what is Mechanical ventilator? A machine critical to save life


A medical ventilator (or simply ventilator in context) is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently.

While modern ventilators are computerized machines, patients can be ventilated with a simple, hand-operated bag valve mask.

Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesiology  (as a component of an  anesthesia machine .

Medical ventilators are sometimes colloquially called “respirators”, a term stemming from commonly used devices in the 1950s (particularly the “Bird Respirator”). However, in modern hospital and medical terminology, these machines are never referred to as respirators, and use of “respirator” in this context is now a deprecated anachronism signaling technical unfamiliarity.

Function                                  

In its simplest form, a modern positive pressure ventilator consists of a compressible air  reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable “patient circuit”. The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When over pressure is released, the patient will exhale passively due to the lungs’ elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold.

Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g. pressure, volume, and flow) and ventilator function (e.g. air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled  turbo-pump.

Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient’s needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada and the United States and in many parts of world, respiratory therapists are responsible for tuning these settings, while biomedical technologists are responsible for the maintenance.

The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive.

Noninvasive methods, which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require     intubation.  For long-term ventilator dependence will normally be a tracheostomy  cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.

Life-critical system

Because failure may result in death, mechanical ventilation systems are classified as a life critical-system and precautions must be taken to ensure that they are highly reliable, including their  power supply .

Mechanical ventilators are therefore carefully designed so that no single point of failure can endanger the patient. They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the mechanical ventilator integrated into an  anesthetic machine . They may also have safety valves, which open to atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient. Some systems are also equipped with compressed-gas tanks, air compressors, and/or backup batteries to provide ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their mechanisms or software fail.

history of ventilator

source 

History of mechanical ventilator 


                

The history of mechanical ventilation begins with various versions of what was eventually called the iron lung, a form of noninvasive negative pressure ventilator widely used during the polio epidemics of the 20th century after the introduction of the “Drinker respirator” in 1928, improvements introduced by John Haven Emerson in 1931,  and the Both respirator in 1937. Other forms of noninvasive ventilators, also used widely for polio patients, include Biphasic Cuirass Ventilation, the rocking bed, and rather primitive positive pressure machines.

In 1949, John Haven Emerson developed a mechanical assister for anesthesia with the cooperation of the anesthesia department at Harvard University. Mechanical ventilators began to be used increasingly in anesthesia and intensive care during the 1950s. Their development was stimulated both by the need to treat polio patients and the increasing use of muscle relaxants during anesthesia. Relaxant drugs paralyze the patient and improve operating conditions for the surgeon but also paralyze the respiratory muscles.

In the United Kingdom, the East Radcliffe and Beaver models were early examples, the latter using an automotive wiper motor to drive the bellows used to inflate the lungs. Electric motors were, however, a problem in the operating theaters of that time, as their use caused an explosion hazard in the presence of flammable anesthetics such as ether and  cyclopropane .

In 1952, Roger Manley of the Westminster Hospital, London, developed a ventilator which was entirely gas driven, and became the most popular model used in Europe. It was an elegant design, and became a great favorite with European anesthetists for four decades, prior to the introduction of models controlled by electronics. It was independent of electrical power, and caused no explosion hazard. The original Mark I unit was developed to become the Manley Mark II in collaboration with the Blease company, who manufactured many thousands of these units. Its principle of operation was very simple, an incoming gas flow was used to lift a weighted bellows unit, which fell intermittently under gravity, forcing breathing gases into the patient’s lungs. The inflation pressure could be varied by sliding the movable weight on top of the bellows. The volume of gas delivered was adjustable using a curved slider, which restricted bellows excursion. Residual pressure after the completion of expiration was also configurable, using a small weighted arm visible to the lower right of the front panel. This was a robust unit and its availability encouraged the introduction of positive pressure ventilation techniques into mainstream European anesthetic practice.

The 1955 release of Forrest Bird’s “Bird Universal Medical Respirator” in the United States changed the way mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment.  The unit was sold as the Bird Mark 7 Respirator and informally called the “Bird”. It was a pneumatic device and therefore required no electrical power source to operate.

Intensive care environments around the world revolutionized in 1971 by the introduction of the first  Servo 900 ventilator Elema – Schonander . It was a small, silent and effective electronic ventilator, with the famous SERVO feedback system controlling what had been set and regulating delivery. For the first time, the machine could deliver the set volume in volume control ventilation.

Ventilators used under increased pressure (hyperbaric) require special precautions and few ventilators can operate under these conditions. In 1979, Sechrist Industries introduced their Model 500A ventilator which was specifically designed for use with hyperbaric chambers.

In 1991 the SERVO 300 ventilator series was introduced. The platform of the SERVO 300 series enabled treatment of all patient categories, from adult to neonate, with one single ventilator. The SERVO 300 series provided a completely new and unique gas delivery system, with rapid flow-triggering response.

In 1999 the LTV (Laptop Ventilator) Series was introduced into the market. The new ventilator was significantly smaller than the ventilators of that time weighing ~14 lbs and around the size of a laptop computer. This new design kept the same functionality of the in hospital ventilators, while now opening up a world of opportunity of mobility for the patients.

A modular concept, meaning that the hospital has one ventilator model throughout the ICU department instead of a fleet with different models and brands for the different user needs, was introduced with SERVO-i in 2001. With this modular concept the ICU departments could choose the modes and options, software and hardware needed for a particular patient category.

mechanical ventilator

Cure for AIDS may be possible in near future


“London patient” becomes second person to be cured of AIDS after stem cell therapy. It has helped them put their infection under remission without medication. The breakthrough offers hope for a potential cure using gene manipulation for an infection. Concept that scientists will one day be able to end AIDS, the doctors said, but does not mean a cure for HIV has been found.

An HIV-positive man in Britain has become the second known adult worldwide to be cleared of the AIDS virus after he received a bone marrow transplant from an HIV resistant donor, his doctors said.

Almost three years after receiving bone marrow stem cells from a donor with a rare genetic mutation that resists HIV infection – and more than 18 months after coming off antiretroviral drugs – highly sensitive tests still show no trace of the man’s previous  HIV infection.

“There is no virus there that we can measure. We can’t detect anything,” said Ravindra Gupta, a professor and HIV biologist who co-led a team of doctors treating the man.

The case is a proof of the concept that scientists will one day be able to end AIDS, the doctors said, but does not mean a cure for HIV has been found.

Gupta described his patient as “functionally cured” and “in remission”, but cautioned: “It’s too early to say he’s cured.”

The man is being called “the London patient”, in part because his case is similar to the first known case of a functional cure of HIV – in an American man, Timothy Brown, who became known as the “ Berlin patient” when he underwent similar treatment in Germany in 2007 which also cleared his HIV.

 

Brown, who had been living in Berlin, has since moved to the United States and, according to HIV experts, is still HIV-free.

Some 37 million people worldwide are currently infected with  HIV  has killed around 35 million people worldwide since it began in the 1980s. Scientific research into the complex virus has in recent years led to the development of drug combinations that can keep it at bay in most patients.

Gupta, now at Cambridge University, treated the London patient when he was working at University College London. The man had contracted HIV in 2003, Gupta said, and in 2012 was also diagnosed with a type of blood cancer called Hodgkin’s Lymphoma.

In 2016, when he was very sick with cancer, doctors decided to seek a transplant match for him. “This was really his last chance of survival,” Gupta told Reuters in an interview.

The donor – who was unrelated – had a genetic mutation known as ‘CCR5 delta 32’, which confers resistance to HIV.

The transplant went relatively smoothly, but there were some side effects, including the patient suffering a period of “graft-versus-host” disease.

Most experts say it is inconceivable such treatments could be a way of curing all patients. The procedure is expensive, complex and risky. To do this in others, exact match donors would have to be found in the tiny proportion of people — most of them of northern European descent — who have the CCR5 mutation that makes them resistant to the virus.

Specialists said it is also not yet clear whether the CCR5 resistance is the only key – or whether the graft versus host disease may have been just as important. Both the Berlin and London patients had this complication, which may have played a role in the loss of HIV-infected cells.

Sharon Lewin, an expert at Australia’s Doherty Institute and co-chair of the International AIDS Society’s cure research advisory board, told Reuters the London case points to new avenues for study. “We haven’t cured HIV, but (this) gives us hope that it’s going to be feasible one day to eliminate the virus,” she said.

Gene manipulation, like any experimental technology, comes with several caveats, including concerns about the “off target effects” that can cause adverse mutations, including cancer.

 

Leopard tortoise designed pill to administer insulin in diabetes


The discovery  has a potential to  transform  lives of millions of patients with diabetics.  It can  counter the availability and cost of insulin in future.  If successful , the new technology can even change the  delivery of other  drugs as well.

Scientists have developed a “needle pill” that could allow diabetics to take insulin without the need for daily injections.

The pea-sized capsule contains a small needle made of solid, compressed insulin, which is injected into the stomach wall after the capsule has been swallowed.

When tested in pigs, the device worked consistently and was able to deliver equivalent doses of insulin to those required by someone with diabetes.

Giovanni Traverso, an assistant professor at Harvard Medical School affiliated Brigham and Women’s hospital and a co-author of the study, said: “Our motivation is to make it easier for patients to take medication, particularly medications that require an injection. The classic one is insulin, but there are many others.”

Injections can be painful, cause injuries and be a barrier to people taking medication, he added.

The shape of the capsule is inspired by the leopard tortoise, found in Africa, which has a steep, domed shell that allows it to right itself if it rolls onto its back. In the case of the capsule, the domed shape ensures that the needle is continually reoriented towards the stomach wall. The needle is attached to a compressed spring that is restrained by a disk made from sugar. When the capsule is swallowed, water in the stomach dissolves the disk, releasing the spring and injecting the needle into the stomach wall.

The stomach wall does not have pain receptors, so it is unlikely that this would cause any discomfort. The insulin needle takes about an hour to dissolve into the bloodstream. In tests in pigs, the researchers said they were able to deliver five milligrams of insulin – comparable to the amount that a patient with type 2 diabetes would need to inject.

The metal spring and rest of the capsule passed through the digestive system, without seeming to cause any problems.

The team are now carrying out further tests in pigs and dogs and hope to start the first human trials within three years.

Modern medicine still primitive compared to “Superbugs”


Antibiotic resistant superbug gene discovered in remote Arctic area thought to be among ‘last pristine ecosystems’ on Earth, shocking study reveals

  • Antibiotic resistant gene first found in Delhi waters in 2010 now found in Arctic
  • Researchers say it likely spread through human activity and bird, animal waste
  • In recent years, antibiotic resistance has grown to be a global health crisis  

 

More the medical science has evolved,   more we realize the  primitiveness  in front of  natural phenomenon, the environmental systems and  life around us. The evolution and adaptation of microbes, which we have discovered  for just last hundred years, are in existence for millions of years, much before humans. Discoveries like this, just  make us realize about our primitiveness in front of a superpower, which is best known as “Nature”.  Scientists have found a gene linked to antibiotic-resistant superbugs in an area said to be one of the last ‘pristine’ locations on Earth.

These antibiotic-resistant genes (ARGs) were first detected outside of the lab in 2010 in surface waters in Delhi, India.

But now, experts say the genes have traveled roughly 8,000 miles through human activity and the fecal matter of birds and other wildlife to reach a remote area in the Norweigian archipelago, Svalbard.

The discovery doesn’t bode well for the fight against antibiotic resistance, which has grown to be a global health crisis in recent years.

In a new study published to the journal Environmental International, researchers form Newcastle University report the discovery of the gene blaNDM-1 and other antibiotic-resistant genes in Kongsfjorden, Svalbard.” 

This gene is carried in the gut of animals and people.

‘Polar regions are among the last presumed pristine ecosystems on Earth, providing a platform for characterizing pre-antibiotic era background resistance against which we could understand rates of progression of AR “pollution,”’ said David Graham, an environmental engineer at Newcastle University.

‘But less than three years after the first detection of the blaNDM-1 gene in the surface waters of urban India we are finding them thousands of miles away in an area where there has been minimal human impact.

‘Encroachment into areas like the Arctic reinforces how rapid and far-reaching the spread of antibiotic resistance has become, confirming solutions to AR must be viewed in global rather than just local terms.’

Strains carrying blaNDM-1 were first identified in the lab in 2008 before they were found in Indian waters just two years later.

In the few years since, it’s been detected in over 100 more countries.

‘What humans have done through excess use of antibiotics on global scales is accelerate the rate of evolution, creating a new world of resistant strains that never existed before,’ Graham said.

Through the overuse of antibiotics, fecal releases, and contamination of drinking water, we have consequentially speeded-up the rate at which superbugs might evolve.

‘For example, when a new drug is developed, natural bacteria can rapidly adapt and can become resistant; therefore very few new drugs are in the pipeline because it simply isn’t cost-effective to make them.’

For the new study, the researchers analyzed DNA from forty soil cores taken from eight locations across Kongsfjorden.

And, they found a total of 131 ARGs in the samples

The resistance genes detected were associated with nine major antibiotic classes, including aminoglycosides, macrolides and β-lactams, which are used to treat many infections,’ Graham said.

‘As an example, a gene that confers MDR in Tuberculosis was found in all cores, whereas blaNDM-1 was detected in more than 60% of the soil cores in the study.

‘Identifying an ARG ‘gradient’ across the study landscape, which varies as a function of human and wildlife impact, shows there are still isolated Polar locations where ARG levels are so low they might provide nature’s baseline of antimicrobial resistance.’

According to the team, improvements in waste management and water quality around the world will be keep in staying on top of the spread of ARGs.

The gradient of resistance genes closely reflects corresponding indicators of wastes in the geochemistry, which suggests a novel basis for identifying sites for further AMR research,’ said lead author Dr Clare McCann.

 

History of Diphtheria


In 1613, Spain experienced an epidemic of diphtheria. The year is known as El Año de los Garrotillos (The Year of Strangulations) in the history of Spain.

In 1735, a diphtheria epidemic swept through New England.

Before 1826, diphtheria was known by different names across the world. In England, it was known as Boulogne sore throat, as it spread from France. In 1826, Pierre Bretonneau gave the disease the name diphthérite (from Greek diphthera “leather”) describing the appearance of pseudomembrane in the throat.

In 1856, Victor Fourgeaud described an epidemic of diphtheria in California.

In 1878, Queen Victoria’s daughter Princess Alice and her family became infected with diphtheria, causing two deaths, Princess Marie of Hesse and by Rhine and Princess Alice herself.

In 1883, Edwin Klebs identified the bacterium causing diphtheria  and named it Klebs-Loeffler bacterium. The club shape of this bacterium helped Edwin to differentiate it from other bacteria. Over the period of time, it was called Microsporon diphtheriticum, Bacillus diphtheriae, and Mycobacterium diphtheriae. Current nomenclature is Corynebacterium diphtheriae. Friedrich Loeffler was the first person to cultivate C. diphtheriae in 1884. He used Koch’s postulates to prove association between C. diphtheriae and diphtheria. He also showed that the bacillus produces an exotoxin. Joseph P. O’Dwyer introduced the O’Dwyer tube for laryngeal intubation in patients with an obstructed larynx in 1885. It soon replaced tracheostomy as the emergency diphtheric intubation method.

In 1888, Emile Roux and Alexandre Yersin showed that a substance produced by C. diphtheriae caused symptoms of   diphtheria in animals. In 1890, Shibasaburo Kitasato and Emil von Behring immunized guinea pigs with heat-treated diphtheria toxin. They also immunized goats and horses in the same way and showed that an “antitoxin” made from serum of immunized animals could cure the disease in non-immunized animals.

 

Behring used this antitoxin (now known to consist of antibodies that neutralize the toxin produced by C. diphtheriae) for human trials in 1891, but they were unsuccessful. Successful treatment of human patients with horse-derived antitoxin began in 1894, after production and quantification of antitoxin had been optimized.

 Von Behring won the first Nobel Prize in medicine in 1901 for his work on diphtheria.

 

In 1895, H. K. Mulford Company of Philadelphia started production and testing of diphtheria antitoxin in the United States. Park and Biggs described the method for producing serum from horses for use in diphtheria treatment.

In 1897, Paul Ehrlich developed a standardized unit of measure for diphtheria antitoxin. This was the first ever standardization of a biological product, and played an important role in future developmental work on sera and vaccines.

In 1901, 10 of 11 inoculated St. Louis children died from contaminated diphtheria antitoxin. The horse from which the antitoxin was derived died of tetanus. This incident, coupled with a tetanus outbreak in Camden, New Jersey, played an important part in initiating federal regulation of biologic products.

On 7 January 1904, Ruth Cleveland died of diphtheria at the age of 12 years in Princeton, New Jersey. Ruth was the eldest daughter of former President Grover Cleveland and the former first lady Frances Folsom.

In 1905, Franklin Royer, from Philadelphia’s Municipal Hospital, published a paper urging timely treatment for diphtheria and adequate doses of antitoxin.

In 1906, Clemens Pirquet and Béla Schick described serum sickness in children receiving large

quantities of horse-derived antitoxin.

Between 1910 and 1911, Béla Schick developed the Schick test to detect pre-existing immunity to diphtheria in an exposed person.

Only those who were not exposed to diphtheria were preferably vaccinated. A massive, five-year campaign was coordinated by Dr. Schick. As a part of the campaign, 85 million pieces of literature were distributed by the Metropolitan Life Insurance Company with an appeal to parents to “Save your child from diphtheria.” A vaccine was developed in the next decade, and deaths began declining significantly in 1924.

In 1919, in Dallas, Texas, 10 children were killed and 60 others made seriously ill by toxic antitoxin which had passed the tests of the New York State Health Department. Mulford Company of Philadelphia (manufacturers) paid damages in every case.

In the 1920s, an estimated 100,000 to 200,000 cases of diphtheria occurred per year in the

United States, causing 13,000 to 15,000 deaths per year.  Children represented a largemajority of these cases and fatalities. One of the most infamous outbreaks of diphtheria was in Nome, Alaska; the “Great Race of Mercy” to deliver diphtheria antitoxin is now celebrated by the Iditarod Trail Sled Dog Race.

In 1926, Alexander Thomas Glenny increased the effectiveness of diphtheria toxoid (a modified version of the toxin used for vaccination) by treating it with aluminum salts. Vaccination with toxoid was not widely used untli the early 1930s.

In 1943, diphtheria outbreaks accompanied war and disruption in Europe. The 1 million cases in Europe resulted in 50,000 deaths. In 1949, 68 of 606 children died after diphtheria immunization due to improper manufacture of aluminum phosphate toxoid.

In 1974, the World Health Organization included DPT vaccine in their Expanded Programme on Immunization for developing countries.

In 1975, an outbreak of cutaneous diphtheria in Seattle, Washington, was reported.

In 1994, the Russian Federation had 39,703 diphtheria cases. By contrast, in 1990, only 1,211 cases were reported.

Between 1990 and 1998, diphtheria caused 5000 deaths in the countries of the former Soviet Union

In early May 2010, a case of diphtheria was diagnosed in Port-au-Prince, Haiti, after the devastating 2010 Haiti earthquake. The 15- year-old male patient died while workers searched for antitoxin.

In 2013, three children died of diphtheria in Hyderabad, India.]

In early June 2015, a case of diphtheria was diagnosed aVt all d’Hebron University Hospita lin Barcelona, Spain. The 6-year-old child who died of the illness had not been previously vaccinated due to parental opposition to vaccination. It was the first case of diphtheria in the country since 1986 as reported by” El Mundo” or from 1998, as reported by WHO.

In March 2016, a 3-year-old girl died of diphtheria in the University Hospital of Antwerp, Belgium.

In June 2016, a 3-year-old, 5-year-old, and 7-year-old girl died of diphtheria in Kedah and Malacca, Sabah Malaysia.

In January 2017, more than 300 cases were recorded in Venezuela.

In November and December 2017, an outbreak of diphtheria occurred in Indonesia with more than 600 cases found and 38 fatalities.

source

 

“Himalayan Viagra” or ‘yarsagumba’ (Ophiocordyceps sinensis)


It’s the time of the year that the mushroom called ‘yarsagumba’ (Ophiocordyceps sinensis), also known locally as ‘keerajari’, appears in the meadows when the snow starts melting.  it is also known as Himalayan Viagra.

The mushroom, which has a long history of use in traditional Chinese medicine (thousands of years), fetches a price of Rs 2 to 5 lakhs per kilogram or much  above locally, depending on quality. It plays a vital role in the local economy, that’s largely pastoral.

It is also called Yart Swa Gun Bu, which in Tibetan means ‘herb in the summer and insect in the winter’. In Nepali it is referred to by the colloquial term Yachagumbu or Yaxagumbu while the Chinese call it Dong cong xia cao.

Usually, as the month of May approaches, villagers from Dasholi, Ghat, Urgam valley, Niti valley, Deval and Joshimath blocks of Chamoli district start start moving into the the higher ranges, armed with essentials and rations. They camp there for at least two months while hunting for the prized mushroom, yarsagumba or Himalayan Viagra.

The heavy snowfall in the higher ranges of Himalayas earlier this week has disrupted the hunt for a prized aphrodisiac fungus popularly referred to as Himalayan viagra. There’s a lot at stake.

Heavy snowfall  has forced villagers to call off the hunt for yarsagumba and climb down from the higher reaches of Chamoli district in Uttarakhand. They will have to wait till the snow melts and that may leave only a handful days left in the Yarsagumba season.

Usually, as the month of May approaches, villagers from Dasholi, Ghat, Urgam valley, Niti valley, Deval and Joshimath blocks of Chamoli district start  moving into the higher ranges, armed with essentials and rations. They camp there for at least two months while hunting for the prized mushroom.

source

Supreme Court judgement on End of Life & Living Will: Partaking moral and ethical dilemma of doctors and relatives


A welcome, long awaited judgement, where law has come to help the doctors and relatives of terminally ill patients. Doctors are often accused of over treatment, without realizing that law does not permit them the termination of treatment as desired by patients or relatives. commonly  doctors come to face these difficult situations, where moral and ethical dilemma  is larger than treatment itself.

The Supreme Court ruled on Friday that individuals have a right to die with dignity, in a verdict that permits the removal of life-support systems for the terminally ill or those in incurable comas.

The court also permitted individuals to decide against artificial life support, should the need arise, by creating a “living will”.

 Living will

A ‘living will’ is a concept where a patient can give consent that allows withdrawal of life support systems if the individual is reduced to a permanent vegetative state with no real chance of survival.

It is a type of advance directive that may be used by a person before incapacitation to outline a full range of treatment preferences or, most often, to reject treatment. A living can detail a person’s preferences for tube-feeding, artificial hydration, and pain medication when an individual cannot communicate his/her choices.

In its verdict on Friday, SC has attached strict conditions for executing “a living will that was made by a person in his normal state of health and mind”.

The US, UK, Germany and Netherlands have advance medical directive laws that allow people to create a ‘living will’.

 Active and passive euthanasia

Active euthanasia, the intentional act of causing the death of a patient in great suffering, is illegal in India. It entails deliberately causing the patient’s death through injections or overdose.

But passive euthanasia, the withdrawal of medical treatment with the deliberate intention to hasten a terminally ill patient’s death was allowed by the Supreme Court in Friday’s landmark verdict.

The court also laid down guidelines on who would execute the will and how a nod for passive euthanasia would be granted by a medical board set up to determine and carry out any “advance directive”.

In cases where there is no “advance directive”, the patient, family, friends and legal guardians can’t take the decision on their own, but can approach a high court for stopping treatment .

 Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill

In 2012, the union health ministry posted a draft of the Terminally Ill Patients (Protection of Patients and Medical Practitioners) Bill on its website and invited public reactions.

The Bill is popularly referred to as the Passive Euthanasia Bill although its draft did not use the emotive word “euthanasia” to skirt complications around the term, a health ministry official told HT in 2016. It says every advance medical directive (also called ‘living will’) or medical power of attorney executed by a person shall be taken into consideration in matter of withholding or withdrawing medical treatment but it shall not be binding on any medical practitioner.

 Misuse of law

A major concern is the misuse of the law. If it is legal to passively allow or hasten death, what’s to say an aged parent won’t be hastened in favor of an inheritance, or a spouse have treatment withdrawn for the sake of a hefty insurance payout? That is why there are legal provisions  in the judgement  by Supreme court, to safe guard the patients.

The bench also stipulated strict conditions for the execution of the living will, which includes the setting up of two medical boards and certification by the judicial magistrate. It also directed high courts to maintain a record of all living will documents prepared within the state.

 Euthanasia in other countries

Euthanasia and physician-assisted suicide have been legal in The Netherlands and Belgium since 2001 and 2002. In the US, Switzerland and Germany, euthanasia is illegal but physician-assisted suicide is legal. Euthanasia remains illegal in the UK, France, Canada and Australia.

Source- Hindustan times

20 interesting facts about the kidneys : World Kidney Day


  1. Kidneys are very important   and   fundamental organs of human body.  They are extremely complex in mechanism and they have two functions  that is blood purification and  waste elimination.
  2. An adult kidney weighs around  142 grams and  is the size of  human fist.
  3. In case of new born human babies, the kidney to body weight ratio is 3 times the kidney to body weight ratio in adults. In case of adults, kidneys form only 0.5% of the entire body weight.
  4. Largest kidney stone recorded was of coconut size and weighed 1.1 kg.
  5. If a child is borne without a kidney, the one kidney will grow and weigh the same as of two kidneys.
  6. The right kidney is below the liver ( largest organ ) and smaller than left kidney.
  7. There are 1.1 million nephrons ( very tiny filters that are capable of filtering blood) in the body. If stretched end to end,  they  will be 8 KM long.
  8. Kidney filter blood around 400 times a day.
  9. If kidney detect fall in Blood pressure, they signal blood vessels to shrink.
  10. A single kidney with only 75 % of its functional capacity can sustain life very well.
  11. They are capable of activating vitamin D in our body. This vitamin is usually produced by special skin cells when they are exposed to sunlight.
  12. Kidneys cleanse 1.3 liters of blood every minute to produce about the same quantity  of urine in a day.
  13. Most common cause of renal stones is not drinking enough water.
  14. About 25 % of the blood from heart, goes to kidneys.
  15. High BP and diabetes can both lead to failure of kidneys.
  16. When the kidney functions are completely lost, it is known as ESRD or End Stage Renal Disease.
  17. People suffering with ESRD can live longer with help of kidney transplant or dialysis.
  18. The first ever kidney transplant was conducted by Yuri Voronoy, a Russian surgeon in year 1933, but was unsuccessful.
  19. The first ever successful kidney transplant was conducted by Dr. Joseph E. Murray in December 1954, in Massachusetts at Peter Bent Brigham Hospital.
  20. A kidney transplant would be normally put in pelvis and  disabled kidney will not be extracted.

 

source

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