December 15   2015, Monday
emedinexus
EDITORIAL

Dr KK AggarwalDr KK Aggarwal Optimistic patients fare better

The human mind is very powerful. And, the state of our mind has a great impact on how we react to events and manage critical periods in our life.

In a study reported in the journal Circulation: Cardiovascular Quality and Outcomes by Jeff C. Huffman, MD, of Massachusetts General Hospital in Boston, and colleagues found that optimistic individuals were more physically and had fewer readmissions for cardiac reasons within 6 months of the episode of acute coronary syndrome acute, while, this was not so in patients who were grateful. This single center study therefore suggests that what patients feel positive about can make a difference in outcomes after an acute event.

One hundred and sixty-four patients enrolled in the GRACE study were included when they were hospitalized for an ACS between 2012 and 2014. Two weeks post hospitalization, the optimism and gratitude of participants were measured, using the Life Orientation Test-Revised and Gratitude Questionnaire-6 scores, respectively. At 6 months, biomarkers of systemic inflammation along with cardiac readmission rates were evaluated.

Patients who were optimistic had lower levels of TNF-alpha, sICAM-1, and hs C-reactive protein. But being optimistic did not correlate with all-cause readmissions. But, after additional adjustment for medical comorbidity in an exploratory analysis, optimistic patients still had 8% lower risk of cardiac readmission. Grateful patients, on the other hand, only had a slight decrease in TNF-alpha levels and no other benefits measured.

The authors suggest that “benefits from positive psychological states may be more related to behavior than to a direct decrease in systemic inflammation or other circulating markers, at least in the early post-ACS period.”

This study reaffirms that clinicians can play an important role in keeping their patients optimistic. It is important to evaluate the level of optimism following any acute event and provide support to patients to manage their illness.

Indian Medical Association versus UOI (NCERT) matter

This is to inform you that the matter titled as "Indian Medical Association versus Union of Indian & Ors." (NCERT) matter was listed for hearing today before High Court of Delhi. Mr. Rahul Gupta, Advocate appeared and argued the said matter on behalf of Indian Medical Association and had duly submitted before the Hon'ble Court that IMA has certain objections as mentioned in the affidavit filed on behalf of IMA. The Hon'ble Court has directed the counsel appearing on behalf of NCERT to seek instructions on the objections as mentioned in the affidavit and has listed the matter for final hearing on 16.12.2015.
Breaking News

Mucosal healing should be the goal of treatment in IBD

Mucosal healing is associated with improved long-term outcomes in both Crohn's disease and ulcerative colitis. In a systematic review and meta-analysis presented in a poster session at the Advances in Inflammatory Bowel Diseases meeting, the odds ratio for long-term clinical remission in patients with Crohn's disease was 2.80 (95% CI 1.91-4.10), according to Shailja C. Shah, MD, of the Icahn School of Medicine at Mount Sinai in New York City. And the odds ratio (OR) for long-term clinical remission with early mucosal healing for patients with ulcerative colitis in another meta-analysis was 4.88 (95% CI 2.54-9.37)... Medpage Today

Health Ministry sets up committee to change PCPNDT rules with reference to record keeping

The Union health ministry has set up a committee to amend the PCPNDT rules with reference to record keeping by the radiologists. The ministry's move is in response to demands made by the radiologists in the regard subsequent to sentencing of a Pune based radiologist for a year’s imprisonment for violating Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act. According to the radiologists, the rules are stringent with equal punishment for sex determination and clerical errors. Therefore, they have called for changes in the PCPNDT rules with reference to record keeping so that rules governing it could be made more practical and compliant friendly… (Pharmabiz – Shardul Nautiyal)
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Specialty Updates
• Findings from a new study, presented at the San Antonio Breast Cancer Symposium and published on December 10 in The Lancet, suggest that in postmenopausal women with ductal carcinoma in-situ (DCIS) who underwent lumpectomy plus radiotherapy, those given tamoxifen complained of more severe hot flashes, while anastrozole users reported greater severity of vaginal dryness and muscle and joint pains. Additionally, hot flashes, weight problems, vaginal symptoms and gynecological symptoms were worse in women <60 years old than those 60 years or older.

• A recent study published in Pediatric Obesity suggests that young girls who are either overweight or obese during childhood were more likely to remain obese as they progressed into young adulthood compared to boys.

• A new study presented at the annual meeting of the American College of Neuropsychopharmacology revealed that female infants have larger volumes of gray matter around the temporal-parietal junction of the brain than males at the time of birth. Sex differences in this area of the brain may be a clue as to why males are at higher risk for certain forms of autism spectrum disorders.

• More than 90% of patients with sickle cell disease remained alive and free of clinical events 3 years after receiving HLA-matched sibling stem-cell transplantation, reported data from an international registry presented at the American Society of Hematology meeting.

• The birth rate is declining in all industrialized countries, and besides socioeconomic factors and women's age, male reproductive health and environmental factors are also significant contributors, concluded a new scientific review article published in the journal Physiological Reviews. Researchers stated that environmental factors had a significant role to play in male reproductive problems.

• Spending large amounts of time participating in sedentary behaviors, such as watching TV and checking the computer, by patients with CAD can worsen various cardiometabolic markers—even if the patients also spend time exercising, suggests a secondary analysis of the Efficacy and Economics of Exercise Maintenance Post-Cardiac Rehabilitation (ECO-PCR) study, published online in the European Journal of Preventive Cardiology.

• Canakinumab and tocilizumab are more effective biologic agents than rilonacept in treating systemic juvenile idiopathic arthritis (sJIA), reported a new meta-analysis of short-term, randomized controlled trials published in Rheumatology.

• Evaluating and treating patients suspected of having an acute stroke in a mobile unit using telemedicine to communicate with a neuroradiologist and stroke physician is feasible, and it may be a cost-effective way of introducing prehospital stroke treatment. The study published in JAMA Neurology also showed that patients cared for by the mobile unit received tissue plasminogen activator (tPA) more quickly than those who received treatment in the hospital.
eSPIRITUAL
Why do we never eat a breakfast of onion?

Anything which cannot be taken as a full meal is not good for health and either should not be taken or taken in a small amount. For example, we never eat a breakfast of onion or garlic or radish. These are the items, which either should not be taken or eaten only in small quantity only as an accompaniment to the main meal. Onion is good for health and has anti–cholesterol and also blood thinning properties, yet it is consumed only in small quantity. In Vedic language, onion has both rajasik and tamasik promoting properties, which make a person more aggressive and dull. .
IOACON 2015
President’s Lecture

Deformity correction

Dr HR Jhunjhunwala, Mumbai

The iconic Dr Jhunjhunwala began his talk to a packed audience.

• Understanding the limb alignment and malalignment is a critical test for orthopedic surgeons who treat children and adults with deformities.
• Considerable efforts to improve functionality by straightening crooked bones to achieve anatomically correct alignment.
• The deformity must be characterized: If bone is angulated, what is the direction? What is the level of deformity? Where is the apex of deformity? Is the bone short or rotated on its axis?
• It is very important to know what the normal alignment is.
o The center of hip joining the center of ankle must fall in the center of the knee. This is normal mechanical axis.
o If it falls lateral to the center of the knee it is a valgus deviation of mechanical axis.
o If it falls medial to the center of the knee, it is a varus deviation of mechanical axis.
• Center of rotational axis (CORA) is the intersection point of the proximal and distal mechanical or anatomical axis lines.
• The axis line of the proximal bone segment is called the proximal mechanical axis or proximal anatomical axis line.
• The axis line of the distal bone segment is called the distal mechanical axis or distal anatomical axis line.

Presidential Guest Lecture

Turning an old leaf analyzing orthopedics

Dr SS Yadav, Mirpur

It’s a singular pleasure and privilege to deliver the Presidential guest lecture and for this I have to thank the organisers, said Dr S S Yadav in his talk. I strongly believe that if you need to move forward you have to look back and learn from the past. I am particularly addressing the youngsters in the profession as our ancestors have made a pavement for us and we must make a ‘need–based’ highway on this. Vit M is a very crucial vitamin and is needed to make the right decisions, Dr Yadav said.

• The existing facts
o There has been a phenomenal progress in the Specialty.
o There has been a ‘Tsunami’ of Techniques.
o There is a Sea of overwhelming confusion & complications.
o But anything that is new & costly is not always good.
o We have to be very–very careful…

• Philosophy of fracture treatment
o It has always generated controversy. There are no agreed recommendations in this regard. Natural healing is the Gold Standard.
o Basic requirement–Recall (Joseph Amesbury 1831)
o "To put the fragments of a fractured bone into their proper situation, which is called setting the fracture, is one thing. Keeping them there, during the uniting process is another".
o Some of the suggestions are so dynamic that their suggestion have not been bettered.

• The Existing – Confusion
o The present research is debatable?
o Much depends on education & training of the Surgeon.
o The Vendors are putting pressure on Surgeon, Hospital, Service Centers & the Patient himself (NET)
o The Journals are under pressure to publish some of the Debatable Manuscripts.
o Before the previous learning curve is over, a New Design comes in.

• Technology is very good for machines like computers & telephones, but in the human body we need to go a step further ‘Biology’. Thus, all technologies have got to be ‘biologically’ oriented.
• It is not always essential that a costly technique is more advantageous.
• We have made mistakes in the past.
• To keep ‘Balance’, the Pendulum must swing both ways.
• We always have been the followers since long. Let us be the ‘Leaders’ in advocating Simple, Biological & Cost–effective techniques. The Globe might/ will appreciate.
• Revisit the Old Themes on the New Canvases
o We have a rich heritage.
o Principle–based Research.
o Role of a role–model.
o Relive history & experience it.
o Headlines always do not reveal the Truth.
o Do not run, otherwise you will Run–away.
o Technique may change but not the good qualities of a doctor.
o Leave behind a strong & meaningful legacy.

• We have a treasured Past.
o We owe a lot to the Indians who taught us how to count, without which no worthwhile scientific discovery could have been made. Albert Einstein
o Our information age is rooted in Indian innovations including the number ‘zero’. Barack Obama
o Intellectual potentialities of the Indian Nation are unlimited. Andre Wei
o The deeper you dive, the more treasures you find. Mahatma Gandhi
o We need ‘Thought–Leaders’ in Ortho, who can be on the forefront of the ‘Need–based’ Innovation. Indian wisdom must prevail.

• Let us listen to our "Inner–Voice"
o It appears we have lost something. We are devoid of some important ingredients of our profession & commitment to our patients. Something has profoundly changed ourselves.
o A bright star has got its own energy but to light a lamp in the dark is more meaningful & powerful.
o Let us go through the ‘Old’ leaves and then turn to the ‘New’ pages to be the Leaders in the World.
• Most certainly we do not wish to create a situation of conflict when there is a potential threat to the National treasures.
• We do not only try the ring the bell and mobilize the International Community but also try to find the best ways of influencing the like–minded colleagues.
• After every Action, there is a Reaction & Repercussion. Making a point is more impotent than winning an argument.
• The Purpose Driven Life
o Man is Mortal and Life is very short. The curtain rises and the curtain fails.
o However, each day is a challenge and a challenge is an opportunity to solve the unsolved problems, especially those which are ‘Need–based’.
o There are common problems that concern us all, the majority and the society at large. Let us adopt a path, follow a direction that takes us to such a common goal. Let us now decide what should be on our Agenda?
The Year in Medicine 2015: News That Made a Difference
EMPA-REG OUTCOME: Results of the Landmark Trial

The landmark trial EMPA-REG OUTCOME has for the first time shown superiority of a glucose-lowering drug in a cardiovascular-outcomes trial. The trial reported that patients with type 2 diabetes and established cardiovascular disease receiving the glucose-lowering agent empagliflozin (Jardiance, Boehringer Ingelheim/Lilly), a sodium glucose cotransporter-2 (SGLT-2) inhibitor, were less likely to die than those taking placebo. In the study, 39 patients needed to be treated with empagliflozin for 3 years to prevent one cardiovascular death. Similar trials with diabetes drugs from other classes have demonstrated only neutrality i.e., cardiovascular safety. Urging caution, Silvio Inzucchi MD, of the Yale Diabetes Center, New Haven, Connecticut and coauthors note that they had only recently seen the results of EMPA-REG and more research is required to understand the mechanisms by which this SGLT-2 inhibitor is exerting its seemingly beneficial effects. In addition, the trial population studied in EMPA-REG — type 2 diabetes patients with existing cardiovascular disease — is not representative of all patients with the condition. (Medscape)
Legal Quote
Indian Medical Association Vs. V.P. Shantha & Ors 1996 AIR 550, 1995 SCC (6) 651

" In the matter of professional liability professions differ from other occupations for the reason that professions operate in spheres where success cannot be achieved in every case and very often success or failure depends upon factors beyond the professional man's control. "
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Relevant laws in India

• MCI Ethics regulations declaration oath: “I will respect the secrets which are confined in me.”
2.2 Patience, Delicacy and Secrecy: Patience and delicacy should characterize the physician. Confidences concerning individual or domestic life entrusted by patients to a physician and defects in the disposition or character of patients observed during medical attendance should never be revealed unless their revelation is required by the laws of the State. Sometimes, however, a physician must determine whether his duty to society requires him to employ knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable disease to which he is about to be exposed. In such instance, the physician should act as he would wish another to act toward one of his own family in like circumstances.
7.17 A registered medical practitioner shall not publish photographs or case reports of his / her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed.
7.18 In the case of running of a nursing home by a physician and employing assistants to help him / her, the ultimate responsibility rests on the physician.
7.19 A Physician shall not use touts or agents for procuring patients.
7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch.
7.22 Research: Clinical drug trials or other research involving patients or volunteers as per the guidelines of ICMR can be undertaken, provided ethical considerations are borne in mind. Violation of existing ICMR guidelines in this regard shall constitute misconduct. Consent taken from the patient for trial of drug or therapy which is not as per the guidelines shall also be construed as misconduct.
2.3 Prognosis: The physician should neither exaggerate nor minimize the gravity of a patient’s condition. He should ensure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.
2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.
7.16 Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be.
• According to MMC, Maharashtra medical council rules and regulations published on its website, if any medical organisation wants foreign doctors to perform any live surgery, it has to not only take permission from the state council, but also submit the documents for the council's review.
IMC Act: 15. Right of persons possessing qualifications in the schedules to be enrolled.
1. Subject to the other provisions contained in this Act, the medical qualifications included in the Schedules shall be sufficient qualification for enrolment on any State Medical Register.
2. Save as provided in section 25, no person other than a medical practitioner enrolled on a State Medical Register:-
a. shall hold office as physician or surgeon or any other office (by whatever designation called) in Government or in any institution maintained by a local or other authority;
b. shall practice medicine in any State;
c. shall be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law to be signed or authenticated by a duly qualified medical practitioner:
d. shall be entitled to give evidence at any inquest or in any court of law as an expert under section 45 of the Indian Evidence Act, 1872 on any matter relating to medicine.
3. Any person who acts in contravention of any provision of sub-section (2) shall be punished with imprisonment for a term which may extend to one year or with fine which may extend to one thousand rupees, or with both;
(To be contd.)
IMA Satyagraha
https://www.youtube.com/watch?v=UV1zCH33BlU
IMA Poll
http://www.ima-india.org/ima/ima-poll.php
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Provisional programme for the ensuing meeting of the Central Council

Dear Colleague

The provisional programme for the ensuing meeting of the Central Council to be held from 27th (Sunday) to 28th (Monday) December, 2015 at Hotel Le Meridien, New Delhi is as below.

This year, the Central Council will not only have issues related to IMA but also have interactions with top luminaries of the country connected with issues related to health.

Kindly send your names, suggestions with questions related to the Agenda, in advance to us so that the same can be incorporated in the various discussions during the Central Council Meeting, as this CC Meeting is absolutely packed minute by minute. To conduct Central Council smoothly, we request your cooperation.

Please note that the whole meeting of the Central Council will be live webcast.

Dr A Marthanda Pillai                                                                                                                             Dr KK Aggarwal
National President                                                                                                                              Hony Secretary General

27–12–2015 (Sunday)
 
Registration
 
08:00 – 08:10 AM
Inviting of leaders to the Dais
Adornment of National President with the Presidential Medallion
 
08.10 – 08:20 AM
Invocation of the IMA Prayer
Flag Salutation
Homage to departed souls
Approval of Minutes of the 135th Ordinary Meeting of IMA Central Council
 
08:30 – 09:00 AM
Dr A Marthanda Pillai
Presidential Address
09:00 – 09:30 AM
Shri Ashok Chakradhar, Padma Shri Awardee
Laughter the best medicine
09:30 – 10:00 AM
Sh Rajat Sharma, Editor, India News
How media perceives the doctors
10:00 – 10:30 AM
Dr K K Aggarwal
Address by Honorary Secretary General
10:30 – 11:00 AM
Sidharth Luthra, Former ASG
CPA vs Council vs IPC vs specific laws
11:00 – 11:30 AM
CC Continues
Satyagraha Update
11:30 – 12:00 NOON
Sh D K Jain (invited)
National Consumer Dispute Redressal Commission
12:00 – 12:30 PM
IMA Update
Membership, Miscellaneous
12:30 – 01:00 PM
Justice Vipin Sanghi, Justice G S Sistani, High Court Judges (invited)
Duties of a medical professional
01:00 – 02:00 PM
LUNCH
 
02:00 – 02:30 PM
IMA Update
RNTCP, Child Sexual abuse, UNESCO
02:30 – 03:00 PM
Sh. Sushil Chandra, Member CBDT
Income tax and medical profession
03:00 – 03:30 PM
IMA Update
IMA Accreditation Council, CME Hours
03:30 – 04:00 PM
Sh. Maninder Singh, ASG
Legal open house
04:00 – 05:00 PM
Shri JP Nadda, Hon’ble Minister of Health
 
05.00 – 07.00 PM
Sh. Satyendra Kumar Jain, Health Minister, Delhi
Reception at 2 Raj Niwas Road
07.00 PM onwards
Banquet hosted by IMA HQs at Asiad Tower Garden (Asian Complex adjacent to Sri Fort Auditorium, New Delhi)
28–12–2015 (Monday)
 
08:30 – 09:00 AM
Dr Ved Prakash Mishra, MCI
Medical education
09:00 – 09:30 AM
CGP, AMS, AKN, JIMA, NPPS, NSSS, Health Scheme, Pension Scheme, HBI, International wing
Reports by wings of IMA
09:30 – 10:00 AM
CSI / AI/ IAP/ NNF/ FOGSI/ QCI
 
10:00 – 10:30 AM
VP, FSC, BSC, YD wing, students wing, Disaster Management
IMA reports
10:30 – 11:00 AM
Shri B S Bassi, Police Commissioner, Delhi
Violence against doctors
11:00 – 11:30 AM
IMA Lybrate, IMA Kent, IMA USV Initiatives
New Initiatives
11:30 – 12:00 NOON
Shri Nalin Kohli, Media Personality
How to face a TV Debate
12:00 – 12:30 PM
Mental health, MMR, IMR, RTA, BMW disposal, Elderly care, safe sound, diabetic blindness, Mediation Cell
New initiatives
12:30 – 01:00 PM
 
 
01:00 – 02:00 PM
LUNCH
 
02:00 – 02:30 PM
Guest lecture
Pediatric Update
02:30 – 03:00 PM
Dr Harsh Vardhan, Minister of Science and Technology, GOI (invited)
Medical Research
03:00 – 03:30 PM
Mental health, MMR, IMR, RTA, BMW disposal, Elderly care, safe sound, diabetic blindness, Mediation Cell
New initiatives
03:30 – 04:00 PM
Shri Sanjay Jaiswal, Member of Parliament
Rural Health options
04:00 – 04:30 PM
CC Meeting
Other issues
04:30 – 05:00 PM
Shri G N Singh, DCGI
Pharmacovigilance Program
05:00 – 07:00 PM
IMA National Awards Function

Dr Jitendra Singh, Hon&rsble Minister of State of Science & Technology, as Chief Guest

Shri Rajyawardhan Rathore, Minister of State of Information & Broadcasting as Co-Chief Guest (Invited)
07.00 - 08.00 PM
Dr S S Agrawal

Shri Mukul Rohatgi, Attorney General of India

Dr Mahesh Sharma, Minister of State for Culture, Tourism & Civil Aviation
Installation of Team IMA – 2015-2016, followed by 136th Ordinary Meeting of Central Council of IMA

Chief Guest

Co-Chief Guest
08.00 PM onwards
Dinner
 
To

Dr RVS Surendran
President, IMA Tamil Nadu State

Sir

At this moment of natural fury, Indian Medical Association stands with you to support and help. Indian Medical Association HQ Disaster Management Cell has appealed to its members for generous donation for the needy people affected by the flood.

Please inform us about the need and requirements to carry out the rehabilitation and Medical help to the affected people. IMA HQs will try to provide help in its best ability.

We also request you to inform us regularly about the activities done by IMA Tamil Nadu with regards current floods in the state.

Dr A Marthanda Pillai                                           Dr KK Aggarwal                                                  Dr Chetan N Patel
President                                                                Hon Sec General                                                         Chairman
IMA HQ                                                                           IMA HQ                                                             IMA HQ DMC
ART Bill seeking to regulate research on human embryos may be passed during current session

The Assisted Reproductive Technology (Regulation) Bill, which is likely to be passed during the ongoing session of Parliament, will regulate research on human embryos in the country. As per the draft Bill, the sale of any human gametes and embryos or their transfer to any country outside India, for research is absolutely prohibited. The import or export of frozen human gametes and embryos shall be considered as transfer of biological material for therapeutic use and shall be permitted as per the rules made in this behalf for exchange of human biological material and with the permission of the National Registry of the Assisted Reproductive Technology Clinics and Banks in India of the Indian Council of Medical Research (ICMR). Research shall be conducted on such gametes and embryos that have been donated for such purpose in India only. No research shall be conducted using embryos except with the permission of the National Registry of Assisted Reproductive Technology Clinics and Banks in India of the ICMR… (Pharmabiz– Ramesh Shankar) ()
Inter-ministerial panel to push organ donation

To address the shortage of organs required for transplantation, an inter-ministerial panel has been set up to coordinate activities related to organ donation. Health Minister JP Nadda said, “An inter-ministerial coordination committee headed by secretary, Ministry of Health and Family Welfare, and comprising representatives from all ministries and departments concerned has been set up to coordinate various activities for the promotion of organ donation.” Financial assistance is being provided under the National Organ Transplant Programme for hiring transplant coordinators in hospitals and trauma centers. Financial assistance has been sanctioned for establishing four Regional Organ and Tissue Transplant Organisation (ROTTO) in Tamil Nadu, Maharashtra, Assam and Chandigarh … (New India Express.com)
AAP Releases updated schedule of Preventive Health Care Screening and Assessment for Children The American Academy of Pediatrics is publishing an updated schedule of its Recommendations for Preventive Pediatric Health Care, also known as the periodicity schedule, in the January 2016 issue of Pediatrics (published online Dec. 7). The changes include:

• The recommendation for routine vision screening at age 18 has been changed to risk-based assessment, based on evidence showing that fewer new vision problems develop in low-risk young adults.

• To help reduce dental cavities, the top chronic disease affecting young children, a recommendation has been added for fluoride varnish applications from 6 months through 5 years.

• Pediatricians are advised to use the CRAFFT (Car, Relax, Forget, Friends, Trouble) screening questionnaire as a tool to screen adolescents for drug and alcohol use.

• Depression screening has been added, with suggested screenings every year from ages 11 through 21, with suicide now a leading cause of death among adolescents.

• A screening for dyslipidemia, or high blood cholesterol levels, has been added for patients between 9 and 11 years old. The change reflected growing concerns about the growing epidemic of obesity in children.

• A risk assessment is added at 15 and 30 months for hematocrit or hemoglobin screening to help detect anemia, an iron deficiency.

• An HIV screen was added for adolescents between 16 and 18 years to address federal statistics showing that 1 in 4 new HIV infections occurs in youth ages 13 to 24 years old, and that about 60% of all youth with HIV do not know they are infected.

• Screen for cervical dysplasia, the presence of pre-cancerous cells on the surface of the cervix, only at 21 years (instead of risk assessment every year from ages 11 through 21).

• A screening for critical congenital heart disease using pulse oximetry has been added and should be performed in the hospital before newborn discharge. (AAP)
26 million women need humanitarian aid, says UN

Of the 100 million people in need of humanitarian assistance around the world; of these about 26 million are women and adolescent girls in their childbearing years, the United Nations Populations Fund has said in its State of World Population report for this year titled ’Shelter from the Storm’ released recently. According to the report, this year essential health needs of women remains neglected after natural disasters and conflicts even though whether women and girls live or die in a crisis often depends on access to basic sexual and reproductive health services like midwives and HIV prevention… (The Pioneer)
Key findings from the World Malaria Report 2015

• Globally, the number of malaria cases fell from an estimated 262 million in 2000 (range 205–316 million) to 214 million in 2015 (range 149–303 million).
• Globally, the number of malaria deaths fell from an estimated 839 000 in 2000 (range 653 000 to 1.1 million), to 438 000 in 2015 (range 236 000–635 000).
• Among children under five, the estimated number of malaria deaths, globally, fell from 723 000 in 2000 (range 563 000–948 000) to 306 000 in 2015 (range 219 000–421 000). The bulk of this decrease occurred in the WHO African Region.
• Most malaria cases (88%) and deaths (90%) occurred in the WHO African Region in 2015.
• Two countries, Nigeria and Democratic Republic of Congo, accounted for more than 35% of global malaria deaths in 2015.
• The WHO South–East Asia Region accounted for 10% of global malaria cases and 7% of deaths in 2015.
• The WHO Eastern Mediterranean Region accounted for 2% of global malaria cases and 2% of deaths in 2015.
• In 2014, 16 countries reported zero indigenous cases of malaria: Argentina, Armenia, Azerbaijan, Costa Rica, Iraq, Georgia, Kyrgyzstan, Morocco, Oman, Paraguay, Sri Lanka, Tajikistan, Turkey, Turkmenistan, United Arab Emirates and Uzbekistan. Seventeen countries are reporting fewer than 1000 cases of malaria. (WHO)
IMA JIMA

http://module.ima-india.org/ima/jima/2015/September/
Bioethical issues in medical practice
Protecting the privacy and confidentiality of patients

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

You are a member of an informal discussion group of doctors who meet regularly to discuss difficult cases. At all these discussions, the conversation is frank and detailed, with all details of the patients, social situation, family issues etc. are discussed threadbare. Sometimes this discussion spills over into the hospital lifts, corridors and canteens. When these issues are really interesting, you discuss them at home with your spouse– a doctor– as well. Many times the name, address, and other details of patients are discussed as well.

a) Do such discussions breach medical confidentiality?
b) At which places should medical cases be discussed?
c) Should interesting medical cases be discussed at home?

Any suggestions? Do write in!

Adapted from: Bioethics Case Studies (AUSN and EEI, November 2013): http://www.eubios.info/

Responses received

Medical discussions of difficult cases are very important from the doctor’s point of view and also from the patient’s point of view. They should definitely be discussed at home, in medical get-togethers, but not in lifts, hotels and public places. Medical science is based on discussions and exploration of the knowledge what one has. Dr BR Bhatnagar
eWELLNESS
Sugar, not salt, may be at fault for high BP

Sugar, not salt contributes to the majority of the hypertension risk associated with processed food and a reduction in the consumption of added sugars and, in particular, processed foods may translate into decreased rates of hypertension as well as decreased cardiometabolic disease. James J. DiNicolantanio, PharmD, from Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, published their review of epidemiological and experimental studies in the journal Open Heart. They concluded that high-sugar diets may make a significant contribution to cardiometabolic risk. Highly refined processed foods should be replaced by natural whole foods.
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
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Inspirational Story
The blind boy!

A blind boy sat on the steps of a building with a hat by his feet. He held up a sign which said: “I am blind, please help.” There were only a few coins in the hat. A man was walking by. He took a few coins from his pocket and dropped them into the hat. He then took the sign, turned it around, and wrote some words. He put the sign back so that everyone who walked by would see the new words. Soon the hat began to fill up. A lot more people were giving money to the blind boy. That afternoon the man who had changed the sign came to see how things were. The boy recognized his footsteps and asked, “Were you the one who changed my sign this morning? What did you write?” The man said, “I only wrote the truth. I said what you said but in a different way.” What he had written was: “Today is a beautiful day and I cannot see it.” Do you think the first sign and the second sign were saying the same thing?

Of course both signs told people the boy was blind. But the first sign simply said the boy was blind. The second sign told people they were so lucky that they were not blind. Should we be surprised that the second sign was more effective?

Moral of the story: Be thankful for what you have. Be creative. Be innovative. Think differently and positively.

Invite others towards good with wisdom. Live life with no excuse and love with no regrets. When life gives you a 100 reasons to cry, show life that you have 1000 reasons to smile. Face your past without regret. Handle your present with confidence. Prepare for the future without fear. Keep the faith and drop the fear.

Great men say, “Life has to be an incessant process of repair and reconstruction, of discarding evil and developing goodness…. In the journey of life, if you want to travel without fear, you must have the ticket of a good conscience.”

The most beautiful thing is to see a person smiling… And even more beautiful is knowing that you are the reason behind it!!!
eMEDI QUIZ
Formation of antibody against acetylcholine receptor in pemphigus can be explained by

a. Desmoglein compensation theory

b. Antibody excess prozone phenomenon

c. Anti idiotypic antibodies

d. Epitope spreading phenomenon

Yesterday’s Mind Teaser:The exaggerated lepromin test seen in cases of Lucio phenomenon is called as:

a. Mitsuda's reaction
b. Medina-Ramirez reaction
c. Fischer's test
d. Fernandez reaction
Answer for Yesterday’s Mind Teaser:b. Medina–Ramirez reaction

Answers received from: Daivadheenam Jella, Dr Avtar Krishan, Sri hari reddy nallagatla, Dr.Bitaan Sen, Dr.Jayashree Sen

Answer for 13th December Mind Teaser: Weakness never begins in the arms or facial muscles

Answers received from: : Dr.K.V.Sarma, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Kailash Chandra Sharma,
Readers column
Dear Sir, We read and enjoy emedinews daily and enjoy it. Regards. Dr K M Mishra
Humor
A newly married husband saved his wife’s mobile number on his mobile as "My life".
After one year of marriage he changed the number to "My Wife".
After 2 years of marriage he changed the number to "Home"
After 5 years of marriage he changed the number to "Hitler".
After 10 years of marriage he changed the number to "Wrong Number".
Press Release
The importance of maintaining good sleep hygiene on one’s overall health and well-being

New Delhi, Dec 14, 2015: Maintaining healthy sleep hygiene is essential for over-all health and well-being. While sleeping is something that each one of us do as a part of our day to day living, only a handful of people are aware of what comprises a good sleep hygiene and its importance.

Sleep hygiene is a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness. The most important sleep hygiene measure is to regulate ones sleep timings. So waking up and sleeping at around the same time each day, seven days a week is ideal. One must also sleep for the right number of hours as per their body requirement, not too little, or too excessive.

Your daily routines – what you eat and drink, the medications you take, how you schedule your days and how you choose to spend your evenings – can significantly impact your quality of sleep. Even a few slight adjustments can, in some cases, mean the difference between sound sleep and a restless night.

Speaking about the importance of sleep hygiene, Padma Shri Awardee Dr. A MarthandaPillai – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA in a joint statement said, “Majority of the Indian population remains unaware of the fact that common ailments such as obesity, depression, hypertension, diabetes, heart disease are all linked to an irregular sleep pattern. Sleep deprivation also is a key influencer of stressed relationships, decreased performance at school and work, accidental injuries, memory and cognitive impairment and a poor quality of life. It is thus essential that awareness be raised about good sleep habits and the importance of getting adequate sleep on a daily basis. The present generation is mostly found sleeping only for 3-5 hours in a day and then compensating their sleep requirements by sleeping for 14 hours on the weekends. This is extremely dangerous for their overall health. They also depend on caffeine and energy drinks to stay awake, which impact their overall cognitive ability. The time has come for each one of us to be cautious about the impact our day to day actions have on our health and take necessary preventions.”

A few practices which indicate a goodsleep hygiene include
• Get up at the same time every day

• Create a sleep sanctuary

• Reserve your bedroom for sleep and intimacy.

• Banish the television, computer, smartphone or tablet, and other diversions from bedroom’

•Nap only if necessary. Taking a nap at the peak of sleepiness in the afternoon can help to supplement hours missed at night. But naps can also interfere with your ability to sleep at night and throw your sleep schedule into disarray.

• If you need to nap, limit it to 20 to 30 minutes.

•Avoid caffeine after noon, and go light on alcohol.

• Caffeine can stay in your body for up to 12 hours.

•Alcohol can act as a sedative, but it also disturbs sleep.

•Get regular exercise, but not within three hours of bedtime.

• Exercise acts as a short-term stimulant.

• Try to go to bed and get up at the same time every day — at the very least, on weekdays. If need be, use weekends to make up for lost sleep.
IMA,IJCP,HCFI
IMA,IJCP,HCFI
IMA,IJCP,HCFI