October 13   2015, Tuesday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
MCI gave a historical judgment to simplify the entrance test procedure for MBBS

Prospective medical students sitting for MBBS examination each year face an array of problems, but the one that troubles them the most is the scattered and vague examination pattern for admission to the MBBS course. Even if they compromise on everything, ignore all the circumstances and prepare the best, some of them just can’t succeed due to the multiple entrance tests.

Seeing the complexity of the issue, Dr. Ketan Desai, the then President MCI, in 2009, appointed a two-member committee. On looking deep into the matter, the committee released a detailed report, which said that there were more than 90 entrance examinations that are conducted annually for admission to the MBBS course for nearly 300 medical colleges in the country. These entrance exams are held in accordance with the schedule of admissions prescribed by the MCI in terms of the pronouncement made by the Hon'ble Supreme Court. The major constraints that the report highlighted were of time, travel and affordability as well. In addition to this, numerous complaints were received of irregularities, manipulations and cheating etc.

Seeing the circumstances, the committee explicitly recommended that there should be a single/ unitary National Eligibility Entrance Test (NEET) to be conducted by a designated authority and the merit generated there from should be available to all the admitting authorities to make admissions to the MBBS course on an Inter-se basis. This could be achieved by incorporating an appropriate amendment to the Indian Medical Council Act, 1956 on an urgent basis, including the issuance of an ordinance by the Government of India, so that the same could be affected from the subsequent academic session.

The Executive Committee of the Council approved the report in May 2009 and looking into the exigencies, the same was circulated to all the members of the council and the approval was received by circulation in June 2009. Upon resultant adoption by the General Body of the Council, the same was made known to the Government of India, and also the University Grants Commission (UGC) urging upon them the importance and necessity of prompt execution of the said decision through incorporation of an amendment to the Indian Medical Council Act, 1956 including through issuance of an appropriate ordinance by the Government of India.

Dr. Ketan Desai who was the President of MCI at that point of time in 2009 mooted and steered this entire concept of NEET.

It is widely perceived by a large section that one of the key reasons of suffering of Dr. Desai was his relentless persuasion to implement National Eligibility Entrance Test. However, the Government of India took no action on the said recommendations.

In the meantime the MCI, was superseded by a Notification dated 15th May, 2010 by the Government of India, and was replaced by a nominated Board of Governors, who also did not venture in pursuing the said issue in any manner. In between a public interest litigation came to be filed before the Hon'ble Supreme Court who upon detailed hearing directed the Government of India, and the MCI to act on the said recommendation made by the MCI in 2009 promptly.

As a result of the same, the Government of India, on the recommendations of the Board of Governors notified NEET through issuance of a regulation under section 33 of the Indian Medical Council Act, without making amendment to the Indian Medical Council Act, in spite of the same having been recommended by the then MCI, after a gap of 2 years.

The said regulation was challenged before the Hon'ble Supreme Court by the various private managements in the country and virtually every senior lawyer was engaged to oppose the same. The net result was that the said regulation was quashed by the Hon'ble Supreme Court by a majority decision of 2:1 primarily on the ground that the MCI did not have the said authority and jurisdiction as the Indian Medical Council Act does not provide for the same.

Upon the said pronouncement, the Government of India, preferred a review petition, which is pending consideration before the Hon'ble Supreme Court since last two years and no pursuance on the said count has been undertaken.
Strangely enough the Board of Governors did not even prefer a review petition although the MCI, which was being run by the Board of Governors at the said point of time in the year 2013, notified the notification towards NEET.

The efforts of Dr. Ketan Desai have borne some fruits now as the government recently agreed to implement the proposal of holding just one entrance test for MBBA, BDS and other medical courses.

The re-constituted MCI, at its General Body Meeting held on 1st October this year, reiterated its earlier decision that a unitary single Common Entrance Test should be held by a designated competent authority for admission to MBBS Course through incorporating an appropriate amendment to section 33 of the Indian Medical Council Act, 1956, whereby MCI with the approval of Government of India, would be vested with the appropriate authority to notify ‘Regulations’ for the purposes of conduct of the said test. The said resolution was further broadened by bringing out that admission to postgraduate courses should be made on the basis of merit generated at the Common Entrance Test for postgraduate admissions.

It was further resolved that in view of the exigencies both the recommendations may be given effect by the Government of India, by urging Hon'ble President of India to issue an ordinance towards the same, if need be.

The resolution was not only unanimously adopted but the minutes thereof were confirmed in the meeting itself and the communication to the required effect has been sent to the Government of India, for the needful in larger public interest.


The MCI has initiated a great move by recommending it to the health ministry. This will help all the prospective medical aspirants who put their sweat and blood in preparing for the examination. The renewed cohesiveness of the upcoming common entrance test will make preparing for one of the country’s toughest examination a bit easier. Judging a candidate’s capabilities on the basis of different examinations gets really difficult for the paper setters and the checkers. Additionally, the multiple examinations create a whole new set of difficulties for students, as some of them have to miss one exam for giving the other one, the time constraint. All these papers have a different pattern that tends to increase the existing burden of studies on an individual candidate. Once the common entrance test pattern is implemented, the students will be much relaxed and eased, as they won’t have to pay for multiple coaching classes, multiple entrance exams and multiple entrance forms. It will be akin to a new revolution and nothing less.
Breaking news
Immune gene prevents Parkinson's disease and dementia

A team of researchers has found that functional changes in an immune regulating gene can prevent Parkinson's disease (PD) and dementia. Research team at University of Copenhagen, Denmark, has discovered that non-inheritable PD may be caused by functional changes in the immune regulating gene Interferon-beta (IFNbeta). Treatment with IFNbeta-gene therapy successfully prevented neuronal death and disease effects in an experimental model of PD. (Source: DNA)
Dr Good Dr Bad
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Specialty Updates
• Prenatal exposure to polybrominated diphenyl ethers, commonly used as fire retardants, has been associated with attention problems in 3 to 7-year-olds, suggested an article published in the journal Neurotoxicology and Teratology.

• The presence of multiple squamous-cell skin cancer lesions significantly increased the likelihood of local recurrence and lymph node metastasis, reported a retrospective cohort study published online in JAMA Dermatology.

• Women younger than age 50 undergoing release surgery for carpal tunnel syndrome had lower vitamin D levels than age-matched controls, although there was no similar association for older women, suggested a new study presented at the American Society for Bone and Mineral Research meeting.

• A novel test seems to predict future heart disease risk for adolescents, as well as the risk for type 2 diabetes. The new test works by assessing an individual's metabolic syndrome status. The report is published in Diabetologia and the Journal of the American College of Cardiology.

• The Endocrine Society has issued a Clinical Practice Guideline (CPG) on identifying women who are candidates for treatment of menopausal symptoms and selecting the best treatment options for each individual. The guidelines will be published in the November issue of the Journal of Clinical Endocrinology and Metabolism.

• New research suggests that the presence of certain gut bacteria may contribute to the development of celiac disease. The findings are published in The American Journal of Pathology.

• Enhanced cleaning of hospital rooms, added to standard procedures, appeared to reduce the risk of transmitting drug-resistant pathogens from patient to patient, suggested new research presented at the IDWeek meeting. Researchers stated that adding ultraviolet light or bleach plus UV light also showed a trend toward a reduced risk.

• A new study in patients with coronary heart disease has found that positive emotions are associated with a range of long-term health habits, which are important for reducing the risk of future heart problems and death. The findings are published in the journal Psychomatic Medicine.

• Cigarette smoking and heavy alcohol use cause epigenetic changes to DNA that reflect accelerated biological aging in distinct, measurable ways, suggested new research presented at the American Society of Human Genetics (ASHG) 2015 Annual Meeting.

• Older individuals may have poorer neural plasticity, and therefore recover from concussion more slowly, according to findings from a small study published online October 6 in Radiology.
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Media
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eSPIRITUAL
Five Types of People
Following are the five types of people:

• Nastik: One who do not believe in God.

• Astik: For whom God exists.

• For them the God also exists in them (I and the God are the same)

• Tatvamasi (God not only exists in me but also in you)

• God is in everybody

People who believe that God exists are fearful people and they always fear God. People who see God in themselves, live a disciplined Satvik life and do not indulge in activities that are not God-friendly.
People who believe that God is not only in me but also in you, treat every person the same way as they treat themselves. People for whom God is everywhere always work for the welfare of the society.
What is the diagnosis and why

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Legal Quote
Jacob Mathew v. State of Punjab SC / 0457 / 2005: (2005) 6 SCC 1 (iv)

“Simply because a patient has not favourably responded to a treatment given by a physician or a surgery has failed, the doctor cannot be held liable per se by applying the doctrine of res ipsa loquitur.”
TB Fact
The most important host factor that determines TB susceptibility to TB is HIV coinfection, followed by other immunosuppressive conditions, including cancer, diabetes, and immunosuppressive medications.
Medicofinance
Asset protection

Asset protection is a field of law that deals with structuring asset and business ownership to make it either impossible or at least very expensive for a plaintiff to reach the assets of a defendant. If a doctor’s personal assets are impossible or too difficult to collect against, a plaintiff’s attorney will either not file the lawsuit in the first place, or will be a lot more willing to settle on terms favorable to the doctor.

(Source: IJCP)
Industry News
New-age firms disrupting hiring processes as well: As new-age firms dole-out fatter salaries to attract the most skilled employees, companies need to strengthen their work environment, increase their staff engagement and reward policies, to hold on to talent. “Well funded organisations are offering better salaries and also getting good talent. This is happening in all the new age industries including e-commerce,” mobile commerce firm Paytm VP – Business Planning and People Amit Sinha said. Anjli Jain mobile app platform Kryptos Mobile Founder said, “The toughest challenge facing most new technology companies these days isn’t getting funded “it’s hiring the best, most skilled employees.” (Financial Express – PTI)

Grooming startups: It is not very easy to start a new business and groom it into a successful venture. It is important to select the correct legal status, whether proprietorship, partnership, LLP or company. A company, firm or LLP has to pay taxes at a higher slab rate and larger number of compliances for their operations, while a proprietorship business enjoys lower income tax and lesser legal compliances. (The Hindu Business Line- Amol Mishra)

The next generation startups of Hyderabad: Bengaluru, Mumbai and Delhi-NCR are the main startup hubs of India, other regions are fast catching up. Goa, Kerala, Coimbatore, Chennai, and now Hyderabad are some of the top startup hubs of the country to watch out for. According to a report by NASSCOM, about 8% of the startup activity in India is happening in Hyderabad. (Yourstory- Sindhu Kashyap)

TiEcon 2015: The annual conference of The Indus Entrepreneurs (TiE), a global body of entrepreneurs with a connection to India will be held on October 16 and 17 and will practice "The Balancing Act". TiEcon has launched its mobile app, TiEConnect, to guide you to sessions, speakers and event information. The app will also help you discover other attendees and delegates and connect and engage with them.
eMEDIPICS
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Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
Inspirational Story
Believe in Yourself

Believe in yourself and you can achieve, things you never thought possible, Believe in yourself and you can discover talents new, that lie away hidden

Believe in yourself and you can reach, new heights that you thought unscalable, Believe in yourself and you can solve, problems that defy any solution

Believe in yourself and you can conquer, any situation, however difficult, Believe in yourself and you can make, the most complicated things seem simple

Believe in yourself and you can learn, the skills of gaining knowledge from experience, Believe in yourself and you can enjoy, the beauty in nature’s abundance

Believe in yourself and you can perceive, new depths your senses can apprehend, Believe in yourself and you can perform way beyond your expectations

Believe in your goal and work towards it with determination and dedication, Believe in yourself and output enhance by contributing to a given situation

Believe in yourself and you’ll feel blessed, as God's very own special creation.
Humor
The Birth Order

Diapering


1st baby: You change your baby's diapers every hour, whether they need it or not.

2nd baby: You change their diaper every 2 to 3 hours, if needed.

3rd baby: You try to change their diaper before others start to complain about the smell or you see it sagging to their knees.
MTNL Perfect Health Mela 2015.

Pls click here for details
IMA Digital TV
Medicolegal
Bioethical issues in medical practice

A Physician’s right to privacy

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

The case concerns a lady who underwent hysterectomy. The surgeon used to suffer from epilepsy, which was currently well under control. While the surgery went off well and the surgeon did not have any health issues during surgery, the patient died due to an inadvertent cystotomy during surgery.

a) Should the surgeon have disclosed his health information with the patient and allowed her to choose?

b) How much privacy should a physician enjoy in disclosing health issues to the patient?

c) When a surgeon suffers from periodic health issue such as epileptic seizures or unstable diabetes, should s/he discuss them with patients, especially if the health condition is under control? Should such a surgeon undertake surgeries without disclosing his health condition?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
Breaking news
Govt asks industry to list top 5 tax issues

First-of-its-kind move where I-T dept will offer informal view on contentious tax issues

The income tax department has issued letters to industry asking them to provide their top five contentious tax issues. The department will, in turn, send across its informal position on these matters to avoid litigation in future.
This view will be uniformly held - right from the chief of the Central Board of Direct Taxes (CBDT) to the assessing officer. This is the first instance where the government is being proactive in offering its position in accordance with the Income Tax Act to resolve contentious tax issues. "We have asked industry associations (to flag five taxation issues they would want clarity on)," said Anita Kapur, chairperson, CBDT in an email response to Business Standard's queries. This is in line with the efforts to bring in transparency and predictability in the taxation regime of the country, Kapur added. (Business Standard - Jayshree P Upadhyay & Dilasha Seth)
MAKE SURE
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Updates
Amid reports of doctors having a lax attitude and cases of medical negligence, the state government has installed LCD screens and circuit television cameras in the premises of Indore's MY Hospital.
The Madras High Court has set aside the order of a single judge and directed the state government to fill 74 medical seats that were unclaimed under all India quota.
The jurisdiction of the apex consumer court to try the Centre’s Rs 640 crore suit against it for the accusation of the unfair trade practices pertaining to Maggi noodles was recently questioned by the Nestle India Limited.
Drug Controller General of India (DCGI) has emphasized the need to consult the chemists and druggists associations besides consulting the state regulatory authorities before giving a concrete shape to the online pharmacy rules which is currently being reviewed by a committee of experts under the chairmanship of Maharashtra FDA commissioner Dr Harshdeep Kamble. Drug Controller General of India (DCGI) has set up an expert committee to examine the validity of the claims made on the labels of some of the high profile vitamin supplements marketed in the country for some years. The committee would evaluate the claims made on the ingredients of these products to help the consumer determine the intended therapeutic or prophylactic use of the products. (Pharmabiz)
Two thirds of students experience depressive symptoms

A survey on “emotional health and psychological well-being” of college-going students revealed that around two-third reported of experiencing depressive symptoms and mood fluctuations. Out of these, 44 per cent reported long-term and recurrent disturbances in their mood. Out of all the students who reported experiencing mood disturbances, nearly 30 per cent were men and 70 per cent were women. Finding of the survey were released on the occasion of “World Mental Health day”.

Psychiatrists and psychologists at Cosmos Institute of Mental Health and Behavioural Sciences (CIMBS) have conducted the survey of over 500 college students between the age group of 18-25 years from across the city. It was found that over 51.6 per cent students reported of experiencing anxiety symptoms. Out of these, in 47 per cent students, these anxiety symptoms were on-going for a chronic period of time. Out of all the students who reported of experiencing anxiety symptoms, nearly 74 per cent were women and the rest 26 per cent were men… A total of 23.4 per cent students reported of having impulsive and high risk behaviours… Students also suffered from sleep disturbances. 34 per cent of female students and 15.7 per cent of male students reported of having sleep disturbances… (Asian Age – PTI)
Rising air pollution aggravates symptoms of rheumatoid arthritis

Doctors at the All India Institute of Medical Sciences (AIIMS) have warned that when suspended particulate matter (SPM) 2.5 increases in the atmosphere, symptoms of rheumatoid arthritis aggravate in a patient.
This was found in a study conducted by the Institute on 500 patients who have been residing in Delhi for more than 10 years. It found that symptoms of rheumatoid arthritis got aggravated during November and December. The report was released ahead of the World Arthritis Day on October 12.

“We collected data on air quality from the Indian Meteorological Department in New Delhi for the past few years and then tracked patients undergoing treatment for rheumatoid arthritis here at AIIMS. It was found that when the particulate matter in air was high, more disease activity was found in the patients,’’ said Professor Uma Kumar, Head of Department and Professor of Rheumatology Medicine at AIIMS. The study — funded by the Department of Science and Technology — noted that symptoms in patients worsened in November and December when suspended particulate matter (SPM) 2.5 increases in the atmosphere. Patients showed worsening of symptoms like joint pain and swelling. The study, conducted as part of a project on climate change, was jointly conducted by the Rheumatology Department at AIIMS and the Meteorological Department between 2008 and 2013… (The Hindu - Bindu Shajan Perappadan)
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GP Tip: Check septum after trauma to nose

After blunt trauma to the nose, be sure to carefully examine the nasal septum for septal hematoma. A hematoma can usually be treated by simple aspiration, but if left untreated it may lead to permanent nasal deformity and nasal obstruction caused by necrosis of the nasal septal cartilage. (Source: IJCP)
Everyone is entitled to a life of dignity, says UN Secretary General on World Mental Health Day

Everyone has the right to respect and dignity, United Nations Secretary-General Ban Ki-moon has declared in his message on World Mental Health Day, highlighting that people who have mental health and psychosocial disabilities deserve to live with the dignity that is integral to a healthy and fulfilling life. “Everyone is entitled to their hopes and dreams ¬– to work, enjoy family and friends, go about their life without stigma and discrimination, and participate in decisions that affect them,” said Mr. Ban in his remarks on the Day, commemorated each year on 10 October and this year focused on the theme 'Dignity in mental health.' The World Day “is an opportunity to raise awareness of the challenges faced by people with mental and psychosocial disabilities, and of efforts needed to ensure that they can lead fulfilling and satisfying lives,” said the Secretary-General… The first target in the 2030 Sustainable Development Agenda stresses the need to ensure all humans can fulfil their potential in dignity and equality and in a healthy environment. Providing help to the people with mental disabilities will advance the process to meet the newly-adopted target. “Together, we can help make sure that people with mental health and psychosocial disabilities can live with the dignity that is integral to a healthy and fulfilling life,” concluded the Secretary-General.(UN News Centre)
eWELLNESS
Too much salt damages blood vessels and cause high BP

Eating a high-salt diet for several years is associated with markers of blood vessel damage like high uric acid and presence of albumin in the urine. People with any of these markers of blood vessel damage, who eat a high-salt diet are more likely to develop high blood pressure.

A study published in the American Heart Association journal, Circulation, analyzed the association between sodium consumption and blood levels of uric acid and albumin in the urine — both markers of blood vessel damage. Higher sodium intake was associated with increasing levels of uric acid and albumin over time. The higher the levels of these markers, the greater the risk of developing hypertension if dietary salt intake was high. Compared with participants eating the least amount of sodium (2.2 g/day), those eating the most (6.2 g/day) were 21% more likely to develop high BP. Those who had high uric acid levels and ate the most salt were 32% more likely to develop high BP, while those with high urine albumin levels and highest salt intake were 86% more likely to develop high BP. A high–salt diet is believed to be responsible for 20-40% of all cases of high BP.
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eMEDI QUIZ
The primary role of chaperones is to help in:

1. Protein synthesis.
2. Protein degradation.
3. Protein denaturation.
4. Protein folding.

Yesterday’s Mind Teaser: Decreased Glycolytic activity impairs oxygen transport by hemoglobin due to:

1. Reduced energy production.
2. Decreased production of 2,3-bisphosphoglycerate.
3. Reduced synthesis of hemoglobin.
4. Low levels of oxygen.

Answer for Yesterday’s Mind Teaser: 2. Decreased production of 2,3-bisphosphoglycerate.
Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Dr Poonam Chablani, Dr Avtar Krishan, Daivadheenam Jella.
Answer for 10th October Mind Teaser: 2.Replacement of glutamate by valine in B-chain of HbA
Correct Answers received from: Dr K V Sarma, Dr Poonam Chablani
Readers column
So good to see you all, after a fully charged session and equipped to face our problems. Good idea and seems to have been well executed. Congrats Dr KK Aggarwal. Dr LVK Moorthy
Digital IMA
Press Release
Swine flu can cause complications in patients with existing morbidities

Just when the cases of dengue started to subside, the swine flu scare has grappled Indian citizens. More and more cases of the disease are being diagnosed in the country.

Swine Flu or H1N1 influenza is a respiratory viral infection, which strikes like a ‘common-cold’ infection but is more severe in symptoms and the outcomes. The influenza virus mutates extremely fast and is highly infectious. The typical symptoms of Swine flu are cough, sore throat, fever, headache chills and fatigue. Though usually not life threatening and manageable on an out-patient basis, swine flu can cause complications for patients suffering from existing morbidities like Diabetes, Heart disease, Asthma/COPD, compromised immune system and old age.

Speaking about this, Padma Shri Awardees Dr A Marthanda Pillai National President Indian Medical Association and Dr K K Aggarwal, Honorary Secretary General IMA and President Heart Care Foundation of India said, "In most cases the swine flu attack is mild and requires no admission and special care, it can be treated like a normal viral fever. However, if a patient suffering from existing lifestyle disorders or very young or old individuals become victims of the disease, they must contact their doctor immediately since it can cause complications for them.“

People who need to take extra precautions if found suffering from Swine Flu includes:

• Children younger than 5 years of age (particularly those less than 2 years of age)
• Individuals 65 years of age or older
• Individuals younger than 19 years of age who are on long–term aspirin therapy which puts them at risk of Reye syndrome after influenza virus infection
• Pregnant women
• Individuals with any of the following chronic medical conditions:

1. Chronic pulmonary disease, including asthma particularly if systemic glucocorticoids have been required during the past year)
2. Cardiovascular disease, except isolated hypertension
3. Active malignancy
4. Chronic renal insufficiency
5. Chronic liver disease
6. Diabetes mellitus
7. Hemoglobinopathies such as sickle cell disease
8. Immunosuppression, including HIV infection (particularly if CD4 <200 cells/microL), organ or hematopoietic stem cell transplantation, inflammatory disorders treated with immunosuppressants
9. Individuals who have any condition that can compromise handling of respiratory secretions (eg, cognitive dysfunction, spinal cord injuries, seizure disorders, neuromuscular disorders, cerebral palsy, metabolic conditions)
10. Children with an underlying metabolic disorder, such as medium–chain acyl–CoA dehydrogenase deficiency, who are unable to tolerate prolonged fasting
11. Children with poor nutritional and fluid intake because of prolonged vomiting and diarrhea
12. Residents of nursing homes and other chronic care facilities
13. People who have had their spleen removed in the past
14. Patients suffering from obesity

The spread of Swine Flu is very rapid and epidemic. Patients suffering from Swine Flu can transfer the virus into the air when cough or sneeze. When a person comes in contact with these drops or touches a surface (such as a wall, door, tap, sink or any articles like phone/keyboard etc) that an infected person has recently touched, the infection spreads. Thus patients must ensure that they cover their nose and mouth when they cough or sneeze, wash their hands immediately after and stay at home for at least 24 hours after getting the illness.