December 16   2015, Wednesday

Dr KK AggarwalDr KK Aggarwal An appeal: Popularize various schemes of IMA; visit the scheme stalls at NATCON, New Delhi

Dear Leaders

IMA has five schemes for the benefit of the medical fraternity. The oldest one is the National Social Security Scheme, which was started in 1993 and which has subsequently been adopted by many other state branches of IMA.

The national Professional Protection Scheme is in existence since 2002, which has handled more than 24 cases out of which all except one have been won by us. The scheme is doing yeomen service to the medical fraternity who are in dire distress whenever a case is filed against them. All types of cases including consumer, civil, and criminal, including those filed in human rights and women’s commission and MCI are handled by the scheme. It has been observed that large compensations have been awarded whenever an individual doctor fights the case on his own. National PP scheme prepared defenses are more medically correct and legally sound. This facility should be utilized by more and more of our members particularly in those states where there is no state level schemes. Even where state PP schemes are present, when a member takes both schemes in an unfortunate situation where compensation has to be paid, both schemes will be at his/her help.

The National Pension Scheme, the National Health Scheme and the Biomedical Waste Disposal Project have been launched this year.

The National Pension Scheme has already enrolled large number of members for various states. In the years to come, the earning capacity of a doctor will become considerably less with the doctor population ratio becoming better. He will be more like a government employee earning a fixed income. The morbidity among doctors is also very high due to the very nature of the service and increase in tension together with violence at work place and compensation cases. This genuinely requires the need for a pension scheme and hence this scheme has been launched. All the members, particularly youngsters, are requested to join the scheme to financially safeguard their future.

The National Health Scheme, which was also launched this year, is a big draw with lot of members joining across the country. The cost of health care is definitely going up and as a result, even a doctor is not able to afford the cost. Through this scheme, without going through any formalities, the expenditure is reimbursed to the tune of up to 2 lakhs per year. This scheme is not denied to members with pre–existing illnesses, there is no age limit and the facilities and benefits are extended to family member including in-laws. Being a member of the scheme does not prevent anybody from availing benefit from other health insurance schemes.

A clean and hygienic working environment is very essential for doctors as well as for the patients. The Biomedical Waste Disposal Project ensures segregation of biomedical wastes at source and definitely prevents nosocomial infections. The biomedical waste collected is disposed off in a scientific manner with zero level pollution. Recycling of waste again reduces quantum of the waste and makes the scheme ecofriendly and financially viable. The first plant under this project is being constructed at Dhule, Maharashtra.

Team IMA wants to popularize all the schemes and wants every member of our organization get the benefit of the schemes and projects

In order to make all the central council members aware of these benefit schemes, a stall will be opened at NATCON 2015 venue, so that every member who attends the conference gets an opportunity to enroll themselves with the schemes and also carry the forms to enroll your own branch members.

Team IMA requests all the members to popularize these schemes

PS: All the scheme chairpersons and secretaries are requested to bring enough application forms and information brochures to be kept in the stalls. Please also ensure that enough personal are available at the stalls to give information about the schemes throughout.

Breaking News

High levels of inflammatory markers appear before IBD symptoms develop

A retrospective study reported at the Advances in Inflammatory Bowel Diseases meeting has found that high levels of serologic markers of inflammation are present in the circulation of patients who develop inflammatory bowel disease (IBD) many years before symptoms develop. Compared with the lowest quintile of interleukin (IL)-6, individuals whose levels were in the highest quintile had more than four times the risk of developing Crohn's disease and the inflammatory marker could be detected up to 20 years before disease onset. They also had triple the risk for developing ulcerative colitis. The preclinical detection of markers such as IL-6 and high sensitivity C-reactive protein (CRP) suggests that there is a time lag between the initiation of mucosal immune dysfunction and disease manifestations... (Medpage Today)

Reducing portion sizes may control obesity

A new policy paper published in the BMJ has suggested that consumers consistently eat and drink more when they are served large portions, and there is an urgent need to intervene with strategies that reduce portion sizes to help combat obesity. According to Dr Marteau and coauthors, people consistently consume more food or nonalcoholic drinks when offered larger-sized portions or packages or when using larger items of tableware [cups, plates, and glasses. eliminating larger portions from the diet could reduce average daily energy consumed by 12% to 15% among UK adults and by 22% to 29% among US adults… (Medscape)
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Specialty Updates
• New research suggests that the use of adhesion-reducing substances, known as adhesion barrier, is associated with slightly increased incidence of fever and ileus after myomectomy and hysterectomy, and with small bowel obstruction after hysterectomy. The findings are published online in Obstetrics & Gynecology.

• A step-wise approach to ablation for persistent atrial fibrillation (afib) did not offer any benefits over pulmonary vein isolation alone, reported the randomized, single-center CHASE-AF study published in the December 22 issue of the Journal of the American College of Cardiology.

• The psoriasis drug ustekinumab can spur hair regrowth and normalize immune function in patients with alopecia areata, suggested the results of a study in three patients published online in a letter to the Journal of Allergy and Clinical Immunology. First author Dr. Emma Guttman-Yassky stated that this opens the door for targeted treatment of alopecia areata.

• Patients whose inflammatory bowel disease (IBD) was managed with a tumor necrosis factor (TNF) inhibitor but whose treatment was changed for reasons other than safety or efficacy typically had worse outcomes than those who continued with the successful treatment, reported a real-world study presented at the Advances in Inflammatory Bowel Diseases meeting.

• A new study, published in JAMA Pediatrics, finds a link between antidepressant use during pregnancy and an increased risk of autism in offspring.

• One-third of men with type 2 diabetes have hypogonadotropic hypogonadism (HH) and they could benefit from testosterone treatment, reported a small trial published online in Diabetes Care. Researchers noted that testosterone treatment increases insulin sensitivity and lean mass and decreases subcutaneous fat.

• In patients with mild Alzheimer’s disease (AD), consumption of moderate amounts of alcohol is associated with a lower risk for death than those who drink only occasionally, suggested a new analysis published online in BMJ Open.

• The risks for late lung cancer and ischemic heart disease among women who undergo irradiation for breast cancer are both reassuringly low, unless the patient is a smoker who just can't kick the habit, reported researchers at the San Antonio Breast Cancer Symposium (SABCS) 2015.
Dharma, Artha, Kama and Moksha of Medical Profession

The eras of Ram and Krishna represent two different perceptions of life. While Rama taught us the message of truthfulness, Krishna taught us when not to speak the truth and when speaking a lie is justified. The medical profession today cannot survive on the principles of Rama. According to principles of Krishna, a truth which if spoken may cause harm to someone and if not spoken does not cause any harm, may not be spoken. Similarly, a lie, which without harming the community may help a particular person or situation, may be spoken. Doctors come across situations every day in their medical practice, where speaking the truth may be harmful to the patient. Quite often false hopes are given and patients of terminal cancer are not told about their exact nature of illness and the prognosis. There is no way a doctor is going to tell the patient that you are going to die in the next 24 hours even if it is medically true.

Dharma, artha, kama and moksha are the four basic purposes of life for which we are born. The basic purpose of life is to fulfill our desires in such a way that we end up in inner happiness. Fulfillment of desires should be done by following the principles of righteous or ethical earning. Most charges in the hospital settings are different depending upon the categories chosen by the patient. A single room patient invariably has to pay more than a patient admitted in the concessional three–bed room or general ward. Even the charges of the treatment, operation theatre, investigations and consultations may be different depending upon the categories. Taking more money from the rich and helping the poor. This principle is more according to Krishna’s principle than Rama’s.

Placebo therapy is a well–established therapy in medical science, which means treating the patient without giving the actual drug to a patient. The information that the drug does not contain any ingredient is withheld from the patient in this type of therapy. As per the literature, 35% of illnesses and symptoms may resolve using a placebo and is based on the principle that the very feeling that a medicine is being given stimulates the inner body pharmacy and produces healing substances and chemicals. Nocebo effect, on the other hand, means that if the patient is told that your illness is not going to be cured even if medicines are given they may not act as the patient’s body produces negative chemicals, which neutralize the effect of medicines that otherwise are effective.

Indian doctors were known for their social medicine, which involves proper assessing of patients’ and their families’ financial status before deciding the treatment. There is no point giving options to a family to spend 10–15 lakhs of rupees for getting an ICD device implanted in the heart, which may increase life span only by 1 or 2 years or improve quality of life for a few years to a family who cannot afford this amount of money and may have to sell their house or spend all the money saved for the marriage of their daughters.

But today, with the Consumer Protection Act applicable to the medical profession also, not informing the family may even amount to negligence.
The Year in Medicine 2015: News That Made a Difference
Medical response to Paris terrorist attacks

French physicians spontaneously responded to the November 13 terrorist attacks that devastated Paris, racing to hospital accident and emergency departments to offer their help. Private practice physicians immediately halted a strike, called Black Friday, to give priority to emergency care. Over a period of just a few hours, the Parisian medical world made the transition from Black Friday to the White Plan, triggered by the Paris hospitals authority. The White Plan has been enshrined in law since 2004 and enables additional means and human resources to be mobilized, nonessential activities to be rescheduled, and additional beds to be opened. At least 132 people died in the attacks and more than 250 were injured. (Medscape)
Legal Quote
Indian Medical Association Vs. V.P. Shantha & Ors 1996 AIR 550, 1995 SCC (6) 651

"In devising a rational approach to professional liability which must provide proper protection to the consumer while allowing for the factors mentioned above, the approach of the courts is to require that professional men should possess a certain minimum degree of competence and that they should exercise reasonable care in the discharge of their duties."
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22nd MTNL Perfect Health Mela, the annual flagship event of the Heart Care Foundation of India
Know about your national and state publications; Visit stalls at NATCON

Dear Leaders

IMA has numerous publications at the national and state level; medical journals like JIMA, state medical journals, books edited by various IMA academic wings and IMA academicians.

A stall has been set apart at NATCON 2015, New Delhi to give an opportunity to the delegates to know about IMA publications. All the state branches and academic wings of IMA and even individual members who have edited books are provided an opportunity to exhibit your publications.

All the state branches are required to bring copies of your publications including those meant for lay public so that the delegates will have a bird’s eye view of IMA’s publications.

Thanks and regards

Dr A Marthanda Pillai                                           Dr KK Aggarwal                                                  
President                                                                Hon Sec General                                                         
IMA HQ                                                                           IMA HQ                                                             
National Student IMA Convention for the first time along with NATCON 2015

Dear Leaders

The National convention of IMA student’s wing is being scheduled to be held at the National conference venue at New Delhi at 2pm on 27th December Sunday. National President, President elect, Honorary Secretary general and Dr Vinay Aggarwal will be addressing the student leaders. There will also be a training session held by the National student wing officials.

All state leaders are requested to send TWO student leaders (preferably office bearers of the state student wing) from your state to attend the meet. You may kindly arrange the registration and travel of the student delegates to Delhi to attend the meeting. Please forward the names and contact details of the delegates at the earliest to to help arrange other logistics

Please help us to organise the National student meet successfully.

Thank you for your kind patronage.

Dr A Marthanda Pillai                                           Dr KK Aggarwal                                                  Dr Sreejith N Kumar
President                                                                Hon Sec General                                        National Coordinator Students Wing
Announcement for 67th Annual Conference of the CSI

Dear Colleague

In continuation of the postponement of 67th Annual Conference of the CSI scheduled on 3rd to 6th December 2015 due to unprecedented national calamity at Chennai, the Executive Committee of Cardiological Society of India in its Emergency EC Meeting, held on 14th December 2015 at Indian Heart House, has decided to hold the 67th Annual Conference of the CSI at Chennai Trade Centre, Chennai, from 10th February 2016 to 13th February 2016.

All are requested to join the program to show solidarity with the people of Tamil Nadu in this time of unprecedented national crisis. The present Executive Body of CSI will continue till the next General Body Meeting of the CSI, to be held on 12th February 2016.

Dr Mrinal Kanti Das
Nearly half of India’s children below 3 stunted or underweight

Nearly half of the Indian children under three years continue to be either stunted or underweight, notwithstanding the government’s efforts in the last decade to improve their nutrition status. According to a new report from the Public Health Foundation of India (PHFI) and International Food Policy Research Institute (IFPRI), India, which has one of highest child under-nutrition rates, has more than 40 million stunted kids and 17 million wasted children under five. Malnutrition is defined by stunting (low height-for-age) or wasting (low weight-for-height) or a combination of both. The report provides clear evidence on how poor nutrition of children are not linked to economic prosperity as reflected by statistics from states. For example, more than 30% children under-five years of age are stunted even though the state’s per capita income is better than the national average. Despite similar income levels, Tamil Nadu has a low stunting rate of 23%, while Gujarat had almost 42% stunting rate... (Deccan Herald)
Govt. asks schools to get midday meals tasted by parents daily

The Centre has asked schools to get the midday meal tasted by at least one of the parents of its students daily and maintain a record for inspection to check if wholesome and nutritious food is being given to the children. The tasting of the meal has to be carried out by the parents on a rotation basis along with one of the teachers of the schools before the food is served to students. Making the exercise mandatory, the Human Resource Development (HRD) Ministry recently asked the state governments to ensure its implementation at all the schools where midday meal program is run. More than 10.22 crore children are served midday meal at their schools every day across the country. This comes almost 10 months after the ministry made tasting of the midday meal by at least two adult persons, including one of the teachers of the schools, a mandatory exercise, issuing a 15-page guideline for the implementation of the scheme.… (Deccan herald)
India records maximum number of newborn deaths in Southeast Asia

India accounts for maximum number of newborn deaths in Southeast Asia region. According to the World Health Organisation (WHO), out of the total deaths in the region, more than 75% of neonatal deaths are reported from India. The recent data by the international health agency revealed that out of 89,4000 neonatal deaths in 2015, India accounted for 69,6000 deaths followed by Bangladesh (74,000) and Indonesia (74,000 deaths). Ironically, with this pace, the WHO said that India will not be able to achieve Millenium Development Goals (MDG) 4 to reduce child mortality, MDG 5 to improve maternal health by 2015 and even the Sustainable Development Goals (SDG), one of the targets to reduce newborn mortality to 12 per 1,000 live births by 2030… (Asian Age – Teena Thacker)
Bioethical issues in medical practice
Disclosure of information under Right to information Act

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

Here is an RTI application: "My client’s wife … was admitted to your hospital on … and died on … Kindly provide discharge summary and copy of entire case sheet.” The application is complete in other respects- it provides the name and address of the applicant lawyer, a postal order etc.

a. Should the treating doctor, to whom the case is referred, comply? b. If not, what should his answer be?
c. Who can he appeal to for help?

Any comments or suggestions? Do write in!

Ref.: Mishra NN, Parker LS, Nimgaonkar VL, Deshpande SN.
Artificial Sweeteners in Sweets May Be Harmful

In a joint statement, the American Heart Association and the American Diabetes Association have given a cautious recommendation to the use of nonnutritive sweeteners to help people maintain a healthy body weight and for diabetics to aid glucose control. These products should be considered like a nicotine patch. They are appreciably better than the real product (sugar), but not part of an optimal diet. The statement, published in both Circulation and Diabetes Care on July 9, 2012, warns that sweeteners are helpful only as long as people don’t eat additional calories later as compensation. The term nonnutritive sweeteners cover six sweeteners including aspartame, acesulfame K, neotame, saccharin, sucralose, and plant–derived stevia. These nonnutritive substances have zero calories. Two things may happen in terms of compensation

1. Physiological, where the body might be expecting more calories and so the individual may be hungrier and therefore may eat more

2. Psychological, where the individual thinks they are allowed to eat more sugar-rich food because they had a diet soda instead of a full–sugar soda.

When people use sweeteners there is compensation. The key is how much? Partial compensation is ok but people often completely compensate or even overcompensate, so these sweeteners have to be used smartly to be successful. Compensation seems less of a problem when these sweeteners are consumed in beverages as opposed to food. People don’t really notice the lack of calories in a diet soda and so don’t tend to eat more, whereas if they consume a low–calorie foodstuff, they do tend to eat more as compensation.

Its better when sweeteners are used in beverages and not sweets or other foods. One is not completely sure about the safety of these products, because their long–term use in humans has not been studied fully. However, the artificial sweeteners on the market are almost certainly safer than consuming large amounts of sugar, which has definite harm when consumed in large amounts. This harm, particularly when consumed in beverage form such as soda, includes increases in risks of obesity, diabetes, cardiovascular disease, and gout. A concern, though, is that just replacing sugar with artificial sweeteners leaves a person, especially children, conditioned to high levels of sweetness, which is likely to influence their food choices adversely.
WP(C) No.8706/2015 titled “Indian Medical Association Vs. Union of India & Anr (NCERT)” Delhi High Court, New Delhi

Click here to read the proposed changes
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Inspirational Story
The Falcon & the Branch

Once there was a king who received a gift of two magnificent falcons. They were peregrine falcons, the most beautiful birds he had ever seen. He gave the precious birds to his head falconer to be trained. Months passed, and one day the head falconer informed the king that though one of the falcons was flying majestically, soaring high in the sky, the other bird had not moved from its branch since the day it had arrived.

The king summoned healers and sorcerers from all the land to tend to the falcon, but no one could make the bird fly. He presented the task to the member of his court, but the next day, the king saw through the palace window that the bird had still not moved from its perch.

Having tried everything else, the king thought to himself, "May be I need someone more familiar with the countryside to understand the nature of this problem." So he cried out to his court, "Go and get a farmer." In the morning, the king was thrilled to see the falcon soaring high above the palace gardens. He said to his court, "Bring me the doer of this miracle."

The court quickly located the farmer, who came and stood before the king. The king asked him, "How did you make the falcon fly?" With his head bowed, the farmer said to the king, "It was very easy, your highness. I simply cut the branch where the bird was sitting."

Moral: We are all made to fly — to realize our incredible potential as human beings. But at times we sit on our branches, clinging to the things that are familiar to us. The possibilities are endless, but for most of us, they remain undiscovered. We conform to the familiar, the comfortable, and the mundane. So for the most part, our lives are mediocre instead of exciting, thrilling and fulfilling. Let us learn to destroy the branch of fear we cling to and free ourselves to the glory of flight.
Isotopic response is seen in scars of which condition?

a. Orolabial herpes
b. Herpes genitalis
c. Pyoderma ganagrenosum
d. Eosinophilic pustular folliculitis

Yesterday’s Mind Teaser: Formation of antibody against acetylcholine receptor in pemphigus can be explained by

a. Desmoglein compensation theory
b. Antibody excess prozone phenomenon
c. Anti idiotypic antibodies
d. Epitope spreading phenomenon

Answer for Yesterday’s Mind Teaser: d. epitope spreading phenomenon

Answers received from: Dr Bitaan Sen & Dr Jayashree Sen, Dr K V Sarma, Dr Kailash Chandra Sharma, Dr K Raju

Answer for 12th December Mind Teaser: b. Medina-Ramirez reaction

Answers received from: Dr.K.V.Sarma, Dr Jainendra Upadhyay, Daivadheenam Jella, Dr Kailash Chandra Sharma
Readers column
Dear Sir, thanks for the information. Regards: Dr Kanan
As my five year old son and I were headed to McDonald’s one day, we passed a car accident. Usually when we see something terrible like that, we say a prayer for those who might be hurt, so I pointed and said to my son, "We should pray."

From the back seat I heard his earnest request: "Please, God, don’t let those cars block the entrance to McDonald’s."
Press Release
Regular exposure to noise pollution increases the risk of heart disease

Noise pollution is an often-overlooked source of environmental stress that can raise your risk of serious health conditions, including strokes and heart disease. Noise pollution can result from automobiles – cars, buses and planes – public areas like schools and even within the home.

The World Health Organization suggests that noise pollution is the "most prevalent irreversible occupational hazard." They estimate 120 million people worldwide are affected by the side effects brought on by noise pollution.

Speaking about the importance of sleep hygiene, Padma Shri Awardee Dr. A Marthanda Pillai – National President and Padma Shri Awardee Dr. KK Aggarwal – Honorary Secretary General IMA in a joint statement said," Recent studies are increasingly establishing a strong association between chronic exposure to increased environmental noise levels (traffic noise, noise from low-flying airplanes, loud music) and an increased risk of developing heart disease. This effect is due to stress-related dysregulation of the autonomic nervous system, leading to increases in hypertension and subsequent heart disease

A lack of sleep, caused by the traffic noise, can also affect the immune system and metabolism. In many cases, people in the city may not realize their sleep patterns are being thrown off by noise pollution.

The ambient noise standard for residential areas is 55 decibel during the day and 45 decibel at night.

• Permissible noise in industrial area is 75 dB in daytime and 70 dB in nighttime.
• Permissible noise in commercial area is 65 dB in daytime and 55 dB in nighttime.
• Permissible sound in residential area is 55 dB in daytime and 45 dB in nighttime.
• Permissible sound in silence zone is 50 dB in daytime and 40 dB in nighttime.
• Day time shall mean from 6am to 10 pm and nighttime shall mean from 10 pm to 6am.
• Silence zone are areas up to 100 metres around hospitals, educational institutions and courts.
• One can complain to the authorities if the noise levels exceed more than 10dB than the allowable limit.
• High noise levels lead to stress related dis-regulation of the autonomic system leading to high Blood Pressure and Heart Disease.

It is strongly recommended that each one of us do our bit to reduce the noise pollution we create. Patients at a high risk of heart attacks must stay away from very crowded places and should maintain caution during Diwali, not be present in areas.