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Morning MEDtalks with Dr KK Aggarwal 7th July 2018
Oral administration of honey or sucralfate after button battery ingestion in children
For asymptomatic children with acute button battery ingestions (witnessed or likely to have occurred within one to two hours) who are older than one year of age give one oral dose of pure honey (eg, 5 to 10 mL) as soon as possible after ingestion.
Guidelines previously recommended no oral intake before timely radiographic localization and emergency endoscopic removal of esophageal button batteries. A recent study using in vitro and in vivo animal models of esophageal battery impaction suggests that early and repeated oral administration of either honey or sucralfate until the battery is removed may reduce the severity of esophageal burns.
Once in the emergency department, the child may receive another dose of honey or a single dose of sucralfate 500 mg prior to confirmation of esophageal impaction and emergency battery removal. ( Laryngoscope 2018.)
Can government give incentives for organ transplant?
Policy Document and Guidelines on National Organ and Tissue Transplant Programme (NOTP) Ministry of Health & Family Welfare, Govt. of India
(v) Utilization of corpus fund: The funds may be utilized for miscellaneous expenditure and upto 50% of the funds may be utilized for giving incentives to the retrieval and Transplant teams and also giving any other benefits to the family of donors. District level committee may be formed under the chairmanship of District Magistrate to device further guidelines, in this regard.
- Guidelines for benefits to Families of deceased donors:
Benefits to the cadaver organ donation toward medical treatment and/or education of dependent family members of the donors with a ceiling of Rs. 1(one) lalch per year for a period of fiver years or till the scheme is in operation whichever is earlier. Voluntary donations will also be encouraged from the recipients, part of which will also be used to give additional benefits to the family of organ donor.
- Financial benefits to the donors will be distributed through SOTTO or State Government where SOTTO is not set up.
- Eligibility Criteria for benefits to be given to the family members of deceased donors: Should be a citizen of India.
- Family Members eligible for benefit: or minor children or major unmarried children etc
- 10% of the benefit is to be given upon retrieval and 90% on transplant
The corpus funds may be created at the level of SOTTO/State Government which will receive funds from following three sources: Government grants Donation from recipients Philanthropic organizations and any other source.
"Leprosy is curable", Supreme Court passes slew of directions for benefit of patients
With the object of ending discrimination against Leprosy patients, the Supreme Court passed a slew of directions aimed at their rehabilitation and integration into society. The directions came to be passed by a Bench of Chief Justice Dipak Misraand Justices AM Khanwilkar and DY Chandrachud in a petition filed by Vidhi Centre for Legal Policy and Pankaj Sinha.
Vidhi had, among other things, prayed for striking down statutes that allegedly discriminate against patients suffering from the disease. Senior Advocate Raju Ramachandran, appearing for Vidhi, had earlier submitted that at least one hundred and nineteen statutes (both Central and State) discriminate against leprosy patients and that the same violate of Articles 14, 19 and 21 of the Constitution. The Court had issued notice in the matter in December last year.
“There has to be social awareness to the factum that with the advancement of science in the past forty years, the disease is curable.”
The Bench then passed the following directions:
- Union of India shall carry out awareness campaigns at various levels so that people come to know that Leprosy is curable.
- There should be specific programmes telecast on All India Radio and Doordarshan on National and regional channels for educating people about the fact that Leprosy is not a communicable disease. The programme should be telecast during primetime.
- Hospitals should not decline to treat persons suffering from Leprosy.
- Union of India and States shall take steps to rehabilitate Leprosy patients and to bring them to the mainstream.
- It is the duty of the Centre and States to ensure that Leprosy patients do not suffer from any stigma.
The Court also directed the Centre and the States to apprise it of the steps taken by filing compliance reports. The matter will now be heard on August 8.
INDIAN-ORIGIN LAWYER NAMED AS ACTING HEAD OF DRUG ENFORCEMENT ADMINISTRATION (DEA) BY US PREZ TRUMP’S ADMINISTRATION
US Attorney General Jeff Sessions stated that, “With one American dying of a drug overdose every nine minutes, there can be no doubt that we are facing the deadliest drug epidemic in our history”. He further added that, “The work of the drug enforcement administration is critical to fighting this crisis, and President (Donald) Trump and I are committed to continuing to give it the strong leadership it deserves. That is why I am pleased to appoint Uttam Dhillon as acting administrator.”
Exposure to air pollution is associated with greater risk of elevated blood pressure (BP) in adults and children. Now a new study has shown that exposure to ambient PM2.5 during the third trimester of pregnancy is associated with elevated BP in children, ages 3 to 9 years. (Hypertension. 2018; 72:194-201. DOI: 10.1161/HYPERTENSIONAHA.117.10944.)
Study showed a sharp increase in offspring SBP percentile and risk for elevated BP when third-trimester PM2.5 concentration was ≥13 μg/m3. The highest versus lowest tertile of third-trimester PM2.5 exposure was associated with a 4.85 percentile increase in child SBP or a 1.61 times higher risk of child elevated BP. A 5-μg/m3 increment in PM2.5 during the third trimester was associated with a 3.49 percentile increase in child SBP or a 1.47 times higher risk of elevated BP.
Binge alcohol and hypertension
Elevated blood pressure and total cholesterol in men aged 18 to 45 may be a sign of repeated binge drinking, according to results of a new study published in the Journal of the American Heart Association. Binge-drinking men had higher systolic blood pressure and total cholesterol levels than did their non–binge-drinking counterparts and women, irrespective of whether the women were binge drinkers or not.
New PATH LAB RULES
Union Health Ministry has notified the Clinical Establishments (Central Government) Amendment Rules, 2018 and that has come into force from May 18, 2018.
As per the new Rules, ‘every clinical establishment engaged in diagnosis or treatment of diseases, where pathological, bacteriological, genetic, radiological, chemical, biological investigations or other diagnostic or investigative services, are usually carried on with the aid of laboratory or other medical equipment’, requires to comply with the minimum standards of facilities and services as specified in the Schedule. The new Rule has classified path labs into three categories - basic composite (small), medium and advanced labs.
The path labs conducting routine biochemistry tests, haematology tests, basic medical microbiology & immunology tests like rapid test (point of care tests) for infection, urine routine examination and microscopy, hanging drop for vibrio cholerae, stool for ova, cyst, etc have been classified as small-scale labs.
For medium and advanced labs, a post-graduate in pathology or biochemistry or medical biology is an essential qualification, but there is no minimum qualification for small labs. For them, a pathology degree in medicine or surgery from a recognised university is desirable. There is no mandatory requirement to have MBBS doctor or pathologist. Besides, path labs are no longer required to get NABL accreditation.
This small labs criteria dilution is a last minute change by the ministry even when the expert committee, set up by MCI to draft rules to regulate path labs, had made MBBS degree an essential qualification for path labs and the Supreme Court order on December 12, 2017 clearly stated that laboratory reports can be countersigned only by a registered medical practitioner with a post-graduate qualification in pathology.
CDC Updates Recommendations of 3HP for Latent TB Infections
US Centers for Disease Control and Prevention (CDC) have issued new recommendations on treatment of LTBI with once weekly isoniazid rifapentine for 12 weeks (3HP) to include more populations. In 2011, the CDC recommended the regimen of 3HP for treatment of LTBI with limitations for children under the age of 12 and individuals with HIV.Following the evidence from the systematic review and TB / LBTI expert recommendations which include the use of 3HP in adults, as well as:
In addition to the new guidelines, the CDC indicates that health care providers should choose the mode of administering 3HP based on individual patient’s needs. Patients should be monitored monthly to assess treatment adherence and baseline hepatic chemistry blood tests should be ordered for patients with HIV and liver disorders.
Participate in survey on Inflammatory bowel disease: https://docs.google.com/forms/d/1SAbiZpxKIqt6bWixE3J-1ZB7VPH-Z530tmAgseQLK4g/edit
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO