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Editorial (Dr K K Aggarwal)                                                                                                    (Dr RN Tandon)
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14th February 2017
Thank you for not smoking: Run a positive campaign
The prevalence of tobacco use in India is very high in India as shown by the Global Adult Tobacco Survey India (GATS India) 2009-2010, more than one-third (35%) of adults in India use tobacco in some form or the other. Of these, 21% adults use only smokeless tobacco, 9% only smoke and 5% smoke as well as use smokeless tobacco. The survey also showed that 52% of adults were exposed to second-hand smoke (SHS) at home.
Tobacco use is associated with many adverse health effects and is a major preventable cause of morbidity and mortality. As per the CDC, smoking increases the risk of coronary heart disease by 2 to 4 times, for stroke by 2 to 4 times, lung cancer by about 25 times. In addition, it reduces quality of life, and increases health care utilization and cost. India has a ‘National Tobacco Control Programme’ in place to make the public aware about the harmful effects of tobacco use, control tobacco consumption and minimize the deaths.
 “Smoking kills” has been the message that has been conveyed in the campaigns on tobacco control with the expectation that highlighting the potentially life-threatening health consequences would deter people from smoking or using tobacco products. It’s time to alter the tone of such public health campaigns, from negative to positive.
Quite often, we may rebuke a patient for failing in his efforts to quit smoking and say, “If you do not quit, you may die”. A statement worded as this may inadvertently sound discouraging to the patient.  While it is important that people know the dangers of smoking or using tobacco products, a positive communication approach may have a more fruitful impact than a critical approach.
Avoid violent communication. Do not condemn, criticise and complaint, the 3 Cs of violent communication. Instead use a nonviolent communication approach to help and support your patient in his efforts to give up smoking. Tell your patient, who is trying to quit smoking or other tobacco products “Thank you for not smoking”. Appreciate the hard work put in by him and his perseverance. This way the patient knows that he has your support and will have trust and faith in you. The chances that the patient would adhere to the lifestyle modifications are higher if communicated in an empathetic and supportive manner.
IMA is committed to working closely with all National Health Programs alongside the government.  As individual doctors, we too can contribute to the success of National Tobacco Control Program. Counsel your patients who smoke about quitting smoking but with a difference… Turn a negative situation to a more positive action.
Dr KK Aggarwal
National President IMA & HCFI
Top News
Mission XI Million, the biggest school sports outreach program launched
Driven by the Prime Minister, Shri Narendra Modi´s vision of making football the sport of choice in India, Mission XI Million, the biggest school sport outreach programme was launched by the Minister of State (I/C) for Youth Affairs and Sports Shri Vijay Goel in the presence of President of AIFF Shri Praful Patel. A first of its kind, the programme will encourage children to play the beautiful game of football, gain healthy habits and learn important life lessons in teamwork and sportsman spirit. The approach is to work with school principals and sports teachers and encourage and incentivize them to make children play football games on regular basis… (Press Information Bureau, Ministry of Youth Affairs and Sports, 10thFebruary, 2017)

WHO/Europe strengthens resilience of hospitals during and after emergencies
118 hospitals in 7 countries in the WHO European Region were assessed using the WHO Hospital Safety Index tool in 2015-2016. Altogether, 93 experts – including doctors, civil and maintenance engineers and emergency planning experts – from 14 European and 6 non-European countries were trained. The Hospital Safety Index is a rapid, reliable way of assessing risk in the health sector. It helps health facilities manage their safety and avoid becoming casualties of disasters. Through it, WHO/Europe has strengthened support to national authorities to build the resilience of health facilities in emergencies … (WHO Europe, 6th February, 2017)
Practice Updates
Blood test may help differentiate Parkinson’s from similar diseases
A simple blood test, which measures the levels of a nerve protein in the blood, neurofilament light chain protein, may be as accurate as a spinal fluid test when trying to determine whether symptoms are caused by Parkinson’s disease or another atypical parkinsonism disorder, according to a new study published in the February 8, 2017, online issue of Neurology. The nerve protein levels were higher in people with APDs and lower in those with Parkinson’s disease and those who were healthy.

Healthy diet reduces risk of new-onset RA in women 
According to a prospective study women in the Nurses' Health Study and Nurses' Health Study II published in Annals of the Rheumatic Diseases, a healthier diet was associated with a reduced risk of rheumatoid arthritis (RA) occurring at 55 years of age or younger, particularly seropositive RA. However, no significant association was found for women older than 55 years.

Designer compound may untangle damage leading to some dementias
In a study of mice and monkeys, National Institutes of Health funded researchers showed that they could prevent and reverse some of the brain injury caused by the toxic form of a protein called tau. The results, published in Science Translational Medicine, suggest that the study of compounds, called tau antisense oligonucleotides, that are genetically engineered to block a cell’s assembly line production of tau, might be pursued as an effective treatment for a variety of disorders.

Men with SLE and systemic sclerosis are likely to be testosterone deficient
Men with systemic lupus erythematosus (SLE) or systemic sclerosis (SSc) are more likely to have a deficiency of testosterone than men without these diseases, according to findings from a cross-sectional study published online January 31, 2017 in the journal Arthritis & Rheumatology, which show the negative effect of corticosteroids on the gonadal function these patients. The study recommends that the treating physicians should be more aware of the possibility of hypogonadism in men with autoimmune diseases.

High hs-troponins may indicate subclinical heart disease
Elevated levels of high-sensitivity troponin T (hs-cTnT) in middle age may be a biomarker of early subclinical heart disease and also predict cardiomyopathy, cardiovascular events and heart failure, providing an opportunity for targeted preventive interventions, says a study published online February 3, 2017 in the journal Circulation. The high hs-cTnT levels, which indicate myocyte injury or death, can also predict later subclinical myocardial fibrosis.
eMedi Humor
What It Means

Five year old Becky answered the door when the Census taker came by.

She told the Census taker that her daddy was a doctor and wasn’t home, because he was performing an appendectomy.
"My," said the census taker, "that sure is a big word for such a little girl. Do you know what it means?"
"Sure! Fifteen hundred bucks and that doesn’t even include the anesthesiologist!"
Medicolegal Corner
Jacob Mathew vs State of Punjab and Anr: 5th day of August 2005: 334/2005/SCI/ 144-145 of 2004
“The jurisprudential concept of negligence differs in civil and criminal law. What may be negligence in civil law may not necessarily be negligence in criminal law. For negligence to amount to an offence, the element of mens rea must be shown to exist. For an act to amount to criminal negligence, the degree of negligence should be much higher i.e. gross or of a very high degree. Negligence which is neither gross nor of a higher degree may provide a ground for action in civil law but cannot form the basis for prosecution.” 
eMedi Quiz
All of the following statement regarding management of side effects of hormonal therapy are correct except
1. Vaginal bleeding is a warning sign for possible endometrial cancer or pathology in postmenopausal women on tamoxifen.
2. Fluoxetine is the "selective serotonin reuptake inhibitors (SSRI)" of choice for the management of hot flushes in women taking tamoxifen.
3. Estrogen replacement therapy is contraindicated in women with ER/PR positive breast cancer for managing hot flushes and bone loss.
4.  Gabapentin is an active agent for the management of tamoxifen related hot flushes.
Press Release
IMA-PvPI: To ensure safety of medicines
Over 50% of all adverse drug reactions treated in hospitals and emergency care are preventable; IMA-PvPI center advocates strong action in this regard.

New Delhi, Feb 13, 2017: Adverse drug events (ADEs) result in significant injuries and deaths every year. Many ADE related injuries, mortalities and incurring hospital costs can be reduced if healthcare institutions strengthen their systems for preventing and detecting ADEs.
Under the IMA-PvPI initiative, Indian Medical Association (IMA) has become a nodal center for reporting of Adverse Drug Reactions (ADR) / Adverse Events (AE) under the Pharmacovigilance Programme of India (PvPI). 
Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement stated that, “Medicines are developed over a period of several years. Efficacy and safety of a new drug are generally studied on a few thousand carefully selected and followed up trial subjects and patients according to strictly defined criteria. For this reason only very frequent adverse reactions and mainly those depending on the drug's pharmacological properties can be observed during its clinical development. Once the product has been placed on the market, a much larger, and also often polymorbid population will be exposed, which may lead to a change in the drug's known safety profile. Adverse drug reactions can then be observed more frequently, these new adverse reactions, should be reported without delay as a contribution to a potentially still incomplete safety profile. If such information is consistently forwarded to the competent authorities, unknown risks can be identified and tackled. ”
“Healthcare professionals and patients can report Adverse Drug Reactions due to Medicines, Vaccines, Medical-devices, blood products, Herbals products and others.

ADR/AE reporting can help all of us in our practice to know whether a particular effect is actually a side effect of a Drug or not and decide whether the production of that Drug needs to be stopped. IMA feels that reporting of such ADR/ AE under PvPI is the only means to know about the adverse effects of various drugs. In the interest of society, IMA has taken this step as a major project. Doctors and patients should be more proactive about reporting adverse drug events. ADR monitoring and reporting is still inadequate in India. Current adverse drug incident reporting system need to be improved, moreover, strengthening nursing medication and monitoring systems is also required”, added Dr. K.K Aggarwal.

Pharmacovigilance Programme of India started with the Vision to improve patient safety & welfare in Indian population by monitoring drug safety and thereby reducing the risk associated with the use of medicines. Healthcare professionals and patients can report Adverse Drug Reactions due to Medicines, Vaccines, Medical-devices, blood products, Herbals products and others through the IMA-PvPI ADRs reporting mobile no. 9717776514, 9:00 AM-5:30 PM, Monday-Friday.