Muzaffurpur encephalopathy: A multi-ministry coordination and comprehensive action plan is the answer

The outbreak of acute encephalitis syndrome (AES) in Muzaffurpur has claimed 109 lives so far. AES has been occurring every year for the past so many years with no solution in sight.

A visit by the Chief Minister of the state, or the state or central health minister is alone not the answer.

Since this is a local outbreak in Muzaffarpur and adjoining districts, the state should declare a public health emergency and invoke the Essential Commodities Act. This would bring the entire state health services, both government and private sectors under the gambit of the Essential Commodities Act and Essential Services Maintenance Act as ‘essential medical services’.

A multi-ministry coordination and comprehensive action plan should be drawn up and acted upon.

• Health Ministry: Should arrange for 24x7 ICU, ventilators, ambulances; Asha workers should be provided with glucometers and thermometers so that they can monitor the temperature and blood sugar levels. They should be taught how to prevent deaths due to hypoglycemia in children. They should be advised to give 1 teaspoon of sugar sublingually (not as a drink) every 20 min in children < 15 years of age. Make sure that the child does not clinch teeth or swallow the sugar. All healthcare providers to do home to home survey
• ICMR/DST/ all medical colleges: Should spearhead research in the illness to understand its cause, to prevent future such outbreaks
• Agriculture Ministry: To act on rotten litchis; advise farmers to destroy the rotten fruits, create awareness on harms of eating only litchis by malnourished children.
• Ayush Ministry:Should deliberate if their pathy has some alternative treatment to offer
• Women & Child Development Ministry: Should look after the nutrition of the children in the area; an Evening Day Meal Scheme for the children can be started in addition to the Midday Meal Scheme already in place.
• Transport ministry and Civil Aviation ministry:to arrange for airlifting patients and shift them to other states for management, as and when required
• Law Ministry:should ensure that no law and order problems arise in such situations and the action plan is implemented smoothly
• Environment Ministry: should take all measures to prevent heat stroke in the area by providing makeshift shelter homes
• Military:can be called in for house to house visits to identify probable cases; when Zika threatened Brazil in 2015-16, when it was preparing to host the 2016 Olympic Games, the army was called into action and asked to join the efforts to control the virus, which was made into a public movement

Its time some concrete steps are taken to prevent recurrence of this illness.

AWaRe: A new WHO tool to reduce spread of antimicrobial resistance

The World Health Organization (WHO) has launched a global campaign urging governments to adopt the AWaRe tool to reduce the spread of antimicrobial resistance, adverse events and costs. It has also set a target to accelerate action against antimicrobial resistance

The AWaRe tool was developed by the WHO Essential Medicines List to contain rising resistance and make antibiotic use safer and more effective. It classifies antibiotics into three groups – “Access, Watch and Reserve” – and specifies which antibiotics to use for the most common and serious infections, which ones should be available at all times in the healthcare system, and those that must be used sparingly or preserved and used only as a last resort.

Using “Access” antibiotics lowers the risk of resistance because they are ‘narrow-spectrum’ antibiotics (that target a specific microorganism rather than several). They are also less costly because they are available in generic formulations.

The new campaign aims to increase the proportion of global consumption of antibiotics in the “Access” group to at least 60%, and to reduce use of the antibiotics most at risk of resistance from the “Watch” and “Reserve” groups… (Source: WHO)

Healthcare News Monitor

No country for doctors? Assaults on healthcare workers are spreading, make it a non-bailable offence

The Times of India- Ramakanta Panda

Doctors all over the country supported the Indian Medical Association’s nationwide protest on Monday, against the attacks on doctors in West Bengal. However, we kept emergency services open; because that is what we are supposed to do as doctors – save lives. I remember reading a quote by Kate Gilmore, UNHRC’s deputy high commissioner for human rights. According to her, healthcare workers are part of the “machinery of human rights defence”, yet are increasingly being targeted for doing their jobs. This is not only unconscionable, but also “against international humanitarian law”. I agree with her in labelling attacks on doctors “wrong, unfair and unjust”. Doctors are in a special position in regard to human rights. Every hospital is like a war zone. There’s anxiety, time pressure, threat of loss of life. No matter how capable and committed, a doctor can’t always save lives.

Karnataka government to attract on-call private doctors with fee hike

The Times of India- Manu Aiyappa Kanathanda

Facing a severe shortage of specialists in government hospitals, Karnataka has decided to bring the on-call fees given to doctors on par with the private sector. The health department has empowered deputy commissioners to constitute Arogya Raksha Samithis involving physicians, surgeons, paediatricians, gynaecologists and other specialists, who will visit taluk and district hospitals and public health centres on call to treat patients and pay them the same amount they get in private hospitals. “The committee will frequently meet and analyse shortage of specialties in public health institutions and fix on-call rates for different types of cases, taking into consideration fees charged by specialists in private hospitals,’’ said Pankaj Kumar Pandey, commissioner, state health department. The rates will be fixed based on taluks and regions. “Local problems, availability of specialists in private sector, convenience of transport and distance to nearest specialty hospital will be taken into consideration. The committee will have the liberty to fix high rates after giving valid reasons,” Pandey said.

Kolkata cops monitor hospital visitors, start helpline

The Times of India- Dwaipayan Ghosh

Specialized training to tackle mobs, a dedicated medical security helpline, installation of alarms across all departments of the hospital, CCTV coverage for all wards — Kolkata Police started taking a host of measures to secure government hospitals. The cops ensured restricted access to emergency, separate female cops for all high-pressure wards and monitoring of people’s movements at main gates and response from a senior officer not below the rank of ACP to save the doctors of government hospitals from being attacked. Though the security measures seemed to be taken on a grand scale, the first day also saw some of the challenges that cops will have to face in the coming days. At the emergency wards of SSKM and CNMC where the restricted entry was enforced during peak hours, cops were questioned and snide remarks passed at them for “daring to question the rights of a patient and her kin.”

2 held for unruly behaviour at Wenlock Hospital

The Times of India

Mangaluru: The Mangaluru City police have arrested two people for unruly behaviour at the Wenlock Hospital. The arrested are Nithin and Deekshith Shetty. They were remanded in judicial custody. The accused, along with friends, abused doctors and staff at the Wenlock Hospital, after an accident victim was allegedly denied treatment for more than an hour, in the early hours of Monday. The accused have recorded a video of hurling abuses at doctors in Tulu. They also shared the three-minute video clip on social media. One of the accused is seen speaking in an abusive manner, while recording the plight of the accident victim, who is also seen lying on a stretcher. A case in this regard was registered at the Mangaluru South police station under Section 504 (intentional insult with intent to provoke breach of of peace) of IPC, Sections 3, 4 of Karnataka Prohibition of Violence Against Medicare Service Personnel and Damage to Property in Medicare Service Institutions Act, 2009. Wenlock Hospital superintendent Dr H R Rajeshwari Devi has filed a complaint with city police commissioner Sandeep Patil in this regard.

Doctors’ strike update: Delhi doctors at various hospitals resume duties

Financial Express-PTI

Doctors at various hospitals in the national capital resumed duties on Tuesday, a day after their colleagues in West Bengal called off their week-long strike after meeting state Chief Minister Mamata Banerjee who assured them of steps to scale up security at government hospitals. Doctors at the Centre-run AIIMS, Lady Hardinge Medical College and Hospital, and RML Hospital, and Delhi government’s healthcare facilities such as GTB Hospital and DDU Hospital, along with some private hospitals had withdrawn non-essential medical services such as OPD, and held protests. Members of several resident doctors associations had also took out marches in their campuses to lodge protest in the city.

Himachal doctors protest against assault on female doctor

Business Standard-IANS

Government doctors across Himachal Pradeshs Mandi district on Tuesday observed a pen down strike for two hours over the failure to arrest an accused involved in assaulting and abusing a female doctor posted in Chief Minister Jai Ram Thakurs home constituency. The doctors threatened to go on an indefinite strike from Wednesday if action was not taken against the guilty. The woman doctor was allegedly assaulted by the accused in an inebriated state at a primary health centre in Seraj. Doctors association President Jatinder Roorkee told the media in Mandi town, some 200 km from the state capital, that the pen down strike was observed across the district to express solidarity with the victim. He demanded the arrest of the accused by Tuesday night. "Otherwise we will be forced to go on indefinite strike from Wednesday. However, the emergency services will not be hampered," he added.

Mumbai: RN Cooper Hospital doctors strike for clean water

Daily News & Analysis

Apart from protesting against the attack on the doctors, the city-based resident doctors are now protesting for clean water in their hostel. On Tuesday morning, the resident doctors at RN Cooper Hospital, went on a strike, because of unclean and non-potable water in their Resident Medical Officer (RMO) quarters and the canteen. Apart from emergency cases, they refused to attend patients. According to the doctors, they have been facing the issue for the last two months. Despite several complaints to the medical superintendent of the hospital as well as the college dean, no action was taken.

In Hyderabad, underprivileged patients worst hit by doctor strike

The New Indian Express

While patients in private hospitals seemed to empathise with the nationwide strike called by the Indian Medical Association, the worst hit were patients who came for out-patient services in government hospitals. Doctors and medical professionals from across the city refused to provide services for 24 hours to condemn the brutal attack on junior doctors in Kolkata. Osmania General Hospital deals with close to 2,000 OPD cases every day, while Gandhi Hospital sees at least 2,500 and Nizam’s Institute of Medical Sciences services over 1,800 OPD patients. At Osmania General Hospital, the OPD ward wore a deserted look with the gate of the registration area under lock and key. Patients from rural areas were spotted in the waiting zone in large numbers as most of them were not aware of the strike. Superintendent of OGH, Dr. B Nagender, said, “We understand the gravity of the situation and therefore post 12 pm we are treating most patients in the casualty ward as emergency cases.”

Online pharmacy flags possible new impurity in blood pressure drug

ET Healthworld- Reuters

Online pharmacy Valisure reported that it found a new cancer causing impurity in some versions of widely prescribed blood pressure medicine valsartan, but U.S. regulators said on Tuesday that the amount in the drugs was well below levels deemed to be potentially harmful. Connecticut-based Valisure informed the U.S. Food and Drug Administration in a citizen petition last week that it had found through its own testing an impurity called dimethylformamide (DMF) in some batches of the drug. DMF is classified as a probable human carcinogen by the World Health Organization. The findings were first reported by Bloomberg earlier on Tuesday. The FDA said it would review the petition, but "it is important to note that the amounts of DMF being reported are more than 100 times less than those determined by international standards as the level of concern to patients."

Sanofi turns to Google in search for better treatments

ET Healthworld- PTI

Pharmaceutical firm Sanofi said Tuesday it is partnering with Google to use artificial intelligence and deep analytics tools to sift through its data to find better treatments. The titan in online search "will apply technology and analytics on Sanofis large real world database to better understand what treatments work for patients," the pharmaceutical firm said in statement. The use of Googles tools for deep analytics -- organising large amounts of data to make insights -- will help it better understand key diseases and patient outcomes to make further improvements. Sanofi will also be moving some of its business applications to Googles cloud computing platform and use artificial intelligence to improve operations.

Gut microbes can hamper efficacy of medications: study

ET Healthworld- PTI

Los Angeles: Our gut microbes can eat up the medications that we take -- degrading the efficacy of the drugs and often causing hazardous side effects, a study has found. Researchers from the University of California (UC) San Francisco in the US describe one of the first concrete examples of how the microbiome can interfere with a drugs intended path through the body. Focusing on levodopa (L-dopa), the primary treatment for Parkinsons disease, they identified which bacteria are responsible for degrading the drug and how to stop this microbial interference. Parkinsons disease attacks nerve cells in the brain that produce dopamine, without which the body can suffer tremors, muscle rigidity, and problems with balance and coordination. L-dopa delivers dopamine to the brain to relieve symptoms. However, only about one to five per cent of the drug actually reaches the brain. This number -- and the drugs efficacy -- varies widely from patient to patient. Since the introduction of L-dopa in the late 1960s, researchers have known that the bodys enzymes can break down L-dopa in the gut, preventing the drug from reaching the brain.

Suvarna Karnataka Chemists & Distributors Association upset over CDSCO plan to allow e:pharmacy

Pharmabiz- Nandita Vijay

Suvarna Karnataka Chemists and Distributors Association expressed its concerns on the biased and unfair attitude of the CDSCO in its decision to regulate the sale of drugs over the internet. This is despite the CCDSCO receiving various grievances from the Association to restrict the online sale of drugs. “Several occasions we have requested to curb the e:pharmacy business model by incorporating the penal provisions for contravention of the Drugs and Cosmetics Rules and its draft rules vide GSR 817(E) dated August 28,2018. These were communicated to the Drugs Controller General of India Dr S Eswara Reddy,” said V Harikrishnan, president, Suvarna Karnataka Chemists and Distributors Association. Now in his letter to top government officials of the Ministries of health and family welfare, law and justice among others, Harikrishnan has said that the office of the DCGI has not taken into consideration any of the objections raised by the Association. “Therefore we are of the view that the CDSCO has a biased and unfair attitude on the issue to regulate the sale of drugs over the internet.”

Approvals to new pharmacy courses should be given to govt institutions to increase quality of education: Sripati Sinha

Pharmabiz- Peethaambaran Kunnathoor

If the Pharmacy Council of India (PCI) honestly desires to have quality teaching and learning in institutions, it must recommend to the central and state governments to initiate steps for starting more colleges in the government sector. Similarly, government level steps are required to monitor regular attendance of students in classes in the private colleges. There are allegations that many students get admissions for diploma course in institutions, do not attend classes, but pass out in good marks, opined Sripati Sinha, secretary of Indian Pharmacy Graduates Association (IPGA), Bihar state branch. “Government institutions do have well qualified teachers and infrastructure for all subjects in the pharmaceutical sciences. State governments should come forward to start new institutions and courses to uplift the educational sector. In the same way, government should design projects to create jobs for the qualifying students.” he said.