Zika fight: Singapore releases more mosquitoes

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The National Environment Agency (NEA) on Tuesday (Oct 18) began its six-month trial in using bacteria-carrying mosquitoes to tackle the mosquito population in Singapore.

The agency released 3,000 male Wolbachia-carrying Aedes aegypti mosquitoes at Braddell Heights on Tuesday as part of a six-month field study to learn more about the species. This will also be done at Nee Soon East and Tampines West next month.

Over the next six months, an average of one to three male mosquitoes per person will be released weekly at multiple points in Tampines West, and monthly from a single point in Nee Soon East and Braddell Heights.

Over the next six months, an average of one to three male mosquitoes per person will be released weekly at multiple points in Tampines West, and monthly from a single point in Nee Soon East and Braddell Heights.

They will not be released directly into homes, but instead at stairwells, void decks and other open spaces, NEA said.

While the male mosquitoes may fly around and enter homes to seek out females and find shelter, they will not bite or transmit disease. Eggs produced from the male Wolbachia-carrying Aedes aegypti mosquito and a female urban Aedes aegypti mosquito will not hatch.

The study aims to find out if mosquitoes behave in the same way in the urban environment as they do in the laboratory. This will be done by studying how far and high they fly, how long they live, and how well they compete in the urban environment.

Dr Ng Lee Ching, who heads the study, said: “The key important data we’re collecting is flight range. So we only release at one point and we have traps all over in the community.

“We’re very happy to have residents to host fan-traps, and they’ll be collecting data for us,” she added.

The study will run till March next year, according to NEA.

(Source: Channel News Asia, October 18, 2016)

Where was the mistake? NCDRC asks Chennai hospital to pay Rs 10L compensation

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The apex consumer commission has awarded a compensation of Rs 10 lakh against Madras Medical Mission hospital to be given the kin of Dr J S Paul who died of brain damage by holding it that the patient was not being monitored while in ICU in post-CABG state.

“I have no hesitation in holding that late Dr Paul was not continuously connected to a pulse oximeter (used for measuring blood oxygen) though his saturation levels were being monitored and recorded on hourly basis. To this extent, the hospital was negligent in rendering services to the patient, during his stay in the ICU of the hospital,” commission’s presiding member Justice V K Jain said. “The Madras Medical Mission is directed to pay compensation quantified at Rs 10,00,000 to complainants along with the cost of litigation quantified at Rs 25,000,” he added.

On July 11, 2007, Paul had undergone a coronary artery bypass graft surgery at the hospital and was shifted to ICU later. He was not connected to a pulse oximeter. Dr Paul remained in comatose state and on life support system with irreversible brain damage from July 15, 2007, and was declared dead on July 28.

Hospital version: It was one of the most well-equipped and well-manned ICUs in the country and there was bedside monitoring by nurses and physicians were available round-the- clock to monitor the patients. The pulse oximeter saturations, arterial blood gases and other hemodynamic parameters are continuously monitored in the ICU and documented.

Where was the mistake?

Commission: The hospital had not submitted any evidence to substantiate its claims.

Lessons learnt

• Whatever you think, say it.
• Whatever you say, do it.
• Whatever you do, document it.
• Whatever you document preserve it.
• Whatever you preserve put it on record in any proceeding.

Should it be challenged?
Yes. The decision should be challenged

• Study the case file in detail. Conduct an internal death audit and an enquiry committee with external experts.
• Take opinions from ICU, ICCU experts reports ( Pan India or International)
• Submit literature support. Prima facie it looks a case of post op stroke and not peripheral anoxia. Take experts opinion weather it was anoxia or cerebral damage due to stroke. Cerebral injury is a frequent complication of cardiac surgery and has been associated with high mortality, morbidity, hospital costs, and an increased likelihood of admission to a secondary care facility after hospital discharge, and impaired quality of life. There are a variety of manifestations of perioperative cerebral injury including ischemic (or, less commonly, hemorrhagic) stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients, and neurocognitive dysfunction affecting 20% to 30% of patients one month after surgery. • Study informed consent weather post op complications including stroke were mentioned. Look for pre op evidence of carotid atherosclerosis (Carotid Doppler)
• In ICU you have 1: 1 nurse and doctors on duty round the clock. If Sao2 falls below 90, other hypoxia signs will be evident. Its persistent hypoxia which is dangerous.
(Source: PTI)

MCI Gazette notifies prescription clause in ethics regulation – IMA View

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MCI gazette notification: “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.”

The notification was issued to amend the Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulation 2002. Approved for publication on September 21, this is an upgrade of the previous notification that says doctors should write generic names of the drugs they prescribe.

Medical Council of India Notification New Delhi, the 21st September, 2016 No.MCI-211(2)/2016(Ethics)/131118:–

In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956 (102 of 1956), the Medical Council of India with the previous sanction of the Central Government, hereby makes the following Regulations to amend the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002: – Short Title and Commencement:-

(i) These Regulations may be called the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) (Amendment) Regulations, 2016 – Part – I”. (ii) They shall come into force from the date of their publication in the Office Gazette.

2. In the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002”, the following additions/modifications/deletions/substitutions, shall be, as indicated therein:-

3. In Chapter 1-B-Duties and responsibilities of the Physician in general, Clause – 1.5 under the heading – Use of Generic names of drugs, the following shall be substituted : -

“Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs”

Dr Reena Nayyar, Secy. I/c
[ADVT.-III/4/Exty./253(100)]

IMA Views
• The notification says ‘should’ and not ‘shall’. So it is an advisory.
• Drugs with generic name means chemical name should be written.
• This does not bar from writing the brand name in addition.
• Even the Jan Aushadhi project of the government, the word ‘Jan Aushadhi’ is a brand.
• Capital letters will reduce prescription errors.
• ‘Legibly’ means electronic prescriptions are not compulsory.
• ‘Preferably’ means attempts should be made.
• Rational use is scientific and evidence-based.

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