Observing that there was no systemic breach for scrapping the entire exam held on May 5th, 2024, the top court bench clarified that there would be no re-exam of NEET.

"In arriving at the ultimate conclusion, the Court is guided by well-settled test on whether it is possible to segregate the tainted student from those who do not suffer from any taint ... If investigation reveals the involvement of an increased number of beneficiaries, then those who are suspects at present stage (may be pursued) ... Data on record is not indicative of a systemic leak of the question paper which would indicate a disruption of the sanctity of the exam," the bench ordered.

"For the above reasons, we are of the considered view that ordering the cancellation of the entire NEET UG 2024 exam is neither justified on application of settled principles propounded by the decisions of this court on the basis of material on record," it further noted.

Pleas Seeking Re-NEET:

Medical Dialogues had earlier reported that during the last hearing of the case on July 18, the Apex Court bench led by Chief Justice of India DY Chandrachud had asked the National Testing Agency (NTA) to publish the marks obtained by all the candidates in the NEET UG 2024 exam while ensuring that the identity of the students was masked.

Yesterday i.e. on July 22nd, 2024, the counsels for the petitioners completed their arguments. Appearing on behalf of the petitioners seeking a re-NEET, several counsels including Advocate Hooda, Advocate Helge and Advocate Nedumpara opined that there should be a re-test, at least for the 13 lakh candidates who qualified in the exam by scoring the cut-off 164 marks.

Hearing on 23rd July, 2024: 

When the Solicitor General sought to know if the Court would be considering individual grievances, the CJI noted, "those candidates who may have some individual grievances we may leave it them to move the HC . I don't think the remit of this court is to start looking at individual grievances. We will detag those matters."

Meanwhile, Advocate Hooda, appearing for the petitioners pointed out that in some centres, the question paper was given in different medium of language and later those candidates were allowed another examination on the same day from 6 PM to 9PM. So, Hooda argued that attempting the same paper twice defeated the integrity of the examination.

Submission by NTA: 

The Solicitor General pointed out that the Court was considering an issue where approximately 24 lakh students were involved. There were altogether 4750 centres, he pointed out, adding that this would be a relevant figure to examine a pan-India cross-country impact.

Centre & City-Wise Sucess Rate: 

He referred to the data in 2022, 2023, and 2024 to show whether there was any mark, jump or rise that would indicate if there was a pan-India impact. Referring to the concept of "percentile", he argued that the young students were unnecessarily getting tensed because of the wrong narrative.

Mentioning that this year, the qualifying percentile was 164 marks, he pointed out that out of 24 lakh students who appeared in the test, 12.5 lakhs were below the 164 cut-off marks and 12.5 lakhs were above 164. 

The SG highlighted that the cut-off last year was 137 and therefore, this indicated that this year's number of students increased, the students might have been more hardworking and the syllabus was sliced out. He also pointed out that for these 12.5 lakh qualified students, there were only 1 lakh 8 thousand seats.

Thereafter, he submitted the centre-wise data of qualified candidates and pointed out the success rate was quite similar to last year with slight increase or decrease in the figures. He argued that there was no "mark spike" which may lead to any conclusion and contended that the marking pattern almost remained consistent.

He submitted that there is an increase in some cities from 2022 to 2023 to 2024 and this increase was proportionate. He also referred to the success ratio and argued that it could not be concluded that the candidates were going to some specific centres to get benefits. Otherwise, the success ratio would jump.

In case of Bihar and Patna, he pointed out that the success rate was 5.53% in 2024 and in earlier years it remained consistent with 2 or 3% plus or minus everywhere. In Hazaribagh, the success rate this year was 4.61%, in Belgavi, where it was claimed the students were shifting to mass copying, the success rate was 2.5%.

In terms of the qualifying percentile, he pointed out that in Bihar, Patna, 49.22% were qualified and Jharkhand, Hazaribagh, Punjab etc do not come in the highest bracket of more than 80%. Giving centre-wise breakup, he submitted that in Gurukul International School, altogether 715 appeared and only 101 ranked within the first 56,000. The success ratio was 14.30% and for those ranking between 1 lakh and 8 thousand, the success rate was 21.16%. He submitted that in the case of Sikar, the total success rate was 19.22% and it was 19.19% in the previous year.

On the issue of opening of window for new registration, the SG submitted that this was done because NTA had received representations from students who could not register and argued that it did not indicate any wrongdoing.

He submitted that out of 24 lakh, 14,000 applied for the change of city. The SG pointed out that these students were spread across 4,020 centres and if one centre was offering reward, it should have been concentrated therein. However, this did not happen.

Address Change: 

When the CJI sought to know if any documents were needed for the change of centre, the SG submitted that no documents are required since NTA does not consider why a particular city is selected.

Responding to the CJI's question that if domicile is required, the SG submitted that there is no domicile factor. He also argued that in absence of any spike in marks or ranks, the change of city does not indicate any cross-country manipulations. He submitted that the success rate among the 14,000 was 6 percent approximately.

Regarding the 1563 candidates who appeared for the retest, the SG submitted that 816 appeared for retest and argued that some of those students were meritorious and they were okay with the race marks being taken away. He also submitted that the success rate among these 1563 candidates was 1.63 percent. 

Canara Bank Question papers: 

At this outset, the CJI questioned how many centres got the Canara Bank stored papers. Submitting that there were two categories, the SG pointed out that some centres chose to continue with the Canara Bank papers and the paper was at the same difficulty level with the SBI stored question papers.

When the CJI observed that the data suggested a lesser success rate of the Canara bank papers, the SG submitted that it depended upon the caliber of students as well. 

"How was Canara Bank (question papers) distributed ? ... Who authorised the city coordinator?" the CJI sought to know.

In response to this, the SG submitted that there were human errors which happen while dealing with 24 lakh students. However, he submitted that the letter of authorisation happens digitally and it is to be printed and sent to the bank. He further submitted that handing over from the bank to the city coordinator is recorded in CCTV cameras.

He argued that the system as a whole has worked except for human error at 0.3 percent centres i.e. 8 out of 4753 centres.

NEET Investigation: 

Referring to the report's content, the SG argued that there were seven layers of security at different layers. He pointed out the sealed envelope and submitted that this is one-time wearable. Therefore, once it is opened, it cannot be re-packed. 

He submitted that from Oasis school, one person entered between 8.02 and 9.23 and opens one of the truck from behind and gives it to the solvers. There were eight solvers and 20-25 questions were distributed among them, ensuring that they do not carry any mobile phones. After memorising the exercise, they burned the paper. But one piece remained unburnt and this was recovered by Bihar police. He submitted that in the middle of the paper was one number belonging to a girl who had already complained that the paper she received was sealed using lighter.

When the CJI sought to know why CBI followed this lead, the SG submitted that it was because of the number, which belonged to only one person. In response to the CJI's query about where the number was recovered from, the SG informed that it was recovered from the place where the students were brought in the morning of May 5th. The papers came in Patna by 10.30-45 in two tranches.

The SG claimed that they have CCTV footage showing that those who assisted malpractices gathered for the purpose of going to school and came back to the meeting point again and disbursed to the respective centres, not the school. 

Meanwhile, the official present in court clarified that the girl to whom the paper was given during the exam was a genuine candidate. She did not raise the issue with the invigilator, but subsequently flagged the issue to CBI and stated that she received a paper that was sealed with a lighter. The paper was not taken out, it was photographed/ reprinted and given to paper solvers.

In response to the CJI's query about the exam centre of the girl, the official submitted that she was in Hazaribagh Oasis School. Further it was submitted that the Invigilator generally has to sign when opening the question papers to attest that there was no tampering. In this case, despite the tampering, the invigilator signed off on them. The official submitted that this was because the centre superintendent and city coordinator were also part of the conspiracy.

Responding to the Court's query of they were arrested, the official submitted in affirmative and informed that he was part of this and took money. The official informed the court that apart from the Centre superintendent and coordinator, who were part of this, there was one more middleman who was a bridge between the gang and the students. It was further submitted that the conspiracy was hatched some months earlier because they had to identify one vulnerable centre who was ready to accept and give access.

At this outset, the CJI questioned, "Once this conspiracy was two or three months back, how is it that they confined the conspiracy to such a small group of people? Human greed otherwise is that you would want to maximise the profits you are going to make through the conspiracy. Why is it that they confined it to, say, 25 students?"

However, the SG claimed that the wrongdoers did not want the paper to go to others or reveal their identities to many people which would expose them to being arrested in advance. He submitted that this gang approached people one by one and those who fell into the trap, they gave post-dated cheques and some amount in advance. He further submitted that the post-dated cheques had been recovered and they could not be encashed.

Meanwhile, the official present in court explained that even the people who paid for getting the leaked/solved paper, had no confirmation that the leaked paper would be used until after they wrote the exam. So, only an advance was given and the rest of the money was to be paid later. 

"So there is no evidence to indicate that conspiracy was wider in Jharkhand and Bihar?" the CJI asked.

Responding to this, the official answer in negative and submitted that what they found was that there were two locations in Hazaribag where this was shared after solving and one location in Patna where it was shared after solving. He submitted that within Patna, there was a sub-group.

At this outset, the CJI sought to know if any mobile had been seized. The official informed that the miscreants had destroyed some of the gadgets. He submitted that it needed to be examined foresically whether those mobiles were from the same gang. He mentioned that FSL report would indicate whether it went to Patna etc. or not. If the WhatsApp chats were not deleted, it could be known where all of it had gone.

"Now we know that there was a leak very much and that it originated in Hazaribagh and WhatsApp message was sent to Patna. What we are unsure is time of leak and is there any forensic data to show where all the messages were sent," observed the CJI.

In response to the CJI's query regarding the lock of the control room, the official informed that there were two doors. one was locked in front of everybody and the key was given to the Centre superintendent and the rear door was kept deliberately kept open. 7:53 am the main door was locked and at 8:02 am the person went inside from rear door. They left at 9:23 am, submitted the official.

"How do you rule out the possibility of the papers being sent to other locations also by WhatsApp messages? Solvers are in custody but how did they transmit.." questioned the CJI.

Responding to this, the CBI official referred to the tick marks on the hard copy, in the half-burnt copy. He submitted that the size of the tick mark was different than the girl candidate who appeared in Oasis school. So, this tick mark was on another hard copy, on a print out.

"The man enters that control room or hall.. He was inside the room for one hour 20 minutes. He must have taken time. Then he takes pictures on his mobile, forwards it to the solvers," Justice Pardiwala observed.

However, the CBI official clarified that not to the solvers, but one of his counterparts who was with the solvers. After solving the question papers it was again scanned.

"And this scanned copy has been sent to Patna (and one other centre in Hazaribagh) ... but how do we conclusively say that this scanned copy was not sent to anywhere else? We don't have forensic data ... else we would have seen the digital footprints." questioned the CJI.

At this outset, the SG informed that this is why they submitted the figures because the time available for them to impart whatever they stole was hardly 1.5 to 2 hours. Therefore, even the students who were caught, the beneficiaries, they also did not fare well.

"Earlier we thought 45 minutes given to solvers.. but the problem solvers probably got the question paper at 8.30 itself?" asked the CJI.

But the CBI official clarified that they got at around 9.24, as he transferred after he came out.

In this regard, the CJI observed that "His mobile is not available, neither is the conspirator's at Hazaribagh guest house." In response, the CBI official informed that they had arrested even the person who received the papers in Hazaribagh.

Therefore, the SG concluded that as per the report, no evidence was there to show that the solver paper were circulated in any form randomly except the 4 locations mentioned above there was no evidence and the total number of the candidates who were benefitted from this stone paper were around 155 people- around 30 in Patna and 125 in Hazaribagh.

The CJI observed that "If we are ordering a retest, students must know that they have to start preparing and if we do not then that they should also know. We cannot keep them hanging, hence we have to wrap the hearing today. It is not correct from institutional perspective also you see."

Relying on the report, the SG stated that the images of the two trunks at the control room of Oasis School at 7.53 AM on May 5th was different from the image of the trunks positioning when the officials had subsequently gone to open the trunks. Referring to this, he submitted that the theft happened between 8:02 to 9:23 AM.

He submitted that there were only two students who got 573 and 581 and this also could be because the students were intrinsically good and the rest of them got 111 etc. 

When the CJI questioned about the Telegram thing, the SG submitted that the digital media could be used to wreck havoc in the country. He submitted that one of the officers also joined the group just to collect evidence. Taking note of the report, the CJI noted that the account was created on May 6th. The SG informed that it was uploaded on May 7 and manipulated to show as if it was before May 5th.

The SG referred to a previous judgment where the investigating agency had concluded that the paper was leaked and travelled through several States. He pointed out that in that judgment, the Court was dealing with an All India scam and on the other hand, the investigation in this case recorded that the issue was only at these four places. It is corroborated by the IIT report.

At this outset, Justice Manoj Misra questioned, "Is their forensic comparison between the paper posted on Telegram and the paper which was eventually given to the students ... Whether it was in same font.. structure etc...? If it's leaked out paper posted on Telegram, then matter ends.. if it's an information independent of the leak, then it is a serious thing.. Thus, there is a forensic investigation or not?"

The SG informed that there was no forensic report. Meanwhile, the Court observed that the Telegram question paper photo did not match the one in the case diary, not only regarding the font but in respect to numbering etc also.

Thereafter, the SG referred to the investigation, which suggested a localized identifiable irregularity and that is why this should not exercise judicial review.

Pleas Opposing Retest: 

A lawyer representing the NEET candidates from tribal areas submitted that it would cause these students immense hardships to go through the entire process of appearing in the exam, which is an expensive affair as well.

Another counsel argued that using the paper leak as an excuse some of the students approached the High Courts on invalid grounds and accused NTA. 

Submissions by Advocate Hooda: 

Advocate Hooda pointed out that the gang head Sanjeev Mukhiya has still not been arrested and reportedly he is involved in at least five major paper leak cases in UP, Haryana, Rajasthan.

He also argued that the moment it is established that the leak took place, that the dissemination was through WhatsApp, and a gang operating in different States was involved, how could the Government say that the beneficiaries of the leak were confined only in Hazaribagh and Patna. According to him, this confidence emanates from only one fact that the accused in custody so far has said that the leak was confined.

Advocate Hooda also pointed out that as per CBI they could not recover mobile phones through which the dissemination of question papers took place. Therefore, it could not be said with confidence that this dissemination happened only in Patna and Hazaribagh and not beyond that.

Even if the leak happened on 5th May, there was sufficient time, he argued, adding that if the Court sustains the exam, it will have to record that tained could not be segregated from the untained.

Referring to the CBI officers' statement that "so far, it has not gone beyond Patna and Hazaribagh", Advocate Hooda pointed out that it is an evolving situation that came first time before the Court. He also demanded an affidavit from the authorities saying that henceforth there could be no investigation to see if it had gone beyond.

He questioned what would happen if the judgment came today and tomorrow Sanjeev Mukhiya got arrested along with the mobile which would show that he had sent for 200 people in Sikkim. 

At this outset, the CJI observed "Just one aspect, if the Court cancel the exam today on the ... investigation is not complete, main conspirator is not arrested - there is a possibility that in some future, even a foreseeable future, it may not be confined to these two (locations).. but in a situation where 23 lakh students appeared and we are dealing with welfare students... how do we? Look at it this way. Let's put it both ways - today, you are right, we can't say that the leak - we can't enter a judicial finding that the leak is confined only to Patna and Hazaribagh for the reason that the investigation is ongoing. Even CBI can't say that. Today, it is confined to Hazaribagh and Patna... CBI investigation in some days may reveal a different (picture)... We, on the one hand, can't say the leak is confined to Hazaribagh and Patna. Equally, today we can't say with any degree of - even prima facie - ... that the leak has gone beyond Hazaribagh and Patna in such a widespread, systemic manner to completely affect the sanctity of the entirety of the exam. That also we cannot say."

"Would the court be justified in a situation like this to say that - not on the basis of material that we have today, but on the hypothesis that some material in the future may show that the leak has gone beyond Hazaribagh and Patna - so therefore today, we cancel the exam?" questioned the CJI.

Advocate Hooda argued that even if there were 1,000 beneficiaries, there had to be a retest since the integrity of the exam was comprised and it could not be concluded that everybody (tainted) had been identified from the untainted. Arguing that there was a systemic failure, Advocate Hooda submitted that if NEET was a patient, it was suffering from multi-organ failure and the patient had to go.

He also referred to a news item stating that a rickshaw was carrying the question papers. While the SG claimed that it was OMR sheets, referring to the newspaper reports, Hooda argued that OMR sheets and questions papers are in the same and never separated. He submitted that the report stated that instead of taking the question paper directly to CBI or Canara Bank, the private courier company took it to the Oasis school where the breach took place on May 3rd.

Submissions by Senior Advocate Sanjay Hegde: 

Referring to the CBI's submission that the leak happened at 8:02 am and till 9:23 am, Advocate Hegde questioned would the parents pay 30 to 75 lakh in advance for this chance that the students would read the papers and memorise it within two hours. He argued that it was not possible.

He referred to Oasis school, where it happened, and relied on a video of the principal saying that when the earlier EOW asked how this had happened, their conclusion was that the leak had happened before the papers were sent to the banks. He pointed out that there was a video of a man when he was not arrested. Therefore, he argued that the leak probably happened on 3rd in Hazaribagh and it was caught in Patna. 

Submissions by Advocate Mathews Nedumpara: 

He pointed out that the only issue was that a leak had happened and therefore, there was no alternative than a retest. While it may be inconvenient, he argued that the only thing to be taught was how to reduce the inconvenience.

Further, he pointed out that the Government did not challenge the maintainability of these pleas, but allowed detailed arguments for days and days. He urged the Court to let the Government do its job. He submitted that the matter should have been relegated to the Government.

Supreme Court's Observations: The Supreme Court observed that the central issue being raised before the Court was a direction for convening a re-test on the grounds that there was a question paper leak and there were systemic deficiencies in the conduct of the exam. The bench noted that the exam was conducted at 4,750 centers at 571 cities besides 14 cities overseas.Further, the top court bench noted that 24 lakh students were competing for 1,08,000 seats and 50th percentile was the cut-off. There were 180 questions totaling 720 marks and one negative mark for each wrong answer.The bench noted that the petitioners argued that the leak, which took place during the court of NEET UG exam, was systemic in nature with structural deficiencies and therefore, the only course permissible would be to conduct a re-test.In this regard, the bench referred to its interim order dated July 8, 2024, where while flagging the principle issues in convention, the Court had called for a disclosure by NTA, Union Government and the CBI.The top court bench noted that in the earlier order the Court had noted that it would scrutinize whether the alleged breach took place at a systemic level, whether the breach was of the nature that it affected the integrity of the entire exam process and whether it was possible to segregate the tainted from the untained. It also took note of submissions regarding the status of the investigation made by Mr. Krishna, additional Director of CBI, which is investigating the paper leak allegations."Arguments have been concluded and judgment has been reserved. In a matter like the present, it is imperative that the final conclusions of the Court in the present case - there is an urgent need to provide certainty and finality to a dispute which affects the careers of over 2 million students," the bench noted.While the court observed that the reasons for the ultimate conclusions would follow later, it proceeded to record the essential conclusions in the following terms:1. It noted that there was no dispute that the leak of NEET UG 2024 paper took place at Hazaribagh (Jharkhand) and at Patna2. It also observed that after being put in the charge of investigation, CBI filed its status reports dated July 10, July 17, and July 21, 2024. The disclosures made by CBI indicated that the investigation was continuing. However, the CBI indicated that at the present stage, the material emerging during the investigation would indicate about 155 students drawn from the examination centres at Hazaribagh and Patna appeared to be beneficiaries of the fraud.3. Since the CBI investigation has not yet attained any finality at resent, the Apex Court bench had indicated to the Union Government to indicate whether certain trends regarding the existence of the abnormalities or otherwise could be drawn based on the results emanating from the 4,750 centres situated in 571 cities. Pursuant to the directions of the Court, the Union government has produced a report from IIT Madras"At this stage, to obviate any controversy, the Court has independently scrutinsed the data which has been submitted by the NTA ... At the present stage, there is absence of material on record to lead to a conclusion that result of the exam is vitiated or that there is a systemic breach of the sanctity of the exam," noted the bench.Referring to the data, the bench noted that it did not indicate a systemic leak of the question paper which would indicate a disruption of the sanctity of the exam. "Court realises that directing a fresh NEET UG for the present year would be replete with serious consequences which will be for over 24 lakh students who appeared in this exam.. and cause disruption of admission schedule, cascading effects on the course of medical education, impact on the availability of qualified medical professionals in the future and seriously disadvantageous for the marginalised group for whom the reservation was made in allocation of seats. For the above reasons, we are of the considered view that ordering the cancellation of the entire NEET UG 2024 exam is neither neither justified on application of settled principles propounded by the decisions of this court on the basis of material on record," it ordered.Regarding the issue of NEET question with ambiguous questions, the bench ordered, "Initially answer key by NTA showed second option to a question was correct answer. However, after representations were taken into account.. both options 2 and 4 was taken to be correct answers. However IIT Delhi Director was requested to constitute a three member committee to submit its opinion on which of the options would be the correct answer. The director and professor at IIT Delhi has in his report dated July 23 indicated that the three member committee from department of physics comprising ... was constituted. The expert team has opined that option 4 is the correct answer. In order to obviate any ambiguity is treated as the correct answer, i.e. "statement 1 is correct, statement 2 is incorrect.""In view of the expert determination by team constituted by IIT Delhi, we have no manner of doubt with regard to the correct option. Options 2 and 4 are mutually exclusive and cannot stand together. We accept IIT Delhi report and accordingly NTA shall re-tally the NEET UG result on the basis that option 4 represents the only correct answer to the question. We have not indicated the number of the question since number of question may vary as per procedure followed in the exam to preserve the integrity of the process," it further mentioned.However, the bench clarified that if any student has any individual grievance not with regard to the answers given in this judgment, they may approach the competent jurisdictional High Courts under article 226.Finally, the top court bench also took note of the fact that the Union Government formed a seven-member expert committee. "The committee shall abide by the further directions as may be issued by this court to ensure that process of conducting NEET UG exam is duly strengthened so that issues cited now does not arise in future. The transfer pleas by NTA stand disposed off," it ordered.

Also Read: NEET 2024: Hold Retest for 13 Lakh Candidates who Scored Cut-off Marks, Petitioners Urge Supreme Court

The research used data from 10 European birth cohorts from 8 countries (Denmark, France, Italy, Lithuania, Norway, the Netherlands, Spain and the UK) to conduct a meta-analysis. This assessment of the data was done at the individual level for each participant.

Data on exposure to green spaces were available from two different points in time: pregnancy and childhood (from 3 to 12 years of age). As a proxy for residential green space, the research team used the Normalised Difference Vegetation Index (NDVI) in a 300m buffer around the participant's address. NDVI is an index that uses satellite images to estimate the amount of vegetation at a given point.

Lung function was measured using spirometry tests. To assess lung volume, the researchers measured forced vital capacity (FVC), which is the maximum amount of air a person can breathe out without a time limit after taking a deep breath. And as an indicator of how open the airways are, forced expiratory volume in one second (FEV1) was taken. FEV1 is the volume of air exhaled in the first second of forced breathing after a deep inhalation.

Statistical analysis showed that children living in greener neighbourhoods had better lung function, specifically higher FVC and FEV1. On the contrary, those who lived further away from green spaces had a lower lung volume (FVC).

While the positive association of living in greener neighbourhoods with lung function was observed regardless of socioeconomic status, the effect was stronger in children from higher socioeconomic backgrounds. “One possible explanation could be that families with higher education or income may have access to higher-quality, safer, and better-maintained green areas" says Amanda Fernandes, first author and ISGlobal researcher at the time of the study.

Possible mechanisms

The researchers also looked at the mothers' home address during pregnancy, but in this case residential greenness was not associated with any of the indicators of respiratory health, suggesting that the link between green spaces and improved lung function has to do with something that happens in childhood.

"Our understanding of how green spaces affect lung function is still incomplete. We know that green spaces reduce air pollution, which in turn affects respiratory health. We also believe that green spaces may expose children to beneficial microbiota, which may contribute to the development of the immune system and indirectly influence lung function. Finally, green spaces close to home are likely to reflect the presence of play areas that encourage physical activity at an age when the lungs are still developing", says Amanda Fernandes.

"Our findings highlight the importance of integrating green spaces into urban environments for better respiratory health, also in children. If the way cities are configured is a factor that contributes to inequality, urban planning that consciously contributes to alleviating inequity is important", says Martine Vrijheid, lead author of the study and co-director of the Environment and Health over the Lifecourse programme at ISGlobal.

Health outcomes unrelated to green spaces

The study also looked at whether green spaces near the home during pregnancy and childhood were associated with other respiratory, cardiometabolic and neurodevelopmental outcomes, but found no other associations.

Reference:

Amanda Fernandes, Demetris Avraam, Tim Cadman, Payam Dadvand, Mònica Guxens, Anne-Claire Binter, Angela Pinot de Moira, Mark Nieuwenhuijsen, Liesbeth Duijts, Jordi Julvez, Montserrat De Castro, Serena Fossati, Sandra Márquez, Tanja Vrijkotte, Ahmed Elhakeem, Rosemary McEachan, Tiffany Yang, Marie Pedersen, Johan Vinther, Johanna Lepeule, Barbara Heude, Vincent W.V. Jaddoe, Susana Santos, Marieke Welten, Hanan El Marroun, Annemiek Mian, Sandra Andrušaitytė, Aitana Lertxundi, Jesús Ibarluzea, Ferran Ballester, Ana Esplugues, Maria Torres Toda, Jennifer R. Harris, Johanna Lucia Thorbjørnsrud Nader, Giovenale Moirano, Silvia Maritano, Rebecca Catherine Wilson, Martine Vrijheid, Green spaces and respiratory, cardiometabolic, and neurodevelopmental outcomes: An individual-participant data meta-analysis of >35.000 European children, Environment International, https://doi.org/10.1016/j.envint.2024.108853.

Santo Domingo.- Eddy Alcántara, the executive director of the National Institute for the Protection of Consumer Rights (Pro Consumidor), announced on Monday that the agency will take stringent measures against businesses that expose bottled water to sunlight due to the health risks it poses.

Alcántara highlighted that Pro Consumidor, during a major operation in 2021 at the start of his administration, had already urged business owners, including grocery stores, supermarkets, and warehouses, to avoid exposing bottled water to direct sunlight.

He instructed the departments of Good Commercial Practices, Inspection and Surveillance, and Consumer Education to intensify verification efforts to rectify this harmful practice.

Alcántara warned that if businesses fail to relocate water bottles to appropriate storage areas, stricter measures and sanctions, first implemented in 2021, will be enforced. These measures include recommending the removal of products from establishments that do not comply with Law 358-05 on Consumer Rights Protection.

Research indicates that bottled water exposed to sunlight can release harmful dioxins and chemicals due to sudden temperature changes. To address this, Alcántara instructed inspectors to promptly notify businesses engaging in this harmful practice.

He emphasized that all operations related to inspection, surveillance, and good business practices are ongoing to ensure compliance with consumer protection laws and the directives of Pro Consumidor’s Executive Directorate.

Dajabón, DR.- Trade at the El Carrizal, Elias Piña border crossing between the Dominican Republic and Haiti has been paralyzed due to health restrictions implemented by the Ministry of Defense in response to a suspected anthrax outbreak in Haiti.

Authorities from the Ministry of Agriculture and agents from the Specialized Corps for Border Security (CESFRONT) are prohibiting the entry of agricultural products, raw meats, and cooked foods into the Dominican Republic from Haiti. This has caused significant frustration among Haitians, who have blocked their border gate, preventing compatriots from crossing with purchased Dominican goods.

“If the Dominicans don’t want us to bring anything, then no one can enter Haiti,” said one Haitian citizen, reflecting the tension at the border.

In Dajabón, border military personnel have increased security measures at the entrance gates to the border market. However, the health controls promised by the Ministry of Public Health are not yet being observed. CESFRONT members are inspecting Haitians by gender to prevent the entry of meat and cooked food from Haiti into the Dominican Republic. The Ministry of Defense’s security protocol also includes inspecting all products entering from Haiti.

The Ministry of Defense has reported that it has taken preventive security measures to protect the Dominican population from the suspected anthrax outbreak in Haiti. These measures include strict health controls and intensified epidemiological surveillance in the border area.

The Ministry of Health remains in constant communication with international organizations, such as the Pan American Health Organization (PAHO) and the Centers for Disease Control and Prevention (CDC), to stay informed about the disease’s status.

Appearing on behalf of the petitioners seeking a re-NEET, several counsels including Advocate Hooda, Advocate Helge and Advocate Nedumpara opined that there should be a re-test, at least for the 13 lakh candidates who qualified in the exam by scoring the cut-off 164 marks.

However, the bench did not give any order on the issue. During the proceedings, a counsel appeared for a petitioner who secured 711 marks and challenged a question which had ambiguous options.

In this regard, the Apex Court bench directed the Director of IIT Delhi to constitute a team of three experts of the subject concerned and formulate the opinion on the correct option and remit the opinion to the Registrar by 12 noon tomorrow.

Pleas Seeking Re-NEET: 

Medical Dialogues had earlier reported that during the last hearing of the case on July 18, the Apex Court bench led by Chief Justice of India DY Chandrachud had asked the National Testing Agency (NTA) to publish the marks obtained by all the candidates in the NEET UG 2024 exam while ensuring that the identity of the students was masked.

NTA had been directed to declare the results separately city and centre-wise within 5 PM on July 19. The top court bench had expressed that it was important to ensure whether the paper leak was confined to the centres in Patna and Hazaribag or was more widespread. Further, the Supreme Court had sought to view the case diary of the Patna Police. 

What Happened at Today's Hearing: 

Advocate Hooda for the petitioners pointed out that NTA has already published the results but they have not given the All India Rank or the seriatum of the exam centres. He informed the Court that the agency has given centre-wise and city-wise results, withholding the All India Rank and serial number of the exam centres.

Meanwhile, CJI observed that the question paper was being ferried in an e-rickshaw without any doubt even though they claimed that the photograph was of OMR sheet. As per the CJI, the ferrying of paper in e-rickshaw was established. Thereafter, the CJI questioned what emerged from the centre-wise and city-wise data.

Responding to this, Advocate Hooda submitted that they had already submitted a note based on the data. He also submitted that they admitted paper leak and admitted that the dissemination happened on WhatsApp. Referring to the Bihar Police materials, he argued that the students were given leaked papers on the 4th and the leak did not happen on the morning of May 5 as was suggested.

Advocate Hooda further claimed that the leak happened before the deposit of the question papers with the respective banks i.e. on 3rd May or before that. "It is not some peon went to the paper room and gave it to some 5-10 students. It was handiwork of a gang who have done it in past too. Sanjeev Mukhya and all have not been arrested," he submitted, while referring to the statement of Anurag Yadav recorded by Bihar Police.

Further referring to the statements of Nitesh Kumar, Amit Anand and Sikander Prasad, Advocate Hooda argued that their 161 statements indicated that the leak was much prior to the examination.

Responding to these arguments, the Solicitor General submitted that Amit Anand was a middleman and he was collecting the students on the night of 4th so that he could get the papers on the 5th. He also claimed that Nitish Kumar was at the place where the papers were received on the 5th. However, Advocate Hooda for the petitioners claimed that the investigation was being botched up by the stand taken by the Government of India. 

At this outset, the CJI took note of Amit Anand's statement that said that the students were gathered to memorize the answers on the night of 4th May, the day before the examination. However, the Solicitor General urged the Apex Court to read the report of the Economic Offences Unit (EOU) of the Bihar police for a complete picture.

"Statements are at variance. One statement says the leak happened on the 4th night, second statement says it was received on WhatsApp on the 5th morning. Amit Anand's statements are at variance," noted the CJI.

Taking note of the first statement, the CJI opined that it indicated that the leak had happened on the May 4th night. "If the leak has taken place on the night of the (May) 4th, then obviously the leak did not took place not at the process of transportation, and it took place prior, at the strong room vault," the CJI further observed at this outset.

The CJI further took note of the fact that all the problem solvers were students and none of them were professors. Responding to this, the Solicitor General submitted that for this work, students are better prepared as per his knowledge. The CJI noted that some of these students were from AIIMS Patna, some from Ranchi and from Rajasthan.

The Solicitor General further submitted that they bifurcated the papers and each had 25-30 questions, 25 questions, with computers and books could be easily solved. He further argued that after comparing the success rate of this particular centre and State with previous years' results, they found no abnormality.

When Senior Advocate Hegde urged the Court to read the statement of Anurag Yadav, who was the student and not a gang member, the CJI noted that Anurag Yadav said in his statement that he got it on the night of 4th May.

"Even so, we have to see if the leak is localised and confined only to Hazaribagh and Patna or whether it is widespread and systemic," observed the CJI, adding that "We don't have any material so far to show the leak was so widespread and spread across the country."

Advocate Hooda argued that according to NTA, the dispatch happened on 24th of April, and the paper reached on 3rd of May. Therefore, the paper remained in the hands of private players in between 24th April to 3rd May.

Referring to the example of Hardyal School of Jhajjar, Advocate Hooda submitted that the principal went to both banks to get the paper and the paper from the Canara bank was distributed. When it appeared that there were six students who got 720/720, two scored 719 and 718, it was asked how so many toppers were from one centre.

Back then, NTA had stated that they were given grace marks as there was a delay. However, the principal said that there was no delay and the Canara bank paper was distributed. But the SBI paper had to be distributed, argued Advocate Hooda.

Taking note of these submissions, the CJI questioned how someone from Jhajjar went to the Canara bank to collect the papers. Responding to this, the Solicitor General submitted that it might be a mistake.

The CJI further questioned NTA what happened exactly at the centre in Jhajjar. In response, the NTA counsel submitted that Jhajjar was a new centre and perhaps the city coordinator might not had seen the message and due to this, the question paper was picked up from both the places.

"Are the banks not informed that you don't have to release? Canara bank wasn't told they are not to release?" observed the CJI.

Responding to this, the Solicitor General informed that the message goes to the bank. When the CJI questioned how the centre-in-charge at Jhajjar went to Canara bank, NTA submitted that it was a mistake, both on the part of the coordinator and the bank. The agency further informed the Supreme Court that there were a little more than 3000 candidates who got the Canara bank paper.

However, the CJI further sought to know at how many centres this happened. The counsel for NTA informed the Court that it would submit the correct number.

The Chief Justice questioned why the students were given grace marks. The Solicitor General informed that it was not a correct decision. He also pointed out that there was a decision stating that in case of time problems, students be given grace marks. However, later this decision was recalled and re-test was done.

Meanwhile, Advocate Hooda pointed out that only one answer key for the SBI paper was declared on 4th June. So, he questioned how they evaluated the Canara bank papers.

NTA submitted that the grace marks were given only to the students whose paper (Canara Bank) was withdrawn midway and the SBI paper was given. The agency further informed that 3300 completed the exam with the wrong paper i.e. was from the Canara Bank.

When Advocate Hooda questioned how the Canara bank papers were evaluated since they had released only one key for the SBI paper, the CJI noted that they must had a key for Canara Bank. However, Advocate Hooda pointed out that till date no key for the Canara bank paper was declared.

"Okay, assuming that wrong things happened, show us the data, how it was widespread," observed the CJI.

Advocate Hooda also pointed out that only 863 out of 1563 candidates appeared for the re-examination. The CJI sought to know these 1563 candidates were from how many centres. The Solicitor General informed the bench that these students were from 8 centres. Advocate Hooda claimed that all of this was being done behind the curtains and nothing was disclosed.

At this outset, the CJI questioned the Solicitor General and NTA about how many centres distributed the Canara bank papers, out of those centres, in how many centres, the correct question booklets from SBI replaced the Canara Bank papers. The bench also asked how many centres altogether were the papers evaluated for Canara bank papers and once the Canara Bank papers were evaluated, how did the candidates fare.

Thereafter the CJI asked who issued the letter of authorisation to the papers who collected the papers from Canara bank. SG informed that the authorisation is given by the Director General of NTA to the City Coordinators. 

"What does the person take to the Bank? He has authorisations both for SBI and Canara Bank or only one?" questioned the CJI.

When the CJI asked if the authorisation is given for both the banks, the CG informed that it is for both the banks and the City Coordinator is told in the morning about which bank to approach.

"Did the city coordinator in Jhajjar go to Canara bank and distributed to all centres or only some?" asked the CJI. Responding to this, Advocate Hooda submitted that he collected from both banks.

"How did that happen? And he distributed in all centres the Can bank paper?" further questioned CJI Chandrachud.

NTA submitted at this outset that he distributed the Canara bank papers to three centres in Jhajjar and from two it was withdrawn when he realised the mistake and at the other centre, it continued.

Advocate Hooda further submitted that there was another blunder in the case of Hardayal school, where the students were given grace marks and 6 out of them got full marks. He argued that if Canara bank paper was attempted, where was the question of giving grace marks.

Responding to this, the SG submitted that it was mistake which was corrected later. He further argued that wherever the wrong paper was initially given, it was taken back and the new paper was given consequently and this resulted in cutting time and therefore grace marks were given.

"Grace marks were given to those students who were given wrong booklet which was withdrawn midway," confirmed the CJI and the SG responded by agreeing to the statement.

Meanwhile, referring to the NTA's statement before the Court, Advocate argued that it showed that the grace marks were given to Hardyal School students too.

CJi asked NTA, "Hardayal School students wrote only Canara Bank paper. Were they also given grace marks?"

When NTA counsel submitted that he would take instructions, Advocate Hooda submitted that he would take instructions. Thereafter Advocate Hooda submitted by saying that it was a "systemic failure".

The counsel for NTA submitted that in Hardayal school, grace marks were given. "In Hardayal school, all students wrote Canara bank paper. Why were they given grace marks," questioned the CJI.

At this outset, the SG pointed out that the counsel for the petitioners was arguing that the entire country's exam was being vitiated and that giving some examples of some mistakes might not assist him. However, Advocate Hooda argued that there was a "systematic failure".

Referring to Jhajjar, Advocate Hooda pointed out that initially, the authorities had argued that the Canara bank paper was given and evaluated and now they were saying that no grace marks were given and extra time were given. He questioned who took this decision.

He pointed out that in Hardayal school, the student who got 719 marks secured 68 rank and after re-test, the rank became 58,000. Now, the authorities were claiming that they did not know whether Canara paper or SBI paper was given, argued Hooda, pointing out that on 4th June, only SBI key was given and at that time they had not disclosed that grace marks were given.

Advocate Hooda also referred to Sikar where there were 49 centres and out of them one was Kendriya Vidyalaya and the rest were private schools. He pointed out that all their coordinators and invigilators were private individuals and also argued that they had shown photos of a school in a village where the exam was being conducted and it did not even have a boundary wall.

He also questioned about the time when OMR sheet had to be sealed, arguing that it kept lying in the Centre. Submitting that there was no specific procedure in this regard, mentioned by NTA, he contended that if the papers were collected at 5.20, they had to be sealed at 5.30.

"How soon after the exam concludes the sealing takes places?" asked the CJI.

Submitting that this was not found in the entire SOP, Advocate Hooda further informed that after analysing the data, they took note of certain centres which were doing exceedingly well. He pointed out that both Kota and Sikar have an equal number of students appearing, and if top centres across the country were counted where students secured more than 650 marks, 38 out of 50 centres were only from Sikar.

Kota and Sikar have both equal students appearing. 38 out of 50 centres which have students with more than 650 marks are from Sikar. 6 are from Mahendragarh, Rewari, noted the CJI.

Advocate Hooda also highlighted the difference in the data declared on the 4th of June and the 20th of July, while pointing out that in Bihar, there was a difference of 13,000 in the number of appearances. So many numbers were reduced. He further argued that as per their system, anyone from anywhere can choose any centre based on the address they put. He highlighted that people travelled from Odisha and Karnataka to Godhra. 

"A student can choose any centre in any part of the country and you don't have to submit any documents?" questioned the CJI and Advocate Hooda submitted that no documents were needed.

"Does the student at any time in the registration process show any document that he is a resident of the address?" CJI asked the Solicitor General, who submitted that he would address the issue after inquiring.

Advocate Hooda also referred to a centre in Rajkot, where 12 students scored above 100 and 115 students scored above 650 marks. In case of Sikar, he submitted that 8 students scored above 700 and 69 scored above 650, 115 students above 600 and 241 above 550.

He argued that the city coordinators were owners of private schools and the invigilators were the employees of such schools. Therefore the possibility could not be ruled out that those teachers were in league with the coaching centres in Kota and Sikar.

"Assuming that it is so, can that be one ground to cancel the exam for the entire country or to cancel the exam only for Sikar?" observed the CJI.

At this outset, Advocate Sanjay Hegde submitted that 6 people per 1000 people on average scored more than 650 marks on a national level and that should be the reference point and in Sikar, one in 4 students secured that marks.

Referring to these arguments, Advocate Hooda claimed that there was a "systemic failure", adding that those students were not students from Sikar and they had not taken coaching in Sikar. He pointed out that one girl from Gujarat went all the way to Belagavi in Karnataka and got 705 marks, but she failed in 12th. CJI, thereafter, questioned if there was any data on people from Belagavi getting unusually high marks.

Advocate Hooda argued that there was a heavy tilt towards Sikar because there was a systemic malaise and the tainted could not be separated from the untainted. He submitted that in Sawai Madahvpur, it was the case that the wrong paper was distributed and the paper started at 2 PM and they got to know at 4.30 PM from social media.

When the CJI questioned how would he establish that the paper leak was spread all over the country, Advocate Hooda submitted that besides the paper leak, his main argument was that the system was so fragile that it was consistently being compromised. 

"Are you challenging this NEET or are you appearing for people who don't want NEET at all?" the CJI questioned Advocate Hooda.

"If there are loopholes, we will address that.. Basically you have concentrated on Hazaribag, Patna...some lapses in Bahadurgarh.....where do you demonstrate a systemic failure?" the Chief Justice further noted.

Responding to this, Advocate Hooda submitted that in places like Sikar, Mahendragarh, where the concentration was happening, the OMR sheets were being manipulated and the private invigilators had the OMRs after 5.20. He questioned what prevented them from filling up the sheets and depositing them at the City Centres after 3 hours. He also questioned why a candidate from Gujarat who failed in 12 and scored high in NEET went all the way to a centre in Belagavi.

When the CJI asked about the success rate in that centre, the SG submitted that the success rate was 6%. The SG further submitted that from their analysis, for 2024, the success rate for Sikar went down.

At this outset, Justice Pardiwala observed, "Mr. Hooda, there are two ways of looking. Yes, there was a paper leak. Is it your argument that systemic failure led to paper leak?"

When Advocate Hooda answered in negative, the Judge noted, "At this point digressing from the issue of paper leak, to what extent we can go into the issue of systemic failure?"

"Let us examine in this manner, whether the students who performed well in Sikar, was it due to the paper leak?" Justice Pardiwala further observed.

Responding to this, Advocate Hooda submitted that regarding paper leak, there was direct evidence before the Court and further submitted that since the petitioners were not privt to the investigation, they could only fall back on the circumstantial evidence.

"So the alternate hypotheses that because of the systemic failures it can possible spread.." observed the CJI.

"Also Mr.Hooda, in many professional exams, students do choose some centres. Because there is a perception that the marking is lenient in those centres. That may not be a ground to cancel the entire exam," the CJI further noted, adding that they would ask the SG to tighten up the systemic flaws.

"You have pointed out issues like no clarity on when the OMR sheets are sealed, time gap between the exam and the deposit of OMR sheets, lack of address verification.." the Chief Justice observed.

After the lunch break, Advocate Hooda summarised his arguments by saying that Sanjeev Mukhya, a gangster is yet to be arrested. He further pointed out that the solvers were taken from Rajasthan and the Dissemination was through WhatsApp. So, it is not possible that the leak is confined to Patna. Referring to the CBI's argument that the leak happened on 5th May, he submitted that if the paper was available on 4th, the leak happened before 4th or even 3rd. Finally, he suggested holding a retest for at least for those who qualified in the exam held on 5th May, 2024 i.e. around 13 lakh candidates.

Meanwhile, Senior Advocate Hegde appearing for the petitioners also argued that the argument that the leak happened on 5th May could not be accepted. Referring to the investigation reports saying that some of the messages went to about 100 people, he argued that the leak happened at least on the night of 4th May or before that.

He further pointed out that the CBI investigation was not only confined to Patna but was covering multiple States. Advocate Hegde further submitted that the investigator did not come to any conclusion that it was a localised leak. He further submitted that NEET is not only used for government seats but it is also accepted in several foreign countries. So, referring to the 13 lakh candidates who obtained the 164 cut-off or more, he questioned whether all of them had been judged with a fair standard.

"Can we say everybody got marks which they were fairly entitled to? A competitive exam turning out 61 toppers cannot be trusted," he further submitted.

At this outset, the CJI pointed out that out of these 61 students, 44 got grace marks. In response to this, Advocate Hegde pointed out that it was for two options for one question and pointed out that those 44 students got marks for getting 179 questions right. 

He further contended that if the syllabus had been easy, then rising tide raised all boats together. Referring to the fact that in the zone above 650, there were more than 50,000 students, he referred to it as a huge red flag.

Relying on a medical analogy, Advocate Hegde pointed out that when a doctor suspects cancer and the tests are inconclusive, the best thing to do is go for chemotherapy because one cannot risk the cancer cells growing.

"Your lordships on this date do not know how many got into the system. Each govt seat is govt spending a crore per student per year," submitted Hegde.

Advocate Hegde, thereafter, referred to the NTA's submissions before the Supreme Court and submitted that had NTA been a serious examination agency, it would have been most concerned about the integrity of the exam. But on 5th itself when it was told that the paper was leaked, supposing that NTA had taken a decision to scrap, would the Court have found an outrageous defiance of logic in that situation?

NTA continued to deny the fact that there was a leak, it did not cooperate with Bihar Police. Even though EOU wrote to the NTA, they did not respond immediately, submitted Hegde, adding that it was only after questions were being asked, that the NTA responded. It was only after the Court started asking questions that NTA started giving data, accepted that grace marks were given and held a retest. He pointed out that it was only on June 22 that changes were made in the personnel and CBI was put in the charge of investigation.

He argued that what came out was that there was an organized gang, with a prior history of leaking papers. It was their business model, submitted Hegde, adding that the leaked paper was a time-limited commodity. Everybody to whom the leaked paper went would try to maximise the profits. He further argued that the students could not be told that it was a fair exam and submitted that if these results were upheld, those post-dated cheques could still be encashed. Somebody who got 720 ended up with 640 in the re-test. With these submissions, he requested for a re-test for all those who qualified in the exam.

Advocate Nedumpara, appearing for the petitioners, also urged the Court to treat the May 5th exam as a preliminary exam and conduct a main exam. He argued that re-test was a question of common sense and prudence. Referring to the National Testing Agency's chart, he argued that the data was manifestly incorrect and the bell chart was a fraud. 

As per Advocate Nedumpara, the leak industry was worth 2500 crore. He pointed out that 50,000 government medical seats are there and for the private medical colleges, the capitation fee could be anything between 50 lakh to 1 crore. He stressed the fact that the leak had been happening for many years and submitted that it happened in 2013, 2014 and 2016. 

He also relied on the intervention application filed by the NEET UG 2024 candidates who scored more than 650 marks and also demanded a retest, considering the issue of paper leak.

One of the counsels appearing for the petitioners relied on the 2015 judgment in the case of "Tanvi Sarwal", in which the All India Pre-Medical 2015 examination was cancelled after finding out that 44 candidates were beneficiaries of unfair means.

Quoting from the concerned Judgement, the counsel submitted that "Even if, one undeserving candidate, a beneficiary of such illegal machination, though undetected is retained in the process it would be in denial of, the claim of more deserving candidates."

Meanwhile, another counsel opposed the NTA's decision of holding retest for 1563 candidates and questioned how did the NTA come up with the figure of 1563 candidates on June 4 when on May 5th, they talked about only once centre in Sawai Madhavpur.

He also objected to NTA opening a 24-hour window on April 9th allowing 24,000 students to additionally register for NEET. He submitted that the candidates who were not vigilant in filling the forms in time shouldn't be given additional opportunities.

During the proceedings, counsel appeared for a petitioner who secured 711 marks and challenged a question which had ambiguous options. The Counsel submitted that the petitioner chose not to attempt the question and NTA later gave full marks to candidates who answered either of the options. She further submitted that had NTA refused to give marks, the petitioner would have been in the top.

Some of the counsels argued that there should be no re-neet as it would cause candidates severe hardships and take them back to the entire timeline of registration, appearing in the exam, publication of results, etc.

Another counsel raised the issue that the students in some centres in Meghalaya were not given grace marks or given an option for a re-test even though they had suffered the loss of time. In this regard, the Supreme Court bench asked the Solicitor General to take instructions.

Meanwhile, Sr. Adv Mukta Gupta submitted the grievance of a petitioner, who was suffering from hyper-sweating problem and was not allowed to take a handkerchief. As per the counsel, because of the excessive sweating, the candidate could not properly attend the exam and sought a re-test. The CJI asked the remaining lawyers, who were arguing for a re-test, to send their written submissions by email.

Also Read: Breaking News: Supreme Court Directs NTA to Publish Entire NEET 2024 Results masking candidates' identities

• Warrens Tower II, Warrens, St Michael – Monday, July 22.
• Emerald City Carpark, Six Roads, St Philip – Tuesday, July 23.
• National Insurance and Social Security Service, Culloden Road, St Michael – Wednesday, July 24.
• Queen’s Park, Constitution Road, St. Michael – Thursday, July 25.

The services being provided are routine screening for non-communicable diseases, Prostate-specific antigen testing, blood pressure checks and blood sugar testing, HbA1c , screening for sexually transmitted infections, breast examination and teaching, and Tetanus Toxoid vaccines.

The post Reminder of Mobile Clinic locations and times for this week appeared first on Barbados Today.

Houston-Sydney-Massachusetts – Extreme heat can increase the danger of heat-related illnesses and, more subtly, threaten health by amplifying the side effects of many common medications.

Heat can also damage medications such as insulin, which requires refrigeration. Inhalers can explode. Epinephrine injectors, such as EpiPens, can malfunction. Medications that are shipped through the mail can deteriorate.

A look at common problems and solutions related to heat and medicine:

What medications could cause problems with heat?

Blood pressure pills that reduce fluid in the blood can cause dehydration. Beta-blockers for heart conditions can reduce blood flow to the skin and make you less aware of dangerous heat.

Some antidepressants can make it harder to stay calm. Aspirin and other over-the-counter pain relievers reduce fluid and sodium levels, making it difficult to manage high temperatures.

In addition, the combination of heat and medication side effects can lead to dizziness and falls. Alcohol increases the danger, said pharmacist Bradley Phillips of the University of Florida College of Pharmacy.

Learn more about your medications’ side effects and storage requirements at the National Library of Medicine’s MedlinePlus website.

Phillips said you can also check with your doctor or pharmacist. Ask how much water you should drink if you take medications that increase dehydration.

He recommends staying hydrated and “not relying on your body’s ability to tell you that you’re thirsty.”

Some medications (antibiotics, antifungals, and acne) can increase sun sensitivity, leading to rashes and burns. If you’re taking them, stay under an umbrella or wear sun-protective clothes and sunscreen, said Dr. Mike Ren, a family physician at Baylor College of Medicine in Houston.

“You may be on antibiotics, not think too much of it, go to the beach and then come back with a huge sunburn,” Ren said.

How should travel medications be stored?

Generally, medications should be kept in a cool, dry place unless they need refrigeration, which can be tricky when traveling.

Before a summer road trip, check labels for storage requirements for your medications. Carry medications in a cooler when traveling by car, even if they do not require refrigeration. The trunk or glove compartment of the car may become too hot to store them, even at room temperature.

Traveling by plane? It is always best to carry medications in carry-on luggage if checked luggage is delayed or lost, and it may be too cold in the cargo hold.

What about mailed prescriptions?

Mail-order pharmacies are responsible for keeping medications at safe temperatures during storage and transport. The best practice is to ship sensitive medications in special containers with ice packs and temperature monitors.

But that doesn’t always happen. Or delivery can come at a bad time, said Ren, who recently helped his vacationing mother by bringing her shipment of supplements to her Houston home as the region faced sweltering heat.

“If you know you’re going to be at work all day or if you’re on vacation and you’re having medications delivered to your home, you definitely don’t want them outside in the scorching 38-degree sun,” Ren said. If you think the heat has damaged your mail-order medication, call the pharmacy to report the problem.

Is more research needed?

Yes. Researchers in the U.S. and Australia say some of the usual warnings about heat and medications don’t have much scientific evidence to back them up. Ollie Jay of the University of Sydney found support for only four of the 11 categories of medications that the World Health Organization lists as of concern in relation to intense heat.

He suggests changing behaviors, not medications, such as not exposing oneself to heat. “You have to be a little more cautious,” he said.

Dr. Renee Salas, an emergency physician at Massachusetts General Hospital, said that as climate change accelerates, there is a need to know which medications are the most risky in the heat.

“We don’t have that answer yet, and it’s one we need to figure out quickly. Some medications (antibiotics, antifungal and acne medications) can increase sensitivity to the sun, leading to rashes and burns.ente,” Salas said.

The Vector Control Unit will take its fogging programme to St George and St John, this week.

The Unit will visit both parishes on Monday when it carries out its fogging exercise in Wakefield Road, Four Road, Lemon Arbour Village, Bayley Alley, Sweet Vale, Butcher Road, Brathwaite Road, and Golden Ridge.

The team will focus on St George, for the rest of the week. On Tuesday the Unit will spray Paradise Village Nos. 1 to 3, Roach Village, Applewhaites, Lucas Hall Tenantry Road, Lucas Heights, Belair Nos.1 and 2, Upper Belair, Jericho, and surrounding areas.

It will be the turn of Cottage Heights, Cottage Crescent, Grove Tenantry, Market Hill, Bridge Cot, Grove Cottage, Bridge Cot Terrace, Old Post Office Road, Cottage Court West, Cottage Crescent Drive, Moon Shine Close, and St Helens, when the Unit fogs on Wednesday.

The next day the following districts will be sprayed:1st and 2nd Lower Newbury, Newbury, Fusilier Road, Rose Hill, Taitt Hill, and Newbury Heights.

The fogging exercise for the week will conclude on Friday in Salisbury, Hope Road, Free Hill, Workmans, and environs.

Fogging takes place from 4:30 to 8:30 p.m. daily. Householders are reminded to open their windows and doors to allow the spray to enter. Children should not be allowed to play in the fog.

Members of the public are advised that the completion of scheduled fogging activities may be affected by events beyond the Unit’s control. In such circumstances, the Unit will return to communities affected in the soonest possible time.

The post St George and St John will be fogged this week appeared first on Barbados Today.