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The central has fully exempted basic customs duty on the import of all drugs and food for special medical purposes and for personal use for the treatment of rare diseases.

The rare diseases that are listed under the National Policy for Rare Diseases 2021 will be considered. Drugs or special Foods required for the treatment of such diseases are expensive and need to be imported.

According to the Central government, in order to avail of this exemption, the individual importer has to produce a certificate from the central or state director of health services or the district medical officer/civil surgeon of the district.
Drugs or medicines generally attract basic customs duty of 10 per cent, while some categories of lifesaving drugs or vaccines attract a concessional rate of 5 per cent or Nil.

“While exemptions have already been provided to specified drugs for the treatment of Spinal Muscular Atrophy or Duchenne Muscular Dystrophy, the Government has been receiving many representations seeking customs duty relief for drugs and medicines used in the treatment of other Rare Diseases,” an official government statement said Thursday.

It is estimated that for a child weighing 10 kg, the annual cost of treatment for some rare diseases may vary from Rs 10 lakh to more than Rs 1 crore per year with treatment being lifelong and drug dose and cost, increasing with age and weight.
Also, the government has also fully exempted Pembrolizumab (Keytruda) used in the treatment of various cancers from basic customs duty.

The Union Health Minister Mansukh Mandaviya will lay the foundation stone of three Critical Care Blocks (CCB) for infectious diseases in Uttarakhand on Friday. He will also lay the foundation of a 500-bedded hospital at New Block at Doon Medical College.

The facilities, for which a foundation stone will be laid, include a 50-bed Critical Care block (CCB) at Rudraprayag under Emergency COVID Response Package (ECRP) – II, 50-bedded CCB at Nainital under ECRP – II and 50-bedded CCB at Srinagar under Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).

To date, seven Critical Care Block (CCMB) from ECRP- II and 2 CCBs from PM- ABHIM have been approved and the foundation stone for these will be laid on Friday.

According to reports, each CCB will be a 50 bedded facility amounting to Rs 23.75 Crore (capital expenditure) comprising of ICU , HDU and other emergency care for infectious diseases during medical emergencies like Covid and will provide regular services during other times.
“This will augment the capacity of the district for assured treatment and management of the patients with infectious diseases or critical,” said a report.

By Prof. Dr. J. M. Hans, Padmashree Awardee, Senior Consultant, ENT Specialist
Madhukar Rainbow Children’s Hospital, Malviya Nagar, New Delhi

Tonsil cancer is the most common type of oropharyngeal malignancy, comprising 23.1% of all malignancies in this region. There has been a sharp rise in its incidence in the last many years due to the increase in HPV-induced cancers. The “viral epidemic” of HPV had dramatically increased the incidence of oropharyngeal cancers in the last 40 years.

CAUSES (ETIOLOGY)

We have blamed smoking and alcohol misuse for causing tonsil cancer traditionally. Smoking is a poor prognostic factor independently. However, in recent years, cases secondary to HPV have increased highly. HPV-16 is the most common strain found in oropharyngeal cancers. Traditionally, in addition to smoking and spirits, sharp tooth, spices, syphilis, and sepsis have also been attributed to oropharyngeal cancer.

RECENT UNDERSTANDING OF HISTOPATHOLOGY

Tonsil cancer is a squamous cell carcinoma. WHO distinguishes tonsillar SCC into HPV-positive and HPV-negative types. HPV-positive SCCs have a non-keratinizing morphology and arise from the deep lymphoid tissue of the tonsillar crypts. HPV-negative SCCs arise from the tonsillar surface epithelium and show keratinizing dysplasia. P16 is a tumor suppressor protein over-expressed in HPV-positive tumors and is an important marker.

SYMPTOMS AND PRESENTATION

Generally, HPV-positive tumors are seen in young non-smoker people of either gender whereas HPV-negative tumors are seen in older males who smoke and have other co-morbidities. The latter has a poorer prognosis.

Some of the common presentations are:

1. Sore throat
2. Unilateral otalgia
3. Sense of fullness in the throat
4. Trismus (if there is local invasion)
5. Asymptomatic patient with an incidental finding of asymmetric tonsils
6. Occult lesion with enlarged neck nodes (JD nodes)

We must always keep in mind the following symptoms – weight loss, loss of appetite, hoarseness of voice that’s persistent, and difficulty or pain while swallowing. A full ENT examination along with palpation of the neck is ideal. The tongue base, vallecula, lateral pharyngeal wall, and post-nasal space must also be examined.

EVALUATION AND TESTS

A pan-endoscopy is done to rule out secondaries and skip lesions in the upper airways and esophagus. It helps plan surgical management. Radiological investigations include MRI, CT, and PET-CT. MRI with contrast helps delineate local spread and gives the best views of soft tissue. CT skull base to mediastinum gives us details about the primary tumor as well as any lung or nodal disease. PET-CT can be used in difficult-to-detect cases and post-treatment surveillance.

MANAGEMENT

Treatment involves surgery and chemoradiation. Early lesions may be treated with surgery alone whereas advanced ones may be treated by chemoradiation alone, as surgery would involve extensive resections with poor postoperative functional outcomes. Small superficial lesions confined to the tonsil-peroral monobloc are treated by tonsillectomy – securing adequate margins in all three dimensions.

Larger lesions require TORS (Trans Oral Robotic Surgery) or TLM (Transoral Laser Microsurgery) to include the underlying pharyngeal wall and/or the adjacent base of tongue to secure clear margins. Much larger lesions need a lower cheek flap approach with either a marginal or segmental mandibulotomy. TORS and TLM have comparable outcomes. They are advantageous because of less operating TORS and TLM have comparable outcomes. They are advantageous because of less operating time, lesser hospital stay, and improved swallowing outcomes post-surgery. Since the tissue is removed in pieces in TLM, histopathological examination becomes difficult and so it is less preferred. All cases undergoing elective surgery will also get their nodes removed, level II to IV. Both tonsils are removed, not the one with cancer alone.

Chemoradiotherapy is emerging as the treatment for choice for advanced tonsillar cancers as it preserves function. Radiotherapy with cisplatin chemotherapy is commonly used. Sometimes cetuximab is added when cisplatin is contraindicated.

PROGNOSIS

HPV-positive tumors have a significantly higher 5-year survival rate than HPV-negative tumors. HPV-positive tumors in smokers have a very poor prognosis.

By. Dr. Rinku Sengupta Dhar, Senior Consultant, Obstetrics and Gynecology, Rosewalk Healthcare

A Tubo ovarian Abscess (TOA ) is a pus-filled infectious mass of the tube and ovary. It can originate from a focus of infection in the upper genital tract. Common organisms causing the infection are E coli, and Streptococcus. It can rarely follow any invasive procedures in the reproductive tract like Dilatation and curettage, MTP, and Hysterosalpingography. TOA may be associated with sexually transmitted diseases like chlamydia. Chronic pelvic pathologies like endometriosis and tuberculosis may predispose to tuboovarian abscesses too. TOA is most common in the reproductive age of sexually active women. However if rarely they happen in postmenopausal women malignancy needs to be ruled out

The most common symptom is sudden onset acute pain abdomen, and fever with systemic symptoms like nausea and vomiting. Foul smelling vaginal discharge and chronic pain abdomen may precede the acute presentation Patients are usually ill and may often need hospitalization. TOA may often be confused with acute appendicitis and ectopic pregnancy. Blood tests ,urine tests and cervical swabs may be done. Clinical examination along with ultrasound usually supports diagnosis. In some cases CT scan and MRI will be needed.

Once diagnosis is reasonably confirmed intravenous antibiotics are started .Most patients respond to IV antibiotics followed by oral antibiotics for a longer period. However if TOA are larger than 6 cm or there is unsatisfactory response to antibiotics, surgery may be needed. Abscess is drained with laparoscopy or open surgery. If tube and ovary extensively damaged removal of tube and ovary may need to be done. If infection involves the uterus hysterectomy may need to be done in selected cases. The focus of infection needs to be completely eradicated as dissemination of pus in abdominal cavity can lead to multiple organ failure and life threatening situation. Long term complications include chronic pelvic pain,ectopic pregnancy and infertility. Rarely TOA may rupture spontaneously and lead to rapid deterioration of clinical condition.

Prevention of TOA is critical to prevent long term sequelae. Adolescents and young women need to be educated about safe sex, contraception and regular Gynae check ups They also need to be educated about Pelvic infection and endometriosis so that they can report to Gynaecologist early. Once diagnosed early treatment with broad spectrum antibiotics plays a pivotal role in prevention of complications.

By, Dr. Ram Gopal Hola, Senior Consultant, Neonalogist, Rosewalk Healthcare

Children under 5 are at maximum risk of dying because of communicable diseases. Many of these can be prevented by the timely use of vaccinations. Diarrhea, pneumonia, and malaria are some of the leading causes of communicable diseases.
All vaccines are by and large safe and go through several safety checks before being marketed for use. However, some side effects are common like fever, irritability, pain, redness, and swelling at the injection site. The frequency and incidence of these side effects vary from vaccine to vaccine and child to child. The risk of major side effects that threaten the life of the child is extremely rare. The claims that vaccines cause autism or other diseases have been carefully researched and disproved. Vaccination schedules often require the administration of multiple vaccines on a single visit. This is safe, saves time and expense, and is less distressing than providing the vaccinations singly in multiple visits.

Here are some do’s and don’ts regarding your child’s vaccination:

Do’s

1)Do get your child vaccinated on time. The vaccination card is a very important document. Do keep it safely and carry it with you to each vaccination session

2)Do learn from your doctor what the vaccination being administered is for and what side effects to expect after the vaccination

3) Do comfort your child during the vaccination process. You can distract the child with a toy while the vaccine is being administered

4) Do look out for fever, redness and pain at the injection site- if there is redness or swelling apply a cold cloth to the area
Some vaccines may be associated with fever after a few hours. Do keep the child in appropriate clothing in a well ventilated environment after the vaccination and keep him or her well hydrated.

5)Do continue breastfeeding your child. Usually, side effects of vaccination (like fever, irritability, fatigue) do not last for more than two days. Do report to your doctor if your baby develops any serious or prolonged symptoms

6)Do remember that vaccines are not 100% effective. Do follow simple hygienic measures and precautions to prevent infection

Don’ts

1) As far as possible don’t miss your child’s scheduled vaccination. Vaccination can be given even if your child is suffering from a minor illness

2) If your child has had a severe side effect or allergy to some medication in the past, don’t fail to inform your doctor before the vaccine is administered

3) Don’t massage the area where the injection has been given

4) Don’t apply heat to the injection site. Don’t apply any oil/ointment/cream/herbs etc to the area

5) Don’t routinely administer paracetamol or fever medication unless the child develops fever or irritability

Amid massive protest by the doctors in Rajasthan against the Right to Health (RTH) Bill, the state health minister Parsadi Lal Meena on Monday said that the government would not take back the bill at any cost.

“If there’s any problem with the bill, then we are ready to hold a discussion but the bill won’t be taken back. At any cost, we will not take back the bill,” Meena said while talking to ANI. He further said that the protesting doctors are taking “undue advantage”.

“After a lot of discussions, the Right to Health bill was brought by our government. People of the state are being benefitted from it. We held discussions and abided by all demands of protesting doctors. CM has appealed to them to come back to work. They are taking undue advantage,” he further said.

The state minister also said that the bill was also sent to a select committee before it was passed.
“If required we will recruit more doctors if protests continue, we will do whatever is required,” he added.
Parsadi Lal Meena’s reaction came amid the strike of private doctors and hospitals regarding the Right to Health Bill.
Significantly, private hospitals and doctors in Rajasthan have been protesting against the Right to Health (RTH) bill through a work boycott urging the state government not to implement it.

Rajasthan, last week passed the Right to Health Bill, which gives every resident of the state the right to avail free Out Patient Department (OPD) services and In Patient Department (IPD) services at all public health facilities, becoming the first state to do so.

Also, similar healthcare services will be provided free of cost at select private facilities.
According to the Bill, free healthcare services, including consultation, drugs, diagnostics, emergency transport, procedure and emergency care, will be provided at all public health institutions and select private facilities subject to conditions specified in the rules, which will be formulated now.

Also, all residents will be entitled to emergency treatment and care for accidental emergencies without prepayment of any fee or charges.

In a case of medico-legal nature, the bill says no public or private hospital can delay treatment merely on the grounds of receiving police clearance.

The bill gives a right to the resident of the state to emergency treatment and care “without prepayment of requisite fee or charges” by any public health institution, health care establishment and designated health care centres.

The Bill was passed amid protests by the opposition BJP, which wanted to bring in certain changes to the provisions, as well as an agitation by a section of doctors.

Union Health Secretary Rajesh Bhushan on Monday chaired a high-level meeting to review the preparedness status of the entire spectrum of management of the COVID19 pandemic in view of the upsurge in cases, with States and UTs through a Video Conference.

Dr V K Paul, Member (Health), NITI Aayog and Dr Rajiv Bahl, Secretary, Dept. of Health Research were also present in the review meeting. Union Health Secretary referred to the message of PM Modi from the high-level review meeting held on 22nd March 2023 and advised States to be on the alert and ensure preparedness for COVID19 management.

He cautioned States and UTs against any complacency and advised them to follow up on the priorities listed in the joint advisory issued today by the Department of Health Research and the Department of Health and Family Welfare on March 25 2023.

He stressed ramping of testing with a higher proportion of RT-PCR and whole genome sequencing of positive samples. Urging everyone to follow COVID Appropriate Behaviour at all times.
He also stressed the need to increase the administration of precaution doses among people, especially for the vulnerable population group.

A comprehensive presentation was made covering the global Covid-19 situation including the rising cases in India. States and UTs were briefed that India has been witnessing an increase in COVID-19 cases with average daily cases rising to 966 in the week ending March 23 2023 from 313 average daily cases in the week ending March 3 2023; and weekly positivity going up to 1.08 per cent during the same time.

It was informed that weekly positivity in Maharashtra has gone up to 4.58 per cent as on March 24, 2023 from 0.54 per cent in the week ending March 3, 2023. In Gujarat, it has increased to 2.17% from 0.07 per cent. In Kerala, weekly positivity shot up to 4.51 per cent from 1.47 per cent. Karnataka witnessed average weekly positivity rise up to 3.05 per cent from 1.65 per cent while Delhi has seen weekly positivity rise to 4.25 per cent from 0.53 per cent. Similarly, Himachal Pradesh witnessed weekly positivity increase to 7.48 per cent from 1.92 per cent. In Rajasthan, it has increased from 0.12 per cent to 1.62 per cent and Tamil Nadu reported an increase in weekly positivity from 0.46 per cent to 2.40 per cent in the same time period.

The Health Ministry in a press note said that a total of 22 States/UTs are reporting average daily TPM less than the national average. It was also pointed that 24 districts in India are reporting more than 10 per cent weekly positivity in the week ending March 24, 2023, while 43 districts are reporting weekly positivity between 5-10 per cent in the same time period.

Rajesh Bhushan also advised States to undertake mock drills across all health facilities on April 10 and 11, 2023 to ensure operational readiness of Hospital Infrastructure, including Oxygen Cylinders, PSA plants, ventilators, logistics and human resources. He informed about the status of the last mock drill which was conducted on December 27, 2023.

“The drills were conducted in a total of 21,939 facilities, including 16,601 govt. facilities and 5,338 private facilities. Over 94 per cent of PSA plants and oxygen concentrators were found functional across the country while over 87 per cent of ICU beds, ventilators, O2 beds and isolation beds were found in working condition,” the Health Ministry said.
Union Health Secretary said that irrespective of the new COVID variants, ‘Test-Track-Treat-Vaccinate & Adherence to COVID Appropriate Behaviour’ continue to remain the tested strategy for COVID management. “This would facilitate undertaking of appropriate public health measures,” he said.

Bhushan also urged the states to ensure availability of sufficient designated beds and health workers across the states, enhance community awareness regarding disease and vaccination and regularly update COVID-19 data in Covid India Portal.

Dr V K Paul highlighted the need for increased vigil due to the prevalence of new variants and vaccine immunity across the country currently at a modest level. He urged states to increase preparedness, including higher level of RT-PCR tests and called for increasing the coverage of precaution dose among population.

Dr Rajiv Bahl encouraged states to ramp up testing, especially RT-PCR tests and maintain precaution. He also asked them to follow the advisory sent from the Union Health Ministry and increase community awareness. He also urged states showing higher number of cases to monitor cluster of new cases and severe cases.

There was comprehensive and detailed discussion on various aspects of COVID management. States appreciated the timely review meetings chaired by the Hon. Prime Minister and the Union Health Minister and advisories from the Union Health Ministry. They assured that they will work with the Centre for effective prevention and management of COVID-19. They informed that they are maintaining vigil and are reviewing the present situation. States also assured they will hold mock drill for readiness of hospital infrastructure on 10th – 11th April, 2023.

Lav Agarwal, AS, Health Ministry, and other officials from the Ministry was present in the meeting. Principal Secretary (Health), Mission Director (NHM) from the States/UTs participated in the review meeting.

Doctors staged a massive protest in Rajasthan’s capital, Jaipur, today. This comes on top of the state’s eighth consecutive day of a strike by doctors working in private medical institutions. Thousands of doctors from across Rajasthan gathered in Jaipur and marched from the SMS Medical College.

Notably, the Indian Medical Association has backed the state’s protesting doctors, and the IMA has declared today, March 27, to be a “Black Day.” Further, the IMA has called for a nationwide shutdown of medical services.

The strike and protest are in response to the recently passed Right to Health Act.

The bill, which was approved by voice vote in the Rajasthan Assembly on March 21, grants every resident of the state the right to emergency treatment and care “without prepayment of any requisite fee or charges” by any public health institution, health care establishment (including private ones), and designated health care centres.

A ‘health care establishment’ is defined as the entire or any part of a public or private institution, facility, building, or place that is operated to provide health care.

Earlier, on March 26, Sunday, the Rajasthan government met with a delegation of striking private hospital doctors. Government officials reportedly assured the doctors of a detailed discussion on their suggestions over the proposed law. The protesting doctors, on the other hand, demanded that the bill be withdrawn because it is ‘unconstitutional’ and will increase bureaucratic interference in the operation of private hospitals.

The meeting was held on the instructions of Chief Minister Ashok Gehlot.

‘Chief secretary Usha Sharma and other officers were present in the meeting. During the meeting, Sharma said the bill has been introduced to further strengthen the rights of the people of the state to their health. The chief secretary also assured the delegation of a detailed discussion on their suggestions,’ a release said.

The secretary of the Private Hospital and Nursing Home Society, Dr Vijay Kapoor, however told reporters after the meeting that their demand for the withdrawal of the bill will continue.

Over 10 per cent of children in Japan who developed acute brain syndrome after infection with COVID-19 have died, Kyodo News reported citing results of a nationwide survey recently announced by a health ministry research team.

The survey found 34 cases of acute encephalopathy related to COVID-19 infection among those below the age of 18 years between January 2020 and May 2022. The team analysed 31 patients who did not have any underlying illnesses that could cause the brain disease. While 19 of the 31 children recovered, four died and eight were confirmed with complications.

Among the eight children, five were reported as having severe aftereffects, including unconsciousness and being bedridden in need of care. Primary initial symptoms included seizures, which were experienced by around half of the patients, impaired consciousness, and abnormal speech or behaviour.

The majority of the patients developed acute encephalopathy in January 2022 or later, when the Omicron strain of the coronavirus became prevalent. However, there was no major difference in the ratio of those who developed the brain symptoms among COVID-infected children before and after 2022, showing that Omicron is not necessarily making it easier for the brain disease to develop, as per the study.

Junichi Takanashi, a professor in pediatric neurology at Tokyo Women’s Medical University Yachiyo Medical Center, who led the research team, said, “We would advise going to a hospital quickly…if convulsions occurring with a fever don’t stop in 10 minutes, loss of consciousness continues, or strange behaviour is noticed,” according to Kyodo News.
As per the news report, acute encephalopathy among children is not limited to COVID-19 infection. It is also known to affect those who have been infected with influenza.

Meanwhile, 514 children attending elementary, junior high and high schools in Japan died by suicide in 2022, topping the previous high of 499 witnessed in 2020, Kyodo News reported citing government data. The upward trend has been apparently fueled by the COVID-19 pandemic.

A total of 17 elementary school pupils, 143 junior high school students and 354 high school students committed suicide in 2022. The increase in the numbers could be attributable to the lingering effect of the COVID-19 pandemic, which started in 2020, Kyodo News reported citing a ministry official working on measures to prevent suicides.

Also Read: Delhi HC issues notice to Centre on plea of 11-year-old child suffering from rare disease

The Delhi High Court on Friday issued a notice to the Central Government on a plea moved by an 11-year-old child suffering from the rare disease Duchenne Muscular Dystrophy (DMD).

The child has sought direction to the Centre to release funds for continuous treatment. Justice Prathiba M Singh on Friday issued notice to the Ministry of Health and Family Welfare on the plea and listed the matter on April 13 for further hearing.
The petitioner has also prayed to direct AIIMS to forthwith procure medicines and continue to provide treatment to the petitioner and other similarly placed petitioners in connected matters.

The application has been filed by advocate Ashok Agarwal and Kumar Utkarsh has alleged inaction on the part of the government to consider the case of the petitioner for treatment through Antisense Oligonucleotide (AON) therapy of the petitioner.

The petitioner is suffering from a rare genetic disease known as Duchenne Muscular Dystrophy (DMD). Treatment is of high cost and is beyond the capacity of the parents of the petitioner, the plea stated.
It is also prayed to direct the All India Institute of Medical Sciences (AIIMS) to provide free of cost treatment to the petitioner.

It is further submitted that the impugned inaction is in violation of the fundamental and human right to life, health, and medical aid of the petitioner suffering from as Duchenne Muscular Dystrophy (DMD) a rare genetic disease as guaranteed to him under Articles 14, 21, 38, 39, 41 and 47 of the Constitution of India.

In terms of the enhanced National Policy for Rare Diseases, 2021 Rs 50 Lakhs qua each DMD petitioner was transferred to respondent AIIMS for procurement of medicines, the plea stated.

It is submitted that respondent AIIMS procured medicine for the petitioner in the budget of Rs 50 lakhs and now treatment has commenced.

It is also submitted that on 13.03.2023 petitioner received 1st dose of Exondys 51 medicine (36 ml) out of 120 ml procured out of the budget of Rs 50 lakhs.

It is further submitted that on 20.03.2023 petitioner was infused with the 2nd dose of Exondys 51 medicine (28 ml).
The plea stated that AIIMS has procured 120 ml of Exondys 51 medicine in the allotted budget of Rs 50 lakhs.
It is also stated that as per the petitioner’s weight, 120 ml of Exondys 51 medicine is divided into 4 doses for infusion.
Therefore, the petitioner will get only 4 doses in total and the remaining two doses will be infused to the petitioner on 27.03.2023 and on 03.04.2023.

It is needless to say that though the treatment of the majority of DMD patients in other connected has started they are facing the same problem like the petitioner herein, the plea said.

All the DMD patients petitioners in other connected whose treatment has commenced with sanction fund of Rs 50 Lakhs, will get only a maximum of 3-5 infusions depending upon the weight of the patient, the plea added.
Therefore, like the petitioner, other DMD patients also require doses of medicines for which timely orders need to be placed by respondent AIIMS so that their continuous treatment is not affected, the plea submitted.

It is submitted that normally the result of the dose infused is seen at least after 6 months. Therefore, it is much required in the interest of DMD patients’ petitioner children, that they may be provided with infusions of Exondys 51 medicine or other concerned medicines continuously. The Union of India and AIIMS are required to arrange for funds and place orders for the medicines in advance.

Therefore, respondent Union of India is required to sanction funds at the earliest to respondent AIIMS so that treatment of petitioner and other similarly placed petitioners whose treatment has commenced and treatment will cease after 3-4 doses of medicine can get further doses before the next date of hearing on 13.04.2023, the plea stated.