August 14  2015, Friday
eMedinewS
editorial
Normal Aging Changes
Dr KK Aggarwal
  • The heart rate shows less variability.
  • There is altered circadian pattern (24–hour cycle of the body).
  • There is a delayed response of bone marrow to loss of blood or hypoxia (reduced oxygen).
  • The function of the white blood cells is impaired.
  • Advancing age is a procoagulant stage. This means that the blood gets clotted easily.
  • Reflux of the stomach acid in the food pipe is common.
  • Tendency to constipation is common.
  • Painkillers can quite easily cause ulcers in the stomach.
  • Renal functions decline with age.
  • Older kidney is more prone to be damaged with painkillers.
  • Calcification of heart valves may occur.
  • The maximum heart rate may not reach the level as that in the young age in response to exercise.
  • About one–third of the lung volume may be lost.
  • Aging slows the rate of fracture repair.
  • Skin may become atrophic (thin) and elasticity is reduced.
  • A person may not be able to read small print.
  • There may be impaired speech recognition in noisy environment.
  • There may be loss of taste.
  • There may be loss of smell.
  • There may be high frequency hearing loss.
  • Immunity may be reduced.
  • With age, one is more prone to get urinary tract infection.
  • With age ejaculation may get impaired.
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eMedipics
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ICON 2015 IMACGP International Conference of Family Medicine organized by IMA HQs, New Delhi
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News
  • Respiratory Medicine/Gastroenterology
    Dr Mustafa Abdul-Hussein, of the Medical University of South Carolina in Charleston and coauthors report in the Journal of Clinical Gastroenterology that patients with cough or throat clearing are not likely to have gastroesophageal reflux disease (GERD). Patients with these atypical symptoms should undergo impedance-pH testing, rather than a trial of proton pump inhibitors (PPIs).
  • Oncology/Urology
    The ECOG E3805 CHAARTED trial published online August 5 in the New England Journal of Medicine has shown that adding docetaxel chemotherapy to androgen-deprivation therapy (ADT) in men with newly diagnosed metastatic disease dramatically improved survival, by more than a year compared with the use of ADT alone
  • Respiratory Medicine/Immunology.
    Tralokinumab did not significantly reduce asthma exacerbations in a phase 2b study of patients with severe uncontrolled asthma, but did provide hints of benefit in post-hoc subgroup analyses, which are now being further investigated in phase 3 trials. Tralokinumab is a human IL-13-neutralizing monoclonal antibody being developed by MedImmune, which funded the mid-stage study, conducted at 98 sites in North America, South America, Europe and Asia.
  • Respiratory Medicine.
    According to a study reported in the Annals of Internal Medicine, treatment of adults with community-acquired pneumonia with corticosteroids was associated with 3% lower mortality, 5% decline in need for mechanical ventilation and a 1-day shorter hospital stay.
  • Obstetrics & Gynecology.
    Women who have pregnancies less than a year apart may have a greater risk for osteoporosis later in life than those who wait longer between babies, as per the findings of a study in the journal Maturitas. Pregnancies no more than 12 months apart were linked to a four-fold higher risk of osteoporosis.
Forthcoming DST school camps
  • Sulabh Public School, Mahavir Enclave on 17th August
  • Mt Abu School, Rohini Sector 5, on 19th August
  • St Mathew School, Paschim Vihar, D Block on 20th August
Cardiology eMedinewS
  • According to findings derived from an analysis of the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI-2D) trial, a rise in cardiac troponin T is associated with an approximate doubling of the risk of cardiovascular mortality, MI, and stroke in patients with stable ischemic heart disease and type 2 diabetes. The findings are published in the August 13, 2015 issue of the New England Journal of Medicine.
  • New research published in the American Heart Journal suggests that prescribers giving too much importance to estimated glomerular filtration rate (eGFR) may be leading to the underuse of renin-angiotensin-system inhibitors (RASIs) after patients with kidney dysfunction have experienced an acute MI, new research suggests.
Pediatrics eMedinewS
  • Pediatric Cardiology. Fetal electrocardiographic (ECG) monitoring used in conjunction with conventional fetal heart rate monitoring did not reduce complications during childbirth. The additional monitoring did not reduce the risk for a composite of outcomes including fetal and neonatal death, and it did not significantly impact the rates of cesarean or operative delivery (New England Journal of Medicine).
  • Pediatric Neurology Some babies born just a week or two premature may later be developmentally unprepared for kindergarten, and screening these children at age two may not accurately predict whether they will be among the ones most at risk for falling behind in school. The late preterm kids were 52% more likely to be unprepared, according to a study reported online August 10 in Pediatrics.
Dr KK Spiritual Blog
Are We Honest?

Most of us are relatively honest. If I introspect myself, I consider myself as an honest doctor but when I go deep into introspection, I see that I am only relatively honest. I have given money to the TTE to get a reservation in a train, buy a cinema ticket in black, pay money to the electrician to get my electricity in time during functions etc.

Corruption is corruption whether it is for one rupee or 1 lakh rupee. Many of the current so called anti–corruption campaigners have purchased their houses by paying in black. Accepting donations from people who are not honest and from people who are donating from their unaccounted money is also corruption.

Only corrupt people approach a corrupt person and therefore for him every one is corrupt. The vice versa is also true.
Inspirational Story
The Three Races

In old times, a fable retells the story of the young athletic boy hungry for success, for whom winning was everything and success was measured by such a result.

One day, the boy was preparing himself for a running competition in his small native village, himself and two other young boys to compete. A large crowd had congregated to witness the sporting spectacle and a wise old man, upon hearing of the little boy, had travelled far to bear witness also.

The race commenced, looking like a level heat at the finishing line, but sure enough the boy dug deep and called on his determination, strength and power… he took the winning line and was first. The crowd was ecstatic and cheered and waved at the boy. The wise man remained still and calm, expressing no sentiment. The little boy, however, felt proud and important.

A second race was called, and two new young, fit, challengers came forward, to run with the little boy. The race was started and sure enough the little boy came through and finished first once again. The crowd was ecstatic again and cheered and waved at the boy. The wise man remained still and calm, again expressing no sentiment. The little boy, however, felt proud and important.

"Another race, another race" pleaded the little boy. The wise old man stepped forward and presented the little boy with two new challengers, an elderly frail lady and a blind man. "What is this?" quizzed the little boy. "This is no race." he exclaimed.

"Race!" said the wise man. The race was started and the boy was the only finisher, the other two challengers left standing at the starting line. The little boy was ecstatic; he raised his arms in delight. The crowd, however, was silent showing no sentiment toward the little boy.

"What has happened? Why don’t the people join in my success?" he asked the wise old man. "Race again", replied the wise man, "this time, finish together, all three of you, finish together." continued the wise man.

The little boy thought a little, stood in the middle of the blind man and the frail old lady, and then took the two challengers by the hand. The race began and the little boy walked slowly, ever so slowly, to the finishing line and crossed it. The crowd was ecstatic and cheered and waved at the boy. The wise man smiled, gently nodding his head. The little boy felt proud and important.

"Old man, I don’t understand! Who is the crowd cheering for? Which one of us three?" asked the little boy.

The wise old man looked into the little boy’s eyes, placing his hands on the boy’s shoulders, and replied softly, "Little boy, for this race you have won much more than in any race you have ever ran before, and for this race the crowd cheer not for any winner!"
Events
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Make Sure
Situation: A chronic smoker developed cancer of lung.
Reaction: Oh my God!! Why was he not screened earlier for cancer of lung?
Lesson: Make sure that all chronic smokers are given an option for lung cancer screening with low dose spiral CT.
Dr Good Dr Bad
Situation: A 80–year–old male patient with acute heart attack was posted for reperfusion therapy.
Dr Bad: Chew 300 mg aspirin.
Dr Good: Chew 300 mg aspirin and 75 mg clopidogrel.
Lesson: Start clopidogrel 75 mg as opposed to prasugrel for patients older than 75 years of age who are treated with fibrinolytic therapy.

(Copyright IJCP)
eIMA Quiz
What is a healthy blood pressure level?

A. 110/70.
B. 125/85.
C. 135/90.
D. 140/95.
E. 150/95.

Yesterday’s Mind Teaser: Which of the following may cause your hair to fall out by the fistful?

A. A medical condition like lupus, a thyroid disorder, or a recent high fever or case of the flu.
B. A fungal infection on the scalp.
C. Tight hairstyles (braids, extensions, cornrows, ponytails).
D. Hormonal shifts caused by pregnancy, changes in birth-control–pill use, or menopause.
E. All of the above and more.

Answer for Yesterday’s Mind Teaser: E. All of the above and more.
Answers received from: Dr Pandit Hantodkar, Dr A C Dhariwal, Dr Shangarpawar, Dr Avtar Krishan, Dr Poonam Chablani, VISWANATHA SARMA, Dr George F Moolayil, Daivadheenam Jella, Dr B R Bhatnagar, Dr K Raju.
Answer for 12th August Mind Teaser: a. Ineffective health maintenance
Correct Answers received from: Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr Bitaan Sen & Dr Jayashree Sen, Dr Poonam Chablani, Dr Shangarpawar, Dr G Madhusudhan.
eMedinewS Humor
A traffic slogan: Don’t let your kids drive if they are not old enough – or else they never will be
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Rabies News (Dr A K Gupta)
Can "major surgery" be conducted after the dog bite?

There is no contraindication for any surgery along with anti–rabies vaccination and a full course of anti–rabies immunization should be given, irrespective of the surgery or other procedures.
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
eIMA News
Save Small Medical Establishments

Dr A Marthanda Pillai, Dr K K Aggarwal

Draft with inputs from Team IMA

  • Single doctor clinic and approachable cost-effective small medical establishments with less than 10 beds provide over 80% of health care. Survival of these small hospitals has a very important bearing on the Indian healthcare system. They provide cheap, affordable, accessible, approachable, quality care with a personal touch.
  • The new corporate health care set up, whether single clinic or a 10-bed set up, is machine-centric and cost escalating. A lot of private equity is coming towards relatively low cost healthcare chains, which specialize in one field. Big hospital chains are rushing to small towns. But this ultimately will raise cost of treatment and the smaller establishments will start vanishing from the society
  • Smaller medical establishments, to cut costs, may be lacking in some aspects of hospitality and use of cutting edge technology. They will have core clinical care but may lack in support activities.
  • Small medical establishments, most being set up in neighborhood residential areas, save money in the land costs.
  • Any corporate set up buys land at high cost and involves huge capital expenditure for buying and replacing expensive equipments including hiring human resources
  • With over 100 Acts to comply with, the cost of any corporate set up is very high.
  • Unfortunately the insurance companies do not cover cost of patients in medical set-ups with less than 10 beds. Under Rashtriya Swasthya Bima Yojana (2007), for Rs. 30 a year each family receives 30K coverage in medical care. Out of 8 crore poor families, already 1.5crore families are enrolled. But, only 4000 hospitals are empanelled.
  • Smaller establishments, through the IMA, will need to fight for their rights. The minimal norms need to change to 5 bedded hospitals and not 10 bedded. Insurance companies need to recognize day care centers and single doctor clinics
  • Make sure the treatment cost is low & HIGH IN QUALITY.
    • Reduce the procedure cost and make profit through volume of work
    • Administrative costs to be contained to 3% of a patient's bill.
    • Adopt IT in health care: Use telemedicine in radiology, ICUs
    • Transform from GP to FP (Family physician) with GMP.
    • Smaller establishments also need to reduce their cost further and insist in quality. They must rely on cheaper quality drugs; learn the concept of ethical earning; buy equipments through equipment protection scheme of IMA; bargain on the costly of equipments through IMA; get their institution or clinic accredited by IMA and by NABH through IMA HBI; sign up for cheap maintenance of medical equipments through IMA and also extend the life of CT, MRI, Cath Labs and all these expensive machines from the current 7 years to 14 years through IMA. They also should adopt IT in health care and make hospitals paperless and filmless.
    • According to WHO standards, the number of beds required is 4 per 1,000 populations, so there is a tremendous scope for growth. Of this, small hospitals will contribute to 80% of the beds. Presently, it is almost a 600,000 crore industry; 20% of the $33 billion that Indians spend on healthcare, is spent in smaller towns.
    • IMA should fight for a single window clearance and permissions for these establishments.
    • IMA should pursue for amendments to insurance stipulations - empanelment to hospitals, clinics, day care centers irrespective of bed strength and floor-space index. Empanelment criteria should be categorized as rural, semi-urban and urban hospitals.
    • All doctors should use universal disease management protocols, stipulated and structured only by medical associations but not by Govt.
    • IMA should ask the government to provide soft loans (4% interest) to these set ups.
    • Small hospitals should be out of the ambit of CE Act, ESI regulations and FIRE SAFETY regulations. Small hospitals are professional service centers and not commercial outfits. Duty on medical equipments and devices should be removed.
New model of care (Pre-emptive care model)
eBOOKs
Kindly sign this petition: For allowing parliament to function
Link: https://www.change.org/p/members-of-parliament-political-parties-parliament-to-function-urge-all-political-parties-to-have-a-collaborative-and-consultative-process-in-the-parliament

Tiny url to pass on to other members: http://tinyurl.com/qff68sf

To sign, we can login through Facebook or email account on the right hand side.

Dr Marthanda Pillai,                        Dr KK Aggarwal
IMA Digital TV – Webcast Done So far
23rd July 2015 – TB Notification

6th August 2015 - Breastfeeding and Neonatal Skin Care

13th August 2015 - All About Vitamin D - IMA USV Initiative
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IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

Team IMA
ICON 2015
Stay in India, Says Govt; Don’t Force Us, Say Doctors in Maha
By Jyoti Shelar, Mumbai Mirror | Aug 13, 2015, 12.00 AM IST

MARD moves court against govt's decision which nullifies chances of doctors going abroad to practice.

Doctors in Maharashtra are a peeved lot as the government has stopped issuing a key certificate that enables them to practice abroad. They say they have been singled out as the education of IIT and IIM students is also subsidised but they have no obligation to work in India.

Taking its fight to the courts, the Maharashtra Association of Resident Doctors (MARD) has filed a writ petition against the Centre for putting a halt on the practice of issuing the No Obligation to Return to India (NORI) certificate.

Any doctor who wants to work in a foreign country needs a NORI certificate.

Doctors say that the government's move is a violation of their fundamental right and that they are free to work and stay outside India.

"Why only doctors? The government spends a huge amount of money on IIT and IIM students too," said Dr Sagar Mundhada, president of MARD. "We had no choice but to approach the judiciary," he said, adding that while IIT and IIM students are not expected to give returns, doctors have a compulsory bond to serve the government for one year.

Last week, health minister JP Nadda had said that the NORI certificate will not be issued under any circumstances, except to those above 65 years of age. The idea behind the move is to prevent medicine's 'creamy layer' from migrating to greener pastures. Government authorities claim that the key reason behind the poor doctor-patient ratio in India is doctors shifting abroad.

"It is an extremely haphazard decision by the government. Instead of looking at why so many doctors prefer to work abroad, the government is taking a short cut which will not work," said Dr Amol Annadate, paediatrician and neonatologist practicing in Marathwada. A student of GS Medical College attached to the KEM hospital, Annadate too headed to Australia after his masters. "I worked there for over 8 months but I had the urge to do something for people in my country," he said, adding that this decision was not easy as the system in India 'bends and breaks you'.

"The government should mend the problems ailing the medical education rather than forcing decisions on doctors," said Annadate, who runs his own 250-bed medical facility and is the only paediatrician and neonatologist catering to a population of over 4 lakh people in five talukas of Marathwada. The Indian Medical Association has not taken a stand on the issue yet. However, Dr KK Aggarwal, Secretary General of IMA said that there was nothing wrong with the government expecting doctors to come back and serve the country. "IMA has not decided its stand. This is my personal opinion," he said.
NEWS
  • A new review suggests that saturated fats, like those found in many dairy products and meat, may not be the big contributors to heart disease or early death that many think they are. (BMJ)
  • Testosterone replacement therapy showed no impact on subclinical atherosclerosis progression in older men with low- to low-normal testosterone levels in a 3-year, randomized clinical study. Medpage Today
  • A high proportion of reproductive-age women may be experiencing pelvic pain that goes untreated, according to a study by researchers from the National Institutes of Health and the University of Utah School of Medicine, Salt Lake City.
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Quote of the Day
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Over 50 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Mandi
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Reader Response
Dear Sir, Thanks for the information. Regards: Dr Kapila
Wellness Blog
Heart Aphorisms: Ten Commandments for a Healthy Heart
  1. Exercise and walking keeps heart talking
  2. High blood pressure puts heart under pressure
  3. Eating more salt makes heart halt
  4. Smoking thrills but kills
  5. Tobacco invitation to cancer death and destruction
  6. Rich fat food does heart no good
  7. Larger the waist line shorter the heart line
  8. Hard drink pushes heart to brink
  9. Heart attack immediate medication only solution
  10. Smoking and health you cannot chose both
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Press Release
Medical fraternity signs petition demanding that the Parliament be allowed to function

Indian Medical Association leads initiative; encourages more and more people to join the movement

Raising its voice against the ongoing disruption of the parliament, the Indian Medical Association urged its 2.5-lakh members to sign a petition against this. In addition to the IMA leadership comprising of Dr. A Marthanda Pillai (National President IMA) & Dr. KK Aggarwal, (Honorary Secretary General, IMA), leaders of the medical fraternity including Dr. Naresh Trehan (Chairman, Medanta – The Medicity), Dr. HK Chopra (President, CSI), Dr. Ketan Desai (President Elect, World Medical Association), Dr. Arul Rhaj (Former President, Commonwealth Medical Association, Dr. Vinay Aggarwal (Former President, CMAAO), Dr. Ajay Kumar (Council member, World Medical Association), Dr. Sudipto Roy (MLA from West Bengal) signed the ongoing petition on http://tinyurl.com/qff68sf which has received over 15,000 signatures already. They all unanimously demanded that the full functioning of the parliament be restored since it works against the overall healthcare benefit the Nation.

Speaking about the issue, Padma Shri Awardee, Dr A Marthanda Pillai, National President IMA & Padma Shri Awardee, Dr KK Aggarwal, Hony. Secretary General IMA in a joint statement said, “Democracy is our country’s biggest asset and we must work towards maintaining it. As representatives of the medical fraternity of India, we urge all political parties in India to put an end to the ongoing protests and let the parliament function smoothly and in harmony. These setbacks only hamper our country’s image in the Global eco-system. Instead we must focus on working towards strengthening the healthcare policies and legislations in our country to deliver a healthy India.”

“As we are all aware the healthcare burden in India is massive. Lifestyle diseases are on the rise, thousands continue to die just because they are unable to afford treatment and overall awareness levels about disease prevention measures amongst the masses is low. In such a case, we must put our energies towards finding a solution to these problems. We must enforce stricter policies in favor of hygiene, sanitation, disease prevention and nutrition.”

The Indian Medical Association also sent out an email and SMS to each of its members across the Nation asking them to support and join the movement.