December 10   2015, Thursday
emedinexus emedinexus
Dr KK AggarwalDr KK Aggarwal Telemedicine shortens door-to-needle time: Nearly half-hour saved

A mobile stroke treatment unit (MSTU) at Cleveland Clinic in the US uses telemedicine to connect emergency team members to a hospital-based vascular neurologist. It reduces time to tPA treatment by more than 25 minutes. Researcher Ken Uchino, MD, and colleagues report their experience in the journal JAMA Neurology, published online Dec. 7.

More than 400 patients have been transported by the telemedicine-assisted MSTUs since the program began operations in July 2014. MSTUs are staffed with a registered nurse, paramedic, emergency medical technician (EMT) and a CT technologist.

CT is performed on board the MSTU and a neuroradiologist remotely assesses the images obtained by CT. The ambulance is also equipped with its own lab to measure prothrombin time, blood glucose, electrolyte levels, hemoglobin levels, platelet, and leukocyte counts.

Ninety-nine of the 100 patients had CT performed in the MSTU and 16 received IV tPA in the MSTU. One additional patient was a candidate for MSTU-delivered IV tPA, but could not be evaluated because of video failure. This patient received IV-tPA after hospital arrival.

• Time from door to CT completion was 13 minutes in the MSTU group (IQR 9-21 minutes) and 18 minutes in the ED group (IQR 12-26 minutes)

• Time from door to IV thrombolysis was 32 minutes in the MSTU group (IQR 24-47 minutes) and 58 minutes in the ED group (IQR 53-68 minutes)

• Time to CT interpretation did not differ significantly between the two groups
Dr. R.V.S.Surendran,
IMA Tamilnadu State


At this moment of natural fury, Indian Medical Association stands with you to support and help.

Indian Medical Association H.Q. Disaster Management Cell has appealed to its members for generous donation for the needy people affected by the flood.

Please inform us about the need & requirements to carry out the rehabilitation and Medical help to the affected people. IMA HQ will try to provide help in its best ability.

We also request you to inform us regularly about the activities done by IMA Tamilnadu with regards current floods in the state.

Dr A Marthanda Pillai                                           Dr KK Aggarwal                                                  Dr Chetan N Patel
President                                                                Hon Sec General                                                         Chairman
IMA HQ                                                                           IMA HQ                                                             IMA HQ DMC
Respected sir,

Our karnataka state govt. is setting up medical booths to screen and treat people coming from Tamil Nadu at major railway stations and Airport at Bangalore. They want IMAs support - Doctors to serve in these booths. The camps will last till 31st December. Interested doctor volunteers may please mail me or message me at 09845901110


Thank you,


Dr.Vani Kori
IMA, Karnataka.
Hon. Secretary General
Indraprastha Marg
New Delhi 110002

Subject: Ultrasonography Services Shut Down Agitation 7th Dec to 9th Dec 2015

Respected Sir

As per IMA Pune’s verbal intimation to you on 5th December during webinar regarding," Ultrasonography Services Shutdown Agitation is called by Indian Radiological & Imaging Association (IRIA) Pune chapter' as a retaliation against recent case of conviction of a Radiologist for mere clerical mistakes in record maintenance under PCPNDT Act 1994.

IRIA Pune Chapter will be observing 'Ultrasonography Services Shutdown Agitation' in Pune district initially for a limited period 7th to 9th Dec 2015 and Complete Radiology Services Shutdown including MRI & CT scan on 9th December 2015.

IMA Pune, IMA Maharashtra State and branches of IMA Maharashtra State and Obstetrics & Gynecological Sonologists are supporting this agitation.

Click here to read the details of the Press Note released by IRIA during Press Meet held on 7th Dec 2015 at IMA Pune Board Room.

Dr Sanjay Patil / Dr. Aarti Nimkar
Hon. Secretaries, IMA Pune
Breaking News
Centre notifies phytopharmaceuticals in D&C (Eighth Amendment) Rules, 2015 in Rule 2

Union government notified in the gazette that phytopharmaceutical drugs will be inserted under a separate definition in the Drugs & Cosmetics (Eighth Amendment) Rules, 2015. The inclusion of phytopharmaceuticals in the D&C Rules comes in after taking into consideration the growing use of these drugs in the country. This rule has come into force on the date of its publication in the official gazette which is November 30, 2015. In the Rule 2 of the D&C Rules, after clause (ea) will have an insertion: (eb): phytopharmaceutical drug which includes purified and standardised fraction with defined minimum four bio-active or phytochemical compounds. These are qualitatively and quantitatively assessed as an extract of a medicinal plant or its part, for internal or external use of human beings or animals for diagnosis, treatment, mitigation or prevention of any disease or disorder. But it does not include administration of pharmaceuticals by parenteral route… (Pharmabiz – Nandita Vijay)

FDA OKs first recombinant von Willebrand Factor

The first recombinant von Willebrand factor, to be used for the on-demand treatment and control of bleeding disorders in adults aged 18 years and older with von Willebrand disease has been approved by the US Food and Drug Administration (FDA). von Willebrand disease is caused by a deficiency or defect in von Willebrand factor, a protein critical for clotting. Even though it is relatively common, at least among bleeding disorders, the FDA granted vonicog alfa (Vonvendi, Baxalta) an orphan designation, a status usually awarded to drugs intended to treat rare diseases that comes with incentives for the manufacturer. von Willebrand disease is usually treated with desmopressin or with von Willebrand factor/factor VIII concentrates derived from plasma. Vonicog alfa provides an additional therapeutic option for these patients. (Medscape)
IMA Digital TV
IMA Digital TV
Specialty Updates
• Cannabidiol (CBD), a cannabis derivative, could help children with epilepsy, suggested a series of studies presented at the American Epilepsy Society's 69th Annual Meeting. Results revealed that after 3 months, the frequency of all seizures was a median of 45% lower in all participants; 47% experienced a >50% reduction in seizures, and 9% of patients were seizure-free.

• Six out of ten adults with controlled type 2 diabetes receive too many hemoglobin A1c (HbA1c) tests, leading to waste and the possibility of overtreatment with hypoglycemic drugs, suggested a retrospective analysis published in The BMJ.

• Heavily pretreated patients with relapsed or refractory multiple myeloma responded well to treatment with the investigative combination of ibrutinib, carfilzomib, and dexamethasone, suggested a phase I/IIb study, presented at the American Society of Hematology meeting.

• Universal decolonization of patients in intensive care units (ICUs) with chlorhexidine baths and an antibiotic nasal ointment reduces bacteriuria and candiduria in men, but not in women, reported a new study published online in The Lancet Infectious Diseases.

• Measuring the levels of RNA biomarkers in blood may help quickly differentiate sepsis from infection-negative systemic inflammation, suggested new research published in PLOS Medicine.

• A new study suggests that there is a higher risk of ischemic stroke for men who take alpha-blockers but who are not already taking other blood pressure medications. The study is published in the Canadian Medical Association Journal. Researchers noted an increased risk for ischemic stroke for men during the first 21 days of starting treatment and a reduced risk 22-60 days after starting treatment.

• Patients with primary glomerulonephritis generally have favorable long-term kidney transplant outcomes, suggested new findings published online in Transplantation.
Inhaled isopropyl alcohol from a medication pad relieves nausea in emergency department patients, at least in the short-term, suggested a small randomized controlled trial published online December 8 in the Annals of Emergency Medicine.
Science behind regrets

In a US–based study, dying people were asked about their regrets, if any. The top five regrets were:

1. I wish I had the courage to live a life I wanted to live and not what others expected me to live.
2. I wish I had worked harder.
3. I wish I had the courage to express my feelings.
4. I wish I had stayed in touch with my friends.
5. I wish I had let myself to be happier.

Regrets are always based on suppression of emotions or non–fulfillment of desires and needs. These need–based desires can be at the level of physical body, mind, intellect, ego or the soul. Therefore, regrets can be at any of these levels.

I did a survey of 15 of my patients and asked them a simple question that if they come to know that they are going to die in next 24 hours, what would be their biggest regret.

Only one of them, a doctor said that she would have no regrets.

Only one person expressed a physical regret and that was from a Yoga expert who said that her regret was not getting married till that day.

Mental regrets were two.

1. A state trading businessman said, "I wish I could have taken care of my parents."
2. A homeopathic doctor said, "I wish I could have given more time to my family."

Intellectual regrets were three.

1. A lawyer said, "I wish I could have become something in life."
2. A businessman said, "I wish I could have helped more people."
3. A retired revenue inspector said, "I wish I had married off my younger child."

Egoistic regrets were two.

1. One fashion designer said, "I wish I could have become a singer."
2. A housewife said, "I wish I could have become a dietician."

Spiritual regrets were six.

1. A Consultant Government Liaison officer said, "I wish I could have made my family members happy."
2. A businessman said, "I wish I could have meditated more."
3. A Homeopathic doctor said, "I wish I could have spent more time with my family."
4. A reception executive said, "I wish I could have spent more time with my parents."
5. An entertainment CEO said, "I wish I could have taken my parents for a pilgrimage."
6. A fashion designer said, "I wish I could have worked more for the animals."

In a very popular and successful movie, Kal Ho Na Ho, the hero was to die in the next 40 days. When asked to remember the days of his life, he could not remember 20 ecstatic instances in life.

This is what happens with each one of us where we waste all our days and cannot remember more than 50 or even 20 of such instances. If we are given 40 days to live and if we live every day ecstatically, we can get inner happiness. Therefore, we should learn to live in the present instead of having a habit of postponing everything we do. We should learn to prioritize our work and do difficult work first or else we would be in a state of constant worry till that work is over.

I teach my patients that they should practice confession exercise and one confession is to talk about your regrets and take them as challenge and finish before the next Tuesday. When working, there are three things which are to be remembered –passion, profession and fashion. Profession is at the level of mind, ego and spirit.

We should convert our profession in such a manner that it is fashionable and passionate. Passion means working from the heart and profession means working from mind and intellect and fashion means working the same at the level of ego, which is based on show–off.
The Year in Medicine 2015: News That Made a Difference
ABIM Makes Concessions to MOC Critics

Following a full-scale revolt by physicians, the American Board of Internal Medicine (ABIM) is considering dropping its expensive 10-year maintenance of certification (MOC) exam. Instead, physicians could be required to take shorter, more frequent tests that could be done online. ABIM has made significant changes to MOC, but one of the outstanding grievances is the exam, which must be taken once every 10 years. Failure can mean loss of job or hospital privileges. Source: Medscape
Medical Breakthroughs that were initially ridiculed or rejected
Traumatic Brain Injuries in Sports

When a purely scientific advance stands to jeopardize a very powerful interest, rejection can turn threatening. Such was the case of forensic pathologist Bennet Omalu, a native Nigerian working in the Allegheny County coroner's office. Dr Omalu had no idea just how powerful the National Football League (NFL) was when he published the first diagnosis of chronic traumatic encephalopathy in Neurosurgery. The NFL immediately mobilized a cadre of physicians on the organization's payroll to attack his research, but Dr Omalu persisted despite such prosecution by the NFL. Even experts without any ties to the NFL initially discounted his research. Because of Dr Omalu's persistence, the NFL has been forced to acknowledge chronic traumatic encephalopathy, and the wider sports culture has begun questioning the costs of repeated brain injuries in sports, both professional and recreational. (Medscape)
Legal Quote
Ayesha Begum vs All India Institute of Medical Sciences on 9 May, 2007, Complaint No. 155/2000

“The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. It is not possible for every professional to possess the highest level of expertise or skills in that branch which he practices.”
IMA Digital TV
Digital IMA
IMA Digital TV
IMA Digital TV
IMA White Paper on Live Surgeries

Objective: LSEs must be performed by the “right” surgeon on the “right” patients in the right environment and with the right intentions. The overriding principle is that patient safety must take priority over all other considerations in the conduct of live surgery.

IMA Live Surgery Code of Conduct

• The educational goals must be predetermined.
• The role and responsibilities of all participants, including the director of the LSE, the local onsite surgeons, the visiting surgeons,    the moderators and all other staff members, must be clearly defined.
• The operating surgeons, all members of the operating team, the hospital and the sponsors must complete and submit a conflict    of interest disclosure.
• All funding must be transparent and all financial arrangements fully disclosed in advance.
• Sponsoring companies are not permitted to exert any influence on the LSE.
• Patient dignity, anonymity and confidentiality must be maintained at all times.
• Any guest surgeons must be invited to arrive the day before surgery and establish personal contact with the patient.
• A specific Informed Consent to Live Surgery addendum must be completed, signed by the local and guest surgeons, and    retained in the patient's medical records.
• All decisions must be made in the best interests of the patient.
• Patient's advocate must be allowed.
• Surgical professionalism is paramount.
• Sensationalism must be avoided.
• All outcomes and complications should be reported.

(To be contd.)
IMA Satyagraha
IMA Poll
22nd MTNL Perfect Health Mela, the annual flagship event
of the Heart Care Foundation of India
Provisional programme for the ensuing meeting of the Central Council

Dear Colleague

The provisional programme for the ensuing meeting of the Central Council to be held from 27th (Sunday) to 28th (Monday) December, 2015 at Hotel Le Meridien, New Delhi is as below.

This year, the Central Council will not only have issues related to IMA but also have interactions with top luminaries of the country connected with issues related to health.

Kindly send your names, suggestions with questions related to the Agenda, in advance to us so that the same can be incorporated in the various discussions during the Central Council Meeting, as this CC Meeting is absolutely packed minute by minute. To conduct Central Council smoothly, we request your cooperation.

Please note that the whole meeting of the Central Council will be live webcast.

Dr A Marthanda Pillai                                                                                                                             Dr KK Aggarwal
National President                                                                                                                              Hony Secretary General

27-12-2015 (Sunday)
08:00 - 08:10 AM
Inviting of leaders to the Dais
Adornment of National President with the Presidential Medallion
08.10 – 08:20 AM
Invocation of the IMA Prayer
Flag Salutation
Homage to departed souls
Approval of Minutes of the 135th Ordinary Meeting of IMA Central Council
08:30 - 09:00 AM
Dr A Marthanda Pillai
Presidential Address
09:00 - 09:30 AM
Shri Ashok Chakradhar, Padma Shri Awardee
Laughter the best medicine
09:30 - 10:00 AM
Sh Rajat Sharma, Editor, India News
How media perceives the doctors
10:00 – 10:30 AM
Dr K K Aggarwal
Address by Honorary Secretary General
10:30 – 11:00 AM
Sidharth Luthra, Former ASG
CPA vs Council vs IPC vs specific laws
11:00 – 11:30 AM
CC Continues
Satyagraha Update
11:30 – 12:00 NOON
Sh D K Jain (invited)
National Consumer Dispute Redressal Commission
12:00 – 12:30 PM
IMA Update
Membership, Miscellaneous
12:30 – 01:00 PM
Justice Vipin Sanghi, Justice G S Sistani, High Court Judges (invited)
Duties of a medical professional
01:00 – 02:00 PM
02:00 – 02:30 PM
IMA Update
RNTCP, Child Sexual abuse, UNESCO
02:30 – 03:00 PM
Sh. Sushil Chandra, Member CBDT
Income tax and medical profession
03:00 – 03:30 PM
IMA Update
IMA Accreditation Council, CME Hours
03:30 – 04:00 PM
Sh. Maninder Singh, ASG
Legal open house
04:00 – 05:00 PM
Shri JP Nadda, Hon’ble Minister of Health
05.00 – 07.00 PM
Sh. Satyendra Kumar Jain, Health Minister, Delhi
Reception at 2 Raj Niwas Road
07.00 PM onwards
Banquet hosted by IMA HQs at Asiad Tower Garden (Asian Complex adjacent to Sri Fort Auditorium, New Delhi)
28-12-2015 (Monday)
08:30 - 09:00 AM
Dr Ved Prakash Mishra, MCI
Medical education
09:00 - 09:30 AM
CGP, AMS, AKN, JIMA, NPPS, NSSS, Health Scheme, Pension Scheme, HBI, International wing
Reports by wings of IMA
09:30 – 10:00 AM
10:00 – 10:30 AM
VP, FSC, BSC, YD wing, students wing, Disaster Management
IMA reports
10:30 – 11:00 AM
Shri B S Bassi, Police Commissioner, Delhi
Violence against doctors
11:00 – 11:30 AM
IMA Lybrate, IMA Kent, IMA USV Initiatives
New Initiatives
11:30 – 12:00 NOON
Shri Nalin Kohli, Media Personality
How to face a TV Debate
12:00 – 12:30 PM
Mental health, MMR, IMR, RTA, BMW disposal, Elderly care, safe sound, diabetic blindness, Mediation Cell
New initiatives
12:30 – 01:00 PM
01:00 – 02:00 PM
02:00 – 02:30 PM
Guest lecture
Pediatric Update
02:30 – 03:00 PM
Dr Harsh Vardhan, Minister of Science and Technology, GOI (invited)
Medical Research
03:00 – 03:30 PM
Mental health, MMR, IMR, RTA, BMW disposal, Elderly care, safe sound, diabetic blindness, Mediation Cell
New initiatives
03:30 – 04:00 PM
Shri Sanjay Jaiswal, Member of Parliament
Rural Health options
04:00 – 04:30 PM
CC Meeting
Other issues
04:30 – 05:00 PM
Shri G N Singh, DCGI
Pharmacovigilance Program
05:00 – 07:00 PM
IMA National Awards Function

Dr Jitendra Singh, Hon’ble Minister of State of Science & Technology, as Chief Guest

Shri Rajyawardhan Rathore, Minister of State of Information & Broadcasting as Co-Chief Guest (Invited)
07.00 - 08.00 PM
Dr S S Agrawal

Shri Mukul Rohatgi, Attorney General of India

Dr Mahesh Sharma, Minister of State for Culture, Tourism & Civil Aviation
Installation of Team IMA – 2015-2016, followed by 136th Ordinary Meeting of Central Council of IMA

Chief Guest

Co-Chief Guest
08.00 PM onwards
Dear All

All doctors of IMA Bahadurgarh (Haryana) had a fruitful meeting with DSP, SHO and staff of police of this town regarding violence in clinics and nursing homes. The DSP suggested that IMA must appoint a committee of five doctors who will be consulted by police in case of any complaints received by police against doctors before initiating any action.

The police advised that as soon as there is any problem in the medical establishment, they should immediately call help by dialling 100. This not only alerts the police but also helps them to reach the doctor. They advised that whatever may be the provocation the doctor and staff should remain cool because taking law in our hands gives a negative impact. The DSP also suggested that we should take the help of MPP Act as applicable to medical establishments and include that in our complaint.

As far as possible we should all protect ourselves by CCTV cameras, which will help not only to identify the offender but also their friends and other elements of the society.

I request all branches of IMA throughout India to seek the cooperation of their respective police personal to have a better understanding with them because it is this department, which can help us at the time of crises even though the police force have a very negative image in the public mind; however, we are concerned only in protecting our property and reputation when there is a crises.

Cooperation is the key.

Dr Neeraj Gupta
6.5% of population has some form of mental disorder

More than 6% of the total population is suffering from either a common or a severe mental disorder such as depression, anxiety and schizophrenia. In a written reply to the Rajya Sabha, the Union Minister of Health, Shri JP Nadda said that in 2005, the National Commission on Macroeconomic and Health reported that 10-20 million (1-2 per cent of population) suffered from severe mental disorder such as schizophrenia and bipolar disorder and nearly 50 million (5 per cent of the population) from common mental disorders such as depression and anxiety, yielding an overall estimate of 6.5 per cent of the population… (Economic Times - PTI)
India records highest infant deaths due to premature births

India has the highest numbers of infant deaths due to premature with more than 3 lakh babies dying every year. "As per World Health Organisation (WHO) Publication 'Born too Soon: The Global Action Report on Preterm Birth' out of an estimated annual 2.7 crore live births, in India 35 lakh babies are born preterm and out of these 3.03 lakh babies die due to complication of preterm birth," the Minister said while replying to a question in Rajya Sabha. Under the National Health Mission (NHM), key interventions such as institutional delivery through Janani Suraksha Yojna cash incentive scheme for pregnant mothers, Janani Shishu Suraksha Karyakaram which entitles all pregnant women and sick infant to absolutely free and no expense treatment at public health facilities are being implemented to lower the infant mortality. Facilities for care of sick newborns such as Special New Born Care Units, New Born Stabilization Units and New Born Care Corners and provision of home-based new born care through Asha workers is provided… (NDTV- PTI)
Reduced antibiotic prescription lowers patient satisfaction

Patients often pressurize doctors to prescribe antibiotics even for viral infections such as colds, coughs, sore throats, or the 'flu’. Findings of a survey published in the British Journal of General Practice show that a 25% lower rate of antibiotic prescribing by a general practitioner corresponds to a 5-6 point reduction on GP (general practice) satisfaction rankings. The survey analyzed records from 7,800 general practices, mostly in England. (The Pioneer - IANS)
Diabetic women are at greater risk of heart disease

A new American Heart Association scientific statement says that women with type 2 diabetes have a 2-folds higher risk of developing coronary heart disease than men. They may also need more frequent and intense physical activity to lower their risk of having a heart attack or stroke. The statement is published in the journal Circulation.

• Women with type 2 diabetes have heart attacks at an earlier age vs men.
• Women with type 2 diabetes are more likely to die after a first heart attack vs men.
• They are less likely to undergo procedures such as angioplasty or coronary artery bypass grafting vs men.
• They are less likely to be on drugs such as statins, take aspirin or antihypertensives vs men.
• They are more likely to have uncontrolled blood sugar or blood pressure vs men.
• They develop type 2 diabetes based on sex-specific differences, such as gestational diabetes and polycystic ovary syndrome

(Science Daily)
Meta-analysis finds high prevalence of depression in trainee doctors

As per a meta-analysis published in JAMA, up to 43% of physicians-in-training may meet criteria for depression. Douglas Mata, MD, MPH, and colleagues analyzed data from 31 cross-sectional studies and 23 longitudinal studies published from January 1963 to September 2015 and involving more than 17,500 medical residents and interns worldwide. Dr Mata said, "We found that a whopping average of 29% of young doctors go through bouts of depression. But even more surprising, as many as 43% of residents get clinically depressed during any given year of their training. This is remarkable, considering how patients often don't report their depression because of the social stigma that's attached to it." (Medpage Today)
Eating Out Tips

• Curb portions: Always order for one if you are two people and if you are alone set aside some of what is on your plate to bring    home.
• Resist refined carbohydrates.
• Load your plate with colorful choices at the salad bar with vegetables, fruits, and small amounts of lean protein. Skip the creamy    dressings.
• Choose dishes that are grilled, roasted, steamed, or sautéed.
• Don’t be afraid to request a salad, vegetables, or fruit instead of starchy side dishes.
• In non–vegetarian food, order only fish or seafood.
• If you decide to have dessert, share it with your dining companion(s).
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
IMA Live Webcast

Click here
Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

Smita N Deshpande
Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse- a doctor- as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013):

Responses received

Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar
Inspirational Story
Inspiring Tears

Unfortunately when people think of teenagers, good thoughts are not always the first to come to mind. I know I avoid going into my teenage daughter’s high school at the end of their day because I don’t want to shoved and pushed in the hallways. I feel like I am running the gauntlet sometimes! I know they are just kids in a hurry to get out and blow off steam. Fortunately I also get an opportunity to see teenagers at their best. Watching my daughter and her high school band's camaraderie is always a joy. For instance, when a fellow band member's music folder fell on the pavement everyone ran to help gather the music before it was scattered by the wind. They are a great group of kids.

But I witnessed an event yesterday that really warmed my heart. My daughter had a band competition at a nearby high school. Her band was the last one to play and before they could play their last selection, the lights in the auditorium flickered and then went out. The atmosphere in the large, dark space was pensive. The band, sensing this, started singing some of the familiar songs that they sing in the stands during football season. The audience started clapping and singing along. It was quite the experience, sitting in total darkness singing and clapping with dozens of people like it was an everyday occurrence.

I was so lucky to be able to experience this firsthand. My daughter is a senior and so this was one of her last concerts in high school. It was a moving inspirational experience I will never forget.
Complete the mnemonic for muscarinic signs and symptoms.


_Urination, Miosis, Bronchorrhea/Bronchospasm/Bradycardia, Emesis, Lacrimation, Salivation

Yesterday’s Mind Teaser: The muscarinic signs can be remembered by the mnemonic, Fill in the blank
Salivation, Lacrimation, …, Defecation, GI symptoms, Emesis, Bronchorrhea, Bronchospasm, Bradycardia

Answer for Yesterday’s Mind Teaser: A: U: Urination

Answers received from: Dr Jayashree Sen & Dr Bitaan Sen, Dr K V Sarma, Dr Jainendra Upadhyay.

Answer for 8th December Mind Teaser: Anemia of inflammation

Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Dr BR Bhatnagar.
A housewife goes to an optometrist and says: Lately I’m seeing grocery items smaller than they appeared till recently. I think I need a change of my eyeglasses.

The optometrist after examining her eyes for refraction and finding no change in dioptric values observes: Manufacturers of grocery items, rather than increasing the prices, have made the packings smaller; and there’s no need for you to change your eyewear.
Readers column
• Emergency services should be replaced by FIRST AID at all places, especially in clinics and hospitals with less than 50 beds.

• PCPNDT Act: It should be emphasized that those indulging in sex determination will never fill forms. Then what are we achieving by giving stringent punishments to those filling incorrect forms? Only wasting energy in useless exercise. How many doctors were caught carrying out sex determination on the basis that their forms had mistakes till date!

• CEA: Nursing homes/hospitals already built should not be made to undertake structural changes, as law cannot be applicable retrospectively. NHs/hospitals below 25 beds should not be in the purview of CEA. License for spirit, diesel etc should be required if they are stored beyond a certain limit. Structural requirements are different for a 25 to 50 bed hospital than a 100 bed hospital e.g. corridors of 8 feet not required in smaller hospitals. Area per bed in IPD, ICU, OT /LR sizes etc. hence, they should be applicable only in >100 bed hospitals. Local building bylaws should be relaxed to implement requirements under CEA wherever necessary. This should be incorporated in the Act. Staff requirements are also less in smaller hospital.

Dr Ramneek Singh Bedi
Press Release
Environmental pollution linked to the high prevalence of diabetes in our country

With air pollution at an all time high in our city, it is becoming crucial that immediate steps are taken to reduce the environmental burden. Pollution has various hazardous effects on a person’s health. It precipitates asthma, heart attacks and COPD. Recent research has also proved that environmental pollution, especially with high particulate matter PM 2.5 exposure, is linked with diabetes.

Any particulate matter of less than 2.5 micro m3 in size can get absorbed from the respiratory system, enter the blood and release pro–inflammatory products leading to endothelial dysfunction and resultant diabetes and heart disease.

As per WHO, the content of PM2.5 in the air should be less than ten µg/m3. However in India the levels are always more than 60 µg/m3. In fact, an60 µg/m3 PM2.5 concentration has been accepted as normal in India. That means that an Indian is already six times more exposed to PM2.5 particulate as opposed to his western counterpart. In India, we find values as high as 300–400 µg/m3 in selected areas on a daily basis. Constant exposure to PM 2.5 particulates leads to endothelial dysfunction, one of the major factors for the increasing diabetics in the country.

Speaking about this, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. K K Aggarwal, Honorary Secretary General IMA in a joint statement said, “ Air Pollution is a modifiable risk factor for the development of diabetes in our country. People with a history of diabetes in the family, at high risk of the disease, must take necessary steps to protect themselves from the harmful air by restricting their outdoor exertion levels. They must also ensure that they keep a check on their diet and get regular exercise especially during early mornings when the air is said to be purer. There is a dire need to raise awareness about the need to reduce environmental pollution in our country. The air we presently breathe is extremely harmful to patients with existing lifestyle diseases, the young and the elderly and it is the responsibility of each citizen to reverse this."

To prevent oneself from diabetes, it is advised that one should avoid eating refined carbohydrates, omit carbohydrates 80 days in a year from diet and avoid exposure to high PM2.5 pollution matter (which can be checked from the official governmental website), exercise more and try to eat a diet full of fruits and vegetables that are live, locally grown and seasonal.