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Morning Medtalks with Dr KK Aggarwal 8th June 2018

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Dr KK Aggarwal    08 June 2018

Clinical

  1. The Centers for Disease Control and Prevention unveiled a new rabies rapid test that can more easily and precisely diagnose rabies infections in animals. The LN34 pan-lyssavirus real-time polymerase chain reaction assay (LN34) displays a higher diagnostic capability when compared to the direct fluorescent antibody test, the current gold standard. 
  2. A former patient is suing UPMC (in US) for negligence after learning she was among thousands of people potentially exposed to tuberculosis by an emergency room nurse who may have been contagious with the infectious disease for four consecutive months. The plaintiff is seeking more than $25,000 in damages.
  3. A total of 12 patients may have died since 2016 due to complications from weight-loss balloon surgery, the Food and Drug Administration. Officials are keeping an eye on the Orbera Intragastric Balloon System from Austin, Texas-based Apollo Endosurgery and San Clemente, California-based ReShape Lifesciences’ ReShape Integrated Dual Balloon System.
  4. Union Heath Minister said India has seen a decline in its Maternal Mortality Ratio (MMR) from 139 to 130. Indias MMR has significantly fallen from 167 in 2011-13 to the present figure of 130, as per the latest Sample Registration System (SRS) figures.

 Public Health

  1. WHO has paid glowing tributes to Keralas young nurse Lini Puthussery, who died of Nipah virus last month, after treating one of the patients. Lini died on May 21 after being infected by a patient, whom she treated initially at the Perambra Taluk hospital, where she was a nurse. In a tweet, WHOS Health Workforce Director Jim Campbellsaid: "Remember them, lest we forget: Razan al-Najjar (Gaza); Lini Puthussery (India); Salome Karwah (Liberia). #WomeninGlobalHealth, #NotATarget. A 28-year-old mother of two young boys, Lini died at the Kozhikode Medical college hospital days after being infected.

Editors Views: If an army person dies he gets a national honour why not when a doctor or nurse dies on duty.

  1. American Society of Clinical OncologyL less than 2% of eligible US smokers are screened for lung cancer with low-dose CT (LDCT) as against 65% of women over age 40 who are screened for breast cancer.
  2. Union environment and forest minister Harsh Vardhan said on World Environment Day on Tuesday that single-use plastic could be eradicated by 2022.
  3. Potential sources of Carbon Monoxide other than fires, include poorly functioning heating systems, improperly vented fuel-burning devices (eg, kerosene heaters, charcoal grills, camping stoves, gasoline-powered electrical generators, and motor vehicles operating in poorly ventilated areas (eg, ice rinks, warehouses, parking garages). CO poisonings following open air exposure to motorboat exhaust have also been reported. Underground electrical cable fires produce large amounts of CO, which can seep into adjacent buildings and homes.
  4. Ira Gupta Reports: A 58-year-old woman in Jharkhand’s Giridih district died allegedly due to starvation of three days as an official team that visited her home found no food in House. Probe has been ordered as to why Savitri Devi, did not have a ration card and whether she had formally applied for one. She lived along with her two daughter-in-laws and four grandchildren, all surviving on little money sent by her elder son, who worked in a Private Company in Maharashtra. Since October 2017 and the death of a 15-year-old girl in Simdega, Jharkhand has seen more than half-a-dozen cases of alleged starvation deaths. Government in February,2018 announced a Committee, largely comprising activists in field of right-to-food, to define the criteria on basis of which a death could be categorised as having been caused due to hunger or starvation. (Latestlaws.com)

Views: A person can only die of starvation in three days if he or she is deprived of water also.

  1. Allowable expense: Any expenditure bona-fide incurred by a company for the purposes of promoting family planning amongst its employees [sec 36]
  2. WMA: Physicians and their medical associations should encourage efforts to curb the manufacture and use of plastic packaging and plastic bags, and to halt the introduction of plastic waste into the environment. These efforts may include specific regulations limiting the use of plastic packaging and plastic bags.
  3. Vedic Medicine: Chapter 2. 58 Bhagavad Gita

yada samharate cayam

kurmo nganiva sarvasah

indriyanindriyarthebhyas

tasya prajna pratisthita

yada—when; samharate—winds up; ca—also; ayam—all these; kurmah—tortoise; angani—limbs; iva—like; sarvasah—altogether; indriyani—senses;indriya-arthebhyah—from the sense objects; tasya—his; prajna—consciousness; pratisthita—fixed up.

 

TRANSLATION: One who is able to withdraw his senses from sense objects, as the tortoise draws his limbs within the shell, is to be understood as truly situated in knowledge.

Message: learn to withdraw and wait for the opportunity.

 

Awards

  1. FICCI is back with the tenth editionof its annual Healthcare Excellence Awards. The Awards are supported by Astron Healthcare, and EY who are the Official Tabulators. Awards 2018 are being organized, on 30 August 2018 from 7:30 pm to 9:30 pm at Le Meridian, New Delhi.  Mr M Damodaran, Former Chairman - SEBI would Chair the Jury panel, with (Hony) Brig Dr Arvind Lal - Chairman & Managing Director | Dr Lal PathLabs Ltd, as Co-Chair.

Weather

Maximum Temperature

Maximum temperatures were markedly above normal ( 5.1°C or more) at isolated places over east Assam; appreciably above normal (3.1°C to 5.0°C) at many places over many places over Sub Himalayan West Bengal &Sikkim; at a few places over East Rajasthan; at isolated places over Saurashtra & Kutch and West Madhya Pradesh; above normal (1.6°C to 3.0°C) at a few places over West Rajasthan, Gujarat region, Bihar, Konkan & Goa and Kerala; at isolated places over east Madhya Pradesh and Tamilnadu & Puducherry.They are markedly below normal (5.1°C or less) at most places over Punjab; at a few places over Coastal Andhra Pradesh; at isolated places over West Uttar Pradesh; appreciably below normal (3.1°C to 5.0°C) at a few places over Haryana, Chandigarh &Delhi; at isolated places over Telangana; below normal (1.6°C to 3.0°C) at a few places over Himachal Pradesh, Uttarakhand and Marathwada; at isolated places over Chhattisgarh & Odisha and near normal over the rest of the country.

  1. The highest maximum temperature of 44.9°C recorded at Barmer (West Rajasthan) over plains of the country.
  2. Temperatures more than 40.0°C is recorded at most parts of Rajasthan, Madhya Pradesh,  Punjab, Haryana, Chandigarh & Delhi, Vidharbha; at some parts of Gujarat region and Saurashtra & Kutch and Uttar Pradesh and at one or two pockets over Chhattisgarh, Jharkhand, Jammu & Kashmir, north Madhya Maharashtra.

Heat Wave Warnings for Next 24 hours

Heat wave warning for next 24 hours: ♦ No Heat wave conditions

WMA

  1. The WMA reaffirms the Declaration of Seoul on professional autonomy and clinical independence of physicians.
  1. The regulation of the medical profession plays an essential role in ensuring and maintaining public confidence in the standards of care and of behaviour that they can expect from the medical professionals who serve them.  That regulation requires very strong independent professional involvement.  This may be the leading voice or one amongst other caring and informed partners providing that regulation assures the highest possible standards within the medical profession.
  1. Physicians aspire to the development or maintenance of systems of regulation that will best protect the highest possible standards of care for all patients. Professionally led models provide the optimum environment to enhance and assure the individual physician’s right to treat patients without interference, based on his or her best clinical judgment. Therefore, the WMA urges its constituent members and all physicians to take actions to ensure effective systems are in place.  These actions should be informed by the following principles:
  1. Physicians enjoy a high degree of professional autonomy and clinical independence, whereby they are able to make recommendations based on their knowledge and experience, clinical evidence and their holistic understanding of the patient including his/her best interests without undue or inappropriate outside influence.
  1. The professional self-regulation of physicians must be based on a model that applies to everyone equally and that protects and benefits patients .The planning and delivery of all types of health care is based upon an ethical model and current evidence-based medical knowledge by which all physicians are governed.  This is an element of professionalism and protects patients.  Physicians are best qualified to judge the actions of their peers against such normative standards, bearing in mind relevant local circumstances.
  1. The medical profession has a continuing responsibility to be strongly involved in regulation or self-regulating. Ultimate control and decision-making authority must include physicians, based on their specific medical training, knowledge, experience and expertise.  In countries where self-regulation remains physicians must ensure that this retains the confidence of the public. In countries that have a mixed regulation system physicians must ensure that it maintains professional confidence.
  1. Physicians in each country are urged to establish, maintain and actively participate in a fair, rigorous and transparent system of professionally-led regulation. Such systems are intended to balance physicians’ rights to exercise medical judgment freely with the obligation to do so wisely and temperately.
  1. National Medical Associations must do their utmost to promote and support the concept of well-informed and effective regulation amongst their membership and the public. To ensure that potential conflicts of interest between their representative and regulatory roles are avoided they must ensure separation of the two processes and pay rigorous attention to a transparent and fair system of regulation that will assure the public of its independence and fairness .
  1. Any system of professionally-led regulation must enhance and ensure:
  1. the delivery of high quality safe care to patients,
  2. the competence of the physician providing that care
  3. the professional conduct of all physicians, and the protection of society
  4. Promote the trust and confidence of patients, their families and the public.
  5. the regulation system itself is subject to quality assurance
  1. To ensure that the patient is offered quality continuing care, physicians must participate actively in the process of Continuing Professional Development, including in reflective practice, in order to update and maintain their clinical knowledge, skills and competence. Employers and management have a responsibility to enable physicians to meet this requirement.
  1. The professional conduct of physicians must always be within the bounds of the Code of Ethics governing physicians in each country. National Medical Associations must promote professional and ethical conduct among physicians for the benefit of patients, and ethical violations must be promptly recognized, reported to the relevant regulatory authority and acted upon. Physicians are obligated to intervene in a timely manner to ensure that impaired colleagues cease practicing and receive appropriate assistance from a physician health program.
  1. The regulatory body should, when the judicial or quasi-judicial processes are complete, and assuming the case is found against the physician, publish their findings and  include details of the remedial action taken.  Lessons learned from every case should, as possible, be extracted and used in professional education processes.
  2. National Medical Associations are urged to assist each other in coping with new and developing problems, including potential threats to professionally-led regulation. The ongoing exchange of information and experiences between National Medical Associations is essential for the benefit of patients.
  1. Whatever judicial or regulatory process a country has established, any judgment on a physician’s professional conduct or performance must incorporate evaluation by the physician’s professional peers who, by their training knowledge and experience, understand the complexity of the medical issues involved.
  2. An effective and responsible system of professionally-led regulation by the medical profession in each country must not be self-serving or internally protective of the profession. National Medical Associations should assist their members in understanding that self-regulation must not be protective of physicians, but must maintain the safety, support and confidence of the general public as well as the honour of the profession itself.
  1. While physicians must always consider the economic dimensions of their recommended care, this must not be a pretext for denial of necessary medical services.

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