Morning MEDtalks with Dr KK Aggarwal 2^nd October 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

Consuming enough alcohol within the space of 2 hours that your blood alcohol concentration (BAC) shoots up to 0.08 grams percent or above is binge drinking as defined by the National Institute on Alcohol Abuse and Alcoholism (NIH). For men, that’s typically 5 drinks or more and for women, it’s 4 or more. Interestingly, binge drinkers are not usually alcohol dependent. 

UK school children will now learn CPR and first aid as part of their regular curriculum. According to draft guidelines, primary school children in England would learn about basic first aid, such as such as dealing with common injuries, including head injuries and how to make a clear and efficient call to emergency services if necessary. Children in secondary schools would be taught basic treatment for common injuries, life-saving skills, including how to perform cardiopulmonary resuscitation (CPR) and the purpose of defibrillators and when one might be needed.

The inclusion of first aid training in the curriculum followed a campaign by the British Heart Foundation, British Red Cross, and St John Ambulance who formed the Every Child a Lifesaver Coalition.

For the first time, a case of rat hepatitis E has been discovered in a human in Hong Kong. A 56-year-old man has been diagnosed with rat hepatitis E, researchers from the University of Hong Kong said. He developed the disease after undergoing a liver transplant following chronic infection with hepatitis B. He continued to show signs of abnormal liver function, with no obvious cause. Investigations revealed signs of an immune response to hepatitis E; but tests for the human form of the virus came back negative. Genetic sequencing of the virus infecting the man then revealed similarities with the rat form of the disease and the man was given antiviral treatment.

 It was not previously known the disease could be passed from rats to humans. “Previous laboratory experiments have found that rat hepatitis E virus cannot be transmitted to monkeys, and human hepatitis A virus cannot be transmitted to rats,” said Dr. Siddharth Sridhar, clinical assistant professor at the University of Hong Kong, explaining that monkeys are very close to humans when it comes to disease susceptibility (CNN).

David Sweanor, Chair of Advisory Board, Centre for Health Law, Policy and Ethics, University of Ottawa, Canada on vaping: “The Canadian government years ago thought the way to deal with things like vaping was to ban the products. What we have ended up with is recognizing that these products are massively less hazardous than cigarettes and we need to encourage smokers to move to these products. So, now Health Canada is actually talking about how to give more information to people and how do you move more smokers to products like vaping. Estimates from prestigious bodies like Royal College of Physicians saying based on all the science and everything that we know, vaping is likely to be at least 95% less hazardous than smoking cigarettes. We can never say anything is risk-free, but some things are less risky than others.”

National initiatives launched in India emblematic of actions needed to achieve SDGs, says UN Secretary General. Indias ambitious programmes such as Clean India and Educate the Girl Child, Save the Girl Child are "emblematic" of the types of actions needed to achieve the Sustainable Development Goals, UN Secretary General Antonio Guterres has said. Guterres said that while India still faces challenges, the country has a long history of innovation and leadership in developing programmes to further social welfare and tackle inequalities… (PTI).

“Studies associate coffee drinking with a decreased risk of depression, Parkinson’s disease, type 2 diabetes, liver disease and liver cancer,” says Trevor Rich, M.D., Mayo Clinic Health System in Eau Claire, Wisconsin. 

Diphtheria Update: One more death due to diphtheria was reported at a civic hospital in north Delhi, taking the toll from the infection in the national Capital to 26, officials said on Sunday. Over the last month, a total of 25 children have died due to diphtheria at North Delhi Municipal Corporation-run Maharishi Valmiki Infectious Diseases Hospital, while one child died at the state-run Lok Nayak Hospital. Doctors said all these children were below the age of nine years (HT, Oct 1, 2018).

Treatment of NASH but without diabetes: For patients with biopsy-proven NASH and fibrosis stage ≥2 who do not have diabetes mellitus, start vitamin E, at a dose of 800 international units daily. Some studies suggest that vitamin E improves steatosis and inflammation in such patients. Since the studies showing a benefit of vitamin E did not include patients with diabetes mellitus or decompensated cirrhosis one may not use vitamin E in such patients. This is consistent with recommendations from the American Association for the Study of Liver Diseases (AASLD).

However, the largest randomized trial included in the meta-analysis (Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with NASH) did suggest a benefit with vitamin E. The trial included 247 adults with NASH without diabetes who were randomly assigned to pioglitazone (30 mg daily), vitamin E (800 IU daily), or placebo for 96 weeks (N Engl J Med. 2010;362:1675).

Is it legally necessary for a physician to display his registration number while issuing a payment receipt? (Dr KK Aggarwal & Advocate Ira Gupta) Yes, it is mandatory for the registered medical practitioner to mention his registration number issued to him by Medical Council of India or any State Medical Council on the payment receipt / money receipt issued by him to his/her patients.

As per the provisions of Clause 1.4.1 of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002 the Registered Medical Practitioner has to mention his registration number accorded to him by the State Medical Council / Indian Medical Council on the payment receipt / money receipt issued by him for his patients.

“1.4 Display of registration numbers:

1.4.1 Every physician shall display the registration number accorded to him by the State Medical Council / Medical Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients.”

However, if the registered medical practitioner fails to mention his registration number on the payment receipt issued by him to his/her patient, then the Medical Council of Indian or his respective State Medical Council can initiate a disciplinary action against him as per the provisions of Clause 7.3 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002which are reproduced hereunder:

“7. MISCONDUCT: The following acts of commission or omission on the part of physician shall constitute professional misconduct rendering him/her liable for disciplinary action.

 7.3: If he/she does not display the registration number accorded to him/her by the State Medical Council or the Medical Council of India in his clinic, prescriptions and certificates, etc. issued by him or violates the provisions of regulation 1.4.2.”

UN stands up to stop 41 million avoidable deaths per year. “Heart disease, stroke, cancer, diabetes, chronic Lyme disease, depression” – just some of the illnesses outlined by World Health Organization (WHO) chief Dr. Tedros Ghebreyesus, who drove home the danger by asking delegates to stand up, when they heard the name of an illness that had killed someone they loved: One by one, every single person in the room, got to their feet. That was the scene on Thursday, at UN Headquarters in New York, when around 500 people gathered to talk about the prevention and control of chronic illnesses – officially called non-communicable diseases, or NCDs. Every year, 41 million people are killed prematurely by preventable chronic illnesses, which Dr. Ghebreyesus declared a “needless suffering, expense and death.”

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India