A whopping 66.11 per cent of children possess "abnormal levels of sugar" in their body, found a pan-India survey. Of the 17,000 children screened over a period of three years, a total of 51.76 per cent male children were found having abnormal HbAlc (an indicator of diabetic control) levels, with the highest prevalence among children in the western zone. "Western Zone had highest percentage of abnormality with 68.48 per cent while eastern and northern zone had 61.48 per cent and 64.71 per cent, respectively. Among the four zones, southern India showed the lowest percentage of abnormality with 54.95 per cent," said Leena Chatterjee, Director, Fortis SRL Labs and SRL Strategic Initiatives, which carried out the survey. The findings of the survey, conducted between 2012-2014, were released today on the occasion World Diabetes Day. The survey checked the response to diabetes therapy and diagnosis of pre-diabetes and diabetes in the children through HbA1c tests, said Chatterjee. "Rapid urbanisation, change in eating habits and shifting more focus to indoor activities have resulted in dramatic lifestyle changes leading to chronic condition associated with abnormally high levels of sugar in children," said Chatterjee. Chatterjee asked people not to become alarmed with a diagnosis of pre-diabetes citing it is a warning sign and a chance to make changes for the better. "We understand that it's pretty difficult to cut out sugar completely, but one can start by skipping it in milk, choosing non-sugary breakfasts, avoiding juice beverages, and limiting bread, pasta and rice. "It is essential that children and adolescents get themselves tested if they are overweight with body weight exceeding 120 per cent of the ideal weight or they have positive family history among first and second degree relatives and if they have signs of insulin resistance," Chatterjee said. According to World Health Organization, 80 per cent of all new cases of diabetes are predicted to occur in the developing countries by 2025. In 2012, an estimated 1.5 million deaths were directly caused by diabetes and more than 80 per cent of diabetes deaths occur in low and middle income countries.(PTI)
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Hundreds of millions of people worldwide could benefit from more intensive treatment to lower blood pressure, according to new research from The George Institute for Global Health at the University of Oxford. Principal Director, Professor Stephen MacMahon, said the research, which was published in The Lancet, showed thatthe lower the level of blood pressure achieved, the greater the reduction in heart attacks and strokes. “We have previously shown that lowering blood pressure below 140 mmHg is of great benefit to people with diabetes and people who have had a previous stroke, but this new finding indicates that the benefits are much wider,” Prof MacMahon said. “By setting blood pressure targets too high, we have sharply limited the benefits that could have been achieved with blood pressure lowering drugs over the past few decades.” “We urgently need new recommendations encouraging both doctors and patients to aim for much lower levels of blood pressure than were previously thought necessary.” The study, Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis found: · Patientsreceiving more intensive treatment had their blood pressure lowered to 133 mm Hg, compared to 140 mm Hg among those receiving less intensive treatment · This produced a 13% reduction in heart attacks and a 22% reduction in strokes · Even patients who had a blood pressure less than 140 mmHg to begin with, benefited from treatment These findings are supported by a second study in the New England Journal of Medicine (NEJM), whichalso shows that setting lower blood pressure targets reduces the risk of stroke, heart attack and death. Executive Director for the Institute, Professor Vlado Perkovic was asked to write the editorial for the research and said it was a game changer. “There are very few treatments proven to reduce the risk of death among mostly healthy people, but lowering blood pressure to low target levels is now one of them,” Prof Perkovic said. “The Systolic Blood Pressure Intervention (SPRINT) trial enrolled more than 9,000 people with blood pressure levels above 130 mm Hg who were at high risk of heart disease and stroke. “It compared standard treatment goals of 140 mmHg or less with more aggressive goals of 120 mmHg or less. “People treated to the lower target had their risks of major complications, including death, reduced by a quarter.” Professor Perkovic said the research changes everything when it comes to understanding and treating high blood pressure. “Now, with this research, more people can be treated appropriately with lifestyle modification, and if they are at high risk, blood pressure lowering medicines, achieving a big reduction in their risk of death,” he said. “Globally, there are several billion people with blood pressure levels that are too high, which underscores the need for better prevention, like reducing salt intake. “These latest results confirm that medical treatment for those at high risk of stroke or heart attack needs to be more intensive, and when this is achieved the benefits will be very worthwhile.” Professor of Global Health at the Institute, Anthony Rodgers said it had taken far too long to get to this point. “The George Institute for Global Health has been recommending these changes for many years,” Prof Rodgers said. “Many people have said the evidence has been ‘hiding in plain sight’ for a while now – but this will really be a tipping point. “The big challenge now is implementing these effective treatments more widely among people at high risk.” (BW Online Bureau)
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Charu Bahri/IndiaSpendA 72-year-old woman in Bengaluru consulted a hospital physician about a severe skin infection and fever. She had previously consulted a couple of general practitioners, who prescribed a course of penicillin for three days and fluoroquinolones—both antibiotics—for two days. There was no relief. So, the consultant ordered a culture sensitivity test of pus from the skin lesions to identify what was causing her ailment and figure out what antibiotics it would respond to. Here’s what the report said:* Pathogen: Klebsiella pneumoniae* Susceptible to: No antibiotic* Resistant to: All antibiotics, including advanced drugs like fluoroquinolones, carbapenems and even the last resort combination usually reserved for severe cases of ICU infection, colistin-tigecycline. With nothing to offer the patient, save a prescription for paracetamol to keep her fever in check, the doctor sent the patient home, and asked her to return after a week. In such cases, sometimes, the body’s immunity kicks in and throws off the infection, the physician, Sheela Chakravarthy, consultant (internal medicine) at Fortis Hospital, Bengaluru, told IndiaSpend. Sometimes, resistance to one or more drugs abates, allowing treatment to be resumed. Chances of that happening are greater at home, not in the hospital, which is a more infectious space where sepsis—a disproportionate and potentially life-threatening immune response by your body to an infection—could set in, she explained. Most patients, however, succumb to the infection. Chakravarthy faces situations where she has nothing to offer patients, not because they are suffering from terminal illnesses, such as some forms of cancer, but even when they present with what should be curable infections, “almost every day”, she said. What Chakravarthy described is the consequence of rampant, inappropriate consumption of antibiotics, spurring the development of superbugs, as the recently released State of the World’s Antibiotics Report 2015 affirms.India is fast becoming home to superbugs Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus are three of the deadliest pathogens facing humanity, according to the World Health Organisation (WHO). And India is gradually but increasingly becoming home to multi-drug resistant strains of these pathogens, according to the State of the World’s Antibiotics Report 2015. Escherichia coli is notorious for causing food poisoning and urinary tract infections. In 2010, 5% of Escherichia coli samples in India were resistant to carbapenems, last-resort antibiotics for bacteria that are resistant to first-, second- and third-line drugs. By 2014, 12% of E. coli samples were similarly resistant.Klebsiella pneumoniae causes pneumonia, septicaemia and infections in the urinary tract, lower biliary tract and at surgical wound sites, to name a few. While 29% of Klebsiella pneumonia isolates were resistant to carbapenems in 2008, this increased to 57% in 2014. For comparison, fewer than 10% of Klebsiella pneumoniae infections in Europe are carbapenem-resistant. Staphylococcus aureus can cause skin and soft tissue infections, bloodstream infections, pneumonia and surgical site infections. A particularly nasty strain of, methicillin-resistant Staphylococcus aureus (MRSA), is common in India and increasingly hard to treat. MRSA was responsible for 40% of post-surgical site infections, according to a 2013 study by the Jawaharlal Nehru Medical College and Hospital, Aligarh. Between 2009 and 2014, the incidence of MRSA in India has risen from 29% to 47%. People with MRSA are 64% more likely to die than people with a non-resistant form of the infection, according to the WHO. How ignorance is spurring the development of superbugs “My understanding of antibiotic is that it stops bacteria growing in body…I think amoxicillin is for throat infection.” – An urban participant of a study of perceptions about antibiotic use and resistance among urban and rural doctors, pharmacists and public in Vellore. Mox, short for amoxicillin, has become a household word across India. A little knowledge, however, is a dangerous thing. It encourages self-medication, even when medicine is unnecessary, such as when people suffer viral infections—against which drugs are ineffective. Most viral fevers dissipate on their own after a few days with rest, hot fluids and a check on the fever. Consuming too many antibiotics contributes to pathogen drug resistance. “Resistance is an outcome of accumulated use,” said Ramanan Laxminarayan, vice president, Research and Policy, Public Health Foundation of India, and director and senior fellow, Centre for Disease Dynamics, Economics & Policy, US, and co-author of the State of the World’s Antibiotic Report 2015. Indians often rely on corner pharmacists, whose knowledge of dosages may be limited. Here’s what a rural pharmacist participant of the aforementioned Vellore study said: “Amoxicillin, 6 tablets is to be taken [for full course].” Amoxicillin’s full course depends on the kind and severity of bacterial infection. When an antibiotic of lower strength or fewer pills than needed is prescribed, the body cannot fully eradicate the pathogen. Sensing it has come under attack, the bacterium responds by evolving into more resilient, antibiotic-resistant strains. But with a course of antibiotics, say generic Amoxicillin, costing about Rs 160, close to a day’s wage in many states, and a doctor’s consultation costing anywhere between Rs 100 and Rs 1,000, more than a day’s wage in most places, patients are bound to cut corners. Another Vellore study participant summed up the situation thus: “If I have money I go to hospital. If not, I get medicine from pharmacy shop. If I get better, I stop and keep for future use.” Stopping a course of drugs mid-way also contributes to antibiotic microbial resistance. In a 2015 study in Chennai, 70% respondents confessed to stopping the medication when they felt better. Only 57% completed the antibiotic course. “Less is more”: the key to preserving antibiotic efficiency Educate health professionals, policy makers and the public on sustainable antibiotic use, says the State of the World’s Antibiotics Report 2015. That is sensible advice. Denmark and Sweden boast of low rates of antibiotic use and near-zero rates of antibiotic resistance because the risks of antibiotic overuse are widely known. Instituting regulations on antibiotic use has reduced the proportion of MRSA in Europe and the US by about a fifth over the last eight years. India requires more stringent regulations for antibiotic use. It isn’t enough to tell physicians that they should prescribe antibiotics only when essential to cure bacterial infections. The right way is to order a culture sensitivity test, which costs money, and the patience to wait for the result. “Patients want instant and cheap relief, and are willing to shop around for a doctor who obliges,” said Himanshu Shekhar, medical director, SCI International Hospital, New Delhi. “Some judge doctors on how fast the prescribed medicine cures. Practice pressures lead many doctors to prescribe advanced drugs, without getting a culture-sensitivity test done.” So, it’s also not enough to have 24 advanced antibiotics, including third- and fourth-generation cephalosporins, carbapenems, and newer fluoroquinolones, under the ambit of Schedule H1 of the Drugs & Cosmetic Rules, 1945, with effect from March 1, 2014. That means these drugs cannot be sold over-the-counter, but they are still freely prescribed. Chakravarthy’s suggestion: “Make Schedule H antibiotics available only through hospitals and health centres.” “Changing antibiotic usage behaviours is critical to preserve the efficacy of existing and new drugs,” proposed Laxminarayan. India also sorely needs regulations to check antibiotic use in animals raised for human consumption, to meet the State of the World’s Antibiotic Report 2015 recommendation to reduce and eventually phase out sub-therapeutic antibiotic use in agriculture. Sub-therapeutic use implies mixing antibiotics in animal feed to make them grow faster and to prevent infections from devastating the herd or flock. India is among the world’s five biggest consumers of antibiotics for livestock. IndiaSpend has earlier reported increasing evidence of antibiotic-resistant bacteria in animals in India, and how this impacts humans. “Using antibiotics to make animals fatter faster is a waste of a precious resource,” said Laxminarayan. How surgeons contribute to antibiotic resistance Surgical antibiotic prophylaxis refers to the prescribing of antibiotics before, during and after operations to prevent infection. Between 19% and 86% of patients in hospitals in India receive “inappropriate antibiotic prophylaxis”, according to the State of the World’s Antibiotics Report 2015. A prophylactic is preventive treatment for a disease. Ideally, antibiotic prophylaxis should be administered as a single dose within 60 minutes of the skin incision. However, a 2013 Mangalore-based study found timing adhered to in 22% of cases in a government hospital, 64.9% cases in a medical-college teaching hospital and 80.7% of patients in a tertiary care corporate hospital. “Smart antibiotic prophylaxis also includes choosing narrow-spectrum antibiotics to target the organism most likely to present concerns based on the kind of surgery being performed, this avoids needless exposure to antibiotics for the other microbes and helps prevent resistance,” said Vimesh Mistry, assistant professor, Pharmacology, Baroda Medical College. Staphylococcus aureus, which lives on the skin, is most likely to cause infection during surgery. But surgeons frequently make poor antibiotic choices. “We found appropriateness of choice of antibiotic in 68% cases and 52% compliance with the in-house prophylaxis guidelines,” said Tanu Singhal, infectious diseases specialist, Mumbai, and co-author of another study on antibiotic prophylaxis conducted in PD Hinduja Hospital, Mumbai. Other prophylaxis inaccuracies include the unnecessary prescribing of antibiotics, inaccurate dose and inaccurate duration of prescription. “We logged 63% accuracy in prescription duration. Surgeons tend to prescribe antibiotics for too long fearing post-surgery infection,” said Singhal. In the trade off between protecting the patient better and increasing the risk to society of a pathogen developing resistance, surgeons are choosing the former. Needed: A back-to-the-basics approach to health Reducing the need for antibiotics through improved water, sanitation and immunisation is another strategy recommended in the State of the World’s Antibiotics Report 2015. “Vaccination against pathogens such as the diarrhoea-causing rotavirus and pneumonia-causing Klebsiella pneumoniae helps curtail antibiotic demand, thereby reducing the chances of resistant strains developing,” said Laxminarayan. In Canada, the widespread use of pneumococcal conjugate vaccines for pneumonia in children has reduced the incidence of pneumonia caused by strains the vaccine covers. However, just as antibiotic usage spurs the development of superbugs, vaccination is a double-edged sword. Canada is seeing a rapid increase in the incidence of other strains of pneumonia not protected against by the vaccine. So, it is better to focus on the basic constituents of health. Making available clean drinking water and improving sanitation would prevent people from getting sick in the first place. India still has a lot to do on both these fronts. Improving individual immunity is the best bet to ward off infections, and that is also achievable by healthier eating, exercising, healthier living and the better management of chronic conditions like diabetes and asthma that increase vulnerability to infections when they are not kept in check.Bahri is a freelance writer and editor based in Mount Abu, Rajasthan
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By CH Unnikrishnan India's largest drugmaker by revenue Sun Pharmaceutical Industries Ltd posted almost 50 per cent drop in net profit at Rs 1,106 crore for the quarter ended September 30, as compared to the year ago quarter’s Rs 2,050 crore. The decline in profit is mainly on the back of a lower sales in all its key markets, including the US and India. Its sales was down 15 per cent at Rs 6,803 crore. "Our performance for the quarter and first half FY16 has been impacted by lower sales growth, volatile currency movements and supply constraints," said managing director Dilip Shanghvi. "Nonetheless, we continue to invest significantly in enhancing our specialty and complex generics pipeline. Integration of Ranbaxy is progressing well and while some of the costs have been incurred, the benefits will be visible going forward. We also continue to evaluate opportunities to expand our global foot print," he added.
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India's largest drugmaker Sun Pharmaceutical Industries Ltd reported a 30 percent slump in quarterly profit on Saturday, as sales in most of its markets fell and costs related to fixing compliance issues continued to hurt. In its largest market, the United States, Sun Pharma's sales in the quarter ended September were down 28 percent, which the company attributed mainly to increasing competition, and a supply crunch at its Halol manufacturing plant in India. Halol was a key contributor to Sun Pharma's sales, but the U.S. Food and Drug Administration outlined a number of problems with manufacturing processes there in September, and the company has since been working on remediating those. But its profit has been hit for a few quarters as it has had to restrict supply, and has not been getting U.S. approvals to launch any products made at the Halol plant. The company's Managing Director Dilip Shanghvi sought to assure analysts on a conference call on Saturday evening that remediation efforts were on track, though they aren't yet complete, so the FDA has not been invited for a re-inspection. "We are keeping (the FDA) updated on the progress at the agreed frequency ... I think the things that we have promised or assured the FDA, we are addressing," Shanghvi said. The company has not received any feedback from the FDA, he added. Halol is one of several Sun Pharma plants that are undergoing remediation. Five of its other plants, most of which it got as part of its acquisition of Ranbaxy Laboratories Ltd last year, are under an FDA import ban ever since the agency found a series of quality control issues at the plants. "Full value" of the Ranbaxy deal will be realized by 2018, Shanghvi said. Apart from generics, the company is developing a drug to treat psoriasis, which is in Phase 3 clinical trials and is expected to be filed for U.S. approval in 2017, Shanghvi said. Sun Pharma reported a July-September net profit of 11.07 billion rupees ($167.4 million), down from 15.72 billion a year earlier. Analysts, on average, were expecting 13.08 billion rupees, according to Thomson Reuters data. Total revenue was down 15 percent as sales across the countries it operates in fell. India was the only exception, where sales rose a marginal 1 percent. The company said currency volatilities, and a decision to cut down on presence in some less-profitable areas hurt its sales in emerging and other markets during the quarter. (Reuters)
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Britain's AstraZeneca said on Friday it had agreed to buy U.S biotech company ZS Pharma for $2.7 billion, pipping Swiss firm Actelion to the prize in the latest bout of deal-making for the hyperactive healthcare sector. AstraZeneca, which on Thursday lifted its full-year earnings forecast despite the eroding sales of some of its top-selling medicines, said it would pay $90 a share to secure ZS Pharma's proprietary technology to develop novel treatments for hyperkalaemia, or high potassium levels. Actelion revealed in September it had initiated talks with ZS Pharma that could have led to a bid. "This acquisition complements our strategic focus on Cardiovascular and Metabolic Disease by adding a potential best-in-class treatment to our portfolio of innovative medicines," AstraZeneca's Chief Executive Pascal Soriot said. Facing the loss of patent protection for some older products, Astra has engineered several bolt-on acquisitions to help build up its pipeline of new drugs. This year it has also divested certain non-core products to boost its profit line. Hyperkalaemia is typically associated with chronic kidney disease and chronic heart failure, AstraZeneca said, adding that peak sales of the company's ZS-9 potassium-binding compound, which is under review by the FDA, were forecast to exceed $1 billion. Astra said the deal would not impact its financial guidance for 2015. It is expected to generate Product Sales from 2016, with minimal earnings dilution over 2016 and 2017, before it becomes accretive to core earnings from 2018. (Reuters)
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By CH Unnikrishnan Dr Reddy's Laboratories Ltd, India's second largest drug maker by revenue, said it received a warning letter from the US drug regulator over manufacturing facilities making pharmaceutical ingredients and oncology products in Andhra Pradesh and Telangana.
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By CH Unnikrishnan India's second largest drug maker by domestic sales Cipla said on Thursday (5 November) that it posted 45 per cent increase in net profit at Rs 431 crore for the quarter ended September 30, 2015 as compared to Rs 299 crore in the year-ago quarter. The growth was mainly on the back of the record rise in export sales. Its total revenue for this quarter grew about 25 per cent to Rs 3452 crore. Cipla, which has significantly expanded in the international markets through a series international acquisitions and partnerships in the last couple of years as part of strategy to increase its global footprint, recorded a 51 per cent growth in exports revenue in the July-September quarter.During the quarter the company also had a one-off revenue from the US market on account of a merger of subsidiary company. But, its sales in India at Rs. 1262 crore grew by only 0.9 per cent during the quarter.The Indian drug maker led by Yusuf Hamied is also currently focusing seriously on the most futuristic healthcare area of biological drugs. The company had said that its biological business will be consolidated under its new biotechnology arm Cipla BioTec, which will focus on research, development, manufacturing and marketing of biosimilars in the field of cancer, auto-immune diseases, respiratory diseases and diabetes. As part of this, it had divested its entire 25 per cent stake in a Hong Kong based joint venture — Biomab Holding Limited to Biomab Brilliant Ltd of British Virgin Islands, which holds the remaining 75 per cent stake. Biomab Holdings was focused on developing Biosimilars for the Chinese market. Cipla sold this stake for a total consideration of $25.77 million. Cipla Biotec aims to create a transformational impact in the way these medicines are used, through innovative technology and go to market solutions.Cipla New Ventures' head Chandru Chawla had earlier said that it is seeing some very good momentum in its biotechnology programmes. "Through Cipla BioTec we will focus on global product development with the aim of making biological therapies accessible and affordable to patients in need," he said. One of the large global generic drug makers, Cipla is currently present across more than 150 countries. Its portfolio includes 1500 plus products across therapeutic categories.Cipla shares closed at Rs 658.50 a unit were down 1.85 per cent on BSE on Thursday, while the benchmark Sensex was down 0.96 per cent to 26304.20 points.
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