Made to wait for 2 hours at Gurgaon hospital, woman delivers prematurely in toilet


Made to wait for 2 hours at Gurgaon hospital, woman delivers prematurely in toilet Gurgaon, Apr 20 : A six-month pregnant woman delivered in the toilet of the civil hospital in Gurgaon after waiting for a medical check-up there for more than two hours, a hospital official and the woman’s husband have said.

Sunita, 27, visited the hospital on Thursday, her husband Govind Kumar said.

He alleged that she was made to wait for the check-up for over two hours, which led to abdominal pain. When she went to the toilet for urinal, the foetus was aborted there, Kumar said.

“She had complained about abdominal pain, and me and my mother suggested her to go to toilet for urinal. She went into the toilet – which was very dark – and came out bleeding,” he added.

Sunita was so scared about the bleeding that she did not realise her foetus was aborted in the toilet. It was later found by one of the staffers, who informed the hospital administration.

The hospital’s Principal Medical Officer Pradeep Sharma confirmed the incident. “When we learnt about the incident… We looked for the woman and admitted her in the gynaecology ward to avoid any infection,” he said.

“It is hard to believe that woman delivered the foetus in toilet and she did not know about it,” the officer added. CORR ABH ABH

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Negligence cases damaging trust, reputation: Gurugram doctors to govt


Negligence cases damaging trust, reputation: Gurugram doctors to govt GURUGRAM: Doctors attached to various private hospitals in the city have formed an association to help “colleagues in distress”, in the wake of a series of medical negligence complaints being filed with the government and the recent arrest of two Fortis doctors on the recommendation of the medical board.

A group of 25 doctors representing the association met deputy commissioner Vinay Pratap Singh on Thursday to express their disapproval about the way medical negligence complaints were being handled and voice concern about the trust deficit this was causing between doctors and patients.

Since 2017, when the district medical negligence board was formed, 60 such complaints have been filed so far. Among those is a complaint filed by the father of Adya Singh, the seven-year-old girl who succumbed to dengue during treatment last year.

In a memorandum handed over to the deputy commissioner on behalf of the newly formed Association of Tertiary Healthcare Consultants, the doctors said it was “irresponsible and detrimental to society at large” if there was a trust deficit between patients and doctors. “Doctors will be pushed into practising defensive medicine, and concentrating more on documentation than actual patient care, an eventuality which will be tragic in both implementation and implication,” said the memorandum.

In the association are doctors from Fortis, Medanta, Paras, Columbia Asia, Max, Rockland and Artemis hospitals. They told the deputy commissioner that medical negligence complaints “are affecting the reputation of the fraternity” and private hospital doctors are being increasingly portrayed as “criminals” who would not think twice about inflating hospital bills.

The doctors also urged Singh to ensure details of an investigation against a doctor accused of medical negligence are not leaked to the media. “This has to stop as it’s affecting the reputation of private hospitals,” the doctors said in the memorandum.

“The deputy commissioner said he will take up the issue with the state health secretary. He will also speak to the police commissioner to ensure that doctors are treated properly after filing of an FIR in a medical negligence case,” said Rahul Bhargava, director of hematology at Fortis who was part of the delegation.

“After the arrest of the chief cardiologist and emergency medical officer of Fortis on April 13 on charges of medical negligence in the wake of the death of a patient, their photos were leaked to the media. Are they wanted criminals or rapists? It is not that we are not participating in the inquiry, this is no way to treat a doctor,” said Dr Sushila Kataria, director of internal medicines at Medanta.

Dr Neeraj Kumar, senior consultant of cardiology at Max hospital, added, “The doctor-patient trust factor has gone down rapidly. We try to give hope to critically ill patients and it is not possible to provide that hope without the trust. We are highly disturbed with the way the private hospital doctors are being treated by the police.”

Gurgaon’s chief medical officer Dr BK Rajora and principal medical officer Dr Pradeep Sharma were also present in the meeting. “Private hospital doctors were against any arrest in medical negligence cases. But as far as we are concerned, the medical negligence board will conduct its inquiries on negligence complaints,” Dr Rajora told TOI later.

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Fortis Healthcare’s board forms expert panel to assess binding bids


Fortis Healthcare’s board forms expert panel to assess binding bids NEW DELHI | MUMBAI: Fortis Healthcare’s board is setting up an expert advisory committee under the leadership of Deepak Kapoor, former India CEO of PwC, to assess the binding bids for the company. This means nonbinding offers will not be considered, a setback for Malaysia’s IHH and China’s Fosun. They had both submitted nonbinding offers and sought time to conduct due diligence. Two binding offers have been submitted — by TPG-backed Manipal Hospital and the Munjal-Burman family offices.

However, contenders have until April 25 to submit binding offers, according to Brian Tempest, the Fortis director who chaired the meeting on Thursday.

The development comes as a section of minority Fortis shareholders has sought an extraordinary general meeting (EGM) to remove and replace four Fortis board members with three independent directors of their choice.

“It is fair to say that the Manipal (offer) is a binding bid… and the Burman (Munjal-Burman) one doesn’t require any due diligence,” Tempest said. “We’re just going to focus on those (offers) which are binding and don’t need any due diligence… this is the brief that we’ve given to the advisory committee.”

Panel to Report to Board by April 26
The deals proposed so far are not comparable as the Manipal-TPG offer is a structured deal in which the healthcare assets are to be acquired through a demerger. The Munjal-Burman offer proposes to inject cash directly into Fortis.

A Radiant-KKR offer, which was submitted on Thursday, is also not a binding one.

The expert advisory committee is to report to the board by April 26, when it’s scheduled to meet again on the issue. The board is not obliged to follow its recommendation, Tempest said.

IHH is considering the submission of a binding bid, ET has learnt, but this would involve investing Rs 4,000 crore upfront, giving it a stake of more than 32%. This will trigger an open offer for another 25% stake that will cost another Rs 3,300 crore at the same price of Rs 160 per share if fully subscribed, giving it a 57.5% holding in Fortis for a total Rs 7,300 crore.

“We really want to make sure that it is a transparent process and actually we have been advised by a number of parties that actually this is one of the recommended ways of going forward,” said Tempest, adding that financial advisor Standard Chartered Bank will assist the expert advisory committee and the board.
Fortis Healthcare’s board forms expert panel to assess binding bids
“We are happy with the decision,” said Ranjan Pai, chairman, Manipal Education and Medical Group. “The board has appointed a committee of independent experts who will recommend the best transaction.”

“We are pleased to note that the board of Fortis Healthcare has found merit in our offer, which is simple, binding and is the quickest to implement,” said Sunil Kant Munjal, chairman, Hero Enterprise. “We believe that this is the only offer which is in the best interest of all stakeholders of Fortis.”

On Thursday, Radiant Life Care, backed by KKR, submitted an offer to immediately inject cash into Fortis by offering to buy Fortis Memorial Research Institute, its flagship hospital in Gurgaon, as well as Fortis Shalimar Bagh. It has made an offer of Rs 165 per share for Fortis Healthcare, ET has learnt. Radiant-KKR is also offering Rs 3,600 crore to spin off the SRL Diagnostics arm. Fortis shareholders would get shares of SRL in this deal, persons aware of the development said.

Fortis ended at Rs 148.45, up 2.66%, after having shot up 5.2% just before the close. The benchmark Sensex ended 0.28% higher.

Fortis is legally required to hold an EGM as sought by stakeholders National Westminster Bank Plc, East Bridge Capital Master Fund Ltd and East Bridge Capital Master Fund I Ltd, Tempest said.

The shareholders, who together hold more than 12% stake in the company, want to remove Tempest, Harpal Singh, Sabina Vaisoha and Tejinder Singh Shergill from the board. They are also seeking the appointment of Suvalaxmi Chakraborty, Ravi Rajagopal and Indrajit Banerjee as independent directors.

The EGM is likely to be held by the end of May, according to Tempest.

Subject to shareholder approval, the Fortis board has also approved the appointment of Rohit Bhasin as additional director (independent) of the company “with immediate effect” for a period of five years. Bhasin was previously senior partner in the deals practice of PwC and India head of the valuation and strategy team, Fortis said.

Offers have poured in for Fortis over the last three weeks after minority shareholders expressed their disappointment with the valuation proposed by Manipal-TPG on March 27. Manipal-TPG last week submitted a revised offer, which analysts estimated had increased its valuation of the Fortis hospital portfolio by around 21%, pegging its shares at Rs 155 apiece, ET reported on April 11.

Earlier on Thursday, IHH had made its proposal to infuse Rs 4,000 crore at Rs 160 per share, thereby valuing it at about Rs 12,000 crore (post equity).

Sunil Munjal’s Hero Enterprise Investment Office and the Dabur group’s Burmans have also raised their joint bid, offering to infuse Rs1,500 crore into Fortis without any due diligence. They asked for two seats on the Fortis board instead of one earlier.

Last week, they had proposed to infuse Rs 1,250 crore, with Rs 500 crore invested upfront and the remaining Rs 750 crore after three weeks’ due diligence.

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P&G to acquire 52% in Merck India for Rs 1,300cr


P&G to acquire 52% in Merck India for Rs 1,300cr MUMBAI: Global consumer products major, The Procter & Gamble Company (P&G), will acquire a nearly 52% stake in drug firm Merck India for Rs 1,300 crore as part of a global deal under which it will take over the international consumer health business of Germany’s Merck KGaA. According to a public announcement, Procter & Gamble Overseas India BV along with P&G will make a mandatory offer to acquire 26% from public shareholders for up to Rs 648 crore, taking the total cost of acquisition in India to Rs 1,948 crore.

The offer is made at a price of Rs 1,500, which is at a 16% discount to Merck’s closing price of Rs 1,792 on the BSE on Thursday. After the global announcement, Merck’s stock jumped nearly 19%.

After the transaction, the Rs 1,119-crore Merck will become the fourth legal entity in India for the Cincinnati-based P&G. The current three companies in India that represent P&G are Procter & Gamble Hygiene And Health Care (PGHH), in which the promoter group holds about 70%, Procter & Gamble Home Products (PGHP), a wholly owned subsidiary, and Gillette India, in which it has 75% shareholding. The P&G Group has a combined turnover of over $1.5 billion in India and is present in laundry, feminine hygiene, cold relief products, hair care, shaving products and diapers.

The global all-cash deal of about 3.4 billion euros will add vitamins and food supplements to P&G’s lineup of overthe-counter (OTC) products. Merck’s consumer health unit includes brands such as Femibion, Neurobion, Nasivin and Seven Seas. Edelweiss Securities senior VP (institutional equities – research) Abneesh Roy said the move will help P&G in scaling up distribution at chemist shops in India, as it will now have a wider portfolio of OTC brands.

A P&G India spokesperson said it is too early to comment on future plans. As part of the transaction, approximately 3,300 employees globally, mainly from consumer health, will transition to P&G.

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Fixing medical entrance tests for a price? FIR filed


Fixing medical entrance tests for a price? FIR filed NEW DELHI: A gang of criminals targeting students appearing for MS/MD/PG diploma courses through NEET-PG examinations is on the radar of Delhi Police after several candidates complained that they were contacted by unknown people offering them question papers and higher ranks in lieu of money. The gang had personal details of the candidates.

National Board of Examination (NBE), which conducts the test, told police that it conducted NEET-PG 2018 on January 7 in which approximately 1.28 lakh students appeared. The computer-based exam was conducted across 150 cities. The results were declared on January 23.

NBE received a complaint from a candidate’s father on January 30 through an email informing that unknown people were constantly contacting his daughter offering help in securing a good rank in the NEET examination. The girl’s father shared four audio clips of the reported phone calls with the board’s senior officials.

“In the phone conversation, the fraudster demanded money from the complainant to help his daughter secure a good rank. To legitimise his claim, he provided personal details of the candidate, including her date of birth, address, application form number and Aadhaar number,” a senior police officer said.

The fraudster also promised the girl’s father that he would help her get a post graduate seat in a government hospital. The father then approached NBE seeking confirmation if the said person was working with the board, which was denied by senior officials.

The candidate’s father then sought clarification from NBE as to how his daughter’s personal details were leaked to an outsider. Suspecting a bigger breach, the organisation initiated an internal inquiry and later approached police.

A case under IPC sections of cheating by personation (419), cheating (420) and attempt to commit offences punishable with imprisonment for life or other imprisonment (511) has been registered, DCP (Dwarka) Shibesh Singh said.

Cops are analysing the audio clips and have called in forensic experts to ascertain their authenticity. The phone numbers used by the criminals have been put on technical surveillance.

Investigating officers are trying to track from where the candidate’s data was pilfered. Similar instances were reported by candidates who had earlier appeared for the NEET examination for MBBS admissions. Then, many candidates who had cleared the examination had received text messages promising a medical seat in a private college for a minimum of Rs 10 lakh.

The autonomous body told police that the role of NBE is limited to conducting the examination, declaring the merit list and providing it to the central and state governments. “The allotment of seats is done by the governments and we have no role in it. The NEET-PG 2018 examination is a high stake sensitive examination and any foul play in it shall affect the future of medical professionals,” the organisation stated in its complaint.

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Aggressive breast cancer has resistant tumour cells already prior to chemotherapy : Study


Lynparza will cost $13,886 per month without insurance, according to AstraZeneca. The company is offering patients financial assistance.
Lynparza will cost $13,886 per month without insurance, according to AstraZeneca. The company is offering patients financial assistance.

SWEDEN, Karolinska Institutet, 19th April : Difficult to treat and aggressive “triple-negative” breast cancer is chemoresistant even before chemotherapy begins, a new study by researchers from Karolinska Institutet and the University of Texas MD Anderson Cancer Center reports. The findings, which are published in the journal Cell, may lead to better and more personalised treatments for breast cancer.

Breast cancer is the most common form of cancer in women and the most common cause of death in middle-aged women in Sweden. Triple-negative breast cancer (TNBC) is an aggressive and difficult to treat form of the disease that makes up about 15 per cent of all breast cancer cases. Chemotherapy is the cornerstone of treatment for TNBC, used either prior to surgery or prophylactically after surgery, as well as for treatment of metastatic disease.

Even though several chemotherapy drugs are effective against TNBC, resistance to treatment is a common problem since it can ultimately lead to relapse and tumour growth. For many years researchers have been trying to understand why such resistance develops and to prevent or reverse it.

“A key question is whether the resistance develops because of the existence of resistant groups of cells, called clones, in the tumour from the start, or whether tumour cells develop new genetic changes (mutations) during the treatment that cause resistance,” says Theodoros Foukakis, Associate Professor at the Department of Oncology-Pathology at Karolinska Institutet, Sweden, who co-led the study with Associate Professor Nicholas Navin at the University of Texas MD Anderson Cancer Center, Houston, USA.

The researchers analysed tumour tissue from 20 patients with TNBC who received preoperative chemotherapy. The tissue was collected before the onset of therapy, after two courses of therapy and on surgery.

The researchers used a technique called single-cell sequencing to examine the DNA and gene expression (RNA) of all genes in the individual tumour cells and thus ascertain the cells’ properties and kinship.

“The DNA analyses revealed tumour clones remaining after treatment in half of the cases,” says Dr Foukakis. “When we studied them in detail at a single-cell level, we found that these same clones were present in the tumour before chemotherapy, often as a small minority of the tumour cell population.”

Single-cell RNA sequencing of thousands of cell nuclei showed that the remaining tumour clones had also adapted their gene expression during treatment to become even more chemoresistant.

“All in all, the study shows that chemoresistance in TNBC is a complex process involving both a selection of resistant clones that existed in the tumour from the start as well as a reprogramming of their gene expression to ensure survival during therapy,” concludes Dr Foukakis.

The results may provide a basis for future studies to identify therapy-resistant tumour clones and thus personalise treatment for breast cancer patients who respond poorly to chemotherapy and have a worse prognosis.

The Swedish part of the study was financed by the Swedish Cancer Society, the Cancer Research Funds of Radiumhemmet and StratCan (KI-MDACC Collaborative Grants). The clinical study was part-financed by Roche, the Cancer Research Funds of Radiumhemmet and the Swedish Breast Cancer Association.

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Mumbai : Rising mercury sends city to hospital with respiratory, waterborne diseases


Mumbai : Rising mercury sends city to hospital with respiratory, waterborne diseases MUMBAI: The sweltering heat combined with humidity has put many in the sickbay. City hospitals have witnessed a significant rise in viral ailments, respiratory and skin diseases, and waterborne ailments. In a small percentage of cases, patients have even required ICU admissions after suffering from severe dehydration and related complications.

At the medical intensive care unit (MICU) of the BMCrun Sion Hospital, for instance, ailments and complications triggered by heat have become common over the last few weeks. “We have at least two admissions every day where patients come in shock, or in a delirious state, or with complaints of cramps. In a more serious presentation among a handful of cases, patients have suffered from cortical venous sinus thrombosis, a potentially serious neurological condition triggered by dehydration,” said Dr Nitin Karnik, head of medicine, Sion Hospital.

Explaining how dehydration can manifest into such a serious form, Dr Karnik said that in weather where daytime temperatures are hovering around 35 degrees Celsius, one could lose up to one to two litres of water in the form of sweat. “Thrombosis occurs when a blood clot forms in the brain’s venous sinuses and prevents blood from draining out of the brain,” he said. “Most patients who suffered from this uncommon condition were in their 30s and have a history of working outdoors. Some of them presented with partial paralysis, while there were others who came with loose motions and vomiting. All could be successfully treated. It is important that people don’t just drink water but also add lime, kokam, and salt to replenish electrolyte levels.”

In a majority of cases though, it is viral fever, redness of eyes, cold, sore throats and lingering cough that patients are complaining of. “We are treating many cases of patients with runny nose and irritable throat, but few are graduating into fever cases,” said physician Dr Hemant Thacker, cautioning people from running into an AC blast after coming in from the sun. Infectious disease expert Dr Om Srivastava said a dozen of his patients is grappling with a bout of post-infection bronchitis that’s taking longer than usual to heal. “Many of them are on steroids, yet the recovery time is longer,” he said. Pollution, as one of the cause factors cannot be ruled out, he said. In 2017, the city saw 167 days when air quality was moderate or poor.

Sporadic cases of dengue are also being reported from the city. After sudden showers were recorded in parts of the state, including extended suburbs like Kalyan and Dombivli, the state is worried that it could contribute to a spurt in dengue. Mumbai has seen nearly 500 cases of suspected dengue in the first three months of the year. But the number of laboratory-confirmed cases was only 17 till February. BMC officials said dengue cases are under control and their concern is mostly about gastroenteritis cases, since people consume water and beverages outside. In a recent drive, the BMC found that 98% of edible ice samples tested were contaminated with the E.coli bacteria.

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KKR-backed hospital chain Radiant Lifecare submits its bid for Fortis Healthcare


KKR-backed hospital chain Radiant Lifecare submits its bid for Fortis Healthcare Radiant Lifecare, the emerging Mumbai-based hospital chain that is backed by buyout firm KKR, has submitted its bid for Fortis Healthcare, the cash-strapped hospital network that is in the middle of a fiercely contested bidding war.

Radiant has made a offer for Rs 165 per share, which comes to Rs 6,500 crore for Fortis healthcare.

Seperately, the company said will offer Rs 3,600 for SRL. SRL will be spun off and Fortis shareholders will get its shares.

This takes the total deal value to Rs 10,000 crore. Radiant has offered to inject cash immediately in the company by buying the FMRI and Shalimar Bagh hospitals that are outside the RHT trusts.

Radiant Hospitals which raised $200 million from private equity firm KKR last year has been looking for hospital assets with minimum 500 beds to acquire and expand its operations. Currently in possession with two hospitals in Delhi and Mumbai, Radiant says it wants to expand in metro cities.

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‘Liver diseases 10th common cause of death among Indians’


‘Liver diseases 10th common cause of death among Indians’
MADURAI: Liver diseases are the 10th common cause of death among the Indians, according to a report by the World Health Organisation. Awareness and understanding the causes of the diseases such as Hepatitis B and C virus, fatty liver and liver cancer can help to prevent these diseases.

Speaking to reporters on the occasion of the World Liver Day, which falls on April 19, medical director and head of the department of surgical gastroenterology at the Meenakshi Mission Hospital and Research Centre, Dr Ramesh Ardhanari said, a liver dysfunction can lead to many complications in other organs. Two of the common and main reasons for liver diseases are consumption of alcohol, unhealthy lifestyle which includes consuming high cholesterol food, he said.

Fatty liver is common in the elderly and this is caused by the accumulation of abnormal amount of fat in the liver. Liver disease caused by alcohol consumption is common in the youth and middle-aged adults, he said.

Consultant gastroenterologist Dr P L Alagumani said that people still lacked awareness on liver diseases though it was life threatening. Patients with liver disease usually come to medical attention only during the advanced stage. This is because the symptoms become overt only in such advanced stage, Alagumani said.

Regular health check-ups can help prevent many diseases. Common symptoms are loss of appetite and weight loss. Jaundice can also occur in a person whose liver is severely damaged.

The common liver diseases in Tamil Nadu are alcoholic liver disease, chronic viral hepatitis due to Hepatitis B and C virus and fatty liver. The alcoholic liver disease can be completely cured if detected in the early stage.

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Indian-American doctors want lowering of cost of prescription drugs


Representative image
Representative image

By Lalit K Jha

Washington, Apr 16 : An influential group of India-American physicians has aligned itself with President Donald Trump’s agenda to lower the cost of prescription drugs and urged the Congress to carry out the immigration reform in particular H-1B and J-1 visas.

Scores of Indian-American physicians gathered at the US Capitol Hill last week urging the Congress to pass the necessary legislations which they said need to address this major issue of concern for patients in the United States.

“The exorbitant cost of prescription drugs is a critical health care issue, as some life-saving drugs are too expensive for many patients,” said a memorandum submitted by American Association of Physicians of Indian Origin or AAPI to the lawmakers.

“As physicians, we want to ensure that the medicines the patients need are affordable and will be taken, to ensure a high quality of life, reduction of chronic ailments, and effective treatment today to prevent increased health care costs in the future,” said AAPI, which is the representative body of thousands of Indian American physicians in the US.

Nearly two dozen lawmakers attended AAPI’s Legislative day at the Capitol Hill. Prominent among them were Tulsi Gabbard, Co-Chair of the Indian Caucus; Ed Royce, Chairman of the House Foreign Affairs Committee; Frank Pallone, Joe Wilson and Indian American lawmakers Raja Krishnamoorthi and Pramila Jayapal.

One of the major Emphasis of the agenda was on immigration reform, said Dr Sampat Shivangi, co-chair of AAPI’s legislative wing.

Noting that H1 & J1 visas has affected physician group with backlog of their green card and their issue as they are restricted to serve in rural and underserved area, he said that emphasis should be on five years limitation.

“They should be given the green cards as they are not competing with US citizens as there is a tremendous short of physicians in USA. These physicians have made tremendous contributions to the US health care where it is needed,” he said.

Later in a meeting with Senator Roger Wicker of Mississippi, an AAPI delegation led by Dr Shivangi said that the Indian professionals in the US have been unjustifiably waiting for more than a decade to get their green cards or permanent legal residency. This is mainly because of the country-specific quota.

“Senator Roger Wicker agreed to look into it and introduce a bill with the language to overcome this problem,” Dr Shivangi said.

“H-1 and J-1 visas are used by many South Asian American physicians, playing an important role in providing critical health care across the country. Combined with the Green Card backlog consisting of more than 4 million people, we are very concerned about the impact immigration reform will have on the South Asian American community,” AAPI said in its legislative agenda to the lawmakers.

Noting that the US is facing a chronic physician shortage, which will only be exacerbated in the years ahead as more baby boomers retire, AAPI said the Congress can act by passing legislation adding 15,000 more residency slots, which will help to train up to 45,000 more doctors in the next two decades. LKJ ZH ZH

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