Tuesday, January 9, 2018

H3N2 Aussies Flu, a near epidemic in Australia, UK and USA: H1N1 in Rajasthan India

H3N2 Aussies Flu, a near epidemic in Australia, UK and USA
H1N1 in Rajasthan India

The flu is rapidly spreading across the US, UK and Australia.

Not only did it start early, but it seemed to occur all over the country more or less simultaneously.
The predominant flu strain is H3N2. Vaccine effectiveness typically ranges from 40 to 60 percent in a good year. Preliminary estimates from last year show the vaccine was 40 percent effective in the U.S., similar to 2014-2015. But concerns have been raised about this year’s vaccine after an editorial published in the New England Journal of Medicine last Thursday said it was only 10 percent effective against H3N2 in Australia.

Additionally, years in which H3N2 is the predominant influenza strain tend to have higher death rates, with approximately 20,000 deaths in the 2012-2013 and 2014-2015 seasons when H3N2 predominated.

Good news is that H3N2 flu is quite susceptible to the available flu medications, like Tamiflu, also known as oseltamivir. Remember, it is most helpful if taken within 48 hours of the start of the flu. It can take up to two weeks for the body to build up defences against the virus.

It is especially important for pregnant women to get the vaccine. There is dual benefit for the pregnant woman to get vaccinated. Not only will she get protection, but she’ll also pass those antibodies along to her infant, which will protect them for the first 6 months of life when the infant is too young to get the vaccine. And the vaccine is safe for pregnant women and the fetus.

For those who contract the flu, it could make symptoms less severe. Next, make sure to wash hands carefully to limit the spread of the virus and try to avoid close contact with sick people.

People who get sick should also keep up with fluids — and seek medical attention if they start to feel worse or develop shortness of breath, worsening congestion or cough.

Public Health Concerns

1.       Trace the first case of H3N2 in India
2.       High risk people to consider vaccinations
3.       Do not allow any person suffering from flu to enter public places
4.       Give compulsory off to people suffering from flu

5.       Learn cough etiquettes and respiratory hygiene

Sunday, January 7, 2018

New strain of H1N1 virus in Rajasthan

New strain of H1N1 virus in Rajasthan
Doctors should follow the national flu guidelines; people should follow basic hygiene 

New Delhi, 07 January 2018Recent estimates have indicated that there have been more than 100 cases of flu in Jaipur, Rajasthan with over 10 deaths within a one-week duration. The cases are due to a new strain in the H1N1 virus called the Michigan strain. H1N1 is associated with increased hospitalizations and deaths among elderly adults and young children.The Rajasthan government on January 3 sounded an alert in the state after more than 400 people were diagnosed positive for the swine flu virus in December 2017.

About 241 swine flu deaths have occurred in the state since January 2017. Apart from this, 3,033 hospitals have swine flu screening centres, 1,580 isolation beds, 214 ICU beds, and 198 ventilators for patients affected by the swine flu virus.

Speaking about this,Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) andImmediate PastNational President Indian Medical Association (IMA), said, “Though the virus may be less dangerous, it is certainly more contagious. As the virus has undergone a change, it is likely to infect more people who have not developed immunity to it yet.Flu (influenza) viruses are divided into three broad categories: influenza A, B or C. Influenza A is the most common type. H1N1 flu is a variety of influenza A.H1N1 indicates the viral serotype.It is a kind of shorthand for characteristics that identify the virus to your immune system and allow the virus to enter your cells. There are many different strains of H1N1 flu.The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet.”

Some symptoms of H1N1 include: muscle pain; dry cough; diarrhea, nausea, or vomiting; chills, fatigue, or fever; headache, shortness of breath, or sore throat.
Adding further, Dr AggarwalVice President CMAAO, said, “All Rajasthan doctors are advised to administer antiviral drugs to all hospitalized, severely ill and high-risk patients with suspected or confirmed influenza. It is also imperative to follow the national flu guidelines.”

Some take home messages
  • No fever no flu; cough, cold, and fever indicate flu unless proved otherwise
  • No breathlessness no admission
  • People with co-morbid conditions, pregnant women and the elderly should not ignore flu
  • For both hospitalized patients and those managed in the outpatient setting, isolation precautions should be implemented.
  • Hygienic techniques such as handwashing have been shown to prevent the spread of respiratory viruses, especially from younger children.
  • Health care workers in Asia often wear surgical-type face masks to prevent their acquisition of respiratory tract infections. Such masks are increasingly used by travelers for the same purpose.Wear a mask when within three feet of the patient.Health care workers should also use gloves, gowns, and eye protection, as appropriate, when in contact with infected patients
  • Gargling with water three times daily or gargling with povidone-iodine is recommended.
  • Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.
  • Let the patient remain in a single room. All contacts should wear simple masks when within three feet reach. Hand wash after coming in contact with respiratory secretions. Consider flu vaccines for contacts.

Friday, January 5, 2018

Now blood donors can avail official leave on the day of donation

India faces a shortage of 10% relative to its blood requirements

The Heart Care Foundation of India (HCFI), which is celebrating 25 years of Perfect Health Mela   this year, lauded the order from DoPT approving 4 days special casual leave each year for blood donation or apheresis donation at any licensed blood bank for all Central Government employees. The aim is towards ushering in 100% voluntary blood donation by 2020.

Every year India requires about 5 crore units of blood, out of which only a meager 2.5 crore units of blood are available. India faces a shortage of 10% relative to its blood requirements. In absolute terms, this means covering a shortfall of over 12 lakh units. Given that the eligible donor population of India is more than 512 million, this deficit is alarming.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “India has huge population of more than 1.3 billion, but is still short of blood. Blood donation is a requirement of the society. All donations should be voluntary. One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion. The move by DoPT is a very positive one and will hopefully encourage more and more people to come forward and donate blood. My humble suggestion is that all private sector establishments should also adopt this rule.All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.”

Under the new National Blood Transfusion Council regulations, no blood is to be wasted. The surplus left over plasma is fractionated to manufacture products like albumin and intravenous immunoglobulins (IVIG). The blood that is donated in voluntary blood donation should be maximally utilized.

Adding further, Dr AggarwalVice President CMAAOsaid, “Now no camp should be organized for ‘whole blood donation’. Instead components-only blood donation camps should be organized. One unit of blood collected can be used to help 3 to 4 patients, instead it is being wasted as whole blood depriving another patient in need. And, voluntary blood donation camps should be now called ‘blood component donation’ camp and not just blood donation camp. So, if the blood being donated is collected in a single bag, do not give blood. Usually two component bags are used. 100 ml bags should be promoted for pediatric use.”

Some things to consider for donating blood are as follows.

  • Prepare yourself by having enough fruit juice and water in the night and morning before you donate blood.
  • Avoid donating blood on an empty stomach. Eat three hours before you donate blood. Avoid fatty foods. Eat food rich in iron such as whole grains, eggs, and beef, and spinach, leafy vegetables, orange and citrus.
  • Don’t consume alcohol or caffeine beverages before donating blood.
  • Avoid donating blood for 6 months if you had any major surgery.

Monday, January 1, 2018

WHO first-ever list of antibiotic-resistant “priority” pathogens

  • A new study by researchers at Harvard University of all 48 million Americans aged 65 and older on Medicare found people were dying after just a single day of breathing air that met federal standards, but was somewhat dirty. The study was published Tuesday in JAMA. Environmental Protection Agency sets safety standards and if pollution is below that standard, everyone is safe but the same is not correct. There is no safe level of exposure to either pollutant.
  • Decades of research, including a new study published December 26 in JAMA has failed to find substantial evidence that vitamins and supplements do any significant good.
  • Delhi LG gave a nod to three big health schemes of the Delhi government – treatment for road and fire accident and acid attack victims, outsourcing of high-end diagnostic tests and surgeries. He has given a nod to the amendment in the Delhi Arogya Kosh (DAK), which would help pay for the free diagnostic tests and surgeries. LG, however, asked the government to maintain an income ceiling for the people who would be allowed to avail the benefits of the scheme “so that the resources of the government are used to help the poor and the needy and the poor are not crowded out by the well-to-do”. With recent cases of medical negligence and malpractices in private hospitals, the LG also urged the government to have a mechanism to penalize institutions in case of malpractice or even poor quality of services.
  • Nabarangpur: A district consumer forum has ordered a doctor of the Christian Hospital here to pay a compensation of Rs 20 lakh for “deficiency of service and medical negligence”, which left a pregnant woman paralysed on the lower part of her body (paraplegia), seven years ago. Sabina, a Bachelor of Physiotherapy was administered anesthesia as many as seven times by Dr Nag on May 19, 2010 while performing cesarean delivery, even though the latter was not qualified as MD (Anesthetist) and did so after her repeated refusal.
  • In a shocking case from Argentina, doctors accidentally tore off an infant’s head during a delivery. The incident occurred as they were trying to deliver a premature baby when the child got stuck inside.
  • WHO published its first ever list of antibiotic-resistant "priority pathogens" – a catalogue of 12 families of bacteria that pose the greatest threat to human health. The WHO list is divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority. The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia. These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria. The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhea and food poisoning caused by salmonella.
  • Drugs banned in 2017: Fixed dose combinations of nimesulide + levocetirizine; fixed dose combinations of ofloxacin + ornidazole injection; fixed dose combinations of gemifloxacin + ambroxol; fixed dose combinations of glucosamine + ibuprofen and fixed dose combinations of etodolac + paracetamol.
  • In a new essay publishing 28 December in the open access journal PLos Biology, Kristofer Wollein Waldetoft and Sam P. Brown of Georgia Institute of Technology propose that development of alternative therapies for mild infections could help slow the development and spread of antibiotic resistance, thereby preserving the drugs' effectiveness for use in severe infections.
  • Do not routinely administer prophylactic antibiotics in low-risk laparoscopic procedures: The use of prophylactic antibiotics in women undergoing gynecologic surgery is often inconsistent with published guidelines. Although the appropriate use of antibiotic prophylaxis for hysterectomy is high, antibiotics are increasingly being administered to women who are less likely to receive benefit. The potential results are significant resource use and facilitation of antimicrobial resistance.
  • Avoid the unaided removal of endometrial polyps without direct visualization when hysteroscopic guidance is available and can be safely performed: Endometrial polyps are a common gynecologic disease. Though conservative management may be appropriate in some patients, hysteroscopic polypectomy is the mainstay of treatment. Removal without the aid of direct visualization should be avoided due to its low sensitivity and negative predictive value of successful removal compared to hysteroscopy and guided biopsy.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Group
President Heart Care Foundation of India

Immediate Past National President IMA

Sunday, December 31, 2017

WHO to include 'gaming disorder' in its list of mental health conditions

 1.       Healthy fats and healthy carbs:  Just as there are "good carbs" and "bad carbs," there are good fats and bad fats. Saturated fat, trans fats, and cholesterol are the bad guys. Good fats are monounsaturated and polyunsaturated.
2.       Do you know? In pleural effusion, 75 mL of fluid is needed to obliterate the posterior costophrenic sulcus; 175 mL to obscure the lateral costophrenic sulcus; 500 mL to obscure the diaphragmatic contour on an upright chest radiograph but on decubitus radiographs, less than 10 mL (as little as 2 mL) can be identified.  If pleural effusion reaches the level of the fourth anterior rib, 1000 mL of fluid is present.
3.       Useful tip in diabetes management: Dividing 1500 with the total daily insulin dose will give one the change in blood sugar levels with one unit of insulin and if you divide 500 with total daily dose of insulin and it will give one the grams of carbohydrates required to neutralize none unit of insulin.
4.       MRI scan safe for most people with older pacemakers, defibrillators: A new study in the New England Journal of Medicine “confirms that pretty much anybody who has a pacemaker or implanted defibrillator can, with very few restrictions, safely get an MRI scan if they need it,” as long as the devices are properly adjusted before the scan and safeguards are in place. To prevent problems, the researchers reprogrammed the devices to adopt a standard heart rhythm for people whose hearts won’t beat on their own and disabled functions that might cause the pacemaker to fire improperly if the MRI produced erratic signals in the heart. After the MRI, the devices were returned to their original settings (Source: bit.ly/2pGopkv The New England Journal of Medicine, online December 27, 2017).
5.       NMC Update: It has been said that NMC Bill need not go to the standing committee because it was brought on the recommendation of standing committee. But, this argument is not correct as Niti Aayog has been working on this document since 2014 and the standing committee only recommended it in 2016. The Bill should be referred to the standing committee.
6.       In 2018, playing video games obsessively might lead to a diagnosis of a mental health disorder. In the beta draft of its forthcoming 11th International Classification of Diseases, the WHO includes "gaming disorder" in its list of mental health conditions. The WHO defines the disorder as a "persistent or recurrent" behavior pattern of "sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning." The disorder is characterized by "impaired control" with increasing priority given to gaming and "escalation," despite "negative consequences." Video game playing, either online or offline, must be "normally evident over a period of at least 12 months" for this diagnosis to be made, according to the beta draft guidance. However, if symptoms are severe and all requirements are met, health care professionals may include people who have been playing for shorter periods of time, the draft reads.
7.       The National Human Rights Commission (NHRC), taking suo moto cognizance of the sheer negligence, wherein, over 30 persons were operated for cataract in torchlight at a Unnao community health centre, has issued a notice to Uttar Pradesh government. The Commission has observed that it was a case of medical negligence and sheer carelessness on the part of the doctors and district health authorities.
8.       For patients with mild cognitive impairment (MCI), regular exercise is likely to improve cognitive functioning, an updated guideline from the American Academy of Neurology (AAN) concludes. The new AAN guideline on MCI, which is endorsed by the Alzheimer's Association, was published online December 27 in Neurology.
9.       To develop a mechanism for eradicating cuts and commissions in medical practice: Payment made to all doctors for services provided should be transparent and reflected in the bill. Any charges paid to doctors without the knowledge of the patient and not reflecting in the patient’s bill should be considered a professional misconduct.
10.    Dear Dr KK Aggarwal: I deem it my pleasure to record my heartfelt compliments to you on the 1st Dr Ketan Desai Medical Statesman of the Highest Order Oration delivered by your good self, which was not only inspiring but also a humble depiction of committed creativity and indicative of futuristic direction as well. It is indeed worth of a publication by the IMA. With warm regards, Yours sincerely, Dr Ved Prakash Mishra, Chancellor, Krishna Institute of Medical Sciences (Deemed University), Karad.

Dr KK Aggarwal

Vice President CMAAO
Immediate Past National President IMA
President HCFI and Group Editor-in-Chief IJCP Group

Friday, December 29, 2017

Exercise may improve memory in patients with mild cognitive impairment

A practice guideline released by the American Academy of Neurology (AAN) has recommended exercise for patients with mild cognitive impairment (MCI) as part of approach to managing symptoms. The guidelines endorsed by the Alzheimer’s Association say that exercising twice a week may improve thinking ability and memory in such patients.

Mild cognitive impairment is a medical condition that is common with aging. While it is linked to problems with thinking ability and memory, it is not the same as dementia. However, there is strong evidence that MCI can lead to dementia. Hence, early diagnosis of MCI is important.

Other major recommendations include:

·         Evaluation of patients with MCI for modifiable risk factors, functional impairment including behavioral/neuropsychiatric symptoms (Level B).
·         Monitoring of cognitive status (Level B).
·         Discontinue cognitive impairing medications should be discontinued where possible and treat behavioral symptoms (Level B).
·         If clinicians choose to offer cholinesterase inhibitors, they must first discuss lack of evidence
·         Cognitive training may also be recommended. There is weak evidence that cognitive training may be beneficial in improving measures of cognitive function (Level C).
·         Clinicians should discuss diagnosis, prognosis, long-term planning, and the lack of effective medicine options (Level B), and may discuss biomarker research with patients with MCI and families (Level C).

The guidelines are published December 27, 2017 online in the journal Neurology.

(AAN News Release, December 27, 2017)

Thursday, December 28, 2017

Straight from the Heart: Time to say Thank You

Dear Friends, it is time for me to say ‘Thank you’ for all your support, friendship, views and wise counsel during these last three years of my term in office.

During these years, I found strength in the general membership of IMA and could further strengthen my bond with them through transparency and my daily communications. I could communicate practically with every IMA member, who is digitally connected. I did bi-weekly webcasts as a part of my e-connect strategy. The viewership crossed one lakh on three such occasions.

At an individual level, I earned a good mentor in Dr Ketan Desai – an intelligent man, a keen observer, a tough taskmaster, yet a soft emotional man from inside who opens up his heart like a child only with trusted old friends.

I found an erudite guide in Dr Ved Prakash Mishra - with his excellent command of the Vedas, the English language, Drafting and Medical Education; a philosopher in Dr Ajay Kumar - a person who is honest to his commitments; a genuine leader in Dr A Marthanda Pillai, with his quality of remaining calm and positive, especially in difficult situations; a trusted friend in Dr Ravi Wankhedkar and a true guide in Dr RV Asokan.

My thanks to Dr Jayshree Mehta, President MCI and Dr Vinay Aggarwal for all the guidance.

Special thanks to the National Vice Presidents - Dr Roy Abraham Kallivayalil, Dr Prakasam K,
Dr Mahendra H Choudhary
and Dr Parmanand Prasad Pal.

Throughout these years, my main strength has been my right-hand Dr RN Tandon, very ably supported by Dr VK Monga. Dr Tandon is a thorough gentleman and a lovable person to work with.

I also take a moment here to remember Late Dr VCV Pillai, who left us in August this year. Dr Pillai taught me the importance of wearing the IMA Pin with pride. When I was elected the National President IMA, he gifted me his personal IMA pin.

Thank you Dr Sudipto, may God give you a long life. Thank you, Dr Ashok Adhao for according me the respect of a son-in-law of Nagpur and Dr Arul Rhaj for your continuous inputs.

Thanks Dr Vijay Kumar for all the inputs. Thank you, Dr KV Babu, for your constructive criticisms.

Thank You Dr Narottam Puri, Dr Naresh Trehan, Dr Shubnum Singh, Dr Anupam Sibal, Dr KK Kalra, Dr Girdhar Gyani, Bejon Misra, Dr NV Kamat, Dr Vijay Agarwal, Dr Alex Thomas, Dr Alex Franklin, Dr AK Agarwal, Dr Arun Gupta, Dr Shiv Utture, Dr Jayesh Lele, Dr Sanjay Dudhat, Dr Dinesh Thakre, Dr Parthiv, Dr Chacker, Dr DD Chaudhury, Dr Jayalal, Dr Ravi Shankar, Dr Jaya Krishan, Dr Pradeep, Dr M Ashraf, Dr Murugunathan, and many more including Team Digital IMA.

Thank you Dr Ashwani Dalmiya, Dr Girish Tyagi, Dr BB Gupta, Dr Rajiv Dhir, Dr Ramesh Datta, Dr Vinod Khetrapal, Dr Naresh Chawla, and Dr Anil Goyal.

I must also acknowledge here Sanjay, Meena, Neeru and Dogra from IMA; Dr Sanchita Sharma, Dr Major Prachi Garg, Dr Uday Kakroo, Geeta Anand, Nidhi, Tanuja, Yogesh, Sanjeev, Dheeraj, Sanjiv, Deepak, Adib, Pranay, Manoj, Ram Singh, and Sapna from my personal staff for their help in various activities of IMA. I thank each one of them.
I would also like to express my thanks and appreciation to the IMA legal team Rahul Gupta, Ira Gupta, Aanchal Dhingra, and Shekhar Gupta.

I take this opportunity to say a special thank you to my daughter Naina, my son Nilesh, my wife Dr Veena Aggarwal, my nephew Saurabh and my future son-in-law Ankit for their constant support and encouragement in all my endeavors.

My special thanks to Shri JP Nadda, Dr Henk BekedamDr Mahesh Sharma, Dr Jitendra Singh, Shri Mukul Rohatgi, Shri CK Mishra and Ms Preeti Sudan, Sanjeeva Kumar, Arun Jha, Shri Arun Panda, Dr Soumya Swaminathan, Dr Anuj Sharma, Dr SY Quarishi, HE AR Kohli and Dr AC Dhariwal for all their help during these years. 

A big thank you to Dr Vinit Ahuja and Dr R Guleria, who ensured that my health did not come in the way of my work for the Association.

Thank you to those, whose names I have not been able to mention all names here; you are always in my heart. 

Friends, these years have been a period of self-learning. And, all that I have learned, I want to pass on as my legacy to Dr Ravi Wankhedkar. I will be there right by his side whenever needed.

The English philosopher and writer Thomas Paine said, It is not in numbers, but in unity, that our great strength lies.”

I seek forgiveness from all of you“If in trying to achieve my goals during these years in IMA, knowingly or unknowingly, I have hurt your consciousness in my writings, speech, actions, or thoughts, kindly forgive me.”