Morning MEDtalks with Dr K K Aggarwal 26^th July 2018

Modicare costing study

The central government has commissioned a costing study on 1,350 treatment packages under Ayushman Bharat – National Health Protection Mission — and said it is open to review the package rates based on the study.  Niti Aayog and ICMR are tasked to do undertake a detailed study that aims to examine the cost of each procedure and arrive at a suitable package rate.

Leptospirosis in Mumbai

Is a zoonosis caused by spirochetes of the genus Leptospira. The organism infects wild and domestic mammals, especially rodents, cattle, swine, dogs, horses, sheep, and goats. Animals can be asymptomatic or develop fatal clinical infection. Reservoir animals may shed the organism in their urine resulting in contamination of water. Humans gets after exposure to environmental sources, such as animal urine, contaminated water or soil, or infected animal tissue through cuts or abraded skin, mucous membranes, or conjunctiva.

The disease may manifest as a subclinical illness, a self-limited systemic infection, or a severe, potentially fatal multiorgan failure. Patients presents with abrupt onset of fever, rigors, myalgias, and headache in 75 to 100 percent of patients.  Conjunctival suffusion in a patient with a nonspecific febrile illness should raise suspicion for the diagnosis of leptospirosis.

Severe cases may develop renal failure, uveitis, hemorrhage, acute respiratory distress syndrome with pulmonary hemorrhage, myocarditis, and rhabdomyolysis.

Treatment is oral doxycycline or azithromycin. These agents are also effective for rickettsial disease, which can be difficult to distinguish from leptospirosis.

Prevention include avoiding potential sources of infection, administration of prophylaxis for individuals at high risk of exposure, and animal vaccination.

Advances in diagnostic and therapeutic medical devices

1. Robotic surgery?
2. PET to detect early Alzheimers?
3. Next-generation sequencing to find actionable cancer mutations?
4. Light microscope, or is it the electron microscope?
5. Proton beam machine for treatment of cancer?
6. Liquid biopsy?
7. Medical Internet
8. Mobile apps?

 Around the globe

1. More information is urgently needed on the physiological and cognitive effects of additives in the American food supply, according to a new policy statement issued by the American Academy of Pediatrics
2. Obesity in the absence of any other metabolic abnormalities does not raise the risk for all-cause mortality, new research suggests. The latest study on the controversial concept of "metabolically healthy obesity" published July 12 in Clinical Obesity. 6% people have obesity with no clinical or preclinical elevations in glucose, lipids, or blood pressure
3. New findings from a large clinical trial suggest that patients with stage III colon cancer who said they drank one or more 12-oz servings of an artificially sweetened beverage each day had a 46% reduction in the risk for death or recurrence when compared to similar patients who did not consume these drinks. The study was published online July 19 in PLos One.
4. Compensation of $3.6 billion in damages to 22 women in the United States who claimed that Johnson and Johnson’s baby powder and other talcum powders caused ovarian cancer, has shown concerns around the globe. The Drug Controller General of India has stated that as these are homecare and personal hygiene products and they do not come under its purview. 
5. A new Advanced Heart Failure Certification program from the American Heart Association (AHA) and The Joint Commission is the first of multiple, jointly offered cardiac certifications that will be made available to hospitals seeking to implement exceptional efforts to foster better quality of care and outcomes for patients with cardiovascular disease. Based on the most recent heart failure clinical practice guidelines, the certification program aims to ensure that patients with heart failure have access to the latest evidence-based care, and improved outcomes and quality of life.
6. The National Institutes of Health (NIH) has launched a new initiative ‘STRIDES’ (Science and Technology Research Infrastructure for Discovery, Experimentation, and Sustainability) with Google Cloud as its first industry partner to harness the power of commercial cloud computing and provide NIH biomedical researchers access to the most advanced, cost-effective computational infrastructure, tools and services available.

Free tuition for entire first class at new medical school

All 30 medical students in the inaugural class of the University of Houstons new College of Medicine will receive free tuition when the school opens in the fall of 2020, thanks to an anonymous $3 million gift, the university has announced.

Stephen Spann, MD, MBA, founding dean of the schools College of Medicine, told Medscape Medical News that preference for admittance will be given to students who want to practice in primary care and those who intend to practice in Texas. "Our goal is to have at least 50% of our graduates choose to practice in primary care specialties," he said. "Theres a significant shortage, and we want to fill that gap where theres the most need. Nationally, only about 20% of US medical school graduates enter primary care, and the state of Texas ranks 47th out of 50 states in primary care physician-to-population ratio."

Speech delivered by President Sri Lanka Medical Association at the Inaugurations of the 131^st Anniversary International Medical Congress on Thursday 26^th July 2018 at 6pm at the Grand Ball Room, Galadari Hotel, Colombo.

It’s Easy to Treat Patients but it is Difficult to Care for Individuals

(Dr Ruvaiz Haniffa, President SLMA)

I consider it an honour and privilege to welcome you all to the 131^st Anniversary International Medical Congress of the Sri Lanka Medical Association.

The SLMA which was established in 1887 is generally and unambiguously acclaimed as the oldest national organization of medical professionals in Asia and Australasia. The SLMA comprises of and represents all grades of doctors from both the private and state sectors in Sri Lanka. This diversity gives us an indisputable and unique opportunity to serve as the apex academic and professional body for all doctors in Sri Lanka. This opportunity also places upon us the greater responsibility to serve as the academic, professional, moral and ethical guardians of the Sri Lankan medical profession.

In today’s medical practice the focus on the holistic/comprehensive care of the individual (as opposed to the patient) has become subservient to attempting to treat/manage illness in patients. The concept of preserving good health by incorporating and practicing preventive and curative aspects of medicine to achieve physical, mental and social well-being in individuals, families and communities by medical professionals adhering to the highest possible standards of professional and ethical conduct seems to be an utopian ideal instead of a practical day-to-day reality. Of course, there are numerous reasons for not being able to achieve this desired state, but the problem is that over time, we in Sri Lanka seem to be moving away from this ideal at a rapidly increasing speed.

We as doctors are forgetting why patients come to us. We are imposing our perceived superior knowledge and skills on patients more often than not in an unsolicited manner. We have in short, developed and come to accept as normal, a system of doctor-centred care in which a medical condition/disease has become the fundamental issue needing the doctor’s attention. We have lost the art of focusing on the holistic health needs of patients.

This is why we need to shift our focus back to patients, now more than ever. Our theme for 2018 Shifting focus from diseases to patients: Today’s vision, Tomorrow’s reality’ is chosen to reflect upon the realities of health and healthcare in the 21^st century, which is going to be patient/people driven from local, regional and global perspectives. The galaxy of resource persons at this conference, would over the next 3 days share their views as to how our vision of today will become tomorrow’s reality from the perspectives of their respective specialities.

Ladies and Gentlemen, let me conclude by wishing you a pleasant and enjoyable evening and take this opportunity to remind myself and all of you that it is indeed easy to treat patients once we master the science of medicine, but it is infinitely more difficult to care for individuals until we master the art of medicine.

 Participate in survey on inflammatory bowel disease:  

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

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO