Diabetes may double the risk of acquiring lifetime tuberculosis

Health Care, Heart Care Foundation of India, Medicine Comments Off

Every case must be notified, and treatment provided accordingly

New Delhi, 19 March 2019: The World Health Organization has indicated that about 15% of the global tuberculosis (TB) burden is now attributed to diabetes. A recent review pointed out that diabetes can double the lifetime TB risk. As per a review paper published in Diabetes Metabolism Research and Reviews recently, the prevalence of TB in diabetes and diabetes in TB was at least two-three times higher than that found in the general population.

In TB infections, the stress responses by the body result in impaired glucose tolerance, a risk factor for diabetes. TB drugs (namely, rifampicin) also make it more difficult to maintain glucose control. People with diabetes should seek treatment if they have a cough lasting more than two weeks, fever, night sweats and/or weight loss.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “To control TB, it is important to prevent diabetes. This is true especially in a country like India where rates of TB are amongst the highest and the incidence of type 2 diabetes is also rising sharply. Diabetes can go undiagnosed for a long period, so it makes sense to do proactive screening for diabetes in all patients with TB. Conversely, diabetes should be on the clinical radar when caring for people with TB. If an elderly develops TB, rule out diabetes and if an elderly develops diabetes, rule out TB. Rule out TB in every case of uncontrolled diabetes.”

India has the highest TB burden country in the world in terms of the absolute numbers of incidence cases each year. Mortality due to TB is the third leading cause of years of life lost (YLLs) lost, in the country.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “All open TB patients need to be immediately identified, and treated till they become sputum negative and non-infective. Most TB-positive patients do not disclose their TB status due to the fear of social stigma and so keep spreading the disease to others. The public needs to be informed that every open case of TB will cause 15 new cases of TB, if not treated in time. TB is a curable disease. Full and adequate treatment is important for complete recovery.”

Some tips from HCFI

TB is a notifiable disease and therefore, the approach should be based on DTR “Diagnose, Treat & Report”: Diagnose early, using sputum GeneXpert test; Treat: Complete and effective treatment based on national guidelines, using FDC; and Report: Mandatory reporting.”

  • Wash your hands after sneezing, coughing or holding your hands near your mouth or nose.
  • Cover your mouth with a tissue when you cough, sneeze or laugh. Discard used tissues in a plastic bag, then seal and throw it away.
  • Do not attend work or school.
  • Avoid close contact with others.
  • Sleep in a room away from other family members.
  • Ventilate your room regularly. TB spreads in small closed spaces. Put a fan in you window to blow out air that may contain bacteria.

It is a medical shame: How Cuban doctors were used to coerce Venezuela voters

Health Care Comments Off

Nicholas Casey wrote in NY Times about Yansnier Arias who was sent to Venezuela by the Cuban government, one of thousands of doctors deployed to shore up ties between the two allies and alleviate Venezuela’s collapsing medical system. But with President Nicolás Maduro’s re-election on the line, not everyone was allowed to be treated.

As per the article a 65-year-old patient with heart failure urgently needed oxygen. But his Cuban and Venezuelan superiors told him to use the oxygen as a political weapon and not for medical emergencies that day. The veto was to motivate and compel patients to vote for the government.

“There was oxygen, but they didn’t let me use it,” said Dr. Arias.

Many tactics were used, from simple reminders to vote for the government to denying treatment for opposition supporters with life-threatening ailments.

The Cuban doctors said they were ordered to go door-to-door in impoverished neighborhoods, offering medicine and warning residents that they would be cut off from medical services if they did not vote for Mr. Maduro.

Many said their superiors directed them to issue the same threats during closed-door consultations with patients seeking treatment for chronic diseases.

As doctors taking care of patients, our guiding principles are “beneficence (act in the best interest of the patient)” and “non maleficence (do no harm)”. These are derived from “physician autonomy”, where a doctor is free to choose the line of treatment that is best for his/her patient. Doctors have an ethical obligation to always act in the best interests of the patients for their well-being and prevent harm to the patients.

Physician autonomy is inherent in the medical profession. No doctor can be told when to treat patients or when to withhold treatment.

Using doctors in this manner is a clear violation of the Universal Principles of Bioethics as embodied in the UNESCO Universal Declaration on Bioethics and Human Rights.

Respect for human dignity, human rights and fundamental freedoms (Article 3.1)
Priority of the interests and welfare of the individual should have priority over the sole interest of science or society (Article 3.2)
Beneficence and non‐maleficence (Article 4)
Autonomy and individual responsibility (Article 5)
Informed consent (Article 6)
Special protection of persons without the capacity to consent (Article 7)
Respect for human vulnerability and personal integrity (Article 8)
Privacy and confidentiality (Article 9)
Equality, justice and equity (Article 10)
Non‐discrimination and non‐stigmatisation (Article 11)
Respect for cultural diversity and pluralism (Article 12)
Solidarity and cooperation (Article 13)
Social responsibility and health (Article 14)
Sharing of benefits (Article 15)
Protection of future generations (Article 16)
Protection of the environment, the biosphere and biodiversity (Article 17).
Doctors are professionals and professional autonomy is their right. No one can take away this autonomy from a doctor.

It’s nothing but a medical shame.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA