The Enquiring About Tolerance (EAT) is a large randomized controlled trial analyzing the allergenic effect of introduction of foods in babies at 3 months compared to exclusive breastfeeding till 6 months. The trial aimed to evaluate whether early introduction of foods can reduce the incidence of allergies later in life. However, the study has thrown up interesting information, which has been analyzed and published separately. It was found that babies who had early introduction of solids slept significantly better and had much lesser awakenings per night compared to those who were exclusively breastfed till 6 months. They also reported fewer serious sleep problems even beyond 6 months through infancy.

The question remains about why the infants with early introduction of solids continue to sleep better even after 6 months throughout infancy when the control group is also on solids. The authors hypothesize that sleep patterns established in early life can persist for several years.

A dash of commonsense goes a long way in bringing up babies. (JAMA Pediatr.　2018;172:e180739)

Human rights as a concept, was developed at the culmination of World War II. The Universal Declaration of Human Rights emphasized "the recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family."　In India, the various legal provisions related to patients’ rights are scattered across different legal documents; e.g., The Constitution of India Article 21, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002, The Consumer Protection Act 1986, Drugs and Cosmetic Act 1940, and the Clinical Establishment Act 2010.

The National Human Rights Commission has tried to consolidate all the documents into one charter of patients’ rights, and have put up a draft on the Ministry of Health website for suggestions and comments.

The first is a right to information about their illness, which must be explained in a language understandable to them. The second is a right to access originals/copies of case papers, indoor patient records, investigation reports (during period of admission, preferably within 24 hours and after discharge, within 72 hours). The third right is that all hospitals, both in the government and in the private sector, are duty bound to provide basic Emergency Medical Care. Such care must be initiated without demanding payment/advance and basic care should be provided to the patient irrespective of paying capacity. Fourth and fifth are the rights to consent and confidentiality. Sixth is the right to second opinion. Seventh is the right to transparency in rates. No patient can be denied choice in terms of medicines, devices and standard treatment guidelines based on the affordability. The eight right states that every patient has the right to receive treatment without any discrimination based on his or her illnesses, including HIV status, religion, sexual orientation or social origins. The ninth right mentions that the hospital management has a duty to ensure safety of all patients in its premises, including clean premises and provision for infection control. Patients have a right to receive quality health care according to currently accepted standard guidelines as per National Accreditation Board for Hospitals (NABH). The other rights include right to alternative treatment options, choose source of medicines or tests, right to proper referral, and protection in clinical trials. A patient also has the right to take discharge and cannot be detained in a hospital, on procedural grounds such as dispute in payment of hospital charges.

The charter ends on a brief note also discussing the responsibilities of patients. But as is human nature, the emphasis is always on right and not responsibilities.

(https://www.mohfw.gov.in/newshighlights/draft-patient-charter-prepared-national-human-rights-commission)

The million-dollar question today is ‘what causes autism?’ The prevalence of autism in the US is now estimated at an all-time high of 1 in 68 children. The JAMA Pediatrics study is a case-control study comparing the number, timing, tissue depth penetration of ultrasonography conducted in antenatal period in patients with autism and those without. The concern was that modern ultrasound machines are more powerful than those tested in fetal safety studies. Further, animal studies have indicated that prenatal ultrasound exposure may cause thermally mediated damage to normal neuronal migration with consequent cognitive deficits.

The fetuses who went on to develop autism had no difference in numbers or timing of ultrasonography. Nor was there any difference in the thermal or mechanical indices of the ultrasonography they were exposed to. However, children who went on to develop autism had a greater tissue penetration depth of the ultrasound as compared to those who did not.