Morning MEDtalks with Dr KK Aggarwal 7th September 2018

Supreme Court decriminalizes Section 377: Heart Care Foundation of India welcomes this historic judgment

Section 377 is irrational, arbitrary and incomprehensible, says Supreme Court.

In a historic and unanimous judgment, the Supreme Court of India has decriminalized section 377 of the Indian Penal Code (IPC), as per which homosexuality is a punishable offence. The five-judge constitutional bench was unanimous in its decision.

The medical community has always considered homosexuality as a normal and natural phenomenon and not a disease or crime.

It becomes important now for a medical doctor to know if the person is a LGBT. Till now, many of them did not come forward and disclose their orientation fearing the law.  

The job of a doctor or the judiciary is to change with the changing times and broaden, delete or re-interpret the laws as per the changing needs of the society.

It is indeed heartening to note that the Court is now coming to the rescue of people, which will help reduce the mental and social disorders in the society.

Following are some key observations of the Supreme Court (TOI).

“Progressive and pragmatic view should be taken by the court to come to the rescue of the oppressed section of society. The law must be interpreted as per the requirement of changing times”, says Supreme Court.

“The court must try to protect the dignity of every individual of the society, including people from LGBT community. Sexual orientation is natural and people have no control on it.”

“Consensual sex between adults in private space, which is not harmful to women or children, cannot be denied as it is a matter of individual choice.”

“It amounts to a retrograde step if we accept the verdict on criminalizing gay sex”

“Section 377 of the IPC was a weapon to harass members of the LGBT community, resulting in discrimination.”

“Any kind of sexual activity with animals shall remain penal offence under Section 377 of the IPC.”

SC terms “sexual orientation as biological phenomenon, says any discrimination on this grounds is violative of fundamental rights.”

“Constitution nurtures dissent as safety valve of society, we cant change history but can pass way for better future.”

Chief Justice Dipak Misra: “Sustenance of identity is the pyramid of life. Right to privacy as part of right to life applies fully to LGBT community. Suresh Koushal judgment of SC in 2013 is retrograde.”

Justice RF Nariman: Homosexuality is not a mental disorder, which has been also recognised by Parliament. Centre must give wide periodic publicity to the SC judgment to eliminate stigma attached to LGBT community.”

Justice Chandrachud: “State has no business to get into controlling the private lives of LGBT community members or for that matter, any citizen... Decriminalising gay sex is only the first step to bury the Colonial Ghost, adding that time has come to move forward and give the LGBT community the other constitutional rights…Denial of right to sexual orientation is akin to denial of right to privacy.”

Justice Indu Malhotra: “History owes an apology to members of LGBT community and their families for ostracisation and persecution they faced because of societys ignorance that homosexuality is a natural trait; its penal suppression infringes a host of fundamental rights.”

Related links

1. http://kkaggarwal.com/Editorial/homosexuality-is-not-a-medical-disorder/
2. http://kkaggarwal.com/Editorial/court-has-a-duty-to-strike-down-law-if-it-violates-fundamental-right-sc/

SC decriminalises consensual gay sex

New Delhi, Sep 6 (PTI) A five-judge Constitution bench of the Supreme Court Thursday unanimously decriminalised part of the 158-year-old colonial law under Section 377 of the IPC which criminalises consensual unnatural sex.A five-judge Constitution bench headed by Chief Justice Dipak Misra termed the part of Section 377 of the Indian Penal Code which crimiminalises unnatural sex as irrational, indefensible and manifestly arbitrary. The bench, which also comprised Justices R F Nariman, A M Khanwilkar, D Y Chandrachud and Indu Malhotra, struck down Section 377 as being violative of right to equality.The top court, in four separate but concurring judgements, set aside its own verdict in the Suresh Kaushal case.Section 377 refers to unnatural offences and says whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to 10 years, and shall also be liable to pay a fine.The apex court, however, said other aspects of Section 377 of IPC dealing with unnatural sex with animals and children shall remain in force.The historic judgement came on a batch of writ petitions filed by dancer Navtej Jauhar, journalist Sunil Mehra, chef Ritu Dalmia, hoteliers Aman Nath and Keshav Suri and business executive Ayesha Kapur and 20 former and current students of the IITs. They had sought decriminalisation of consensual sex between two consenting adults of the same sex by declaring Section 377 illegal and unconstitutional.The issue was first raised by the NGO, Naaz Foundation, which approached the Delhi High Court in 2001. The Delhi High Court had in 2009 decriminalised sex between consenting adults of the same gender by holding the penal provision as "illegal".This high court judgement was overturned in 2013 by the apex court which also dismissed the review plea against which the curative petitions were filed which are pending.The writ petitions were opposed by Apostolic Alliance of Churches and Utkal Christian Association and some other NGOs and individuals, including Suresh Kumar Kaushal.

MRI of the brain is often performed for patients with primary headaches, which account for about 90% of all headaches. An incidental finding (IF) or normal anatomical variant is frequently revealed (2-8%) and may cause concern for the patient and family. Before MRI is done for primary headaches, it is useful to advise patients that the chance of finding an abnormality that is causing the headache is very small, but that of an incidental or normal anatomic finding is common. This may decrease potential anxiety for the patient and save you time.

American College of Gastroenterology H. pylori new treatment consensus clinical guideline

Antibiotic selection: There is increased resistance to clarithromycin, and traditional triple therapy (clarithromycin + amoxicillin + proton pump inhibitors [PPIs]) should not be prescribed unless the rates of clarithromycin resistance are known to be < 15%. We should not use clarithromycin triple therapy.

What should be the first-line therapy then?

1. Quadruple therapy: Clarithromycin (500 mg), amoxicillin (1 g), metronidazole (500 mg) and a PPI, all given twice a day, or
2. Bismuth subsalicylate (2 tablets four times a day), metronidazole (500 mg three or four times a day), tetracycline (500 mg four times a day), and a PPI (twice a day). Patients on this regimen will need to be informed about bismuth-related stool darkening, or
3. Triple therapy with levofloxacin (500 mg once a day), amoxicillin (1 g twice a day), and a PPI (twice a day) is an alternative but not recommended as the best initial option.

Treatment duration: Recommended duration of treatment is 14 days

Salvage therapy for persistent Helicobacter pylori infection

1. Avoid antibiotics previously used
2. Bismuth-based quadruple therapy or levofloxacin triple therapy are accepted salvage regimens. 

California lawmakers have voted to ban middle schools and high schools from starting before 8:30 a.m. The Bill, known as SB328, was narrowly passed by the state legislature. Schools have three years to comply. Later school times could improve student health, boost graduation rates and also save the school system billions of dollars.

Sleep is important for all, but it is even more important for children. Research from Harvard Medical School and other institutions indicates that inadequate sleep can lead to obesity, behavioral and developmental problems and depression in kids and young adults. But due to the increased prevalence of technology such as cell phones, tablets and computers, and an increased emphasis on time-consuming extracurricular activities, students today are staying up later.

Intensive BP control increases risk of serious falls and syncope. The effect of BP lowering with antihypertensive medications and lower BP targets remains a significant concern for adverse events including falls, which are a concern, especially in the elderly patients. In a study published August 23, 2018 in the American Journal of Preventive Medicine, both minimum and mean systolic blood pressure less than 110 mmHg among treated hypertensive patients were associated with greater chances of serious falls and syncope. The chances of falls and syncope were more than twofold higher in those with any minimum systolic BP less than 110 mmHg, whereas they were nearly 50% higher among patients with mean systolic BP less than 110 mmHg. These differences were similar and persisted regardless of age (<65 and ≥65 years). The study recommends frequent monitoring of BP and also consider low BP threshold for medication modification.

CDC guideline for children with mild traumatic brain injury (mTBI) includes five key practice-changing recommendations:

1. Do not routinely image pediatric patients to diagnose mTBI.
2. Use validated, age-appropriate symptom scales to diagnose mTBI.
3. Assess for risk factors for prolonged recovery, including history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors).
4. Provide patients and their parents/caregivers with instructions on returning to activity customized to their symptoms.
5. Counsel patients and their parents/caregivers to return gradually to non-sports activities after no more than a 2-3 days of rest.

Eleven people on an Emirates airline flight were taken to a New York City hospital suffering flu-like symptoms on Wednesday after scores of passengers and crew complained of feeling sick during a 14-hour trip from the Middle East. Laboratory tests on respiratory samples from the patients have yet to confirm the illness, but their histories and symptoms - fever, cough and vomiting - indicate influenza, said Dr. Oxiris Barbot, New York City’s acting health commissioner. All the passengers were screened by officials from the Centers for Disease Control and Prevention (CDC)… (Reuters/CDC).

The sensitive words mental health experts say you should stop using in a conversation. Terms such as nutter, lunatic, psycho, schizo, deranged, mad and mental patient should be avoided even when not used maliciously, according to Everymind Director Jaelea Skehan. Using the word schizophrenic to denote duality such as a “schizophrenic economy” to describe rapid fiscal movements was also potentially damaging.

Do you know that globally, more than a quarter of adults (27·5%, 95% UI 25·0–32·2) were insufficiently physically active in 2016 (The Lancet)

Johnson and Johnson to pay 30 lakh compensation but what about Kellogg’s in US? US Federal health officials are warning consumers to stay away from all Honey Smacks cereal, which is likely behind a multi-state salmonella outbreak that has sickened 130 people. Kellogg’s voluntarily recalled Honey Smacks in June, citing possible salmonella contamination. But the CDC announced on Tuesday that at least 30 people from 19 states have become ill since mid-July, suggesting that contaminated products may still be in people’s homes or on store shelves.

Children conceived through assisted reproductive technologies (ART) may be at an increased risk of developing arterial hypertension early in life, among other cardiovascular complications. ART adolescents were found to have both a higher systolic and diastolic BP vs controls born of natural conception at 119/71 mmHg versus 115/69, respectively. Eight of the ART adolescents reached the criteria for the diagnosis of arterial hypertension of more than 130/80 mmHg (September 3, 2018 in the Journal of the American College of Cardiology).

Three-quarters of patients seeking bariatric surgery prefer the term “person with obesity” to “obese person”. Among a selection of terms used for patients with a body mass index (BMI) ≥30, study participants favored people-first language, rating "person with elevated BMI" highest (5.3 out of 7), followed by “person with obesity” and “person with excess weight” (4.9 and 4.7, respectively), reported Rebecca Pearl, PhD, and colleagues from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia in JAMA Surgery.

More than 10% of children in the US have been diagnosed with attention deficit hyperactivity disorder (ADHD), which is a significant increase during the past 20 years, according to researchers from the University of Iowa who recently conducted a study and published the results in JAMA.

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