March 15  2015, Sunday
editorial
Dear Colleague
Dr KK AggarwalWe need to oppose the Govt. stand on allowing Ayush doctors to practice abortions. The IMA stand is as below. Kindly use your good office to oppose the move at every level.

Dr AM Pillai                                  Dr KK Aggarwal

Ayush doctors can conduct abortions soon

TNN: New Delhi: The government proposes to allow Ayush practitioners and paramedical staff (excluding yoga and naturopathy) in the public sector to do abortions on pregnant women under the MTP (medical termination of pregnancy) Amendment Bill, Union health minister JP Nadda has said.

"The government is of the view that expanding the provider base with strict conditionalities will enhance the access and availability of safe abortion services to women without compromising on quality of service," Nadda informed Lok Sabha on Friday.

He underlined "strict conditionalities" will include requisite training and certification which would be specified in the rules.

TOI had reported on March 4 that the health ministry has worked out final changes to MTP Amendment Bill to allow Ayush doctors to conduct abortions. Sources say the health ministry is expected to soon take the draft bill to the Cabinet.

Nadda said the draft bill was in the public domain seeking views of general public as well as various stakeholders including Indian Medical Association (IMA). "IMA supported most of the amendment but had objections pertaining to non-MBBS service providers.

The government's proposal, originally formulated taking a cue from a study conducted by Population Council, is aimed at increasing access to safe abortion by expanding the number of healthcare providers to reduce maternal mortality.

Estimates show around seven million abortions are conducted in India every year and over 50% of the total abortions are estimated to be illegal.

IMA, a pan India voluntary organization with a membership of 2.5 lakh allopathic practitioners, said the move can put patients at risk as well as allow unethical practices and sex selective abortions.

IMA Stand on why Ayush doctors cannot prescribe modern medicine drugs

Background note on Government Stand
  1. Central Government is envisaging starting one year course for AYUSH doctors and allowing them to practice modern medicine. IMA attended a meeting convened by the Secretary, Ministry of Health and Family Welfare, Govt. of India on 22nd January, 2015 in his office at 6.00 P.M.
  2. Mainstreaming of AYUSH doctors: Back Ground Note by the ministry

    The Doctor Population Ratio as per WHO norms should be 1:1000, in India it is 1:1674. Thus, there is overall shortage of doctors in the country which is more pronounced in rural areas. As per MCI, the total number of doctors in India as on 30.09.2014 is 9.32 lakhs. There are 6,86319 AYUSH practitioners in the country out of which 4,46,051 are ASU doctors.

    Section 15 of the Indian Medical Council Act, 1956 states that no person other than a medical practitioner enrolled on a State Medical Register shall practice medicine in any State. Any person who acts in contravention of this shall be punished with imprisonment of 1 year or fine of Rs 1,000 or both.

    In the case of Dr. Mukhtiar Chand vs State of Punjab, the Hon’ble Supreme Court held that practice of modern system of medicine by ISM qualified professionals is possible provided such professionals are enrolled in the State Medical Register for practitioners of modern medicine maintained by the State medical Council. The respective State Government can notify and give recognition to qualifications eligible for registration in the State medical Register.

    The Ministry requested all the State governments vide letters dated 29th May, 2013 and reminders dated 20th Novembers, 2013 and 19th March, 2014 to consider amending their respective State laws relating to registration of practitioners of modern scientific medicine and provide an enabling provision to allow the enrolment of an ISM professional in the State medical Register maintained for registration of the practitioners of modern medicine by the respective State Medical Councils. Comments were received from some of the States, which are as follows:
S.No.
State/UT
Comments
I.
Kerala
Govt. of Kerala doesn’t face any shortage of doctors of modern medicine for posting in PHCs as a large number of medical graduates will be passing out from the colleges in the state in the next few years.
II.
Daman & Diu and Dadra & Nagar Haveli
There is no State/UT Medical Council and, hence, no enrolment of practitioners of modern medicine.
III.
Goa
They strongly opposed the matter.
IV.
Rajasthan
Initiating registration of AYUSH doctors in State medical Register will complicate matters and will dilute the efforts of brining them into the mainstream.
Under NRHM, services of AYUSH practitioners are utilized for providing essential new-born care services, managing common childhood illness, counseling on family planning methods and most importantly, they render their services as Skilled Birth Attendants (SBA).

Department of AYUSH in consultation with National Board of Examination (NBE) prepared one year curriculum, for bridge course to provide competency to ISM doctors to practice modern medicines in a limited way in rural areas. Ministry requested the MCI to vet the draft curriculum; MCI has vehemently opposed the move.

A meeting was convened to discuss the introduction of a bridge course for AYUSH Doctors on 10th September, 2014 in which it was decided that a bridge course may be prepared keeping in consideration the course curriculum of B.Sc. (CH). It was agreed that a 9 months course (6 months regular and 3 months internship) duration may be developed for this purpose.

Department of AYUSH vides their D.O. letter dated 23.09.2014 made the following objections:

a) The proposal to allow ASU doctors to only dispense and not prescribe modern medicines is not agreeable to them.
b) It will make ASU doctors subservient to Allopathic doctors.
c) The decision to develop a Bridge Course of 9 months on the lines of B.Sc. (CH) is a unilateral stand of DoHFW.
Now, on 10th November, 2014, Department of AYUSH has been made a separate Ministry with Sh. Shripad Naik, Minister of State (Independent Charge).

Discussion and IMA Point of view

Government wants that Ayush Graduates with a bridging course should be
  • Entitled to practice and prescribe Modern Medicine Drugs
  • Also be entitled to be included in the State Register as registered medical practitioner upon incorporation of necessary enabling provisions in the governing State Act, in the light of pronouncement made by the Hon'ble Supreme Court in Mukhtiar Chand case.
3. Rajya Sabha Question on Ayush practicing modern medicine

AYUSH practitioners prescribing allopathic medicines: Rajya Sabha, information given by the Minister for Health & Family Welfare, Dr. Anbumani Ramadoss in a written reply to a question in the Rajya Sabha.

The matter regarding qualified practitioners of Ayurveda, Unani, Siddha and Homoeopathy systems prescribing allopathic medicines has been examined in depth by the Hon'ble Supreme Court of India in Civil Appeal No.89 of 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others.

Representations have been received from time to time on this matter and accordingly Department of AYUSH entrusted the study of the contemporary acts on medical practice in the light of judgement of Hon'ble Supreme Court in 1987 Dr. Mukhtiar Chand & Others versus State of Punjab & Others and other similar judgements. Drugs can be sold and supplied by a Pharmacist or a Druggist only on a prescription of a Registered Medical Practitioner and who can also store them for treatment of patients.

According to Section 2 (ee) of the Drugs and Cosmetics Rules, 1995, Registered Medical Practitioner means a person -

(i) holding a qualification granted by an authority specified or notified under Section 3 of the Indian Medical Degrees Act, 1916 (7 of 1916), or specified in the Schedules to the Indian Medical Council Act, 1956 (102 of 1956); or

(ii) registered or eligible for registration in a medical register of a State meant for the registration of persons practicing the modern scientific system of medicine (excluding the Homoeopathy system of medicine); or

(iii) registered in a medical register (other than a register for the registration of Homoeopathic practitioners) of a State, who although not falling within sub-clause (i) or sub-clause (ii) is declared by a general or special order made by the State Government in this behalf as a person practicing the modern scientific system of medicine for the purposes of this Act.

Hon'ble Supreme Court upheld the validity of Rule 2 (ee) (iii) as well as the notifications issued by various State Governments there under allowing Ayurveda, Siddha, Unani and Homoeopathy practitioners to prescribe allopathic medicines.

In view of the above judgment, Ayurveda, Siddha, Unani and Homoeopathy practitioners can prescribe allopathic medicines under Rule 2 (ee) (iii) only in those States where they are authorized to do so by a general or special order made by the concerned State Government in that regard. Practitioners of Indian Medicine holding the degrees in integrated courses can also prescribe allopathic medicines if any State act in the State in which they are practicing recognizes their qualification as sufficient for registration in the State Medical Register. KR/SK/95 – RS:
http://pib.nic.in/newsite/erelease.aspx?relid=30117, 20th August 2007

IMA Stand
  • In the agenda item No. A-2 (a): MENACE OF QUACKERY, the issue was discussed in the 75th Meeting of the Central Council of IMA held on December 27-28 December, 2014 on Govt. Sponsored Quackery. It was discussed that the Maharashtra Govt. has promulgated an Ordinance permitting AYUSH doctors to practice modern medicine. It was decided that IMA should publicize this as a social evil, malpractice and should take it as a very serious issue. At the same time IMA, along with MCI, should give stringent directions to hospitals and doctors not to appoint AYUSH doctors as RMO / Assistants and strong action taken against those violating the directions”.
  • The following MCI Code of Medical Ethics and Regulations 2002 disallow such practices
    • “7.9 Performing or enabling unqualified person to perform an abortion or any illegal operation for which there is no medical, surgical or psychological indication”. The regulations clearly prohibits taking assistance from any unqualified person for surgery, especially abortions.
    • "7.10 A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or non-medical person”: The regulation again clearly states that any allopathic doctor shall not appoint any non-allopathic doctor for any allopathic services. Appointing a non-allopathic doctor would amount to issuing a certificate of efficiency in modern medicine.
    • “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” According to this regulation, if there is any emergency, we have to take care of our patients ourselves. We cannot pass on this responsibility to unqualified persons.
    • “7.20 A Physician shall not claim to be specialist unless he has a special qualification in that branch”: The above regulation clarifies that because Ayush doctors do not have special qualification in allopathy they cannot be treated as allopathic practitioners.
    • “7.19 A Physician shall not use touts or agents for procuring patients.” As per this regulation, we should not use touts or agents for procuring patients. If any non-allopathic doctor assists us in procuring patients, the same will be a violation of the above clause.
    • “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.” This regulation clearly mentions that if any MBBS doctor, appoints any Ayush Doctor, the responsibility will be of an MBBS doctor and not that of Ayush Doctor.
    • The Maharashtra FDA has recently issued guidelines regarding prescription where it clearly mentions that another doctor cannot sign on the prescription paper of treating doctor.
Provisions in Indian Medical Council Act, 1956
  1. Section 2 (f) defines the word ‘medicine’ as ‘medicine means modern scientific medicine in all its branches and includes surgery and obstetrics but does not include veterinary medicine and surgery’.
  2. Section 2(a) defines the word ‘approved institution’ as ‘a hospital, health centre or other such institution recognized by a University as an institution in which a person may undergo the training, if any, required by his course of study, before the award of any medical qualification to him’.
  3. Section 2 (d) defines the word ‘Indian Medical Register’ as ‘Indian medical registers means the medical register maintained by the council’.
  4. Section 2 (h) defines the word ‘recognized medical qualification’ as ‘recognized medical qualification means any of the medical qualifications included in the schedules’.
  5. Section 2 (j) defines the word ‘State Medical Council’ which reads ‘State Medical Council means a medical council constituted under any law for the time being in force in any State regulating the registration of practitioners of medicine’.
  6. Section 2 (k) defines State Medical register’ as ‘State Medical Registers means a register maintained under any law for the time being in force in any state regulating the registration of practitioners of medicine’.
  7. Section 11 of the concerned Act deals with the ‘recognition of medical qualifications granted by Universities or medical institutions in India’ and that ‘MBBS qualification recognized by the Medical Council of India with reference to a concerned institution and examining University thereto duly incorporated in schedule A amounts to the registering medical qualification for the purposes of enrolment in the appropriate register maintained by a State medical council or the Medical Council of India as the case may be’.
  8. Section 15 of the Act, deals with ‘Right of person possessing qualifications in the schedules to be enrolled’ and section 15(2)(d) clearly prescribes that “no person other than a medical practitioner enrolled on a State Medical Register shall practice medicine in any State”.
  9. Vide provision included at section 21 the council is duty bound to maintain Indian Medical Register in a prescribed manner which shall contain the names of all persons who are for the time being enrolled in any State Medical register and who possess any of the recognized medical qualifications. The said provision has to be harmoniously read with the provisions incorporated at section23 of the very Act, which deals with ‘registration in the Indian Medical Register and mandates that the Registrar of the council may, on receipt of the report or registration of a person in a State Medical Register or on application made in the prescribed manner by any such person, enter his name in the Indian Medical register, provided that the registrar is satisfied that the person concerned possessed a recognized medical qualification’.
  10. Resultantly, section 27 of the Act, provides for the ‘privileges of the persons who are enrolled in the Indian medical register’ to the effect ‘that every person whose name is for the time being borne on the Indian medical register shall be entitled according to his qualifications to practice as a medical practitioner in any part of India and to recover in due course of law in respect of such practice any expenses, charges in respect of medicaments or other appliances, or any fees to which he may be entitled’.
  11. Modern medicine can be practiced exclusively by a person who possess recognized medical qualifications included in the appropriate schedule appended to the Indian Medical Council Act and is duly registered with a concerned State Medical Council and resultantly is included in the State Medical Register in terms of the explicit embargo as has been brought out in Section 15(2)(b) of the IMC Act, 1956. The said position has been fortified in several pronouncements made by the various judicial forums including the one brought out in Poonam Varma Vs. Ashwin Patel case by the Hon'ble Supreme Court in 1992.
  12. The entitlement of the Ayush Graduates in the State medical register will have another problem. Who shall govern the disciplinary jurisdiction on them in regard to enforcement of ethical conduct and practice as contemplated in the code of medical ethics which is applicable to every registered medical practitioner possessing registering medical qualification in modern medicine.
Supreme Court and CPA Judgments stating that Ayush Doctors cannot prescribe allopathic drugs
  1. National Consumer Disputes Redressal Commission New Delhi Original Petition No.214 of 1997, “When a patient is admitted in a hospital, it is done with the belief that the treatment given in the hospital is being given by qualified doctors under the Indian Medical Council Act, 1956. It is not within the knowledge of the relatives of the patient that the patient is being treated by a Unani Specialist. We hold that it is clear deficiency in service and negligence by the hospital for leaving the patient in the hands of Unani doctor.

    "As laid down by Apex Court in the above case (Jacob Mathew case), we feel that it is high time that hospital authorities realize that the practice of employing non-medical practitioners such as Doctors specialized in Unani system and who do not possess the required skill and competence to give allopathic treatment and to let an emergency patient be treated in their hands is a gross negligence. We do not wish to attribute negligence on the part of Dr R alone while the patient was in his charge in terms of directing to pay compensation but solely on the hospital authorities for leaving the patient in his complete care knowing he is not qualified to treat such cases."

    "Supreme Court came down heavily in cases where Homeopathic Doctors treated the patients with allopathic medicines. In Poonam Verma Vs. Ashwin Patel and Others (1996) 4 SCC 332 where a doctor holding Diploma in Homeopathic Medicine and Surgery (DHMS) and registered under Bombay Homeopathic Practitioners Act, caused the death of a patient due to administration of Allopathic medicine, the Supreme Court held him being not qualified to practice Allopathy, was a quack or pretender to the medical knowledge and skill as a charlatan and hence guilty of negligence per se. The facts being similar in this case, we hold that there is total negligence in treating the deceased patient."

    "Thus, we feel that an amount of Rs.7,50,000/- would be appropriate amount of compensation in face of peculiar facts and circumstances."
     
  2. Dr. Mukhtiar Chand & Ors. Vs. State Of Punjab & Ors., decided by the Supreme Court on 08/10/1998, reported as AIR 1999, SC 468, (1998 (7) SCC 579) K.T. Thomas, Syed Shah Mohammed Quadri," A harmonious reading of Section 15 of 1956 Act and Section 17 of 1970 Act leads to the conclusion that there is no scope for a person enrolled on the State Register of Indian medicine or Central Register of Indian Medicine to practice modern scientific medicine in any of its branches unless that person is also enrolled on a State Medical Register within the meaning of 1956 Act."
eMedipics IMA,IJCP,HCFI
Dr (Major) Prachi Garg, Senior Consultant with Heart Care Foundation of India was honored today with 'Women of Substance Award' in a function organized by "Honour our Women" UP Chapter to earmark International Women’s Day.
News
  • Lindioil, an olive oil extract of indigo naturalis, is an effective treatment for psoriatic nails, suggests new research published online in JAMA Dermatology.
  • Male smokers have a greater risk for osteoporosis than other men and even women smokers, suggests a new study published online in the Annals of the American Thoracic Society.
  • Men with acromegaly that is not controlled by surgery and somatostatin receptor ligands (SRLs) may do better with clomiphene citrate (CC) added to the current treatment, reveals a new study published online in the Journal of Clinical Endocrinology & Metabolism.
  • Patients report no significant difference in 2-year outcomes for surgical vs. nonsurgical treatment of displaced upper arm fractures, pointed a UK randomized controlled trial published in the March 10 issue of JAMA.
  • A prospective observational study published online March 12 in the Journal of the American Society of Nephrology suggests that across all stages of kidney disease, the risk for adverse pregnancy outcomes increases.
Dr KK Spiritual Blog
What do you mean by ‘food is Brahman’?

‘Food is Brahman’ is a Vedic Upanishad and Bhagavad Gita saying.

Brahma is consciousness, therefore, food is consciousness. Though the traditional Vedic teaching has been that consciousness is present in everything and yet only food is considered Brahman. It is never said that a stone is Brahman or a dog is Brahman.

As per Chandogya Upanishad (6.15.1) at the time of death, our Vak Vritti (motor senses) merges into Karm Indriyas or manovritti (sensory senses, mind, intellect, ego and memory) and that now merges with Prana (Udana Vayu) and finally this merges into Tejas which leaves the body to merge into the Sat.
Vak Vritti, Manovritti and Prana Vritti, in the form of vibrations in the atmosphere, come back through rain and are taken by the plants to become plant consciousness.

Therefore, as per Chandogya Upanishad, the consciousness of the Brahman moves from human to plants and plants to human.

The plant food once eaten and absorbed enters into the human body and ultimately makes Prana, Tejas, Ojas, Sperms and Ova. Through Sperm and Ova, it enters into the next life.

If this theory is correct, then food makes the consciousness and consciousness makes food. This also further proves that vegetarian food, as it is full of Brahman creating a satvik mind and takes one towards spirituality.

Tamsik food, which is dead and devoid of consciousness does not lead to a healthy mind as it may produce Mal (waste) or make flesh but will not make essence.

As per Chandogya Upanishad, fiery food makes Karma Indriyas, earthy food makes Gnan Indriyas and Water in food makes Prana.

It further emphasizes on the fact that one should eat freshly cut fruits and vegetables as far as possible as life or consciousness in them can only stay for some time (as per Jainism up to 48 minutes).
IMA,IJCP,HCFI
Cardiology eMedinewS
  • Early signs of frailty predict cardiovascular disease (CVD) over a relatively short follow-up in community-dwelling elderly men and women with no obvious impairments at baseline, suggests new research published in the March 17 issue of the Journal of the American College of Cardiology.
  • Individuals with a genetic-based sensitivity to warfarin have a significantly increased risk of bleeding within the first 90 days of treatment compared with individuals who respond normally to the anticoagulant, suggests a new analysis of the ENGAGE AF-TIMI 48 study published online March 10 in the Lancet.
Pediatrics eMedinewS
  • New research suggests that children presenting with first-episode psychosis may have serum autoantibodies to the dopamine-2 receptor (D2R) and the N-methyl-D-aspartate (NMDA) receptor, thus indicating that psychosis may be immune-mediated in some patients. The research is published in the March 15 issue of Biological Psychiatry.
  • The US Food and Drug Administration (FDA) has approved asenapine for the treatment of pediatric patients with bipolar I disorder. The drug received approval as monotherapy for the acute treatment of manic or mixed episodes associated with bipolar I disorder in pediatric patients aged 10 to 17 years.
Make Sure
Situation: A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.
Reaction: Oh my God! Why was aspirin given!
Lesson: Make sure to remember that aspirin is contraindicated in children.
Medicolegal
Q. My hospital sometimes advertises in the newspapers inviting philanthropists to help poor patients who do not have money to pay for costly surgery etc. When the donors, including MLAs, come to the hospital for the charity, they bring with them local press and media people for publicity. This sometimes affects the normal functioning of the hospital. Are any hospital ethics being violated? What are your comments?

A. My comments are as follows:
  • Your hospital is doing a good service. No hospital ethics are being violated.
  • The media and press coverage might cause some disturbance in the hospital but that is for a good cause. Moreover, the hospital gets free publicity. This may be good for the hospital.
Dr Good Dr Bad
Situation: A patient with Mediclaim of Rs. 2 lakhs has used a cumulative bonus of Rs. 40000 after 8 years. How much can he claim in the next year?
Dr. Bad: Same as 2.4 lakhs.
Dr. Good: It will be 10% less.
Lesson: Incase of claim under the policy in respect of insured person who has earned the cumulative bonus, the increased percentage will be reduced by 10% of claim of sum insured on the next renewal. However, basic sum insured will be maintained and will not be reduced.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
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
IMA NEWS
Facts about Tuberculosis (TB)
Is TB a hereditary disease?

TB is not a hereditary disease
Not notifying TB patients unethical’
Bindu Shajan Perappadan: “As per municipal laws and a Central Government order, TB is a notifiable disease but over 10 lakh patients treated in India every year are not reported to the appropriate authorities,” noted Indian Medical Association (IMA) national president Dr. A. Marthanda Pillai here on Friday while stating that “India has been able to notify 1,04,670 TB patients in the last one year.”

Speaking at a press meet organised in association with Central TB Division, Central Government, Dr. K.K. Aggarwal of the IMA said: “Not notifying TB is a violation of the MCI Code of Medical Ethics Regulations under Sections 5.2 & 7.14 and can lead to suspension of the license of the doctor.” The IMA has now asked the government to come out with a policy, in which sputum-positive TB cases are given paid leave, so that such patients do not hide their illness. It has also communicated to its members that TB patients should not default during their full course of treatment.

As a part of TB awareness, the IMA will be organising a series of programmes for nurses, school/college principals, TB-rally, medical education programmes for doctors and nursing home owners and an all-India Medical College TB Slogan contest.

The campaign will culminate on April 7 with a tableaux, which will go around in Delhi/NCR to create awareness on TB.

Meanwhile, explaining the difference between TB and swine flu, Dr. Aggarwal noted: “Swine flu is a droplet infection, while TB is droplet nuclei infection. Infected particles of size more than five microns are called droplet infection and of less than five microns are called droplet nuclei.”

“TB is principally transmitted in hospitals by droplet nuclei; hence, hospital can be a place where TB is transmitted to other patients and healthcare staff,’’ said Dr. Aggarwal.

While prevention of flu requires simple three layered mask, the one for TB prevention requires N95 mask.

IMA physicians also noted that most TB patients do not disclose their TB status as they fear the social stigma. The public needs to be informed that every open sputum case of TB will infect and be responsible for 15 new more TB cases if not taken care of.

In India, 2.1 million new TB cases occur annually and 2,40,000 TB deaths occur every year
Media
IMA,IJCP,HCFI
Event
IMA,IJCP,HCFI
Inspirational Story
Shake It Off and Step Up

A parable is told of a farmer who owned an old mule. The mule fell into the farmer's well. The farmer heard the mule 'braying' - or whatever mules do when they fall into wells. After carefully assessing the situation, the farmer felt sorry for the mule, but decided that neither the mule nor the well was worth saving. Instead, he called his neighbors together and told them what had happened and asked them to help haul dirt to bury the old mule in the well and put him out of his misery.

Initially, the old mule was hysterical! But as the farmer and his neighbors continued shoveling and the dirt hit his back, a thought struck him. It suddenly dawned on him that every time a shovel load of dirt landed on his back: he should shake it off and step up! This is what the old mule did, blow after blow.

"Shake it off and step up... shake it off and step up... shake it off and step up!" he repeated to encourage himself. No matter how painful the blows, or distressing the situation seemed, the old mule fought "panic" and just kept right on shaking it off and stepping up!

You guessed it! It wasn't long before the old mule, battered and exhausted, stepped triumphantly over the wall of that well! What seemed like it would bury him, actually end up blessing him. All because of the manner in which he handled his adversity.

In addition to "shaking it off and step up," we Christians have our heavenly Father to help get us through rough times. When the going gets rough, keep looking up, and trust him.
Wellness Blog
Treatment of Fatty Liver
  • 10 % weight loss can improve fatty liver and possibly inflammation.
  • Metformin and ursodeoxycholic acid are not recommended.
  • Statins are safe in patients with fatty liver but whether they can reduce fatty liver is not known.
  • Omega-3 fatty acids have been tried
  • Pioglitazone is useful in the treatment of biopsy-proven fatty liver with inflammation
  • Vitamin E at a dose of 800 IU/day improves liver inflammation
  • Use of bariatric surgery for treatment of fatty liver is premature and should be avoided in patients with cirrhosis.
Dr (Major) Prachi Garg Honored
Dr (Major) Prachi Garg, Senior Consultant with Heart Care Foundation of India was honored today with 'Women of Substance Award' in a function organized by "Honour our Women" UP Chapter to earmark International Women’s Day. The Function was held at Sunderdeep Group of Institutions, Ghaziabad.

Ten different women achievers from different walks of life were honored on the occasion. Dr Prachi Garg was awarded in the field of medicine. The award was given by Ms Rashmi Singh IAS and Anurag Singh Thakur National President Honour our Women (HOW).

Dr Garg is also Senior Associate with Padma Shri Awardee Dr K K Aggarwal President, Heart Care Foundation of India. Commenting on the award Dr Aggarwal said that it is an honour for the Foundation that Dr Prachi Garg has been recognized for her contribution to the society.

A panel discussion on Women Empowerment - Need of the Hour was also organized.

Dr (Major) Garg is also a Senior Clinical Associate at Moolchand Medcity, New Delhi. She is known for her work in the field of CPR, First Aid etc.

During her Army tenure, Dr Maj Garg had the honour of serving in the active Operation Vijay (Kargil War) with 8 mountain Artillery Brigade. During her tenure she also participated in Operation Parakaram. Dr (Major) Garg took voluntary retirement from the Army in 2003 and decided to serve the civil society. She has been actively associated with NCC.

Dr Garg was also a Family Counsellor in Police Paramarsh Kendra, Police Line, Ghaziabad under the guidance of the SP Traffic Sh. Vijay Garg and Sh. Ashfaq Ahmad.
Quote of the Day
Luck is what happens when preparation meets opportunity. Seneca
IMA in Social Media
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http://www.ima-india.org/ima/

www.indianmedicalassociation.info
Reader Response
People in Govt. , in AMAI , should respect the Constitution of Inida according to which different Councils to control Systems of Medicine under diffident systems came into being.By Practicing Allopathic Medicine Ayurveda Practitioners are spoiling chances to furtherance to Ayurveda among practitioners and public. Looking them as second class is not good but certainly highly graded people in qualifying enterance tests get admission in Allopathic systems and lase left out join Ayurveda and still they want to earn quick money through illegal means by practicing allopathy even if they are constitutionally ineligible to do so. Govt. , if wants to respect the Constitution should turn down their demands. Dr.OPS Kande
IMA Videos
News on Maps
eMedi Quiz
The extent to which ionization of a drug takes place is dependent upon pKa of the drug and the pH of the solution in which the drug is dissolved. Which of the following statements is not correct?

1. pKa of a drug is the pH at which the drug is 50% ionized.

2. Small changes of pH near the pKa of a weak acidic drug will not affect its degree of ionisation.

3. Knowledge of pKa of a drug is useful in predicting its behavior in various body fluids.

4. Phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non-ionized in plasma.

Yesterday’s Mind Teaser: Ofleck's phenomenon is seen due to which component?

a. Joint psoriasis

b. Mucosal psoriasis

c. Nail psoriasis

d. Pustular psoriasis

Answer for yesterday’s Mind Teaser: c. Nail psoriasis

Correct Answers received from: Sheen Saji, Tukaram Pagad, Dr Avtar Krishan, Daivadheenam Jella, Tukaram Pagad, Raju Kuppusamy.

Answer for 13th March Mind Teaser: c. Pyoderma gangrenosum

Correct Answers receives: Sheen Saji, Tukaram Pagad.
IMA Humor
Mr. Smith is Dead

A law firm receptionist answered the phone the morning after the firm's senior partner had passed away unexpectedly.

"Is Mr. Smith there?" asked the client on the phone.

"I'm very sorry, but Mr. Smith passed away last night," the receptionist answered.

"Is Mr. Smith there?" repeated the client.

The receptionist was perplexed. "Perhaps you didn't understand me I'm afraid Mr. Smith passed away last night."

"Is Mr. Smith there?" asked the client again.

"Ma'am, do you understand what I'm saying?" said the exasperated receptionist. "Mr. Smith is DEAD!"

"I understand you perfectly," the client sighed. "I just can't hear it often enough."
Sputum Disposal Guidelines
One sputum positive case can infect 10 more persons, if sputum disposal guidelines are not followed by the patients, said Padma Shri Awardee Dr A Marthanda Pillai National President IMA and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.

IMA is observing TB Awareness Fortnight to reduce the menace of TB in the country.

As per IMA, patients should be provided with individual containers with lids, containing 5% phenol, to collect sputum. Patients should be instructed about spitting the sputum directly in the container or in a tissue paper, which is then thrown in the container. The container should be emptied daily and the sputum should be disposed of.

Disposal of sputum at health settings need to be considered. All health care settings should make available tissue papers, and make bins with disinfectants accessible to patients for disposal of sputum.

Segregation of patients with respiratory symptoms in OPDs should be achieved by having a separate waiting area for chest symptomatic patients.

A patient flow control mechanism at the entry point of the waiting area should be implemented, so that chest symptomatic patients, those who have been screened earlier and are carrying priority slips or other similar identification are diverted to this special area rather than the common waiting area. The outpatient area, more so this segregated area, should be well-ventilated to reduce overall risk of airborne transmission.

One should minimize hospitalization of TB patients and establish separate rooms, wards, or areas within wards for patients with infectious respiratory diseases.

The best choice for infectious or potentially-infectious patients is to house them and manage them in airborne precaution rooms. Where such airborne precaution rooms are not feasible, other options for physical separation include: Having a few small ‘airborne precautions rooms’ for patients with infectious respiratory disease patients, having a separate ward designated for patients with infectious respiratory disease; keeping a designated area with better ventilation available for the placement of potentially-infectious patients; having a “No Immune-Compromised Patient Area.”
Rabies News (Dr A K Gupta)
Can a person receiving/completed antirabies immunization, either pre–exposure or post–exposure, donate blood?

A person receiving/completed antirabies immunization can donate blood. However, the recipient does not benefit from the transfer of rabies–neutralizing antibodies due to hemodilution.
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