NHRC notices to Delhi Chief Secretary, DCGI and Police Commissioner after epilepsy drug Sodium Valproate fails quality test

New Delhi: The National Human Rights Commission, NHRC, India has taken suo motu cognizance of a media report that a medicine ‘Sodium Valproate’, recommended for treatment of epilepsy in Delhi government-run hospitals and Mohalla Clinics, has been found to be not meeting the requisite standards as per a report issued by the Regional Drug Testing Laboratory (RDTL), Chandigarh.

According to the media report, another medicine prescribed by the doctors for the treatment of epilepsy was also found to be inadequate.

The report released by the Directorate of Vigilance showed that a total of 43 samples of medicines were sent for examination by the government laboratories, out of which 4 samples failed the test, and the report for 11 samples is still awaited.

The Commission has observed that the contents of the news report, if true, raise a serious issue of violation of human rights, which is a matter of concern. Accordingly, it has issued notices to the Delhi Chief Secretary, the Drugs Controller General of India, and the Police Commissioner calling for a detailed report within four weeks.

According to the media report, carried on 28th December, 2023, five medicines have been banned so far, including those being prescribed for the treatment of hypertension, epilepsy, excess acid influx, joint pain, and swelling in the lungs.

Read also: Delhi Vigilance Dept sends suspected spurious drugs matter to Health Ministry, urges CBI probe

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More than 400 Seats vacant: Doctors Urge Health Ministry, NMC to Reduce NEET SS Cutoff, conduct special round

New Delhi: Referring to the significant number of vacant super-specialty medical seats, the doctors under the United Doctors Front Association (UDFA) recently urged the Union Health Ministry and the National Medical Commission to reduce the cut-off percentile for the National Eligibility-cum-Entrance Test Superspeciality (NEET-SS) Counselling 2023.

Further, the association has also urged the authorities to release the schedule for the mop-up round/special round promptly to fill up all the vacant seats so that no super-specialty seats are left vacant.

UDFA sent this letter to the authorities after the NEET SS 2023 aspirants wrote a letter to the association and pointed out that more than 400 DM/MCH/DrNB seats are still vacant after the Round 2 of the NEET SS Counselling.

In the letter directed to the UDFA president, the super speciality aspirants further mentioned that the seats not joined by candidates after round 2, the seats upgraded from round 1 and the seats left by the INI SS candidates will add to this pool in addition to the seats left vacant after the Round 2.

Therefore, in order to avoid wastage of precious medical seats, the aspirants mentioned, “So we request to consider announcing an early mop-up counselling this year immediately after the last date of reporting and joining of round 2 alloted candidates with cut-off percentile reduction to the minimum percentile to ensure 100% participation as done for NEET SS 2021 and NEET PG 2023 counselling which happened without any percentile requirements. We request the Medical Counselling Committee and DGHS to consider this issue as a serious matter of concern and revise cut off to the minimum percentile and conduct mop-up round, and to release the schedule for the same at the earliest.”

“This will prevent the wastage of precious super speciality seats across the country and will also help in commencing the academic session earlier. We would like to bring to your notice that the late scheduling of mop-up round will delay the commencement of the academic session and thesis protocol submission and the course and tenure extension,” the letter further mentioned.

The aspirants also highlighted that the NEET SS 2023 exam, which was held on 29th and 30th of September had an unusual delay in the exam time. Due to this, even though the candidates reported to the exam centre by 7 am, the exam that was scheduled to commence by 9 am was allegedly rescheduled to beyond 11 am due to a technical error from NBEMS.

Also Read: More than 1000 Super-Specialty Seats Vacant: FORDA writes to DGHS, demands NEET SS mop-up round after reducing cut-off

Blaming the low marks in the exam on the mismanagement in the examination, the aspirants mentioned in the letter, “As the reporting time was earlier and the exam was conducted late, many candidates had hypoglycemic issues and anxiety which hindered their performance in this exam.Despite addressing this issue after examination, no necessary steps had been taken. Now the candidates despite preparing well, are suffering with low marks because of exam day hassle.”

The letter highlighted that the cutoff for NEET SS 2021 was revised and reduced to zero percentile. Further, the cut-off for NEET PG 2023 was also reduced to zero and due to this every candidate who appeared in the exam became eligible to participate in the counselling. Despite this, 247 PG medical seats remained vacant even after the counselling without any percentile requirement.

Further, the aspirants pointed out that even the Supreme Court expressed concern about vacancies in super speciality seats recently, and had asked the Union Government and MCC to find a solution so that none of the seats go wasted.

After receiving the letter from the aspirants, the issue was raised by UDFA. Writing to the Union Health Ministry, the National Medical Commission (NMC), Medical Counselling Committee (MCC) and the National Board of Examinations in Medical Sciences (NBEMS), the association highlighted the fact that after the conclusion of Round 2 of NEET SS counselling, a significant vacancy of DM/MCH/ DrNB seats has been identified.

“In light of this, we kindly request for re- revision of the cut-off percentile to the least effective percentile, aligning with the practices observed in the NEET PG 2023 and the previous year’s NEET SS Examination. Furthermore, we urge you to release the mop-up round/special round schedule promptly to fill up all the vacant seats so that no superspeciality seat remains vacant,” the association urged the authorities.

The association also emphasized the unusual delay in the conduct of the NEET SS exam on the 29th and 30th of September, technical errors by NBEMS resulting in rescheduling of the exam, which ultimately allegedly impacted the performance of the well-prepared candidates.

“So we request the Government to kindly please consider the request of NEET SS aspirants & release a special round /mop-up round schedule with a re-revision of cutoff scores for participation in counselling so that there will be prevention of wastage of precious super speciality seats across the country,” the letter further mentioned.

Medical Dialogues had earlier reported that in the case of NEET SS 2022 also, the eligibility criteria had been reduced from 50 percentile to 20 percentile. This move came against the backdrop of over 1000 super speciality seats being vacant after the completion of the two counselling rounds.

This year, the Information Bulletin for NEET SS 2023 mentioned that candidates placed at 50th percentile score or above in their respective groups will be declared as qualified as per minimum qualifying criteria.

However, the Health Ministry intervened, and after discussing the issue with NMC, the Union Ministry of Health and Family Welfare (MoHFW) directed NBE to reduce the cut-off qualifying percentile for NEET SS 2023 to 20 percentile points.

Also Read: Breaking News: Health Ministry Directs NBE to Reduce NEET SS Cut-off to 20 percentile

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Medical Bulletin 30/December/2023

Here are the top medical news of the day:

Low-carbohydrate diet macronutrient quality and weight change

In this study using data from three large prospective cohort studies among 123,000 individuals, low-carbohydrate diets that emphasized high-quality proteins, fats and carbohydrates from whole grains and other healthy plant-based foods were significantly associated with slower weight gain in the long term. In contrast, low-carbohydrate diets emphasizing animal-sourced proteins and fats or refined carbohydrates were associated with faster weight gain.

The associations of low-carbohydrate diets (LCDs) with long-term weight management remains unclear, and the source and quality of macronutrients within LCDs are less explored.

Reference: Liu B, Hu Y, Rai SK, Wang M, Hu FB, Sun Q. Low-Carbohydrate Diet Macronutrient Quality and Weight Change. JAMA Netw Open. 2023;6(12):e2349552. DOI: 10.1001/jamanetworkopen.2023.49552

Hormone Therapy may lower risk of Allergic Rhinitis in Perimenopausal Women

In a recent study conducted between May 2020 and March 2021 at Shijitan Hospital, researchers explored the complex connections between hormone therapy (HT), obesity, and allergic rhinitis (AR) in perimenopausal women. The study found that HT was found to reduce the risk of AR in perimenopausal women and intriguingly an association was also found between HT, BMI, and AR as lean women on HT exhibited a higher risk for AR compared to overweight women on HT.

The study results were published in the journal Allergy, Asthma and Clinical Immunology.

Reference: Liu J, Ma T, Wang X, Bai W, Wang X. Associations between HT, BMI, and allergic rhinitis in perimenopausal women. Allergy Asthma Clin Immunol. 2023;19(1):107. Published 2023 Dec 19. DOI: 10.1186/s13223-023-00839-7

Benzodiazepine use during pregnancy and risk of miscarriage

In this case-time-control study, benzodiazepine use during pregnancy was associated with an increased risk of miscarriage, even after accounting for unmeasured confounders, including those related to genetics and the family environment. The study is published in JAMA Psychiatry.

Benzodiazepine use during pregnancy has raised significant concerns due to the potential harmful effects of this drug class on neonates. Studies on the association between benzodiazepine use and the risk of miscarriage are limited.

Reference: Meng L, Lin C, Chuang H, Chen L, Hsiao F. Benzodiazepine Use During Pregnancy and Risk of Miscarriage. JAMA Psychiatry. Published online December 27, 2023. DOI: 10.1001/jamapsychiatry.2023.4912.

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Explosion at Hi-Tech Medical College Hospital, 3 employees injured

Bhubaneswar: In an unfortunate incident, at least three employees of the Hi-Tech Medical College and Hospital here were injured in an explosion while filling gas in an outdoor Air conditioner on Friday.

Hospital sources said all of them sustained minor injuries and were undergoing treatment in the hospital. They were out of danger.

Also Read:Explosion at Markandeya Sahakari Hospital oxygen plant in Solapur, 1 dead

The hospital authorities denied about any fire incident.

As per a media report in Odisha TV, “There was no oxygen cylinder blast in the hospital. The explosion took place during AC gas filling. Three to four persons sustained minor injuries in the mishap and they are currently under treatment in the hospital,” Hi-Tech hospital PRO told OTV.

Also Read:Gujarat: 2 dead, 2 injured in explosion at Valsad pharma company

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UP: Medical colleges instructed to install solar plants

Lucknow: The medical colleges in Uttar Pradesh will produce additional electricity through solar plants.

UP Deputy Chief Minister Brajesh Pathak, who also holds the health portfolio, said: “Principals of medical colleges have been instructed to install solar plants on campuses. This will help in obtaining uninterrupted power supply.”

Also Read:Odisha: Govt to set up solar rooftop plants at 32 District headquarters hospitals,7 Medical colleges

The state has 35 medical institutions in the government sector, including King George’s Medical University, Lohia Institute, and Meerut Medical College, which generate electricity using solar plants.

Pathak said that if all colleges generate excess electricity, they can enter into a contract with the Uttar Pradesh New and Renewable Energy Development Agency (UPNEDA) for the sale of excess electricity.

“Generating solar power will also contribute to improving patient care through uninterrupted power supply,” added Pathak.

He also mentioned plans to upgrade the modular operating theatre at King George’s Medical University, and the Cardiology Institute at GSVM Memorial Medical College in Kanpur is set to initiate a DNB course in vascular surgery.

Also Read:Delhi AIIMS signs MoU with IREDA aimed at powering hospital campus by solar energy

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Roche enters into agreement to acquire LumiraDx Point of Care technology combining multiple diagnostic modalities on single platform

Basel: Roche has announced the entry into a definitive agreement to acquire select parts of the LumiraDx group related to LumiraDx’s innovative Point of Care technology. Following closing of the transaction, which is expected by mid-2024, the acquired entities will be fully integrated into Roche Diagnostics.

“The addition of the LumiraDx technology to our diagnostics portfolio will enable us to transform testing at the point of care.” said Matt Sause, CEO Roche Diagnostics. “LumiraDx has developed a highly versatile platform that delivers strong performance across multiple disease areas and technologies. We believe this will enable better patient access to timely results in decentralised healthcare settings worldwide.”

Veronique Ameye, Chief Executive Officer of LumiraDx added, “Since our founding, we have sought to transform community-based healthcare by consolidating multiple Point of Care tests on a single instrument. We are thrilled that Roche will continue this important work and increase its reach around the globe. This will enable more patients to get fast and easy access to better diagnostic testing.”

The acquired technology platform offers a wide range of immunoassay and clinical chemistry tests, with great potential for additional high medical value tests in the future. These are capable of being stored at room temperature which enables convenient handling in a range of decentralised healthcare settings. 

The transaction is subject to certain conditions including antitrust and regulatory approvals.

Under the terms of the agreement, at the closing of the transaction Roche will pay a purchase price of USD 295 million (subject to customary closing adjustments) and an additional payment of up to USD 55 million for the reimbursement of amounts to fund the Point of Care technology platform business until the closing of this acquisition. The transaction is part of a pre-packaged UK administration sale, with the full support of LumiraDx group’s senior secured lender.

Read also: Roche Xolair gets USFDA priority review for children, adults with food allergies

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COVID-19 JN.1 Variant: Safdurjung hospital reserves 50 isolation beds, 9 ICU beds

New Delhi: Amid the rise in COVID-19 cases due to the JN.1 sub-variant in various states, after AIIMS, Safdarjung Hospital in the national capital has also reserved beds for patients and made other arrangements including oxygen and testing. 

The hospital administration has reserved 50 beds for isolations, and 9 ICU beds. Apart from this, complete arrangements have also been made in the hospital regarding oxygen, PPE kits, and COVID testing.

Senior pulmonologist and former Safdarjung Hospital HOD, Dr Neeraj Gupta, said, “JN.1 is a variant of Omicron. It is a very mild virus. The only advantage this virus has because of this mutation is that it crosses our immune barriers and is able to infect us with a normal infection. Like any viral infection, this is also mild; it is not of a very severe nature, and we are not expecting any admissions or higher admission rates.” 

Also Read:COVID subvariant JN.1: AIIMS Delhi advises not to panic, need to remain alert

He further said that normally, patients with comorbidities or any severe condition that decreases the immune system are going to have more morbidity, which may lead to mortality.

“We had one patient of Covid, which was rapid antigen positive when the patient got admitted, and now the patient is negative, so we don’t really know whether it’s genuine or not, but we are testing all the patients who are suspected of Covid-like symptoms, and still now we have not detected any,” Dr Gupta said.

He said they have not detected any positive case till now, but are ready with all the kits, and have all the arrangements for treatment of any COVID patients, including isolation beds.

“We have about 50 beds for isolation and 9 ICU beds, which are ready for all the deployments. There are also adequate PPE kits or medicines available, including oxygen. And if any eventuality comes in, we are ready for it but I do not really anticipate any such rush because, in time, Omicron also did not get so many admissions,” he added.

He further said, “I will want people to beware. Take all the precautions, including avoiding any exposure to excessive cold. Try to remain healthy and exercise when the Sun comes out. Take a nutritious diet and exercise all Covid-appropriate behaviour, like wearing masks in public, and this will also prevent them from many pollution-related issues.”

Meanwhile, Delhi’s Health Minister, Saurabh Bharadwaj, visited Lok Nayak Jai Prakash Narayan Hospital on Thursday to assess the preparedness. The hospital has reserved 20 beds for COVID-19 patients, but there hasn’t been a confirmed case in the hospital yet.

Separate help desks have been set up for COVID-19 patients, along with a dedicated testing centre in the hospital. Immediate treatment will be given upon confirmation of Covid. Directives have been issued to maintain readiness in all Delhi government hospitals. The Delhi Health Minister is continuously monitoring the situation.

“Currently, the entire ward is empty as there have not been any confirmed case of a COVID patient in the hospital yet. However, continuous screening of patients with COVID-related symptoms is ongoing. As soon as any COVID-related patient is confirmed, they will be immediately admitted, and treatment will commence. Almost all preparations in the hospital have been completed, and further preparations will be made as per the evolving situation,” said Saurabh Bharadwaj.

The Health Minister, during this briefing, mentioned that directives have been issued to all hospitals under the Delhi government to maintain all preparations for dealing with COVID-19.

“Although there isn’t any situation causing panic in Delhi presently, it doesn’t mean that hospital administrations should be lax. All hospitals must remain prepared to deal with COVID,” he added.

Also Read:COVID subvariant JN.1: AIIMS Delhi advises not to panic, need to remain alert

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High Frequency of Adding Salt to Food increases Risk of Incident CKD

In a groundbreaking study researchers from the U.S.A reported the effect of adding salt to foods on chronic kidney disease. They found that increased addition of salt to foods, reported by self, lead to an increased risk of chronic kidney disease in general population.

The study results were published in the journal JAMA Network Open.

Also Read: Dietary Sodium Cut linked to Significant Blood Pressure Reduction

The frequency with which individuals report adding salt to their food may indicate their enduring preference for salty tastes. High salt intake has been linked to a heightened risk of cardiovascular diseases (CVD). However, it is currently unclear whether self-reported salt addition to foods correlates with an elevated risk of chronic kidney disease (CKD). Hence researchers from New Orleans and Boston conducted a cohort study to prospectively examine the association of self-reported frequency of adding salt to foods with incident CKD risk in a general population of adults.

This cohort study, based on a population from the UK Biobank, focused on individuals aged 37 to 73 years who did not have CKD when the study began. Recruitment took place between 2006 and 2010, with participants then monitored over time for disease development. Participants’ self-reported habits of adding salt to their food were classified as never/rarely, sometimes, usually, or always. The main outcome was incident CKD occurrences identified using specific diagnostic codes. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were computed using Cox proportional hazards models. These models took into account various potential variables, including age, gender, racial background, ethnicity, the Townsend Deprivation Index, baseline factors like eGFR, BMI, smoking habits, alcohol consumption, regular exercise, high cholesterol levels, diabetes, history of CVD, hypertension, infectious and immune-related diseases, as well as the use of nephrotoxic medications at the study’s onset.

Findings:

  • In a cohort comprising 465,288 individuals with average [SD] age of 56.32 [8.08] years; 255,102 females [54.83%] and 210,186 males [45.17%]), those who frequently added salt to their foods tended to have a higher BMI, a greater Townsend Deprivation Index score, and a lower baseline eGFR than those who added salt less often.
  • Furthermore, individuals who regularly added salt were more inclined to be current smokers and to have diabetes or CVD at the study’s outset compared to their counterparts who seldom added salt.
  • Over a median (IQR) tracking period of 11.8 (1.4) years, 22,031 CKD incidents were recorded.
  • After accounting for various factors, a greater self-reported salt addition frequency was notably linked to an elevated CKD risk.
  • Specifically, compared to those seldom or never adding salt, the risk was higher for those who sometimes added salt (adjusted HR [aHR], 1.04; 95% CI, 1.00-1.07), usually added salt (aHR, 1.07; 95% CI, 1.02-1.11), and always added salt (aHR, 1.11; 95% CI, 1.05-1.18) to their food (P for trend < .001).
  • Moreover, factors like eGFR, BMI, and physical activity levels influenced these associations, with more significant effects seen in participants with higher eGFR, lower BMI, or reduced physical activity. 
Also Read: Gut microbiota dysbiosis tied to progression of chronic kidney disease
    Thus, the present study summarized that an increased self-reported habit of adding salt to foods correlates with an elevated risk of CKD. These results advocate for minimizing salt addition to foods as a potential approach to prevent CKD. Further post hoc analyses or subsequent studies in clinical settings are essential to confirm these observations.
    Further reading: Tang R, Kou M, Wang X, et al. Self-Reported Frequency of Adding Salt to Food and Risk of Incident Chronic Kidney Disease. JAMA Netw Open. 2023;6(12):e2349930. doi:10.1001/jamanetworkopen.2023.49930

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    Delhi Health Minister visits LNJP Hospital, takes stock of Covid preparedness

    New Delhi: Delhi Health Minister Saurabh Bharadwaj visited the LNJP Hospital on Thursday to take stock of its preparedness for COVID-19 and asserted that the facility is fully geared to deal with any exigencies. 

    Bharadwaj told PTI Video that arrangements for conducting RT-PCR tests have been made outside the hospital and there is modern equipment at the health facility. He said no Covid patient is admitted in the hospital at present.

    Also Read:COVID JN.1 Surge: Lady Hardinge Hospital reserves 48 beds for patients

    “Following the oxygen shortage that was seen during the Covid wave in Delhi and across the country, the hospital now has piped oxygen supply through a centralised system,” he said.

    Asked if the Delhi government is planning to reserve any beds for Covid patients, the minister said only four people are currently hospitalised with the infection in the city.

    “If you reserve beds, where will those patients who have surgeries planned or have suffered from strokes or heart attacks go? We are monitoring the situation and, if need be, will reserve beds. There are only four patients who have been hospitalised,” he said.

    Later in a statement, he said a separate ward has been set up at LNJP Hospital for Covid patients with approximately 20 beds and all necessary facilities arranged to address issues related to the viral disease.

    “Currently, the entire ward is empty as there hasn’t been any confirmed case of a Covid patient in the hospital yet. However, continuous screening of patients with Covid-related symptoms is ongoing,” Bharadwaj said.

    “As soon as any Covid-related patient is confirmed, they will be immediately admitted and treatment will commence. Almost all preparations in the hospital have been completed and further preparations will be made, as per the evolving situation,” he added.

    Delhi on Wednesday reported its first case of COVID-19 sub-variant JN.1. The 52-year-old female patient was vaccinated against the virus.

    The patient has now recovered and returned home, Bharadwaj said, adding that although this variant is considered less dangerous than the previous ones, “it’s crucial not to be negligent”.

    “Vaccination was for the old variants (of the virus). The new variants have bypassed vaccines. But the latest variant is causing a mild disease. People should understand that this is a new variant,” Bharadwaj said.

    The health minister mentioned that directives have been issued to all hospitals under the Delhi government to maintain preparations for dealing with COVID-19.

    “Although there isn’t any alarming situation in Delhi at the moment, as a precautionary measure, instructions have been given to all hospitals to ensure readiness. This is to handle any emergencies more effectively in the future,” he said.

    “We hope that there won’t be any such issues but it’s essential for us to remain vigilant and cautious. In this context, directives have been given to all hospitals to maintain their preparedness,” the minister stated.

    If any negligence is found in any hospital, strict action will be taken against the administration, Bharadwaj said.

    Earlier, LNJP Hospital Medical Director Dr Suresh Kumar said there is no reason to panic.

    “This (JN.1) is a sub-variant of Omicron. The symptoms are mild and rarely do people get a severe infection. However, those who have diabetes, a liver-related disease or are on dialysis should get themselves tested if they show symptoms,” he said.

    “If you are immunocompromised, you should wear a mask while visiting crowded places or hospitals. Opt for a balanced diet, including fruits,” he added.

    Also Read:Special 500-bedded COVID ward set up at Salem Government Hospital

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    Potassium magnesium citrate bests potassium chloride for Prevention of thiazide induced hyperglycemia

    USA: A recent study published in Hypertension has shown potassium magnesium citrate (KMgCit) to be superior to potassium chloride (KCl) in preventing thiazide diuretic (TD)-induced hyperglycemia in patients with hypertension without diabetes. Potassium chloride is the common form of potassium supplement used in clinical practice.

    Thiazide diuretics are the first-line hypertension treatment because of their consistent benefit in lowering blood pressure (BP) and cardiovascular (CV) risk. TD is also known to cause an excess diabetes risk, which may limit long-term use. Potassium depletion is suggested to be the main mechanism of TD-induced hyperglycemia, TD also triggers, but also triggers magnesium (Mg) depletion.

    There has been no investigation of the role of Mg supplementation in modulating metabolic side effects of TD. Considering this, Wanpen Vongpatanasin, University of Texas Southwestern Medical Center, Dallas, TX, and colleagues aimed to determine the effect of KMgCit on fasting plasma glucose and liver fat by magnetic resonance imaging during thiazide diuretic therapy.

    For this purpose, they conducted a double-blind RCT comprising 60 nondiabetic hypertension patients to compare the effects of KCl versus KMgCit during chlorthalidone treatment. Each patient received chlorthalidone alone for three weeks before randomization. The primary endpoint was the change in fasting plasma glucose following 16 weeks of KMgCit or KCl supplementation from chlorthalidone alone. The mean age of subjects was 59±11 years.

    The study revealed the following findings:

    • Chlorthalidone alone induced a significant rise in fasting plasma glucose, and a significant fall in serum K, serum Mg, and 24-hour urinary citrate excretion.
    • KMgCit attenuated the rise in fasting plasma glucose by 7.9 mg/dL versus KCl, which was not observed with KCl.
    • There were no significant differences in liver fat between the 2 groups.

    “These findings suggest that potassium magnesium citrate may offer a superior alternative to potassium chloride, typically used in clinical practice, in maintaining serum potassium during thiazide-diuretic treatment while avoiding thiazide-induced hyperglycemia,” the researchers wrote.

    ‘This action may improve cardiovascular safety and tolerability in patients with hypertension treated with this drug class,” they concluded.

    Reference:

    Vongpatanasin W, Giacona JM, Pittman D, Murillo A, Khan G, Wang J, Johnson T, Ren J, Moe OW, Pak CCY. Potassium Magnesium Citrate Is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone. Hypertension. 2023 Dec;80(12):2611-2620. doi: 10.1161/HYPERTENSIONAHA.123.21932. Epub 2023 Oct 17. PMID: 37846572.

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