November 15   2015, Monday

Dr KK AggarwalDr KK Aggarwal Dear Leaders

Team IMA thanks all the members, state and branch presidents/secretaries and senior leaders for ratifying and approving the decision of postponing the protest/Satyagraha planned on November 16th.

It is for the first time that the central government has constituted an inter-ministerial committee headed by additional secretary health with MCI and three IMA representatives to address the problems of medical profession and public health. Apart from the five issues (Central hospital protection act, PCPNDT act, clinical establishment act, capping of compensation and AYUSH) any other point which IMA may have impinging on the above issues and other issues will also be considered by the committee in a time-bound manner (six weeks)

Issues concerned with public health and medical fraternity that were in existence for almost 15 years are going to be addressed by the government and a solution is expected thereof. The government order (No. Z.17016/5/2015-Cdn-I, dated 10th November 2015) also commits to taking expeditious action upon receipt of the recommendation of the committee.

It goes without saying that the unity and single handed determination every member of IMA particularly the local and state branch presidents/secretaries shown have forced the government to the negotiation table. You have proved that IMA can achieve any goal if there is unity and determination.

We have only won a battle and not the war. We have a long way to go. The amount of pressure you are putting on MPs and MLAs has to be sustained because in spite of the government agreeing to our demands, since all the demands need amendments of the existing acts, the opinion of the Members of Parliament matters

Continue meeting MPs, MLAs, state ministers, political leaders and give the impression that this time Indian Medical Association means business and will not retract till our demands are met.

Keep up with the preparedness for protest/satyagraha and continue online campaign; at any moment we may be forced to resort to action. In case you have any comments, click here
Mr. Nilesh Aggarwal

We are extremely happy to have been part of IMA Satyagraha campaign and would like to congratulate the Indian doctor community as a whole. We are aiming to be a digital voice of all Indian doctors and will continue to work towards raising such important issues. Currently, we are in our Beta phase and we will soon be introducing features such as interesting cases, online CME's, conference updates etc. Please do register and read eMediNews, eIMANews as well as other engaging content on the website/app. You can also add other doctors to your network, find long lost alumni, chat and discuss cases, post questions for the medical fraternity, create your detailed medical resume and lots more.
Breaking News
FDA expands use of hepatitis C antiviral COMBO Harvoni
The US Food and Drug Administration (FDA) has okayed expanded use of the combination antiviral drug ledipasvir/sofosbuvir (Harvoni, Gilead Sciences) in patients with genotype 4, 5, and 6 chronic hepatitis C virus (HCV) infection and in patients coinfected with HIV. The FDA also approved a 12-week regimen of Harvoni plus ribavirin (RBV) as an alternative to 24 weeks of Harvoni for treatment-experienced genotype 1 patients with cirrhosis … (Medscape)

Home cooking means lower type 2 diabetes risk

Cooking meals at home was associated with a slightly lower risk of developing type 2 diabetes, said researchers at the annual conference of the American Heart Association. Those who ate 11-14 lunches or dinners prepared at home per week -- or about two meals per day -- faced a lower risk of diabetes compared with those who ate only six or fewer homemade meals a week (hazard ratio 0.87). In the 8 years of follow-up, those who ate more meals prepared at home had lower weight gain and risk of obesity (HR 0.87 for obesity), which could have accounted for the lower diabetes risk… (Geng Zong, PhD, at the Harvard T.H. Chan School of Public Health and colleagues) (Medpage Today)
Dr Good Dr Bad
New food allergies unique to Asian Indians

The first large-scale survey of food-allergic reactions in the Asian Indian population has revealed a difference in the patterns of food allergy between Asian Indian children living in the United States and white children and suggests the need to address allergies unique to their ethnic diet. The list of allergies in the Asian Indian children also included some unusual allergens besides the top eight allergens commonly seen in the general population. Tree nut, the most common allergy, was seen in 59% of the children, but it is not the most common allergy in the general population in the United States. Some of the Asian Indian children were allergic to besan, which is a chickpea flour, capsicum, which is a variant of green pepper, and Indian lentils, which are used in tur and masoor dals. Other allergens considered unique were avocado, banana, beef, bulgur wheat, coconut, corn, eggplant, food dye, garlic, ginger, green peas, jalapeno peppers, kiwi, melon, rice, and tomato… (Medscape)
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Make Sure
Indian Medical Association National Satyagraha for a Healthy India
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Specialty Updates
• Although limb pain is not included as a manifestation of migraine in international headache classifications, children and adults may experience recurrent limb pain as part of the migraine spectrum, suggests a new study presented at the XXII World Congress of Neurology (WCN).

• When considering ongoing treatment with lipid-lowering drugs, clinicians need to pay more attention to percent reduction in LDL cholesterol, rather than just focusing on actual LDL levels, suggested a new analysis from the JUPITER trial presented at the American Heart Association (AHA) 2015 Scientific Sessions.

• An ozone injection into the knee can relieve pain and improve quality of life for people with knee osteoarthritis, reported a randomized controlled trial presented at the American College of Rheumatology (ACR) 2015 Annual Meeting.

• Mass prostate cancer (PSA) screening before the age of 55 may not have any benefit over screening starting after the age of 55, reported a new 20 year analysis of 6822 patients, presented at the 7th European Multidisciplinary Meeting on Urological Cancers.

• A high body mass index (BMI) is linked to longer survival terms for several chronic serious diseases; however, a large European epidemiological study has shown that the protective effect is not applicable to all patients with a high BMI. The findings, published in the Journal of the American Society of Nephrology, indicate that chronic inflammation plays an important part in the so-called “obesity paradox.”

• Diabetic patients undergoing revascularization for multivessel coronary disease have a lower risk of death, heart attack, and serious complications if they receive CABG instead of PCI, especially if the setting is stabilized acute coronary syndrome, suggests Canadian registry data presented this week here at the American Heart Association (AHA) 2015 Scientific Sessions.

• For patients with moderate to severe chronic obstructive pulmonary disease (COPD), the dual bronchodilator combination of tiotropium plus olodaterol improves quality of life better than either therapy alone, according to an analysis of data from the Tiotropium+Olodaterol Fixed Dose Combination (FDC) Versus Tiotropium and Olodaterol in Chronic Obstructive Pulmonary Disease (COPD) (TONADO) studies.

• Quan Lan Lew, MD, from the Duke–National University of Singapore Graduate Medical School reported at the Kidney Week 2015 that a high intake of red meat appears to increase ESRD risk, and that replacement of red meat protein with other sources of protein has the potential to reduce this risk.
There is a ritual and tradition of offering food to God before eating

This is a Vedic reminder to oneself that one should eat only those foods that are offered to God. Each time you offer food to God, this reminder makes you change your decision and choices. For example, alcohol, tobacco, onion, garlic, radish, etc. are not offered to God. If they are part of your food, there are chances that you will not consume these food items, if you observe this ritual. Cheating is permitted out of 21 meals in a week. Over a period of time people have stopped following this ritual and now eat some foods, which cannot be offered to God in all their 21 meals. This is the reason why the incidence of lifestyle diseases is increasing in the community
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Legal Quote
Martin F. D' Souza vs Mohd. Ishfaq on 17 February, 2009; Civil Appeal No. 3541 of 2002

“An expert should be consulted in case of any doubt.”
Developing an Investment Portfolio: Responsibility of Doctors as Clients

• Understand their own interests and objectives.
• Understand the basic nature of investments.
• Have the discipline to maintain basic policies.
• Stay focused on the long-term objectives

(Source: IJCP)
22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Over two-thirds of Indian children prone to diabetes

Results of a new nationwide three-year-long survey have shown that 66.11% of Indian children have "abnormal levels of sugar" in their body, reveals. Of the 17,000 children screened pan-India, it was revealed that 51.76% comprise male children with abnormal HbA1c levels, with the highest prevalence among children in the western zone. The western zone showed the highest level -- 68.48% abnormality, while the southern zone showed the lowest -- 54.95% of this abnormality. The northern zone was in the second place at 64.71% with the eastern zone ranking third with 61.48%... (Economic Times – IANS)
Landmark study identifies mutations that lead to melanoma
A sequence of gene changes associated with melanoma progression has been identified and might lead to tools to help clinicians identify the subgroup of intermediate lesions likely to progress to invasive disease, according to findings published in the New England Journal of Medicine.
US hospital to offer uterus transplants
The Cleveland Clinic said it will be the first hospital in the United States to offer transplanted uteruses to 10 women beginning in the next few months. The clinical trial is open to women of childbearing age who are unable to become pregnant "because they were born without a uterus, have lost their uterus, or have a uterus that no longer functions," said a hospital statement. The transplants will come from deceased donors and will be temporary. Each organ will be removed after the recipient is able to bear one or two children. Sweden's University of Gothenburg achieved its first birth via a transplanted uterus in September 2014… (ET HEalthworld – AFP)
Facts about noise pollution
• The permissible work limit for noise is 8 hours for 90 dB, 4 hours for 95 dB and 2 hours for 100 dB.
• Normal conversation is 60 dB.
• A lawn mower is 90 dB.
• A loud Rock Concert is 120 dB.
Two African countries free of Ebola but risks remain
Two of the three countries hardest hit by the Ebola epidemic have been declared free of the disease, while the third has only limited transmission and no new cases in the week ending Nov. 8, according to the World Health Organization (WHO). Sierra Leone was declared free of the disease Nov. 7 after a 42-day period -- twice the Ebola incubation period -- in which no new cases were reported. Liberia had been declared free of Ebola Sept. 3. Both countries are now in a 90-day period of heightened surveillance intended to ensure that the disease does not recur, as happened in Liberia in July. Meanwhile only four new cases have been reported in Guinea in the past 21 days, the WHO said in its weekly situation report on the epidemic, and all involve members of a single family in the Forécariah prefecture, in the southwestern part of the country… (Medpage Today)
Guidelines on Health

• Keep your blood cholesterol less than 160 mg%. Even 1% reduction in cholesterol reduces the chances of heart attack by 2%.
• Uncontrolled diabetes and blood pressure can precipitate a heart attack. Keep these under check.
• Eat less, walk more.
• Regular exercise is good for health. The best exercise is 'walking', which is a brisker than brisk walking.
• Soya products are good for health. These should form an essential ingredient of the diet.
• Fruits are better than juices.
• Brown rice is better than polished rice and jaggery is better than white sugar.
• Eat high fiber diet.
• Driving and drinking do not go together.
• Pregnant women must not drink. It harms the baby in the womb.
• Get your health check-up done at least once in a year.
• Salt intake should be restricted.
• Avoid APC where A stands for achar, P for papad and C for chutney.
Bioethical issues in medical practice
Rights and duties of a parent

Smita N Deshpande

Head, Dept. of Psychiatry, De-addiction Services
PGIMER-Dr. Ram Manohar Lohia Hospital
Park Street, New Delhi

A girl suffering from intellectual disability, serious enough so that she could not take care of herself became pregnant at the care home. By the time the pregnancy was discovered she was pregnant for over four months. The girl was admitted to a government hospital and assessed for MTP. The girl insisted- from the point of view of her limited understanding of the matter- that she wanted to keep the child and bring it up herself. Doctors at the hospital where she was admitted after the pregnancy was discovered were of the opinion that she was intellectually unfit to look after herself, what to say of a child. What should the doctors do?

a) Carry out MTP regardless of the girl’s wishes

b) Allow the pregnancy to continue possibly to the future detriment of the unborn baby.

c) Any other recourse such as going to court – but what if the court orders continuance of the pregnancy? Who will look after the baby?

Do write in with views and your solutions!

Responses received

• The pregnancy should be allowed to be continued. Efforts should be made to find out the father. He should be compelled to take care of the child and in case he is unable to take care of, he should be prosecuted for rape and child be sent to some social organisation along with the mother. Dr BR Bhatnagar
Inspirational Story
Burned biscuits

When I was a little child, my mom liked to make breakfast food for dinner every now and then. And I remember one night in particular when she had made breakfast after a long, hard day at work.

On that evening so long ago, my mom placed a plate of eggs, sausage and extremely burned biscuits in front of my dad. I remember waiting to see if anyone noticed! Yet all my dad did was reach for his biscuit, smile at my mom and ask me how my day was at school. I don’t remember what I told him that night, but I do remember watching him smear butter and jelly on that biscuit and eat every bite!

When I got up from the table that evening, I remember hearing my mom apologize to my dad for burning the biscuits. And I’ll never forget what he said: “Baby, I love burned biscuits.”

Later that night, I went to kiss Daddy good night and I asked him if he really liked his biscuits burned. He wrapped me in his arms and said, “Your Momma put in a hard day at work today and she’s real tired. And besides – a little burned biscuit never hurt anyone!”

You know, life is full of imperfect things… and imperfect people. I’m not the best housekeeper or cook. What I’ve learned over the years is that learning to accept each other’s faults – and choosing to celebrate each other’s differences – is one of the most important keys to creating a healthy, growing, and lasting relationship. And that’s my prayer for you today!
eMedi Quiz
Which one of the following is a recognized x-ray feature of rheumatoid arthritis?

1. Juxta-articular osteosclerosis.
2. Sacroilitis.
3. Bone erosions.
4. Peri-articular calcification.

Yesterday’s Mind Teaser:  High resolution computed tomography of the chest is the ideal modality for evaluating:

1. Pleural effusion.
2. Interstitial lung disease.
3. Lung mass.
4. Mediastinal adenopathy.

Answer for Yesterday’s Mind Teaser: 2. Interstitial lung disease.

Answers received from: Daivadheenam Jella, Dr Bitaan Sen & Dr Jayashree Sen, Dr Avtar Krishan.

Answer for 13th November Mind Teaser: 4. Progesterone therapy

Answers received from: B R Bhatnagar, Dr PK Sasidharan, Dr Bitaan Sen, Dr Jayashree Sen, Dr Avtar Krishan, Dr Poonam Chablani.
Wife or Mistress?

An architect, an artist and an engineer were discussing whether it was better to spend time with the wife or a mistress.

The architect said he enjoyed time with his wife, building a solid foundation for an enduring relationship.

The artist said he enjoyed time with his mistress, because of the passion and mystery he found there.

The engineer said, "I like both."


Engineer: "Yeah. If you have a wife and a mistress, they will each assume you are spending time with the other woman, and you can go to the lab and get some work done."
Readers column
Dear Sir, wonderful updation and coverage. Regards: Dr Saroj
Press Release
Open and honest communication between the patients and doctors key to reduce the increasing violence incidents against the medical fraternity

Maximum number of cases pertaining to violence on doctors are registered in he emergency circumstances, intensive care units (ICUs) or after a patient had undergone a specific surgery

The medical profession is highly respected and regarded by everyone in the society. However, it is also the most likely to be subjected to acts of violence when the demands of the patients’ relatives are not met. The inability of the patient’s family to understand in an emotional state of mind that doctors can try to save a person's life but cannot be successful each time is a leading cause of this.

What makes this worse is the absence of stringent laws to protect doctors. In this regard, the Indian Medical Association started a Satyagraha movement by initiating a petition along with eMediNexus - a leading doctor social networking platform. The petition signed by over 50,000 doctors put forward five demands to the Health Ministry. The demands cover important aspects such as the need to implement a cap on the compensation amount for medical negligence cases and the need for Central Hospital and Medical Doctors’ Protection Act. The Health Ministry has in return set up a special working committee that will review and work towards finding solutions to the problem in a period of three weeks.

The committee which has been ordered to be established by Shri JP Nadda – Minister of Health will consist of the Additional Secretary Health, Joint Secretary Law, Joint Secretary Home, Joint Secretary Home, and Joint Secretary Consumer Affairs. In addition to this, the committee will have three representatives of IMA and one from MCI.

Speaking on the issue of violence against doctors, Padma Shri Awardee Dr. A Marthanda Pillai National President IMA and Padma Shri Awardee Dr. KK Aggarwal - President HCFI & Honorary General Secretary of IMA said, “Seeing the drastic rise in the cases of violence against doctors, physicians are demanding for the formulation of new laws that will protect the doctors from any violence in case if the patients are not cured fully. We at IMA have appealed to the health ministry to review our pleas in this regard and are hopeful that together we can work towards eliminating violence against doctors.”

“In addition to the amendments done at the policy level, it is important that both the patient and doctor work towards establishing an effective communication strategy to elevate the chances of the patient's dissatisfaction. To help this plan work out in a better way, it has been suggested that ethics and effective communication skills be included in the medical curriculum, and all medical professionals should study the subject at all levels during the span of their career", Dr. KK Aggarwal added.

The Indian Medical Association feels that the need of the hour now is to act on the following points:

• Informed consent is required; a doctor should inform the patient about the condition and the course of the treatment, treatment options, and associated risks

• Patient understanding and involvement are central to effective treatment and recovery. Their active participation maximizes their benefit and safety

• The doctor and the staff must show care and compassion towards the patient

• Patients often have unrealistic expectations, which they may or may not be overtly aware of. A physician should discuss these and attempt to elicit them

• Doctors should make the patient understand that it is impossible for a doctor to know the exact cure for the disease at first consultation

• A stringent law should be made to save doctors from the violence resulting from unmet, unrealistic expectations • Clarity from the beginning is required for further successful diagnosis

• Integration and coordination of care are required so that the patients feel less vulnerable when faced with a disease