20th Issue

World Osteoporosis Day

October, 2012

Editor’s Choice - India’s Public Health Crisis: The Government Response

Special Article- Spotlight on Pharmacovigilance

Excecutive Council

Call for Articles

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Cover Story - Insights on Osteoporosis

Student Exchange Program

Homework

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Editor’s Choice PANACHE LIVE

2012-2013

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Cover Story

Insights on Osteoporosis

Osteoporosis (OP) is a systemic bone disease characterized as the diminishment of bone mass and damage of bone micro-structural. It causes the bone strength reduction and increase of osteopsathyrosis. Modern medical researches indicate that many bone diseases are accompanied with Osteoporosis. In the US, it is estimated that 10 to 15 billion dollars are used for treating osteoporosis every year. The indirect expenses for treating diseases resulted from osteoporosis, such as fracture, avascular necrosis, prolapse of lumbar intervertebral disc and osteoarthritis are even larger. Treating OP is one of the most urgent to be solved issue for medical and pharmaceutical industry.

The essential character of osteoporosis is the degradation of bone mechanical performance. It is very important to study the treatment mechanism that can restore the bone structure and strength. Osteoporosis is a multi-gene disease. Recent studies showed that most Western medicines aim single-target. It is believed that ADFR (Activate, Depress, Free, and Repeat) therapy better complies with the principal of bone reconstruction, and can greatly improve the treatment effectiveness.

Osteoporosis prevention

Some of the most important treatments for preventing osteoporosis include diet, exercise, and not smoking. These recommendations apply to men and women.

Diet- An optimal diet for preventing or treating osteoporosis includes consuming an adequate number of calories as well as optimal amounts of calcium and vitamin D, which are essential in helping to maintain proper bone formation and density.

Calcium intake- Experts recommend that premenopausal women and men consume at least 1000 mg of calcium per day; this includes calcium in foods and beverages plus calcium supplements. The main dietary sources of calcium include milk and other dairy products, such as cottage cheese, yogurt, or hard cheese, and green vegetables, such as kale and broccoli. A rough method of estimating dietary calcium intake is to multiply the number of dairy servings consumed each day by 300 mg. One serving is 8 oz of milk or yogurt, 1 oz of hard cheese, or 16 oz of cottage cheese.

Vitamin D intake- Experts recommend that men over 70 years and postmenopausal women consume 800 international units (IU) of vitamin D each day. This dose appears to reduce bone loss and fracture rate in older women and men who have adequate calcium intake (described above). Although the optimal intake has not been clearly established in premenopausal women or in younger men with osteoporosis, 600 international units of vitamin D daily is generally suggested.

Alcohol, caffeine, and salt intake-Drinking alcohol excessively (more than three drinks a day) can increase the risk of fracture due to an increased risk of falling, poor nutrition, etc., so it should be avoided.

A goal of treatment is to prevent the development of osteoporosis (if decreased bone mass or other risk factors exist) and to prevent further bone loss (especially if osteoporosis has already been diagnosed). There are two main types of drugs: antiresorptive drugs that slow the progression of bone loss and bone-building agents that help increase bone mass. Antiresorptive drugs are already widely available. Bone-building drugs are being developed by researchers and are just becoming available. Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva), Zoledronate (Reclast annual infusion), Raloxifene (Evista, postmenopause), Bazedoxifene (in development) are some of the drugs which are used as medication today for osteoporosis.

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Cover Story

Exercise- Exercise may decrease fracture risk by improving bone mass in premenopausal women and helping to maintain bone density for women after menopause. Furthermore, exercise may decrease the tendency to fall due to weakness.

Smoking-Stopping smoking is strongly recommended for bone health because smoking cigarettes is known to speed bone loss.

Reference: www.uptodate.com

www.osteomedicine.com

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Editor’s ChoiceIndia's Public Health Crisis:

The Government Responds

Indian government officials say the country's public health infrastructureis sorely deficient, but they argue it is improving because of several initiatives underway. They acknowledge the government has spent too little–around 1% of gross domestic product–on public health. But they say India will likely double that proportion to at least 2% in the five-year plan beginning in 2012.

“Now you will see more improvements,” said Anuradha Gupta, joint secretary of reproductive and child health at the National Rural Health Mission, a division of the Indian health ministry. But, she added in an interview: “There is still a very long road to cover.”

The poor state of public health, outlined in an exhaustive government report in 2005, led to the creation of the National Rural Health Mission, which is charged with improving healthcare in rural India, where the majority of the 1.2 billion people still reside. That health mission has spear-headed several grassroots programs to improve primary healthcare, and India's high rates of maternal mortality and infant mortality have declined in recent years. Still, these rates remain far higher than many other emerging economies.

K. Srinath Reddy, head of the Public Health Foundation of India, a public-private partnership focusing on research and training, says India's failure to develop a strong public health system has left it struggling with developing world problems—such as high rates of infant and child mortality as well as infectious diseases, such as malaria and tuberculosis.

On top of these developing world problems, India's dilapidated public health infrastructure now faces the dual burden of chronic diseases that accompany more affluent lifestyles—diabetes and heart disease.

“This results in the dual burden being more acutely felt” in India, Dr. Reddy said. “The total neglect of public health has conspired to create this crisis in India's health.”

P.K. Pradhan, managing director of the National Rural Health Mission, says in an interview that the agency has focused on improving primary healthcare by creating a new cadre of first-line medical officers, one for every 1,000 people, known as accredited social health activists. These part-time workers, chosen from the communities where they live, serve as the liaisons with the government's public healthcare system. But because healthcare in India is the primary responsibility of the states, Mr. Pradhan says his health mission's job is limited to conceptualizing these types of programs and funding them. Implementation falls to the states.

Indeed, much of the burden for public health falls on states, and while some, such as Gujarat, have made strides, many others, such as Uttar Pradesh, in central India, are performing poorly.

A team of central government investigators who visited 11 districts in Uttar Pradesh in May found gross misuse of funds from Mr. Pradhan's health mission by state and local authorities as well as “irregularities” in the way no-bid contracts were awarded for everything from hospital cleaning to drinking water supply, according to a summary of the investigators' report reviewed by The Wall Street Journal.According to the report, 620 of the 779 ambulances the state purchased were lying idle at a warehouse and more than 50% of government funds allocated between 2009 and 2011 had not yet been spent

Mr. Pradhan says misuse of funds was not widespread but limited to Uttar Pradesh, and that many states were doing a great job of implementing his health mission programs.Among the programs he touted were a series of incentives offered to health activists in an effort to improve maternal and child health. The government gives these health activists 350 rupees, or about $8, for every mother brought into a hospital to deliver a baby, he says.

The health mission also offers cash incentives to the mothers themselves for delivering their babies in hospitals: 1,400 rupees, or about $32, for every child born in a hospital, Mr. Pradhan says.

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Editor’s Choice

Mr. Pradhan says the program has been so successful that 17 million women delivered their babies in hospitals in 2010, compared to just 750,000 in 2006.

Still, he and Ms. Gupta acknowledge that many women show up at these government hospitals to find them overcrowded, understaffed and lacking medicines and supplies. They say these problems would be solved in coming years as the government focuses more on funding infrastructure improvements and training doctors and nurses, who are in extreme short supply in India.

“The glass is half full. We still need to fill it up completely,” Ms. Gupta said.Meanwhile, Mr. Pradhan says his health mission was adding incentives to draw even more mothers

into hospitals. He says there were still nine million at-home births in 2010. During the next few months, he says, the government would begin offering mothers another 1,200 rupees, $27, to cover the cost of transportation to hospital.

Millions of Indians are still so poor that the cost of traveling to a hospital is an impediment to delivering a baby there.

India's maternal death rate has improved, to 230 deaths per 100,000 births in 2008 from 280 in 2005, according to World Bank data. But its record is still worse than 116 other countries and far worse than China, which improved to 38 maternal deaths per 100,000 births from 44 during the same time period.India has made some strides in reducing infant mortality but still lags behind many other emerging economies and poorer countries. Infant mortality in India fell to 50 per 1,000 babies in 2009 from 57 in 2005, according to World Bank data, but India's rate is higher than China and Brazil, both of which lost 17 babies per 1,000 born in 2009. India also ranks behind some of its neighbors, including Bangladesh and Sri Lanka, the same data shows.

To improve India's high rate of infant mortality, Mr. Pradhan says, his health mission is also giving health activists cash incentives of 250 rupees, or about $6, for every baby that doesn't die in its first 28 days of life.

To improve critically ill babies' chances of survival, Mr. Pradhan says, the mission has offered states financing for the construction of special newborn care units in district hospitals. So far, 243 units have been set up in district hospitals, equipped with incubators and ventilators, he says. By next year, he says he hopes all district hospitals in India will have such centers.

Because clean water and good sanitation are vital to improving public health, Mr. Pradhan says, his mission also offers cash incentives of 10,000 rupees, or $226, to local governing bodies–known as panchayats, for every village health and sanitation committee that gets started. Mr. Pradhan says 440,000 such committees have formed in recent years.

He acknowledges the government's last comprehensive assessment of healthcare in India called for an increase in the proportion of government spending on healthcare to 2% from 1%, and that this has not happened in the intervening six years since the 2005 report was written.But Mr. Pradhan says he has recommended that the government, in its next five-year plan that is currently being written for 2012-17, aim to increase the proportion of GDP spent on healthcare to 3%. He says he expects the government will at least reach 2%.

In the years ahead, his health mission will focus on improving district hospitals, which must be better equipped and staffed so sick babies aren't rushed from there to city hospitals that are already overcrowded, he says. By the time premature and low-birth weight babies arrive at city hospitals that are equipped to save them, they are often too sick to save, he says.

“So what starts out as a low birth weight problem that can be solved ends up as a crisis with infections and malnutrition and the baby can't be saved,” he said.India's ruling coalition, led by the Congress party, has been espousing “inclusive growth” and has adopted several major social programs to try to improve life in rural India. But other social programs have taken priority.

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Editor’s Choice

“We have so many competing social priorities that have required enormous expenditure,” Ms. Gupta said. The government had spent millions of dollars on initiatives to improve education and rural employment. It also plans to massively increase food subsidies.

“Given the vastness of the country, improvement takes time,” said Mr. Pradhan. “But things are improving.”

Reference: http://blogs.wsj.com/indiarealtime/2011/07/30/indias-

public-health-crisis-the-government-responds/

Editor’s Choice PANACHE LIVE

2012-2013

S.E.O:- Gabriela Keerthana+91 8019289075

seoindiasp@gmail.com

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Editor’s Choice PANACHE LIVE

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Special Article

Spotlight on Pharmacogenomics

Pharmacogenomics is a science that examines the inherited variations in genes that dictate drug response and explores the ways these variations can be used to predict whether a patient will have a good response to a drug, a bad response to a drug, or no response at all. Thus, Pharmacogenomics is the branch of which deals with the influence of variation on drug response in patients by correlating or with a drug's or . By doing so, pharmacogenomics aims to develop rational means to optimize drug therapy, with respect to the patients' , to ensure maximum efficacy with minimal . Such approaches promise the advent of " "; in which drugs and drug combinations are optimized for each individual's unique genetic makeup

The way a person responds to a drug (this includes both positive and negative reactions) is a complex trait that is influenced by many different genes. Without knowing all of the genes involved in drug response, scientists have found it difficult to develop genetic tests that could predict a person's response to a particular drug. Once scientists discovered that people's genes show smallvariations (or changes) in their nucleotide (DNA base) content, all of that changed—genetic testing for predicting drug response is now possible. Such approaches promise the advent of " "; in which drugs and drug combinations are optimized for each individual's unique genetic makeup

Benefits of pharmacogenomics

More Powerful Medicines- Pharmaceutical companies will be able to create drugs based on the proteins, enzymes, and RNA molecules associated with genes and diseases. This will facilitate drug discovery and allow drug makers to produce a therapy more targeted to specific diseases. This accuracy not only will maximize therapeutic effects but also decrease damage to nearby healthy cells.

Better, Safer Drugs the First Time- Instead of the standard trial-and-error method of matching patients with the right drugs, doctors will be able to analyze a patient's genetic profile and prescribe the best available drug therapy from the beginning. Not only will this take the guesswork out of finding the right drug, it will speed recovery time and increase safety as the likelihood of adverse reactions is eliminated. Pharmacogenomics has the potential to dramatically reduce the the estimated 100,000 deaths and 2 million hospitalizations that occur each year in the United States as the result of adverse drug response.

More Accurate Methods of Determining Appropriate Drug Dosages-Current methods of basing dosages on weight and age will be replaced with dosages based on a person's genetics --how well the body processes the medicine and the time it takes to metabolize it. This will maximize the therapy's value and decrease the likelihood of overdose.

Advanced Screening for Disease- Knowing one's genetic code will allow a person to make adequate lifestyle and environmental changes at an early age so as to avoid or lessen the severity of a genetic disease. Likewise, advance knowledge of a particular disease susceptibility will allow careful monitoring, and treatments can be introduced at the most appropriate stage to maximize their therapy.

Better Vaccines-Vaccines made of genetic material, either DNA or RNA, promise all the benefits of existing vaccines without all the risks. They will activate the immune system but will be unable to cause infections. They will be inexpensive, stable, easy to store, and capable of being engineered to carry several strains of a pathogen at once.

pharmacology geneticgene expression single-nucleotide polymorphisms efficacy toxicity

genotype adverse effectspersonalized medicine

personalized medicine

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Improvements in the Drug Discovery and Approval Process- Pharmaceutical companies will be able to discover potential therapies more easily using genome targets. Previously failed drug candidates may be revived as they are matched with the niche population they serve. The drug approval process should be facilitated as trials are targeted for specific genetic population groups --providing greater degrees of success. The cost and risk of clinical trials will be reduced by targeting only those persons capable of responding to a drug.

Decrease in the Overall Cost of Health Care- Decreases in the number of adverse drug reactions, the number of failed drug trials, the time it takes to get a drug approved, the length of time patients are on medication, the number of medications patients must take to find an effective therapy, the effects of a disease on the body (through early detection), and an increase in the range of possible drug targets will promote a net decrease in the cost of health care.

Applications:

Pharmacogenomics has applications in illnesses like cancer, cardiovascular disorders, depression, bipolar disorder, attention deficit disorders, HIV, tuberculosis, asthma, and diabetes.- In cancer treatment, pharmacogenomics tests are used to identify which patients are most likely to respond to certain cancer drugs. - In behavioral health, pharmacogenomic tests provide tools for physicians and care givers to better manage medication selection and side effect amelioration. - Pharmacogenomics is also known as companion diagnostics, meaning tests being bundled with drugs.Examples include KRAS test with cetuximab and EGFR test with gefitinib. - Beside efficacy, germline pharmacogenetics can help to identify patients likely to undergo severe toxicities when given cytotoxics showing impaired detoxification in relation with genetic polymorphism, such as canonical 5-FU. - In cardio vascular disorders, the main concern is response to drugs including warfarin, clopidogrel, beta blockers, and statins.- Many people take medications called SSRIs, or selective serotonin reuptake inhibitors, for different psychiatric disorders. Many of the medications are metabolized by CYP450 enzymes, including fluoxetine, paroxetine, and citalopram.

Practical applications of pharmacogenomics today

Pharmacogenomics has found practical applications in treating cancer, depression, cardiovascular disease and drug metabolism. Example :- - Cancer pharmacogenomics- Pharmacogenomics study of statin therapy and cholesterol reduction·- Role of pharmacogenomics in individualizing treatment with SSRIs- Cardiovascular pharmacogenomics: current status, future prospects- Pharmacogenomics Drug disposition, drug targets, and side effects.

Special Article

Editor’s C

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PANACHE LIVE

2012-2013

HOMEWORK

*Answers on Page No: 11

Name the company..

1) This company is owned by Mr. Khwaja Abdul Hamied, the founder of the company, was born on October 31, 1898 and founded it in 1935 and was registered as a public limited company with an authorised capital of Rs 6 lakhs. July 4, 1939 was a red-letter day for this company when the Father of the Nation, Mahatma Gandhi, honoured the factory with a visit. In 1968 - manufactured ampicillin for the first time in the country, 1976 - launched medicinal aerosols for asthma, 1991 - Lauched etoposide, a breakthrough in cancer chemotherapy, in association with Indian Institute of Chemical Technology.

2) This company is owned by Mr. Ajay G. Piramal, it is one of India's foremost business conglomerates. Piramal Healthcare, Piramal Life Sciences, Piramal Glass and Piramal Realty are the flagship companies that operate within these sectors. It is one of the top 10 custom manufacturing Pharma companies in India, Europe and North America and 3rd largest manufacturer of inhalation anesthetics globally. It dedicated original drug discovery with focus on 4 therapeutic areas: Oncology, Inflammation, Diabetes and Anti-Infectives.

3) This company was founded in 2003, it has a subsidiary of this multinational pharmaceutical company. The company develops, manufactures and markets generic drugs as well as pharmaceutical and biotechnological active ingredients. As of 2011, it was the world's second largest generic drug company, with revenue of US$10.7 billion. In 2010, the company reported revenue of US$8.5 billion.

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EXECUTIVE COUNCIL FOR THE YEAR 2012-13

POSITIO N NAME CONTACT NO. E-MAIL ID Chairperson Chittoory Ratna

Geetardha 9581322211 chittooryrg@gmail.com

Vice Chairperson Kondeti Ranjit

Reddy

9962645850 ranjithreddykondeti@gmail.com

Hon. Secretary M ohit Durve 9920820009 durvester@g mail.com

Jt. Secretary Bharath Vikas 9538138189 bharathvikas007@g mail.com

Hon. Treasure Franklin Israel Sirra 7207625682 franklinindia .frank lin14@g mail.com

Editor Aditya N ar 9769176435 naraddy@yahoo.co.in

panachelive@gmail.com Public Relation

Officer

Anuj Shah 9930077486 shah.anuj507@g mail.com

Student Exchange Officer

Gabriela Keerthana 8019289075 seoindiasp@gmail.com

Pharmacy

Education Officer

P.Ajay 9550942300 a jju.nani@gmail.com

IPA-SF Contact

Person

Paya l Kikila 9820665989 paya l.k89@gmail.com

Public Health Officer

A.Pavan Kumar 9581398978 pavank umar.achanta@gmail.com

National Blood Donation

Co-ordinator

C.Charndra Shekar 9533332309 chanduvips@gmail.com

National Anti-TB Co-ordinator

Samhitha Reddy 9966090999 samhithareddy91@gmail.com

1. The selection of articles will solely be the discretion of the Publication Committee of IPA-SF.

2. Every article should have a word limit between 150 to 200 words.3. Articles should be typed in any normal font (Times New Roman) and should have a font size 12 and sent to panachelive@gmail.com in Microsoft Word Format.

4. Articles should be the Author's original work. If the article has been directly picked up from some source then it may amount to plagiarism and such Author's will be barred from any future participation.

5.The names of any references used should be clearly mentioned.6.The names of any Co-author/s should also be mentioned.7.The name of the institution/company of the Author/Co-author/s should be mentioned.8.The efforts of the Authors and Co-authors whose articles have been selected will be duly acknowledged.

CALL FOR ARTICLES

Answers to homework:

C E UA TM I CR AA L

H AP S

SN

OAI C

D IANI T IE OH N

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1. Cilpa Ltd. 2. Piraamal Healthcare Ltd. 3. Sandoz Ltd.

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