Morning MEDtalks with Dr KK Aggarwal 21^st August 2018

IRDAI asks insurance companies to also cover mental illness in insurance policies

Insurance Regulatory and Development Authority of India (IRDAI) has directed all the insurance companies to make a provision to cover mental illness also in insurance policies.

"Reference is drawn to the Mental Healthcare Act, 2O17 which has come into force w.e.f 29.5.2018. As per Sec 21(4) of the said Act, every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.

All insurance companies are hereby directed to comply with the aforesaid provisions of the Mental Healthcare Act, 2017 with immediate effect, IRDAI said in its orders issued on August 16.

According to the Mental Healthcare Act-2017, every person with mental illness shall be treated as equal to persons with physical illness in the provision of all healthcare. The Act further says that every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness (Daily Pioneer – PTI, August 18, 2018).

Let children play if you want creative, curious, healthier children with 21st century skills, says AAP

American Academy of Pediatrics (AAP) clinical report, “The Power of Play: A Pediatric Role in Enhancing Development in Young Children” recommends play for children to buffer toxic stress, build parental relationships and improve executive functioning. The most powerful way children learn isnt only in classrooms or libraries but rather on playgrounds and in playrooms.

"Were recommending that doctors write a prescription for play, because its so important," said pediatrician Michael Yogman, MD, FAAP, lead author of the AAP report. "Play with parents and peers is fundamentally important for developing a suite of 21st century skills, including social, emotional, language and cognitive skills, all needed by the next generation in an economically competitive world that requires collaboration and innovation. The benefits of play cannot really be overstated in terms of mitigating stress, improving academic skills and helping to build the safe, stable and nurturing relationships that buffer against toxic stress and build social-emotional resilience." (Pediatrics, Online August 20, 2018)

Stocking EpiPens at restaurants might reduce fatal allergic reactions

The number of fatal allergic reactions (anaphylaxis) could decrease if restaurants and other food establishments stocked epinephrine autoinjectors. After a two-year test of an epinephrine autoinjector stocking program in Hamilton, Ontario, diners with allergies as well as restaurant owners and staff said that having the devices onsite made them feel better about possible emergencies, researchers report in The Journal of Allergy and Clinical Immunology: In Practice, online August 2, 2018.

“Self-management of food allergy and anaphylaxis is sub-optimal, particularly among adolescents and young adults who most often engage in risk-taking behaviors such as neglecting to carry epinephrine autoinjectors or delaying its timely administration to treat reactions,” said lead author Dr. Susan Waserman, a professor of medicine at McMaster University in Hamilton and director of the Adverse Reactions Clinic at the Firestone Institute of Respiratory Health … (Reuters Health).

Improving influenza virus detection in Latin America and the Caribbean

Laboratory specialists from 11 countries across Latin America and the Caribbean have received training from the US Centers for Disease Control (CDC) and the Pan American Health Organization (PAHO) in a bid to improve detection of influenza viruses circulating in the region.

The international course on molecular diagnostics of influenza is part of “a joint effort to better prepare ourselves to deal with the flu,” said José Narro Robles, Secretary of Health of Mexico during the inauguration ceremony for the training, which took place in Mexico City from August 6 to 10, in partnership with Mexico’s Institute of Epidemiological Diagnosis and Reference (InDRE). The influenza virus causes outbreaks and infections all over the world. During the influenza “season” up to 15% of the population can be affected, leading to up to 500,000 deaths each year. As well as this, the emergence of a new strain of influenza virus has the potential to generate pandemics, leading to both sickness and death… (WHO/PAHO, August 10, 2018).

Around the globe

1. “There have been a number of spontaneous reports of sudden unexpected death soon after the administration of Infanrix hexa (combined diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated poliomyelitis and Haemophilus influenza type B vaccine). The manufacturer, GlaxoSmithKline (GSK), submits confidential periodic safety update reports (PSURs) on Infanrix hexa to the European Medicines Agency (EMA). The latest is the PSUR 19. Deaths acknowledged in the PSUR 16 were deleted from the PSUR 19. The number of observed deaths soon after vaccination among children older than one year was significantly higher than that expected by chance once the deleted deaths were restored and included in the analysis”. (Indian J Med Ethics. 2018 Jan-Mar;3(1):43-47)

Infanrix-hexa is a combination vaccine that protects infants from six diseases. This vaccine requires three doses, at 6 weeks, 3 months and 5 months of age, to be fully effective and to induce long-lived immunity. 

1. Treatment-resistant depression in adults: In patients with mild to moderate treatment-resistant major depression, augment the initial antidepressant with a second drug and/or psychotherapy, rather than switching antidepressants or switching from pharmacotherapy to psychotherapy. In an open label trial, more than 1500 patients with treatment resistant depression were randomly assigned to one of three treatment strategies: augment the current antidepressant with aripiprazole, augment with bupropion sustained release, or switch to bupropion. At 12 weeks, remission was more likely in the augment-aripiprazole group than the switch group, but the clinical difference was small (29 versus 22 percent) (JAMA. 2017;318(2):132).
2. In Indian Journal of Medical Ethics, Dr. Jacob Puliyel, Head of Pediatrics, St. Stephen’s Hospital and C Sathyamala, Public Health Physician and Epidemiologist, examined sudden infant deaths following vaccination with GlaxoSmithKline’s hexavalent (6 in 1) “Infanrix hexa” vaccine. The authors point out that their analysis of the data submitted by GlaxoSmithKline to the European Medicines Agency (EMA) in a confidential report (2012) reveals that 83 % of the reported infant deaths have taken place within the first 10 days after vaccination with “Infanrix hexa” vaccine. Only 17% occurred in the next 10 days. They point out that: If this were simply coincidental deaths then it would not all cluster immediately after vaccination but would have been distributed uniformly over the 20 day period.  The authors point out, that Hexavac – a similar vaccine manufactured by Sanofi Pasteur, had been introduced in the market in 2000 and it was removed from the European market in 2005, after it was found to have increased deaths of children within two daysof vaccination.(ahrp.com, 2017)
3. A new research in 14th August, 2018 in JAMA has shown that a new combination drug may have the potential to revolutionize hypertension treatment worldwide. This drug referred to as ‘triple pill’ contains telmisartan (20 mg), amlodipine (2.5 milligrams) and chlorthalidone (12.5 mg).
4. In a new article published in the July issue of Trends in parasitology, researchers have outlined their learnings while developing vaccines for human parasites. According to authors, there have been no parallel advances in the product and clinical development sciences that may be needed to take these candidate vaccines into human trials.
5. Phase 3 trial results of the US FDA approved drug ibalizumab were published in the August 16 issue of the New England Journal of Medicine. The results showed that when ibalizumab is added to the regimen, 83% of the participating patients witnessed a reduction in the amount of HIV in their body.
6. In an original research published in the July issue of BMJ, the researchers showed that women with abnormal prenatal biochemical screening results, especially for dimeric inhibin-A, may be at higher risk of cardiovascular disease.
7. A moderate carb diet may hold the key to longevity, says a study published August 16 in the Lancet Public Health journal, which showed that moderate consumption of carbohydrates (50 to 55% of calories) was associated with the lowest risk of early death.
8. A new research has shown that preferring evening activities, going to bed late, and not getting enough sleep may lead to weight gain among people with prediabetes. The study published on August 15 in the journal Frontiers in Endocrinology, has shown that in patients with prediabetes, more evening preference was directly associated with higher BMI and indirectly through insufficient sleep duration, while social jetlag did not mediate the relationship between composite Scale of Morningness and BMI.

Video to watch: TEDx Talk by Dr KK Aggarwal: Modern day doctor-patient relationship

https://www.youtube.com/watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO