BEAUTIFUL LIFE IN STORIESLIFE IS AWESOME

DR. MAHESH BALDWA

MEDICO LEGAL WRITES

OUR REGULAR FEATURES

EDITOR’S POINT OF VIEW

THE DOCTOR’S PEOPLETHE DOCTOR’S PEOPLE“HOWEVER DIFFICULT LIFE MAY SEEM,THERE IS ALWAYS SOMETHING YOU CAN DO AND SUCCEED AT.”

OCTOBER 2017

Year : 2017 Pages :20 Volume : 98 : 525

-STEPHEN HAWKING

Medical and medico-legal field is always in a dynamic state, with a continuous influx of new knowledge, practices and judicial pronouncement. Everyday results of new researches new judicial pronouncements broaden our understanding of the subject, improve our medical and legal practices and change our approach and methods. Doctors should use their clinical acumen, experience, skill and knowledge in evaluating and using any information written in brochure supplied by drug manufacturers, techniques, procedures, equipment, but should not experiments without ICMR and institutional ethics committee approval. In clinically applying such knowledge or methods they should be careful of their own safety as well as that of others, including parties for whom they have a professional liability. When using any drug described herewith, readers are advised to check the most current information provided by the manufacturer. They should verify the recommended dose or formula, the method, route and duration of administration, side effects and contra-indications. The clinician should assess each patient individually and use their own

knowledge, skill and experience to make a diagnosis and determine the best peri-operative or procedural anesthetic regime for each patient . Contributors are individually responsible for their respective opinions, views, information and figures assimilated in their respective chapters and are hereof individually responsible for the source of such information.

To the fullest extent of the law, neither the publisher, nor the authors, contributors nor editors assume any liability for any injury and / or damage to persons or property as a matter of product liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

DISCLAIMER FOR DOCTOR’S PEOPLE MAGAZINE

LIFE IS AWESOME

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BEAUTIFUL LIFE THROUGH STORIES

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Advertising DirectorSanjay K. Mishra.

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Editorial Assistants

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Dr. Mahesh Baldwa

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THE DOCTOR'S PEOPLE TEAM BRIEF

INDEX

Dear friends and colleagues, Wishing you a Happy Diwali. This time I would like to draw your attention towards the health sector in rural areas.

Don't force young doctors to serve in rural areas Inadequate, inequitable distribution of the medical workforce remains a challenge across the globe, and India is no exception. The acute shortage of doctors in India, especially in rural areas, is a nuisance for the government, a problem that has not been successfully tackled till now.

Why IAS, IPS, Bank managers and people like them prefer rural postings These posting is attached with power. Doctors in rural areas, unlike these people are powerless, helpless with proper housing and food facilities.

Why IIT, IIM, CA, CS are not forced to do rural postings Even though they have a good role in rural areas, innovating and teaching rural people, but the government has not such policy for them.

Why force is ineffective The forced compulsion of one year of rural service after five and a half years MBBS course, just to be merely eligible to apply for a PG seat is, however a futile, ineffective and vastly unpopular method to fill this shortage. Not surprisingly, the new government has decided to scrap the proposal of one-year compulsory rural-service after completion of MBBS and asked the Medical Council of India (MCI) to include it instead as a part of the PG course. But that alone is not the solution. This is not “Maximum Governance and Minimum Government”

Rural stint to become mandatory for MBBS doctors aspiring to pursue a PG degree A regulation that makes a year-long rural stint mandatory for MBBS doctors who want to pursue a postgraduate medical degree (MD, MS) in the country.

Kerala abolishes compulsory rural service for medical students The state government has abolished the compulsory rural service (CRS) for medical students and replaced it with the voluntary rural service (VRS).

Odisha government makes three-year rural service made compulsory Odisha government makes three-year rural service made compulsory for students of Odisha government medical colleges will have to sign a bond making a commitment that they will serve in backward areas as posted by the government for three years or refund the cost of education, which could be Rs 5 lakh to Rs 15 lakh. According to a study published in medical journal The Lancet, over 8% of 25,300 primary health centers in the country were without a doctor in 2015, 38% were without a laboratory technician while 22% had no pharmacist. Nearly 50% of posts for female health assistants and 61% for male health assistants were vacant. In community health centers, the shortfall is huge -surgeons (83%), obstetricians and gynaecologists (76%), physicians (83%), and pediatricians (82%). Even in health facilities where doctors, specialists, and paramedic staff have been posted, their availability remain s in question because of high absenteeism. Incentives for rural work Government is now trying to incentives doctors to serve in the rural areas and remote villages. It is also planning to involve AYUSH practitioners to make primary health services available in such areas. At present, there is just one doctor for around 1,700 people in India, whereas the WHO stipulates a minimum ratio of 1: 1,000

One-year rural service will become mandatory for students who are in their final year of MBBS and those studying post-graduate courses in medicine Even as the Union government and Medical Council of India appear set to extend the duration of MBBS course by a year from the existing five-and-a-half from 2013-14, the State government

EDITOREDITOR’S POINT OF VIEW

Dr Mahesh Baldwa

Editorial by Dr. (Prof.) Mahesh Baldwa,

M.D, D.C.H, FIAP, MBA, LL.B, LL.M, PhD (law)SENIOR PAEDIATRICIAN & SENIOR MEDICO-LEGAL ADVISOR

Author/Editor of “Doctors know your Rights and Responsibilities under Consumer Act” [1994,1995] “Legal Problems in day-to-day Pediatric Practice” [2005,2010], “Desktop reference book on medicolegal

issues”[2007]” Textbook of Medicolegal

issues” [2012] “Textbook of Paediatric Anaesthesia”[2015]

Formerly Assistant Professor of Pediatrics at T.N. Medical College and Nair Hospital, Mumbai-400008

Ex. Asst. Professor JJ Hosp, Grant medical college

Ex. Professor, paper setter & examiner of law to postgraduate students of University Department of Law, University of Mumbai-400032

will make rural service mandatory for students clearing MBBS and post-graduate courses in medicine this academic year itself. A draft Bill on making one-year rural service mandatory for MBBS and post-graduate students of medicine on July 30 2017. Several Opposition MLAs cited the shortage of government doctors in rural areas and urged the government to promulgate an ordinance to make rural service mandatory for MBBS doctors if the passage of the Bill is delayed.

Maharashtra: 4,548 doctors lose registration for not serving in rural areas The Maharashtra government has cancelled the registration of over 4,500 doctors for failing to serve in rural areas for a year, which is mandatory, a Directorate of Medical Education and Research.

In all, 4,548 doctors have faced action. They graduated from a government-run medical colleges in the state between 2005 and 2012 and have neither served in rural areas nor paid the fine. “If the doctors do not serve the bond, they must pay a penalty, which is Rs 10 lakh for an MBBS, Rs 50 lakh for post-graduates and Rs 2 Crore for super-speciality doctors.” “The objective of the bond is to give doctors exposure to complicated cases. It is a highly educational and learning experience for newly-graduated doctors. Hence, we want them to go to rural areas and work for at least a year”

Young doctors say “Nobody is complaining about remuneration, but the real issue is poor infrastructure at primary health centres, where these doctors serve as a part of their bond.” “Except for a handful of medicines, no other drugs are supplied. Other essential materials provided are of low quality and in poor quantity. The quarters provided to these doctors are poorly maintained and still they are expected to stay there for a year” “The government forgets its responsibility of maintaining infrastructure and keeping a smooth supply of medicines and other necessary materials. Minor surgery has to carried out at PHCs and not a single equipment is available at the centres. In such cases, a doctor faces the wrath of the people,”

Karnataka government has made it mandatory for medical graduates who register with KMC Karnataka government has made it mandatory for medical graduates who register with the Karnataka Medical Council to undergo Compulsory Service Training with the Candidates Completed Medical Courses (Amendment) Bill, 2017. Therefore, all graduates who wish to practise in Karnataka now need to undergo one-year rural service, and this legislation was passed by the Karnataka State Legislative Assembly on June 21,2017.

Include rural posting in PG course The Union health ministry has reportedly asked the Medical Council of India (MCI) to include a year-long mandatory village posting for doctors pursuing postgraduate medical courses. The PG course duration is likely to remain the same. This will be a better option.

Heartiest season's greetings! Have a safe and Great Practice!

"So now I just have a faulty alarm clock

forever?" "Well, you could send it off to the

manufacturer with a letter explaining the

problem." "It was made in China. That's more

hassle than it's worth." "Then I would suggest taking it to a

repair shop." "That sort of thing usually costs more

than what you paid for something in the

first place." "I know." "Can I speak to the manager, please?" "The manager's off today." "Then can I speak to whoever's in

charge?" "You already are." "Is the manager in tomorrow?" "No." "When's he next in?" "It's a she." "Okay. When's she next in?" "Monday." "I'll come back Monday then." "Very good. Can I help you with anything

else today, sir?" "I doubt it." "Okay. Would you like to open a store

card? It's completely free and you get five

percent off every purchase." "No thank you." "If you open one today, you get a free

gift." "What's the free gift?" "An alarm clock."

“I'm proof! I'm telling you now that I

bought it here. In fact, I think you might

have even served me." "Did you register the product warranty

number online?" "No." "Ah well, that's a problem. How did you

pay for it? Cash or card?" "Cash." "If you'd paid on card you could've got a

statement from your bank proving you'd

made a purchase here and on what date." "Well, I paid cash." "The thing is, other stores sell this brand

too. You could've bought it anywhere." "I could. But I didn't. I bought it here and

it doesn't work and you owe me an alarm

clock." "When did you buy it?" "A few weeks ago.” "Our exchange

policy is twenty-one days, so you might be

out of warranty anyway." "I bought it last month sometime. I don't

remember the exact date." "We've been selling this model for a

couple of years now." "Are you saying I'm lying?”

"No, sir. I'm simply saying that you might

have bought it twenty-two days ago and in

that case, even with a receipt and the

original packaging, I wouldn't be able to do

anything to help." "Nothing?" "No.”

"Hello, sir. How may I help you?" “I'd like to return this alarm clock, please.""What's wrong with it?" "The alarm doesn't work." "How do you mean?""The alarm makes no sound." "Did you troubleshoot using the

manual?" "Yes." "And it still didn't work?" "No." "Okay. Do you have the receipt?" "No. I can't find it anywhere." "Then I can't give you a refund." "Oh no, you misunderstand. I don't want

a refund. I just want to exchange it for one

that works." "Okay. Do you have the original

packaging?" "No. I threw it away." "I can't do an exchange without the

original packaging." "It came in a plastic clamshell. I had to

hack it open with a knife. I don't

understand. Why do you need the

packaging?" "Our policy for all exchanges is that the

product be returned in its original

packaging." "It was just a load of ripped up plastic.

Why would I keep that?" "In case you needed to return the item." "I didn't think an alarm clock would

break after a few weeks. So you're telling

me you can't do anything to help?” "To do anything I need some proof of

purchase.”

BEAUTIFUL LIFE IN STORIES

EXCHANGE- Jon Langford

THE

signs of being impressed by peaceful persuasion, more violent methods came into vogue. Meetings were disturbed, Ministers were mobbed, policemen were bitten, and ordinary prison fare rejected, and on the eve of the anniversary of Trafalgar women bound themselves in tiers up the entire length of the Nelson column so that its customary floral decoration had to be abandoned. Still the Government obstinately adhered to its conviction that women ought to have the vote.

Then, as a last resort, some woman wit hit upon an expedient which it was strange that no one had thought of before. The Great Weep was organized. Relays of women, ten thousand at a time, wept continuously in the public places of the Metropolis. They wept in railway stations, in tubes and omnibuses, in the National Gallery, at the Army and Navy Stores, in St. James's Park, at ballad concerts, at Prince's and in the Burlington Arcade. The hithertounbroken success of the brilliant farcical comedy "Henry's Rabbit" was imperilled by the presence of drearily weeping women in stalls and circle and gallery, and one of the brightest divorce cases that had been tried for many years was robbed of much of its sparkle by the lachrymose behaviour of a section of the audience. "What are we to do?" asked the Prime Minister, whose cook had wept into all the breakfast dishes and whose nursemaid had gone out, crying quietly and miserably, to take the children for a walk in the Park. "There is a time for everything," said the King; "there is a time to yield. Pass a measure through the two Houses depriving women of the right to vote, and bring it to me for the Royal assent the day after tomorrow." As the Minister withdrew, Hermann the Irascible, who was also nicknamed the Wise, gave a profound chuckle.

"There are more ways of killing a cat than by choking it with cream," he quoted, "but I'm not sure," he added "that it's not the best way."

become elective, and failure to vote at any election falling within her area of residence will involve the female elector in a penalty of 10 pounds. Absence, unsupported by an adequate medical certificate, will not be accepted as an excuse. Pass this Bill through the two Houses of Parliament and bring it to me for signature the day after tomorrow.”

From the very outset the Compulsory Female Franchise produced little or noelation even in circles which had been loudest in demanding the vote. The bulk of the women of the country had been indifferent or hostile to the franchise agitation, and the most fanatical Suffragettes began to wonder what they had found so attractive in the prospect of putting ballot-papers into a box. In the country districts the task of carrying out the provisions of the new Act was irksome enough; in the towns and cities it became an incubus. There seemed no end to the elections. Laundresses and seamstresses had to hurry away from their work to vote, often for a candidate whose name they hadn't heard before, and whom they selected at haphazard; female clerks and waitresses got up extra early to get their voting done before starting off to their places of business. Society women found their arrangements impeded and upset by the continual necessity for attending the polling stations, and week-end parties and summer holidays became gradually a masculine luxury. As for Cairo and the Riviera, they were possible only for genuine invalids or people of enormous wealth, for the accumulation of 10 pound fines during a prolonged absence was a contingency that even ordinarily wealthy folk could hardly afford to risk. It was not wonderful that the female disfranchisement agitation became a formidable movement. The No-Votes-for-Women League numbered its feminine adherents by the million; its colours, citron and old Dutch-madder, were flaunted everywhere, and its battle hymn, "We Don't Want to Vote," became a popular refrain. As the Government showed no

It was in the second decade of the Twentieth Century, after the Great Plague had devastated England, that Hermann the Irascible, nicknamed also the Wise, sat on the British throne. The Mortal Sickness had swept away the entire Royal Family, unto the third and fourth generations, and thus it came to pass that Hermann the F o u r t e e n t h o f S a x e - D r a c h s e n -Wachtelstein, who had stood thirtieth in the order of succession, found himself one day ruler of the British dominions within and beyond the seas. He was one of the unexpected things that happen in politics, a n d h e h a p p e n e d w i t h g r e a t thoroughness. In many ways he was the most progressive monarch who had sat on an important throne; before people knew where they were, they were somewhere else. Even his Ministers, progressive though they were by tradition, found it difficult to keep pace with his legislative suggestions. "As a matter of fact," admitted the Prime Minister, "we are hampered by these votes-for-women creatures; they disturb our meetings throughout the country, and they try to turn Downing Street into a sort of political picnic-ground."

"They must be dealt with" said Hermann. "Dealt with," said the Prime Minister; "exactly, just so; but how?"

“I will draft you a Bill," said the King, sitting down at his type-writing machine, "enacting that women shall vote at all future elections. Shallvote, you observe; or, to put it plainer, must. Voting will remain optional, as before, for male electors; but every woman between the ages of twenty-one and seventy will be obliged to vote, not only at elections for Parliament, county councils, district b o a r d s , p a r i s h - c o u n c i l s , a n d municipalities, but for coroners, school inspectors, churchwardens, curators of museums, sanitary authorities, police-court interpreters, swimming-bath instructors, contractors, choir-masters, market superintendents, art-school teachers, cathedral vergers, and other local functionaries whose names I will add as they occur to me. All these offices will

GREAT WEEP- Saki Hermann the Irascible

The Story of the

-founder and Asana CEO believes that the mandate gives him and his team a solid amount of time each week for "focused, heads-down work."

3. Set limits for tasks, emails, and meetings

Wasted time and fewer results no

time for that. Successful folks know how to

make the most out of every minute and

meeting. For example, businessman and

former Nissan CEO Carlos Ghosn sets time

limits on a single purpose, non-operational

meetings. "The maximum is one hour and

30 minutes. Fifty percent of the time is for

the presentation, 50 percent is for

discussion."

Sheryl Sandberg sets another kind of limit -- the length of her emails. The Facebook COO and author says she responds to every single work email, but she saves time by keeping the responses short. "I would rather give a short, quick, incomplete answer than wait and do it better."

4. Establish "deep work" zones

Focus, focus, focus. This is the final and perhaps most important productivity secret. Take Bill Gates for example. In his20s, he adopted a productivity technique called "deep work." And so he would set aside stretches of time each week to do his most challenging work without any distractions -- no stopping, not even for sleep. Author Cal Newport, who wrote a book titled Deep Work, has said, "Deep work is important...not because distraction is evil, but because it enabled Bill Gates to start a billion-dollar industry in less than a semester."You might try all four approaches. Or chip away one tip at a time. The point is, these productive billionaires focus on doing a few things really well each day -- not a hundred things haphazardly.And that might be the ult imate productivity secret: focus. When you bring more and more of it into your life, you might be amazed at what you can accomplish in a single day.

What are your productivity secrets?

ways to be your best. And you can

learn these skills by following the

lead of some of the world's most

successful people.

Here are four secrets for getting

important work done, according to

these billionaires and successful

entrepreneurs:

1. Make room for big goals

Staying productive is about

setting big goals and then taking

serious steps to accomplish them.

This is why Mark Zuckerberg makes

room each year for a new challenge,

saying he wants to "learn new

things and grow outside my work at

Facebook." To date, he has done

everything from learning Mandarin

to meeting a new person each day

outside work -- big goals that fit into

his overall vision for work and life.

Amazon's Jeff Bezos takes a

backward approach to this goal-

oriented thinking -- literally. He

makes room for big goals by starting

with the customer's needs and

working backward to build skills to

get that work done faster. "We learn

whatever skills we need to service the

customer. We build whatever technology,

we need to service the customer.”2. Give

each day a job or theme

The way you structure your day can either hurt or help your productivity. When CEO Jack Dorsey was splitting his time between Square and Twitter, he stayed productive by giving each day a theme -- Mondays for management, Tuesdays for product, etc. As he explains, "There is interruption all the time, but I can quickly deal with an interruption and then know that it's Tuesday, I have product meetings, and I need to focus on product stuff."

Then there are the "no-meeting W e d n e s d a y s " a d o p t e d b y DustinMoskovitz. The Facebook co

Brian de Haaff

Forget the small hacks -- these

productivity secrets of Bezos and

Zuckerberg have material impact.

Frigid offices. Summertime weather.

Fantasy football leagues. What do these

three things have in common? Studies say

they all cause your productivity at work to

plummet.

You cannot always control your

environment, but you can control what

you get done. And more than that, you can

learn from others to be even more

productive. Sure, there are simple ways to

achieve more like finding the ideal room

temperature or cutting out Monday Night

Football.

But these are small hacks that will only

do so much. There are more meaningful

China's richest man does Michael Jackson dance routine The Alibaba chief executive Jack Ma has performed a dance routine to 40,000 employees at the firm's annual party. And it is not the first time he has dressed up on stage.

MLIFE IS AWESO E

I've never been someone to shy away from being different, and it's something I've always enjoyed about myself.

When I was in high school, I thrived onbeing a contemplate person and someone who was more interested in poetry and philosophy than my friends it's just what I wanted to do.

Nowadays, I place high value on authenticity and keeping things real, which in today's business world isn't quite the norm. In her book, Sophia's

transparency about her journey is infectious, and something that drew me in from the start.

4. Be original in what you do.“In whatever you do, you're not going to stand out unless you think big and have ideas that are truly original. That comes from tapping into your own creativity, not obsessing over what everyone else is doing.”This goes hand-in-hand with a few of the previous points, and is something that just makes sense to me. It's all about standing out and being different.Having an awesome life isn't the same thing as having a typical (or expected) life — it's about trying new things, going about them in unique ways and living the life you want to live, rather the life you think others want you to live.

5. Live out what you believe.“The heartbeat of Nasty Gal doesn't exist in one style or article of clothing. It's in the way we talk, the way we carry ourselves, and the way we see the world.”

In whatever you do, do it fully. Be sold on your approach to life, and make it everything you are. After all, you're the one in charge.

The way people will see you is really just a reflection of how you see yourself. If you're a happy person, people will see a happy person. If you're a person living an awesome life, people will see a person living an awesome life.

In the end, we have the luxury of determining where we go, what we do and who we bring — and all of this will be based on how we choose to live our life.

need to want it first. And when we want it we're motivated to be committed to the work it takes to stay there.Here are five quotes from Sophia's book that stood out to me. I hope these provide the perspective needed to help you experience an awesome life.1. Focus on your own journey.

“The energy you'll expend focusing on someone else's life is better spent working on your own.”Why bother wasting time and energy thinking about the journey of someone else when you can channel that into your own?

As easy as that sounds, I find myself frequently suffering from imposter syndrome and comparing myself to others. Obviously it's something I need to remind myself often, but beneath it all, I know it to be true.

If we embrace the “my grass is plenty green” mentality, I think we'll be in a much better place and on our way to experience a joy-filled life.

2. Invest in your own well-being.

“Spend money because it's an investment in your own own well-being, not because you're bored and have nothing else to do.”

I have no problem buying something if it makes me feel good about myself. A new pair of running shoes, an enjoyable book or a well-designed coffee mug — these are examples of item that bring value to my life, without a high cost.

Now, if we're talking about impulse items ones that are typically higher in price those are the ones I have to worry about and fight the temptation to buy. These are the things that typically bring instant regret upon transaction.

If it brings me happiness without regret, it's a green light in my eyes.

3. Embrace your uniqueness.

“The last thing the world needs is another boring person or another boring brand, so embrace all the things that make you different.”

ast weekend my wife and I spent a much-needed evening out on a date. We enjoyed fireside lattes, vanilla

cupcakes and some really great conversation. Afterwards, we had

some extra time, so we decided to drop by Barnes & Noble bookstore believe it or not, there are a few of those places still around.

While we were there, I walked past a book that I had seen a number of times and one that was recommended to me by many friends: #GIRLBOSS by Sophia Amoruso, Founder and Executive Chairman of Nasty Gal.

I felt a little weird picking it up, but I knew this was the story of her life, from a h o m e l e s s t e e n a g e r t o a s p i r i n g entrepreneur — in some ways, something I knew I'd related to. But something on the back cover caught my attention:#GIRLBOSS is more than a book … #GIRLBOSS is a movement.

When I started No Sidebar, it began as something personal that I was going through and was something I thought others would benefit from. But it quickly grew into a community of like-minded folks.

In short, No Sidebar became more than a blog — it became a movement.

We currently have 25 contributors, and many of those not only contribute to us, but they also write for their own blogs and websites. We have more than 19,000 fans on Facebook, and the engagement and reach we get there far exceeds my expectations. On any given post or photo, we get a tremendous amount of likes and shares — please keep that coming! I share these numbers with you because they matter.

They matter because they reflect a movement, we are experiencing together. At some point in our journey, we've all made the same decision, and it's something Sophia Amoruso writes about in her book, #GIRLBOSS: “You've already taken the first step toward an awesome life by simply wanting one.”

I believe we're all in a similar place, and this one very important thing is the key

AN AWESOME LIFE- Brian Gardner

THE FIRST STEP TOWARD

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Introduction

The Central Drugs Standard Control Organisation (CDSCO), the regulatory body for pharmaceuticals and medical devices, which constituted the core committee for the preparation of the NLEMD. The government has assembled a committee to create a National List of Essential Medical Devices which it intends to make available with assurances related to both quality and price. Along with a list of essential devices, the committee also a ims to produce guidel ines and procedures for the National List, as well as producing measures outlining the use of medical devices in preventive care.

Current scenario

At present, India has a National List of Essential Medicines (NLEM) published by the central government, which sets maximum limits on drug prices for essential medicines and some devices. NLEM comprises drugs that are listed after considering the disease burden, efficacy, safety, and comparative cost-effectiveness of the medicines. While medicines and devices listed in NLEM are required to be sold at the price fixed by the National Pharmaceutical Pricing Authority (NPPA), those in the non-scheduled list are allowed a maximum annual price hike of 10%. Drugs outside price control can be sold at prices set by the manufacturer.

How slashing of prices started

After slashing prices of coronary stents and knee implants, the government is capping prices of more medical devices deemed essential in health care centers to improve their affordability and accessibility a move that is expected to hit the medical device industry.

The government has constituted a core committee, which will start deliberations on a “war footing” to include essential devices under the ambit of a National List of Essential Medical Devices (NLEMD). The devices are intended to be available within health care systems with assured quality and at an affordable price.“The devices and medical equipment included under the list will be those which are required for the basic running of medical premises, including hospitals, clinics and those required to handle medical emergencies,”

Knee Implant

Implant like knee joint, hip implants, dental implants and stents have become unaffordable. A report by the NPPA, released earlier this month, found the 'joint component of knee system' was being sold to patients at a profit of 369 per cent. The landing cost stood at Rs 1.98 lakh per unit, while the maximum retail price was marked at Rs 9 lakh. Therefore National Pharmaceutical Pricing Authority (NPPA) introduced a price cap on knee implants. NPPA and the Maharashtra Food

and Drug Administration (FDA) have started their respective helplines for patients to register complaints of over-priced knee implants and various other implants. The NPPA has already requested hospitals to refund the extra amount charged on knee implants. NPPA and FDA will monitor each complaint against hospitals and manufacturers. Concerns of doctors

National Pharmaceutical Pricing Authority (NPPA) has reduced costs by 65 percent. Now doctors are concerned that international pharma companies may withdraw from Indian markets for specialized implantable products that i nvo l ve ex p e n s i ve re s e a rc h a n d development. In India, respectable international manufacturers like Zimmer, Johnson and Johnson (J&J), Biomet, Smith and Nephew, and Stryker are among the international companies that supply implants to private hospitals. The price regulation framework does not consider the different categories of implants and puts everything under one pigeon hole. Like in any device, there are different technologies and qualities that one needs to ensure which meets the requirement of individual patients. Pharma giants say that NPPA and FDA have done categorization for price caps is a very broad sense thus making it difficult for companies selling high-end quality products, difficult to sellat regular prices fixed by NPPA and FDA. Persona implant (Zimmer) and Atune (J&J) are specialized implants used for premium surgeries. These surgeries constitute 10 percent of total knee

SH H E OULD T ER BE

CA PI O P S FP NG N RICE O

MEDICAL IMPLANTS?( o

wa1. Dr. Pr f.) Mahesh Bald ,

D C A

i d l d o rf a

M. , D. .H, FI P, MBA, LL.B, LL.M, PhD (law) Senior Pediatric an & Me ico egal A visorF rme ly Assistant Professor o Pedi trics at

c l e al t

p G Me

T.N. Medi al Co l ge nd Nair Hospita , Mumbai-8 Ex. Ass . Professor JJ Hos , rant dical College

o p er

o e y n v si y o

Ex. Profess r, ap r setter & examine of law to postgraduate students f Univ rsit Department of Law, U i er t f Mumbai. Baldwa

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3. Dr Namita Padvi, MBB , MD, DNB, PGDML, E i ate Hospi al Dubai

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4. Dr Varsha Baldwa, MBBS, MD, PGDML, Government Med ca ol eg , Kota, ajasth n

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implants. But these patients may suffer if the company decides to withdraw its premium product in the wake of price capping. But there are different types of material used for specialized implants, and research and quality differs in the products used for complex revision surgeries. The price capping should be encouraged for the majority of routine first time knee implant surgeries save and except those who requiring high quality implants for revision surgeries. There are different categories in the femoral or tibial implants. There is room for reduction in prices of routine implants and it is a good move, but new capping makes unclear how the pricing will be done for each category of implant. But irrespective of specification, the prices are uniform, with the price cap, a general knee implant will cost a patient 65 per cent less meaning from Rs 1.58 lakh to Rs 54,720, while revision implants' prices have been slashed by 58 to 81 percent. Doctors fear that knee implants may face a situation similar to stents after the price control was implemented, where manufacturers could no longer provide certain brands due to lower profits. Same thing may happen to knee implants meaning lower quality and lower prices.

The standard, widely used cobalt chromium in knee replacement surgery will now cost Rs 54,720 as against an earlier MRP of Rs 1,58,324. Similarly, the price of special metals like titanium and oxidised zirconium have been slashed by almost 70%, to Rs 76,600 from Rs 2.49 lakh. In case of revision knee replacement, which is usually done if the primary replacement fails, prices of implants have been cut by 59%.

Concerns of implant dealers

The Medical Technology Association of India (MTaI), an umbrella association of all pharma, medical device companies in the country, is reviewing the order and will soon submit its recommendations to the NPPA. According to officials, MTaI has been in touch with the NPPA over the price cap issue. The association includes Stryker, Zimmer, Smith and Nephew and all other manufacturers for medical devices.

Association of Indian Medical Device Industry (AiMeD), said that the move was disadvantageous for the growth of industries manufacturing medical devices.“Unlike the stent industry, the margins here in the orthopaedic industry were not very high,” he said, even though the NPPA found 400% trade margins on certain implants. “Also, it is an elective procedure, most commonly performed for patients from the upper classes of the society.” Knee implant is not a life saving device.

Cardiac Stent pricing

If any product falls under the National List of Essential Medicines, it needs to be regulated. Stents have been included in it now. NLEMs take care of 90 percent of the people. Basic stents are in NLEM. But those with modifications are in non-NLEM and still cost more. As far as quality or safety is concerned, there is no difference between the two. The cut in price of stents makes angioplasty more accessible. The National Pharmaceutical Pricing Authority (NPPA) recently fixed the price of bare metal stents at Rs 7,260 as against Rs 45,000 previously and of most used drug-eluting stents at Rs 29,600 as against Rs 80,000 to Rs 175,000. Both imported and domestic stents will cost the same. There are massive margins charged at each step in the distribution and supply of stents, and by the time the patient gets it, the increase from the original cost of the stent is often in the range of 1,000-2,000%.

How it happens and benefits to patients

All medicines under NLEM have to be notified as schedule-I drugs so that their p r i c e s ca n b e co nt ro l l e d . W i t h cardiovascular diseases on the rise, the number of angioplasties being performed has doubled in the country during the past 5 years.

Are low cost stents qualitatively poor?

Bare metal stents or Drug-eluting metallic stents have no difference in mortality, whether made in India or imported, as long as they are approved by the Drugs Controller General of India (DCGI) they have the same efficacy as well as they come under price control..

Special case for “Fourth generation hi-tech stents” cost

A health committee, comprising top cardiologists and scientif ic advisors decided to fix prices of stents for all generations. But a breakthrough technology-based stents will not be a part of this price fixing.

Three major companies, Abbott, Medtronic, and Boston Scientific, havefiled applications to the NPPA to withdraw their new-generation stents from the country, explaining that the current stent price cap would make the sale of these products unviable in India. However, the Indian government rejected the a p p l i c a t i o n s f r o m t h e s e companies, citing clauses from DPCO (Drug Price Control Order) 2013. Whether the pressure by

top MNCs will force some policy refinements or if the government will be ready to let go of new-generation stents that is something to keep a close eye on in the near future.

Dangers of such price control could be circumvented

“The impact of capping the prices will be nullified if hospitals further hike their p r o c e d u r e a n d o t h e r h o s p i t a l infrastructure utility costs”

“The cost of implants has reduced, it does not necessarily mean that everyone would be able to afford the surgery,” she said. “Even existing hospital costs are prohibitive. The government has to ensure that hospitals offer affordable surgeries and there is an urgent need to improve public sector hospitals and equip them to offer these surgeries so they actually become affordable.”

Way ahead

Even if there are exorbitant profits or margins being made price fixing still isn't the solution. Instead, the license issued to more manufacturers into the Indian market shall pave way for competition and lowering of price by market forces. Government should not create a monopoly by insisting upon no sole distributor arrangements, so creating market competition in that sector is the right way to reduce prices. But the solution to high implant prices as a result of sudden control the prices shall kill the stent and implant market by creating non-availability.

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Certain factors related to pregnancy and delivery may affect a woman's risk of having postpartum depression, a new study suggests.

The study showed that giving birth in the winter or the spring was linked to a lower risk of developing postpartum depression, as was having a baby at full-term. Using anesthesia during delivery also appears to lower the risk of postpartum depression.

"We wanted to find out whether there are certain factors influencing the risk of developing postpartum depression that may be avoided to improve women's health both physically and mentally," the study's lead author, Dr. Jie Zhou, said in a news release from the American Society of Anesthesiologists. Zhou is from Brigham & Women's Hospital in Boston.

About 10 percent of women suffer from anxiety or depression after childbirth, the r e s e a r c h e rs s a i d . S y m p t o m s o f postpartum depression include sadness, restlessness, agitation and decreased concentration.

Dr. Mitchell Kramer is chairman of obstetrics and gynecology at Huntington Hospital in Huntington, N.Y. He said women who are at high risk for postpartum depression include those who have a history of depression or anxiety, who suffered from the condition after a previous delivery, or who have a family history of mental problems.

Untreated, postpartum depression can interfere with mother-child bonding, the U.S. National Institute of Mental Health says.

Dr. Margaret Seide is a psychiatrist at Staten Island University Hospital in New York City. She said that mothers suffering from postpartum depression are more likely to neglect or abuse their baby.

"Excessive anxiety that's not relieved by

visits to their pediatrician , and failure to bond or take joy in their baby are signs of the condition," Seide said.

Treatment is available for women suffering from postpartum depression, Seide noted. These therapies include a nt i d e p re s s a nt m e d i cat i o n s a n d psychological counseling.

For the study, Zhou and colleagues reviewed medical records of more than 20,000 women. All had delivered babies from June 2015 through August 2017. Just over 800 (4 percent) of the women experienced postpartum depression.

The researchers found that being overweight or obese was tied to an increased risk of postpartum depression.The study wasn't designed to prove cause-and-effect relationships. But the authors have some theories as to why certain factors might influence the development of postpartum depression.

For example, mothers of babies born with a higher gestational age have a lower risk of depression. That may be because the baby is more mature, the researchers said."It is expected that the mother will do better and be less mentally stressed when delivering a mature, healthy baby," Zhou said.

White women had a lower risk of postpartum depression than women of other races/ethnicities, which could be due to socioeconomic status, Zhou suggested.

Overweight and obese women often have more complications during pregnancy and need more follow-up after childbirth, and this may account for their increased risk for postpartum depression, Zhou said.

Women who skip anesthesia during labor may increase the risk for postpartum depression, because the

pain of delivery might be traumatizing, or women who don't want anesthesia may have characteristics that make them more vulnerable to the condition, the researchers added.

According to Kramer, having or not having anesthesia during labor may be an important factor, especially among women already at high risk for postpartum depression.

"It's not unreasonable to counsel women who are at high risk to minimize the trauma and pain during delivery," he said.Kramer said he doesn't think that the season in which a baby is born is a significant factor in whether the mother will experience postpartum depression.

"I don't think it's anything that's so significant that I would counsel patients not to have your baby in the summer or fall," he noted.The researchers suggested that the lower risk of postpartum depression when babies are delivered in the winter and spring may be due to mothers enjoying indoor activities with their babies.

The report was presented Sunday at the meeting of the American Society of Anesthesiologists in Boston. Findings presented at meetings are typically viewed as preliminary until they've been published in a peer-reviewed journal.

POSTPARTUM DEPRESSION?Source : HealthDay News

SUMMER BABY, HIGHER ODDS FOR

A W SMEDIC L NE S UPDATE

Being in relatively poor financial health when middle-aged or older appears to significantly increase the risk for developing a disability or dying early.

The observation stems from an analysis of data from the United States and England that drew links between wealth and health among almost 20,000 people aged 54 to 76.

For example, over a 10-year period, Americans aged 54 to 64 who were in the lowest wealth bracket (with financial holdings of $39,000 or less) faced a 48 percent risk for developing a disability and 17 percent risk for dying prematurely, the investigators found.

By comparison, their peers in the highest bracket (with holdings equaling $560,000 or more) had a 15 percent disability risk and 5 percent premature death risk.

The fact that people in England are guaranteed cradle-to-grave government-run health care coverage, while Americans are not, did not seem to have much effect."We saw similar relationships in both the United States and England, which are two countries with very different health and social safety-net systems," explained Dr. Lena Makaroun, the study's lead author.

"We also saw the same pattern for older adults, both above and below age 65," she said.

Makaroun noted that in the United States, Medicare becomes available at age 65, and both countries also start dispensing retirement benefits in the form of U.S. Social Security and the State Pension in England around that age.

“Seeing similar results in both countries, and in both age groups, suggests that [additional] health care or [additional] financial benefits later in life may not be enough" when it comes to trying to improve the health prospects of people who enter their later years in poor financial shape, said Makaroun. She is a research fellow with the VA Puget Sound Health Care System and the division of gerontology and geriatric medicine at the University of Washington in Seattle.

For the study, the researchers focused on two groups of study participants -- those aged 54 to 64 ("middle aged"), and those aged 66 to 76.

Each person's wealth status was calculated based on their total assets -- including real estate, vehicles, retirement savings and investment accounts -- minus their total debts.

Disability status was assessed on the basis of whether participants could, on their own, get dressed, bathe, eat, get in and out of bed, and use the bathroom.

The researchers determined that, in both countries, the poorest people in their mid-50s or older faced a "high" absolute risk for becoming disabled or dying early. That absolute risk did rise among the older group, relative to the middle-aged group.But in relative terms, the link between being in the poorest financial health and the poorest physical health, compared with the richest individuals, held steady across the 54-and-up age spectrum in both countries.

Still, the study team also observed that even those who were only slightly better off than the poorest participants saw theirhealth prognosis markedly improve

Makaroun stressed that the study could not prove that poverty actually causes early death or disability. But she suggested that main stressors associated with poverty -- such as unstable housing, trauma and sleep problems -- may take a toll.

“And from our study it does not seem that universal health care alone can eliminate the inequalities in health outcomes for low-wealth individuals that we see," she said.

Co-author of an accompanying editorial, Dr. Martin McKee, a professor of European public health with the London School of Hygiene & Tropical Medicine, suggested that the connection between higher wealth and better health could have a lot to do with empowerment.

"Most poor people know what they should do to stay healthy," he explained. "However, if they are struggling with trying to hold down several poorly paid jobs, lack of child care, and debt, it is unrealistic to expect them to travel further and pay higher prices for healthy foods, to go to the gym, and the like."

Having resources also "seems to give people a more positive outlook on life, seeing the value of investing in their future through healthy activities," McKee added. "Essentially, they see a point in investing for the long term, while those who see the future as just more pain, worry and misery don't."

The study was published online Oct. 23 in JAMA Internal Medicine.

POVERTY Source : HealthDay News

DOES NO FAVORS FOR HEALTH

While obesity in pregnancy has long been linked to a higher risk for complications during childbirth, there's now another reason to avoid it: a late start to breast milk production.

That's the finding from a new study of more than 200 women with newborns who planned to breast-feed. The researchers found that delays in "lactogenesis" -- the production of breast milk within three days of delivery -- "occurred more frequently among women who were obese at the time of delivery."

The study highlights an issue many new moms have to deal with, said one pediatrician who reviewed the new study."Breast-feeding is hard for all mothers," said Dr. Sophia Jan, who directs pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y. "This study found that breast-feeding is even harder for mothers who were obese prior to pregnancy."

There are potential consequences for babies, too, she said.

"Newborns of mothers whose breast milk comes in late may lose more weight during those initial days and weeks after birth compared to newborns of mothers whose milk comes in within three days postpartum," Jan noted.

These babies also often end up on formula, which cannot match breast milk's nutritional goodness.

The new study was led by Diane Spatz, a professor of nutrition at the University of Pennsylvania School of Nursing. She and her colleagues tracked the onset of breast milk production in 216 women who gave birth to single babies.

The study found that breast milk production was delayed to beyond three days post-delivery in about 46 percent of non-obese women.

However, that rose to almost 58 percent for new moms who were statistically obese.

Statistical obesity begins with a body mass index (BMI) of 30 or above -- BMI being a measurement of height versus weight. For example, a 5-foot-5-inch woman weighing 180 pounds has a BMI of 30.

"Because nearly 1 in 4 women in the United States begins pregnancy with a body mass index [BMI] equal to or greater than 30, the study underscores the n e e d f o r t a r g e t e d interventions and support to help these women achieve their personal breast-feeding goals," Spatz said in a university news release. Dr. Jennifer Wu, an o b - g y n w i t h L e n o x HilldHospital in New York City, agree.

The new findings should at least let obese women understand that their milk may "come in later," she said, and "encourage them to continue to try breast-feeding for longer."

According to Wu, "hospitals need to partner with milk banks to help meet the needs of these newborns. Patients should be reminded that there are merits to even small amounts of breast milk for their babies."

For her part, Jan said the study raises the question as to why weight gain can slow breast milk production. More studies that try to answer that question would help identify targets for interventions, she said.The study will be published Nov. 1 in the Journal of Human Lactation.

BREAST MILK MAY ARRIVE LATE FOR OBESE NEW MOMSSource : HealthDay News

Source : HealthDay NewsTYPE 2 DIABETES?

DO STATINS RAISE ODDS FOR

Cholesterol-lowering medications known as statins may lower your risk of heart disease, but also might boost the odds you'll develop type 2 diabetes, new research suggests.

"In a group of people at high risk of type 2 diabetes, statins do seem to increase the risk of developing diabetes by about 30 percent," said the study's lead author, Dr. Jill Crandall. She's a professor of medicine and director of the diabetes clinical trials unit at Albert Einstein College of Medicine in New York City.

But, she added, that doesn't mean anyone should give up on statins.

"The benefits of statins in terms of cardiovascular risk are so strong and so w e l l e s t a b l i s h e d t h a t o u r recommendation isn't that people should stop taking statins, but people should be monitored for the development of diabetes while on a statin," she explained.

At least one other diabetes expert agreed that statins are still beneficial for those at risk of heart trouble.

Dr. Daniel Donovan Jr. is professor of medicine and director of clinical research at the Icahn School of Medicine at Mount Sinai Diabetes, Obesity and Metabolism Institute in New York City.

“We still need to give statins when LDL (bad) cholesterol isn't under control. A statin intervention can lower the risk of a cardiovascular event by 40 percent, and it's possible the diabetes may have been destined to happen," he said.

The new study is an analysis of data collected from another ongoing study. More than 3,200 adults were recruited from 27 diabetes centers across the United States for the study.

The research goal was to prevent the progression of type 2 diabetes in people with a high risk of the disease, Crandall said. All of the study participants were overweight or obese. They also all showed signs that they weren't metabolizing sugar properly at the start of the study, but not poorly enough to be diagnosed with type 2 diabetes.

Study volunteers were randomly chosen to get treatment with lifestyle changes that would lead to modest weight loss, the drug met for min or a placebo pill.

At the end of the intervention, they were asked to participate in the 10-year follow-up program. They had their blood sugar levels measured twice a year, and their statin use was tracked, too.

At the start of the follow-up period, 4 percent of participants were taking statins. At the end, about one-third were.

Simvastatin (Zocor) and atorvastatin (Lipitor) were the most commonly used statins

The study was an observational study, so it couldn't show a cause and effect relationship. However, Crandall said the researchers measured levels of insulin secretion and insulin resistance. Insulin is a hormone that helps the body usher the sugar from foods into the body's cells to be used as fuel.

Crandall said insulin secretion goes down when people take statins. Less insulin would lead to higher blood sugar levels. She said there was no indication that statins affected insulin resistance.

Donovan added that the study provides important information. "But I don't think the message is stop statins," he said. "Most people are probably developing heart disease before diabetes, and it's important to treat the risk factors you can."

Though they weren't included in this study, people who already have type 2 diabetes should be closely monitored for increases in blood sugar when they start taking a statin, Crandall said. "The evidence so far is rather limited, but there have certainly been anecdotal reports

of blood sugar being higher when someone starts statins," she said.

She also suggested that blood sugar levels likely aren't as much of a concern for those without diabetes or risk factors for diabetes when starting a statin. Besides excess weight, those risks include older age, high blood pressure and a family history of diabetes.

Crandall added that there are many people 50 and over with prediabetes who don't know it, so it could be an issue for them.

Findings from the study were published online Oct. 23 in BMJ Open Diabetes Research & Care.

THERE IS NO SAFE AMOUNT OF

ALCOHOL DURING PREGNANCY, NEW STUDY SHOWSSource : HealthDay News

Any amount of alcohol exposure during

pregnancy can cause extreme lasting

effects on a child, according to new

research from Binghamton University,

State University of New York.

A team of researchers led by Marvin

Diaz, assistant professor of psychology at

Binghamton University, determined that

even a small to moderate amount of

alcohol exposure produces significant

amounts of anxiety in offspring, lasting

through adolescence and into adulthood.

This research differed in its use of only low

levels of alcohol exposure, whereas prior

studies used high levels of exposure to

reach the same conclusion.

"There's been a lot of media coverage

on whether there's a safe amount of

alcohol to drink," said Diaz. "This study

shows that there isn't."

Pregnant rats were exposed to ethyl

alcohol vapor for a six-hour period on their

twelfth day of gestation; this was the only

time the rats were exposed to alcohol. The

offspring were then subjected to a

series of anxiety tests. The researchers

found that anxiety was most apparent in

male rats during their adolescence.

After entering adulthood, the effects

were opposite, with ethanol exposed

male rats showing reduced anxiety,

while the females still appear to be

unaffected.

"The most important takeaway

from this study is that the effects we

studied on the rats only took one day of

exposure to produce -- just six hours,"

said Diaz.

Diaz is interested in taking this

research further, to determine exactly

what changed in the brain to cause such

increased levels of anxiety after alcohol

exposure, and to see why the effects are

apparent in male rats but not females.

For millions of Americans, their world is dissolving into an unrecognizable blur. Diabetic retinopathy is an eye disease affecting one-third of the estimated 30 million Americans who struggle with diabetes. As the patients' vision slowly fades, it never recovers and few treatments are available.

Researchers at University of Utah Health have identified a protein (ARF6) that when inhibited reduces diabetic retinopathy, a condition that results when blood vessels at the back of the eye leak fluid into the eye, impairing vision. Published in the October 23 issue of The Journal of Clinical Investigation, these results offer an opportunity to develop new treatments for this eye disorder.

"What is exciting about this study is that we and our collaborators identified a compound (NAV-2729) that inhibits ARF6, which is crucial for the development of diabetic retinopathy," explained co-first author Weiquan (Wendy) Zhu, Ph.D., research assistant professor in Internal Medicine at U of U Health.

Studies were conducted in rodents treated to simulate the diabetic condition. By injecting NAV-2729 into the eyes of these animals, vessel leakage, as well as, the overgrowth of blood vessels, another driver of disease, were significantly reduced.

The long-term efficacy of treatment remains unknown. It also remains to be determined whether the drug will be suitable as a therapeutic intervention for people.

“ARF6 acts like a traffic cop at a busy intersection within a cell," explained Dean

Li, Ph.D.,vice president, Head of Transnational Medicine at Merck & Co. and senior author on the paper. Li is the former associate vice president and chief scientific officer at U of U Health and co-founder of Navigen Inc. "ARF6 orchestrates multiple inflammatory signals that contribute to inflammation common in many diseases, including diabetic eye disease."

ARF6 amplifies and maintains the signal protein (vascular endothelial growth factor (VEGF)) receptor, which stimulates a series of cascading responses, leading to a diseased state in the eye.

Today, patients with diabetic eye disease can receive monthly anti-VEGF injections directly into the eye to reduce inflammation, a treatment that is successful in only 40 percent of patients. In the study, injections of NAV-2729 into the eyes of diabetic mice were more effective in reducing blood vessel leakage than the anti-VEGF injections.

"Diabetic retinopathy can develop over time, leading to dramatic vision loss that may not be improved with glasses," said M. Elizabeth Hartnett, M.D., professor in Ophthalmology and Visual Sciences at Moran Eye Center and a contributor to this study. "New treatments are needed, because diabetic retinopathy is increasing world-wide and anticipated to increase more in the next decades."

Also new to this study, the researchers identified two proteins ? GEP100 and ARNO ? that play a critical role in the signaling process. These proteins activate ARF6 at two different locations in the cell to continue the signaling cycle. “We think these results are important because they identified a mechanism by which ARF6

controls VEGF receptor signaling and therefore may have much broader implications, extending to other diseases that involve VEGF receptor activation, such as cancer," said Shannon Odelberg, Ph.D., research associate professor in Internal Medicine at U of U health and corresponding author on the study.

According to Odelberg, ARNO activates ARF6, which shuttles the VEGF receptor into the cell where its signal can be amplified. GEP100 activates ARF6 to recycle the VEGF receptor back to the outside of the cell where it can be reactivated for the signaling process to begin again. This signaling loop triggers disease by increasing blood vessel leak and the formation of new and weak blood vessels.

The team of researchers plan to continue to explore the role of ARF6 in other inflammatory diseases.

NAV-2729 was identified by A6, a subsidiary company of Navigen Inc, a Salt Lake City drug discovery and development company, whose research scientists contributed to this study. According to Zhu, A6 researchers are pushing forward with development of other compounds, which are more suitable as potential new treatments.

DIABETIC BLINDNESS: PROTEIN THAT PLAYS KEY ROLESource : HealthDay News

Source : HealthDay NewsA DAY KEEP LIVER CANCER AWAY?

CAN AN ASPIRIN

A new study presented this week at The Liver Meeting® -- held by the American Association for the Study of Liver Diseases found that daily aspirin therapy was significantly associated with a reduced risk in hepatitis B virus - related liver cancer.

Hepatitis B is a viral infection that attacks the liver. HBV can be contracted through contact with an infected person's blood or other bodily fluid, and the infection can either be acute or chronic.

According to AASLD's Guidelines for Treatment of Chronic Hepatitis B, an estimated 240 million people worldwide have chronic HBV, and the highest prevalence of the virus is in Africa and Asia. Death from HBV is commonly due to the development of cirrhosis (scaring of healthy liver tissue) or hepatocellular carcinoma (liver cancer).

Past research suggests that daily

aspirin therapy -- which is often prescribed

to prevent cardiovascular disease -- may

also prevent the development of cancer.

However, clinical evidence is lacking for

the effectiveness of aspirin therapy in

preventing HBV - related liver cancer.

Researchers at Taichung Veterans

General Hospital in Taichung, Taiwan; E- Da

Hospital in Kaohsiung, Taiwan; Fu Jen

Catholic University in New Taipei City,

Taiwan ; and National Taiwan University

c l in ica l ev idence support ing the chemopreventive effect of aspirin therapy on liver cancer remains limited. Therefore, we conducted a large-scale cohort study to evaluate the association of aspirin therapy with HBV-related liver cancer.”

The researchers retrieved medical records from the National Health Insurance Research Database between 1998 and 2012 for their study. They screened records of 204,507 patients with chronic hepatitis B, and excluded patients with other forms of infectious hepatitis. After excluding patients with liver cancer before the follow-up index dates, 1,553 patients who had continuously received daily aspirin for at least 90 days were randomly matched 1:4 with 6,212 patients who had never received anti- platelet therapy by means of propensity scores consisting of baseline characteristics, the index date and nucleos (t)ide analogue (NA) use during follow-up. The researchers analyzed both cumulative incidents of and hazard ratios for HCC development after adjusting for competing mortality.

Cumulative incidence of liver cancer in the group treated with aspirin therapy was significantly lower than that in the

untreated group in five years. In their multivariate regression analysis, the researchers found aspirin therapy was independently associated with reduced liver cancer risk. Sensitivity subgroup analyses also verified this association. Older age, male gender, cirrhosis and diabetes also were independently associated with an increased risk, but nucleos(t)ide analogue or statin use was associated with a decreased risk.

“For effectively preventing HBV-related liver cancer, the findings of this study may help hepatologists treat patients with chronic HBV infection in the future, particularly for those who are not indicated for antiviral therapy. We are pursuing prospective investigations for further confirming the findings," says Dr. Lee.

Hospital cohort study to determine if aspirin therapy could, indeed, reduce liver cancer risk.

"Liver cancer is the second leading cause of cancer death worldwide, and HBV is the most prevalent risk factor in our region, says Teng-Yu Lee, MD, PhD, a researcher in the Department of Gastroenterology at Taichung Veterans General Hospital and lead investigator in the study. "HBV - related liver cancer is therefore a major public health issue with a severe socioeconomic impact."

Although current antiviral medicines such as nucleos (t)ide analogue therapy could significantly reduce liver cancer risk, Dr. Lee notes these therapies do not c o m p l e t e l y e l i m i n a t e t h e r i s k . Additionally, Dr. Lee says most HBV carriers are not indicated for antiviral therapy, so another effective way of reducing liver cancer risk needs to be developed.

“Aspirin has been investigated to explore its chemopreventive effect in cancers that are related to chronic inflammation, particularly in the prevention of colorectal cancer. However,

in Taipei conducted a nationwide

RHEUMATOID ARTHRITIS LINKED TO AN INCREASED RISK OF COPD

New research suggests that rheumatoid arthritis may increase the risk of developing chronic obstructive pulmonary disease (COPD). The findings, which appear in Arthritis Care & Research, indicate that greater vigilance may be needed to protect the respiratory health of individuals with chronic inflammatory conditions.

Research has demonstrated an a s s o c i a t i o n b e t we e n C O P D a n d inflammation, raising the question of whether prolonged inf lammatory conditions such as rheumatoid arthritis predispose individuals to COPD. To investigate, a team led by Diane Lacaille, MD, FRCPC, MHSc, of Arthritis Research Canada and the University of British Columbia, examined information on individuals in the province of British Columbia who were diagnosed with rheumatoid arthritis between 1996 and 2006, and compared it with information on matched individuals in the general population. The analysis included 24,625 patients with rheumatoid arthritis and 25,396 controls.

The investigators found that the incidence of COPD hospitalization was greater in patients with rheumatoid arthritis than in the general population. After adjusting for potential confounding factors, individuals with rheumatoid arthritis had a 47% greater risk of needing to be hospitalized for COPD than controls. The increased risk remained significant after modeling for smoking and with varying COPD definitions.

"These findings are novel because it has only recently been recognized that inflammation plays a role in the development of COPD, and clinicians treating people with rheumatoid arthritis are not aware that their patients are at increased risk of developing COPD," said Dr. Lacaille. "Our results emphasize the need to control inflammation, and in fact to aim for complete eradication of inflammation through effective treatment of rheumatoid arthritis."

Dr. Lacaille added that clinicians and people living with rheumatoid

Source : HealthDay News

arthritis should be vigilant in watching for early symptoms of COPD. "That way, appropriate tests can be administered to diagnose COPD early , at the onset of symptoms , so that effective treatments for COPD can be initiated before irreversible damage to the lungs occurs." Such steps will improve long-term outcomes for patients and reduce the costs of COPD. The study also points to the need to address COPD risk factors -- such as smoking in people living with rheumatoid arthritis.

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