Morning MEDtalks with Dr KK Aggarwal 28^th October 2018

“Multi-sectoral action is a key to addressing social and environmental determinants. We have developed operational strategies to build a shared goal and vision between sectors such as Nutrition, Drinking Water and Sanitation, education, rural and urban development departments…”, said the Health Minister of India Shri JP Nadda at the ‘Second Plenary Session’ of the 2nd International Conference on Primary Health Care towards UHC & SDGs at Astana, Kazakhstan on Thursday. The theme of his talk was “The Future of Primary Health Care”… (Press Information Bureau, Ministry of Health and Family Welfare, Oct. 25, 2018).

Harm Reduction: 5 ways to limit breathing polluted air (WHO)

1. Limit walking on busy streets during rush hour – and if you have a young child with you, try and lift them up above the level of vehicle exhausts
2. Limit spending time at specific hotspots of traffic such as cars stopped at traffic lights
3. When you’re doing physical activity outdoors, try exercising in less polluted areas
4. Limit the use of cars in highly polluted days
5. Don’t burn waste as the smoke that results damages our health

A new treatment for a drug-resistant strain of tuberculosis can cure more than 90% of sufferers, according to a trial hailed on Monday as a "game changer" in the fight against the global killer. Doctors in Belarus - a country with one of the highest rates of multidrug-resistant tuberculosis in the world - spent months treating patients with a new drug, bedaquiline, alongside other antibiotics.

Studies have definitively linked a diet high in legumes with a lower risk of developing obesity, diabetes, high blood pressure, high cholesterol, heart disease, or strokes. As a matter of fact, eating legumes every day can effectively treat these diseases in people who already have them.

Use of angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure was associated with an overall increased risk for lung cancer of 14% compared to hypertension therapy with angiotensin receptor blockers (ARBs), a large, population-based cohort study shows (Laurent Azoulay, PhD, of the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, Quebec, Canada).

A persons cumulative lead burden, as measured from the shin bone, appears connected to resistant hypertension. Tibia lead levels in the 75th percentile (28.5 µg/g) were associated with 19% greater likelihood (95% CI 1.01-1.41) of resistant hypertension than were levels in the 25th percentile (13 µg/g) in a fully-adjusted model, according to Sung Kyun Park, ScD, MPH, of University of Michigan School of Public Health in Ann Arbor, and colleagues reporting online in the Journal of the American Heart Association.

Only crackers with reduced emission (improved crackers) and green crackers are allowed by Hon’ble Supreme Court (AdvocateIra Gupta & Dr KK Aggarwal) Vide judgment dated 23.10.2018 the Hon’ble Supreme Court of India in the matter titled as “Arjun Gopal & others versus Union of India & Others” has permitted the crackers with reduced emission (improved crackers) and green crackers to be manufactured and sold. The manufacture, sale and use of joined firecrackers (series crackers or laris) has been banned by the Hon’ble Apex Court as the same causes huge air, noise and solid waste problems.

The following are the specific directions as laid down by the Hon’ble Supreme Court:

1. The crackers with reduced emission (improved crackers) and green crackers, as mentioned in Suggestion Nos. II and III above only would be permitted to be manufactured and sold
2. As a consequence, production and sale of crackers other than those mentioned in Suggestion Nos. II and III is hereby banned.
3. The manufacture, sale and use of joined firecrackers (series crackers or laris) is hereby banned as the same causes huge air, noise and solid waste problems.
4. The sale shall only be through licensed traders and it shall be ensured that these licensed traders are selling those firecrackers which are permitted by this order.
5. No e-commerce websites, including Flipkart, Amazon etc., shall accept any online orders and effect online sales. Any such e-commerce companies found selling crackers online will be hauled up for contempt of court and the Court may also pass, in that eventuality, orders of monetary penalties as well.
6. Barium salts in the fireworks is also hereby banned.
7. PESO is directed to review the clinical composition of fireworks, particularly reducing Aluminum content, and shall submit its report in respect thereof within a period of two weeks from today. For undertaking this exercise, PESO would also associate FRDC.
8. Even those crackers which have already been produced and they do not fulfill the conditions mentioned in Suggestion Nos. II and III above will not be allowed to be sold in Delhi and NCR.
9. PESO will ensure fireworks with permitted chemicals only to be purchased/possessed/sold/used during Diwali and all other religious festivals, of any religion whatsoever, and other occasions like marriages, etc. It shall test and check for the presence of banned chemicals like Lithium/Arsenic/ Antimony/Lead/Mercury.
10. PESO will ensure suspension of the licenses of manufacturers of such fireworks items and appropriate disposal of such stock.
11. PESO will ensure that only those crackers whose decibel (sound) level are within the limits are allowed in the market and will ensure to take action by suspending the licenses of the manufacturers on such violations and disposal of such lots. To add to it, as mentioned in the order dated September 12, 2017, the directions issued and restrictions imposed in the order passed by this Court on July 18, 2005 in Noise Pollution (V) shall continue to be in force.
12. Direction Nos. 4 to 9 and 11 contained in the order dated September 12, 2017 shall continue to operate and are reiterated again.
13. Extensive public awareness campaigns shall be taken up by the Central Government/State Governments/Schools/ Colleges informing the public about the harmful effects of firecrackers.
14. On Diwali days or on any other festivals like Gurpurab etc., when such fireworks generally take place, it would strictly be from 8:00 p.m. till 10:00 p.m. only. On Christmas eve and New Year eve, when such fireworks start around midnight, i.e. 12:00 a.m., it would be from 11:55 p.m. till 12:30 a.m. only.
15. The Union of India, Government of NCT of Delhi and the State Governments of the NCR would permit community firecracking only (for Diwali and other festivals etc. as mentioned above), wherever it can be done. For this purpose, particular area/fields would be pre-identified and predesignated by the concerned authorities. This exercise shall be completed within a period of one week from today so that the public at large is informed about the designated places one week before Diwali. The areas designated now for the purpose of Diwali shall be valid for community firecracking on other occasions/festivals as well, as mentioned above. Even for marriages and other occasions, sale of improved crackers and green crackers is only permitted. Insofar as other States are concerned, an endeavour shall be made by them also to explore the feasibility of community firecracking. However, it is made clear that Direction No. (xiv) pertaining to the duration within which fireworks can take place on all such occasions would be applicable throughout India. Similarly, Direction No. (xiii) for extensive public awareness campaigns is also a pan India direction.
16. All the official respondents, and particularly the Police, shall ensure that fireworks take place only during the designated time and at designated places, as mentioned above. They shall also ensure that there is no sale of banned firecrackers. In case any violation is found, the Station House Officer (SHO) of the concerned Police Station of the area shall be held personally liable for such violation and this would amount to committing contempt of the Court, for which such SHO(s) would be proceeded against.
17. CPCB and respective State Pollution Control Boards/ Pollution Control Committees (SPCBs/PCCs) of the States and Union Territories shall carry out short-term monitoring in their cities for 14 days (commencing from 7 days prior to Diwali and ending 7 days after Diwali) for the parameters namely, Aluminum, Barium, Iron apart from the regulatory parameters against the short-term Ambient Air Quality Criteria Values (AAQCVs) proposed by CPCB with regard to bursting of firecrackers. This will help in generation of data on pollution caused by the bursting of firecrackers and would be helpful for regulation and control quantity of Aluminum, Barium and Iron used in the manufacture of firecrackers.

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

President Elect CMAAO

President Heart Care Foundation of India