May 10  2015, Sunday
editorial
Natural Disasters
Dr KK Aggarwal
  1. A natural disaster is always unpredictable and requires crisis management.
  2. The role of medical doctors is very important. Disaster Management and Crises Management should be made compulsory subjects in MBBS and Post Graduation courses. There are protocols for medical crisis management in a war. Similar protocols should be followed during any natural disaster.
  3. Disaster Management is based on the following principles: One cannot live for more than 3 minutes without air, one cannot live for more than 3 days without water and one cannot live for more than 3 weeks without food.
  4. Triage management is the basic principle to be adopted in disaster management.
  5. Most people who reach the hospital within the first hour are the ones who are usually not injured much. The real emergencies or critical patients start coming in after one hour.
  6. Number of people reaching for medical help at the end of one hour can be multiplied by two to calculate the total requirement.
  7. In Triage management, priority should be given to people who require emergent and urgent care based on the facilities available in the set-up.
  8. Everybody in the team should know how to resuscitate a person. The senior most person should become the team leader and be responsible for management.
  9. Medical profession faces a lot of problems during the natural disaster such as scarcity of medical supply, unavailability of specialists, and scarcity of safe water. They often have to manage patients in stop gap arrangements like a hospital in the tent.
  10. The main diseases which spreads after disaster are water-borne diseases, especially cholera. If not prevented, it can also end up in another disaster. The prevention is safe water supply.
  11. Any doctor who wants to help and wishes to provide his/her services during the disaster, should go through Medical Associations like the IMA so that there is a rational use of medical resources available.
  12. Commercialization of medical profession does not mean that the medical profession will not remain noble. Corporatization is by the commercial bodies for the purpose of profit. The difference between the corporate hospital and trust hospital is that in corporate hospital money earned can be used by the Board of Directors for their personal use and in a trust, the money earned has to be used only for the purpose for which the trust was made.
  13. As far as doctors are concerned, whether they work in trust or in corporate hospital, their job is to provide services which are transparent, ethical and full of seva.
IMA,IJCP,HCFI
eMedipics IMA,IJCP,HCFI
Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
News
  • Aggressive blood pressure and lipid-lowering treatment after stenting had the expected effect on the surrogate markers but did not slow down atherosclerosis any better in the Japanese MILLION trial.
  • For people with type 2 diabetes, quitting smoking may lead to a worsening of glycemic control unrelated to weight gain, a new study suggests. The findings, from a large UK primary-care database, were published online April 29 in Lancet Diabetes & Endocrinology by Deborah Lycett, PhD, RD, clinical dietitian and principal lecturer in nutrition and dietetics at Coventry University, United Kingdom, and colleagues.
  • Hemoglobin A1c (HbA1c) identifies three times more undiagnosed individuals as having prediabetes or diabetes than does fasting plasma glucose (FPG), researchers from Canada report.
  • A woman in central Kashmir’s Ganderbal district died Friday hours after giving birth to a baby due to alleged medical negligence by authorities. Kadija Begum, 35, wife of Ghulam Muhammad Lone, resident of Wusan in Kangan was admitted at the hospital under MRD number 117 after she developed labour pains yesterday morning. She was operated upon by the doctors and gave birth to a girl child, the family of the deceased said. “However, the woman was continuously in state of unconsciousness and her situation worsened following which a team of doctors shifted her to SKIMS Soura,” her family said. They said that instead of sending a doctor with her, the medical authorities deputed a nurse in an ambulance along with the patient. “In the ambulance, Khadija was put on ventilator but the oxygen exhausted after 15 minutes leading to her death at Wayul Bridge,” the family alleged, adding, “it is a sheer negligence on the part of hospital authorities. She was declared “brought dead” by doctors at SKIMS.”Meanwhile, the Chief Medical Officer RD Kasana told GNS that a four-member team has been constituted to probe the cause of death. He said the Medical Superintendent Dr Javaid has been attached with CMO Office until further orders. (greaterkashmir.com)
  • Mangaluru, May 8, 2015: Relatives and public staged protest infront of the Government Lady Goshen hospital following sudden death a 25-year-old woman died at the Wenlock hospital here on 8 May 2015. Resident of Ajjava in Sullia Poovakka (25), wife of Ganesh, died on May 7. She was admitted for treatment in Lady Goshen Hospital and later shifted to Wenlock hospital, where she breathed her last.
  • A real estate firm has been directed by the apex consumer commission to pay Rs 4.77 crore to seven buyers for "huge delay" in handing over apartments to them, noting that the builder had attempted to make profit at the cost of others. The National Consumer Disputes Redressal Commission bench presided by Justice J M Malik noted that the apartments booked nine years ago in Greater Noida were yet to be delivered by Unitech Reliable Projects Pvt Ltd and asked it to pay Rs 4,77,58,658 with 18% interest to the seven consumers.
IMA,IJCP,HCFI
Dr KK Spiritual Blog
Leverage your strengths
  • Know your strengths
  • According to a British study, only about one–third of people have a useful understanding of their strengths.
  • If something comes easily, you may take it for granted and not identify it as a strength.
  • If you are not sure, ask someone you respect and who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
  • Strengths which are most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.
  • Strengths are so important that they're worth cultivating and applying in your daily life, even if they don't come naturally to you.
Make Sure
Situation: A patient was brought to the ICU in cardiogenic shock.
Reaction: Oh my God! Why didn’t you take him for emergency angiography and subsequent PTCA?
Lesson: Make Sure to perform an emergency diagnostic angiography and mechanical revascularization with PTCA in patients of cardiogenic shock. Results of NRMI–2 trial suggest that this intervention is much better than thrombolytic therapy in such patients.
Dr Good Dr Bad
Situation: A patient with diabetic nephropathy was found to have a high homocysteine levels.
Dr Bad: Homocysteine has no correlation with nephropathy.
Dr Good: You should control your homocysteine levels.
Lesson: Results of a nested case–control study suggest that hyperhomocysteinemia has an etiologic role in the pathogenesis of diabetic nephropathy. In the study, baseline plasma homocysteine concentrations and mean HbA1C levels during follow–up were significantly higher in patients who developed microalbuminuria than in those who remained normoalbuminuric. Multivariate logistic regression analysis showed that baseline plasma homocysteine level and mean HbA1C were independent predictors of microalbuminuria in type 2 diabetes.

(Copyright IJCP)
Inspirational Story
Story of Appreciation

One young academically excellent person went to apply for a managerial position in a big company. He passed the first interview; the director did the last interview, made the last decision. The director discovered from the CV that the youth’s academic achievements were excellent all the way, from the secondary school until the postgraduate research, never had a year when he did not score good grades. The director asked, "Did you obtain any scholarships in school?" the youth answered "None." The director asked, "Was it your father who paid for your school fees?" The youth answered, "My father passed away when I was one year old, it was my mother who paid for my school fees."

The director asked, "Where did your mother work?" The youth answered, "My mother worked as clothes cleaner." The director requested the youth to show his hands. The youth showed a pair of hands that were smooth and perfect.

The director asked, "Have you ever helped your mother wash the clothes before?" The youth answered, "Never, my mother always wanted me to study and read more books. Furthermore, my mother can wash clothes faster than me."

The director said, "I have a request. When you go back today, go and clean your mother’s hands, and then see me tomorrow morning." The youth felt that his chance of landing the job was high. When he went back, he happily requested his mother to let him clean her hands. His mother felt strange, happy but with mixed feelings, she showed her hands to the kid. The youth cleaned his mother’s hands slowly. His tear fell as he did that. It was the first time he noticed that his mother’s hands were so wrinkled, and there were so many bruises in her hands. Some bruises were so painful that his mother shivered when they were cleaned with water.

This was the first time the youth realized that it was this pair of hands that washed the clothes everyday to enable him to pay the school fee. The bruises in the mother's hands were the price that the mother had to pay for his graduation, academic excellence and his future.

After finishing the cleaning of his mother hands, the youth quietly washed all the remaining clothes for his mother. That night, mother and son talked for a very long time.

Next morning, the youth went to the director’s office. The Director noticed the tears in the youth’s eyes, asked: "Can you tell me what have you done and learned yesterday in your house?"

The youth answered, "I cleaned my mother’s hand, and also finished cleaning all the remaining clothes." The Director asked, "Please tell me your feelings."

The youth said, Number 1, I know now what appreciation is. Without my mother, there would not be the successful me today. Number 2, by working together and helping my mother, only now I realize how difficult and tough it is to get something done. Number 3, I have come to appreciate the importance and value of family relationship.

The director said, "This is what I am looking for to be my manager." I want to recruit a person who can appreciate the help of others, a person who knows the sufferings of others to get things done, and a person who would not put money as his only goal in life. You are hired. Later on, this young person worked very hard, and received the respect of his subordinates. Every employee worked diligently and as a team. The company's performance improved tremendously.

Lessons to be learnt

A child, who has been protected and habitually given whatever he wanted, would develop "entitlement mentality" and would always put himself first. He would be ignorant of his parent's efforts. When he starts work, he assumes that every person must listen to him, and when he becomes a manager, he would never know the sufferings of his employees and would always blame others. For this kind of people, who may be good academically, may be successful for a while, but eventually would not feel sense of achievement. He will grumble and be full of hatred and fight for more. If we are this kind of protective parents, are we really showing love or are we destroying the kid instead?

You can let your kid live in a big house, eat a good meal, learn piano, watch a big screen TV. But when you are cutting grass, please let them experience it. After a meal, let them wash their plates and bowls together with their brothers and sisters. It is not because you do not have money to hire a maid, but it is because you want to love them in a right way. You want them to understand, no matter how rich their parents are, one day their hair will grow gray, same as the mother of that young person. The most important thing is your kid learns how to appreciate the effort and experience the difficulty and learns the ability to work with others to get things done.
Events
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: AV bundle.

Correct Answers received from: Dr Poonam Chablani, Dr K Raju, Dr KV Sarma, Daivadheenam Jella, Dr K C Sharma, Dr G Madhusudhan, Dr Avtar Krishan.

Answer for 8h May Mind Teaser: 3. Loss of overhead abduction.

Correct Answers received: Dr K Raju, Dr Jainendra Upadhyay, Dr Shangar Pawar.
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
If for some reason, IDRV cannot be given in deltoid region, what are the alternative sites?

IDRV can be given in deltoid region, suprascapular, anterior abdominal wall and the upper part of thigh.
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
Press Release
Take Care of your Mother

Over 60% of mothers believe their biggest health threat to be breast cancer but heart disease kills 6 times as many women as breast cancer, said Padma Shri Awardee Dr A Marthanda Pillai, National President IMA and Padma Shri, Dr B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal, Honorary Secretary General IMA and President Heart Care Foundation of India

Some risk factors are different for women than for men. Heart disease symptoms may be milder in women. Heart attacks often strike without warning. If a woman does not realize heart disease is a health threat, she will not make heart healthy changes or respond to symptoms once they occur.

The woman is at risk if:
  1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  2. She is over 55 years old. (After age 65, the death rate increases sharply for women)
  3. She smokes or is exposed to second-hand smoke every day.
  4. Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise for 60–90 minutes with moderate–intensity activity on most days.
  6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  7. Her HDL (High Density Lipoprotein or "good" cholesterol) is less than 50mg/dL.
  8. LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C <100mg/dL; HDL–C >50mg/dL; triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3 tbsps of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  9. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)
  10. Either natural or through surgery, early menopause, before the age of 40 is associated with increased risk for cardiovascular disease.
  11. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  12. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  13. A healthy diet consists of eating fruits, vegetables and whole grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily); eating fish, especially oily fish, at least twice a week; limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL. Limiting alcohol intake to no more than 1 drink per day; limiting sodium intake to <2.3 g/d (approximately 1 tsp salt) and avoiding all trans–fatty acids (listed as "hydrogenated oil" in the ingredients section)
  14. Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  15. Having at least three of a cluster of symptoms that are listed below put her at risk:
    • High blood sugar >100 mg/dL after fasting
    • High triglycerides, at least 150 mg/dL
    • Low HDL (<50 mg/dL in women)
    • Blood pressure of 130/85 or higher
    • Waist >35 inches (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).
eIMA News
Indian Medical Association HQ - Nepal Medical Relief Activity
Nature’s fury, no forecasting system combined with poor preparedness has left Nepal battling its worst earthquake. On April 25th severe earthquake caused havoc in Nepal. Many people have died. Property and infrastructure worth billions of rupees have been damaged.

The earthquake fury has overtaken the community of Nepal especially of interior parts of it and left them numbs. There are huge losses of human life as well as properties and need to help. It is our social responsibility towards our neighboring country to help in all ways.

Indian Medical Association HQ., immediately came into action under the guidance of our Hon. Secretary General Dr. K K Aggarwal. A line of action was prepared immediately and sent to all IMA members along with “DO’s & DON’Ts during Earthquake”. A monitoring cell was established at IMA HQ. An appeal was sent to all Working Committee Members; State Branch Presidents and Hon. Secretaries of local branches and IMA members to volunteer their services reaching Nepal for help and to contribute for medicines and financial contribution to the IMA President Disaster Relief Fund. A request was done to Indigo airlines to provide free tickets to go to Kathmandu. We received a positive response. We received many request from our IMA members to go to Nepal at the service of affected victims. IMA HQ’s unique initiative started to help the needy brethren of our neighboring country, which was affected by disaster, the natural calamity of earthquake. The important aspect of this activity was that all the doctors went voluntarily. Doctors were sent from different states like Chhattisgarh, Gujarat, Maharashtra and Punjab.

Dr. Ashok Gupta, Dr. Kanchan Gupta, Dr. Shashank Shrigarpure, Dr. Sujit Adsol, Dr. Mansukh Kanani, Dr. Anoop Verma, Dr. Roohi Deol & Dr. Dilip Sheth along with few paramedical attended from 30th April to 9th May 2015.

Our IMA Team worked together with the doctors of Vayodha Hospital, B.K. Eye Foundation Hospital and Bhaktapur Civil Hospital. Along with seeing the patients in OPD, they assisted the hospital doctors in debridement of wounds, dressings, anesthesia procedure, emergency cesarean section and emergency resuscitation of new born also. Along with hospital doctors our team rendered services in the periphery area of Kathmandu to the interior part of Nepal.

Our team examined about 300 patients of Charagadh village of Kirtipura Dist., about 250 patients at village Ranitar of Sindupalchok district (at a distance of around 100 Km from Kathmandu) and 60 patients in Karyabinayak Municipality area in a temporary OPD erected in tent. In the Hospital OPD of Bhaktapur Civil Hospital Dist.

Bhaktapur, our team had examined about 500 patients including pediatric patients in three days. Around 1100 patients were examined from pediatric to geriatrics patients by our team in 10 days.

The whole relief activity was carried out with the support of Heart Care Foundation of India.

Long Live IMA

Dr. Marthanda Pillai, National President IMA

Dr. KK Aggarwal, Honorary Secretary General IMA

Dr Chetan N Patel, Chairman IMA HQ DMC
IMA Rise & Shine: Fight for your dignity
  1. Boycott all movies of Akshay Kumar and Sanjay Leela Bhansali: http://tinyurl.com/kzkg48o
  2. IMA asks doctors to boycott Mika functions: http://tinyurl.com/mqat9b3
  3. Doctors want censor's scissors for Bhansali's 'Gabbar Is Back': http://tinyurl.com/m85dftz
  4. Doctors demand laws against violence - Navbharat Times: http://tinyurl.com/kelvn4t
Views on Medical laboratory Registration
Dr. Rakesh Sharma
S.
No.
Type of Lab
Activity
Lab
Director
(overall Respon-sibility)
Regist-ering body
Suggestion
1
Independ- ent
stand alone
labs
Labs
perform
tests
under
supervision
of Lab
Director
who is
MBBS, MD
in any field
of
Laboratory
Medicine
(Pathology,
Microbiology,
Biochemistry
etc.)
MBBS, MD
in any field
of
Laboratory
Medicine
(Pathology,
Microbiology,
Biochemistry
etc.)
MCI
or SMC
Additional Registra-tion not
required
2
Labs in
NH and ME
Labs
perform
tests under
direct
supervision
of an
MBBS, MD
in any field
of
Laboratory Medicine
(Pathology,
Microbiology,
Biochemistry
etc.)
during routine
hours.

However
qualified
technicians
perform
tests
and issue
interim
report
during
emergency
which are
authenticated
by Lab
Director
etc.
next day.
MBBS, MD
in any
field of
Laboratory
Medicine
(Pathology,
Micro-biology,
Bio-
chemistry
etc.)
MCI
or SMC
and DHS
Regis-
tration
with
DHS
under
NH
and ME
Act.
Pathol-
ogists
who
authent-
icate
reports
released
by
Techni-
cians
in
emerge-
ncy
is
regist-
ered
with
DMC,
MCI or
SMC.
Additio-
nal
Registra-
tion not
required.
3
Small Labs
in Clinic
of GPs
Usually
Lab
technicians
perform
tests under
supervision
of General
Practitioner.
Perform
routine
tests.
General
Physician,
MBBS
Registered
with Medical
Council who
owns the
establish-
ment.
MCI
or SMC
Additio-
nal
Re-
gistration
not
required.
However,
list of
tests
performed
in the
establish-
ment
should
be defined.
4
Specimen Collection Centre
in Clinics, 
NH and ME
Specimen
are
collected
under
medical  
supervision
and
transported
to
Independent
Labs for
analysis.
Medical
Superint-
endent of
the
establish-
ment
(NH and ME)
for Specimen
collection
and trans-
portation and Pathologist for reporting.
MCI
or SMC
and DHS
Regis-
tration along
with
NH and
ME
Regis-
tration
suggested. Guidelines
to
transport
specimen
to the
Indep-
endent
lab may
be
prepared
and
strictly
followed
5
Specimen Collection Centre
in Non
medical establish-ments
Specimen
are not
collected
under
medical
supervision
and
tran-sported
to
Indep-endent
Labs for
analysis.
Pathologist incharge of
Indep-endent Lab
None
Should
be
banned
with
an
office
order
from
DHS.
6
Independent Labs run
by un-qualified persons.
Labs perform tests under by unskilled staff.
Unqualified persons
None
Should
be
banned
with
an
office
order
from
DHS.

Summary:
  1. Clinical laboratories are medical establishments.
  2. Medical councils have powers to take action against persons registered with them only.
  3. Only persons registered with DMC, MCI or SMC should be allowed to establish and run them.
  4. Director of Health Services (DHS) should issue orders banning all activities carried out by non-medical personnel, which are obviously not registered with medical councils.
  5. There is no need of any Act because it will have fate similar to anti quackery bill.
  6. Pathologists are medical graduate with special postgraduate training in pathology and clinical laboratory testing. If specialists of other fields performing delicate operations and activities including invasive techniques are not regulated, why should pathologists require separate legislation?
IMA wants derogatory scene from Akshay Kumar’s ‘Gabbar is Back’ removed
The Indian Medical Association (IMA) has demanded removal of a scene from Akshay Kumar-starrer "Gabbar is Back".

Indian Express: By: Press Trust of India | New Delhi | Updated: May 9, 2015 1:57 pm

The video clipping of the scene has been sent by IMA to its 2.5 lakh doctor members for creating an awareness about the issue with a request to them to boycott the film.

The Indian Medical Association (IMA) has demanded removal of a scene from Akshay Kumar-starrer “Gabbar is Back”, expressing anger over the way the medical profession has been projected in a “derogatory and unrealistic” manner in the movie.

Taking umbrage to a scene in the film purportedly showing doctors providing medical treatment to a person who was already “dead” before arriving at the hospital, the association said it should be withdrawn immediately and till such time that this is done, the movie should be boycotted and banned.

“The Indian Medical Association is in deep anguish about the way the medical profession has been projected in the movie ‘Gabbar is Back’. Its portrayal is derogatory and unrealistic and we together stand against it,” National President of IMA Dr A Marthanda Pillai and Secretary General Dr K K Aggarwal said in a joint statement.

“With cases of violence against doctors on the rise, a totally unjustified message such as this one as shown in the movie will only add fuel to the fire and further provoke public outrage against the medical profession,” it said. “The IMA wants the above-referred scene to be withdrawn from the movie immediately. Till such time that this is done, the movie should be boycotted and banned,” Aggarwal said.

The video clipping of the scene has been sent by IMA to its 2.5 lakh doctor members for creating an awareness about the issue with a request to them to boycott the film.

“The IMA feels that if the Censor Board, Ministry of Information and Broadcasting, Health Ministry or the Home Ministry do not take any immediate action against this, IMA will be forced to start a public protest against the movie,” it said in its statement. First Published on: May 9, 201510:14 am
ACP Highlights: Top Studies of 2014
The U.S. Preventive Services Task Force recommended annual screening for lung cancer with low-dose computed tomography in high-risk patients.
  1. New guidelines on hypertension were issued by researchers appointed to the Eighth Joint National Committee (officially dissolved before their report appeared). Among the recommendations: For patients older than 60, treat to a goal less than 150 mmHg systolic and 90 mmHg diastolic; for patients younger than 60 and adult patients with diabetes or chronic kidney disease, treat to a goal less than 140 mmHg systolic and less than 90 mmHg diastolic.
  2. A review of 17 randomized, controlled trials found that antibiotic therapy for acute bronchitis had minimal clinical benefit and significantly increased adverse effects.
  3. A review of 24 studies found that ambulatory blood pressure (BP) monitoring consistently predicted cardiovascular outcomes independent of office-based measurements. "An isolated office BP measurement that indicates hypertension may need to be confirmed with ambulatory BP monitoring," authors concluded.
  4. "I love the focus on the potential harms of medications in older adults," Alex Smith, MD, a palliative care specialist at the University of California San Francisco, told MedPage Today in an email. "We desperately need this perspective, particularly in light of enormous economic incentive that drug and device makers have to show only positive findings."
  5. Three different guidelines for primary prevention of cardiovascular disease (those of the American College of Cardiology/American Heart Association, the Adult Treatment Panel III, and the European Society of Cardiology) overestimated risk of fatal and nonfatal coronary disease and stroke. The study population consisted of white people from a single European city. Nevertheless, authors concluded that all three guidelines "probably lead to overtreatment with statins in older patients, especially those who are at low risk for (cardiovascular disease) outcomes and mortality."
WVA/WMA Global Conference One Health
Thursday, May 21-22, 2015, Madrid, Spain

Drivers towards One Health “Strengthening collaboration between Physicians and Veterinarians”

The World Veterinary Association and the World Medical Association in collaboration with the Spanish Medical and Veterinary associations are inviting you to participate at the Global Conference on 'One Health' Concept to be held on 21st and 22nd of May in Madrid, Spain. The Global Conference aims to bring together Veterinarians, Physicians, Students, Public Health Officials, NGOs and others from the different world regions to learn, discuss and to address critical aspects of the 'One Health' Concept.

The main objectives of the conference are to strengthen the links and communications and to achieve closer collaboration between Physicians, Veterinarians and all appropriate stakeholders to improve the different aspects of health and welfare of humans, animals and the environment.

The conference sessions will focus on the issues of

• Zoonotic diseases
• Antimicrobial resistance
• Natural disaster management – Preparedness and vet-med collaboration
• Environmental hazards exposure to humans and animals
Criminal Cases Filed Against 60 Nursing Homes for Operating Without Licences
TOI: The civic body's health department has filed criminal cases against 60 nursing homes in the city for allegedly functioning without the mandatory licence. The crackdown has caused much anxiety to the city's medical fraternity because most nursing homes that operate from residential premises do not possess the licence to function as made mandatory by the development control (DC) rules.

Earlier, these nursing homes were asked to comply with the norms or face legal action. Doctors, however, failed to get their clinical setups regularised, following which the civic health officials filed criminal cases against them at various courts of the judicial magistrates (first class).

The drive against the illegal nursing homes had started in October last year, following which about 20 nursing homes even closed down their premises fearing that they would not be able to make the mandatory compliance needed to obtain the licence.

“We have filed criminal cases against 60 nursing homes in Pune city from October last year onwards. The court has imposed a penalty on 10 -15 nursing homes in the range of Rs 5,000 to Rs 10,000 and ordered those to ensure the mandatory compliance of the norms. Around seven, nursing homes have already furnished the necessary documents and obtained the licences,” said Sanjeev Wavare, the assistant medical officer of health and head of the Pune Municipal Corporation's (PMC) hospital wing. As many as 620 nursing homes in Pune city are registered with the civic body. Doctors running these nursing homes have been at loggerheads with PMC officials over the stringent implementation of DC rules.

In Mumbai, the municipal corporation relaxed the DC rules on a case-to-case basis and also regularised some unregistered hospitals after the Bombay high court directed it to relax the rules on an individual basis in 2011.The Brihanmumbai Municipal Corporation later issued a notification and regularized the hospitals and nursing homes, Wavare said.
IMA Wants 'Derogatory' Scene from 'Gabbar is Back' Removed
Outlook: The Indian Medical Association (IMA) has demanded removal of a scene from Akshay Kumar- starrer Gabbar is Back, expressing anger over the way the medical profession has been projected in a "derogatory and unrealistic" manner in the movie. Taking umbrage to a scene in the Sanjay Leela Bhansali- directed film purportedly showing doctors providing medical treatment to a person who was already "dead" before arriving at the hospital, the association said it should be withdrawn immediately and till such time that this is done, the movie should be boycotted and banned.

"The Indian Medical Association is in deep anguish about the way the medical profession has been projected in the movie Gabbar is Back. Its portrayal is derogatory and unrealistic and we together stand against it," National President of IMA Dr A Marthanda Pillai and Secretary General Dr KK Aggarwal said in a joint statement.

"With cases of violence against doctors on the rise, a totally unjustified message such as this one as shown in the movie will only add fuel to the fire and further provoke public outrage against the medical profession," it said.

"The IMA wants the above-referred scene to be withdrawn from the movie immediately. Till such time that this is done, the movie should be boycotted and banned," Aggarwal said.

The video clipping of the scene has been sent by IMA to its 2.5 lakh doctor members for creating an awareness about the issue with a request to them to boycott the film.

"The IMA feels that if the Censor Board, Ministry of Information and Broadcasting, Health Ministry or the Home Ministry do not take any immediate action against this, IMA will be forced to start a public protest against the movie," it said in its statement.
Letter to Editor
Greetings, I am Dr. Srikanth, an orthopedic surgeon and secretary of IMA, Nanjangud branch, Karnataka. This is in context to the ban on the Akshay Kumar movie ‘Gabbar is Back’. It is common knowledge that none of the people, be it the film industry, the common man, the police, the politicians and any such, are threatened by our existence. We have been silent spectators of bad mouthing, the horrible stories depicted about us in the media even by Aamir Khan, the blanket ban on the pharma industries helping us for seminars, and now another movie which shows us as evil people in the society. Asking for a ban will not be sufficient and it will never happen. The movie has been shot spending hundreds of crores and the makers will do anything to ensure it doesn't get banned. I am hereby, submitting a few things which can at least show that we also have some hold in society.
  • Request all doctors from attending to the people who are involved with the making of the movie, the directors, producers, actors and others, and spell out their names for the benefit of everyone.
  • Request for deletion of the scene from the movie, and not banning the movie. And also mention that if the same is not done, then we will make pirated discs of the movie and distribute it free of cost to all our patients. The revenues of the movies will fall by more than 50% and that should make them realize we can also do some harm.
  • Have some people inside the parliament, or form a political party since Indians understand only that.
  • Have a news channel, you tube channel or any such media network, which we can use for proclaiming the things intelligently missed by the mass media. Like an interview with Dr. Sridhar Reddy who was unnecessarily at the other end of the stick without any chance to say his part of the story, in an episode of Aamir Khan's Satyamev Jayate.
Hope the ideas are agreeable and can be implemented. If there are some hitches which make the implementation not possible, please reply back as to the negative, so that I can do some of the said things individually.
Sonal Namaste
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Pacing Without Leads

The first leadless pacemaker, less than one-tenth the size of a conventional pacemaker, has been approved for use in Europe. It can be delivered via a catheter into the heart.

There will be elimination of the visible lump and scar at a conventional pacemaker’s implant site. Also there is removal of patient activity restrictions that may prevent the dislodgement or damage to a conventional lead.

Initial results from the first–in–man LEADLESS study presented at the Heart Rhythm Society meeting, showed successful implantation in 32 of 33 patients and performance comparable with traditional pacemakers with leads.
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Reader Response
Dear D KK Aggarwal, Thanks for taking up the issue of Gabbar is back. Now no one will believe the doctors when we ask them to get medicines and paraphernalia for resuscitation and when we ask them for reference fees for specialists. The public is going to doubt all of us and this will also cost them their lives!!! Because time is of the essence for a critical patient and we can't waste precious time answering their queries and doubts! We must get this scene removed! Sometimes we do try to resuscitate dead patients in very flimsy hope and insistence of attendants ! We have been taught not to give up easily!!! The film shows us in a very bad light and puts us in a dilemma !! Dr Arati Lalchandani
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