February 12  2015, Thursday
Ministry of Health & Family Welfare Nirman Bhawan, New Delhi
              Public Notice                Dated: August 22nct, 2014

   The Medical Professionals and General Public are hereby informed that the Medical Education in the country is governed by the Indian Medical Council (IMC) Act, 1956 and various rules and regulations made thereunder which are mandatory and binding in nature.

The letter No.MCI-12(1)/2014-Med.Misc./101884 dated 09.04.2014 issued by Medical Council of India (MCI) to the Health Secretaries/DMEs of States/UTs in connection with instructions relating to the amendment in Teachers' Eligibility Qualification Regulations, 1998 is void ab-initio. Such kind of instructions which contrary to the provisions contained in IMC Act, 1956, rules and regulations issued by Medical Council of India (MCI) without prior approval of the Ministry of Health & Family Welfare are not valid.

Further, the observations made by the Executive Committee in its, meeting held on 14.03.2014 regarding permissibility and equivalence of DNB degree are untenable in view of Teachers' Eligibility Regulations Amendment Notification dated 11.06.2012 which was notified after wide consultation and approval of the Competent Authority.

 
By Order Joint Secretary to the Government of India
Ministry of Health & Family Welfare
editorial
Heart disease starts in youth
Dr KK Aggarwal Autopsy studies of young people who died in accidents have shown that by the late teens, the heart blockages, the kind of lesions that cause heart attacks and strokes are in the process of developing.

The best opportunity to prevent heart disease is to look at children and adolescents and start the preventive process early. More than a third of children and adolescents are overweight or obese.

The first signs that men are at higher risk of heart disease than women appear during the adolescent years despite the fact that boys lose fat and gain muscle in adolescence, while girls add body fat.

Between the ages of 11 and 19, levels of triglycerides, a type of blood fat associated with cardiovascular disease, increases in the boys and drops in the girls. Levels of HDL cholesterol, the "good" kind that helps keep arteries clear, go down in boys but rise in girls.

Blood pressure increases in both, but significantly more in boys. Insulin resistance, a marker of cardiovascular risk, which is lower in boys at age 11, rises until the age of 19 years.

Any protection that the young women have for cardiovascular protection can be wiped out by obesity and hence obesity in girls at any cost should be handled on priority.
eMedipics
IMA,IJCP,HCFI
CPR 10 training Camp at NP Primary School DG Block,Sarojini Nagar-14th July 2014
News Around the Globe
  • A nationally representative survey shows that natural product use in the United States has shifted since 2007, with some products becoming more popular and some falling out of favor. Overall, natural products (dietary supplements other than vitamins and minerals) remain the most common complementary health approach.
  • The illness that has been called "chronic fatigue syndrome" (CFS) in the United States and "myalgic encephalomyelitis" (ME) elsewhere is a "serious, complex, multisystem disease" that physicians need to view as "real" and diagnose, the Institute of Medicine (IOM) says in a new 235-page report. To reflect the condition's hallmark defining symptom, postexertional malaise, the report proposes a new name be adopted, "systemic exertion intolerance disease (SEID)," defined in both adults and children by the following:
    • Substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
    • Postexertional malaise (often described by patients as a "crash" or "collapse" after even minor physical or mental exertion);
    • Unrefreshing sleep; and
    • Cognitive impairment and/or orthostatic intolerance.
  • A mixed-methods survey of 120 clinicians who provide mental health services showed that 58% reported that burnout had a negative impact on either work quality or productivity. Other reported negative effects included decreased empathy, communication, and patient engagement. In addition, those who reported higher levels of depersonalization were significantly more likely to report that burnout affected their interaction with patients. The study is published in the February issue of Psychiatric Services.
  • According to researchers from Brazil, in addition to causing significant weight loss, gastric bypass surgery appears to significantly reduce gastroesophageal reflux disease (GERD) symptoms and incidence in morbidly obese individuals long after the procedure. The findings are published in Annals of Surgery.
Dr KK Spiritual Blog
Be Positive, Be Different and Be Persistent

You should be not only positive, different but also persistent. Of the ten incarnations of Lord Vishnu, the first was a fish, which indicates to be different in life. The second incarnation is tortoise, which indicates that you should be different but learn to withdraw when the need arises. The third is a boar, which indicates persistence.

The mantra of a successful life is to be positively different and persistent and yet learn to withdraw when the situation arises.
IMA,IJCP,HCFI
Cardiology eMedinewS
  • Patients with type 2 diabetes who lowered their systolic blood pressure (BP) had a significantly decreased risk for death and cardiovascular events, especially stroke, in the largest meta-analysis to examine this relationship to date. Specifically, a 10-mm-Hg reduction in systolic BP was associated with an 11% to 17% lower relative risk of death, cardiovascular events, heart disease, retinopathy, and albuminuria and a 27% lower relative risk of stroke in this review of 40 trials by Connor A Emdin, HBSc, from the George Institute for Global Health, Oxford University, United Kingdom, and colleagues, published in the February 10 issue of Journal of the American Medical Association.
  • In asymptomatic and symptomatic patients at low risk for coronary artery disease, the use of coronary artery calcium (CAC) imaging improves long-term prediction of risk beyond that established by the Framingham Risk Score (FRS) and exercise-treadmill and stress-perfusion testing, according to the results of a new study published February 9, 2015 in JACC: Cardiovascular Imaging.
Pediatrics eMedinewS
  • Middle-school children who consume heavily sweetened energy drinks are 66% more likely to be at risk for hyperactivity and inattention symptoms, as per findings of a new study led by the Yale School of Public Health and published in the journal Academic Pediatrics. The finding has implications for school success and lends support to existing recommendations to limit the amount of sweetened beverages schoolchildren drink. The authors also recommend that children avoid energy drinks, which in addition to high levels of sugar also often contain caffeine.
  • Fetal alcohol syndrome (FAS) is widely underdiagnosed in young children, preventing them from receiving crucial support services early in life as reported in the January 30 issue of the Morbidity and Mortality Weekly Report.
Make Sure
Situation: A patient after receiving 40 units of insulin developed severe hypoglycemia.
Reaction: Oh my God! The order was for 4 units.
Lesson: Make sure that 4 unit is not written as 4.0 units.
Medicolegal
Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Sudden death due to cardiac origin–autopsy


Right coronary artery supplies blood to electrical area of heart

The most common cause of sudden cardiac death in adults over the age of 40 is coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in AIIMS Mortuary.
  • The most common finding at postmortem examination is chronic high–grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
  • A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
  • In 75 cases out of hundreds, the clots were seen in right coronary artery supplying the electrical area of heart.
  • Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall which induces a ventricular arrhythmia/fibrillation and no changes in the myocardium is seen during postmortem examination.
  • The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
  • Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
  • Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.
Dr Good Dr Bad
Situation: A patient on aspirin was to go for non vascular surgery.
Dr Good: Stop aspirin for seven days.
Dr Bad: Stop aspirin fir two days.
Lesson: Based on POISE-2, we recommend discontinuing aspirin about seven days before noncardiovascular surgery.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
IMA,IJCP,HCFI
Wellness Blog
Nitrate-Rich Diet Good for the Heart

Do not heat leafy vegetables twice

Nitrates in foods such as spinach, beet root and lettuce stimulate the production of nitric oxide in the body. Nitric oxide relaxes blood vessels. Ingested nitrate is reduced by oral, commensal, bacteria to nitrite, which can further be reduced to nitric oxide.

Vegetables are a major source of dietary nitrate. Green leafy and root vegetables, such as spinach and carrots, provide more than 85 percent of dietary nitrate. Foods in which nitrite are present are bacon, fermented sausage, hot dogs, bologna, salami, corned beef, ham and other products such as smoked or cured meat, fish and poultry. The conversion of dietary nitrate to nitrite has antimicrobial benefits in the mouth and stomach. Some epidemiological studies show a reduced rate of gastric and intestinal cancer in groups with a high vegetable-based nitrate intake. Nitrate is totally harmless; however, it can be converted to nitrite and some portion of nitrite to nitrosamines, some of which are known to be carcinogenic. Heating increases the conversion rate. The longer the heat treatment, the more nitrosamines will be formed. Hence, the recommendation not to heat leafy vegetables twice. Adding lemon juice to vegetables will reduce the formation of nitrosamines. It contains vitamin C, which also reacts with nitrite, thereby preventing the nitrosamine formation.
Twitter of the Day
Dr KK Aggarwal: Long term use of painkillers can cause kidney cancer http://tl.gd/n_1rvf2c6
Dr Deepak Chopra: Despite five decades of modern neuroscience, we have only a very limited knowledge of the role of sleep http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Why is rabies an important disease?

Rabies is one of the oldest and most feared zoonotic diseases, and has been a threat to human health for more than 4000 years. Rabies is a neglected and severely under–reported disease killing each year an estimated 55,000people (24,000 to 90,000 deaths) worldwide (WHO 2007). All mammals, but mainly carnivores and bats, are susceptible and can transmit rabies virus. Human exposures are most frequently associated with bites by rabid dogs and transmission of virus from dogs’ saliva. The Association for the Prevention and Control of Rabies in India (APCRI) estimated in 2004 that in India, there were 20,565 reported human deaths every year. About half of the world’s population lives in areas in which rabies is enzootic. Rabies is practically 100% fatal even today but easily preventable.
eMedi Quiz
A 55-year-old lady presenting to outpatient department (OPD) with postmenopausal bleeding for 3 months has a 1x1 cm nodule on the anterior lip of cervix. The most appropriate investigation to be done subsequently is:

1. Pap smear.
2. Punch biopsy.
3. Endocervical curettage.
4. Colposcopy.

Yesterday’s Mind Teaser: The following are true regarding Lyme's Disease, except:

1. It is transmitted by ixodes tick.
2. Erythema chronicum migrans may be a clinical feature.
3. Borrelia recurrentis is the etiological agent.
4. Rodents act as natural hosts.

Answer for yesterday’s Mind Teaser: 3. Borrelia recurrentis is the etiological agent.
Correct Answers received from: Daivadheenam Jella, Dr Avtar Krishan.
Answer for 10th Feb Mind Teaser: 4. IgM.
Correct Answers receives: Daivadheenam Jella, Dr Mahesh, Dr Avtar Krishan, Dr Pushpa Otiv, Dr Mahesh.
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
About the Editor
National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
No. V.l1012/l/2014-MEPI
Government of India
Ministry of Health & Family Welfare
                                   Nirman Bhavan, New Delhi-110 011.
                                   Dated the 10 December, 2014
To
1. Dr. Alexander Thomas,
President,
Association of National Board
Accredited Institutions (ANBAI),
Bangalore Baptist Hospital,
Bellary Road,
Bangalore - 560 024
To
Dr. Anurag Agarwal,
Additional Director
National Board of
Examinations (NBE),
Ansari Nagar
Mahatma Gandhi Marg,
New Delhi- 110 029.


Sub: Representation of Association of National Board Accredited Institutions (ANBAI) and National Board of Examinations (NBE) relating to amendment in Teachers' Eligibility Regulations-Regarding.

Sir,

I am directed to refer to ANBAI's letter dated 0'6.10.2014 and NBE's letter Nos. NBE/XXXII/2014/4895 dated 01.10.2014,NBE/XXXII/2014f8743 dated 08.10.2014, NBE/III/20 14/9835 dated 11.11.2014 on the above cited subject and to reiterate that the matter has already been taken up with Medical Council of India (MCI) and a D.O. letter of even number dated 21.08.2014 from Secretary (Health) to the President, MCI has been sent directing the Council to withdraw the circular issued in this regard and also advised to refrain from such practices in future. Further, a Public Notice has also been uploaded on the website of Ministry of Health & Family Welfare, i.e. www.mohfw.nic.in, informing that the letter dated 09.04.2014 issued by MCI to the Health Secretaries/DMEs of States/UTs in connection with instructions relating to the amendment in Teachers' Eligibility Qualification Regulations, 1998 is void ab-initio.

2. This issues with the approval of Joint Secretary (ME).

 
Yours faithfully,

(Amit Biswas}
Under Secretary to the Government of India
Tele: 011-2306 1120
IMA NEWS
Seven directors nominated to IMA HBI
They shall hold office for 2 years, ie 2015-2016.
  1. Dr Vinay Aggarwal
  2. Dr V Varadarajan
  3. Dr Ram Dayal Dubey
  4. Dr C Srinivasa Raju
  5. Dr Vinod C Shah
  6. Dr Vijay Aggarwal
  7. Dr Anand Kate
IMA initiative for safe sound
Chairman: Dr KA Seethi
National Co-ordinator: Dr C John Panicker


Sound is alternate contraction and rarefaction of molecules travelling in a wave form.

Unit of sound
  • Decibel- Unit of Measuring sound
  • Logarithmic value of ratio of standard sound to the sound in question.
  • Zero decibel is the minimum intensity a healthy person can hear
  • 100 db is 10 (1000 crores) intensity amplified
Sound levels
  • Normal Speech         30-40 db
  • Shouting                  50 db
  • Ordinary car horn     70 db
  • Air Horn                    90-100 db
  • Rock Music               100 db
  • Busy street noise     80-100 db
Clinician – Patient Communication
Vinay Sharma, New Delhi

Communication Model
  • Rapport
  • Exploration
  • Collaboration
The Cycle of Eight

Questions all patients have
  • What has happened to me? (Diagnosis)
  • Why has it happened to me? (Etiology)
  • What is going to happen to me? (Prognosis)
  • What are you doing to me?
  • Why are you doing that (and not something else)
  • Will it hurt or harm me? How much? How long?
  • When will you know the results?
  • When will I know the results?
Health ministry drops abortions proposal
Feb 10, 2015 - TEENA THACKER | The Asian Age:

Succumbing to unrelenting pressure from the Indian Medical Association (IMA) and the Federation of Obstetric and Gynaecological Societies of India (FOGSI), an umbrella body of gynaecologists, the Union health ministry has decided to downplay its own proposal of allowing midwives, homeopaths and Ayush doctors to perform abortions.

With pressure mounting from doctors and their associations, the health ministry had now decided that these healthcare specialists may only be allowed to carry “non-invasive” procedures. In its draft medical termination of pregnancy (MTP) bill, the health ministry had proposed an amendment to allow midwives to terminate pregnancy, which had received a lot of flak.

With the final changes in sight, the ministry is expected to take the draft of the MTP bill to the Cabinet soon.

“The government is considering watering down the proposal and considering that these healthcare specialists be allowed to carry out the non-invasive part, which would mean prescribing medicines etc,” a senior official in the health ministry said. A proposed amendment also enhances the period of abortion till 24 weeks.

FOGSI and IMA, in their recent meetings with the health ministry, had vehemently opposed the ministry’s decision, saying that “abortions performed by them could pose a grave threat to women and will give a rise to sex-selective abortions”.

While ministry officials say that FOGSI members were part of the consultations and supported the amendments earlier, the IMA, which opposed the amendments from the very beginning, went ahead and even wrote to the Prime Minister asking for the withdrawal of the new amendments.

FOGSI secretary-general Nozer Sheriar had earlier said that wider discussions on the issue made them change their mind. “We supported the amendments initially. However, there were lot of internal discussions and the position that we have taken now is that abortions should only be done by a gynaecologist or at least an MBBS doctor. As far as the scarcity of doctors at the PHC level is concerned, I believe periphery needs to be strengthened. Enough support has not been provided by healthcare providers, the way it is done in railways and armed forces. Moreover, a much larger debate is required before any decision is taken,” he said.

Significantly, the women and child development ministry, the National Commission for Women and other women’s groups had supported the draft bill. Approximately 64 per cent of the responses received by the ministry were in favour of the draft. According to the figures available with the government, out of six million abortions every year in the country, 55-60 per cent are unsafe, with the younger population being the usual prey to complications.

Medscape Family Physician Lifestyle Report 2015

Family Physician Marijuana and Daily Alcohol Use

Family physician responses to questions about use of alcohol and marijuana suggest that higher levels of alcohol consumption are associated with a greater tendency to use marijuana. Of those who have more than two alcoholic drinks per day, 46% claim to have ever used marijuana, and the less family physicians drink, the less likely they are to have used marijuana; only 12% of those who don't drink at all claim to have ever used marijuana.

Media
IMA,IJCP,HCFI

Inspirational Story

Once upon a time a very strong woodcutter asked for a job in a timber merchant, and he got it. The pay was really good and so were the work conditions. For that reason, the woodcutter was determined to do his best. His boss gave him an axe and showed him the area where he was supposed to work. The first day, the woodcutter brought 18 trees.

"Congratulations," the boss said. "Go on that way!" Very motivated by the boss’ words, the woodcutter tried harder the next day, but he could only bring 15 trees. The third day he tried even harder, but he could only bring 10 trees. Day after day he was bringing less and less trees.

"I must be losing my strength", the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on.

"When was the last time you sharpened your axe?" the boss asked. "Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut trees."

Our lives are like that. We sometimes get so busy that we don’t take time to sharpen the axe." In today’s world, it seems that everyone is busier than ever, but less happy than ever. Why is that? Could it be that we have forgotten how to stay sharp?

There’s nothing wrong with activity and hard work. But God doesn’t want us to get so busy that we neglect the truly important things in life, like taking time to pray, to read. We all need time to relax, to think and meditate, to learn and grow.

If we don’t take time to sharpen the axe, we will become dull and lose our effectiveness. So start today. Think about the ways by which you could do your job more effectively and add a lot of value to it.

Event
IMA,IJCP,HCFI

White paper on pain killers
  • Do not give aspirin in children as it can cause fatal liver failure.
  • Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin.
  • Paracetamol should not be taken without medical consultation. It is number one suicidal agent in the west. As per US FDA, combination products that contain paracetamol should not have paracetamol salt dose more than 325 mg in each tablet or capsule.
  • In patients with kidney disease even one tablet of painkiller can precipitate kidney failure.
  • Central government prohibits the use of Nimesulide in children below 12 years of age.
  • Drug Controller General of India approved Nimesulide on 13th January 1995 for painful & inflammatory conditions as well as fever.
  • Nimesulide can be safely prescribed upto 15 days.
  • Nimesulide is available and approved in 54 countries worldwide.
  • In general painkillers are safe drugs when used in patients who are not at high risk for gastrointestinal, renal, or cardiovascular reactions.
  • Heart patients should consult their doctor before taking a painkiller.

Quote of the Day

Dream as if you’ll live forever, live as if you'll die today. James Dean

IMA in Social Media

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Reader Response
  1. Regarding DNB not equivalent to MD or MS: Good morning Sir, Thanks for the update, can you please tell which are the teaching institutions for DNB in Delhi. Thanks. Regards: Devinder Gupta
IMA Videos
News on Maps
IMA Humor
Dream of a necklace

After she woke up, a woman told her husband, "I just dreamed that you gave me a pearl necklace for our anniversary. What do you think it means?"

"You’ll know tonight." he said.

That evening, the man came home with a small package and gave it to his wife.

Delighted, she opened it to find a book entitled "The Meaning of Dreams."
Press Release of the Day
Health Budget should be 5% of the GDP: IMA

Increase the health budget; promote cure in India concept, reserve money for digital health and medical research and provide subsidy to doctors and medical establishments who provide concessional services to the poor are a few of the suggestions sent to the finance ministry by the Indian Medical association.

Giving the details Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General IMA said that doctors who wish to open a medical establishment need clearances from over 72 Acts and unless there is a single window registration concept, the cost of medical treatment will not come down.

Here are the suggestions that were sent to the Finance Ministry.
  1. Health Budget should be 5% of the GDP.
  2. Rupees 500 Crores should be earmarked for “Cure in India” Project. This project to be earmarked for creating awareness and promoting indigenous manufacturing of kits, reagents and equipments devices.
  3. Provision to be made for Indian Health Act 2015 where single window registration should be done of medical establishments. At present 72 such registrations are required.
  4. Rupees 1,000 crores to be reserved for promoting digital health (Cure & Learning)
  5. Health to be given an infrastructure status
  6. Medical services should be declared as a service industry.
  7. Interest-free loan to be provided to open a medical college in rural area.
  8. Lifesaving equipments should be exempt from all duties.
  9. Rupees 1,000 crores should be earmarked for promoting research and CME Programmes for health care providers.
  10. Health care providers should be given subsidy for solar power and digital health.
  11. Honeymoon period of 10 years should be given for new medical establishment for loan.
  12. Small medical establishment and single doctor clinic who are ready to provide 15% free service should be given the status of aided Hospitals like aided schools.
  13. New Medical Colleges should be opened in rural areas where there are no medical college established by the Government.
  14. Permission for opening medical colleges should be given in the rural areas on fixed criteria i.e. states which do not have medical college proportionate to the population and areas where health care facilities is not available.
  15. In all life-saving conditions where private medical establishments are supposed to provide free service, compensation should be given by State on CGHS rates.
  16. Doctors who want to serve in rural areas should be paid a 3 times more salary and should have facilities for accommodation and education like Railway Colony near railway stations.
  17. Every doctor and hospital who does charity, should be given the same exemption as is provided in Section 80G of Income Tax Act.