Morning MEDtalks with Dr K K Aggarwal 25^th July 2018

Letter to editor about NEET age

Respected Dr KK Aggarwal Sir

We a group of students above the age of 25 are in dilemma. We had given NEET-UG on 6th of May this year. On 4th of June, CBSE declared the result but did not declare result of students of above age 25. Now the registration for counselling have been started.

We want to become doctors. No one has the right to spoil our life. Why is there a barrier of maximum age limit for becoming Doctor in India? This is the main reason for students to go to other countries for becoming a doctor and settle there forever. At present, there is already shortage of doctors in our country.

Our parents are also in stress because of this. Our result is not being declared by the collusion of both CBSE and MCI. The first counselling for seat allotment is over. The second counselling is also going to be closed soon. (mahajanrickyoct1990@gmail.com)

Oxytocin controversy

The Hindu from Delhi & Kerala (July 23, 2018)

 “According to the information we have received from KAPL, the new price of Oxytocin will be ₹17.78 / vial (₹15.58 +12 % GST), which is unacceptably high and could seriously upset the budgets of small hospitals. Also, KAPL says that the minimum order quantity should be 1,000 ampoules, which might be difficult for small nursing homes,” according to gynaecologists.

“Pitocin, manufactured by Pfizer and a popular brand preferred by gynaecologists, was being sold at ₹13.77/vial for hospital supply and at a lesser rate for bulk purchase. It is unbelievable that an essential drug which used to be cheap even in the private pharma sector, has been made the monopoly of a single PSU and that hospitals are now expected to procure it at the highly exorbitant price of ₹17.78/vial.

Gynaecologists concern: On Ban on Pvt pharma for domestic use. All of them asked in the same voice "If the product of KAPL is not as effective as the existing Brands, what will we do?"

Govt. launches nationwide Student Police Cadet (SPC) program to bridge gap between police & school students

Ministry of Home Affairs-sponsored programme focuses on the students of Classes VIII and IX. In the initial phase, it will be implemented in all Government Schools in urban and rural areas across the country. SPC would lead to a silent revolution over the years by focusing on character building and imparting moral values to budding minds.  SPC programme will provide a healthy interface between schools and police and help inculcate in students the aspects of public safety, discipline, patience, tolerance, empathy, respect of senior citizens, social harmony, traffic sense and a corruption-free environment. (Source Indian Express)

Supreme Court asks AIIMS to formulate national action plan to combat drug menace

The Apex Court Bench made it clear that no extension of time would be granted to Government and AIIMS in formulating the policy on Drug Menace as the issue was of “national importance”. The bench directed to finalise the report of the High Powered Committee on or before September 7″.

Supreme Court in December 2016, had issued a slew of guidelines and had asked Centre to formulate within 6 months National Action Plan to curb rising substance abuse cases among school children and had also ordered a national survey to gauge the extent of the menace.

Study by the Delhi Commission for Protection of Child Rights on substance abuse by kids showed last year stated that 100 per cent of the children in conflict with the law were drug abusers, 95.5 per cent of them staying in childcare institutions were on drugs and 93 per cent of street children consumed narcotics. (Source PTI)

“Only Yes means Yes”: Spanish Government promises new Sexual Consent Law

 Spanish Prime Minister Pedro Sanchez told Parliament that under the new measure sex without explicit consent would constitute rape. He further added that “if they say no it means no, and if they don’t say yes, it means no”. Under Spanish law, a case is only considered to be rape if violence and intimidation are involved.  “If a woman does not expressly say yes, then everything else is no”. “Consent must be given voluntarily”. (Source: LatestLaws.com)

SC/ST court in Jaipur awarded death to a 19 year old man for raping a 7-month-old girl 2 months back, making it the 1st death to be given in Rajasthan to a rapist following an amendment to the POCSO Act

The accused, Pintu, was found guilty on 18.07.2018 after considering the medical report, eyewitness account & circumstantial evidence. On 9th May, Pintu had taken the baby girl from her house when she was with her partially-blind grandmother & raped her at a nearby school building. He was caught by some people & handed over to Police. The decision in the case came after 30 days of continuous hearings. Evidences were presented during the hearing against the accused. (Ira Gupta)

Around the globe

1. Cyclospora update: The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. As of July 19, 2018, health officials say a total of 163 lab-confirmed cases of Cyclospora infection were reported in people who ate salads from McDonalds restaurants in 10 states, including Missouri.

1. Cyclospora cayetanensis is a food and waterborne parasitic cause of diarrheal illness in children and adults. Humans are the only natural hosts. It is most frequently reported in Latin America, the Indian subcontinent, and Southeast Asia.
2. Risk factors for infection in endemic areas include contaminated water, food or soil, poor sanitation and low socioeconomic status.
3. Oocysts of C. cayetanensis passed in the stool are shed in a noninfective form and require several days before they become infectious, so person-to-person transmission is not likely. A low infectious dose (10 to 100 organisms) is probably sufficient for infection.
4. The infection is characterized by anorexia, nausea, flatulence, fatigue, abdominal cramping, diarrhea, low-grade fever, and weight loss. In watery diarrhea with pain, think of microspore.
5. In endemic areas, asymptomatic infections are more frequent, although more severe clinical symptoms occur in young children and older adults. The median incubation period is about seven days.
6. In stool microscopy, oocysts can be detected by modified acid-fast staining of stool, in which oocysts appear light pink to deep purple (diameter 8 to 10 microns).
7. It is important to distinguish the Cyclospora oocysts from those of Cryptosporidium, which are also acid fast but smaller (diameter 5 microns).
8. Treatment is trimethoprim-sulfamethoxazole one double-strength 160 mg/800 mg tablet orally twice daily for 7 to 10 days.

CDC launches first vision and eye health surveillance system in the US

CDC has developed the first Vision and Eye Health Surveillance System (VEHSS) in the US in collaboration with the National Opinion Research Center (NORC). VEHSS is designed to help health care professionals, researchers, policymakers, and state health departments better understand the scope of vision loss, eye disorders, and eye care services in the United States. Visitors to the site can search for information about eye conditions and diseases at the state and national levels.  They also can use the system to:

1. Identify and collect existing data on residents’ vision and eye health.
2. Create case definitions to analyze data consistently across sources.
3. Analyze data to estimate:

1. Prevalence of eye disorders and disabilities
2. Use of eye health services
3. Health disparities in visual health treatment and outcomes

First guidelines for clinical evaluation of Alzheimers disease and other dementias  

The Alzheimer’s Association has developed the first guidelines for clinical evaluation of Alzheimers disease and other dementias for Primary and Specialty Care, which were previewed at the Alzheimers Association International Conference (AAIC) 2018 in Chicago. Key recommendations include:

1. All middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely evaluation.
2. History should be obtained not only from the patient but also from someone who knows the patient well to:

1. Establish the presence and characteristics of any substantial changes, to categorize the cognitive behavioral syndrome.
2. Investigate possible causes and contributing factors to arrive at a diagnosis/diagnoses.
3. Appropriately educate, communicate findings and diagnosis, and ensure ongoing management, care and support.

   3. Concerns should not be dismissed as “normal aging” without a proper assessment.

   4. Evaluation should involve not only the patient and clinician but, almost always, also involve a care partner (e.g., family member or confidant).

Participate in survey on inflammatory bowel disease:

https://docs.google.com/forms/d/e/1FAIpQLSedaDx2iXiwU1vBpYdU6ebfCap-7PYAPSqXRJTeg8ULvNOcLg/viewform

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI