Morning MEDtalks with Dr KK Aggarwal 3rd September 2018

The role of a judge is to make sure that fundamental rights of the people are protected

The 2nd GL Sanghi Memorial Lecture was delivered by Hon’ble Justice AK Sikri on 1st September, 2018 at Nagpur. The event was presided over by Hon’ble Justice Sharad Bobde.

Hon’ble Justice Vipin Sanghi, Honble Justice Bhushan Gavai, Honble Justice Bhushan Dharmadhikari and Shri Mukul Rohatgi, Former Attorney General of India were among the Guests of Honor. Here are some excerpts from the lecture.

1. The role of a law school is to make great lawyers.
2. The first role of a judge is to uphold the constitution and the rules of the law. His second role is to bridge the gap between the law and the society. His third role is, in view of globalization, to connect the law with economics in decision-making process and to be a person who contributes to the economic progress of the nation.
3. Rule of the law is the basic feature of the constitution and a judge is its guardian.
4. A judge must see that

1. The democratic principles are followed by the government in power
2. There is good governance
3. Fundamental rights of the people are protected
4. The centre-state relationship is respected
5. Rights of the marginalized section of society and their dignity are translated into reality

1. The courts can

1. Create law in enforcing the public rights (Vishakha case). These are "hard cases". A judge must make them by applying constitutional norms.
2. Enforce the public rights (child labor)
3. Appropriately interpret the rights of the people or can broaden the scope of such norms by interpretative process

All the above principles are true for the medical profession also.

The Health Ministry has issued draft rules on sale of drugs by e-pharmacy to regulate online sale of medicines across the country and to also provide patients accessibility to genuine drugs from authentic online portals. The draft rules on “sale of drugs by e-pharmacy” state that no person will distribute or sell, stock, exhibit or offer for sale of drugs through e-pharmacy portal unless registered… (ET Healthworld-PTI, Sept. 2, 2018).

Think before you prescribe: Monitor electrolytes in hypertensive patients on thiazide diuretics. The effectiveness of thiazide diuretics in hypertensive patients with chronic kidney disease (CKD), especially those with a glomerular filtration rate less than 30 ml/min/1.73 m2, has been of concern. Consequently, they were thought to be ineffective in patients with advanced CKD.

Studies have documented the beneficial effects of thiazide diuretics in moderate to advanced CKD challenging this widely held belief. Chlorthalidone was found to significantly reduce BP among people with moderate to advanced CKD with poorly controlled hypertension in a small study. Albuminuria was significantly reduced by 40-45% (Am J Nephrol. 2014;39(2):171-82). But, the 2017 ACC/AHA guideline for treatment of hypertension recommend loop diuretics in patients with moderate to severe CKD.

Thiazide diuretics are a common cause of hyponatremia. When prescribed to elderly patients who are also taking drugs e.g. selective serotonin reuptake inhibitors, the resulting hyponatremia can be more severe. Hence, electrolytes should be monitored in these patients.

Obstructive sleep apnea increases the risk of gout. The risk of incident gout among OSA patients compared to those without was highest one to two years after index date (1.64). This finding persisted among those overweight and obese (August 30, 2018 in Arthritis and Rheumatology).

Boarding a moving train should be an offence, says Gujarat High Court. The Court denied compensation to a sweeper who lost his leg while trying to board a running train, and said that boarding a moving train should be an offence, especially when the train has left the station and if a passenger sustains injury while boarding a train in motion, he will not get compensation. “This aspect can be looked into by the legislation in accordance with law,” the order reads.

Cardiac surgeries are most costly in India than other Asian countries, according to a study reported in TOI. The study conducted between 2011 and 2014 compared the costs of cardiac procedures across seven Asian countries and showed that India had the highest cost of angioplasty other than in Singapore, but that was before the prices of cardiac stents were capped by the pharmaceutical pricing regulator in 2017. The cost of most procedures in India was cheaper than in China or Thailand but more expensive than in South Korea and Vietnam.

Delhi, Karnataka, Kerala, Tamil Nadu, Punjab and Goa have more doctors than the WHO norm of one for 1,000 people. The density of doctors per 1,000 people in Tamil Nadu is as high as 4, almost at the same level as Norway and Sweden. In Delhi, the density is 3, higher than the UK, US, Canada and Japan, where it ranges from 2.3 to 2.8.

CDC Flood Safety Tips: After flooding occurs

1. Avoid driving through flooded areas and standing water. As little as 6 inches of water can cause you to lose control of your vehicle.
2. Do not drink flood water, or use it to wash dishes, brush teeth, or wash/prepare food. Drink clean, safe water.
3. If you evacuated: return to your home only after local authorities have said it is safe to do so.
4. Listen to water advisory from local authorities to find out if your water is safe for drinking and bathing.

1. Use only bottled, boiled, or treated water for drinking, cooking, etc.
2. When in doubt, throw it out! Throw away any food and bottled water that comes/may have come into contact with flood water.

  5. Prevent carbon monoxide (CO) poisoning. Use generators at least 20 feet from any doors, windows, or vents. If you use a pressure washer, be sure to keep the engine outdoors and 20 feet from windows, doors, or vents as well.

 6. Walls, hard-surfaced floors, and many other household surfaces should be cleaned with soap and water and disinfected with a solution of one cup of bleach to five gallons of water. Throw out items that cannot be washed and cleaned with a bleach solution: mattresses, pillows, carpeting, carpet padding, and stuffed toys.

TB Harega Desh Jeetega ... The Health Ministry has launched an active case finding campaign with Mobile TB vans, to reduce transmission time of tuberculosis. This campaign has shown effective result in screening and diagnosis of TB patients. Between January 2017 and July 2018, 10.31 crore population were screened and 39,437 new TB cases were diagnosed.

Listening to yoga music at bedtime is good for the heart, according to research presented August 27, 2018 at the ESC Congress 2018. The heart rate variability increased during the yoga music, decreased during the pop music, and did not significantly change during the silence. Anxiety levels fell significantly after the yoga music, increased significantly post the pop music, and increased after the no music session.

WHO 5 key facts on aging

1. Between 2015 and 2050, the proportion of the worlds population over 60 years will nearly double from 12% to 22%.
2. By 2020, the number of people aged 60 years and older will outnumber children younger than 5 years.
3. In 2050, 80% of older people will be living in low- and middle-income countries.
4. The pace of population ageing is much faster than in the past.
5. All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.

Ibudilast slows down brain shrinkage in patients with progressive multiple sclerosis. Results from a clinical trial of more than 250 participants with progressive multiple sclerosis (MS) revealed that ibudilast was better than a placebo in slowing down brain shrinkage. The findings of the study are published August 29, 2018 in the New England Journal of Medicine. The main side effects observed were headaches and gastrointestinal.

Video to watch: TEDx Talks

Dr KK Aggarwal: Modern day doctor-patient relationship

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

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI