Monday, 15 December 2014

Turacoz's Insight: Influenza vaccination Week, 7-13 Dec 2014


Influenza Vaccination Week was from December 7-­13, 2014, with a primary aim to remind everyone that 6 months and older should be vaccinated with the flu vaccine. National Influenza Vaccination Week (NIVW) was established in 2005 by the Centers for Disease Control and Prevention (CDC) to draw attention to the importance of continuing influenza vaccination after the holiday season into January and beyond.

The influenza is an infectious respiratory illness which can cause mild to severe illness, and at times lead to death.  According to recent estimates influenza attacks 5-10% of adults and 20-30% of children globally, thus leading to considerable levels of illness, hospitalization and deaths. Children <5 years of age, and particularly those <2 years of age, have a high burden of influenza. In India, influenza virus has been reported to cause 1.5% to 14.5% of all acute respiratory infections (ARIs) episodes. The two major mechanisms by which these viruses undergo rapid changes in their genetic constituents are “antigenic drift and antigenic shift” and are a challenge in the field of vaccination.

Globally, trivalent inactivated vaccines (TIV) and live attenuated influenza vaccines (LAIV) are the most common vaccines available for influenza whereas in India, LAIV is not available and a monovalent vaccine containing single pandemic strain, A (H1N1) pdm09 is available. Current trivalent influenza vaccines are not approved for children <6 months of age. Children (previously immunized with seasonal influenza vaccine) and adults should receive one dose of influenza vaccine each year. Children 6 months to < 9 years of age receiving seasonal influenza vaccine for the first time should be given two doses, with a minimum interval of four weeks between doses. For intramuscular (IM) TIV, the dose is 0.5 ml for all age groups.4

The "Influenza Vaccination Week" focused on the following activities:
  • Increase awareness by interactive programs and blogs to get vaccinated in December, January and beyond for better protection.
  • Remind parents and providers of the need for high risk children receive a second dose of flu vaccine for optimal protection.
  • Provide an opportunity for interaction with people ask questions about the flu and flu vaccination.
  • Provide an update on local influenza activities.
  • CDC launched a Google keyword search and display to raise awareness that everyone 6 months of age and older should get vaccinated.
Recommendations of Advisory Committee on Immunization Practices (ACIP) for influenza vaccination 2014-2015
  • The flu shots are recommended for children as ≥6 months of age and in pregnant women and people with chronic health conditions and for children < 6 months are not recommended for a flu shot. Factors like an egg allergy and presence or clinical history of Guillain-Barré Syndrome (GBS) require a consultation from doctor before getting a flu shot. 
  • The nasal spray vaccine is approved for people 2 -49 years of age. Asthmatic patients, patients with chronic condition like lung disease, heart disease, kidney or liver disorders, neurologic/neuromuscular, or metabolic disorders and the presence or clinical history of Guillain-Barré Syndrome (GBS) require a consultation from doctor before getting a nasal spray.
Read more at:
Key Facts about Influenza (Flu) & Flu Vaccine. www.cdc.gov/flu/keyfacts.htm (Accessed on December12, 2014).
WHO. Vaccines against influenza. WHO position paper – November 2012 Weekly Epidemiol Record 2012.87(47):461–76. 


Thursday, 11 December 2014

Medical Device Price Control in India

With the growing middle class and increasing world class healthcare facilities, India has emerged as one of the largest medical device markets in Asia and is rallying ahead in this field with striking rate. The medical device market in India is expected to grow with a rate 15% per year for the coming years. Selling of medical devices in India requires compliance with Indian Medical Device regulations. Foreign companies cover 70% of the medical device market in India.
For the first time after 2005, medical devices have been regulated under Drugs and Cosmetics Rule in India, which is under the control of Central Drugs Standard Control Organization (CDSCO) headed by Drug Controller General of India (DCGI). The manufacturers of medical devices either from India or from International market require their prior market authorization in US, Canada, Europe, Australia, Japan or any other international market as well as proof of approval in their home market, in order to register the device in India.
National Pharmaceutical Pricing Authority (NPPA) of India controls the prices of drugs and other products in India. The essential drugs are regulated under a Drug Price Control Order (DPCO) in India, to make them affordable to poor patients. In recent past, the Maharashtra Food and Drugs Administration (FDA) has recommended to the DCGI and NPPA to bring the medical devices in India under DPCO. This recommendation came in the wake of some studies conducted by the Maharashtra FDA in which it was found that manufacturers in collusion with importers, distributors and hospitals which ultimately provide the devices to the patients and fixes maximum retails price (MRP) of medical devices randomly which is finally passed on to credulous patients. Specially, in the case of drug eluting stents (DES), MRP was found to be exorbitantly high and patients have no option but buy it without any bargain. MRP of the devices are fixed in India by the importers and not the manufacturers. There is one more startling fact associated with the costing that, the cost of devices is recovered immediately from patients (sometimes even before implantation in patients), but the payment to distributors are made after a period of 60-120 days, and applicable taxes to the state government are made only within 51 days by the distributors.
In one case of overpricing it was found that a DES imported in India at around Rs. 31,000 has an MRP of Rs. 1,62,000, it was sold to distributor for Rs. 67,000 and in turn the DES is provided to hospital at a price of Rs. 1,06,650 by the distributor which was in turn sold to patients.
In yet another case of profit making practice by the importer, A DES imported from Europe for Rs. 40,710  has an MRP of Rs. 1,50,000, a mark-up of more than 250%, was sold to a distributor at Rs. 73,440 and in turn sold to the hospital at Rs. 1,13, 400 and the patient paid a price of Rs. 1,19,070.
These devices are generally not available freely in the market and patients get the supply from hospitals at their quoted price through distributor and are forced to pay double or triple the price at which it has been imported. It has also been reported that distributor bribe doctors and hospitals from the extra money through selling at higher prices.
NPPA has taken steps recently in response to the recommendation from Maharashtra FDA about the price violation of these devices; especially FDA demanded a price cap on DES and orthopaedic implants. It is recommended that most effective way to regulate the price of these devices is to bring them in National List of Essential Medicines (NLEM), which can bring relief to millions of patients. In India two medical devices – intra uterine device and condoms are already covered under NLEM and their prices are under control.
Role of NPPA in this regard can be effective in this scenario to bring relief to the common middle class population of this country.
References:

Thursday, 6 November 2014

Turacoz Insights: Can cancer awareness noise make a difference?

Supporting the fighters, admiring the survivors, honoring the taken, and never ever giving up Hope.

How can cancer awareness help us?

The Cancer Research UK, has estimated the risk of a newborn child has of being diagnosed with cancer at some point during its life. The results are quite shocking with more than one in three people in the UK getting some cancer during their lifetime.

The American Cancer Society, estimates the risk of developing a cancer at all invasive sites as 1 in 2 males with a mortality of 1 in 4 males. In the females the corresponding figures are 1in 3 for developing cancer at all invasive sites and 1 in 5 as the risk of dying due to cancer.

So developing a cancer is not something that cannot happen to you. The one difference that an individual can make in his life is by taking the informed decision to be aware of the types of cancer, what factors increase the probability of developing cancer and how to get it diagnosed on time with regular checkups and screening methods so that a disease like cancer can be fought with

Some of the factors that increase the cancer risk, according to the National Cancer Institute are:
  1. Chemicals/Environment
    1. Asbestos
    2. Formaldehyde
    3. Hair dyes
  2. Food
    1. Acrylamide
    2. Alcohol
    3. Artificial sweeteners
    4. Fluorinated water
  3. Lifestyle habits
  4. Genetic factors
    1. BRCA1 and BRCA2
    2. TP53
    3. PTEN
    4. APC
    5. MEN1
  5. Hormones
    1. Diethylstilbesterol
    2. Menopausal factors
    3. Oral contraceptive
  6. Infectious agents
    1. HIV
    2. HPV
    3. Helicobacter pylori
  7. Radiation
  8. Sunlight
  9. Tobacco
  10. Weight and physical activity
Bringing better cancer awareness among the population by individual, community and government levels will go a long way in reducing the incidence, and improving the health economics. About 4/10 cancer cases can be prevented by making lifestyle changes like:
  1. Quit smoking
  2. Healthy diet
    1. Eat plenty of fruits and vegetables
    2. Limit fat
    3. Drink alcohol in moderation
  3. Maintain a healthy body weight and be physically active 
  4. Avoid excessive sun exposure
  5. Get immunized
    1. Hepatitis B
    2. Human papilloma virus
  6. Avoid risky behaviors
    1. Safe sex
    2. Do not share needles
  7. Regular medical checkup with screening for specific cancer
As a socially responsible medical communication company, Turacoz is dedicated to spread the word on cancer by conducting awareness campaigns for cancer and reaching out to the healthcare fraternity and decision makers to get their viewpoint on this issue.

Our aim is to
 Prevent benign from becoming malignant.
Read more at

http://www.cancerresearchuk.org/

Wednesday, 5 November 2014

For a sweet life – Think of prediabetes as a wake-up call


  • Are you hungrier than normal?
  • Are you losing weight, despite eating more?
  • Are you thirstier than normal?
  • Do you have to go to the bathroom more frequently?
  • Are you more tired than usual?


Are you ignoring the slow signs of prediabetes. Diabetes doesn’t usually appear all of a sudden. Many people have a long, slow, invisible lead-in to it called prediabetes. During this period, blood sugar levels are higher than normal. However, they’re not high enough to cause symptoms or to be classified as diabetes. It’s still possible at this stage to prevent the slide into full-blown diabetes. Think of prediabetes as a wake-up call.


"India is facing an epidemic of diabetes. At present, confirmed diabetes patients in India are more than 70  million, with another 30 million in prediabetes group. By 2030, India will have the largest number of patients in the world. Diabetes is not only a blood sugar problem, but brings along other complications as well,"

The American Diabetes Association and other organizations recommend routine blood sugar testing in people at high risk for developing diabetes. These include:
  • Everyone over age 45
  • Younger people who are overweight and who also have one of these diabetes risk factors:
  • Little or no physical activity
  • Family history of diabetes
  • High blood pressure or high cholesterol
  • Previous diagnosis of heart disease or polycystic ovary syndrome
  • Diabetes during pregnancy (gestational diabetes) or having delivered a baby weighing more than nine pounds


There's good news, however. Prediabetes can be an opportunity for you to improve your health, because progression from prediabetes to type 2 diabetes isn't inevitable. With healthy lifestyle changes — such as eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight — you may be able to bring your blood sugar level back to normal.

So chose a healthy and sweet life.. #DiabetesAwarenessMonth

Saturday, 1 November 2014

November is National Diabetes Awareness Month



November is National Diabetes Awareness Month (NDAM), an event celebrated across the world as a month to educate and raise awareness about type 1 diabetes (T1D).
The theme for this year is “You don’t know the half of it.” Type 1 diabetes has both a visible, public side and a second private, invisible side. The public side, the one that everyone sees, is physical, treatment-focused and often showcases few visible signs of struggle. 
 What is diabetes?
Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood.
What are the types of diabetes?
·         Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes, may account for about 5% of all diagnosed cases of diabetes.
·         Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases of diabetes.
·         Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 10% of all pregnancies but usually disappears when a pregnancy is over.
·         Other specific types of diabetes resulting from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 5% of all diagnosed cases of diabetes.
Prediabetes is an elevated blood glucose level that is not quite high enough to be diagnosed as diabetes, but is higher than normal. One in three American adults has prediabetes, and most do not even know they have it. Many people with prediabetes who do not lose weight or do moderate physical activity will develop type 2 diabetes within 3 years.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and amputations of the foot, toe or leg. Diabetes is the seventh leading cause of death in the United States.
Risk Factors for Type 2 Diabetes
You are at increased risk for developing prediabetes and type 2 diabetes if you:
·         Are 45 years of age or older.
·         Are overweight.
·         Have a family history of type 2 diabetes.
·         Are physically active fewer than three times per week.
·         Ever gave birth to a baby that weighed more than 9 pounds.
·         Ever had diabetes while pregnant (gestational diabetes).
How you can manage your diabetes?

Friday, 31 October 2014

A doctor who went that extra mile for Breast cancer awareness


Women, who struggle and suffer pain to ensure the continuation of the human race, make much tougher and more courageous soldiers than all those big-mouthed freedom-fighting heroes put together.”   Anne Frank, The Diary of a Young Girl

Rarely do you meet a person who is selflessly dedicating their lives completely for the welfare and happiness of others. There are only few people in this world doing incredibly selfless acts stretching their boundaries and limitations. Well, Dr. Anita Khokhar is one such person; a doctor who is conducting Voluntary Breast cancer awareness programs for last 9-10 years and Turacoz team has been fortunate enough to interview this outstanding woman.

It is a myth that we cannot have breast cancer.  Breast cancer is inherited in <10% of patients 
and whereas majority,90 % are random cases with no risk factors; hence you cannot predict who will get and who will not. According to doctors,” This disease is as common as common cold and can be treated if detected in time”

Dr. Anita Khokhar, a professor at Dept of Community Medicine, V.M.M.C & Safdarjang Hospital, Delhi , author of two BOOKS - Breast cancer awareness and early detection and women over forty books and a selfless activist for breast cancer awareness, here tells us about her mission:

What she has done so far?

Dr. Anita Khokhar has been conducting Voluntary Breast cancer awareness programs and workshops for last 9-10 years. While asking about the numbers, she says that she has conducted more than 250 breast cancer awareness workshops and educated more than 18-20,000 women on the same. The workshops have been for various organizations like Supreme Court, high court, café coffee day, schools, HRD dept, CRPF, IIT, CBI, RWAs etc.

What is taught in these sessions?

In the sessions the various types of examination techniques are demonstrated on models/mannequin. Women are made aware of self examination for breast cancer and the treatments.

What is her observation in breast cancer awareness among Indian women?

Dr. Khokhar says that the first observation is 2/3rd of Indian patients are diagnosed very late. On self examination, lumps as small as 2 cm can be detected, which are normally stage 1 and curable? In her review article, she says that in developing countries like ours, lack of public awareness about breast cancer means that patients ignore their symptoms till the very late stage. Only 36% of the teachers had heard the term breast self examination. Teachers knew little about when and how to perform a breast self exam. Only 13.37% knew that the correct frequency of doing it was once a month. Some 7.2% knew about the position in which it should be done and only 1.36% participants were aware of the right time of doing it i.e. for those women who menstruate, a week from the start of periods and for those women who do not menstruate, one a fixed date every month.

She says that “Take out 10-15 min of your time every month for yourself to examine your breast, get familiar with your breast”. Is it too much to ask from ourselves?


 What are Challenges in Indian women population?
  • The major challenge is the delay in diagnosis is at the level of the patient as well as getting the right treatment and reaching the right destination.
  • There is no national policy/program and no screening support.
  • Most of the breast cancer surgeons are male and Indian women avoid visiting them. They are reaching gynecologist first, who cannot treat them. Many reach a quack, or some alternate medicine and further cause delay in treatment. Nobody knows the term oncoplastic surgeon, or a breast cancer surgeon.
  • Expensive and sophisticated screening techniques are only available in metro cities and very less in remote areas.
  • Clinical breast examination is not a part of normal graduate education (MBBS) therefore doctors are not primed for this technique.
How to prevent Breast Cancer?
  • Awareness of your breasts
  • Incorporate self breast examination as a lifestyle.
  • If diagnosed go to a Surgeon/Onco-surgeon
Some of the modifiable Factors are
  • Reduce weight as if there are less fat cells, there is going to be lesser estrogen.
  • Increase physical activity.
How to contact her for conducting a breast cancer awareness workshop?
You can contact Dr. Anita Khokhar who is Professor, Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjang Hospital, Delhi on her email is: anitakh1@yahoo.com  on her Facebook page #knowyourbreasts or Twitter or Linkedin.
OR
You can contact us at www.turacoz.com our email ids are pooja@turacoz.com, namrata@turacoz.com  and our contact numbers are +91-7042166399 /+91-9810036125.