Sleep disorders on the rise in India

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Measure your neck circumference to know your proneness

Unhealthy lifestyles and eating some of the pertinent reasons

New Delhi, 15th March 2018: One of every five patients in India suffers from sleeping disorder, as per a study and about 20.3% patients visiting doctors for such issues ask for sleeping pills.

Many patients suffer from sleep disturbances, the reasons for which include hectic schedule, night shifts, and high stress levels. Obstructive sleep apnea (OSA) seems to be one of the most common sleep disorders.

OSA is a disorder in which there is brief and repeated interruptions in breathing during sleep because the muscles at the back of the throat press down on the upper airway. Some of the causes include being overweight, small upper airway, large tongue, and tonsils.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “OSA is the most common types of sleep disorders a noticeable sign of which is snoring. The low blood oxygen levels and disturbed sleep occurring due to OSA can lead to heart disease. About half of those with OSA have high blood pressure. It is more common in men and chances of its occurrence increase with ageing. It could also be genetic, and people of certain ethnicities are more prone to it than others. This condition is also more common in people with a large neck circumference — greater than 17 inches for men, and 15 inches for women.”

Signs and symptoms of obstructive sleep apnea include excessive daytime sleepiness, loud snoring, observed episodes of breathing cessation during sleep, waking up abruptly, waking up with dry or sore throat, morning headache, difficulty concentrating, mood changes, high blood pressure, nighttime sweating, and decreased libido.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “It is important to watch out for certain symptoms and consult a specialist if you consistently feel tired and groggy through the day. A sleep study (called nocturnal polysomnography) is carried out at an overnight sleep laboratory. By recording brain waves, eye and leg movements, oxygen levels, airflow, and heart rhythm during sleep, it can help in diagnosing this condition. While extreme cases may require surgery, certain lifestyle changes can help avoid this condition or prevent it from getting worse.”

Some tips from HCFI.

  • Try losing excess weight as even a 10% loss can make a difference.
  • Do not consume alcohol or sleeping pills. These can cause the airways to collapse during sleep and lengthen the time you are unable to breathe well.
  • Try sleeping on your side instead of the back.
  • Avoid nasal sprays as any sinus problems or congestion can make it harder for you to breathe.

Ambitious target of TB-free India by 2025 will require continuous and consistent efforts

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There is a need to mobilize resources further and increasing awareness on the importance of immunization

New Delhi, 14th March 2018: Year 2025 has been set as the deadline for a tuberculosis (TB)-free India by Prime Minister Shri Narendra Modi. This is five years ahead of the global deadline set by the WHO. About 25 years, TB was declared as an emergency, and since then, different countries have adopted varied strategies to keep it under check.

The number of TB-related deaths in India in 2016 was more than 4 lakh, a number that is one-third of the global toll.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “The target set for a TB-free India sounds ambitious and promising. However, it remains to be seen what efforts go into actualizing the same. TB is the third leading cause of years of life lost (YLLs) lost, in the country. It is caused by bacilli spread through droplet nuclei (less than 5 microns) infection. Droplet nuclei can remain suspended in the air for extended periods, and thus are a source of exposure to susceptible individuals. Split AC is not the right atmosphere for sputum-positive cases. Natural windows and fans are better alternatives. TB does not spread through handshakes, using public toilets, sharing food and utensils, blood transfusion and casual contact. TB can be of lungs (pulmonary), or outside the lungs (extra pulmonary). In 85% of cases, lungs are involved.”

Contact tracing increases community awareness about the disease and interrupts the chain of transmission of the disease through early diagnosis of cases.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Early diagnosis and complete treatment is important to prevent and control TB. To address the problem of rising drug resistance, TB is a notifiable disease. The approach to all notifiable diseases should therefore be based on DTR “Diagnose, Treat & Report”: Diagnose early, using sputum GeneXpert test; Treat: Complete and effective treatment based on national guidelines, using FDC; and Report: Mandatory reporting.”

Some tips from HCFI.

  • Wash your hands after sneezing, coughing or holding your hands near your mouth or nose.
  • Cover your mouth with a tissue when you cough, sneeze or laugh. Discard used tissues in a plastic bag, then seal and throw it away.
  • Do not attend work or school.
  • Avoid close contact with others.
  • Sleep in a room away from other family members.
  • Ventilate your room regularly. TB spreads in small closed spaces. Put a fan in you window to blow out air that may contain bacteria.

Consult a specialist before switching any medications

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Consult a specialist before switching any medications

Urgent need to take measures to stop marketing same drug under different brands and prices

New Delhi, 13th March 2018: As per a recent study, none of the five most commonly prescribed diabetes pills in India that combine metformin with other medicines have gone through rigorous testing meeting standards laid out by the WHO. In recent years, drug makers have increasingly been blending fixed doses of this medicine with fixed doses of other diabetes drugs that attack the disease differently.

The study, which appeared in BMJ Global Health, noted that the five top-selling fixed dose combination pills in India account for 500 different brands.

The findings of the study are concerning in light of the fact that clinical trials demonstrating safety and efficacy of these fixed dose combinations are neither publicly available or of low quality. It suggests that Indian patients taking these combinations should discuss with their clinicians before making a switching to a different agent.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Bioequivalence studies are conducted to establish that two medicines, normally the original patented drug and a generic version, have the same biological equivalence – that is, that they work the same way, to the same extent and for the same purpose. The most important characteristics of any drug is its Bioequivalence to the innovator product to prove its safety, clinical efficacy equivalence and cGMP compliance on continuous basis for sustainable supply. It is imperative that the government takes strong measures to strengthen the quality assurance infrastructure to the required level so that the quality of every batch of drugs is assured. Adequate regulatory manpower should also be deployed to enforce laws regarding drugs.

More than 95% of the drugs available in India are generic with no patent. They are available in the market with a generic name, trade name, or brand name from the same company. Being with no patent, over one thousand companies can market a single molecule. The word brand means a way to differentiate various generic drugs from each other.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Doctors are committed to the welfare and safety of patients. Economy of drugs is only one dimension of the issue. There is a need to stop over-the-counter sale of prescription drugs without a prescription. Measures should be taken to disallow a company to market same drug in different prices under different brands.”

Medical Council of India Code of Medical ethics: 1.5 Use of Generic names of drugs: Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that there is a rational prescription and use of drugs. The interpretation is as follows.

  • Use of Generic names of drugs: it’s not use of generic drugs
  • Every physician should: the word SHOULD makes it non-binding
  • As far as possible means to the best of his or her capacity
  • Prescribe drugs with generic names:  is not the same as prescribing generic drugs. It only means the name of the salt should also be written.
  • Shall ensure that there is a rational prescription: Rational means prescription of drugs which are evidence based and or with informed consent.
  • Rational use of drugs: means the same when dispensing.

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