October 10   2015, Saturday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
IMA White Paper on cases of physical cases of physical violence / assault on doctors and immediate need for central legislation to prevent and stop such incidents against doctors

Indian Medical Association is very disturbed and concerned about the increasing incidents and cases of physical violence and assault/attack on doctors and their staff, clinical establishments etc.

It is most relevant to understand that protection of doctors and their medical staff, as well as clinical establishment is of paramount importance as the physical violence, assault or any criminal act on the doctors, their medical staff, clinical establishment, etc. also affects the life of the patients and public at large. If the doctors, their medical staff, etc. are always under a constant threat and pressure from the ongoing violence and assault then the doctors and their medical staff shall not be able to do justice with their profession and also they shall not be able to treat and cure their patients who are under emergency and undergoing risk and danger of their life properly and promptly. Thus, it is in the interest of public at large that such cases of physical violence against doctors must be condemned and controlled and not allowed to happen.

The act of physical violence, assault, attack on doctors, nurses, their staff, clinical establishments, etc. amounts to following criminal offences which are punishable under the provisions of Indian Penal Code, 1860 (hereinafter referred to as IPC):

• Offences Affecting The Public Health, Safety, Convenience, Decency And Morals

o Public Nuisance:

• According to Section 268 IPC, a person is guilty of a public nuisance who does any act or is guilty of an illegal omission which causes any common injury, danger or annoyance to the public or to the people in general who dwell or occupy property in the vicinity, or which must necessarily cause injury, obstruction, danger or annoyance to persons who may have occasion to use any public right. A common nuisance is not excused on the ground that it causes some convenience or advantage.

• According to Section 269 IPC, a person who commits public nuisance shall be punished with fine which may extend to two hundred rupees.

• Offences Affecting Human Body

o Hurt

• According to Section 319 IPC, a person who causes bodily pain, disease or infirmity to any person is said to cause hurt.

• According to Section 323 IPC, a person who voluntarily causes hurt shall be punished with imprisonment of either description for a term which may extend to one year, or with fine which may extend to one thousand rupees, or with both.

• According to Section 324 IPC, a person who voluntarily causes hurt by means of any instrument for shooting, stabbing or cutting, or any instrument which, used as weapon of offence, is likely to cause death, or by means of fire or any heated substance, or by means of any poison or any corrosive substance, or by means of any explosive substance or by means of any substance which it is deleterious to the human body to inhale, to swallow, or to receive into the blood, or by means of any animal, shall be punished with imprisonment of either description for a term which may extend to three years, or with fine, or with both.

o Grievous Hurt

• According to Section 320 IPC, the following kinds of hurt only are designated as "grievous":-

First - Emasculation.
Secondly - Permanent privation of the sight of either eye.
Thirdly - Permanent privation of the hearing of either ear,
Fourthly - Privation of any member or joint.
Fifthly - Destruction or permanent impairing of the powers of any member or joint.
Sixthly - Permanent disfiguration of the head or face.
Seventhly - Fracture or dislocation of a bone or tooth.
Eighthly- Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain, or unable to follow his ordinary pursuits.

• According to Section 325 IPC, a person who voluntarily causes grievous hurt, shall be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine.

• According to Section 326 IPC, a person who voluntarily causes grievous hurt by means of any instrument for shooting, stabbing or cutting, or any instrument which, used as a weapon of offence, is likely to cause death, or by means of fire or any heated substance, or by means of any poison or any corrosive substance, or by means of any explosive substance, or by means of any substance which it is deleterious to the human body to inhale, to swallow, or to receive into the blood, or by means of any animal, shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine.

o Act Endangering Life or Personal Safety of Others

• According to Section 336 IPC, a person who does any act so rashly or negligently as to endanger human life or the personal safety of others, shall be punished with imprisonment of either description for a term which may extend to three months, or with fine which may extend to two hundred and fifty rupees, or with both.

• According to Section 337 IPC, a person who causes hurt to any person by doing any act so rashly or negligently as to endanger human life, or the personal safety of others, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine which may extend to five hundred rupees, or with both.

• According to Section 338 IPC, a person who causes grievous hurt to any person by doing any act so rashly or negligently as to endanger human life, or the personal safety of others, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine which may extend to one thousand rupees, or with both.

o Wrongful Restraint

• According to Section 339 IPC, a person who voluntarily obstructs any person so as to prevent that person from proceeding in any direction in which that person has a right to proceed, is said wrongfully to restrain that person.

• According to Section 341 IPC, a person who wrongfully restrains any person shall be punished with simple imprisonment for a term which may extend to one month, or with fine which may extend to five hundred rupees, or with both.

o Criminal Force and Assault

• According to Section 350 IPC, a person who intentionally uses force to any person, without that person's consent, in order to the committing of any offence, or intending by the use of such force to cause, or knowing it to be likely that by the use of such force he will cause injury, fear or annoyance to the person to whom the force is used, is said to use criminal force to that other.

• According to Section 351 IPC, a person who makes any gesture, or any preparation intending or knowing it to be likely that such gesture or preparation will cause any person present to apprehend that he who makes that gesture or preparation is about to use criminal force to that person, is said to commit an assault.

Explanation- Mere words do not amount to an assault. But the words which a person uses may give to his gestures or preparation such a meaning as may make those gestures or preparations amount to an assault.

• According to Section 352 IPC, a person who assaults or uses criminal force to any person other than on grave and sudden provocation given by that person, shall be punished with imprisonment of either description for a term which may extend to three months, or with fine which may extend to five hundred rupees, or with both.

• According to Section 355 IPC, a person who assaults or uses criminal force to any person, intending thereby to dishonor that person, other than on grave and sudden provocation given by that person, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

• Offences against Property

o Mischief

• According to Section 425 IPC, a person who with intent to cause, or knowing that he is likely to cause, wrongful loss or damage to the public or to any person, causes the destruction of any property, or any such change in any property or in the situation thereof as destroys or diminishes its value or utility, or affects it injuriously, commits "mischief".

• According to Section 426 IPC, a person who commits mischief shall be punished with imprisonment of either description for a term which may extend to three months, or with fine, or with both.

o Criminal Trespass

• According to Section 441 IPC, a person who enters into or upon property in the possession of another with intent to commit an offence or to intimidate, insult or annoy any person in possession of such property, or having lawfully entered into or upon such property, unlawfully remains there with intent thereby to intimidate, insult or annoy any such person, or with intent to commit an offence, is said to commit "criminal trespass".

• According to Section 447 IPC, a person who commits criminal trespass shall be punished with imprisonment of either description for a term which may extend to three months, with fine or which may extend to five hundred rupees, or with both.

• Offence of Defamation

o According to Section 499 IPC, a person who by words either spoken or intended to be read, or by signs or by visible representations, makes or publishes any imputation concerning any person intending to harm, or knowing or having reason to believe that such imputation will harm, the reputation of such person, is said, except in the cases hereinafter expected, to defame that person.

o According to Section 500 IPC, a person who defames another shall be punished with simple imprisonment for a term which may extend to two years, or with fine, or with both.

• Offences of Criminal Intimidation, Insult and Annoyance

o According to Section 503, a person who threatens another with any injury to his person, reputation or property, or to the person or reputation of any one in whom that person is interested, with intent to cause alarm to that person, or to cause that person to do any act which he is not legally bound to do, or to omit to do any act which that person is legally entitled to do, as the means of avoiding the execution of such threat, commits criminal intimidation. Explanation- A threat to injure the reputation of any deceased person in whom the person threatened is interested, is within this section.

o According to Section 504 IPC, a person who intentionally insults, and thereby gives provocation to any person, intending or knowing it to be likely that such provocation will cause him to break the public peace, or to commit any other offence, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

o According to Section 506 IPC, a person who commits, the offence of criminal intimidation shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both;

If threat be to cause death or grievous hurt, etc- and if the threat be to cause death or grievous hurt, or to cause the destruction of any property by fire, or to cause an offence punishable with death or imprisonment for life, or with imprisonment for a term which may extend to seven years, or to impute, unchastity to a woman, shall be punished with imprisonment of either description for a term which may extend to seven years, or with fine, or with both.

If any person commits any of the above mentioned offence, then the doctors and their staff can lodge a police complaint under Section 154 of the Criminal Procedure Code and get the FIR lodge against the said offender.

Apart from the above mentioned remedy under IPC/CrPC, around 15 States and Union Territories in India have their respective State/UT legislations on the issue of physical violence / assault of doctors. However, the said legislations framed by the 15 States / UTs are not effective and also there is no awareness about the same either amongst the doctors or the concerned police authorities.

IMA feels that it is imperative in the larger interest of public health that a common act is framed and passed in the Parliament to curb this menace. Even in war, hospitals, doctors and paramedics have immunity against attacks. But now we find that in very flimsy grounds, anti-social elements who have a grudge against a hospital, utilise certain situations in the clinical institutions to seek vengeance, perpetuating vandalism. This cannot be allowed in a civilised society. This has to be considered as a crime against the helpless patients who are still in the hospital under treatment.

It is the need of the hour that appropriate and suitable central legislation is promulgated which provides the following measures:

i) Provision to be made providing deterrent punishment to offenders who cause such violence and assault on the doctors and their staff, clinical establishments etc. and to provide for immunity in favor of the doctors while on work and duty as in case of government/public servants under the provisions of the Indian Penal Code, 1860. Any person causing physical violence and assault on the doctor on duty must be punished in similar manner as causing attack on a “public servant”.
a. Section 186 IPC: Obstructing public servant in discharge of public functions.—whoever voluntarily obstructs any public servant in the discharge of his public functions, shall be punished with imprisonment of either description for a term which may extend to three months, or with fine which may extend to five hundred rupees, or with both.
b. Section 189: Threat of injury to public servant: Whoever holds out any threat of injury to any public servant, or to any person in whom he believes that public servant to be interested, for the purpose of inducing that public servant to do any act, or to forbear or delay to do any act, connected with the exercise of the public functions of such public servant, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.
c. Complaint to be filed under Section 195 CrPC

ii) One Central Legislation with respect to Medicare Service Persons and Medicare Service Institutions Suitable be framed as the present State Legislations are not sufficient enough to punish the offenders.

iii) Provisions to be made in Indian Penal Code in providing deterrent punishment to offenders who cause violence and assault on the doctors and their staff, clinical establishments etc. for audio-video recordings at the time when the patient is informed and explained by the doctor about the medical procedures and process to be performed on the patient and when the consent of the patient/guardian/close relative etc. is obtained.

iv) Provisions to be made in Indian Penal Code in providing deterrent punishment to offenders who cause violence and assault on the doctors and their staff, clinical establishments etc. for doctors and their medical staff to put on a small camera on their dress on work/duty to film and record the incident of any assault, attack etc.
Breaking news
New Findings May Revolutionize Approach to Autism Education

Repetitive training, used widely in autism education, may hinder the learning process by promoting inflexibility, a new study with potentially "earthshaking" implications shows.
The study unexpectedly found that repetitive training, a technique widely used in intervention and education for people with autism spectrum disorder (ASD), hinders the learning process by promoting inflexibility. Counterintuitively, the study found that reducing repetition in teaching may enhance learning in individuals with ASD.
The study, which one autism expert who was not involved in the study called potentially "earthshaking," was published online October 5 in Nature Neuroscience. (Source: Medscape)
Dr Good Dr Bad
Situation: A 36–year–old executive used to take 5 pegs of alcohol once a week.
Dr Bad: Continue it.
Dr Good: Either stop it or just take one peg a day.
Lesson: The French habit of drinking wine almost daily is less taxing to the heart than the Irish custom of downing an equivalent amount of beer on one or two nights a week, which confers a higher risk, according to a study published in the British Medical Journal (BMJ. 2010 Nov 23;341:c6077). (Copyright IJCP)
Specialty Updates
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    A new test - the high sensitivity cardiac troponin test - can quickly and safely rule out a diagnosis of heart attack for many people, suggests new research published in The Lancet.
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    In men with obesity-related hypogonadism who underwent laparoscopic sleeve gastrectomy, the condition resolved 1 year after surgery, suggested a new study presented at the American College of Surgeons Clinical Congress 2015.
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IMA,IJCP,HCFI
Media
IMA,IJCP,HCFI
eSPIRITUAL
Should there be a mourning room in the hospital?

In a survey conducted by Heart Care Foundation of India of 400 people from all walks of life, 90% of the people wanted that wishes of the dying person and dead body should be respected in the hospital setting. They said that doctors should be more compassionate and empathetic at the time of declaring a patient dead.
Unless people are expecting a death, death usually comes as a shock to the family members. It is expected that the relatives may be in agony, pain and even anger. Every hospital should have a mourning room where relatives should be made to sit, counseled and death declared.
After death is declared, the treating doctors, nurses and hospital staff must sit with the patient’s relations, counsel them, tell them about the sequence of what happened before death and also counsel them about how to handle dead body. People also want to know the cause of death so that a similar thing may not happen to another person in the family.
They also want to know if the body is infectious or not and what rituals should not be done if the body is infectious. They also like to know about how to preserve the dead body till cremation. They also may like to know whether a postmortem is required to know exact cause of death, which can help future family members of the family.
Legal Quote
JJacob Mathew v. State of Punjab SC / 0457 / 2005: (2005) 6 SCC 1 (iv)

““A mere deviation from normal professional practice is not necessarily evidence of negligence. Let it also be noted that a mere accident is not evidence of negligence.””
TB Fact
The tubercle bacilli establish infection in the lungs after they are carried in droplets small enough to reach the alveolar space (5 to 10 microns).
Medicofinance
Risk profile ng
As one get older and the target date for retirement moves closer, the financial advisory team automatically starts to pull the risk profile back to a more conservative stance. This reduces the volatility and through this period the doctor will build confidence in the investment portfolio’s ability to protect him or her from downturns in the market and deliver the income one seeks in retirement.
Risk profiles are all about a person’s tolerance for risk, tolerance for loss, and how a loss might emotionally affect him and the subsequent decisions the person may choose to make. The decision to take on a level of investment risk is a process of understanding the level of risk necessary to achieve the goals a person wishes for in his lifetime and then considering whether the required level of risk is appropriate and whether it can be managed.


(Source: IJCP)
Industry News
Government introduces faster exits, flexible hiring rules for encouraging startups
New Delhi: The government has a blueprint to encourage more startups that would introduce flexibility in hiring norms and allow failed start-ups to wind up faster. Special incentives are also being planned to promote women entrepreneurs, including giving a preference to their enterprises in public procurement and making it easier for them to access capital. Officials hope that an overhaul of the regulatory framework for startups could also help prevent an exodus of successful ventures to foreign shores, as the focus is on making it easier to launch, run and close a startup in India. (The Economic Times- Vikas Dhoot)
Novel Concepts Attract Global Funds To Indian Healthcare Start-ups
At least half a dozen global private equity and venture capital companies including Actis, Fulcrum Capital, Carlyle, Sequoia, responsAbility and Rare Enterprises are actively pursuing talks with some of India's latest healthcare start-ups for early stage investments. The investment deals in these start-up companies built on niche as well as disruptive technologies would be signed before March 2016. Some of their concepts include an innovative manufacturing technology for pharmaceuticals that is capable of entirely disrupting the hitherto followed batch-based drug manufacturing process, a zero-residue crop protection technology, drug delivery technologies that changes the way medicines are consumed traditionally, and an ultra-niche sports nutrition technology. (Business World)
Kerala now creating a strong State-fuelled entrepreneurial ecosystem
You have a startup idea in mind but don’t have the funds needed to build the MVP. Normally, you would look for a basic family-and-friends round or look for some form of seed or angel investment. But if you happen to start up in Kerala, there isn’t much running around needed. From funding, to incubation to mentorship to investment and acceleration, everything is taken care of by the government. (Yourstory- Sindhu Kashyap)
Digital marketer Mobikon raises fresh VC funding
Digital marketing startup Mobikon Asia Pte Ltd has raised fresh funding from Singapore-based venture capital firms Life.Sreda and Qualgro Pte Ltd to create new technological infrastructure and provide restaurants with better products and faster upgrades. (Techcircle.in- Debjyoti Roy))
eMEDIPICS
IMA,IJCP,HCFI
Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
Inspirational Story
True Treasure

My daughter saw a colorful rainbow the other day after a thunderstorm. She called to me to look out the window and see it as well. Looking at it I was amazed at how its beauty could still uplift my middle–aged heart. As I gazed upon it, I also remembered one of the very first times I ever saw a rainbow as a boy.
I had been sitting in the house for an hour waiting impatiently for the rain to stop so I could go out and play. It had been pounding on the roof incessantly and I thought it would never end. When it finally did stop I raced outside and was greeted with the glorious sight of a rainbow curving across the sky. I had just recently heard the old legend of leprechauns hiding a pot of gold at the end of a rainbow. Excited, I looked to where the rainbow seemed to be touching the ground in the far distance. I started to quickly run down the railroad tracks near our house in search of that elusive treasure. The quicker I ran, though, the more the rainbow began to fade. Finally, I found myself running as fast as I possibly could, but it was too late. By the time I got there the rainbow and its pot of gold were gone.
Sadly that wasn’t the last time I found myself chasing after false treasure. Over the years I ran after fame, success, money, and even relationships that I thought would bring me the happiness I always wanted. None of them did, however. It took me a long time to find the true treasure that doesn’t rust, break, fade, or flee. That treasure is the love of God and it is free to all. I welcomed this treasure into my heart, soul, and life and shared it with others as well. The funny thing too was that the more love I gave away, the more love I had within me.
God loves you so much. He is forever ready to light up your life with the rainbow of His love. Accept His treasure with joy, share it with everyone, and grow richer every day. ’
eWELLNESS
HExpress gratitude

Gratitude is a thankful appreciation for what you have — from a roof over your head to good health to people who care about you. Set aside a few minutes every day and think about five large or small things you're grateful for. Write them down if you like. Be specific and remember what each thing means to you.
Humor
While he was talking to me, his nurse came in and said, "Doctor, there is a man here who thinks he’s invisible." The doctor said, "Tell him I can’t see him. "
Medicolegal
Bioethical issues in medical practice

Achieving Privacy and confidentiality in day to day practice- an ethical dilemma

Pragya Sharma
Lecturer, Dept. of Clinical Psychology
Smita N Deshpande
Head, Dept. of Psychiatry,
De-addiction Services
PGIMER- Dr. Ram Manohar Lohia
Hospital, New Delhi

Doctors in busy settings face an ethical dilemma. Maintenance of confidentiality and privacy becomes problematic due to the use of shared rooms. At times, the patient hesitates to share medical information due to this fact. More funds and better infrastructure may not always be possible. What is your preferred solution in such circumstances?

a) Ignore the issue as sharing information is culturally acceptable in India

b) Acknowledge overcrowding, try to make the patient comfortable within the shared setting

c) Extend work hours, push back appointments to ensure one patient per room at a time

d) Whisper/ talk in low voices

Do write in with your views and solutions.

Here are the responses received
  • I will go for a) Ignore the issue, as sharing information is culturally acceptable in India unless someone specifically asks for not sharing a small part of information. Saranya Devanathan, Psychiatrist
  • I think we cannot see 2 or 3 patients in one room. The patient’s right of privacy cannot be compromised for any reason. Each patient should be interviewed in a single room, and the patient and the family members should also be seen separately at least once and as and when needed. Infrastructural issues cannot be the excuse for inefficient treatment. Prof. Anil Agarwal, Psychiatrist
  • Lack of infrastructure is not an excuse for not observing privacy and confidentiality Patients should be seen alone as well as with family members. Prof. Satish Malik
  • Explain that the other person too is a doctor like me and assure that she would maintain confidentiality. Sudhakar Bhat, Psychiatrist
  • It is very difficult to provide a separate place and extending work hours may not be possible for doctors. They can talk in low voices and make the patient as comfortable as possible. If the issue really demands confidentiality like HIV or any other which patient is not at all confident to discuss in overcrowded situations, then extra time can be given after the crowding hours. Respecting the privacy of the patient is very important. Triptish Bhatia, Principal Investigator, GRIP-NIH, USA Project, Dept. of Psychiatry, Dr Ram Manohar Lohia Hospital, New Delhi
  • Firstly, we can have cabins or space with glass partitions, which prevent the sound from reaching other places. Secondly, if we are to be economical then probably the patients, of course depending upon their problem and certainly alongside giving him assurance and confidence about confidentiality, can be asked to record their voices in their phones and then ear phones can be used as a medium to listen to the voice recorded by the patient. These ear phones shall be inserted/worn by both - the patient as well as the client so that they are on the same track of conversation. But, this can be done only at the time of case history taking. If the client is educated, he can write and the doctor can ask and clarify. Enquiry questionnaires could be used. Structuring the room accordingly can help. I don't know how much do we support online counselling and case history taking. However, people (doctors and patients) who are ready for the online case history-taking, shall be taken separately by doctors at say a particular day and they must be given facility and services of the same with helpers available around in a particular room Or can be done in a booth placed to be able to communicate with the doctors in any given area within the compound. Parul
  • Lack of rooms is a fact in mental health care. But mental health service cannot and should not be stopped due to this fact only. Privacy is definitely an important issue but when infrastructure is not adequate then also treatment means a lot. When any country does not have adequate infrastructure then decision should be taken according to what is available in nearby surrounding. So treatment comes first as per hierarchy of decision criteria. So the clinician should explore the possibility of privacy if possible. S/he may evaluate himself/herself, the nature of information forthcoming during the interview and take decision accordingly whether to ensure privacy or not. However privacy of any nature should be given due respect. But this suggestion is for setting where rooms are not available in adequate number. So the clinician may also ask the patient and family about their comfort level. However it has been observed that people do not care that much in a hospital outpatient department as they have their mind made up for such crowded places. And again people feel a kind of security being stranger in the crowd. If there are not too many patients then privacy must be secured for the patient. But during a rush this issue should be dealt by considering the nature of the problem and the sensitivity of the patient and the family. Ranjita Thakur
  • Having interned at Sion Hospital in Dept of psychiatry department, this dilemma was an everyday problem. However, practitioner skills made huge difference. Doctors who were able to successfully get history and provide details at the same time respecting confidentiality showed the following:
    • Apologize to the patient for the overcrowding but saying at the same time that all these people require a doctor so we have to work with this.
    • Telling that other professionals in this room are competent and caring doctors and will not make fun of (most men who were hesitant came with premature ejaculation issues); instead can actually assist in solving the problem.
    • Allowing them to speak softly if it is a sensitive detail.

      Therefore if we really want to keep patient’s interest at the fore, a way can always be found to do so. Sadaf Vidha
  • Acknowledge overcrowding, try to make the patient comfortable within the shared setting and talk in an audible voice/tone. At the same time, if the number of patients is very high, capital expenditure in infrastructure is required. Dr S Rastogi, Director
  • It is quite natural that the patient will not like to express his symptoms before anybody and the doctors may not find a place to listen to him exclusively. In this situation, if the patient is hesitating to tell his problem, the doctors should ask him to write it on a paper and the doctor should read it and give it back to him after reading. Dr BR Bhatnagar
Breaking news
SC notice on plea for banning firecrackers during Dussehra, Diwali

Thursday, 08 October 2015 | IANS | New Delhi
The Supreme Court on Thursday sought response from the central and Delhi governments on a plea seeking ban on the sale and bursting of firecrackers during the festival of Dussehra and Diwali as this further aggravates the already dangerous level of air pollution. Besides the governments, notice was also issued to the Central Pollution Control Board (CPCB), Delhi Pollution Control Board (DPCB) and Delhi Police on a petition by three toddlers.

Three toddlers - six-month-old Arjun Gopal and Aarav Bhandari and 14-month-old Zoya Rao Bhasin - have told the apex court that their lungs are not yet fully developed and the large-scale bursting of firecrackers during the festival season of Dussehra and Diwali would further aggravate the already polluted air and will be seriously detrimental to their health ...(Source: The Pioneer).”

In order to improve transparency, accountability and efficiency in processing of clinical trial applications and monitoring, CDSCO with the approval of Ministry of Health and Family Welfare, Government of India has taken the initiative to create an IT enabled system for online submission and processing of applications as well as monitoring of clinical trials in the country. The objective of the software is to simplify the application process and also to be user friendly… (Financial Express – Usha Sharma)
MAKE SURE
Situation: A patient of gross ascites presented with complaints of difficulty in breathing on lying down.
Reaction: Oh my God! Why did you drain so much ascitic fluid?
Lesson: Make sure to evaluate the patient thoroughly and only moderately tap the ascitic fluid since overenthusiastic tapping can be life–threatening.
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Updates
IMA Stress Detox & Leadership Meet

IMA is organizing a 2-day Detox Meeting of state/local branch presidents and secretaries at Om Shanti Retreat Centre, Pataudi Road, Near Manesar, Gurgaon on 10th and 11th October, 2015. This meet is being organized by IMA in association with Heart Care Foundation of India and Brahma Kumaris. The final program is as below.

Saturday 10th October 2015
 
12.00 noon to 2.00 PM
Allotment of Rooms to the delegates
4.00 PM to 4.30 PM
Address by National President & Hony. Secretary General
4.30 PM to 5.00 PM
Acquiring Leadership Qualities (BK)
5.00 PM to 5.30 PM
Detox Tea
5.30 PM to 6.30 PM
Inauguration
6.30 PM to 7.00 PM
Communication Skills (BK)
7.00 PM to 7.30 PM
IMA Satyagraha
7.30 PM to 8.30 PM
Detox Dinner
8.30 PM to 9.00 PM
Clinical Establishment Act (IMA)
9.00 PM to 11.00 PM
Spiritual Outing and Relaxation in Detox atmosphere (BK)


Sunday 11th October 2015
 
7.00 AM to 8.00 AM
Pranayam & Rajyog Meditation
8.00 AM to 9.00 AM
Detox Breakfast
9.00 AM to 9.30 AM
Acquiring Leadership Qualities (BK)
9.30 AM to 10.00 AM
Happy Group (BK)
10.00 AM to 10.30 AM
Violence against doctors
10.30 AM to 11.00 AM
Communication Skills (BK)
11.00 AM to 11.30 AM
Crosspathy
11.30 AM to 12.00 Noon
Doctor-Patient Relationship (BK)
12.00 Noon to 12.30 PM
Clinical Establishment Act (IMA)
12.30 PM to 1.00 PM
Detox of doctors (Dr KK)
1.00 PM to 2.00 PM
Detox Lunch
2.00 PM to 2.30 PM
Parasympathetic lifestyle
2.30 PM to 3.00 PM
Parasympathetic lifestyle
3.00 PM to 3.30 PM
Open House Discussion
3.30 PM to 4.00 PM
Open House Discussion & Resolutions
4.00 PM onwards
Prasadam & Valedictory Function
Antibiotic resistance a global health crisis: WHO
Durgesh Nandan Jha,TNN | Oct 8, 2015, 10.08 PM IST
 
NEW DELHI: WHO director general Margaret Chan on Thursday said the rise of antimicrobial resistance is a global health crisis. Medicine is losing more and more mainstay as pathogens develop resistance and the second-line treatments are less effective, more costly, more toxic, and sometimes extremely difficult to administer, Chan added in her address at the G7 health ministers' meeting in Germany.
According to the WHO director general, superbugs haunt hospitals and intensive care units all around the world. "Gonorrhoea is now resistant to multiple classes of drugs. An epidemic of multidrug-resistant typhoid fever is rolling across parts of Asia and Africa. Even with the best of care, only around half of all cases of multidrug- resistant tuberculosis can be successfully cured," she said.
The WHO, in May this year, had come up with an action plan to deal with the crisis. It included increasing awareness, strengthening surveillance and research, to reduce infections, using medicines wisely, and to ensure sustainable investment, also in R&D for replacement products and better diagnostic tools.
The experts warn if the current trends continue modern medicine will end. Sophisticated interventions, like organ transplantation, joint replacements, cancer chemotherapy, and care of pre-term infants, will become more difficult or even too dangerous to undertake ...(TOI)
Lack of awareness major cause for vision disorders: Study
PTI | Oct 8, 2015, 09.16 PM IST


NEW DELHI: As many as 42 per cent drivers in India have vision problems and 59 per cent of the road accidents are related to poor sight, says a study.
The major challenge for overcoming eye disorders in India is lack of awareness and accessibility to eye care, the study, conducted by Vision Impact Institute, said.
It added that 42 per cent of workers in India have vision problems, reducing their productivity and resulting in a loss of USD 37 billion annually.
The study was released in the run up to World Sight Day.
IMA,IJCP,HCFI
MCI Code of Ethics Regulations, 2002

1.4 Display of registration numbers

1.4.1 Every physician shall display the registration number accorded to him by the State Medical Council / Medical Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients.
1.4.2 Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.

Cut visual impairment rates by 25 per cent within 2019: WHO
Kolkata: With 80 per cent of visual impairment being avoidable, the World Health Organisation (WHO) today called for reducing the prevalence of avoidable blindness and visual impairment by 25 per cent within 2019. "To reduce avoidable blindness and visual impairment, we must ensure universal access to comprehensive eye care services. There is a need to review and reinforce existing measures so that nobody suffers visual impairment and those with unavoidable vision loss can still achieve their full potential," WHO regional director Dr Poonam Khetrapal Singh said in a statement.
The WHO Global Action Plan (GAP) for the prevention of avoidable blindness and visual impairment 2014-2019 emphasises on improving eye health for everyone and reducing the prevalence of avoidable blindness and visual impairment by 25 per cent by the year 2019, she said. World Sight Day is being observed today with a focus on 'eye care for all.' The South East Asia Region has an estimated 12 million blind people including 8 million from India. More than 50 per cent of all blindness is caused by cataract which accounts for 33 per cent of visual impairment, the WHO said, adding that these statistics should be viewed against the fact that 80 per cent of visual impairment is avoidable…(Economic Times – PTI)
Centre asks states for precautionary measures on swine flu

TNN | Oct 8, 2015, 07.21 AM IST

New Delhi: With swine flu cases being reported from various parts of the country, the health ministry on Wednesday issued advisories to states asking them to take all precautionary measures to tackle the disease and also submit a status report on their preparedness by end of this week. Health Minister J P Nadda reviewed the situation with representatives of Goa, Kerala, Telangana, Gujarat and Madhya Pradesh.
"The states are advised to ensure that they have the required and adequate quantities of stock of drug Oseltamivir, viral diagnostic kits, viral transport media, personal protective equipment and N-95 masks, at different levels in the healthcare system," the health ministry said in a statement. State governments have also been requested to ensure that sufficient isolation facilities are available and functional, well-equipped to manage critical respiratory emergencies, it said. The ministry also asked the states to remain vigilant and take precautionary measures to prevent morbidity or mortality due to the H1N1 virus.
Swine flu cases have been reported from Maharashtra, Gujarat, Karnataka, Rajasthan and Telangana and with winter approaching, these cases might see an increase, one of the advisories said. Chief secretaries of states and UTs have been requested to review level the preparedness measures in the state at their level and issue necessary guidance to address shortfalls. "All assistance has also been assured by the Centre to the efforts of the states in the matter," the statement said.
The advisory said while most of influenza A H1N1 cases will be mild, persons with chronic medical conditions such as diabetes, heart diseases, cancer and other immuno- compromised conditions, adults more than 65 years old, children under 5 years of age and pregnant women are at higher risk. It said that mortality due to Influenza A H1N1 among these high risk groups can be prevented by early diagnosis and prompt treatment. The advisory has asked state governments to ensure adequate epidemiological surveillance to immediately detect clustering of influenza-like illnesses along with requisite laboratory preparedness to test the clinical samples. Training and re-training workshops can be held for doctors to reiterate guidelines on patient categorisation, clinical treatment and ventilatory management protocols, it said.
According to the other advisory, the impact of seasonal influenza activity can be mitigated by simple public health measures such as frequent washing of hands, respiratory etiquettes, avoiding crowded places and maintaining distance of arm's length from those affected from flu-like symptoms. The ministry also recommended campaigns to create awareness among the public. Besides, states have been asked to give emphasis for timely vaccination against Influenza A H1N1 so as to reduce vulnerability against the virus. (TOI)
GP Tip:

Tip: Alleviate pruritus with ice
For scratching itchy skin lesions ask them to use an ice cube instead of their fingers. The ice is nearly frictionless, and the cold helps relieve the itch.
IMA,IJCP,HCFI
eMEDI QUIZ
The main enzyme responsible for activation of xenobiotics is:

1. Cytochrome P-450.
2. Glutathione S-transferase.
3.NADPH cytochrome P-450-reductase.
4. Glucuronyl transferase.

Yesterday’s Mind Teaser: The right coronary artery supplies all of the following parts of the conducting system in the heart except:
1. SA node.
2. AV node.
3. AV bundle.
4. Right bundle branch.

Answer for Yesterday’s Mind Teaser: 3. AV bundle.

Answers received from:Dr Poonam Chablani, Dr.B.R.Bhatnagar, Dr.K.V.Sarma, Dr.K.Raju, NIKHIL KUMAR MOHANTY, Dr Avtar Krishan

Answer for 8th October Mind Teaser:3. Loss of overhead abduction

Correct Answers received from: Dr. Kusum Gandhi, Dr.B.R.Bhatnagar, Dr Pravar Passi, Priyanka Kesarwani, Dr Jainendra Upadhyay, Dr.Bitaan Sen & Dr.Jayashree Sen
Readers column
Dear Sir, it's iindeed a pleasure to see JIMA back in the new form. The quality articles were missed for a long time. Wishing the journal all the success and may it reach new heights. Regards: Dr. Bidita Khandelwal
Press Release
Lobby scuttling the Presidency of an Indian Doctor

New Delhi October 09, 2015: A doctor is considered an incarnation of God. The profession in itself is highly noble and moreover is measured to be honorable and self-sacrificing in nature. Then how does a renowned doctor of International fame come under the unscrupulous light of the global media for delinquencies he did not commit jeopardizing his upcoming appointment as the World Medical Association President for the year 2016. However, factual discrepancies are glaring in every negative report and the political motive evident – to deter a Non-White Indian from holding the said post.

Despite the fervent air of negative news being spread globally about Dr. Ketan Desai, the man in question, one only has to see the body of respectable work he has done to start questioning the media hype.

Unanimously elected thrice to head the Medical Council of India, once Indian Medical Association and being associated with almost all premier Medical Institutions, Dr. Desai has been instrumental in reforming medical education, implementing the common entrance medical exam, making research compulsory for teachers and post graduates and bringing stringent laws to prevent pharma-doctor nexus and hiring fake doctors to get medical college recognition at the risk of annoying many of the big industrial houses.

He has served as a professor and head of Urology at most prestigious Government B J Medical College, Ahmedabad from 1988- 2015 and as President of Gujarat Medical Council from 1993-2010. He was an institutional member of Institute Body of Premier institutes like AIIMS, New Delhi, PGIMER Chandigarh, Drug Technical Advisory Board, New Delhi, ICMR, National Board of Examination (NBE) and ESIS Corporation.

Commenting on his achievements and contribution to the medical profession in India, Padma Shri Awardee – Dr. A Marthanda Pillai, National President and Padma Shri Awardee – Dr. K K Aggarwal, Honorary Secretary General, Indian Medical Association in a joint statement said, “Actions speak louder than words and the pivotal role played by Dr. Desai in streamlining the medical profession cannot be undermined by a few false accusations. The truth must come to the forefront and mere politics must not deter him from taking his rightful place as the President of the World Medical Association”.

Although elected unopposed as WMA President in 2009, Dr. Desai was not permitted to take over as President in Oct 2010 at its General Assembly in Canada, by the Govt. of India due to seven cases registered against him pertaining to corruption and disproportionate assets. After a detailed investigation had carried out for well over two years, the Central Bureau of Investigation closed all corruption charges linked to disproportionate assets and gave a clean chit to Dr. Desai.

The 2013, Brazil General Assembly unanimously revoked his suspension and the council meeting at Japan scheduled his installation in October 2016 at Taiwan, based on a communication sent by IMA enclosing a CBI letter enlisting status of seven cases against Dr. Desai. The said decision was ratified in South Africa WMA General Assembly in October 2014.

The lone case stayed by the apex court pertains to the fact that MCI had recommended third renewal of a medical college for not having an auditorium. The fact is that ‘an auditorium’ is required at fourth and not the third renewal. This was reiterated after re-inspections by teams led by CBI, Health Ministry and MCI Board of Governors.

In 2013, Dr. Desai's suspension was revoked with two cases pending. In 2015 when only one case is left on a frivolous accusation, a lobby is trying to prevent him from taking over as President of WMA in the garb of "Perception".

One is blindsided by the hours of dedicated and undivided service Dr. Desai has put in throughout his career. Simple misunderstandings and politically driven attempts to not have an Indian leading an esteemed organization like the WMA have brought down Dr. Desai’s image like a house of cards, nevertheless one should not overlook the volume and expanse of work put in by Desai.

His capability evident from the several prestigious awards he has been conferred with like Dr. B C Roy National Award for Eminent Medical Teacher, Visiting Professorship by Dr. M G R Medical University, Chennai, Special award to Eminent Medical Men for Distinguished Achievement of highest order by IMA, Dr. A K N Sinha National Award for distinguished services to medical profession by IMA, President's Gold Medal Award for outstanding contribution to Urology by the Urology Society of India amongst several others.

According to the Indian law, you are not guilty unless convicted. The time has come that the truth be unveiled, and justice be served.
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