Tuesday, December 31, 2019

Revisiting Healthcare in 2019

Revisiting Healthcare in 2019

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

The year 2019 saw a lot on new health promises. Let us review some of the important ones.

Disease Outbreaks
1.               As per Who list https://www.who.int/csr/don/archive/year/2019/en/ No major health outbreak in India in 2019.

2.               No case of Polio was noted.

3.               In June 2019, an outbreak of acute encephalitis syndrome occurred in Muzaffarpur and the adjoining districts in Bihar state of India, amidst the second-longest heatwave in the region, resulting in deaths of more than 100 children, mainly due to hypoglycemia.

4.               The index case of Nipah in Koci in June was contained the disease was controlled before it took off

5.               Congo fever: 17 cases were reported in Gujarat and three tested positive in Rajasthan.

6.               More than 67,000 people across India have been diagnosed with dengue so far this year, reports by the National Vector Borne Disease Control Programme (NVBDCP) show. By mid-October, reports show, the disease had claimed 48 lives.

7.               The number of HIV-infected people who go on to develop Tuberculosis (TB) is increasing in India, according to the India TB Report 2019, which was released by the government on September 25, 2019.Nearly 25 per cent of all deaths among PLHIV are estimated to be due to TB. The highest percentage of patients who tested positive for TB and were also infected with HIV came from Nagaland (15.6 per cent), followed by Karnataka (10 per cent), Chandigarh (9.1 per cent) and Manipur (8.9 per cent).

Major Concerns of the year
1.               Pollution in North India
2.               Rising AMR

Parliament Bills
1.               The parliament passed the National Medical Commission (NMC) Bill. The bill provided for setting up a National Medical Commission (NMC) in place of the MCI to develop and regulate all aspects of medical education, profession and institutions in India.

2.               The government in November referred a bill, which seeks to ban commercial surrogacy in India, to a 23-member select committee of Rajya Sabha.

3.               The government passed Prohibition of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement

4.               The draft bill Healthcare Service Personnel and Clinical Establishments (Prohibition of violence and damage to property) Bill, 2019 is pending to be passed

5.               The Allied and Healthcare Professions Bill, 2018 was introduced in Rajya Sabha by the Minister of Health and Family Welfare, Mr. J P Nadda on December 31, 2018. The Bill seeks to regulate and standardise the education and practice of allied and healthcare professionals. Jan 02, 2019 referred to standing committee

6.               The Occupational Safety, Health and Working Conditions Code, 2019 pending

1.               Delhi health bill, which will replace Delhi Nursing Home act

2.               The Delhi Government will shift serious patient to private ICU. The payment will be done by DG if no bed is available with them

Major Courts Decisions
1.               Delhi high court on ‘courts in its own motion’ has asked the CDSCO to release a list of over the counter drugs
2.               Delhi high court on ‘courts in its own motion’ has asked the Railways to have emergency medical services at all major stations

On 11 June 2019, following the assault of two junior doctors at Nil Ratan Sircar Medical College and Hospital (NRSMCH) the previous night, junior doctors in Kolkata began protesting and demanded the Chief Minister of West Bengal, Mamata Banerjee to intervene and provide adequate security to medical professionals, culminating into the collapse of healthcare facilities in the state. Despite attempts at mediation, protests continued through 13 June, finally resulting in the Chief Minister issuing an ultimatum to the protesting doctors, which was eventually defied by the protesting doctors who wanted the government to meet their demands for security and a public apology from the Chief Minister.

Life expectancy and Vital Statistics
1.               Life expectancy in India has increased from 49.7 years in 1970-75 to 68.7 years in 2012-16, as per the National Health Profile 2019. For the same period, the life expectancy for females is 70.2 years and 67.4 years for males.

2.               HIV virus now can be made untraceable undetectable and an HIV positive person will be able to live a normal married life on daily uninterrupted treatment

Major Campaigns
1.               Fit India Movement by Ministry of Sports GOI
2.               Perfect Health Mela by Heart Care Foundation of India

1.               The downfall in the economy was a major issue in 2019.

2.               In 2019Fortis Healthcare announced that it has completed the acquisition of RHT Health Trust (RHT) assets for an enterprise value of Rs 4,650 crores.

3.               Rs 5,800 cr Medanta-Manipal deal falls through as sides disagree over valuation

Medical  Update
1.               For patients with heart failure and low heart pumping function with persistent symptoms and an elevated serum natriuretic peptide level on optimal pharmacologic and device therapy a new ray of hope came for better due to availability  of  a new drug dapagliflozin

2.               In patients with type 2 diabetes with kidney involvement (urine albumin excretion >300 mg per day and eGFR >30) the incorporation of an SGLT-2 inhibitor into the patient's glucose-lowering regimen has been shown to improve the diabetics complications.

3.               We expect in 2020 all patients with an LDL-C >100 mg/dL and a greater than 10 percent risk of a cardiovascular disease event within 10 years, will be put on statins. Also, All patients with  cardiovascular disease independent of the baseline low density lipoprotein cholesterol (LDL-C) level they will be put on lifelong high-intensity statin therapy (atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg) rather than moderate intensity statin or no LDL-C lowering therapy.

Ayushman Bharat
As on 2nd December 19590 hospitals empanelled, 6800774 patients benefitted via admissions and  11.46.69,820 cards issued


Dr Rajan Sharma took over as the National President 

New Drugs introduced in India in 2019
1.     Fenspiride hydrochloride film coated extended release tablet 80 mg and Fenspiride hydrochloride bulk for allergic asthma

2.     Bilastine tablets 20 mg and Bilastine Bulk for urticaria

3.     Iguratimod film coated tablets 25mg and Iguratimod Bulk for rheumatoid arthritis

4.     Fingolimod Capsules 0.5mg and Fingolimod hydrochloridebulk for multiple sclerosis

5.     Remogliflozin etabonate bulk and Remogliflozin etabonate film coated tablets 100 mg for diabetes

6.     Concentrate of Proteolytic enzyme enriched in Bromelain topical gel for eschar

7.     Menotrophin injection 600 IU/ml, 1 ml & 2 ml multi dose vial (Highly purified) for infertility

8.     Rifapentine 150mg film coated tablet for TB

9.     FDC of Bictegravir, Emtricitabine and Tenofovir alafenamide 50mg/200mg/25mg tablets for HIV

10.  Levomilnacipran ER capsules 20mg/40mg/80mg/120mg for depression

11.  Bosutinib bulk and Bosutinib tablets 100mg, 400mg, 5600 mg for cancer

12.  Algard HWS-256 (didecyl dimethyl ammonium chloride 10.14% w/w + n-Alkyl dimethyl benzyl ammonium chloride 6.76% w/w as disinfectant

13.  Algard - R-82 (octyldecyl dimethyl ammonium chloride 6.510 w/w + Dioctyl dimethyl ammonium chloride 2.604% w/w + Didecyl dimethyl ammonium chloride 3.906% w/w + Alkyl dimethyl benzyl ammonium chloride 8.680% w/w as disinfectant

14.  Safinamide methane sulphonate bulk drug and Safinamide tablets 50, 100mg for Parkinson disease for Parkinson disease

15.  Droxidopa bulk drug and Droxidopa capsules 200mg/300mg for postural hypotension

16.  Acalabrutinib 100mg capsules for multiple myeloma

17.  Abemaciclib 50mg, 100mg, 150mg and 200mg film coated tablets for breast cancer

18.  Ripasudil hydrochloride hydrate bulk drug and Ripasudil Eye drops 0.4% w/v for glaucome

19.  Diperoxochloric acid concentrate and Diperoxochloric acid topical solution for diabetic neuropathy ulcers

Cheers: Happy and Healthy 2020

Cheers: Happy and Healthy 2020

Dr KK Aggarwal
President CMAAO ands Past National President IMA

Beware of Alcoholic Drinks during New Year

Cheers but just because there are few studies indicating that moderate alcohol consumption is good for heart it should not be a reason for nondrinkers to start drinking. You can do cheers that with a non-alcoholic drink to.

Indulging into alcohol for the first time is common during New Year's Eve. Once started it invariably leads to a habit. Along with that, during New Year people also indulge into smoking and drugs as experimentation.

Consuming six drinks in one sitting in men (180 ml of 80 proof whisky) and in women (90 ml of 80 proof whisky) is considered health hazard and can precipitate dangerous rise in blood pressure, uncontrolled diabetes leading to sudden cardiac death in susceptible individuals.

For those who drink, the safest limit of alcohol is 6 gm per day. However, the current recommendation is, in the absence of contraindication, is that one can take 10 gm of alcohol in one hour, 20 gm in a day and 80 gm in a week.

10 gm of alcohol is present in 30 ml of whisky, 50 ml of wine and one bottle of beer. One peg lasts in the body for one hour, therefore, it is safe to drive only one hour after taking a peg. The rough formula is number of pegs taken should be equal to number of hours after which a person can drive. Alcohol and smoking together is more harmful.

Women should beware of rape date drugs which can be given to them in the drinks. Nobody should take any drinks offered by strangers. Date rape drugs are odorless and colorless drugs which if added to drinks can cause a state of mind where the person cooperates for everything but develops complete amnesia after the effect of the drug has gone for the period the person was drunk.

Sunday, December 29, 2019

Off label Use of PRP and ABI

Off label Use of PRP and ABI

Dr KK Aggarwal
President CMAAO and Past National President IMA

Platelets have a role in variety of processes not related to haemostasis and these include dissemination of cancer metastasis, liver regeneration, inflammatory arthritis, and immunity against pathogens.

Platelets secretes granules, which contain large amounts of cytokines and growth factors.

Platelets contain so many growth factors within their granules that they can accelerate wound healing by injecting platelets suspended within plasma (Platelet-Rich Plasma).

There are widely reported anecdotes and testimonies about the merits of Platelet-Rich Plasma therapy.

Ultrasound-guided dry needling and injection of autologous blood or platelet-rich plasma (PRP) may theoretically stimulate a healing response in chronic tendinopathy.

Such trials are needed, particularly in patients with chronic tendinopathy who have failed standard conservative treatment involving eccentric or heavy load exercise.

Other blood-derived therapies include injection of autologous whole blood (ABI) and extracted blood derivatives. They are injected at the site of injury and are purported to deliver supraphysiologic concentrations of cytokines and other substances that promote growth and repair and mediate the inflammatory process.

PRP is also used for medical healing of perforated tympanic membrane.

An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post Dural puncture headaches caused by lumbar puncture (spinal tap).

Also, ABI is used to treat refractory urticarias.

Both PRP and ABI describes a treatment without standardization of manufacturing methodology, administration schedules, or return-to-exercise guidelines. Use of these products require adherence to country specific off label policies.

ABI and PRP are not stem cell therapies. Indian Council of Medical Research (ICMR), is coming up with norms in January that will serve as guidelines for stem cell banks and research bodies. 

Pauses in Speech: Normal or Abnormal From Ronald Reagan to Atal Ji

Pauses in Speech: Normal or Abnormal
From Ronald Reagan to Atal Ji

Dr KK Aggarwal
President CMAAO and Past National President IMA

Bharat Ratna Awardee Sh Atal Bihari Vajpayee, the former Prime Minister of India was known for his oratory as well as his pauses.
Pauses in your senses can be very powerful way of communication and can be the sign of early dementia.
Silence does have a sound. And the effective use of silence in communication, often speaks louder than words. In Vedic description the word AUM has a silence after M.
As a public speaker, one must incorporate pauses at the right places, in the right moments to connect with the audience. Pauses help the audience understand & absorb the right message. Pauses add meaning & power to the spoken words.
Type of pauses
1.     The pregnant dramatic pause suggests more than what is expressed in words. It is pregnant with unexpected possibilities and longer than the other pauses. It adds a dramatic impact to what one is about to say. It is often used in comedy, suspense and by experienced & polished speakers to heighten anticipation in the listener.
2.      The meaningful pauses: are the essential pauses in communication meant for clarity. They are the commas & full-stops of spoken communication.
3.      The emotional pauses: are used by leaders using the art in similar sounding, repetitive phrases, to arouse emotions in the audience.
4.      The physiological pauses: are the pauses needed to replenish the breath. Breath training helps to speak long phrases and deliver a powerful & emotional message.
5.      The pathological pauses: More pauses (specifically when you want to name the person, place or the event) and filler words ( in place of the name of the person or the place) might be an early sign of mental decline and Alzheimer's disease.
Lots of people say “um” and have trouble quickly recalling names as they age. They used more pronouns such as “it” or “they” instead of specific names for things, spoke in shorter sentences and took longer to convey what they have to say.
A study in 2015 analysed dozens of press conferences by former US President Ronald Reagan and found evidence of speech changes more than a decade before he was diagnosed with Alzheimer's. Similar changes can be seen when you follow the sequential speeches over last two decades of late Sh Atal Ji: a changed from normal pauses to pauses with fillers.
I also saw a change in the speeches of Advani ji over last two decades, often speaking repetitive sentences.
Leaders are our role models and their illnesses and early illness signs help in public education. Remember Atal Ji knee replacement surgery created a wave of knee surgeries in India.

FDA Makes Legal Smoking raised to 21: All countries should raise it and make it uniform

FDA Makes Legal Smoking raised to 21: All countries should raise it and make it uniform

Dr KK Aggarwal
President CMAAO and Past National President IMA

The smoking age is the minimum legal age required to purchase or smoke tobacco products. Most countries have laws that restrict those below a minimum age from legally purchasing tobacco products.

The U.S. Food and Drug Administration has raised the legal smoking age from 18 to 21. As per FDA “On December 20, 2019, the President signed legislation to amend the Federal Food, Drug, and Cosmetic Act, and raise the federal minimum age of sale of tobacco products from 18 to 21 years. It is now illegal for a retailer to sell any tobacco product to anyone under 21.”
CMAAO welcome these decision and urges all National Medical Associations to urge their respective governments to follow the same

In India in 2014 The health ministry set up a committee to recommend amendments to the Tobacco Regulation Act which may suggest raising minimum age for smoking from 18 years to 25. But the same was not implemented.

Singapore 19
Thailand 20
India 18
Pakistan 18
Sri Lanka 21
Bangladesh 16
Nepal 18
Malaysia 19
Korea 19 (purchasing age 20)
New Zealand 18
Australia 18
Hong Kong 18
Philippians 18
Taiwan   18
Japan 20
Indonesia 18