Editor in Chief Dr KK Aggarwal, Padma Shri Awardee
Dated: 21th June, 2019
Cleveland successfully performs in utero fetal surgery and our children are dying of Malnutrition in Bihar
Ancient India:We have the example of Lord Ganesha brain transplant, case of revivals after death and what not.
Modern America:Cleveland Clinic has successfully done its first in utero fetal surgery to repair a spina bifida birth defect in a nearly 23-week-old female fetus, which was later delivered by cesarean section near full term June 3.
During the fetal repair surgery, a cesarean section-like incision is made and the mother's uterus is exposed. An ultrasound is then used to locate the placenta and fetus. The uterus is opened 4.5 cm and the back of the fetus is exposed, showing the spina bifida lesion. The surgeons then carefully suture several individual layers of tissue (myofascia, dura and skin) in order to cover the defect. After the uterus is closed back up, the fetus remains in the womb for the remainder of the pregnancy and is ultimately born by cesarean section.
Modern India: In 2014 over 350 and in 2010 over 100 children died of malnutrition with acute hypoglycemia episodes linked to lychee consumption. When will we get back mera Sone ki chidiya Bharat?
HR/June 19/6: Safe nicotine products and tobacco harm reduction
(Source: No Fire, No Smoke Global State of Tobacco Harm Reduction, 2018 (2018). London: Knowledge-Action-Change)
AES outbreaks in Muzaffarpur: Lessons to be learnt
In 2015, in a letter to the Principal Secretary (Health), Government of Bihar, Dr Jagdish Prasad, the then Director General Health Services had shared the findings of a study carried out in 2013 on the outbreaks of AES in Muzaffarpur including the plan and implementation of the study in the year 2014 with an aim to reduce the associated mortality and morbidity. This study was carried out jointly by NCDC, NVBDCP and ICMR. The US CDC provided technical support for the study.
Hypoglycemia came up as a distinctive finding of the study and it was observed that its management improved prognosis. Hence, it was advised to monitor blood sugar in these patients. This necessitates availability of glucometer with all Asha workers and primary health care centers.......read more
Spiritual prescriptions learnt from patients
As doctors, we are witnesses to human suffering. When we were young in medical college, we were quite disturbed seeing the sufferings of the people. But, in our practice, we have learnt many spiritual prescriptions from our patients. These have not only helped us to heal our patients but also changed our perception to health and sickness.......read more
Current Temperature Status and Warning for next five days
Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 19 June, 2019 to 0830 hrs IST 20 June, 2019)
Yesterday, Heat Wave Conditions in many places with Severe Heat Wave in isolated pockets were observed over Coastal Andhra Pradesh. Heat Wave Conditions were observed at a few places over Vidarbha and in isolated pockets over Gangetic West Bengal, Bihar, Telangana and Tamilnadu, Puducherry & Karaikal.
Maximum temperatures were markedly above normal (5.1°C or more) at many places over Jharkhand, Telangana and Coastal Andhra Pradesh; at a few places over Nagaland, Manipur, Mizoram & Tripura, Vidarbha and Gangetic West Bengal and at isolated places over Assam & Meghalaya and Chhattisgarh;appreciably above normal (3.1°C to 5.0°C) at most places over Rayalaseema and Bihar; at many places over Kerala and Tamilnadu, Puducherry & Karaikal; at a few places over South Interior Karnataka, Sub-Himalayan West Bengal & Sikkim and Odisha and at isolated places over North Interior Karnataka; above normal (1.6°C to 3.0°C) at a few places over East Madhya Pradesh, Marathawada and Coastal Karnataka and at isolated places over Madhya Maharashtra and Konkan & Goa. Yesterday, the highest maximum temperature of 43.5°C was recorded at Machilipatnam (Coastal Andhra Pradesh).
Temperatures Recorded at 1430 Hours IST of Yesterday, the 20th June, 2019
Healthcare News Monitor
Firstpost- Pallavi Rebbapragada
The last mile of governance is the longest mile of the governance. Over hundred children in Bihar’s Muzaffarpur district have died. The disease medically termed ‘acute encephalitis syndrome’ (AES) is suspected to be the cause of the deaths. It has also spread to adjoining districts like East Champaran and Vaishali. Like every year since it first hit the national headlines in 1995, whodunits doing the rounds have varied. Dr KK Aggarwal, president-elect of the Confederation of Medical Associations in Asia and Oceania and national president of the Indian Medical Association, shared with Firstpost that this year, primary healthcare givers posted at remote areas were on election duty. “There’s lack of awareness among primary healthcare givers that sub-lingual (spoonful of moistened sugar deposited under the tongue of a young child) can help rescue children,” shared Dr Aggarwal, who was general secretary of the IMA in 2014, when the epidemic took 300 lives. He said that in the following years, the state machinery was better prepared but rued the lack of consistency in skill development and awareness levels among care givers.
The Times of India- Ajay Kumar Pandey
The toll in the outbreak of Acute Encephalitis Syndrome (AES) in Bihar rose to 114 on Wednesday with seven more deaths in the endemic zone even as reports came in of children being admitted with similar symptoms in other districts like Samastipur, Banka and Vaishali. Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, where most of the patients have been undergoing treatment since the disease spread, struggled to handle the spate of new admissions with its limited infrastructure. Sources at the hospital said the stream of high-profile visitors, including the chief minister and the Union health minister, was adding to the chaos. The scarcity of beds and doctors continued even as the Bihar State Health Society issued a list of 15 doctors, technicians and nurses deputed by the Union health ministry to assist at the hospital. "All 637 beds, including 30 in the paediatric ICUs, are occupied. We have had to put two kids on one bed to accommodate more children," SKMCH superintendent Sunil Kumar Shahi said. He admitted that there was a shortage of senior resident doctors in every department. "Though there is a shortage, it is inhuman to turn away patients just because we cannot accommodate them. Many of them have come from far-flung villages of north Bihar. Around 40 to 50 new cases of AES have been coming every day, but our resources are very limited." To ease the crisis, a makeshift paediatric ICU with 20 beds and four new ACs was set up on Wednesday. But frequent power cuts hampered the efforts. The hospital authorities said 154 children were undergoing treatment for AES at three paediatric ICUs with 10 beds each.
The New Indian Express- Sana Shakil and Rajesh K Thakur
Untrained doctors who don’t have the skill to handle critical equipment in intensive care units, and the lack of an awareness drive because of the Lok Sabha elections in April-May, could be behind the sudden spike in the deaths of children due to suspected Acute Encephalitis Syndrome (AES) in this district. A seven-member team of experts from the All India Institute of Medical Sciences (AIIMS) at Delhi and Patna, which visited the Shri Krishna Medical College Hospital (SKMCH) here to study the high rate of deaths, blamed the hospital’s doctors in its report for not being able to operate equipment such as CT scan machines, ventilators and blood gas analysers. Official sources privy to the report told TNIE that while critical life-saving equipment were available in the Paediatric Intensive Care Unit (PICU) of the SKMCH, they were largely unutilised as the doctors did not know how to operate them or use them optimally. Most of the children afflicted by AES are admitted in the SKMCH as it is the largest hospital that caters to at least eight districts in the vicinity. The report was submitted to the Centre’s Director General of Health Services on June 14 with a copy to the Bihar government. It said the hospital’s CT scanners were not used to diagnose the children, neither were the six available ventilators put to use as no trained intensivist (intensive care technician-doctor) was available.
Let me begin with a candid confession: I have not seen God with my own eyes whom I worship but yes I have always seen the best creation of God – “Doctors” right from my childhood days because whenever I had any problem of any kind pertaining to my physical well being, my parents always took me to doctor who always took utmost care to ensure that I don’t suffer from any problem any more and prescribed the best medical treatment for my problem! The mere soothing words of doctors prove to be the biggest medicine for patients in many cases. Yet it is most unfortunate that doctors themselves in our country are not safe and are abused, attacked and assaulted by some disgruntled people on one pretext or the other! It is an unpalatable truth and sad commentary on the state of affairs in our country that three out of every four doctors admit to face some form of verbal or physical abuse! It cannot be lost on us that Dr KK Aggarwal who was President of IMA when the draft Act was submitted told the media that, “At that time, when we looked at the legal protection available to doctors, we found that 19 states have some provisions, many have promulgated ordinances. When we met the Inter-Ministerial Committee, the Additional Secretary told us that health is a state subject, so only if some states write to the Centre for such an Act, can a central Act be made. Their position was that there are enough provisions in the IPC to tackle this situation, but our position was that in public interest, doctors need a special provision. If one doctor is assaulted, several hundred patients suffer as he goes off duty.”
The Economic Times- Anna Edney
An online pharmacy told U.S. regulators it found another cancer-causing chemical in widely prescribed blood-pressure pills, raising new questions about a complex global web of companies that produce medicine for millions of people. A solvent called dimethylformamide was discovered in the drug valsartan made by several companies, including Swiss pharmaceutical giant Novartis AG, according to a filing last week to the Food and Drug Administration by New Haven, Connecticut-based Valisure. DMF, as the solvent is known, is classified by the World Health Organization as a probable carcinogen. Dozens of forms of generic valsartan have been recalled since July 2018, when the carcinogenic chemical N-Nitrosodimethylamine, or NDMA, was detected in a version of the drug made by a Chinese company. Valsartan is a decades-old treatment for hypertension that is frequently combined with other medicines into a single pill. Valisure found DMF in valsartan that is still on the market in the U.S., including in medicines the FDA had highlighted as alternatives to recalled drugs. The findings could complicate the agency’s efforts to pull tainted drugs from pharmacies while informing doctors and patients which medications are safe. DMF is the fourth potential carcinogen to be found in batches of the heart pills.
ET Healthworld- AP
Organization notified U.S. lawmakers Wednesday that it will discontinue two publications on prescribing opioid painkillers in response to allegations that the pharmaceutical industry influenced the reports. The pledge to remove the guidelines comes a month after U.S. Reps. Katherine Clark and Hal Rogers accused the WHO of being influenced by Purdue Pharma, the American manufacturer of the potent painkiller OxyContin. The lawmakers' report claimed the guidelines, crafted in part by organizations with financial ties to the company, downplay the risk of opioids despite the American epidemic that has killed more than 390,000 since 1999. WHO's reports are viewed around the world as best practices in public health policy, and the opioid prescribing documents have been in circulation for years. "That is a very dangerous situation," Clark said. "We do not want to see the opioid crisis in this country exported around the globe." The WHO, the health arm of the United Nations, could not be reached for comment Wednesday evening. Purdue has denied the allegations, and said it transparently discloses its relationships with doctors and organizations and markets its drugs only as they have been approved by the U.S. Food and Drug Administration.
The Siasat Daily- Tanveer
Govt. of Telangana has decided to provide medicine free of cost to the patients suffering from Diabetes and Blood Pressure. Higher officials of Health Department informed that after identifying the chronic patients of Diabetes and BP, medicines would be provided to them free for lifetime. At present, patients who are 30 years of age or above are being identified and they are being screened on NCD in 12 selected districts. Remaining districts would be covered at the end of this month or in July this year. National Health Mission is monitoring this scheme. Asha workers and ANMs are visiting the houses to collect information about the patients. They are giving medicines only for a week or ten days which is causing inconvenience to the patients.
The Times of India- Amrita Didyala
While the Medical Council of India’s (MCI) revamped MBBS curriculum introducing communication as a subject for medical education is scheduled to be introduced this year in the state, doctors say that the measure is a classic example of misdirected action. The logic behind bringing in communication skills as part of medical education was to address the growing communication gap between patients and doctors, which has now escalated to a near communication breakdown. The subject is meant to help MBBS students learn the basics of medical ethics and learn nuances of doctor-patient relationship. Although at present, medical professionals do not receive any such focused training in soft skills, junior doctors blame the lack of basic infrastructure and huge workload to be the main reason behind the repeated incidents of attacks on doctors in government hospitals. “Attacks on doctors are due to administrative failure by the government and not due to lack of communication skills. When patients come here, there are no stretchers, no medication and no wheelchairs. The government is encouraging the corporate hospitals at the cost of primary healthcare. How will communication help in this circumstance? Without addressing the basic lapses, MCI just wants to do fancy things. It is just an eyewash to fool citizens,” said Dr PS Vijayender Goud, president Telangana Junior Doctors Association (TJUDA). Adding that communication has to be learnt in practice rather than as a subject, a junior doctor working at the state-run Osmania General Hospital (OGH) said, “Nuances of dealing with sensitive situations are learnt during practice, by observing seniors’ reactions during such situations. Now, with a large number of undergraduate and postgraduate seats, there is an imbalance between the number of faculty and medical students, making it impossible to learn anything.”
The Times of India
Thiruvananthapuram: In its first action against doctors who promote unscientific and magical remedies for various diseases, the Travancore Cochin Medical Council has suspended the registration of an Ayurveda doctor for one month. The suspension has been given to Dr K Siddharthan of Ezhukone, Kollam, who has been advertising about alleged remedies for various ailments, including cancer, through his “thulli marunnu” (oral drops). Travancore Cochin Medical Council’s registrar Dr A Mohammed Hussain said in his order that the advertisements issued by the doctor are against the Drugs and Magic Remedies (objectionable advertisement) Act. This was informed to the council by the state drugs controller. The council had probed the issue and it has been found that the doctor has violated the code of ethics of a registered medical practitioner. The registrar said this order will be an eye opener for those violating the code of professional ethics of registered medical practitioners. The doctor who had appeared before the council had offered an apology and urged the council not to suspend his registration. However, the council observed that despite the notices issued by the state drugs control department against the doctor’s advertisements, he continued publishing them. This doctor has been advertising about his “tullimarunnu chikitsa” (oral drops treatment) claiming remedy for diabetes, cancer, obesity, asthma, ulcer, thyroid and various other diseases. The complaint was filed before the Travancore Cochin Medical Council against him by Kerala Sastra Sahitya Parishad claiming that the treatment offered by this doctor was not scientifically proven.
The Times of India- Abhyudaya Kotnala
A doctor at a primary health centre in Dhauntri village of Dunda block in Uttarkashi district was beaten up by villagers after a local woman accused him of molestation. An FIR was filed on Wednesday against the doctor, who said the allegations were baseless. The local medical association expressed its resentment, saying a mob attacking a doctor without looking into an issue first was demoralizing for physicians. According to sources, the doctor managed to save himself from the violent mob by locking himself in a medical store. Later, the district magistrate and other senior officials reached the spot and rescued him. The woman on Wednesday filed a complaint against the doctor with the revenue police. Dismissing all allegations against him, the doctor said, “A few days ago, some tourists approached me, requesting me to help them find a cheap hotel. I suggested them a local hotel. The woman who accused me of molestation also runs a hotel along with her husband, and was upset that I didn’t recommend her hotel. She first abused and thrashed me. Later, she leveled baseless allegations against me and incited a mob to attack me. I will file a complaint against her, as she tried to ruin my image.” Dr SP Kudiyal, district president of a local medical association said, “It is worrying that a mob attacked a doctor without verifying if the issue was real. This incident will affect the morale of doctors, who are working in the hills, despite various challenges. We have called a meeting of all doctors before taking any further action.” Prem Singh Makhloga, the revenue officer said, “We have filed a complaint against the doctor under sections 323 (punishment for voluntarily causing hurt), 352 (punishment for assault or criminal force otherwise than on grave provocation), 354 (assault or criminal force to woman with intent to outrage her modesty), 504 (intentional insult with intent to provoke breach of the peace) and 506 (punishment for criminal intimidation) of the IPC. We are investigating the issue before taking any action against him.”
The New Indian Express-IANS
The government doctors in Himachal Pradesh on Wednesday continued with the two-hour 'pen down' strike over the failure to arrest an accused involved in assaulting and abusing a female doctor. The woman doctor was allegedly assaulted by the accused in an inebriated state at a primary health centre in Seraj which falls under Chief Minister Jai Ram Thakur's constituency. The doctors in Mandi district threatened to go on an indefinite strike if action was not taken against the guilty, who is yet to be identified. Expressing solidarity, doctors at Zonal Hospital in Dharamsala joined the 'pen down' strike, hampering the health services. Meanwhile, the government has constituted a Special Investigating Team to probe the incident. State Health Minister Vipin Parmar, who has sought a report on the incident, directed his department not to post woman doctors alone in remote public prime health centres at night. "If a woman doctor has to be deployed at night, a woman paramedic must accompany her," he said.
Boom- Swasti Chatterjee
An image of an IAS officer resting his foot on a patient’s bed is viral on Facebook with a misleading claim that the man is a junior doctor. The photograph, where a man can be seen resting his foot on the hospital bed while talking to a patient, is originally of an IAS officer Jagdish Sonkar. Sonkar’s image sparked a row and he was strongly criticised for such disrespectful behaviour. The photo of Sonkar is being passed off a junior doctor in light of the recent strike by doctors of Nil Ratan Sircar Medical College, Kolkata. West Bengal’s state run hospitals faced a shutdown after medical students went on a strike following an attack on NRS students over the death of a 75-year-old patient. The NRS called off their six-day long strike on June 17 after an interaction with chief minister Mamata Banerjee. The viral image, captioned as, “This is (the condition of) junior doctor,” (Bengali caption: ?? ??? ??????? ??????? ) had been shared more than 150 times at the time of writing this article. BOOM ran a reverse image search and found that the original photo is from 2016 when Sonkar’s act was captured on camera. The same photo was widely circulated at that time.