December 12   2015, Saturday
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EDITORIAL

Dr KK AggarwalDr KK Aggarwal Breastfeeding may help prevent type 2 diabetes after gestational diabetes

Among women who had gestational diabetes, breastfeeding was associated with a lower rate of type 2 diabetes for up to 2 years after childbirth. Results of a new research funded by the NIH published in the Annals of Internal Medicine suggest that breastfeeding after gestational diabetes may have lasting effects that reduce a woman’s chance of developing type 2 diabetes.

Over 9% of pregnant women nationwide develop high blood sugar levels or gestational diabetes, which increases the risk of developing type 2 diabetes later on. It has been shown that breastfeeding increases insulin sensitivity and improves glucose metabolism in the mother.

The research team led by Dr Erica P. Gunderson at the Kaiser Permanente Division of Research enrolled more than 1,000 ethnically diverse women who were diagnosed with gestational diabetes. The researchers tested for glucose tolerance 6 to 9 weeks after delivery and then annually for 2 years.
During the 2–year follow–up, 113 of the 1,010 women without diabetes at the study baseline (11.8%) developed type 2 diabetes. After accounting for differences in age, pre–pregnancy body size, and other risk factors, it was estimated that women who exclusively breastfed or mostly breastfed were about half as likely to develop type 2 diabetes as those who did not breastfeed.

Breaking News

Govt. separates Medical device sector from pharma sector

The government has accepted the long–standing demand of the medical devices sector to delink it from the pharmaceutical sector. The health ministry has agreed to separate Schedule M III of the Drug Rules, which deals with medical devices, from Schedule M, which deals with drugs and pharmaceuticals. The revised schedule is being put up on the website of the Central Drugs Standards Control Organisation (CDSCO) inviting comments from the public after which a notification will be issued through the law ministry for changing the Drug Rules. Schedule M III provides requirements of factory premises for manufacture of medical devices under the Drugs and Cosmetics Rules (DCR), 1945. However, it relates only to three medical devices, namely sterile perfusion and blood collection sets and syringes and needles… (ET Healthworld)

FDA panel backs reslizumab for adults with severe asthma

The US Food and Drug Administration’s (FDA’s) Pulmonary and Allergy Drugs Advisory Committee has recommended for approval for the monoclonal antibody reslizumab to be used in treating adults aged 18 years and older with moderate to severe asthma. Reslizumab is not currently marketed in the United States or any other country. If approved by the FDA, it would be the third monoclonal antibody approved for asthma, after mepolizumab and omalizumab. … (Medscape)
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Specialty Updates
• There is no difference in response or remission rates produced by second–generation antidepressants and those achieved by cognitive–behavioral therapies (CBT) in the treatment of major depressive disorder (MDD), suggested a systematic review and meta–analysis published online in the BMJ.

• New research has identified a marker that can indicate one’s likelihood of suffering from rheumatoid arthritis (RA) even sixteen years before the condition takes effect. The blood test looks for antibodies that recognize the protein tenascin–C and could reliably show those who will contract the condition. The findings are published in the journal Annals of Rheumatic Diseases.

• Live–attenuated influenza vaccine (LAIV), administered intranasally, is unlikely to trigger systemic allergic reactions in children aged 2 – 18 years with egg allergy and is well tolerated in those with well–controlled asthma or recurrent wheeze, suggested a new multicenter study published online December 8 in the BMJ.

• Being overweight or obese in early as well as later adulthood strongly increases the risk of sudden cardiac death (SCD) in women, independent of potentially mediating CVD risk factors, suggested a new analysis of the Nurses’ Health Study (NHS)published online in JACC: Clinical Electrophysiology.

• Melanoma patients with preexisting autoimmune disease can be safely treated with ipilimumab, as long as they are monitored carefully, reported a new review of 30 cases published online in JAMA Oncology.

• Adding liraglutide to insulin in overweight adults with inadequately controlled type 1 diabetes does not improve glucose control compared with placebo but does reduce body weight, daily insulin requirements, and hypoglycemia, suggested a new study published online in Lancet Diabetes & Endocrinology.

• Heart function in morbidly obese patients returns to normal after bariatric surgery but not after lifestyle intervention, suggests new research published in the European Journal of Preventive Cardiology. The results suggest that bariatric surgery may reduce the risk of cardiovascular disease in morbidly obese patients.

• New research has determined a link between brain levels of the neurotransmitter GABA, the main source of inhibition in the brain, and tactile learning. Using magnetic resonance spectroscopy, researchers demonstrated that success in learning can be predicted by baseline GABA levels. The results were published in the journal Cerebral Cortex.
eSPIRITUAL
Managing grief by free expressive writing

The loss of a loved is often painful. The resultant grief makes it hard to eat, sleep and leads to loss of interest in routine life affecting behavior and judgment. Some can feel agitated or exhausted, to sob unexpectedly, or to withdraw from the world and others may find themselves struggling with feelings of sorrow, numbness, anger, guilt, despair, irritability, relief, or anxiety. It is well known that disclosing deep emotions through writing can boost immune function as well as mood and well–being. Conversely, the stress of holding in strong feelings can ratchet up blood pressure and heart rate and increase muscle tension. One can write on a piece of paper, in your personal book, on the open website with nick name or keep it in the mind. One doesn’t have to preserve the emotions and can through away the writings. In absence of deeply troubling situations, such as suicide or a violent death, which are best explored with the help of an experienced therapist, one can choose writing as a way to express out the grief.

• Start writing for 15 to 30 minutes a day for three to four days
• Continue up to a week if it is helping
• Continue writing for 15 to 30 min once a week for a month.
• Writing has stronger effects when it extends over more days.
• Remember, writing about grief and loss can trigger strong emotions (one may cry or feel deeply upset)
• Many people find journal writing valuable and meaningful and report feeling better afterward.
• Don’t worry about grammar or sentence structure.
• Truly let go. Write down how you feel and why you feel that way. You’re writing for yourself, not others.

(Source Harvard News Letter)
IOACON 2015
Technical tips of proximal humerus locking plate

Dr M Shantharam Shetty, Mangalore

• Proximal humeral locking plate is a good option.
• It has improved outcomes as compared to traditional methods of treatment. However, it is not a magic wand.
• Medial support and bone quality are the two important factors that predict the outcome.
• Filling screws in empty space does not provide support.
• Cement augmentation in osteoporotic bone.
• Cannot predict AVN.

Tips & Tricks: Lower femoral plating

Dr Dilip Patel, Ahmedabad

• ATLS protocol in acute trauma cases.
• Do not miss any other injury
• Do not forget nerves and vessels
• Healing ability is reduced in the elderly and so large open approaches should be avoided. Young patients too often have high–energy soft–tissue injuries where large open approaches are also high risk.
• Imaging: Assess & classify fracture, do not miss Hoffa element or patella. Imaging helps decision making for plating type and stability
• Supine position is commonly preferred.
• Exposure can be open lateral, lateral and medial, medial or minimally invasive
• Fixation: Plate in anterior two–thirds distally, avoid varus / anterior translation
• The intra–articular component needs absolute stability → Interfragmentary compression
• Postoperative management: Mobilization (CPM) as soon as pain and swelling subside, splintage initially while walking, weight bearing (by 6 weeks), implant removal (18–24 months)

Tips & Tricks: Lower femoral plating

Dr Dilip Patel, Ahmedabad

• ATLS protocol in acute trauma cases.
• Do not miss any other injury
• Do not forget nerves and vessels
• Healing ability is reduced in the elderly and so large open approaches should be avoided. Young patients too often have high–energy soft–tissue injuries where large open approaches are also high risk.
• Imaging: Assess & classify fracture, do not miss Hoffa element or patella. Imaging helps decision making for plating type and stability
• Supine position is commonly preferred.
• Exposure can be open lateral, lateral and medial, medial or minimally invasive
• Fixation: Plate in anterior two-thirds distally, avoid varus / anterior translation
• The intra–articular component needs absolute stability → Interfragmentary compression
• Postoperative management: Mobilization (CPM) as soon as pain and swelling subside, splintage initially while walking, weight bearing (by 6 weeks), implant removal (18–24 months)

Tips & Tricks: Intra-articular glenoidfracture

Prof. Dr Rajesh Malhotra
New Delhi

• Scapula fracture is high energy by definition.
• 1st Rule: Search for other injury; associated injuries are seen in 80-90%. Fracture of rib, ipsilateral clavicle, spine, brachial plexus injury etc.
• Examination of patient involves ATLS protocol, complete neurologic examination of the ipsilateral upper extremity, symmetricity of pulses, abrastions
• 2nd Rule: Excellent and detailed imaging is a prerequisite
o Standard chest x–ray (to r/o pneumothorax, other chest injuries), lateral cervical spine x–ray, AP shoulder, axillary and scapular Y views.
o 2D/3D CT:Must if planning for surgery
• Scapular neck fracture: Operate if scapular neck angulated >40° or displaced ≥1–2 cm ora displaced double disruption of the superior shoulder suspensory complex
• Surgical dangers: Suprascapular nerve, ascending branch of circumflex scapular artery

Key points

• Prognosis depends upon associated injuries
• 2D/3D CT an important tool
• Patient positioning and surgical approach decided by combination of injuries
• Radiographic parameters are very helpful in patient selection

Did you know?

First depiction of a scapula fracture was published by AmbroiseParé in 1579
The Year in Medicine 2015: News That Made a Difference
Chronic Fatigue Syndrome gets a new name and definition

A report by the Institute of Medicine (IOM) termed chronic fatigue syndrome as a "serious, complex, multisystem disease" that physicians and other healthcare professionals need to view as "real" and diagnose. The report proposed calling it "systemic exertion intolerance disease." Ellen Wright Clayton, MD, JD, professor of pediatrics and director of the Center for Biomedical Ethics and Society at Vanderbilt University and Committee Chair, said that this is a real disease, with real physical manifestations that need to be identified and cared for. Elsewhere in the world the illness is called "myalgic encephalomyelitis." (Medscape)
Legal Quote
Sanjeevan Medical Research Centre (Private) Ltd. & Ors. Vs State of NCT of Delhi & Anr Crl.M.C.No. 2358/2010

"The basic and underlying principle of these three judgments* and other similar judgments is that every careless act of a medical man cannot be termed as "criminal". It can be termed "criminal" only when the medical man exhibits a gross lack of competence or inaction and wanton indifference to his patient’s safety and which is found to have arisen from gross ignorance or gross negligence."

* Jacob Matthew v. State of Punjab (2005) 6 SCC 1, Martin F. D’Souza v. Mohd. Ishfaq (2009) 3 SCC 1 and Kusum Sharma v. Batra Hospital (2010) 3 SCC 480.
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eIMA NEWS
IMA White Paper on Live Surgeries

Issues to be seen by the committee

Type

1. The procedure can be live hands on, pre–recorded and unedited, pre-recorded and edited, commercially produced videos.
2. Commercially produced videos may be biased.
3. Edited video can be potentially misleading.
4. Recorded videos may be influenced by pressure from third parties.
5. The purpose of live cases should be first and foremost for education.
6. Access to new technology or techniques can improve the outcome.
7. Performance at the surgeon’s home institution may be safer.
8. Video transmission of a surgical procedure from the surgeon’s institution to a conference room anywhere in the world is the simplest and most efficient way for live teaching of surgery. Spectators can see what the surgeon sees, and, by working in their own environment, the surgeon can ensure that the patient receives the best possible care.
9. Video recording of surgery that is then presented to the audience by the surgeon is another way of surgical teaching. The immediacy of the live operation is lost, but this has the advantage of being more interactive, since the video can be replayed at any time to review a technique, an anatomic detail, or a surgical situation. What we lose in spectacle, we gain in education.

Advantages

1. Live surgery has the advantage of live interaction with the surgeon and allows viewers to follow the decision process.
2. It is exciting to see live surgery.
3. Live surgery can promote the adoption of innovations.
4. Seeing is believing.

(To be contd.)
IMA Satyagraha
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IMA Poll
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Media
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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)
Registration
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
LUNCH
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
CSI / AI/ IAP/ NNF/ FOGSI/ QCI
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
LUNCH
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&rsble 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
Dinner
To

Dr RVS Surendran
President, IMA Tamil Nadu State

Sir

At this moment of natural fury, Indian Medical Association stands with you to support and help. Indian Medical Association HQ 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 and requirements to carry out the rehabilitation and Medical help to the affected people. IMA HQs will try to provide help in its best ability.

We also request you to inform us regularly about the activities done by IMA Tamil Nadu 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
Health Ministry signs MoU for strategic partnership with Doordarshan to increase health awareness

The Ministry of Health & Family Welfare signed a Strategic Partnership Memorandum of Understanding (MoU) with Doordarshan (DD), Prasar Bharati on Thursday. According to the Health Secretary BP Sharma, under the terms of this partnership, Doordarshan will provide a significantly high amount of bonus airtime to the Ministry for its Information Education and Communication (IEC) activities. This presents a unique opportunity for the Ministry to create heightened visibility on crucial public health issues among the masses, especially in the rural and far flung areas where the reach of DD is very high. The focus will be on issues such as handwashing, breastfeeding, shunning tobacco/drugs/alcohol etc., and adopting healthy habits … (PIB)
Health Minister increases number of designated beds for H1N1 patients

The Union Health Minister J P Nadda has increased the designated beds for H1N1 (swine flu) influenza patients by three times in central government hospitals, as compared to last year. Starting with the All India Institute of Medical Sciences (AIIMS), the ministry has directed all heads of clinical departments and units in AIIMS to augment isolation bed capacity for H1N1 patients. He also asked to ensure adequate quantities of stock of oseltamivir, viral diagnostic kits, viral transport media, personal protective equipment and N-95 masks, at different levels in the health care system… (India Today)
"India Health Report: Nutrition 2015" and "Global Nutrition Report" released

Shri J P Nadda, Union Minister for Health and Family Welfare along with Smt. Maneka Gandhi, Minister for Women and Child Development released the "India Health Report: Nutrition 2015" and "Global Nutrition Report" at a function ‘Made in India: Good Nutrition for All: Implications of the Global Nutrition Report and the India Health Report for Nutrition Security in India’, jointly organized by Public Health Foundation of India (PHFI) and the International Food Policy Research Institute (IFPRI)... (PIB)
Urging stronger regulation of codeine use in children, an FDA advisory committee has voted 28-0 to remove the drug from its OTC monograph for use in the treatment of cough and cold… (Medpage Today)
The government is in the process of revising the National List of Essential Medicines (NLEM) 2011… (ET Healthworld)
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): http://www.eubios.info/

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
eWELLNESS
Wound Hygiene

It is a common occurrence that simple wounds may be sustained at home as a result of fall, animal bite etc. Following are the ways to manage them:

• Irrigation is the most important thing for reducing bacterial impact.
• Irrigation should be urgently done in every wound. It can be done by warm normal saline or simple running tap water.
• One can add dilute iodine or any aseptic solution if required.
• Irrigation can be low or high pressure. At home, low pressure injection is sufficient, which can be done using any of the infant milk bottle system.
• In case of burn injury, irrigation should be done continuously till the burning disappears.
• In case there is a foreign body with irritation, continuous irrigation should be done till burning disappears.
• Do not forget to wash your hands with soap and water before cleaning the wound and wear medical gloves, if available.
• It is good idea to let the injured person clear his or her own wounds, if possible.
• Rinsing of the wounds should be done for at least 5–10 minutes.
• Cool water may feel better than warm water on the wound.
• If there is a mild bleeding, clean the wound first and then stop the bleeding.
• Moderate scrubbing can be done if the wound is very dirty.
• If there are foreign bodies or objects, remove them using a clear tweezers. Do not push the tweezers, deeply into the wound.
• Apply the dressing and bandage to the wound as the need may be.
IMA JIMA

http://module.ima-india.org/ima/jima/2015/September/
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

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Inspirational Story
The Doctor and the Father

A doctor entered the hospital in hurry after being called in for an urgent surgery. He answered the call ASAP, changed his clothes & went directly to the surgery block. He found the boy’s father pacing in the hall waiting for the doctor. On seeing him, the dad yelled: "Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have any sense of responsibility?" The doctor smiled & said: "I am sorry, I wasn’t in the hospital & I came as fast as I could after receiving the call…… And now, I wish you’d calm down so that I can do my work"

"Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do??" said the father angrily. The doctor smiled again & replied: "I will say what Job said in the Holy Book "From dust we came & to dust we return, blessed be the name of God". Doctors cannot prolong lives. Go & intercede for your son, we will do our best by God’s grace." "Giving advises when we’re not concerned is so easy" murmured the father.

The surgery took some hours after which the doctor went out happy. "Thank goodness!, your son is saved!" And without waiting for the father’s reply he carried on his way running. "If you have any questions, ask the nurse!!"

"Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state" Commented the father when seeing the nurse minutes after the doctor left. The nurse answered, tears coming down her face: "His son died yesterday in a road accident, he was at the burial when we called him for your son’s surgery. And now that he saved your son’s life, he left running to finish his son’s burial."

Moral of the story

1. Never judge anyone…… because you never know how their life is & what they’re going through"
2. People who jump the gun in most cases happen to be foul mouthed. "Just keep away from them".
eMEDI QUIZ
The cardinal clinical features of Guillain-Barré syndrome (GBS) are except

1. Progressive, fairly symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes.
2. Patients usually present a few days to a week after onset of symptoms.
3. The weakness can vary from mild difficulty with walking to nearly complete paralysis of all extremity, facial, respiratory, and bulbar muscles.
4. Weakness never begins in the arms or facial muscles

Yesterday’s Mind Teaser: Which of the following are true about Campylobacter?

1. C enteritis is an important cause of acute diarrhea
2. It is never seen in India
3. It is typically caused by Campylobacter jejuni or Campylobacter coli, and is largely a foodborne disease.
4. Campylobacter infection can also be transmitted via water-borne outbreaks and direct contact with animals or animal products.

Answer for Yesterday’s Mind Teaser: It is never seen in India

Answers received from: Dr Jainendra Upadhyay, Dr.Bitaan Sen & Dr Jayashree Sen, Raghavendra Chakurkar, Raju Kuppusamy, Dr Avtar Krishan.

Answer for 10th December Mind Teaser: A: D: Defecation

Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Dr Avtar Krishan.
Readers column
• Dear Sir, Another great achievement for medical fraternity through highly admirable & incessant team efforts of IMA HQ Leadership. Hearty congrats to all concerned in this endeavor. Feel very proud of you all. Dr S K Joshi, Ex – President, IMA Mumbai West Branch.

• It is a great achievement for IMA and profession. The present Leadership means business. They believe in action not on press release alone. Congratulations to National President, Hon. Secretary General and Team IMA. Dr. Alex Franklin.

• Congratulations to Leaders and Team India of IMA. Dr Arun Malhotra, Jabalpur.
Humor
Jack's Last Will and Testament

Jack has died. His lawyer is standing before the family and reads out Jack's Last Will and Testament:

"To my dear wife Esther, I leave the house, 50 acres of land, and 1 million dollars…

"To my son Barry, I leave my Big Lexus and the Jaguar…

"To my daughter Suzy, I leave my yacht and $250,000…

"And to my brother-in-law Jeff, who always insisted that health is better than wealth, I leave my treadmill.
Press Release
Take necessary precautions to protect your child from Pneumonia this winter season

According to the reports, pneumonia and diarrhea cause one in five deaths in India

With over 43 million people suffering from pneumonia in the country, it is extremely important that awareness about disease prevention and detection is raised especially during the winter season. The reason for this is the similarity in the symptoms of pneumonia with those of flu, a chest infection or a persistent cough.

Pneumonia can be described as an acute respiratory infection or inflammation of the lungs caused by bacteria, virus, fungus or parasites, which causes the blood and oxygen flow to stop due to the deposition of fluid like substance in them. Coughing up phlegm, chest pain, a high temperature and quick breathing are all indicators of pneumonia. Generally if you or your child have the flu or heavy cold-like symptoms, which don't show signs of improvement, it is important to visit a doctor and get a chest x-ray to rule out pneumonia.

Recent reports of the World Health Organization (WHO) indicate that Streptococcus pneumonia is the prime cause of the hospitalization and death of many children below five years of age. As per WHO statistics, around 1, 20,000 deaths of children under five are caused due to pneumonia and a child dies every minute from pneumonia in India.

Creating awareness, Padma Shri Awardee Dr. A Marthanda Pillai –National President IMA and Padma Shri Awardee Dr. KK Aggarwal, Honorary Secretary General, IMA and President, HCFI said, “Infants, neonates, premature babies aged 24-59 months with underdeveloped lungs, narrow airways, poor nutrition and immature immune system are at risk of contracting pneumonia. It is extremely important that awareness is raised amongst the masses of how unhygienic and unclean environments, malnutrition and lack of breastfeeding can increase the rate of mortality of children suffering from pneumonia. Several child deaths are preventable, and it is the duty of all doctors to educate new mothers about ways to keep their child healthy and the importance of timely vaccination".

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat can infect the lungs if they are inhaled. They may also spread via airborne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth.

Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors. Pneumonia caused by bacteria can be treated with antibiotics, but only one-third of children with pneumonia receive the antibiotics they need at present. It is important that during winter months, children are kept warm, exposed to adequate sunlight and are kept in well-ventilated rooms. It should also be ensured that they receive adequate nutrition and necessary vaccinations.

Pneumococcal Conjugate Vaccine (PCV) and Haemophilus influenza type b (Hib) are the two vaccines, which prevent pneumonia. However over 70% of children are not given these vaccinations due to the high-cost factor as well as a lack of awareness. It is important that a government led vaccination program for the pentavalent vaccine is implemented at a National level to help reduce the disease incidence.
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