Morning MEDtalks with Dr KK Aggarwal 27th September 2018

Dear Colleague

Here are two links for videos to watch. Share them with your colleagues and friends.

1. Vedic Health - A Dialogue with Shri Ashwini Kumar Choubey https://www.youtube.com/watch?v=wdorsM5IZTQ
2. TEDx Video: Doctor-patient relationship  https://www.youtube.com/watch?v=i9ml1vKK2DQ

Ordinance cleared to set up committee to run MCI until Parliament passes NMC

Just like it was 5 years back, a Board of Governors has taken over the MCI. Dr VK Paul has taken charge of MCI today evening.

The present MCI gets dissolved with immediate effect.

Proposed NMC is in Parliament and has nothing to do with present ordinance.

The ordinance is as below:

The Gazette of India

New Delhi, Wednesday, September 26, 2018/Asvin 4, 1940 (Saka)

MINISTRY OF LAW AND JUSTICE (Legislative Department)

New Delhi, the 26th September. 2018/4svina 4, 1940 (Saka)

THE INDIAN MEDICAL COUNCIL (AMENDMENT)

ORDINANCE, 2018

No. 8 of 2018

Promulgated by the President in the Sixty-ninth Year of the Republic of India.

An Ordinance further to amend the Indian Medical Council Act. 1956.

WHEREAS Parliament is not in session and the President is satisfied that circumstances exist which render it necessary for him to take immediate action;

NOW, THEREFORE, in exercise of the powers conferred by clause (1) of article 123 of the Constitution, the President is pleased to promulgate the following Ordinance:-

1. (1) This Ordinance may be called the Indian Medical Council (Amendment) Ordinance, 2018.

(2) It shall come into force at once.

2. In section 3A of the Indian Medical Council Act, 1956,- --

1. in sub-section (I), for the words, brackets and figures "Indian Medical Council (Amendment) Act. 2010", the words, brackets and figures "Indian Medical Council (Amendment) Ordinance, 2018" shall be substituted;
2. in sub-section (2), for the words "three years", the words "one year" shall be substituted;
3. in sub-section (4), for the words "and medical education", the words "and medical education or proven administrative capacity and experience" shall be substituted;
4. after sub-section (7), the following sub-section shall be inserted, namely: — "

(7A) The Board of Governors shall be assisted by a Secretary General who shall be appointed by the Central Government on deputation or contract basis and he shall be the head of the secretariat in the Council.".

RAM NATH KOVIND,

President.

DR. G. NARAYANA RAJU.

Secretary to the Govt. of India

Supreme Court declares Aadhaar as constitutionally valid: Ayushman Bharat should now be linked to Aadhar

The Supreme Court has declared the Centres flagship Aadhaar scheme as constitutionally valid in a 4:1 verdict in favour of Aadhaar.

“Aadhaar is also to empower the marginalised section of society; it gives them an identity”, says SC.

The apex courts five-judge Constitution bench said Aadhaar means unique and it is better to be unique than being best.

There were three judgments - One by Justice AK Sikri who pronounced the judgement for himself, Chief Justice Dipak Misra and Justice AM Khanwilkar other two judgments were given by Justices DY Chandrachud and Ashok Bhushan.The first of the three judgements was pronounced by Justice AK Sikri, who said, “There is a fundamental difference between Aadhaar and other identity proof as Aadhaar cannot be duplicated and it is a unique identification.”

Section 57 of Aadhar Act has been struck down which allowed sharing of data with private body corporate. SC has said that the Centre must bring a robust data protection law urgently. This means that private bodies like telecom companies, e-commerce firms, private banks and other such firms cannot ask for biometric and other data from consumers for their services.

1. Aadhaar must not be made compulsory for school admission and school administration cannot make it mandatory.
2. Aadhaar not to be made mandatory for opening of bank account and for getting mobile connection.
3. Aadhaar card is mandatory for PAN linking.

The Supreme Court said that sufficient security measures are taken to protect Data and it is difficult to launch surveillance on citizens on the basis of Aadhaar. However, it has asked the government to provide more security measures and to reduce the period of storage of data.

Justice Ashok Bhushan delivered a judgment agreeing with the majority verdict on Aadhaar.

In a minor dissenting view, Justice Chandrachud declared Aadhaar scheme unconstitutional saying, “Aadhaar violates privacy rights as it could possibly lead to profiling of persons and voters. It is very difficult to live in contemporary India without Aadhaar as all schemes have been linked with Aadhaar.”

(PTI, TOI)

Did I interfere with the last words of the patient? We often intubate or sedate terminally ill patients often forever? Recently a poignant perspective was published in JAMA Internal Medicine (June 2018): “Saving a death when we cannot save a life in the intensive care unit.” In this piece, a critical care doctor relates the story of a woman in the ICU who was electively intubated for a procedure and then died, without ever having had the opportunity for her loved ones to say goodbye.

One can have a different approach to intubation, which can be likened to the talk a parent has with a child who is going off to war. Of course, these parents hope their children will come back safely, but they are given the chance to say what they want to say — knowing the conversation might be their last. One should build a similar pause into our protocols before intubation, lest we unwittingly deprive our patients of the opportunity for a final exchange with their loved ones.

0-15 mortality: An estimated 6.3 million children died before their 15^th birthdays in 2017, or one every five seconds, mostly due to a lack of water, sanitation, nutrition and basic healthcare. The vast majority of these deaths – 5.4 million – occur in the first five years of life, with newborns accounting for around half of the deaths. With simple solutions like medicines, clean water, electricity and vaccines this toll could be dramatically reduced. Without urgent action, 56 million children under five - half of them newborns - will die between now and 2030.

Most children under five die due to preventable or treatable causes such as complications during birth, pneumonia, diarrhea, neonatal sepsis and malaria. Among older children - aged 5 to 14 - injuries become a more prominent cause of death, especially from drowning and road traffic.

For children everywhere, the most precarious time is the first month of life. In 2017, 2.5 million newborns died in their first month, and a baby born in sub-Saharan Africa or in Southern Asia was nine times more likely to die in the first month than one born in a high-income country (Reuters-UN).

Diagnosing type 2 diabetes: Current guidelines recommend fasting glucose, A1c or 2-hour glucose for the diagnosis of diabetes. There is no preferred test; however, the guidelines explicitly state that a second blood sample at a second point in time is recommended to confirm the diagnosis of type 2 diabetes. To make a diagnosis of diabetes, there needs to be an elevated fasting glucose, elevated A1c or elevated 2-hour glucose at two separate time points in two separate blood samples.

In a prospective cohort study of over 13,000 people, definition of diabetes was made using an elevated A1c and an elevated fasting glucose in a single blood sample. If only one test was elevated and the diagnosis was not confirmed in that single blood sample, the individual could be followed up with a second visit, consistent with current guidelines. So next time you want to rule out diabetes ask for both fasting sugar and A1c together.

Use of inhaled corticosteroids may increase the risk for non-tuberculosis mycobacterial pulmonary infection, according to a study published online September 14 in the Annals of the American Thoracic Society.

Higher BP in older adults increases risk of brain lesions. Researchers from the Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago examined the association of hypertension and brain health in older people and found that for a person with one standard deviation above the average systolic BP, there was a 46% increased risk of having one or more brain lesions, specifically infarcts. The effect of an increase by one standard deviation on the risk of having one or more brain infarcts was the equivalent of nine years of brain aging. Those with one standard deviation above the average systolic blood pressure also had a 46% greater chance of having large lesions and a 36% greater risk of very small lesions (Neurology, July 11, 2018).

The world now has more young people than ever before – of the 7.2 billion people worldwide, over 3 billion are younger than 25 years, making up 42% of the world population. Around 1.2 billion of these young people are adolescents aged between 10 and 19 years.

Underreporting and under-diagnosis of TB cases remains a major challenge. Of the 10 million people who fell ill with TB in 2017, only 6.4 million were officially recorded by national reporting systems, leaving 3.6 million people undiagnosed, or detected but not reported. Ten countries accounted for 80% of this gap, with India, Indonesia and Nigeria topping the list. Less than half of the estimated one million children with TB were reported in 2017, making it a much higher gap in detection than that in adults… (WHO’s Global TB Report 2018).

Cases of newborn syphilis in the US more than doubled since 2013, reaching the highest rate reported since 1997. Reported cases of congenital syphilis rose from 362 in 2013 to 918 in 2017, the agency said in the full Sexually Transmitted Disease Surveillance Report released Tuesday.

Food Safety and Standards Authority of India (FSSAI) has asked restaurateurs to put up a food safety display board, in the format prescribed by the apex food regulator, prominently in their premises and warned that non-compliant food business operators (FBOs) might lose their licences post-October 15, 2018.  The FBOs can download the display board from FSSAI’s website. Food Safety Display Boards are informative board, which primarily display food safety and hygiene practices to be followed by FBO in their establishment.

The FSDBs are color coded for different kind of food businesses for ease of recognition by the consumers. The color designation as per kind of business is as follows:

1. Restaurant (Purple)
2. Fruit & Vegetable Retail (Green)
3. Meat Retail (Red)
4. Milk Retail (Blue)
5. Street Food (Purple)
6. Retail Store (Grey)
7. Liquor Retail (Brown)
8. Transport & Distribution (Navy Blue)
9. Storage (Yellow)
10. Manufacturing (Turquoise)

(FSSAI-FnBnews.com, Sept. 24, 2018)

Dr KK Aggarwal

Padma Shri Awardee

President-Elect CMAAO

President Heart Care Foundation of India