Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 4th July, 2019

FSSAI Guidance Note on gluten-free foods

Recognizing the challenges faced by celiac patients, Food Safety and Standards Authority of India (FSSAI) has established the standard for 'gluten free foods' and their labelling requirements under the Food Safety and Standards Regulations, 2011. It has released a guidance note, set up standards and made easy to perform rapid tests available for the common consumer. The key takeaways from the guidance note:

People with celiac disease should not consume food product containing gluten (wheat, barley etc.)

  • Only foods that contain 20 mg gluten/kg or less can be labelled as 'gluten-free'.

  • The patients with celiac disease should:

  • Buy foods that are labelled 'gluten- free'.

  • Check the ingredient list and confirm that there is no gluten in the food.

  • Check the food package for 'gluten free' label in the immediate proximity of the name of the product.

  • Should not buy flour from local mills where wheat may also be grounded for other customer and there are high chances of cross contamination.

  • Check FSSAI license number on the package(s).

  • Always read the manufacturing/ packaging date and best before date before buying food.

  • Check the labels, even on foods one buys regularly, as there may be some changes in ingredients used and that may contain gluten.

(Source: FSSAI)

Long-term increased risk of cancer death following radioactive iodine treatment for hyperthyroidism

(NIH): Findings from a study of nearly 19,000 patients who received radioactive iodine (RAI) treatment for hyperthyroidism and none of whom had had cancer at study entry show an association between the dose of treatment and long-term risk of death from solid cancers, including breast cancer. The study, led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, was published July 1, 2019 in JAMA Internal Medicine.

Most of the radiation is absorbed by the thyroid gland, but other organs like the breast and stomach are also exposed during treatment.

The relationship was statistically significant for female breast cancer, for which every 100 mGy of dose led to a 12% increased relative risk of breast cancer mortality, and for all other solid tumors considered together, for which relative risk of mortality was increased by 5% per every 100 mGy.

Based on these findings, the researchers estimated that for every 1,000 patients aged 40 years with hyperthyroidism who were treated with the radiation doses typical of current treatment, a lifetime excess of 19 to 32 radiation-attributable solid cancer deaths would be expected.

Investigative public health: The scope of public health detectives

Resurgence of infectious diseases is a reflection of the existing public health system in the country. Infectious diseases occur every year in India with monotonous regularity and we are unable to control the frequency of their occurrence and their subsequent spread.

A public health approach to health care may be the answer. Unlike clinical medicine, which focuses on individuals and diagnosis and treatment, public health deals with the whole community and is preventive.

Every preventable death should be audited, and every index case of any communicable disease should be traced for the source.

The time has come for investigative public health department with appointment of public health detectives, who will help establish the cause of the outbreak and how can its spread be limited. Here lies the importance of contact tracing and their monitoring. Contacts can be the immediate family and/or those who have been in close proximity to the index case, including the health care workers who have looked after the patient.......read more

Healthcare News Monitor

Ansal University partners with Heart Care Foundation of India

Business Standard-ANI

Ansal University, India's leading private university, signed a memorandum of understanding with the Heart Care Foundation of India (HCFI), a leading national non-profit organization committed to making India a healthier and disease-free nation, on Doctor's Day (1 July 2019). The partnership is intended towards setting up a Centre of Excellence at Ansal University campus to impart students training in advance areas relevant to emerging healthcare industry. The MoU was signed by the Registrar, Ansal University and Padma Shri Awardee, Dr K K Aggarwal, President, HCFI. Through this specialized centre, the University aims to introduce new healthcare and related courses for its students and make use of HCFI's expertise in various aspects. Since its inception in 1986, the HCFI has been using consumer-based entertainment modules to impart health education and increase awareness about preventive health amongst people. In addition to this, the NGO conducts programmes and camps to train people on the technique of hands-only CPR through its CPR 10 mantra for revival after a sudden cardiac arrest. HCFI currently holds three Limca Book of World Records for the maximum number of people trained in hands-only CPR in one go. "This association with HCFI is a step towards a better, vibrant future for our students. HCFI is an entity known for its exemplary work in the field of heart care and medicine and with their help, we will be able to hone potential doctors and professionals in the field of medicare. Our aim is to enhance the future of the healthcare sector which is on its path to achieve an exponential growth in this area in our country", said Prof (Dr) Raj Singh, Vice Chancellor, Ansal University.

This institute is using smart robots instead of dead bodies to help medical students practice

India Today- Harshita Pathak

Ansal University has launched a hi-tech simulation laboratory, Immersive Learning Simulation Lab, for the training of students of its Sushant School of Health Science. In association with Yuva Healthcare Institute, the launch took place at the university campus on July 1, which is also celebrated as National Doctor's Day. YUVA Healthcare is an advanced skilling institute, which strives to elevate the quality of healthcare delivery. It provides requisite skills to the Nursing and Allied Health professionals in the state-of-the-art medical simulation center, and makes them ready for the workplace. Dr Dharminder Nagar, MD and CEO of Paras Hospitals, was the Chief Guest for the event. Other eminent personality present during the launch was Padmashree Dr KK Agarwal, who is also the president of Heart Care Foundation of India.

Write in capital letters, KGMU tells doctors

The Times of India-Vivek Singh Chauhan

Doctors at King George’s Medical University (KGMU) will have to write prescriptions in capital letters from August 1. The university has taken the decision following complaints that its prescriptions are often illegible and patients find it difficult to procure medicines. There have also been instances when pharmacies have handed wrong medicines to patients because they too couldn’t decipher what was actually prescribed. “The circular has been issued to all the departments in accordance with the Medical Council of India guidelines,” said KGMU medical superintendent Dr BK Ojha. Patients in general welcomed the move. Some also recalled how wrong pills had done them or at least threatened to do them more harm than good. Bharti of Khadra, an ENT patient, said a pharmacy misread her prescription a week ago. “They gave me a pill to cure an ear infection, but it induced vomiting. Later, a doctor at a private hospital said the pharmacy had given me a wrong pill because they confused a spelling,” she said. Narendra Kumar (25) of Barabanki, who was escorting a cancer patient on Tuesday, told TOI that a medical store outside KGMU sent him back to the doctor twice for clarifications. Aliganj resident Shikha Pandey said recently, a doctor of general medicine had prescribed her a pill for blood pressure, but no pharmacist or chemist could read what it was. “I had to go back to KGMU and request the doctor to rewrite the prescription more clearly,” she added. Atul Singh, a resident of Balaganj who visited the urology OPD on Tuesday, said he had to hop from one private clinic to another to get some pathological tests done. “I simply wanted to avoid the rush at KGMU. But, no lab outside could read what tests were prescribed. So, here I am, waiting for my turn at KGMU”.

Supreme Court seeks details from doctor alleging hospitals declare patients brain dead in Kerala to harvest organs

The New Indian Express

The Supreme Court Tuesday asked a doctor to bring on record specific instances showing that patients were prematurely declared brain dead by private hospitals in Kerala to harvest their organs as has been alleged in his petition. The apex court said it can examine the allegations if some evidence is brought on record by naming certain hospitals which are purportedly declaring patients as brain dead in order to harvest their organs for transplant. A Bench comprising Chief Justice Ranjan Gogoi and Justices Deepak Gupta and Aniruddha Bose granted four weeks to S Ganapathy, who appeared in person, to highlight the gross malpractice in the certification of brain dead in Kerala. "We are grateful to you for bringing the issue but you have not given a single instance of patients being declared brain dead prematurely. Your petitions is very general," the bench observed. The doctor filed the appeal in 2017 against a Kerala High Court order which stated that it was satisfied with the steps taken to prevent such malpractices. It has been alleged that especially in private hospitals, the patients are "prematurely" declared brain dead to ensure cadaveric donation of organs like heart, lungs, kidneys, liver and pancreas.

Doctors at Hindu Rao hospital continue agitation

Business Standard- PTI

Doctors at the Hindu Rao Hospital in north Delhi continued their agitation on Tuesday to demand adequate security deployment inside the campus, a day after they met civic authorities and decided not to go on strike. A meeting was currently underway among representatives of the hospital's Resident Doctors Association (RDA), Federation of Resident Doctors Association (FORDA), senior civic and police officials, said Rahul Chaudhary, president of RDA. Doctors at the North Delhi Municipal Corporation-run hospital have been protesting since Sunday and had threatened to go on strike from Monday after two of their colleagues were allegedly beaten on Saturday night by relatives of a patient who had died at the facility. On Monday, they had met civic authorities, who had assured them that their demands will be met. Post the assurance, the doctors had decided not go on strike. Agitating doctors have been demanding augmentation of security deployment and setting up of a police 'chowki' inside the campus of the hospital. "We had threatened to go on a strike from Monday if our demands were no met. But, senior officials of the NDMC met us this afternoon to discuss the ongoing situation," the president of the hospital's RDA had said on Monday, and claimed, "NDMC officials gave us assurance in writing that our demands will be met".

Will regulations on e-pharmacies affect the brick-and-mortar stores?

ET Healthworld

Today e-commerce has taken over and online shopping is almost de rigueur. Can the $140 billion pharma market be lagging behind by way of e-commerce? More than 250 e pharmacies have mushroomed and flexed their muscles. They crave to carve a massive cut from the pharma cake. According to a recent EY report ‘e-pharma: delivering healthier outcomes’, the e-pharma players are expected to attain a combined market size of US$2.7 billion by 2023 from about US$360 million currently in the next four years. The ease of doing e-business, offers and discounts, adds to the lure of e-pharmacy but all this is not music to their brick-and-mortar counterparts who are governed by laws that were written much before the arrival of computers, raising questions on misuse of former regulation (Drugs and Cosmetics Act, 1940, Drugs and Cosmetics Rule, 1945 and Pharmacy Act, 1948 ). Comparatively, there are no new laws to regulate, govern or monitor the e-pharmacy. The disagreements on the working of online pharmacies were well witnessed when All India Organisation of Chemists and Druggists (AIOCD), an association of brick-and-mortar retail chemists called on all its 800,000 members across the country to observe a day-long nationwide strike on September 27. The strong opposition was an after-effect of the government’s decision on regulating online pharmacy.

Himachal Pradesh: Man gets 3 year's RI for assaulting on-duty doctor

The Times of India- Anand Bodh

A court in Chamba awarded three year's rigorous imprisonment along with Rs 10,000 fine for assaulting an on-duty doctor. For the offence of voluntarily causing grievous hurt to deter a public servant from his duty, sessions judge Rajesh Tomar awarded convict Vijay Kumar of Upper Julakhari, three years of rigorous imprisonment along with Rs 10,000 fine, for offence of assault or criminal force to deter public servant from discharge of his duty, the court awarded him one years of rigorous imprisonment along with Rs 5,000 fine, for the offence of voluntarily causing hurt to deter public servant from his duty, Kumar was awarded two years of imprisonment along with Rs 8,000 fine, for the offence intentional insult with intent to provoke breach of the peace, he was awarded six month's rigorous imprisonment along with Rs 5,000 fine while for the offence of punishment for criminal intimidation, if threat be to cause death or grievous hurt, etc, the court awarded him six month's rigorous imprisonment along with Rs 5,000 fine. All these sentences would run simultaneously. The accused came to the emergency ward along with his wife and told him that his wife is not feeling well. Dr Kamaljeet examined his wife and prescribed the medicines to her. After some time, the accused came along with his wife to the emergency ward and used abusive language against the doctor. At the same time the doctor went to attend another patient. The accused followed him and insisted that he should attend his wife first. The accused caught hold of the doctor’s collar and assaulted him. He also tried to strangulate the doctor and threatened to kill him. The doctor was rescued by a person who was present there. Thereafter the police were informed.

Mumbai crime: Doctor films female client during hair removal treatment

Mid day

A Lokhandwala based doctor was booked for allegedly filming a 27-year old woman while she was undergoing a body hair removal procedure at his clinic in Andheri. The complainant had gone to the clinic for the procedure on June 24. According to the police, she had to take off her clothes in front of three woman assistants of the doctor as part of the procedure. During the procedure, she noticed that a camera was installed inside the smoke detector on the ceiling. She stopped the treatment and left the clinic after clicking a picture of the camera. In a heated exchange with the doctor on the issue, the doctor told her that all the footage is deleted automatically after 15 days. Hindustan Times reported that the woman filed a complaint at the Oshiwara police station. However, as per the three assistants, the woman was aware of the camera before the procedure started.