctors can be legitimately given the right to have

private incomes from practice.

Dr. Sunil Mittal sharing his views with DTMT

WESTINDIA

DruG TODAY MEDICAl TIMES 11Medical Nation1st - 31st July 2013, New Delhi

DTMT NETWOrKMuMBAI

An infant from Maha-rashtra’s Beed district has died after being diag-nosed with Vaccine De-rived Polio Virus (VDPV). This is the first VDPV case in the state and third in the country, the last one being in March, 2012.

According to health of-ficials, the stool sample of the 11-month-old boy tested positive after the child was found to be ill for a while. He was diag-nosed with fever on April 27, 2013 and thereafter he suffered from paralysis and then convulsions of his left limbs. On May 9, he was shifted to the Gov-ernment Medical College, Latur, from a private hos-pital in Ambejogai. The other limbs of the child

were also paralyzed even-tually.

Doctors feel that the child might have missed the timely polio dose as his family keeps migrat-ing from one place to an-other. The child belongs to a socio-economically backward family and was delivered under normal conditions at the Primary Health Centre (PHC) in Hatta, in Hingoli district. At the time of birth on July 3, 2012 he was ad-

ministered with zero po-lio dose followed by first dose which was given on September 7, 2013. There occurred a gap of seven months between the first and the second dose which was administered on April 2, 2013, instead of the ideal period of a month.

The discovery, however, does not affect India's progress towards achiev-ing polio free status next year as VDPV (P2 strain)

is not counted among the country’s polio num-bers. Only the infections caused by P1 and P3 are counted. ‘Such a case of VDPV is found if the im-munity of the child is low, it suffers from chronic illnesses of the heart or kidney or if it is severely malnourished. In such cases, the P2 virus mu-tates and can cause pa-ralysis,’ said HV Wadgave, district reproductive and child health officer, Beed. The in-depth investiga-tion under the case is on, informed the officer.

Oral Polio Vaccine is a live-attenuated vaccine whereby the high patho-genicity of the virus is removed. Such a formula-tion activates an immune response in the body, pro-ducing antibodies against the virus which provide

immunity for later life. It is only in very rare in-stances that the virus in the vaccine undergoes mutation to cause some form of paralysis (VDPV).

The vaccinated indi-vidual also transfers the altered virus in the vac-cine to the people around him who also develop im-munity against the virus. So to be on the safer side the stool samples of other children in the neighbor-hood were also sent to the National Institute of Virology, Pune. Besides, a study of the immuniza-tion coverage has been conducted in the village.

India is less than a year away from being declared as polio free. The last case of polio virus type 1 in the country was reported in Howrah, West Bengal, on January 13, 2011.

DTMT NETWOrKMuMBAI

In a recent case from Mumbai, a nine-year-old’s life had been troubled when her dear ones dis-covered that the child suf-fered from renal failure. Both Sakshi Shahpure’s kidneys were found to be dysfunctional and so she could not attend school or play with kids.

However, the girl can now lead a normal life with her new transplanted kidney, donated by her 58-year-old grandmother Ratan. “I don’t feel tired any more. I even go out to play now,” said Sakshi who got her transplant done at Marol’s Seven Hills Hospi-tal in Mumbai.

“The case was challeng-ing because an adult kid-ney had to be transplanted into a minor,” Dr Avinash Arora, transplant surgeon who conducted the sur-

gery, told a daily.“We had to ensure the

continuity of the blood vessels after the trans-plant. Since the recipient was a minor, there was disparity between the size of her blood vessels and those of the donor,” explained Arora, further stating that Sakshi’s kid-ney functions are normal now.

According to the ex-perts, grandparents have been the most willing do-nors. A bill on organ trans-plant introduced in the Lok Sabha in December, 2009 included grandpar-ents and grandchildren in the list of near relatives who can donate organs

to a patient. Earlier, only a spouse, parents and siblings were allowed to donate organs. “Grand-parents are still willing, but most of them are not fit owing to the increased incidence of diabetes and hypertension,” said Arora.

Kidney failure is a rare condition in case of chil-dren. Santosh Shahpure, Sakshi’s father, a business-man from Kolhapur, says, “She suddenly stopped eating and would vomit continuously. We were shocked when doctors said her kidneys had failed”.

“We were all ready to donate the organ, but only my mother was the right match according to the doctors,” he added. Ratan is happy to see Sakshi fit and says that it pained her to see her grand-daughter getting dialysis six times a day. She leads a normal life now.

DTMT NETWOrKAHMEDABAD

An illiterate car mechanic from Telav village near Sanand on the outskirts of Ahmedabad, in Guja-rat, gifted his family land to build a hospital for the needy. The hospital was built two years ago on the land that belonged to his forefathers.

Adarsh Hospital, the multispecialty facility built by 48-year-old Hus-sain Momin, has a unique payment option where the patients can pay whatever they can, but the treatment would not stop for lack of money.

For the realization of his dreams, Momin was helped by Dr Kar-tik Shukla, a leading or-thopedic surgeon from Ahmedabad, who also heads the hospital.

At the age of 20, Mo-min left his village to

earn bread for his family. He learned the nuances of vehicle repairing at a garage in Chidola, near Gandhinagar. With over 7 lakh in his pocket af-ter fifteen years of hard work, Momin decided to return home and con-tinued his work as a me-chanic near his village. Soon he was able to es-tablish a good business and wished to construct a multispecialty hospital

in his village.Shukla narrates how

Momin got the hospital constructed on the 1200 sq yard plot that was family property. “The lo-cation of the plot made it a prime property and Hussain bhai had many offers to sell it off with some offers even going up to Rs. 10 crore,” said Shukla.

However, Momin with-out any distractions

stuck to his dream and used the money he had saved all these years to establish the hospital. “Unlike urban patients, the rural people rarely plan a treatment and hence seldom have ready cash for it,” said Shukla. While the lack of cash, he says, leads to compro-mise in treatment, many patients later are forced to seek further proce-dures which often turn

complicated.He further informed

that initially Momin was opposed to charging fees. However, it was later de-cided that to meet the expenses and running cost of the hospital, the patients will be explained the medical procedure they have to undergo and how much it can cost. They, then, will be asked to pay whatever they can afford.

About the availabil-ity of staff in the hospi-tal Shukla informs, “We have three orthopedic surgeons, four gynecolo-gists, an ENT surgeon, a dental surgeon, an ortho-dontist, and an ophthal-mologist apart from a general physician and we will soon have a physio-therapist as well. The best part of it is that no doctor has come to this hospital with any terms and con-ditions”.

DTMT NETWOrKJAIPur

Consumption of bidi, zarda (chewing tobacco) and cigarettes has seen a drastic decline in Ra-jasthan in the past three years. Recently, the state bagged two WHO direc-tor general’s awards in South East Asia region for its efforts in tobacco control.

Every year WHO rec-ognizes the contribution of individuals and or-ganizations and awards six regions for their ef-forts in tobacco control. Among the five recipients of the WHO awards this year, in the South East Asia region are the Di-rectorate of Medical and Health Services (DMHS) and city-based oncolo-gist Dr Rakesh Gupta for

their contribution in the decline of tobacco con-sumption in the state.

While the state gov-ernment increased tax rate on tobacco products from 20 per cent to 50 per cent and to 65 per cent now, which is even more than prescribed by WHO, DMHS has been continu-ously making efforts for promotion and imple-mentation of anti-tobac-co policies to cut down

tobacco consumption. DMHS introduced a first

of its kind helpline 104 for free counseling of tobac-co users who wish to quit tobacco consumption. Besides, it also provides free nicotine-free chew-ing gums and medication to help consumers quit tobacco consumption.

The state saw a remark-able drop in the tobacco sale. Cigarette sale in the state dipped to Rs 349.67 crore in 2011-12 from Rs 413.55 crore in 2010-11, whereas in the financial year 2012-13 the total sale was just Rs 160.28 crore in the first six months.

A 50 per cent decline in bidi sale has been registered while chew-ing tobacco sale dipped from Rs 31.54 crore to Rs 14.56 crore in the past two years.

Illiterate mechanic invests savings to build hospital for villagers

rajasthan registers sharp decline in tobacco consumptionThe state has been awarded by WHO for its efforts to curb tobacco consumption

Infant dies due to Vaccine derived Polio Virus in BeedDoctors suspect the child missed timely vaccination

Grandmother donates kidney to save nine-year old

Dr. A. ramayogaiah

The TV programme "Satyamevajayethe" of

Aamir Khan angered doc-tors who sought an apolo-gy from him. Aamir did not budge. Let me share my feelings from the depths of my heart with 38 years experience as a medical doctor.

When I was a child, Aripi-rala Kotaiah was my family doctor. He also worked as a teacher in an elementary school in a neighbouring village. We lived in a vil-lage without high school and electricity. Ours was an agricultural extended family with 32 members. All our family members were completely secure for medical care under Dr. Aripirala Kotaiah. We could just walk into his house and get treatment. He would come to our house every day on his way to school. He knew all our names. He calleed my fa-ther Anna (Elder Brother), my mother Akka (Elder Sister). My father called him ‘Swami’ - a respect-able word. We regularly sent him grain, vegetables, milk, etc. Our bullocks ploughed his lands when-ever he requested. My father provided all his do-mestic day-to-day needs. My father paid the doctor's fees whenever he liked and whatever he liked.

Ediga Narayana was our doctor in a neighbouring town. We used to depend on him for some emer-

gencies and for conditions for which Dr. Kotaiah re-ferred. He was popularly known as ‘Narayana Doc-tor’. If we could not go to hospital due to any rea-son, somebody from our house would go to him. Dr. Narayana would rush immediately on his mo-tor bike to our village and attend to us. That person also returned as a pillion rider. He had not gradu-ated from any system of medicine and from any university.

Both Kotaiah and Naray-ana were ‘our doctors’.

When I was at medical school, Dr. N. Ramachan-dra Rao, our Professor of Medicine, was ‘our doctor’. He was known as ‘Medi-cal Students' Doctor’ . We could meet him anywhere, anytime for our medical needs. Dr. Rao was an ever-smiling person. Whenever I met him I used to see Hippocrates, the father of modern medicine, in him.

Many patients from my village and neighboring villages came to the ter-tiary hospital where I had training as a medical stu-dent. I used to take care of their medical needs, shel-ter, food and even emer-gency financial assistance. It was the duty and honor of our family.

I worked as government doctor for 30 years. I was ‘my doctor’ for lakhs of people. I was ‘my doctor’ to Araveti Kondanna, Vun-dela Rama Subba Reddy, Nayuni family, Tallapaka

family, beggars, poor per-sons, people from middle class, people from rich class, officials, Judicial Of-ficers, Criminals and even murderers. On one mid-night I gave my blood to save Kondanna. Even sev-eral faction leaders were affectionate towards me. I used to walk to hospital any time in the night with-out fear as I was known as ‘peoples’ doctor’. I cannot forget visiting a house of a poor man to see his ailing wife. The roof of his house was about 4 ft. from the ground and I had to bend all my body to enter his house. On two occasions at district headquarters, Chittoor, when I was re-turning from the hospital, people picked me up from the streets and took me to their houses to confirm death of their family mem-bers.

35 years ago I went to the bus stand in Adoni to travel to Kurnool. The bus I was supposed to board had already left. The bus route was towards bus de-pot. The staff at the bus stand immediately con-tacted the staff at bus de-pot and requested them to stop the bus at the depot for me. I reached the bus depot by cycle rikshaw. The bus waited for me and I boarded it. This was all because I was ‘their doc-tor’. My strong resistance for the help was not ac-cepted by them and they prevailed. Of course, this caused delay for other pas-

sengers, but that was the prevailing order.

About 28 years ago, I was travelling from Prod-datur to by bus. The con-ductor refused to take bus fare, but issued the ticket. He paid from his pocket for the ticket. My resist-ance did not help. I did not even know him. To repeat his words for his action - “Sir, How can I take bus fare from ‘my doctor’!

About 25 years back I went from Chittoor to Proddatur. I checked into DCSR lodging house. The room boy greeted me with a lot of familiarity. I did not even know him. I asked him whether he knew me. He said, “What Sir? How can we forget you? You treated all our family members. When a nurse could not give an injec-tion due to exhaustion of medicines, you overheard

it. Immediately you got the stores opened and gave medicines and instructed the nurse not to repeat such things. You saved my wife from death”. I can-not forget what I saw in his eyes. Dhanvantaries of 2013 are missing that. I re-ally pity them.

I was in-charge paedia-trician at District Hospi-tal Chittoor for 8 years. Whenever a child came to the emergency, it was my practice to take the child personally to in-patient area and render emergen-cy care. Usually, I would bypass all administrative procedures and proto-cols. On one day a child in emergency attended by me died in one hour. I felt sad and started consoling the parents. The father of the child said which I repeat verbatim – “Sir, we know that this child was definite-

ly going to die. This child is suffering from serious disease since many years. But we are very happy with the way in which you at-tended to our child.” The feelings of a father are due to ‘my doctor’ philosophy.

I saw tears in the eyes of Dr. Manju Kulakarni of Sankar Netralaya, Chen-nai, when she saw severe eye injury to a young boy. She was the “doctor of that young boy”. When I was a number 2 Administrator of a teaching hospital, Gun-tur, I helped a person from my village for an in-patient treatment. When I visited the ward to see him, sud-denly his wife fell at my feet. Though it was very embarrassing, this hap-pened because I was “their doctor”.

But alas things are rap-idly drifting. On two occa-sions, tears rolled from my eyes when an Orthopaedi-cian rudely behaved with me when I took my mother to him and from a cardiol-ogist when I took my aunty to him. Love, compassion and concern heals. “Medi-cine is a science of uncer-tainty and an art of prob-ability” said William Osler.

Recently, I was at my native place. My grand-son got skin rash. It was not a contagious rash. He was at Hyderabad. It was a Sunday. My daugh-ter telephoned me and we were very much worried. I frantically tried to con-tact several doctors. After lot of effort I could contact

two dermatologists who had worked as my sub-ordinates. Both expressed inability to attend to my grandson at their houses because it was a Sunday. At last, medical care also had its Sunday. Both suggested to send my grandson to the hospitals where they work on the next day. Ul-timately my grandson did not receive the immediate treatment in a place like Hyderabad. First time in my life, I learnt that medi-cal care can also be post-poned. After living as ‘my doctor’ for lakhs of people for more than 3 decades, this is where I am today.

It pains me when I of-ten hear that some of my professors who practiced medicine in a noble way faced humiliation in the present “not my patient” culture. I know an eminent doctor who left the hospi-tal refusing to take medical care as he was humiliated. My dear great noble souls, I join you silently in shar-ing your agony.

I am now living in Hy-derabad, sustaining with my pension and without my own house anywhere in the world. I am indepen-dently working on a broad-er platform of changing health practices in people with my own resources. But one agony that always haunts me is I don’t have ‘my doctor’ .

For my own needs and needs of my friends, rela-tives, associates, kith and kin, I am in dilemma about

whom to approach when in need. I am like anybody. When I step into a hospital, my first doctor is a security guard, my second doctor is a receptionist, and prob-ably my third doctor may be a real doctor. But I am not sure that he/she is ‘my doctor’.

The present order is very distressing and agonizing for me. Many times, I feel sorry for not having been born as an idiot or a moron. This is a beautiful world for them. As all roads are blocked to revive ‘my doc-tor’, I pray great nature to bless me to breathe my last without assistance of doc-tors and hospitals though I am an agnostic.

Bidhan Chandra Roy, on whose birthday the nation celebrates the ‘National Doctors Day’ was a noble soul. He treated patients while working as the Chief Minister of West Bengal. Are the medical doctors of the country willing to emulate him?

Let me conclude with another quote of Hippo-crates – “Wherever the art of medicine is loved, there is also a love of Humanity”. Satyamevajayethe.

(The author is Founder, Organization for Promo-tion of Social Dimensions of Health, and Former Addl. Director of Health, A.P. Views expressed in this article are those of the au-thor and do not necessarily represent the views of, and should not be attributed to, Drug Today Medical Times.)

Who is “my doctor?” – Where is “my doctor?” – Whose patient am I?

“Cure some times, treat often, comfort always”- Hippocrates.

Microscopic view of Vaccine Derived Polio Virus (VDPV)

The case was challenging because an adult kidney had to be transplanted

into a minor

DruG TODAY MEDICAl TIMES12 Medical Latest 1st - 31st July 2013, New Delhi

Solution on page 16

Across

1 Developing faction within organization (7, 2)

6 Epic stories that can be read in a couple of ways (5)

9 Call about museum piece dur-ing the day (7)

10 Problem with remembering I am sane, oddly (7)

11 Victim’s appeal to heaven overheard (4)

12 Athlete sat, playing minimally (2, 3, 5)

14 Certain magician repeats acts, I suspect (6, 6)

18 Jail head passing up guards henceforth (6, 6)

21 Don’t waste back of graph that’s yellow-green (10)

23 Go around gym area on the way back (4)

25 Newly categorizes vacation destinations (7)

26 Still wearing delinquent youngster’s outfit (7)

27 Bad smells leaving first of the cesspools (5)

28 Changing seed’s name was reasonable (4, 5)

Down

1 Good wishes for a traveler climbing Deep South trail (8)

2 Whine, consumed by erst-while wealth (8)

3 Hostels in opposite direc-tions (4)

4 Party isn’t crazy about a book of the Bible (9)

5 Course includes Latin poet (5)

6 Place to meet someone dancing in less garb (7, 3)

7 Blowhard recalled chats with a general (6)

8 Troops finally leave one Greek city-state (6)

13 Fitness facility permanently takes away midriff bulges (5, 5)

15 Type of sandwich ordered as an adult (4, 5)

16 Canadian city, not Alaskan city, harboring Democrat from the south (8)

17 Speaker’s acquired calm, modest swimsuit (3-5)

19 Large numbers sitting in alfresco restaurant (6)

20 Endlessly bringing up dried fruit (6)

22 Poems about English racing city (5)

24 Some loaves are cut at both ends, of course (4)

Sudoku Corner

Amazing Facts

How to play

Fill in the grid so that every hori-zontal row every vertical column and every 3 x 3 box contains the digits 1 to 9, without repeating the numbers in the same row, column or box.You can’t change the digits already given in the grid. Every puzzle has one solution.

Crossword Hints

Solution on page 16

� The highest amount of vitamins and nutrients are contained within the vegetable's skin and the layer directly underneath it.

� The nutritional value of vegetables decreases dur-ing the cooking process.

� Soluble vitamins are lost through the absorption of liquid - for example, when boiling.

� Vegetables are generally very low in fat and calo-ries - excellent for healthy diets!

� Frozen vegetables are just as beneficial to the health as fresh vegetables.

� There are many different ways of cooking with veg-etables including roasting, baking, boiling, steam-ing, blanching, deep frying, stir frying, sweating, grilling and marinating.

� There are vegetable varieties which are packed highly with vitamins and nutrients that can help to improve our immune systems and help our bodies to fight against illness and disease - even some of the most major diseases such as heart disease can be prevented through eating the right diet.

� Vegetables have many healing qualities and bene-fits, they can help to cure many ailments or at least significantly reduce the effects.

� Dark green vegetables like spinach have much more Vitamin C than light green veggies such as celery.

MADHurI SHuKlA

India is home to one of the largest HIV positive popu-lations in the world with an estimated 2.3 to 2.5 mil-lion infected individuals. HIV burden is unevenly distributed amongst high risk groups and certain regions of the country. According to National AIDS Control Programme Phase-III (2007-12) Fact Sheet, there are an esti-mated 23,95,000 people living with HIV and around 1,20,000 new infections are taking place. And, a majority of HIV-infected individuals are unaware of their HIV status.

A new study by a team of researchers at Brown, Yale, Massachusetts General Hospital, Harvard and in Chennai integrated scores of factors specific to India. It found that HIV-testing for the whole country, with greater frequency for high-risk groups and areas would pay off despite In-dia’s huge population and even in cases where con-ditions are worse than the researchers assume.

The main results from the model are projections of the dollar cost per year of extended lifespan. The World Health Organiza-tion’s standard for cost effectiveness is an ex-penditure that is less than three times the per capita GDP of a country. In India in 2010, per capita GDP was $1,300. A program is therefore cost-effective in India if the expense is less than $3,900 to save a year of someone’s life.

Modern antiretroviral therapies can give HIV-positive people a normal lifespan, and in India, which has a thriving ge-neric pharmaceutical sec-tor, first-line therapy costs only $8.61 a month (sec-

ond-line therapy for those whose viruses prove re-sistant is $55.12 a month). HIV tests, meanwhile, cost only $3.33, stated the re-search paper.

Co-lead author Dr. Kar-tik Venkatesh, a post-doctoral fellow at Brown University and Women & Infants Hospital said the main benefit of national testing would simply be getting more people to learn they are positive and therefore to seek effective care before they have full-blown AIDS and a compli-cation. A secondary ben-efit, however, would be to curb transmission of the virus, both because be-havior can change and be-cause therapy can reduce

transmissibility.“Universal testing can

have a big impact in catch-ing a large number of indi-viduals who are infected and getting them to seek treatment and seek ser-vices earlier in the course of their disease,” said Ven-katesh. “The classic story in India has always been of patients presenting them-selves to care, tradition-ally men with TB, the most common opportunistic disease. Then they get an HIV test and are found to be infected. At that point they bring their female partner, who happens to be infected and sometimes it’s too late and a child has also been infected.

“If we tested earlier we may be able to have an impact on this kind of cas-cade of familial infection,” Venkatesh said.

Co-author Dr. Nagalin-geswaran Kumarasamy, chief medical officer of the YRG Care Medical Center, a major non-governmen-tal HIV clinic in Chennai, India, said he thought the study could have an im-portant influence.

Arresting HIV-epidemic in India

DTMT NETWOrKNEW DElHI

Yet another milestone in anti-ageing treatment history. SmartXide – 2 system brings together scientific know-how and technological innovation. The new technique was unveiled by Italian brand Deka in Delhi, which is an anti-wrinkle treatment, for the first time in North India. It uses CO2 laser with radiofrequency to treat wrinkles.

The product was launched by the Skin & Hair clinic along with in-ternational cosmetic as-sessment specialist Paolo Banon here.

"People between 35 and 75 years of age can take this treatment. At least five to six sessions are required to remove wrin-kles from the face. Skin scars, visibility of pores and hyperpigmentation

are also taken care of," Banon told DTMT at the launch.

Launched in the nation-al capital for the first time, it is exclusively available at the Skin & Hair clinic and will cost Rs. 5,000 per session.

After the treatment one needs to follow it up with proper skin care.

Dr RK Srivastava, Pro-fessor and Senior Plastic Surgeon, Vardhman Ma-haveer Medical College said Smartxide-2 is a good combination to correct skin imperfections and counteracts the effects of aging, including wrinkles and flabbiness. It is also

ideal for Skin Tightening, Body Shaping & Contour-ing, Laser Hair Removal, Warts & Mole Removal, Pigmentation Removal, Hair & Nail Treatments, and has no side effect.

Speaking at the launch, Dr Deepali Bhardwaj, der-matologist stated, “Early aging is a huge concern these days. External en-vironment, stress, smok-ing and modern lifestyle have expedited the ag-ing process. But there is now advanced fool-proof, safe technology which not only prevents aging but also helps in present-ing the best of you in just three days.”

“The system is a very efficient platform for pro-viding fast and excellent results for multiple in-dications. Using Specific shapes for a particular medical or aesthetic in-dication not only helps doctors maximise treat-ment results, but allows patients to have quicker outcomes with a reduced risk of adverse events post procedures,” said Dr Poonam Puri of Depar-ment of Dermatology, Safdarjang Hospital.

Currently, there are sev-eral fractional CO2 lasers in the market. These ma-chines can be set up in terms of maximum pow-er, pulse type, maximum fluence, spot size, heat index, incisional hand-pieces, and cost so that the surgeon will be able to make an educated de-cision as to which laser would be most suited for his/her practice.

New anti-wrinkle treatment

DTMT NETWOrK

A team of research-ers from the US has built a Good Manufacturing Practices compliant plant factory which operates on molecular farming. Mo-lecular farming is an easy, fast, and safe method for producing vaccines and therapeutic proteins in plants.

Molecular farming in-

volves the production of vaccines and therapeu-tic agents in plants with shorter production times and larger capacity. The vaccine shortage during the swine flu pandemic in 2009 showed that al-though chicken-egg pro-duction is a reliable meth-od, in a global emergency, it takes too long and does not yield enough vaccine. In molecular farming, as this method is known in the trade, the genetic in-formation needed for tar-get protein production is introduced into the plant via virus vectors that are harmless to humans. Moreover, plants have protein synthesis ma-chinery similar to that of humans and can accom-modate complex proteins.

It has been demonstrat-ed in the laboratory that the method works well. The approach has been scaled for mass produc-tion as the researchers have already cleared the first hurdle after develop-ing a fully integrated, au-tomated, GMP facility – a fundamental prerequisite for the production of bi-opharmaceuticals.

This was after receiving a contract from the U.S. government’s Defense Advanced Research Pro-

jects Agency (DARPA), which was looking for vaccine production alter-natives, when researchers at Fraunhofer began their research. “Once some ini-tial difficulties in under-standing each other were overcome, our teams of biologists and engineers succeeded in building up our automated plant-based vaccine produc-tion factory. Now we have

plants that consistently grow and make proteins to the same predictable quality, time after time whenever and wherever we like – crazy as that might sound!” says Andre Sharon from Fraunhofer CMI and Professor of En-gineering at Boston Uni-versity.

Light, water, and nutri-ents are precisely dosed and distributed to the plants that are grown in trays with cultures of mineral wool as opposed to soil, in specially de-signed growth modules. Specially developed ro-bots bring the plants from station to station to carry out the various steps – from inserting the tiny seeds and vacuum infil-tration, to harvesting and extraction.

The vector is intro-duced by means of vac-uum infiltration after the plants have grown for four weeks. Then the plants are put back in the growth module to grow further. In about a week they have produced the proteins. Once harvested, the leaves are cut into small pieces and homog-enized in fully automated processes. The liquid produced is further pro-cessed to yield vaccine.

Automated plant factory: Alternative to vaccine production

Professor Vidadi Yusibov and Professor Andre Sharon (from left to right) in the fully automated plant factory

DTMT NETWOrKNEW DElHI

The Delhi Government has entered into part-nership with Cure Inter-national India for over-coming cases of clubfoot and making affected children disability free. In the first phase of the Club Foot Management Programme around 2200 children were perma-nently cured of disabil-ity enabling them to live normal lives. The Gov-ernment and Cure Inter-national India intensified the Programme in eight government hospitals in Delhi in phase two with the target to permanent-ly cure 3200 children of the disability.

The CURE Clubfoot Delhi programme was launched in 2010 and has managed to change the lives of thousands of children in the city us-ing a nonsurgical cast-ing procedure called the Ponseti Method.

At present the treat-ment of club foot is avail-able in Chacha Nehru Bal Chikitsalaya, Maula-na Azad Medical College and Lok Nayak Hospital, Deen Dayal Upadhayaya Hospital, Maharishi Bal-miki Hospital, Kalawati Saran Hospital, Safdar-jung Hospital, AIIMS and St. Stephens Hospital.

After curing 3200 children suffering from clubfoot, CURE Interna-tional India celebrated its second anniversary in Delhi. Delhi chief minis-ter Sheila Dikshit stated that government is com-mitted to pursue this programme forcefully so that every child affected with Club-foot is cured. The Capital City will be-come the first State to become a clubfoot Free State, she asserted.

In Delhi around 500 children are born with clubfoot every year and

in India over 50000 chil-dren are born with this disability every year. The cause of this disability is unknown and so it can-

not be prevented.Dr Mathew Varghese,

Head Department of Or-thopedics, St Stephen’s Hospital says “Club-foot is one of the world's most common disabili-ties in newborn infants where the children are born with feet twisted inward and around.”

CURE International In-dia is functioning in 18 states across the coun-try and has so far treated over 8,000 children born with clubfoot.

“The goal of the pro-gramme is to eliminate clubfoot as a lifelong disability for children in India through its pro-grammes in different states including Delhi. We also plan to contin-ue to launch State-wide programmes in other parts of the country,'' said Andrew Mayo, in-ternational executive di-rector of CURE Clubfoot Worldwide.

Progress in eradicating Clubfoot across IndiaCurE International India is functioning in 18 states across the country and has so far treated over 8,000 children born with clubfoot.

At least five to six sessions are required to remove wrinkles from the face. Skin scars, visibility of pores and hyperpigmentation are also taken

care of says international cosmetic assessment specialist Paolo Banon

Child with clubfoot wearing curative device which cures the condition over a period of time

DruG TODAY MEDICAl TIMES 13Medical Globe1st - 31st July 2013, New Delhi

Full time/freelance journalists in Delhi, Mumbai, Bangalore, Chennai, Hyderabad & Kolkata for our pan India level English monthly medical

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A recent research sug-gests that babies regularly fed fish in the first year of life are much less likely to catch common allergies that they might develop in the later years.

The diets of the babies were monitored for a pe-riod of 12 years. The re-searchers concluded that the babies who ate fish early in life were much more likely to still be free of allergies 12 years later, when the study ended.

The study, published in the American Journal of Clinical Nutrition, found that chances of developing hay fever dipped by 26 per cent and that of eczema dipped by 22 per cent in kids fed with fish. The find-ings suggest that giving fish to kids two or three times a month is sufficient to reduce their risks of al-lergies.

Eczema is highly preva-lent among kids. There are very few treatments to this condition that causes red and itchy skin. In certain cases the children have to wear cotton dressings from head to foot.

Hay fever is even more prevalent. Both the con-ditions are linked to in-creased risk of asthma. Previous research con-cluded that early fish feed-ing could have a protec-tive effect up to the age of

four. However, the recent research at the Karolin-ska Institute in Stockholm, Sweden, suggests the ef-fect last longer. In their report on the findings the researchers said, ‘Regular fish consumption in infan-cy may reduce the risk of allergic disease up to the age of 12’.

Experts tracked 3,285 babies to study their di-etary intake at the ages of one, two, four, eight and

12. During these years they also looked at how many went on to develop aller-gies.

The results showed fish plays a big part in dietary patterns among Swedish infants, with 80 per cent consuming it at least twice a month. The risk of devel-oping allergies dropped significantly in these chil-dren as compared to oth-ers that rarely or never ate fish.

DTMT NETWOrK

Eating cheese increases se-cretion of saliva in the mouth which is the body’s natural way of maintaining a healthy pH level. Also, cheese releases chemical compounds that form a protective layer on teeth

A new study by the Academy of General Dentistry in the U.S. claims cheese helps reduce cavities in teeth as it neutral-izes plaque acid.

According to the researchers, the fermented dairy product raises the alkalinity of mouth (higher pH) thus reducing the need for dental treatment. The discovery further establishes the fact that cheese creates a protective film around teeth.

Higher pH level on the sur-face of the teeth protects them against dental erosion. Dental erosion causes cavities which require fillings.

The research divided 68 chil-dren between 12 and 15 years of age into three groups.

One group was asked to consume a daily portion of cheddar, another a sugar-free yoghurt, and another a glass of milk, followed by a mouth rinse.

The pH levels on their dental plaque were measured both before the test and then ten

minutes, 20 minutes and half an hour afterwards. Children who ate the yoghurt or drank the milk showed no changes to the pH levels in their mouths at any of the time intervals, said lead researcher Vipul Ya-dav.

But the group that ate the

cheese showed a 'rapid' in-crease in pH level at each of the time intervals.

The study says that eating cheese increases secretion of saliva in the mouth which is the body’s natural way of maintaining a healthy pH lev-el. In addition to this, cheese releases chemical compounds that form a protective layer on teeth which further protects them against the acids that at-tack enamel.

DTMT NETWOrKNOTTINGHAM

In a recent breakthrough, researchers from the Uni-versity of Nottingham, UK, discovered a new layer in the cornea of the eye and named it after the Indian researcher who made the discovery.

Previously, scientists believed that cornea is composed of five layers, from anterior to posteri-or, viz. the corneal epithe-lium, Bowman’s layer, the corneal stroma, Descem-et’s membrane and the corneal endothelium. The newly discovered Dua’s layer, named after the

academic Professor Har-minder Dua who discov-ered it, is located between the corneal stroma and Descemet’s membrane.

Cornea is the transpar-ent dome-shaped win-dow, around 0.5mm (500 microns) thick, covering the front part of the eye. Cornea along with the anterior chamber and lens refracts light and ac-counts for 2/3 of the eye’s focusing power. The find-ings could help surgeons to dramatically improve outcomes for patients un-dergoing corneal grafts and transplants.

Professor Dua, Profes-sor of Ophthalmology

and Visual Sciences, said “This is a major discov-ery that will mean that ophthalmology textbooks will literally need to be re-written. Having identified this new and distinct layer deep in the tissue of the cornea, we can now ex-ploit its presence to make operations much safer and simpler for patients.”

Dua’s layer is just 15 mi-

crons thick but is tough and strong enough to withstand one and a half to two bars of pressure. "From a clinical perspec-tive, there are many dis-eases that affect the back of the cornea which cli-nicians across the world are already beginning to relate to the presence, ab-sence or tear in this layer," Dua added.

To uncover the exist-ence of the tough layer scientists stimulated hu-man corneal transplants and grafts on eyes donat-ed for research purposes to eye banks located in Bristol and Manchester.

During the procedure,

different layers were gen-tly separated by injecting tiny bubbles of air into the cornea. The separated layers were then studied under the electron micro-scope, magnifying them to more than 1000 times to their actual size.

The discovery has led scientists to believe that corneal hydrops, bulging of the cornea caused by fluid buildup, is caused by a tear in the Dua layer, through which water from inside the eye rushes in and causes waterlogging. The condition affects the patients with Keratoco-nus, conical deformity of the eye.

Named after Indian Scientist, a new layer in the human cornea uncovered

Babies fed fish stay protected against allergies‘regular fish consumption in infancy may reduce the risk of allergic disease up to the age of 12’.

Eating cheese keeps away dental problems

MADHurI SHuKlA

Oral Cancer has been in news for long, mainly

because of tobacco con-sumption and alcohol in-take. But recently, Holly-wood star Micahel Dough-las, made headlines by pointing out that there is a link between Human Pap-illoma Virus (HPV) and oral cancer.

Most people know that HPV is the most common cause of cervical cancer in women, but this new shift of attention has high-lighted that HPV can also cause oral cancer in both men and women. It can be transmitted through oral sex and is one of the several risk factors for the highly prevalent oral can-cer.

Dr Ashish Bhanot, Spe-cialist Surgeon explains “Human Papilloma virus belongs to the Papilloma family and is typically transmitted through sexu-al contact. It is present on

the penis shaft and vaginal lips,semen, and vaginal fluid. Apart from causing cervical cancer, HPV 16 and 18 stains infections are strongly associated with an increased odds ratio of developing oropharyngeal (throat) cancer,more com-mon in men with multiple sexual partners.”

“It’s difficult to de-termine when one ac-quires HPV infection as it does not come with one exposure,and symptoms may take 10,12 even 20 years to manifest and still not all HPV cases may lead to oral cancers. Infact, in 99 percent of those who get HPV, their immune system clears it within 12 to 24 months. The bottom line is that both men and women should get HPV immunization to safe-guard themselves from being affected with HPV-induced oral cancer”, adds Dr Bhanot.

So, immunization might take care of HPV-induced

oral cancer, but what about other causes of oral cancer? What are they and how to tackle them?

Dr Sumit Mrig, Senior Consultant ENT, Primus Super Speciality Hospital, explains the prevalence, diagnosis and preventive measures to be adopted for oral cancer. “HPV has always been a risk factor for oral cancer, but HPV alone per se cannot be re-sponsible for oral cancer.

If we see a countrty like India, where a majority of the people are in the low-er socio-econmic strata, most of them are workers or labourores, the inci-dence of chewing tobacco (locally known as kheni) is very prevalent.

They mix dry tobacco leaves with lime (chuna), make a paste and keep it like a quid in the area between the gums and buccal mucosa (Quid

Chewing) and slowly and steadily it starts to release nicotine from it. Generally the buccal mucosa starts to undergo changes, histo-logically the changes oc-cur, and slowly and stead-ily it leads to cancer.

Apart from tobacco chewing, other risk factors include spicy food, alcohol consumption, ciggarette smoking, lack of good sleep. All these factors are generally stress inducing.”

Lack of oral hygiene, poor diet, alcohol, smok-ing, lack of good sleep, stress and hereditary trends are other fac-tors associated with oral cancer. Experts also no-tice that there has been a drastic decline in the age group of pateints coming for treatment.

Earlier it had been 50-60, but now it has come down to 30-40. There are multiple reasons for this.

This trend can be attrib-uted to adulterated foods, changing lifestyle and a weakened immune sys-tem. Number of carcino-gens have emerged, and so chances of oral can-cer have gone up and age group of pateints have gone down.

“Early signs are when pateints notice bleeding from gums, or an ulcer in the mouth or buccal mu-cosa or gums. Since these are also common oral health problems, they go for self medication or to a local doctor who would prescribe some multi-vitamins or ointment to apply. But, a failure to cure this ulcer for about 7-10 days, should give a suspicion to the pateint, and it should be shown to an ENT or oral surgeon or onco-surgeon. The ul-cer can be non-healing, severely painful, and it would bleed on touch”, points out Dr Mrig.

“I started my career

from MAMC, Delhi. There, we used to operate a head and neck cancer, almost daily. So, prevalence is pretty high, diagnosis is poor because they do not reach the specialist on time, and because of this delay the overall morbid-ity is very high.

Surgery gets complicat-ed as skin from the chest is used for grafting and flaps are to be created to cover the defected area. Patients have to stay for 2-3 weeks and undergo a mandatory post-operative therapy,to take care of micro-metas-tasis and to prevent any remission of the disease,” adds Dr Mrig.

The good news is if the cancers are picked up on time, there is a fantastic survival rate and pateints can survive upto 7-8 years on an average. So the key is to quit smoking, quit tobacco, go for routine checkups , and never ig-nore bleeding gums or ul-cers. Take care.

Oral Cancer: Don’t ignore bleeding gums

DTMT NETWOrK

A new research conducted by scientists at the Wyss Institute for Biologically Inspired Engineering Col-lege at Harvard Universi-ty has concluded that low doses of silver make bac-teria more susceptible to antibiotic attack, paving the way for new therapies for drug-resistant and re-current infections.

The efficacy of a broad range of widely used an-tibiotics increased signifi-cantly when treated with a silver-containing com-pound and helped them stop otherwise lethal in-fections in mice. The ef-

ficacy was increased to such an extent that an otherwise resistant bacte-ria was found to become sensitive to antibiotics again. And, it expanded the power of an antibi-otic called vancomycin. For the first time, vanco-mycin was observed to penetrate and kill Gram-negative bacteria, a group that includes microbes that can cause food poi-soning and dangerous hospital-acquired infec-tions, on addition of low dose of silver to it.

Silver compounds cause bacteria to produce more oxygen reactive species - chemically reactive mol-

ecules that damage the bacterial cell's DNA and enzymes, as well as the membrane that encloses the cell. Silver also made the bacteria's cell mem-brane leakier.

In mice, silver also helped antibiotics fight E. coli-induced urinary-tract infections. It made a previously impervious strain of E. coli sensitive to the antibiotic tetracy-

cline. Silver also proved useful for two types of stubborn infections that usually require repeated rounds of antibiotic treat-ment and multiple vis-its to the clinic: dormant bacteria that lie low dur-ing antibiotic treatment and rebound to cause recurrent infections, and microbial slime layers called biofilms that coat catheters and prosthetic joints.

In recent years more disease-causing bacte-ria have grown resistant to common antibiotics, with serious public health consequences. Yet, drug companies have strug-

gled for years to develop new types of antibiotics that target these tough bacteria. That has led scientists to re-examine older methods that were used to fight infection well before penicillin use took off in the 1940s. Sil-ver treatment, which has been used since antiquity to prevent and heal infec-tions, is one of them.

"The results suggest that silver could be incredibly valuable as an adjunct to existing antibiotic treat-ments," said Jim Collins, Ph.D., a pioneer of syn-thetic biology and Core Faculty member at the Wyss Institute.

Silver improves efficacy of antibioticsThe findings suggest that giving fish to kids two or

three times a month is sufficient to reduce their risks of allergies.

Hollywood star Micahel Doughlas made headlines recently by pointing out that there is a link between Hu-man Papilloma Virus (HPV) and oral cancer. HPV can be transmitted through oral sex.

Silver could be incredibly valuable as an adjunct to existing antibiotic

treatments

�� I wish DTMT all the best on its first anni-versary and can proudly state that you are already right on top. Wish you all success! Regards,Dr. Pradeep NambiarCardio-thoracic Surgeon, New Delhi

�� Drug Today Medical Times has been an excellent pub-lication. This has served a dual purpose - first to educate all of us and secondly serve as a useful tool for Medical Manufacturers to display and advertise their products. I wish the entire team my Best Wishes and Greetings. Happy Progress.Dr Rajesh Makashir Ex-President IMA SDB.New Delhi

�� Thanks a lot. Your newspa-per is very informative and it enhances our knowledge.Thanks again.Rekha Gulabani, Vice President, Cancer Sahyog (Emotional support group of the In-dian Cancer Society)

�� I appreciate the quality of medical news, its authentic-ity and, above all, keeping away from sensationalism, as strengths of DTMT.Your creativity and passion-ate way of working is quite inspiring. God willing, you have a bright future awaiting you.RegardsDr Gulshan Rai SethiDirector Professor (Paediatrics) Maulana Azad Medical College

�� On behalf of State Infor-mation & Public Relations Officers Association (SIPRA), I congratulate the Publisher and entire editorial team of 'Drug Today Medical Times' for completing one year of publication.Health is becoming a major global concern with access to quality healthcare almost becoming an uncertainty what with high cost bills and negligence. In the times when masses are increasingly doubting the universal faith placed in the hands of doctors and hospitals, I must appreci-ate your efforts of highlight-ing health-related issues with

gravity and factual accuracy. The editorial team deserves a special pat on the back for making the medical jargon simplified without losing its meaning, giving an interesting read to the readers. I particu-larly like the column – "Know your enemy" and interviews of medical experts.I again express my best wish-es to all of you and a bright future for DTMT.Neha BhatnagarGeneral Secretary, SIPRA

�� I am delighted to know that Drug Today – Medical Times is completing its one year of inception.ASSOCHAM firmly believes that DTMT as a change driver is constantly highlighting crucial issues pertaining to In-dian Healthcare System in an opportune manner and their efforts will for sure lead to fea-sible solutions by positively impacting the impediments in the way of Indian Healthcare.I also acknowledge pertinent efforts put in by DTMT in preparing their monthly news-paper by sharing their knowl-edge & expertise in highlight-ing comprehensive issues of Indian Healthcare Sector.DTMT has been spreading its research and publications activities in Healthcare Sec-tor to serve the Government, Economy & Society at large and their pivotal role is well recognized.I congratulate DTMT for their seminal & relevant initiative and I am confident that they will achieve their pre-decided objectives standing up to the needs and expectations of their readers and Indian popu-lation at large.Please accept my heartiest greetings and best wishes for a prosperous future ahead.Dr. Om S TyagiSenior Director, ASSOCHAM

�� Am really lucky to have come across DTMT, 7 months ago just by chance and since then I have never felt the need or desire to read any other medical newspaper. I have yet to come across a newspaper which is so concise yet filled with facts touching every as-pect of medical science.This medical newspaper touches each and every sub-ject of the medical world. No matter how small or big the ailment might have been, it has always been highlighted in "DTMT".Congratulations for achieving a feat which may seem easy but infact requires a lot of de-

termination and hard work.Wishing the entire "DTMT" team and everybody associat-ed with it a very Happy First Anniversary and hoping that it reaches the highest ranks of success in all of its future endeavours.Dr Samar Hossain.Delhi

�� I found your story on Poi-sonous Veggies, May Issue, 2013, to be an eye-opener. But, we would have liked more sta-tistics and a specific detailed information on what chemi-cals can cause what harm. Overall the paper has im-proved tremendously. I wish the entire team a very happy first anniversary.Karan SharmaBusinessman, New Delhi

�� I am immensely pleased to know that Drug Today Medical Times is celebrating its first anniversary in July 2013.For last several years, I was regretfully feeling the need of some periodical devoted to the information and up-dating regarding drugs and medi-cines in the current market. But now, I can happily and gratefully mention that Drug Today Medical Times has more than filled the void in the relevant field. Every Issue of Drug Today Medical Times is a wonderful, colourful and excellent presentation of the thorough and up-dated infor-mation of current medical for-mulations. It is extremely use-ful for doctors, patients and students alike and though you call it as a ‘Ready Reckoner’ I would prefer to describe it as a ‘Master Guide’!I once again congratulate you and your precious team on this anniversary and wish to assure you that, like numerous others, I am looking forward to several such anniversaries in future !! All The Best !!!Sanjeev Pendharkar, Director, Vicco Laboratories

�� Namaste. I am a Medical Graduate with P.G. Diploma in Child Health. I had my entire education in state run schools. I worked in Andhra Pradesh Medical and Health Services for 30 years as Medical Officer of Primary Health Centres, 30 beded hospitals, 10 bedded dispensary and district hos-pital, as a Teacher in Medical

College, as administrator of teaching and district hospital, as Joint Director and Addi-tional Director of State Medi-cal Health Services.I was instrumental in getting accreditation of ‘Baby Friendly Hospital’ to District Hospital, Chittoor, the first government hospital in the country, way back in 1994.I picked up June 2013 issue of Drug Today Medical Times from News Paper Stand at Hy-derabad. DTMT impressed me very much. I was disturbed to know about the pathetic conditions of primary health centre at the village of former president of India Sri Late. R. Venkataraman. Dr. Araveeti Ramayogaiah, MBBS, DCH, Hyderabad

�� I am a regular reader of DTMT. It updates me about the lat-est knowledge in the field of health, medi-cine and pharmaceuticals. I keenly read the legal column and editorials. Features like quotes of history makers, jokes, cross word puzzles and amazing facts make it more interesting for the students and the children. The news-paper has been exposing the malpractices in various gov-ernment institutions. It also contains articles that educate the general public about proper use of cosmetics and medicines. I congratulate the team DTMT on their first an-niversary and hope that they will keep up the good work.A P Singh, Ex-Assistant Drug Controller, Govt. of India.

�� “I just love the exclusivity of the paper. Being a regular reader of DTMT and a health conscious person, I like the way DTMT picks one or the other health con-cerning topic from our day to day life and gives an extensive coverage to that topic from different possible aspects. I congratulate DTMT team on their first an-niversary and hope that they will keep up their good work.Karamjeet Singh, Production Manager, Bisleri.

�� “I would like to congratulate the entire team of Drug Today Medical Times for completing its first year, which has been a resounding success, evi-denced from the fact that its readership continues to in-crease by leaps and bounds. The newspaper gives an equal platform to the medical pro-fessionals cutting across all the specialties to interact with the readers. The information provided is crisp, accurate, in easy language and unbiased.I wish the entire team all the best for the efforts they are putting in; Keep it up!”Dr Subhash Kumar Wangnoo, Senior Consultant Endocrinologist and Diabetologist, Indraprastha Apollo Hospital, New Delhi.

�� I would like to congratu-late the whole DTMT team on their first an-niversary. We sincerely appre-ciate your kind support in helping us to raise our concerns and voice so that it can reach to the concerned authorities. We would sug-gest you to keep up the good work and would like you to continuously follow up the is-sues with concerned authori-ties until we get a positive outcome. LD Ramchandani, Nursing Union Leader, Delhi.

�� At the outset I would like to tell you that possessing

and reading your paper has been a delight in all respects. There was a vacuum about the medical news and the complete information and its dissemination was lacking. Your publication has bridged that gap not only at the policy news level but also about the latest developments. It has been a very enriching experience for me and my family to read DTMT. It offers knowledge, awareness, and in-depth analysis of the things concerning the medical world. Please continue the good work you are doing and I wish you all the best on your anniver-sary special.With best wishesDevendra SinghDelhi

�� It is a great pleasure and privilege to send you my warmest congratulations on the first anniversary of Drug Today Medical Times. Most of the articles are nice and im-prove our knowledge level but the legal column is fantastic. Paper quality makes it so nice. The credit of success goes to hardwork and talent of your working staff.I hope your newspaper per-forms even better in future. Congratulations to you once again.Sincere wishesVikas Tushir, President, Pharmacops Association.

�� The entire team at Drug Today Medical Times feels hum-bled by the kind words of our dear well-wishers. This is an oc-casion to redouble our resolve to continue to meet your expectations - Editor

Dear readers, Advertisers and Well-wishers,

As you hold this issue of Drug Today Medi-cal Times in your hands, your newspaper has completed one year of service to the healthcare sector, incessantly focusing on the needs of the ordinary Indian.

We humbly place on record our deep ap-preciation of all those who have supported us in the year gone by and have enabled DTMT to become the newspaper that is trusted across the country by bureaucrats and pharma majors, doctors and workers, and by patients and students. We have built this trust on the basis of never compromis-ing on news and by focusing on issues of real concern and relevance.

It is a matter of some satisfaction that even the leading national dailies in India and abroad, and also health journals across the world, give credit to DTMT when they pick up our stories and leads reaffirming the pre-eminent position that DTMT has earned in this short time.

The journey over the past one year has been both enlightening and sobering. We began with passion in our hearts and the zeal to make a difference to the health-care landscape. Little did we realize then that the hard work of Team-DTMT would place upon this newspaper the onerous respon-sibility of enlightening healthcare profes-sionals across the country about the latest developments, in deference to the fact that they place us in that exalted position. The journey has been sobering because the task ahead of us all to deliver "Good Health to All" is a mammoth one. Today, we rededi-cate ourselves to achieving this goal.

We once again thank everyone who has been part of this one-year journey, spe-cially our dear readers, with the conviction that the DTMT caravan will continue to grow and we shall together overcome all odds to achieve our goals.

I am reminded of the following couplet as DTMT celebrates its first anniversary:

"Main Akela Hee Chala Tha, Janibe Manzil.Log Judte Hee Gaye, Aur Carwan Banta Gaya."(I proceeded all alone towards my objective. But along the way, more and more people joined in, and the caravan kept growing.)

Lalit Mishra, Editor

Congratulating the entire DTMT Team on its success and the completion of its first yearHere is a poem from an Unborn Child to its Mother

begging for a chance to Live.

PRAYER OF AN UNBORN O mother! O mother! Imply your heart one more time,

Think about me and my dream, O mother!!!I want to love your face , I want to live my life,

I want to be there always by your side,But Ah!!! I lost my life and am shrouded in the midst of life.

I kept waiting and watching as we got separated,How much I called out to you mother, how much I hoped.

But you were silent, you didn’t reply to me. O mother!You took away my life even before I lived it.

You aborted me like you didn’t even know me…Mother why did you do this to me?

Wasn’t my life precious enough, wasn’t I a part of you,Or did my voice not reach you ?

SHAZIA IDREES, Patna

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DTMT reaches every nook and cranny of the country through its vast circulation network.

DruG TODAY MEDICAl TIMES14 DTMT Exclusive 1st - 31st July 2013, New Delhi

Drug Today Medical Times completes One Year of serving the healthcare sector

DruG TODAY MEDICAl TIMES 15Medical Business1st - 31st July 2013, New Delhi

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The health care sector in India is likely to witness a major break-through as Russia is looking to en-hancing bilateral ties in the health-care sector. In this regard, Russia has invited Indian pharma compa-nies and hospitals to set up base in Russia.

India-Russia cooperation in the health care sector still remains largely untapped, even as it has a massive potential which needs to be explored. Towards this end, a maid-en trade delegation of 20 members from Russia visited India recently to do the spadework for mutually beneficial cooperation in the sector.

Vijay G Kalantri, president, All In-dia Association of Industries briefed that the Russian delegates were very keen on collaborating with the Indian counterparts in the field of medical technology that is aimed at benefiting both the countries.

Russian delegates expressed their interest in collaborating with the Indian healthcare companies for research and development ac-tivities along with marketing their technologies in India. During the meeting, Alexander Lukianov, the head of the PR Directorate of Mos-cow Foreign Economic and Inter-national Relations Department, informed that Russia has a sling of incentives for pharma compa-nies who are interested in setting up their base in Russia and invited the Indian companies to take full opportunity of the same before its deadline in 2020.

“Through this meeting the Rus-sian government has clearly ex-pressed its interest in working closely with Indian health care companies, which again received a tremendous response from the In-dian counterparts. We are happy to note that many of the Indian hospi-tals, medical equipment and phar-

ma companies have already shown positive inclination towards start-ing proactive initiatives to boost exchange of ideas and trade rela-tions with Russia,” Kalantri added.

Kalantri pointed out that Russia is one of the top manufacturers of high quality medical devices and hospi-tal equipment, hav-ing a huge potential in the Indian market. Likewise, India is a huge source of highly skilled and experi-enced workforce in the health care sector. There is huge interest in Russia to attract Indian pharma com-panies and hospitals to Russia to set up their base to better leverage the services which will be mutu-ally beneficial for all.

russia looks forward to stronger bilateral relations with India in healthcare sector

MADHurI SHuKlA

Social media addiction is not a new syndrome. How-ever, it is not just limited to casual conversations or sharing pictures and videos. Social media has now become a medium to voice your opinion, share latest news and spread awareness. Almost all the corporates are there on social networking sites, and even hire people to exclusively manage com-pany accounts.

Social networking for a noble cause was recently highlighted by John Hop-kins researchers when a social media push boosted the number of people who registered themselves as organ donors. They re-corded a 21-fold increase in a single day. The gains were made in May 2012 when the social-network-ing giant Facebook creat-ed a way for users to share their organ donor status with friends and provided easy links to make their status official on state de-partment of motor vehicle websites. The findings are published in the American Journal of Transplanta-tion.

The Facebook organ do-nor project came about af-ter Cameron, a transplant surgeon, and his Harvard University classmate and current Facebook chief operating officer Sheryl

Sandberg began talking about the organ shortage at their 20th college reun-ion in 2011. Through many conversations, the idea of having a place in the Fa-cebook timeline for users to share organ donor sta-tus was born.

"The short-term re-sponse was incredibly dramatic, unlike anything we had ever seen before in campaigns to increase the organ donation rate. And at the end of two weeks, the number of new organ donors was still climbing at twice the normal rate," says study leader Andrew M. Cameron, M.D., Ph.D., an associate professor of surgery at the John Hop-kins University School of Medicine. "If we can har-ness that excitement in the long term, then we can really start to move the needle on the big picture. The need for donor organs vastly outpaces the avail-able supply and this could be a way to change that equation."

Over the last 20 years, despite many efforts, the number of donors has re-mained relatively static, while the number of peo-ple waiting for transplants has increased 10-fold.

By looking at data from Facebook and online mo-tor vehicle registration websites, the researchers found that on May 1, 2012, the day the initiative be-gan, 57,451 Facebook us-ers updated their profiles to share their organ donor status. There were 13,012 new online donor regis-trations on the first day, representing a 21.2-fold increase over the average daily registration rate of 616 nationwide.

While the number of on-line registrations dropped over the following 12 days, Cameron says it was still twice the normal rate at the end of that study pe-riod. "The half-life of a movement online is often just hours," he says. "This had a very powerful, last-ing effect. But we need

to find a way to keep the conversation going."

While the number of declared organ donors increased, it could be dec-ades before researchers determine whether those people ultimately donate their organs.

Going forward, Cam-eron says the key to con-tinuing the push for more organ donors is figuring out a way to bring back some of the lost attention of those early days of the campaign and to find a way to get it to again go viral. Cameron says he has spoken to Facebook officials who are discuss-ing relaunching it on its mobile platform, chang-ing its prominence on the Web version or even of-fering incentives, such as coupons, for people who declare they are organ do-nors.

Cameron says that in recent years social media has shown it is not only a place for sharing what you ate for lunch or post-ing cute pictures of your kids. It can be an agent of social change."This was the first effort like this de-signed to mobilize people for a public health cause," he says. "Now we want to build on that. Studying the response to the organ donor effort is the next step in the process of us-ing social media for social good."

Now Share your Organ Donation Status on Facebook are safety concerns on

Pioglitazone. Besides this, a group of Diabetologists from India in the “Journal of the Association of the Physicians in India’’ have reported 8 cases of blad-der cancer associated with Pioglitazone use from dif-ferent geographical loca-tions in India such as Sa-lem, Belgaum, Hyderabad and Mumbai.

The FDC of Flupenthixol + Melitracen has also been banned. It is marketed under the brand name Deanxit in India. FDC was approved in the year 1998 for the treatment of psychogenic depres-sion, depressive neuroses, marked depression and psychosomatic affection accompanied by anxiety and apathy. After 13 years, the Parliamentary Stand-ing Committee on health had raised issues concern-ing approval of this FDC and the matter was sub-sequently observed by an expert committee and the committee recommended that phase 4 clinical tri-

als should be conducted. A couple of years later, in 2013, Drug Controller General of India (DCGI) in a letter asked all the State Drug Controllers to instruct the manufacturer to establish safety and ef-ficacy of the drug within a period of six months. It was also decided to get the issue examined by NDAC (Neurology & Psychiatry) and the expert committee for the same felt that the rationality and essential-ity of continued marketing of this FDC is questionable as Melitracen is reported to be not efficacious as a single agent in depression and Flupenthixol use is as-sociated with potentially serious neurologic side ef-fects.

The points mentioned above seems to be more relevant today in view of the fact that series of other more efficacious, safe and relatively inexpensive al-ternate antidepressants and anti anxiety drugs are already available in the market. The matter

was again deliberated by NDAC on 11.5.2013 and the committee recommended suspension of the manu-facturing and marketing of FDC. Beside this the Par-liamentary Standing Com-mittee in its 66th report opined that it is an open and shut case that needs immediate action.

In view of the above, the manufacturing and mar-keting of the FDC has final-ly been suspended under section 26A of the Drugs and Cosmetic Act till the safety, efficacy and toler-ability of the drug is exam-ined and established in the country.

Buclizine has a market share of Rs. 12.4 crore, Pi-oglitazone of Rs. 77 crore, Denaxit of Rs. 20 crore and Analgin of a further sub-stantial amount.

Buclizine is an antihis-tamine of the piperazine derivative family and was introduced in the Indian market in 1982 by UCB India Pvt. Ltd. It was ap-proved in 2006 for addi-tional indication as an ap-

petite stimulant based on regulatory status at that time and was marketed in 32 countries. Gradually another indication was ap-proved in the year 2010 for the symptomatic treat-ment of various allergic conditions (rhinitis, con-junctivitis and urticaria) and for prevention and treatment of motion sick-ness.

The matter regarding continued marketing of Buclizine in Indian market for appetite stimulant is also raised in 59th report of Rajya Sabha Parliamen-tary Standing Committee and it has been mentioned that responsibility needs to be fixed for unlawfully ap-proving Buclizine, a drug of hardly any consequence to public health in India, more so since it is being administered to babies/children. It is, therefore, on the cards that manufac-ture for sale or distribution of Buclizine may be sus-pended till the safety and efficacy of the said drug is established.

Four drugs banned in India, more on radarContinued from page 1

Meenakshi alleged in the FIR (a copy is with DTMT) that these doctors had not treated her father properly when he was admitted to Apollo Hos-pital, Sarita Vihar on March 6, 2009.

The FIR says that the de-ceased was “a patient of diabe-tes, hypertension and coronary artery diseases, for which he was on medication. But the staff of Apollo Hospital had stopped his cardiac medicine and im-mediately after that, he died due to cardiac arrest.”

As per the FIR, the medicines, especially Tab Deplatt-A, were discontinued and never started again. This contributed to the patient suffering a heart attack on March, 27, 2009. It is also al-leged that anaemia was not cor-rected on time which proved hazardous for Mr Jain. It is fur-ther alleged that hyponatremia, very low albumin and plasma proteins and blood gases were not managed at all.

The FIR contends that there was unreasonable delay in con-ducting surgery for drainage of perianal abscess. “It is claimed that the surgery was performed after an unjustified delay of 20 hours from the time of admis-sion,” the FIR added.

“After remaining in the hos-pital for 27 days, Mr Jain died on April 1, 2009, due to gross, grave, reckless and culpable criminal negligence of the ac-cused, who had vision, reasonable foresight and complete knowledge and awareness of the conse-quences of their acts, but showed thorough disre-gard and indifference,” the FIR said quoting Meenakshi’s allegations.

Worse, the FIR also re-fers to the tampering of documents and case re-cords by Apollo doctors.

The Apollo Hospital administration has de-nied the allegations and

claimed there was no medical negligence.

Prof VJ Anand, the famous consultant Surgeon, In-draprastha Health Care said in his opinion that patient was treated negligently and allowed to slip into irreversible medi-cal state by sheer negligence of treating doctors.

“We are questioning doctors and other hospital staff,” said a senior police officer to DTMT.

FIr against Apollo Hospital, its 6 docs.Continued from page 1

CLASSIFIEDS

DruG TODAY MEDICAl TIMES16 Medical Mix

RNI No. DELBIL/2012/45560Published by Poonam Mishra for and on behalf of Drug Today Medical Times, 252, Kailash House, Kotla, Mayur Vihar –I, Delhi -110 091 Ph No.: (011) 22792078, 22792554, Fax No.: (011) 22759677 and printed at India Offset Printers, X-36, Okhla Industrial Area, Phase-II, Delhi - 110 020 Email - drugtodaymedicaltimes@gmail.comEditor: Lalit Mishra© All rights reserved. Reproduction in whole or in part without written permission of the publisher is strictly prohibitedWe have taken every possible care to avoid errors. Since this publication is being sold on the condition and understanding that information given herein is merely for reference, it must not be treated as an authority of or binding in any way on the writers, editors, publisher, and printer and sellers who do not owe any responsi-bility for any damage or loss to any person. All disputes are subject to the exclusive jurisdiction of competent court and forums in Delhi/NCR only.

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For inquiries call us at : 09971523292

1st - 31st July 2013, New Delhi

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Crossword solution

Jokes

Sudoku solution

Aries: Very favourable results indi-cated. Good time for students. Business will prosper. Family will be happy. Travel to reli-gious place indicated. Some tension to you and your fam-ily over unfavourable news on family front.

Taurus: Prosperity in business. New sources of income indicated. Good time to start new ven-ture/buy plots. Your perfor-mance will make the parents happy. Students will get admis-sion of choice. Expenditure on wedding in family indicated.

Gemini: Good time for family, health, work environment. There will be monetary benefit. Do not try to change your job. Don't interfere in other people's business. Time to look at new property. Good time for par-ents . Look after your mother..

Cancer: Some trouble in business in-dicated., so do not have too much expectations. Tough time for students. Tension in family. Relatives will insult you, cause problems. Control your temper. Look after par-ents' health. Control expenses.

Leo:Major ups and downs in poli-tics. Try your hand in any field and you will succeed. Travel will get benefits. A long time family dispute will be settled. Hide your happiness as en-emies are observing. You will have joy with family/ friends.

Virgo: Business will give success. Some friend will be of great help. You will get help as well as promotions in office. Good time for travel. Lawyers/CAs will make money. Emotional happiness indicated. Good time for family and parents.

Libra: Hard work will get you suc-cess., but results will still not satisfy you. Bosses will not be happy, giving you tension. There will be lack of money. Change of stream for students will be good. Disharmony with partner, do not end relations.

Scorpio: Tension in wporkplace indi-cated. You may be dragged into litigation. Health issues may require surgery. Control your anger. Ignore flattery. Keep harmonious relations with your partner. Help others. Your favour will be returned..

Sagittarius: Good time at work. A good transfer indicated. This is a joyful time of your life. You will gain some personal benefits. Good for architects. Good time with family and friends. Good news on the family front will give you joy.

IMPOrTANT DATES IN JulY 2013

● 3rd July –Tara uday (Guru uday) ● 8th July-Somavati amavasya

● 10th July- Jagannathji rath yatra ● 19th July –Dev shayani ekadashi

● 22nd July-Poornima, Vyas pooja ● 19th July- to 12 Nov. Chaumasa.

CONTACT : (011) 22752723, arun_jaitly@yahoo.co.inCONTACT : (011) 22752723, arun_jaitly@yahoo.co.in

Horoscope – By Pandit Arun Jaitly[1st July - 31stJuly 2013]

DISHA TOMAr

The recent news of Bollywood star Jiah Khan’s suicidal death has shocked the

nation and left everyone with the question as to what provoked the 25-year old to take this extreme step.

Suicide not only results into the loss of a person but the people around are left won-dering if they could have done something to prevent that person from taking the extreme step. Many millions of hours are spent by near and dear ones trying to cope with the loss of those who died by suicide. Short periods of overwhelming hopeless-ness or frustration mar the chances to live a normal life leading the person to end his/her life.

Suicide is among the top three causes of death among youth worldwide. According to a WHO report almost one million people die from suicide every year and 20 times more people attempt suicide. A global mor-tality rate of 16 per 100,000 or one death every 40 seconds and one attempt every 3 seconds has been recorded on an average. India alone accounts for more than one lakh suicidal deaths every year. In the last three decades (1975 to 2005) the suicide rates increased by 43 per cent. It may be noted that 71 per cent of suicides in India are by persons below the age of 44 years. This imposes a huge social, emotional and economic burden on the country.

Over 90 per cent of people who die by su-icide had suffered from some form of men-tal illness at the time of their death and the most common mental illness is depression. Depression is triggered by several negative life experiences. Thus, there are usually several causes, and not just one, for suicide. Death of a loved one, failure of a relation-ship, loss of property, loss of hope, being victimized as in case of rape, childhood emotional and physical neglect, a feeling of not being accepted by family, friends or society, physical or sexual abuse, feeling ‘trapped in a situation’ or ‘taken advantage of’ are among the negative experiences of life that may lead to major depression dis-order. Losing a parent early in life probably increases the risk to some extent.

Getting depression is involuntary, no one wishes to have it, just like one don’t ask for diabetes or cancer. A person who has it does not look at life like a typical person who feels good. Their mental illness pre-vents them from being able to look for-ward to life. They lose their ability to look forward to a good future. They don’t realize they are suffering from a treatable condi-

tion and feel hopeless and helpless. They don’t wish to end life, but it’s the only way they feel they can kill their pain.

Ending life with suicide is not an over-night decision. The person remains men-tally sick for a long period and may need medication or help of friends and family to overcome the tough time. Individuals who are depressed and exhibit symptoms as extreme hopelessness, lack of interest in activities that were previously pleasurable, panic attacks, heightened anxiety, previ-ous suicide attempts and irritability are at a higher risk of suicide.

Depression is a treatable condition and people can feel good again. Psychothera-py has emerged as the quickest and most effective way to treat depression. It is a therapeutic interaction between a trained professional and the patient to solve prob-lems which are psychological in nature. Dr Om Prakash, Geriatric Psychiatrist & As-sociate Professor, IHBAS Delhi, said “Psy-chotherapy – also called talk therapy or counseling – is a constructive way to deal with problems and issues that are psycho-logical in nature. This is done by regular counseling and distortion in thinking and attitudes are corrected by resolving the conflicts and providing a supportive hand. It is recommended to a person with men-tal health concern that is causing the indi-vidual a great deal of pain for longer than a few days.”

Moreover, depression leading to suicidal thoughts is a temporary state of mind. If timely emotional support is offered to the person who is experiencing deep unhap-piness and distress, the risk of them com-mitting suicide can be prevented. Regular exercise, healthy eating and maintaining friendships can help individuals to cope better with stressful situations.

Depression, the leading cause of suicides

Capricorn: Good time for those in chemi-cal and healthcare industries. Good time to travel, especially abroad.. Do help your friends who need your help. Happy time with family and friends. Good time with your spouse. Your parents will be happy.

Aquarius: Joy at work. Gains for those in metal work. Good time for journey. Family/friends will be helpful. You will accumu-late wealth. Foreign countries will benefit you. Look after the health of your parents. Part-ners will be happy with you..

Pisces: Business will bring average results. Your loans will be ap-proved. Those doing job will get good appraisal. Look after your partner's health. Your father may have knee/foot-related problem. Your partner will undertake a journey.

Horoscope – By Pandit Arun Jaitly[1st July - 31stJuly 2013]