Morning Medtalks with Dr KK Aggarwal 29^th June 2018

Seven Indore doctor’s suspension by MCI set aside by High Court of MP, Indore bench

Earlier MCI had recommended three months suspension of 7 senior faculty members from MGM Medical College, Indore, MP alleging irregularities in conduction of Clinical Drug Trials.

This matter was earlier investigated in 2012 by the regulatory authority DCGI, who did not find any unethicality or violation in conduct of Clinical Trials that were duly approved and monitored by ethics committees and DCGI.

The MCI order was quashed by the Honb’le High court on 27/06/18 on the grounds that the order was not a speaking order and the doctors were not given opportunity to present their case.

Artificial pancreas

Closed-loop automated insulin delivery offers the potential for improving glycemic control among hospitalized noncritically ill patients with type 2 diabetes. Findings from a randomized open-label trial of a prototype fully closed-loop system in 136 adults with type 2 diabetes were presented June 25 here at the American Diabetes Association (ADA) 2018 Scientific Sessions by Lia Bally, PhD, of Inselspital, Bern University Hospital, Switzerland. The results were also simultaneously published in the New England Journal of Medicine.

Mass drug administration in Malaria

Mass drug administration campaigns can rapidly reduce malaria parasitemia in low-transmission areas, particularly in the setting of threatened P. falciparum drug resistance.

A regional elimination program in Myanmar included identification of malarial "hotspots" (defined as presence of malaria in >40 percent of individuals, of which 20 percent was P. falciparum); hotspot villages had incidence of P. falciparum three times higher than neighboring villages. Mass drug administration (dihydroartemisinin-piperaquine plus single-dose primaquine once per month for three consecutive months) was was associated with an 80 percent reduction in incidence of P. falciparum.

Another approach is identifying asymptomatic individuals with malaria with rapid diagnostic tests (RDTs) followed by "focal" mass drug administration. In Zanzibar (an area of low falciparum transmission), drug treatment of all individuals residing within 300 to 1000 meters of individuals with positive RDT enabled elimination of malaria in up to 66 percent of asymptomatic individuals.

Oil of lemon eucalyptus extract

Oil of lemon eucalyptus extract (also known as p-menthane-3,8-diol, or PMD) is derived from the leaves of lemon eucalyptus trees and chemically synthesized, usually in the form of a spray. It is a natural mosquito repellent.

Wisconsin Supreme Court upholds medical malpractice caps in case of Wisconsin woman who lost four limbs

Wisconsins caps on medical malpractice awards are constitutional. With this a Milwaukee woman 50, who lost all four limbs to malpractice will receive only $750,000 for the pain and suffering.

In a 5-2 decision written by Chief Justice Patience Roggensack, the court declared the cap on noneconomic damages that was enacted in 1986 to be constitutional, overruling a Milwaukee County Circuit Court judge, a state appellate court and a 2005 Supreme Court decision.

As a result, Ascaris and Antonio Mayo will receive less than five percent of the $16.5 million in noneconomic damages — that is, pain and suffering and loss of companionship — that a Milwaukee County jury awarded them in 2014.

Mayo lost her limbs after medical personnel at Columbia St. Marys Hospital failed to diagnose an infection or offer her antibiotics to treat the condition. Her Strep A infection ultimately led to septic shock and sepsis and the amputations.

A Milwaukee County jury awarded the Mayos $25.3 million for her economic and noneconomic damages. Milwaukee County Judge Jeffrey Conen upheld the jurys verdict saying that in the Mayo case the $750,000 cap for noneconomic damages was unconstitutional. He did not, however, rule the cap itself as unconstitutional.

The Supreme Court rejected both lower court orders.

Variation in private medical college fees

1. Supreme Court repeatedly ruling that education cannot be for profit.
2. The average annual tuition fees for MBBS in private colleges varies from about Rs 5 lakh to Rs 25 lakh, with deemed universities typically charging the most.
3. Data for the 2017 fees in about 210 private colleges given to the Medical Council of India shows only 25 averaged Rs 5 lakh or less and about half averaged under Rs 8 lakh.
4. In Pune, the average fees range from Rs 6 lakh to over 17 lakh, in Mumbai from Rs 7.7 lakh to Rs 25 lakh, and in Bangalore from Rs 4 lakh to 10 lakh.
5. After the SC ruled that states can regulate medical college fees to curb commercialisation and promote merit, states constituted fee fixation committees. Colleges submit their expenses, on the basis of which the committees fix the fees.
6. Many claim higher expenses for extra amenities but luxurious facilities cannot be the criteria to fix exorbitant fees. Fees ought to be based only on expenses for facilities mandated by MCI.
7. In the eight deemed universities in Tamil Nadu, fees range from Rs 18.5 lakh to Rs 22.5 lakh. 
8. Under the law, only nonprofit societies or charitable trusts could run medical colleges till the government in November 2016 permitted private companies to run them.
9. Many deemed universities and their affiliated colleges have escaped the jurisdiction of the fee fixation committees. In Rajasthan, all private medical colleges are affiliated to deemed universities and their average fees range from roughly Rs 15 lakh to Rs 18 lakh. (TOI)
10. An 11-member national level fee regulation committee has been formed by University Grants Commission to finalize the fee for the MBBS course in deemed universities of Tamil Nadu. A bench of the Madras High Court has directed the committee to give a finalized fee structure by October 31.

In June, an interim order on the fee was passed by the bench, capping the fee at Rs 13 lakh. The High Court bench then said, “We are informed that the (UGC) fee committee has earlier fixed Rs 11.50 lakh as management quota for medical colleges run by the deemed universities and the students may now be admitted subject to the payment of Rs 13 lakh.”

However, last week the High Court order on the fee was stayed by a vacation bench of the Supreme Court, permitting Sri Ramachandra Medical College and Research Institute to collect Rs 22 lakh as the fee for this academic year. Until the UGC committee finalizes the fee, this will be the fee collected by the college.

Non-Identical Twins Becoming Common in India

TOI:  The odds for natural twins are one pair per 70 natural births.

1. The country is witnessing a “ten-fold rise” in twinning rates over the past two decades owing mostly to assisted reproductive technology, hormonal drugs to boost ovulation and increased maternal age with women delaying motherhood
2. 30-50% of all twins now occur as a result of infertility treatment
3. An ICMR study of 113 couples in Mumbai revealed that 45% of pregnancies via assisted reproduction techniques resulted in twins or triplets.
4. In IVF more number of embryos are implanted simultaneously in the womb to increase chances of conception.
5. IVF also involves a procedure called ‘laser assisted hatching’ to thin the outer shell of the embryo in order to allow the embryo to hatch. That increases chances of implantation as well as twinning.
6. Advancing maternal age: Women in their mid-thirties often resort to hormonal drugs that increase ovulation, leading to a heightened chance of bearing twins or triplets.
7. Twins born out of assisted pregnancies are usually fraternal (non-identical) since they arise from separate embryos and a different egg cell.
8. Europe has strict rules on single embryo transfers now
9. Currently ICMR recommends not more than three embryo transfers and the recent advent of technology to freeze embryos is helping curb the temptation to transfer all the embryos generated in a given cycle.

Automatic no antibiotic unless renewed

An automatic 48-hour antibiotic stop order generated during neonatal intensive care unit (NICU) admission reduced antibiotic usage effectively, according to research published in the Journal of the Pediatric Infectious Disease Society.