December 22   2015, Tuesday
+ W.P.(C) 8706/2015 and CM No.19131/2015 (stay)
Through: Mr. Rahul Gupta, Mr. Shekhar Gupta,
Ms. Ira Gupta and Mr. Umang Gupta, Advocates

UNION OF INDIA & ANR..... Respondents

Through: Mr. Jasmeet Singh, Mr.Srivats Kaushal, Mr. Arjun Bedi and Ms. Astha Sharma, Advocates for R-1

1. Mr. Singh has returned with instructions as indicated in the last order. The petitioner after having examined the “Report of Changes” (Report); a copy of which was supplied to its counsel, had articulated grievance only with respect to the two aspects.

2. This grievance arose in the background of the following brief facts:
2.1 The aforementioned Report was handed over by Mr Jasmeet Singh with a note sheet dated 18.11.2015, generated by Mr M.V.S.V. Prasad, Asstt. Professor of Political Science, Department of Education in Social Sciences, NCERT to the court on 24.11.2015. A copy of the Report was given to the counsel for the petitioner. In the Report, changes were suggested in Chapter 2, titled: Role of the Government in Health; in the Social Science text book prescribed for class VII students. The text book bears the title: Social and Political Life-II.
2.2 On the next date i.e. 14.12.2015, Mr. Gupta, learned counsel for the petitioner communicated that all suggestions (except two aspects to which I will make a reference hereafter) made in the Report were acceptable.

3. Therefore, in so far as the other aspects are concerned, the revisions adverted to in the Report, I am told, once again, by Mr Gupta, are acceptable to the petitioner. The said changes, as incorporated in the Report are taken on record. The changes referred to in chapter 2, in pages 22, 23, 24, 26, 29 and 122, as indicated in the Report, shall be incorporated as suggested by the respondent.

4. In so far as the two outstanding grievances are concerned, they relate to matters, which are set out in page 37 and 40 of the appeal paper book. In respect of these two grievances, following changes are suggested, which are accepted by the petitioner.
4.1 In page 26 of the text book, which corresponds with page 37 of the appeal paper book, the following change is to be incorporated: “some private services encourage incorrect practices to earn more”
4.2 At page 29 in the glossary of the aforementioned text book, which corresponds to page 40 of the appeal paper book, following change is to be incorporated : “Private: An activity or service that is organised by an individual or company for their own profit. (replace the word ‘profit’ with ‘gain’)”

5. Mr. Gupta, the learned counsel for the petitioner says that in view of the aforesaid stand of the respondents, the petition has worked itself out and therefore, the petition be disposed of.
6. It is ordered accordingly. Accordingly, the pending application also stands disposed of.
7. Dasti.

DECEMBER 16, 2015
Breaking News

Non-Alcoholic Fatty Liver may be a risk factor for hypertension

Results of a study conducted in more than 1,500 Korean adults suggest that non-alcoholic fatty liver disease (NAFLD), assessed by fatty liver index (FLI) may be an independent risk factor for hypertension. During a 2.6-year period between an initial and follow-up examination, 153 study participants (10%) developed high BP. FLI values were higher in the incident hypertension group vs those who did not develop hypertension (30.95 ± 22.16 versus 21.69 ± 20.15, P<0.001), FLI was positively associated with baseline BP, homeostasis model assessment of insulin resistance, urinary albumin/creatinine excretion and high sensitivity C-reactive protein. The results are reported in the journal PLoS One... (Medpage Today)

Health ministry working on a new strategy to increase organ transplant facilities in the country

In order to increase the organ transplant facilities in all the parts of the country, the Union health ministry is working on a three-pronged road map for action which can further improve the organ donation system in terms of infrastructure, education and training and awareness strategy. At present, all organ transplant facilities are available in metropolitan cities and 95% are in private sector. The ministry is working to create a transplant facility in every medical college in the country in a phased manner. The ministry will impart training in this regard at leading transplant centers of the country such as AIIMS, PGI, SGPGI, Nizam Institute of Medical Sciences and leading transplant centers in private sector. This will augment trained manpower and infrastructure for organ donation and transplantation and help to bridge the gap between requirement and availability of human organs for transplantation… (PIB - Ramesh Shankar)
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Specialty Updates
• New research suggests that acupuncture may be a safe and effective treatment strategy for chronic pain in children. The findings are published in the journal Alternative and Complementary Therapies.

• Exercise during menopause, especially if it makes you hot, sweaty and fitter, can reduce the number and intensity of hot flashes, suggests a study published in The Journal of Physiology.

• Sleeping less than 7 hours a night may mean that people are eating and drinking more, contributing to obesity, suggests new research published in the American Journal of Health Promotion.

• A tailored dose-tapering strategy for anti-tumor necrosis factor (TNF) drugs is clinically equivalent and less costly over 1 year than standard dosing in patients with ankylosing spondylitis (AS) who achieve low disease activity, suggests a new study published in Annals of the Rheumatic Diseases.

• A patient's mental health prior to bladder cancer surgery can influence postoperative outcomes, suggests a new study published in The Journal of Urology. Researchers noted that patients whose self-assessment of mental health was low suffered more high grade complications in the 30 days following surgery than patients with higher self-assessments.

• Many patients taking direct acting antivirals (DAA) to treat hepatitis C virus (HCV) are at risk of clinically significant drug-drug interactions (DDIs), suggests new research published online in Clinical Infectious Diseases. These interactions have the potential to cause treatment failure, which is especially problematic since it is currently unclear how to treat patients who fail DAA treatment.

• Women who have an inactive daily routine and are at high risk of type 2 diabetes can help prevent the condition by regularly standing up or walking for five minutes at a time, suggests a new study published in Diabetes Care.

• A new study, published online in the Journal of Neuroscience, suggests that playing three-dimensional (3D) video games can stimulate the hippocampus and boost the formation of memories.
You can reverse heart disease

Every cell in the body eventually dies and is replaced by a new cell. Every day is a new opportunity to build a new body. The entire body totally rebuilds itself in less than 2 years with 98% in less than one year.

• Stomach lining rebuilds itself in 5 days.
• Skin rebuilds itself in one month.
• Liver rebuilds itself in 6 weeks.
• DNA rebuilds itself every 2 months.
• Bone rebuilds the whole new skeleton in 3 months
• Blood rebuilds itself in 4 months.
• Brain rebuilds itself in 1 year.

You cannot swim in the same river twice. With every breath, we inhale 1022 atoms coming from all cells present in the universe. We share everything with everybody with every breath. Quadruplet atoms in the last three weeks have gone through our breath. Billion atoms out of them may have been those of Christ or Mohammad.

The very fact that our body rebuilds itself, it is possible to change the Dharma of the new cells and even prevent or regress cancers and heart diseases.
Legal Quote
Martin F. D'Souza vs Mohd. Ishfaq, 3541 of 2002, dated 17.02.2009

“For civil liability only damages can be imposed by the court but for criminal liability the doctor can also be sent to jail (apart from damages which may be imposed on him in a civil suit or by the consumer fora).”
The switch from trivalent to bivalent oral polio vaccine

18th December, 2015

Objectives of the Polio Eradication & Endgame Strategic Plan 2013-2018

• Detect and interrupt all poliovirus transmission
• Strengthen immunization systems, introduce inactivated polio vaccine (IPV) and withdraw oral polio vaccines (OPV)
• Contain poliovirus and certify interruption of transmission
• Plan polio’s legacy
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The Year in Medicine 2015: News That Made a Difference
Record HIV outbreak in Indiana, USA

In March this year, Indiana Governor Mike Pence declared a public health disaster in southern Indiana, USA following the worst HIV outbreak in the state's history. More than 170 people tested positive for the disease, almost all of whom were also infected with hepatitis C. In previous years, Scott County, where the epidemic was centered, reported fewer than five new HIV cases each year. Authorities said the majority of cases were caused by syringe sharing among people who injected prescription oral pain medication, primarily oxymorphine. In the wake of the epidemic, Indiana — as well as Kentucky, which experienced an increase in hepatitis C cases — passed laws permitting needle exchanges, which helped control the outbreak... (Source: Medscape)
Mandrola's Top 10 Cardiology Stories 2015
Coffee and fat are back

Nothing is more basic to health than what we eat. This year, we relearned that not a single randomized controlled clinical trial backed the 1970s-era advice to cut fat consumption to less than 30% and saturated fat to less than 10%. This revelation led an expert panel to release new recommendations to the US government. In the 570-page report, many of the basics remained, such as eat more fruits, vegetables, whole grains, nuts, and fatty fish and fewer refined sugars and trans fats. Two major reversals included the allowance of moderate caffeine intake and removal of limits on dietary cholesterol. In 2015, a consensus grew that refined sugars promote illness—and momentum grew for using nudges, such as taxes, to reduce their consumption. (Source: Medscape)
Health ministry to omit Rule 124-A from Drugs & Cosmetics Rules

The Union health ministry will soon omit Rule 124-A from the Drugs and Cosmetics Rules, 1945 which sets standards for veterinary drugs as Rule 124-A has become redundant. According to sources, the issue of omitting of Rule 124-A, which sets standards for veterinary drugs, from the Drugs and Cosmetics Rules, 1945 was deliberated in the Drugs Technical Advisory Board (DTAB)'s latest meeting held on August 18, 2015 and the DTAB, the highest authority under the Union health ministry on technical matters, recommended that Rule 124-A has become redundant and therefore should be omitted… (Pharmabiz - Ramesh Shankar)
CDSCO to review guidelines on biosimilars to meet healthcare needs

To improve access to biosimilars for meeting medical needs of the country, guidelines on biosimilars are expected to be released for stakeholder review shortly. The guidelines which were first released in 2012 in consultation with the Central Drugs Standard Control Organisation (CDSCO) and industry are in the process of revision currently. The guidelines- Guidelines on Similar Biologics, released by the department of biotechnology in 2012 for the first time in June 2012, provided requirements for preclinical evaluation of those recombinant products that are claimed to be similar to the already approved biopharmaceutical products, referred as 'similar biologics'. These guidelines prescribe the quality, preclinical studies and clinical trial requirements of similar biologics in India... (PHarmabiz - Shardul Nautiyal)
Infant Mortality Rate in the country has shown steady decline from 47 per 1000live births in 2010 to 40 per 1000 live births in 2013. Currently, there are 602 Special Newborn Care Units (SNCU), 2228 New Born Stabilization Units (NBSU) and 16968 Newborn Care Corners (NBCC) established across the country. SNCU is a 12-20 bedded unit and NBSU is 4 bedded unit for care of sick newborn. NBCC is an earmarked area at delivery points equipped with radiant warmer and resuscitation kit to provide essential newborn care… (PIB)
HvPI adds 31 more centres for blood transfusion reaction reporting

Aimed at raising awareness about blood transfusion hazards in blood banks across the country, Haemovigilance Programme of India (HvPI) has added 31 more centers for reporting blood transfusion related adverse reactions.
With this, the HvPI program has also been able to generate 3098 blood transfusion related adverse reaction reports till date through its total 238 centers across the country. There are in total 2760 licensed blood banks in the country which will be covered under the program. Launched on December 10, 2012 by NIB, HvPI earlier had 207 centres covering blood banks, medical colleges, government and private hospitals across the country. NIB is an autonomous institution under the Union health ministry which ensures quality of biologicals and vaccines in the country available through domestic manufacturers or imports… (Pharmabiz - Shardul Nautiyal)
De-worming drive to reach 48 crore kids in 2016

The health ministry is planning to ramp up its de-worming programme to cover 48 crore children across the country next year, up from nine crore targeted during 2015 in 11 high-burden states. The initiative, aimed at improving overall child health and addressing malnutrition, achieved coverage of around 70% since February when it was launched. While the program achieved coverage of almost 90% in high-burden states of Bihar, Madhya Pradesh and Maharashtra and more than 80% in states of Haryana, Rajasthan and Tripura, a few states like Assam which lagged behind will be the focus in the next phase. The government has also increased the number of health workers and consultants involved in the exercise to expand the program to cover all states during the next phase… (ET HEalthworld)
Drug overdose deaths hit record numbers in 2014

The CDC reports that from 2000 to 2014 nearly half a million Americans died from drug overdoses. Opioid overdose deaths, including both opioid pain relievers and heroin, hit record levels in 2014, with an alarming 14 percent increase in just one year. According to new data published in Morbidity and Mortality Weekly Report, the most commonly prescribed opioid pain relievers, those classified as natural or semi-synthetic opioids such as oxycodone and hydrocodone, continue to be involved in more overdose deaths than any other opioid type. These deaths increased by 9% (813 more deaths in 2014 than 2013)... (CDC)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India

Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

Smita N Deshpande
Head, Dept. of Psychiatry, De–addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse– a doctor– as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013): http://www.eubios.info/

Responses received

Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar
When is your doctor at fault while prescribing antibiotic?

• Prescribing antibiotics when no bacterial infection exists.
• Prescribing the wrong antibiotic or the wrong dose.
• Prescribing antibiotics for longer than necessary.
• Prescribing strong antibiotics, when a less strong would be as effective.
• Prescribing an expensive antibiotic when a cheaper but equally effective antibiotic is available.

When are you at fault?

• You demand antibiotics even when the doctor thinks it is unnecessary
• You buy an antibiotic without prescription.
• You buy an antibiotic without a bill
• You stop antibiotics as soon as your symptoms start improving and you do not take a full course of antibiotics.
• When you change brands without the doctor’s knowledge.
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
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Inspirational Story
A mountain of dirt

Once a man had a dream in which his hands and feet and mouth and brain all began to rebel against his stomach.

"You good–for–nothing sluggard!" the hands said. "We work all day long, sawing and hammering and lifting and carrying. By evening we’re covered with blisters and scratches, and our joints ache, and we’re covered with dirt. And meanwhile you just sit there, hogging all the food."

"We agree!" cried the feet. "Think how sore we get, walking back and forth all day long. And you just stuff yourself full, you greedy pig, so that you’re that much heavier to carry about."

"That’s right!" whined the mouth. "Where do you think all that food you love comes from? I’m the one who has to chew it all up, and as soon as I’m finished you suck it all down for yourself. Do you call that fair?"

"And what about me?" called the brain. "Do you think its easy being up here, having to think about where your next meal is going to come from? And yet I get nothing at all for my pains." And one by one the parts of the body joined the complaint against the stomach, which didn’t say anything at all.

"I have an idea," the brain finally announced. "Let’s all rebel against the lazy belly, and stop working for it." "Superb idea!" all the other members and organs agreed. "We’ll teach you how important we are, you pig. Then maybe you'll do a little work of your own."

So they all stopped working. The hands refused to do lifting and carrying. The feet refused to walk. The mouth promised not to chew or swallow a single bite. And the brain swore it wouldn’t come up with any more bright ideas. At first the stomach growled a bit, as it always did when it was hungry. But after a while it was quiet.

Then, to the dreaming man’s surprise, he found he could not walk. He could not grasp anything in his hand. He could not even open his mouth. And he suddenly began to feel rather ill. The dream seemed to go on for several days. As each day passed, the man felt worse and worse. "This rebellion had better not last much longer," he thought to himself, "or I’ll starve."

Meanwhile, the hands and feet and mouth and brain just lay there, getting weaker and weaker. At first they roused themselves just enough to taunt the stomach every once in a while, but before long they didn't even have the energy for that.

Finally the man heard a faint voice coming from the direction of his feet. "It could be that we were wrong," they were saying. "We suppose the stomach might have been working in own way all along." "I was just thinking the same thing," murmured the brain. "It’s true that he's been getting all the food. But it seems he's been sending most of it right back to us."

"We might as well admit our error," the mouth said. "The stomach has just as much work to do as the hands and feet and brain and teeth." "Then let’s get back to work," they cried together. And at that the man woke up.

To his relief, he discovered his feet could walk again. His hands could grasp, his mouth could chew, and his brain could now think clearly. He began to feel much better.

"Well, there’s a lesson for me," he thought as he filled his stomach at breakfast. "Either we all work together, or nothing works at all."
Appropriate teledematology tool to screen (active survey) a dermatology case of public health importance like leprosy is

a. Mobile teledermatology
b. Videoconference
c. Store and forward teledermatology
d. Online discussion group

Yesterday’s Mind Teaser: IRIS commonly occurs after how many weeks of ART initiation

a.1-4 week
b.2-12 weeks
c.12-24 weeks
d. after 6 months

Answer for Yesterday’s Mind Teaser: b.2-12 weeks

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr Jayashree Sen & Dr Jayashree Sen, Dr K Raju, Dr Kailash Chandra Sharma, Dr Avtar Krishan.

Answer for 19th December Mind Teaser: c.pyoderma gangrenosum

Answers received from: Dr Poonam Chablani, Dr Bitaan Sen & Dr Jayashree Sen, Jayashree Sen, Daivadheenam Jella.
Readers column
Dear Sir, Thanks for enriching our knowledge. Regards: Dr Shubham
A chemist, a physicist, and a mathematician are stranded on an island when a can of food rolls ashore. The chemist and the physicist come up with many ingenious ways to open the can.

Then suddenly the mathematician gets a bright idea: "Assume we have a can opener …"
Press Release
2016 to witness a switch from trivalent Oral Polio Vaccine to bivalent Oral Polio Vaccine

In routine immunization babies will get bOPV and not tOPV from 25th April and at third dose of oral polio vaccine (OPV) they will also be administered an injection with inactivated polio vaccine (IPV)

By that date all vaccines having three types of polioviruses will be destroyed. Type 2 virus will also be destroyed in all laboratories (except Pune Virology Institute) to eliminate the chances of its spread again. The efficacy of bOPV will be five times that of tOPV because there will be only two viruses in the vaccine.

Type 3 virus would be removed from the vaccine as next step because not a single case of this virus had been reported from anywhere in the world during the past two years. By 2020 OPV will be completely stopped and only Inactivated Polio Vaccine, which is a dead virus, will be used all over the world.

IPV and OPV together can provide additional protection to a child. The last polio case was reported in India in 2011. India was certified polio-free on 27 March 2014, but the immunization programme continues since two of its neighbors (Pakistan and Afghanistan) remain polio-endemic and due to the threat of vaccine-derived polio. Since 2009, India has witnessed 41 cases of Vaccine-derived poliovirus (VDPV), including two such cases in 2014

Speaking about this, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA in a joint statement said, “A switch to bivalent is necessary as in settings with low immunization coverage, live vaccine virus used in Oral polio vaccines (OPV) can multiply for long and undergo mutations to gain neuro-virulence. This VDPV can cause paralysis and circulate in the community to cause outbreaks. Vaccine-associated paralytic polio (VAPP) is a rare but serious adverse event following OPV administration. VAPP tends to occur in both OPV recipients and their unimmunized contacts”.

Currently, two types of polio vaccines are mainly used in National health programs in India. The trivalent OPV (tOPV) contains live attenuated polioviruses of all three serotypes (1,2,3). Bivalent OPV (bOPV) contains two serotypes of live attenuated poliovirus (type 1 and 3). More than 90% VDPV cases in India are caused by type 2 virus.

OPV was preferred over IPV for public health programs during pre-eradication period, mainly due to its lower costs and ease of implementation. Now, VAPP and VDPV overwhelmingly outnumber polio due to WPVs, and therefore OPV has to be discontinued as early as feasible, for ethical reasons. It is imperative to eliminate the iatrogenic risk of VAPP at any cost, (in line with the principle of first do no harm).

There is an increased risk of emergence of cVDPVs during the withdrawal of trivalent OPV as the immunity level against type 2 poliovirus will decrease. To prevent such an emergence of VDPV, it is recommended that before this switch population immunity against type 2 polio virus be boosted by introduction of at least one dose of Inactivated Polio Vaccine (IPV) in the UIP. Global OPV2 withdrawal requires the absence of ‘persistent’ cVDPV2 for at least 6 months.

If one dose of IPV is used, it should be given from 14 weeks of age (when maternal antibodies have diminished and immunogenicity is significantly higher), and can be co-administered with an OPV dose. New schedule (three OPV doses + one IPV dose)