Tuesday, January 21, 2020

New China corona virus can spread between humans

New China coronavirus can spread between humans

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

A new Corona virus that has killed at least three people and sickened more than 200 in China can be transmitted between humans as per Chinese government fueling fears about the possibility of a deadly epidemic as millions prepare to travel for the Lunar New Year holiday.

Zhong Nanshan, from China's National Health Commission confirmed that at least two cases had been spread  Zhong, who helped discover the severe acute respiratory syndrome-related coronavirus (SARS) in 2003, said the infectiousness of this virus was not as strong as SARS. SARS infected more than 8,000 people and killed 774 in a pandemic that ripped through Asia in 2002 and 2003.

The outbreak has spread to Beijing, Shanghai and Shenzen, hundreds of miles from Wuhan, where the virus first surfaced last month. Thailand has also reported two cases, while Japan and South Korea reported one each, taking the global total to 222.

There is only a 1 in 574 chance that a person infected in Wuhan would travel overseas before they sought medical care. This implies there might have been over 1,700 cases in Wuhan so far.

US Centers for Disease Control and Prevention announced three US airports -- in New York, San Francisco and Los Angeles -- will start screening passengers arriving from Wuhan to check for signs of the new virus, following similar measures taken by governments in Asia. [Excerpts CNN]

Monday, January 20, 2020

Tranexamic acid in acute traumatic brain injury

Tranexamic acid in acute traumatic brain injury

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

In patients with moderate traumatic brain injury (Glasgow Coma Scale greater than 8 and less than 13) presenting within three hours of injury immediately administer tranexamic acid (Grade 1B).
In the CRASH-3 trial, which included over 9000 patients presenting within three hours of TBI with a Glasgow Coma Scale (GCS) <13 or any evidence of intracranial bleeding on computed tomography scan, those receiving tranexamic acid had a risk of head injury-related death that was non-significantly lower relative to placebo (18.5 versus 19.8 percent).

This difference was statistically significant when patients with unreactive pupils were excluded (11.5 versus 13.2 percent) and in the subgroup of patients with mild to moderate TBI (5.8 versus 7.5 percent).

Tranexamic acid may also be considered in other patient groups, such as those with severe TBI and reactive pupils or those with mild TBI (GCS >12) and intracranial bleeding; however, a benefit is less certain in these patients. 


CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019; 394:1713.

Sunday, January 19, 2020

Belgian Doctors Face Trial in Country's First Euthanasia Case

19th Jan 20
Belgian Doctors Face Trial in Country's First Euthanasia Case

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

Three Belgian doctors go on trial for murder for helping a woman end her life.

The doctors, are accused of unlawfully poisoning 38-year-old Tine Nys on April 27, 2010.

They are the first doctors to go on trial for euthanasia in Belgium since the country legalized the practice in 2002.

Nys's parents and sisters, who were present at her death, complained that the euthanasia was carried out in an amateurish manner and that Nys did not have an incurable mental disorder, a key condition for granting euthanasia.

Belgian law allows adults to request the right to die on condition that they are facing unbearable physical or mental suffering resulting from a serious and incurable disorder. It was extended to terminally ill children in 2014.

Most patients choosing medically assisted death have terminal cancer, but mental suffering has extended, for example, to twins born deaf and becoming blind who are unable to bear not being able to see or hear each other.

In neighboring the Netherlands, where euthanasia is also legal, a doctor was acquitted in a trial in September after being accused of failing to secure proper consent from a woman who had Alzheimer's.

Saturday, January 18, 2020

WHO: 13 Global Health Challenges for the New Decade

WHO: 13 Global Health Challenges for the New Decade

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

1.     Climate Crisis

2.     Delivering Health in Conflict and Crisis

3.     Healthcare Equality

4.     Expanding Access to Medicines

5.     Infectious Diseases: tuberculosis, viral hepatitis, malaria, neglected tropical diseases, and sexually transmitted infections 


6.     Preparing for Epidemics: influenza , dengue, malaria, Zika, chikungunya, and yellow fever 

7.     Antimicrobial Resistance


8.     Clean Water, Sanitation, Hygien

9.     Harnessing New Technologies:  monitoring and regulation of  Genome editing and artificial intelligence

10. Keeping Teens Safe: More than one million adolescents aged 10 to 19 years die every year.


11. Earning Public Trust: Public health is compromised by the uncontrolled dissemination of misinformation in social media, as well as through an erosion of trust in public institutions.


12. Investing in People Who Defend Our Health: global shortage of healthcare workers. 

13.  Dangerous Products

Friday, January 17, 2020

Dengue 3 in Singapore

Dengue 3 in Singapore

Dr KK Aggarwal
In Singapore a total of 15,998 dengue cases were reported last year, almost five times the number for 2018. However, the figure is lower than the annual numbers reported in 2013 and 2014.

The surge in dengue cases in 2019 may be attributable to several factors – including a high Aedes aegypti mosquito population, warmer weather and low population immunity.

The less common dengue-3 serotype has been detected in more clusters across the island, including at the large clusters of Jalan Bangau near Yio Chu Kang, Cashew Road in Bukit Panjang and Jalan Paras in Chai Chee.

As Singapore has not seen a dengue-3 outbreak in the last three decades, the population immunity for dengue-3 is low and therefore more susceptible to transmission of the virus.

Since 2016, Singapore has seen mostly cases of the dengue-2 serotype. As of Monday, there were 107 active dengue clusters in Singapore.

Thursday, January 16, 2020

Dramatic Health Benefits Following Air Pollution Reduction

Dramatic Health Benefits Following Air Pollution Reduction

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

American Thoracic Society’s journal, Annals of the American Thoracic Society.

1.     Starting at week one of a ban on smoking in Ireland, there was a 13% drop in all-cause mortality, a 26% reduction in ischemic heart disease, a 32% reduction in stroke, and a 38% reduction in chronic obstructive pulmonary disease. The greatest benefits in that case occurred among non-smokers.

2.     In the United States, a 13-month closure of a steel mill in Utah resulted in reducing hospitalizations for pneumonia, pleurisy, bronchitis and asthma by half. School absenteeism decreased by 40 percent, and daily mortality fell by 16 percent for every 100 µg/m3 PM10 decrease. Women who were pregnant during the mill closing were less likely to have premature births.

3.     A 17-day “transportation strategy,” in Atlanta, Georgia during the 1996 Olympic Games involved closing parts of the city to help athletes make it to their events on time, but also greatly decreased air pollution. In the following four weeks, children’s visits for asthma to clinics dropped by more than 40 percent and trips to emergency departments by 11 percent. Hospitalizations for asthma decreased by 19 percent. Similarly, when China imposed factory and travel restrictions for the Beijing Olympics, lung function improved within two months, with fewer asthma-related physician visits and less cardiovascular mortality.

4.     In Nigeria, families who had clean cook stoves that reduced indoor air pollution during a nine-month pregnancy term saw higher birthweights, greater gestational age at delivery, and less perinatal mortality.

5.     25 years after enactment of the Clean Air Act, the U.S. EPA estimated that the health benefits exceeded the cost by 32:1, saving 2 trillion dollars, and has been heralded as one of the most effective public health policies of all time in the United States. Emissions of the major pollutants (particulate matter [PM], sulfur oxides, nitrogen oxides, carbon monoxide, volatile organic compounds, and lead) were reduced by 73 percent between 1990 and 2015 while the U.S. gross domestic product grew by more than 250 percent.

Wednesday, January 15, 2020

Part 2: Draft policy on rare diseases

Part 2: Draft policy on rare diseases

HCFI Recommendations

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

A petition in the Delhi High Court regarding directions that government provide free treatment for rare diseases the Delhi High Court in W.P. (C) No. 4444/2016, W.P. (C) No. 7730/2016,  and  W.P.  (C) No.  7729/2013 directed The Ministry of Health to frame in national policy on treatment of rare diseases. The government has issued draft guidelines.

Here are HCGFI suggestions

1.     Various countries have used different approaches for funding treatment for rare diseases. European countries cover the cost through their National Health Services. In USA once a happy is approved by FDA the insurance company e will need to cover the cost. In other countries the government for the cost of the treatment for instance in Egypt, Thailand,  Argentina, Chile,  Peru, Serabia, Malaysia and Philippines.
2.      According to the proposed draft policy Ayushman Bharat scheme will cover up to 15 lacs as one time cost for the treatment of curable diseases under category 1 and a crowd funding mechanism will be created for diseases requiring long term treatment un der category 2 and 3.
3.     Upto 15 lacs as onetime treatment cost should be considered even for category B and category c patients. The cost of maintenance in them may be covered through a crowd funding mechanism.
4.     The department of financial services and IRDA should amend the acts to consider that once a treatment of a rare/ genetic disease has been approved by Indian GCGI the same should be covered under the available insurance cover.
5.     Once a treatment is approved by DCGI the same should also be covered by CGHS, PSU, ESI etc
6.     Based on this the Ayushman Bharat should also consider up to 15 lac grant for all organ donations apart from sanctioning for rare diseases curable transplants.