eMedinewS
3rd October 2014, Friday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Drug prize control

  • Paragraph 19 of DPCO, 2013, authorises the NPPA in extraordinary circumstances, if it considers necessary so to do in public interest, to fix the ceiling price or retail price of any drug for such period as it deems fit.
  • 29th May, 2014: NPPA has issued Internal Guidelines on fixation/revision of prices of scheduled and non–scheduled formulations, under Para 19 of the DPCO, 2013 (Approved by the Authority in its 147th Meeting held on 16.5.2014). NPPA approved objective guidelines for fixation/ revision of price of non–scheduled drugs showing extreme inter-brand price differences. It has decided that, to start with inter–brand price variation will be examined in respect of single ingredient formulations in eight therapeutic groups, namely, anti–cancer, HIV/ AIDS, anti–TB, anti–malaria, cardiovascular, anti–diabetics, anti–asthmatic, and immunological (sera/ vaccines); and wherever the maximum retail price (MRP) of the brand(s) of medicine of a particular formulation exceeds 25 per cent of the simple average price the same will be capped at the 25 per cent level.
  • 10th July: The National Pharmaceutical Pricing Authority has fixed the prices Anti diabetic & Cardiovascular in respect of 108 non–scheduled formulation packs under Paragraph 19 of DPCO, 2013 in related Notification / order dated 10.7.201 on the basis of the May 29 guideline.
  • 19th September: The Department of Pharmaceuticals under the Ministry of Chemicals and Fertilizers had on September 19 ordered the NPPA to withdraw a guideline under the Drug (Prices Control) Order (DPCO) of 2013 that gave the pricing authority powers to cap prices of non–scheduled drugs.
  • 24th September: Clarification by NPPA: NPPA Powers Not Withdrawn : Certain sections of media have carried headlines which indicate that the Government has withdrawn the power of NPPA to fix /revise prices under para 19 of DPCO, 2013; and also that Government has directed NPPA to withdraw the notifications dated 10.07.2014 fixing prices of 108 non–scheduled drugs. In this connection it may be stated that the correct factual position is as under: " Consequent to notification of National Pharmaceuticals Pricing Policy– 2012 (NPPP–2012) on 07.12.2012 and notification of Drugs Price Control Order, 2013 (DPCO, 2013), the powers of the Government were delegated to NPPA on 30.05.2013. NPPA on 29.05.2014 came out with internal guidelines dated 29.05.214 on fixation/revision of prices of scheduled and non–scheduled formulations under para 19 of DPCO, 2013. Consequent to that NPPA issued various orders dated 10.07.2014 fixing prices under exercise of powers of para 19 of DPCO, 2013.

    The above said guidelines dated 29.05.2014 and orders dated 10.07.2014 have been challenged in Bombay and Delhi High Court.

    The Union of India and NPPA which have been made respondents, after careful consideration in consultation with the M/o Law and Justice had decided to convey to the Hon’ble Courts that the guidelines dated 29.05.2014 are to be withdrawn.

    The action of NPPA dated 22.09.2014 needs to be seen in the above context. The Government has neither withdrawn the powers delegated to NPPA on 30.05.2013 nor NPPA has been directed to withdraw the orders dated 10.07.2014."

Order dated 29th May 2014: National Pharmaceutical Pricing Authority

Sub: Internal Guidelines on filiation /revision of prices of scheduled and non–scheduled formulations, under Para 19 of the DPCO, 2013. (Approved by the Authority in its 147:ri Meeting held on 16.05.2014)

In exercise or the powers conferred by paragraph 19 of the Drugs (Prices Control} Order. 2013. read with S.O. No 1394 (EJ daled the 30" May, 2013, NPPA is empowered to fix/revise the ceiling or retail prices of both scheduled and non–scheduled formulations under certain circumstances, in public interest Accordingly, ceiling prices I retail prices of formulations shall have to be fixed / raised by the NPPA in pursuance of paragraph 19 of DPCO, 2013 In This connection. NPPA could also cause enquiry, call for information as the tase may be and fix I revise Ihe prices of scheduled formulations, nan–scheduled formulations and ‘new drugs’ if considered necessary so to do in public interest.

2, In order to have an uniform policy for price fixation / revision under para 19 of DPCO, 2013. the Authority in its meeting held on 16.05.2014 has decided that the following guidelines be followed in this regard;.

(a) NPPA will monitor "inter–brand price differences" of non–scheduled formulations on me basis of monthly MRP based data provided by the IMS"Health. To begin with, this exercise of monitoring of ‘inter–brand prize difference1 will be carried out in respect of single ingredient formulations /medicrnes used for anticancer / HIV medicines, anti tuberculosis, anti–malaria. cardiovascular. anti–diabetics. anti asthmatics immunologicals {sera/vaccines) etc. From the data obtained from IMSHealth. NPPA would identify the cases where the MRP of the price of brand(s) exceeds 25% of the simple average price of the medicines in that group. Monitoring Division after verification of the data / MRP reported by the IMS Health will initiate the case for price fixation under paragraph 19 of DPCO, 2013.

(The Authority also decided that the guidelines for therapeutic groups indicated above may be extended to other therapeutic groups also if required and in this regard Drugs Controller General (India) and Slate Drugs Controllers will also be requested to identify any other therapeutic groups / diseases to be coveted under the guidelines}.

(b) As mere is no control on the launch price of non–scheduled formulations under DPCO, 2013, for the therapeutic groups specified in para (a) above. Monitoring Division of the NPPA will monitor the prices of these single ingredient formulations launched by the manufacturers For the first time on the basis of monthly MRP based data of IMS–Health. Wherever prices of such formulation packs are found to be more than the price of highest price brand, Monitoring Division will initiate price fixation of those packs lo reduce lo the level of existing highest price brand under para 19 of DPCO, 2013.

(c) The cases of shortages of scheduled and non–scheduled formulations reported by the SDCS / Governments may be examined, on case to case basis (or price fixation! revision under para 19 of OPCO. 2013.

(d) In respect of cases lying sub–judice in various courts appropriate action will be considered by NPPA depending upon the directions / order / judgment passed by the Hon’ble courts in such cases.

3, The above guideline shall be put in place prospective and all the cases under examination shall be processed as per these revised guidelines.

(Jagdish Kumar)

Director (MSE|

News Around The Globe

  • Elderly patients taking proton-pump inhibitors (PPIs) are at a 43% increased risk of being hospitalized with hypomagnesemia, suggests a population-based case control study. The risk was concentrated among patients taking both a PPI and a diuretic. The study is published online September 30 in Plos Medicine.
  • Evaluating the possibility of large population-based programs of Helicobacter pylori screening and treatment should be a global priority in order to reduce the burden of gastric cancer, suggests a report from the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization.
  • Spinal-cord stimulation appears to be a "last-resort" treatment for some patients with severe painful diabetic neuropathy when pharmacologic therapy has failed, suggested a new 2-center study published online in Diabetes Care.
  • A US study has suggested that women who were unemployed in their youth tend to have fewer children into middle-age than women who worked. The study was published recently in the Proceedings of the National Academy of Sciences.
  • A major consequence of the obesity epidemic is that nonalcoholic fatty liver disease (NAFLD) is now recognized worldwide and not just in Western countries. Fatty liver disease-associated mortality has been reported in populations of the Middle East, Far East, Africa, the Caribbean, and Latin America.

National News

Ek din ka Chairman: On 1st October, 2014, as both the President and Vice President of Delhi Medical Council were on leave of absence, I got an opportunity to chair the meeting for the first time in the last ten years of my presence in DMC as a member, firstly, as an elected member of DMC and lately elected member in the DMC. Chairing the Delhi Medical Council meeting was a nice experience.

For me, it was another feather in my cap. I experienced the same excitement when I first anchored the DD Healthy India show sometime back when the main anchor was absent on that particular day.

Dr KK Spiritual Blog

On 9th Navratri Enjoy the spiritual powers

Siddhidatri is worshipped on the Ninth Day of Navratri. She gives all the eight siddhis – Anima, Mahima, Garima, Laghima, Prapti, Prakamya, Lishitva and Vashitva. She rides on a lion or on a lotus. She has four hands and looks pleased.

Spiritual mantra on the 9th Navratri

By the 9th day of spiritual detoxification one gets all spiritual powers.

Dusshera is a festival to purify one’s mind

Dussehra is a festival to purify one’s mind, body and soul and control the ego. Killing of effigies of Kumbhkaran, Meghnath and Ravana means killing one’s tamasik, rajasik and egoistic behavior. Reunion of Ram, Sita and Lakshman means the union of mind and body with the soul.

‘Internal Dussehra’ where you kill the devils within is the spiritual meaning behind the festival but people observe external Dussehra, where they kill man–made effigies of Kumbhkaran, Meghnath and Ravana with the help of bow and arrow which if misdirected can cause perforating injuries in the eyes.

The basic meaning of bow and arrow is to practice humility and focus at the same time. The word "Bow" means leaving ego personality and the word "Arrow" means not losing your focus while working. Using Bow and Arrow to kill the three devils, therefore, means that by practicing humanity and not losing your focus, you will be able to kill and control your own ego.

Inspirational Story

A Bit of Wisdom

During a trying time in my life I have received much comfort from the comments and the input of your readers and I would like to submit a bit of wisdom of my own. It results from my life experiences thus far.

Do not look in books for instructions on how to live your life, by doing so you will only end up following someone else's road. Look only inside yourself. You must trust your own voice, think with your own mind, follow your own heart, and believe in your own dreams. Only you know what you need or what is good for you. You can only survive and succeed when you are true to yourself and not to the opinions of others.

Do not look at life through the eyes of someone else; do not end up second-guessing your own thoughts and feelings in the false believe that others are automatically wiser than you are. Trust yourself, listen to your heart, chart your own course, be your own North Star and be what the Great Spirit intended you to be – one of a kind.

Rabies News (Dr A K Gupta)

Can RIG be given locally to a healed wound?

Yes. If anti–rabies vaccination has not been started, then RIG can be given locally without disturbing the scab.

Cardiology eMedinewS

  • The antihypertensive drug fenoldopam does not decrease death or the need for dialysis at 30 days' follow-up in comparison with placebo among patients with acute kidney injury after cardiac surgery, suggested a randomized controlled trial published online September 29 in JAMA. Fenoldopam was also linked with higher rates of hypotension.
  • A large cohort study has found that patients aged 18-64 years had higher readmission rates for heart failure than patients aged ≥65 years (23.4% vs. 22.0%), and lower readmission rates for myocardial infarction (11.2% vs. 17.5%) and pneumonia (14.4% vs. 17.3%). The study was published September 30 in PLoS Medicine.

Pediatrics eMedinewS

  • A new study of children with autism has found that they are more sedentary than their typically-developing peers, averaging 50 minutes less moderate physical activity per day and 70 minutes more each day sitting. The study is published in the journal Autism Research and Treatment.
  • A new study, published in Pediatrics, has found that at least 60 minutes of physical activity after school every day is not only beneficial for children's physical health, but it may also improve their cognitive functioning. Study authors noted that children who took part in at least an hour of physical activity every day after school showed improved cognitive functioning.

Quote of the Day

There are some people, who live in a dream world, and there are some who face reality; and then there are those who turn one into the other. Douglas H. Everett Problems are only opportunities in work clothes. Henry John Kaiser

IMA NEWS

  • IMA awards 2014 will be presented during a Special IMA Awards’ ceremony to be held on 27th-28th December, 2014 at the venue of the Annual Conference of IMA at Ahmedabad (Gujarat). Nominations are invited to reach the IMA Headquarters, I.P. Marg, New Delhi-110 002 latest by 1st November, 2014.  Notification can be uploaded on the official website of IMA.
  • The government decision to decontrol prices of 108 drugs to treat tuberculosis, AIDS, diabetes and heart ailments has increased their prices. The price of Glivec, an anti-cancer tablet, for example, has risen from Rs 8,500 to Rs 1.08 lakh. Plavix, used to treat blood pressure and heart ailments, will cost Rs 1,615, against the earlier Rs 147. An anti-rabies injection, Kamrab, priced at Rs 2,670, will now cost Rs 7,000, reports DNA. 

    In a circular issued before Prime Minister Narendra Modi's visit to the US, the government asked the National Pharmaceutical Pricing Authority (NPPA), an autonomous body, to withdraw its May 2014 guidelines on drug price control. NPPA had capped the prices of these 108 drugs, in addition to the already listed 800 essential drugs, to improve their affordability, in the wake of official figures that there are 4.1 crore diabetes, 4.7 crore coronary heart disease, 22 lakh TB, 11 lakh cancer and 25 lakh HIV/AIDS patients in the country.

    These 108 drugs mostly relate to lifestyle diseases and are not 'essential'.  The Ministry of chemicals and fertilizers had, on May 30, 2013, delegated powers to the NPPA to regulate the prices of life-saving drugs. This resulted in a significant reduction in prices of a broad spectrum of drugs. The Modi government extended this regulation to even lifesaving drugs for cancer, HIV, tuberculosis, malaria, diabetes, cardiovascular diseases and asthma. The government later withdrew these guidelines, ahead of Modi's visit to the US.

Wellness Blog

5 Ways to Stop A–Salting Your Kidney

Eating white salt is like a slow poison. If the amount of salt is reduced to less than 1 teaspoon per day, a large percentage of people with high blood pressure will become normal blood pressure patients. High salt intake via increase in blood pressure leads to kidney damage over a period of time and kidney failure. Consume less–anything which is artificially white in feature–white sugar, white maida and white rice.

Most people who have presence of high salt in their body will have characteristic feature of liking to both ice cold as well as boiling beverages.

5 tips to reduce salt in your diet

  1. Make reading food labels a habit. Sodium content is always listed on food labels. Sodium content can vary from brand to brand, so compare and choose the lowest sodium product. Certain foods don’t taste particularly salty but are actually high in sodium, such as cottage cheese, so it’s critical to check labels.
  2. Stick to fresh meats, fruits and vegetables rather than their packaged counterparts, which tend to be higher in sodium.
  3. Avoid spices and seasonings that contain added sodium, for example garlic salt. Choose garlic powder instead.
  4. Many restaurants list the sodium content of their products on their websites, so do your homework before dining out. Also, you can request that your food be prepared without any added salt.
  5. Try to spread your sodium intake out throughout the day; it’s easier on your kidneys than eating lots of salt all at once.

ePress Release

Dussehra is the most auspicious day to learn CPR 10

There are only three days in a year, which are considered 100% auspicious when one can start a new work without asking the priest or pandit. Dussehra is one of them.

Spiritually, Dussehra means that one has been able to detoxify one’s mind, body and soul and kill one’s ego. One has attained a healing parasympathetic state of mind.

This Dussehra should be devoted to learn how to revive a person after sudden cardiac death. Most people equate the festival of Dussehra with punishing or killing t people who are bad in the society. But the real meaning of Dussehra is to kill what is bad in you.

Dussehra is different from Holi festival. In Holi you remove negativity from mind of other people; in Dussehra, you remove negativity from your own mind.

Both require a process of purification for 8 to 9 days. Holi is preceded by eight days of Holashtak and Dussehra by nine days of Navratri.

On the day of Dussehra one must have a positive affirmation to learn that it is possible to revive a person even after death.

Chandokya Upanishad talks about process of death where it says that Vak Vriti merges into Manu Vriti and that merges into Prana Vriti that finally merges into Tejas which leaves the body to merge with the ultimate, the sat.

If heart and respiration have stopped, the process of Prana Vriti merging into Tejas may take many minutes. During this period if the heart can be revived the person’s life can be revived back.

Also if during this period, the merger of Prana Vriti with Tejas can be delayed, one can postpone death and can do successful CPR even hours after death.

Dr. Aggarwal said that in the forthcoming 21st MTNL Perfect Health Mela every person will be trained in CPR 10 and every person in the city should visit Mela with their family and learn hands only cardiac pulmonary resuscitation 10.

eMedi Quiz

Brocq's phenomenon is analogous to which clinical sigh in psoriasis

a. olfleck's phenomenon
b. auspitz sigh
c. salmon patch
d. candle wax scales

Yesterday’s Mind Teaser: A 64-year-old hypertensive obese female was undergoing surgery for fracture femur under general anaesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mmHg followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Answer for yesterday’s Mind Teaser: 2. Hypovolemia.

Correct answers received from: Dr Poonam chablani, Daivadheenam Jella, Dr.Bitaan Sen & Dr Jayashree Sen, Dr palanivelrajan

Answer for 30th Sept Mind Teaser: 3.Pain sensation on the contralateral side.

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr B K Agarwal, Dr Ayyavoo Erode, Dr Bitaan Sen, Dr Jayashree Sen, Dr Prakash Khalap.

Send your answer to email

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at A.S.V.J Sr Sec School, New Delhi on 24th September 2014

mela_brochure
Self-Assessment-Quiz

 

expert_choice
Zee News – Health Wealth Shows

Alcohol

press release

One can predict acute lung injury

video of day video of day

Other Blogs

Video Library

MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

cpr 10 mantra
VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation: A patient came with tubercular pericarditis
Dr. Bad: No steroids are needed
Dr. Good: Start steroids
Lesson: The current recommendation is to use corticosteroids for patients with constrictive tuberculous pericarditis and for those felt to be at high risk of developing the condition (i.e., large effusion, high level of pericardial fluid inflammatory cells, or early signs of constriction)

 

Make Sure

Situation: A patient with pyogenic meningitis developed complications.
Reaction:Oh my God! Why were antibiotics not given at the time when meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

eMedinewS Humor

Kidneys and Livers

Two old men were arguing the merits of their doctors. The first one said, "I don’t trust your fancy doctor. He treated old Jake Waxman for a kidney ailment for nearly a year, and then Jake died of a liver ailment." "So what makes you think your doctor is any better?" asked his friend.

"Because when my doctor treats you for a kidney ailment, you can be sure you’ll die of a kidney ailment.

Twitter of the Day

Dr KK Aggarwal: Heart risks detected by age 7 in overweight kids
Dr Deepak Chopra: Living our lives with love for all beings helps us realize our spirit’s true nature

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Can doctor-couple dispense drugs without license?

Dr P Kamalasanan, a private medical practitioner from Kollam in Kerala was punished last month for dispensing drugs without a license. Additional Sessions Judge, Kollam on August 7 sentenced Dr Kamalasanan of one-day "imprisonment" and also fined him Rs 1.20 lakh on the charges of running a pharmacy without a license from his clinic. Appearing before the court, Dr Kamalasanan reportedly served the sentence by remaining there till the rising of the court.

View1: Under the rules, only a single-doctor clinic is exempted from the process of obtaining a license before dispensing drugs and any clinic run with the help of more than one doctor falls under the category of hospital, for which it is mandatory to obtain a license to dispense medicines.

View 2: The Drugs & Cosmetics Act, 1940 & Rules, is very clear that private clinics, the place where professional activities of registered medical practitioners take place, are exempted from the drug licence. Private clinics are fully protected from harassment of drug controllers.

Clause–5 of Schedule-K of the Drugs and Cosmetics Rules allows a single doctor to stock, prescribe or dispense medicines without having a license, it does mandate a clinic run by more than one doctor to obtain a license.

A doctor cannot dispense medicines on the prescription given by another doctor, neither can a visiting doctor dispense medicines from that clinic.

Item 5. Drugs supplied by a registered medical practitioner to his own patient or any drug specified in Schedule C supplied by a registered medical practitioner at the request of another such practitioner if it is specially prepared with reference to the condition and for the use of an individual patient provided the registered medical practitioner is not (a) keeping an open shop or (b) selling across the counter or (c) engaged in the importation, manufacture, distribution or sale of drugs in India to a degree which render him liable to the provisions of Chapter IV of the Act and the rules there under." "Excerpts from a news in IMT"

medicolegal update
  1. Dear Sir, Very informative spiritual blog. Regards: Dr Shantanu

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