Thursday, March 3, 2016

Air pollution can lead to preterm birth in asthmatic mothers

Air pollution can lead to preterm birth in asthmatic mothers

With the soaring pollution levels in the Capital, IMA urges citizens to do their bit to reduce air pollution

New Delhi, March 3, 2016: The ill effects of air pollution on respiratory health are well-known. Now, a study from the National Institutes of Health (NIH) says that when pregnant women with asthma are exposed to high levels of certain traffic-related air pollutants, they face a greater risk of preterm birth.

The increased risk is associated with both ongoing and short-term exposure to nitrogen oxides and carbon monoxide particularly when women were exposed to those pollutants just before conception and in early pregnancy.

An increase of 30 parts per billion in nitrogen oxide exposure in the three months prior to pregnancy increased preterm birth risk by nearly 30 percent for women with asthma, compared to 8 percent for women without asthma. Greater carbon monoxide exposure during the same period raised preterm birth risk by 12 percent for asthmatic women, but had no effect on preterm birth risk for non-asthmatics. The last six weeks of pregnancy was another critical window for women with asthma. Exposure to high levels of particulate matter — very small particles of substances like acids, metals, and dust in the air — also was associated with higher preterm birth risk.

The study was published online in the Journal of Allergy and Clinical Immunology.

Sharing details, Dr SS Agarwal, National President IMA & Padma Shri Awardee Dr KK Aggarwal, President HCFI and Honorary Secretary General IMA said, “People with asthma who are concerned about exposures to air pollution may want to limit their outdoor activity during periods when the air quality is forecast to be unhealthy for sensitive groups. It is the responsibility of each and every citizen to work towards the reduction of environmental pollution given its serious effects on one’s overall health and well being. If each one of us takes simple environmental friendly steps such as carpooling, discouraging the use of fire-crackers, planting more trees around our houses, the pollution levels can be brought down and several diseases prevented.”

Other Harmful Effects of Air Pollution:
1.      Air pollution affects respiratory system causing breathing difficulties and diseases such as bronchitis, asthma, lung cancer, tuberculosis and pneumonia.
2.      Air Pollution affects the central nervous system causing carbon monoxide poisoning. CO has more affinity for hemoglobin than oxygen and thus forms a stable compound carboxy haemoglobin (COHb), which is poisonous and causes suffocation and death.
3.      Air pollution causes depletion of ozone layer due to which ultraviolet radiations can reach the earth and cause skin cancer, damage to eyes and immune system.
4.      It causes acid rain, which damages crop plants, trees, buildings, monuments, statues and metal structures and also makes the soil acidic.
5.      It causes greenhouse effect or global warming which leads to excessive heating of earth's atmosphere, further leading to weather variability and rise in sea level. The increased temperature may cause melting of ice caps and glaciers, resulting in floods.
6.      Air pollution from certain metals, pesticides and fungicides causes serious ailments.
·         Lead pollution causes anemia, brain damage, convulsions and death.
·         Certain metals cause problem in kidney, liver, circulatory system and nervous system.
·         Fungicides cause nerve damage and death.

·         Pesticides like DDT (Dichloro diphenyl trichloroethane) which are toxic enter into our food chain and gets accumulated in the body causing kidney disorders and problems of brain and circulatory system.

Monday, December 22, 2014

Pharma companies can no longer gift freebies to Indian doctors

Excerpts from a report by Rupali Mukherjee in TOI news dated Dec 23.

1. Doling out freebies, cruise tickets, paid vacations and sponsorship to educational conferences and seminars for doctors by pharmaceutical companies has been banned from January.

2. The government has woken up belatedly to curb unethical marketing practices of pharma companies by spelling out a uniform code of conduct for the industry. The code will be voluntary to start with, and kicks in from January 1. It will be reviewed after six months; if not implemented "effectively", the government will "consider"' making it mandatory, sources told TOI.

3. At present, the pharma industry follows a "self-regulatory'' code that curbs unethical sales promotion and marketing expenses, bans personal gifts, and all-expenses paid junkets for doctors and their families, but there have been several instances where companies have violated the code, industry experts say. They say the code exists only on paper as companies try to influence prescriptions through several ways.

4. This is the first time in years that the code has been finalized by the government, as earlier attempts to do so got mired in bureaucratic red tape.

5. Industry experts say that the government's Uniform Code of Pharmaceutical Marketing Practices has been modelled on the Medical Council of India (MCI) guidelines for doctors and healthcare professionals, which were further tightened in 2012.

6. The code clarifies the relationship with healthcare professionals. Regarding gifts, it says "no gifts, pecuniary advantages, or benefits in kind may be supplied, offered or promised to persons qualified to prescribe or supply drugs, by a pharma company, or any of it agents including retailers, distributors or wholesalers".

7. It says "in any seminar, conference or meeting organized by a pharma company for promoting a drug or disseminating information, if a medical practitioner participates as a delegate, it will be on his/her own cost."

8. It further says that gifts for the personal benefit of healthcare professionals and family members (both immediate and extended) such as tickets to entertainment events are also not to be offered or provided by pharma companies, nor cash or monetary grants for individual purposes. Hospitality should also not be extended to any doctor or their family members.

9. The industry associations have to upload the Uniform Code on their websites and will be responsible for informing its members, and the government in case of violations.

10. The code also adds that "where there is any item missing, the code of MCI as per the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002 as amended from time to time, will prevail''.

eMedinewS Comments: Dr K K Aggarwal

MCI code of ethics exists for doctors. Any violation can only be challenged in High Court.

Pharma companies until now were affected for any violation in the Income Tax exemptions.  Now pharma companies will also be governed by a similar ( like MCI) code of conduct.

Unless both pharma and doctors group are covered in their respective code of conduct the problem will not be over. So far the MCI code did not cover pharma companies violating MCI regulations'

It is same like, if doctors violate any MCI code they are punished under violation of MCI ethics regulations but same violations if done by medical establishments they are not punished. The need of the hour is to have uniform code of conduct for medical establishments' also.

Another answer is to bring medical establishments and pharma companies also under the preview of MCI ethics regulations.

Saturday, December 20, 2014

Padma Shri Awardee Dr K K Aggarwal Receives Orator of the Year 2014 Award by St Mathew's School

Padma Shri Awardee Dr K K Aggarwal Receives Orator of the Year 2014 Award by St Mathew's School

New Delhi, December 20, 2014: Recognizing outstanding contribution in the field of social work St. Mathew’s Senior Secondary School New Delhi honored Dr. K K Aggarwal with the Orator of the year Award 2014 in New Delhi on its Foundation Day.

An eminent cardiologist, President of Heart Care Foundation of India and the Senior National Vice President Indian Medical Association, Dr Aggarwal has also worked extensively towards helping the lower sections of the society.

Commenting on the occasion, Dr Aggarwal, Sr. National Vice President of the Indian Medical Association and the President of the Heart Care Foundation of India said, “I am honored to receive such a prestigious award from the St. Mathew’s Sr. Sec. School. Every individual has a right to live a healthy life and keeping this mind we started the Heart Care Foundation of India and till date have continued to help many patients live a healthy and normal life. The trust recognized my efforts towards the society and it gives me immense happiness and encouragement to keep doing the same throughout life.”

Dr Aggarwal is the recipient of three National Awards, namely the Padma Shri for brilliance in medicine, Dr. BC Roy award for excellence in socio-medical awareness and DST National Award for Outstanding Efforts in Science & Technology Communication. DR Aggarwal is also Limca Book of Record holder in CPR 10.

Friday, December 19, 2014

Indian Medical Tourism Incomplete without Yoga Department in every Hospital

Recently in one of the interaction the Indian Tourism Minister Dr Mahesh Sharma said that India is going to be the hub of medical tourism because of its hospitality and culture.

It is correct but for that a slight paradigm shift is required in the way we practice medicine in the country. 

Most western patients come to India to take advantage of Yoga and Ayurveda in addition to the western medicine.

Only for a lower cost we cannot attract medical tourists for long as sooner or later the China will over power us in future for medical treatments.

Our Prime Minister has convinced the world to have an international Yoga day. But unfortunately we do not have a yoga department in every government or a private medical institution.

Let India be the first country to have a yoga and an Ayurveda department in every hospital in addition to the western medicine.

The time is to promote traditional Yoga and Ayurveda. Unfortunately as they are not getting an uplifment they are ending up in cross pathy which is not on the interest of both their profession as well as the community.

Recently a review of studies examining the benefits of yoga suggests that Yoga practice provides significant benefits on cardiovascular risk factors, including LDL cholesterol and systolic blood pressure.

Those who practiced asana-based yoga reduced their LDL-cholesterol levels by 12.1 mg/dL and systolic blood pressure by 5.2 mm Hg and increased their HDL-cholesterol levels by 3.2 mg/dL. 

In addition, the yoga practitioners also saw significant reductions in body-mass index, diastolic blood pressure, total cholesterol, triglycerides, and heart rate. Overall, the yogis lost 2.35 kg compared with non exercisers.

Individuals who cannot or prefer not to perform traditional aerobic exercise might still achieve similar benefits in cardiovascular-disease risk reduction by Yoga.
The review, which is published December 15, 2014 in the European Journal of Preventive Cardiology, included 32 randomized, controlled trials involving 2768 participants.

[The author Dr K K Aggarwal is Senior National Vice President Indian Medical Association and President Heart Care Foundation of India]

Thursday, December 18, 2014

Pharmacists Charged With Murder in Fungal Meningitis Outbreak in US

Two pharmacists at the notorious New England Compounding Center have been charged with second-degree murder in the deaths of 25 individuals who received non-sterile steroid pain injections in 2012 and 2013, according to a criminal indictment unsealed today in a federal district court in Boston, USA. The pain medicine preservative-free methyl-prednisolone acetate harbored fungal meningitis.

The two pharmacists, knew they were producing their medications in an unsafe manner and in unsanitary conditions.

The second-degree murder charges are framed as racketeering acts. Prosecutors generally do not need to prove that someone charged with second-degree murder specifically intended to kill someone, only that he or she acted with extreme indifference to human life. If convicted they could be sentenced to life in prison.

The charge framed are

using expired and expiring ingredients to compound the steroid injections and falsifying expiration dates on documents,
autoclaving drugs for less than the 20 minutes needed for sterilization,
failing to properly test drugs for sterility,
failing to recall tainted drugs when microbial growth was later detected,
falsifying drug labels to conceal how expired or untested drug solution lots were mixed with other lots, and
failing to properly clean and disinfect the "clean rooms" where the steroid injections were manufactured. Cleaning logs were falsified to state otherwise, said prosecutors.

IMA Comments: A similar charges should be framed amongst all in India who end up with substandard spurious drugs. The recent Chattisgarh sterilization case is one such example.

In India the person can be and should be booked under 304A of IPC: "Causing death by negligence.—Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both".

Saturday, November 22, 2014

The first Indian Ebola patient can be a potential cure for a future patient

New Delhi, November 22nd, 2014: The use of whole blood or serum from convalescent Ebola virus disease survivors is being used for the treatment of affected patients.

The World Health Organization has issued interim guidance for the collection and administration of convalescent whole blood or plasma for treatment of Ebola virus disease (EVD).

“The patient who is currently undergoing convalescence from Ebola should be persuaded to donate blood or plasma for a future patient”, said Padma Shri, National Science Communication and Dr. B C Roy National Awardee Dr. K K Aggarwal President Heart Care Foundation of India and Senior National Vice President Indian Medical Association.

Giving his valuable insights on the deadly virus Dr. Aggarwal said, "While there is no proven treatment available for Ebola virus disease, whole blood collected from patients in the convalescent phase of infection has been used as an empirical treatment with promising results in a small group of cases with Ebola virus disease and the concept that this treatment could be efficacious is biologically plausible, as convalescent plasma has been used successfully for the treatment of a variety of infectious agents".

 WHO guidelines cover all aspects of this procedure. Patients who have recovered from EVD and been discharged from Ebola treatment centers or units could be potential donors for convalescent whole blood or plasma from 28 days after their day of discharge.
Only those EVD patients who have been discharged according to the WHO criteria as clinically asymptomatic and have twice tested negative for EBOV RNA by molecular techniques, should be considered as potential donors.  The two samples for EBOV RNA testing should be taken at least 48 hours apart, and the test results should be negative on each sample.

Donated convalescent whole blood should be stored between +2 degree and +6 degree (never frozen) preferably in a separate blood bank refrigerator dedicated to convalescent whole blood or plasma units, fitted with a temperature monitoring system and alarm. Plasma separated from whole blood donations or collected by apheresis may be stored as ‘Liquid Plasma’ between +2 degree and six degree in blood bank refrigerators for up to 40 days. Alternatively, it may be frozen either within 8 hours of collection as ‘Fresh Frozen Plasma’ or within 18-24 hours of collection as ‘Plasma Frozen within 24 hours’ and stored for up to 12 months at or below -18 degree.

Only patients with confirmed EVD preferably in its early stages should be considered for transfusion, as an empirical treatment for EVD. ABO and RhD matched blood or plasma units that need to be selected for transfusion.

About HCFI

Initiated in 1986, the Heart Care Foundation of India is a leading National NGO working in the field of creating mass health awareness among people from all walks of life and providing solutions for India’s everyday healthcare needs. The NGO uses consumer based entertainment modules to impart health education and increase awareness amongst people. A leading example of this is the Perfect Health Mela, an annual event started in 1993 that is attended by over 2-3 lakh people each year. The Mela showcases activities across categories such as health education seminars and checkups, entertainment programs, lifestyle exhibitions, lectures, workshops and competitions. In addition to this, the NGO conducts programs and camps to train people on the technique of hands only CPR through its CPR 10 mantra for revival after a sudden cardiac arrest. They currently hold three Limca Book of World Records for the maximum number of people trained in hands only CPR in one go. Keeping article 21 of the Indian constitution in mind, which guarantees a person Right to Life, Heart Care Foundation of India has also recently initiated a project called the Sameer Malik Heart Care Foundation Fund to ensure that no one dies of a heart disease just because they cannot afford treatment.

Heart Care Foundation of India and Indian Medical Association now part of NCD Alliance

Heart Care Foundation of India and Indian Medical Association now part of NCD Alliance

New Delhi India: Heart care Foundation of India and Indian Medical Association have joined the NCD Allincae, said Padma Shri Awardee Dr K K Aggarwal President Heart Care Foundation of India and incoming Honorary Secretary General IMA.

The NCD Alliance was founded by four international NGO federations representing the four main NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease.  

These involved International Diabetes Federation, World Heart Federation, and the Union for International Cancer Control.

Together with other major international NGO partners, the NCD Alliance unites a network of over 2,000 civil society organizations in more than 170 countries.  The mission of the NCD Alliance is to combat the NCD epidemic by putting health at the centre of all policies.

The NCD Alliance uses targeted advocacy and outreach to ensure that NCDs are recognized as a major cause of poverty, a barrier to economic development, and a global emergency. 

Other member associations from India are Disease Management Association of India; India800 Foundation, Breastfeeding Promotion Network of India, Indian Centre for Alcohol Studies, Indian Alcohol Policy Alliance and Indian Medical Association.

NCD Global Facts

Non-communicable diseases (NCDs) are the world’s number one killer, bringing hardship to rich and poor nations alike.

NCDs make the largest contribution to mortality both globally and in the majority of low- and middle- income countries (LMICs). 

Worldwide, NCDs account for 60% (35 million) of global deaths.

The largest burden - 80% (28 million) - occurs in LMICs, making NCDs a major cause of poverty and an urgent development issue. They will be the leading global cause of disability by 2030.

NCDs in LMICs also put G20 nations at risk since we all benefit from healthy individuals and stable populations around the globe. 8 million people below the age of 60 die each year in LMICs from preventable causes, which include tobacco use, unhealthy diets, alcohol consumption, and physical inactivity. Lack of access to affordable medicines and health care services are also major causes of these preventable deaths.

Globally, the NCD burden will increase by 17% in the next ten years, and in the African region by 27%. The highest absolute number of deaths will be in the Western Pacific and South-East Asia regions.

This rapidly changing health and disease profile has serious implications for poverty reduction and economic development. NCDs strangle macro-economic development and keep the bottom billion locked up in chronic poverty. NCDs have a severe impact on individuals, communities and countries. The magnitude and rapid spread of NCDs means we are all headed for a sick future unless we take action now. Low-income countries still grappling with heavy burdens of infectious disease risk being overwhelmed by this wave of largely preventable NCDs.