Morning MEDtalks with Dr KK Aggarwal 25^th August 2018

Medical device margins set to be capped at 65% in India. Prime Minister Narendra Modi is likely to accept government think tank NITI Aayog’s recommendation to cap trade margin at 65% for medical devices. According to NITI Aayog’s formula, the MRP of a device will be decided by adding the trade margin to the price at the first point of sale (stockist). The trade margin is the difference between the price at which the manufacturers/importers sell to stockists and the price charged to consumers.

This will give flexibility to the company to make any amount of margin before they bill it to the stockist. As per the companies many expenditures are incurred by the importing companies, including clinical education on deployment, and therefore trade margins should start from the first point of sale that is the stockist. High margins with the company will not able to correct the so-called companies’ distribution of money to the end users and the hospitals.

The National Diabetes Education Program (NDEP) has revised its "Guiding Principles" for management of diabetes and prediabetes. Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDKK) and Centers for Disease Control and Prevention (CDC), though not official guidelines, it emphasizes the importance of diabetes self-management education and support, and of providing patient-centered care using shared decision-making and individualized care and include 10 guiding principles. A new guiding principle 6 “Address Overweight and Obesity in the Management of Diabetes” has been also added to the existing guiding principles.

Always wear your seat belt when you drive, the prime minister does. Press Information Bureau has shared an inspiring video on Twitter to promote road safety awareness, which shows Prime Minister Narendra Modi putting on his seat belt as soon as he enters his car.

A1c measurement during the first trimester of pregnancy may aid in early detection of women at risk for gestational diabetes as per a study in August 16 in Scientific Reports. Among participants, the risk for gestational diabetes increased linearly with first-trimester A1c. Also, the addition of first-trimester A1c to conventional risk factors enhanced gestational diabetes predictive capability.

Noninvasive brain stimulation technology delivered during sleep may improve memory. Investigators found closed-loop transcranial alternating-current stimulation delivered overnight to augment endogenous slow-wave oscillations in humans improves generalized memory. The study was published online July 23, 2018 in the Journal of Neuroscience.

Prehabilitation prior to cardiac surgery can improve postoperative outcomes for frail older adults. A three-pronged approach called NEW, a component of the enhanced recovery protocols targets nutritional status (N), exercise capacity (E), and worry reduction (W) to support the growing number of older patients undergoing complex cardiac procedures. The article was published in the July 2018 issue of the Canadian Journal of Cardiology.

A new study at the McMaster University, Ontario, Canada has shown that an average salt consumption, between one and half teaspoons daily, will not constitute a health risk. But it adds that a quantity that exceeds 5 gm, or two and half teaspoons, of salt may be quite dangerous for the heart. It also showed that even for those who consumed too much salt, the health risk would be eliminated if people improved the quality of their diets by eating fruits, vegetables, dairy foods, potatoes and other potassium-rich foods.

National Eye Donation Fortnight 2018 begins today. Observed across the country under the National Program for Control of Blindness, the National Eye Donation Fortnight starts today and ends on September 8, 2018. The objective is to educate the public about cornea donation and pledge their eyes for donation after death. Most blind people are young in the productive age group, who have lost their vision due to deficiency of Vitamin ‘A’, malnutrition, congenital or other factors underscoring the need to bridge the gap between demand and supply of cornea.

The approval of the first drug for neurotrophic keratitis has come as a ray of hope for those suffering with this rare disease. Oxervate, a topical eye drop containing cenegermin has been approved by US FDA for the treatment of neurotrophic keratitis. Neurotrophic keratitis is a degenerative disease resulting from a loss of corneal sensation. The loss of corneal sensation impairs corneal health causing progressive damage to the top layer of the cornea, including corneal thinning, ulceration, and perforation in severe cases. 

Congress MP Shashi Tharoor has suggested that the Kerala government request the World Health Organisation (WHO) to supply 2 million anti-cholera vaccines to minimize the risk of water-borne diseases in the flood-ravaged state.

Two new user friendly initiatives launched by the ESIC (Employees State Insurance Corporation) “IVR (Interactive Voice Response)/Help Desk” for ESIC Toll Free No. - 1XXX-XX-2526 and production of “seven Audio-Visual clips on ESI Benefits” aim to empower insured persons and their beneficiaries and create awareness among other stakeholder, as per a press release from Ministry of Labour & Employment. The audiovisuals are available on You Tube (ESIC HQ You Tube Channel).

Breath tests to detect cancer have a relatively high level of sensitivity and specificity as per a new meta-analysis of early trials of the concept published online August 16 in JAMA Oncology. A breath test detects and quantifies preidentified, named volatile organic compounds (VOCs) within exhaled breath in order to diagnose cancer, explain the study authors, led by George Hanna, MD, PhD, a surgeon at the Imperial College London in the United Kingdom. The concept is already in use in other areas of clinical practice, including breathalyzer devices for ethanol detection, carbon 13 urea breath testing for Helicobacter pylori and exhaled nitric oxide testing in asthma.

Do you know that approximately 4% of the population use benzodiazepines, and prolonged treatment is common despite clinical recommendations for short-term use? Discontinuing benzodiazepines is difficult for many patients.

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