September 16   2015, Wednesday
eMedinewS
Managing wounds at home
Dr KK Aggarwal
  • A wound is a disruption of the normal structure and function of the skin.
  • Antibiotic therapy is not indicated in all the wounds and is reserved only for infected wounds.
  • It is important to keep blood sugar under control while managing a wound.
  • All wounds, which are contaminated or with foreign bodies, require debridement.
  • Irrigation of the wound is the best to reduce bacterial load and removing loose material.
  • Irrigation can be done with warm saline.
  • Principles of wound management are – scrub, clean and dress.
  • Scrubbing means that dressing should be done with clean hands, which requires proper scrubbing of the hands.
  • Would cleaning means that the wound should first be cleaned and finally after cleaning it requires a proper dressing.
  • Some wounds may require suturing, especially if the wound is less than 6 hours old.
  • In an accident if a finger is cut or a tooth is removed, one should preserve the finger or the tooth and take it to the nearest hospital along with the patient for reimplantation.
  • The best way to carry the amputated finger or uprooted tooth is to put them in a plastic bag and put that bag in a box containing ice.
  • Skin burns should be treated firstly by putting the area under the running water till the burning disappears.
  • In a patient with burns, the blister that forms should not be punctured.
  • Presence of pain is also a good sign and indicates that the burns are superficial.
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eMedipics
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Beneficiaries of Sameer Malik Heart Care Foundation Fund, tuesday meeting
News
Neurology
Low vitamin D levels are very common in older adults, especially African Americans and Hispanics, and are associated with accelerated decline in episodic memory and executive function, the two cognitive domains strongly associated with Alzheimer's disease dementia, suggests a new study published online September 14 in JAMA Neurology.

Anesthesiology
Surgery

A double-blind, phase 2 study of the investigational opioid TRV130 showed that it was superior to placebo in terms of reducing pain intensity in patients undergoing a bunionectomy, relieving pain within 5 minutes of administration and without causing serious adverse events. The results were presented at PAINWeek 2015.

Orthopedics
Geriatrics

Brief, daily bouts of hopping or jumping can strengthen hip bones and reduce the risk of fracture following a fall, suggests a new study of older men, published in the Journal of Bone and Mineral Research.

Obstetrics and Gynecology
Nocturnal enuresis in postmenopausal women may be associated with symptoms of obstructive sleep apnea (OSA), suggests data from the Women's Health Initiative (WHI) program, published online in Menopause.

Nutrition
New research suggests that people who think they are doing the right thing by choosing a diet beverage then do the wrong thing by snacking on sodium, sugar and high-carbohydrate goodies like cookies, ice cream, fries and pastries. The findings are published in the Journal of the Academy of Nutrition and Dietetics.
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Cardiology eMedinewS
  • The US Food and Drug Administration (FDA) has approved the first implantable cardioverter defibrillator (ICD) that was designed to be used safely in patients who undergo MRI. The device (Evera MRI ICD) is a single- or dual-chamber ICD modified with changes to the firmware and hardware to make it compatible with an MRI scan.
  • A new study suggests that greater adherence to the American Heart Association's Life's Simple 7 in middle age is associated with a lower lifetime occurrence of heart failure and greater preservation of cardiac structure and function. The findings are published in The American Journal of Medicine.
Pediatrics eMedinewS
Pediatrics
Neurology/Psychiatry

A diagnosis of attention deficit hyperactivity disorder (ADHD) was associated with an almost 3-year delay in the diagnosis of Autism Spectrum Disorder (ASD) when compared with the age of diagnosis of children diagnosed with ASD alone, suggested a new study published online September 14 in Pediatrics.

Pediatrics
Cardiology

Three hours of uninterrupted sitting causes substantial disruption to vascular function in the legs in young girls, reported a study published in Experimental Physiology.
Pulmonary Embolism
The initial resuscitative therapy for patients with suspected pulmonary embolism (PE) should focus upon oxygenating and stabilizing the patient. The mainstay of therapy for patients with confirmed PE is anticoagulation, depending upon the risk of bleeding. Alternative treatments include thrombolysis, inferior vena cava filters and embolectomy.
Dr KK Spiritual Blog
Are we reborn as humans each time we die?

As per Vedic sciences, Hindu philosophy believes in rebirth unless your Sanchit and Prarabdha Karmas are totally exhausted.

It also believes in liberation in which once your past karmas debt is over, you do not take a rebirth.

On the other hand, Garuda Purana says that you can be reborn as animals, which means you can be born like a donkey or a dog. Vedic science, on the other hand, says that once you get a human body, you will either be liberated or only get another human body.

The message of Garuda Purana can be read and interpreted in a different perspective. In mythology humans have been linked to animal tendencies. For example, bull is linked to sexual and non–sexual desires, peacock to vanity etc. Probably, people who wrote Garuda Purana meant that if you do not live according to the Shastras, you will end up in getting another human body but with animal tendencies and behavior.
Wellness Blog
Caffeine–Alcohol combination in paralysis

A drug Caffeinol containing caffeine and alcohol may help stroke patients recover.

In a small study at Texas Health Science Center in Houston, 60% of stroke patients who were given the drug, had no or minimal disability when they were discharged from the hospital. In contrast, only 26% of stroke survivors given standard therapy with tissue plasminogen activator, or tPA, fared that well.

Caffeinol contains about as much caffeine as 5 to 7 cups of good, strong New Orleans coffee and the equivalent of two shots of alcohol.

The study involved 100 people who had suffered an ischemic stroke. All received intravenous tPA; 10 were also given an infusion of caffeinol. Caffeinol allows cells to tolerate reduced blood flow longer, thereby giving tPA a longer opportunity to do its action.

Will these findings be applicable to heart attack? Only time will tell as heart attack is also treated with tPA.
Beneficiaries of Sameer Malik Heart Care Foundation Fund
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Make Sure
Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure of 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored, it is an impending sign that the patient is going into shock.
Dr Good Dr Bad
Situation: A patient with heart failure needed a beta blocker.
Dr. Bad: Start any beta blocker.
Dr. Good: Start metoprolol succinate.
Lesson: Only carvedilol, bisoprolol and metoprolol succinate are approved for heart failure.

(Copyright IJCP)
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CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
Press Release
Dengue 4 is less fatal: IMA
It’s not an epidemic yet: IMA


IMA today released dengue guidelines and said not to panic. The present serotype is less fatal than the one which caused dengue cases in 2013.

Addressing a press meet here, Dr A Marthanda Pillai National President Indian Medical Association (IMA) and Dr K K Aggarwal, Padma Shri Awardee and Honorary Secretary General IMA said that only suspected severe dengue cases need medical attention and admission. Most can be managed as OPD care. IMA said NO to platelet transfusion unless patient has active bleed and the platelet count is less than 10,000.

Platelet counts by machine readings are not reliable and can have an error of up to 40,000.

The reliable test is hematocrit and not platelet count. Most cases can be managed without testing by only measuring difference between upper and lower blood pressure. The pulse pressure should be kept over 40 mm Hg.

IMA also appealed to the public not to panic and not force doctors for hospital admission unless it is important. “Do not fill beds with patients not requiring admission. Make beds available for sever dengue cases,” added Dr Aggarwal.

Co-addressing the press Dr V K Monga and Dr R N Tandon from IMA said that most dengue patients can be managed with oral fluids. Unnecessary admissions and overcrowding of hospitals can lead to hospital-acquired infections.

New strain of dengue
  • Dengue normally is caused by four serotypes of the dengue virus: Den1, Den2, Den 3 and Den4. Serotypes 1 and 3 are less dangerous as compared to serotypes 2 and 4.
  • This year, serotypes 2 and 4 serotypes are prevalent.
  • As per AIIMS, the serotype 4 of the virus has emerged as the dominant type for the first time in the capital, along with dengue serotype 2.
  • Symptoms of type 4 dengue include fever with shock and a drop in platelets; type 2 causes a severe drop in platelets, hemorrhagic fever, organ failure and dengue shock syndrome.
  • Every strain carries the risks of hemorrhagic fever, but type 4 is less virulent than type 2. Risk of severe dengue is highest with the serotype 2 virus.
  • Barring stray cases in 2003, the type 4 strain of the virus has never been isolated in Delhi
  • Doctors were expecting the strain to change this year, given the large number of cases. Doctors were not expecting type 4 because it has never been actively circulating in Delhi.
  • When the dominant strain remains the same for a long period, a significant population develops immunity to it, and fewer patients are diagnosed with the virus. However, the type 4 strain had never shown a significant presence. A new serotype will always result in an epidemic-like situation.
  • Infection with one of the four serotypes of dengue virus (primary infection) provides lifelong immunity to infection with a virus of the same serotype. However, immunity to the other dengue serotypes is transient, and individuals can subsequently be infected with another dengue serotype (secondary infection). Subsequent infection with a second type increases the likelihood of serious illness.
  • The risk for severe dengue appears to decline with age, especially after age 11 years.
  • AIIMS lab is also suspecting a new serotype this year in addition. Is it Den 5? Researchers screening dengue viral samples found a virus collected during an outbreak in Malaysia's Sarawak state in 2007, which they suspected was different from the four original serotypes. They sequenced the virus and found that it is phylogenetically distinct from the other four types. Experiments found that monkey antibodies produced against the new type differ significantly from those resulting from the previously known dengue viruses. So far, dengue 5 has been linked to only one outbreak in humans.
  • In 1996, when an outbreak of the disease was reported in Delhi with over 10,000 cases, the relatively severe type 2 strain of the virus was identified as the most common serotype.
  • In 2003, when a sharp rise in dengue cases was again reported, type 3, a mild strain, emerged as the most common serotype.
  • In 2013, with over 5,500 cases, serotype 2 returned as the common strain in the capital.
Most dengue patients are not serious
  • Dengue is both preventable and manageable.
  • The risk of complications is in less than one percent of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.
  • A platelet transfusion is not needed unless patient has active bleeding (other than petechiae) and platelet counts are less than 10,000.
  • Unnecessary platelet transfusion can cause more harm than good.
  • Classic dengue fever is an acute febrile illness accompanied by headache, retro orbital pain, and marked muscle and joint pains. Symptoms typically develop between 4 and 7 days after the bite of an infected mosquito. The incubation period may range from 3 to 14 days. Fever typically lasts for 5 to 7 days. The febrile period may also be followed by a period of marked fatigue that can last for days to weeks, especially in adults. Joint pain, body aches and rash are more common in females.
  • Most complications of dengue occur after the fever is over. The two days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar.
  • The main complication is leakage of capillaries and collection of blood outside the blood channels leading to intravascular dehydration. Giving fluids orally or by intravenous routes, if given at a proper time, can save fatal complications
Only these patients need hospitalization

The World Health Organization (WHO) guidelines recommend attention to clinical “warning signs” for severe dengue
  • Severe abdominal pain or tenderness
  • Persistent vomiting
  • Lethargy or restlessness
  • Abrupt change from fever to hypothermia
  • Bleeding
  • Pallor
  • Cold /clammy extremities
  • Liver enlargement on physical exam
  • Abnormal mental status
Early recognition
  • Dramatic plasma leakage often develops suddenly; therefore, substantial attention has been placed on early identification of patients at higher risk for shock and other complications.
  • The period of maximum risk for shock is between the 3rd and 7th day of illness. This tends to coincide with resolution of fever. Plasma leakage generally first becomes evident between 24 hours before and 24 hours after defervescence.
  • An elevation of the hematocrit is an indication that plasma leakage has already occurred and that fluid repletion is urgently required.
  • Low platelet count usually precedes overt plasma leakage.
  • Mild elevations in serum SGOT and SGPT levels are common. But in severe dengue the levels are very high with SGOT > SGPT levels
  • A normal SGOT levels is a strong negative predictor of severe dengue even in the first three days of illness.
  • NS 1 antigen levels of >600 ng/mL suggest severe dengue.
  • Coexisting medical conditions, such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, and chronic hemolytic disease may increase the risk of severe dengue and/or complicate management. Referral for hospitalization is recommended for such patients, regardless of other findings
  • Additionally, hospitalization should be considered for patients who may have difficulties with outpatient follow-up or with timely self-referral should complications develop (e.g., patients who live alone or who live far from a healthcare facility without a reliable means of transport).
  • Patients with suspected dengue who do not have any of the above indicators probably can be safely managed as outpatients, as long as close clinical observation is assured. Daily outpatient visits may be needed to permit serial assessment of blood pressure, hematocrit, and platelet count.
Government may clarify: is it an epidemic?
  • Recent government circulars say: Postpone routine surgeries to accommodate dengue patients/ Postpone routine admissions/Make provision of extra beds/Do not refuse any patient who needs admission.
  • These all are done when an epidemic is announced.
  • In an epidemic, all cases are presumed to be dengue, no confirmatory testing are done, a triage announcement is done, clear cut directions are announce regarding which patients are to be admitted and which patients are not to be admitted.
Management of significant bleeding
  • Gastrointestinal bleeding, epistaxis, or menorrhagia in patients with severe dengue (and occasionally in patients with dengue fever) can be severe enough to require blood transfusion.
  • Blood replacement should be done with 5 mL/kg of packed red blood cells (or 10 mL/kg whole blood).
  • Platelet transfusions have not been shown to be effective at preventing or controlling hemorrhage but may be warranted in patients with severe thrombocytopenia (<10,000/mm3) and active bleeding.
  • Prophylactic platelet transfusions in patients with severe thrombocytopenia but without active bleeding are not recommended.
Fluid requirement
  • 20 ml/kg body weight as bolus
  • 10 mL/kg over the next first hour
  • Then 7 mL/kg/hour for next 2 hours
  • Then 5 mL/kg/hour for next 4 hours
  • Then 3 mL/kg/hour for next 8 hours
Assessment

The patient must pass urine every three hours

Duration of extra fluids

The fluids that are lost into potential spaces (e.g., pleura, peritoneum) during the period of plasma leakage are rapidly reabsorbed.

Intravenous fluid supplementation should be discontinued once patients have passed the period of plasma leakage. Usually no more than 48 hours of intravenous fluid therapy are required. Excessive fluid administration after this point can precipitate hypervolemia and pulmonary edema.

When to discharge
  • In the absence of complications from prolonged hypotension or from medical interventions, most patients with severe dengue recover within a few days of admission
  • No fever for at least 24 hours
  • Two days have passed after an episode of shock
  • Patient is clinically well
  • Normal appetite, urine output and hematocrit.
No aspirin

Patients with dengue should be cautioned to maintain their fluid intake to avoid dehydration and to take paracetamol as needed for fever and myalgia. Aspirin or nonsteroidal anti-inflammatory agents (NSAIDs) should generally be avoided.
eIMA News
News
  • NIH: Students who reported using electronic cigarettes by the time they started high school were more likely to report later use of traditional tobacco products. The finding highlights the importance of learning more about how e-cigarettes can affect teen smoking patterns.
  • Children who were exposed to indoor-based pesticides appear to have a higher risk of developing leukemia and lymphoma, according to a small meta-analysis on 16 observational studies examining pesticide exposure and childhood cancer.
  • On September 10, the American Board of Anesthesiology (ABA) unveiled a redesign of its maintenance of certification (MOC) in Anesthesiology (MOCA) program that replaces a dreaded 10-year exam with an online learning tool called the MOCA Minute that will quiz and teach physicians on a continuous, baby-step basis at their convenience. MOCA 2.0, as it is called, also drops a requirement for assessing an anesthesiologist's simulated care of a dummy patient and makes it optional instead. (Medscape)
  • Screening healthy men for prostate cancer remains controversial, but if the decision is taken to undergo such screening — after detailed discussion with the individual, then “both a blood test for prostate-specific antigen (PSA) and a digital rectal examination (DRE) should be carried out”, says David Penson, MD, MPH, chair of the Department of Urologic Surgery at Vanderbilt University Medical Center in Nashville, Tennessee.
  • Organizers expect to hear guidance on which treatments work best in age-related macular degeneration, diabetic macular edema, and retinal vascular occlusion at the European Society of Retina Specialists 15th EURETINA Congress.
  • Infants who contract pertussis from a known source are now more likely to have gotten it from a sibling than from their mother. That represents a shift in the pattern of known sources of infection, although in about half of cases the source is unknown, reports an article published online September 7 in Pediatrics.
Doctors say low platelet count no cause for worry
Sushmi Dey, TNN | Sep 15, 2015

NEW DELHI: Low blood platelet count may not necessarily mean dengue or at least may not be a reason to panic. Doctors and health officials advise people to drink plenty of water to avoid dehydration and maintain good sanitation to avoid dengue. Doctors say patients should take paracetamol in case of fever and closely keep a watch on symptoms like blood pressure, rise in pulse rate and if PCV blood count goes beyond 50.

According to experts, rapidly falling platelets may trigger plasma leakage which needs monitoring but merely low platelet count --up to 8000-9000-- may not be serious or a threat to life. However, doctors say once platelets are below the 10,000 level, it is safer to go for medical fluid intake -either orally or IV fluid.

"Platelet counts are not reliable and do not indicate anything. In other words, platelet deficiency is not alarming, neither can platelet transfusion save anyone's life," said Dr K K Aggarwal, secretary general, Indian Medical Association. Dr SP Byotra, chairman (internal medicines) at Ganga Ram Hospital, also maintains falling platelet count and fever could be symptoms for other diseases like malaria, typhoid and kala azar. Though these symptoms are present even in case of dengue, but patients need not panic and instead should go for proper investigation of the disease, he said. Doctors say if persistent high fever is coupled with bleeding, vomiting, nausea and dehydration, one should investigate for dengue.

According to Dr Aggarwal, there is nothing to worry if a patient is passing urine every three hours. He said a patient persistently running high fever, feeling extreme weakness and with rapidly falling platelets should keep a close watch on blood pressure and whether the pulse rate is shooting up and if PCV blood count is over 50. Officials in the health ministry also advised patients not to seek hospital admission out of panic in case of high fever and falling platelet count.

"Other viral infections are on and fever could be a result of that. Hospitalization is not required in each and every case," said a senior official.

Maintaining that there is no shortage of beds, the official attributed it to patients seeking admission in panic. Officials said patients should avoid easily available rapid diagnostic kits for testing dengue as these kits have low sensitivity and therefore often produce false results.
Dengue cases surge in Delhi
Bindu Shajan Perappadan, The Hindu

New Delhi, September 15, 2015 Delhi registers 1,872 cases, including 158 from neighbouring States, since January; 768 reported to Hindu Rao Hospital on Sunday night

On Sunday night, 768 patients reported to Hindu Rao Hospital’s casualty with suspected dengue fever, confirmed North Delhi Mayor Ravinder Gupta on Monday, even as Health Minister Satyendra Jain said that the city health department is ‘prepared to tackle the dengue menace’.

The city has reported 1,714 cases of dengue so far and five deaths this season since January. Dengue cases reported from other States stands at 158, taking the total number of cases in Delhi to 1,872. The maximum number of cases has been reported from Narela (260), West Zone (158), Najafgarh (166), Civil Line Zone (145), Rohini (168), Karol Bagh (136), and South (120).

Mr. Gupta said that the North Corporation was taking all possible measures to deal with the increasing number of cases. “Staff at the fever clinic have been increased so that more number of dengue patients can be treated,’’ he said.

Hindu Rao has so far admitted 1,322 suspected dengue patients and made additional 110 beds available.

Lata Gupta, chairman, standing committee, East Delhi Municipal Corporation, on Monday inspected Swami Dayanand Hospital in Shahdara (North Zone) for preparedness and checked the dengue platelet machine at the hospital. The hospital’s medical superintendent, Dr. Jaipal, said that additional beds in casualty and children wards have been provided.

“Hospitals have been told to use mosquito repellents, nets, and spray to check breeding or kill adult mosquitoes. Beds are to be made available on an emergency basis,’’ said a senior health official. Meanwhile, the Union Health Ministry has asked the Delhi Health Department to increase bed strength in State hospitals and check overcharging of patients by private hospitals.

“The number of dengue cases is very high between August and November in Delhi,” said Dr. K.K. Aggarwal from the Indian Medical Association.

“The weather is conducive for virus to spread. After November, when temperatures dip, the virus cannot survive beyond a point and the cases will become fewer,’’ he said
Researchers suspect a new dengue strain
Times of India September 14, 2015, 4:35 PM 0

New Delhi: There may be a new strain of dengue this time causing all the havoc, researchers suspect. The All India Institute of Medical Sciences (AIIMS) has tested 50 samples and found growth of a new strain in some of the samples, a senior official in the health ministry told TOI. “We have asked AIIMS to conduct further testing and ascertain the results,” the official said, after a review meeting on Dengue. The ministry has again called for a meeting with AIIMS officials and doctors to review the specific issue of strains. AIIMS is expected to submit its final findings by end of this week, the official said.

According to an expert, if there is a new strain it may be a reason for concern because then more people will be impacted by it. “A known strain is not so dangerous because those who are already attacked by them are less vulnerable to the same one. But, they will still be vulnerable to the new one,” said Dr KK Aggarwal, secretary general, Indian Medical Association.

So far, India has been hit by Den 1, Den 2, Den 3 and Den 4. However, estimates show there is a significant rise in the cases of Dengue this year. Over 1500 cases have been registered this year, with at least five deaths. Though officials maintain there was a forecast of more number of cases this year, there is panic among patients running high fever.

The government is constantly reviewing situation and measures to control the menace. Even as health ministry officials and doctors maintain that mere fall in platelet count does not indicate dengue, the Delhi Health Department has ordered all government blood banks to stock adequate quantity of the blood product and also directed private blood banks to ensure their availability at nominal rates. The move comes in the wake of spiraling demand for platelets across the city.

The Centre has also asked hospitals to ramp up facilities and beds for Dengue patients.
Clarification regarding Genetic Clinics & lnvitro fertilization (IVF) Centers
DIRECTORATE OF FAMILY WELFARE,

GOVT. OF NCT OF DELHI
B&C Wing, 7th Level, Vikas Bhawan - II,
Near Metcalf House, Civil Lines, Delhi- 110054
Ph. 23813477, Email pndt.delhi@gov.in

F. No. 9(10}/45/64/PC&PNDT/ARISLVF/DFW/2014 / 538-577 Dated8/9/15

To,
 
The Deputy Commissioner (West), Govt. of NCT of Delhi,Old Middle School Building, Lawrence Road, Rampura,Delhi- 35
The Deputy Commissioner (North West), Govt. of NCT of Delhi, Kanjhawala, New Delhi- 68
The Deputy Commissioner (Central), Govt. of NCT of Delhi, Employment Exchange Building, Darya Ganj, Delhi
The Deputy Commissioner (North), 1, Kirpa Narain Marg, Delhi54
The Deputy Commissioner (North East), Govt. of NCT ofDelhi, DC Office Complex, Nand Nagri, Delhi
The Deputy Commissioner (New Delhi), Govt. of NCT of Delhi,12/1, Jam Nagar House, New Delhi- 11
The Deputy Commissioner (East), L.M.Bandh, Shastri Nagar, Geeta Colony, Govt. of NCT of Delhi, Delhi
The Deputy Commissioner (South), Govt. of NCT of Delhi, M.B.Road, Saket, New Delhi- 68
The Deputy Commissioner (South West), Govt. of NCT ofDelhi, 37 /Old Terminal Tax Building, Kapashera, M.B.Road, Saket, New Delhi-37
District Appropriate Authority- Deputy Director Medical Services,Headquarter Delhi Area, Delhi Cantt. 110010, (DDMS)
Deputy Commissioner, Govt. of NCT of Delhi, DC Office Complex, Nand Nagri, Delhi-93 (Shahdara District).
The Deputy Commissioner, Lajpat Nagar, Behind Old Gargi College, New Delhi-49. (South East)

Sub:- Clarification regarding Genetic Clinics & lnvitro fertilization (IVF) Centers.

Sir/ Madam,
This is in reference to the various queries received from the IVF centre and the districts regarding the registration of IVF Centers under PC & PNDT Act.
A. Clarification regarding Genetic Clinics:-
As per PC & PNDT Act Genetic Clinic means- a clinic, institute, hospital, nursing home or any place, by whatever name called, which is used for conducting pre-natal diagnostic procedures.

As per PC & PNDT Act-"Pre-Natal Diagnostic procedures" means all gynaecological or obstetrical or medical procedures such as ultrasonography, foetoscopy, taking or removing samples of amniotic fluid, chorionic villi, embryo, blood or any other tissue or fluid of a man, or a woman before or after conception, for being sent to a Genetic laboratory or Genetic Clinic for conducting any type of analysis or pre-natal diagnostic tests for selection of sex before or after conception.

Hence, all centers providing these facilities for pre-natal diagnostic procedures including ultrasound are to be registered under Genetic Clinic. Therefore, once a centre is registered as Genetic Clinic, it will be permitted to do all Pre-Natal Diagnostic Procedures as per PC & PNDT Act and are required to submit fees for only one facility (Rs. 25,000/-) and the certificate will be valid for 5 years subject to qualification of person performing procedure and inspection of equipment & facility.

Once registration for one procedure is done under PC & PNDT Act and the center intimates about another procedure under Genetic Clinic, no fees separately for each procedure is to be taken but qualification & inspection of facility needs to be done as per PC & PNDT Act for approval.

B. Clarification regarding IVF centers:

All IVF centers shall be registered as Genetic clinic for ultrasound facility.
  1. A center already registered as genetic clinic with Ultrasound facility if later starts IVF procedure, only an intimation is required to be submitted to District.
  2. No separate fees to start IVF procedure at already registered center is to be submitted. No separate IVF registration is to be given by districts as IVF registration is done by ICMR, only an intimation that IVF is being done by center has to be given to districts. ICMR registration is not required for IVF registration under PC & PNDT registration where PC & PNDT registration is mandatory for centers to be registered as IVF with ICMR. District shall mention all the facilities being provided by the Genetic Clinic on the Registration Certificate which includes IVF and all Pre Natal Diagnostic procedures. This is for your kind information and further necessary action at your end.
                                                      Yours truly,
                                                      (Dr. R.K. Gupta)
                                                      Director, Family Welfare

F.No. 9(10}/45/64/PC&PNDT/ARISIVF/DFW/2014/538-577

Dated: 8/9/15


Copy to :-
  1. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. Begumpur Village, Near Malviya Nagar, New Delhi-110017 (South District)
  2. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. Bagichi Allaudin, Gali No.4, Nabi Karim, Pahar Ganj, New Delhi-55, (Central District)
  3. COMO Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg., Gulabi Bagh, Delhi-110007.(North District)
  4. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. Sector 2, Dwarka, New Delhi-110075(South West District)
  5. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. A-14, G-1 Dilshad Garden, Delhi-110095(North East District)
  6. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. Sector 13 Rohini, New Delhi-110085 (North WestDistrict)
  7. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. A-Block, Surajmal Vihar, Nr. Jain Mandir, Delhi-92.(East District)
  8. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. Flat No. 202-204, DDA Local Shopping Complex, A-6, Paschim Vihar, New Delhi-110063(West District)
  9. Chief District Medical Officer, 0/o the CDM0,2nd floor, Dispensay complex, NangaI Raya, Near post office, New Delhi-46(New Delhi District)
  10. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. A-14, G-1 Dilshad Garden, Delhi-110095(Shahdara District)
  11. Chief District Medical Officer, 0/o the COMO, Delhi Admn. Dispy. Bldg. near PVR Complex, Saket, New Delhi-110017(South East District}
  12. Guard File
                                                      Dr. R.K. Gupta
                                                      Director, Family Welfare
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IMA IPMO Initiative
Kindly go to http://module.ima-india.org/ipmo/
and pledge your organs. Unless we do it, the public will not listen to us.

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Inspirational Story
Bank account

Imagine there is a bank, which credits your account each morning with Rs 86,400, carries over no balance from day to day, allows you to keep no cash balance, and every evening cancels whatever part of the amount you had failed to use during the day. What would you do? Draw out every pence, of course!

Well, everyone has such a bank. Its name is Time.

Every morning, it credits you with 86,400 seconds. Every night it writes off, as lost, whatever of this you have failed to invest to good purpose. It carries over no balance. It allows no overdraft. Each day it opens a new account for you. Each night it burns the records of the day. If you fail to use the day's deposits, the loss is yours.

There is no going back. There is no drawing against the "tomorrow."

Therefore, there is never not enough time or too much time. Time management is decided by us alone and nobody else. It is never the case of us not having enough time to do things, but the case of whether we want to do it.
eIMA Quiz
LE cell is a

a. Neutrophil
b. Macrophage
c. Histiocyte
d. Dendritic cell

Yesterday’s Mind Teaser: Bell's phenomenon can be seen in the following conditions except

a. Hemiplegia
b. Ramsay Hunt syndrome
c. Bell's palsy
d. Leprosy

Answer for Yesterday’s Mind Teaser: a. Hemiplegia
Correct answers received from: Daivadheenam Jella, Dr Poonam Chablani, Viswanatha Sarma, Dr Avtar Krishan.
Answer for 14th September Mind Teaser: b. Procaine penicillin
Correct Answers received from: Viswanatha Sarma, Dr Avtar Krishan.
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Courage is the first of human qualities because it is the quality which guarantees all others. Winston Churchill
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IMA Humor
The Lecture

A man is stopped by the police at midnight and asked where he’s going.

“I’m on the way to listen to a lecture about the effects of alcohol and drug abuse on the human body.”

The policeman asks, “Really? And who’s going to give a lecture at this time of night?”

“My wife”, he replied.
Reader Response
Dear Sir, Very informative news. Regards: Dr Krishna
Rabies News (Dr A K Gupta)
Is washing of animal bite wound (s) essential?

The risk of rabies reduces by about 50% simply by washing the bite wound and application of antiseptics.

The maximum benefit of the wound washing is obtained when the fresh wound is cleaned immediately. It is important to remove saliva containing rabies virus at the site of bite by physical or chemical means. This can be done by prompt and gentle thorough washing with ordinary soap or detergent and flushing the wound with running tap water for at least 15 minutes.

Washing of the wound must be done as long as the wound is raw irrespective of the time elapsed since the exposure. Care must be taken not to disturb the scab, if formed.

After washing with water and soap, disinfectants like povidone iodine or surgical spirit must be applied.

In extraneous circumstances, other alcoholic (>40%) preparations like Rum, Whisky or aftershave lotion may be applied on the wound. If soap or antiviral agent is not available, the wound should be thoroughly washed with water.
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