Kerala Flood, August 2018. Aleem.M.A. BMJ 2018;362:k3493

BMJ

News

Seven days in medicine: 8-14 August 2018

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3493 (Published 16 August 2018)

Cite this as: BMJ 2018;362:k3493

Rapid response

Re: Seven days in medicine: 8-14 August 2018

Kerala Flood, August 2018

In the South Indian state of Kerala in August 2018 in devastating rain and flood about 400 people have lost their lives and more than 1 million people have been displaced because of flooding. About 8,000 houses and innumerable livestock have been washed away in the rain and flood. Now the need of the hour problem is to tackle the outbreak of waterborne communicable diseases; many health measures may be required.

For relief measures 500 crore were pledged by our Prime Minister Narendra Modi and Rs 100 crore by our Home Minister Rajnath Singh during their visits to Kerala. The Health Ministry approved an additional grant of Rs 18.71 crore under the National Rural Health Mission (NHM) to flood-hit Kerala. In total the Government of India has announced 6,18,71,00,000 Indian Rupees, equal to 8,84,81,964.58 United States Dollars, as relief fund to its flood hit southern Indian state of Kerala.

Competing interests: No competing interests

24 August 2018

M.A. Aleem

Emeritus Professor* Neurologist**

The Tamilnadu Dr.M.G.R.Medical University** ABC Hospital**

Chennai 600032* Trichy 620018** Tamilnadu India

@drmaaleem

Sunday, August 19, 2018

Need change in Terminology. ALEEM.M.A. BMJ 2018;362:k3528

BMJ

Editor's ChoiceOverdiagnosis and the cancer label

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3528 (Published 16 August 2018)

Cite this as: BMJ 2018;362:k3528

Rapid response

Re: Overdiagnosis and the cancer label

Need change in Terminology.

A new terminology is required to name the low grade cancers . Whenever the word cancer is mentioned as a diagnosis of a tumour , patients and their families are worrying much, even the type of the neoplasm is low grade one.

So to avoid the word cancer in low grade cancer it can be considered to find a new name for this condition or can be named as LGN ( Low Grade Neoplasm) to avoid over interpretation of the the condition by the patients or their relatives.

Competing interests: No competing interests

17 August 2018

M.A. Aleem

Emeritus Professor* Neurologist**

The Tamilnadu Dr.M.G.R.Medical University** ABC Hospital**

Chennai 600032* Trichy 620018** Tamilnadu India

@drmaaleem

Wednesday, August 15, 2018

With Comment by M.A.Aleem #Neurologist #Trichy #Tamilnadu #India in Times of India Trichy on 16.8.2018

https://timesofindia.indiatimes.com/city/madurai/sleep-disorders-a-rising-cause-for-concern/articleshow/65417154.cms

Ayushman Bharat / Modicare Health Insurance Scheme 2018 -Dr.M.A.Aleem  M.D.D.M (Neuro) Emeritus Professor The Tamilnadu Dr.M.G.R. Medical University

Ayushman Bharat / Modicare
Health Insurance Scheme 2018

-Dr.M.A.Aleem  M.D.D.M (Neuro)

Emeritus Professor
The Tamilnadu Dr.M.G.R. Medical University

Former President
Tamilnadu Pondycherry Association of Neurologists

Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.

Consultant Neurologist
ABC Hospital

Trichy 620018
Tamilnadu
India

drmaaleem@hotmail.com
Phone 9443159940

PM Modi has Announced the 
Launching Date of   Ayushman Bharat / Modicare the world largest

Health Insurance Scheme 2018 in India as September 25, 2018 in his 72nd Independence Day Speech on 15.8.2018

Ayushman Bharat is National Health Protection Scheme, which will cover over 10.74 crore poor and vulnerable families (approximately 50 crore beneficiaries 40 %  of our Indian population) providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization. 

Ayushman Bharat - National Health Protection Mission will subsume the on-going centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Salient Features

Ayushman Bharat - National Health Protection Mission will have a defined benefit cover of Rs. 5 lakh per family per year.
Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

Ayushman Bharat - National Health Protection Mission will be an entitlement based scheme with entitlement decided on the basis of deprivation criteria in the Socio Economic Cast Cences ( SECC )database.

The beneficiaries can avail benefits in both public and empanelled private facilities.
To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.

One of the core principles of Ayushman Bharat - National Health Protection Mission is to co-operative federalism and flexibility to states.

For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.
States would need to have State Health Agency (SHA) to implement the scheme.

To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat - National Health Protection Mission to State Health Agencies may be done through an escrow account directly.
In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.

IMPLEMENTATION STRATEGY

At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (AB-NHPMA) would be put in place. States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme.
States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

Major Impact

Ayushman Bharat - National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of:

Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)

Covering almost all secondary and many tertiary hospitalizations. (except a negative list)

Coverage of 5 lakh for each family, (no restriction of family size)

This will lead to increased access to quality health and medication. In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to. 

This will lead to timely treatments, improvements in health outcomes, patient satisfaction, improvement in productivity and efficiency, job creation thus leading to improvement in quality of life.

EXPENDITURE INVOLVED

The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue. The total expenditure will depend on actual market determined premium paid in States/ UTs where Ayushman Bharat - National Health Protection Mission will be implemented through insurance companies. In States/ UTs where the scheme will be implemented in Trust/ Society mode, the central share of funds will be provided based on actual expenditure or premium ceiling (whichever is lower) in the pre-determined ratio.

NUMBER OF BENEFICIARIES

Ayushman Bharat - National Health Protection Mission will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers' families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban. The scheme is designed to be dynamic and aspirational and it would take into account any future changes in the exclusion/ inclusion/ deprivation/ occupational criteria in the SECC data.

STATES/DISTRICTS COVERED

Ayushman Bharat - National Health Protection Mission will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.

Monday, August 13, 2018

Tiruchy best city to live in Tamil Nadu: National index Published: Aug 14,201803:39 AM- in DTNext

https://www.dtnext.in/News/TamilNadu/2018/08/14033958/1084185/Tiruchy-best-city-to-live-in-Tamil-Nadu-National-index.vpf

, AUG 14, 2018

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Tiruchy best city to live in Tamil Nadu: National index
Published: Aug 14,201803:39 AM

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The Ease of Living Index-2018, released by the Union Ministry of Housing and Urban Affairs on Monday, for identifying the best cities to live in India has said that Tiruchy was the best liveable city in Tamil Nadu and the 12th best in the country.

Thiruchirapalli: Significantly, Tiruchy managed to rank first in the health category.

As many as 12 cities (Tiruchy, Chennai, Coimbatore, Erode, Madurai, Tiruppur, Tirunelveli, Dindigul, Salem, Thanjavur, Thoothukudi and Vellore) in the state showed better performance than New Delhi. Delhi was ranked 65th in the index while Puducherry, secured the 60th position.

“In Tiruchy, no cholera or acute gastroenteritis or dengue cases have been reported in the past 18 months. So, I congratulate our corporation commissioner and other officials and workers for their dedicated work to achieve this milestone,” said Dr MA Aleem, former vice principal, KAPV Government Medical College, Tiruchy.

Tiruchy Corporation officials said the city will figure in the top five in the next list.

Chennai was ranked at 14 and Coimbatore 25th in the index topped by Pune in Maharashtra. In the top 10, Pune, Navi Mumbai and Greater Mumbai were followed by Tirupati, Chandigarh, Thane, Raipur, Indore, Vijayawada and Bhopal.

Rampur in Uttar Pradesh figured at the bottom of the liveability index.

Sunday, August 12, 2018

THE TEN DAYS OF DHUL HAJJ! -M.A.Aleem Trichy

THE TEN DAYS OF DHUL HAJJ!
____________________________________

-M.A.Aleem Trichy

The Ten days of Dhul Hajj are almost here, 12th August In shaa Allah. Did you plan them as to what deeds you will perform on these days? if not then do it please, because these days will run out and you won't even know. If you fail to plan, then you plan to fail.
This is the time to do business with Allah Subhanahu wa ta'ala, grab as much rewards as possible by doing good deeds,on these 10 days have a reward better than fighting in the cause of Allah.
Below are some checklists for performing some of the deeds as a reference.
1. Give love to your parents, smile at them, kiss them , hug them, make them feel special, as they used to do when you were kids.
2. Be dutiful to your parents, because one of the major sin after shirk is being undutiful to the parents.
3. Feed the birds and cats in this hot summer with water /grains/milk.
4. Take cold water and distribute to those working on the Sun, like laborers, cleaners, your staffs, passerby or any one in need.
5. Going to Salah /prayer on time. Read Quran as much as you can, listen to good lectures.
6. In these days, visit patients, old relatives, feed people.
7. Try to fast all 9 days, everyday you fast is like 70 years away from Jahannum.
And it will help you stay away from Haram things, In shaa Allah.
8. If not 9 days then fast at least the day of Arafah. It wipes 2 years of sins.
9. On the day of Aarafa, recite the dua most beloved to Allah subhanahu wa ta'ala on the day of Arafa that is....
"Laa ilaha illallahu wahdahu laa sharikalahu lahul mulku walahul
hamdu wahuwa ala kullishaiin qadeer " !!
10. Give lots of Sadaqa.
11. Stay away from Music and video songs and all that filth found on the web.
12. Don't waste your time on face book posts, it eats your time like the disease that eats healthy cells in the body.

The use of Marijuana (cannabis) for neurologic disease Aleem. M.A. BMJ 2018;362:k3357

Editor's Choice

Medical cannabis on the NHS

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3357 (Published 03 August 2018)

Cite this as: BMJ 2018;362:k3357

Re: Medical cannabis on the NHS

The use of Marijuana (cannabis) for neurologic disease can be traced at least as far back as 1500–3000 BC, in the writings of Chinese Emperor Shen-Nuang. Much of the early use of this was for treatment of headaches, with the first documentation of its use for this purpose being in 600 AD. 

Medicinal Marijuana was introduced to the West in the mid-1800s and used for spasms in rabies and tetanus and infantile convulsions, and it was also advocated in migraines in the early 1900s. 

Action site at Neuronal Axis
Cannabis acts presynaptically on endocannabinoid receptors, namely, CB1, modulating their function.

The medical use of cannabis for the treatment of neurologic diseases has been recently discussed.

Multiple Sclerosis
In neurological disorders  Multiple sclerosis has the most robust evidence for the efficacy of cannabis, primarily in subjective, and possibly objective, improvement in spasticity and spasms and pain.

Seizure Disorders
Oral liquid formulation of plant-derived Cannabis can be effective in seizure control in Dravet syndrome, Lennox-Gastaut syndrome, and neonatal hypoxic-ischemic encephalopathy. A recent presentation found that the liquid formulation in doses up to 25 mg/kg can reduce the seizure frequencies in multiple drug-resistant epilepsy syndromes and in some seizure types.

Parkinson Disease
Clinical trials show that the effect of cannabis on Parkinson disease is conflicting and poorly understood. It is ineffective in dyskinesias in parkinson disease. 

Headache
Cannabis can be useful to control migraine and other headaches but needs more clinical studies. 

Pain
Oral cannabis extract may be useful to reduce central neurogenic pain.

Bladder Disorders
Cannabinoids (Nabiximols) is probably effective in certain urinary bladder disorders.

Until recently cannabis has not shown promising results in tremors, Huntington's disease, Tourette syndrome, or cervical dystonia.

Side effects
Acute use of cannabis has been shown to cause anxiety and panic, impaired attention/memory/psychomotor performance, increased chance of psychosis in those already predisposed, and tachycardia. 

Long-term effects are less well studied, but there is evidence of cannabis dependence, bronchitis, increased risk of accidents, and the potential for mild withdrawal symptoms. There is no evidence cannabis use increases risk of cancer, leads to permanent psychiatric cognitive deficits, or can result in overdose.

Marijuana in India
It has a long history in India. The earliest mention of cannabis has been found in The Vedas, the sacred Hindu texts. These writings may have been compiled as early as 2000 to 1400 B.C. 

In Indian society, common terms for Marijuana preparations include charas (resin), ganja (flower), and bhang (seeds and leaves).

The prevalence of "abuse" of Marijuana in India is at or more than 3.2%.

According to the World Drug report 2016, the retail price of cannabis in India was US$0.10 per gram, the lowest of any country in the world. 

The medicinal use of cannabis is also shown in Sharngadhara Samhita (13th century) ancient Indian medical scripts.

Competing interests: No competing interests

04 August 2018

M.A. Aleem

Emeritus Professor* Neurologist**

The Tamilnadu Dr.M.G.R.Medical University*. 

ABC Hospital**

Chennai 600032*. Trichy 620018**

Tamilnadu India

@drmaaleem

Thursday, August 9, 2018

Marijuana In Neurological disorders M.A.Aleem Trichy

Marijuana In Neurological disorders.

Dr.M.A.Aleem  M.D.D.M (Neuro)

Emeritus Professor
The Tamilnadu Dr.M.G.R. Medical University

Former President
Tamilnadu Pondycherry Association of Neurologists

Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.

Consultant Neurologist
ABC Hospital

Trichy 620018
Tamilnadu
India

drmaaleem@hotmail.com
Phone 9443159940

The use of Marijuana ( cannabis) for neurologic disease can be traced at least as far back as 1500–3000 BC, in the writings of Chinese Emperor Shen-Nuang. Much of the early use of this was for treatment of headaches, with first documentation of its use for this purpose was noted in 600 AD. 

Medicinal Marijuana was introduced to the West in the mid-1800s and usef for spasms in rabies and tetanus, infantile convulsions and it was also advocated in migraines in the early 1900s. 

Action site at Neuronal Axis

In Neuronal axis  cannabis acts presynaptically on endocannabinoid receptors, namely, CB1 and it modulate its functions.

The medical use of cannabis for the treatment of neurologic diseases is in raise in recent days.

Multiple Sclerosis

In neurological disorders  Multiple sclerosis has showed the most robust evidence for the efficacy of cannabis, primarily in subjective, and possibly objective, improvement in spasticity and spasms and pain.

Seizure Disorders

 Oral liquid formulation of plant-derived Cannabis can be  effective in seizure control in Dravet syndrome, Lennox-Gastaut syndrome, and neonatal hypoxic-ischemic encephalopathy. A recent presentation found that the liquid formulation in doses up to 25 mg/kg can reduce the seizure frequencies in multiple drug-resistant epilepsy syndromes and in some  seizure types.

Parkinson Disease

Clinical trials showed that the effect of cannabis on Parkinson disease is conflicting and poorly understood.It is ineffective in dyskinesias in parkinson disease. 

Headache

Cannabis can be useful to control migraine and other headaches but needs more clinical studies. 

Pain

Oral cannabis extract may be useful to reduce central neurogenic pain.

Bladder Disorders

Cannabinoids ( Nabiximols) is probably effective in certain urinary bladder disorders.

Until  recently cannabis is not showing promising results  in tremors Huntingdon disease Tourette syndrome and in cervical dystonia.

Side effects

 Acute use of cannabis has been shown to cause anxiety and panic, impaired attention/memory/psychomotor performance, increased chance of psychosis in those already predisposed, and tachycardia. 

Long-term effects are less well studied, but there is evidence of cannabis dependence, bronchitis, increased risk of  accidents, and the potential for mild withdrawal symptoms.here is no evidence cannabis use increases risk of cancer, leads to permanent psychiatric cognitive deficits, or can result in overdose.

Marijuana in India

It has a long history in India. The earliest mention of cannabis has been found in The Vedas the sacred Hindu texts. These writings may have been compiled as early as 2000 to 1400 B.C. 

In Indian society, common terms for Marijuana preparations include charas (resin), ganja (flower), and bhang (seeds and leaves).

The prevalence of abuse" of Marijuana in India is at or more than 3.2%.

According to the World Drug report 2016, the retail price of cannabis in India was US$0.10 per gram, the lowest of any country in the world. 

The medicinal uses of cannabis is also available in Sharngadhara Samhita (13th century) ancient Indian medical scripts.