Morning MEDtalks with Dr KK Aggarwal 5^th August 2018

Smoking and air pollution have similar effects

Smokers and non-smokers now represent an equal number of lung cancer patients, according to a study carried out by the Lung Care Foundation. An analysis of 150 patients at Sir Ganga Ram Hospital (SGRH), New Delhi, found that about 50% of patients with lung cancer–the type of cancer responsible for the highest number of cancer deaths nationwide–had never smoked, and yet had developed the pulmonary disease. There is strong evidence that points to the role of air pollution in the increasing incidence of lung cancer amongst the young and female populations.

AEDs in schools

Automated external defibrillators (AEDs) are portable devices that read and analyze the heart rhythm and provide an electric shock, or defibrillation, to restore a normal rhythm. For more than a decade, medical organizations have recommended that schools create formal emergency medical response plans to SCA — and for good reason: For every minute that defibrillation is delayed, the likelihood of survival from SCA drops about 10%. If bystanders quickly recognize what is happening and use a local AED, the survival rate is 89% among student-athletes suffering SCA on a school campus.

Screen for familial high cholesterol, if ‘bad’ LDL cholesterol >190

About four in 1,000 adults in the US are born with a genetic condition characterized by abnormally high cholesterol levels, known as familial hypercholesterolemia (FH). Their "bad" LDL cholesterol can be two to three times as high as the common target LDL value of 100 mg/dL or lower for healthy people. But only about half of people with FH are getting proper treatment for the disease, according to a report in the May 22 issue of Circulation.

If untreated, a person with FH has at least 13 times the risk of a heart attack compared with someone without FH. Anyone with an LDL cholesterol level of 190 mg/dL or higher should be screened for FH and treated appropriately.

Do not fabricate records

The Punjab State Consumer Disputes Redressal Commission has directed Fortis Hospital, Ludhiana, to pay Rs 55 lakh compensation after a 68-year-old woman, Rita Jain, admitted to the hospital for brain tumour surgery in May 2016, died within 10 days. The hospital has also been directed to pay Rs 33,000 towards litigation costs.

“The cause of death mentioned in the death summary is sudden cardiac arrest due to the lung injury (pneumothorax)”

Fortis stated that the complaint was not maintainable as there is no evidence on record that there was any negligence or deficiency or delay in service on the part of the hospital. It was alleged that the patient was diagnosed with pneumonitis, and the hospital, via an x-ray of a chest, showed that pneumonia could lead to pneumothorax.

Hospital tampered with documents, said the Commission. The commission ruled that there was medical negligence on the part of the hospital “A look at the critical care flow sheets reveal that a number of cuttings have been made at various points which show that the documents have been tampered with,”

“No explanation has been forthcoming on record on why the cuttings were made and by whom. Such record, which has been tampered with in order to save itself (the hospital) from liability, cannot be taken into consideration.”

Around the globe

1. Researchers reported in the New England Journal of Medicine that 4 months of rifampin was noninferior to 9 months of isoniazid for the treatment of adults with latent tuberculosis (TB). The shorter regimen was also associated with higher rates of treatment completion and better safety.
2. A study published August 2nd in the journal Cell Metabolism reveals that successful response to weight loss is associated with the early and sustained improvement in the functioning of pancreatic beta cells. This finding challenges the previous paradigm that beta-cell function is irreversibly lost in patients with type 2 diabetes.
3. The Democratic Republic of Congo has announced a new outbreak of the deadly Ebola virus, just days after a recent emergence of the disease, which killed 33 people, was declared over. Four cases of the virus were confirmed in northeastern North Kivu province. A team of 12 experts are to set up a response operation.
4. A man in Wisconsin man underwent amputation of lower legs and hands after developing a rare blood infection caused by bacteria called Capnocytophaga canimorsus, which is commonly found in the saliva of most healthy dogs and is usually not harmful to humans. The bacteria entered his blood stream causing sepsis.

Around the Nation

1. Over 500 licensed water trolleys were seized in north Delhi after samples taken from them were found unfit for consumption. Civic body officials check the chlorine content of water during inspection of the trollies. According to WHO maximum amount of chlorine allowed in drinking water is 5 mg/l. These water samples were tested this year starting January 1 and the trolleys were seized by the authorities after they were found in violation of norms, the NDMC said.
2. The Institute of Medical Sciences (IMS), Banaras Hindu University (BHU) has been formally upgraded to the level of All India Institute of Medical Sciences (AIIMS) on Saturday.  IMS-BHU will now be entitled to get enhanced funding and better health care facilities. Its Sir Sunderlal Hospital is the only tertiary care referral centre for the entire eastern UP, western Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh and neighbouring country Nepal catering to the medical needs of about 20 crore population. 
3. WHO lauds India’s commitment to accelerated coverage of safe sanitation services which, assuming 100% coverage is achieved by October 2019, could avert up to 300 000 deaths due to diarrheal disease and protein-energy malnutrition (PEM) since the country launched the Swachh Bharat Mission in 2014.
4. According to ICMR India State-Level Disease Burden Study report “India: Health of the Nation’s States”, the estimated proportion of all deaths due to Non-Communicable Diseases (NCDs) has increased from 37.09% in 1990 to 61.8% in 2016.
5. A parliamentary panel has asked the Union Health Ministry to make efforts to formulate a scheme to extend financial assistance to HIV/AIDS patients "at the earliest" (The Pioneer)

Current scenario of health care resources in India

1. Total number of registered Allopathic doctors is 1,041,395 (up to 2017)
2. Assuming 80% availability, an estimated 8.33 lakh doctors may be actually available for active service.
3. Doctor-population ratio 1:1596 as against 1:1000 as prescribed by the WHO.
4. Patient-bed ratio: 0.9 beds per 1,000 population
5. Govt spending for health care: Rs 1,112 per capita, which means only Rs 3 per day is spent per day for the healthcare of an average Indian
6. Health Sector spending 1.16% of the GDP (proposed to increase to 2.5% of the GDP in National Health Policy 2017)
7. Govt. contribution to health insurance 32% (vs 83.5% in UK)
8. Density of doctors at national level 79.7 per lakh population, of nurses and midwives 61.3 per lakh, and of dentists just 2.4 per lakh. Of all doctors, 77.2% were allopathic and 22.8% were Ayurvedic, Homeopathic or Unani.
9. More than 60% of the registered doctors are concentrated in urban areas
10. There are 476 medical colleges, 313 Colleges for BDS courses and 249 colleges which conduct MDS courses.
11. There are 23,582 government hospitals having 710,761 beds in the country. 19,810 hospitals are in rural area with 279,588 beds and 3,772 hospitals are in urban area with 431,173 beds.
12. 70% of population of India lives in rural area and to cater their need there are 156,231 Sub Centres, 25,650 Primary Health Centres and 5,624 Community Health Centres in India as on 31st March 2017.
13. Total no. of licensed Blood Banks is 2903 (2017).

(Source: National Health Profile 2018)

Video to watch: Wheat disorders

https://www.facebook.com/drkkaggarwal/videos/1945381452149815/

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO