Morning MEDtalks with Dr KK Aggarwal 9th September 2018

Practice changing guidelines: Give vitamin D in patients with painful diabetic neuropathy. Lower vitamin D levels are found in patients with painful diabetic peripheral neuropathy (DPN) compared to those with painless DPN, patients with diabetes without any neuropathy, and healthy people. The findings have major clinical significance because painful DPN is distressing and disabling. 25% of DPN patients have pain and most are undiagnosed and suffer in silence because they believe it is just part of the aging process," said lead author Solomon Tesfaye, MD, consultant endocrinologist at the Royal Hallamshire Hospital, Sheffield, UK. The small proof-of-principle study was a borne out of anecdotal findings that vitamin D supplements or injections given to patients with painful DPN improved their pain. The article was published online August 13, 2018 in Diabetic Medicine.

Video to watch: TEDx Talks: Dr KK Aggarwal on Modern day doctor-patient relationship: https://www.youtube.com/watch?v=i9ml1vKK2DQ

Are children conceived with assisted reproductive technology at increased risk for premature vascular aging and hypertension? Compared with age- and sex-matched controls, a group of adolescents conceived via ART had a 25% reduction in the flow-mediated dilation of the brachial artery and a significant thickening of the carotid-femoral artery (463.7 µm vs 435 µm). The prevalence of arterial hypertension (defined as >130/80 mmHg) was 6-fold higher in the ART group (15% vs 2.5%, P=0.041) reports Journal of the American College of Cardiology. According to 24-hour ambulatory blood pressure monitoring, both mean systolic and diastolic blood pressure were significantly higher in the ART group than the control group (systolic, 119.8 ± 9.1 mmHg vs 115.7 ± 7.0 mmHg,  diastolic, 71.4 ± 6.1 mmHg vs 69.1 ± 4.2 mmHg)

New findings reported in Gastroenterology, online August 23, 2018 suggest that people with NAFLD and cirrhosis should be monitored for liver cancer. Among people with less severe non-alcoholic fatty liver disease (NAFLD), the risk of liver cancer was not particularly high.

Poor sleep habits are associated with high BP and obesity and low levels of physical activity. In the study of overweight and obese black women, nearly half reported sleeping less than 7 hours at night, and many also reported daytime sleepiness. Women who had day-time sleepiness were less likely to be physically active and more likely to have higher BP vs those who had normal levels of daytime sleepiness. The study authors suggest that efforts to manage obesity and high blood pressure should also address sleep quality (AHA Joint Hypertension 2018 Scientific Sessions, September 06, 2018)

The United Kingdom has confirmed a single case of Middle East respiratory syndrome coronavirus (MERS-CoV) in a male resident of Saudi Arabia who had been visiting his family. The patient initially sought medical care at a hospital in Leeds, where he was put into isolation. He was later transferred to a specialist infectious disease facility in Liverpool. The patient’s condition has improved and he continues to be in isolation. This is the fifth case of MERS-CoV diagnosed in the United Kingdom; previous cases were diagnosed in 2012 and 2013. WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend the application of any travel or trade restrictions… (WHO Europe)

Hospitals are now under competition commission regulation earlier called MRTP Act

No corporate hospital can dictate terms to smaller healthcare establishments.

The clause: Prohibition of abuse of dominant position 4.3

No hospital shall abuse its dominant position:  There shall be an abuse of dominant position if an establishment.

(a) directly or indirectly, imposes unfair or discriminatory condition in providing a service or

(ii) price in purchase or sale of goods or service.

Dominant position means a position of strength, enjoyed by an enterprise, in the relevant market, in India, which enables it to operate independently of competitive forces prevailing in the relevant market; or affect its competitors or consumers or the relevant market in its favour.

Predatory price means the sale of goods or provision of services, at a. price which is below the cost, as may be determined by regulations, of production of the goods or provision of services, with a view to reduce competition or eliminate the competitors.

Prohibition of agreements: 3

Anti-competitive agreements

1. No hospital or association or doctor or association of persons shall enter into any agreement in respect of provision of services, which causes or is likely to cause an appreciable adverse effect on competition within India.
2. Any agreement entered into in contravention of the provisions shall be void.
3. Any agreement entered into between two establishments or associations or doctors or associations of persons or between any person and establishment which—

1. directly or indirectly determines purchase or sale prices
2. limits or controls production, supply, markets, technical development, investment or provision of services
3. shares the market or source of production or provision of services by way of allocation of geographical area of market, or type of goods or services, or number of customers in the market or any other similar way
4. directly or indirectly results in bid rigging or collusive bidding, shall be presumed to have an appreciable adverse effect on competition:

Provided that nothing contained in this sub-section shall apply to any agreement entered into by way of joint ventures if such agreement increases efficiency in production, supply, distribution, storage, acquisition or control of goods or provision of services.

Nurse handed caution for not carrying out CPR on “clearly dead patient” (Nursing Times, 7 March 2017); Prison told to issue guidance after nurses carried out CPR on “clearly dead” inmate (Nursing Times, 22 August 2018).

Conditions which Yoga can help. Yoga works at the level of wave particle duality of the body. By shifting from sympathetic to parasympathetic mode it can heal and help the following conditions: Chronic stress, Reduce anxiety, Decrease depression, Improve heart health, Relieve chronic back pain, Improve brain health, Control anger, Improve balance and prevent falls, Improve your thyroid function, Prevent diabetes and Boost immune system.

Government is planning to reduce the noise level of horns on vehicles to under 100 decibels, a reduction of about 10% from the existing maximum permissible limit.

As per Central Motor Vehicle Rules, the noise range for horns is currently fixed between 93 decibels (dB) and 112 dB. "We are looking to bring down this range to 88dB at the lower end with the maximum limit at just under 100dB," Abhay Damle, joint secretary in the ministry of road transport and highways, told TOI… (ET Healthworld, Sept. 8, 2018)

Global physician leaders express revulsion about torture reports from Uganda. Reports that detainees in Uganda are being tortured and denied access to specialised medical care have been denounced by the World Medical Association.

WMA President Dr. Yoshitake Yokokura said: ‘We have received appalling reports about a number of detainees in Uganda being tortured while under arrest and then denied access to medical attention, even when the Uganda Medical Association has offered to help them. ‘Such activities are especially disappointing, since Uganda is one of only 10 African countries with anti-torture legislation and is a signatory to the United Nations Torture Convention’

Dr. Yokokura has written to Uganda’s Prime Minister to express the WMA’s revulsion about what he described as ‘the pervasive practice of torture in Ugandan detention places’. The letter sets out details of the violence and rape that the Uganda Human Rights Commission discovered when it visited detention centres. 

The letter reinforces the call from the Uganda Medical Association to respect the rights of patients and to protect doctors documenting and denouncing torture in Uganda. It states: ‘Torture and other cruel or degrading treatments are one of the gravest violations of international human rights law. It destroys the dignity, the essence of the human being. As physicians, we are revolted by the devastating consequences of this practice for victims, their families and society as a whole, with severe physical and mental injuries.

‘Torture is unconditionally prohibited by the United Nation Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment that Uganda ratified in 1987, hereby establishing its consent to be bound by the provisions of the Convention. No exceptional circumstances whatsoever, whether a state of war or a threat of war, internal political instability or any other public emergency, may be invoked as a justification of torture’.

The letter calls on Uganda’s Prime Minister to take immediate and effective measures ‘to prevent and stop such intolerable shaming practices’ and to be an inspiring model for other countries.

It concludes: ‘We call on you to act as a matter of priority to ensure effective access to comprehensive health care to those in need and to allow and ensure that physicians can follow their ethical duties to provide medical care in an undisturbed and professional manner without intimidation and repression’.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI