March 1  2015, Sunday
editorial
Shoe Hygiene
Dr KK Aggarwal
  1. Avoid poorly fitting shoes.
  2. Diabetic patients should avoid walking bare feet.
  3. Shoes that are too tight can cause pressure ulcers.
  4. High heels are okay for occasions but if you wear them all the time, significant foot pain and other problems can develop. These problems can range from bunions, corns and calluses to more complex problems like misshapen hammer toes or worsening excruciating pain in the ball of the foot.
  5. Whenever you wear shoes that are tight, they will cause foot pain.
  6. Whenever you wear shoes that constrict the natural shape of the foot, it is bound to cause foot pain.
  7. Women, who regularly wear high heels, walk with shorter, more forceful strides and require more muscles to walk.
  8. Shoes can be classified under following three categories:
    1. Good shoes or low risk shoes: athletic and casual sneakers.
    2. Average mid risk shoes: hard or rubber–soled shoes – special shoes and work boots.
    3. Poor or high risk shoes are the ones that do not have support or structure such as high heels, sandals, sleepers.
  9. Pointed toed shoes are equally bad as they disrupt the natural shape of the feet.
  10. If you love to wear heels, then choose heels that are not higher than 2" and are wide.
  11. It is always better to buy shoes in the evening as the foot swells up by evening. If you buy them in the morning, the shoes may feel tight in evening hours.
  12. Always try both shoes as one foot may be smaller or larger than the other one in some people.
  13. Always wear the shoes that are wider than your foot.
  14. The actual size of the shoe may vary between different manufactures.
  15. The selected shoe should be wider than broadest part of the foot.
  16. Your foot tends to become longer and wider as you age, always check the size of your shoes every two years.
  17. Narrow shoes with heels should only be used for a function, dinner or a formal party, specially a party where you do no have to stand for a longer time.
eMedipics
IMA,IJCP,HCFI
21st MTNL Perfect Health Mela 2014
News Around the Globe
  • A new study has shown a J-shaped relationship between sleep duration and future stroke risk, with a particularly strong signal associated with long sleep duration. Researchers found that short sleep was associated with an 18% increased stroke risk and long sleep was associated with a 46% increase in stroke risk after adjustment for conventional cardiovascular disease risk factors and comorbidities.
  • The risk for adverse events during peanut oral immunotherapy is high in people with allergic rhinitis and those who react strongly to a peanut skin-prick test, suggests new research presented at the American Academy of Allergy, Asthma & Immunology 2015.
  • Combination therapy with diphenylcyclopropenone (DPCP) and anthralin is more effective than DPCP alone in patients with chronic extensive alopecia areata (AA), suggests new research published online in the Journal of the American Academy of Dermatology.
  • Hepatitis B virus (HBV) infection is associated with gastric cancer, particularly in patients without a family history of gastric cancer, points new research published online in the British Journal of Cancer.
  • In patients with HIV who are taking tenofovir, ritonavir-boosted atazanavir, or ritonavir-enhanced lopinavir, the risk for chronic kidney disease increases over time, suggests new research presented at the Conference on Retroviruses and Opportunistic Infections 2015.
Dr KK Spiritual Blog
Leverage your strengths
  1. Know your strengths
  2. According to a British study, only about one-third of people have a useful understanding of their strengths.
  3. If something comes easily, you may take it for granted and not identify it as a strength.
  4. If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.
  5. Strengths which most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.
  6. Strengths are so important that they're worth cultivating and applying in your daily life, even if they don't come naturally to you
IMA,IJCP,HCFI
Cardiology eMedinewS
  • One in five patients with coronary artery disease receiving a statin failed to have a significant LDL-lowering response to treatment, and these patients experienced a significant progression of atherosclerosis over a follow-up period of 18 to 24 months, suggests a new analysis published February 26 in Arteriosclerosis, Thrombosis, and Vascular Biology.
  • Tandem measurements of cardiac troponin T (TnT) and brain-type natriuretic peptide (BNP) provide insight into how well patients scheduled for cardiac resynchronization therapy (CRT) will do at 12 months, suggests a multicenter, prospective study published in Pacing and Clinical Electrophysiology.
Pediatrics eMedinewS
  • Respiratory viruses seem to be responsible for most cases of community-acquired pneumonia among hospitalized children, and one in four children studied had multiple pathogens, suggests a study published in the February 26 issue of the New England Journal of Medicine.
  • Developmental delays are common among school-age children with single-suture craniosynostosis, suggests a case-control study published online in Pediatrics.
Make Sure
Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.

Reaction: Remember to start macrolides immediately.

Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.
Medicolegal
Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

What are Rubber Bullets?

Rubber bullets were introduced in the US to quell anti–war and civil rights demonstrators in the 1960s. They were reintroduced in the late 1980s. Rubber bullets describe about 75 types of "less than lethal devices" that are designed to deliver a stinging blow that incapacitates but do not kill or penetrate flesh as regular metal bullets.
  • The first less–than–lethal bullets appeared in the 1880s when Singapore police shot sawed–off broom handles at rioters. By the 1960s, riot control police in Singapore, Malaysia, and Hong Kong were using wooden bullets. The Wooden bullets still in use today are called "knee–knockers.
  • British colonists replaced the wood, which could shatter and possibly penetrate, with rubber. By the 1980s, they switched to more accurate plastic bullets, solid polyvinyl chloride cylinders about 4 inches long and 1.5 1/2 inches wide.
They are most often used by individual police officers to subdue armed, mentally ill people. The bullets are supposed to be shot at the lower half of the body; but have also accidently killed people. Numerous groups from the European Parliament to Human Rights Watch have called for a ban on plastic bullets.
Dr Good Dr Bad
Situation: A patient with low BMD wanted to know if he could take potassium citrate.
Dr. Bad: There is no role.
Dr. Good: Take it.
Lesson: Daily supplementation with potassium citrate significantly increases BMD in the elderly. With daily supplementation of 60 mmol potassium citrate, BMD increases significantly.

(Copyright IJCP)
Inspirational Story
Beginning Today

Beginning today I will no longer worry about yesterday. It is in the past and the past will never change. Only I can change by choosing to do so.

Beginning today I will no longer worry about tomorrow. Tomorrow will always be there, waiting for me to make the most of it. But I cannot make the most of tomorrow without first making the most of today.

Beginning today I will look in the mirror and I will see a person worthy of my respect and admiration. This capable person looking back at me is someone I enjoy spending time with and someone I would like to get to know better.

Beginning today I will cherish each moment of my life. I value this gift bestowed upon me in this world and I will unselfishly share this gift with others. I will use this gift to enhance the lives of others.

Beginning today I will take a moment to step off the beaten path and to revel in the mysteries I encounter. I will face challenges with courage and determination. I will overcome what barriers there may be which hinder my quest for growth and self-improvement.

Beginning today I will take life one day at a time, one step at a time. Discouragement will not be allowed to taint my positive self-image, my desire to succeed or my capacity to love.

Beginning today I walk with renewed faith in human kindness. Regardless of what has gone before, I believe there is hope for a brighter and better future. Beginning today I will open my mind and my heart. I will welcome new experiences. I will meet new people. I will not expect perfection from myself nor anyone else: perfection does not exist in an imperfect world. But I will applaud the attempt to overcome human foibles.

Beginning today I am responsible for my own happiness and I will do things that make me happy . . . admire the beautiful wonders of nature, listen to my favorite music, pet a kitten or a puppy, soak in a bubble bath … pleasure can be found in the most simple of gestures.

Beginning today I will learn something new; I will try something different; I will savor all the various flavors life has to offer. I will change what I can and the rest I will let go. I will strive to become the best me I can possibly be.

Beginning today and every day. Just a thought, but as I often think of you and realize how much God loves you, sometimes I think we need to also love ourselves through His eyes.
IJCP Book of Medical Records
IJCP’s ejournals
IMA,IJCP,HCFI
eMedi Quiz

All of the following are features of hallucinations, except:

1.It is independent of the will of the observer.
2.Sensory organs are not involved.
3.It is a vivid as that in a true sense perception.
4. It occurs in the absence of perceptual stimulus.

Yesterday’s Mind Teaser: All of the following drugs act on cell membrance, except:

1. Nystatin.
2. Griseofulvin.
3. Amphotericin B
4. Polymixin B.

Answer for yesterday’s Mind Teaser: 2. Griseofulvin.

Correct Answers received from: Dr Amit Desai, Dr Avtar Krishan, Daivadheenam Jella.

Answer for 27th Feb Mind Teaser: 1. Phenytoin.

Correct Answers receives: Dr Bharat Bhushan Aggarwal, Daivadheenam Jella, Dr Prabodh K Gupta, Arvind Diwaker, Dr Avtar Krishan, Dr Shangarpawar, Dr K V Sarma.

CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh,
SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
IMA NEWS
INDIAN MEDICAL ASSOCIATION
RAICHUR BRANCH – 2014-15
TO
THE DEPUTY COMMISSIONER
RAICHUR

SIR,

Sub: Closer Of Medical Establishments From 26-2-2015 Indefinitly As A Mark Of Portest AGAINST REPEATED ATTACKS ON MEDICAL PERSONEL AND ESTABLISHMENTS REG.

On accounts of repeated attacks on doctors and medical establishment making a dangerous atmosphere to work in, as a mark of protest for their life and property,

IMA Raichur has decided to close down hospitals, clinics & labs from Date: 26-02-2015 indefinitely.

This is for your kind information and needful action.

                                                                     Yours sincerely

                                                                     President/Secretary
                                                                                  IMA Raichur

Copy to:- 1. Superintendent of Police Raichur for kind information needful action. 2. P.S.I Sadar Bazar police station Raichur for kind information needful action.

Private Doctors go on strike, 36 hospitals remain closed in Raichur
Condemning the increased attacks on medical professionals on alleged medical negligence and seeking proper action against the offenders and proper protection to medical professionals, hundreds of private doctors, under the banner of Indian Medical Association (IMA), staged a flash protest on Thursday.

As a result of the strike, as many as 36 private clinics and hospitals remained closed in the city.

The agitation was triggered by the recent attack on doctors and other staff of Nandini Hospital in Raichur on Tuesday night by around 250 people.

The agitating doctors expressed that conducive environment where doctors and other healthcare professionals could freely discharge their duties without fear was repeatedly disturbed owing to unjustifiable physical attacks on medical professionals.

They alleged that four First Information Reports (FIRs) had been registered in the last four months in different police stations within the city against several people for physically assaulting doctors and other medical staff and damaging properties of hospital and clinics. They expressed dissatisfaction over the police by stating that no one was arrested in any of the four cases. They demanded the government to pay double compensation for the damages caused in the assault and provide proper protection to healthcare professionals.

“In all the four cases, the conditions of patients were critical and they were brought to the hospitals at last stage. In such situation, patients have little chances of survival despite doctors’ honest efforts. Unable to understand the situation, the people have physically assaulted doctors holding them responsible for the death of their relatives or friends”, Dr. V.A. Malipatil, leading psychiatrist, told The Hindu.

IMA district president Dr. Jagajeevanram T.K., General Secretary Abdul Kaleem Siddiqi, treasurer Dr. Vijaya Shankar, Riachur city MLA Dr. Shivaraj Patil and others doctors, healthcare professionals were present.
Media
IMA,IJCP,HCFI
Wellness Blog
What type of a vegetarian are you?

There are 4 main types of vegetarian diets:
  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.
Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.
Quote of the Day
A total commitment is paramount to reaching the ultimate in performance Tom Flores
IMA in Social Media
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Reader Response
  1. Pls start with financial advice and planning advice for average member of our organisation before we start advice reg our patients and finances! Things like starting at young age with rs 1 crore term insurance and other advice to invest a proportion of money in land and immovable property would be a great help indeed. Arguably, the best financial help we can do to our patients is to increase the health budget to 10% of GDP and get the Govt to fund 80% of the health needs of our population. This is the need of the century for Indian development into a progressive economy with due care to our countrymen. Kind regards: Dr Girish Kumar FRCS Ortho: Consultant Ortho Surgeon
IMA Videos
News on Maps
IMA Humor
Violin Practice

Little Harold was practicing the violin in the living room while his father was trying to read in the den. The family dog was lying in the den, and as the screeching sounds of little Harold’s violin reached his ears, he began to howl loudly. The father listened to the dog and the violin as long as he could. Then he jumped up, slammed his paper to the floor and yelled above the noise, "For pity’s sake, can’t you play something the dog doesn’t know?"
Medical fraternity disappointed with the budget
The medical fraternity had expected the union health budget to be increased to at least 2.5%, with a separate budget being allocated for disease outbreaks, rare diseases, rural posting of doctors, and free emergency care treatment for all. They had also been demanding health be given ‘Infrastructure status’.

A total allocation of 33150 crore for health will not make universal healthcare a reality.

IMA’s opinion on the budget:

Positives
  • Including yoga as charitable activity, which is applicable for exemption under the income tax act, will promote Yoga in the country.
  • Separate budget for age related disability is a welcome step
  • IMA hopes that the money collected from the Swatch Bharat Abhiyaan will be used for health purposes.
  • Increasing the health insurance exemption limit to 25000 from 15000.
  • Opening five more institutions like AIIMS. However the government should have in one stroke announced that there will be a similar institutions in every state and should have strengthened the existing ones
Negatives:
  • Rise in service tax to 14% is not in the interest of the common man.
  • IMA also hopes that the service tax exemption in the health sector is not taken away
  • No provisions have been made in the budget for free drugs, investigations or emergency care.
Dr A M Pillai and Dr K K Aggarwal.
Indian needs extra health budget for rare diseases
IMA has advised the medical students not to ignore reading about rare disease and the practicing doctors to update their knowledge about rare diseases

27 February 2015, 7:34 PM IST: http://health.economictimes.indiatimes.com/

New Delhi, 27th February, 2015: Rare Diseases Day was observed on 27th February to raise awareness about rare diseases and improve access to treatment and medical representation for individuals with rare diseases and their families.

Addressing a press meet , Dr A Marthanda Pillai and Dr K K Aggarwal, National President and Honorary Secretary General IMA, said that rare diseases does not mean they should be rarely read.

A Supreme Court Judgment (appeal 2867 of 2012) quoted "Finally, we hope and believe that the institutions and individuals providing medical services to the public at large educate and update themselves about any new medical discipline and rare diseases so as to avoid tragedies such as the instant case where a valuable life could have been saved with a little more awareness and wisdom from the part of the doctors and the Hospital. "

IMA has advised the medical students not to ignore reading about rare disease and the practicing doctors to update their knowledge about rare diseases.

IMA wants separate budget for the same. In two recent high court judgments, the court had said "....on account of lack of Government planning, there is 'pricing out' of orphan drugs for rare and chronic diseases, like Gaucher. The enzyme replacement therapy is so expensive that there is a breach of constitutional obligation of the Government to provide medical aid on fair, reasonable, equitable and affordable basis. By their inaction, the Central and the State Governments have violated Articles 14 and 21 of the Constitution.

"... Just because someone is poor, the State cannot allow him to die. In fact, Government is bound to ensure that poor and vulnerable sections of society have access to treatment for rare and chronic diseases........"

".............After all, health is not a luxury and should not be the sole possession of a privileged few."

The court also took serious note of the limited availability of affordable treatment for persons with neglected diseases like Haemophillia and ensured that the State Government provide treatment free of cost, as part of its obligation under Article 21 of the Constitution of India.

Some of the rare disease

Amyotrophic Lateral Sclerosis; Cystic Fibrosis; Ebstein Anomaly; Factor XII Deficiency; Fanconi Anemia; Friedreich Ataxia; Gaucher Disease; Hirschsprung Disease; Huntington Disease; Multiple Endocrine Neoplasia Type 1; Tourette Syndrome; Wegener Granulomatosis; Weil Disease; Zollinger-Ellison Syndrome; von Willebrand Diseases etc.
UNICEF and IMA launch 10-key action plan on child sexual abuse
POST 27 FEBRUARY 2015: AFREEN FATIMA : http://www.drugtodayonline.com/

Child sexual abuse (CSA) is a widespread phenomenon which causes lifelong consequences to the physical and mental health of victim. In India, 4.5 per cent of girls aged 15-19 are subjected to forced sexual intercourse (NFHS3) while boys are also at risk but comparatively less vulnerable.

In view of the serious nature of the heinous crime and its prevalence, Unicef and Indian Medical Association (IMA) have joined hands to strengthen the response of medical practitioners in identifying, reporting and treating cases of CSA.

Speaking on the occasion, Dr KK Aggarwal, Honorary Secretary General IMA, said, “Medical professionals have a critical role to play in the prevention, detection and response to sexual offences against children. They are often the first point of contact to come across a child abuse case and are required to take prompt action to ensure immediate and effective treatment of the child.”

Messages will be distributed to more than 2.5 lakh medical doctors through 30 state level branches and district branches of IMA, Dr Aggarwal added.

Any sexual activity with a child below 18 years, including penetrative sexual assault, (non penetrative) sexual assault, sexual harassment and use of a child for pornography come under CSA and hence is a crime.

Doctors can educate parents on child safety, safe and unsafe touch, teach children how to protect themselves, provide care and treatment to survivors, enable justice process with accurate forensic medical exam and testimony in court.

It is mandated by law that any adult aware of a child being sexually assaulted and/or at risk of being sexually assaulted has to report to the nearest police station/special juvenile police unit.

Every case of sexual assault is a medical emergency: Free treatment mandatory by government and private medical facilities. No police or magisterial requisition required to examine or provide emergency medical care to child sexual abuse survivor.

Legal duty of doctors in a case of child sexual assault is to provide medical care, collect forensic evidence, report offence and give testimony in court.

Informed consent is required from survivor or guardian where child is below 12 years before medical examination, informed refusal recorded if consent is not received.

A doctor is liable to imprisonment of up to one year and/or fine for refusing to perform medical examination in child sexual assault cases, section 166B of the IPC.

And finally, clinics and hospitals should prominently display childline number “1098” for cases of known or suspected child abuse or neglect.

Supporting the initiative, eminent Indian classical dancer and choreographer, Sonal Mansingh said, “All children have to right to live free from violence. We believe that they are closer to god and therefore any violence on them is a sin. Violence harms their physical and mental growth. When people come together and say that it is not acceptable. I appeal to one and all to support the initiative whole heartedly and respect their dignity and self esteem.”
Rabies News (Dr A K Gupta)
What is the "potency" of rabies vaccine?

WHO recommends that the vaccine potency should be at least 2.5 IU per dose. The potency is the capacity of the vaccine to induce immune response.