May 15  2015, Friday
Even the elderly should exercise
Dr KK Aggarwal Research has found that older runners live longer and suffer fewer disabilities than healthy non–runners. This observation applies to a variety of aerobic exercises, including walking.

A study by authors, from Stanford University School of Medicine, published in the Archives of Internal Medicine has shown that being active reduces disability and increases survival.

There are benefits of vigorous activity late in life. Earlier many experts believed that vigorous exercise would actually harm older individuals. And running, in particular, would result in an epidemic of joint and bone injuries. But this new study proves otherwise.

Two hundred and eighty–four runners and 156 healthy "controls," or non–runners, in California completed annual questionnaires over a 21–year period. The participants were 50 years old or over at the beginning of the study and ran an average of about four hours a week. By the end of the study period, the participants were in their 70s or 80s or older and ran about 76 minutes a week. At 19 years, just 15 percent of the runners had died, compared with 34 percent of the non–runners.

In the study, running delayed the onset of disability by an average of 16 years. It’s so important to be physically active your whole life, not just in your 20s or 40s, but forever.

Exercise is like the most potent drug. Exercise is by far the best thing you can do.

One should take lessons from Yudhishthir in Mahabharata who walked till his death. However a word of caution, if an elderly is walking or entering into an exercise program, he or she should have a cardiac evaluation done to rule out underlying heart blockages.
IMA-KSB President Dr.Honnegowda and team serviced at Katmandu-Nepal from: 27.04.2015 to 07.05.2015
  • Single whole-arm ultrasound can rule out upper-extremity deep vein thrombosis with a lower rate of repeat screening than a multi-step strategy using clinical scoring and D-dimer testing, researchers reported May 11 in JAMA Internal Medicine.
  • Males benefit indirectly when girls are immunized against the sexually transmitted human papillomavirus (HPV), according to a new Dutch study published online May 12 in BMJ.
  • New research conducted in both the United Kingdom and the United States suggests that the public would accept "nudging" techniques to lower sugar-sweetened-beverage (SSB) intake to reduce obesity. "Nudge" interventions involve modifying the environment — for example, limiting the size or changing the shape of drink containers or changing the location in which they are placed in stores. (2015 European Congress on Obesity)
  • A large-scale remote monitoring program is reducing readmission rates and increasing patient satisfaction, according to a presentation at the American Telemedicine Association 2015 Annual Meeting.
  • The US FDA on Tuesday issued draft guidance proposing to lift the agency's ban on blood donations from men who have sex with men, as long as the donors have abstained for a year.
Dr KK Spiritual Blog
Namkaran Sanskar

In India, a person is identified by his/her name, which usually is a reflection of his/her own family. It may include not only your maiden name but also the name of your father and your surname/caste.

When you are born, you are usually given your special name, which you carry throughout your life unless it is changed for a specific purpose. For example, the surname may change after marriage or the in–laws may change your name, specifically, when you are a girl.

Artists often change their names to those which may reflect their profession. A classical example is Rajesh Khanna, who changed his name from Jatin to Rajesh, which was easier for the public to recall.

A name for a baby is chosen on any of the following grounds:
  1. The priest, as per the horoscope, decides the sound present in the universe and that Akshar (Alphabet) is given to the family to choose a name beginning with that Akshar.
  2. Sometimes, the name of the baby may be chosen depending upon the auspiciousness of the day he/she was born, e.g. a baby body born on Krishna Janmashtami, may be named ‘Krishna’ by the family after Lord Krishna.
  3. If the parents have vowed a Mannat to a deity, then they may name their child after one of the several names of that deity. For example, if parents have taken a Mannat from Vaishno Devi, their baby girl may be named as one of the forms of Goddess Durga or Parvati.
  4. People may also choose similar names for their children, e.g. Ramesh, Mahesh and Suresh.
  5. People may also keep the name of the child in the form of known pairs. If the name of the first child is Luv, the parents may like to name the second child as Kush, especially when the parents have twins. Other examples are Karan Arjun, Sita and Gita etc.
  6. Sometimes, parents name their child after their favorite celebrity. For example, if someone is a big fan of Sachin Tendulkar, he may name his child Sachin. Sachin Tendulkar himself was named after the noted Hindi film music director Sachin Dev Burman by his father, who was a great fan of SD Burman.
Name has a lot of significance as Akshar in Sanskrit has a vibration and if that positive vibration matches with the vibrations of universe at the time of your birth, it helps in healing.

Normally, it is expected that you live up to your name. For example, if your name is Durga, you are expected to know all about Maa Durga and try to adopt characteristics of Durga.

Therefore, everyone is expected to know the literal meaning of his or her name and try to follow a lifestyle that is consistent with your name. For example, if you are named Ram, you are not expected to act like Ravana.

Namkaran Sanskar or the naming ceremony is a complete ceremony and is one of the 16 sanskars. It is both a social and legal necessity. As the naming process creates a bond between the child and the rest of the community, it is considered auspicious.

Some people name their child before he/she is born but a Namkaran Sanskar is usually performed on the 12th day after birth but it may vary from religion to religion and custom to custom.

The formal ritual involves a Namkaran puja, which is held at their home or a temple where the priest offers prayers to all the Gods, Navagrihas, five elements, Agni and the ancestors. The horoscope of a child is made and is placed in front of the idol of the deity for blessings. With the baby in the lap of the father, the chosen name of the child is whispered in the right ear.

Some people name the child on the 101st day of the birth and still some others choose the first birthday to name their child.

The name of the child also entails certain etiquettes as it reflects a person. You cannot take the name of a person with disrespect. If you abuse a name it means you have abused a person.
Cardiology eMedinewS
  • Time is critical when it comes to stroke, and early treatment is associated with better outcomes. According to the Screening with MRI for Accurate and Rapid stroke Treatment (SMART) study published in the journal Neurology, small changes in quality improvement procedures enabled clinicians to use MRI scans to diagnose stroke patients before giving acute treatment, within 60 minutes of hospital arrival. MRI scans provide detailed images but take longer to complete than CT scans, which are commonly used in most centers.
  • Results of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Study in Boston (MOBILIZE Boston Study) suggest that chronic use of antihypertensives may not be as strong a risk factor for falls as previously thought in the elderly. In this 1-year study of community-dwelling 70- to 97-year-olds, neither standard nor high doses of antihypertensives were linked to falls.
Pediatrics eMedinewS
  • Chee Y. Ooi, MBBS, PhD, from the Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia, and colleagues report in Pediatrics that eleven percent of infants who had inconclusive results for cystic fibrosis (CF) as newborns went on to develop the disease by age 3 years, underscoring the need for additional tests by skilled clinicians, including monitoring of sweat chloride and searching for disease-causing mutations, according to a prospective longitudinal study.
  • Another study in the journal Pediatrics by Rosa Luciano, MSc, from the Department of Laboratory Medicine, Bambino Gesu Children's Hospital in Rome, Italy, and colleagues reported that teenagers with insulin resistance had higher levels of two proteins, Aβ42 and PSEN1, thought to be predictive of Alzheimer's disease. Elevated levels were more common in obese teenagers than in those who were overweight or normal weight, but the same correlation was not seen in preschoolers.
Make Sure
Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Start macrolides.
Lesson: Make sure to remember that infection with Chlamydia pneumoniae has been implicated in atherosclerosis. Macrolides may have a beneficial role in atherosclerotic disease as shown in trials like CLARIFY, STAMINA.
Dr Good Dr Bad
Situation: A patient with COPD developed Herpes zoster.
Dr Bad: They are not related.
Dr Good: There is an association between the two.
Lesson: People with chronic obstructive pulmonary disease, or COPD, are more likely than others to develop shingles (CMAJ 2011 Mar 22;183(5):E275-80).

(Copyright IJCP)
Wellness Blog
Every arthritis is not the same

Every arthritis is not the same. While osteoarthritis, also called as green arthritis, may require only painkillers and rehabilitation exercises, the red inflammatory arthritis called rheumatoid arthritis may lead to serious deforming complications if not treated early and aggressively.

Any arthritis in young women of child-bearing age should not be ignored, especially if it is worse in the morning and improves by movement. Most of them will have high platelet count on blood examination. These patients require aggressive treatment with disease–modifying drugs within days of the onset of symptoms and diagnosis. Approximately 1–2% of population may have this type of disease.

Osteoarthritis, on the other hand, is a disease of 50+ age group and is due to wear and tear of various joints in the body and break down of the cartilage cushion in the joints. It mainly affects the weight–bearing joints like the knees, hips, neck and lower back joints. Inflammation is not a major feature of osteoarthritis. The experts said that another form of joint disorder is due to gout which is never seen in people below 40 years of age and is almost never seen in young women before the onset of menopause unless there is a known underlying kidney disease and never seen in children.

The progression of osteoarthritis can be arrested with appropriate exercises, weight reduction and preventing posture and movement that worsen the disease.

Typical wear and tear of osteoarthritis is caused by sitting cross legged, doing Padmasana, squatting, other non physiological postures, sitting on low level surface like floor and low chairs, doing push-ups, going up and down on stairs, etc.

Most yoga postures should be done under medical supervision and should follow with a counter yoga exercise.

Most patients of serious arthritis end up taking treatment in other systems of medicines or with quacks.
eMedi Quiz
A recent fitness walk left you breathless, and you’ve been having trouble sleeping. You’ve also been dealing with an upset stomach and occasional dizziness. These could be symptoms of:

A. Depression.
B. Heart disease.
C. Diabetes.
D. High blood pressure.
E. All of the above.

Yesterday’s Mind Teaser: Since sunscreen-awareness campaigns began, have skin-cancer rates decreased?

A. Yes, fewer people are getting skin cancer.
B. No, skin-cancer rates and deaths from the disease are on the upswing.
C. No, skin cancer is on the rise, but fatalities are down.
D. Skin-cancer rates have been stable over the past decade.
E. Yes, but only among older women.

Answer for yesterday’s Mind Teaser: B. No, skin-cancer rates and skin-cancer deaths are on the upswing

Correct Answers received from: Dr Shangarpawar. Dr K C Sharma, Dr Jainendra Upadhyay, Dr Poonam Chablani, Raju Kuppusamy, Daivadheenam Jella, Tukaram Pagad.

Answer for 13th May Mind Teaser: D. 30 minutes of exercise at least four times a week.

Correct Answers received: Dr Nikhil Kumar Mohanty, Tukaram Pagad.
eMednewS Humor
You should write more legibly

As an English professor, my father would often write little notes on student essays. Often he worked late, and as the hours passed, his handwriting deteriorated. One day a student came to him after class with an essay that had been returned. "Mr. McDonald," he said, "I can’t make out this comment you wrote on my paper."

My father took the paper and, after studying it, sheepishly replied, "It says that you should write more legibly."
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Rabies News (Dr A K Gupta)
What is "furious form" of rabies in animals?

The excitative phase follows the prodromal phase in some animals. The animal becomes irrational and may aggressively use its teeth, claws, horns, or hooves. The expression is one of anxiety with dilated pupils. Noise invites attack. The rabid animal roams extensively and attacks other animals, including humans and any moving object. Cats usually manifest furious type of rabies.
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
Press Release
Hypertension in children: Never ignore high blood pressure in children younger than 10 years

17th May is World Hypertension Day

Hypertension or high blood pressure is a condition that is usually prevalent in adults. However, hypertension is now becoming common in children too.

Speaking on the occasion of World Hypertension Day, Padma Shri Awardee Dr A Marthanda Pillai National President Indian Medical Association (IMA) and Padma Shri Awardee Dr KK Aggarwal Honorary Secretary General IMA and President Heart Care Foundation of India said that hypertension in childhood and adolescence contributes to the early development of heart disease, but all high BP in children is not benign. Curable blood pressure in children should always be ruled out, especially in children when they develop blood pressure below the age of 10.

World Hypertension Day is celebrated on 17th of May every year in order to create awareness about hypertension amongst the public around the world. The theme for 2015 is ‘Know your Numbers’.

IMA released some facts on high BP in children on the occasion.
  • First blood pressure should be checked at age of 4 years.
  • Hypertension in childhood and adolescence contributes to premature heart disease.
  • Childhood hypertension is divided into two categories: primary hypertension (no identifiable cause is found) and secondary hypertension (an underlying cause is identified).
  • Always identify a child with secondary hypertension, who may have a curable disease.
  • Always identify other comorbid risk factors like obesity, abnormal lipids, diabetes.
  • It has become clear that hypertension begins in childhood and adolescence, and that it contributes to the early development of heart disease.
  • Secondary hypertension should be suspected in children with one or more of the following findings:
    • Pre-pubertal, particularly younger than 10 years of age.
    • A thin child with a negative family history for high BP
    • An acute rise in blood pressure above a previously stable baseline.
    • Severe HT defined as stage 2 hypertension (BP >5 mmHg above the 99th percentile)
    • Past history of urinary tract infection, especially pyelonephritis, or underlying congenital kidney or urologic anomalies raises the possibility of renal scarring.
    • Symptoms suggestive of excess levels of catecholamines include headache, sweating and tachycardia in addition to high BP
    • Ambiguous genitalia
    • Swelling feet
    • Blood in urine
    • Family history of chronic or congenital kidney disease (such as polycystic kidney disease)
    • Drug history (steroids, or oral contraceptives)
    • History of umbilical arterial catheterization as a neonate.
    • Presence of an abdominal bruit
    • High BP in upper limbs and low BP in lower limbs.
eIMA News
IMA World Hypertension Day: 17th May
Lifestyle modifications to manage hypertension
  • Treatment of hypertension should involve non pharmacologic therapy (also called lifestyle modification) alone or along with antihypertensive drug therapy
  • The overall impact of moderate sodium reduction is a fall in blood pressure in hypertensive and normotensive individuals of 4.8/2.5 and 1.9/1.1 mmHg, respectively
  • A high dietary intake of sodium is associated with the development of hypertension.
  • Some individuals are particularly sensitive to sodium in the diet, and are referred to as being sodium sensitive.
  • Sodium-sensitive individuals obtain a greater degree of blood pressure (BP) reduction with dietary sodium restriction.
  • Dietary sodium reduction can lower BP in both hypertensive and normotensive individuals, and enhances the response to most antihypertensive therapies.
  • Dietary sodium reduction may decrease the risk of cardiovascular disease, potentially though, in part, a reduction in BP.
  • In all hypertensive individuals, reduce dietary sodium intake. A reasonable goal is to reduce daily sodium intake to <100 mEq/day (2.3 g of sodium or 6 g of sodium chloride (one gram of sodium = 44 mEq; one gram of sodium chloride contains 17 mEq of sodium)). Reduce dietary sodium intake to similar levels in the general population with the goal of preventing hypertension and decreasing the risk of adverse cardiovascular events.
  • Weight loss in overweight or obese individuals can lead to a significant fall in blood pressure independent of exercise.
  • The decline in blood pressure induced by weight loss can also occur in the absence of dietary sodium restriction, but even modest sodium restriction may produce an additive antihypertensive effect
  • The weight loss-induced decline in blood pressure generally ranges from 0.5 to 2 mmHg for every 1 kg of weight lost, or about 1 mmHg for every 1 pound lost
  • The DASH dietary pattern is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts; and low in sweets, sugar-sweetened beverages, and red meats. It is consequently rich in potassium, magnesium, calcium, protein, and fiber, but low in saturated fat, total fat, and cholesterol. DASH dietary pattern reduced blood pressure by 6/4 mmHg compared with typical American-style diet that contained the same amount of sodium and the same number of calories.
  • DASH diet can reduce the upper blood pressure by 8-14 mm Hg
  • Combining the DASH dietary pattern with modest sodium restriction produced an additive antihypertensive effect.
  • Aerobic exercise, and possibly resistance training, can decrease systolic and diastolic pressure by, on average, 4 to 6 mmHg and 3 mmHg, respectively, independent of weight loss. (3 to 4 sessions of moderate-intensity aerobic exercise lasting approximately 40 minutes for a period of 12 weeks.)
  • Women who consume two or more alcoholic beverages per day and men who have three or more drinks per day have a significantly increased incidence of hypertension compared with nondrinkers. This effect is dose related and is most prominent when intake exceeds five drinks per day.
  • Decreasing alcohol intake in individuals who drink excessively significantly lowers blood pressure.
  • Moderate alcohol use (one drink per day for women and one to two drinks per day for men) has a limited effect on blood pressure, associated with a modest decrease in cardiovascular risk as compared with no alcohol consumption.
  • The benefits of comprehensive lifestyle modification, including the DASH diet and increased exercise are much more than managing a single life style intervention'
  • Patient education has been demonstrated to result in improved blood pressure
Clinical Establishment Act (Suggestion Review) for Amendments
  1. Chapter 1: 2 (c) : Under the heading Clinical Establishment means: Single clinic needs to be deleted from the preview of clinical establishment. Single clinic if comes under the preview of medical establishment, the treatment will become very costly and beyond the reach of the common man. Most of the clinics of doctors are held at doctor’s own residence in a limited space.
  2. Similarly, 1:2 C (ii) (e), single doctor needs to be excluded.
  3. Chapter II, 3 (2) (b) (iii) (iv) : there is no provision in the Nursing Council Act as well as Pharmacy Council Act for such activities. The main objective of Indian Nursing Council Act is to establish uniform standards of training for nurses, mid wives & health visitors. Similarly the Pharmacy Act 1984 was made as an Act to regulate the profession of pharmacy.
  4. Chapter II 3 (2) (c ) : Instead of 3 representatives only one representative needs to be taken from the Central council of Indian Medicine, as Ayurveda, Sidha and Unani representative have only one system and one council.
  5. Chapter II 3 (2) (e): Instead of one representative, there should be two representatives from the IMA (Elected) as IMA has a membership of over 2.5 lacs doctors.
  6. Chapter II 3 (2) (f) Representation of Bureau of Indian Standards has no role in clinical establishments.
  7. Chapter II 3 (2) (g) : Two representations from the Zonal Council has no place in Clinical Establishment Act, as it is not as per the their aims & objectives set up under Section 15 of the said Reorganization Act 1956 Clause 12.
  8. Chapter II 3 (2) (h) : Similarly, North Eastern Council Act 1971 Clause 4 does not define any aim in a medical clinical establishment. Therefore 2 representatives from there may not be required.
  9. Chapter II 3 (2) (i) Till the Para Medical Council is made, there is no role of Para Medical Representation.
  10. Chapter II 3 (2) (j) : Instead of two, only one representation should be from the Consumer Group.
  11. Chapter II 3 (2) (k): This clause needs to be removed as it is a replicable of the clause 3 (c ).
  12. Chapter II 5 (b) : Functions of the National Council” The Council instead of classification, the CE into different categories should adopt the classifications by NABH .
  13. Chapter II 5 ( c): Developing minimum standards and their periodic view is against the medical sciences which changes on day to day basis. Here the minimum standards should be judged by the State Medical Council and not the CEA.
  14. Chapter III 8 (2) (d) (iii) & (iv) : may be deleted for reasons above ( State Nursing Council of India/State Pharmacy Council of India)
  15. Chapter III 8 (2) (e) : Instead of 3, only one representative of Ayurveda, sidha and Unani, should be there, as stated above.
  16. Chapter III 8 (2) (f) : Two representatives from State IMA as explained above.
  17. Chapter III 8 (2) (h): one representative from consumer Group as explained above.
  18. Chapter II (10): Authority for registration: a) District Collector Chairperson should be deleted and District Health Officer as in (B) should be chairperson. c) Out of these 3 members, one should be from IMA, one should be from Ayurveda and one from Dental.
  19. Chapter III 12 (ii) : The minimum requirement of all personnel should be as per NABH requirements.
  20. Chapter III 12 (2): Instead of stabilizing the patient, it should be restricted to provide first aid with the available facilities and infrastructure.
  21. Chapter III 13 (1) : Classification of different establishments should be as per NABH Guidelines.
  22. Chapter III 13 (2) : This clause to be deleted as this is the job of NABH.
  23. Chapter IV (21): The authority shall give minimum 30 days notice before taking any action, may be added.
  24. Chapter IV (26): It should be replaced with “as soon as the clinical establishment submits the required evidence of having compiled with the prescribed minimum standards, the Authority shall verify all evidence submitted by the clinical establishment of having compiled with the prescribed minimum standards within a period of 30 days before processing for grant of permanent registration.
  25. Chapter IV (27) :Communication of deficiencies. If authority finds any deficiency, such deficiency shall be communicated to the clinical establishment for response within a period of 45 days.
  26. Chapter IV (33): Inspection of registration of clinical establishments: To be replaced by “that the authority or an officer authorized, in writing, by district/State Authority Team, shall have the rights to cause an inspection in respect of any registered medical clinical establishment/lab and equipment. The inspection team must give 48 hours show cause notice and one of the members of the inspection team should be an IMA member.
  27. Chapter vi 40: The first penalty should be a warning, 2nd should be censure and for subsequent, it should be fine of Rs. 10,000/-.
  28. Chapter vi 41: The first penalty should be In all penalty clauses, the first should be a warning, 2nd should be censure and 3rd should be a reasonable penalty.
  29. Chapter vi 42: On similar lines as 40, 41
  30. Chapter vi 43: On similar lines as 40, 41
  31. Chapter 44: On similar lines as 40, 41
  32. Rules : Central Rules 2015 :

    9 (ii) : The rate list shall be transparent. Rates cannot be decided by the Central or State Govt. for the private sector.
    (iii) to be deleted as this is the job of State Medical council.
    (iv) & (v) should be, as far as possible, not mandatory.

    Dr K K Aggarwal
IMA written a letter to IRDA
Mr. T. S. Vijayan
Insurance Regulatory and Development Authority
Delhi Office – Gate No. 3
Jeevan Tara Building, First Floor
Sansad Marg
New Delhi – 110 001.

Dear Mr. Vijayan,

Greetings from Indian Medical Association!

Indian Medical Association (IMA) is a pan Indian voluntary organization of modern medicine doctors. It has a membership of 2.5 lakh doctors spread over 1700 branches in almost all the districts of India.

Many of our members have complaint that Insurance Companies does not cover cost of breast reconstruction surgery in a patient who has undergone the same.

The breast reconstruction surgeries, for these cases are not a cosmetic surgery but a part of breast cancer surgery. There is no reason why Insurance Companies should not cover the cost of such a surgery.

Indian Medical Association is willing to discuss this matter, if required, with the representatives of your Organization.

Kindly treat this matter as most urgent.

Thanking you & with regards,

Yours sincerely,

(Dr K K Aggarwal)
Padma Shri Awardee
National Science Communication &
Dr B C Roy National Awardee
Honorary Secretary General, IMA
Reply received from IRDA
Dr. K.K. Aggarwal,
Padma Shri Awardee
National Science Communication &
Dr B C Roy National Awardee
Honorary Secretary General, IMA

Sub:- Insurance Cover to Breast Reconstruction Surgery
Ref:- Your letter dated 31st March 2015

While appreciating the idea and the suggestion seeking Insurance Coverage to cover the cost of Breast Reconstruction Surgery, we wish to impress upon you that the Authority does not interfere into the designs of the products of the Insurance Companies unless these are in violation of the Insurance Act 1938, IRDA Act 1999,IRDA Health Insurance Regulations 2013 and circulars/guidelines issued by the Authority from time to time.

Generally, surgeries of this nature that are medically necessary are not excluded. However inclusion or exclusion of a particular cover (including the cover for any disability/for and surgery like the one mentioned) in a product depends on the design of that particular product. Similarly acceptance or rejections or accepting a risk with certain conditions depends on the underwriting policy of the Insurance Company. The product design is solely done by the Insurance Companies taking into account various factors like risk assumptions, claims experience etc.

In view of the above, your suggestion may, please, be taken forward with any of the Insurance Companies offering Heath Insurance. By marking a copy this letter, we are forwarding the copy of your letter dated 31st March 2015, to the General Insurance Council Mumbai, which is a representative body of all General Insurance Companies and stand alone Health Insurance Companies for their further looking into the matter.

Thanking you,

Yours sincerely,

Yegnapriya Bharath
Joint Director (Health) IRDAI, Hyderabad
Insurance cover to Breast Reconstruction Surgery
IMA has raised an issue with the Insurance Regulatory & Development Authority (IRDA) regarding Insurance Companies not covering the cost of Breast Reconstruction Surgery after a patient has undergone removal of breast due to the breast cancer.

Claims have been denied on the ground that Breast Reconstruction Surgery falls in the category of cosmetic surgery.

“Breast Reconstruction Surgery in patients with breast cancer is not a cosmetic surgery but a medically indicated part of the Breast Reconstruction Surgery said Padma Shri Awardee Dr. (Prof.) M.Marthanda Pillai, National President and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA”

In a letter dated 31st March, 2015, Joint Director, IRDA has clarified that though the Authority does not interfere into the design of the products of the Insurance Companies, “however, surgeries of this nature that are medically necessary are not excluded.”

Breast Cancer Surgery is a staged surgical procedure. In stage I breast is removed and in the second stage, removed breast space is reconstructed.

IMA has written to all its members to specifically mention this in claim form as “stage one radical mastectomy followed by State 2 breast Reconstruction surgery.”

IMA has also written to its members that if the Insurance Companies fail to pass the claim they must approach IMA Hqrs so that this issue can be taken up by IRDA again.

Dr K K Aggarwal
Hony. Secretary General, IMA
Indian Medical Association Sends Legal Notice To Bhansali, Akshay Over 'Gabbar Is Back' Scene
PTI: Huffington Post: Posted: 13/05/2015 22:39 IST Updated: 13/05/2015 22:40 IST

New Delhi -- The Indian Medical Association (IMA) has sent a legal notice to filmmaker Sanjay Leela Bhansali and actor Akshay Kumar demanding removal of a scene from the film 'Gabbar is Back', which it claimed projects the medical profession in a "derogatory" manner.

"In accordance with the Cinematograph Act, 1952, and other provisions of law, the director, producer and actor are under the obligation and responsible so that no scene from the movie incites commission of any offence," IMA said in a statement today.

Bhansali has produced the film while it has been directed by Krish. Kumar acts in the lead role in the film.

"The film shows doctors intentionally providing medical treatment to a person who was already 'dead' before being brought to a hospital. The scene in the movie has not only lowered the dignity of the medical profession, but has also provoked the public at large against the noble profession of the doctors," IMA said in a statement issued today.

Dr KK Aggarwal, the Secretary General of IMA, said, "The legal notice issued yesterday says that the producers, directors and actors created false images for the public so that the movie becomes a hit... (The said scene has) caused immense loss to the reputation of the doctors.

"IMA has demanded immediate removal of the scene from the movie."

IMA has also sent a notice to the Censor Board to ban the movie with immediate effect till the objectionable scenes are removed and has also called upon the addressees to tender a written apology to doctors in national newspapers and pay Rs 5 crore as compensation for damaging the image of the medical profession.
Gabbar lands in trouble
The Tribune: According to reports, the Indian Medical Association (IMA) has decided to serve a legal notice to Gabbar is Back actor Akshay Kumar and producer Sanjay Leela Bhansali. Apparently the IMA is not too happy with the makers of Gabbar Is Back for portraying the medical profession in poor light. Honorary secretary-general Dr KK Aggarwal said, “The way the producer and the actor have shown the medical profession is a wrong way. People may lose faith in this noble profession. That is why we have decided to serve them legal notice soon.”
Letter to editor
  • If I'm bound ethically and legally to attend and give emergency medical therapy to the needy and then if the patient dies or worsens during that time and I'm assaulted for that, who is going to help me out? Law and ethics should also consider doctors safety. Else, I would not like to have provision for emergency care. Please take a note. Thank you. Dr Ronak Patel
  • Dear Dr Aggarwal, in one of your recent issues you had highlighted the CAG's Report on huge losses to the exchequer due to the fraudulent evasion of Income Tax, by Pharma companies both by claiming rebate for expenses on R&D which they had never undertaken as well as heavy expenses on Freebies provided to Doctors etc. The figures revealed were based on Test Check; the full evasion must be to a far greater extent. No doubt the IT Department would take action to recover the dues and even impose penalties on the Pharma Companies concerned. My concern is however the effect the loading of the actual fraudulent expenditure on the R&D which were never carried out and the expenses on the Freebies on the loading of drug and Pharmaceutical prices, which the consumers have already incurred! Such overcharging which cannot be reimbursed to individual consumers, but have unduly enriched the Pharma Companies must be recovered in full from them and credited to the Consumer Welfare Fund under the Ministry of Consumer Affairs. This is also a matter to be taken note of by NPPA. I have written in this regard to the Chairperson CBDT, Ms. Anbita Kapur and to the Chairman NPPA, and have asked for time to discuss this issue with them. I am not sure whether and when they will respond. I request your support on this issue on behalf of consumers. S Krishnan
Sonal Namaste
CDC guidelines advise use of a plain (nonantimicrobial) soap with water for routine hand washing.
Team IMA at Nepal
Dr. Sujit Damodar Adsul, Anesthesiologist

Communication throughout Nepal was extremely difficult due to the absence of any internet or local calling facilities. We carried a host of supplies with us since until now, no team had managed to reach Sindupal to help the victims there. We saw several patients in the region who had been affected by the earthquake and provided them medical aid. We distributed the supplies to them and returned in the night to our base camp.

A Brief Report of the Relief Activities Carried out by the Team of ten (10) Doctors Deputed by Govt. of Karnataka on 27-4-2015 to Nepal for the Earth Quake Relief operation
  1. A team consisting of 6 doctors from Health & Family Welfare Dept. and 4 doctors from Indian Medical Association were deputed to Nepal Earthquake Disaster Management.
    1. Health & Family Welfare Dept: Dr. Srinivas, Dr. Manjunath, Dr. Rajesh, Dr. Kiran, Dr. Jayanthi, Dr. Asha
    2. Indian Medical Association: Dr. Honnegowda, Dr. Vani Kori, Dr. Nirmala, Dr. Nagesh
  2. Team left Bangalore on 27/04/2015 and arrived at Nepal on 28/04/2015.
  3. The team is carrying out relief operations in two Groups.
    • Group 1: Orthopedic team consisting of Dr. B Manjunath and Dr. M Kiran Kumar.
    • Group 2: Medical Team comprising of the remaining 8 Doctors.
  4. Total 1,152 kg (1.15 tons) of medicines and consumables were sent by Govt. Of Karnataka, which was handed over to Director of Tribhuvan University Teaching hospital, Nepal as per instructions of the Indian Embassy.
  5. After obtaining the necessary permission from the Ministry Of Health, Govt. of Nepal, the Medical Team in coordination with Federation of Nepalese Chambers of Commerce & Industries (FNCCI), the team started with community outreach Health services.
  6. Medical Team has successfully conducted 5 outreach health camps covering about 2,000 victims
  7. The following aspects were covered during the outreach camps
    • Medical evaluation of survivors
    • Providing required medicines
    • Treating minor injuries
    • Counselling the patients
    • Health Education
  8. The outreach camps were conducted with the help of volunteers and Federation of Nepalese Chambers of Commerce and Industries. All the stakeholders appreciated the team of doctors for their efforts in providing health relief and Govt. of Karnataka for providing relief materials.
  9. The Orthopedic team comprising of Dr. B Manjunath and Dr M Kiran Kumar reported to the Nepal Police Hospital, where 60-70 air lifted patients were awaiting surgery
  10. The team screened, examined and selected 52 patients for surgical procedures.
  11. In the course of stay in the hospital, our Orthopedic team successfully conducted necessary procedures for 52 severely injured and complicated patients.
  12. AIGP Dr Suman Rana, who is in charge of the police hospital Nepal, appreciated the efforts of our team whole- heartedly and Govt. of Karnataka’s contribution towards sending relief materials and Orthopedic Surgeons team in time for conducting the surgeries.
  13. There are 75 districts in the Nepal out of which districts were badly affected by earthquake. The team of Karnataka Govt. Doctors had carried out relief work in the following 5 districts: Kathmandu, Bhaktpur, Nuwkoat, Kavri, Dhading
The team has successfully completed all the relief task assigned to them and the team is preparing to return home starting tomorrow after having tirelessly contributed towards the relief operations in Nepal.
Inspirational Story
The Bumblebee

According to scientists, the bumblebee's body is too heavy and its wing span too small. Aerodynamically, the bumblebee cannot fly. But the bumblebee doesn't know that and it keeps flying. When you don't know your limitations, you go out and surprise yourself. In hindsight, you wonder if you had any limitations. The only limitations a person has are those that are self-imposed. Don't let education put limitations on you.

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Thank you very much for starting "IMA Doctor of the year Award". It will inspire doctors fraternity to work more and more and will provide sense of recognition. Sir, is there any specific format in which we need to send nomination ? (as there was formate for IMA Medachivers Awar -2014). Please guide . warm regards: Dr. Chinmay Shah

IMA response - 800 words citation to be forwarded by a nominee containing last years achievement
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