October 20   2015, Tuesday
EDITORIAL
Dr KK AggarwalDr KK Aggarwal
World Medical Association demands independent enquiry into hospital bombing

An immediate independent enquiry into the attack on the Médecins Sans Frontières hospital in Kunduz, Afghanistan two weeks ago has been demanded by the World Medical Association.

Delegates from almost 60 national medical associations attending the WMA's annual General Assembly in Moscow voted for an enquiry by an independent body ‘and the assumption of responsibilities'.

The motion said the WMA: ‘Extends its deepest condolences to families, colleagues and friends of doctors, healthcare workers and patients killed in the bombing; deeply regrets and condemns the bombing of the hospital of MSF, considering it a violation of human rights; and reaffirms its positional statements on "Healthcare in Danger" and calls on all countries to respect healthcare personnel in conflict situations'.
Breaking news
'Ground-Breaking' Ocrelizumab Data highlight of ECTRIMS 2015

Results of three new phase 3 studies – OPERA I, OPERA II, ORATORIO - with the new anti–B cell humanized antibody ocrelizumab (Genentech) in multiple sclerosis (MS) were the major talking point at the Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2015.

The OPERA studies in relapsing-remitting MS suggested ocrelizumab may be a highly effective agent in relapsing-remitting MS but without the serious adverse effects seen with other, similarly potent agents. ORATORIO trial is the first phase 3 study to show a slowing of disability progression in primary progressive MS. Describing ocrelizumab as a "game changer", Jaume Sastre Garriga, MD, Hospital Vall d'Hebron, Barcelona, Spain said, “In relapsing-remitting MS it has shown a significant reduction in relapse rate and heavy suppression of inflammation as shown by reduction in gadolinium-enhancing lesions, without serious side effects as yet.” (Medscape)
Dr Good Dr Bad
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Specialty Updates
• New research suggests that watching 9 hours of dichoptic movies over 2 weeks leads to a significant improvement in vision for children with lazy eye or amblyopia. The findings are published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

• Lowering systolic blood pressure below the currently recommended target can reduce the risk of left ventricular hypertrophy (LVH), the most common complication of high blood pressure, suggests new research published in the early online edition of Hypertension.

• Functional magnetic resonance imaging (fMRI) may help identify patients in remission from major depressive disorder (MDD) who are most apt to experience relapse, suggests a new study published online in JAMA Psychiatry.

• Scientists have shown why a drug used to treat chemotherapy-induced anemia in ovarian and breast cancer patients also may shorten survival times in some patients by inadvertently stimulating tumor growth. The cell receptor EphB4 was identified as a catalyst for a chain of cell-signaling events leading to tumor growth. The findings were published in the journal Cancer Cell.

• In older women, but not men, ambulating with a longer step length was associated with reduced odds of prevalent patellar-femoral joint structural damage, suggested new research published in Arthritis Care & Research.

• Maternal marijuana use is associated with an increased risk of having small-for-gestational-age (SGA) babies and of neonatal intensive care unit (NICU) admission, suggests a new study published in the Journal of Perinatology.

• University of Florida pharmacy researchers are calling on the Food and Drug Administration to remove a common over-the-counter decongestant – phenylephrine - from the market. An editorial published in the September - October issue of The Journal of Allergy and Clinical Immunology: In Practice has stated that oral phenylephrine is ineffective at treating nasal congestion.

• A new study suggests that genetic factors affect the location of the inflammation in the gut, with implications for diagnosis and treatment of patients with inflammatory bowel diseases. The research uncovers a continuum of inflammatory bowel diseases, and shows that genetic information could be used to reveal misdiagnoses.

• Nearly half of the infections after surgery and over a quarter of infections after chemotherapy are caused by organisms already resistant to standard antibiotics, reported new estimates published in The Lancet Infectious Diseases. The findings point out that rising antibiotic resistance could have disastrous consequences for patients undergoing surgery or cancer chemotherapy.

• A new study reported in the American Journal of Obstetrics and Gynecology has found that midtrimester short cervix interventions to prevent preterm delivery appear to be effective only in the setting of intra-amniotic inflammation. Dr. Nazeeh Hanna from Winthrop University Hospital in Mineola, New York said, “Our study proposes an alternative paradigm in favor of a selective and individualized therapeutic approach based on the pathogenesis of short cervix. For inflammation-related short cervix, progesterone and/or cerclage will be effective; however, in non-inflammatory related short cervix, expectant non-intervention management will be preferred. Such individualized management will help prevent unnecessary interventions, save time for additional scanning, and improve perinatal outcome."
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Media
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eSPIRITUAL
8th Chaitra Navratri: Maha Gauri
Maha Gauri is worshipped on the 8th day of Navratri. SHE looks as white as moon and jasmine. White means purity of mind. SHE is dressed in a white sari. SHE has three Eyes and four hands and holds a drum and a trident and is often depicted riding a bull (control over the desires).

Her upper left hand is in a fearless pose and she holds a ‘Trishul’ in her lower left hand. Her upper right hand has a tambourine and the lower right hand is in a blessing Mudra.

Spiritual message on the 8th Navratri

By the 8th day of spiritual detoxification, purity of mind is attained.
Legal Quote
Samira Kohli vs Dr. Prabha Manchanda and Anr, SCI, Civil Appeal No. 1949 of 2004, 16.01.2008

“There can be a common consent for diagnostic and operative procedures where they are contemplated. There can also be a common consent for a particular surgical procedure and an additional or further procedure that may become necessary during the course of surgery.”
Medicofinance
The contribution of the residence to a limited liability company (LLC) or a limited partnership may be another way to protect the personal residence. The protection afforded by LLCs and limited partnerships is derived from the concept of the charging order protection, addressed in more detail later. While the charging order protection is generally powerful, its usefulness may not extend to personal residences.

(Source: IJCP)
Industry News
Govt to comeout with enabling ecosystem for start-ups soon: The government is working on an enabling framework for start-ups to remove various procedural issues as they have the potential for job creation, said Shaktikanta Das economic affairs secretary. He has also invited suggestions from the public to improve ecosystem for start-ups. Prime Minister Narendra Modi is expected to make a series of important announcements in December to promote start-ups in the country… (The Times of India- PTI)

Startups adopting innovative HR onboarding policies: In a start-up ecosystem, engaging with the employee for the first 30 days is extremely crucial, as some employees sometimes choose to work in a start-up because of the fat paycheck, but delivering according to the requirement often seems difficult, as compared to an established corporate. Some start-ups have introduced a "free-look" period wherein all new hires have the right to leave or stay based on a deeper understanding of the company's working culture… (Business Standard – PTI)

Medical apps taking the place of referral books for doctors: They help people connect, keep you informed, and now they guide scalpels to save lives. While technology increasingly finds its way into operation theatres, surgeons are hooked to their gizmos for help to direct their surgeries. From fine-tuning their surgical skills to calculating the risks involved in a procedure and keeping them updated on the latest scientific breakthroughs, apps are replacing referral books for surgeons as they prepare to make the cut. And it's not just surgeries. Apps like Epocrates help doctors choose drugs and dosage... (The Times of India- Ekatha Ann John)

New policy may link incentives with job creation in factories: The government is working on offering ‘special incentives’ to manufacturing companies that provide ‘employment to a certain number of people’. According to a senior official, the ministry of commerce and industry and the NITI Aayog have started finalising the contours of the “new policy that will link incentives for the manufacturing units in some sectors in proportion to the direct employment generated by them”. “A working group was earlier constituted for dwelling on the issues pertaining to employment generation by manufacturing units. The report should be in the public domain by the end of the month,” he said. The sectors that are likely to be a part of the new policy include auto, textiles, and leather, which provide employment to over 23 million people in the country… (Financial Express – Shruti Srivastava)
Inspirational Story
The Three Dolls

A sage presented a prince with a set of three small dolls. The prince was not amused. "Am I a girl that you give me dolls?" He asked.

"This is a gift for a future king," said the sage. "If you look carefully, you’ll see a hole in the ear of each doll." The sage handed him a piece of string. "Pass it through each doll," he said. Intrigued, the prince picked up the first doll and put the string into the ear. It came out from the other ear. "This is one type of person," said the sage, "whatever you tell him, comes out from the other ear. He doesn’t retain anything."

The prince put the string into the second doll. It came out from the mouth. "This is the second type of person," said the sage, "whatever you tell him, he tells everybody else." The prince picked up the third doll and repeated the process. The string did not come out. "This is the third type of person," said the sage, "whatever you tell him is locked up within him. It never comes out."

"What is the best type of person?" asked the prince. The sage handed him a fourth doll, in answer. When the prince put the string into the doll, it came out from the other ear.

"Do it again." Said the sage. The prince repeated the process. This time the string came out from the mouth. When he put the string in a third time, it did not come out at all.

"This is the best type of person," said the sage. "To be trustworthy, a man must know when not to listen, when to remain silent and when to speak out."
eWELLNESS
High fat diet, prostate cancer prone

Diets high in saturated fat increase the risk of prostate cancer. As per a report from University of Texas M. D. Anderson Cancer Center in Houston published in the International Journal of Cancer:

• Men who consume high saturated animal fat diet are two times more likely to experience disease progression after prostate cancer surgery than men with lower saturated fat intake.

• There is also shorter "disease–free" survival time among obese men who eat high saturated fat diet compared with non–obese men consuming diets low in saturated fat.

• Men with a high saturated fat intake had the shortest survival time free of prostate cancer (19 months)

• Non–obese men with low fat intake survived the longest time free of the disease (46 months).

• Non–obese men with high intake and obese men with low intake had "disease–free" survival of 29 and 42 months, respectively.

Take home messages

• High saturated fat diet has been linked to cancer of the prostate

• Reducing saturated fat in the diet after prostate cancer surgery can help reduce the cancer progression.

• Cancer prostate has the same risk factors as that of heart blockages and both are linked to high saturated fat intake.

• With an increase in number of heart patients, a corresponding increase in prostate cancer patients is also seen in the society.
eMEDIPICS
IMA,IJCP,HCFI
Cardiology - Yesterday, Today & Tomorrow - A CME was organized by IMA HQs on World Heart Day at IMA House, New Delhi
MTNL Perfect Health Mela 2015.

Pls click here for details
IMA Digital TV
eMEDI QUIZ
All of the following muscles are grouped together as muscles of mastication except:

1. Buccinator.
2. Masseter.
3. Temporalis.
4. Pterygoids.

Yesterday’s Mind Teaser: All of the following are examples of traction epiphysis, except:

1. Mastoid process.
2. Tubercles of humerus.
3. Trochanters of femur.
4. Condyles of tibia.

Answer for Yesterday’s Mind Teaser: 4. Condyles of tibia.

Answers received from: Dr Jainendra Upadhyay, Dr Poonam Chablani, Dr K Raju, Dr Arvind Jain, Dr Avtar Krishan.

Answer for 18th October Mind Teaser: 2.Iliohypogastric

Correct Answers received from: Dr K V Sarma, Dr K Raju, Daivadheenam Jella, Dr Avtar Krishan.
Humor
Cardiovascular: The three kinds of blood vessels are arteries, veins and caterpillars.
Medicolegal
Bioethical issues in medical practice

Defensive Medicine

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

The rate of cesarean section deliveries is growing all over the country. Obstetricians are often accused of using cesarean section to increase their income. On the other hand, issues such as increasing maternal age, precious babies, mothers’ insistence, safety and ease, parents’ schedule preferences, and preferences for doctor’s and hospital’s office hour delivery all result in increasing operative deliveries. However all doctors believe that ‘natural is the way to go’ in pregnancy. Yet operative deliveries are undertaken to avoid the smallest risk to mother or child. What do you think?

a. Is caesarean section a part of defensive medicine?

b. Do you agree to cesarean section deliveries in general?

c. Can such sections lead to complications for the baby such as prematurity and therefore, should they be always avoided?

d. If no to cesarean section, then what is the alternative?

e. Should there be definite essential requirements for cesarean section?

Adapted and shortened from: UNESCO, 2011. Casebook on Human Dignity and Human Rights, Bioethics Core Curriculum Casebook Series, No. 1, UNESCO: Paris, 144 pp.

Do write in with views and your solutions!
Breaking news
Government set to expand network of medical colleges in India

With an aim to reduce the burden of patients in AIIMS, the Union government is all set to expand the network of medical colleges in the country. Union Finance Minister, Arun Jaitley on Sunday pushed for relaxation in medical council and the municipal norms to achieve the desired goal. Speaking at the 43rd annual convocation of AIIMS on Sunday, he said the network of medical colleges in the country is set for expansion in a big way. "We need more medical colleges. Both public and private sector education has expanded. But medical colleges are still inadequate. A review of the policy is required as far as increasing the number of medical schools is concerned," he said while addressing the students and faculty. Jaitley, also the minister for information and broadcasting, opined that over involvement in the past had led to crisis for AIIMS and asked the health ministry to play a supportive role without getting into micro-management of the institution. He also insisted on the fact that the medical colleges attach huge importance to the promotion of high-quality tertiary care services and expansion of medical education in the country.

"We need to expand quality institutions. There are many restraints like unavailability of contiguous land and inability to have medical colleges next to it. All this needs a serious review. We have ready-made hospitals of excellence which have worked for decades and there is no reason why, by relaxing municipal laws and medical council regulations, we are not able to encourage the expansion of a few hundred more medical colleges in India," he said. Jaitley also announced recognition of AIIMS as an 'Institute of National Eminence' and said 100 per cent tax exemption would be available for any voluntary donation made to the premier institute…

Talking about the aim to expand the network of medical colleges in the country, Health Minister JP Nadda said in the first phase, around 58 district hospitals will be upgraded to medical colleges while 70 medical colleges are being upgraded by adding superspeciality blocks under various phases of the Pradhan Mantri Swasthya Suraksha Yojana. "This reflects the importance attached by the government to the promotion of high-quality tertiary care services and expansion of medical education in the country," he said... (India Today – Mail Today)
MAKE SURE
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IMA Satyagraha, suggested slogans
• Writing prescription drugs by a non-MBBS is injurious to health of the community.

• Writing prescription drugs by unqualified people can be dangerous.

• Allow doctors to treat patients irrespective of patients’ income.(If compensation is not capped, we can't do this)

• When there is capping of Rs 2 lakh for a sterilization death, why not for other procedures?

• When there is a compensation of Rs 30,000/- for a sterilization failure, why not for other procedures?

• Allow us to treat poor and rich equally.

• Non pelvic ultrasound providers should be out of PCPNDT Act.

• Unless caught doing sex determination, no criminal offence shall be registered.

• If any prospective parent asks for sex determination, they should be booked under a non bailable offense.

• More patients will die if doctors are not provided protection during duty hours.

• Death does not mean negligence.

• Money spent does not mean you will get a cure.

• Including single clinic and small establishments under Clinical Establishment Act will make treatment costly.

• How can we treat patients using outdated standard treatment guidelines made by government?

• How can government decide the charges of a clinical establishment?
Mumbai to Become First Indian City to Have Mobile Medical Shops
Mumbai: Mumbai is set to become the country's first city to have mobile generic medicine shops. These aim at providing low-cost, but effective, medicines to needy people. Goregaon-based NGO, Prabodhan Aushadh Pedhi (medicine bank), has got an in-principal approval from the Centre to start at least two mobile shops, one each for the western and eastern suburbs. These will have an outdoor patients department, with a doctor, who will examine patients and prescribe generic medicine….. (NDTV – Mid Day)
Pharma companies team up to clean industry’s image
Mumbai: For the first time ever, some of India's biggest pharmaceutical companies, cutting across their respective associations and representing nearly half the Rs 93,000 crore market, have come together to push for ethical marketing practices to clean up the industry's image. The forum, comprising of 40 to 50 domestic and MNC firms, had its first closed-door meeting on October 14. It has made a "voluntary and moral commitment" to follow ethical marketing practices in "letter and spirit", and will work with the regulatory mechanism to facilitate the exercise… This comes even as the government has already expressed its intention to make the 'Uniform Code of Pharmaceutical Marketing Practices' mandatory from next year. The code — banning cruise tickets, freebies and paid vacations for doctors sponsored by drug companies — is voluntary at present. But in light of rampant violations, the government plans to make it binding on companies… (Times of India)
75% of Indians suffer vitamin deficiency
Chennai: More than seven out of ten Indians lack in vitamins, and most of them suffer from vitamin D deficiency that is linked to Alzheimer's disease, prostate cancer, erectile dysfunction and schizophrenia. Chennai-based Metropolis Healthcare studied 14,96,683 samples over three years and found an increasing trend of deficiency in vitamin D, vitamin B12 and vitamin B9 (Folic Acid) among all age groups of Indians. The samples tested across four zones showed that 75% of the population was deficient in three vital vitamins. While 21.02% were deficient in vitamin B12 and 15.06% deficient in vitamin B9, 81.28% of all samples were deficient in vitamin D. Dr Sonali Kolte of Metropolis said symptoms of vitamin D deficiency can be vague, with muscle or joint pain, weakness, and depression. "Vitamin deficiencies usually show slowly. Nowadays, it is observed that people deficient in Vitamin D are more likely to have diabetes, regardless of how much they weigh," Dr Sonali Kolte said… Lack of Vitamin B12 is so staggering that it is the culprit behind the suboptimal blood levels of nearly half the Indian population, said consultant nutritionist Dr Deepa Agarwal of Asian Bariatrics… The study found that Vitamin B9 or folic acid was deficient especially in the 20-40 age group. Vitamin B9 is vital for pregnant women to prevent anaemia and major birth defects in the baby… The study indicated that the majority of the population had poor practices and were ignorant of vitamin sufficiency… (Source: Times of India - Janani Sampath)
Despite progress, road traffic deaths remain too high: WHO
Some 1.25 million people die each year as a result of road traffic crashes, according to the WHO's Global status report on road safety 2015, despite improvements in road safety. “Road traffic fatalities take an unacceptable toll – particularly on poor people in poor countries,” says Dr Margaret Chan, Director-General of WHO. However, the number of road traffic deaths is stabilizing even though the number of motor vehicles worldwide has increased rapidly, as has the global population. In the last three years, 79 countries have seen a decrease in the absolute number of fatalities while 68 countries have seen an increase. Countries that have had the most success in reducing the number of road traffic deaths have achieved this by improving legislation, enforcement, and making roads and vehicles safer. “We’re moving in the right direction,” adds Dr Chan. “The report shows that road safety strategies are saving lives. But it also tells us that the pace of change is too slow. “The WHO report highlights that road users around the world are unequally protected. The risk of dying in a road traffic crash still depends, in great part, on where people live and how they move around. A big gap still separates high-income countries from low- and middle- income ones where 90% of road traffic deaths occur in spite of having just 54% of the world’s vehicles. Europe, in particular the region’s wealthier countries, has the lowest death rates per capita; Africa the highest.

The report reveals that globally:

• 105 countries have good seat-belt laws that apply to all occupants;

• 47 countries have good speed laws defining a national urban maximum speed limit of 50 Km/h and empowering local authorities to further reduce speed limits;

• 34 countries have a good drink–driving law with a blood alcohol concentration (BAC) limit of less than or equal to 0.05 g/dl as well as lower limits of less than or equal to 0.02 g/dl for young and novice drivers;

• 44 countries have helmet laws that apply to all drivers, passengers, roads and engine types; require the helmet to be fastened and refer to a particular helmet standard;

• 53 countries have a child restraint law for occupants of vehicles based on age, height or weight, and apply an age or height restriction on children sitting in the front seat.

Motorcyclists are particularly vulnerable, making up 23% of all road traffic deaths…Pedestrians and cyclists are also among the groups with the least protection, making up 22% and 4% of global deaths respectively…(WHO Media Center)
IMA JIMA
IMA Digital TV
GP Tip: Blood pressure cuff for venepuncture

Instead of applying the usual thin elastic band to the upper arm for venipuncture, use a blood pressure cuff inflated to between 20 and 35 mmHg. This has several advantages:

• The pressure is measurable, and the risk of “blowout” from overdilated, fragile veins is avoided

• The procedure is easier for personnel who do not perform venipunctures often

• The patient is more comfortable, and there is no need to tighten or “pump” the fist.

(Source: IJCP)
10 Habits of Ultra-Likable Leaders

1. They form personal connections.
2. They’re approachable.
3. They’re humble.
4. They’re positive.
5. They’re even-keeled.
6. They’re generous.
7. They demonstrate integrity.
8. They read people like a book.
9. They appreciate potential.
10. They have substance.

(Medpage Today - Entrepreneur)
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Readers column
Thanx for enriching us scientifically, spiritually, medico–legally… Som Datt Bherwal
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Digital IMA
Press Release
IMA demands strengthening of primary health care/rural health service

Rural population is suffering from the unavailability of primary health care services, which is leading to increased mortality rate and medical emergencies

As we all know, the healthcare infrastructure of a country is one of the most important parameters to measure its growth prospects. Simultaneously, it is equally important that basic health facilities are present both in urban areas as well as rural areas. While urban areas are continuously developing in terms of high-tech medical amenities, rural areas are still struggling to tackle underdeveloped health clinics, lack of adequate medicines and equipment's and the even lesser number of physicians.

To achieve a balance between health care delivery in urban and rural areas, managing the skewed distribution of primary health care professionals is extremely important. In recent times, the Government has launched a plethora of policies and programmes to eliminate the medical crisis faced by the rural population. These programmes have been successful to an extent; however their efficacy hampered due to weak implementation regulations.

Speaking on the issue, Padma Shri Awardee Dr Marthanda Pillai – Honorary President IMA and Padam Shri Awardee Dr K K Aggarwal – Honorary Secretary General IMA and President HCFIin a joint statement said, “More than a third of the rural populace goes to urban areas to avail medical facilities offered by private health care hospitals. The government needs to do a lot of policing to keep a check on the health delivery process. The new beginning should start with creating awareness and accountability in the health care sector. Essentially, the need of the hour is to understand the major issues that people are facing and then review policies in accordance with them. Right to quality healthcare is right of every citizen, both those residing in urban areas as well rural.“

A National sample survey conducted in 2014 has shown that 40% of our population depends on single man clinic and small rural hospitals for their health needs. It is observed that these small and medium level hospitals are closing down due to financial non-viability. IMA demands that the government support these hospitals financially through a program of ‘aided hospitals.'

To attract modern medicine practitioners to serve in rural areas, IMA suggests the following:

• Government to identify difficult areas (primary health centers where doctors are not available for more than three years)

• To develop a package to attract doctors to these areas by offering higher salary, accommodation preferably at headquarters with transportation, weight for PG admission for those serving in difficult rural areas (up to 30% weightage), admission of children to Central schools

• To post minimum of three MBBS Doctors in PHCs instead of the present system of posting one MBBS doctor

• To utilize the service of private practitioners in the locality on a retainership/contract basis

• To utilize the services of foreign degree holders (Russia/China Indian graduates) as trainees under the supervision of PHC doctors up to 3 years or till they get registered

• Population covered by PHCs to be revised from existing 30,000 to 20,000; presently up to 1.5 lakhs population is covered by one PHC

• To get an orientation of rural health problems, and to motivate them to work in rural areas at least both undergraduates and postgraduates should spend 3 to 6 months in a rural setup, undergraduates should get training in PHC during their Community Medicine posting and also as part of vertical integration at clinical postings. The post graduates can work at least 3 to 6 months in CHCs along with or under the supervision of specialists. The period for preparation of the thesis for this can be reduced to 6 months.