October 14   2015, Wednesday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
IMA urges government to withdraw plans to start Bachelor of Science in Community Health

IMA strongly objects the Government move to start BSc Community Health course under the National Board, to man sub-centers and empowering them to prescribe medicines.

Sub centers are the cornerstones of disease prevention activities and implementation of national health programs and not primarily meant to provide curative service except home remedies. The staff pattern in the sub center consists of one male and one female multipurpose health worker (JPHN/JHI/ANMs). The job description of these staffs is family welfare services, immunization, awareness, household visits, data collection regarding disease prevalence, and coordinating other national disease control programs. These staffs currently work under the supervision of a medical officer posted in PHC. For this purpose there is no need for a more qualified workforce. Posting the proposed BSc (Community Heath) graduates in sub centers will be a wrong human resource management.

At the Sub Centre level, a more suitable workforce would be an ASHA worker with basic primary education and training. So the concept of posting paramedics at sub centers will be a gross waste of human resources and will be counterproductive for the purpose they are meant. The policy proposal on this is not based on ground reality and is conceptually wrong. The deployment of over qualified staff at sub centers will only increase the attrition rate. Entrusting the newly proposed BSc (Community health) graduates to manage very sensitive areas like child health within the health system may even worsen the situation. To leave the health of children and adolescents in the hands of ill-equipped personals is detrimental and may nullify the results of years of hard work that the country has put into reducing child mortality and morbidity

Moreover, if the Government’s intention is to produce health workers to work in sub centers, then why should such courses be conducted by the National Board of Examination (NBE)? In fact the NBE conducts post graduate courses and not even undergraduate courses in modern medicine. Allowing these graduates to be registered under Medical Council will set a wrong practice.

IMA therefore, urges the Government to desist from the move to start BSc (Community Health) course.
Breaking news
A genetic brake on ageing

In what could lead to potential new ways of slowing the pace of ageing in humans, research have identified 238 genes that when removed from living cells can extend their life. The 10-year study by scientists at the Buck Institute for Research on Aging and the University of Washington was conducted on yeast cells. As many of these genes and genetic pathways are found in mammals, the researchers believe that if the same gene editing technique could be replicated in humans, it could help extend lifespan. “This study looks at ageing in the context of the whole genome and gives us a more complete picture of what ageing is,” said Brian Kennedy, lead author of the study and president and chief executive officer of the institute. The research was published online in the journal Cell Metabolism. (The Hindu – IANS)
Dr Good Dr Bad
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Specialty Updates
• A glass of wine with dinner can improve lipid and glycemic control profiles in patients with type 2 diabetes mellitus, suggest findings from the Cardiovascular Diabetes and Ethanol trial (CASCADE), published online October 13 in the Annals of Internal Medicine.

• Drinking multiple cups of black tea (as opposed to green or other tea) with or without milk was linked to a substantially lower risk of fractures in older women who participated in the Calcium Intake Fracture Outcome Study (CAIFOS) and were followed for a mean of 5 years. The findings were presented at the American Society for Bone and Mineral Research (ASBMR) 2015 Annual Meeting.

• Effective treatment with highly active antiretroviral therapy (HAART) for HIV also protected patients against hepatitis B virus (HBV), suggest new data on men who have sex with men (MSM). The findings were published online October 13 in the Annals of Internal Medicine.

• New research suggests that exercise and stopping smoking may improve depression after heart attack. The findings were published in the European Heart Journal.

• Increased physical activity among children throughout the first 8 years of school sharply decreased their overall risk of fracture, suggested a Swedish study presented at the American Society for Bone and Mineral Research meeting.

• New research has discovered a molecule - the protein syndecan-4 found in the cell membrane of antigen presenting cells - that plays a significant role in the development of allergic airway inflammation. The report is published in Nature Communications.

• Lack of oxygen in the womb, combined with high salt intake in later life, can lead to vascular problems, suggests a new research published in The Journal of Physiology.

• New research published in Psychosomatic Medicine suggests that people with anorexia nervosa may have very different gut microbial communities than those found in healthy individuals.

• High-dose vitamin D supplementation did not improve bone mineral density (BMD) in postmenopausal women, reported an NIH-sponsored randomized study presented at the American Society for Bone and Mineral Research meeting.

• Researchers at the Nottingham Trent University, in collaboration with Nottingham University Hospital NHS Trust, have designed a way to improve the safety and efficiency of a complex surgical procedure for children with cerebral palsy by using wearable technology like Google Glass. The procedure - a selective dorsal rhizotomy - involves the severing of two-thirds of a nerve root to improve the muscle stiffness experienced by children with cerebral palsy in their limbs.
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Media
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eSPIRITUAL
The spiritual meaning of the word ‘Artha’
Dharma, Artha, Kama and Moksha are the four fundamental principles of our very existence, which mean earning righteously with a desire to fulfill the inner happiness.

Righteous earning is called ‘Artha’ and mistakenly it has been linked to materialistic money. In mythology, Artha is synonymous with Lakshmi, Saraswati and Kali where Lakshmi represents righteously earned materialistic wealth, Saraswati represents wealth of knowledge and Kali represents wealth of wisdom to fight the bad in you and in the society.

In any country, it is the wealth of knowledge, which is more important. India was ruled initially by warriors (Kali), later by money (Lakshmi) and in future will be ruled by knowledge (Saraswati).

It is the human resources, which today decide the growth of a company and the amount of money invested. If you have good human resources, your company is going to succeed.
What is the diagnosis and why

IMA,IJCP,HCFI

Answer: Erythema migrans with central clearing and a necrotic centre typical of Lyme disease
Legal Quote
Martin F. D’Souza vs Mohd. Ishfaq SCI: 3541 of 2002, dated 17.02.2009

“The higher the acuteness in an emergency and the higher the complication, the more are the chances of error of judgment.”
TB Fact
Environmental factors, such as crowding, low socioeconomic status, poor access to healthcare, and family history, also contribute substantially to the incidence of TB worldwide, and these are important to understanding TB pathogenesis.
Medicofinance
Asset protection does not deal with secrecy or hiding assets because an intelligent and determined creditor will always be able to unearth hidden assets. A properly structured asset protection plan would utilize commonly used structures such as trusts and limited liability companies in a manner that would legally, ethically and effectively shield a doctor’s assets from any lawsuit and any creditor. A doctor, who has an asset protection plan in place, will be able to sleep soundly, knowing that whether he is hit with a malpractice claim or is involved in an automobile accident, his assets will be safe and unreachable. (Source: IJCP)
Industry News
• Three issues for Digital India to succeed: The three major issues that Digital India needs to consider include the responsibility of the big companies, evolving a policy framework in terms of digital electronics and platforms by the government and a focus on local manufacture. This was stated by Ashok Chawla, chairperson, Competition Commission of India while addressing the Second Digital India Dialogue organized by The Indian Express Group. Chawla emphasized that for manufacturing to take-off in the country, we need critical mass. The theme of the discussion was Fostering India’s Digital Economy. The focus area of the discussion revolved around privacy and security of data. (Financial Express – Anup Jayaram)

• NHAI plans to introduce a mobile app to promote road safety: The National Highways Authority of India (NHAI) will introduce a mobile application integrated with transport registration network in the next couple of months, through which people could report against any vehicle which is either over-speeding or violating transport structures. Inaugurating a national conference on 'Roadtech: Role of new technologies & value engineering in construction, maintenance and safety,' organized by Assocham, NHAI chairman Raghav Chandra said, "This may take a month or two to create, but we shall get it going and make it available to the citizens, so that they can check on their mobile, may be take a photograph of the vehicle, which is speeding or violating any structures pertaining to transport and be able to press a button and it will get registered against the name of that vehicle.” (Times of India – Arunav Sinha)

Karnataka launches new fund for early-stage ventures: Karnataka launched a new fund-of-funds for early-stage ventures as part of a wider policy being drafted to ensure Bengaluru holds on to its lead as India's startup capital. Chief Minister Siddaramaiah told an audience that included stars of the tech world at the inaugural Jio Economic Times Startup Awards on Monday that his government will introduce more business friendly measures shortly for startups. (The Economic Times- Anirban Sen and Bharat Joshi)

Investment in food start-ups rises 93% in 2015: Food technology start-ups attracted $130.3 million investments between January and September 2015, according to Chennai-based Venture Intelligence. The five deals in 2014 brought in $67.7 million and six deals in 2013 $42.06 million. (Business Standard - T E Narasimhan and Gireesh Babu)
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
Peace of mind

Once Buddha was walking from one town to another town with a few of his followers. This was in the initial days. While they were traveling, they happened to pass a lake. They stopped there and Buddha told one of his disciples, I am thirsty. Do get me some water from that lake there.

The disciple walked up to the lake. When he reached it, he noticed that some people were washing clothes in the water and, right at that moment, a bullock cart started crossing through the lake. As a result, the water became very muddy, very turbid. The disciple thought, How can I give this muddy water to Buddha to drink! So he came back and told Buddha, The water in there is very muddy. I don’t think it is fit to drink.

After about half an hour, again Buddha asked the same disciple to go back to the lake and get him some water to drink. The disciple obediently went back to the lake. This time he found that the lake had absolutely clear water in it. The mud had settled down and the water above it looked fit to be had. So he collected some water in a pot and brought it to Buddha.

Buddha looked at the water, and then he looked up at the disciple and said, See what you did to make the water clean. You let it be… and the mud settled down on its own and you got clear water… Your mind is also like that. When it is disturbed, just let it be. Give it a little time. It will settle down on its own. You don’t have to put in any effort to calm it down. It will happen. It is effortless.

What did Buddha emphasize here? He said, It is effortless. Having ‘peace of mind’ is not a strenuous job; it is an effortless process. When there is peace inside you, that peace permeates to the outside. It spreads around you and in the environment, such that people around start feeling that peace and grace.
Humor
Doctor, Doctor! I keep getting pains in the eye when I drink coffee!

Doc: Have you ever tried taking the spoon out FIRST?
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
New health policy: Private sector role set to grow?

Suggesting significant changes in the Centre’s draft National Health Policy 2015 (NHP-2015), the Niti Aayog has suggested more engagement with the private sector in healthcare and setting up of a sickness fund, where people can contribute to avail of services from both private and public providers. It also advocated against offering a “chimera” of free drugs and healthcare to people. These strong recommendations could delay the unveiling of the policy as the government must take into account these suggestions before finalising it, sources said. The sickness fund could be on the lines of the government’s recently-launched social security schemes like Atal Pension Yojana, Pradhan Mantri Jeevan Jyoti Yojana and Pradhan Mantri Suraksha Bima Yojana, contributory in nature, Niti Aayog suggested to the government. In a note on its views on the NHP-2015 draft, a copy of which is with this newspaper, the government’s think tank strongly opposed its vision of providing “free care and drugs”. It noted that the government struggled to provide even one per cent of GDP for healthcare. (Asian Age – Animesh Singh)
MAKE SURE
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IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.

• Writing prescription drugs by unqualified people can be dangerous.

• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)

• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?

• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?

• Allow us to treat poor and rich equally.

• Non pelvic ultrasound providers should be out of PCPNDT Act.

• Unless caught doing sex determination, no criminal offence shall be registered.

• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.

• More patients will die if doctors are not provided protection during duty hours.

• Death does not mean negligence.

• Money spent does not mean you will get a cure.

• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.

• How can we treat patients using outdated standard treatment guidelines made by government?

• How can government decide the charges of a clinical establishment?
IMA JIMA
IMA Digital TV
Pharma companies to face ban on doctor gifts

Pharma companies may soon be barred from giving any gift, cash or offer hospitality to doctors, as the government is considering making it mandatory for them to follow uniform marketing practices code. The Department of Pharmaceuticals has prepared the Uniform Code of Pharmaceuticals Marketing Practices (UCPMP) and its voluntarily adoption and compilation was started from January 1 this year. The code also prohibits companies from supplying drugs as samples, which are used to treat depression, inducing sleep such as hypnotic, sedative or tranquilliser. As per the code, the companies should not offer any gift or benefits in kind or offer foreign trips to doctors and if any firm was found following such practices, it could be expelled from the association. “As of now, it is voluntary for pharmaceuticals companies to follow UCPMP, but we are considering to make it compulsory in next few months,” a senior government official said.

A process has already been started to rework the entire code so that it could be make compulsory and the department will hold discussions for the same with all stakeholders including industry, Medical Council of India and others, the official added. Discussions will also take place with Drug Controller General of India, health ministry and NGOs, the official said. The marketing code, which also cover medical devices sector was initially implemented from January 1 this year for a period of six months, which was extended for two months till August 31 and now has been extended for four months till December 31 this year. As per the code, the companies can extend funding for medical research and study through approved institutions as per law and it should be fully disclosed. The code also have stringent measures for audio-video promotional activities and for the supply of free samples of medicines. (Asian Age – PTI)
One in 13 world cancer patients are Indian

The National Cancer Institute (NCI), a unit of US Department of Health and Human Services (USDHHS), has observed that India shares a large proportion of the global cancer burden, with rising mortality rates. The situation can improve with dissemination of scientific information among the general populace, claimed NCI officials. India has around 1.8 million people suffering from cancer, with patients of breast, cervical and oral cancers topping the list. Every 13th new cancer patient in the world is an Indian. The NCI has organised a two-day international workshop for scientific journalism, aimed at media professionals, in association with Public Health Foundation of India and Institute of Cytology and Preventive Oncology (ICPO), Noida, on October 12 and 13. This is NCI's first such workshop in South Asia. Earlier, the institute had organised similar workshops in Brazil (2010), Mexico (2011), China (2012), Argentina (2012) and Puerto Rico (2013).
Preetha Rajaraman, programme director, NCI (South Asia), said there is need for global co-ordination to defeat cancer. "Every 13th new cancer patient in the world is an Indian. India has a huge capacity and strong media network. The aim is to train journalists so they can convey accurate messages to the public about prevention and treatment," Rajaraman said… (Times of India)
1 billion people globally predicted to become obese by 2025

New analysis indicates UN's goal on diet-related disease will fail to be met due to the growing numbers of people becoming obese, as close to 1 billion of the world's adult population is predicted to become obese by 2025. According to experts, the cause is the spread of the westernised diet around the world because of the food industry's big marketing strategy. During a 2011 UN summit, the World Health Organisation (WHO) was commissioned to set targets to reduce the rate in weight gain and obesity, as it is a contributing factor that has led to the rise in diabetes, heart disease, cancer. The UN goal was set for 2025 of no increase in obesity or diabetes beyond the levels of 2010. However, World Obesity Federation (WOF) told the Gaurdian, the latest statistics show that goal will not be met. Research showed, in 2010, 11.5% of adults were obese and by 2014 it rose to 13%. The organisation revealed that if there is no action to reduce these numbers,17% of adults will be obese by 2025. That means, 170 million adults with a BMI above 35 will need urgent medical treatment. WOF also revealed child obesity is also on rise in countries like the Middle East, Latin America, China and south east Asia, which will only contribute to the already alarming adult numbers. (DNA India)
Chikungunya has spread to 1.7 million cases in the Americas

The number of suspected or confirmed cases of Chikungunya has now reached 1.74 million in 45 countries or territories in the Americas, Marc Fischer, MD, from the Centers for Disease Control and Prevention (CDC), reported at IDWeek 2015. "At the peak of the outbreak in the middle of last year, there were 150,000 to 250,000 suspected cases being reported per month," Dr Fischer reported. "Even now, there are over 50,000 cases reported by month." From December 2013 to December 2014, a disproportionate level of the burden was being borne in the Dominican Republic, according to the Pan American Health Organization. In addition, "Colombia and El Salvador now account for about a third of the cases and the outbreaks are still going on, although the Colombian Ministry of Health reported in the past 2 weeks that the outbreak has been waning or even ending in that country," said Dr Fischer. Before 2006, Chikungunya was rarely seen in the United States, but by 2013, an average of 28 cases per year was identified. All those infected had traveled to an affected area, mostly in Asia, Africa, and the Indian Ocean Islands. None of these infections resulted in local transmission. In 2014, after Chikungunya was identified in the Caribbean, there was a significant increase in the number of American travelers infected. Local transmission was then identified in Florida, Puerto Rico, and the US Virgin Islands. (Medscape)
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GP Tip: Sphygmomanometer helps determine pulses

Pulsus alternans and pulsus paradoxus can be easily diagnosed with the help of a sphygmomanometer. Elevate the mercury above the patient’s systolic pressure and then slowly deflate, bringing the mercury down. When the Korotkoff sounds appear, hold the pressure static. If the Korotkoff sounds disappear with inspiration and reappear with expiration, pulsus paradoxus is present. If pulsus alternans is present, the Korotkoff sounds initially appear at a rate that is half the pulse rate. On further lowering of the mercury, the rate of Korotkoff sounds will suddenly double and equal the pulse rate.
eWELLNESS
Myths

1. The right skin cream can keep your skin looking young: For reducing wrinkles, the topical treatment with the best evidence behind it is retinoic acid. The best ways to keep wrinkles at bay are using sunscreen and not smoking.

2. Antibacterial soap is best for keeping your skin clean: Many experts are concerned that the use of antibacterial soap could lead to more antibiotic-resistant bacteria. Antibacterial soap is not necessary for everyday use. Regular soap is fine. Thorough and consistent hand-washing, not antibacterial soap, is what helps prevent the spread of infection.
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eMEDI QUIZ
In all of the following conditions neuraxial blockade is absolutely contraindicated, except:

1. Patient refusal.
2. Coagulopathy
3.Severe hypovolemia.
4. Pre-existing neurological deficits.

Yesterday’s Mind Teaser: The primary role of chaperones is to help in:

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

Answer for Yesterday’s Mind Teaser: 4. Protein folding.

Answers received from: Dr Poonam Chablani, Dr Jainendra Upadhyay, Dr K V Sarma, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.

Answer for 11th October Mind Teaser: 2. Decreased production of 2,3-bisphosphoglycerate

Correct Answers received from: Dr Jainendra Upadhyay, Dr K V Sarma, Dr Poonam Chablani, Dr Avtar Krishan, Daivadheenam Jella.
Readers column
Dear Sir, very informative news. Regards: Dr Karan
Digital IMA
Press Release
Swine flu prevention: Awareness must be generated at the school level itself

With the sudden surge in Swine Flu cases, it is essential that awareness be raised about its prevention especially amongst school children who run the risk of contracting the disease from their peers. Prevention of Swine Flu mainly involves taking simple precautionary steps while coughing and maintaining respiratory and hand hygiene.

Swine Flu or H1N1 influenza is a viral respiratory 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 a cough, sore throat, fever, headache chills and fatigue.

Respiratory hygiene involves maintaining a distance of at least 3 feet from a person who is coughing and sneezing. Proper cough etiquettedemands that the infected person ensures that he or she covers their mouth and nose with a tissue while coughing or sneezing and then disposes of the tissue immediately to stop the disease from spreading to others. In a case where a tissue may not be available, it is best to cough and sneeze into one's upper sleeves and not in their hands or a handkerchief. Sneezing and coughing into one's hands/ using a handkerchief are reasons why the disease spreads at such a rapid pace.

Speaking about this, Padma Shri Awardee – Dr K K Aggarwal, President HCFI and Honorary Secretary General IMA 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. It is important that awareness is raised especially amongst school children about necessary prevention measures. They must be taught the importance of regular hand washing especially in a season where swine flu and other infections are rampant. People suspected of swine flu must take necessary steps to avoid spreading the illness."

In a recent study conducted by Heart Care Foundation of India, involving 63 schools (both Public and Govt.) and 6047 students (2817 girls and 3230 boys), 76% of the students (4576) did not know about the role of proper cough etiquette in preventing flu. They answered that the best way to cough was either in the hands or into the handkerchief.

Hand hygiene refers to washing one's hands with soap and water or using alcohol-based hand rubs. Patients suspected of swine flu must ensure that they never cough and sneeze in their hands as they can spread the infection through mere touch. School children should regularly maintain hygiene since they are in regular contact with several children who may be suffering from the disease but may not be aware of how to prevent it from spreading. It is thus necessary for all parents to educate their children about necessary preventive measures.