February 15  2015, Sunday
editorial
How to defend yourself in the court
Dr KK Aggarwal How to defend yourself in the court is an art. We must read the constitution of the respective courts and answer point by point.

For example, the Delhi Medical Council Act (32) defines the procedure of receiving a complaint, against medical practitioner.

“The Council may inquire into complaint against medical practitioner either suo moto or on the basis of any complaint made to the Council in respect of misconduct or negligence of any medical practitioner for the purposes of the Act through the Disciplinary Committee. The proceedings shall be conducted by the Registrar in the presence of the Chairman Disciplinary Committee and at least two members thereof sitting together.”

The complaint shall contain the following particulars:
  • the name, description and address of the complainant;
  • the name, description and address of the opposite party or parties, as the case may be, as far as they can be ascertained;
  • the facts relating to the complaint, when the cause of action arose and
  • what are the grounds or causes of the complaint;
  • the documents in support of the complaint if any;
  • the relief which the complaint claims.
No complaint shall be entertained unless it is in writing and signed by the person making it. The complaint shall be verified by the complainant. The complainant shall file six copies of the complaint along with such number of copies as there are opposite parties in the complaint. All anonymous and frivolous complaints shall be rejected.

“On the date of hearing or any other date to which hearing could be adjourned, it shall be obligatory on the parties to appear before the Council. Where the complainant fails to appear before the Council on such days, the Council may in its discretion either dismiss the complaint for default or decide it on merits, where the opposite party fails to appear on the date of hearing, the Council may decide the complaint ex-parte.”

The Complainant has to be present and provide all the records before the hearing.

The DMC examined a complaint in 2006, of Dr JSG alleging medical negligence on the part of doctors of MA Hospital in the treatment administered to complainant’s wife. The Council perused the complaint, reply of Medical Superintendent of MA Hospital, copy of medical records and other documents on record. The treating doctors were heard in person. But the complainant on second occasion failed to appear in spite of notice. He also did not provide the X-ray film and report No. 15724 dated 6.5.2006 of the patient along with the casualty card No. 9394 of MA Hospital and other treatment records, which were reported to be in his possession, in spite of directions from the Council. In view of the same, complaint was dismissed for default.
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Welcome President of World Medical Association
News Around the Globe
  • Achillion Pharmaceuticals Inc said its experimental hepatitis C drug, when used in combination with Gilead Sciences Inc's Sovaldi, eradicated signs of the virus after six weeks of therapy, sending its shares up before the opening bell. If the combination of Sovaldi and Achillion's ACH-3102 continues to show this level of effectiveness, the treatment could eventually rival offerings from Gilead and AbbVie Inc to fight the liver-destroying virus.
  • Meditation may slow age-related brain atrophy, suggests new research published online in Frontiers in Psychology.
  • Hormone replacement therapy (HRT) seems to be significantly associated with an increased risk for ovarian cancer in postmenopausal women, reported an extensive meta-analysis from the Collaborative Group on Epidemiological Studies of Ovarian Cancer. The findings are published online February 13 in the Lancet.
  • Obesity is a complex medical problem that requires a multimodal approach beyond merely advising patients to go on a diet and exercise, suggest obesity experts in a new opinion piece published online February 12 in Lancet Diabetes & Endocrinology.
  • Low vitamin D levels are associated with larger brain infarct volume and worse outcomes in patients with ischemic stroke, reported a new study presented at the International Stroke Conference (ISC) 2015.
DERMACON 2015
Resistant Dermatophytosis
Dr Chitra Nayak
Mumbai
  • Longer duration of treatment with antifungals is the need of the hour.
  • Combinations of a systemic antifungal with two different topical antifungals is needed now.
  • Half strength Whitfield's ointment or 3% salicylic acid ointment should be added to the prescription
  • Treating all affected family members simultaneously is advocated.
Dr Rinky Kapoor
Mumbai

Investigation of the efficacy & safety of QR678 TM in enhancing human hair growth: A pilot study
  • QR 678 novel drug treatment for hair growth & stopping hair loss
  • Effective and safe in improving density and diameter of scalp hair; slowing hair loss, in men and women with patterned hair loss
Abuse of Topical steroid in India: A silent epidemic of astronomical magnitude

Dr Koushik Lahiri
Chairperson
IADVL Taskforce for Topical Steroid Abuse

Abuse of topical steroids has increased alarmingly and our member dermatologists all across our country are confronted with an increasing number of cases of Topical Steroid Damaged Face (TSDF). Potent topical steroid creams and combination of steroids, with depigmenting agents, antifungals and antibacterials are being used irrationally by GPs, and alternative medicine practitioners to complicate and compound this problem on almost all the parts of human body.
An alarming concern is the use of these creams as fairness creams in beauty clinics and self-medication by patients themselves.
Although most of these preparations are listed under Schedule H drugs, which cannot be purchased without the prescription of a qualified doctor, the harsh and unfortunate reality is that, these are being sold over-the-counter freely without any valid prescription by the dermatologist.
In a multicentric study at 12 centers conducted in a cross-section of the Indian populace, it was found that 59.3% of patients were using TC on the face without any doctor’s prescription. Of the remainder, only 26.7% patients had used TC prescribed by a dermatologist.
As mentioned earlier, the use of topical steroids in India is not restricted to dermatological disorders, it is mostly based on non-physician, non-dermatologists’ prescription and is growing alarmingly in recent years leading to situation that can only be compared to an impending holocaust. The sale of topical steroids in India accounts for 82% of sale of all topical drugs in India. The financial stakes can be easily gauged from the sales figures of TC in 2013, which stood at Rs 1400 crores (approximately $233 million).
This situation has serious medium- and long-term implications. Several problems which can occur are worsening of primary condition, masking of underlying skin problem, thinning of skin, development of pimples, red-colored rashes and dilated blood vessels showing through the skin, excessive hair growth and ageing skin. Worse is a sense of dependence of the patient on the cream leading to further continued use of the drug leading to a vicious cycle culminating into more and more cumulative permanent damage.
IADVL has launched a nationwide program to create awareness to keep people away from using these preparations.
A special Task Force titled IADVL Task force Against Topical Steroid Abuse (ITASTA) has recently been constituted. Most of our members have taken a pledge to fight this menace by minimizing use of these cocktail steroid combinations.
We have already forwarded a petition signed by a large number of our members, to the Drug Controller of India. We are taking up this issue at the state level all across the Nation.
We have approached the pharma industry
  • To increase awareness among General Practitioners about this scourge and to motivate and facilitate them in discontinuing their indiscriminate prescriptions.
  • To minimize and avoid, if possible, manufacture, sale and promotion of irrational steroid-based cocktail combinations.
  • To avoid and discourage organizing camps where samples of such preparations are dispensed free in guise of fairness creams.
  • To educate your retail vendors to avoid dispensing such potentially harmful preparations without valid prescriptions.
  • To limit potent steroid promotion only to dermatologists.
  • Avoid promoting these products to alternative medical practitioners.
  • Help us in preparing health education posters, pamphlets and videos; such posters need to be put up in all medical shops and in clinics.
  • Insert an advisory in bold letters on all tubes that it is meant for prescription by dermatologist only.
  • Insert a special advisory in all drug brochures in the tubes on the side effects of this menace- we can help you in preparing such advisory.
Abbott has come forward and joined hands with IADVL in taking up this movement to the next level.
Now we will reach not only our 8000 Dermatologists, but another 16000 general physicians, 38000 chemists to effectively reach, sensitize and educate 3 crore people.
Hope with the concerted effort from one and all this historic social initiative from IADVL will bear fruits and wipe off the shame of topical steroid abuse from the face of the Nation once and for all.
Dr KK Spiritual Blog
Search for Happiness in the Present Moment

Happiness should not be considered as being synonymous with pleasure. Pleasure is transient and is always associated with pain later. Any transient addiction to any of the five senses will either lead to pleasure or pain. Pleasure leads to attachment resulting in more intense and greater desires, and if these are not fulfilled, they cause pain which manifest as anger, irritability or even a physical disease. This type of transient pleasure is chosen by the individuals who attach themselves not to the actions only, but also to its results.
The soul, which is an energized field of information and energy, is controlled by the person’s action, memory and desire. With every action, a memory is created which either gets stored or is recirculated again as an action. If one does not control the desires, the recurrent actions may cause more problems than happiness.
True happiness, on the other hand, is internal happiness or the happiness of the soul or of the consciousness. It is often said, “You are what you eat; you are what you think; and you are what you do.” Hence, your own internal happiness will vary with what you eat, think, and do.
Living in the present moment leads to true happiness. If one is constantly lamenting about the past or fearing the future, he/she will never be able to live in the present. Not living in the present is bound to cause unhappiness. One should learn to live and enjoy the present which can only be done by attaching oneself to the actions and not to its results.
Doing one’s duty with devotion and discipline helps one to remain in the present. Performing good action is important, but it is equally important to maintain the purity of the mind at the same time. Because any intention in the thought creates the same chemical reaction as when the actual deed is done, abusing a person in thought is the same as abusing him in person. Cultivating positive actions in day-to-day life, like, giving or sharing etc., helps in acquiring internal happiness.
Thoughts ultimately get metabolized into various chemicals and hormones changing the internal biochemistry of the person; hence by thinking about cancer all the time, one can actually induce it over a period of time. And similarly, cancers can be cured by thinking positive over a period of time.
Internal happiness gives a deep feeling of satisfaction and is not associated with any transient chemical changes which are generally associated with bodily pleasure activities. People who are internally happy are always contented and are devoid of jealousy, anger, irritability, greed and ego.
One should learn to disassociate from, both, external pain as well as pleasure, and only then can one acquire true internal happiness.
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Cardiology eMedinewS
  • Marathon training seems perfectly safe for middle-aged adults and engaging in a structured training program translates into significant and healthy improvements in the heart's size and function, suggests a new study published in the February 2015 issue of Circulation: Cardiovascular Imaging.
  • In a large study of patients who were hospitalized for HF, those who were newly diagnosed with sleep-disordered breathing (sleep apnea) were more likely to die within a few years compared with their peers. Specifically, the hazard ratio for all-cause mortality within 3 years of hospital discharge was 1.57 for HF patients with sleep apnea, after adjustment for multiple variables, in this study by Dr Rami Khayat (Ohio State University, Columbus) and colleagues, published online January 29, 2015 in the European Heart Journal.(Medscape)
Pediatrics eMedinewS
  • New research suggests that 13-month-olds use their understanding about others' perspectives and social evaluation skills to make sense of social interactions. The findings are published in Psychological Science.
  • Parents' lifestyles, rather than their genes, are primarily responsible for their children being overweight, reports new research by the Centre for Economic Performance based at the London School of Economics and Political Science (LSE).
Make Sure
Situation: A patient developed fainting attack after sublingual nitrate.
Reaction: Oh my God! Why was the systolic murmur missed on auscultation?
Lesson: Make sure that patient with left ventricular outflow tract obstruction are not given sublingual nitrates.
Medicolegal
Dr Sudhir Gupta, Prof & Head, Dept. of Forensic Medicine & Toxicology, AIIMS

What is the medicolegal importance of age up to 14 years?
  • 7 years age: In accordance with Section 82 of Indian Penal Code, any act that is done by a child under seven years of age is not an offence.
  • 7–12 years of age: In accordance with Section 83 of Indian Penal Code, a child between 7–12 years of age is presumed to be capable of committing an offence, if he attained sufficient maturity of understanding to judge the nature and consequences of his conduct on that occasion. This maturity is presumed in a child of 7–12 years age until the contrary is proved.
  • 10 years age: In accordance with Section 369 of Indian Penal Code kidnapping or abducting child less than 10 years of age with intention to steal from its person is a criminal punishable offence.
  • 14 years age: A child below 14 years of age cannot be employed to work in any factory or mine under Indian Factory Act 1948. A person completing 15 and up to 18 years is allowed to work as adolescent employee in a factory if a fitness certificate is issued by a competent registered doctor.
Dr Good Dr Bad
Situation: A senior citizen with an insurance of one lakh came for admission.
Dr. Bad: You should opt for Rs. 1000/- room.
Dr. Good: Take any room you want.
Lesson: The 1% room rent clause is not applicable to senior citizens.

(Copyright IJCP)
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Twitter of the Day
Dr KK Aggarwal: Diabetes and heart patients beware during Navratri fasts http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: Recurrent anxiety can have a devastating toll on all aspects of our life. How to deal with anxiety? http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
What does humanizing your dog means?
  • Talking to your dog like he/she is a person.
  • Treating your dog like he/she is a person.
  • Allowing dogs to do what they want because it will hurt their "feelings."
  • Dressing them up in little doggie clothes.
Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.
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
IMA NEWS
IMA Initiative for Safe Sound
Mental / Psychological effects
  • Lack of concentration.
  • Decreased memory.
  • Inability to do skilled work/ learning.
  • Loss of sleep
  • Irritability
  • Poor academic performance
  • Effects on animals and other living or even non living things. (e.g. damage to old buildings)
Maximum noise standards

Ambient Air Quality Standards in respect of noise
 
 
Day
Night
A
Industrial
75 decibels
70
B
Commercial
65
55
C
Residential
55
45
D
Silent Zone
55
40
  • Daytime: 6am to 10 pm, Night: 10 pm to 6 am
  • Silent zone - Not less than 100 m around hospitals, educational institutions, courts or other areas declared
Clinician – Patient Communication
Vinay Sharma, New Delhi

Non Verbal Cues to Avoid
  • Tapping fingers, pens pencils
  • Clenching fists
  • Yawning
  • Looking out of the window
  • Tapping your feet
  • Crossing arms
  • Sitting with knee over knee (crossing legs)
  • Hands in pocket
It’s not the power of the Pen. It’s the power of the Ear!
An emblem for allopathic doctors
Bindu Shajan Perappadan

The Hindu, New Delhi, February 14, 2015 “Could the allopathic doctor please raise his/her hands up?” Precisely to avoid this confusion among patients the Indian Medical Association (IMA) is coming out with an emblem for medical profession which will differentiate allopathic doctors from doctors of other systems of medicine. IMA national president Dr. (Prof.) M. Marthanda Pillai giving details of this latest venture said: “There is an urgent need for a new medical emblem which can be used by all the modern medicine doctors so that public is not confused about which ‘pathy’ they are approaching for treatment.”He added that there is much confusion among the patients, especially from the lower economic strata, about which field of medicine the doctor is from. “Today, doctors from all system of medicine prefix their name with the word “Dr.” which is unable to differentiate the system of medicine they practice. Even unqualified and quacks have also started using prefix ‘Dr’”, said IMA honorary secretary general Dr. K. K. Aggarwal. The Association has asked all its 30 branches to send their suggestions and a suggested emblem. It has also kept a prize of Rs.25,000/- for the best selected emblem. “Once selected by IMA the emblem will be sent to Union Ministry of Health and Family Welfare, Medical Council of India for approval. Letters are also been issued to all medical colleges to involve their students in designing the same,” added Dr. Aggarwal.

Sonal Namaste

Sonal Mansingh, Padma Vibhushan, an eminent Indian classical dancer and choreographer of Odissi dancing style; who is also proficient in other Indian classical dancing styles including Bharatnatyam, Kuchipudi, and Chhau, has started a campaign ‘Sonal Namaste’. The campaign aims at traditional custom of Namaste when greeting each other. At the present moment with swine flu fear everywhere, Sonal Namaste is one of the best moves to prevent flu.
Listening and Hearing
Listening requires concentration, Complex, Information gathering, Mental function

Hearing is Effortless, Simple, and Prerequisite for listening, Physical function
 
Medscape Family Physician Lifestyle Report 2015

Do Family Physicians Believe that Marijuana Should be legalized?

A 2014 Gallup poll reported that over half (51%) of Americans support legalization, with the largest number of supporters in the East and the West. In a Medscape survey conducted last year on marijuana, about 70% of physicians believed that it had real medical benefits, although only 1% had ever personally used marijuana for medicinal purposes. Among family physicians who responded to this survey, 59% of those who have ever used marijuana support total legalization, and 19% support it only for medicinal purposes. Even among family physicians who have never used marijuana, 43% support some form of legalization (20% total and 23% medicinal).

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Inspirational Story

Be Content about Your Life

Wonder if any of you ever had the feeling that life is bad, real bad…and you wish you were in another situation. Do you find that life seems to make things difficult for you, work sucks, life sucks, and everything seems to go wrong?

It was not until yesterday that I totally changed my views about life; after a conversation with one of my friends.

He told me despite taking 2 jobs, and bringing back barely above 1K per month, he is happy as he is. I wonder how he can be as happy as he is now, considering that he has to skimp his life with the low pay to support a pair of old-age parents, in-laws, wife, 2 daughters and the many bills of a household.

He explained that it was through one incident that he saw in India……

That happened a few years ago when he was really feeling low and was touring India after a major setback. He said that right in front of his very eyes, he saw an Indian mother chopped off her child’s right hand with a chopper. The helplessness in the mother’s eyes, the scream of the pain from the innocent 4 years old child haunted him until today. You may ask why did the mother do so, has the child been naughty, was the child’s hand infected??

No, it was done for two simple words — to beg. The desperate mother deliberately caused the child to be handicapped so that the child can go out to the streets to beg. I cannot accept how this could happen, but it really did, just in another part of the world which I don’t see.

Taken aback by the scene, he dropped a small piece of bread he was eating half–way. And almost instantly, flock of 5 or 6 children swamp towards this small piece of bread which was then covered with sand, robbing of bits from one another. The natural reaction of hunger. Stricken by the happenings, he instructed his guide to drive him to the nearest bakery. He arrived at two bakeries and bought every single loaf of bread he found in the bakeries.

The owner is dumb folded, but willing sold everything. He spent less than $100 to obtain about 400 loaf of bread (this is less than $0.25/per loaf) and spend another $100 to get daily necessities. Off he went in the truck full of bread into the streets. As he distributed the bread and necessities to the children (mostly handicapped) and a few adults, he received cheers and bows from these unfortunate. For the first time in life he wonders how people can give up their dignity for a loaf of bread which cost less than $0.25. He began to ask himself how fortunate he is as a Singaporean. How fortunate he to be able to have a complete body, have a job, have a family, have the chance to complain what food is nice what isn’t, have the chance to be clothed, have the many things that these people in front of him are deprived of……

Now I begin to think and feel it, too. Was my life really that bad? Perhaps…no,… it should not be bad at all…

What about you? Maybe the next time you think you are, think about the child who lost one hand to beg on the streets.

Wellness Blog

All diabetics must have an eye check up done

The vast majority of diabetic patients who develop diabetic retinopathy (eye involvement) have no symptoms until the very late stages (by which time it may be too late for effective treatment). Because the rate of progression may be rapid, therapy can be beneficial for both symptom amelioration as well as reduction in the rate of disease progression, it is important to screen patients with diabetes regularly for the development of retinal disease.

The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere. Diabetic people with retinopathy are more likely to die of heart disease over the next 12 years than those without it.

As per a study from the University of Sydney and the University of Melbourne in Australia and the National University of Singapore, people with retinopathy are nearly twice as likely to die of heart disease as people without it.

People with these changes in the eyes may be getting a first warning that damage is occurring in their arteries, and work to lower cholesterol and blood pressure.

Patients with retinopathy have a greater risk of incident cardiovascular disease (CVD) events, including heart attack, stroke, revascularization and CVD death, compared with those without retinopathy.

Quote of the Day

The only good luck many great men ever had was being born with the ability and determination to overcome bad luck. Channing Pollock

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Reader Response
 
  1. Nice guidelines . .. good initiative ... needs to be implemented .... drsudhirss

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Law of Bag/Box Occupancy

All bags and boxes in a given room must contain a cat within the earliest possible nanosecond.

eMedi Quiz

A case of gestational trophoblastic neoplasia belongs to high risk group if disease develops after:

1. Hydatidiform mole.
2. Full term pregnancy.
3. Spontaneous abortion.
4. Ectopic pregnancy.

Yesterday’s Mind Teaser: A primigravida at 37 weeks of gestation reported to labor room with central placenta previa with heavy bleeding per vaginum. The fetal heart rate was normal at the time of examination. The best management option for her is:

1. Expectant management.
2. Cesarean section.
3. Induction and vaginal delivery.
4. Induction and forceps delivery.

Answer for yesterday’s Mind Teaser: 2. Cesarean section.

Correct Answers received from: Raju Kuppusamy, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Avtar Krishan, Dr U C Vasavada, Dr Pravar Passi.

Answer for 13th Feb Mind Teaser: 2. Medical management.

Correct Answers receives: Dr Jainendra Upadhyay, Dr Avtar Krishan, Daivadheenam Jella, Dr KV Sarma, Daivadheenam Jella.

 

Press Release of the Day

Declaring fitness for air travel for an asthmatic or a patient with heart failure

Air travel has become a very common mode of travel today. And many air travelers may have underlying respiratory disease like asthma or heart disease such as heart failure, who may require oxygen during flight. Such patients have concerns about traveling by air and therefore consult their physicians for advice regarding safe travel.

Before deciding on fitness to fly, doctors should keep in mind certain factors while examining such patients, said Padma Shri Awardee Dr A Marthanda Pillai National President IMA and Padma Shri and Dr B C Roy National Awardee & DST National Science Communication Awardee, Dr K K Aggarwal Honorary Secretary General IMA in a joint statement.

Important facts to be considered to assess need for oxygen supplementation during flight
  • Aircrafts cabins are pressurized but flying at a high altitude can lower oxygen levels in patients with underlying lung disease.
  • Patients who are at high risk need supplemental oxygen during the flight.
  • Screen such patients with pulse oximeter at rest and breathing room air.
  • If SpO2 or the blood oxygen level is above 95%: give them clearance. They do not need further testing. If person has serious illness but SpO2 is above 95, it is better to do 6-minute walk test.
  • If SpO2 is less than 92%, then the person will need in-flight supplemental oxygen.
  • If SpO2 is between 92 and 95%, look for risk factors. If no risk factors, give them clearance. If present, then get these patients to take a 6-minute walk test. During test, desaturation to a SpO2 less than 84% indicates the need for in-flight oxygen.
  • If the patient is on oxygen at room air, increase the oxygen flow 1 to 2 L/minute over baseline during the flight.
  • Supplemental oxygen may be derived from approved portable oxygen canisters or oxygen concentrators.
  • Airlines allow use of portable oxygen concentrators throughout the flight but a medical prescription is needed.
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About the Editor

National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)