Delay in treatment of cancer patient leading to death: GTB hospital, doctors held negligent, slapped Rs 5 lakh compensation

Noting that the apathetic approach of the hospital and its doctors towards the gravity of the ailment raises a presumption as regards to the failure of treating doctors in clinical judgment and choosing the right course of action in time, the Delhi State Consumer Disputes Redressal Commission has upheld the District Forum’s order that found GTB Hospital and its two doctors guilty of negligence and delay in treating a cancer patient who eventually succumbed to the disease.

The District Commission had directed the facility and the doctors to jointly pay a lump sum compensation of Rs 5 lakhs to the heirs (complainants) of the deceased patient.

For more details, check out the link given below:

Delay In Treatment Of Cancer Patient Leading To Death: GTB Hospital, Doctors Held Negligent, Slapped Rs 5 Lakh Compensation

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Nashik Municipal Corporation alerts hospitals after person tests Zika virus positive

The Nashik Municipal Corporation (NMC) has issued a cautionary alert to all hospitals under its jurisdiction following a positive Zika virus case approximately one month ago. The infected individual, a 22-year-old, received successful treatment in a private hospital, with blood and urine samples subsequently sent to the National Institute of Virology (NIV) Pune for further analysis, confirming the Zika virus infection.

Conducting an extensive survey in the Bharat Nagar slum area of Nashik, where the patient resides, the NMC has proactively sent samples from all 91 women in the locality to the NIV for testing. Given the significance of protecting pregnant women from Zika, these women have been advised to sleep under mosquito nets. Authorities assured the public that there is no cause for panic, asserting control over the situation.

For more news & updates, check out the link given below:

https://medicaldialogues.in/

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FDA approves travoprost implant for treatment of ocular hypertension and glaucoma

The US Food and Drug Administration has approved travoprost intracameral implant for treatment of ocular hypertension and glaucoma.

The implant iDose TR developed by Glaukos is designed to provide long-duration treatment for the full range of glaucoma disease severity.

iDose TR is a first-of-its-kind, long-duration, intracameral procedural pharmaceutical therapy designed to continuously deliver 24/7 therapeutic levels of a proprietary formulation of travoprost inside the eye for extended periods of time. iDose TR is intended to improve the standard of care by addressing the ubiquitous patient non-compliance issues and chronic side effects associated with topical glaucoma medications.

“The FDA approval of iDose TR represents a significant milestone for Glaukos following an extensive pioneering journey since the inception of the original idea nearly 15 years ago. Today’s approval ushers in a new era of interventional glaucoma therapy by enabling a more proactive and reliable approach for patients in need,” said Thomas Burns, Glaukos chairman and chief executive officer. “We believe iDose TR can be a transformative, novel technology able to fundamentally improve the treatment paradigm for patients with open-angle glaucoma or ocular hypertension. We are grateful to the clinical investigators and study participants in the clinical trials for their instrumental roles in helping us reach this important advancement for glaucoma patient care. At Glaukos, we are relentlessly focused on delivering novel therapies for chronic eye diseases and now iDoseTR has the potential to redefine the standard of care for patients in the U.S. affected by open-angle glaucoma and ocular hypertension.”

“With the next generation of procedural pharmaceutical solutions for glaucoma such as iDose TR, we now have a new tool that will confront the standard legacy practice of relying on topical drops, which are known to cause uncomfortable side effects and present a myriad of challenges such as treatment adherence, complex dosing regimens, and difficulty with self-administration,” said John Berdahl, MD, clinician and researcher at Vance Thompson Vision. “The clinical data suggest that iDoseTR is not only effective with a favorable safety profile, but it has potential to relieve patients from the burdens of prescription eye drops for an extended period of time. I look forward to adding this novel therapy into my treatment toolbox for the benefit of my patients.”

The FDA approval is based on results from two prospective, randomized, multicenter, double-masked, Phase 3 pivotal trials (GC-010 and GC-012) designed to compare the safety and efficacy of a single administration of one of two iDose TR models with different travoprost release rates (referred to as the fast- and slow-release iDose TR models, respectively) to topical timolol ophthalmic solution, 0.5% BID (twice a day), in reducing IOP in subjects with open-angle glaucoma or ocular hypertension. In total, the Phase 3 trials randomized 1,150 subjects across 89 clinical sites. The FDA approval and Phase 3 data referenced below is for the slow-release iDose TR model, consistent with the company’s NDA submission and commercialization plans.

Both Phase 3 trials successfully achieved the pre-specified primary efficacy endpoints through 3 months and demonstrated a favorable tolerability and safety profile through 12 months. IOP reductions from baseline over the first 3 months were 6.6-8.4 mmHg in the iDose TR arm, versus 6.5-7.7 mmHg in the timolol control arm (mmHg range represents IOP reduction means across the six U.S. FDA pre-specified timepoints of 8 a.m. and 10 a.m. at Day 10, Week 6 and Month 3). Based on these outcomes, the FDA concluded in the prescribing information that iDose TR demonstrated non-inferiority to timolol ophthalmic solution in IOP reduction during the first 3 months. The FDA also noted that subsequently iDose TR did not demonstrate non-inferiority over the next 9 months.

At 12 months, 81% of iDose TR subjects were completely free of IOP-lowering topical medications across both trials. In both trials, iDose TR demonstrated excellent tolerability and subject retention with 98% of iDose TR subjects continuing in the trial at 12 months, versus 95% of timolol control subjects. In controlled studies, the most common ocular adverse reactions reported in 2% to 6% of iDose TR patients were increases in intraocular pressure, iritis, dry eye, and visual field defects, most of which were mild and transient in nature.

iDose TR is also supported by positive results from a Phase 2b clinical trial, which were recently highlighted in a peer-reviewed publication in Drugs ). The study authors concluded, “The travoprost intraocular implant demonstrated robust IOP-lowering and substantially reduced topical IOP-lowering medication burden for up to 36 months following a single administration, while maintaining a favorable safety profile.”

Glaukos intends to commence initial commercial launch activities for iDose TR in the latter part of the first quarter of 2024. Glaukos has established a wholesale acquisition cost for iDose TR of $13,950, per dose (or implant).

Alongside the iDose TR approval announcement, Glaukos is proud to introduce the iDose Your Dose Initiative. For every iDoseTR sold, Glaukos pledges to make available an equal number of iDoseTR units for qualifying charitable donation requests in the U.S. and around the globe for recipients that satisfy independent eligibility requirements.

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Treat e-cigarettes same as tobacco: WHO urges Govts

The World Health Organization (WHO) on Thursday urged governments to treat e-cigarettes similarly to tobacco and ban all flavours, threatening cigarette companies’ bets on smoking alternatives.

Some researchers, campaigners and governments see e-cigarettes, or vapes, as a key tool in reducing the death and disease caused by smoking. But the U.N. agency said “urgent measures” were needed to control them.

For more details, check out the link given below:

WHO Calls For Ban On Flavoured Vapes, Treating E-Cigarettes The Same As Tobacco

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Health Bulletin 15/December/2023

Here are the top health stories for the day:

WHO calls for ban on flavored vapes

The World Health Organization (WHO) on Thursday urged governments to treat e-cigarettes similarly to tobacco and ban all flavours, threatening cigarette companies’ bets on smoking alternatives.

Some researchers, campaigners and governments see e-cigarettes, or vapes, as a key tool in reducing the death and disease caused by smoking. But the U.N. agency said “urgent measures” were needed to control them.

For more details, check out the link given below:

WHO Calls For Ban On Flavoured Vapes, Treating E-Cigarettes The Same As Tobacco

NMC hosps alerted after man tests positive for Zika virus

The Nashik Municipal Corporation (NMC) has issued a cautionary alert to all hospitals under its jurisdiction following a positive Zika virus case approximately one month ago. The infected individual, a 22-year-old, received successful treatment in a private hospital, with blood and urine samples subsequently sent to the National Institute of Virology (NIV) Pune for further analysis, confirming the Zika virus infection.

Conducting an extensive survey in the Bharat Nagar slum area of Nashik, where the patient resides, the Nashik Municipal Corporation has proactively sent samples from all 91 women in the locality to the NIV for testing. Given the significance of protecting pregnant women from Zika, these women have been advised to sleep under mosquito nets. Authorities assured the public that there is no cause for panic, asserting control over the situation.

Delay in treatment of cancer patient leading to death: GTB hospital, doctors held negligent, slapped Rs 5 lakh compensation

Noting that the apathetic approach of the hospital and its doctors towards the gravity of the ailment raises a presumption as regards to the failure of treating doctors in clinical judgment and choosing the right course of action in time, the Delhi State Consumer Disputes Redressal Commission has upheld the District Forum’s order that found GTB Hospital and its two doctors guilty of negligence and delay in treating a cancer patient who eventually succumbed to the disease.

The District Commission had directed the facility and the doctors to jointly pay a lump sum compensation of Rs 5 lakhs to the heirs (complainants) of the deceased patient.

For more details, check out the link given below:

Delay In Treatment Of Cancer Patient Leading To Death: GTB Hospital, Doctors Held Negligent, Slapped Rs 5 Lakh Compensation

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COPD treatment: CDSCO nod to AstraZeneca India to market triple drug combination inhalation aerosol

Bangalore: Biopharmaceutical company AstraZeneca India has announced that it has received Central Drugs Standard Control Organisation (CDSCO) approval to market its inhalation aerosol, a triple combination of budesonide (160 mcg), glycopyrrolate (9 mcg), and formoterol fumarate (4.8 mcg). The pressurized metered dose inhaler is recommended for the treatment and maintenance of patients with chronic obstructive pulmonary disease (COPD).

COPD is the second leading cause of death in India, accounting for more than 50% of chronic respiratory diseases. It is the third leading cause of death worldwide. Coughing, difficulty breathing, wheezing, and fatigue are the symptoms of the disease. Smoking or using tobacco in any form, sedentary lifestyle choices, and air pollution are all risk factors for COPD.
The damage from exacerbations due to COPD extends beyond the lungs. The risk of a cardiovascular event rises dramatically during a severe hospitalised exacerbation.

“In comparison to currently available dual therapies, this triple combination therapy is proven to considerably lower the rate of moderate to severe exacerbations, mortality rates, and increase lung function. The inhalation aerosol is highly recommended for all patients with a history of multiple exacerbations,” the Company stated.

Dr. Anil Kukreja, Vice-President, Medical Affairs and Regulatory, AstraZeneca India added, “Preventing exacerbations is central to the management of chronic obstructive pulmonary disease. The triple combination therapy has clinically demonstrated a significant reduction in the rate of moderate or severe exacerbations as compared with other available dual therapies. The indication improves lung function, helps with COPD symptoms and prevents flare-ups. We are also looking at the possibility of extending benefit towards the complete spectrum of respiratory disorders like chronic bronchitis, emphysema, or both.”

Dr. Sanjeev Panchal, Country President & Manging Director, AstraZeneca India, said, “COPD is probably an underprioritized disease around the world. In India, government has already demonstrated its intent to manage COPD better by including it in National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS). With this approval, we are bringing science based novel therapy to India and bridging access to better therapies that can transform outcomes for COPD patients. This approval is also a strong example of innovative drug delivery technique that can target a common therapeutic challenge thereby reducing mortality as well as overall COPD disease burden.”

Read also: AstraZeneca gets CDSCO panel Nod to study anti-cancer drug Volrustomig in women with cervical cancer

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Standards of Care in Diabetes 2024: ADA updates recommendations on hypoglycemia prevention and management

USA: The American Diabetes Association (ADA) has released an updated “Standards of Care in Diabetes 2024,” which is available online and is published as a supplement to the January 2024 issue of Diabetes Care.

The ADA’s Standards of Care for 2024 include new recommendations to screen for heart failure, type 1 diabetes risk, and peripheral arterial disease (PAD), along with new obesity management guidance. It also includes new recommendations related to bone health and liver disease. The Standards of Care are essentially the global guidelines for the care of individuals with diabetes and those at risk.

This article will focus mainly on updated recommendations on hypoglycemia prevention and management. Recommendations are described below:

Hypoglycemia Assessment, Prevention, and Treatment

  • History of hypoglycemia should be reviewed at every clinical encounter for all individuals at risk for hypoglycemia and evaluated as indicated.
  • Clinicians should screen all individuals at risk for hypoglycemia for impaired hypoglycemia awareness.
  • Clinicians should consider an individual’s risk for hypoglycemia when selecting diabetes medications and glycemic goals.
  • The use of CGM (continuous glucose monitoring) is beneficial and recommended for individuals at high risk for hypoglycemia.
  • Glucose is the preferred treatment for the conscious individual with glucose <70 mg/dL (<3.9 mmol/L), although any form of carbohydrate that contains glucose may be used. Fifteen minutes after initial treatment, repeat the treatment if hypoglycemia persists.
  • Glucagon should be prescribed for all individuals taking insulin or at high risk for hypoglycemia. Family, caregivers, school personnel, and others providing support to these individuals should know its location and be educated on how to administer it. Glucagon preparations that do not have to be reconstituted are preferred.
  • All individuals taking insulin A or at risk for hypoglycemia C should receive structured education for hypoglycemia prevention and treatment, with ongoing education for those who experience hypoglycemic events.
  • One or more episodes of level 2 or 3 hypoglycemia should prompt reevaluation of the treatment plan, including deintensifying or switching diabetes medications if appropriate.
  • Refer individuals with impaired hypoglycemia awareness to a trained healthcare professional to receive evidence-based intervention to help reestablish awareness of symptoms of hypoglycemia.
  • Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if impaired or declining cognition is found.

Reference:

American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111–S125. https://doi.org/10.2337/dc24-S006

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Zydus Lifesciences bags USFDA nod for HIV-1 drug Darunavir

Ahmedabad: Zydus Lifesciences Limited today announced that the Company has received final approval from the United States Food and Drug Administration
(USFDA) for Darunavir Tablets 600 mg and 800 mg, and tentative approval for 75 mg and 150
mg tablets (USRLD: Prezista Tablets, 75 mg, 150 mg, 600 mg, and 800 mg).

Darunavir is a protease inhibitor antiviral medicine that prevents Human Immunodeficiency
Virus (HIV-1) from multiplying in the body. It is indicated for the treatment of HIV-1 infection
in adult patients. It is also indicated for the treatment of HIV-1 infection in pediatric patients 3
years of age and older.

It must be –co-administered with Ritonavir and with other antiretroviral
agents.

The product will be manufactured at the group’s formulation manufacturing facility in
SEZ, Ahmedabad (India).

Darunavir Tablets, 75 mg, 150 mg, 600 mg, and 800 mg had annual sales of USD 275 mn in
the United States (IQVIA MAT Oct. 2023).
The group now has 383 approvals and has so far filed over 440* ANDAs since the
commencement of the filing process in FY 2003-04.

Read also: Zydus, Daewoong Pharma collaborate to co-develop, commercialise Leuprolide Long-Acting Injectable in US

Formerly known as Cadila Healthcare Limited, Zydus Lifesciences Limited is an Indian multinational pharmaceutical company headquartered in Ahmedabad. The company is primarily engaged in the production of generic drugs. Cadila was founded in 1952 by Ramanbhai Patel.

Read also: Zydus Lifesciences gets USFDA okay for acquired methemoglobinemia injection Methylene Blue

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Synthetic Glucocorticoids use tied to Neuropsychiatric Effects, depression and mania most common

A recent systematic review and meta-analysis shed light on the neuropsychiatric effects of synthetic glucocorticoids, commonly used in treating various diseases. Glucocorticoids, known for their efficacy, are associated with neuropsychiatric adverse effects, prompting researchers to delve into their prevalence and severity. This study was published in The Journal Of Clinical Endocrinology & Metabolism by Anne-Sophie C A M Koning and colleagues.

The comprehensive analysis involved 49 studies, encompassing various patient populations, types, doses, and durations of synthetic glucocorticoid use. Here are the significant findings regarding neuropsychiatric adverse effects among glucocorticoid users:

  • Depression (22%): The proportion of patients experiencing depression following glucocorticoid use was reported at 22% (95%CI 14%-33%).
  • Mania (11%): Neuropsychiatric effects extended to mania, with an 11% prevalence (95%CI 2%-46%) observed among users.
  • Anxiety (8%): Approximately 8% of patients reported anxiety (95%CI 2%-25%) as an adverse effect.
  • Delirium (16%): Delirium was noted in 16% of cases (95%CI 6%-36%).
  • Behavioural Changes (52%): A substantial 52% of users reported experiencing behavioural changes (95%CI 42%-61%).

Psychiatric Scores:

Further analysis evaluated questionnaire scores between glucocorticoid users and non-users:

  • Depression (SMD 0.80): Glucocorticoid users showed higher scores for depression (SMD of 0.80 (95%CI 0.35-1.26)), suggesting a greater incidence of depressive symptoms.
  • Mania (SMD 0.78): Similarly, mania scores were elevated in users (SMD of 0.78 (95%CI 0.14-1.42)), indicating increased manic symptoms post glucocorticoid use.

The study underscores the substantial neuropsychiatric adverse effects associated with synthetic glucocorticoid use. Notably, depression and mania demonstrated the most pronounced associations with glucocorticoid treatment. Researchers emphasize the critical need for awareness among healthcare professionals and patients regarding the potential neuropsychiatric side effects upon initiating glucocorticoid therapy. The findings highlight the necessity for more structured investigations into the incidence and underlying pathways of these adverse effects.

Reference:

Koning, A.-S. C. A. M., van der Meulen, M., Schaap, D., Satoer, D. D., Vinkers, C. H., van Rossum, E. F. C., van Furth, W. R., Pereira, A. M., Meijer, O. C., & Dekkers, O. M. Neuropsychiatric adverse effects of synthetic glucocorticoids: a systematic review and meta-analysis. The Journal of Clinical Endocrinology and Metabolism,2023. https://doi.org/10.1210/clinem/dgad701

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Bestatin promising drug for treatment and prevention of periodontitis

Researchers have found in a new study that Bestatin may be a promising drug for treatment and prevention of periodontitis.  The findings of the  new study have been published in the Journal of Periodontology.

Chronic periodontitis (CP), the most prevalent dysbiotic bacteria-driven chronic inflammatory disease, is an underestimated global health problem in itself, and due to a causative relationship with other disorders such as cardiovascular diseases or Alzheimer disease. The Chronic periodontitis pathogenesis is primarily driven by Porphyromonas gingivalis in humans, and Porphyromonas gulae in dogs. These microorganisms initiate a pathogenic shift in the composition of the tooth-surface microflora. The objective of researchers was to evaluate antimicrobial effects of bestatin, a potential Chronic periodontitis drug candidate.

Researchers evaluated bestatin bacteriostatic efficiency against periodontopathogens in planktonic cultures via microplate assay, and mono- and multispecies oral biofilm models. Neutrophil bactericidal activities, such as phagocytosis, were investigated in vitro using granulocytes isolated from the peripheral blood. The therapeutic efficacy and the immunomodulatory function of bestatin was assessed in a murine model of Chronic periodontitis.

Results

Bestatin exhibited bacteriostatic activity against both P. gingivalis and P. gulae, and controlled the formation and species composition of the biofilm. We demonstrated that bestatin promotes the phagocytosis of periodontopathogens by neutrophils. Finally, we found that providing bestatin in the animal feed prevented alveolar bone resorption.

They showed that in a murine model of Chronic periodontitis bestatin not only shifted the biofilm species composition from pathogenic to a commensal one, but also promoted bacteria clearance by immune cells and alleviated inflammation. Taken together, these results suggest that bestatin is a promising drug choice for the treatment and/or prevention of periodontitis and clinical trials are required to fully evaluate its potency.

Reference:

Kaminska, M, Benedyk-Machaczka, M, Adamowicz, K, et al. Bestatin as a treatment modality in experimental periodontitis. J Periodontol. 2023; 94: 1338–1350. https://doi.org/10.1002/JPER.22-0614

Keywords:

Bestatin, promising, drug, for, treatment, prevention, periodontitis, Kaminska, M, Benedyk-Machaczka, M, Adamowicz, K

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