Morning MEDtalks with Dr KK Aggarwal

New Delhi, September 24, 2018 :

Alcohol consumption is responsible for one in 20 deaths globally each year, according to World Health Organization. Worldwide, harmful use of alcohol kills up to 3 million people annually, accounting for 5% of the global disease burden. Most of those who die due to alcohol use—over 75%—are men.

Two new legal codes – civil and criminal – have been introduced in Nepal, threatening the medical profession and media industry, and dividing the country over the consequences. Doctors went on strike over the new penal code earlier this month in protest against the criminalising of medical negligence and lodged a petition with more than 6000 signatures to the Nepal Medical Council. Journalists in Nepal could face up to three years in prison if they publish information deemed to be “confidential” under the new criminal code, says RSF.

Sections 293, 294 and 295 criminalise publishing private information, recording conversations or taking pictures without permission. Under article 306.2, showing ‘disrespect’ towards someone either directly or through satire is also punishable by up to three years in prison. When an article is “shared on social media by someone once it is in the public domain, the sharer will be jailed rather than the government questioning the publisher of the content.

Are life-saving machines, devices and equipments like CPAP machine covered under insurance policy? (Dr KK Aggarwal & Advocate Ira Gupta) Life-saving machines and devices such as pacemaker, CPAP, BiPAP, orthopedic implants, intracardiac valve replacements, vascular stents, relevant laboratory diagnostic tests, X-ray and such similar implants and machines are often prescribed by registered medical practitioners to their patients. Such machines are duly covered under the insurance policy / Mediclaim policy.

If any patient is advised to use CPAP machine for his treatment and such patient has an insurance policy / Mediclaim policy in his/her name, then the insurance company has to make the payment of the cost of CPAP machine to such patient as the same is covered by the insurance policy. Even if there is no specific clause in insurance policy / mediclaim policy stating that the CPAP machine is covered under the insurance policy, then also the insurance company has to pay the patient for the cost of CPAP machine as the same is life-saving machine and without it the treatment of the patient is not complete.

All the doctors, registered medical practitioners, hospitals, nursing homes, etc. should educate their patient that the CPAP machine being a life-saving machine is duly covered by the insurance policy / Mediclaim policy obtained by them and they should immediately contact their insurance company for claiming the reimbursement of the cost of the said machine.

In numerous cases, the National Consumer Dispute Redressal Commission and State Consumer Dispute Redressal Commission of Delhi have held that the CPAP machine being a life-saving machine is completely covered by the insurance policy and the claim of the patient for the same has to be paid by the insurance company.

“New India Assurance Co. Ltd. versus Ghanshyamdas A. Thakur,” order and judgment dated 07.02.2014 passed by Hon’ble National Consumer Disputes Redressal Commission

Narender Kumar Jain versus United India Insurance Company Limited, Hon’ble State Consumer Dispute Redressal Commission of Delhi

“The New India Assurance Co. Ltd. & Anr. Versus Mrs. Sonali Sareen & Anr.” Delhi State Consumer Disputes Redressal Commission order dated 09.12.2014.

US challenges world to intensify global fight against antibiotic resistance.During the United Nations (UN) General Assembly, US Department of Health and Human Services (HHS) Secretary, Alex Azar, will call on leaders worldwide to commit to an unprecedented global initiative led by HHS and the Centers for Disease Control and Prevention: The AMR Challenge. The launch event is co-hosted by CDC and HHS, the Bill & Melinda Gates Foundation, CDC Foundation, Pew Charitable Trusts, the UN Foundation, and the Wellcome Trust.

Resistant hypertension in elderly can be a clinical presentation of heart failure with preserved ejection fraction (HFpEF). In the retrospective single-center analysis of outpatient data published online Sept. 5, 2018 in the journal Clinical and Experimental Hypertension, 22 of older patients had high levels of NT-proBNP compared to only 3 patients in the younger age group. NT-proBNP levels were disproportionally high in elderly and high levels in patients with resistant hypertension were related to a larger left atrial diameter. In conclusion, the study suggests that older patients with resistant HT should be investigated for HF and treated accordingly.

It’s always better to choose soaked almonds over raw almonds. The brown peel of almonds contains tannin, which inhibits nutrient absorption. When soaked overnight the germination process starts in these seeds so the quality of proteins may show some improvement. Almonds provide a healthy, low-carb mix of monounsaturated fats plus magnesium. A large study carried out by Harvard University found that high daily magnesium intake reduced the risk of developing diabetes by 33%. Almonds are a fat-rich food, so do not consume more than an ounce (25-30 grams) a day.

IMA-Karnataka is hosting National IMA Conference from 27th to 29th December, 2018 at B.G.S Global Institute of Medical Sciences, Bangalore.

According to CDC in Atlanta, the overall life expectancy in the US was 78.6 years, down 0.1 from the previous year. Men can expect to live 76.1 years, down from 76.3. Women held steady at 81.1 years.

Some TB Statistics (WHO 2018 Global TB Report)

Overall, TB deaths have decreased over the past year. In 2017, there were 1.6 million deaths (including among 300 000 HIV-positive people). Since 2000, a 44% reduction in TB deaths occurred among people with HIV compared with a 29% decrease among HIV-negative people;
Globally, an estimated 10 million people developed TB in 2017. The number of new cases is falling by 2% per year, although faster reductions have occurred in Europe (5% per year) and Africa (4% per year) between 2013 and 2017;
Some countries are moving faster than others – as evidenced in Southern Africa, with annual declines (in new cases) of 4% to 8% in countries such as Lesotho, Eswatini, Namibia, South Africa, Zambia, and Zimbabwe. In the Russian Federation, high level political commitment and intensified TB efforts have led to more rapid declines in cases (5% per year) and deaths (13% per year).
Drug-resistant TB remains a global public health crisis: In 2017, 558 000 people were estimated to have developed disease resistant to at least rifampicin – the most effective first-line TB drug. The vast majority of these people had multidrug-resistant TB (MDR-TB) i.e. combined resistance to rifampicin and isoniazid.
WHO estimates that a quarter of the world’s population has TB infection.

Personalized medicine and diabetes: In patients with prediabetes determined to be at high risk of progression to diabetes through oral glucose testing, treatment with a triple regimen of medications significantly reduced the likelihood of progression to type 2 diabetes compared with lifestyle modifications alone. Treatment with antidiabetic agents that target insulin resistance (pioglitazone) and beta-cell dysfunction (pioglitazone and glucagon-like peptide 1 [GLP-1] receptor agonist markedly reduces development of type 2 diabetes as per a report in September 14 in Lancet Diabetes & Endocrinology.

Clinicians might want to reconsider their approach to prediabetes on the basis of the pathophysiology of the disease in individual patients and should not simply rely on fasting plasma glucose and HbA1c concentrations.

“We believe that this is light years ahead of present guidelines. Your patients will be happy when you tell them diabetes can be prevented using available tests and targeted anti-hyperglycemic medications.”

In the STOP DIABETES study, 422 patients identified as having prediabetes at an internal medicine and endocrinology community practice between 2009 and 2016 were assessed. By measuring the glycemic response during oral glucose tolerance testing (1-h glucose concentration > 8.6 mmol/L), insulin sensitivity, and β-cell function, the investigators were able to categorize the patients according to risk. In total, 81 patients determined to be at high-risk were treated with a triple therapy regimen of low-dose metformin, pioglitazone, and a GLP-1 receptor agonist. Those assessed as having an intermediate risk (n = 141) were treated only with metformin and pioglitazone. Both groups also received lifestyle therapy. The lowest doses considered to have a physiological effect were used, 850 mg/day for metformin and 15 mg/day for pioglitazone. For the GLP-1 receptor agonist, medications were used based on insurance coverage: exenatide 10 μg twice daily (n = 26), liraglutide 1.2 mg daily (n = 49), exenatide extended-release 2 mg weekly (n = 3), or dulaglutide 1.5 mg weekly (n = 3).