Editor in Chief Dr KK Aggarwal, Padma Shri Awardee


Dated: 18th April, 2019

Medtalks with Dr KK

1.In an apparent bid to increase the number of enrollments and to reduce the burden on super-specialist doctors, the Medical Council of India could soon start promoting the Post Graduation in Family Medicine course aggressively.

2. Regular infusions of an antibody that blocks the HIV binding site on human immune cells may have suppressed levels of HIV for up to four months in people undergoing a short-term pause in their antiretroviral therapy (ART) regimens, according to a report published online today in The New England Journal of Medicine. Results of the Phase 2, open-label study indicate the antibody, known as UB-421, was safe and did not induce the production of antibody-resistant HIV. The study was supported in part by the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health, and United Biopharma, Inc.

3. Women with very low levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides may be more than twice as likely to have a hemorrhagic strokethan women with higher levels. Investigators at Harvard University prospectively studied a cohort of almost 28,000 women who had been enrolled in the Women's Health Study over a period of approximately 20 years.

4. Multidrug-resistant organisms (MDROs), or "superbugs," are commonly found on hospitalized patients' hands, investigators report. The researchers found that 13.3% of patients had MDROs on their hands and that 39.8% of commonly touched surfaces in patients' rooms had MDROs at any time during the patients' hospital stays. The study, by Lona Mody, MD, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School and Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, and colleagues, was published online April 13 in Clinical Infectious Diseases.


Measles in 2019

In 2000, the United States achieved a historic public health goal: the elimination of measles, defined by the absence of sustained transmission of the virus for more than 12 months.

Localized measles outbreaks have recently been triggered by travel-related introductions of the virus by infected persons, with subsequent spread through undervaccinated subpopulations.

According to the Centers for Disease Control and Prevention, 555 cases of measles in 20 states had already been confirmed from January 1 through April 11, 2019.

The increase in measles cases in the United States mirrors patterns elsewhere: several other countries that had eliminated measles are now seeing resurgences.

1.Measles is a highly contagious cause of febrile illness typically seen in young children.

2.It is transmitted primarily by means of respiratory droplets and small-particle aerosols and can remain viable in the air for up to 2 hours.

3.Exposed people who are not immune have up to a 90% chance of contracting the disease, and each person with measles may go on to infect 9 to 18 others in a susceptible population.

4.Most people with measles recover uneventfully after approximately 1 week of illness characterized by fever, malaise, coryza, conjunctivitis, cough, and a maculopapular rash.

5.Even today, it remains a leading cause of vaccine-preventable illness and death worldwide, claiming more than 100,000 lives each year.

6.Common complications include secondary infections related to measles-induced immunosuppression, diarrhea, keratoconjunctivitis (which may lead to blindness, particularly in vitamin A–deficient populations), otitis media, and pneumonia (the leading cause of measles-related deaths).

7.In approximately 1 in 1000 cases of measles, serious and often fatal neurologic complications such as acute disseminated encephalomyelitis and measles inclusion-body encephalitis occur, and most patients who survive these complications have long-term neurologic sequelae.

8.In addition, a rare neurologic complication (affecting approximately 1 in 10,000 patients) called subacute sclerosing panencephalitis (SSPE) can occur years after measles virus infection, with a severe, progressive, and fatal course.

9.Live-attenuated measles vaccines are among the most highly effective vaccines available (providing 97% protection with two doses, given at 12 to 15 months and 4 to 6 years of age), with a proven safety record.

10.The most common side effects of the measles vaccine are a sore arm and fever.

11.A small proportion of vaccinees (about 5%) will develop a rash; an even smaller proportion will have a febrile seizure or transient decrease in platelet counts. A very rare complication, meningoencephalitis, has been described, almost always in immunocompromised vaccinees.

12.Previous strides are now being threatened by a 31% increase in the number of measles cases reported globally between 2016 and 2017.

13.Measles has all the components of an eradicable disease: there is a safe and highly effective vaccine, it has a readily diagnosable clinical syndrome, and it has no animal reservoir to maintain circulation.

14.Because of the highly contagious nature of the virus, near-perfect vaccination coverage (herd immunity of 93 to 95%) is needed to effectively protect against a measles resurgence.

15.Apart from medical contraindication due to marked immunosuppression, the failure to vaccinate too often stems from misconceptions about vaccine safety, especially those resulting from a now-debunked claim that posited a connection between the vaccine and autism.

16.Vaccine hesitancy has been identified by the WHO as one of the top 10 threats to global health and is a serious hurdle to the global elimination and eradication of measles.

17.The successful implementation of measles vaccination programs is changing the epidemiology of measles from seasonal epidemics in young children to sporadic cases in older children and adults, including pregnant women.

18.The greatest risk of measles-related complications occurs in immunosuppressed people. This population may have atypical presentations with severe complications that have not been documented in immunocompetent patients, such as giant-cell pneumonia and measles inclusion-body encephalitis.

19.Exposure to measles in the community certainly represents a danger to high-risk persons during a local outbreak; however, nosocomial transmission may pose an even greater threat and has been reported throughout the world. For example, during a measles outbreak in Shanghai in 2015, a single child with measles in a pediatric oncology clinic infected 23 other children, more than 50% of whom ended up with severe complications, and the case fatality rate was 21%.5 When the umbrella of herd immunity is compromised, such populations are highly vulnerable.

20.Measles is a public health problem with a clear scientific solution. Measles vaccination is highly effective and safe. [Excerpts from NEJM]


Healthcare News Monitor

Dated: 18th April, 2019

Violence against doctors is unacceptable but creating a positive communication channel with patients

PRLOG

A recent survey by the Indian Medical Association (IMA) revealed that nearly 75% of doctors in India have faced some form of violence or threat of violence at some point in their careers. In several states, doctors have frequently gone on strike demanding stringent punishments for those who attack doctors. Others have written articles highlighting the need for better security and surveillance at hospitals. Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India, said, "The doctor-patient relationship is facing turbulent times these days. Trust forms the foundation of this relationship and determines the outcome. However, this trust has corroded over the last few years and must be restored urgently, as it is crucial to the survival of this very important relationship. The doctor-patient relationship too needs CPR to revive it. And, it is revivable, just as a dying person or a clinical dead person can be revived by CPR."

Roche launches Haemophilia A treatment drug in India

The Hindu Business Line-PTI

Drug firm Roche on Wednesday said it has launched Emicizumab under the brand name Hemlibra in India for preventive treatment of Haemophilia A, an inherited disorder in which a person’s blood does not clot properly. Hemlibra is the first weekly subcutaneous prophylaxis injection shown to prevent or reduce the frequency of bleeding episodes and improve the quality of life, Roche said in a statement.All current prophylactic treatment options for people with Haemophilia A with factor VIII inhibitors require intravenous infusions several times a week, it added. “The introduction of Emicizumab (Hemlibra) is a significant milestone in the treatment of Haemophilia A in India and reaffirms our commitment to bring Roche’s ground breaking medicines to patients in India as early as possible,” Roche Pharma India’s Chief Purpose Officer Lara Bezerra said. This breakthrough medicine represents a completely new way to manage Haemophilia A and redefines the standard of care, she added. The company, however, did not disclose the price at which it would be selling the drug in the country.

Government invites initial bids for strategic sale of IMPCL

ETHealthworld- PTI

The government has invited initial bids for selling its entire stake in Indian Medicines Pharmaceutical Corporation Ltd (IMPCL). IMPCL is engaged in manufacture and supply of 'ayurvedic' and 'unani' medicines and is under the Ministry of AYUSH. The government holds 98.11 per cent stake in IMPCL and the rest 1.89 per cent is held by Uttarakhand government PSU Kumaon Mandal Vikas Nigam Ltd.

Tuberculosis: India’s Silent Epidemic

The Diplomat-Siddharthya Roy and Sayan Ghosh

Aditi (name changed), 18, sat cross-legged on her private hospital bed in Kolkata. The black scarf covering her mouth did little to hide her emaciated face. Cheeks stained with long-dried tears, she stared at the ceiling unsure of whether she’d live or die – unsure of whether or not there was a real cure for her. It had all begun about a year before our meeting, when she’d started experiencing severe bouts of coughing and unexplained weight loss. Her parents initially took her to a homeopathic doctor who had prescribed medicines. As is the norm in most homeopathic clinics, no diagnosis or pathological tests were done and whatever was given to her as medicine was to treat the symptoms.

Attract more talent to public health

Hindustan Times-Ashok Alexander

I am sometimes asked, “What really is public health?” The term refers to the health of populations, in contrast to clinical health, which considers one patient’s well-being. Public health also has a larger prevention component — for example mass immunisation programmes. It has multiple components: disease surveillance, epidemiology (transmission routes of diseases), designing programmes for scale (supply, demand, advocacy components), monitoring and evaluation, effective management, financing and more. India’s polio programme is one of the world’s great public health successes. Surveillance was precise, household by household, reaching even the remotest areas. There was active engagement with the community, involving religious leaders. There was creative use of media. Remember Amitabh Bachchan’s catchy “sirf do boond (just two drops)” appeal delivered in his trademark baritone? Logistics for safe distribution of vaccines were carefully worked out. The polio programme was much more than a techno-medical campaign. Indeed, its success was in the seamless coming together of business, social and medical skills.

‘Vision-blurring’ drugs put on alert

Deccan Chronicle

Two suspected drugs Dabigartan and Sertraine that are leading to severe adverse events in the vision and also the neuro system must be reported to the Pharmacovigilance Programme of India (PvPI) as the prescription of these drugs has to be revised. The alert has been issued by the Indian Pharmacopoeia Commission after 20 of 250 ADR centres reported the adverse effects.

Demand for fair pricing of medicines at WHO forum

Down to Earth-Vibha Varshney

In an effort to increase affordability of medicines, delegates from governments and civil society organisations at a World Health Organisation (WHO) forum demanded for greater transparency around the cost of research and development as well as production of medicines. This demand was made at the Fair Pricing Forum, which was hosted by the government of South Africa and co-hosted by the WHO, held between April 13 and 14). The delegates said a frank discussion among all stakeholders would help identify strategies to reduce medicine prices and expand access for all. “Medical innovation has little social value if most people cannot access its benefits,” said Mariângela Simão, WHO assistant director general for medicines and health products.

E-cigarettes are injurious to health

Deccan Herald

A letter written by over 1,000 doctors from 27 states and three union territories to Prime Minister Narendra Modi seeking an immediate ban on e-cigarettes in the country is based on a serious public health concern. The request is for a ban on Electronic Nicotine Delivery Systems (ENDS), which includes e-cigarettes and e-hookahs, and are variously called as vapes, vape pens, etc. They are devices that look like regular cigarettes or pens or other items that electronically act upon e-liquids, most of which contain nicotine. The use of ENDS products is increasing among young people as most anti-tobacco campaigns are focussed on their direct use. Though there is a view that the dangers of the use of ENDS products are yet to be fully established, the wider consensus is that they are as harmful as tobacco products. E-cigarette vapour contains many chemicals, some of which are not found even in tobacco, and are harmful to the user and others exposed to it.

Healthcare News

Healthcare reeling! India needs 600,000 more doctors, and 2 more million nurses, says study

Financial Express-PTI

India has shortage of an estimated 600,000 doctors and 2 million nurses, say scientists who found that lack of staff who are properly trained in administering antibiotics is preventing patients from accessing live-saving drugs. Even when antibiotics are available, patients are often unable to afford them. High out-of-pocket medical costs to the patient are compounded by limited government spending for health services, according to the report by the Center for Disease Dynamics, Economics & Policy (CDDEP) in the US.

The challenging paradigms of healthcare in India

The New Indian express

If healthcare has recently moved to centre-stage, it is because it has become a political priority in the setting of the upcoming elections. The magnitude of ill-health in India has become too severe to be ignored. Every political party is keen to address this issue as life-saving and potentially, vote-winning. One just needs to read WHO’s ‘Global Burden of Disease (GBD) India 2017’ to get a glimpse of the falling standards of healthcare in India. What is striking is the strong presence of a dual disease burden — objective evidence of sub-optimal health parameters of the Indian population, and the emergence of new public health concerns. The GBD report must provoke the stakeholders of health to sincerely appraise the situation scientifically more than politically, to avoid a national crisis, which it may already be. The Ayushman Bharat is certainly commendable as a courageous initiative to address health as a national priority, but its long-term financial sustainability is questionable.

Medapp - a game changer of the healthcare ecosystem in India

Business Standard-ANI

Modern lifestyles and changing food habits over the years have led to a growth in the number of chronic disease cases in India. Medapp - a healthcare service provider united around a mission of touching lives, changing lives and saving lives, is all set to revolutionise the way people manage health on a day-to-day basis. Providing patient support and disease management programmes across 30 cities in India, at patients' doorstep, the company has already touched millions of lives by diagnosing and helping people manage chronic diseases like diabetes, asthma and COPD. Started in 2015, the bootstrapped company ventured into health services by connecting patients with the existing healthcare system. By holding regular medical camps in multiple cities across India to spread awareness about the importance of ongoing disease management, the founder -Niranjan Swamy soon realized that the problem of healthcare in India was much bigger and complex to address.

Same difference in public policy

Business Standard-Kanika Dutta

The taxpayer-funded National Infrastructure Investment Fund has thought fit to bid for failing private airline Jet Airways, which is used by a minuscule fraction of the Indian population. Yet, plans for the redevelopment of railway stations, used by millions of Indians every day, are yet to get off the ground. Doctors in India frequently make headlines for accomplishing state-of-the-art surgeries and associated medical marvels — so much so that the country has become a hub for cost-effective sophisticated medical tourism. Yet the average Indian’s access to medical treatment.

Ahmedabad: Woman in ICU after nurse gives wrong injection

DNA-Chandrika Makwan

It is the worst nightmare that one can go through. Chandrika Makwan (27), a resident of Amraiwadi was waiting to be discharged from the LG Hospital after recovering from malaria, but she ended up in the ICU. According to her brother Chandu Makwana, a nurse from the LG Hospital administered his sister with an injection which was actually meant for another 75-year-old patient in the ward by the same name. On Tuesday, Chandu submitted an application against the hospital and its staff to the Maninagar police. Chandu has alleged that due to the negligence of the L.G hospital staff his older sister is in critical condition right now and battling for life.

‘Technology will increase efficiency’

The New Indian Express-Dia Rekhi

Rahul Menon, MGM Healthcare CEO, speaks about the state of healthcare in India and the role of the group’s hospital in providing healthcare to different sections of society. What are the challenges that the healthcare industry is facing today? Skilled manpower is a big challenge. There is a huge shortage, especially on the clinical side. Perception is another problem because people feel the prices are exorbitant and they are being charged unnecessarily. This perception needs to change. There are so many players in the medical treatment space. Where does MGM Healthcare fit in? We are fortunate that we have been involved in medical education for very long so we have a sound understanding of the needs of the industry. For instance, we have a strong emphasis on including cutting-edge technology, not only clinical but non-clinical technology too. This will help with backend processes.

Bionic Yantra: The robot giving patients a leg up

Forbes India-Naini Thaker

Vaidy Narayanan had seen his 27-year-old cousin suffer from an auto-immune condition (Transverse Myelitis) that caused his spinal cord to collapse, leaving him paralysed. Inspired by a woman skier who was paralysed but walking because of a robotic exoskeleton at the opening ceremony of FIFA 2014, Narayanan thought he could make his cousin walk again.

Surgical Infection can have a catastrophic impact on patients in India! UK experts join Indian medics to counter the threat

Financial Express-PTI

Experts from the University of Birmingham have tied up with medical professionals in India to set up an innovative research centre that will help improve care for surgical patients. A team from the university’s joint research team, involving the UK’s National Institute for Health Research Global Health Research Unit on Global Surgery (NIHR), travelled to Punjab recently to launch the first-ever surgical research hub in India at Christian Medical College and Hospital (CMC) in Ludhiana and deliver a training workshop.

Can’t blame doctors alone for failed eye surgeries

The Tribune

RECENT reports of failed eye surgeries in several hospitals of Haryana have brought into focus the failure to ensure vision to cataract patients even after successful surgical procedures by experienced surgeons and observance of operation theatre (OT) protocols. Studies reveal that such incidents have been occurring across the nation in private as well as public hospitals. Adverse events do occur with some frequency after any surgery, including eye surgery, but should the blame squarely lie on the operating surgeons? The failure of the surgery, coupled with the charge of negligence against doctors, obfuscates the underlying core issues and unduly exposes the doctor to the hysterical anger of society, physical assaults, and avoidable litigation by the patient’s kin. While most consumers have come to expect defect-free electronic gadgets, medical scientists are loath to accept the same perfection in the delivery of surgical care.


Hospital and not doctors to file FIR for any violence against doctors

18th April 2019: In a recent directive issued by the Principal Secretary of Health and Family Welfare, Govt of NCT of Delhi, HODs of hospitals or medical institutions will file FIR against any incidents of abuse or violence by patients or their attendants. As per the directive, no individuals, be it hospital staff or doctors can file the FIR. It will be incumbent on the MS/Director of the institution to ensure that FIR is registered immediately in such cases and any non-compliance will be dealt with seriously.

Speaking about this, Dr Girish Tyagi President Delhi Medical Association said that the prompt action by Chief Secretary Delhi Sh Vijay Dev Ji is an important step to combat the rising violence in the hospitals. Sh Vijay Dev was the chief guest it the annual IMA New Delhi Branch function where Dr G K Mani took over as its President and Dr Prachi Garg as the secretary.

The same process should also be adopted by the private hospitals. The DMA also has requested the Delhi government to exempt individual prescription only clinics from bio medical waste registration and single window registration for most nursing home setups.

Addressing at the function Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, that there are three types of doctors: those who expect patients to accept what they say without questions; those who give choices to patients; and those who take time and help the patients in taking a decision. This is the discord and the number one cause of miscommunication and disputes. While the types of patients have changed very rapidly from ignorant to enlightened, doctors are still in the first phase, where they feel that they don’t need to spend time with the patient.”

The first principle required for a better doctor-patient relationship is to understand that I need to spend time with the patient, explain, reason out and review.

‘ALERT’ is a concept that every doctor and patient must remember.

  • Acknowledge: When the patient enters your office, greet him/her by name and introduce yourself or your staff who would be involved in patient care.
  • Listen to your patient.
  • Explain to the patient about the disease.
  • Review the information given with the patient to make sure that they have been understood correctly.
  • Thank you: This is most important. Doctors must thank their patients for giving an opportunity to serve.


Dated: 18th April, 2019

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 17 th April to 0830 hrs IST of 18 th April, 2019)

Heat Wave:

Nil (Annexures 1 & 2).

Maximum Temperature

Maximum Temperature more than 40.0°C was recorded at isolated places over Vidarbha, Odisha, Telangana, Interior Karnataka, Coastal Andhra Pradesh, Rayalaseema and Tamilnadu.

Maximum temperature departures as on 17-04-2019: Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at isolated places over Kerala and Tamilnadu & Puducherry; above normal (1.6°C to 3.0°C) at isolated places over Coastal & South Interior Karnataka, Odisha and Tripura. They were markedly below normal (- 5.1°C or less) at most places over Jammu & Kashmir, Himachal Pradesh, Punjab, Haryana, Chandigarh & Delhi, Rajasthan and Uttar Pradesh; at many places over Madhya Pradesh, Gujarat Region and Bihar and at isolated places over Vidarbha; appreciably below normal (-3.1°C to -5.0°C) at most places over Jharkhand; at many places over Chhattisgarh; at a few places over Saurashtra & Kutch and at isolated places over Sub-Himalayan West Bengal & Sikkim and Madhya Maharashtra; below normal (-1.6°C to -3.0°C) at most places over Marathwada; at many places over Gangetic West Bengal and at isolated places over North Interior Karnataka and Assam & Meghalaya and near normal over rest parts of the country. The highest maximum temperature of 42.6°C was recorded at Tirupathi (Rayalaseema) over the country.

Heat Wave Warnings for Next 24 hours (From 0830 hrs IST of 18 th to 0830 hrs IST of 19 th April 2019):-

Nil


Drug Safety Update

SGLT2 inhibitors
Citing concerns raised by the US FDA and Health Canada regarding safety of SGLT2 inhibitors used for type 2 diabetes, the DCGI has issued a safety warning (F. No. 12-74/13-DC dated 25.3.19) and asked manufacturers of SGLT2 inhibitors to include the following warning in the package insert and promotional literature of these drugs:
"Warning: Cases of a rare but serious infection of the genitals and area around the genitals have been reported with this class of type 2 diabetes medicines i.e. sodium-glucose cotransporter-2 (SGLT-2) inhibitors. This serious rare infection, called necrotizing fasciitis of the perineum, is also referred to as Fournier’s gangrene.”....read more


Can benzodiazepines, opioids and muscle relaxants be combined in one patient?

The answer is No. This can be deadly. Never prescribe all three drugs to one patient. If a patient overdoses on opioids, the doctor who prescribed them can expect a review of records. Prescribing two of the three drugs is even more risky.
If the combination is truly medically necessary, then your rationale for prescribing them should be documented.
Never prescribe even one of these medications without performing and documenting a thorough assessment and diagnosing a condition that necessitates their prescription. ...read more


eSpiritual

Is it necessary to take a dip in Ganga to remove your sins?