emedinews
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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 15 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

7th February 2013, Thursday

Generic drugs vs patented drugs vs branded drugs vs generic names of drugs

Medical Council of India Code of Medical ethics: 1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that there is a rational prescription and use of drugs.

Interpretation

  1. Use of Generic names of drugs: it’s not use of generic drugs
  2. Every physician should: the word SHOULD makes it binding
  3. As far as possible means to the best of his or her capacity
  4. Prescribe drugs with generic names: is not the same as prescribing generic drugs. It only means the name of the salt should also be written.
  5. Shall ensure that there is a rational prescription: Rational means prescription of drugs which are evidence based and or with informed consent.
  6. Rational use of drugs: means the same when dispensing.

Thus Medical Council of India says “prescribe drugs with their generic names” which makes sense as what they insist on is that as far as possible we should write the name of the salt also. By writing the name of the salt one will be able to avoid lot of prescription errors and will be able to do and prescribe drugs rationally. For example instead of writing Stamlo 5 mg once daily at night one should write AMLODIPINE (STAMLO) 5mg at bed time.

What is the difference between a patented and a generic drug?

  1. PATENT DRUG means a drug belonging to the original company who has researched the pharmaceutical molecule. The company holds the rights of that molecule for 10 years. During these 10 years, no other company can manufacture and sell this compound. After 10 years, when the patent ends, then any company can copy or modify the molecule and come out with its own brands.
  2. After the patent ends, the patent drug becomes a GENERIC DRUG.
  3. Brand means any drug which is marketed by a company specific name. Both patented and generic drugs can have a brand name. Brand names are so designed that a person can easily remember the drug, or its action
  4. The word GENERIC NAME means the name of the original salt in the compound. It is not the same as generic drug.
  5. A drug can be sold under any of the three categories: Under the name of the generic salt (no brand name), unpopular brand name and a popular brand name. The same company usually sells them under all three categories. Under the salt name they sell in a supply of 100 or more; under unpopular brand name they pitch for an institutional bulk supply and under popular brand name they market for individual doctor’s prescription. The cost of the generic salt will obviously be cheaper.
  6. Actually almost all the drugs produced in India are GENERIC DRUGS (generic equivalents) under different BRAND NAMES. Their prices may vary and are not controlled by the doctors. MRP is decided and permitted by the government.
  7. In USA, BRAND is the name given to the patented drug. After 10 years, the same drug is sold as generic equivalent.

How to reduce the cost of the drugs being prescribed?

  1. One can write AMLODIPINE (Dr Reddy’s lab) instead of a known brand. In that case the chemist should give the unbranded version of the drug, which will be cheaper.
  2. The government should ensure availability of unbranded drugs with generic name.
  3. The reimbursement policy should be to reimburse the cheapest drug (branded or unbranded with generic name version). If a person wants a costlier brand he or she should be allowed to pay the difference.
  4. For example, there are three types of stents in India - the Drug Controller of India approved stents, the European approved stents and American approved stents with Indian stents being the cheapest and the American the costliest. If the Government reimburses all three of them, most of the patients and doctors will opt for the costlier American stents. The Government should reimburse only for the cheapest stents and anybody who wants an American stents should pay the difference.
  5. Similarly, the insurance companies, public sector undertakings, CGHS and related agencies should reimburse for the cheapest drugs and devices. But will be policy makers and the politicians allow that because they are the ones who will opt for costly branded drugs or devices.
  6. Quite often it is argued that the drugs differ in efficacy and bioavailability. That is the difficult to understand as if a drug is approved by the Drug Controller of India, its efficacy should not be a matter of concern or challenge.
  7. There are also arguments that drug licenses are a State subject and the reliability of a state licensed drug may be under question mark.

Conclusions

I personally feel that ever doctor should write a brand with the name of the generic salt in the bracket so that prescription errors goes to minimum. Also, the Drug Controller of India should release a website where every doctor should be able to find out which drugs are cheapest in the market and yet approved by the Drug Controller of India.

Padma Shri and Dr B C Roy National Awardee and National Vice President Elect India Medical Association

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What lab tests are done to find out the
etiology of constipation?

A comprehensive metabolic panel, complete blood count, and thyroid function tests can identify metabolic conditions that may be causative as well as secondary anemia that will indicate further evaluation.

 
Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal

NIH pilot study shows feasibility of MRI to guide heart catheter procedures

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

4th eMedinewS Revisiting 2012

A daylong conference, eMedinewS Revisiting 2012, organized by eMedinewS, Heart Care Foundation of India and World Fellowship of Religions.

 
Dr K K Aggarwal
    National News

Cervical cancer test may soon cost just Rs 100

MUMBAI: The most technologically advanced cancer detection will soon be within the reach of the common man (or woman in this case). The central Food and Drugs Association is working towards making the optimum cervical cancer screening option available at a low price. Cervical cancers are associated with persistent infection with oncogenic human papillomavirus (high risk HPV). An HPV DNA test can detect the presence of oncogenic strains of the virus in cervical cells. The government is working to bring down the cost of this test to make it available to poor patients. "Right now, this test is being offered for Rs 900. For below poverty line patients, the test is for Rs 300. But the FDA is working towards bringing down the cost of the test. Soon, it will be available for less than 2 dollars," said Dr Surendra Shastri, head of preventive oncology at Tata Memorial Hospital. Converted to Indian currency, the test will be available for Rs 100. What's more, the test will not only reveal whether a woman is suffering from cancerous lesions, but also whether she will get it in future. "Once the test results show negative predictive value, it means that the likelihood of the woman getting cervical cancer in future is very low," said Dr Shastri. The projections from Globocan 2008 reveal that 72,825 women died due to cervical cancer. Globocan is a software that is worked out by the World Health Organisation and the International Agency for Research on Cancer every few years to help public health officials to work out a battle-plan against cancer. (Source: TOI, Feb 5, 2013)

With 1.71L patients, UP accounts for 16% of India's cancer cases

LUCKNOW: Oncologists in the country see Uttar Pradesh as the emerging cancer capital of India. Findings of the Population Based Cancer Registry functioning under the National Cancer Registry Programme of Indian Council of Medical Research, suggest that UP accounts for more than 16% of cancer patients in India. Figures show that more than 10.55 lakh cancer cases were reported in the country in 2011. Of the total, 1.71 lakh patients hail from UP. Doctors feel that the number is only suggestive and it could be higher in reality. "There is no centre linked to the national cancer registry as of now. Once the registry gets functional, the reporting would be more correct," said Prof MC Pant, radiologist and director, Ram Manohar Lohia Institute of Medical Sciences. He added that the cancer centre at the institute is new, but the patient burden over it is increasing despite the fact that the services are offered at a nominal fees. "As of now, we provide radio therapy to 60 patients and chemotherapy to 10-15 patients on a daily basis. Some 4-5 patients are operated everyday," he informed. Prof Pant's observation was true. Head of radiotherapy department in King George's Medical University, Dr Naseem Jamal informed that the burden at the centre is much high. "We see more than 50 new cancer patients in the OPD daily," he said. (Source: TOI, Feb 5, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

Child below 14 cannot work

There is a total ban on all work for children under the age of 14, and restrict non-hazardous work to adolescents between the age of 14 and 18.

Employing a child under 14 for any work will be a cognizable offence punishable with imprisonment up to two years or a fine up to Rs 50,000 or both, an increase from the current one-year jail or Rs 20,000 punishment. Repeat offenders can be imprisoned for up to three years.

For comments and archives

 
    Valvular Heart Disease Update

Bicuspid aortic valve is also associated with coarctation of the aorta.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Vitamin C boosts kidney stone risk in men

Men who took high-dose vitamin C supplements doubled their risk of developing painful kidney stones, a large prospective study found. (Source: Medpage Today)

New MRI methods may improve MS evaluation

Spinal cord lesions imaged with quantitative MRI-based technologies correlated significantly better with clinical disability of multiple sclerosis (MS) patients than did simple lesion counts based on conventional MRI, researchers said. (Source: Medpage Today)

FDA clears drug for urea cycle disorders

The US Food and Drug Administration (FDA) today approved glycerol phenylbutyrate (Ravicti, Hyperion Therapeutics) for the chronic management of some urea cycle disorders (UCDs) in patients aged 2 years and older. (Source: Medscape)

WHO issues sodium-, potassium-intake guidelines

In a pair of new guideline documents, the World Health Organization (WHO) recommends a maximum daily intake level for sodium and a minimum level for potassium in both adults and children, with the aim of reducing the risks of stroke and cardiovascular disease from elevated blood pressure. Most populations around the world, the group says, consume less-than-recommended levels of potassium and disproportionately high levels of sodium. (Source: Medscape)

 
    Twitter of the Day

@DrKKAggarwal:Today's health question As per medical council of India 1.5: Every physician should, as far as possible, (cont) http://tl.gd/kuopav

@Dr Deepak Chopra: Please take a look at the season preview of Holy Factshttp://tinyurl.com/aegnv2j

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Debts in Mythology

It is said that there are three debts which everybody has to pay in his or her lifetime. In Vedic language, they are called Dev Rin, Pitra Rin and Rishi Rin.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What is hydrosalpinx?

The embryo travels through the tube into the uterus .When it reaches the uterus, it can implant into the uterine wall and develop into a baby. However, an old infection can cause the tubes to fill with fluid and enlarge (dilate). When this happens, the tube is called a hydrosalpinx.

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

How long can the blood be stored?

The whole blood can be stored up to 35 days, in CPDA anticoagulant solution in refrigerated conditions at 4°–6°C. But, in reality, the demand is so much that blood hardly remains stored for such a long period and is used much before expiry.

For comments and archives

 
    An Inspirational Story

I Wish You Enough!

Recently, I overheard a mother and daughter in their last moments together at the airport as the daughter’s departure had been announced. Standing near the security gate, they hugged and the mother said: “I love you and I wish you enough.”

The daughter replied, “Mom, our life together has been more than enough. Your love is all I ever needed. I wish you enough, too, Mom.” They kissed and the daughter left.

The mother walked over to the window where I sat. Standing there, I could see she wanted and needed to cry. I tried not to intrude on her privacy but she welcomed me in by asking, “Did you ever say good-bye to someone knowing it would be forever?” “Yes, I have,” I replied. “Forgive me for asking but why is this a forever good-bye?” “I am old and she lives so far away. I have challenges ahead and the reality is the next trip back will be for my funeral,” she said.

When you were saying good-bye, I heard you say, “I wish you enough.” May I ask what that means?” She began to smile. “That’s a wish that has been handed down from other generations. My parents used to say it to everyone.” She paused a moment and looked up as if trying to remember it in detail and she smiled even more. “When we said ‘I wish you enough’ we were wanting the other person to have a life filled with just enough good things to sustain them”.

Then turning toward me, she shared the following, reciting it from memory.

“I wish you enough sun to keep your attitude bright. I wish you enough rain to appreciate the sun more. I wish you enough happiness to keep your spirit alive. I wish you enough pain so that the smallest joys in life appear much bigger.

I wish you enough gain to satisfy your wanting. I wish you enough loss to appreciate all that you possess. I wish you enough hellos to get you through the final good-bye.”

She then began to sob and walked away.

For comments and archives

 
    Cardiology eMedinewS

Selenium supplements 'not justified' for CVD prevention Read More

Atrial size key to Afib-pacemaker link Read More

 
    Pediatric eMedinewS

New Down syndrome DNA test effective and economical Read More

Antibiotics help in malnutrition treatment in children Read More

 
    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady was suspected to have DVT.
Dr. Bad: Go for MRI.
Dr. Good: Go for complete Doppler sonography test.
Lesson: A study published in BMJ from France has shown that a single negative complete Doppler sonography can conclusively rule out deep vein thrombosis in pregnancy.

Make Sure

Situation: A patient died after consuming six pegs of alcohol.
Reaction: Oh my God! Why was he allowed to consume six pegs?
Lesson: Make sure that no patient is allowed binge alcohol i.e. consuming more than six pegs in a day or five pegs at a time.

 
  Quote of the Day (Dr GM Singh)

Keep your face always toward the sunshine – and shadows will fall behind you. Walt Whitman

 
    Mind Teaser

Read this…………………

The intrinsic pacemaker rate of ventricular myocardial cells is:

a. More than 80 bpm
b. 60 t0 80 bpm
c. 40 to 60 bpm
d. Fewer than 40 bpm

Yesterday’s Mind Teaser: The husband of a client asks the nurse about the protein-restricted diet ordered because of advanced liver disease. What statement by the nurse would best explain the purpose of the diet?

A. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system.”
B. “The liver heals better with a high carbohydrates diet rather than protein.”
C. “Most people have too much protein in their diets. The amount of this diet is better for liver healing.”
D. “Because of portal hyperemesis, the blood flows around the liver and ammonia made from protein collects in the brain causing hallucinations.”

Answer for Yesterday’s Mind Teaser: A. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system.”

Correct answers received from: Dr Jella, Prabha Sanghi, Dr Bharat Bhushan Aggarwal, Chandra Psl Singh, Dr Suresh Arora, Dr PC Das, Dr Kanta Jain,
Dr Shagufta Moin, Dr K Raju, Dr Valluri Ramarao, Dr Arpan Gandhi,
Dr KV Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Thakor Hitendrsinh G, Dr AK Singhal,
Dr Jayashree Sen, Dr Bitaan Sen.

Answer for 5th February Mind Teaser: (B) Empty bladder before procedure

Correct answers received from: Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Thakor Hitendrsinh G, Dr AK Singhal, Dr Jayashree Sen, Dr Bitaan Sen.

Send your answer to ijcp12@gmail.com

 
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

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    Laugh a While (Dr GM Singh)

During their silver anniversary, a wife reminded her husband: Do you remember when you proposed to me, I was so overwhelmed that I didn't talk for an hour?" The hubby replied: "Yes, honey, that was the happiest hour of my life."

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

What are resuscitative injuries?

Doctor should always document in detail the resuscitative injury in case of death

The injuries produced in human body during resuscitation pose difficulty in interpretation of injuries noted at postmortem examination or in inquest paper by the investigating law enforcement agency. Before proceeding to make an interpretation, the doctor conducting the autopsy should know if there has been an attempt for resuscitation and who did it and for how long. He should also know about the methods used in a particular case and whether all these have been documented in the clinical sheets or not. Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries. The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

  • The method generally used for life saving attempts by non–medical persons who are near the critical patient is mouth–to–mouth respiration and manual chest massage may causes contusions.
  • Resuscitation in hospitals includes bag and mask intubations, endotracheal tube, obdurate airways used for respiratory ventilation.
  • Mechanical methods like Thumper, active compression–decompression device and defibrillators are used in resuscitation. Closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
  • The injections and closed–chest cardiac massage and other resuscitation procedures to the patients may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral hemothorax, tension pneumothorax, rupture of kidney and of the spleen.
  • Fractures of ribs and/or sternum were found in 40% of cases, the frequency increasing with age. The number of fractured ribs ranged up to 16, mainly 3–8 ribs was fractured. Fractures of the 1st and 8th to 12th ribs were very rare.
  • The common site of rib fractures after heavy blunt thoracic injuries was found in the dorsal region.
  • The injuries which are received or inflicted on the body prior to death are called mortem injuries and may or may not be a contributing factor in causing the death or they may have occurred due to much other reason like resuscitation/transport of sick/ill person for medical care called artifacts.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

Even typhoid can have chills and rigors

Changing trends have been reported in typhoid fever since last decade. Continuous and intermittent fever with rigors and chills, headache, body aches, abdominal pain, enlarged spleen, enlarged liver, high pulse rate, and deranged liver functions are more commonly observed in typhoid fever reports Dr NS Neki, Assistant Professor Dept. of Medicine Govt. Medical College Amritsar, Punjab in January issue of Indian Journal of Clinical Practice.

In the study of 100 patients 48, 30, 14 and 8 were in the age group of 20-30, 31-40, 41-50 and 51-60 years, respectively. In all the patients, fever (100-104°F) was the major presenting symptom. Duration of fever was one week in 32%, 1-2 weeks in 40%, 2-3 weeks in 20%, 3-4 weeks in 7% and >4 weeks in 1% patients. 65 patients presented with continuous fever and 32% with intermittent fever and 3% with remittent fever.

Sixty percent patients presented with rigors and chills and 40% without rigors and chills. Headache was reported in 80%, body ache in 60%, abdominal pain in 13%, cough in 10%, nausea in 4%, constipation in 2% and vomiting is 2% cases. Clinical findings were enlarged spleen in 70%; high pulse rate in 65%; enlarged liver in 23%, coated tongue 12%; relative slow pulse rate in 3% and irritation of the brain layers in 3% with stupor in 1%.

Laboratory findings were anemia with Hb 6-11 g/dl in 25%; severe anemia with Hb <6 g/dl in 16%; neutropenia or low white cells in 9%; lymphopenia in 4%; lymphocytosis in 2%; low platelet count in 4 %; raised liver enzymes SGOT and SGPT in 42%; raised alkaline phosphatase in 7% and raised serum bilirubin in 5% cases.

Presence of fever with child and rigors does not always mean malaria or urinary tract infection. If the fever is continuous one should look for typhoid. Raised SGOT and SGPT levels can be present in most viral fevers especially in the dengue season, said Padmashri and Dr B C Roy National Awardee Dr KK Aggarwal, Editor in Chief IJCP.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 26404 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

 
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  1. i liked emedinews too much keep it up inspiration stories.Dr baul
 
    Forthcoming Events

ANNOUNCEMENT

Sri Aurobindo Ashram – Delhi Branch will organize the 6th Study Camp on ‘Mind-Body Medicine and Beyond’ for doctors, medical students and other health professionals at its Nainital Centre (Van Nivas) from June 8-14, 2013. The camp, consisting of lectures, practice, and participatory and experiential sessions, will help the participants get better, feel better, and bring elements of mind-body medicine into their practice. The camp will be conducted by Prof. Ramesh Bijlani, M.D., former Professor, AIIMS, founder of the Mind-Body Medicine Clinic at AIIMS, and the author of Back to Health through Yoga, Eating Wisely and Well and Essays on Yoga. For more details, send an e-mail to the Ashram (aurobindo@vsnl.com) or to Dr. Bijlani (rambij@gmail.com).

 
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