New 12,591 Covid-The Union health ministry said on Thursday that 19 infections were recorded across the country in the last 24 hours, a significant increase from Wednesday’s tally of 10,542 cases. Earlier last week, the country saw a downward trend in the five days from April 15 to April 18, with 11,109 and 7,633 cases reported, respectively. On April 18, India recorded 7,633 people, 9,111 on April 17, 10,093 on April 16, and 10,753 on April 15.

According to the Union Health Ministry, the number of active cases in the country has risen to 65,286 from 63,562 yesterday. The current recovery rate is 98.67%, with a daily positivity rate of 5.46 percent, according to the Health Ministry’s release.

New 12,591 Covid-The Union health ministry said on Thursday that 19 infections were recorded across the country in the last 24 hours, a significant increase from Wednesday’s tally of 10,542 cases. Earlier last week, the country saw a downward trend in the five days from April 15 to April 18, with 11,109 and 7,633 cases reported, respectively. On April 18, India recorded 7,633 people, 9,111 on April 17, 10,093 on April 16, and 10,753 on April 15.

According to the Union Health Ministry, the number of active cases in the country has risen to 65,286 from 63,562 yesterday. The current recovery rate is 98.67%, with a daily positivity rate of 5.46 percent, according to the Health Ministry’s release.

Following a surge in the number of COVID-19 cases across the country, Dr. PK Mishra, the Prime Minister’s Principal Secretary, convened a high-level meeting on Wednesday to assess the situation. According to the PMO, the meeting focused on the status of preparedness of health infrastructure and logistics, drugs, vaccination campaign in the country, and the key necessary steps in response to the recent surge in Covid cases.

“Dr PK Mishra stressed that the time tested 5-fold strategy of Test-Track-Treat-Vaccination and adherence COVID Appropriate Behaviour must continue to be implemented and equally crucial to promote awareness within the community regarding COVID appropriate behaviour and caution citizens against complacency,” the PMO statement read.

During the meeting, Rajesh Bhushan, Secretary of Health and Family Welfare, provided a comprehensive overview of the global COVID-19 situation.

Bhushan stated that the number of COVID-19 cases in India has been rapidly increasing, with the majority of cases being reported in eight states: Kerala, Delhi, Maharashtra, Haryana, Uttar Pradesh, Tamil Nadu, Karnataka, and Rajasthan. Furthermore, the unexpected increase in positivity was highlighted, as was the status of tests being conducted in the country. A thorough examination of active cases within these eight states was presented. It was stated that approximately 92% of the cases are being treated at home.

The presentation also provided an overview of different variants’ genome sequencing since January 2023, as well as the proportion of circulating variants in India. According to the PMO, the status of vaccination was discussed, followed by drug availability and infrastructure readiness across the country.

A nationwide mock drill for the assessment of functional infrastructure was conducted per the Prime Minister’s instructions, and the status of the mock drill was presented to participants. Furthermore, the COVID-19 vaccination program’s expenditures and budget provisions for drugs and vaccine raw materials were examined.

The Health Secretary also stated that states have already been advised that they may proceed with the procurement of required Covid vaccine doses directly from manufacturers without seeking prior approval from the Union Ministry of Health. Private hospitals in the United States may also obtain such vaccines directly from the manufacturer. Once obtained, these vaccines can be administered in accordance with the current Covid vaccination guidelines. He also advised officials to keep a close eye on the COVID-19 situation and to take the necessary steps to contain the COVID-19 spread.

Apollo, the world’s largest vertically integrated healthcare provider, has released its annual Health of the Nation report that deep dives into the prevalence and growth of NCDs and highlights the importance of the right preventive healthcare measures to ensure India stays healthy.

Infographic_Apollo Health of Nation 2023.pdf

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Dr. Prathap Reddy, Chairman, of Apollo Hospitals Group, stated that “Preventive healthcare needs to become a national priority. Over the past 3 decades, non-communicable diseases have become the leading cause of death and suffering, contributing to 65% of deaths in India. NCDs affect not just health, but also productivity and economic growth. The estimated economic burden on India is expected to be about $4.8 trillion by 2030. As the youngest and fastest-growing major economy in the world, the health of our nation is a critical indicator of our future, and the health of our people will determine how effectively we live up to our full potential. What we need is a proactive and highly defined strategy to minimize the impact of NCDs. And the best solution lies in prevention.” 

The increasing trend for NCDs and a significant rise in early risk factors

The rise in preventive screenings has also led to an increase in the diagnosis of early risk factors like Obesity and Dyslipidemia (cholesterol irregularities) among Indians across age groups. These are indications of the potential onset of chronic conditions like diabetes and hypertension and a wake-up call for individuals to make early shifts in their lifestyle behaviors.

• There is a 50% increase in the prevalence of Obesity among Indians between 2019 and 2022.

o      Obesity has seen an uptick in diagnosis in those less than 45 years of age by 43% and by 60% in people over the age of 45.

• Dyslipidemia or Cholesterol irregularities has seen an 18% increase in prevalence among Indians between 2019 and 2022

o      This is also fuelled by a significant increase in its prevalence among those over 45 years of age by more than 35%

Along with these early risk factors, we also see a rise in the prevalence of conditions like Diabetes and Hypertension.

• Diabetes and Hypertension diagnoses have seen an 8% and 11% increase respectively between 2019-22

o      There is also an increased risk of Hypertension amongst Indians over 45 years, its prevalence in diagnosis has increased from 14% to 16% in the last 3 years.

o      Chronic stress and anxiety increase the risk of incidence of hypertension by 1.5X and diabetes by up to 2X. Men with chronic stress have double the risk of incidence of diabetes than women.

We administered the PHQ9 Depression Questionnaire to about 2000 people with Type 2 Diabetes at Apollo Hospitals to understand their Mind Health status. Our analysis showed that with every one unit increase in age and BMI, PHQ9 the depression score also increases. About 50% had some form of depression, and Diabetes along with any weight-related comorbidity is an indicator to screen for depression.

• The report also puts the spotlight on the importance of getting more frequent or extended health tests for conditions that are prevalent in our families

o      The report finds that Diabetes is prevalent in 1 in 3 people with a history of the condition in their family.

• Healthy sleep is an important indicator of overall health.

o      In one study with 20,000 people, 47% have sleep problems and 52% have impairments in their mental health state, and 1 in 3 have both issues.

o      2 out of 3 individuals do not have an optimal gap between dinner and bedtime, which is critical for good quality sleep. It is either less than 1 hour or more than 2 hours, both scenarios leading to sub-optimal sleep quality.

• Impaired metabolism is also closely linked with digestive irregularities, such as gas/bloating, heaviness post-meal, burning sensation, and belch/burp. The analysis found that 64% of people had digestive irregularities, going up to 81% amongst diabetics.

Many ‘Indias’ in one India

Our diversity in lifestyle has led to the emergence of different NCD trends across regions, likely impacted by our regional diet preferences.

• While liver diseases saw maximum prevalence in the East (at 50%), its lowest impact relatively is in the South (28%)
• West has seen the least relatively the lowest prevalence of diabetes (15%) while the South has the highest (27%)
• Obesity trends have been similar across regions, ranging between 22-24%
• Dyslipidemia (cholesterol) has the highest prevalence across all regions, with the North seeing the most (48%), followed by the West (41%), the East (39%), and then the South (37%).

Power of Prevention

The silent epidemic of NCDs is behind 40% of all hospital stays. While there is an increase in Indians taking preventive screenings, these are still largely symptom led. Regular and comprehensive health checks, starting at a young age, can significantly reduce mortality rates, disease incidence as well as the frequency of hospital visits throughout our lifespan.

There is also a need to reimagine preventive health assessments and design them more suitable for the Indian population.

For instance:

• The median age of breast cancer diagnosis from mammograms done at Apollo in the last year was 54-57 years; lower than that seen in mature markets (where the median age of detection is 62-65 years). This suggests an earlier onset of disease in Indian women, warranting annual screening for women from 40 years onwards.

o    According to clinically published sources, early diagnosis through preventive checks of breast cancer can reduce mortality rates by up to 30%.

• Undetected sleep disorders often lead to chronic health conditions due to late diagnosis and oversight by the healthcare systems

o    Obstructive Sleep Apnea (OSA) is known to increase the risk of heart problems, and is often screened only in the obese (BMI > 30) and with neck circumference > 40cm

o    Apollo’s study of people with Type 2 suggests that intermediate to high risk of OSA occurs even at a lower BMI (26) in the population screened, with a majority (91%) having a neck circumference < 40cm, thus highlighting the need to screen for OSA rigorously, irrespective of the BMI, especially for high-risk cohorts like patients with Diabetes.

Enhanced ‘ProHealth’ by Apollo

In a bid to strengthen the preventive healthcare ecosystem, Apollo has launched an enhanced ProHealth, India’s most individualized preventive health program that brings together the power of AI to help individuals stay ahead of potential NCDs. Combined with Apollo’s pioneering experience of 40 years, the healthcare group has developed new technologies based on AI and ML for predicting risk scores and developing structured lifestyle programs with new models of care that lead to improved clinical outcomes.

What differentiates ProHealth:

1. ProHealth is a 100% doctor-designed health program
2. It creates a first-of-its-kind health profile that determines the areas of concern and custom designs a unique health check for every individual
3. It integrates predictive health metrics through a sophisticated AI engine to determine potential areas of prevention
4. In addition to the results, every individual also has access to health mentors to transform their lifestyle and make the program truly preventive in every sense

Technology is transforming the approach to dealing with health risks and enabling early detection and therefore must be integrated into preventive screenings. With a firm belief that AI and big data will be key in predicting risks and delivering personalized health solutions, Apollo’s ProHealth today is India’s most individualized preventive health program. Apollo also strongly believes that a laundry list of tests is not an effective solution to get to the root of the problem. For instance, there is a clear data-driven correlation between diabetes-obstructive sleep apnea-heart problems OR weight-related comorbidities & depression, however, generic health checks are unable to deduce these. The need of the hour is true personalization and prediction, which forms the foundation of Apollo ProHealth. Additionally, by offering convenient access to health mentors as a part of ProHealth, every individual is empowered to take charge of their own health and create a long-term and permanent impact in the battle over NCDs.

Apollo ProHealth is backed by a predictive algorithm that captures one’s health status, predicts potential health risks, and individualizes every health check. A personal health risk assessment is digitally available to every individual, post which they can visit the nearest Apollo facility to them to conduct the set of customized tests recommended for them.

About Health of the Nation Report

The Health of the Nation by Apollo gives insights into the prevalence and risk factors of NCDs, emphasizing hotspots, that is, areas of elevated disease burden across the country. The report derives from data based on people Apollo has engaged with through its system. The report aims to put in place approaches to improve disease prevention, increase the accuracy of diagnoses and create a more personalized and patient-centric treatment approach. Over 500,000 health checks have been studied over the past 3 years to arrive at the findings. The majority of the data shared through the Health of the Nation is based completely on Apollo’s de-identified hospital information systems and EMR, AyurVAID, and other studies as part of the Apollo Group.

A total of 5,357 new Covid-19 infections were documented in the country in the last 24 hours, a modest decline from Saturday’s figure of 6,155 cases, according to a bulletin issued by the Union Health Ministry on Sunday. Covid infections throughout the country have increased in recent days, with daily fresh infections reaching 2,994 on April 1, 3,824 on April 2, 3,641 on April 3, 3,038 on April 4, 4,435 on April 5, 5,335 on April 6, and 6155 on April 7. As of Sunday, the total number of active cases was 32,814, with a daily positive rate of 3.39 percent, according to the Health Ministry.

After considering the low infection incidence and the quantity of Covid cases in Delhi and across the country, the Supreme Court restored to the physical hearing mode of case adjudication on April 4, 2022. For quite some time, the Supreme Court has been successfully experimenting with the hybrid form of hearing (a blend of physical and virtual).

Even when actual hearings resume, the Supreme Court has begun live-streaming the Constitution bench proceedings via the Supreme Court app and YouTube. According to the ministry, the weekly positive rate is currently at 3.54 percent.

With a statewide increase in Covid cases, Union Health Minister Dr Mansukh Mandaviya conducted a review conference with health ministers from all states and union territories through video conferencing on Friday. Mandaviya advised state health ministers to hold simulated drills at hospitals on April 10 and 11 to test their readiness to handle an increase in cases. He also advised states to monitor trends in influenza-like illness (ILI) and severe acute respiratory infections (SARI) cases, send enough samples for COVID-19 and Influenza testing, and ramp up whole genome sequencing of positive samples.

According to a recent UCLA Health study, pregnant women whose household tap water included higher levels of lithium had a slightly increased risk of their children being diagnosed with an autism spectrum disease. The study, which was published in JAMA Pediatrics on April 3rd, is thought to be the first to identify naturally occurring lithium in drinking water as a probable environmental risk factor for autism.

“Any drinking water contaminants that may affect the developing human brain deserve intense scrutiny,” said lead study author Beate Ritz, MD, PhD, professor of neurology in the David Geffen School of Medicine at UCLA and professor of epidemiology and environmental health at the UCLA Fielding School of Public Health. “In the future, anthropogenic sources of lithium in water may become more widespread because of lithium battery use and disposal in landfills with the potential for groundwater contamination. The results of our study are based on high-quality Danish data but need to be replicated in other populations and areas of the world.”

Certain lithium compounds have long been utilized as a treatment for depression and bipolar disorders due to their mood-stabilizing properties. Nonetheless, there has been controversy regarding whether mothers can safely take lithium during pregnancy, despite mounting evidence that it is linked to an increased risk of miscarriage and heart abnormalities or malformations in babies.

Ritz, whose research focuses on how environmental exposures influence neurodevelopmental disorders and neurodegenerative diseases, said she decided to investigate the possible link between lithium and autism risk after discovering that there had been little human research on how lithium affects brain growth and development.

Yet, she discovered that some experimental data suggested that lithium, one of several naturally occurring metals contained in water, could influence a key biochemical process involved in neurodevelopment and autism.

According to Zeyan Liew, PhD, MPH, the study’s first author and an Assistant Professor of Epidemiology at the Yale University School of Public Health, this study is important because previous research from Denmark using high-quality medical registry data has shown that ingestion of chronic and low-dose lithium from drinking can influence the occurrence of adult-onset neuropsychiatric disorders. Unfortunately, no research has been conducted to determine whether lithium in drinking water eaten by pregnant women impacts the neurodevelopment of their children.

Ritz and Liew collaborated with Danish researchers who examined lithium levels in 151 public waterworks in Denmark, which served approximately half of the country’s population. The researchers analyzed address information from Denmark’s comprehensive civil registry system to determine which waterworks serviced mothers’ houses at the time of their pregnancy.

Utilizing a countrywide database of individuals with psychiatric problems, the researchers selected children born between 1997 and 2013 and compared them to 63,681 youngsters who did not have an autism diagnosis. The researchers also took into account maternal features, socioeconomic factors, and exposure to air pollution, all of which have been related to an elevated risk of autism in offspring.

According to the researchers, as lithium levels rose, so did the risk of being diagnosed with autism. In comparison to the lowest quartile of observed lithium levels (the 25th percentile), lithium levels in the second and third quartiles were related to a 24-26% increased risk of autism. The risk was 46% higher in the top quartile than in the lowest.

When the data was broken down by autism subtypes, the researchers discovered a similar association between elevated lithium levels and a higher risk of autism diagnosis. They also discovered that the link between lithium levels and autism risk was slightly stronger in urban regions than in smaller cities and rural locations.

Aside from Denmark’s extensive civil databases, which have shown to be excellent tools for public health researchers, a number of other characteristics made Denmark an appropriate location for this study. Denmark’s bottled water use is among the lowest in Europe, implying that Danes primarily rely on tap water. The country also has a solid system in place for monitoring trace metals and other impurities in its water supply. When compared to other countries, lithium levels in Danish water are likely to be in the low to moderate range, according to Ritz.

According to union health ministry data, a total of 3,824 new Covid-19 infections were registered across the country in the last 24 hours, a small increase from Saturday’s tally of 2994 coronavirus cases. India currently has 18,389 active Covid-19 cases. The 3,824 new coronavirus cases reported on Sunday represent the largest single-day increase in nearly six months.

According to today’s health bulletin, the daily positivity rate was 2.87 percent and the weekly positivity rate was 2.24 percent. The total number of patients who have recovered from the sickness is 4,41,73,335.

In the last 24 hours, a total of 2,799 Covid vaccine doses were provided. According to the ministry’s website, 220.66 crore doses of the Covid-19 vaccine have been distributed as part of the statewide vaccination campaign. In response to the recent spike in Covid-19 instances around the country, the Ministry of Health and Family Welfare has released amended instructions.

“Antibiotics should not be used unless there is clinical suspicion of bacterial infection. The possibility of coinfection of COVID-19 with other endemic infections must be considered. Systemic corticosteroids are not indicated in mild disease,” revised guidelines said.

“Antibiotics should not be used unless there is clinical suspicion of bacterial infection. The possibility of coinfection of COVID-19 with other endemic infections must be considered. Systemic corticosteroids are not indicated in mild disease,” revised guidelines said.

“Seek immediate medical attention if difficulty breathing, High-grade fever/ severe cough, particularly if lasting for more than 5 days. A low threshold is to be kept for those with any of the high-risk features,” guidelines discussed and prepared in January said.

Furthermore, “consider Remdesivir for up to 5 days (200 mg IV on day 1 followed by 100 mg IV OD for the next 4 days)” in moderate or severe conditions at high risk of advancement, according to the guidelines.

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

The Delhi High Court recently ordered the Delhi Development Authority (DDA) to file an affidavit regarding a private hospital’s refusal to provide dialysis to an Economically Weaker Section (EWS) patient. The hospital claimed that it won the land in an auction from the DDA.

The hospital abruptly stopped his dialysis on March 1, according to the petitioner. He filed a petition through advocate Ashok Agarwal, expressing his dissatisfaction with the denial of dialysis treatment to him. It was also argued that because the private hospital obtained land on a concessional basis from the DDA, it must provide free treatment to EWS patients.

The Delhi High Court recently ordered the Delhi Development Authority (DDA) to file an affidavit regarding a private hospital’s refusal to provide dialysis to an Economically Weaker Section (EWS) patient. The hospital claimed that it won the land in an auction from the DDA.

The hospital abruptly stopped his dialysis on March 1, according to the petitioner. He filed a petition through advocate Ashok Agarwal, expressing his dissatisfaction with the denial of dialysis treatment to him. It was also argued that because the private hospital obtained land on a concessional basis from the DDA, it must provide free treatment to EWS patients.

The high court, on the other hand, has asked the DDA to state whether there is any condition for free treatment to be provided to EWS patients. Justice Prathibha M Singh served the private hospital with notice and ordered it to file an affidavit within four weeks.

The hospital stated that the land was not given on a concessional basis and that the current petition is not maintainable because it is a private hospital. The hospital also stated that it purchased the land from the DDA through an auction.

“The hospital must place all the documents of the auction purchase with the affidavit. The DDA shall file its affidavit and state whether the land was allotted on a concessional basis, an auction basis, and whether there is any condition for free treatment given to EWS patients,” directed Justice Singh on Tuesday.

Meanwhile, the bench further directed to check if there is any other Delhi government hospital, which is providing dialysis treatment to EWS patients and the same may be communicated to the counsel for the petitioner within one week.

If such a hospital is found, the petitioner must receive dialysis treatment there, according to Justice Singh. Furthermore, the Delhi Government’s counsel submitted that people who want to get reimbursed for medical treatment can do so through the Delhi Arogya Kosh Scheme.

The World Health Organization (WHO) has called for increased efforts to eradicate tuberculosis (TB) in the South East Asian region, which has the world’s highest TB burden. According to the WHO Press Release, Dr. Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, highlighted the urgent need for countries and partners to strengthen high-level leadership and investments, accelerate uptake of new WHO recommendations and innovations, better address social and economic determinants, and improve multisectoral collaboration.

Globally, the COVID-19 pandemic has not only halted, but also reversed, years of progress towards the end-of-TB milestones. The estimated global burden of new and relapse TB cases in 2021 was 10.6 million, up half a million from 2020.

WHO stated in an official release that TB and TB-HIV coinfection mortality stood at 1.6 million, an increase of around 200 000 from pre-COVID-19 levels. The WHO South-East Asia Region has the highest TB burden in the world. In 2021, the Region was responsible for more than 45 percent of global tuberculosis incidence and more than half of global tuberculosis deaths.

Throughout the COVID-19 response, the Region prioritised maintaining essential health services, including TB, but in 2020, 2.6 million new and relapse TB cases were reported, a 24% decrease from 2019. The Region achieved a partial recovery in 2021, reporting 3 million new and relapsed cases, 12% fewer than in 2019.

According to the official release, the COVID-19 crisis has exacerbated key social and economic determinants of tuberculosis (TB), such as poverty and malnutrition, pushing tens of millions more people into extreme poverty in the Region. Even before the pandemic, an estimated 30-80% of TB patients in the Region faced catastrophic costs as a result of the disease, and around 1 million new TB cases per year – more than one in five – were attributable to malnutrition. It is estimated that the overall impact of the crisis could result in over 7 million additional TB cases and 1.5 million additional TB deaths across the Region between 2022 and 2026.

Despite enormous and ongoing challenges, the Region is stepping up efforts to meet the End TB milestones, in accordance with its Flagship Priority and Regional Strategic Plan for Ending TB 2021-25, as well as the global End TB Strategy, the UN Political Declaration on the Fight Against TB, and Sustainable Development Goal 3.3.

Preliminary data shared with WHO shows a strong recovery in TB case notifications in the majority of the Region’s countries. In several high-burden countries, the total number of patients started on treatment in 2022 is expected to be higher than in 2019, and in some cases, the highest ever.

Budget allocations for TB programmes in the Region totaled nearly USD 1.4 billion in 2022, with nearly 60% coming from domestic sources. Momentum must be maintained in the run-up to the second UN High Level Meeting on Tuberculosis (TB), which is scheduled for September 2023 and will bring together Heads of State from around the world to mobilise increased political and social commitment to ending TB and ensuring comprehensive and universal care for all.

The Region has several priorities in this regard. First, high-level leadership, engagement, and advocacy must be strengthened in order to increase investments to end tuberculosis. According to WHO, the Region requires at least USD 3 billion per year to avert nearly 4.5 million new TB cases and more than 1.5 million TB deaths by 2025.

Countries and partners must urgently – and sustainably – increase funding availability and strengthen investments, recognising that every dollar invested yields 40 dollars back. Over 5000 molecular test platforms have been installed across the Region to quickly diagnose tuberculosis and medication resistance.

Such platforms must be expanded to ensure rapid diagnosis and treatment, as well as to halt disease spread. A new, WHO-approved treatment plan that has improved cure rates in just 6-9 months should be quickly adopted and implemented globally, according to a WHO press release.

Furthermore, in the fight against tuberculosis, mechanisms should be established and/or strengthened to assist TB patients and their families in avoiding catastrophic costs, supplementing nutrition, and promoting treatment adherence. Stigma and discrimination must be addressed indefinitely, including through community engagement and empowerment programmes that promote high-quality information.

On World Tuberculosis Day, WHO reiterates its commitment to assisting all countries in the Region in getting back on track, turning the tide, and eliminating TB by 2030, leaving no one behind.

The health sector cannot eliminate tuberculosis on its own. Ending TB, on the other hand, necessitates concerted action from multiple sectors, which, as stated at the 2021 Regional High-level Meeting to End TB, should be coordinated by national high-level mechanisms. According to the press release, such mechanisms, which have been developed by seven countries, must define clear roles and responsibilities and be accompanied by an accountability framework that is aligned with WHO guidance.